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INTRODUCTION: Mandibular advancement device (MAD) may represent a feasible choice in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), in well selected patients. OBJECTIVE: The aim of this study is to assess the efficacy of MAD in patients with OSAHS, using split night polysomnography (SNP). METHOD: We performed an auto controlled clinical trial to assess the efficacy of MAD in 30 patients with snoring and OSAHS. Clinical evaluation was made every 2 weeks to adjust treatment and observe changes in clinical symptoms. Three-months after placement of the MAD, a SNP was performed, using the MAD in the second half of the night, in order to compare the respiratory results. RESULTS: SNP show significant changes with use of MAD (p<0.05) such as: Decrease in Snore index (from 159.95 to 32.46/h) and in Apnea-hypopnea index (AHI, from 22.45 to 4.63/h), increase in oxygen saturation (SaO2, from 89.98% to 91.39%) and somnolence improvement, using the Epworth Sleepiness Scale (from 14.4 to 4.6 points). CONCLUSION: Our data supports that the use of MAD is an alternative in the management of OSAHS, in well selected patients, used in a multidisciplinary fashion, and evaluated using a SNP.
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Introducción: El síndrome de apnea obstructiva del sueño (SAOS) ha aumentado su incidencia en los últimos años, con repercusiones importantes en la salud, su tratamiento debe ser elaborado por un equipo multidisciplinario según las necesidades de cada paciente. Los dispositivos de avance mandibular pueden ser una herramienta útil y no invasiva. Objetivo: Evaluar el efecto que tienen los dispositivos de avance mandibular (DAM) en pacientes con SAOS de intensidad severo, en quienes presentan como único sitio de obstrucción la base de lengua y son candidatos para utilizar el dispositivo. Diseño: Estudio cuasi-experimental no controlado de antes y después. Materiales y Métodos: Se incluyeron 30 pacientes con diagnóstico de SAOS de intensidad severo, con único sitio de obstrucción en la base de lengua, que fueran candidatos al uso de dispositivos de avance mandibular, también se realizó polisomnografía de noche dividida de control, comparándose índice de apnea hipopnea (IAH) e índice de ronquido (IR) antes y después del tratamiento. Resultados: En el estudio polisomnográfico de noche dividida de control, se encontró diferencia significativa p<0,001 al comparar el índice de apnea hipopnea e índice de ronquido antes y después de usar el dispositivos de avance mandibular. Discusión: Los dispositivos de avance mandibular pueden ser una herramienta considerada en el manejo del SAOS con cualquier grado de intensidad, siempre y cuando el sitio de obstrucción sea evaluado adecuadamente mediante un grupo multidisciplinario, donde se individualice a cada paciente.
Introduction: The obstructive sleep apnea syndrome (OSAS) has increased its incidence in the last years, with important health repercussions, treatment should be developed by a multidisciplinary team according to the needs of each patient. Mandibular advancement devices can be a useful noninvasive tool. Objective: To evaluate the effect of mandibular advancement devices in patients with severe OSAS, with base of the tongue as the only obstruction site and who are candidates to use the device. Design: Quasi-experimental uncontrolled before and after study. Materials and methods: 30 patients with a diagnosis of severe OSAS, with an unique site of obstruction at the base of tongue, who meet the mandibular advancement devices use criteria; split night polysomnography control was also performed, comparing apnea hypopnea index (AHI) and snoring index (SI) before and after treatment. Results: There is a significance difference p<0,005 between AHI and SI before and after use the mandibular advancement devices in the control split-night polysomnography. Discussion: The mandibular advancement devices may be a treatment tool in OSAS regardless of the severity; a multidisciplinary group should determine the obstruction site, to select a specific treatment in each patient.
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Síndromes da Apneia do Sono , Terapêutica , Avanço MandibularRESUMO
Introducción: El Síndrome de Apnea Obstructiva del Sueño (SAOS) es uno de los trastornos de sueño más frecuentes, asociada con el riesgo cardiovascular. En la actualidad se ha descrito el uso de esclerosantes en el manejo del ronquido simple, no en la apnea del sueño leve. Objetivo: Evaluar la eficacia de este procedimiento para los pacientes con SAOS de intensidad leve con sitio exclusivo de obstrucción en paladar blando. Diseño: Estudio cuasi-experimental no controlado de antes y después. Métodos:Se incluyeron 11 pacientes con SAOS leve, con sitio de obstrucción exclusivo en paladar blando. Se realizó polisomnografía basal y de control a los 6 meses del tratamiento. Se usó tetradecil sulfato de sodio 3%, submucoso en paladar blando 1ml. en la línea media y 0.5 ml paramedial. Se evaluó el índice de ronquido, de apnea/hipopnea (IAH), saturación de oxígeno y despertares. Discusión: Aunque el número de pacientes es muy pequeño, este es el único antecedente del uso de esclerosantes en el tratamiento de apnea del sueño leve, siendo un procedimiento rápido, económico y poco molesto. Se observó mejoría en los parámetros evaluados exceptuando los despertares. Conclusiones: La inyección de esclerosantes podría ser un tratamiento de elección en pacientes con SAOS leve que cumplan con los criterios de obstrucción ya nombrados.
