Impact of CPAP treatment for a short period in moderate-to-severe OSAS patients: a randomized double-blind clinical trial / Impacto do tratamento com CPAP por um curto período em pacientes com SAOS moderada a grave: um estudo clínico duplo-cego randomizado

Abstract Introduction: Obesity is the most frequent reversible agravating factor of obstructive sleep apnea syndrome, with physical activity very important for its control. Continuous positive air pressure during sleep is the ‟gold standard" treatment for obstructive sleep apnea syndrome. Objective: we aimed to investigate if the use of continuous positive air pressure for a short period (7 days), would improve sleep quality, daytime sleepiness, and the disposition for physical activity. Methods: Eighty obstructive sleep apnea syndrome patients were randomly assigned as follows: group I - continuous positive air pressure with a steady pressure of 4cm H2O; group II - ideal therapeutic pressure. After filling out the questionnaires related to the studied variables (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index), patients underwent a baseline pulmonary function test and continuous positive air pressure titration. After continuous positive air pressure therapy for 4> hours a night for 7 consecutive days, patients returned and filled out new (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index) forms. New spirometry was carried out. Results: 39 patients completed the study. The mean age was 52 ±11 years old and 28 patients (71.79%) were obese. Both groups were similar for all variables studied at baseline. After Continuous positive air pressure use, patients of group II presented more significant improvements (p< 0.05) for sleep quality and diurnal sleepiness. Time spent with physical activities did not change. Spirometric data were at normal range at baseline. Solely the variable FEF 25%-75% was significantly enhanced (p< 0.05) in group II. Conclusion: Continuous positive air pressure therapy for 1 week, with ideal pressure, improves daytime sleepiness and sleep quality, enhances pulmonary function, but does not change the mean time spent with physical activities.

Resumo Introdução: A obesidade é o fator causal reversível mais frequente da síndrome da apneia obstrutiva do sono, a atividade física é muito importante para o seu controle. A pressão positiva contínua na via aérea, CPAP, durante o sono é o tratamento padrão ouro para essa condição clínica. Objetivo: Avaliar se o uso do CPAP na síndrome da apneia obstrutiva do sono por um curto período (7 dias) melhoraria a qualidade do sono, a sonolência diurna e a disposição para a prática de atividades físicas, além da função pulmonar. Método: Oitenta pacientes com síndrome da apneia obstrutiva do sono foram distribuídos aleatoriamente da seguinte forma: grupo I - CPAP com pressão constante de 4cm H2O; grupo II - pressão terapêutica ideal. Após o preenchimento dos questionários relacionados ao estudo das variáveis (PSQI, ESS e IPAQ-L), os pacientes foram submetidos a teste de função pulmonar basal e titulação da CPAP. Após terapia com CPAP por ≥ 4 horas por noite durante sete dias consecutivos, os pacientes retornaram e preencheram novos questionários PSQI, ESS e IPAQ-L. Nova espirometria foi feita. Resultados: Apenas 39 pacientes completaram o estudo. A média de idade foi de 52 ± 11 anos e 28 pacientes (71,79%) eram obesos. Ambos os grupos eram semelhantes quanto às variáveis avaliadas no início do estudo. Após o uso de CPAP, os pacientes do grupo II apresentaram melhorias mais significantes (p < 0,05) para qualidade do sono e sonolência diurna. O tempo gasto com atividades físicas não mudou. Os dados espirométricos estavam na faixa normal no início do estudo. Apenas a variável FEF 25%-75% aumentou significantemente (p < 0,05) no grupo II. Conclusão: A terapia com CPAP por uma semana, com pressão ideal, melhora a sonolência diurna e a qualidade do sono, melhora a função pulmonar, mas não altera o tempo médio despendido com atividades físicas.

Comparación entre el análisis automático y manual de 301 poligrafías respiratorias domiciliarias con ApneaLink / Comparison between automatic and manual scoring of 301 home respiratory polygraphs with ApneaLink device

