Sleep parameters in patients with chronic hypersensitivity pneumonitis: a case-control study / Parâmetros do sono em pacientes com pneumonite de hipersensibilidade crônica: estudo de caso-controle

ABSTRACT Objective: To compare patients with chronic hypersensitivity pneumonitis (cHP) and controls with normal spirometry in terms of their sleep characteristics, as well as to establish the prevalence of obstructive sleep apnea (OSA) and nocturnal hypoxemia. Secondary objectives were to identify factors associated with OSA and nocturnal hypoxemia; to correlate nocturnal hypoxemia with the apnea-hypopnea index (AHI) and lung function, as well as with resting SpO2, awake SpO2, and SpO2 during exercise; and to evaluate the discriminatory power of sleep questionnaires to predict OSA. Methods: A total of 40 patients with cHP (cases) were matched for sex, age, and BMI with 80 controls, the ratio of controls to cases therefore being = 2:1. The STOP-Bang questionnaire, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index, the Berlin questionnaire and the Neck circumference, obesity, Snoring, Age, and Sex (NoSAS) score were applied to all cases, and both groups underwent full-night polysomnography. Results: The patients with cHP had longer sleep latency, lower sleep efficiency, a lower AHI, a lower respiratory disturbance index, fewer central apneas, fewer mixed apneas, and fewer hypopneas than did the controls. The patients with cHP had significantly lower nocturnal SpO2 values, the percentage of total sleep time spent below an SpO2 of 90% being higher than in controls (median = 4.2; IQR, 0.4-32.1 vs. median = 1.0; IQR, 0.1-5.8; p = 0.01). There were no significant differences between cases with and without OSA regarding the STOP-Bang questionnaire, NoSAS, and ESS scores. Conclusions: The prevalence of OSA in cHP patients (cases) was high, although not higher than that in controls with normal spirometry. In addition, cases had more hypoxemia during sleep than did controls. Our results suggest that sleep questionnaires do not have sufficient discriminatory power to identify OSA in cHP patients.

RESUMO Objetivo: Comparar pacientes com pneumonite de hipersensibilidade crônica (PHc) e controles com espirometria normal quanto às características do sono, bem como estabelecer a prevalência de apneia obstrutiva do sono (AOS) e hipoxemia noturna. Os objetivos secundários foram identificar fatores associados à AOS e hipoxemia noturna; correlacionar a hipoxemia noturna com o índice de apneias e hipopneias (IAH), função pulmonar, SpO2 em repouso, SpO2 em vigília e SpO2 durante o exercício; e avaliar o poder discriminatório de questionários do sono para predizer AOS. Métodos: Um total de 40 pacientes com PHc (casos) foram emparelhados por sexo, idade e IMC com 80 controles (2:1). O questionário STOP-Bang, a Escala de Sonolência de Epworth (ESE), o Índice de Qualidade do Sono de Pittsburgh, o questionário de Berlim e o escore Neck circumference, obesity, Snoring, Age, and Sex (NoSAS, circunferência do pescoço, obesidade, ronco, idade e sexo) foram aplicados a todos os casos, e ambos os grupos foram submetidos a polissonografia de noite inteira. Resultados: Os pacientes com PHc apresentaram maior latência do sono, menor eficiência do sono, menor IAH, menor índice de distúrbio respiratório, menos apneias centrais, menos apneias mistas e menos hipopneias do que os controles. Os pacientes com PHc apresentaram SpO2 noturna significativamente menor; a porcentagem do tempo total de sono com SpO2 < 90% foi maior que nos controles (mediana = 4,2; IIQ: 0,4-32,1 vs. mediana = 1,0; IIQ: 0,1-5,8; p = 0,01). Não houve diferenças significativas entre os casos com e sem AOS quanto à pontuação no questionário STOP-Bang, no NoSAS e na ESE. Conclusões: A prevalência de AOS em pacientes com PHc (casos) foi alta, embora não tenha sido maior que a observada em controles com espirometria normal. Além disso, os casos apresentaram mais hipoxemia durante o sono do que os controles. Nossos resultados sugerem que os questionários do sono não têm poder discriminatório suficiente para identificar AOS em pacientes com PHc.

Comparing CPAP masks during initial titration for Obstructive Sleep Apnea Syndrome: one-year experience

Abstract Objective: Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for OSA. A wide variety of masks are used during CPAP therapy. The aim of the study is to compare polysomnography outcomes during titration for different types of masks (oronasal, nasal and pillow) and assess the impact on PAP titration. Methods: We retrospectively analyzed all CPAP titration polysomnography for one year. Anthropometric data and baseline apnea severity were documented. Results: A total of 497 patients were evaluated. Nasal masks were used in 82.3% (n = 409), pillow in 14.1% (n = 70) and oronasal in 3.6% (n = 18). There was no difference according to body mass index and baseline apnea-hypopnea index among the groups. The oronasal group was older and had higher titrated CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency, more superficial N1 sleep and longer wake time after sleep onset. All other polysomnography outcomes were similar among the groups. The mean CPAP level was 11.6 ± 2.1 cm H2O for the oronasal mask, 10.1 ± 2.1 cm H2O for the nasal mask and 9.8 ± 2.2 cm H2O for the pillow. The residual apnea-hypopnea index was 10.4 ± 7.9 for the oronasal mask, 5.49 ± 5.34 events/h for the nasal mask and 4.98 ± 5.48 events/h for the pillow. The baseline apnea-hypopnea index was correlated with of a higher CPAP pressure for all the groups (p< 0.001 for the nasal group, p = 0.001 for the pillow group and p = 0.049 for the oronasal group). Body mass index and residual AHI were correlated with of a higher CPAP pressure for the nasal and pillow groups only (p < 0.001). Conclusion: The interface can have a significant impact on the effectiveness of PAP titration. Patients with oronasal masks have higher CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency and higher wake time after sleep onset. Oronasal masks should not be recommended as the first choice for apnea patients. Level of evidence: Level 3.

