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1.
Sleep Med Clin ; 15(3S): e1-e7, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33008491

RESUMO

Prior to the COVID-19 pandemic, few pediatric sleep medicine clinicians routinely engaged in telemedicine visits because thorough examinations were difficult to perform; there was lack of consistent reimbursement; and many clinicians were busy with their in-office practices. This article reviews how telemedicine has been explored in pediatric sleep medicine prior to the pandemic, current applications of telemedicine, challenges, and reimagining pediatric sleep within the realm of telemedicine.


Assuntos
Pediatria , Medicina do Sono , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/terapia , Telemedicina/métodos , Betacoronavirus , Criança , Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus , Humanos , Otolaringologia , Pandemias , Pneumonia Viral , Polissonografia , Encaminhamento e Consulta , Síndrome das Pernas Inquietas/diagnóstico , Síndrome das Pernas Inquietas/terapia , Sono , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/terapia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia
2.
Rev Med Suisse ; 16(709): 1865-1869, 2020 Oct 07.
Artigo em Francês | MEDLINE | ID: mdl-33026729

RESUMO

Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder affecting up to 49 % and 23 % of middle to older aged men and women respectively. CPAP (continuous positive airway pressure) is the gold-standard treatment for severe apneas. In mild and moderate forms of OSAS, mandibular advancement devices (MAD) are equally a first line of treatment. Both CPAP and MAD have their advantages and side effects. Patient tolerance to these two therapies varies according to different patient-parameters. In order to guide physicians and patients in choosing between these two treatments, we present a description of both treatment modalities.


Assuntos
Tomada de Decisão Clínica , Pressão Positiva Contínua nas Vias Aéreas , Avanço Mandibular , Apneia Obstrutiva do Sono/terapia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Humanos , Avanço Mandibular/efeitos adversos , Placas Oclusais/efeitos adversos
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2792-2795, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018586

RESUMO

Plant gain quantifies the extent and rapidity with which arterial blood gases change following hypopneic or hyperpneic events. High plant gain, acting in concert with a highly collapsible upper airway and low arousal threshold, may contribute significantly towards increasing the severity of obstructive sleep apnea (OSA), even when controller gain is low. Elevated plant gain may be a manifestation of abnormal gas exchange resulting from ventilation-perfusion mismatch in the lungs. Using a mathematical model, we explore in this paper how ventilation-perfusion mismatch can affect plant gain, as well as the severity of OSA.


Assuntos
Apneia Obstrutiva do Sono , Nível de Alerta , Humanos , Pulmão , Perfusão , Respiração , Apneia Obstrutiva do Sono/terapia
4.
Praxis (Bern 1994) ; 109(12): 967-972, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32933391

RESUMO

Are There Recommended Alternatives to Positive Airway Pressure Therapy in the Treatment of Sleep Apnea? Abstract. For decades, positive airway pressure (PAP) ventilation has been considered the gold standard in the therapy of obstructive sleep apnea (OSA). Although this is a very successful procedure with regard to the elimination of apnea, the long-term adherence of patients to PAP is only 60-80 % for various reasons. In the meantime, there are numerous options such as intraoral devices, spine sleep position avoidance or newer surgical procedures which are advertised as an alternative to PAP in the therapy of OSA. This raises questions about the significance and effectiveness. This article is intended to provide an up-to-date overview of the significance and possibilities of the therapy alternatives.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Humanos , Modalidades de Fisioterapia , Apneia Obstrutiva do Sono/terapia
5.
HNO ; 68(10): 791-800, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32897392

RESUMO

In Germany about one third of adults aged between 30 and 69 years suffer from obstructive sleep apnea (OSA). Snoring, inspiratory flow limitations, hypopneas, and apneas occur, leading to disturbed sleep, reduced daytime performance, and increased cardiovascular morbidity and mortality. Positive airway pressure therapy (PAP therapy) can be successfully administered in every OSA severity. However, other conservative treatments have to be considered for some patients, particularly in PAP failure or intolerance. The individual treatment concept is based on poly(somno)graphic, morphological, and functional assessment, taking treatment acceptance, adherence, and compliance into account.


