Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 84
Filter
1.
Article in Spanish | LILACS | ID: biblio-1411804

ABSTRACT

El Síndrome de Treacher Collins (STC) es una enfermedad congénita del desarrollo craneofacial, siendo una complicación frecuente la obstrucción de la vía aérea. Objetivo: Describir clínicamente tres casos de STC y sus hallazgos polisomnográficos. Diseño: Estudio observacional, descriptivo y retrospectivo. Revisión de fichas clínicas y polisomnografías (PSG). Resultados: Se incluyeron tres pacientes con STC, de 1, 17 y 20 años, dos hombres. Todos presentaron malformaciones faciales compatibles con el STC. El paciente menor tuvo apneas desde el nacimiento. En las PSG, todos presentaron eficiencia del sueño disminuida e índice de microdespertares aumentado. Solo un paciente tuvo diagnóstico de Síndrome de Apnea/Hipoapnea Obstructiva del Sueño (SAHOS) severo. Conclusiones: Aún cuando las anomalías craneofaciales no difirieron entre los pacientes, hubo sólo un caso de SAHOS severo. Las otras alteraciones descritas en la PSG afectan la calidad de vida, siendo relevante la búsqueda activa de trastornos respiratorios del sueño en estos pacientes.


Treacher Collins Syndrome (STC) is a congenital craniofacial disorder, being the airway obstruction a frequent complication. Objective: To describe clinical and polysomnographic findings of three cases with STC. Methods: An observational, descriptive and retrospective study. Review of clinical records and nocturnal polysomnography was carried out. Results: Three patients with STC were included of 1, 17 and 20 years old, two were males. All of them with facial malformations compatible with STC. Only the youngest presented apneas since birth. All patients had decreased sleep efficiency and increased arousal index. Only one patient presented with severe Obstructive Sleep Apnea Syndrome (OSAS). Conclusions: Despite the fact that all the patients had similar craniofacial anomalies, only one presented with severe OSAS. The other abnormalities described in the polysomnography affect the quality of life, being relevant performing an active screening of breathing-related sleep disorders in these patients.


Subject(s)
Humans , Male , Female , Infant , Adolescent , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/etiology , Polysomnography/methods , Mandibulofacial Dysostosis/complications , Phenotype , Retrospective Studies , Sleep Apnea, Obstructive/etiology
2.
Arq. neuropsiquiatr ; 78(10): 629-637, Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131695

ABSTRACT

ABSTRACT Introduction: A diagnosis of rapid eye movement sleep behavior disorder (RBD) currently requires confirmation with polysomnography (PSG). However, PSG may not be sufficiently available. In these situations, a clinical diagnostic measure might be useful. Objective: To validate the Brazilian Portuguese version of RBD screening questionnaire (RBDSQ) for patients with Parkinson's disease (PD). Methods: Using detailed clinical interviews and PSG analysis (diagnostic gold standard), a convenience sample of 69 subjects was divided into the following subgroups: patients with PD and RBD (PD+RBD; n=50) and patients with PD alone (PD-RBD; n=19). Results: RBDSQ-BR showed adequate internal consistency (Cronbach's α=0.809) and, except for item 8, adequate item-test correlation. The retest performed in a second sample (n=13, consecutive) showed high agreement for total score (intraclass correlation coefficient, ICC=0.863) and acceptable agreement for items 2, 3, 6.2, 6.3, 7, and 8 (K>0.60). The receiver operating characteristic (ROC) curve analysis had an area under the curve (AUC) of 0.728. A cut-off score of 4 enabled the correct diagnosis of 76.8% subjects and provided the best balance between sensitivity (84%) and specificity (57.9%), with a 2.0 likelihood ratio of a positive result (LR+) and a 0.3 likelihood ratio of a negative result (LR-). Items 2 and 6.2 had 84.2% specificity and 3.2 LR+. Combined items 1+2+6.2, 2+6.1, and 6.1+6.2 increased the specificity to 94.7%, with LR+ ranging from 6.1 to 7.6. Conclusions: RBDSQ-BR is a reliable instrument, which may be useful for RBD diagnosis of Brazilian patients with PD. The instrument is also valid and may help in a better selection of cases for a more detailed clinical evaluation or even PSG analysis.


RESUMO Introdução: O diagnóstico do transtorno comportamental do sono REM (TCSREM) implica na realização da polissonografia (PSG), mas sua disponibilidade pode não ser suficiente. Portanto, meios clínicos para o diagnóstico podem ser úteis. Objetivo: Validar para a língua portuguesa falada no Brasil o questionário de triagem do TCSREM (QT-TCSREM) em pacientes portadores de doença de Parkinson (DP). Métodos: Uma amostra por conveniência composta de 69 indivíduos foi dividida em portadores de DP com TCSREM (n=50) e DP sem TCSREM (n=19) através de entrevista clínica detalhada e análise da PSG. Resultados: QT-TCSREM-BR apresentou consistência interna adequada (α de Cronbach=0,809) e, exceto pelo item 8, correlação item-total adequada. Reteste feito em uma segunda amostra (n=13, consecutivos) evidenciou concordância elevada para o escore total (coeficiente de correlação intraclasse, CCI=0,863) e aceitável para os itens 2, 3, 6.2, 6.3, 7 e 8 (K>0,60). Análise da curva característica de operação do receptor (COR) obteve uma área sob a curva de 0,728. O corte 4 permitiu o diagnóstico correto de 76,8% dos indivíduos e apresentou o melhor equilíbrio entre sensibilidade (84%) e especificidade (57,9%), com uma razão de verossimilhança de um resultado positivo (RV+) 2,0 e de um resultado negativo (RV-) 0,3. Os itens 2 e 6.2 obtiveram especificidade 84,2% e RV+ 3,2. Itens combinados 1+2+6,2, 2+6,1 e 6,1+6,2 aumentaram a especificidade para 94,7%, com RV+ variando de 6,1 até 7,6. Conclusões: O QT-TCSREM-BR é um instrumento confiável que pode ser útil para o diagnóstico do TCSREM em pacientes com DP no Brasil. O instrumento também é válido e pode auxiliar numa melhor seleção de casos a serem submetidos a uma avaliação mais detalhada ou até mesmo a uma análise de PSG.


Subject(s)
Humans , REM Sleep Behavior Disorder , Brazil , Mass Screening , Surveys and Questionnaires , Polysomnography/methods
4.
Rev. bras. neurol ; 56(2): 35-44, abr.-jun. 2020. ilus
Article in English | LILACS | ID: biblio-1102915

ABSTRACT

Dreaming is the result of the mental activity of rapid eye movement (REM) sleep stage, and less commonly of non-REM sleep. Dreams offer unique insights into the patients' brains, minds, and emotions. Based on neurophysiological and neuroimaging studies, the biological core of dreaming stands on some brain areas activated or inactivated. Dream abnormalities in neurological disorders include a reduction / cessation of dreaming, an increase in dream frequency, changes in dream contents and accompaniments, and the occurrence of dreamlike experiences (hallucinations) mainly during the wake-sleep/sleep-wake transitions. Dream changes can be associated with several neurological conditions, and the unfolding of biological knowledge about dream experiences can also have significance in clinical practice. Regarding the dream importance in clinical neurological management, the aim of this paper encompasses a summary of sleep stages, dreams neurobiology including brain areas involved in the dreams, memory, and dreams, besides Dreams in the aging people and neurodegenerative disorders.


