Effects of respiratory training on obstructive sleep apnea: systematic review and meta-analysis.

PURPOSE: This systematic review sought to answer the following focused question: "What are the effects of respiratory training devices on obstructive sleep apnea (OSA) outcomes in adults?" METHODS : The acronym "PICOS" was used to determine eligibility criteria, which consists of (P population) = adults with mild to moderate OSA, (I intervention) = spirometry devices or breathing exercises, (C comparison) = compared to no breathing exercises in adults (> 18 years) with mild to moderate OSA, (O outcomes) = improved sleep quality (sleep quality indexes) and improved apnea-hypopnea indexes (AHI), (S study types) = randomized, pseudo-randomized, and non-randomized clinical trials. The search was performed in the following databases: PubMed/Medline, LILACS, Scopus, Web of Science, Scopus, and Cochrane Library, in addition to gray literature through Google Scholar, Proquest, and Open Grey. The risk of bias was assessed using the Cochrane Collaboration tool. The certainty of the evidence was assessed using the GRADE tool. Meta-analyses of random effects were performed for the outcomes of interest. RESULTS: A total of 1171 references were found. Applying the eligibility criteria, six studies were included in qualitative synthesis. Expiratory exercises showed a decrease in the apnea-hypopnea index (AHI) when compared to baseline (MD = - 8.4; 95% CI = - 12.4 to - 4.4; I2 = 19%). There was a decrease in values compared to baseline (MD = - 4.4; 95% CI = - 8.2 to - 0.6; I2 = 0%) for the Epworth Sleepiness Scale (ESS), when considering the inspiratory exercises. Both groups of breathing exercises showed a significant decrease in the mean index assessed by the Pittsburgh Sleep Quality Index (PSQI). CONCLUSION: Results of this meta-analysis suggests that breathing exercises lead to a measurable improvement in AHI for patients with mild to moderate OSA, as well as an improvement in sleep quality and daytime sleepiness. SYSTEMATIC REVIEW REGISTRATION: CRD42020148513 (PROSPERO).

Front lines of the COVID-19 pandemic: what is the effectiveness of using personal protective equipment in health service environments?-a systematic review.

PURPOSE: This systematic review aimed to evaluate the effectiveness of the use of personal protective equipment (PPE) in closed environments, similar to waiting or exam rooms of healthcare facilities, in the face of exposure to a bioaerosol. METHODS: Combinations of words were selected for six electronic databases and for the gray literature. To consider the eligibility of the studies to be included/excluded, the acronym "PECOS" was used: humans and/or experimental models that simulate aerosol (Population); aerosol exposure and the use of masks/respirators (exposition/intervention); controlled or not controlled (comparison); effectiveness of PPE and the receiver exposure (outcomes); and randomized clinical studies or not, observational or laboratory simulation studies (Studies design). RESULTS: A total of 4820 references were retrieved by the search strategy. Thirty-five articles were selected for complete reading, of which 13 articles were included for qualitative synthesis. A surgical mask or N95 respirator reduced the risk of transmission, even over short distances. The use of masks, even those with less filtering power, when used by all individuals in the same environment is more effective in reducing risk than the use of respirators with high filtering power for only some of the individuals present. CONCLUSION: The use of mask in closed environments is effective in reducing the risk of transmission and contagion of a contaminated bioaerosol, with greater effectiveness when these devices are used by the source and receiver, regardless of the equipment's filtering power. (PROSPERO 2020 CRD 42020183759).

Is there scientific evidence of the mouthwashes effectiveness in reducing viral load in Covid-19? A systematic review.

BACKGROUND: The aim of this research is to verify whether there is evidence in the literature regarding the decrease in viral load present in saliva after using three types of mouthwashes. MATERIAL AND METHODS: Clinical and/or in vitro experimental studies that have used mouthwashes as a form of intervention to reduce the viral load in saliva were included. Combinations of words and appropriate truncations were adapted for each of the seven selected electronic bases including grey literature. RESULTS: The selection of articles was carried out in two phases by two independent reviewers. After removing duplicate articles, 1245 references were maintained, and 2 articles were included in the Systematic Review. Both studies were performed in vitro and tested the virucidal action of the PVP-I solution for mouthwash at two different concentrations, 1% without dilution and 7% with 1:30 dilution, on the SARS-CoV and MERS-CoV viruses. Both showed a viral reduction of ≥ 99.99% with 15 s exposure. CONCLUSIONS: Based on the evidence currently available in the literature, PVP-I, at concentrations of 1 and 7%, appears to be the most effective mouthwash for reducing the viral load of COVID-19 present in human saliva. However, the guidelines for dental care refer to the use of hydrogen peroxide but there is insufficient scientific evidence to support this recommendation. Key words:COVID-19, Coronavirus, Mouthwash, Chlorhexidine, Hydrogen Peroxide, PVP-I.