RESUMO
Los trastornos del sueño son comunes en pacientes con fibrosis quística y afectan significativamente su calidad de vida. Estos pacientes experimentan una reducción en la calidad del sueño, hipoxemia nocturna, alteraciones en la polisomnografía y una alta prevalencia de síndrome de apneahipopnea obstructiva del sueño. Los factores que contribuyen a estas alteraciones incluyen la tos crónica, los síntomas digestivos, las rutinas de tratamiento y, posiblemente, la disfunción del canal CFTR. Sin embargo, el impacto de los moduladores de CFTR en la mejora de los trastornos del sueño aún no está claramente establecido, lo que resalta la necesidad de más estudios para comprender mejor su papel en el manejo del sueño en pacientes con fibrosis quística.
Sleep disorders are common in patients with cystic fibrosis and significantly affect their quality of life. These patients experience reduced sleep quality, nocturnal hypoxemia, polysomnography alterations, and a high prevalence of obstructive sleep apnea-hypopnea syndrome. Contributing factors include chronic cough, digestive symptoms, treatment routines, and potentially CFTR channel dysfunction. However, the impact of CFTR modulators on improving sleep disorders is not yet clearly established, highlighting the need for further studies to better understand their role in sleep management in cystic fibrosis patients.
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Humanos , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/etiologia , Fibrose Cística/complicações , Transtornos do Sono-Vigília/terapia , Fatores de Risco , Polissonografia , Regulador de Condutância Transmembrana em Fibrose Cística , Apneia Obstrutiva do Sono , Qualidade do Sono , HipóxiaRESUMO
Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for snoring, and daytime sleepiness had a clinical evaluation including collection of anthropometric data and ENT examination and rhinofibroscopy with Müller maneuver. The patients undergoing upper airway multilevel surgery and we selected for MESP the patients with an oropharyngeal transverse pattern of collapse at Müller maneuver. Results In the postoperative assessment, all of the patients reported a reduction in snoring scores and daytime sleepiness. We observed a reduction in the mean apnea-hypopnea index (AHI) of 57.5% of the sample, which decreased from a mean value of 41.7 ( ± 21.5) to 17.4 ( ± 8.9) (p< 0.05), with a success rate, according to the Sher criteria, of 65%. We observed very few postoperative complications. Conclusion Modified expansion sphincter pharyngoplasty in multilevel surgical therapy preceded by a careful selection of patients has proven to be effective in treating patients with moderate to severe syndromes.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Músculos Faríngeos/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Apneia Obstrutiva do Sono/cirurgia , Palato Mole/cirurgia , Ronco/diagnóstico , Endoscopia , AnamneseRESUMO
Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for snoring, and daytime sleepiness had a clinical evaluation including collection of anthropometric data and ENT examination and rhinofibroscopy with Müller maneuver. The patients undergoing upper airway multilevel surgery and we selected for MESP the patients with an oropharyngeal transverse pattern of collapse at Müller maneuver. Results In the postoperative assessment, all of the patients reported a reduction in snoring scores and daytime sleepiness. We observed a reduction in the mean apnea-hypopnea index (AHI) of 57.5% of the sample, which decreased from a mean value of 41.7 ( ± 21.5) to 17.4 ( ± 8.9) ( p < 0.05), with a success rate, according to the Sher criteria, of 65%. We observed very few postoperative complications. Conclusion Modified expansion sphincter pharyngoplasty in multilevel surgical therapy preceded by a careful selection of patients has proven to be effective in treating patients with moderate to severe syndromes.
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BACKGROUND: Obesity is associated with obstructive sleep apnea-hypopnea syndrome (OSA) and both induce endothelial dysfunction. However, the effect of OSA on endothelial function after bariatric surgery has not been investigated yet. OBJECTIVES: This study aims to evaluate the impact of weight loss on endothelial function in patients with and without obstructive sleep apnea (OSA) in the first 6 months after bariatric surgery. SETTING: This study was conducted at a university hospital, in Brazil. METHODS: The sample consisted of 56 patients homogeneously divided into groups with and without OSA. All patients underwent Roux-en-Y gastric bypass (RYGB), and the diagnosis of OSA was performed by polysomnography. The patients were evaluated preoperatively and 6 months after surgery. The evaluations included anthropometric measures, electrical bioimpedance, clinical symptoms of OSA, and endothelial function (flow-mediated dilation). RYGB improved the anthropometric, bioimpedance, and endothelial function results in both groups. RESULTS: Patients presented a significant clinical improvement in OSA symptoms throughout the study. However, patients with OSA had an improvement in the endothelial function 2.5% lower (p < 0.001) than patients without APNEA syndrome. CONCLUSION: This study demonstrates that the existence of OSA prior to bariatric surgery interferes in the improvement of endothelial function.