Sonhar é o resultado da atividade mental do estágio do sono de movimento rápido dos olhos (REM) e, menos comumente, do sono não-REM. Os sonhos oferecem informações únicas sobre o cérebro, a mente e as emoções dos pacientes. Com base em estudos neurofisiológicos e de neuroimagem, o núcleo biológico do sonho está em algumas áreas do cérebro ativadas ou inativadas. As anormalidades do sonho nos distúrbios neurológicos incluem uma redução / cessação do sonho, um aumento na frequência do sonho, alterações nos conteúdos e acompanhamentos do sonho e a ocorrência de experiências semelhantes ao sonho (alucinações), principalmente durante as transições de vigília-sono / sono-vigília. As mudanças do sonho podem estar associadas a várias condições neurológicas, e o desenvolvimento do conhecimento biológico sobre as experiências do sonho também pode ter significado na prática clínica. Com relação à importância do sonho no manejo neurológico clínico, o objetivo deste artigo é resumir os estágios do sono, a neurobiologia dos sonhos, incluindo as áreas do cérebro envolvidas nos sonhos, a memória e os sonhos, além dos sonhos nos idosos e nos distúrbios neurodegenerativos.


Subject(s)
Humans , Child , Adult , Sleep/physiology , Sleep, REM/physiology , Sleep Stages , Dreams/physiology , Polysomnography/methods , REM Sleep Behavior Disorder , Memory , Narcolepsy
5.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 65(7): 995-1000, July 2019. tab
Article in English | LILACS | ID: biblio-1013018

ABSTRACT

SUMMARY OBJECTIVES Assess the performance of the Stop-Bang questionnaire in Brazilian patients for the screening of OSA. METHODS A cross-sectional study with historical and consecutive analysis of all patients who underwent polysomnography tests in the Sleeping Sector of the Ear, Nose, and Throat, and Cardiopulmonary (LabSono) Departments of the Gaffrée and Guinle University Hospital (HUGG), from 10/17/2011 to 04/16/2015. The variables relating to the SB questionnaire were collected by direct research from the medical records of patients. RESULTS In a series of 83 patients, we found that our sample were similar to other studies conducted in specialized centers of Sleep Medicine, and the population presented characteristics similar to those found by studies in Latin America. Men and women only behaved similarly in relation to the presence of Observed Apnea and body mass index, with a predominance of women who had systemic hypertension over men. In our study, the discriminatory value of 4 or more positive answers to the questionnaire had the best performance in identifying patients with an hourly Apnea-Hypopnea Index greater than 15/h, with a sensitivity of 72.97% (55.9% - 86.2%) and specificity of 67.39% (52.0% - 80.5%). CONCLUSIONS The Stop-Bang questionnaire proved to be, in our sample, a good screening instrument for diagnosing OSA Syndrome.


RESUMO OBJETIVO Avaliar o desempenho no Questionário Stop-Bang (QSB) em pacientes brasileiros para rastrear a Apneia Obstrutiva do Sono. MÉTODO Estudo transversal, com análise histórica e consecutiva de todos os pacientes que realizaram exames de polissonografia pelo Setor de Sono da Otorrinolaringologia e da Cardiopulmonar (LabSono) do Hospital Universitário Gaffrée e Guinle (HUGG), no período de 17/10/2011 a 16/04/2015. As variáveis referentes ao QSB foram colhidas por pesquisa direta nos prontuários dos pacientes. RESULTADOS Numa casuística de 83 pacientes, encontramos amostras semelhantes a outros estudos realizados em Centros Especializados em Medicina do Sono, com características da população semelhantes aos estudos feitos na América Latina. Homens e mulheres só se comportaram de forma semelhante em relação à presença de apneias presenciadas e o índice de massa corporal, com um predomínio de mulheres com hipertensão arterial sistêmica sobre os homens. Em nosso estudo, o valor discriminatório de quatro ou mais respostas positivas ao questionário mostrou o melhor desempenho em identificar pacientes com um índice de apneia/hipopneia por hora maior do que 15/h, obtendo sensibilidade de 72,97% (55,9% - 86,2%) e especificidade de 67,39% (52,0% - 80,5%). CONCLUSÕES O QSB mostrou-se, em nossa amostra, um bom instrumento de rastreio da Síndrome da Apneia Obstrutiva do Sono.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Surveys and Questionnaires/standards , Sleep Apnea, Obstructive/diagnosis , Reference Values , Snoring/diagnosis , Severity of Illness Index , Brazil , Cross-Sectional Studies , Reproducibility of Results , Sensitivity and Specificity , Polysomnography/methods , Sex Distribution , Sleep Apnea, Obstructive/physiopathology , Middle Aged
6.
Rev. chil. enferm. respir ; 35(2): 104-110, jun. 2019. tab
Article in Spanish | LILACS | ID: biblio-1020625

ABSTRACT

INTRODUCCIÓN: El síndrome de apnea obstructiva del sueño (SAHOS) es más prevalente en hombres, los estudios poblacionales muestran una relación de 2:1, sin embargo, en los estudios clínicos la frecuencia llega a ser de hasta de 6:1. Estas diferencias en el ambiente clínico puede ser consecuencia de variaciones en el reporte de síntomas en hombres comparados con mujeres. OBJETIVO: Evaluar las diferencias de género en la presentación clínica de apnea obstructiva de sueño. Pacientes: Estudio transversal de pacientes sometidos a una poligrafía respiratoria (PR) con sospecha clínica de SAHOS. Se recolectaron datos demográficos, antropométricos, comorbilidades y las variables de la PR. Se realizó estudio t de student, Mann-Whitney y chi-cuadrado según correspondiera. RESULTADOS: Se incluyeron 1.044 pacientes: edad promedio 53,2 ± 14 años, 76% hombres. Las mujeres con SAHOS poseen mayor IMC (32,2 ± 6,1 vs 30,8 ± 5,0; p=0,002) y edad (61,4 ± 12,2 vs 52,6 ± 13,9; p < 0,001), pero menor circunferencia de cuello (CC) (38,1 ± 3,6 vs 43,2 ± 3,3; p < 0,001), además, presentan menor IA/H y menor duración de las apneas. No hubo diferencias en los síntomas clásicos de apneas presenciada y somnolencia diurna, sin embargo, describen más frecuentemente insomnio, cefalea matinal, depresión y uso de fármacos hipnóticos. CONCLUSIONES: Las mujeres al momento del diagnóstico son de mayor edad y más obesas, aunque presentan una CC menor, presentan una enfermedad más leve, pero refieren más fatiga, cansancio, cefalea e insomnio. Debemos estar alerta en la presentación clínica diferente de las mujeres para mejorar la sospecha diagnóstica.


