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1.
Rev. Odontol. Araçatuba (Impr.) ; 43(3): 61-67, set.-dez. 2022. tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1381326

RESUMO

Atualmente, o tratamento do ronco primário e da Síndrome da Apnéia/Hipopnéia Obstrutiva do Sono (SAHOS)1 através de aparelhos intra-orais (AIO) tem recebido a atenção dos pesquisadores pela comprovada eficácia destes dispositivos. Os aparelhos mais indicados são os reposicionadores de mandíbula que promovem um avanço mandibular, afastando os tecidos da orofaringe superior, o que evita a obstrução parcial ou total da área. Sua indicação é para casos de ronco primário e apnéias leves e moderadas2, no entanto é necessário que os candidatos apresentem número de dentes suficientes com saúde periodontal para a ancoragem do aparelho. Por ser uma doença de consequências sistêmicas graves, o tratamento da SAHOS é em sua essência de responsabilidade do médico especialista na área, porém o cirurgião dentista deve ter conhecimento para diagnosticar e tratar, quando o AIO for a opção terapêutica. A interpretação da polissonografia, exame que diagnostica e conduz para a escolha correta do tratamento, e dos dados cefalométricos são os principais quesitos ao Cirurgião Dentista que se propõe a tratar portadores da SAHOS. Nesse trabalho foi elaborado um questionário e aplicado aos cirurgiões dentistas de três diferentes cidades do Estado de São Paulo para que fosse possível avaliar o conhecimento desses profissionais a respeito do diagnóstico e tratamento da SAHOS. 70 Cirurgiões Dentistas foram entrevistados e os resultados mostraram que 70% destes têm interesse em trabalhar com os AIOs. Esse grupo se relacionou estatisticamente significante com aqueles que afirmaram já terem sido alguma vez questionado por algum paciente a respeito desse tratamento. Quanto à criação de uma especialidade para essa área, os profissionais da área de prótese e implante se mostraram mais interessados. E, do número total de entrevistados, apenas 25% já tiveram contato com esse tipo de aparelho, mas não conhece o protocolo de atendimento para o tratamento desses pacientes(AU)


Currently, the treatment of primary snoring and Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS)1 through intraoral appliances (OA) has received the attention of researchers due to the proven effectiveness of these devices. The most suitable devices are jaw repositioning devices that promote mandibular advancement, moving the tissues away from the upper oropharynx, which prevents partial or total obstruction of the area. Its indication is for cases of primary snoring and mild to moderate apnea2, however it is necessary that candidates have a sufficient number of teeth with periodontal health to anchor the appliance. As it is a disease with serious systemic consequences, the treatment of OSAHS is, in essence, the responsibility of the specialist in the area, but the dental surgeon must have the knowledge to diagnose and treat, when OA is the therapeutic option. The interpretation of polysomnography, na exam that diagnoses and leads to the correct choice of treatment, and cephalometric data are the main requirements for the Dental Surgeon who proposes to treat patients with OSAHS. In this work, a questionnaire was developed and applied to dentalsurgeons from three different cities in the State of São Paulo so that it was possible to assess the knowledge of these professionals regarding the diagnosis and treatment of OSAHS. 70 Dental Surgeons were interviewed and the results showed that 70% of them are interested in working with AIOs. This group had a statistically significant relationshipwith those who stated that they had already been asked by a patient about this treatment. Regarding the creation of a specialty for this area, professional in the area of ??prosthesis and implant were more interested. And, of the total number of respondents, only 25% have already had contact with this type of device, but do not know the care protocol for the treatment of these patients(AU)


Assuntos
Apneia Obstrutiva do Sono , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/diagnóstico por imagem , Modelos Dentários , Ronco , Polissonografia , Avanço Mandibular , Odontólogos
2.
Sleep Med Clin ; 17(4): 543-550, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36333073

