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    Comparação entre os tratamentos aparelho de pressão positiva contínua na via aérea superior e aparelho intraoral nos parâmetros metabólicos em pacientes com a síndrome da apneia obstrutiva do sono de grau leve : estudo randomizado, paralelo e controlado
    (Universidade Federal de São Paulo (UNIFESP), 2017-06-29) Silva, Luciana Oliveira e [UNIFESP]; Moura, Sonia Maria Guimarães Pereira Togeiro de [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; http://lattes.cnpq.br/6882391059348792; http://lattes.cnpq.br/6468650044481017; http://lattes.cnpq.br/9762078330597305; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Mild obstructive sleep apnea (OSA) is characterized by an apnea hypopnea index (AHI) of between 5 and 15 events/h, and is highly prevalent in the adult population. There is no consensus on the existence of metabolic alterations in mild OSA compared to healthy controls, or on the best treatment for mild OSA. Objectives: To evaluate the metabolic profile of patients with mild OSA compared to controls, and the effectiveness of continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) treatments on metabolic outcomes. Methods: Adults (18-65 years-old) of both genders with a BMI ≤35 Kg/m² were included. The mild OSA group comprised patients with an AHI of ≥5 and ≤15 events/h, independently of somnolence. The control group comprised 35 individuals with an AHI of <5 events/h, and an Epworth sleepiness scale (ESS) score of <10. All groups were submitted to clinical, polysomnographic and metabolic evaluation of metabolism (glycated hemoglobin, fasting insulin, HOMA-IR, HOMA-β, QUICKI, cortisol, total cholesterol and fractions (VLDL-c, LDL-c, HDL-c), and triglycerides). The OSA group was randomized as follows: CPAP group (n=34), MAD group (n=29) and control group (n=22). Evaluations were performed at baseline and at 12-month follow-up. For statistical analysis, the Univariate General Linear Model (GLM) was used for comparing the groups, and the Generalized Estimating Equation (GEE) test was used to evaluate the repeated measures with the subsequent analysis of the intention to treat by means of the imputation of the data. Results: At baseline, the mild OSA group showed increased triglycerides (CG: 90.05 ± 51.91 vs. OSA: 140.32 ± 78.23 mg / dL, p = 0.004) and TG/HDL-c fraction (CG: 1.97 ± 1.44 vs. OSA: 3.13 ± 2.01, p = 0.05) after adjusting for BMI, waist circumference, age and gender. After 12 months, there was no reduction in either BMI or somnolence. HbA1C decreased in the MAD group (p = 0.006) and total cholesterol and LDL-c fraction had a significant reduction in the CPAP group (p = 0.01 and p = 0.002, respectively). Conclusion: Mild OSA is associated with dyslipidemia characterized by elevated levels of triglycerides and the TG /HDL-c fraction compared to the control group, regardless of confounding factors. In the comparison of treatments, CPAP was superior in improving dyslipidemia, despite the better therapeutic adherence to the MAD.