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1.
Sleep Sci ; 16(1): 7-13, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37151764

RESUMO

Objectives To evaluate the evolution of obstructive sleep apnea (OSA), comparing data from preoperative, immediate postoperative and late postoperative, in patients undergoing pharyngeal surgery associated with nasal surgery, and to compare the findings of arterial tonometry and type 1 polysomnography in the late postoperative period. Methods Seventeen adults with moderate or severe OSA were included in the study. They underwent clinical evaluation, surgical intervention, and sleep study preoperatively, on the 1 st night after surgery, and after a minimum period of 3 months. The data for the three moments were compared. Results The mean age was 38.1 ± 12.5 years old (22 to 59 years old), and 82.3% were male. Body mass index (BMI) ranged from 25.6 to 45.1 kg/m2 (mean = 33.1 ± 5.8 kg/m 2 ). Fifteen patients (88.2%) were diagnosed with severe OSA. There was a progressive improvement, with a decrease in the indexes (AHI and RDI) and in the percentage of time with peripheral oxyhemoglobin saturation below 90% (tSpO < 90%), and an increase in nadir of SpO2. In the comparison between the 2 methods used in the late postoperative period - arterial tonometry and polysomnography - there was no difference in the indexes and in the tSpO < 90%. Discussion There was a progressive and favorable impact of pharyngeal surgery on the improvement of polysomnographic and clinical respiratory parameters; however, many patients maintained residual OSA, suggesting the need for a new sleep study in the postoperative period. The arterial tonometry showed similar findings to polysomnography, which can be considered as an option in postoperative follow-up of patients.

2.
Arq. neuropsiquiatr ; 80(10): 1017-1025, Oct. 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1420227

RESUMO

Abstract Background Individuals with spinocerebellar ataxia type 3 (SCA3) present communication and swallowing disorders, and consequent deterioration in quality of life (QOL). Objective To evaluate the impact of a speech therapy rehabilitation program on the QOL of patients with SCA3. Methods All participants were randomly assigned to two groups, an intervention group receiving speech therapy (STG) and a control group (CG). The International Cooperative Ataxia Rating Scale scores were 32.4 ± 20.2, and the Scale for the Assessment and Rating of Ataxia scores were 11.8 ± 8.0. The intervention consisted of a 12-session speech therapy rehabilitation program with oral, pharyngeal, and laryngeal strengthening exercises—the so-called ATAXIA-Myofunctional Orofacial and Vocal Therapy (A-MOVT). They all were submitted to pre- and postintervention evaluations using the World Health Organization's Quality of Life (WHOQOL-BREF) assessment, as well as the Living with Dysarthria (LwD), Quality of Life in Swallowing Disorders (SWAL-QOL), and Food Assessment Tool (EAT-10). Results The study sample consisted of 48 patients with SCA3 (STG = 25; CG = 23), mean age was 47.1 ± 11.4 years; mean age at symptom onset was 36.9 ± 11.3 years; disease duration was 11.9 ± 13.3 years. After the 3-month intervention, there were significant changes in the QOL in the STG compared with the CG, when assessed by the LwD (179.12 ± 62.55 vs. 129.88 ± 51.42, p < 0.001), SWAL-QOL (869.43 ± 153.63 vs. 911.60 ± 130.90, p = 0.010), and EAT-10 (5.16 ± 7.55 vs. 2.08 ± 3.85, p = 0.018). Conclusions Patients with SCA3 should receive continuous speech therapy as part of the A-MOVT program, because therapy helps to improve difficulty swallowing and dysarthria.


Resumo Antecedentes Indivíduos com ataxia espinocerebelar tipo 3 (AEC3) apresentam distúrbios da comunicação e deterioração da deglutição e, consequentemente, na qualidade de vida (QV). Objetivo Avaliar o impacto de um programa de reabilitação fonoaudiológica na QV em pacientes com AEC3. Métodos Todos os participantes foram alocados aleatoriamente em dois grupos, um grupo intervenção que recebeu terapia fonoaudiológica (GTF) e um grupo controle (GC). As pontuações das escalas: International Cooperative Ataxia Rating Scale (ICARS) foram 32,4 ± 20,2 e da Scale for the Assessment and Rating of Ataxia (SARA) foram 11,8 ± 8,0. A intervenção consistiu em um programa de reabilitação fonoaudiológica de 12 sessões composto por exercícios de fortalecimento oral, faríngeo e laríngeo - denominados ATAXIA - Terapia Miofuncional Orofacial e Vocal (A-TMOV). Todos foram submetidos a avaliações pré e pós-intervenção por meio dos protocolos World Health Organization's Quality of Life (WHOQOL-BREF), Vivendo com Disartria (VcD), Quality of Life in Swallowing Disorders (SWAL-QOL) e Food Assessment Tool (EAT-10). Resultados A amostra foi composta por 48 pacientes com AEC3 (25 no GTF e 23 no GC), média de idade 47,1 ± 11,4anos; média de idade de início dos sintomas 36,9 ± 11,3anos; duração da doença 11,9 ± 13,3anos. Após intervenção de três meses, houve mudanças significativas na QV no GTF em comparação com o GC quando avaliado pelo VcD (179,12 ± 62,55 versus129,88 ± 51,42, p < 0,001), SWAL-QOL (869,43 ± 153,63 versus 911,60 ± 130,90, p = 0,010), EAT-10 (5,16 ± 7,55 versus 2,08 ± 3,85, p = 0,018). Conclusões Pacientes com AEC3 devem receber terapia fonoaudiológica contínua como parte do programa A-TMOV, pois a terapia ajuda a melhorar a dificuldade de deglutição e a disartria.

