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1.
Medicine (Baltimore) ; 99(10): e19329, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150069

RESUMO

Sleep-disordered breathing symptoms may recur in some children after successful adenoidectomy. A potential etiology that warrants consideration is torus tubarius hypertrophy (TTH) as well as residual or recurrent adenoid hypertrophy. Here, we report our experience and the treatment outcomes with microscopic coblator-assisted partial resection of TTH.Seven children who had undergone coblator-assisted partial resection of TTH under microscopy from April 2000 through January 2017 were retrospectively reviewed. The patient age at the time of initial adenotonsillectomy and the interval between the first operation and partial resection of TTH were identified. Lateral cephalometry and scores on the Korean version of the obstructive sleep apnea-18 (KOSA-18) questionnaire were reviewed.The median age at the time of the first operation was 3.0 years and the average time interval between the first operation and subsequent tubal tonsillectomy was 44.0 months. The average width between the torus tubarius was 2.1 mm preoperatively. Symptoms of sleep-disordered breathing were relieved in all patients after operation. Preoperative and postoperative KOSA-18 scores were 73.5 and 35.5, respectively (P = .024). On polysomnography, the preoperative and postoperative apnea-hypopnea index scores were 22.9 and 4.7, respectively (P = .068). The patients were followed up for an average of 1.3 years. One patient developed a recurrence of symptoms and underwent a revision operation. Complications such as bleeding and nasopharyngeal stenosis were not observed.Otorhinolaryngologists should keep TTH in mind as one of the differential diagnoses for recurrent upper airway obstruction symptoms after adenoidectomy. Microscopic coblator-assisted partial resection of TTH is likely to be safe and effective.


Assuntos
Tonsila Faríngea/cirurgia , Ronco/cirurgia , Resultado do Tratamento , Estudos de Casos e Controles , Pré-Escolar , Humanos , Hipertrofia , Lactente , Masculino , República da Coreia , Estudos Retrospectivos , Síndromes da Apneia do Sono/etiologia , Síndromes da Apneia do Sono/cirurgia , Ronco/etiologia , Inquéritos e Questionários
2.
Arch. bronconeumol. (Ed. impr.) ; 56(1): 18-22, ene. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-186461

RESUMO

Background: Large variation in diagnostic procedures and treatment recommendations may hinder the management of obstructive sleep apnea (OSA) and also compromise correct interpretation of the results of multicenter clinical trials, especially in subjects with non-severe OSA. The aim of this study was to analyze the therapeutic decision-making between different sleep physicians in patients with AHÍ < 40 events/h. Methods: Six experienced senior sleep specialists from different sleep centers of Spain were asked to make a therapeutic decision (CPAP treatment) based on anonymized recordings of patients with suspected OSA that has previously performed a sleep study. The clinical data was shown in an online database and included anthropometric features, clinical questionnaires, comorbidities, physical examination and sleep study results. Intra- and inter-observer decision-making were analyzed by the Fleiss’ Kappa statistics (Kappa). Results: A total of 720 medical decisions were taken to analyze the agreement between sleep professionals. Overall intra-observer evaluation reliability was almost perfect (Kappa = 0.83, 95% CI, 0.75-0.90, p < 0.001). However, overall inter-observer concordance decreased to moderate agreement (Kappa = 0.46, 95% CI, 0.42-0.51, p < 0.001). Nevertheless, it was especially low when considering AHÍ < 15 events/h. Conclusions: This study demonstrates a good intra-observer concordance in the therapeutic decision-making of different sleep physicians treating patients with low/moderate OSA. However, when analyzing inter-observer agreement the results were considerably worse. These findings underline the importance of developing improved consensus management protocols