Assuntos
Tratamento Conservador , Apneia Obstrutiva do Sono , Adulto , Idoso , Pressão Positiva Contínua nas Vias Aéreas , Alemanha , Humanos , Pessoa de Meia-Idade , Apneia Obstrutiva do Sono/terapia , Ronco
6.
Medicine (Baltimore) ; 99(34): e21591, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846767

RESUMO

BACKGROUND: Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common, chronic sleep disease. As the incidence of OSAHS increases, it has seriously threatened people's health. There have been an increasing number of clinical trials of OSAHS in recent years. However, the clinical trials of OSAHS have heterogeneous outcomes, surrogate outcomes, subjective outcomes, and composite outcomes, as well as the lack of endpoints or patient perspectives. The best method is to develop a core outcomes sets (COSs) for OSAHS's clinical trials. METHODS: The development of COSs of OSAHS will include 5 stages: RESULTS:: The results of our study will be published in a peer-reviewed journal. DISCUSSION: The development of the COSs of OSAHS will improve the design and operation of OSAHS clinical trials to conform to international standards and ensure the credibility of the outcomes. In addition, this study will involve different stakeholder groups to help ensure that the developed COSs will be suitable and well accepted. TRIAL REGISTRATION NUMBER: 1544.


Assuntos
Ensaios Clínicos como Assunto/métodos , Apneia Obstrutiva do Sono/terapia , Humanos , Resultado do Tratamento
7.
Am J Orthod Dentofacial Orthop ; 158(4): 527-534, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32807630

RESUMO

INTRODUCTION: This study aimed to evaluate the follow-up observation of patients with obstructive sleep apnea treated with maxillomandibular advancement (MMA) procedure with or without genial tubercle advancement (GTA). METHODS: A total of 25 patients (mean age 37.1 ± 17.3 years) were included in the study. Cone-beam computed tomography scans were taken before treatment; after presurgical orthodontic treatment; immediately after MMA procedure; and follow-up visit. All Digital Imaging and Communications in Medicine files were analyzed using the Dolphin 3D Imaging software program (Dolphin Imaging and Management Solutions, Chatsworth, Calif) to determine the total airway volume (TAV), airway area (AA), and minimal cross-sectional area (MCA). Dolphin 3D voxel-based superimposition was used to determine the amount of skeletal advancement with MMA and changes after surgery. RESULTS: Significant increase in TAV, AA, and MCA was found with MMA treatment (40.6%, 28.8%, and 56.4%, respectively, P <0.0001). Smaller but significant decrease in TAV, AA, and MCA was found during a follow-up visit (20.0%, 9.7%, and 26.8%, respectively, P <0.0001) giving a net increase of TAV, AA and MCA (35.8%, 27.1%, and 45.9%, respectively). No significant differences were found in any of the airway measurements with or without the GTA procedure. The average forward movements of the maxilla, mandible, and chin were 6.6 mm, 8.2 mm, and 11.4 mm, respectively. A relapse of less than 1 mm was found in each of the variables during the follow-up period. No correlation was found between the magnitudes of skeletal advancement and the change in oropharyngeal airway space (OPAS). CONCLUSIONS: Significant increase in OPAS can be expected with MMA surgery with or without GTA procedure in patients diagnosed with obstructive sleep apnea. A partial loss in OPAS was found during the follow-up visit. The surgical movements were found to be stable, with less than 1 mm of relapse during the follow-up period, which was not clinically significant.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/terapia , Adulto , Cefalometria , Seguimentos , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Pessoa de Meia-Idade , Osteotomia de Le Fort , Faringe/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
8.
Am J Orthod Dentofacial Orthop ; 158(4): 564-571.e2, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32829973