INTRODUCTION: Obstructive sleep apnea (OSA) is more prevalent in men, population studies show a ratio of 2:1, however in clinical studies the frequency is as high as 6:1. These differences in the clinical setting may be a consequence of variations in the reporting of symptoms in men compared to women. OBJECTIVE: To evaluate gender differences between women and men with recent diagnosis of OSA. Patients: A cross-sectional, study of patients undergoing home sleep apnea testing (HSAT) with clinical suspicion of OSA. Demographic, anthropometric, comorbidities and HSAT variables were collected. We performed t student analysis, Mann-Whitney test or chi square test as appropriate. RESULTS: 1,044 patients were included: mean age 53.2 ± 14 years, 76% men. Women with OSA have a higher BMI (32.2 ± 6.1 vs 30.8 ± 5.0, p = 0.002), were older (61.4 ± 12.2 vs 52.6 ± 13.9, p <0.001), but have a lower neck circumference (NC) (38.1 ± 3.6 vs. 43.2 ± 3.3, p <0.001). The women presented lower AHI and shorter duration of apneas. Although the classic symptoms of apnea and daytime sleepiness showed no differences, women reported more frequently insomnia, morning headache, depression and use of hypnotic drugs. CONCLUSIONS:: Clinical differences between gender are present at time of diagnosis. Woman are older and more obese, although they have a lower NC. They have a milder disease, but they refer to be more tired, headache, insomnia and depression. We must be alert in the different clinical presentation of women to improve the diagnostic suspicion.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Polysomnography/methods , Sleep Apnea, Obstructive/epidemiology , Body Mass Index , Chi-Square Distribution , Comorbidity , Sex Factors , Anthropometry , Cross-Sectional Studies , Retrospective Studies , Statistics, Nonparametric , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/physiopathology
7.
Rev. chil. pediatr ; 90(3): 309-315, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1013838

ABSTRACT

INTRODUCCIÓN: El diagnóstico precoz de los Trastornos Respiratorios del Sueño (TRS) puede permitir una intervención oportuna. La poligrafía (PG) es una alternativa confiable y accesible en la actualidad. OBJETIVO: Describir y analizar PG de niños > 1 año con sospecha de TRS. PACIENTES Y MÉTODO: Se incluyeron PG de niños y adolescentes > 1 año de edad con sospecha de TRS, desde diciembre de 2011 hasta agosto de 2017 provenientes de la ciudad de Concepcion, Chile. Se recopilaron datos demo gráficos, clínicos y variables poligráficas. Estadística descriptiva, expresando resultados en mediana y rango. Se determinó asociación entre índice de apnea hipopnea (IAH) y saturación mediante Rho de Spearman; considerando significancia p < 0,05. RESULTADOS: Se analizaron 190 estudios. Edad 7,9 años (1,0-20,6), varones 61%. Diagnósticos: enfermedades neuromusculares (ENM) (24,2%), daño pulmonar crónico (21,1%), obstrucción de vía aérea superior (OVAS) (19,5%), daño neurológico (11%), síndrome de Down (8,9%) malformaciones VAS (7,4%), hipoventilación central (3,7%), obesidad (2,6%) y otros (1,6%). El 55,3% de las PG resultaron alteradas; síndrome de apnea hipopnea obstructiva del sueño (SAHOS) leve en 53,3%, moderado 30,5% y severo 16,2%. No se observaron diferencias significativas en IAH entre grupos de patologías (p = 0,032), destacando un mayor IAH en Obesidad 9,0 (0,41-51) y ENM 23,9 (0,4-36,6). Se constató asociación entre IAH y parámetros de saturación; saturación promedio (rho = -0,425; p = 0,001); mínima (rho = -0,654; p = 0,001); y saturación bajo 90% (rho = 0,323; p = 0,001) en la totalidad de la muestra. DISCUSIÓN: Existió un alto porcentaje de SAHOS en pacientes pediátricos de riesgo, en especial en aquellos con ENM y obesidad. La PG es una herramienta accesible e implementable en un hospital público; situación potencialmente extrapolable a otros centros asistenciales.


INTRODUCTION: The early diagnosis of Sleep Disordered Breathing (SDB) may allow proper intervention. Currently, polygraphy (PG) is a reliable and accessible alternative. OBJECTIVE: To describe and analyze the PG of children > 1 year old with suspicion of SDB. PATIENTS AND METHOD: PG of children > 1 year old and adolescents from Concepcion, Chile, with suspected SDB were included, from December 2011 to August 2017. Demographic, clinical and polygraphic variables were collected. It was used descriptive sta tistics, expressing results in median and range. The association between apnea-hypopnea index (AHI) and oxygen saturation was determined by Spearman's Rho, considering significance of p < 0.05. RESULTS: 190 studies were analyzed. Age 7.9 years old (1.0-20.6), 61% males. Diagnosis: neuromuscular disease (NMD) (24.2%), chronic lung damage (21.1%), upper airway obstruction (UAO) (19.5%), neurological damage (11%), Down syndrome (8.9%), upper airway malformations (7.4%), central hypoventilation (3.7%), obesity (2.6%), and others (1.6%). 55.3% were altered PG, with 53.3% of mild Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS), 30.5% moderate, and 16.2% severe. There were no significant differences in AHI between groups of pathologies (p = 0.032), highlighting a higher AHI in obese patients 9 (0.41-51), and those with NMD 23.9 (0.4-36.6). It was found asso ciation between AHI and oxygen saturation parameters: mean saturation (rho = -0.425; p = 0.001), minimum (rho = -0.654; p = 0.001), and oxygen saturation below 90% (rho = 0.323; p = 0.001) in the whole sample. DISCUSSION: There was a high percentage of OSAHS in at-risk pediatric patients, especially in those with NMD and obesity. PG is an accessible and implementable tool in a public hospital, a situation that can potentially be extrapolated to other healthcare centers.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Sleep Apnea Syndromes/diagnosis , Polysomnography/methods , Sleep Apnea, Obstructive/diagnosis , Oxygen/metabolism , Sleep Apnea Syndromes/epidemiology , Chile/epidemiology , Retrospective Studies , Risk Factors , Sleep Apnea, Obstructive/epidemiology , Pediatric Obesity/epidemiology , Neuromuscular Diseases/epidemiology
8.
Braz. j. otorhinolaryngol. (Impr.) ; 85(3): 379-387, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1011633