Risk prediction for Obstructive Sleep Apnea prognostic in Obese patients referred for bariatric surgery / Predição de risco para o prognóstico de Apneia Obstrutiva do Sono em pacientes encaminhados para cirurgia bariátrica

ABSTRACT Objectives (i) To assess the anthropometric measurements, along with the clinical characteristics and quality of life profiles of the studied patients; (ii) To determine the occurrence and severity of Obstructive Sleep Apnea (OSA), using polysomnography; and (iii) To identify the best anthropometric and clinical indicators to predict OSA in obese patients who are candidates for bariatric surgery. Methods a prospective observational study conducted in a private clinic, using consecutive sampling of patients eligible for bariatric surgery with a BMI ≥ 40, or with a BMI of ≥ 35 kg/m² accompanied by comorbidities associated with obesity. Results Sixty patients were initially selected, of whom 46 agreed to take part in the preoperative evaluation. OSA was observed in 76% of patients, 59% of whom had moderate-to-severe OSA, with a predominance of men in these groups. Among the variables suggesting statistical difference between groups, waist-to-hip ratio (WHR) was the only clinical factor associated with scores the apnea hypopnea index (AHI) ≥ 15, with a cut-off value of 0.95. The results showed that patients scoring above 0.95 are three times more likely to have moderate-to-severe apnea. Conclusion The best risk factor for the prognostic of moderate-to-severe OSA was presenting a WHR score with a cut-off value of 0.95 or above.

RESUMO Objetivos (i) Avaliar as medições antropométricas e as características clínicas e perfis de qualidade de vida dos pacientes estudados, (ii) determinar a ocorrência e severidade da Apneia Obstrutiva do Sono (AOS) por meio de polissonografia e (iii) identificar os melhores indicadores antropométricos e clínicos para prever a AOS em pacientes obesos que são candidatos à cirurgia bariátrica. Métodos Estudo prospectivo de observação conduzido em uma clínica particular, por meio de amostragem consecutiva de pacientes qualificados para cirurgia bariátrica com IMC ≥ 40 ou IMC de ≥ 35 kg/m² e comorbidades associadas à obesidade. Resultados Inicialmente, 60 pacientes foram selecionados, dos quais 46 concordaram em participar de avaliação pré-operatória. A AOS foi observada em 76% dos pacientes, sendo que 59% deles apresentavam AOS de moderada a grave, com uma predominância de homens nesses grupos. Entre as variáveis que sugerem diferença estatística entre os grupos, a relação cintura/quadril (RCQ) foi o único fator clínico associado à pontuação no índice de apneia-hipopneia (IAH) ≥ 15, com um valor de corte de 0.95. Os resultados mostram que pacientes com uma pontuação acima de 0,95 têm três vezes mais probabilidade de apresentarem apneia de moderada a grave. Conclusão O melhor fator de risco para o prognóstico de AOS de moderada a grave foi apresentado na pontuação de RCQ, com um valor de corte de 0,95 ou acima.

Using craniofacial characteristics to predict optimum airway pressure in obstructive sleep apnea treatment / Uso de características craniofaciais para predizer a pressão ideal nas vias aéreas notratamento da apneia obstrutiva do sono

Abstract Introduction: Manual titration is the gold standard to determinate optimal continuous positive airway pressure, and the prediction of the optimal pressure is important to avoid delays in prescribing a continuous positive airway pressure treatment. Objective: To verify whether anthropometric, polysomnographic, cephalometric, and upper airway clinical assessments can predict the optimal continuous positive airway pressure setting for obstructive sleep apnea patients. Methods: Fifty men between 25 and 65 years, with body mass indexes of less than or equal to 35 kg/m2 were selected. All patients had baseline polysomnography followed by cephalometric and otolaryngological clinical assessments. On a second night, titration polysomnography was carried out to establish the optimal pressure. Results: The average age of the patients was 43 ± 12.3 years, with a mean body mass index of 27.1 ± 3.4 kg/m2 and an apnea-hypopnea index of 17.8 ± 10.5 events per hour. Smaller mandibular length (p = 0.03), smaller atlas-jaw distance (p = 0.03), and the presence of a Mallampati III and IV (p = 0.02) were predictors for higher continuous positive airway pressure. The formula for the optimal continuous positive airway pressure was: 17.244 − (0.133 × jaw length) + (0.969 × Mallampati III and IV classification) − (0.926 × atlas-jaw distance). Conclusion: In a sample of male patients with mild-to-moderate obstructive sleep apnea, the optimal continuous positive airway pressure was predicted using the mandibular length, atlas-jaw distance and Mallampati classification.

Resumo Introdução: A titulação manual é o padrão-ouro para determinar a pressão ideal para o tratamento com a pressão positiva contínua nas vias aéreas; e a predição da pressão ideal é importante para evitar retardos na sua prescrição. Objetivo: Verificar se as avaliações clínicas antropométricas, polissonográficas, cefalométricas e das vias aéreas superiores podem predizer a configuração ideal da pressão do aparelho de pressão positiva contínua nas vias aéreas para pacientes com apneia obstrutiva do sono. Método: Foram selecionados 50 homens entre 25 e 65 anos, com índice de massa corporal menor ou igual a 35 kg/m2. Todos os pacientes fizeram polissonografia basal, seguida de avaliações clínicas cefalométricas e otorrinolaringológicas. Na segunda noite, foi feita polissonografia de titulação para estabelecer a pressão ideal. Resultados: A média de idade dos pacientes foi de 43 ± 12,3 anos, com índice de massa corporal médio de 27,1 ± 3,4 kg/m2 e índice de apneia-hipopneia de 17,8 ± 10,5 eventos por hora. Menor comprimento mandibular (p = 0,03), menor distância atlas-maxila (p = 0,03) e a presença de Mallampati III e IV (p = 0,02) foram preditores de pressão mais elevada. A fórmula para a pressão positiva contínua nas vias aéreas foi: 17,24 - (0,133 × comprimento da mandíbula) + (0,969 × classificação de Mallampati III e IV) - (0,926 × distância atlas-mandíbula). Conclusão: Em uma amostra de homens com apneia obstrutiva do sono leve a moderada, a pressão positiva contínua nas vias aéreas foi predita com o comprimento mandibular, a distância atlas-mandíbula e a classificação de Mallampati.

Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review

ABSTRACT Introduction: Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. Objective: This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. Methods: An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. Results: A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. Conclusion: The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.

RESUMO Introdução: efeitos colaterais oclusais e o desenvolvimento de dor e/ou disfunção do complexo temporomandibular podem levar à baixa adesão ou ao abandono do tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular. Objetivo: fornecer uma revisão abrangente da literatura sobre os efeitos colaterais craniofaciais do tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular. Métodos: foram realizadas buscas eletrônicas sistematicamente no PubMed e na Biblioteca Virtual em Saúde até outubro de 2016. Foram incluídos apenas Ensaios Controlados Randomizados, com o objetivo primário de mensurar objetivamente os efeitos colaterais no complexo craniofacial associados ao uso de aparelhos de avanço mandibular no tratamento do ronco e da apneia obstrutiva do sono. Os pacientes estudados deveriam ter 20 anos de idade ou mais. A avaliação do risco de viés dos trabalhos selecionados seguiu as recomendações do The Cochrane Risk of Bias. Resultados: no total, 62 artigos completos foram avaliados em relação à elegibilidade. Após o processo de revisão, apenas 6 atenderam aos critérios de inclusão. Todos os estudos foram julgados como tendo alto risco de viés. Os efeitos colaterais mais frequentemente encontrados foram de natureza dentária e incluíram uma diminuição do overjet e do overbite. O risco de desenvolvimento de dor ou disfunção do complexo temporomandibular pareceu limitado na avaliação de longo prazo do uso do aparelho de avanço mandibular. Conclusão: as evidências disponíveis são limitadas e sugerem que o tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular resulta em alterações craniofaciais predominantemente dentárias, especialmente nas avaliações de longo prazo. Considerando-se que a apneia obstrutiva do sono é crônica e que os aparelho intrabucais se constituem em uma forma de tratamento contínuo e por tempo indefinido, é necessário um acompanhamento individualizado para monitorar possíveis efeitos colaterais no complexo craniofacial. Também é importante informar aos pacientes sobre esses possíveis efeitos, especialmente àqueles nos quais são esperadas maiores alterações oclusais ou nos quais elas sejam desfavoráveis. Ainda são necessárias avaliações de longo prazo dos efeitos colaterais do tratamento com aparelhos intrabucais, com amostras maiores e mais homogêneas.

Predictors of success for mandibular repositioning appliance in obstructive sleep apnea syndrome

Abstract The characteristics of non-obese patients with mild to moderate Obstructive Sleep Apnea Syndrome (OSAS) who will present with a good response to Mandibular Repositioning Appliance (MRA) treatment have not yet been well established in the literature. The aim of this study is to assess whether polysomnographic (PSG), demographic, anthropometric, cephalometric, and otorhinolaryngological parameters predict MRA success in the treatment of OSAS. Forty (40) males with mild and moderate OSAS were assessed pretreatment and 2-months post-treatment after wearing an MRA. Demographic, anthropometric, otorhinolaryngological (ENT), cephalometric, and polysomnographic parameters, including continuous positive airway pressure (CPAP) titrated pressure, dental models, Epworth Sleepiness Scale, quality of life (Short Form SF-36), and mood state (Profile of Mood States – POMS), were assessed. The responders exhibited fewer oropharyngeal alterations, increased upper pharyngeal space, reduced lower airway space, and increased mandibular intercanine width, and they had milder disease. Nevertheless, no predictive factors of MRA success could be found. MRA was more successful among men with a more pervious airway, a larger interdental width and milder OSAS. However, a combined [1] functional and structural assessment is needed to successfully predict the [2] effectiveness of MRA treatment of OSA.

Orofacial-cervical alterations in individuals with upper airway resistance syndrome / Alteração cérvico-orofacial em indivíduos com síndrome da resistência de via aérea superior

ABSTRACT INTRODUCTION: Studies that assess the upper airways in sleep-related breathing disorders have been performed only in patients with obstructive sleep apnea syndrome who seek medical attention. Therefore, in addition to the need for population studies, there are no data on the orofacial-cervical physical examination in subjects with upper airway resistance syndrome. OBJECTIVES: To compare the orofacial-cervical examination between volunteers with upper airway resistance syndrome and without sleep-related breathing disorders. METHODS: Through questionnaires, physical measurements, polysomnography, and otorhinolaryngological evaluation, this study compared the orofacial-cervical physical examination, through a systematic analysis of the facial skeleton, mouth, throat, and nose, between volunteers with upper airway resistance syndrome and volunteers without sleep-related breathing disorders in a representative sample of the adult population of the city of São Paulo. RESULTS: There were 1042 volunteers evaluated; 49 subjects (5%) were excluded as they did not undergo otorhinolaryngological evaluation, 381 (36%) had apnea-hypopnea index > 5 events/hour, and 131 (13%) had oxyhemoglobin saturation < 90%. Among the remaining 481 subjects (46%), 30 (3%) met the criteria for the upper airway resistance syndrome definition and 53 (5%) met the control group criteria. At the clinical evaluation of nasal symptoms, the upper airway resistance syndrome group had more oropharyngeal dryness (17% vs. 29.6%; p = 0.025) and septal deviation grades 1-3 (49.1% vs. 57.7%; p = 0.025) when compared to controls. In the logistic regression model, it was found that individuals from the upper airway resistance syndrome group had 15.6-fold higher chance of having nose alterations, 11.2-fold higher chance of being hypertensive, and 7.6-fold higher chance of complaining of oropharyngeal dryness when compared to the control group. CONCLUSION: Systematic evaluation of the facial skeleton, mouth, throat, and nose, between volunteers with upper airway resistance syndrome and volunteers without sleep-related breathing disorders, showed that the presence of upper airway resistance syndrome is mainly associated with nasal alterations and oropharyngeal dryness, in addition to the risk of hypertension, regardless of gender and obesity.