RESUMO

INTRODUCTION: The clinical choice of diagnostic tests or treatment options is determined by the probability that the value of their execution (called the warrant for the test) exceeds their cost, and by their usefulness. The purpose of this study was to determine the warrant and usefulness of STOP-Bang, an obstructive sleep apnea screening questionnaire, and cone-beam computed tomography (CBCT) information about the minimal cross-sectional area for referring a mouth-breathing patient to a sleep specialist and for modifying planned orthodontic treatment. METHODS: A branching survey was used to identify the prominence of paths between the presenting situation, 2 diagnostic tests, and 2 referral and/or treatment options. A description was given of a hypothetical patient: an overweight, mouth-breathing female teenager. Path analysis was used as a method for quantifying diagnostic warrant and usefulness. RESULTS: There was a wide variation among the 125 orthodontists who responded to the survey. All paths were chosen. The use of tests altered the referral (χ2 = 8.039; P = 0.03) and/or treatment decisions (χ2 = 12.636; P = 0.005). Ownership of a CBCT system significantly influenced the use of this diagnostic test, with owning a CBCT system resulting in greater use in-office (χ2 = 50.416; P <0.001) and greater use in the study (χ2 = 22.959; P <0.001). The usefulness of the diagnostic tests could not be determined directly because common values were used for each test, but the variation in the use of this standard stimulus was very large, indicating personal differences in the interpretation of actual data. CONCLUSIONS: Wide variation in the choice and interpretation of diagnostic tests for referral and orthodontic treatment modification relative to airway condition exists among orthodontists. Diagnostic path analysis is a potentially useful model for studying how practitioners make decisions independent of research evidence.


Assuntos
Respiração Bucal/diagnóstico por imagem , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Adolescente , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Boca , Inquéritos e Questionários
9.
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
10.
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
11.
Tuberk Toraks ; 68(2): 135-140, 2020 Jul.
Artigo em Turco | MEDLINE | ID: mdl-32755113

RESUMO

Coronavirus disease 2019 (COVID-19) is an infectious disease that causes important mortality and morbidity all over the world caused by SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2), which started in China at the end of 2019. It spreads rapidly, mainly through droplets, and especially for all healthcare workers involved in aerosol producing procedures are at high risk. During COVID-19 pandemic , the health systems worldwide, along with the practice of chest diseases daily were affected. In our article, we aimed to give some clinical suggestions related to sleep practices according to current data.


Assuntos
Infecções por Coronavirus/terapia , Pessoal de Saúde/estatística & dados numéricos , Pneumonia Viral/terapia , Apneia Obstrutiva do Sono/terapia , Atitude do Pessoal de Saúde , Comorbidade , Infecções por Coronavirus/epidemiologia , Saúde Global , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/terapia , Apneia Obstrutiva do Sono/epidemiologia
14.
Medicine (Baltimore) ; 99(24): e20589, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541492

RESUMO

BACKGROUND: This study will explore the effectiveness and safety of respiratory muscle training therapy (RMTT) for the treatment of patients with obstructive sleep apnea syndrome (OSAS) after stroke. METHODS: In this study, we will systematically and comprehensively search Cochrane Library, PubMed, EMBASE, WANGFANG, VIP, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for relevant literature from their inception to March 1, 2020 without any limitations to language and publication status. We will consider any randomized controlled trials focusing on the effectiveness and safety of RMTT for the treatment of patients with OSAS after stroke. The study quality will be checked using Cochrane risk of bias tool, and statistical analysis will be performed utilizing RevMan 5.3 software. RESULTS: This study will summarize and synthesize the current evidence of RMTT for the treatment of patients with OSAS following stroke. CONCLUSION: The findings of this study will assess the present evidence for the benefits and harms of RMTT for treating OSAS after stroke, and will inform clinical practice and future research. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020170355.


