Is there a chronic sleep stage-dependent linear and nonlinear cardiac autonomic impairment in obstructive sleep apnea?

RATIONALE: Obstructive sleep apnea (OSA) is a respiratory disorder that has the potential to negatively impact heart rate variability (HRV) during the sleep cycle. However, it is uncertain whether there is a chronic sleep stage-dependent linear and nonlinear cardiac autonomic impairment in OSA. The aim of this study was to perform HRV analysis in apnea-free samples as well as during stage 2 and rapid eye movement (REM) sleep in mild and moderate OSA (MiOSA and MOSA, respectively) subjects as well as health controls (NonOSA). METHODS: This study included 20 MiOSA (37 ± 14 years), 20 MOSA (39 ± 8 years), and 18 NonOSA (36 ± 8 years) subjects. Subjects underwent in-laboratory overnight polysomnography with electrocardiography recording. HRV indices were obtained by analyzing the R-R intervals (RRis) in 5-min apnea-free samples by the linear frequency domain [low frequency (LF), high frequency (HF) and LF/HF], Poincaré plot [standard deviation (SD1) and (SD2)], recurrence plot [mean line length (Lmean)], recurrence rate (REC), determinism (DET), and Shannon entropy (ShanEn). RESULTS: The MOSA group presented with higher LF, LF/HF, and DET indices compared to NonOSA as well as a lower parasympathetic index (HF), suggesting sympathetic hyperactivity in MOSA subjects. Interestingly, MiOSA subjects failed to show the expected linear HRV difference between sleep stages, as observed in NonOSA, which may represent an early onset of autonomic impairment at this stage of OSA. CONCLUSION: In OSA patients, there is a chronic sleep stage-dependent impairment of linear and nonlinear cardiac autonomic modulation. Interestingly, this impairment may be identifiable during the early stages of the disease.

Uso del aparato bucal "PMpositioner" en el tratamiento del ronquido y la apnea obstructiva del sueño / Use of PMpositioner oral appliance in the treatment of snoring and mild obstructive sleep apnea

La elección de un aparato bucal apropiado para lograr los mejores resultados en el tratamiento de la apnea obstructiva del sueño es importante. El objetivo de este estudio fue evaluar el efecto de un aparato bucal específico, el PMPositioner, para el tratamiento del ronquido y la apnea obstructiva del sueño leve, a través de polisomnografía y la Escala de Epworth del sueño, después de seis meses de uso del mencionado aparato. Se incluyeron en el estudio 17 pacientes divididos en dos grupos: un grupo de roncadores (n=7) y otro grupo (n=10) con apnea obstructiva leve. Los resultados fueron significativos para el segundo grupo, revelando una disminución en el índice de apnea-hipoapnea de 7,4 +- 5,0 a 3,0 +- 2,5 (p<0.05), aumento del sueño REM de 16,0+-4,0 a 19+-6,0 y una mejora de la somnolencia en la Escala Epworth de 12,5+-5,4 a 7,4+-2,4. Se constató una disminución en los ronquidos y los síntomas subjetivos. PMPositioner, fue efectivo en el tratamiento de los ronquidos y la apnea obstructiva leve, la reducción de la somnolencia y de otros síntomas.

The choice of an adequate oral appliance is very important in the treatment of obstructive sleep apnea. The present study evaluated the effect of PMPositioner for the treatment of snoring and mild obstructive sleep apneathrough polysomnography and Epworth Sleep Scale prior to treatment and after six months. Seventeen patients, divided into 2 groups, snoring (n=7) and 10 with mild obstructive sleep apnea were enrolled. The results were significant for obstructive sleep apnea group reveling a decrease in the apnea/hypopnea index from 7.4±5.0 to 3.0±2.5 (p<0.05), anincrease in oxigen saturation from 88.0±6.0 to 90.0±2.8 (p<0.05), an increase in REM sleep from 16.0±6.0 to 19±4.0 and a sleepiness improved in from 12.5±5.4 to 7.4±2.4. Furthermore, it was noticed an improvement in snoring and subjective symptoms. The PM Positioner is efficient in the treatment of snoring and mild obstructive sleep apnea and in reduction of sleepness and others symptoms.