Introduction: The obstructive sleep apnea syndrome (OSAS) is a frequent sleep disorder, and is linked with cardiovascular risk. Actually the sclerotherapy was described in the snoring therapy, but not in the mild OSAS patients. Objective: To evaluate the efficacy of this procedure for patients with mild OSAS with exclusive site of obstruction in the soft palate. Design: Quasi-experimental uncontrolled before and after study. Methods: We collected 11 patients with mild OSAS, only with obstruction in soft palate. The assessment was done by basal and control polysomnography 6 months later of the treatment. The sodium tetradecyl sulfate was used in the submucosal space in the soft palate with 1 ml in the midline and 0,5 ml in the paramedian location. We evaluated snoring index, apnea hyponea index (AHI), oxygen saturation and arousals number. Discussion: Despite the small sample, this is the only report in the literature that describes the use of sclerotherapy in the mild OSAS, it's a quick, low cost and not annoying procedure with a significant improve in all the parameters with an exception in the arousals. Conclusions: Sclerotherapy may be a treatment option in patients with mild OSAS, with the inclusion criteria mentioned above.
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Síndromes da Apneia do Sono , Terapêutica , EscleroterapiaRESUMO
Es muy importante establecer el sitio de obstrucción en la vía aérea, en pacientes con sospecha de apnea obstructiva del sueño (AOS); la obstrucción ocurre mientras dormimos, por lo tanto ¿la evaluación en posición supina debería dar una mejor información del estado de la vía aérea? Establecer la correlación y diferencias entre la evaluación en posición supina y sentado, mediante el examen físico y endoscópico. Métodos: Cohorte longitudinal, observacional, prospectiva, analítica y prolectiva. Se evaluaron 63 pacientes con sospecha de AOS mediante: posición de la lengua según Friedman, maniobra de Müller y evaluación endoscópica de la vía aérea en posición supina y sentado. Se evaluó la correlación y diferencias entre cada grupo. Resultados: No hay diferencia significativa entre la posición supina y sentado tanto en la evaluación física y endoscópica de la vía aérea, sin ser modificado por sexo o IMC. Se encontró un coeficiente de correlación > 0,8 con p=<0,001 entre la evaluación sentado y en supino. Conclusiones: No hay diferencia entre la evaluación de la vía aérea en posición supino y sentado, pero con una correlación significativa de los hallazgos de estos dos grupos, por esta razón no es necesario evaluar la vía aérea en posición supina...
Introduction: It is very important to establish the site of obstruction in the airway, in patients with obstructive sleep apnea (OSA) suspicion. All these events occur in the supine position while the patient is sleeping; therefore the evaluation in the supine position would give a better assessment of the airway obstruction? Objective: establish the correlation and difference between supine and sitting position evaluation of the physical and endoscopic assessment of the airway. Methods: This was a longitudinal, observational, prospective, analytic study and prolective cohort. We collected 63 patients with suspicion of OSA, they were assessed with the Friedman tongue position, Müller maneuver and endoscopic evaluation of the airway in supine and sitting position. We evaluate the correlation and differences of each one. Results: There is no statistical significance between sitting and supine position findings in the physical and endoscopic evaluation, without influence by sex or BMI. With correlation coefficient >0,8 with a statistical significance p=<0,001 between sitting and supine evaluation. Conclusion: No difference in the evaluation of the airway in sitting and supine position, but with a significance correlation between the findings. For this reason is not necessary to do the airway evaluation in the supine position...