Assuntos
Exercícios Respiratórios , Metanálise como Assunto , Projetos de Pesquisa , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/terapia , Acidente Vascular Cerebral/complicações , Revisões Sistemáticas como Assunto , Exercícios Respiratórios/efeitos adversos , Humanos , Resultado do Tratamento
15.
J Laryngol Otol ; 134(5): 447-452, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32493527

RESUMO

OBJECTIVES: This paper aimed to: retrospectively analyse single-centre results in terms of surgical success, respiratory outcomes and adverse events after short-term follow up in obstructive sleep apnoea patients treated with upper airway stimulation; and evaluate the correlation between pre-operative drug-induced sleep endoscopy findings and surgical success. METHODS: A retrospective descriptive cohort study was conducted, including a consecutive series of obstructive sleep apnoea patients undergoing implantation of an upper airway stimulation system. RESULTS: Forty-four patients were included. The total median Apnoea-Hypopnea Index and oxygen desaturation index significantly decreased from 37.6 to 8.3 events per hour (p < 0.001) and from 37.1 to 15.9 events per hour (p < 0.001), respectively. The surgical success rate was 88.6 per cent, and did not significantly differ between patients with or without complete collapse at the retropalatal level (p = 0.784). The most common therapy-related adverse event reported was (temporary) stimulation-related discomfort. CONCLUSION: Upper airway stimulation is an effective and safe treatment in obstructive sleep apnoea patients with continuous positive airway pressure intolerance or failure. There was no significant difference in surgical outcome between patients with tongue base collapse with or without complete anteroposterior collapse at the level of the palate.


Assuntos
Terapia por Estimulação Elétrica/métodos , Apneia Obstrutiva do Sono/terapia , Pressão Positiva Contínua nas Vias Aéreas , Terapia por Estimulação Elétrica/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Nervo Hipoglosso , Masculino , Pessoa de Meia-Idade , Polissonografia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Retrospectivos , Sono/efeitos dos fármacos , Decúbito Dorsal , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(20): e20309, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443381

RESUMO

BACKGROUND: This study will evaluate the effectiveness and safety of respiratory muscle training (RMT) for patients with obstructive sleep apnea (OSA). METHODS: Randomized controlled trials will be retrieved through electronic database searches from MEDLINE, EMBASE, Cochrane Library, CINAHL, Scopus, CBM, and CNKI from the beginning to the present. All electronic databases will be searched without any language limitation. Two researchers will independently select studies, collect data, and assess study quality, respectively. RevMan 5.3 software will be used for statistical analysis. RESULTS: The primary outcome is severity of OSA, as measured by polysomnography or any relevant tools. The secondary outcomes are hypopnea index, apnea index, respiratory event index, respiratory disturbance index, sleep-related quality of life, and any expected or unexpected adverse events. CONCLUSION: The results of this study will summarize current evidence of RMT for the treatment of patients with OSA. SYSTEMATIC REVIEW REGISTRATION: INPLASY202040051.


Assuntos
Exercícios Respiratórios/métodos , Apneia Obstrutiva do Sono/terapia , Humanos , Polissonografia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Índice de Gravidade de Doença
17.
Ann Otol Rhinol Laryngol ; 129(9): 924-929, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32363887

RESUMO

STUDY OBJECTIVES: To conduct a systematic review of the medical literature evaluating the effects of playing a musical instrument on obstructive sleep apnea (OSA). DATA SOURCES: Scopus, CINAHL, PubMed, and OVID. REVIEW METHODS: Searches were performed through October 22, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. RESULTS: After thorough investigation amidst specific exclusion criteria, four studies were included in the systematic review: one randomized controlled trial and three cross-sectional studies. Polysomnography was used to assess apnea-hypopnea index (AHI) related to obstructive sleep apnea (OSA) in the randomized controlled trial, while the Berlin questionnaire was used to assess high- and low risk OSA in the cross-sectional studies. Various instrument types were mentioned in these studies, largely focusing on wind instruments and subgroups within the wind instrument family. CONCLUSION: Current literature, although sparse, suggests that playing certain types of wind instruments are associated with either improving patients' AHI or reducing the risk of developing OSA. Future studies with larger sample sizes utilizing validated diagnostic tools to measure the presence and severity of OSA are necessary to determine the true impact of such interventions. Although more research is needed, sustainable and minimally invasive interventions such as playing a specific type of musical instrument could serve as an accessible, inexpensive, and effective adjunctive treatment for OSA.