ABSTRACT

Abstract Introduction: There is no consensus on a single classification system for the obstructive findings in drug-induced sleep endoscopy. Previous classification systems have neglected to address the upper retropalatal obstruction, the segmental division of the lateral pharyngeal wall and the primary or secondary nature of laryngeal collapse. Objective: To propose, illustrate and evaluate a more comprehensive and yet simple classification for drug-induced sleep endoscopy findings. Methods: Cross sectional study in a tertiary sleep surgery unit. A total of 30 patients with obstructive sleep apnea underwent drug-induced sleep endoscopy according to a new classification system called LwPTL, and its findings were analyzed according to obstructive sleep apnea severity and body mass index. LwPTL incorporates the description of upper retropalatal collapse, distinguishes the lateral pharyngeal wall collapse into three levels and clarify when laryngeal collapses are primary or secondary. Results: 93.3% of the patients presented lateral pharyngeal wall collapse, usually at the level of the velum (73.3%). 80% presented multilevel collapse. Regarding the upper retropalatal region, LwPTL identified 10% of the cases presenting lateral salpingopharyngeal obstruction and 6.6% with high palatal collapse. 3.3% presented epiglottic collapse. Patients presenting lower levels of collapse, either from the lateral wall and/or tongue and/or larynx, represented 30% of the cases and had significantly more severe obstructive sleep apnea, without significant differences in body mass indexes. Conclusion: LwPTL seems a simple and straightforward staging system for classifying drug-induced sleep endoscopy, distinguishing the important upper retopalatal obstruction and the primary and secondary laryngeal collapses, providing more information for appropriate treatment selection.


Resumo Introdução: Não há consenso sobre um sistema único de classificação para os achados obstrutivos da endoscopia do sono induzido por drogas. Os sistemas de classificação anteriores negligenciaram a abordagem da obstrução retropalatal alta, a divisão segmentar da parede lateral da faringe e a natureza primária ou secundária do colapso laríngeo. Objetivo: Propor, ilustrar e avaliar uma classificação mais abrangente e simples para os achados da endoscopia do sono induzido por drogas. Método: Estudo transversal em uma unidade terciária de cirurgia do sono. Foram submetidos à endoscopia do sono induzido por drogas 30 pacientes com apneia obstrutiva do sono, de acordo com um novo sistema de classificação denominado LwPTL, e seus achados foram analisados de acordo com a gravidade da apneia obstrutiva do sono e índice de massa corpórea. O LwPTL incorpora a descrição do colapso retropalatal alto, distingue o colapso da parede faríngea lateral em três níveis e esclarece quando os colapsos laríngeos são primários ou secundários. Resultados: Apresentaram colapso da parede faríngea lateral 93,3% dos pacientes, geralmente no nível do palato mole (73,3%). Em 80% dos pacientes o colapso foi multinível. Em relação à região retropalatal alta, o LwPTL identificou 10% dos casos com obstrução salpingo-faríngea lateral e 6,6% com colapso alto do palato. Em 3,3% ocorreu colapso epiglótico. Pacientes com colapso em regiões baixas, tanto da parede lateral e/ou língua como e/ou laringe, representaram 30% dos casos e apresentaram apneia obstrutiva do sono significativamente mais grave, sem diferenças significantes no índice de massa corpórea. Conclusão: O LwPTL parece um sistema de estadiamento simples e direto para classificar os achados da endoscopia do sono induzido por drogas, distingue a importante obstrução retropalatal alta e os colapsos laríngeos primários e secundários, fornece mais informações para uma seleção adequada do tratamento.


Subject(s)
Humans , Pharynx/physiopathology , Sleep Apnea, Obstructive/physiopathology , Airway Obstruction/physiopathology , Endoscopy/methods , Hypnotics and Sedatives/administration & dosage , Pharynx/diagnostic imaging , Severity of Illness Index , Cross-Sectional Studies , Polysomnography/methods , Sleep Apnea, Obstructive/diagnostic imaging , Airway Obstruction/diagnostic imaging
9.
J. bras. pneumol ; 45(3): e20180085, 2019. tab, graf
Article in English | LILACS | ID: biblio-1012554

ABSTRACT

ABSTRACT Objective: To investigate the extent to which exercise is associated with symptoms in patients with severe obstructive sleep apnea (OSA). Methods: We included subjects with an apnea-hypopnea index (AHI) > 30 events/h who completed validated sleep and exercise questionnaires. We compared symptom frequency/scores between exercisers and nonexercisers, adjusting for the usual confounders. Results: The sample included 907 nonexercisers and 488 exercisers (mean age, 49 ± 14 years; mean AHI, 53 ± 20 events/h; 81% men). Nonexercisers and exercisers differed significantly in terms of obesity (72% vs. 54%), the mean proportion of sleep in non-rapid eye movement stage 3 sleep (9 ± 8% vs. 11 ± 6%), and tiredness (78% vs. 68%). Nonexercisers had a higher symptom frequency/scores and poorer sleep quality. Adjustment for exercise weakened the associations between individual symptoms and the AHI, indicating that exercise has a mitigating effect. In binary logistic models, exercise was associated with approximately 30% lower adjusted questionnaire1 score > 2, tiredness; poor-quality sleep, unrefreshing sleep, and negative mood on awakening. Although the odds of an Epworth Sleepiness Scale score > 10 were lower in exercisers, that association did not withstand adjustment for confounders. Conclusions: Exercise is associated with lower frequency/intensity of symptoms in patients with severe OSA. Because up to one third of patients with severe OSA might exercise regularly and therefore be mildly symptomatic, it is important not to rule out a diagnosis of OSA in such patients.


RESUMO Objetivo: Investigar até que ponto o exercício está associado a sintomas em pacientes com apneia obstrutiva do sono (AOS) grave. Métodos: Foram incluídos indivíduos com um índice de apneia-hipopneia (IAH) > 30 eventos/h que completaram questionários de sono e exercício validados. Comparamos a frequência/pontuação de sintomas entre praticantes e não praticantes de exercícios, ajustados para os fatores de confusão habituais. Resultados: A amostra incluiu 907 não praticantes e 488 praticantes (idade média de 49 ± 14 anos; IAH médio, 53±20 eventos/h; 81% homens). Não praticantes e praticantes diferiram significativamente em termos de obesidade (72% vs. 54%), proporção média de sono em estágio de sono 3 com non-rapid eye movement (9 ± 8% vs. 11 ± 6%) e cansaço (78% vs. 68%). Os não praticantes tiveram uma maior frequência/pontuação de sintomas e uma pior qualidade do sono. O ajuste para exercício enfraqueceu as associações entre sintomas individuais e o IAH, indicando que o exercício tem um efeito atenuante. Nos modelos logísticos binários, o exercício foi associado a uma redução de aproximadamente 30% no escore > 2 no questionário ajustado1 para cansaço; sono de má qualidade, sono não reparador e humor negativo ao despertar. Embora as chances de um escore >10 na Escala de Sonolência de Epworth ter sido menor nos praticantes, essa associação não resistiu ao ajuste para fatores de confusão. Conclusões: O exercício está associado a uma menor frequência/intensidade de sintomas em pacientes com AOS grave. Como até um terço dos pacientes com AOS grave pode se exercitar regularmente e, portanto, ser levemente sintomático, é importante não descartar um diagnóstico de AOS nesses pacientes.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Sleep/physiology , Exercise/physiology , Sleep Apnea, Obstructive/physiopathology , Sleep Apnea, Obstructive/prevention & control , Exercise Therapy/methods , Reference Values , Body Mass Index , Logistic Models , Sex Factors , Cross-Sectional Studies , Surveys and Questionnaires , Retrospective Studies , Risk Factors , Age Factors , Polysomnography/methods , Sleepiness
10.
Braz. j. med. biol. res ; 52(3): e8059, 2019. tab, graf
Article in English | LILACS | ID: biblio-984037

