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1.
Medicine (Baltimore) ; 97(43): e12877, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30412081

RESUMO

RATIONAL: Chronic obstructive pulmonary disease (COPD) impairs lung function and induces systemic effects, resulting in impaired quality of life. Skeletal muscle dysfunction-characteristic of advanced COPD patients-limits a patient's ability to perform activities of daily living (ADL). In addition, dysphagia is commonly observed in COPD patients. PATIENT CONCERN: This case report documents a 42-year-old man with very severe COPD. He experienced aggravation of the symptoms during standard medical treatment and his ability to perform the ADL was significantly impaired. Furthermore, his dysphagia worsened despite oromotor training. DIAGNOSIS: He was diagnosed as very severe COPD have a problem with swallowing and respiratory function. INTERVENTION: Upon NIPPV treatment, the patient's ability to perform the ADL, as well as his dysphagia, showed improvement. OUTCOMES: Thus, we report the remarkable improvement of physical function, as well as dysphagia, in a very severe COPD patient after NIPPV treatment. LESSONS: NIPPV may be useful as a treatment option for such patients.


Assuntos
Respiração com Pressão Positiva/métodos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Atividades Cotidianas/psicologia , Adulto , Transplante de Medula Óssea/efeitos adversos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Progressão da Doença , Humanos , Masculino , Ventilação não Invasiva/métodos , Ventilação não Invasiva/psicologia , Oxigênio/uso terapêutico , Respiração com Pressão Positiva/psicologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida/psicologia , Testes de Função Respiratória/métodos , Resultado do Tratamento
2.
Respir Care ; 61(8): 1023-32, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27118876

RESUMO

BACKGROUND: Research on subthreshold compliance with positive airway pressure (PAP) therapy in sleep apnea patients may inform clinical sleep medicine practice. We retrospectively assessed compliant and subthreshold compliant sleep apnea subjects to test whether regular but fewer hours of PAP use would demonstrate clinically meaningful improvements and correlate with outcomes. METHODS: A chart review was conducted of 113 consecutive sleep apnea subjects, naive to treatment, who completed a titration study and filled a PAP therapy prescription. Objective data categorized subjects into 3 groups: compliant, subthreshold compliant, and minimal use. Outcome measures assessed changes in insomnia, sleepiness, and nocturia on average 7 months from PAP initiation. Correlation coefficients analyzed dose-response relationships between hours of use and changes in outcomes. RESULTS: Among 113 PAP attempters, 104 (92%) were current users. Among 93 users with objective data, regular (consistent) PAP users included 59 compliant and 21 subthreshold compliant, and 13 subjects were minimal users. Compliant users averaging 6.6 ± 1.3 h/night and 42.0 ± 12.1 h/week showed the largest outcome improvements (all P < .05) with moderate to large effects for insomnia (d = 0.94), sleepiness (d = 0.58), and nocturia (d = 0.56). Subthreshold users averaging 4.1 ± 0.7 h/night but only 18.0 ± 5.6 h/week showed a large effect for insomnia (d = 0.76, P = .03) and nonsignificant, small effects for sleepiness (d = 0.38) and nocturia (d = 0.22). Correlation coefficients showed a trend for decrease in insomnia (P = .08; r = .20) and a significant decrease in nocturia (P = .034; r = 0.25), each in association with hours of PAP use. CONCLUSIONS: In a clinical sample, 86% of sleep apnea subjects regularly used PAP, but adherence was 63%. Regular users showed clinical treatment effects and potential dose-response relationships, suggesting that the term use offers advantages over the term adherence. Currently, subthreshold compliance may not merit insurance coverage in many countries, an issue affecting many sleep apnea patients.