RESUMO

Although data are limited, studies suggest on average lower positive airway pressure use in Black, indigenous, and people of color (BIPOC) compared with Whites in most but not all studies. Most of these observational studies are certainly limited by confounding by socioeconomic status and other unmeasured factors that likely contribute to differences. The etiology of these observed disparities is likely multifactorial, due in part to financial limitations, differences in sleep opportunity, poor sleep quality due to environmental disruptions, and so forth. These disparities in sleep health are likely related to chronic inequities, including experiences of racism, neighborhood features, structural, and contextual factors. Dedicated studies focusing on understanding adherence in BIPOC are lacking. Further research is needed to understand determinants of PAP use in BIPOC subjects and identify feasible interventions to improve sleep health and reduce sleep apnea treatment disparities.


Assuntos
Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Distúrbios do Início e da Manutenção do Sono , Humanos , Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/terapia , Fatores Raciais , Cooperação do Paciente
3.
Sleep Med Clin ; 17(4): 639-645, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36333082

RESUMO

Both epilepsy and obstructive sleep apnea are common conditions and hence frequently coexist in a given patient. A complex bidirectional relationship exists between the 2 conditions where the presence of one affects the other. Treatment of obstructive sleep apnea with continuous positive airway pressure may improve seizure control in medically refractory epilepsy patients, leading to improved quality of life. Understanding of this complex relationship between epilepsy, sleep, and sleep disorders such as obstructive sleep apnea continues to evolve.


Assuntos
Epilepsia , Apneia Obstrutiva do Sono , Humanos , Qualidade de Vida , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Pressão Positiva Contínua nas Vias Aéreas , Epilepsia/complicações , Epilepsia/terapia , Resultado do Tratamento
4.
Sleep Med Clin ; 17(4): 569-576, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36333076

RESUMO

Continuous positive airway pressure is the gold standard treatment for obstructive sleep apnea. Different interfaces with distinct characteristics, advantages, and disadvantages are available, which may influence long-term adherence. Oronasal masks have been increasingly used. However, recent evidence suggest that nasal masks are more effective when continuous positive airway pressure is used to treat obstructive sleep apnea. The main objective of this review is to describe the basis for the selection of the interface for the treatment of obstructive sleep apnea with continuous positive airway pressure.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/terapia , Máscaras , Tomada de Decisão Clínica
5.
Sleep Med Clin ; 17(4): 647-656, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36333083

RESUMO

Obstructive sleep apnea (OSA) is highly prevalent sleep disorder that causes sleep fragmentation, frequent awakenings, and intermittent hypoxia. Both OSA and cognitive decline increase in prevalence with factors such as increasing age and body mass. Multiple areas of cognition can be affected, including attention, executive function, memory, as well as emotional functioning through direct effects on brain health. Although positive airway pressure therapy has shown to improve some aspects of cognitive functioning, it does not fully alleviate all cognitive complaints. Inclusion of complementary approaches to comorbidities associated with OSA could potentially enhance treatment outcomes.


Assuntos
Disfunção Cognitiva , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia , Função Executiva , Cognição , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/terapia , Disfunção Cognitiva/etiologia , Atenção
6.
Sleep Med Clin ; 17(4): 629-638, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36333081

RESUMO

Pediatric obstructive sleep apnea is becoming more common and better diagnosed and treated. It is seen in children with obesity, genetic disorders, neuromuscular disorders, and congenital malformations. After adenotonsillectomy, continuous positive airway pressure (CPAP) is a major mode of treatment. CPAP is traditionally initiated by titrating in the laboratory. However, auto-CPAP titration in the home environment is becoming more accepted as an option. When children are adherent to CPAP, there are significant benefits to treatment, both short-term and long-term. The short-term benefits include improved behavior, focus, attention, and improved sleep. The long-term benefits include improved cardiovascular and metabolic comorbidities.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Humanos , Criança , Polissonografia , Apneia Obstrutiva do Sono/terapia , Programas de Rastreamento , Laboratórios , Cooperação do Paciente
7.
Rehabil Psychol ; 67(4): 461-473, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36355639