3.
Laryngoscope ; 132(9): 1877-1882, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35174884

RESUMO

OBJECTIVES/HYPOTHESIS: To evaluate the presence of laryngopharyngeal reflux (LPR) and the potential association between presence of LPR symptoms and obstructive sleep apnea (OSA) in a representative sample from a population-based study. STUDY DESIGN: Cross-sectional study. METHODS: Participants of the follow-up of the Epidemiological Sleep Study were evaluated. Sleep was assessed through questionnaires and polysomnography. The presence of LPR was based on the questionnaire Reflux Score Index (RSI), and scores higher than 13 were suggestive of LPR. A general linear model test was used for comparison of continuous data and Pearson's chi-square test was used to compare categorical variables. Predictors of LPR were obtained by regression analysis. RESULTS: 701 were enrolled (54.8% female, 45.2% male; mean age, 50.2 ± 13.3 years). The mean apnea-hypopnea index score was 17 ± 18.3 events/hr, and the mean RSI score was 7.0 ± 8.1. LPR was found in 17% of the volunteers, whereas OSA was present in 38.5% of the sample. Specifically, in those patients with OSA, the prevalence of LPR was 45.4%; however, there was no statistically significant association between LPR and the presence of OSA. The severity of OSA was not associated with RSI score. The presence of LPR was associated with older age, smoking, excessive daytime sleepiness and worse quality of life and sleep scores questionnaires. CONCLUSIONS: Age, smoking, but not body mass index, were associated with LPR. There was not statistically significant association of LPR with OSA. Individuals with symptoms of LPR had greater drowsiness and worse quality of life and sleep. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1877-1882, 2022.


Assuntos
Refluxo Laringofaríngeo , Apneia Obstrutiva do Sono , Adulto , Estudos Transversais , Feminino , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico , Refluxo Laringofaríngeo/epidemiologia , Masculino , Pessoa de Meia-Idade , Polissonografia , Qualidade de Vida , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Inquéritos e Questionários
4.
Braz. j. otorhinolaryngol. (Impr.) ; 86(2): 174-179, March-Apr. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1132578

RESUMO

Abstract Introduction: Manual titration is the gold standard to determinate optimal continuous positive airway pressure, and the prediction of the optimal pressure is important to avoid delays in prescribing a continuous positive airway pressure treatment. Objective: To verify whether anthropometric, polysomnographic, cephalometric, and upper airway clinical assessments can predict the optimal continuous positive airway pressure setting for obstructive sleep apnea patients. Methods: Fifty men between 25 and 65 years, with body mass indexes of less than or equal to 35 kg/m2 were selected. All patients had baseline polysomnography followed by cephalometric and otolaryngological clinical assessments. On a second night, titration polysomnography was carried out to establish the optimal pressure. Results: The average age of the patients was 43 ± 12.3 years, with a mean body mass index of 27.1 ± 3.4 kg/m2 and an apnea-hypopnea index of 17.8 ± 10.5 events per hour. Smaller mandibular length (p = 0.03), smaller atlas-jaw distance (p = 0.03), and the presence of a Mallampati III and IV (p = 0.02) were predictors for higher continuous positive airway pressure. The formula for the optimal continuous positive airway pressure was: 17.244 − (0.133 × jaw length) + (0.969 × Mallampati III and IV classification) − (0.926 × atlas-jaw distance). Conclusion: In a sample of male patients with mild-to-moderate obstructive sleep apnea, the optimal continuous positive airway pressure was predicted using the mandibular length, atlas-jaw distance and Mallampati classification.