Introducción: La gran variedad de procedimientos diagnósticos y recomendaciones de tratamiento puede dificultar el manejo del síndrome de apnea obstructiva del sueño (SAHS), y del mismo modo comprometer la correcta interpretación de los resultados de ensayos clínicos multicéntricos, especialmente en pacientes con SAHS no grave. El objetivo de este estudio fue analizar la decisión terapéutica de distintos médicos expertos en sueño en pacientes con el índice de apnea hipopnea < 40 eventos/h. Métodos: Se pidió a seis especialistas con amplia experiencia en sueño de diferentes centros de España que tomaran una decisión terapéutica (terapia de presión positiva continua en las vías respiratorias o CPAP) basada en datos anónimos de los pacientes con sospecha de SAHS en los que previamente se había llevado a cabo un estudio del sueño. Los datos clínicos procedían de una base de datos online e incluían características antropométricas, cuestionarios clínicos, comorbilidades, examen físico y resultados del estudio del sueño. La concordancia intra- e interobservador de la toma de decisiones se analizó mediante el estadístico Fleiss' Kappa (Kappa). Resultados: Se analizaron un total de 720 decisiones médicas para evaluar el consenso entre profesionales del sueño. De manera global, la fiabilidad de la evaluación intraobservador fue casi perfecta (Kappa = 0,83; 95% CI; 0,75 a 0,90, p < 0,001). Sin embargo, la concordancia global interobservador disminuyó hasta alcanzar un grado moderado de consenso (Kappa = 0,46; 95% CI; 0,42 a 0,51, p < 0,001), que fue especialmente bajo cuando se tuvo en cuenta un índice de apnea hipopnea < 15 eventos/h. Conclusiones: Este estudio demuestra una buena concordancia intraobservador en la toma de decisiones terapéuticas de distintos médicos expertos en sueño que tratan a pacientes con SAHS leve o moderado. Sin embargo, los resultados relativos al acuerdo interobservador fueron notablemente peores. Estos hallazgos señalan la importancia de desarrollar mejores protocolos consensuados de manejo


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Síndromes da Apneia do Sono/terapia , Tomada de Decisão Clínica/métodos , Respiração com Pressão Positiva , Respiração com Pressão Positiva Intermitente/métodos , Análise de Variância , Antropometria , Inquéritos e Questionários , Comorbidade , Consenso , Apneia Obstrutiva do Sono/epidemiologia
3.
J Stroke Cerebrovasc Dis ; 29(2): 104510, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31767524

RESUMO

BACKGROUND AND PURPOSE: Evidence of an association between sleep apnea (SA) and early neurological deterioration (END) in acute phase ischemic stroke is scant. We investigated the prevalence of SA and the impact of SA severity on END in acute ischemic stroke (AIS) patients. METHODS: We prospectively enrolled consecutive AIS patients admitted to our stroke unit within 72 hours of symptom onset. SA severity was assessed with ApneaLink-a validated portable respiratory monitor. SA was defined as an apnea-hypopnea index (AHI) of greater than or equal to 5 per hour. END was defined as an incremental increase in the National Institutes of Health Stroke Scale (NIHSS) score by greater than or equal to 1 point in motor power, or greater than or equal to 2 points in the total score within the first week after admission. RESULTS: Of the 305 patients studied, 254 (83.3%) patients had SA (AHI ≥ 5 per hour), and of these, 114 (37.4%) had mild SA (AHI 5-14 per hour), 59 (19.3%) had moderate SA (AHI 15-29 per hour), and 81 (26.6%) had severe SA (AHI ≥ 30 per hour). Thirty-six (11.8%) patients experienced END: 2 of the 51 (3.9%) patients without SA and 34 of the 254 (14.4%) patients with SA. Multivariable regression analysis showed AHI independently predicted END (odds ratio 1.024; 95% confidence interval 1.006 to 1.042; P = .008). CONCLUSIONS: SA is common in the acute phase of ischemic stroke, and SA severity is associated with the risk of END.


Assuntos
Isquemia Encefálica/fisiopatologia , Síndromes da Apneia do Sono/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Avaliação da Deficiência , Progressão da Doença , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo
5.
Heart Fail Clin ; 16(1): 45-51, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735314

RESUMO

Sleep-disordered breathing (SDB), including obstructive sleep apnea, central sleep apnea (CSA), and Cheyne-Stokes respiration, is common in patients with heart failure (HF) and associated with lower left ventricular ejection fraction (EF), increased arrhythmia burden, and increased mortality. Continuous positive airway pressure therapy improves short-term and long-term outcomes in HF patients. Adaptive servoventilation (ASV) therapy in patients with low-EF HF with predominant CSA is not recommended. Ongoing trials are evaluating whether ASV will have a role in SDB treatment. Phrenic nerve stimulation is an emerging treatment option that has shown promising outcomes. All HF patients should be screened for SDB.