Assuntos
Cooperação do Paciente/estatística & dados numéricos , Respiração com Pressão Positiva/estatística & dados numéricos , Apneia Obstrutiva do Sono/terapia , Adulto , Humanos , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/psicologia , Estudos Retrospectivos , Apneia Obstrutiva do Sono/psicologia , Fatores de Tempo , Resultado do Tratamento
3.
Chest ; 144(1): 87-91, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23392731

RESUMO

BACKGROUND: Patient cooperation is crucial for the success of noninvasive positive pressure ventilation (NPPV). This study evaluated the efficacy of medical hypnosis to reduce anticipatory anxiety and acclimatization time in children who are candidates for long-term NPPV. METHODS: Medical hypnosis was performed by a trained nurse. The acclimatization time and long-term compliance with NPPV were evaluated. RESULTS: Hypnosis was performed in nine children aged 2 to 15 years. Seven children had a high level of anticipatory anxiety because of a tracheotomy since birth (n=2), a history of maxillofacial surgery (n=2), severe dyspnea because of lung disease (n=2), and morbid obesity and depression (n=1), and two children with obstructive sleep apnea failed standard NPPV initiation. The hypnosis techniques were based on distraction in the youngest patient and indirect or direct hypnotic suggestions in the older children to obtain a progressive psychocorporal relaxation. All patients accepted the interface and the NPPV after the first hypnosis session. A median of three sessions was needed for overnight (>6 h) NPPV acceptance. The 6-month compliance with NPPV was excellent, with a median use of 7.5 h per night. CONCLUSION: Medical hypnosis is an effective, safe, noninvasive, and inexpensive tool for reducing the anticipatory distress and acclimatization time for NPPV. This therapy is particularly useful in children with traumatic experiences, such as a tracheotomy or facial surgical procedures.


Assuntos
Ansiedade/prevenção & controle , Hipnose/métodos , Cooperação do Paciente/psicologia , Respiração com Pressão Positiva/psicologia , Terapia Respiratória/psicologia , Adolescente , Ansiedade/psicologia , Criança , Pré-Escolar , Dispneia/psicologia , Feminino , Humanos , Masculino , Obesidade Mórbida/psicologia , Projetos Piloto , Cirurgia Bucal/psicologia , Traqueotomia/psicologia , Resultado do Tratamento
4.
South Med J ; 102(6): 589-94, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19434037

RESUMO

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAH) is associated with impairment of cognitive functions and disturbances in emotional status. The aim of this study was to objectively evaluate the benefits of prolonged and sustained treatment for OSAH at two sleep centers serving rural community hospitals. METHODS: Fifty-six patients diagnosed with OSAH syndrome underwent Cognistat, Beck Depression Inventory (BDI) and Millon Behavioral Medicine Diagnostic Inventory (MBMD) testing before initiation of treatment. Repeated testing after six months of therapy with positive airway pressure (PAP) was performed. RESULTS: Significant improvements were noted in the BDI scale scores and a reduction in the MBMD scores reflected initial abnormal clinical personal symptoms that improved with treatment. MBMD analysis showed subjects with fewer symptoms of anxiety post baseline, which were sustained at 6 months post-treatment. Memory function improved as reflected by performance on the Cognistat. Women were observed to have a higher post-treatment BDI and younger patients appeared to have more shifts for improvement than older subjects in depressive symptomatology. CONCLUSIONS: These results indicate that prolonged and sustained PAP therapy is effective in restoring some of the deficiencies in patients with OSAH, particularly in terms of memory, depression, anxiety and increased psychological pathology.


Assuntos
Cognição , Emoções , Respiração com Pressão Positiva/psicologia , Síndromes da Apneia do Sono/psicologia , Adulto , Feminino , Humanos , Masculino , Memória , Pessoa de Meia-Idade , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Síndromes da Apneia do Sono/terapia , Inquéritos e Questionários
5.
Amyotroph Lateral Scler ; 9(2): 91-8, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18428001

