Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.134
Filtrar
1.
Rev. esp. patol ; 53(3): 182-187, jul.-sept. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-192407

RESUMO

We describe the implementation of a COVID-19 Autopsy Programme in our Hospital, report the main findings from the first autopsy of the programme and briefly review the reports of lung pathology of these patients


En este artículo presentamos el proceso de implementación de un Programa de Autopsias COVID-19 en nuestro hospital, presentamos los principales hallagos de la primera autopsia realizada y revisamos brevemente la patología pulmonar publicada previamente en estos pacientes


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Autopsia/estatística & dados numéricos , Causas de Morte , Infecções por Coronavirus/patologia , Alvéolos Pulmonares/patologia , Síndrome Respiratória Aguda Grave/complicações , Vírus da SARS/isolamento & purificação , Apneia Obstrutiva do Sono/complicações , Hipertensão/complicações , Reação em Cadeia da Polimerase/métodos , Esteroides/uso terapêutico , Pandemias , Técnicas Histológicas/métodos , Espanha/epidemiologia
2.
PLoS One ; 15(8): e0237359, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790789

RESUMO

BACKGROUND: Patients diagnosed with obstructive sleep apnea (OSA), who also consume prescription opioids, have a greater likelihood of morbidity and mortality. This study evaluated whether a primary care team, focused on chronic pain care management, could use a validated questionnaire (STOP-Bang) and motivational follow-up, to increase identification and treatment of OSA. METHODS: This study was a retrospective, dual arm, pre/post controlled study. Participants of this study included the complete chronic pain management sub group treated by this primary care team. Participants were ≥ 18 years old and prescribed daily opioids for treatment of chronic pain. All participants had a multifaceted, individualized, educational meeting that included completing a STOP-Bang questionnaire. Participants who received a score ≥ three were advised to follow up with their primary care physician. Participants were seen quarterly throughout the study. RESULTS: The primary outcome of this study was that 65% of participants with likely OSA were using CPAP for a minimum of 12 months (range of 12-25 months, 18-month average) post-intervention vs. 37% CPAP-use in the control group (12 months of observation), both groups were chronic opioid users with OSA. This was a 28% relative improvement (p = 0.0034). A secondary outcome was that 8.9% of non-prior CPAP users obtained CPAP post- intervention; a 56.7% pre-post improvement (p = 0.0064, x2 = 10.08 with 1 degree of freedom). Also, participants who were likely to have OSA (STOP-Bang score ≥ 3 or had a positive polysomnography (AHI >5 with comorbidities)) compared to those unlikely to have OSA (STOP-Bang score <3 or had a negative polysomnography (AHI <5)) in this study were more likely to be male, have a higher BMI, have hypertension, have cardiovascular disease and/or have diabetes (all types). CONCLUSION: Team based care management for participants taking prescription opioids, where STOP-Bang questionnaires were completed, were associated with an increase in the identification and treatment of OSA.


Assuntos
Manejo da Dor/métodos , Dor/patologia , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Índice de Massa Corporal , Doença Crônica , Feminino , Humanos , Hipertensão/patologia , Masculino , Pessoa de Meia-Idade , Dor/complicações , Dor/tratamento farmacológico , Polissonografia , Atenção Primária à Saúde , Estudos Retrospectivos , Fatores Sexuais , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Inquéritos e Questionários
3.
PLoS One ; 15(8): e0236667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756570

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is associated with cardiovascular co-morbidities and mortality. Arterial stiffness is an independent predictor of cardiovascular risk and mortality, and is influenced by the presence of OSA and related comorbidities. There is a paucity of data regarding long-term evolution of arterial stiffness in CPAP-treated OSA patients. We aimed to prospectively study long term PWV variations and determinants of PWV deterioration. METHODS: In a prospective obese OSA cohort, at time of diagnosis and after several years of follow-up we collected arterial stiffness measured by carotid-femoral pulse wave velocity (PWV), clinical and metabolic parameters, and CPAP adherence. Univariate and multivariate analyses were performed in order to determine contributing factors. RESULTS: Seventy two OSA patients (men: 52.8%, median age: 55.8 years and median BMI of 38.5 kg/m2) with a prevalence of hypertension: 58.3%, type 2 diabetes: 20.8%, hypercholesterolemia: 33.3%, current or past smoking: 59.7%, were evaluated after a median follow-up of 7.4 [5.8; 8.3] years. Over the period of follow-up, the median increase in PWV was 1.34 [0.10; 2.37] m/s. In multivariate analysis, the increase in PWV was associated with older age (10 extra years was associated with a 5.24 [1.35; 9.12] % increase in PWV) and hypertension (a significant increase in PWV of 8.24 [1.02; 15.57] %). No impact of CPAP adherence on PWV evolution was found. CONCLUSION: PWV progression in CPAP-treated OSA patients is mainly related to pre-existing cardio-metabolic comorbidities and not influenced by CPAP adherence. In this high cardiovascular risk population, it is crucial to associated weight management and exercise with CPAP treatment.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Obesidade/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Rigidez Vascular/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Pressão Positiva Contínua nas Vias Aéreas/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Polissonografia , Fatores de Risco , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/fisiopatologia
5.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(7): 553-556, 2020 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-32629553