Resumen Introducción: El síndrome de apnea obstructiva del sueño (SAOS) se asocia a aumento de morbimortalidad cardiovascular y metabólica, y a mala calidad de vida. Su diagnóstico y tratamiento eficaz mejora la salud individual y pública. Objetivo: evaluar concordancia entre análisis automático versus manual del dispositivo ApneaLink para diagnosticar y clasificar SAOS en pacientes con sospecha clínica. Material y Método: Evaluación retrospectiva de 301 poligrafías respiratorias del HOSCAR. Se mide correlación, acuerdo general y concordancia entre parámetros obtenidos manual y automáticamente usando coeficiente de Pearson, coeficiente de correlación intraclase y gráfico de Bland y Altman. Resultados: En 11,3% de casos el análisis automático interpreto erróneamente la señal de flujo. No hubo diferencias significativas entre índices de apnea-hipopnea automático (AHIa 18,9 ± 17,5) y manual (AHIm 20,8 ± 19,4) r + 0,97 (95% CI: 0,9571 a 0,9728; p < 0,0001) y tampoco entre la saturación mínima de oxígeno automática (82,1 ± 7,6) y manual (83,1 ± 6,8) r + 0,85 (95% CI: 0,8108 a 0,8766; p < 0,0001). No hubo buena correlación entre análisis automático y manual en clasificación de apneas centrales, r + 0,51 (95% CI: 0,4238 a 0,5942; p < 0,0001). Hubo subestimación de gravedad de SAOS por análisis automático: en 11% de casos. Conclusión: El diagnóstico entregado automáticamente por ApneaLink podría aceptarse sin confirmación manual adicional solamente en casos clasificados como severos. Para AHI menores se requeriría confirmación mediante análisis manual de experto.

Abstract Introduction: Obstructive sleep apnea syndrome (OSAS) is associated with increased cardiovascular and metabolic morbidity and mortality, and poor quality of life. Its effective diagnosis and treatment improve individual and public health. Aim: To evaluate concordance between automatic versus manual analysis of the ApneaLink device to diagnose and classify OSAS in patients with clinical suspicion. Material and Method: Retrospective evaluation of 301 respiratory polygraphs from HOSCAR. Correlation, general agreement and concordance between parameters obtained manually and automatically are measured using Pearson's coefficient, intraclass correlation coefficient, and Bland and Altman graph. Results: In 11.3% of cases, the automatic analysis misinterpreted the flow signal. There were no significant differences between automatic (AHIa 18.9 ± 17.5) and manual (AHIm 20.8 ± 19.4) apnea-hypopnea indices r + 0.97 (95% CI:0.9571 to 0.9728, p < 0.0001) and nor between automatic (82.1 ± 7.6) and manual (83.1 ± 6.8) minimum oxygen saturation r + 0.85 (95% CI: 0.8108 to 0.8766, p < 0.0001). There was no good correlation between automatic and manual analysis in the classification of central apneas, r + 0.51(95% CI:0.4238 to 0.5942, p < 0.0001). There was an underestimation of the severity of OSAS by automatic analysis in 11% of cases. Conclusion: The diagnosis delivered automatically by ApneaLink could be accepted without additional manual confirmation only in cases classified as severe. For minors AHI, confirmation through manual expert analysis would be required.

Craniofacial morphology in patients with obstructive sleep apnea: cephalometric evaluation / Morfologia craniofacial em pacientes com apneia obstrutiva do sono: avaliação cefalométrica

Abstract Introduction: Obstructive sleep apnea is characterized by a reduced airflow through the upper airways during sleep. Two forms of obstructive sleep apnea are described: the central form and the obstructive form. The obstructive form is related to many factors, such as the craniofacial morphology. Objective: To evaluate the correlation between the morphology of the cranial base, of the mandible and the maxilla, and obstructive sleep apnea severity. Methods: Eighty-four patients, mean age of 50.4 years old; 73 males and 11 females with obstructive sleep apnea were enrolled in the present study. Patients with high body mass index and comorbidities were excluded. Lateral cephalograms and polysomnography were collected for each patient to evaluate the correlation between craniofacial morphology and obstructive sleep apnea severity. A Spearman's rho correlation test between cephalometric measurements and obstructive sleep apnea indexes was computed. Statistical significance was set at p < 0.05. Results: Patients with a severe obstructive sleep apnea presented a reduction of sagittal growth of both effective mandibular length and cranio-basal length. The mandibular length was the only variable with a statistical correlation with apnea-hypopnea index. Vertical dimension showed a weak correlation with the severity of obstructive sleep apnea. No correlation with maxillary sagittal dimension was shown. Conclusion: Obstructive sleep apnea severity may be correlated to mandibular and cranial base growth. Facial vertical dimension had no correlation with obstructive sleep apnea severity.