Resumo Introdução: Estudos que avaliam a via aérea superior (VAS) nos distúrbios respiratórios relacionados ao sono (DRRS) foram realizadas somente em pacientes com Síndrome da apneia obstrutiva do sono (SAOS) que procuram o atendimento médico. Portanto, além da necessidade de estudos populacionais, não há dados sobre o exame físico cérvico-orofacial em indivíduos com Síndrome de Resistência das Vias Aéreas Superiores (SRVAS). Objetivos: Comparar o exame cérvico orofacial entre voluntário com SRVAS e sem DRRS. Método: Através de questionários, medidas físicas, polissonografia e avaliação otorrino-laringológica comparou-se o exame físico cérvico orofacial, através de uma análise sistemática do esqueleto facial, boca, faringe e nariz, entre voluntários com SRVAS e voluntários sem DRRS em uma amostra representativa da população adulta da cidade de São Paulo. Resultados: Avaliamos 1042 voluntários. Foram excluídos: 49 indivíduos (5%) que não realizaram avaliação otorrinolaringológica; 381 (36%) apresentaram índice de apneia e hipopnéia (IAH) > 5 eventos/hora e 131 (13%) apresentaram saturação da oxihemoglobina < 90%. Entre os 481 voluntários restantes (46%), 30 (3%) preenchiam os critérios estabelecidos para a definição de SRVAS e 53 (5%) que preenchiam os critérios do grupo controle. Na avaliação clínica dos sintomas nasais, o grupo SRVAS apresentou mais ressecamento orofaríngeo (17% vs. 29,6%; p = 0,025), desvio septal grau 1 a 3 (49,1% vs. 57,7%; p = 0,025), comparado ao controle. No modelo de regressão logística observamos que indivíduos do grupo SRVAS apresentaram uma razão de chance 15,6 vezes maior de apresentarem nariz alterado; 11,2 vezes maior de serem hipertensos e 7,6 vezes maior de se queixarem de ressecamento orofaríngeo quando comparados ao grupo controle. Conclusão: A avaliação sistemática do esqueleto facial, boca, faringe e nariz, entre voluntários com SRVAS e voluntários sem DRRS, mostrou que a presença de SRVAS está principalmente associada à alterações nasais e ressecamento orofaríngeo, além do risco de hipertensão arterial, independentemente do gênero e obesidade.

Factors influencing excessive daytime sleepiness in adolescents / Fatores que influenciam na sonolência excessiva diurna em adolescentes

Abstract Objective: Sleep deprivation in adolescents has lately become a health issue that tends to increase with higher stress prevalence, extenuating routines, and new technological devices that impair adolescents' bedtime. Therefore, this study aimed to assess the excessive sleepiness frequency and the factors that might be associated to it in this population. Methods: The cross-sectional study analyzed 531 adolescents aged 10–18 years old from two private schools and one public school. Five questionnaires were applied: the Cleveland Adolescent Sleepiness Questionnaire; the Sleep Disturbance Scale for Children; the Brazilian Economic Classification Criteria; the General Health and Sexual Maturation Questionnaire; and the Physical Activity Questionnaire. The statistical analyses were based on comparisons between schools and sleepiness and non-sleepiness groups, using linear correlation and logistic regression. Results: Sleep deprivation was present in 39% of the adolescents; sleep deficit was higher in private school adolescents (p < 0.001), and there was a positive correlation between age and sleep deficit (p < 0.001; r = 0.337). Logistic regression showed that older age (p = 0.002; PR: 1.21 [CI: 1.07–1.36]) and higher score level for sleep hyperhidrosis in the sleep disturbance scale (p = 0.02; PR: 1.16 [CI: 1.02–1.32]) were risk factors for worse degree of sleepiness. Conclusions: Sleep deficit appears to be a reality among adolescents; the results suggest a higher prevalence in students from private schools. Sleep deprivation is associated with older age in adolescents and possible presence of sleep disorders, such as sleep hyperhidrosis.