RESUMO

PURPOSE/OBJECTIVE: To evaluate the feasibility of a psychological intervention designed to increase Positive Airway Pressure (PAP) adherence, adapted with cognitive accommodations for comorbid obstructive sleep apnea (OSA) and traumatic brain injury (TBI). RESEARCH METHOD/DESIGN: This was an open-label single arm (nonrandomized) study. Eligibility criteria were moderate-to-severe TBI, OSA diagnosis, prescribed PAP, nonadherent, and able to consent. Participants were recruited from inpatient and outpatient settings at a tertiary care hospital. The four-module manualized intervention was delivered primarily via telehealth. Feasibility aspects measured included eligibility, recruitment, and retention rates; session duration and attendance; and characteristics of outcome and process measures (e.g., completion rates, data distribution). Symptom measures included the Epworth Sleepiness Scale, Fatigue Severity Scale, Functional Outcomes of Sleep Questionnaire, Self-Efficacy Measure for Sleep Apnea, OSA Treatment Barriers Questionnaire (OTBQ), and Kim Alliance Scale-Revised. RESULTS: Of 230 persons screened, 14.3% were eligible. Recruitment rate (n = 17) was 51.5%. Retention rate (n = 13) was 76.5%. Treatment completers had no missing data. The OTBQ deviated from normality, but other measures had adequate skew (< 2.0) and kurtosis (< 7.0) and were free from significant floor and ceiling effects (<15%). Change score effect sizes were minimal to moderate (d = .10-.77). There were no adverse events. CONCLUSIONS/IMPLICATIONS: These results inform ways in which procedures should be modified to enhance the success of a future clinical trial testing the efficacy of this adherence intervention. Inclusion criteria should be reconsidered, and recruitment sites expanded, to capture eligible persons and adequately power an efficacy study. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Lesões Encefálicas Traumáticas , Apneia Obstrutiva do Sono , Humanos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Estudos de Viabilidade , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/psicologia , Cooperação e Adesão ao Tratamento , Lesões Encefálicas Traumáticas/complicações
8.
Sleep Med Clin ; 17(4): 619-627, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36333080

RESUMO

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial upper airway obstruction during sleep, with a worldwide estimate of 936 million sufferers. Treatments of OSA include continuous positive airway pressure (CPAP), weight loss, positional therapy, oral appliances, positive upper airway pressure, oro-maxillofacial surgery, hypoglossal nerve stimulation, and bariatric surgery, and others, with CPAP being the most commonly prescribed treatment. In this review, the neurologic conditions of stroke, cognitive decline, epilepsy, and migraines will be discussed as they relate to OSA. Additionally, the literature regarding improvement in these conditions following treatment with CPAP will be explored.


Assuntos
Apneia Obstrutiva do Sono , Humanos , Pressão Positiva Contínua nas Vias Aéreas , Epilepsia/complicações , Sono , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Transtornos Cognitivos/complicações , Acidente Vascular Cerebral/complicações , Transtornos de Enxaqueca/complicações
9.
Sci Rep ; 12(1): 19563, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36380059

RESUMO

To improve patients' adherence to continuous positive airway pressure (CPAP) therapy, this study aimed to clarify whether machine learning-based data analysis can identify the factors related to poor CPAP adherence (i.e., CPAP usage that does not reach four hours per day for five days a week). We developed a CPAP adherence prediction model using logistic regression and learn-to-rank machine learning with a pairwise approach. We then investigated adherence prediction performance targeting a 12-week period and the top ten factors correlating to poor CPAP adherence. The CPAP logs of 219 patients with obstructive sleep apnea (OSA) obtained from clinical treatment at Kyoto University Hospital were used. The highest adherence prediction accuracy obtained was an F1 score of 0.864. Out of the top ten factors obtained with the highest prediction accuracy, four were consistent with already-known clinical knowledge. The factors for better CPAP adherence indicate that air leakage should be avoided, mask pressure should be kept constant, and CPAP usage duration should be longer and kept constant. The results indicate that machine learning is an adequate method for investigating factors related to poor CPAP adherence.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Humanos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Projetos Piloto , Apneia Obstrutiva do Sono/terapia , Cooperação do Paciente , Aprendizado de Máquina
11.
JAMA ; 328(19): 1945-1950, 2022 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-36378202