Resumo Introdução: A apneia obstrutiva do sono é caracterizada por um fluxo de ar reduzido nas vias aéreas superiores durante o sono. Duas formas de apneia são descritas: a forma central e a forma obstrutiva. A forma obstrutiva tem sido relacionada a vários fatores, como a morfologia craniofacial. Objetivo: Avaliar a correlação entre a morfologia da base do crânio, da mandíbula e da maxila e a gravidade da apneia obstrutiva do sono. Método: Foram incluídos no presente estudo 84 pacientes com apneia obstrutiva do sono, com média de 50,4 anos; 73 homens e 11 mulheres. Pacientes com alto índice de massa corpórea e comorbidades foram excluídos. Foram coletados cefalogramas laterais e polissonografia para cada paciente para avaliar a correlação entre a morfologia craniofacial e a gravidade da apneia. Foi computado o coeficiente de correlação de postos de Spearman (rho) entre medidas cefalométricas e índices de apneia obstrutiva do sono. A significância estatística foi estabelecida em p < 0,05. Resultados: Pacientes com apneia obstrutiva do sono grave apresentaram redução do crescimento sagital do comprimento mandibular efetivo e do comprimento crânio-basal. O comprimento mandibular foi a única variável que apresentou correlação estatística com o índice de apneia-hipopneia. A dimensão vertical mostrou uma fraca correlação com a gravidade da apneia. Não foi demonstrada correlação com a dimensão maxilar sagital. Conclusão: A gravidade da apneia obstrutiva do sono pode estar correlacionada ao crescimento da base mandibular e craniana. A dimensão facial vertical não apresentou correlação com a gravidade da apneia.

Impacto del síndrome de apneas obstructivas del sueño en accidentes de tránsito en Chile

Resumen Introducción: Existe abundante evidencia para considerar al síndrome de apnea obstructiva del sueño (SAOS) como un factor de riesgo significativo en la ocurrencia de accidentes de tránsito. En el año 2018, los accidentes de tránsito en Chile provocaron 1.507 muertes, 60 mil lesionados, y generaron un costo país de US $5.985 millones al año (2,1% PIB). Sin embargo, se desconoce la prevalencia de SAOS en conductores, ni su impacto en la accidentabilidad a nivel nacional. Objetivo: Estimar la prevalencia de SAOS en conductores nacionales, y su importancia relativa en el número de accidentes, lesionados, muertes y costos asociados. Material y Método: Revisión de la literatura, análisis descriptivo con bases de datos secundarias. Estimación de prevalencia de riesgo de SAOS en conductores nacionales, profesionales, y cálculo de costos asociados a accidentabilidad. Resultados: Se estima prevalencia de SAOS moderado a severo en un 28,6% para conductores nacionales y 30,2% para conductores profesionales. Utilizando un odds ratio de 2,52 (IC 1,84-3,35) como estimador de riesgo, se obtiene un riesgo atribuible porcentual poblacional de 30,28%, que se traduce en que SAOS sería responsable de 27.046 accidentes, 17.545 lesionados, 456 muertes, y un costo país de US $1.812,4 millones al año atribuibles a SAOS para las cifras de accidentabilidad 2018. Conclusión: El presente trabajo es la primera aproximación al tema a nivel chileno. Se requieren estudios de prevalencia de SAOS en conductores para realizar estimaciones más precisas. Impresiona necesario colocar este tema en la agenda pública, por la posible reducción de riesgos.

Abstract Introduction: There is abundant evidence to consider obstructive sleep apnea syndrome (OSAS) as a significant risk factor in the occurrence of traffic accidents. In 2018, traffic accidents in Chile caused 1,507 deaths, 60 thousand injured, and generated a country cost of US $ 5,985 million per year (2.1% GDP). However, the prevalence of OSAS in national drivers, nor its impact on accident rate level is unknown. Aim: To estimate the prevalence of OSAS in Chilean drivers, and their relative importance in the number of accidents, injuries, deaths and associated costs. Material and Method: Literature review, descriptive analysis with secondary databases. Estimation of risk prevalence of OSAS in Chilean drivers, professional drivers, and calculation of costs associated with accident rates. Results: The prevalence of moderate to severe OSAS is estimated at 28,6% for national drivers, 30,2% for professional drivers. Using an OR of 2.52 (CI 1.84-3.35) as a risk estimator), a population attributable risk percentage of 30,28% is obtained, which translates to 27,046 accidents, 17,545 injured, 456 deaths, and a country cost of US $ 1,812.4 million per year attributable to OSAS for accidents in 2018. Conclusion: This paper is the first approach to the subject at the Chilean level. OSAS prevalence studies in drivers are required to make more accurate estimates. It is necessary to place this topic on the public agenda, due to the possible risk reduction.

Surgical treatment in obstructive sleep apnea syndrome: an overview

Obstructive sleep apnea syndrome is a common pathology affecting pediatric and adult population. It is caused by an increase upper airway resistance due to augmented collapsibility that cause alteration in ventilation and oxygen saturation. Sleep oxygen desaturations have multi-organ implications. Since many years, OSAS, has been recognized as a risk factors for comorbid cardiovascular disease. Well-known is the causal link with cognitive impairment and atherosclerosis. Healthcare professionals, should be trained to recognize signs and symptoms of the disease in order to send the patients forward for specialist care in centers dealing with sleep-disordered breathing. However treatment knowledge is of pivotal importance in the cultural baggage of all the physicians.  Surgical and non-surgical therapies have undergone a great number of changes. Going along with the innovations in diagnostic evaluation and phenotyping of the patients, surgeries were heightened by new developments such as advances in tailoring procedures and technologies. The aim of this overview is to describe the evolution and main characteristics of encoded procedures classified into site of surgical correction.