RESUMO

Non-invasive ventilation (NIV) is known to improve quality of life and to prolong survival in amyotrophic lateral sclerosis (ALS) patients. However, little is known about the circumstances of dying in ventilated ALS patients. In the light of the debate on legalizing euthanasia it is important to provide empirical data about the process of dying in these patients. In a structured interview, 29 family caregivers of deceased ALS patients were asked about their own and the patient's attitude toward physician-assisted suicide (PAS) and euthanasia, circumstances of dying, and the use of palliative medication. Quantitative and qualitative content analysis was performed on the data. Non-recurring suicidal thoughts were reported by five patients. Three patients and seven relatives had thought about PAS. Seventeen caregivers described the patients' death as "peaceful", while choking was reported in six bulbar patients. In final stages of dying, the general practitioner (GP) was involved in the treatment of 10 patients, with palliative medication including sedatives and opiates being administered in eight cases. In conclusion, in contrast to the Netherlands, where 20% of terminal ALS patients die from PAS or euthanasia, only a small minority of our patients seems to have thought about PAS. The legal situation in Germany (where euthanasia is illegal), a bias due to the selection of NIV patients as well as a high percentage of religious patients and those with good levels of social support from family and friends, might account for this. Most of our patients died peacefully at home from carbon dioxide narcosis, but choking was described in some bulbar patients. Thus, palliative care, especially the use of opiates, anxiolytics and sedatives should be optimized, and the involvement of GP should be strongly encouraged, especially in bulbar patients.


Assuntos
Esclerose Lateral Amiotrófica/enfermagem , Esclerose Lateral Amiotrófica/psicologia , Atitude Frente a Morte , Cuidadores/psicologia , Eutanásia/psicologia , Cuidados Paliativos/psicologia , Respiração com Pressão Positiva/psicologia , Suicídio Assistido/psicologia , Adulto , Idoso , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade
6.
Am J Respir Crit Care Med ; 164(4): 608-13, 2001 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-11520724

RESUMO

Application of continuous positive airway pressure (CPAP) as the standard treatment for sleep apnea/hypopnea syndrome (SAHS) is a moot point. Studies on the effectiveness of this treatment have been challenged because of the lack of a suitable placebo. The recent description of a true placebo (sham CPAP) prompted us to conduct a randomized trial of CPAP or placebo to assess the effectiveness of CPAP in improving SAHS-related symptoms and daytime function in patients with moderate to severe SAHS. Forty-eight patients, stratified in four groups according to severity, were randomly allocated into two treatment groups (optimal and sham CPAP) for a 6-wk period. Of these, 45 completed follow-up (91% males; age: 54 +/- 10 yr; body mass index [BMI]: 32 +/- 6 kg/m(2); apnea-hypopnea index [AHI]: 54 +/- 19 events/h; and Epworth Sleepiness Scale [ESS]: 16 +/- 5). The ESS, a questionnaire on SAHS-related symptoms, Functional Outcomes Sleep Questionnaire (FOSQ), and the Short Form Health Survey (SF-36) were completed at inclusion and after treatment. After 10 d of washout, the placebo group was treated with optimal CPAP and reassessed before and after optimal CPAP. The group receiving optimal CPAP when compared with the group with sham CPAP showed considerably greater improvement in the relief of sleepiness (-9.5 versus -2.3, p < 0.001), other SAHS-related symptoms (-18.5 versus -4.5, p < 0.001), vigilance (+8.5 versus +3.4, p = 0.009), and general productivity (+4.0 versus +0.5, p = 0.04) FOSQ scales. Both groups used a similar number of hours for the optimal and the sham CPAP (4.3 versus 4.5, (p = NS). The patients initially treated with placebo CPAP improved significantly more when optimal CPAP was applied for ESS (-2.3 versus -6.7, p < 0.001) and other sleep apnea syndrome (SAS)-related symptoms (-4.5 versus -11.2, p = 0.02). Our study provides strong evidence of the effectiveness of CPAP treatment in improving symptoms and perceived health status in moderate to severe SAHS.