Assuntos
Insuficiência Cardíaca/complicações , Síndromes da Apneia do Sono/etiologia , Sono/fisiologia , Função Ventricular Esquerda/fisiologia , Saúde Global , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Incidência , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/fisiopatologia , Taxa de Sobrevida/tendências
6.
Am J Orthod Dentofacial Orthop ; 156(6): 840-845, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31784018

RESUMO

INTRODUCTION: The aim was to study the association between snoring and development of occlusion, maxillary dental arch, and soft tissue profile in children with newly completed deciduous dentition. METHODS: Thirty-two (18 female, 14 male) parent-reported snorers (snoring ≥3 nights/week) and 19 (14 female, 6 male) nonsnorers were recruited. Breathing preference (nose or mouth) was assessed at the mean age of 27 months by otorhinolaryngologist. At the mean age of 33 months, an orthodontic examination was performed, including sagittal relationship of second deciduous molars, overjet, overbite, and occurrence of crowding and lateral crossbite. Bite index was obtained to measure maxillary dental arch dimensions (intercanine and intermolar width, arch length). A profile photograph was obtained to measure facial convexity. RESULTS: No significant differences were found between nonsnorers and snorers in any of the studied occlusal characteristics or in measurements of maxillary dental arch dimensions. Snorers were found to have a more convex profile than nonsnorers. Occurrence of mouth breathing was more common among snorers. CONCLUSIONS: Parent-reported snoring (≥3 nights/week) does not seem to be associated with an adverse effect on the early development of deciduous dentition, but snoring children seem to have more convex profile than nonsnorers. Snoring is a mild sign of sleep-disordered breathing, and in the present study its short time lapse may not have had adequate functional impact on occlusion.


Assuntos
Má Oclusão , Síndromes da Apneia do Sono , Ronco , Dente Decíduo , Pré-Escolar , Arco Dental/crescimento & desenvolvimento , Feminino , Humanos , Masculino , Maxila
7.
Rev. salud pública Parag ; 9(2): [P16-P21], Dic 2019.
Artigo em Espanhol | LILACS, BDNPAR | ID: biblio-1047046

RESUMO

Introducción: Los trastornos del sueño pueden afectar significativamente la calidad de vida de los niños. Objetivo: Determinar la frecuencia de trastornos respiratorios del sueño en niños que acuden a la consulta ortodóncica. Métodos: Para realizar este estudio de corte trasversal se aplicó la sección A del Pediatric Sleep Questionnaire de forma consecutiva a padres de niños que acudieron a la consulta ortodóncica en el Instituto de Odontología Avanzada en el año 2018. Para las mediciones de variables cualitativas y cuantitativas, se utilizaron medidas de frecuencias absolutas y relativas con el programa EPI Info™ 7 (CDC). Resultados: Se incluyeron 52 pacientes (28 niñas, 24 niños) con edad media 13 años (DP: 2,23). En los resultados se observó que 12 niños (23%) presentaban algún tipo de patología respiratoria siendo la alergia (58,3%) la más reportada; y la medicación mayormente usada (antialérgicos, broncodilatadores, etc.) en presentación de aerosol (40%) y sólo 4 casos (7,6%) fueron sometido a alguna cirugía de las vías respiratorias, principalmente en la adenoides. El ronquido se registró en 30 individuos (57,69 %) de los cuales 18 (58%) pertenecen al sexo femenino y 13 (42%) al sexo masculino, sin tener alguna asociación por edad o sexo. Las horas de sueño en la semana fueron en promedio 9h. (DS= 1,78). Conclusión: La alta frecuencia de ronquido entre los trastornos respiratorios detectados en pacientes que buscaron tratamiento ortodóncico en el IOA, señala que la aplicación de un cuestionario fue una herramienta adecuada para la detección de TRS y permite que los niños con riesgo puedan ser identificados y remitidos a un especialista. Palabras clave: Trastornos respiratorios. Ronquido. Niños. Ortodoncia. Paraguay