La cirugía ortognática en el tratamiento del síndrome de apnea obstructiva del sueño / Orthognathic surgery in the treatment of obstructive sleep apnea syndrome

RESUMEN Introducción: El síndrome de apnea obstructiva del sueño provoca somnolencia diurna; incide negativamente sobre el sistema cardiovascular y disminuye la calidad de vida. La cirugía ortognática provoca cambios en el espacio aéreo faríngeo, por lo que ha sido empleada en el tratamiento de dicho síndrome. Objetivo: Caracterizar las técnicas en cirugía ortognática más empleadas en el tratamiento del síndrome de apnea obstructiva del sueño, sus influencias sobre la vía aérea faríngea y efectividad terapéutica. Métodos: Se realizó una revisión de la literatura científica desde diciembre del 2016 a junio del 2017 a través de los buscadores de información y plataformas SciELO, Medline, Pubmed y Hinari. Los descriptores empleados para la búsqueda fueron cirugía ortognática, síndrome de apnea obstructiva del sueño, vía aérea faríngea, avance máxilo mandibular y sus combinaciones. Se obtuvieron 127 artículos de los que se seleccionaron 28 por su contenido, actualidad y objetividad. Análisis e integración de la información: El adelanto quirúrgico del maxilar, mandíbula, mentón o sus combinaciones minimiza los efectos del síndrome de apnea obstructiva del sueño. Es recomendable la cirugía bimaxilar en la corrección de las clases III esqueletales para atenuar posibles efectos perjudiciales sobre la vía aérea por la retroposición mandibular aislada. Conclusiones: La cirugía ortognática de avance, incrementa el espacio faríngeo y mejora la calidad del sueño. Los movimientos de retroposición pueden tener efecto inverso, aspecto importante en la corrección de las clases III esqueletales(AU)

ABSTRACT Introduction: Obstructive sleep apnea syndrome causes daytime sleepiness, affects the cardiovascular system and reduces the quality of life. Since orthognathic surgery brings about changes in the pharyngeal airway space, it has been used to treat this syndrome. Objective: Characterize the orthognathic surgery techniques most commonly used to treat obstructive sleep apnea syndrome, their impact on the pharyngeal airway and their therapeutic effectiveness. Methods: A bibliographic review was conducted from December 2016 to June 2017 using the search engines and platforms SciELO, Medline, Pubmed and Hinari. The search words used were orthognathic surgery, obstructive sleep apnea syndrome, pharyngeal airway, maxillomandibular advancement, and combinations thereof. Of the 127 papers obtained, 28 were selected based on their content, topicality and objectivity. Data analysis and integration: Surgical advancement of the maxilla, mandible, chin or combinations thereof minimizes the effects of obstructive sleep apnea syndrome. Bimaxillary surgery is recommended to correct skeletal class III malocclusion so as to lessen potential damaging effects on the airway caused by isolated mandibular retroposition. Conclusions: Advancement orthognathic surgery broadens the pharyngeal airway space and improves the quality of sleep. The fact that retroposition movements may have an opposite effect is an important aspect to be considered in the correction of skeletal class III malocclusions(AU)

El paciente ortodóncico en dentición mixta y los trastornos del sueño / The orthodontic patient with mixed dentition and sleep disorders

Los desórdenes respiratorios del sueño (DRS) y, principalmente, roncopatías y apneas obstructivas afectan aproximadamente al 7% de los pacientes ortodóncicos. Los DRS no solo son importantes por la cantidad de pacientes afectados, sino por la gravedad de los posibles efectos secundarios a nivel de la salud general del paciente. La obstrucción de las vías aéreas superiores (VAS) provoca alteraciones del crecimiento y deformaciones craneofaciales importantes, por lo que el tratamiento temprano y la prevención de la respiración oral es muy importante.El papel del ortodoncista es muy importante en el diagnóstico y en el tratamiento de los DRS, pero también en su prevención, realizando tratamientos que aumenten la dimensión y la permeabilidad de las VAS. El protocolo de exploración interdisciplinar en niños y adolescentes y la cefalometría de vías aéreas son importantes en el diagnóstico y deben ser tenidos en cuenta en el plan de tratamiento. Pero las pruebas más significativas, el CBCT de vías aéreas y la polisomnografía no son pruebas rutinarias por la dificultad logística y el precio de estas pruebas. En este artículo también se recomiendan los tratamientos de ortodoncia más indicados en estos casos y que tienden al aumento de la dimensión de las VAS (AU)