Resumo Introdução: A titulação manual é o padrão-ouro para determinar a pressão ideal para o tratamento com a pressão positiva contínua nas vias aéreas; e a predição da pressão ideal é importante para evitar retardos na sua prescrição. Objetivo: Verificar se as avaliações clínicas antropométricas, polissonográficas, cefalométricas e das vias aéreas superiores podem predizer a configuração ideal da pressão do aparelho de pressão positiva contínua nas vias aéreas para pacientes com apneia obstrutiva do sono. Método: Foram selecionados 50 homens entre 25 e 65 anos, com índice de massa corporal menor ou igual a 35 kg/m2. Todos os pacientes fizeram polissonografia basal, seguida de avaliações clínicas cefalométricas e otorrinolaringológicas. Na segunda noite, foi feita polissonografia de titulação para estabelecer a pressão ideal. Resultados: A média de idade dos pacientes foi de 43 ± 12,3 anos, com índice de massa corporal médio de 27,1 ± 3,4 kg/m2 e índice de apneia-hipopneia de 17,8 ± 10,5 eventos por hora. Menor comprimento mandibular (p = 0,03), menor distância atlas-maxila (p = 0,03) e a presença de Mallampati III e IV (p = 0,02) foram preditores de pressão mais elevada. A fórmula para a pressão positiva contínua nas vias aéreas foi: 17,24 - (0,133 × comprimento da mandíbula) + (0,969 × classificação de Mallampati III e IV) - (0,926 × distância atlas-mandíbula). Conclusão: Em uma amostra de homens com apneia obstrutiva do sono leve a moderada, a pressão positiva contínua nas vias aéreas foi predita com o comprimento mandibular, a distância atlas-mandíbula e a classificação de Mallampati.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Apneia Obstrutiva do Sono/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Índice de Gravidade de Doença , Índice de Massa Corporal , Cefalometria , Polissonografia
5.
Sleep Breath ; 24(2): 505-511, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31286330

RESUMO

PURPOSE: One of the concerns regarding surgical treatment of the obstructive sleep apnea syndrome (OSAS) has been the possibility that these patients may experience a higher rate of perioperative complications, which could be aggravated by the upper airway edema caused by surgical trauma. The purpose of this study was to evaluate the immediate impact of pharyngeal surgery on the respiratory parameters of adult patients with OSAS. METHODS: Twenty-three adults with moderate to severe OSAS and indications for pharyngeal surgery (with or without nasal surgery) were consecutively selected. The subjects underwent surgical treatment and monitoring of sleep parameters preoperatively (by type I polysomnography, PSG) and in the immediate postoperative period (arterial tonometry). RESULTS: Twenty-two subjects, aged 20 to 59 years (mean ± SD, 38.0 ± 12.1 years), were included in the study. Nineteen (86.4%) were male. The mean apnea-hypopnea index (AHI) was 59.3 ± 26.0 events/h. Comparison between preoperative PSG and postoperative arterial tonometry revealed statistically significant reductions in AHI (p = 0.03), respiratory disturbance index (RDI) (p = 0.05), and oxygen desaturation index (p = 0.001), as well as increases in nadir oxyhemoglobin saturation (p = 0.003) and percentage of REM sleep (p = 0.01). CONCLUSIONS: In this sample of patients with moderate and severe OSAS who underwent pharyngeal surgery, the vast majority of patients did not exhibit any deterioration of respiratory parameters in the immediate postoperative period. Conversely, there was a significant improvement in the parameters.


Assuntos
Faringe/cirurgia , Fenômenos Fisiológicos Respiratórios , Apneia Obstrutiva do Sono/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Período Pós-Operatório , Resultado do Tratamento , Adulto Jovem
6.
Braz. j. otorhinolaryngol. (Impr.) ; 85(4): 408-415, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1019588

RESUMO

Abstract Introduction Obstructive sleep apnea syndrome and laryngopharyngeal reflux are diseases with a high prevalence in the overall population; however, it remains unclear whether they are diseases with the same risk factors present in the same populations or if there is any association between them. Objectives To evaluate and determine the prevalence of laryngopharyngeal reflux in patients with moderate and severe obstructive apnea syndrome and also to determine its predictive factors. Methods Historical cohort, cross-sectional study of patients aged 18-70 years, referred to a tertiary service Otorhinolaryngology outpatient clinic with a polysomnographic diagnosis of moderate or severe obstructive sleep apnea syndrome. The reflux symptom index questionnaire and the reflux finding score at indirect videolaryngoscopy were applied to the assessed population, considering the inclusion and exclusion criteria. Results Fifty-six patients were evaluated, of which 64.3% had a positive laryngopharyngeal reflux (positive reflux symptom index and/or positive endolaryngeal reflux finding score). Body mass index was a predictor of reflux presence in this group of patients with moderate to severe obstructive sleep apnea syndrome. In patients with positive score for endoscopic findings and reflux symptom index (12.3%), there was a trend toward significance for a higher mean apnea-hypopnea index and a higher percentage of sleep time with oxyhemoglobin saturation below 90% (p = 0.05). Conclusion The prevalence of laryngopharyngeal reflux was higher in this group of patients with moderate to severe obstructive sleep apnea syndrome, and the body mass index was a predictor of laryngopharyngeal reflux in these patients. There was a trend toward greater oxyhemoglobin desaturation in patients with a positive score for reflux symptoms index (RSI) and reflux finding score (RFS).