RESUMO

Objective: To investigate the awareness of snoring hazard and prevalence of obstructive sleep apnea (OSA) among civil servants. Methods: A cross-sectional survey was conducted to investigate the awareness of snoring hazards among in-service civil servants who had annual medical examination in a Guangdong provincial institution from September to November 2017. The high-risk group for OSA was screened and diagnosed by sleep monitoring. Results: 1 036 of 1 241 civil servants were enrolled in the study for integral data. 60.1% (623/1 036) of the subjects realized that snoring was harmful to health. The most common source to develop OSA awareness was network (59.6%, 371/623), followed by television (48.0%), relatives and friends (46.6%), newspaper (44.5%) and radio (18.9%). The awareness rate of snoring consequences was as follows: decreased sleep quality (71.9%, 448/623), sudden death (52.2%), daytime sleepiness (44.3%), cardiovascular and cerebrovascular diseases (42.9%), hypertension (24.4%) and sexual dysfunction (16.7%). 22.0% (228 / 1 036) of the cases were classified into high-risk OSA. The prevalence of OSA among high-risk group was 46.05%(105/228)and only 0.9% (2/228) of them had been diagnosed with OSA. Conclusion: Civil servants had awareness of snoring hazard to a certain extent. Among civil servants classified into high-risk OSA, the OSA perveance was high but the rate of diagnosis and treatment was very low.


Assuntos
Apneia Obstrutiva do Sono/epidemiologia , Ronco/epidemiologia , China/epidemiologia , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Prevalência , Fatores de Risco , Apneia Obstrutiva do Sono/complicações , Ronco/etiologia
10.
Health Qual Life Outcomes ; 18(1): 128, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32381095

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness (EDS), which may go undiagnosed and can significantly impair a patient's health-related quality of life (HRQOL). This qualitative research examined timing and reasons patients sought medical care for their EDS and OSA symptoms, and the impact of EDS on HRQOL. METHODS: Focus groups were conducted in 3 US cities with 42 participants currently experiencing EDS with OSA. Transcripts were coded and analyzed using an adapted grounded theory approach common to qualitative research. RESULTS: Over three-fifths of study participants (n = 26, 62%) were currently using a positive airway pressure (PAP) or dental device; one-third (n = 14, 33%) had previously used a positive airway pressure (PAP) or dental device, and the remainder had either used another treatment (n = 1, 2%) or were treatment naïve (n = 1, 2%). Twenty-two participants (52%) reported experiencing OSA symptoms for ≥1 year, with an average duration of 11.4 (median 8.0, range 1-37) years before seeking medical attention. Several (n = 7, 32%) considered their symptoms to be "normal," rather than signaling a serious medical condition. Thirty participants (71%) discussed their reasons for ultimately seeking medical attention, which included: input from spouse/partner, another family member, or friend (n = 20, 67%); their own concern about particular symptoms (n = 7, 23%); and/or falling asleep while driving (n = 5, 17%). For all 42 participants, HRQOL domains impacted by EDS included: physical health and functioning (n = 40, 95%); work productivity (n = 38, 90%); daily life functioning (n = 39, 93%); cognition (n = 38, 90%); social life/relationships (n = 37, 88%); and emotions (n = 30, 71%). CONCLUSIONS: Findings suggest that patients may be unaware that their symptoms could indicate OSA requiring evaluation and treatment. Even following diagnosis, EDS associated with OSA can continue to substantially affect HRQOL and daily functioning. Further research is needed to address diagnostic delays and unmet treatment needs for patients with EDS associated with OSA.


