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Navegando por Palavras-chave "CPAP"

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Acute impact of continuous positive airway pressure on nasal patency
(Wiley, 2017) Balsalobre, Leonardo [UNIFESP]; Pezato, Rogerio [UNIFESP]; Gasparini, Hiran [UNIFESP]; Haddad, Fernanda [UNIFESP]; Gregorio, Luis Carlos [UNIFESP]; Fujita, Reginaldo R. [UNIFESP]
Background: Continuous airflow in the upper airway can cause discomfort, leading to nasopharyngeal complaints. The aim of the present study is to evaluate the acute effects of continuous positive upper-airway pressure on nasal patency in awake normal subjects. Methods: Twenty-seven adults (17 men
Acesso aberto (Open Access)
Análise do clearance mucociliar nasal e dos efeitos adversos do uso de CPAP nasal em pacientes com SAHOS
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2004-04-01) Ferri, Ricardo Gimenes [UNIFESP]; Zonato, Adriane; Guilherme, Arnaldo [UNIFESP]; Gregório, Luiz Carlos [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
Since 1981 the use of positive airway pressure through the nasal CPAP has been considered the main clinical treatment of the SAOS- sleep obstructive apnea syndrome, despite its low adhesion on a long- term. Some authors report that the nasal complaints from the continuous positive airway pressure in the nasal cavity are the main causes for the therapy discontinuance. This would probably occur because the treatment would lead to epithelium alterations and changes in the mucociliarytransport and hence, a greater number of upper respiratory infections. AIM: To evaluate the nasal mucociliary clearance in patients with SAHOS under nasal CPAP use through saccharin test, and correlate the adverse effects of this therapy with the treatment endurance and the pressure level used in it. STUDY DESIGN:Clinical study case-control. MATERIAL AND METHOD: Twenty five patients, carriers of SAHOS - between their 18 and 70 - submitted to nasal CPAP use for one month, were followed-up at the Instituto do Sono (UNIFESP-EPM) and subjected to the saccharin test. The results were compared to a group of 25 normal individuals. RESULTS: There was no statistical difference among the groups regarding the saccharin test. The adverse effects were present in 84% of the sample, being 60% for nasal dryness and 36% for nasal obstruction. CONCLUSIONS: The mucociliary transport stays normal in the SAHOS group submitted to nasal CPAP use and the nasal obstruction and nasal dryness do not present correlation with the treatment time and pressure level used by the device.
Acesso aberto (Open Access)
Aplicação, eficácia e segurança do Sham-CPAP em ensaios clínicos com pacientes com apneia obstrutiva do sono moderada e grave
(Universidade Federal de São Paulo (UNIFESP), 2017-04-28) Mello, Luciane Impelliziere Luna de [UNIFESP]; Poyares, Dalva Lucia Rollemberg [UNIFESP]; Cintra, Fátima Dumas [UNIFESP]; http://lattes.cnpq.br/8836659601497424; http://lattes.cnpq.br/4176832922554657; http://lattes.cnpq.br/3150882510083170; Universidade Federal de São Paulo (UNIFESP)
A Apneia Obstrutiva do Sono (AOS) moderada e grave, tem como principal tratamento a pressão positiva contínua nas vias aéreas (CPAP). Nos estudos clínicos randomizados (ECRs) em pacientes com a AOS, a eficácia do CPAPfoi comparada a procedimentos “placebo” não ideais. O desenvolvimento do Sham-CPAP, já foi validado, no entanto, o tempo máximo de seu uso, sua eficácia e segurança ainda não foram adequadamente avaliados. Objetivo: Verificar a eficácia e segurança do uso do Sham-CPAP durante 6 meses, em um ECR, em pacientes com AOS moderada e grave. Desenho do Estudo: ECR duplo-cego. Método: Pacientes de ambos os sexos, com diagnóstico de AOS e com índice de apneia e hipopneia (IAH) ≥ 20 eventos/hora, diagnosticados por polissonografia (PSG) de noite inteira e com idade 35-65 anos, randomizados para uso de CPAP ou Sham-CPAP. As variáveis antropométricas, polissonográficas, ecocardiográficas e laboratoriais dos pacientes tratados, foram coletadas e analisadas durante 6 meses. Os valores normais do Dióxido de Carbono (CO2) e do Dióxido de Carbono Exalado (EtCO2) foram medidos na máscara durante a noite da PSG para a titulação do Sham-CPAP. Resultados: Dos 212 pacientes com a AOS, 72 foram randomizados para o tratamento com o CPAP ou o Sham-CPAP. Não foram observadas diferenças significativas entre os grupos no momento basal, com exceção do IAH e do índice de despertares que foram maiores no grupo CPAP (31,5±11,3Sham-CPAPvs.49,3±24,7CPAP e 25,3±11,9Sham-CPAPvs35,9±19,0CPAP, p<0,001).O número de desistências foi similar nos dois grupos durante o protocolo (p=0,59). Durante o acompanhamento do grupo Sham-CPAP foi observado um aumento da Pressão Arterial Diastólica (PAD), um aumento no Índice de Massa Corpórea (IMC) e uma redução da Lipoproteína de Alta Densidade (HDL) no sexto mês do protocolo (respectivamente p<0,001; p=0,01; p=0,001). A adesão ao Sham-CPAP foi menor no sexto mês de acompanhamento, em relação aos meses anteriores. Em relação às variáveis sanguíneas, houve queda progressiva e significativa nos valores da Hemoglobina (Hg) e do Hematócrito (Ht) no grupo estudado (respectivamente p<0,001; p=0,04; p=0,01). Conclusões: Os resultados reforçam o uso do Sham-CPAP como placebo efetivo em ECRs nos pacientes com a AOS, em relação à adesão, ao cegamento e à ausência de retenção do CO2 na máscara. No entanto, o Sham-CPAP mostrou não ser seguro após o terceiro mês de tratamento, devido ao aumento da PA, do IMC e da redução do HDL.