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Humanos , Nasofaringe , Otolaringologia , Saúde , Síndromes da Apneia do SonoRESUMO
Introducción: El examen físico no ha demostrado una predicción diagnóstica significativa en la apnea obstructiva del sueño (AOS). Aunque la polisomnografía es el estándar de oro, sus costos y disponibilidad la hacen difícil de realizar en algunos casos; así, es importante encontrar otras herramientas que brinden una aproximación referente a la severidad de la AOS. Objetivo: Establecer la relación entre la circunferencia del cuello y los parámetros polisomnográficos. Métodos: Estudio longitudinal, prolectivo, observacional, analítico en una cohorte prospectiva. Se reclutaron pacientes con sospecha de AOS en la consulta de Otorrinolaringología; se les practicó polisomnografía y medición de la circunferencia del cuello (CC). Se realizó prueba T para muestras independientes y parámetros descriptivos en el análisis estadístico. Resultados: Se evaluaron 141 pacientes, 95 hombres (67%); CC, 30-59 cm; saturación mínima de oxígeno, 35-91%; saturación promedio con rango de 65-96%; índice de apnea-hipopnea, 0,6-173 eventos/hora. Se encontraron diferencias significativas, p < 0,05, entre los parámetros medidos en los pacientes con circunferencia del cuello mayor de 43 cm. Conclusión: La CC mayor de 43 cm se asocia con peores resultados en los parámetros polisomnográficos, lo cual indica la asociación de la CC con la severidad de la AOS...
Introduction: Physical assessment hasnt shown a very strong predictive severity diagnostic value in the obstructive sleep apnea (OSA). Polysomnography is the gold standard diagnostic tool, but it is expensive and difficult to get it in some cases. Therefore it is important to find other diagnostic studies that may give us an approximation to the severity of OSA. Objective: To establish the relationship between neck circumference and polysomnography parameters. Methods: This was a longitudinal - observational and analytic study in a population-based prospective and prolective cohort. We collected the patients with suspicion of OSA, in the Otolaryngology clinics; they were assessed with the neck circumference measure and diagnostic Polysomnography. We determined the Independent samples T- Test, and the descriptive parameters in the statistical analysis. Results: We evaluated 141 patients, 95 males (67,4%), neck circumference (NC) range: 30 59 cm; minimal oxygen saturation range: 35 91% with a mean of 72%; mean oxygen saturation range: 65 96% with a mean of 88,9%; apnea hipopnea index (AHI) range: 0,6 173 events/hour with a mean 52,6 events/hour. There is a statistical significance p value lesser than 0,05 between the NC greater than 43 cm and NC lesser than 43 cm group, in these parameters: minimal saturation, mean saturation and AHI. Conclusion: The NC greater than 43 cm was associated with the worse results in the following polysomnography parameters: minimal saturation, mean saturation and AHI. These findings may give us an association between NC and the severity of the OSA...
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Humanos , Apneia Obstrutiva do Sono , Apneia Obstrutiva do Sono/diagnóstico , Pescoço/fisiologiaRESUMO
Background. As described by Mair et al. in 2001, snoreplasty, the application of sclerosant agents in the palate is a promising and cheap alternative to treat snoring. We decided to try this kind of therapy for the management of mild sleep apnea. Study Design. Experimental, longitudinal, prospective, nonrandomized, self-controlled pilot study. Methods. 11 patients were included, all of them with a polysomnographic study showing an Apnea-Hypopnea Index (AHI) from 5 to 20, and with a Müller maneuver showing only retropalatal collapse. Results. We found significant decrease in the number of apneas hypopneas and oxygen desaturation as well as in the snoring index (P < 0.05), although no differences were found in the number of arousals. Conclusion. Sclerosant agents might become a relevant part in the treatment of sleep apnea, in very well-selected patients.
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OBJECTIVE: To review the outcome of 50 snoring patients treated with uvulopalatopharyngoplasty and uvulopalatal flap, looking for a decrease in the surgical complications rate. DESIGN: A longitudinal, prospective, self-controlled pilot study. SETTING: Sleep Disorders Clinic of the National University of Mexico and Angeles Lomas Hospital. MATERIAL AND METHODS: Fifty consecutive patients underwent surgical treatment for snoring. The Müller manoeuvre was performed in all of them to determine the site of obstruction. In all cases, the bed partner was asked about the presence of snoring before and 6 months after the procedure. Polysomnography was performed before and after the surgery to assess sleep apnea in all patients and to determine the success regarding the snoring index. Every complication was registered. RESULTS: All patients had only habitual snoring, without sleep apnea. Thirty-eight males and 12 females were included in the study. At the sixth postoperative month, the bed partner of 48 patients (96%) reported that snoring was gone, 2 (4%) said that snoring was no longer a problem, the initial snoring index mean was 214, and 6 months after the procedure it decreased to 12. No patients had any complication related to the surgical procedure. CONCLUSIONS: Despite the fact that there are a number of techniques for snoring and sleep apnea, we achieved good postoperative results while avoiding the most common complications.