Assuntos
Musicoterapia , Música , Apneia Obstrutiva do Sono/terapia , Humanos
18.
Cardiovasc Pathol ; 47: 107221, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32371340

RESUMO

Unexpected sudden cardiac death (SCD), sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death (SIUD) are major unsolved, devastating forms of death that occur frequently. Obstructive sleep apnea (OSA) has been associated with increased cardiovascular and cerebrovascular morbidity and mortality, including sudden cardiac death (SCD). This editorial will review the pathology of SCD, including sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death (SIUD); OSA with its cardiovascular consequences; the possible link between SCD and OSA, discussing the potential mechanisms underlying these two frequent, but yet overlooked pathologies. Finally, the possible preventive benefits of treating OSA and identifying patients at common risk for OSA and SCD and SIDS-SIUD to prevent unexpected deaths will be discussed. Post-mortem examination is of great importance in every case of SCD sine materia, with examination of the brainstem and cardiac conduction system on serial sections, when general autopsy fails, but it should be stressed that also the investigations of patients suffering from OSA should focus on the possibility of pathological findings in common with cases of SCD.


Assuntos
Tronco Encefálico/patologia , Morte Súbita Cardíaca/patologia , Morte Fetal/etiologia , Sistema de Condução Cardíaco/patologia , Apneia Obstrutiva do Sono/patologia , Morte Súbita do Lactente/patologia , Tronco Encefálico/imunologia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Feminino , Morte Fetal/prevenção & controle , Sistema de Condução Cardíaco/imunologia , Humanos , Lactente , Recém-Nascido , Mediadores da Inflamação/imunologia , Gravidez , Prognóstico , Fatores de Risco , Apneia Obstrutiva do Sono/imunologia , Apneia Obstrutiva do Sono/mortalidade , Apneia Obstrutiva do Sono/terapia , Morte Súbita do Lactente/epidemiologia , Morte Súbita do Lactente/imunologia , Morte Súbita do Lactente/prevenção & controle
19.
Am J Otolaryngol ; 41(4): 102500, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32402692

RESUMO

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is caused by a complete or partial obstruction of the upper airway. A new Cahali lateral pharyngoplasty as a stand-alone procedure for the treatment of OSA patients, whatever the level and pattern of airway obstruction in patients with CPAP failure or non-compliant patients, is it? PATIENTS AND METHODS: 40 patients with known OSAS non-compliant with CPAP or CPAP failures included. BMI, Stop-Bang score, and sleep study parameters were reported before and after the new Cahali pharyngoplasty operation. Preoperative DISE was done for all cases. RESULTS: There were 28 (70%) cases with successful operation outcomes, and 12 (30%) failed cases. Postoperative Stop Bang score, AHI, snoring index were significantly reduced in comparison to preoperative data (p-value <0.001); however, minimal SpO2 and baseline SpO2 were significantly increased in comparison to preoperative data. There was a significant improvement in AHI postoperative. Patients collapse at the level of lateral wall hypopharynx, high tongue collapse, laryngeal collapse, tongue palate interaction, all significantly predict failure outcome of the operation (p-value = 0.022). However, the absence of laryngeal collapse (L0) had a successful prediction outcome. The high snoring index significantly predicts operation failure. However, preoperative high baseline SpO2 predicts operation success significantly. CONCLUSION: The new Cahali lateral pharyngoplasty can be used as a stand-alone procedure in the absence of lateral wall collapse at the level of the hypopharynx (LH), high tongue base collapse (TH), laryngeal collapse (L1) or tongue palate interaction.


Assuntos
Faringe/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Apneia Obstrutiva do Sono/cirurgia , Feminino , Humanos , Masculino , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
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