Resumo Objetivo: A privação de sono na adolescência é um importante problema de saúde na atualidade e só tende a se agravar com o aumento do estresse, da rotina extenuante e do advento de novos aparelhos tecnológicos que parecem refletir negativamente no início do sono em adolescentes. O estudo objetiva avaliar a frequência da sonolência excessiva e quais fatores podem estar associados a ela nessa população. Métodos: O estudo transversal avaliou 531 adolescentes de 10 a 18 anos em duas escolas de ensino privado e uma de ensino público e aplicou para cada adolescente cinco questionários: Cleveland Adolescent Sleepiness Questionnaire; Sleep Disturbance Scale for Children; Critério de Classificação Econômica Brasil; Questionário Geral de Saúde e Maturação Sexual; Questionário de Atividade Física. Fizeram-se comparações entre as escolas e entre grupos com e sem sonolência por meio de correlação linear e regressão logística. Resultados: Observou-se privação de sono em 39% dos adolescentes, débito de sono maior para escolares do ensino privado (p < 0,001) e correlação positiva entre idade e débito do sono (p < 0,001; r = 0,337). Na regressão logística, apontaram-se como fatores para pior grau de sonolência maior faixa etária dos escolares (p = 0,002; RP: 1,21 [IC: 1,07-1,36]) e maior escore na variável hiperidrose do sono do questionário de distúrbios do sono (p = 0,02; RP: 1,16 [IC: 1,02-1,32]). Conclusões: O déficit de sono é uma realidade na população estudada e apresenta-se pior em escolares do ensino privado. A privação de sono está relacionada com a maior faixa etária dos adolescentes e possível presença de distúrbios do sono, como a hiperidrose do sono.

Eszopiclone versus zopiclone in the treatment of insomnia

OBJECTIVE: To determine the therapeutic effects of two selective GABA-A agonists, zopiclone and eszopiclone, in the treatment of insomnia. METHODS: This study comprised a phase III, single-center, randomized, double-blind, double-dummy, parallel-group, non-inferiority trial. Patients were randomized to receive zopiclone 7.5 mg or eszopiclone 3 mg, both orally, for four weeks. In total, 199 patients were evaluated during two visits and then followed for at least six weeks. The primary endpoint was the Insomnia Severity Index after four weeks of treatment. Secondary endpoints were obtained through polysomnography data, including total sleep time, sleep latency and sleep efficiency. The frequency of adverse events was also analyzed. ClinicalTrials.gov: NCT01100164. RESULTS: The primary efficacy analysis demonstrated the non-inferiority of eszopiclone over zopiclone. Analysis of objective parameters assessed by polysomnography showed that eszopiclone increased total sleep time and also improved sleep efficiency. The safety profile of both study treatments was similar and the most common events reported in both groups were dysgeusia, headache, dizziness, irritability and nausea. Adverse events were observed in 223 patients, 109 (85.2%) in the eszopiclone group and 114 (87.7%) in the zopiclone group. CONCLUSION: Based on the Insomnia Severity Index at the end of four weeks of treatment, eszopiclone demonstrated efficacy comparable to that of zopiclone in the treatment of insomnia, increasing total sleep time as well as sleep efficiency according to polysomnography.

Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome, / O impacto das alterações da via aérea superior na adesão e sucesso do tratamento com aparelho intraoral na Síndrome da Apneia Obstrutiva do Sono

ABSTRACT INTRODUCTION: The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS). OBJECTIVE: To assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS. METHODS: Prospective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared. RESULTS: 28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p = 0.02), smaller cervical circumference (p = 0.05), and lower AHI at baseline (p = 0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p = 0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence. CONCLUSION: MAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities.

RESUMO INTRODUÇÃO: O Aparelho Intraoral (AIO) é uma opção para tratamento da Síndrome da Apneia Obstrutiva do Sono (SAOS). OBJETIVOS: Avaliar a influência das alterações da VAS e esqueléticas faciais através de uma avaliação clinica sistematizada no sucesso e adesão ao (AIO) em pacientes com (SAOS). MÉTODO: Estudo prospectivo em que foram avaliados 30 pacientes com SAOS leve a moderada e indicação de AIO. Protocolo incluiu questionários de sono e queixas nasais; polissonografia e avaliação da VAS por rinoscopia anterior e oroscopia. Os parâmetros analisados foram comparados entre pacientes com sucesso e insucesso, e com boa e má adesão à terapia. RESULTADOS: Completaram o protocolo 28 pacientes. O sucesso ao tratamento foi de 64,3% e a adesão 60,7%. Os fatores associados ao sucesso foram menor idade, menor circunferência cervical e menor IAH basal. Quanto à presença de alterações nasais, houve predomínio de pacientes sem alteração nasal entre os pacientes com sucesso comparados àqueles com insucesso (p = 0,04); o que não foi observado em relação à adesão. Quanto às alterações faríngeas e alterações esqueléticas faciais, não houve significância. CONCLUSÃO: O sucesso do tratamento com AIO foi significativamente menor nos pacientes com alterações nasais, porém a adesão não foi influenciada pela presença de alterações de VAS ou esqueléticas faciais.

Influence of obstructive sleep apnea syndrome in the fluctuation of the submaximal isometric torque of knee extensors in patients with early-grade osteoarthritis

OBJECTIVE: The aim of this study was to investigate whether obstructive sleep apnea (OSA) alters the fluctuation of submaximal isometric torque of the knee extensors in patients with early-grade osteoarthritis (OA).METHOD: The study included 60 male volunteers, aged 40 to 70 years, divided into four groups: Group 1 (G1) - Control (n=15): without OA and without OSA; Group 2 (G2) (n=15): with OA and without OSA; Group 3 (G3) (n=15): without OA and with OSA; and Group 4 (G4) (n=15) with OA and with OSA. Five patients underwent maximal isometric contractions of 10 seconds duration each, with the knee at 60° of flexion to determine peak torque at 60°. To evaluate the fluctuation of torque, 5 submaximal isometric contractions (50% of maximum peak torque) of 10 seconds each, which were calculated from the standard deviation of torque and coefficient of variation, were performed.RESULTS: Significant differences were observed between groups for maximum peak torque, while G4 showed a lower value compared with G1 (p=0.005). Additionally, for the average torque exerted, G4 showed a lower value compared to the G1 (p=0.036). However, no differences were found between the groups for the standard deviation (p=0.844) and the coefficient of variation (p=0.143).CONCLUSION: The authors concluded that OSA did not change the parameters of the fluctuation of isometric submaximal torque of knee extensors in patients with early-grade OA.