Resumo Introdução A síndrome da apneia obstrutiva do sono e o refluxo laringofaríngeo são doenças com alta prevalência na população em geral. No entanto, ainda não está claro se são doenças com os mesmos fatores de risco presentes nas mesmas populações ou se há alguma relação entre elas. Objetivo Avaliar e determinar a prevalência de refluxo laringofaríngeo em pacientes com síndrome da apneia obstrutiva moderada e acentuada, bem como determinar os fatores preditivos de refluxo nesses pacientes. Método Estudo de coorte histórica com corte transversal de pacientes entre 18 e 70 anos, encaminhados a um ambulatório de Otorrinolaringologia em serviço terciário, com diagnóstico polissonográfico de síndrome da apneia obstrutiva do sono moderada ou acentuada. Foram aplicados o questionário Reflux Sympton Index e o escore de achados endolaríngeos por meio de videolaringoscopia indireta na população estudada, respeitando os critérios de inclusão e exclusão. Resultados Foram avaliados 56 pacientes, dos quais 64,3% apresentaram refluxo laringofaríngeo (Reflux Sympton Index positivo e/ou Reflux Finding Score positivo). O índice de massa corpórea foi fator preditor da presença de refluxo laringofaríngeo nesse grupo de pacientes com síndrome da apneia obstrutiva do sono moderada e acentuada. Nos pacientes cujos Reflux Sympton Index e o escore de achados endolaríngeos foram positivos (12,3%), houve uma tendência à significância para maior índice de apneia e hipopneia e maior porcentagem do tempo de sono com saturação de oxi-hemoglobina abaixo de 90% (p = 0,05). Conclusão A prevalência de refluxo laringofaríngeo foi alta nesse grupo de pacientes com síndrome da apneia obstrutiva do sono moderada e acentuada e o índice de massa corpórea foi fator preditor de refluxo nesses pacientes. Houve uma tendência a maior dessaturacão de oxi-hemoglobina em pacientes com "índice de sintomas de refluxo" e escore de achados endolaríngeos positivos.


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Apneia Obstrutiva do Sono/complicações , Refluxo Laringofaríngeo/complicações , Índice de Gravidade de Doença , Brasil , Índice de Massa Corporal , Estudos Transversais , Inquéritos e Questionários , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Refluxo Laringofaríngeo/diagnóstico
7.
Int Arch Otorhinolaryngol ; 23(2): 147-151, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30956697

RESUMO

Introduction It has been hypothesized that increasing the interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis (NP) might decrease the size of nasal polyps. Objective To evaluate the effects of positive airway pressure, delivered by a continuous positive airway pressure (CPAP) device, in patients with NP and in control subjects. Methods Twelve patients with NP and 27 healthy subjects were exposed to CPAP (20 cm H2O) for 2 hours. Visual analog scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, acoustic rhinometry (AR), peak nasal inspiratory flow (PNIF) and nasal endoscopy (NE-Meltzer polyp grading system) were performed before and after the intervention, for all patients. Results The control group showed a significant worsening in nasal obstruction symptoms, as measured by VAS and NOSE ( p < 0.01), and a significant decrease in nasal patency, as measured by the PNIF and AR ( p < 0.01). For the NP group, VAS, NOSE, and AR did not differ significantly ( p = 0.72, p = 0.73, and p = 0.17, respectively), but PNIF values worsened ( p = 0.04) after exposure to CPAP. There was a statistically significant reduction in the nasal polyps' size ( p = 0.04). Conclusions Positive pressure worsened the nasal obstruction symptoms and decreased objective parameters of nasal patency in control subjects. In patients with NP, exposure to CPAP reduced the nasal polyps' size, and the nasal patency, as measured by PNIF. However, it had no significant effects in AR and in nasal obstruction symptoms.

8.
Int Arch Otorhinolaryngol ; 23(2): 241-249, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30956711

RESUMO

Introduction The importance of our study lies in the fact that we have demonstrated the occurrence of mechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP.