Acesso aberto (Open Access)
Comparação Dos Efeitos Das Diferentes Modalidades De Cpap Na Estrutura Do Sono E Adesão De Pacientes Com Apneia Obstrutiva Do Sono
(Universidade Federal de São Paulo (UNIFESP), 2017-08-31) Pinto, Evelyn Lucien Brasil Vieira [UNIFESP]; Poyares, Dalva Lucia Rollemberg [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Obstructive sleep apnea (OSA) is associated with behavioral, cognitive, metabolic and cardiovascular consequences. CPAP (Continuous Positive Airway Pressure) is the gold standard treatment of OSA. However, the benefits of CPAP treatment are limited because of poor adherence to therapy. To improve CPAP use and adherence, flexible pressure devices were developed with the purpose of increasing patient´s comfort namely: C-Flex Plus, which reduces inspiratory/expiratory pressure and Sensawake, which allows the reduction of pressure when it identifies that patient is awake. Studies evaluating polysomnographic parameters and adherence of these devices compared to fixed pressure CPAP are scarce. Objective: To examine the effect of different CPAP modalities on sleep and adherence parameters in patients with moderate to severe OSA. Methods: Patients with a recent diagnosis of OSA and with apnea and hypopnea index (AHI) ≥ 20 events/hour, aged 30 to 65 years, were randomized and used CPAP for 30 days in each of the three modalities: CPAP fixed pressure, C-Flex Plus and Sensawake, followed by a 7-day washout between modalities. At the end of each modality, participants performed polysomnography (PSG) with the CPAP in use according to the randomized order of treatments. They also filled Epworth Sleepiness Scale, FOSQ, Pittsburgh scale, and visual analog scale. CPAP adherence was systematically checked for each modality. Results: Of the 23 patients evaluated, 15 patients were recruited for the study. The mean age and body mass index (BMI) of the participants was 42.4 ± 15.1 years, 29.9 ± 4.8 kgs, respectively. The mean AHI was 43.5 ± 22.9 events/hour. The arousal index was significantly lower in SensaWake compared to fixed pressure CPAP (10 ± 5.2 versus 12.7 ± 5.5 events / hour, p = 0,05) and the Respiratory DisturbanceIndex was also significantly lower in SensaWake modality compared with C- Flex Plus (3.5 ± 3.6 versus 5 ± 3.1 events / hour, p = 0,02). Adherence to therapy was higher in C-Flex Plus (C-Flex Plus: 5.8 ± 1.2 versus SW: 4.4 ± 1.1 versus fixed pressure: 4.67 ± 1.48 hours, p = 0.01). We also found an improvement in sleep quality with the use of fixed pressure compared with baseline (p = 0.01). All CPAP modalities significantly improved sleepiness in a similar manner (p <0.001). Conclusions: SensaWake significantly reduced the arousal index and RDI; C-Flex Plus showed higher compliance compared with Fixed Pressure and SensaWake. The three modalities improved sleepiness when compared to baseline. The Fixed Pressure CPAP improved the quality of sleep measured by the Pittsburgh questionnaire. The authors propose that CPAP modalities may benefit different patient profiles. Future studies will evaluate the patients` profile who will benefit most from each CPAP mode.
Acesso aberto (Open Access)
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.
Acesso aberto (Open Access)
Comparison of the effects of continuous positive airway pressure, oral appliance and exercise training in obstructive sleep apnea syndrome
(Faculdade de Medicina / USP, 2013-01-01) Schutz, Teresa Cristina Barros [UNIFESP]; Cunha, Thays Crosara Abrahao [UNIFESP]; Moura-Guimaraes, Thais [UNIFESP]; Luz, Gabriela Pontes [UNIFESP]; Ackel-D'elia, Carolina [UNIFESP]; Alves, Eduardo da Silva [UNIFESP]; Pantiga Junior, Gilberto [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Tufik, Sergio [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: There are several treatments for obstructive sleep apnea syndrome, such as weight loss, use of an oral appliance and continuous positive airway pressure, that can be used to reduce the signs and symptoms of obstructive sleep apnea syndrome. Few studies have evaluated the effectiveness of a physical training program compared with other treatments. The aim of this study was to assess the effects of physical exercise on subjective and objective sleep parameters, quality of life and mood in obstructive sleep apnea patients and to compare these effects with the effects of continuous positive airway pressure and oral appliance treatments. METHODS: Male patients with moderate to severe obstructive sleep apnea and body mass indices less than 30 kg/m2 were randomly assigned to three groups: continuous positive airway pressure (n = 9), oral appliance (n = 9) and physical exercise (n = 7). Polysomnographic recordings, blood samples and daytime sleepiness measurements were obtained prior to and after two months of physical exercise or treatment with continuous positive airway pressure or an oral appliance. Clinicaltrials.gov: NCT01289392 RESULTS: After treatment with continuous positive airway pressure or an oral appliance, the patients presented with a significant reduction in the apnea-hypopnea index. We did not observe changes in the sleep parameters studied in the physical exercise group. However, this group presented reductions in the following parameters: T leukocytes, very-low-density lipoprotein and triglycerides. Two months of exercise training also had a positive impact on subjective daytime sleepiness. CONCLUSIONS: Our results suggest that isolated physical exercise training was able to modify only subjective daytime sleepiness and some blood measures. Continuous positive airway pressure and oral appliances modified the apnea-hypopnea index.