ABSTRACT

Cyclic alternating pattern (CAP) is a neurophysiological pattern that can be visually scored by international criteria. The aim of this study was to verify the feasibility of visual CAP scoring using only one channel of sleep electroencephalogram (EEG) to evaluate the inter-scorer agreement in a variety of recordings, and to compare agreement between visual scoring and automatic scoring systems. Sixteen hours of single-channel European data format recordings from four different sleep laboratories with either C4-A1 or C3-A2 channels and with different sampling frequencies were used in this study. Seven independent scorers applied visual scoring according to international criteria. Two automatic blind scorings were also evaluated. Event-based inter-scorer agreement analysis was performed. The pairwise inter-scorer agreement (PWISA) was between 55.5 and 84.3%. The average PWISA was above 60% for all scorers and the global average was 69.9%. Automatic scoring systems showed similar results to those of visual scoring. The study showed that CAP could be scored using only one EEG channel. Therefore, CAP scoring might also be integrated in sleep scoring features and automatic scoring systems having similar performances to visual sleep scoring systems.


Subject(s)
Humans , Male , Female , Sleep Stages/physiology , Electronic Data Processing , Polysomnography/methods , Electroencephalography/methods , Observer Variation , Reproducibility of Results , Sensitivity and Specificity , Polysomnography/instrumentation , Electroencephalography/instrumentation
11.
Rev. méd. Chile ; 146(10): 1123-1134, dic. 2018. tab
Article in Spanish | LILACS | ID: biblio-978747

ABSTRACT

Background: Simple but accurate tools should be used to identify patients with obstructive sleep apnea syndrome (OSAS), aiming at an early detection and prevention of serious consequences. Aim: To assess the predictive value of four sleep questionnaires (Berlin, Epworth Sleepiness Scale [ESS], STOP, and STOP-Bang) in the screening of patients with OSAS. Material and Methods: The four sleep questionnaires were administered to 1,050 snorers aged 56 ± 15 years (68% males) assessed at a sleep clinic. An overnight unattended respiratory polygraphy was performed to all patients to confirm the diagnosis of OSAS. The sensitivity, specificity, positive and negative predictive values of the four questionnaires were calculated. Results: Eighty four percent of participants had OSAS. The clinical variables associated with OSAS risk were age, male gender, hypertension, overweight, cervical circumference, waist/hip ratio, history of snoring, witnessed apneas and nycturia. Eighty-three, 86, 92 and 46 % of cases were classified as having a high risk for OSAS, according to the Berlin, STOP and STOP-Bang questionnaires and ESS, respectively. STOP and STOP-Bang questionnaires had the highest sensitivity to predict OSAS (88 and 95%, respectively) while the Flemons Index had the highest specificity (82%). Conclusions: Sleep questionnaires were able to identify patients with a high risk for OSAS but without accurately excluding those at low risk.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Surveys and Questionnaires/standards , Sleep Apnea, Obstructive/diagnosis , Reference Values , Snoring/diagnosis , Severity of Illness Index , Prospective Studies , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Polysomnography/methods , Statistics, Nonparametric , Sleep Apnea, Obstructive/etiology
12.
Rev. Soc. Bras. Clín. Méd ; 16(2): 108-112, 20180000. tab, graf
Article in Portuguese | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-913371

ABSTRACT

OBJETIVO: Descrever o perfil de pacientes com e sem apneia obstrutiva do sono. MÉTODOS: Estudo transversal, descritivo, observacional, realizado em centro terciário de cardiologia, por meio da análise de 255 prontuários de pacientes consecutivos submetidos à polissonografia em um laboratório do sono do hospital. Os pacientes foram divididos de acordo com a presença de apneia obstrutiva do sono clinicamente significativa (índice de apneia e hipopneia ≥15 eventos/hora). Dentre as informações analisadas, estavam: características clínicas; dados antropométricos; antecedentes pessoais; medicamentos em uso; doença aterosclerótica; exames laboratoriais e polissonografia. RESULTADO: A prevalência da apneia obstrutiva do sono foi de 35,6%; deste porcentual, 90,1% apresentaram hipertensão arterial sistêmica; 70,3%, dislipidemias; 36,3%, tabagismo; e 35,2%, diabetes. Não houve diferença estatística com relação à maior parte dos parâmetros analisados, mas os pacientes com apneia obstrutiva do sono eram, em sua maioria, do sexo feminino, com idade mais avançada e maior índice de massa corporal, quando comparados aos indivíduos sem apneia obstrutiva do sono. CONCLUSÃO: Foi alta a prevalência de apneia obstrutiva do sono em indivíduos portadores de diversos fatores de risco cardiovasculares. Esta condição deve sempre ser pesquisada em indivíduos de maior risco cardiovascular.(AU)


OBJECTIVE: To describe the profile of patients with and without obstructive sleep apnea. METHODS: This is a cross-sectional, descriptive and observational study that was conducted in a tertiary cardiology center through the analysis of 255 records of consecutive patients who underwent polysomnography in a sleep laboratory of the hospital. Patients were divided according to the presence of clinically significant obstructive sleep apnea (apnea-hypopnea index ≥15 events/ hour). The analyses included: clinical features, anthropometric data, personal background, ongoing medication, atherosclerotic disease, laboratory tests and polysomnography. RESULTS: The prevalence of obstructive sleep apnea was 35.6%; of these, 90.1% had hypertension, 70.3% dyslipidemias, 36.3% were smokers, and 35.2% had diabetes. There was no statistical difference in most of the parameters analyzed; however, patients with obstructive sleep apnea were mostly female, older and with higher BMI when compared to individuals without obstructive sleep apnea. CONCLUSION: The prevalence of obstructive sleep apnea was high in individuals with various cardiovascular risk factors. Therefore, it is a condition that should always be investigated in patients with higher cardiovascular risk.(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Polysomnography/methods , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/epidemiology , Hypertension/complications , Obesity/complications , Risk Factors
13.
Neumol. pediátr. (En línea) ; 13(2): 56-60, mar. 2018. tab
Article in Spanish | LILACS | ID: biblio-915604

ABSTRACT

The sleep physiology associated to high altitude hypobaric hypoxia is different from that observed at sea level. Normal parameters set by the North American and European consensus for interpretation of polysomnography (PSM) do not apply to high altitude (HA) conditions. This article reviews the PSM studies carried out in children at altitudes >2,500 m and provides a comparison with studies undertaken at sea level. The importance of interpreting PSM taking HA normal values into consideration is highlighted.