Assuntos
Qualidade de Vida , Apneia Obstrutiva do Sono/complicações , Sonolência , Atividades Cotidianas , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Apneia Obstrutiva do Sono/psicologia
11.
PLoS One ; 15(5): e0232596, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384092

RESUMO

STUDY OBJECTIVES: To determine the prevalence of obstructive sleep apnea (OSA) in adults with Down syndrome (DS), to investigate factors related to OSA severity and to identify which sleep questionnaire is the most appropriate for the screening of OSA in this population. METHODS: Cross-sectional study that consecutively included 60 adults with DS. All patients underwent type III polysomnography and clinical and laboratory data were collected; sleep assessment questionnaires were applied. Multiple linear regression models evaluated the associations between OSA severity (measured by the respiratory event index-REI) and clinical and laboratory data and sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, BERLIN and STOP-Bang questionnaires). RESULTS: Results show that 60 (100%) adults with DS had OSA, with moderate-severe OSA identified in 49 (81.6%). At the multivariate linear regression, REI significantly correlated with hematocrit levels, BMI and STOP-Bang questionnaire (SBQ) results (P <0.001). The positive STOP-Bang ≥3 points) showed 100% of sensitivity (95%CI: 92.75-100%), 45.45% of specificity (95%CI: 16.75-76.62), positive predictive value of 89.09% (95%CI: 82.64-93.34%), negative predictive value of 100%, accuracy of 90% (95%CI: 79.49-96.24%) and OR of 24.29. CONCLUSIONS: Adults with DS have a very high prevalence of OSA. Hematocrit levels, BMI and SBQ showed a strong correlation with OSA severity. The SBQ performed well in identifying moderate to severe OSA in this population. Considered together, these results point to the need to perform OSA screening in all adults with DS, and STOP-Bang may play a role in this screening.


Assuntos
Síndrome de Down/complicações , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Polissonografia , Apneia Obstrutiva do Sono/complicações , Inquéritos e Questionários , Adulto Jovem
13.
Am J Cardiol ; 125(10): 1571-1576, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32245633

RESUMO

This study was undertaken to investigate whether obstructive sleep apnea (OSA) produces a survival advantage in acute coronary syndrome (ACS), and to evaluate the mechanism of any benefit, including the impact of age and other risk factors. The National Inpatient Sample was queried for all patients who were admitted for ACS during the years 2013 to 2014. The primary outcomes were all-cause in-hospital mortality and cardiogenic shock (CS). Multivariable logistic regression was used for analysis. A total of 1,080,340 patients with ACS were included, 63,255 patients had OSA. The majority of patients were males (60.3%) and of Caucasian race (75%). The mean age was 67 years (SEM: 0.1). Despite a higher burden of risk factors and older age, OSA patients had a lower risk for mortality and cardiogenic shock adjusted OR 0.68 (95%CI 0.61-0.75), p <0.001 and 0.81 (95%CI: 0.74 to 0.89), p <0.001 respectively. Age was an important effect modifier. Survival advantage and lower risk for CS arises at the age above 55 and become more apparent with increasing age. In conclusion, despite a higher CV risk profile, and older age, OSA produces a survival benefit in ACS. Age is a significant modifier of risk in OSA patients with ACS. Ischemic preconditioning might explain these results.


Assuntos
Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/mortalidade , Mortalidade Hospitalar , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/mortalidade , Fatores Etários , Idoso , Feminino , Humanos , Precondicionamento Isquêmico , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico/mortalidade , Taxa de Sobrevida , Estados Unidos
14.
Am J Cardiol ; 125(10): 1529-1535, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32245637

RESUMO

Although several risk calculators are available to determine risk for readmission following a heart failure (HF) hospitalization, none provide information on cause-specific readmission. Understanding risk for cause-specific readmission could aid in developing a targeted approach to reducing readmissions. We sought to determine if a simple cardiac co-morbidity count could identify individuals at high risk for a cardiovascular (CV) readmission following a HF hospitalization. Using the Nationwide Readmissions Database, we examined nonfatal hospital discharges with a principal diagnosis of HF. We calculated a 0 to 3 cardiac co-morbidity count based on the presence of coronary artery disease, atrial arrhythmia, and/or ventricular arrhythmia. We used a multinomial logistic regression to determine if the cardiac co-morbidity count was independently associated with CV readmission or non-CV readmission, adjusting for patient- and hospital-level confounders. In 380,075 discharges, 28% had a co-morbidity count of 0, 47% had a count of 1, 23% had a count of 2, and 2% had a count of 3. In a fully adjusted model, cardiac co-morbidity count was independently associated with CV readmission: compared with individuals with a count of 0, the relative risk for those with a count of 1 was 1.27 (95% confidence interval [CI]: 1.23 to 1.31); for those with a count of 2 was 1.40 (95% CI: 1.35 to 1.46); and for those with a count of 3 was 1.36 (95% CI: 1.23 to 1.51). Cardiac co-morbidity count was not independently associated with non-CV readmission. In conclusion, we found that a simple cardiac co-morbidity count was independently associated with increased risk of CV but not non-CV readmission.