Sleep breathing disorders (SBD) and in the first place, roncopathy and obstructive apnea, affect approximately 7% of orthodontic patients. The SBD are not only important for the number of affected patients, but also for the severity of the possible side effects at the level of general health of a patient. The upper air ways (UAW) obstruction provokes important alterations in growth and craniofacial deformations, and this is why the early treatment and prevention of mouth breathing are very important. The role of an orthodontist in diagnosis and treatment of SBD is very important, but it is also in its prevention, carrying out the treatments which increase the dimension and permeability of UAW. The protocol of interdisciplinary examination.In children and adolescents and the air ways cephalometry analysis have an important role in diagnosis and they should be taken into account in treatment planning. But the most important tests, the air ways CBCT and polysomnography, are not routine tests due to the complicated logistics and their cost. In this article, the orthodontic treatments most indicated in these cases are recommended, because they tend to increase the UAW dimension (AU)

Validation of the Japanese Version of the STOP-Bang Test for the Risk Assessment of Obstructive Sleep Apnea Syndrome / 日本プライマリ・ケア連合学会誌

Objective: The objective of this study was to validate the Japanese version of the STOP-Bang test for risk assessment of obstructive sleep apnea syndrome (OSAS).Methods: We retrospectively evaluated inpatients who underwent nocturnal pulse oximetry for OSAS screening at the internal medical wards.Results: One hundred and forty-four subjects were included the study, and 57 subjects who had a 3% oxygen desaturation index ≥10/hr underwent polysomnography. Seventeen and 29 subjects were diagnosed with moderate and severe OSAS, respectively. According to the receiver operating characteristic (ROC) curve analysis, the STOP-Bang test had a higher diagnostic value using a cutoff of 30 kg/m2 for BMI than using a cutoff of 35 kg/m2. A STOP-Bang score of 3 or greater had a sensitivity of 95.7% and specificity of 42.9% for detecting moderate-to-severe OSAS.Conclusion: The STOP-Bang test is a simple and useful tool for the risk assessment of OSAS.

Síndrome de apnea obstructiva del sueño en pediatría / Pediatric Obstructive Sleep Apnea Syndrome

El síndrome de apnea/hipopnea obstructiva (SAHOS) se caracteriza por un aumento de la resistencia de la vía aérea superior asociado a una estrechez y colapso intermitente de la faringe produciendo roncopatía y periodos de apneas e hipopneas (1,2,3). Es una patología frecuente que puede ocasionar complicaciones importantes si no se diagnostica y trata adecuadamente. La clínica en niños es distinta que en adultos, ya que la somnolencia se manifiesta de forma paradójica, con alteraciones de la conducta y emocionales. Si no se trata puede ocasionar morbilidad importante que afecta a los sistemas nerviosos central, cardiovascular y endocrino. La identificación de factores de riesgo permite un diagnóstico y un tratamiento precoz. La Polisomnografía nocturna (PSG), es el método diagnóstico de elección. Registros más simplificados son útiles solo cuando los resultados son positivos. El tratamiento más frecuente es la adenoamigdalectomía, con ella se obtiene un porcentaje elevado de curación. En otros pacientes va a depender de la causa o factores predisponentes como puede ser la baja de peso en los niños obesos. En algunos casos van a requerir de CPAP/BiPAP-nasal, dispositivos intraorales, distracción maxilomandibular o tratamiento tópico antiinflamatorio. Palabras Clave: apnea del sueño infantil, ronquidos, trastornos respiratorios, polisomnografía, SAHOS.

Abstract. Obstructive sleep apnea/hypopnea syndrome (OSAS) is characterized by an increased resistance in the upper airway, associated with a narrow and intermittent collapse of the pharynx causing snoring and periods of apneas and hypopneas (1,2,3). It is a highly prevalent pathology that can cause major complications when it is not diagnosed and treated properly. The presentation is different in children than in adults, since sleepiness can be manifested in a paradoxical way, with behavioral and emotional symptoms. If left untreated, it can cause significant morbidity affecting the cardiovascular, endocrine and central nervous systems. The identification of risk factors allows making a diagnosis and establishing treatment earlier. Nocturnal polysomnography (PSG) is the diagnostic method of choice. Simpler recordings are useful only when the results are positive. The most common treatment is tonsillectomy, which is a highly successful treatment. In other patients, the treatment will depend on the cause or risk factors, such as weight loss in obese children. In some cases, children might require the use of a nasal CPAP/BiPAP, intraoral devices, maxillomandibular advancement or anti-inflammatory topical treatment.Key Words: pediatric sleep apnea, snoring, respiratory disorders, polysomnography, OSAS.