La fisiología del sueño, en el entorno de la hipoxia hipobárica que caracteriza a la altura, es diferente de la del nivel del mar. Los parámetros de normalidad de la polisomnografía (PSM) de los consensos norteamericano y europeo no son aplicables en la gran altura. Este artículo revisa los estudios publicados sobre PSM en niños en lugares ubicados por encima de los 2.500 metros y los compara con los del nivel del mar. Se insiste en la necesidad de interpretar la PSM de acuerdo a la normalidad de la altura donde se realizó.


Subject(s)
Humans , Child , Sleep/physiology , Polysomnography/methods , Sleep Apnea, Obstructive/physiopathology , Altitude , Oxygen Consumption , Oximetry , Sleep Apnea, Obstructive/diagnosis
14.
J. bras. pneumol ; 44(1): 65-68, Jan.-Feb. 2018. tab
Article in English | LILACS | ID: biblio-893888

ABSTRACT

ABSTRACT Sleep studies conducted at an altitude that is different from the home altitude can yield misleading results regarding the severity of obstructive sleep apnea (OSA). The objective of the present study was to determine the sleep characteristics of a patient undergoing polysomnography (PSG) in three Colombian cities at different altitudes (Bogotá, at 2,640 m above sea level [ASL]; Bucaramanga, at 959 m ASL; and Santa Marta, at 15 m ASL). The patient was an obese man with diabetes and suspected OSA. All PSG recordings were scored and interpreted in accordance with American Academy of Sleep Medicine criteria. In Bogotá, PSG revealed moderate OSA (an apnea-hypopnea index [AHI] of 21 events/h); in Bucaramanga, PSG revealed increased upper airway resistance (an AHI of 2 events/h); in Santa Marta, PSG revealed mild OSA (an AHI of 7 events/h). The reduction in the AHI was predominantly a reduction in hypopneas and obstructive apneas. The respiratory events were shorter in duration in the city at an intermediate altitude. Given that the AHI varied widely across cities, we can assume that the patient is normal or has moderate OSA depending on the city where he is. Central apneas were found to have no influence on the AHI.


RESUMO Estudos do sono realizados a uma altitude diferente da altitude do local onde se vive podem produzir resultados enganosos quanto à gravidade da apneia obstrutiva do sono (AOS). O objetivo do presente estudo foi determinar as características do sono de um paciente submetido a polissonografia (PSG) em três cidades colombianas a diferentes altitudes [Bogotá, a 2.640 m acima do nível do mar (ANM); Bucaramanga, a 959 m ANM e Santa Marta, a 15 m ANM]. O paciente era um homem obeso com diabetes e suspeita de AOS. Os dados obtidos receberam pontuação e foram interpretados de acordo com os critérios da American Academy of Sleep Medicine. Em Bogotá, a PSG revelou AOS moderada [índice de apneias e hipopneias (IAH) = 21 eventos/h]; em Bucaramanga, a PSG revelou aumento da resistência das vias aéreas superiores (IAH = 2 eventos/h); em Santa Marta, a PSG revelou AOS leve (IAH = 7 eventos/h). A redução do IAH foi predominantemente uma redução de hipopneias e apneias obstrutivas. Os eventos respiratórios tiveram menor duração na cidade a uma altitude intermediária. Como houve grande diferença entre as cidades quanto ao IAH, pode-se concluir que o paciente é normal ou apresenta AOS moderada dependendo da cidade onde está. As apneias centrais não influenciaram o IAH.


Subject(s)
Humans , Male , Middle Aged , Sleep/physiology , Sleep Apnea, Obstructive/physiopathology , Altitude , Reference Values , Cities , Polysomnography/methods , Colombia , Sleep Apnea, Central/physiopathology , Diabetes Mellitus/physiopathology
15.
Rev. chil. pediatr ; 88(6): 759-764, dic. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-900048

ABSTRACT

Resumen Introducción: La Saturometría Nocturna Continua (SpChC), es utilizada en Unidades de Neonato logia para detección de eventos de hipoxemia en Recién Nacidos (RN) con episodios de apneas. La Poligrafía (PG) presenta un número mayor de canales de medición. El objetivo fue evaluar el rendi miento diagnóstico de la SpOhC respecto a la Poligrafía en RN con sospecha de apneas. Pacientes y Método: Se analizaron retrospectivamente resultados de SpOhC y PG realizadas en forma simultáneas en RN con sospecha de apneas, en un periodo de tres años. Se utilizó un saturómetro Masimo Radi-cal-7® con 2 canales y un polígrafo Apnea Link Plus® con 5 canales de registro simultáneos. Se con sideró PG alterada: índice de desaturaciones bajo 80% por hora > a 1 y/o número de desaturaciones bajo 80% > 20 segundos mayor a uno en todo el registro validado y/o índice de apnea hipoapnea > a 1 evento por hora. Paralelamente, se definió SpOhC alterada cuando uno o ambos de los criterios de saturometria bajo 80%, estaban alterados. Se calcularon valores de sensibilidad, especificidad, valores predictivos y Likelihood Ratio (LLR) para la SpÜ2C. Los resultados se expresaron en valor absoluto, con 95% de intervalo de confianza. Resultados: Se realizaron 40 SpÜ2C y PG simultáneos; un 80% (32/40) de ellos fueron RN prematuros, 60% (24/40) varones. Un 38% (15/40) de las SpOhC y un 15% (6/40) de las PG resultaron alteradas (p < 0,05). La SpÜ2C presenta una Sensibilidad 100%, Especificidad 74%, El VPP 40%, VPN 100%, LLR + 3,78 y LLR-0. Conclusión: En los RN estudiados, la SpC2C posee un alto valor diagnóstico, sin embargo, puede presentar falsos positivos; por lo cual se sugiere utilizar como método de tamizaje y realizar confirmación diagnóstica con otro examen de sueño, como la PG.