Upper airway dimensions in patients with craniocervical junction malformations with and without sleep apnea. A pilot case-control study / Dimensões da via aérea superior em pacientes com malformações da transição craniocervical com e sem apnéia do sono. Um estudo piloto caso-controle

Objective Patients with craniocervical junction malformations (CCJM) tend to suffer more frequently from sleep respiratory disturbances, which are more frequent and severe in patients with basilar invagination. Here we evaluate if patients with CCJM and sleep respiratory disorders (SRD) present smaller airway dimensions than patients without SRD. Method Patients with CCCM with and without sleep respiratory disturbances were evaluated clinically by Bindal's score, modified Mallampati classification, full-night polysomnography and upper airway cone beam tomography. Results Eleven patients had sleep respiratory disorders (SRD), and nine patients performed control group without SRD. CCJM patients with SRD were predominantly female, older, had higher BMI, were more likely to have Mallampati grades 3 and 4 and had statistically significant smaller anteroposterior diameter of the upper airway than patients without SRD. Conclusion Patients with CCJM and sleep respiratory disturbances have higher BMI, higher Mallampati score and smaller anterior posterior diameter of the upper airway. .

Objetivo : Pacientes com malformação da transição craniocervical (MTCC) tendem a apresentar mais frequentemente distúrbios respiratórios do sono (DRS), os quais são mais intensos em pacientes com invaginação basilar. O objetivo desse estudo é avaliar se pacientes com MTCC e DRS apresentam dimensões das vias aéreas reduzidas em comparação a pacientes sem DRS. Método : Pacientes com MTCC com e sem apneia do sono foram avaliados com a escala de Bindal, classificação de Mallampati modificada, polissonografia de noite inteira e tomografia da via aérea superior. Resultados Onze pacientes tinham DRS e nove não apresentaram esses distúrbios (grupo controle). Pacientes com MTCC e DRS foram principalmente mulheres, mais velhos, apresentaram maior IMC e maior gradação na escala de Mallampati, além de menor diâmetro anteroposterior de via aérea superior do que pacientes sem DRS. Conclusão Pacientes com MTCC e DRS têm maior IMC, maior pontuação na escala de Mallampati e menor diâmtero anteroposterior da via aérea superior. .

New clinical staging for pharyngeal surgery in obstructive sleep apnea patients, / Novo modelo de estadiamento para indicação de cirurgia faríngea em pacientes com apneia obstrutiva do sono,

Introduction: The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients. Objective: To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome. Methods: A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m2 with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4. Results: The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I–V. Conclusion: The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III). .

Introdução: O sucesso da cirurgia faríngea no tratamento da síndrome da apneia obstrutiva do sono (SAOS) depende da adequada seleção de pacientes. Objetivo: Propor um novo estadiamento para indicação de cirurgia faríngea na SAOS. Método: Estudo retrospectivo, onde foram inclusos, 54 pacientes submetidos a amigdalectomia ampliada, divididos em 6 estádios. Estádio I: pacientes com tonsilas palatinas graus 3/4 e índice de Mallampati modificado (IMM) 1/2; Estádio II: tonsilas palatinas 3/4 e IMM 3/4; Estádio III: tonsilas palatinas 1/2 e IMM 1/2; Estádio IV: tonsilas palatinas 1/2 e IMM 3/4; Estádio V: IMC (índice de massa corpórea) ≥ com tonsilas palatinas 3/4 e IMM 1, 2, 3 ou 4. Estádio VI: IMC ≥ kg/m2 com tonsilas palatinas 1 ou 2 e IMM 1, 2, 3, ou 4. Resultados: As taxas de sucesso cirúrgico foram de 88,9%; 75,0%; 35,7%; 38,5% e 100,0% nos estádios I a V. Conclusão: A presença de tonsilas palatinas hipertróficas foi o fator anatômico em comum nos estádios de maior sucesso (I, II e V), independente do IMC. Apesar do IMM classe III e IV diminuir a taxa de sucesso da cirurgia em pacientes com tonsilas hipertróficas (estádio II), a presença de IMM classe I e II não favoreceu o sucesso cirúrgico em pacientes com tonsilas normotróficas (estádio III). .

Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study / Apneia do Sono e Arritmia Cardíaca Noturna: Estudo Populacional

Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart®) system. Results: A total of 767 participants (461 men) with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat) was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001). After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample. .

Fundamento: Os mecanismos relacionados às consequências cardiovasculares da apneia obstrutiva do sono incluem modificações abruptas no tônus autonômico, que podem desencadear arritmias cardíacas. Os autores tiveram como hipótese a ocorrência de arritmias cardíacas noturnas maiores em pacientes portadores de apneia obstrutiva do sono. Objetivo: Analisar a relação entre a apneia obstrutiva do sono e o registro de anormalidade no ritmo cardíaco, durante o sono, em uma amostra populacional. Métodos: Estudo transversal com uma amostra representativa da cidade de São Paulo de 1.101 voluntários. A polissonografia de noite inteira foi realizada por meio de um sistema digital (EMBLA® S7000), durante o horário regular de sono do indivíduo. O canal de eletrocardiograma foi extraído, duplicado e, em seguida, analisado com um sistema Holter (Cardio Smart®). Resultados: Um total de 767 participantes, sendo 461 do sexo masculino, com idade média de 42,00 ± 0,53 anos, foi incluído nas análises. Pelo menos um tipo de distúrbio do ritmo cardíaco noturno (arritmia atrial/ventricular ou pausa) foi observado em 62,7% da amostra. A ocorrência de arritmias cardíacas noturnas foi mais frequente com o aumento da gravidade da doença. A perturbação do ritmo foi observada em 53,3% da amostra sem distúrbios respiratórios do sono, enquanto que 92,3% dos pacientes com grave apneia obstrutiva do sono apresentaram arritmia cardíaca. Ectopia atrial e ventricular isolada foi mais frequente em pacientes com apneia obstrutiva do sono moderada/severa quando comparada com controles (p < 0,001). Após controle de potenciais fatores de confusão, idade, sexo e Índice de Apneia-Hipopneia foram associados à arritmia cardíaca noturna. Conclusão: Arritmias cardíacas ...