9.
Sleep Sci ; 12(3): 126-131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31890086

RESUMO

IMPORTANCE: Aesthetic rhinoplasty is the fifth surgical procedure most performed worldwide by plastic surgeons. With the growing demand for rhinoplasty, there is an unmet need for research into the profile of patients who seek aesthetic nasal surgery in an attempt to improve not only cosmetic dissatisfactions, but also the manifestations of other, possibly interrelated disorders, especially sleep disturbances. OBJECTIVE: To evaluate the sleep quality and the risk of Obstructive Sleep Apnea in patients referred for aesthetic rhinoplasty, as well as the association of these conditions with nasal symptoms. Design: Cross-sectional study performed at the period of June/2016 to August/2017. Setting: Department of Otolaryngology and Head and Neck Surgery - Universidade Federal de São Paulo. Participants: Patients of both sexes, aged 18 to 65 years, who were referred for aesthetic rhinoplasty. We evaluated 46 patients, two of whom were excluded because they were outside the inclusion age criteria. Main Outcome(s) and Measure(s): Anterior rhinoscopy and the following validated surveys were used. Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Nasal Obstruction Symptom Evaluation scale; Berlin Questionnaire. The visual analog scale for snoring was also used. RESULTS: Of the 44 participants, 18 (41%) were males and 26 (59%) were females. 82% had poor sleep quality. 46% presented excessive daytime sleepiness. There was a high risk for Obstructive Sleep Apnea in 27%. Regarding to nasal symptoms, the mean score in the Nasal Obstructive Symptoms Evaluation was 66.25±25.38. When comparing the groups with good and poor sleep quality, we observed a higher risk for Obstructive Sleep Apnea (p=0.05) in patients with poor sleep quality. Patients at high risk for Obstructive Sleep Apnea had higher scores on the Nasal Obstructive Symptoms Evaluation (p=0.001) and on the analogue snoring scale (p<0.001) compared to patients at low risk. CONCLUSIONS: We observed a high occurrence of poor sleep quality in participants. All participants who were at high risk for obstructive sleep apnea were also classified as having poor sleep quality. An association was also observed between the presence of high risk for obstructive sleep apnea and presence of nasal symptoms.

10.
Int. arch. otorhinolaryngol. (Impr.) ; 23(2): 241-249, 2019. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-1015650

RESUMO

Introduction: The importance of our study lies in the fact that we have demonstrated the occurrence ofmechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective: To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data: Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion: The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP (AU)


Assuntos
Humanos , Pólipos Nasais/fisiopatologia , Pólipos Nasais/patologia , Inflamação/fisiopatologia , Sinusite/fisiopatologia , Fenômenos Biomecânicos , Brasil , Mecânica dos Fluidos , Doença Crônica , Edema/fisiopatologia , Matriz Extracelular/patologia , Pressão Hidrostática , Mucosa Nasal/fisiopatologia , Mucosa Nasal/patologia
11.
Int. arch. otorhinolaryngol. (Impr.) ; 23(2): 147-151, 2019. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-1010208

RESUMO

Introduction: It has been hypothesized that increasing the interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis (NP) might decrease the size of nasal polyps. Objective: To evaluate the effects of positive airway pressure, delivered by a continuous positive airway pressure (CPAP) device, in patients with NP and in control subjects. Methods: Twelve patients with NP and 27 healthy subjects were exposed to CPAP (20 cm H2O) for 2 hours. Visual analog scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, acoustic rhinometry (AR), peak nasal inspiratory flow (PNIF) and nasal endoscopy (NE-Meltzer polyp grading system) were performed before and after the intervention, for all patients. Results: The control group showed a significant worsening in nasal obstruction symptoms, as measured by VAS and NOSE (p < 0.01), and a significant decrease in nasal patency, as measured by the PNIF and AR (p < 0.01). For the NP group, VAS, NOSE, and AR did not differ significantly (p = 0.72, p = 0.73, and p = 0.17, respectively), but PNIF values worsened (p = 0.04) after exposure to CPAP. There was a statistically significant reduction in the nasal polyps' size (p = 0.04). Conclusions: Positive pressure worsened the nasal obstruction symptoms and decreased objective parameters of nasal patency in control subjects. In patients with NP, exposure to CPAP reduced the nasal polyps' size, and the nasal patency, asmeasured by PNIF. However, it had no significant effects in AR and in nasal obstruction symptoms (AU)


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Pólipos Nasais , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Obstrução Nasal/diagnóstico , Pico do Fluxo Expiratório , Estudos Transversais , Rinometria Acústica , Endoscopia , Matriz Extracelular , Escala Visual Analógica , Mucosa Nasal/fisiopatologia
12.
Sleep Sci ; 10(1): 1-6, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28966731

RESUMO

INTRODUCTION: Obesity is a factor that is strongly related to the occurrence of obstructive sleep apnea (OSA) in adults, although this association remains controversial for children. OBJECTIVE: The aim of this study was to compare the clinical and upper airway charactheristics, obtained by questionnaires, physical examination and laboratory tests, among obese children with and without OSA. METHOD: This was aprospective cohort study. 44 obese children (body mass index above the 95th percentile) were included in the study. Questionnaires, physical examination of the upper airway, nasofibrolaryngoscopy, polysomnography, and laboratory allergic tests were performed. RESULTS: There were 22 male patients (50%), and the mean age was 7.6±2.5 years. OSA was present in 19 (43%) patients. There were no statistically significant differences between the groups with and without OSA, in relation to clinical or laboratory allergic parameters. For the upper airway assessments, hypertrophy of the pharyngeal (p=0.001) and palatine (p=0.049) tonsils were the only parameters associated with OSA, and a modified Mallampati index of class III/IV also demonstrated a tendency towards being statistically associated with OSA (p=0.081). Moreover, these findings were confirmed to be factors associated with OSA in this group of children according to a logistic regression analysis. CONCLUSIONS: The occurrence rate of OSA in this obese pediatric population was high. Adenotonsillar hypertrophy and a modified Mallampati index of class III/IV were the factors associated with OSA.