Abstract Introduction: Night Continuous Saturometry (CSO2) is used in Neonatal Units to detect events of hypoxemia in Newborns (NB) with apnea episodes. Polygraphy (PG) has a larger number of measuring channels. Our goal was to evaluate the diagnostic performance of CSO2 compared to Polygra phy in NB with suspected sleep apneas. Patients and Method: Results of CSO2 and PG performed simultaneously in RN with suspected apneas were retrospectively analyzed over a three-year period. A 2-channel Masimo Radical-7® pulse oximeter and an Apnea Link Plus® polygraph with 5 simulta neous recording channels were used. Altered PG was defined as: desaturation index under 80% per hour > 1 and/or number of desaturations under 80% > 20 seconds greater than one in the whole va lidated registry and/or hypoapnea apnea index > 1 event per hour. In parallel, altered SpO2C was de fined when one or both of the 80% saturation criteria were altered. Sensitivity, specificity, predictive values and Likelihood Ratio (LLR) for CSO2 were calculated. Results were expressed in absolute value, with 95% confidence interval. Results: Simultaneous 40 CSO2 and PG were performed; 80% (32/40) of them were preterm infants, 60% (24/40) males. 38% (15/40) of the CSO2 and 15% (6/40) of the PGs were altered (p < 0.05). CSO2 has a 100% Sensitivity, 74% Specificity, 40% VPP, 100% VPN, LLR + 3.78 and LLR-0. Conclusion: In the studied NB, CSO2 has a high diagnostic value, however, it may present false positives; It is suggested to use as a screening method and to perform diagnostic confirmation with another sleep test, such as PG.


Subject(s)
Humans , Male , Female , Infant, Newborn , Sleep Apnea Syndromes/diagnosis , Oximetry , Polysomnography/methods , Retrospective Studies , Sensitivity and Specificity
16.
Rev. bras. neurol ; 53(3): 19-30, jul.-set. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-876873

ABSTRACT

Esta é uma primeira parte (1/2) da abordagem de fundamentos do sono e transtornos do sono (TS) sobre aspectos: neurobiológicos (neuroanatômicos, neuroquímicos e fisiológicos); clínicos (anamnese e exame físico; exames subjetivos - questionários e escalas; exames objetivos - polissonografia, teste de latências múltiplas e actigrafia). É valorizada a terceira Classificação Internacional dos Transtornos do Sono (ICSD-3) para abordar aspectos clínicos, diagnósticos e terapêuticos, segundo as quatro queixas principais referentes dos TS: Insônia, Sonolência excessiva diurna, Movimentos e comportamentos anormais durante o sono e Incapacidade de dormir na hora desejada. Neste artigo abordamos apenas: 1-Insônia - dificuldade em adormecer ou manter-ser dormindo, acordar cedo, ou um distúrbio na qualidade do sono que faz com que o sono pareça inadequado ou não restaurador; duração: aguda ou crônica; 2- Sonolência excessiva diurna; consequente a distúrbios do sono, privação do sono; distúrbios centrais da hipersonia; distúrbios médicos ou psiquiátricos. (AU)


This is the first part (1/2) on this paper about sleep fundamentals and sleep disorders (TS) questions: neurobiological (neuroanatomical, neurochemical and physiological); clinical (anamnesis and physical examination; subjective exams - questionnaires and scales; objective examinations - polysomnography, multiple latency tests and actigraphy). The third International Classification of Sleep Disorders (ICSD-3) is valued to address clinical, diagnostic and therapeutic aspects, according to the four main complaints regarding TS: Insomnia, Excessive daytime drowsiness, Abnormal movements and behaviors during sleep, and Inability to sleep at the desired time. In this paper, it is discussed the only first two: 1-Insomnia: difficulty falling as-leep, staying asleep, early morning waking, non- restorative sleep, quality of sleep, and amount of sleep; duration: acute or chronic. (AU)


Subject(s)
Humans , Sleep Wake Disorders/classification , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/drug therapy , Polysomnography/methods , Sleep Disorders, Circadian Rhythm/diagnosis , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/drug therapy
18.
Braz. j. otorhinolaryngol. (Impr.) ; 83(4): 445-450, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-889271

ABSTRACT

Abstract Introduction: Knowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with Obstructive Sleep Apnea Syndrome (OSAS). To this end, several diagnostic tests and procedures have been developed. Objective: To determine whether drug-induced sleep endoscopy (DISE) or Müller's maneuver (MM) would be more successful at identifying the site of obstruction and the pattern of upper airway collapse in patients with OSAS. Methods: The study included 63 patients (52 male and 11 female) who were diagnosed with OSAS at our clinic. Ages ranged from 30 to 66 years old and the average age was 48.5 years. All patients underwent DISE and MM and the results of these examinations were characterized according to the region/degree of obstruction as well as the VOTE classification. The results of each test were analyzed per upper airway level and compared using statistical analysis (Cohen's kappa statistic test). Results: There was statistically significant concordance between the results from DISE and MM for procedures involving the anteroposterior (73%), lateral (92.1%), and concentric (74.6%) configuration of the velum. Results from the lateral part of the oropharynx were also in concordance between the tests (58.7%). Results from the lateral configuration of the epiglottis were in concordance between the tests (87.3%). There was no statistically significant concordance between the two examinations for procedures involving the anteroposterior of the tongue (23.8%) and epiglottis (42.9%). Conclusion: We suggest that DISE has several advantages including safety, ease of use, and reliability, which outweigh MM in terms of the ability to diagnose sites of obstruction and the pattern of upper airway collapse. Also, MM can provide some knowledge of the pattern of pharyngeal collapse. Furthermore, we also recommend using the VOTE classification in combination with DISE.


Resumo Introdução: O conhecimento do local da obstrução e do padrão de colapso das vias respiratórias é essencial para determinar o tratamento cirúrgico e clínico corretos de pacientes com Síndrome de Apneia Obstrutiva do Sono (SAOS). Para este fim, vários testes e procedimentos de diagnóstico foram desenvolvidos. Objetivo: Determinar se a Endoscopia de Sono Induzido por Fármacos (DISE) ou Manobra de Müller (MM) seria mais bem-sucedida na identificação do local de obstrução e do padrão de colapso das vias respiratórias superiores em pacientes com SAOS. Método: O estudo incluiu 63 pacientes (52 do sexo masculino e 11 do sexo feminino) que foram diagnosticados com SAOS em nossa clínica. As idades variaram de 30 a 66 anos e a idade média foi de 48,5 anos. Todos os pacientes foram submetidos a DISE e MM e os resultados destes exames foram caracterizados de acordo com a região/grau de obstrução, bem como a classificação VOTE. Os resultados de cada teste foram analisados de acordo com o nível das vias respiratórias superiores e comparados por análise estatística (teste estatístico kappa de Cohen). Resultados: Houve concordância estatisticamente significativa entre os resultados da DISE e MM para os procedimentos que envolvem configuração anteroposterior (73%), lateral (92,1%) e concêntrica (74,6%) do véu palatino. Os resultados da parte lateral da orofaringe também estavam em concordância entre os testes (58,7%). Os resultados da configuração lateral da epiglote estavam em concordância entre os testes (87,3%). Não houve concordância estatisticamente significativa entre os dois exames para os procedimentos que envolvem a parte anteroposterior da língua (23,8%) e epiglote (42,9%). Conclusão: Sugere-se que a DISE apresenta várias vantagens, como segurança, facilidade de uso e confiabilidade, que superam a MM em termos da capacidade de diagnosticar locais de obstrução e o padrão de colapso da via respiratória superior. O MM pode também fornecer algum conhecimento sobre o padrão de colapso da faringe. Além disso, recomendamos o uso da classificação VOTE em combinação com DISE.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Polysomnography/methods , Sleep Apnea, Obstructive/diagnosis , Endoscopy/methods , Severity of Illness Index , Retrospective Studies , Sensitivity and Specificity , Anesthetics, Intravenous/administration & dosage
19.
Arq. bras. cardiol ; 108(4): 361-369, Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-838726