The importance of clinical monitoring for compliance with Continuous Positive Airway Pressure / A importância do seguimento clínico para adesão ao CPAP

Abstract Introduction: Obstructive sleep apnea syndrome is currently a public health problem of great importance. When misdiagnosed or improperly treated, it can lead to serious consequences on patients' quality of life. The gold standard treatment for cases of obstructive sleep apnea syndrome, especially in mild to severe and symptomatic cases, is continuous positive airway pressure therapy. Compliance with continuous positive airway pressure therapy is directly dependent on the active participation of the patient, which can be influenced by several factors. Objective: The objective of this study is to describe the factors related to compliance with continuous positive airway pressure therapy, and to analyze which associated factors directly influence the efficiency of the treatment. Methods: Patients who received continuous positive airway pressure therapy through the Municipal Health Department of the city of Ribeirão Preto were recruited. A structured questionnaire was administered to the patients. Compliance with continuous positive airway pressure therapy was assessed by average hours of continuous positive airway pressure therapy usage per night. Patients with good compliance (patients using continuous positive airway pressure therapy ≥4 h/night) were compared to those with poor compliance (patients using <4 h/night). Results: 138 patients were analyzed: 77 (55.8%) were considered compliant while 61 (44.2%) were non-compliant. The comparison between the two groups showed that regular monitoring by a specialist considerably improved compliance with continuous positive airway pressure therapy (odds ratio, OR = 2.62). Conclusion: Compliance with continuous positive airway pressure therapy is related to educational components, which can be enhanced with continuous and individualized care to patients with obstructive sleep apnea syndrome.

Resumo Introdução: Síndrome da apneia obstrutiva do sono (SAOS) é, atualmente, um problema de saúde pública de suma importância. Quando mal diagnosticada ou tratada inadequadamente, pode levar a sérias consequências na qualidade de vida do paciente. O tratamento padrão-ouro para casos de SAOS, principalmente nos casos moderados a grave e sintomáticos, é o CPAP (Continuous Positive Airway Pressure). A adesão ao CPAP depende diretamente da participação ativa do paciente, que pode ser influenciada por vários fatores. Objetivo: O objetivo deste estudo é descrever os fatores relacionados à adesão ao CPAP e analisar quais fatores associados influenciam diretamente na eficiência do tratamento. Método: Foram recrutados pacientes que receberam CPAP pela Secretaria Municipal de Saúde de Ribeirão Preto. Um questionário estruturado foi aplicado ao paciente. A adesão ao CPAP foi avaliada pela média de horas de uso do CPAP por noite. Pacientes com boa adesão (pacientes em uso de CPAP ≥4 horas/noite) foram comparados aos com má adesão (pacientes em uso < 4 horas/noite). Resultados: No estudo, 138 pacientes foram analisados: 77 (55,8%) foram considerados aderentes e 61 (44,2%) foram não aderentes. A comparação entre os dois grupos demonstrou que o seguimento regular com especialista melhorou consideravelmente a adesão ao CPAP (odds ratio, OR = 2,62). Conclusão: A adesão ao CPAP está relacionada a componentes educacionais, que podem ser aprimorados com assistência contínua e individualizada ao paciente com SAOS.

Sleep EEG Characteristics in Young and Elderly Patients with Obstructive Sleep Apnea Syndrome

OBJECTIVE: In the present study, it was hypothesized that the sleep electroencephalogram (EEG) characteristics of young (55 yrs) OSAS patients would differ. METHODS: We analyzed 76 sleep EEG recordings from OSAS patients (young group: n=40, mean age: 24.3±4.9 yrs; elderly group: n=36, mean age: 59.1±4.9 yrs), which were obtained during nocturnal polysomnography. The recordings were assessed via spectral analysis in the delta (0.5–4.5 Hz), theta (4.5–8 Hz), alpha (8–12 Hz), beta (12–32 Hz), slow sigma (11–13 Hz), and fast sigma (13–17 Hz) frequency bands. RESULTS: Apnea Hypopnea Index (AHI) and sleep efficiency (%) did not differ significantly between the two groups (19.8±14.4 vs. 25.9±16.0, p=0.085; 84.4±12.6 vs. 80.9±11.0, p=0.198, respectively). After adjusting for gender, the slow/fast sigma ratio was not significantly correlated with AHI in the elderly group (r=-0.047, p=0.790) but AHI was inversely correlated with the slow/fast sigma ratio in the young group (r=-0.423, p=0.007). A multiple linear regression analysis revealed that a higher AHI was related with a lower slow/fast sigma ratio in the young group (β=-0.392, p=0.028) but not the elderly. CONCLUSION: In the present study, sleep EEG activity differed between young and elderly OSAS patients. The slow/fast sigma ratio was associated with OSAS severity only in young patients, suggesting that young OSAS patients may have a distinctive brain plasticity compared with elderly patients.