Assuntos
Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar , Readmissão do Paciente/estatística & dados numéricos , Choque Cardiogênico/complicações , Choque Cardiogênico/mortalidade , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/mortalidade , Fatores Etários , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taxa de Sobrevida , Estados Unidos
15.
Arch Cardiovasc Dis ; 113(5): 350-358, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32224049

RESUMO

Obstructive sleep apnoea syndrome is a growing health concern, affecting nearly one billion people worldwide; it is an independent cardiovascular risk factor, associated with incident obesity, insulin resistance, hypertension, arrhythmias, stroke, coronary artery disease and heart failure. Obstructive sleep apnoea-related cardiovascular and metabolic co-morbidities are a major concern for prognosis and the complexity of obstructive sleep apnoea integrated care. Continuous positive airway pressure, the first-line therapy for the treatment of obstructive sleep apnoea, is highly effective at improving symptoms and quality of life, but has limited effect on co-morbidities. Deciphering the molecular pathways involved in obstructive sleep apnoea metabolic and cardiovascular consequences is a priority to make new pharmacological targets available, in combination with or as an alternative to continuous positive airway pressure. Intermittent hypoxia, a landmark feature of obstructive sleep apnoea, is the key intermediary mechanism underlying metabolic and cardiovascular complications. Experimental settings allowing intermittent hypoxia exposure in cells, rodents and healthy humans have been established to dissect the molecular mechanisms of obstructive sleep apnoea-related co-morbidities. The main objective of this review is to recapitulate the molecular pathways, cells and tissue interactions contributing to the cardiometabolic consequences of intermittent hypoxia. Sympathetic activation, low-grade inflammation, oxidative stress and endoplasmic reticulum stress are triggered by intermittent hypoxia and play a role in cardiometabolic dysfunction. The key role of hypoxia-inducible factor-1 transcription factor will be detailed, as well as the underestimated and less described importance of mitochondrial functional changes in the intermittent hypoxia setting.


Assuntos
Doenças Cardiovasculares/etiologia , Sistema Cardiovascular/fisiopatologia , Hemodinâmica , Hipóxia/etiologia , Apneia Obstrutiva do Sono/complicações , Remodelação Vascular , Animais , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/metabolismo , Hipóxia Celular , Estresse do Retículo Endoplasmático , Humanos , Hipóxia/metabolismo , Hipóxia/fisiopatologia , Fator 1 Induzível por Hipóxia/metabolismo , Estresse Oxidativo , Fatores de Risco , Transdução de Sinais , Apneia Obstrutiva do Sono/metabolismo , Apneia Obstrutiva do Sono/fisiopatologia
16.
J Laryngol Otol ; 134(4): 354-361, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32284084

RESUMO

OBJECTIVE: To evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea. METHODS: A total of 124 male patients diagnosed with obstructive sleep apnoea by overnight polysomnography, who underwent upper airway computed tomography, were enrolled. The linear dimensions, cross-sectional area and volume of the upper airway region and the surrounding bony frame were measured. The association between ageing and upper airway morphology was analysed. RESULTS: Soft palate length, minimum cross-sectional area of the retroglossal region, lateral dimensions at the minimum cross-sectional area of the retropalatal and retroglossal regions, nasopharyngeal volume, and average cross-sectional area of the nasopharyngeal region were found to significantly increase with ageing in all patients, while the upper airway shape flattened with ageing. The volume of the retropalatal region increased with ageing among the patients with a body mass index of less than 24 kg/m2. The volume of parapharyngeal fat pad increased with ageing among patients with a body mass index greater than 28 kg/m2. CONCLUSION: A number of dimensional, cross-sectional and volumetric parameters of the pharynx increased with age, indicating that non-anatomical factors may play a more important role in the pathogenesis of obstructive sleep apnoea in aged patients.