ABSTRACT

Abstract Obstructive sleep apnea (OSA) has been associated to cardiovascular risk factors. However, the association between OSA and cardiovascular disease is still controversial. The objective of the present study was to verify the association between OSA and myocardial infarction (MI). This is a systematic review of the literature performed through electronic data sources MEDLINE/PubMed, PubMed Central, Web of Science and BVS -Biblioteca Virtual em Saúde (Virtual Health Library). The descriptors used were: 'obstructive sleep apnea' AND 'polysomnography' AND 'myocardial infarction' AND 'adults NOT 'treatment.' The present work analysed three prospective studies, selected from 142 articles. The studies followed a total sample of 5,067 OSA patients, mostly composed by male participants. All patients underwent night polysomnography, and all studies found an association between OSA and fatal and non-fatal cardiovascular outcomes. Thus, we were able to observe that 644 (12.7%) of the 5,067 patients suffered MI or stroke, or required a revascularization procedure, and 25.6% of these cardiovascular events were fatal. MI was responsible for 29.5% of all 644 analysed outcomes. There is an association between OSA and MI, in male patients, and apnea and hypopnea index (AHI) are the most reliable markers.


Resumo A apneia obstrutiva do sono (AOS) tem sido associada a fatores de risco cardiovascular, porém a relação entre a AOS e doença cardiovascular ainda é controversa. O objetivo do presente estudo foi verificar a associação entre AOS e infarto do miocárdio (IM). Revisão sistemática de literatura por meio das fontes de dados eletrônicas MEDLINE/PubMed, PubMed Central, Web of Science e Biblioteca Virtual em Saúde (BVS). Os descritores utilizados foram: "obstructive sleep apnea" AND "polysomnography" AND "myocardial infarction" AND "adults" NOT "treatment".O presente trabalho analisou três estudos prospectivos, selecionados dentre 142 artigos encontrados. Os estudos acompanharam uma amostra total de 5.067 pacientes diagnosticados com AOS, composta majoritariamente por participantes do sexo masculino. Todos os pacientes realizaram polissonografia noturna, e todas as pesquisas encontraram associação entre AOS e desfechos cardiovasculares fatais e não fatais. Assim, foi possível observar que 644 (12,7%) dos 5.067 pacientes sofreram IM ou acidente vascular cerebral, ou precisaram de procedimento de revascularização, sendo que 25,6% desses eventos cardiovasculares foram fatais. O IM foi responsável por 29,5% do total de 644 desfechos analisados. Existe associação entre AOS e IM, no sexo masculino, sendo o índice de apneia e hipopneia (IAH) um dos marcadores mais fidedignos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Sleep Apnea, Obstructive/complications , Myocardial Infarction/etiology , Sex Factors , Risk Factors , Polysomnography/methods , Sleep Apnea, Obstructive/diagnosis , Hypertension/complications , Myocardial Infarction/mortality
20.
Rev. chil. pediatr ; 88(2): 230-235, abr. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-844604

ABSTRACT

La apnea y eventos aparentemente letales poseen una gran diversidad etiológica por tanto exámenes complementarios podrían contribuir a su diagnóstico. El objetivo del presente estudio fue describir los resultados de estudios poligráficos de niños menores de 3 meses hospitalizados con sospecha de apnea. PACIENTES Y MÉTODO: Serie retrospectiva de casos. Se consideraron niños menores de 3 meses con sospecha de apnea y en quienes se realizó una poligrafía (PG) durante su hospitalización. Se registraron datos generales, así como también, el índice de apnea/hipopnea (IAH), índice de apnea central, índice de apnea obstructiva, saturación promedio y mínima. Como criterios de trastornos respiratorios del sueño (TRS) fueron considerados: índice de desaturaciones (ID) por debajo de 80% mayor 1 por hora; uno o más eventos de desaturaciones por debajo de 80% por más de 20 segundos; o un IAH mayor o igual 1. Se realizó estadística descriptiva y se determinó la posible asociación entre el IAH y parámetros de saturación. RESULTADOS: Ingresaron 51 pacientes, 32 varones. 8 (15,6%) presento PG alteradas, de ellos, en 5 coexistió más de un criterio diagnóstico. En el 15,6% se observó un IAH mayor o igual a 1, en el 7,8% se observó un índice de desaturación bajo 80% y en el 11,8% un índice de desaturación bajo 80% por más de 20 segundos. El IAH se asoció con los parámetros de saturación. CONCLUSIÓN: La mayoría de los pacientes presentó PG normales y entre los pacientes con TRS predominó un patrón poligráfico sugerente de inmadurez respiratoria, lo cual, es característico de esta edad.


Apnea and apparently lethal events have great etiological diversity thus complementary tests may help diagnosis. The aim of this study was to describe the results of polygraph studies of children under 3 months hospitalized with suspected apnea. PATIENTS AND METHODS: Retrospective case series. Children under 3 months with suspected apnea were considered and in whom a polygraphy (PG) was performed during hospitalization. General data, the apnea/hypopnea index (AHI), index of central. apnea, obstructive apnea index, average and minimum saturation were recorded. Desaturation index (ID) below 80% higher 1 per hour, one or more events of desaturation below 80% for more than 20 seconds or an AHI greater than or equal 1 were considered as criteria of sleep disorder breathing (SLB). Descriptive analysis was performed and the associations between AHI and saturation parameters were determined. RESULTS: 51 patients, 32 males, entered the study. 15,6% had altered PG. In 5 of them coexisted more than one diagnostic criterion. Iin 15,6% of the patients was observed an IAH greater 1, in 7.8% a desaturation index below 80% and in 11,8% a desaturation index under 80% for 20 seconds greater than 1. The AHI was associated with the parameters of saturation. CONCLUSION: Most of the patients had normal PG and among patients with a suggestive SLB a pattern of respiratory immaturity prevailed, which is characteristic of this age.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Sleep Apnea Syndromes/diagnosis , Polysomnography/methods , Hospitalization , Child, Hospitalized , Retrospective Studies
SELECTION OF CITATIONS
SEARCH DETAIL