Somente Metadadados
Continuous positive airway pressure treatment associated with face injury during rapid eye movement behavior disorder
(Elsevier B.V., 2015-06-01) Santos Coelho, Fernando Morgadinho [UNIFESP]; Kim, Lenise Jihe [UNIFESP]; Cremaschi, Renata Carvalho [UNIFESP]; Pereira, Debora Dias [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Acesso aberto (Open Access)
Efeito da apneia obstrutiva do sono sobre o comprimento telomérico e seus mecanismos associados
(Universidade Federal de São Paulo, 2022-04-25) Tempaku, Priscila Farias [UNIFESP]; Tufik, Sergio [UNIFESP]; D´Almeida, Vania [UNIFESP]; http://lattes.cnpq.br/7220411418339421; http://lattes.cnpq.br/1375290481822767; http://lattes.cnpq.br/1848763194021358
A apneia obstrutiva do sono (AOS) é um distúrbio de sono de elevada prevalência e morbidade. Dentre os fatores associados à sua fisiopatologia, destaca-se o papel da hipóxia intermitente, a qual contribui com o desenvolvimento do estresse oxidativo e da inflamação. Sabe-se que níveis cumulativos desses fatores influenciam negativamente a porção final do cromossomo, denominada telômero. Portanto, hipotetizamos que a AOS seja capaz de acelerar o processo de envelhecimento por meio do encurtamento telomérico mediado por marcadores inflamatórios e oxidativos. Assim, o objetivo do presente trabalho foi investigar o efeito da AOS e do seu tratamento com aparelho de pressão contínua positiva nas vias aéreas (CPAP) sobre a variação do comprimento dos telômeros e seus mecanismos associados. Foi conduzido um estudo clínico randomizado duplo-cego e sham- controlado com duração de 6 meses. Recrutamos participantes do sexo masculino, com diagnóstico de AOS (índice de apneia-hipopneia ≥20/hora), idade entre 35-65 anos e índice de massa corpórea <35 kg/m2; os quais foram randomizados para uso de CPAP ou sham-CPAP ao longo de 6 meses. Os participantes realizaram 7 visitas (basal e após 1, 2, 3, 4, 5 e 6 meses), nas quais foram submetidos à avaliação clínica e otorrinolaringológica, aplicação de questionários de sono, polissonografia e coleta de sangue para extração de DNA e mensuração do comprimento médio dos telômeros de leucócitos (CMTL), bem como ensaios de quantificação de mediadores inflamatórios, metabólicos e oxidativos. Dentre a amostra total (n=127) que entramos em contato no período de coleta, cumpriram os critérios de inclusão e exclusão e participaram do protocolo 46 indivíduos (36,2%), sendo 30 (65,2%) para o grupo CPAP e 16 (34,8%) para o grupo sham-CPAP. No geral, os grupos foram homogêneos nas avaliações basais, inclusive no CMTL (p=0,106). A adesão apresentada durante a intervenção foi de 5,29 ± 1,09 no grupo sham-CPAP e de 5,71 ± 0,19 no grupo CPAP. Após 6 meses de intervenção, observamos um efeito estatisticamente significativo do tratamento (p=0,001) sob o CMTL, em que o grupo sham-CPAP (1,0117 ± 0,1552, 0,9457 ± 0,0747, 0,8482 ± 0,2163) apresentou uma redução mais expressiva do que o grupo CPAP (1,0960 ± 0,1122, 1,0521 ± 0,1094, 1,0675 ± 0,1225) comparando as médias das Visitas 1, 4 e 7. Além disso, encontramos uma correlação negativa entre os deltas CMTL e delta TNF-α da Visita 7 e Visita 1 (rho=- 0,216, p=0,003), devido à intervenção sham-CPAP (rho=-0,383, p=0,009) em relação ao uso de CPAP (rho=0,021, p=0,800). Podemos concluir que o CPAP, ao compararmos com o placebo sham-CPAP, causou um efeito na estabilidade do CMTL, potencialmente pela modulação do TNF-α.