Introduction: Sleep disorders can significantly affect the quality of life of children. Objective: To determine the frequency of respiratory sleep disorders in children who come to the orthodontic office. Methods: To perform this cross-sectional study, section A of the Pediatric Sleep Questionnaire was applied consecutively to parents of children who attended the orthodontic clinic at the Institute of Advanced Dentistry in 2018. For qualitative and quantitative variables measurements , absolute and relative frequency measurements were used with the EPI Info ™ 7 (CDC) program. Results: We included 52 patients (28 girls, 24 boys) with an average age of 13 years (PD: 2.23). In the results it was observed that 12 children (23%) presented some type of respiratory disease being the allergy (58.3%) the most reported; and the most commonly used medication (antiallergics, bronchodilators, etc.) in aerosol presentation (40%) and only 4 cases (7.6%) were subjected to some surgery of the respiratory tract, mainly in the adenoids. The snoring was recorded in 30 individuals (57.69%) of whom 18 (58%) belong to the female sex and 13 (42%) to the male sex, without having any association by age or sex. The hours of sleep in the week were on average 9h. (DS = 1.78). Conclusion: The high frequency of snoring among the respiratory disorders detected in patients who sought orthodontic treatment in the IOA, indicates that the application of a questionnaire was an adequate tool for the detection of SDB and allows children at risk to be identified and referred to a specialist. Key words: Respiration Disorders. Snoring. Orthodontics. Child. Paraguay


Assuntos
Humanos , Masculino , Feminino , Adolescente , Transtornos Respiratórios , Criança , Consultórios Odontológicos , Síndromes da Apneia do Sono , Apneia do Sono Tipo Central
8.
Acta otorrinolaringol. esp ; 70(6): 364-372, nov.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184882

RESUMO

En noviembre 2014 la Sociedad Española de Otorrinolaringología, la Sociedad Española de Sueño y la Sociedad Española de Cirugía Maxilofacial propusieron y avalaron la elaboración de una Guía de Práctica Clínica sobre la exploración física de la vía aérea superior en pacientes con apnea obstructiva del sueño. La Guía ha seguido de forma estricta en toda su elaboración las recomendaciones del manual de elaboración de guías de práctica clínica del Sistema Nacional de Salud 2007 y 2009 y el manual de la Scottish Intercollegiate Guidelines Network (SIGN) 2015. El documento final puede ser altamente útil para los fines que se propuso inicialmente: ser un referente para unificar las regiones que deben ser exploradas en los pacientes con síndrome de apnea-hipoapnea obstructiva del sueño, mediante qué tipo de exploración y cómo gradarla, y expresada para todos los ámbitos asistenciales a los que estos pacientes pueden acudir. Las conclusiones y recomendaciones están basadas en una revisión exhaustiva y actualizada de la bibliografía con alto nivel de evidencia, además de la experiencia y conocimientos demostrados de todos los integrantes del grupo de elaboración. Dicho grupo se constituyó pensando siempre en la transversalidad del proyecto, y, por tanto, han participado especialistas de todos los ámbitos implicados (cirugía maxilofacial, medicina de familia, neumología, neurofisiología clínica, odontología y otorrinolaringología). Con la misma idea se seleccionaron los revisores externos del texto final


In November 2014 the Spanish Society of Otolaryngology, the Spanish Sleep Society and the Spanish Society of Maxillofacial Surgery proposed and endorsed the development of a Clinical Practice Guideline on the physical examination of the upper airway in patients with obstructive sleep apnoea. The Guideline strictly followed the recommendations of the manual for the preparation of clinical practice guidelines of the National Health System 2007 and 2009 and the manual of the Scottish Intercollegiate Guidelines Network (SIGN) 2015. The final document could be highly useful for the purposes that were originally proposed: to act as a reference to unify the regions that should be explored in patients with obstructive sleep apnoea-hypopnoea syndrome, the type of examination and how to grade it, and specific to all the care areas to which these patients have access. The conclusions and recommendations are based on a thorough and up-to-date review of the literature with a high level of evidence, as well as the experience and knowledge demonstrated by all the members of the drafting group. This group was formed bearing in mind at all times the transversality of the project, and, therefore, specialists from all the involved areas participated (maxillofacial surgery, family medicine, pneumology, clinical neurophysiology, odontology and otolaryngology). The external reviewers of the final text were selected along the same lines


Assuntos
Humanos , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/terapia , Manuseio das Vias Aéreas/normas , Exame Físico/métodos , Sociedades Médicas/normas , Exame Físico/normas
12.
Neurology ; 93(24): e2181-e2191, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31694923