RESUMO

Importance: Current prevalence of obstructive sleep apnea (OSA) in the US is not well established; however, based on cohort and survey data, in 2007-2010 the estimated prevalence of at least mild OSA (defined as an apnea-hypoxia index [AHI] ≥5) plus symptoms of daytime sleepiness among adults aged 30 to 70 years was 14% for men and 5% for women, and the estimated prevalence of moderate to severe OSA (defined as AHI ≥15) was 13% for men and 6% for women. Severe OSA is associated with increased all-cause mortality. Other adverse health outcomes associated with untreated OSA include cardiovascular disease and cerebrovascular events, type 2 diabetes, cognitive impairment, decreased quality of life, and motor vehicle crashes. Objective: To update its 2017 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for OSA in adults. Population: Asymptomatic adults (18 years or older) and adults with unrecognized symptoms of OSA. Evidence Assessment: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in the general adult population. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in the general adult population. (I statement).


Assuntos
Diabetes Mellitus Tipo 2 , Apneia Obstrutiva do Sono , Adulto , Masculino , Humanos , Feminino , Qualidade de Vida , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Programas de Rastreamento/efeitos adversos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Comitês Consultivos
12.
JAMA ; 328(19): 1951-1971, 2022 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-36378203

RESUMO

Importance: Obstructive sleep apnea (OSA) is associated with adverse health outcomes. Objective: To review the evidence on screening for OSA in asymptomatic adults or those with unrecognized OSA symptoms to inform the US Preventive Services Task Force. Data Sources: PubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021; surveillance through September 23, 2022. Study Selection: English-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or treatment of OSA reporting health outcomes or harms, and systematic reviews of treatment reporting changes in blood pressure and apnea-hypopnea index (AHI) scores. Data Extraction and Synthesis: Dual review of abstracts, full-text articles, and study quality. Meta-analysis of intervention trials. Main Outcomes and Measures: Test accuracy, excessive daytime sleepiness, sleep-related and general health-related quality of life (QOL), and harms. Results: Eighty-six studies were included (N = 11 051). No study directly compared screening with no screening. Screening accuracy of the Multivariable Apnea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score >10) measured as the area under the curve in 2 studies (n = 702) was 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90). Five studies assessing the accuracy of other screening tools were heterogeneous and results were inconsistent. Compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline (pooled mean difference, -2.33 [95% CI, -2.75 to -1.90]; 47 trials; n = 7024), sleep-related QOL (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 17 trials; n = 3083), and general health-related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change (pooled mean difference, 2.20 [95% CI, 0.95 to 3.44]; 15 trials; n = 2345) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials; n = 2031). Use of mandibular advancement devices was also associated with a significantly larger ESS score change compared with controls (pooled mean difference, -1.67 [95% CI, 2.09 to -1.25]; 10 trials; n = 1540). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; however, the difference was relatively small (2-3 mm Hg). Conclusions and Relevance: The accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain. Positive airway pressure and mandibular advancement devices reduced ESS score. Trials of positive airway pressure found modest improvement in sleep-related and general health-related QOL but have not established whether treatment reduces mortality or improves most other health outcomes.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Apneia Obstrutiva do Sono , Adulto , Humanos , Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/complicações , Comitês Consultivos , Qualidade de Vida
13.
Artigo em Inglês | MEDLINE | ID: mdl-36361031