13.
Braz. j. otorhinolaryngol. (Impr.) ; 81(6): 663-670, Nov.-Dec. 2015. tab
Artigo em Português | LILACS | ID: lil-770205

RESUMO

ABSTRACT INTRODUCTION: The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS). OBJECTIVE: To assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS. METHODS: Prospective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared. RESULTS: 28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p = 0.02), smaller cervical circumference (p = 0.05), and lower AHI at baseline (p = 0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p = 0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence. CONCLUSION: MAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities.


RESUMO INTRODUÇÃO: O Aparelho Intraoral (AIO) é uma opção para tratamento da Síndrome da Apneia Obstrutiva do Sono (SAOS). OBJETIVOS: Avaliar a influência das alterações da VAS e esqueléticas faciais através de uma avaliação clinica sistematizada no sucesso e adesão ao (AIO) em pacientes com (SAOS). MÉTODO: Estudo prospectivo em que foram avaliados 30 pacientes com SAOS leve a moderada e indicação de AIO. Protocolo incluiu questionários de sono e queixas nasais; polissonografia e avaliação da VAS por rinoscopia anterior e oroscopia. Os parâmetros analisados foram comparados entre pacientes com sucesso e insucesso, e com boa e má adesão à terapia. RESULTADOS: Completaram o protocolo 28 pacientes. O sucesso ao tratamento foi de 64,3% e a adesão 60,7%. Os fatores associados ao sucesso foram menor idade, menor circunferência cervical e menor IAH basal. Quanto à presença de alterações nasais, houve predomínio de pacientes sem alteração nasal entre os pacientes com sucesso comparados àqueles com insucesso (p = 0,04); o que não foi observado em relação à adesão. Quanto às alterações faríngeas e alterações esqueléticas faciais, não houve significância. CONCLUSÃO: O sucesso do tratamento com AIO foi significativamente menor nos pacientes com alterações nasais, porém a adesão não foi influenciada pela presença de alterações de VAS ou esqueléticas faciais.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avanço Mandibular/instrumentação , Apneia Obstrutiva do Sono/terapia , Cefalometria , Polissonografia , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
14.
Otolaryngol Head Neck Surg ; 153(4): 663-70, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25820578

RESUMO

OBJECTIVES: To investigate the anatomy of the upper airway (UA) of a representative sample of the adult population of São Paulo city, Brazil, and to identify factors associated with the presence of obstructive sleep apnea syndrome (OSAS), as confirmed using full-night polysomnography (PSG). STUDY DESIGN: Cross-sectional study. SETTING: Population-based sample. METHODS: A 3-stage sampling procedure was used to proportionally recruit adult residents of São Paulo city according to gender, age, and socioeconomic status. A complete evaluation was performed, including a systematic evaluation of the UA prior to conducting PSG. RESULTS: Nine-hundred ninety-three (90.2%) of the participants were seen by an ear, nose, and throat (ENT) specialist. Individuals who were diagnosed with OSAS (32.9%) presented a higher frequency of nasal symptoms and structural abnormalities (both nasal and oropharyngeal) compared with those without OSAS. No anatomical differences were observed in the facial skeleton. An abnormal nasal structure visible via anterior rhinoscopy was the only UA factor predicting OSAS after adjustments for the other common OSAS risk factors (male sex, aging, obesity, and increased neck circumference). CONCLUSION: This is the first study in which a systematic evaluation of the UA was followed by a sleep study in a population-based sample. In a sample of the general population that had not previously been screened for OSAS, having an abnormal nasal structure was found to be a risk factor for OSAS, in conjunction with other well-established clinical and demographic factors, such as male gender, increased age, increased neck circumference, and body mass index.


Assuntos
Apneia Obstrutiva do Sono/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Anormalidades da Boca/complicações , Nariz/anormalidades , Orofaringe/anormalidades , Polissonografia , Fatores de Risco , Apneia Obstrutiva do Sono/etiologia
15.
Braz J Otorhinolaryngol ; 80(6): 490-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25457068

RESUMO

INTRODUCTION: The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients. OBJECTIVE: To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome. METHODS: A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m(2) with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4. RESULTS: The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I-V. CONCLUSION: The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III).


Assuntos
Tonsila Palatina/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tonsila Palatina/patologia , Polissonografia , Estudos Retrospectivos , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/classificação , Tonsilectomia , Resultado do Tratamento , Adulto Jovem
16.
Braz. j. otorhinolaryngol. (Impr.) ; 80(6): 490-496, Nov-Dec/2014. tab
Artigo em Inglês | LILACS | ID: lil-730457

RESUMO

Introduction: The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients. Objective: To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome. Methods: A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m2 with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4. Results: The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I–V. Conclusion: The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III). .