L-carnitine as an ergogenic aid for patients with chronic obstructive pulmonary disease submitted to whole-body and respiratory muscle training programs.

The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 +/- 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 +/- 16 and 36 +/- 12%, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40%) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 +/- 14 vs 14 +/- 5 cmH2O, and 87 +/- 30 vs 34 +/- 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 +/- 0.7 vs 2.3 +/- 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.

L-carnitine as an ergogenic aid for patients with chronic obstructive pulmonary disease submitted to whole-body and respiratory muscle training programs

The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 ± 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 ± 16 and 36 ± 12 percent, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40 percent) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 ± 14 vs 14 ± 5 cmH2O, and 87 ± 30 vs 34 ± 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 ± 0.7 vs 2.3 ± 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.

Avaliação fisioterapeutica dos sistemas mastigatorios e respiratorio de um portador de sindrome otodental: um estudo de caso / Physiotherapeutic evaluation of masticatory and respiratory systems in a patient with otodental syndrome: a case study

Sindrome Otodental e uma sindrome autossomica rara de carater dominante que apresenta como principais manifestacoes, anomalias dentarias e perda gradual da audicao. Objetivos Detectar atraves de avaliacao fisioterapeutica alteracoes nos sitemas mastigatorio, respiratorio e postura corporal em uma portadora de sindrome otodental. Metodologia: Foram realizadas a avaliacao postural e inspecao facial, palpacao dos musculos mastigatorios e respiratorios. Medidas de amplitude da articulacao temporomandibular e cirtometrica toracoabdominal, alem de coleta de dados na anamnese. Resultado e discurssao Foram observados respiracao bucal associada a maior morbilidade da regiao axiliar, e nao foram encontrados sinais ou sintomas de desordens temporomandibulares. Os achados das caracteristicas faciais e postura foram comuns aos de portadores de respiracao bucal, surgindo um desenvolvimento de alteracoes respiratorias secundarias a sindrome Otodental.No entanto, a raridade desta patologia associada a descricao na literatura restrita a area odontologica, dificultam uma analise comparativa com os dados do presente estudo

Efeitos agudos da aplicacao do BiPAP sobre a tolerancia ao exercicio fisico em pacientes com doenca pulmonar obstrutiva cronica (DPOC) / Acute effects of BiPAP application on physical exercise tolerance among chronic obstructive pulmonary disease patients

Pacientes com Doenca Pulmonar Obstrutiva Cronica (DPOC) apresentam prejuizos sobre a capacidade de exercicio fisico. A ventilacao nao-invasiva (VNI) tem sido associada ao exercicio fisico com o objetivo de melhorar a tolerancia aos esforcos nesses pacientes. Objetivos: avaliar os efeitos agudos da aplicacao da pressao positiva nas vias aereas por dois niveis pressoricos(BiPAP) sobre a tolerancia ao exercicio fisico, a dispneia e a saturacao periferica de oxigenio (SpO2) em pacientes com DPOC. Material e metodos: foram estudados 27 pacientes com DPOC (68+-8,3 anos) com volume expiratorio forcado no 1 segundo (VEEF1) < 50 por cento do previsto e sintomas de dispneia aos esforcos. os pacientes foram submetyidos, de modo randomizado, a dois testes de caminhada de 6 minutos em esteira (TC6E); um com a aplicacao do BiPAP, com niveis pressoricos inspirados de 14+-1 cmH2O, e o outro sem o BiPAP

Efeitos fisiologicos de um programa de fisioterapia respiratoria(FR) em pacientes com doenca pulmonar obstrutiva cronica(DPOC) associada a hipertensao arterial(HA) / The physiological effects of respiratory therapy on patients with chronic obstructive pulmonary disease(CPOD) associated to arterial hypertension(AH)