RESUMO

BACKGROUND: In obstructive sleep apnoea (OSA), treatment with mandibular advancement devices (MADs) reduces patients' Apnoea-Hypopnoea index (AHI) scores and improves their sleepiness and quality of life. MADs are non-invasive alternatives for patients who cannot tolerate traditional continuous positive airway pressure (CPAP) therapy. The variability of responses to these devices makes it necessary to search for predictors of success. The aim of our study was to evaluate the presence of mandibular torus as a predictor of MAD efficacy in OSA and to identify other potential cephalometric factors that could influence the response to treatment. METHODS: This was a retrospective cohort study. The study included 103 patients diagnosed of OSA who met the criteria for initiation of treatment with MAD. Structural variables were collected (cephalometric and the presence or absence of mandibular torus). Statistical analysis was performed to evaluate the existence of predictive factors for the efficacy of MADs. RESULTS: A total of 103 patients who were consecutively referred for treatment with MAD were included (89.3% men); the mean age of the participants was 46.3 years, and the mean AHI before MAD was 31.4 (SD 16.2) and post- MAD 11.3 (SD 9.2). Thirty-three percent of patients had mandibular torus. Torus was associated with a better response (odds ratio (OR) = 2.854 (p = 0.035)) after adjustment for sex, age, body mass index (BMI; kg/m2), the angle formed by the occlusal plane to the sella-nasion plane (OCC plane to SN), overinjection, and smoking. No cephalometric predictors of efficacy were found that were predictive of MAD treatment success. CONCLUSIONS: The presence of a mandibular torus practically triples the probability of MAD success. This is the simplest examination with the greatest benefits in terms of the efficacy of MAD treatment for OSA.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Placas Oclusais , Qualidade de Vida , Estudos Retrospectivos , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
14.
Medicina (Kaunas) ; 58(11)2022 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-36363468

RESUMO

Background: Cardiovascular remodeling is essential in patients with obstructive sleep apnea (OSA), and continuous positive airway pressure (CPAP) therapy could improve these processes. Two-dimensional (2D) speckle-tracking (ST) echocardiography is a useful method for subclinical biventricular dysfunction diagnosis and thus might help as an earlier treatment for OSA patients. It is still not clear which blood serum biomarkers could be used to assess CPAP treatment efficacy. Objectives: To evaluate left heart geometry, function, deformation parameters, and blood serum biomarker (galectin-3, sST2, endothelin-1) levels in patients with OSA, as well as to assess changes after short-term CPAP treatment. Materials and Methods: Thirty-four patients diagnosed with moderate or severe OSA, as well as thirteen patients as a control group, were included in the study. All the subjects were obese (body mass index (BMI) > 30 kg/m2). Transthoracic 2D ST echocardiography was performed before and after 3 months of treatment with CPAP; for the control group, at baseline only. Peripheral blood samples for the testing of biomarkers were collected at the time of study enrolment before the initiation of CPAP therapy and after 3 months of CPAP treatment (blood samples were taken just for OSA group patients). Results: The left ventricle (LV) end-diastolic diameter and volume, as well as LV ejection fraction (EF), did not differ between groups, but an increased LV end-systolic volume and a reduced LV global longitudinal strain (GLS) were found in the OSA group patients (p = 0.015 and p = 0.035, respectively). Indexed by height, higher LV MMi in OSA patients (p = 0.007) and a higher prevalence of LV diastolic dysfunction (p = 0.023) were found in this group of patients. Although left atrium (LA) volume did not differ between groups, OSA group patients had significantly lower LA reservoir strain (p < 0.001). Conventional RV longitudinal and global function parameters (S', fractional area change (FAC)) did not differ between groups; however, RV GLS was reduced in OSA patients (p = 0.026). OSA patients had a significantly higher right atrium (RA) diameter and mean pulmonary artery pressure (PAP) (p < 0.05). Galectin-3 and sST2 concentrations significantly decreased after 3 months of CPAP treatment. Conclusions: OSA is associated with the left heart remodeling process-increased LV myocardial mass index, LV diastolic dysfunction, reduced LV and RV longitudinal strain, and reduced LA reservoir function. A short-term, 3-months CPAP treatment improves LV global longitudinal strain and LA reservoir function and positively affects blood serum biomarkers. This new indexing system for LV myocardial mass by height helps to identify myocardial structural changes in obese patients with OSA.