Acesso aberto (Open Access)
Efeito da pressão positiva aguda na cavidade nasal
(Universidade Federal de São Paulo (UNIFESP), 2018-10-25) Balsalobre Filho, Leonardo Lopes [UNIFESP]; Fujita, Reginaldo Raimundo [UNIFESP]; Gregório, Luís Carlos [UNIFESP]; http://lattes.cnpq.br/3121718741179338; http://lattes.cnpq.br/3164472905601886; Universidade Federal de São Paulo (UNIFESP)
Introduction: Many studies have shown the influence of nasal obstruction on sleep disorders and adaptation to continuous positive airway pressure (CPAP). However, data are lacking on the impact of continuous positive pressure on the nasal cavity – whether in healthy individuals or patients with allergic rhinitis – and on the effect, if any, of topical corticosteroids on nasal patency after exposure to CPAP. In addition, it has been hypothesized that increasing interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis may decrease polyp size. Objective: The overarching goal of this series of studies was to evaluate the effect of continuous positive pressure on the nasal cavity of healthy individuals, subjects with allergic rhinitis, and subjects with nasal polyposis by objective and subjective methods. Methods: Three studies were carried out. The first included 27 subjects who were exposed to 2 hours of positive nasal pressure by CPAP via nasal mask with a pressure of 20 cm/H2O. A questionnaire on nasal allergic symptoms was applied, and participants were subsequently divided into two groups: with and without nasal allergic symptoms. Four methods were applied immediately before and after exposure to positive pressure: a visual analogue scale (VAS) of nasal obstruction; the Nasal Obstruction Symptom Evaluation (NOSE) scale; peak nasal inspiratory flow (PNIF) measurement; and acoustic rhinometry (AcRh). For the second study, 10 patients with nasal allergic rhinitis were exposed to 1 hour of positive nasal pressure by CPAP via nasal mask with a pressure of 15 cm/H2O. VAS, NOSE, PNIF, and AcRh measurements were obtained immediately before exposure to positive pressure. Topical intranasal budesonide therapy (400 mcg/day) was administered for 4 weeks, and the aforementioned tests were performed again, now before and after exposure to positive pressure. For the third study, 12 patients with nasal polyposis and 27 controls without polyposis were exposed to CPAP (20 cm/H2O) for 2 hours. VAS, NOSE, PNIF, AcRh, and nasal endoscopy (for polyp grading with the Meltzer Clinical Scoring System) were performed before and after the intervention. Results: In the first study, an increase in nasal obstruction was observed both on subjective parameters (VAS and NOSE) and on objective evaluation (reduction of nasal cavity volume on AcRh and lower PNIF). Deterioration of indicators of nasal patency was worse in subjects with nasal allergic complaints. In the second study, comparison of VAS, NOSE, PNIF, and AcRh findings after and before topical budesonide therapy and after exposure to positive pressure showed a statistically significant improvement in nasal obstruction scores and indicators of nasal patency. In the third study, for the polyposis group, VAS, NOSE and AcRh findings did not differ significantly (p=0.72, p=0.73, and p=0.17, respectively), but PNIF worsened (p=0.04) after exposure to CPAP. There was a statistically significant reduction in nasal polyp volume (p=0.04). The control group experienced deterioration of all measured parameters of nasal obstruction. Conclusion: Acute exposure to positive pressure via CPAP impairs nasal patency. This effect is even more pronounced in individuals with nasal allergic symptoms. Topical corticosteroid therapy was able to mitigate the irritant effects of CPAP on the nasal mucosa, leading to improvement of nasal patency parameters. In patients with nasal polyposis, CPAP exposure reduced the size of nasal polyps, but also reduced nasal patency as measured by PNIF. However, it had no significant effects on acoustic rhinometry findings or clinical symptoms of nasal obstruction.
Acesso aberto (Open Access)
Efeito do tratamento da apneia obstrutiva do sono de grau leve, sobre a qualidade ee vida, humor e atenção sustentada: estudo randomizado, paralelo, simples cego e controlado
(Universidade Federal de São Paulo (UNIFESP), 2017-05-31) Luz, Gabriela Costa Pontes [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; http://lattes.cnpq.br/2605106957934146; http://lattes.cnpq.br/6882391059348792; http://lattes.cnpq.br/6552172920168051; Universidade Federal de São Paulo (UNIFESP)
Introduction: The effect of Continuous Positive Airway Pressure (CPAP) or Oral Appliance (OA) treatment on obstructive sleep apnea (OSA) in the domains of quality of life, mood and cognition is still controversial and especially in mild OSA. Objective: To evaluate and compare the effect of treatment with CPAP and OA in patients with mild OSA in improving quality of life, mood and sustained attention. Methods: Patients of both genders were included; body mass index (BMI) ≤ 35 kg /m2; age between 18 and 65 years; diagnosis of mild OSA - apnea and hypopnea index (AHI) ≥ 5 events per hour of sleep and ≤ 15 events per hour of sleep independent of the presence of excessive daytime sleepiness (EDS), but with at least one sign and/or symptom and with a minimum mandibular protrusion of 7mm. Patients were randomly assigned to 3 groups: group 1 - CPAP, group 2 - OA and group 3 - control without treatment. The patients were submitted to two evaluations: baseline and after 6 months of treatment. The subjects performed the following procedures in these evaluations: Pittsburgh Sleep Quality Index (PSQI), physical examination, otorhinolaryngological examination, baseline polysomnography (PSG) (and using CPAP in group 1), Epworth Sleepiness Scale (ESS), Beck Anxiety and Depression Inventories (BAI and BDI), Functional Outcomes of Sleep Questionnaire (FOSQ) and 5 measures of Psychomotor Vigilance Task (PVT). For statistical analysis, we used a descriptive analysis (means ± standard deviation) and for assessment of the groups at different times we used General Linear Model (GLM). Results: 48 patients participated in the study, 15 in group 1, 15 in group 2 and 18 in group 3. Regarding the PSG, we observed better results in several variables, after six months of treatment in group 1, compared to groups 2 and 3. No differences between groups were observed in ESS, PSQI, BAI and BDI. Regarding FOSQ, we observed that group 1 presented improvement in the followings domains: general productivity; social outcomes and overall mean, when compared to the other groups. Regarding PVT, we observed no difference between the groups. Adherence to OA was higher when compared to CPAP. Conclusion: CPAP was the best intervention for normalization of polysomnographic parameters and improvement of quality of life. There was no difference in mood and sustained attention between treatments. The OA showed greater adherence than CPAP during the six months of treatment.