Efficacy and Safety of Newly Developed Korean Continuous Positive Airway Pressure Treatment in Patients with Obstructive Sleep Apnea Syndrome

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea syndrome(OSAS) is characterized by repeated apnea, hypopnea, and micro-arousals during sleep. Among various treatment modalities of OSAS, continuous positive airway pressure(CPAP) treatment is the most effective and successful. The aim of this study was to compare efficacy and safety of newly developed Korean CPAP with standard CPAP in OSAS patients. MATERIALS AND METHOD: In total, 20 of 26 recruited OSAS patients completed the study. All subjects first used the standard CPAP for 4 weeks. After an at least 2 week wash-out period, the subjects used the newly developed CPAP for 4 weeks. Polysomnography, questionnaires associated with sleep, lipid profile, pulmonary function test, cardiac marker, and physical examinations were evaluated at baseline and were followed-up after each treatment. RESULTS: After treatment with the newly developed CPAP, the apnea-hypopnea index was decreased from 53.2/hr to 2.5/hr and was equivalent to that of the standard CPAP. Most of the changes in questionnaire scores, laboratory findings, and physical examinations after newly developed CPAP treatment were equivalent to those with standard CPAP. No serious adverse events were observed during the study. CONCLUSION: The efficacy and safety of a newly developed CPAP are equivalent to those of standard CPAP in OSAS patients.

Consensus & Evidence-based INOSA Guidelines 2014 (First edition).

Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive Sleep Apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or comorbidities or >15 such episodes without any sleep related symptoms or comorbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the “gold standard” for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

Rapid maxillary expansion in the treatment of obstructive sleep apnea syndrome:A case report / 实用口腔医学杂志

1 case of OSAS was treated by valuating rapid maxillary expansion,sleep monitoring indicated that the device reduced nasal re-sistance and improved respiratory function of the patient.

Wang Huireng's Experience in Treating Chronic Obstructive Pulmanarg Drisease(COPD) Combined with Obstructive Sleep Apnea Sydrome(OSAS) / 浙江中医药大学学报

[Objective]To introduce national prominet TCM doctor Wang Huireng’s experience on treating COPD(chronic obstructive pulmanary disease) combined with OSAS(obstructive sleep apnea syndrome).[Method]Summarize Professor Wang Huireng ’s viewpiont on TCM pathogenesis and symptom of COPD combined with OSAS. Analyse recipe case to figure out Pro.Wang’s characteristic of using formula and herb on that syndrome.[Results] Pro. Wang points out main TCM pathogenesis of COPD combined with OSAS are interior sputum and dampness stasis ,sputum and blood stasis in lung, blood stasis due to qi deficiency, lung spleen and kidney deficiency. The principle of treatment is diffusing the lung by dispel ing sputum, regulating qi-flowing for eliminating phlegm, strengthening the foundation by tonifying qi, invigorating blood circulation.Sputum,blood stasis, deficiency are the focus of treatment.[Conclusion] Clarifying a dignosis of COPD combined with OSAS and differenciating TCM syndrom are both important. Pro Wang has obtained good effect on dealing with COPD combined with OSAS. His experience has valuable reference for TCM clinical medication and research.

The relationship between the predictors of obstructive sleep apnea and difficult intubation / 대한마취과학회지

BACKGROUND: The study was performed in order to determine the risk factors for difficult tracheal intubation in obstructive sleep apnea patients. METHODS: For 115 male patients with obstructive sleep apnea syndrome and who were undergoing palatal muscle resection (PMR), we investigated the correlation between their age, height, weight, body mass index (BMI), their Epworth Sleepiness Scale (ESS), their apnea-hypopnea index (AHI), their neck circumference and the difficulty of tracheal intubation. RESULTS: The factors significantly related to difficult tracheal intubation in obstructive sleep apnea patients were a high AHI and a large neck circumference. There was no significant correlation between weight, BMI, arterial hypertension, ESS and difficult tracheal intubation in obstructive sleep apnea patients. CONCLUSIONS: In this study, a high AHI and a large neck circumference can predict difficult tracheal intubation in obstructive sleep apnea patients.

Continuous positive airway pressure therapy: New generations.