Assuntos
Atividades Cotidianas , Respiração com Pressão Positiva/métodos , Síndromes da Apneia do Sono/fisiopatologia , Síndromes da Apneia do Sono/terapia , Fases do Sono , Adulto , Idoso , Atitude Frente a Saúde , Índice de Massa Corporal , Método Duplo-Cego , Feminino , Seguimentos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/induzido quimicamente , Obesidade/complicações , Placebos , Respiração com Pressão Positiva/psicologia , Respiração com Pressão Positiva/normas , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/etiologia , Fumar/efeitos adversos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
7.
Acta Clin Belg ; 53(2): 105-13, 1998 Apr.
Artigo em Holandês | MEDLINE | ID: mdl-9639949

RESUMO

A survey performed in 100 CPAP users indicated that irritation of the face, a painful nose and nasal obstruction were among the most frequently mentioned complaints in chronic CPAP users. In 132 normocapnic SAS patients a significant improvement of PaO2 was shown, with a decrease of the alveolo-arterial oxygen difference. This improved gas exchange was parallelled by a significant increase in the FRC and TLC. Maybe a modulation in force of the respiratory muscles may be involved. These data were more pronounced in obstructive sleep apnea than in central sleep apnea. In 50 chronic CPAP users we could show a lower AHI immediately after CPAP withdrawal after a previous prolonged treatment. These findings may support the insufflation theory as a mechanism of action of CPAP. Traditionally, mechanical splinting of the upper airway has been considered as the dominant mechanism of action. Other mechanisms like changes in regulation of breathing and decrease of the pharyngeal edema may be involved as well.


Assuntos
Cooperação do Paciente/psicologia , Respiração com Pressão Positiva , Troca Gasosa Pulmonar , Síndromes da Apneia do Sono/terapia , Gasometria , Doença Crônica , Feminino , Capacidade Residual Funcional , Humanos , Masculino , Oxigênio/sangue , Respiração com Pressão Positiva/efeitos adversos , Respiração com Pressão Positiva/psicologia , Síndromes da Apneia do Sono/metabolismo , Síndromes da Apneia do Sono/fisiopatologia , Síndromes da Apneia do Sono/psicologia , Capacidade Pulmonar Total
8.
Laryngorhinootologie ; 73(11): 581-5, 1994 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-7818743

RESUMO

In a prospective study between 1989 and 1993, 50 patients (45 males, 5 females, mean age: 58.4 years; mean AHI = 37.8/h) suffering from obstructive sleep apnoea were examined. They underwent nocturnal polysomnography and were provided nightly treatment with nasal CPAP (Respironics Sleep-Easy III und REMSTAR, Respironics Inc, Monroeville, PA). 41 patients were given primary treatment with nCPAP. Nine patients were secondarily treated with a nCPAP mask after other modalities of therapy (weight reduction, mandibular positioning appliance, nasal surgery, uvulopalatopharyngoplasty) had been applied without success. All patients were controlled in the sleep laboratory nine to fourty-two months (mean: 18 months) after the masks were fitted. A questionnaire was used to evaluate subjective complaints, use of the CPAP mask, technical problems, partner's acceptance of the mask etc. 46 patients wore the mask on an average of 6.2 nights per week and 6.5 hours per night. These self-reported data from the questionnaire correlated only in 85 per cent of the cases with the data provided by the time clock installed in the CPAP machine. The long-term compliance with nCPAP of the studied group was 92 per cent. Four patients returned their masks within two months. It was possible to provide sufficient respiration to more than 90% of the patients using an average pressure between 7 and 8 cm water column. Respiration presented no problems for all six patients who had previously been treated with uvulopalatopharyngoplasty in our hospital. Despite the mask 41 patients slept with their partner in a common room.


Assuntos
Cooperação do Paciente , Respiração com Pressão Positiva/instrumentação , Síndromes da Apneia do Sono/terapia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação do Paciente/psicologia , Polissonografia , Respiração com Pressão Positiva/psicologia , Síndromes da Apneia do Sono/sangue , Síndromes da Apneia do Sono/psicologia
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