Acesso aberto (Open Access)
Efeito do uso CPAP na recuperação de atletas de alto rendimento
(Universidade Federal de São Paulo (UNIFESP), 2016-01-31) Pantiga Junior, Gilberto [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; http://lattes.cnpq.br/4215971444001756; http://lattes.cnpq.br/3330461490172438; Universidade Federal de São Paulo (UNIFESP)
Introdução: O objetivo do presente estudo foi avaliar o uso do CPAP sobre a recuperação física e cognitiva, de atletas, de alto rendimento, sem distúrbios do sono. Métodos: Foram selecionados 12 atletas de alto rendimento, do gênero masculino, saudáveis (sem SAOS), praticantes de corrida de rua há pelo menos um ano, com o tempo de prova para os 10 quilômetros entre 31 e 45 minutos. Participaram de duas etapas de pesquisa: Etapa1 (sem CPAP)- 5 dias de treinamento de alta intensidade/volume sem utilização do CPAP para dormir; 2 dias de descanso (washout: sem treinamento e sem CPAP); 5 dias de treinamento de baixa intensidade/volume sem a utilização do CPAP para dormir. Etapa 2 (com CPAP)- 5 dias de treinamento de alta intensidade/volume dormindo com o CPAP à noite durante 5 noites seguidas; 2 dias de descanso (washout); 5 dias de treinamento de baixa intensidade/volume durante o dia dormindo com o CPAP à noite durante 5 noites seguidas. Foram realizadas quatro avaliações ao longo do estudo que incluíam exames de polissonografia (PSG), análise sanguínea, aplicação do inventário de ansiedade IDATE Traço e Estado, do Inventário de Beck (BDI), escala de humor de Brunel (BRUMS), Escala Subjetiva de Experiência em Exercício (SEES), Dolorimetria, Actigrafia, Escala Likert de Bem-Estar (diário de sono) e diário de sono. Resultados: Foi observado uma redução estatisticamente significante (p<0,01) na latência para início de sono REM. Foram encontradas diferenças estatisticamente significantes (p<0,01) nas variáveis sanguíneas aldolase, hematócrito e leucócitos. Encontramos um aumento da sensação de bem estar, medido através de escala likert de bem estar (diário de sono), (p< 0,01). Houve uma redução dos tempos dos 10 km nas diferentes semanas com a utilização do CPAP. Conclusão: O uso do CPAP durante o período de recuperação do treinamento físico em atletas de elite promove benefícios nos parâmetros do sono como a redução da latência para início do sono REM, assim como em alguns parâmetros sanguíneos, e redução nos tempos da prova de 10 km (Deltas), mas não promove alterações na ansiedade, experiência subjetiva em exercício, humor, depressão, dolorimetria e actigrafia.
Acesso aberto (Open Access)
Efeito do “Continuous positive airway pressure” (CPAP) e do Aparelho Intraoral de avanço mandibular (AIOam) nos parâmetros cardiovasculares da Apneia obstrutiva do sono de grau leve.