RESUMO

OBJECTIVE: To determine the population-level odds of individuals with spinal cord injury (SCI) experiencing fatigue and sleep apnea, to elucidate relationships with level and severity of injury, and to examine associations with abnormal cerebrovascular responsiveness. METHODS: We used population-level data, meta-analyses, and primary physiologic assessments to provide a large-scale integrated assessment of sleep-related complications after SCI. Population-level and meta-analyses included more than 60,000 able-bodied individuals and more than 1,800 individuals with SCI. Physiologic assessments were completed on a homogenous sample of individuals with cervical SCI and matched controls. We examined the prevalence of (1) self-reported chronic fatigue, (2) clinically identified sleep apnea, and 3) cerebrovascular responsiveness to changing CO2. RESULTS: Logistic regression revealed a 7-fold elevated odds of chronic fatigue after SCI (odds ratio [OR] 7.9, 95% confidence interval [CI] 3.5-16.2), and that fatigue and trouble sleeping are correlated with the level and severity of injury. We further show that those with SCI experience elevated risk of clinically defined sleep-disordered breathing in more than 600 individuals with SCI (pooled OR 3.1, 95% CI 1.3-7.5). We confirmed that individuals with SCI experience a high rate of clinically defined sleep apnea using primary polysomnography assessments. We then provide evidence using syndromic analysis that sleep-disordered breathing is a factor strongly associated with impaired cerebrovascular responsiveness to CO2 in patients with SCI. CONCLUSIONS: Individuals with SCI have an increased prevalence of sleep-disordered breathing, which may partially underpin their increased risk of stroke. There is thus a need to integrate sleep-related breathing examinations into routine care for individuals with SCI.


Assuntos
Síndromes da Apneia do Sono/epidemiologia , Traumatismos da Medula Espinal/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Síndromes da Apneia do Sono/etiologia
13.
Cas Lek Cesk ; 158(5): 178-184, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31703529

RESUMO

Sleep is a condition of physiological relaxation for the cardiovascular system, and sleep-disordered breathing disturbs it. Recurrent episodes of sleep apnea disrupt the physiological interactions between sleep and the cardiovascular system. Sleep apnea can affect not only patients quality of life with cardiovascular diseases, but also their morbidity and mortality. Thus sleep apnea becomes a significant, influential risk factor in cardiology.


Assuntos
Doenças Cardiovasculares , Síndromes da Apneia do Sono , Doenças Cardiovasculares/complicações , Humanos , Qualidade de Vida , Fatores de Risco , Síndromes da Apneia do Sono/complicações
14.
Indian J Dent Res ; 30(4): 625-629, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31745063

RESUMO

Severe restriction of airway volume in the orofacial region, caused by temporomandibular joint (TMJ) ankylosis, may lead to obstructive sleep apnea (OSA). If the TMJ ankylosis is progressive, rarely, the caregivers may fail to notice the problem. Such patients may have only symptoms of snoring, daytime sleepiness, fatigue, inability to concentrate, and irritability. At times, emergency tracheostomy may be needed to increase the oxygen supply. Distraction osteogenesis (DO) is a less invasive surgical technique in the management of such OSA by correcting the reduced airway space. In DO, the angulation of the distractors and the pace of activation determine the success of the neo-generation of segments of bone. The formation of a well-corticated mandibular canal (MC) in the newly generated bone is an evidence of the success of the procedure. Such bilateral formation of the MC is not reported from this part of the world. We report a case of a 4-year-old boy who was struggling with OSA due to TMJ ankylosis. He was successfully treated by bilateral mandibular DO. The formation and cortication of the MC is discussed with emphasis on the neural regeneration.


Assuntos
Anquilose , Micrognatismo , Osteogênese por Distração , Síndromes da Apneia do Sono , Pré-Escolar , Humanos , Masculino , Mandíbula , Traqueostomia
17.
Zhonghua Er Ke Za Zhi ; 57(10): 792-796, 2019 Oct 02.
Artigo em Chinês | MEDLINE | ID: mdl-31594067