Introdução: O sucesso da cirurgia faríngea no tratamento da síndrome da apneia obstrutiva do sono (SAOS) depende da adequada seleção de pacientes. Objetivo: Propor um novo estadiamento para indicação de cirurgia faríngea na SAOS. Método: Estudo retrospectivo, onde foram inclusos, 54 pacientes submetidos a amigdalectomia ampliada, divididos em 6 estádios. Estádio I: pacientes com tonsilas palatinas graus 3/4 e índice de Mallampati modificado (IMM) 1/2; Estádio II: tonsilas palatinas 3/4 e IMM 3/4; Estádio III: tonsilas palatinas 1/2 e IMM 1/2; Estádio IV: tonsilas palatinas 1/2 e IMM 3/4; Estádio V: IMC (índice de massa corpórea) ≥ com tonsilas palatinas 3/4 e IMM 1, 2, 3 ou 4. Estádio VI: IMC ≥ kg/m2 com tonsilas palatinas 1 ou 2 e IMM 1, 2, 3, ou 4. Resultados: As taxas de sucesso cirúrgico foram de 88,9%; 75,0%; 35,7%; 38,5% e 100,0% nos estádios I a V. Conclusão: A presença de tonsilas palatinas hipertróficas foi o fator anatômico em comum nos estádios de maior sucesso (I, II e V), independente do IMC. Apesar do IMM classe III e IV diminuir a taxa de sucesso da cirurgia em pacientes com tonsilas hipertróficas (estádio II), a presença de IMM classe I e II não favoreceu o sucesso cirúrgico em pacientes com tonsilas normotróficas (estádio III). .


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Tonsila Palatina/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Polissonografia , Tonsila Palatina/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/classificação , Tonsilectomia , Resultado do Tratamento
17.
Sleep Breath ; 18(4): 825-8, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24535631

RESUMO

PURPOSE: A large goiter can cause a series of compressive symptoms such as dyspnea and dysphagia, and previous case reports have indicated the coexistence of obstructive sleep apnea syndrome (OSAS) in these patients. The aim of this study was to evaluate the impact of thyroidectomy on the control of OSAS in patients with large goiters. METHODS: Twenty-four patients with euthyroid goiters larger than 100 ml were consecutively selected. Of these, 17 (70.8%) presented OSAS and formed the research group. The protocol consisted of sleep questionnaires, physical examination, and polysomnography in baseline and after 3 months of surgery. RESULTS: The average age of the patients was 58.3±9.9 years, and there were 5 (29.4%) males and 12 (70.6%) females. The significant findings in the postoperative period included a reduced neck circumference (p=0.041), reduced Epworth sleepiness score (p=0.025), decreased percentage of high-risk OSAS cases according to the Berlin questionnaire (p<0.001), and a tendency for a significant reduction in snoring (p=0.052). However, polysomnographic respiratory parameters showed no significant improvement after surgery. CONCLUSION: Despite the high prevalence of OSAS in patients with large goiters and the improvement of OSAS symptoms, thyroidectomy showed no significant impact on the polysomnographic parameters.


Assuntos
Bócio Nodular/complicações , Bócio Nodular/cirurgia , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/cirurgia , Tireoidectomia , Adulto , Idoso , Comorbidade , Feminino , Seguimentos , Bócio Nodular/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Complicações Pós-Operatórias/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia
18.
Otolaryngol Head Neck Surg ; 146(5): 757-63, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22298684

RESUMO

OBJECTIVES: To study the prevalence of otorhinolaryngologic symptoms and findings of physical examination of the upper airway (UA) of a representative sample of the adult population of São Paulo, Brazil, and the association between these findings. STUDY DESIGN: Cross-sectional survey. SETTING: Population sample. METHODS: A total of 1101 randomly selected volunteers representing the adult population of São Paulo according to sex, age, and socioeconomic class were included in this study. Otorhinolaryngological evaluation included investigation of nasal complaints, physical examination of the UA, and a facial inspection. RESULTS: A total of 993 volunteers (53.9% women), with a mean age of 41.8 ± 0.89 years, underwent otorhinolaryngologic examination. The most prevalent symptoms were the following: symptoms suggestive of rhinitis (44.9%), snoring (42.8%), mouth breathing (39.3%), and nasal obstruction (33.3%). In physical examination, the most common findings were a web palate (redundant posterior pillar; 62.9%), septum deviation (56.9%), and inferior turbinate hypertrophy (37.7%). Significant associations were found between nasal obstruction and septum deviations, inferior turbinate hypertrophy, high-arched palate, and class II dental occlusion; between symptoms of rhinitis and inferior turbinate hypertrophy; and between snoring and obstructive deviated septum, modified Mallampatti grades III and IV, increased neck circumference, and age greater than or equal to 50 years. CONCLUSIONS: The prevalence of otorhinolaryngologic symptoms and alterations in physical examination of the UA were high in the adult population of São Paulo, Brazil. The snoring and nasal symptoms were significantly associated with findings from UA physical examination and inspection of the facial skeleton.