Frequencia dos disturbios de sono em mulheres na pos-menopausa com sobrepeso/obesidade / Frequency of sleep disturbances in overweight/obese postmenopausal women

OBJETIVOS: Avaliar a frequência dos distúrbios do sono, como apneia obstrutiva do sono, síndrome das pernas inquietas e insônia, em pacientes na pós-menopausa com sobrepeso/obesidade no ambulatório de distúrbios do sono no climatério. MÉTODOS: Foram selecionadas 34 pacientes na pós-menopausa, e os seguintes critérios de inclusão foram adotados: idade entre 50 e 70 anos, mínimo de 12 meses de amenorreia, Índice de Massa Corporal igual ou superior a 25 kg/m2, pacientes com queixas relacionadas ao sono e que tivessem sido submetidas a pelo menos uma polissonografia. As pacientes responderam a seis questionários sobre características do sono e sintomas do climatério e uso de medicações. Foram aferidos o peso e a altura em balança padronizada e as medidas das circunferências do abdome e do quadril. Para a análise estatística, o teste do χ2 foi utilizado para variáveis qualitativas, e o teste t de Student, para análise das variáveis quantitativas. RESULTADOS: A média de idade foi de 60,3 anos, o Índice de Massa Corporal médio de 31,6, o tempo de pós-menopausa médio de 11,6 anos e o Índice Menopausal de Kupperman médio de 19. Da amostra, 85,2% apresentou relação cintura/quadril igual ou superior a 0,8; metade apresentou escore igual ou superior a 9 na Escala de Epworth; 68% apresentou distúrbio do sono de acordo com o índice de Pittsburgh e 68% dos casos foram classificados como de alto risco para apneia do sono pelo Questionário Berlin. Na polissonografia, 70,5% apresentou eficiência do sono menor que 85%; 79,4% com latência do sono menor que 30 min; 58,8% com latência para sono REM menor que 90 min e 44,1% com apneia leve. Comparando os grupos, houve associação linear média entre IMC e IAH e relação ...

PURPOSE: To evaluate the frequency of sleep disorders, such as obstructive sleep apnea, restless leg syndrome and insomnia in overweight/obese postmenopausal women seen in a climacteric sleep disorders clinic. METHODS: Thirty-four postmenopausal women were selected using the following inclusion criteria: age between 50 and 70 years; at least 12 months of amenorrhea; body mass index (BMI) greater than or equal to 25 kg/m2; and sleep-related complaints with at least one previous polysomnography. Patients provided responses to 6 questionnaires related to sleep characteristics and menopausal symptoms. Weight and height were measured using standardized scales, and abdomen and hip circumferences were also measured. The statistical analyses were performed using the χ2 test for qualitative variables and using Student's t-test for quantitative variables. RESULTS: Patients' characteristics were as follows: mean age of 60.35 years; mean BMI of 31.62; an average of 11.61 postmenopausal years and an average Kupperman Index of 19. A total of 85.2% of the patients had a waist/hip ratio of less than 0.8. The Epworth Scale score was greater than or equal to 9 in 50% of patients; 68% had sleep disturbances according to the Pittsburgh Index, and 68% were classified as high-risk for sleep apnea by the Berlin Questionnaire. On polysomnography, 70.58% of the patients had a sleep efficiency lower than 85%; 79.41% had a sleep latency of less than 30 min; 58.82% had a REM sleep latency of less than 90 min, and 44.11% had mild apnea. When the groups were compared, a linear association was identified between BMI and the AHI average, and a relationship between high BMI and use of drugs for thyroid treatment was found. CONCLUSION: There was a high prevalence of sleep-disordered breathing, initial insomnia, fragmented sleep, and thyroid disorders in the group with higher BMI. .

Cognition and biomarkers of oxidative stress in obstructive sleep apnea

OBJECTIVES: The aim of this study was to investigate neuropsychological performance and biomarkers of oxidative stress in patients with obstructive sleep apnea and the relationships between these factors. METHODS: This was an observational, cross-sectional study of 14 patients (36.0±6.5 years old) with obstructive sleep apnea and 13 controls (37.3±6.9 years old). All of the participants were clinically evaluated and underwent full-night polysomnography as well as neuropsychological tests. Blood samples were used to assay superoxide dismutase, catalase, glutathione and homocysteine, as well as vitamins E, C, B11 and B12. RESULTS: The patients performed poorly relative to the controls on several neuropsychological tests, such as the attention test and tests of long-term memory and working memory/executive function. They also had lower levels of vitamin E (p<0.006), superoxide dismutase (p<0.001) and vitamin B11 (p<0.001), as well as higher concentrations of homocysteine (p<0.02). Serum concentrations of vitamin C, catalase, glutathione and vitamin B12 were unaltered. Vitamin E levels were related to performance in the backward digit span task (F = 15.9; p = 0.002) and this correlation remained after controlling for age and body mass index (F = 6.3, p = 0.01). A relationship between superoxide dismutase concentrations and executive non-perseveration errors in the Wisconsin Card Sorting Test (F = 7.9; p = 0.01) was also observed. CONCLUSIONS: Decreased levels of antioxidants and lower performance on the neuropsychological tasks were observed in patients with obstructive sleep apnea. This study suggests that an imbalance between antioxidants and pro-oxidants may contribute to neuropsychological alterations in this patient population. .