Assuntos
Apneia Obstrutiva do Sono , Disfunção Ventricular Esquerda , Humanos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Soro , Galectina 3 , Polissonografia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Biomarcadores , Obesidade/complicações
16.
Braz J Med Biol Res ; 55: e12331, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36197415

RESUMO

The aim of this randomized controlled trial was to analyze the effects of an inspiratory muscle training (IMT) program on apnea and hypopnea index (AHI), inspiratory muscle strength, sleep quality, and daytime sleepiness in individuals with obstructive sleep apnea (OSA), whether or not they used continuous positive airway pressure (CPAP (+/-) therapy. The intervention group underwent IMT with a progressive resistive load of 40-70% of the maximum inspiratory pressure (PImax) for 30 breaths once a day for 12 weeks. The control group was submitted to a similar protocol, but with at a minimum load of 10 cmH2O. Changes in the AHI were the primary outcome. PImax was measured with a digital vacuometer, daytime somnolence was measured by the Epworth sleepiness scale (ESS), and the quality of sleep by the Pittsburgh Sleep Quality Index (PSQI). CPAP use was treated as a confounder and controlled by stratification resulting in 4 subgroups: IMT-/CPAP-, IMT-/CPAP+, IMT+/CPAP-, and IMT+/CPAP+. Sixty-five individuals were included in the final analysis. Significant variations were found in the 4 parameters measured throughout the study after the intervention in both CPAP- and CPAP+ participants: PImax was increased and AHI was reduced, whereas improvements were seen in both ESS and PSQI. The twelve-week IMT program increased inspiratory muscle strength, substantially reduced AHI, and had a positive impact on sleep quality and daytime sleepiness, whether or not participants were using CPAP. Our findings reinforce the role of an IMT program as an adjunct resource in OSA treatment.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Músculos , Sono , Apneia Obstrutiva do Sono/terapia
17.
Adv Exp Med Biol ; 1384: 219-239, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36217087

RESUMO

Obstructive sleep apnea (OSA) is a multidimensional disease often underdiagnosed due to the complexity and unavailability of its standard diagnostic method: the polysomnography. Among the alternative abbreviated tests searching for a compromise between simplicity and accurateness, oximetry is probably the most popular. The blood oxygen saturation (SpO2) signal is characterized by a near-constant profile in healthy subjects breathing normally, while marked drops (desaturations) are linked to respiratory events. Parameterization of the desaturations has led to a great number of indices of severity assessment commonly used to assist in OSA diagnosis. In this chapter, the main methodologies used to characterize the overnight oximetry profile are reviewed, from visual inspection and simple statistics to complex measures involving signal processing and pattern recognition techniques. We focus on the individual performance of each approach, but also on the complementarity among the great amount of indices existing in the state of the art, looking for the most relevant oximetric feature subset. Finally, a quick overview of SpO2-based deep learning applications for OSA management is carried out, where the raw oximetry signal is analyzed without previous parameterization. Our research allows us to conclude that all the methodologies (conventional, time, frequency, nonlinear, and hypoxemia-based) demonstrate high ability to provide relevant oximetric indices, but only a reduced set provide non-redundant complementary information leading to a significant performance increase. Finally, although oximetry is a robust tool, greater standardization and prospective validation of the measures derived from complex signal processing techniques are still needed to homogenize interpretation and increase generalizability.