Assuntos
Remodelação das Vias Aéreas/fisiologia , Nasofaringe/patologia , Palato Mole/patologia , Faringe/patologia , Apneia Obstrutiva do Sono/fisiopatologia , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , China/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nasofaringe/anatomia & histologia , Nasofaringe/diagnóstico por imagem , Palato Mole/anatomia & histologia , Palato Mole/diagnóstico por imagem , Faringe/anatomia & histologia , Faringe/diagnóstico por imagem , Polissonografia/métodos , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
18.
Ann. intern. med ; 172(5): [325-336], Mar. 3, 2020.
Artigo em Inglês | BIGG | ID: biblio-1117220

RESUMO

Description: In September 2019, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a new joint clinical practice guideline for assessing and managing patients with chronic insomnia disorder and obstructive sleep apnea (OSA). This guideline is intended to give health care teams a framework by which to screen, evaluate, treat, and manage the individual needs and preferences of VA and DoD patients with either of these conditions. In October 2017, the VA/DoD Evidence-Based Practice Work Group initiated a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched and evaluated the literature, created three 1-page algorithms, and advanced 41 recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. This synopsis summarizes the key recommendations of the guideline in 3 areas: diagnosis and assessment of OSA and chronic insomnia disorder, treatment and management of OSA, and treatment and management of chronic insomnia disorder. Three clinical practice algorithms are also included.


Assuntos
Humanos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/prevenção & controle , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/diagnóstico
19.
Rev. patol. respir ; 23(1): 34-36, ene.-mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-191891

RESUMO

La hipertensión pulmonar (HP) puede presentarse en muchas enfermedades respiratorias como la enfermedad pulmonar obstructiva crónica (EPOC) y las enfermedades intersticiales. Existen otras patologías que pueden contribuir a su desarrollo como son los trastornos respiratorios del sueño. Presentamos el caso de un paciente varón de 39 años diagnosticado de EPOC y síndrome de apnea hipopnea del sueño (SAHS), síndrome overlap, con hipertensión pulmonar. Tras iniciar tratamiento con CPAP presenta resolución casi completa de las alteraciones ecocardiográficas, y una PAPm registrada mediante cateterismo cardíaco derecho dentro de los límites de la normalidad


Pulmonary arterial hypertension (PAH) can occur in many respiratory diseases such as COPD and interstitial diseases. There are other pathologies that can contribute to each development such as respiratory sleep disorders. We report a case of a 39-year-old man diagnosed with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea síndrome (OSAS), overlap syndrome, with pulmonary hypertension. After beginning CPAP treatment presented almost complete resolution of echocardiographic abnormalities and a PAPm within normal limits, measured by right heart catheterization


Assuntos
Humanos , Masculino , Adulto , Doença Pulmonar Obstrutiva Crônica/complicações , Apneia Obstrutiva do Sono/complicações , Hipertensão Pulmonar , Pressão Positiva Contínua nas Vias Aéreas , Doença Pulmonar Obstrutiva Crônica/terapia , Apneia Obstrutiva do Sono/terapia
20.
Medicine (Baltimore) ; 99(12): e18949, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195926

RESUMO

INTRODUCTION: Dreaminess is one of the common symptoms of sleep disorders and often leads to complaint of poor sleep quality and morning fatigue. Literatures on the relationship between obstructive sleep apnea (OSA) and dreams have been reported with contradictory results. In this case report, we identified a moderate OSA related dreaminess that was successfully treated by continuous positive airway pressure (CPAP). PATIENT CONCERNS: We present a case of a 47-year-old woman who was bothered by all-night dreaminess for over 20 years. DIAGNOSIS: An overnight polysomnography (PSG) examination showed the apnea-hypopnea index (AHI) was 21.7 events/hour and the rapid eye movement (REM)-AHI was 46.3 events/hour. The patient was diagnosed with moderate OSA. INTERVENTIONS: The patient received auto CPAP therapy. OUTCOMES: The symptoms of dreaminess and daytime functioning significantly improved after CPAP treatment. During the 4-month follow up, 3 CPAP titrations showed that OSA events and OSA related REM interruption almost disappeared. On the night of PSG diagnosis, only 1 non-rapid eye movement sleep 3 (N3) episode occurred before the first REM episode. Nevertheless, N3 episodes were observed before the majority of REM episodes on all three nights of CPAP titration. CONCLUSION: This case suggests that specific REM related OSA could be the main reason for dreaminess symptoms and could be successfully treated by CPAP. The identification of OSA, especially for mild-moderate OSA, has not received enough attention in the management of complaints of dissatisfactory sleep issues. We believe this case has educational value in clinical practice.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Sonhos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Polissonografia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA