Eficácia do aparelho intraoral na síndrome da resistência de via aérea superior: estudo randomizado, placebo, paralelo e controlado
Data
2018-03-29
Autores
Godoy, Luciana Balester Mello De 
Orientadores
Moura, Sonia Maria Guimaraes Pereira Togeiro De
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A Síndrome da Resistência da Via Aérea Superior (SRVAS) é um distúrbio respiratório do sono que se caracteriza pela ocorrência de episódios de esforço respiratório que produzem múltiplos despertares e consequentes fadiga e
sonolência excessiva diurna. Atualmente, existem poucos estudos avaliando o impacto de tratamentos da SRVAS. Com efeito, não há, até o momento, um tratamento bem estabelecido para a doença. Objetivo: Avaliar a eficácia do tratamento com aparelho intraoral de avanço mandibular (AIO) em pacientes com
SRVAS em relação à melhora da queixa de cansaço, da sonolência medida de forma subjetiva e objetiva, assim como das queixas de insônia, das alterações da cognição e do humor e da resposta do sistema nervoso autônomo (SNA) a desafios
autonômicos. Métodos: Foram incluídos pacientes de ambos os sexos; com índice de massa corpórea ≤ 30Kg/m2; idade entre 25 e 50 anos. Todos apresentavam diagnóstico clínico e polissonográfico de SRVAS: queixa de sonolência excessiva
diurna (Escala de Sonolência de Epworth ≥ 10) e/ou fadiga (Escala de Impacto da Fadiga – MFIS BR ≥ 38) associada à polissonografia (PSG) com índice apneia / hipopneia (IAH) ≤ 5 eventos por hora e índice de distúrbio respiratório (IDR) > 5
eventos por hora e / ou tempo em limitação do fluxo aéreo (LFA) > 30% do tempo total do sono. Os pacientes foram randomizados para tratamento com AIO ou placebo. Foram realizados na condição basal, após 6 meses e com 1,5 ano questionários de sono, PSG, teste múltiplo das latências do sono (TMLS), Teste de
Vigilância Psicomotora (“Psychomotor Vigilance Test” - PVT), testes neurocognitivos e avaliação de SNA (ANSAR). Resultados: O IDR, o número de despertares relacionados ao esforço respiratório (RERA), a porcentagem do tempo total do sono
em limitação ao fluxo aéreo e o índice de despertares diminuíram significativamente após 1,5 ano de tratamento com AIO. O resultado total do Índice de Qualidade do Sono de Pittsburgh (PSQI) melhorou, a gravidade dos sintomas de depressão
diminuiu, os valores do teste de estresse de Lipp referente às fases de alerta e resistência melhoraram e o tempo médio de reação medido pelo PVT às 8 horas da manhã diminuiu após 1,5 ano de tratamento. O teste ANSAR nos desafios respiração
profunda e posição ortostática demonstrou manutenção da tendência parassimpática no grupo placebo em relação ao grupo tratamento. Conclusão: O aparelho intraoral de avanço mandibular melhorou a qualidade do sono, a atenção sustentada e reduziu os sintomas depressivos bem como o estresse nas fases de alerta e resistência em pacientes com SRVAS.
Introduction: Upper Airway Resistance Syndrome (UARS) is characterized by episodes of increased respiratory efforts during sleep that can cause sleep disruption, fatigue and excessive daytime sleepiness. There are few studies about UARS treatment and it is unclear what the best treatment for the condition is. Objective: To evaluate the effects of a mandibular advancement device (MAD) on fatigue, subjective and objective excessive daytime sleepiness, insomnia, cognition, mood and autonomic nervous system (ANS) response after autonomic challenges. Methods: Inclusion criteria consisted of both genders; body mass index ≤ 30Kg/m2 age ranging from 25 to 50 years of age. UARS diagnosis was presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index (AHI) ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time. Patients were randomized in two groups: placebo and MAD. The following evaluations were performed before and after 6 months and 1.5 year of treatment: sleep questionnaires, full-night polysomnography, Multiple Sleep Latency Test (MSLT), Psychomotor Vigilance Test (PVT), cognitive evaluation and ANS test (ANSAR). Results: RDI, number of Respiratory Effort Related Arousals (RERAs), percentage of total sleep time with flow limitation and arousal index significantly decreased after 1.5 year of MAD. Pittsburgh Sleep Quality Index (PSQI) total score improved, severity of depression symptoms decreased, alert and resistance stress phases in Lipp test improved and mean reaction time in the PVT, based on the first measurement taken at 8 a.m. significantly decreased after 1.5 year treatment. ANSAR test results in deep breath and stand position challenges showed maintenance of the parasympathetic tendency in the placebo group when compared to treatment group. Conclusion: Mandibular advancement device was effective in improving sleep quality, sustained attention and reducing the severity of depression and stress. Oral appliance had also decreased the objective sleep fragmentation and respiratory events in sleep studies and the parasympathetic reflex response during deep breath and stand up position challenges in ANSAR in UARS patients. Our results suggest that mandibular advancement device can be considered a good treatment option for UARS patients.
Introduction: Upper Airway Resistance Syndrome (UARS) is characterized by episodes of increased respiratory efforts during sleep that can cause sleep disruption, fatigue and excessive daytime sleepiness. There are few studies about UARS treatment and it is unclear what the best treatment for the condition is. Objective: To evaluate the effects of a mandibular advancement device (MAD) on fatigue, subjective and objective excessive daytime sleepiness, insomnia, cognition, mood and autonomic nervous system (ANS) response after autonomic challenges. Methods: Inclusion criteria consisted of both genders; body mass index ≤ 30Kg/m2 age ranging from 25 to 50 years of age. UARS diagnosis was presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index (AHI) ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time. Patients were randomized in two groups: placebo and MAD. The following evaluations were performed before and after 6 months and 1.5 year of treatment: sleep questionnaires, full-night polysomnography, Multiple Sleep Latency Test (MSLT), Psychomotor Vigilance Test (PVT), cognitive evaluation and ANS test (ANSAR). Results: RDI, number of Respiratory Effort Related Arousals (RERAs), percentage of total sleep time with flow limitation and arousal index significantly decreased after 1.5 year of MAD. Pittsburgh Sleep Quality Index (PSQI) total score improved, severity of depression symptoms decreased, alert and resistance stress phases in Lipp test improved and mean reaction time in the PVT, based on the first measurement taken at 8 a.m. significantly decreased after 1.5 year treatment. ANSAR test results in deep breath and stand position challenges showed maintenance of the parasympathetic tendency in the placebo group when compared to treatment group. Conclusion: Mandibular advancement device was effective in improving sleep quality, sustained attention and reducing the severity of depression and stress. Oral appliance had also decreased the objective sleep fragmentation and respiratory events in sleep studies and the parasympathetic reflex response during deep breath and stand up position challenges in ANSAR in UARS patients. Our results suggest that mandibular advancement device can be considered a good treatment option for UARS patients.
Descrição
Citação
GODOY, Luciana Balester Mello de. Eficácia do aparelho intraoral na síndrome da resistência de via aérea superior: estudo randomizado, paralelo, placebo e controlado. 2018. 132 f. Tese (Doutorado em Psicobiologia) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2018.