Assuntos
Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Humanos , Hipóxia/diagnóstico , Oximetria/métodos , Oxigênio , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/terapia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia
18.
Int J Mol Sci ; 23(20)2022 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-36293288

RESUMO

Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse, chronic hypoxia and a proinflammatory phenotype. The purpose of our study was to evaluate readily available inflammatory biomarkers (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), WBC-to-MPV ratio (WMR) and lymphocyte-to-C-reactive protein ratio (LCR)) before and after CPAP in patients with moderate-severe OSA. We performed a prospective study that included patients with newly-diagnosed moderate-severe OSA. The control groups (patients without OSA and with mild OSA) were selected from the hospital polygraphy database. All subjects underwent routine blood panel, which was repeated in moderate-severe OSA patients after 8 weeks of CPAP. Our final study group included 31 controls, 33 patients with mild, 22 patients with moderate and 37 patients with severe OSA. CRP, ESR, NLR and WMR were correlated with OSA severity. After 8-week CPAP therapy, we documented a decrease in weight status, which remained statistically significant in both CPAP-adherent and non-adherent subgroups. Readily available, inexpensive inflammatory parameters can predict the presence of moderate-severe OSA, but are not influenced by short-term CPAP.


Assuntos
Proteína C-Reativa , Apneia Obstrutiva do Sono , Humanos , Projetos Piloto , Proteína C-Reativa/metabolismo , Estudos Prospectivos , Apneia Obstrutiva do Sono/terapia , Biomarcadores
19.
Sleep Med ; 100: 448-453, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36252413

RESUMO

OBJECTIVES: Falls in older people can lead to serious injury and significant societal health and financial burden. Obstructive sleep apnoea (OSA) is associated with impaired gait/balance and may increase fall risk, yet few studies examined whether treating OSA reduces fall risk. This study examined the effect of continuous positive airway pressure (CPAP) on fall risk markers in people over 65yrs diagnosed with OSA. DESIGN: Single arm intervention study. SETTING: University and tertiary care CPAP clinic. PARTICIPANTS: Individuals over 65 years diagnosed with OSA and recommended CPAP. INTERVENTION: 3-6 months CPAP therapy. MEASUREMENTS: 28 participants had a physiological profile assessment (PPA) at baseline and following 3-6 months of CPAP. The PPA examines visual contrast sensitivity, lower limb proprioception, knee extension strength, reaction time and postural sway to generate a fall risk score (FRS). t-tests were used to determine difference between pre- and post-treatment FRS. Regression was used to examine the associations between CPAP use and daytime sleepiness with FRS. RESULTS: CPAP significantly reduced the FRS ([Mean ± SD] 0.59 ± 1.0 vs 0.04 ± 1.1, p = 0.016), contrast sensitivity and lower limb proprioception (P < 0.05). Increased CPAP use was associated with improvement in FRS in unadjusted analysis (ß = -0.213, 95%CI -0.371 to -0.056, p = 0.01). Reduction in Epworth sleepiness score was associated with a reduction in FRS in unadjusted (p = 0.023) and adjusted analysis (adjusted for AHI p = 0.027 or O2Nadir p = 0.015). CONCLUSIONS: CPAP may reduce fall risk in people over 65yrs, possibly related to better CPAP adherence and reduced daytime sleepiness. Future controlled trials and mechanistic studies are needed to elucidate how CPAP may reduce fall risk.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Procedimentos Cirúrgicos Reconstrutivos , Apneia Obstrutiva do Sono , Humanos , Idoso , Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/terapia , Fatores de Risco
20.
Harefuah ; 161(10): 642-644, 2022 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-36315213

RESUMO

INTRODUCTION: Some systemic diseases have ophthalmic manifestations. Findings on examination of the fundus can assist in the diagnosis and treatment of these diseases. In this manuscript, we present two ophthalmic conditions that cause optic disc edema and are highly associated with obstructive sleep apnea (OSA). The conditions are non-arteritic anterior ischemic optic neuropathy (NAION), and Papilledema associated with the Pickwickian syndrome. When these conditions are suspected, the patient should be referred for a polysomnography examination.


Assuntos
Neuropatia Óptica Isquêmica , Apneia Obstrutiva do Sono , Humanos , Polissonografia/efeitos adversos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Neuropatia Óptica Isquêmica/diagnóstico , Neuropatia Óptica Isquêmica/etiologia , Nervo Óptico , Edema
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