(Universidade Federal de São Paulo (UNIFESP), 2020-07-30) Silveira, Thais de Moura Guimarães [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4797424Y1; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4336161Z0; Universidade Federal de São Paulo (UNIFESP)
Objectives: To evaluate and compare the effects of Continuous Positive Airway Pressure (CPAP), mandibular advancement device (MAD) and no treatment on 24-h ambulatory blood pressure monitoring (24h-ABPM) and peripheral arterial tonometry (PAT) at 6 and 12 months follow-up in individuals with mild Obstructive Sleep Apnea (OSA), and in subgroups with presence of daytime sleepiness, hypertension, or non-dipping pattern at baseline, or who had an AHI of < 5 and adherence ≥ 4 hours per night (effective treatment subgroups). Methods: The inclusion criteria were individuals with mild OSA, any gender, aged between 18 and 65 years, and Body Mass Index (BMI) ≤ 35Kg/m2 . Patients were randomized to CPAP, MAD and no-treatment groups. The evaluations included physical examination, full polysomnography, 24-h ABPM and PAT at baseline, after 6 and 12 months. The GLMM test was used for comparisons. Results: 79 volunteers were included, 31 in the CPAP group, 25 in the AIOam group and 23 in the control group. The CPAP and MAD groups had lower AHIs than the control group at 6 and 12 months (CPAP: 1.7 ± 14.2; MAD:3.8 ± 12.6; control: 9.3 ± 5.2). The MAD group had more hours of treatment per night and better adaptation to treatment than the CPAP group (MAD: 5.7 ± 2.7 h/per night; CPAP: 3.8 ± 3.4 h/per night; MAD: 16% did not adapt; CPAP: 42% did not adapt). No differences were found in the total sample and effective treatment in relation to PAT or 24-h ABPM outcomes. Conclusion: Treatment of mild OSA with CPAP or MAD did not improve BP or endothelial function after one year, even in patients with associated daytime sleepiness, hypertension, non-dipping pattern or in effective treatment.
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Effects of exercise training associated with continuous positive airway pressure treatment in patients with obstructive sleep apnea syndrome
(Springer, 2012-09-01) Ackel-D'Elia, Carolina [UNIFESP]; Silva, Antonio Carlos da [UNIFESP]; Santos-Silva, Rogerio [UNIFESP]; Truksinas, Eveli [UNIFESP]; Sousa, Bolivar Saldanha [UNIFESP]; Tufik, Sergio [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The aim of this study was to evaluate the effects of a 2-month exercise training associated with continuous positive airway pressure (CPAP) treatment on the subjective and objective sleep measurements, quality of life, and mood in moderate to severe obstructive sleep apnea syndrome (OSAS) patients.Male patients were randomized into two treatment groups: CPAP (n = 19) and CPAP + exercise (n = 13). All patients completed 1 month of sleep hygiene, 2 months of treatment (CPAP or CPAP + exercise), and 1 week of washout (no treatment). Fletcher and Luckett sleep questionnaire, Epworth sleepiness scale, sleep diaries, polysomnography, SF-36 inventory of quality of life, Profile of Mood States (POMS) questionnaire, neck circumference, and body composition were evaluated. CPAP + exercise group also underwent cardiopulmonary exercise test before and after treatment.Both treatments were effective in improving subjective sleepiness but CPAP + exercise treatment was more effective in maintaining this improvement after washout. No significant differences were found in most of the sleep parameters studied in both groups. CPAP + exercise group showed lower values of tension and fatigue on POMS and higher values of physical functioning, general health perception, and vitality on SF-36 after treatment.A 2-month exercise training associated with CPAP treatment for OSAS patients has a positive impact on subjective daytime sleepiness, quality of life (physical functioning and general health perception), and mood state (tension and fatigue).
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Pharmacotherapy for residual excessive sleepiness and cognition in CPAP-treated patients with obstructive sleep apnea syndrome: A systematic review and meta-analysis
(W B Saunders Co Ltd, 2016) Avellar, Ariane Bernardes Camilo Castilho de [UNIFESP]; Carvalho, Luciane Bizari Coin de [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Prado, Lucila Bizari Fernandes do [UNIFESP]
Pharmacotherapy has been used as an adjunct to CPAP for treatment of residual excessive sleepiness in patients with a diagnosis of obstructive sleep apnea syndrome (OSAS). However, no studies with a high level of evidence have been conducted to support this practice and confirm its effectiveness. We conducted a meta-analysis to summarize and quantify the effects of pharmacological treatment in adults with OSAS who experience residual excessive sleepiness despite adequate CPAP use. We reviewed clinical trials that compared medications to placebo and evaluated the outcomes residual excessive sleepiness, cognition, and quality of life, as well as treatment effectiveness and safety. The MEDLINE, EMBASE, LILACS, Cochrane Central Register of Controlled Trials - CENTRAL and PsycINFO electronic databases were searched using highly sensitive search strategies. Trials were only included if measures were taken to ensure effective CPAP treatment. Eight randomized clinical trials were included. Pharmacotherapy with modafinil and armodafinil led to improvement of excessive daytime sleepiness, attention/alertness, and clinical condition as measured with the CGI-C. No improvements in quality of life or other cognitive domains (including memory, executive function, and language) could be confirmed. Pharmacotherapy did not cause any severe adverse effects, but was associated with significant dropout rates as compared with placebo. In conclusion, although our results demonstrate the effectiveness of pharmacological treatment as an adjunct to CPAP, further investigation is necessary to improve confidence in its effects. Many findings on the impact of pharmacotherapy on cognition and quality of life were evaluated through analysis of single studies, with heterogeneity in tests and absence of standardization, which reduced certainty as to whether actual improvement occurred in these outcomes. (C) 2015 Elsevier Ltd. All rights reserved.