RESUMO

Objective: To study the short-term and long-term efficacy of the non-invasive ventilation treatment in children with spinal muscular atrophy (SMA) and sleep-disordered breathing. Methods: This was a prospective research to study the effect of night-time non-invasive ventilation in children with SMA and moderate to severe sleep-disordered breathing during March 2016 to January 2018, from the Pulmonary Department of Capital Institute of Pediatrics Affiliated Children's Hospital. Patients were divided into the treated group (with night-time non-invasive ventilation) and the control group (without ventilator). Sleep breathing pressure titration was suggested to the patients who were prepared to receive non-invasive ventilation. All cases were followed up for one year. Parameters'changes in polysomnography were assessed (paired t-test) in titration patients. Frequency of respiratory tract infection during the next year in the patients with and without ventilation was collected and compared (Mann-Whitney U-test). Results: Seventeen cases were recruited. The average age was (5.1±2.9) years, 10 cases were boys and 7 cases were girls. In the titration group (8 patients), after non-invasive ventilation, the average apnea hypopnea index was (3.8±2.5) times/h (t=4.086, P=0.005), hypopnea index was (2.4±1.2) times/h (t=2.779, P=0.027), average oxygen saturation during total sleep time was 0.966±0.007 (t=-5.292, P=0.001), and the minimum oxygen saturation was 0.906±0.023 (t=-3.938, P=0.006). All the above parameters were significantly improved after treatment. Than before, which was (16.6±9.7) times/h, (7.2±4.7) times/h, 0.946±0.015, 0.786±0.092 respectively. Ventilator mode for the 9 children with long time non-invasive ventilation at home was Bi-level positive airway pressure S/T. The positive airway pressure was set at 8-14 cmH(2)O (1 cmH(2)O=0.098 kPa) in inspiratory phase and 4-6 cmH(2)O in expiratory phase. In the treated group (9 patients), the average frequency of upper respiratory tract infection was 1.0 (0, 3.0) times/year (Z=-2.245, P=0.023), the lower respiratory tract infection was 0 (0, 0) times/year (Z=-3.189, P=0.001), hospitalization was 0 (0, 0) times/year (Z=-3.420, P<0.01), and admission to intensive care unit was 0 (0, 0) times/year (Z=-3.353, P=0.029). All the above indexes were significantly decreased compared with the control group (8 patients), which was 3.0 (2.3, 7.0) times/year, 2.0 (1.3, 4.5) times/year, 1.0 (1.0, 4.3) times/year, 0.5 (0, 1.0) times/year respectively. Conclusion: Non-invasive ventilation is efficient to SMA children with sleep-disordered breathing, and also can reduce the incidence of respiratory tract infections for children with SMA.


Assuntos
Ventilação não Invasiva/métodos , Síndromes da Apneia do Sono/terapia , Atrofias Musculares Espinais da Infância/terapia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Ventilação não Invasiva/efeitos adversos , Polissonografia , Estudos Prospectivos , Síndromes da Apneia do Sono/diagnóstico , Atrofias Musculares Espinais da Infância/diagnóstico , Resultado do Tratamento
19.
Sleep Med Clin ; 14(4): 431-439, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31640871

RESUMO

Obstructive sleep apnea is associated with excessive daytime sleepiness in about 50% of cases, and with increased risk of driving accidents. Treatment with continuous positive airway pressure effectively decreases such risk, but compliance with continuous positive airway pressure treatment is often suboptimal. According to the European Union Directive on driving risk, retention of a driving license in patients with obstructive sleep apnea requires assessment of sleepiness and adherence to continuous positive airway pressure treatment, but there remains uncertainty on the optimal methods to assess sleepiness on a large scale.


Assuntos
Condução de Veículo , Síndromes da Apneia do Sono/fisiopatologia , Sonolência , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Cooperação do Paciente , Fatores de Risco , Síndromes da Apneia do Sono/terapia , Vigília
20.
Praxis (Bern 1994) ; 108(12): 793-798, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31530127

RESUMO

Fatigue - a Common Symptom in General Practice Abstract. When patients suffering from fatigue consult a GP surgery, GPs should understand what patients mean by fatigue, how strongly they are affected in everyday life and how they themselves explain the symptom. In a next step, dangerous diseases such as depression, addiction or sleep apnea syndrome must be excluded. The main somatic and psychiatric causes of fatigue should be explored simultaneously with a more in-depth history. A simple physical exam and a few lab examinations are sufficient to capture the major disorders that present with the isolated symptom of fatigue. For further care, a primary biopsychosocial approach with a viable physician-patient relationship is crucial. Rough conclusions based on laboratory findings should be avoided; comorbidities must be considered.


Assuntos
Fadiga , Medicina Geral , Comorbidade , Depressão/complicações , Depressão/diagnóstico , Medicina de Família e Comunidade , Fadiga/diagnóstico , Fadiga/etiologia , Humanos , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
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