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Obstrução das Vias Respiratórias/cirurgia , Palato Mole/cirurgia , Faringe/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Ronco/cirurgia , Retalhos Cirúrgicos , Úvula/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos Piloto , Polissonografia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Insuficiência Velofaríngea/etiologia , Adulto JovemRESUMO
BACKGROUND: There are many therapeutic modalities to treat obstructive sleep apnea, and somnoplasty is one of the most widely used around the world. However, there are few reports about its complications. METHODS: The charts of consecutive patients who underwent tongue base somnoplasty were reviewed in the search for complications. RESULTS: The total number of patients was 237. We found only 2 postoperative complicated cases. DISCUSSION: Tongue base somnoplasty can be considered a safe procedure with a low incidence of complications.
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Eletrocoagulação/métodos , Complicações Pós-Operatórias/etiologia , Apneia Obstrutiva do Sono/cirurgia , Língua/cirurgia , Adulto , Transtornos de Deglutição/etiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , México , Pessoa de Meia-Idade , Estudos Retrospectivos , Ronco/cirurgia , Doenças da Língua/etiologia , Úlcera/etiologiaRESUMO
OBJECTIVE: To determine the efficacy of flutamide as a tumor reduction factor in patients who have juvenile angiofibroma (JA) with intracranial invasion. DESIGN: A longitudinal, prospective, experimental, self-controlled pilot study. MATERIAL AND METHODS: Seven consecutive patients with JA were enrolled in the study. CT scan with measurements of the tumor was performed before and after the treatment with flutamide, and the results were compared. RESULTS: The biggest reduction in tumor size was 11.1%. All patients underwent surgical resection, and the bleeding was similar to patients without flutamide. No statistically significant difference was found between the measurements before and after the flutamide administration. CONCLUSIONS: Despite the fact that there is a report of the efficacy of flutamide in the literature, we did not find advantages in using it in patients with JA. However, and due to the very small number of patients enrolled, we think that more studies are required.
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Antagonistas de Androgênios/uso terapêutico , Angiofibroma/tratamento farmacológico , Antineoplásicos Hormonais/uso terapêutico , Flutamida/uso terapêutico , Neoplasias Nasofaríngeas/tratamento farmacológico , Adolescente , Angiofibroma/cirurgia , Encéfalo/patologia , Criança , Humanos , Masculino , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/cirurgia , Invasividade Neoplásica , Projetos Piloto , Falha de TratamentoRESUMO
Antecedentes: la esteatohepatitis no alcohólica es una enfermedad poco conocida, cursa casi asintomática, con cambios mínimos en las pruebas de funcionamiento hepático (PFH); predomina en mujeres obesas con diabetes, con alcoholismo negativo; sin embargo sus biopsias hepáticas muestran daño similar a la enfermedad hepática por alcohol. Puede evolucionar a cirrosis. Objetivo: conocer la prevalencia de la EHNA en derechohabientes del IMSS en Pachuca Hidalgo, México. Método: se estudiaron voluntarios de cada sexo, entre 17 y 75 años, sin hepatopatía conocida, ni consumo de alcohol mayor de 20 g/semana. Se les practicó revisión clínica, exámenes de laboratorio y ultrasonido hepático, a aquellos que mostraron cambios en las PFH y en el ultrasonido se les propuso la biopsia hepática. Resultados: completaron el estudio 97 voluntarios, 70 de ellos no-diabéticos y 27 diabéticos. Se indicó la biopsia en 15 casos, y se confirmó EHNA en 10 (10.3 por ciento); la prevalencia en diabéticos fue de 18.5 por ciento y en no-diabéticos de 7.1 por ciento. Aunque encontramos diferencias en género, edad, y diabetes entre los enfermos con EHNA y los controles, en ningún caso se obtuvo significancia estadística; sin embargo, el sexo femenino y la diabetes se identificaron como factores de riesgo para EHNA. El antecedente de colelitiasis, fue notablemente más frecuente en el grupo de EHNA (p= 0.003). Conclusiones: la prevalencia de EHNA fue 10.3 por ciento en el grupo estudiado, es más frecuente en diabéticos y en mujeres. La obesidad no mostró ser un factor de riesgo adicional a la diabetes.