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Placebo and modafinil effect on sleepiness in obstructive sleep apnea
(Elsevier B.V., 2008-02-15) Bittencourt, Lia Rita A. [UNIFESP]; Lucchesi, Ligia M. [UNIFESP]; Rueda, Adriana D. [UNIFESP]; Garbuio, Silvério Aparecido [UNIFESP]; Palombini, Luciana O. [UNIFESP]; Guilleminault, Christian; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Stanford Univ
Introduction: Previous studies have evaluated the effect of modafinil on residual excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea syndrome (OSAS) under effective CPAP treatment. Even though those trials also used placebo groups, we suppose that the placebo effect might influence the patients' response to modafinil.Methods: Twenty sleepy patients with OSAS under CPAP treatment were selected. All of them had Epworth Sleepiness Scale (ESS) > 10. Following baseline evaluation (T1), all subjects were instructed to take placebo for 7 days. After this single-blind placebo phase and second evaluation (T2), patients were randomly allocated to placebo or modafinil treatment for 21 days in a double-blind protocol. Patients underwent a final evaluation (T3) on the last day of drug intake. the evaluations at T1, T2 and T3 consisted of. medical and laboratory examinations, nocturnal polysomnography, ESS, maintenance of wakefulness test (MWT) and complex reaction time (CRT-NY). in addition, in T2 and T3 the change of illness severity scale (CGI-C) and the evaluation of quality of life. (SF-36) were applied.Results: the comparison between the two groups during the three periods studied, showed the following results: in the modafinil group, ESS score did not change during the initial placebo period, but there was a significant reduction during the modafinil treatment period (p=0.0006); in the placebo group a significant reduction occurred during the initial placebo period (p=0.05), and no further change was observed in the treatment (placebo) period. A significant difference was found between the two groups after the placebo period (T2) (p=0.02). Three patients (33%) of the modafinil group and 9 patients (81%) of the placebo group were classified as placebo-responsive (X-2 : p=0.039). in the treatment period, reaction time was significantly reduced in the modafinil group compared to the placebo group (p<0.02). There was a trend toward improvement in overall clinical condition and also in some domains of SF-36 in the modafinil group.Conclusion: in summary, our study confirms that modafinil used adjunctively with CPAP therapy improves subjective daytime sleepiness in patients with OSAS who were regular users of CPAP therapy but still experienced sleepiness. Moreover, it could help in the improvement of objective measures of behavioral alertness and reduce functional impairments. the usefulness of a blinded placebo period for systematic investigation of placebo role in studies based on subjective response is a point that should be considered in this type of drug trial. (c) 2007 Elsevier Inc. All rights reserved.
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Quality-Adjusted Life-Years Gain and Health Status in Patients with OSAS after One Year of Continuous Positive Airway Pressure Use
(Amer Acad Sleep Medicine, 2014-12-01) Rizzi, Camila Furtado [UNIFESP]; Ferraz, Marcos Bosi [UNIFESP]; Poyares, Dalva [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Study Objectives: To estimate the health utility score and quality-adjusted life-years (QALY) index of obstructive sleep apnea syndrome (OSAS) in patients over 1 y of continuous positive airway pressure (CPAP) treatment.Design: Longitudinal interventional study.Setting: the study was carried out in São Paulo Sleep Institute, Brazil.Patients and participants: Ninety-five patients with OSAS and with apnea-hypopnea index (AHI) > 20 of either sex, body mass index < 40 kg/m(2) and no previous contact with CPAP were included.Interventions: the participants underwent baseline and titration polysomnographies, clinical evaluation, and ambulatory blood pressure (BP) measurement, completed Short-Form 6 Dimension Health Survey (SF-6D) and Epworth Sleepiness Scale (ESS) questionnaires, and implementation of CPAP. the patients were followed for 1 y.Measurements and Results: the mean AHI and age were 57.6 +/- 29.2 events/h and 53.3 +/- 9.3 y, respectively. One year of CPAP treatment increased the health utility score from 0.611 +/- 0.112 to 0.710 +/- 0.121 (P < 0.01). Therefore, CPAP resulted in a mean gain of 0.092 QALY/patient. the improvements in utility scores were associated with decreases in the ESS after 1 mo, in systolic BP after 1 y, and in diastolic BP at 6 mo. BP normalization group (<= 130/85 mmHg) showed higher QALY than that of the non-normalization group (0.10 +/- 0.09 versus 0.05 +/- 0.10; P = 0.03). One-year ESS score (P = 0.03), diastolic BP reduction (P = 0.01) and baseline utility scores (P < 0.01) were significantly associated with QALY gain.Conclusion: This study showed a significant quality-adjusted life-years (QALY)/patient gain after 1 y of regular CPAP use. in addition, blood pressure normalization was associated with higher QALY gain. Thus, utility studies can provide more complete analyses of the total benefits of CPAP treatment in patients with obstructive sleep apnea syndrome and should be encouraged.