Assuntos
Otorrinolaringopatias/diagnóstico , Exame Físico , Transtornos do Sono-Vigília/diagnóstico , Adulto , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Humanos , Masculino , Cavidade Nasal , Otorrinolaringopatias/epidemiologia , Fatores de Risco , Transtornos do Sono-Vigília/epidemiologia , Estatísticas não Paramétricas , População Urbana
19.
Rev. bras. hipertens ; 16(3): 158-163, jul.-set. 2009. ilus
Artigo em Português | LILACS | ID: lil-541047

RESUMO

Neste manuscrito serão apresentadas as principais abordagens do paciente portador da síndrome da apneia obstrutiva do sono (SAOS). O diagnóstico deve ser realizado por meio de uma minuciosa história clínica voltada para as queixas de ronco, relato de paradas respiratórias e sonolência excessiva. O exame físico deve contemplar medidas antropométricas e avaliação sistemática da via aérea superior. Para a confirmação diagnóstica, se faz necessária a realização da polissonografia completa de noite inteira sob supervisão, visto que, em pacientes cuja suspeita clínica é alta, registros simplificados domiciliares podem ser uma alternativa. O tratamento da SAOS requer medidas gerais, uso de aparelhos de pressão positiva, sendo o CPAP o mais indicado a casos graves e aparelhos intraorais em casos mais leves. Os procedimentos cirúrgicos têm sua indicação quando alterações anatômicas são evidentes ou como auxílio aos demais tratamentos.


In this manuscript the principal approaches will be presented in the patient with obstructive sleep apnea syndrome (OSAS). The diagnosis should be carried out through clinical history focused to the complaints of snore, report of breathing pauses and excessive sleepiness. The physical examination must contemplate measures anthropometrics and systematic evaluation of the upper airway. For diagnostic confirmation is necessary to perform full night polissonography under supervision, being that in patients whose clinical suspicion is high, register simplified in home be an alternative. The treatment of OSAS applies for general measures, for use of appliances of positive pressure, being the CPAP most indicated inserious cases and oral appliances in more mild cases. The surgical proceedings have his indication when anatomical alterations are obvious or like help to too manytreatments.


Assuntos
Humanos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia
20.
Braz. j. otorhinolaryngol. (Impr.) ; 75(3): 463-466, maio-jun. 2009.
Artigo em Inglês, Português | LILACS | ID: lil-521108

RESUMO

Sleep apnea-hypopnea syndrome was described twenty years ago, and since then there have been doubts and controversies regarding it. Fiberoptic nasopharyngoscopy with Muller's maneuver, first described by Borowieck and Sassin (1983), is among them. AIM: Careful literature review on Muller's maneuver, regarding whether it can predict the sucess of uvulopalatopharyngoplasty, location of upper airway obstruction and severity of the disorder. DISCUSSION AND LITERATURE REWIEW: Literature has shown that there isn't a consensus about the use of Muller's maneuver. In spite of being technically easy, inexpensive and widely used, it is very unespecific and subjective. CONCLUSION: The importance of Muller's maneuver in evaluating apneic patients has been questioned, because there are controversies whether it can predict the sucess of uvulopalatopharyngoplasty, location of upper airway obstruction and severity of the disease.


A Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono é uma patologia descrita há apenas vinte anos, havendo ainda várias dúvidas e controvérsias a seu respeito. Nesse âmbito inclui-se a nasofibrolaringoscopia com Manobra de Müller descrita por Borowieck e Sassin em 1983 e motivo de análise neste artigo. OBJETIVO: Revisão da literatura, com análise crítica e comparativa a respeito da capacidade da nasofibrolaringoscopia com manobra de Müller de predizer o sucesso da uvulopalatofaringoplastia, o local de colapso da via aérea superior e a gravidade da doença. DISCUSSÃO E REVISÃO DA LITERATURA: A revisão da literatura mostra que não há um consenso sobre a utilização da manobra de Müller, pois apesar de ser um exame de fácil execução, custo e tempo efetivos, é também bastante inespecífico e subjetivo. CONCLUSÃO: A relevância da manobra de Müller na avaliação do paciente apnéico tem sido questionada, pois há controvérsias na literatura quanto a sua capacidade de predizer o sucesso da cirurgia orofaríngea, o local de colapso da via aérea superior e a gravidade da apnéia.


Assuntos
Humanos , Apneia Obstrutiva do Sono/cirurgia , Endoscopia/métodos , Valor Preditivo dos Testes , Palato Mole/cirurgia , Faringe/cirurgia , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Úvula/cirurgia
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