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS). However, CPAP is not tolerated by all patients with OSAS and alternative modes of pressure delivery have been developed to overcome pressure intolerance, thereby improving patient comfort and adherence. Auto-adjustable positive airway pressure (APAP) devices may be utilised for the long-term management of OSAS and may also assist in the initial diagnosis of OSAS and titration of conventional CPAP therapy. Newer modalities such as C-Flex and A-Flex also show promise as treatment options in the future. However, the evidence supporting the use of these alternative modalities remains scant, in particular with regard to long-term cardiovascular outcomes. In addition, not all APAP devices use the same technological algorithms and data supporting individual APAP devices cannot be extrapolated to support all. Further studies are required to validate the roles of APAP, C-Flex and AFlex. In the interim, standard CPAP therapy should continue as the mainstay of OSAS management.

Epidemiology of adult obstructive sleep apnoea syndrome in India.

There is a paucity of published Indian studies on the prevalence and risk factors of obstructive sleep apnoea (OSA) in adults. The limited published literature, however, does not suggest significant differences in the prevalence and risk factors for OSA and obstructive sleep apnoea syndrome (OSAS) as compared to western studies. Well designed studies are required from all parts of India. Patients should be screened carefully before referring them to costly investigations such as overnight polysomnography. With the background of increasing urbanization, fast growing economy and changes in lifestyle, India will have an epidemic of obesity. Therefore, future studies on the association of OSA and metabolic syndrome should carefully evaluate confounding effect of obesity on metabolic abnormalities in patients with OSA.

Overview of sleep & sleep disorders.

Sleep is defined on the basis of behavioural and physiological criteria dividing it into two states: non rapid eye movement (NREM) sleep which is subdivided into three stages (N1, N2, N3); and rapid eye movement (REM) sleep characterized by rapid eye movements, muscle atonia and desynchronized EEG. Circadian rhythm of sleep-wakefulness is controlled by the master clock located in the suprachiasmatic nuclei of the hypothalamus. The neuroanatomical substrates of the NREM sleep are located principally in the ventrolateral preoptic nucleus of the hypothalamus and those of REM sleep are located in pons. A variety of significant physiological changes occur in all body systems and organs during sleep as a result of functional alterations in the autonomic and somatic nervous systems. The international classification of sleep disorders (ICSD, ed 2) lists eight categories of sleep disorders along with appendix A and appendix B. The four major sleep complaints include excessive daytime sleepiness, insomnia, abnormal movements or behaviour during sleep and inability to sleep at the desired time. The most important step in assessing a patient with a sleep complaint is obtaining a detailed history including family and previous histories, medical, psychiatric, neurological, drug, alcohol and substance abuse disorders. Some important laboratory tests for investigating sleep disorders consist of an overnight polysomnography, multiple sleep latency and maintenance of wakefulness tests as well as actigraphy. General physicians should have a basic knowledge of the salient clinical features of common sleep disorders, such as insomnia, obstructive sleep apnoea syndrome, narcolepsy-cataplexy syndrome, circadian rhythm sleep disorders (e.g., jet leg, shift work disorder, etc.) and parasomnias (e.g., partial arousal disorders, REM behaviour disorder, etc.) and these are briefly described in this chapter. The principle of treatment of sleep disorders is first to find cause of the sleep disturbance and vigorously treat the co-morbid conditions causing the sleep disturbance. If a satisfactory treatment is not available for the primary condition or does not resolve the problem, the treatment should be directed at the specific sleep disturbance. Most sleep disorders, once diagnosed, can be managed with limited consultations. The treatment of primary sleep disorders, however, is best handled by a sleep specialist. An overview of sleep and sleep disorders viz., Basic science; international classification and approach; and phenomenology of common sleep disorders are presented.

Preliminary Study About Effect of Continuous Positive Airway Pressure on Cardiac Autonomic Imbalance in Obstructive Sleep Apnea Syndrome

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with cardiac arrhythmia due to autonomic dysfunction. The aim of this study was to elucidate the effect of OSAS on the QT interval and the efficacy of continuous positive airway pressure (CPAP) treatment on a prolonged QT interval. METHODS: From March 2007 to January 2008, 13 patients diagnosed as OSAS received CPAP treatment. Ten age- and sex-matched healthy controls were enrolled, and nighttime polysomnography was performed. We analyzed the full-night electrocardiogram.which is one of the elements of nighttime polysomnography.in all patients and controls. RESULTS: In the patient group, the QTc interval was 0.380+/-0.45 ms (mean+/-SD) before CPAP treatment and 0.368+/-0.32 ms during CPAP treatment. In the control group, the QTc interval was 0.348+/-0.26 ms. The QTc interval did not differ between OSAS patients and controls (p=0.143), but it did significantly shorten between before and after CPAP treatment (p=0.047). CONCLUSIONS: This study suggests that CPAP treatment can improve QTc prolongation and thereby prevent future ventricular arrhythmia.