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Treatment of obstructive sleep apnea syndrome associated with stroke
(Elsevier B.V., 2015-06-01) Mello-Fujita, Luciane [UNIFESP]; Kim, Lenise Jihe [UNIFESP]; Palombini, Luciana de Oliveira [UNIFESP]; Rizzi, Camila [UNIFESP]; Tufik, Sergio [UNIFESP]; Andersen, Monica Levy [UNIFESP]; Coelho, Fernando Morgadinho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The association between sleep-disordered breathing and stroke has been a subject of increased interest and research. Obstructive sleep apnea (OSA) is an important risk factor for stroke incidence and mortality. Moreover, OSA is a common clinical outcome after stroke, directly influencing the patient's recovery. the treatment of choice for OSA is positive airway pressure (PAP) support and the PAP appliance is considered the most recommended clinical management for the treatment of patients with cardiovascular complications. However, the implementation of PAP in stroke patients remains a challenge, considering the increased frequency of motor and language impairments associated with the cerebrovascular event. in the present study, we reviewed the main findings describing the association between stroke and OSA treatment with continuous positive airway pressure. We also discussed the types of OSA treatment, the different options and indications of PAP treatment, PAP adherence and the clinical outcomes after treatment. (C) 2014 Elsevier B.V. All rights reserved.
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Upper airway surgery: the effect on nasal continuous positive airway pressure titration on obstructive sleep apnea patients
(Springer, 2006-05-01) Zonato, A. I.; Bittencourt, LRA; Martinho, F. L.; Gregorio, L. C.; Tufik, S.; Universidade Federal de São Paulo (UNIFESP)
The objective of this study was to observe the change in CPAP pressure after nasal and/or tonsil surgery in a retrospective study involving 17 patients unable to tolerate CPAP titration. All patients had two polysomnography studies for titration: one before and another subsequent to upper airway surgical treatment. the results showed a mean age of 49 +/- 9 years, a body mass index of 30 +/- 4 kg/m(2) and an apnea-hypopnea index of 38 +/- 19. Surgical procedures were radiofrequency reduction of the inferior turbinate (eight patients), septoplasty (one patient), septoplasty with inferior turbinectomy (two patients), septoplasty with inferior turbinate submucosal diathermy (two patients), septoplasty with tonsillectomy (two patients), septoplasty with inferior turbinate submucosal diathermy and tonsillectomy (one patient) and tonsillectomy (one patient). CPAP titration before and after surgery had respectively a mean pressure of 12.4 +/- 2.5 and 10.2 +/- 2.2 cmH(2)O (P = 0.001). Maximum CPAP pressure was 16.4 cmH(2)O before and 13 cmH(2)O after surgery. A pressure reduction >= 1 cmH(2)O occurred in 76.5% of the patients and >= 3 cmH(2)O in 41.1%. Upper airway surgical treatment appears to have some benefit by reducing nasal CPAP pressure levels. the effect seems to be greater when the prior pressure was >= 14 cmH(2)O.
Acesso aberto (Open Access)
Uso do suporte ventilatório com pressão positiva contínua em vias aéreas (CPAP) por meio de máscara nasofacial no tratamento da insuficiência respiratória aguda
(Associação Médica Brasileira, 1997-09-01) Scarpinella-bueno, M.a. [UNIFESP]; Llarges, C.m. [UNIFESP]; Isola, A.m. [UNIFESP]; Holanda, M.a. [UNIFESP]; Rocha, R.t. [UNIFESP]; Afonso, J.e. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE. To evaluate the efficacy of continuous positive airway pressure (CPAP) administered by face mask in patients with acute respiratory failure with indication of mechanical ventilation. MATERIALS AND METHOD. Eleven patients (mean age 41.3 years) in acute respiratory failure were admitted in the Respiratory Unit - Hospital São Paulo - Escola Paulista de Medicina. At the admission pH, PaO2, PaCO2, respiratory rate (f), arterial pressure and heart rate were measured. The measurements were repeated with administration of oxigen with a high flow face mask at ambient airway pressure and then with 5cm H2O of CPAP by face mask. RESULTS. The use of CPAP by face mask significantly improved the arterial blood oxigenation and decreased the respiratory rate (p<0.05). CONCLUSION. These data allow the conclusion that CPAP administered by face mask improves gas exchange and decreases respiratory rate in patients with acute respiratory failure and may reduce the need for invasive mechanical ventilation.
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Whole blood hypoxia-related gene expression reveals novel pathways to obstructive sleep apnea in humans
(Elsevier B.V., 2013-12-01) Perry, Juliana C. [UNIFESP]; Guindalini, Camila [UNIFESP]; Bittencourt, Lia [UNIFESP]; Garbuio, Silvério Aparecido [UNIFESP]; Mazzotti, Diego R. [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
In this study, our goal was to identify the key genes that are associated with obstructive sleep apnea (OSA). Thirty-five volunteers underwent full in-lab polysomnography and, according to the sleep apnea hypopnea index (AHI), were classified into control, mild-to-moderate OSA and severe OSA groups. Severe OSA patients were assigned to participate in a continuous positive airway pressure (CPAP) protocol for 6 months. Blood was collected and the expression of 84 genes analyzed using the RT2 Profiler (TM) PCR array. Mild-to-moderate OSA patients demonstrated down-regulation of 2 genes associated with induction of apoptosis, while a total of 13 genes were identified in severe OSA patients. After controlling for body mass index, PRPF40A and PLOD3 gene expressions were strongly and independently associated with AHI scores. This research protocol highlights a number of molecular targets that might help the development of novel therapeutic strategies. (C) 2013 Elsevier B.V. All rights reserved.

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