A reducao da capacidade fisica no paciente com doenca pulmonar obstrutiva cronica (DPOC) leva-o a uma intolerancia ao exercicio fisico, resultando deficit cardiovascular e respiratorio, sendo necessario um programa de reabilitacao fisica individualizado. Os programas de fisioterapia respiratoria (FR) visam reduzir a dispneia, aumentar a forca muscular e melhorar a tolerancia aos esforcos. No entanto pacientes, pacientes com comprometimento cardiovascular associado sao excluidos desses estudos. Assim, o objetivo deste estudo foi avaliar os efeitos de um programa de FR em pacientes com DPOC associado a hipertensao arterial (HA) sobre os seguintes parametros fisiologicos: pressao arterial (PA), frequencia cardiaca (FC), saturacao de oxigenio (SaO2) e disoneia. Foram estudados 6 individuos com diagnostico clinico e espirometrico de DPOC e HA, estaveis, com idade de 67,6 +- 4 anos, que foram submetidos a um teste incremental na esteira, ate a exaustao voluntaria, por dispneia, aumentos excessivos da PA ou da FC axima (FCmax) prevista. Durante cada estagio foram mensuradas PA, Fc e SaO2 e a dispneia, no inicio e termino do teste. Os pacientes realizaram um programa de exercicios fisicos que constou de exercicios respiratorios, reeducacao diafragmatica, alongamentos e caminhada de 30 minutos na esteira rolante com intensidade de 70 (por cento) da FCmax, durante 6 semanas consecutivas. Foram observadas alteracoes significativas das FC, aumento da SaO2, do tempo, da velocidade e da distancia percorrida (p<0,05), porem a dispneia nao reduziu significativamente. Os resultados obtidos demonstraram que o programa de FR neste estudo proporcionou modificacoes fisiologicas beneficas aos pacientes

Efeitos do treinamento fisico e muscular respiratorio em pacientes com doenca pulmonar obstrutiva cronica (DPOC) grave submetidos a BiPAP / Effects of the physical and respiratory muscular training in patients suffering from severe cronic obstructive pulmonary disease submitted to BiPAP

O objetivo deste estudo foi verificar a influencia do treinamento fisico (TF) e do muscular respiratorio (TMR), associados a ventilacao nao invasiva (VNI) pela `bilevel positive airway pressure``(BiPAP), sobre pressao inspiratoria e expiratoria maxima (PImax e Pemax), distancia percorrida (DP) e escala de Borg (EB) no teste de caminhada de 6 minutos (TC6min) e no esforco (TE) da avaliacao para reavaliacao. Participaram 24 pacientes com DPOC grave (VEF1,40 por cento), estaveis clinicamente. com dispneia ao esforco fisico, randomizados em 4 grupos de 6 pacientes: G1, realizando somente BiPAP por 30 minutos, com nivel pressorico fixado na inpiracao em 12 cmH2O e expiracao em 4 cmH2O. Foram realizadas sessoes de 1 hora, 3 vezes por semana, com duracao total de 6 semanas. O TF na esteira teve duracao de 30 minutos om intensidade de 80(por cento) da FC maxima obtida no TE. Utilizou-se para o TMR carga de 40(por cento) da PImax. Constatou-se aumento significativo (teste t p<-0,05) da PImax e PEmax para os grupos G1 e G3 e da DP no TC6min para os grupos G1 E G2, com diminuicao significativa da EB para os pacientes do G4. Em relacao ao TE, observou-se aumento significativo da DP para os grupos G1, G2 e G3. Embora nao tenham sido constatadas alteracoes significativas da EB e da DP em todos os grupos, observou-se maior tolerancia ao exercicio fisico e forca muscular respiratoria quando as tecnicas foram utilizadas em conjunto. Com base neses resultados, conclui-se que o TF e o TMR associados ao BiPAP tiveram importante influencia nas variaveis estudadas