Clinical complications in patients with severe cervical spinal trauma: a ten-year prospective study / Complicações clínicas em pacientes com trauma raquimedular cervical grave: estudo prospectivo de dez anos

OBJECTIVE: To determine the complications due to severe acrescentar sigla após o nome (CST). METHODS: Between 1997 and 2006, 217 patients (191 men and 26 women) were prospectively evaluated. The mean age was 36.75±1.06 years. RESULTS: Forty-five percent of the patients had medical complications. The most important risk factor was alcoholic beverage use. The most important associated injury was head trauma (HT). Patients with American Spine Injury Association (ASIA) A or B had a 2.3-fold greater relative risk of developing complications. Thirty-three patients (15.2%) died. Patients with neurological deficit had a 16.9-fold higher risk of death. There was no influence of age and time between trauma and surgery on the presence of complications. CONCLUSIONS: Of the patients, 45% had clinical complications and 7.5% had associated injuries; pneumonia was the most important complication; patient age and time between trauma and surgery did not influence the development of medical complications; neurological status was the most important factor in determining morbidity and mortality.

OBJETIVO: Identificar complicações decorrentes do trauma raquimedular cervical grave. MÉTODOS: Avaliação prospectiva de 217 pacientes (191 homens e 26 mulheres) entre 1997 e 2006, com média de idade de 36,75±1,06 anos. RESULTADOS: Houve complicações em 45% dos pacientes. O fator de risco mais importante foi ingestão de bebida alcoólica. Trauma craniano foi a associação mais frequente. Pacientes com classificação A ou B da American Spine Injury Association (ASIA) tiveram 2,3 vezes maior chance de complicações. Faleceram 33 pacientes (15,2%), sendo a chance de óbito 16,9 vezes maior naqueles com déficit neurológico. Não houve influência da idade ou do tempo decorrido entre o trauma e a cirurgia. CONCLUSÕES: Dos pacientes, 45% apresentaram complicações e 7,5% apresentaram traumas associados; pneumonia foi a principal complicação clínica; a idade dos pacientes e o tempo entre o trauma e a cirurgia não influenciaram na frequência de complicações; o status neurológico após o trauma foi o fator de risco mais importante na determinação de morbidade e mortalidade.

Fisiopatologia da narcolepsia / Pathophysiology of narcolepsy

Introdução: A narcolepsia é um distúrbio primário do sistema nervoso central com uma prevalência ao redor de 0.02%. A narcolepsia é caracterizada por sonolência diurna excessiva, cataplexia, alucinações hipnagógicas, paralisia do sono e fragmentação do sono. Diagnóstico: O diagnóstico da narcolepsia é estabelecido pela clínica e análise de cinco cochilos diurnos durante o teste de múltiplas latências do sono. Fisiopatologia: A fisiopatologia da narcolepsia não é totalmente esclarecida. Existem várias teorias que são discutidas. Há uma maior prevalência do alelo HLA DQB1*0602 e uma diminuição da concentração da hipocretina-1 na forma de narcolepsia associada à cataplexia. Recentemente foram descritos diferentes padrões no loco do receptor de linfócito T alfa e a presença de anticorpos específicos tribbles homolog 2 em pacientes com narcolepsia. Estes achados fortalecem a teoria imunológica. Tratamento: O tratamento da narcolepsia deve garantir a integração social e familiar podendo ser dividido em comportamental e medicamentoso. Conclusão: A narcolepsia é uma fascinante doença que integra a neurologia, a imunologia, a medicina do sono, a psiquiatria e a genética. Pacientes com narcolepsia possuem prejuízo no campo pessoal, profissional e familiar. Embora muitos avanços tenham sido feitos, a melhor ferramenta ainda é a informação para os colegas médicos e para a população em geral.

Oxidative stress and quality of life in elderly patients with obstructive sleep apnea syndrome: are there differences after six months of Continuous Positive Airway Pressure treatment?

OBJECTIVES: This study evaluated the effect of Continuous Positive Airway Pressure treatment on oxidative stress parameters and the quality of life of elderly patients with obstructive sleep apnea syndrome. METHODS: In total, 30 obstructive sleep apnea syndrome patients and 27 subjects without obstructive sleep apnea syndrome were included in this study. Both groups underwent quality of life and oxidative stress evaluations at baseline and after six months. Polysomnography was performed in both groups at baseline and a second time in the obstructive sleep apnea syndrome group after six months of Continuous Positive Airway Pressure treatment. All of the variables were compared between the control and obstructive sleep apnea syndrome groups in this prospective case-control study. RESULTS: The baseline concentrations of the antioxidant enzyme catalase were higher in the obstructive sleep apnea syndrome group than the control group. After Continuous Positive Airway Pressure treatment, the obstructive sleep apnea syndrome group exhibited a reduction in the level of oxidative stress, as indicated by a decrease in the level of lipid peroxidation measured by the malondialdehyde (MDA) concentration [pre: 2.7 nmol malondialdehyde/mL (95% 1.6-3.7) vs. post: 1.3 nmol MDA/mL (0.7-1.9), p<0.01]. Additionally, improvements were observed in two domains covered by the SF-36 questionnaire: functional capacity [pre: 77.4 (69.2-85.5) vs. post: 83.4 (76.9-89.9), p = 0.002] and pain [pre: 65.4 (52.8-78.1) vs. post: 77.8 (67.2-88.3), p = 0.004]. CONCLUSION: Our study demonstrated that the use of Continuous Positive Airway Pressure to treat obstructive sleep apnea syndrome in elderly patients reduced oxidative stress and improved the quality of life.