Assuntos
Endotélio Vascular/fisiopatologia , Derivação Gástrica , Obesidade Mórbida/cirurgia , Apneia Obstrutiva do Sono/fisiopatologia , Redução de Peso , Adulto , Antropometria , Cirurgia Bariátrica , Brasil , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/fisiopatologia , Polissonografia , Apneia Obstrutiva do Sono/complicações , Adulto JovemRESUMO
Resumen Introducción: El síndrome de apnea hipopnea obstructiva del sueño (SAHOS) es un trastorno del dormir que se caracteriza por obstrucción de la vía aérea durante el sueño. Los factores de riesgo más importantes para este trastorno son la obesidad y la edad. La obstrucción de la vía aérea ocasiona síntomas como ronquido de gran intensidad, pausas en la respiración o sensación de ahogamiento durante el sueño. Por otra parte, se ha descrito en la literatura que el uso de benzodiacepinas empeora el ronquido y las pausas en la respiración, por lo que podría incrementar la duración y severidad del SAHOS. Reporte del caso: Mujer de 74 años de edad que acude a consulta a la Clínica de Sueño de la UNAM por sintomatología anímica, y al interrogarla sobre otros trastornos del dormir refiere ronquido intenso, interrumpido por períodos de silencio y pausas en la respiración, por lo que se le realizó polisomnografía nocturna dividida que arrojó el resultado de SAHOS grave. Discusión: El consumo de benzodiacepinas es muy frecuente en los adultos mayores. En este caso, la paciente llevaba ingiriendo 1.5 mg/día de clonazepam durante 8 años, por lo que podría haber empeorado el SAHOS. Conclusiones: La paciente tenía factores de riesgo para desarrollar el SAHOS. Es necesario estudiar más la asociación entre las benzodiacepinas y el empeoramiento del SAHOS.
Abstract Introduction: Obstructive sleep apnea hypopnea syndrome (OSAHS) is caused by an obstruction in the upper airway during sleep. Obesity and advanced age are main risk factors for OSAHS. The classic symptoms of OSAHS include snoring, apneas and choking during sleep. On the other hand, some scientific literature describes that the consumption of benzodiazepines may worsen the snoring and the severity and duration of OSAHS. Case report: A 74-year-old female reported on her appointment to have mood alterations. When asked about other sleep disorders, she said that she snored loudly, with pauses on her breathing. Therefore, a split night polysomnography was performed which revealed a diagnosis of severe OSAHS. Discussion: Old people are frequent consumers of benzodiazepines. The woman of this study had been taking 1.5 mg of clonazepam per day for the last eight years. This may have worsened the OSAHS. Conclusion: The patient presented risk factors that could lead to OSAHS. It is important to study the relationship between benzodiazepines and the severity of OSAHS.
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Esta investigación tiene como objetivo establecer el perfil neuropsicológico de una paciente quien padece Síndrome de apnea obstructiva junto con Síndrome metabólico, esta interacción la cual actualmente se conoce como Síndrome Z. Mediante un estudio descriptivo de caso único, teniendo en cuenta una batería neuropsicológica previamente determinada, se caracteriza el desempeño cognitivo de un paciente masculino de 34 años con el diagnóstico mencionado. Los datos fueron analizados con la baremación correspondiente a cada prueba, encontrando dificultades cognitivas a nivel de función ejecutiva, especialmente en funciones de la corteza prefrontal dorsolateral. Como conclusión se establece que el síndrome Z se asocia a un trastorno neurocognitivo menor en un adulto joven.
This research aims to establish the neuropsychological profile of a patient suffering from obstructive apnea syndrome along with metabolic syndrome, this interaction is currently known as Z Syndrome. A descriptive study of a single case, considering a neuropsychological battery previously determined, the cognitive performance of a 34-year-old male patient with the mentioned diagnosis is characterized. The data was analyzed with the corresponding standard to each test, finding cognitive difficulties at the level of executive function, especially in functions of the dorsolateral prefrontal cortex. In conclusion, it is established that Z syndrome is associated with a minor neurocognitive disorder in a young adult.
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Humanos , Masculino , Adulto , Apneia Obstrutiva do Sono , Síndrome Metabólica , Função Executiva/fisiologia , Testes NeuropsicológicosRESUMO
This study aimed to investigate the efficacy of minimally invasive tonsil surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. Tonsil ablation or turbinate reduction was performed on 49 pediatric patients with OSAHS by minimally invasive tonsil surgery. In order to evaluate the efficacy of surgery, a comparison was conducted between pre-operation and post-operation data in terms of the symptoms, signs and polysomnography test. Total effectiveness rate of the surgery was 83.7%. Subgroup analysis was also performed based on the severity of their conditions: mild, moderate, and severe groups had an effectiveness rate of 90.0, 88.9, and 66.7%, respectively (Hc=6.665, P<0.05). Postoperatively, the apnea-hypopnea index, the minimum oxygen saturation (SaO2), and corresponding symptoms improved compared to pre-operation conditions (P<0.05). Minimally invasive tonsil surgery was a safe and effective method for treating OSAHS in children.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Técnicas de Ablação/métodos , Tonsila Palatina/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Técnicas de Ablação/instrumentação , Tonsila Faríngea/patologia , Tonsila Faríngea/cirurgia , Hipertrofia/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Tonsila Palatina/patologia , Polissonografia , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
Introduccióny objetivos: Las alteraciones del sueño parecen tener un efecto negativo en la percepción del dolor o en la aparición de este, por lo que surge el interrogante de si el síndrome de apnea/hipopnea obstructiva del sueño (SAHOS) puede tener algún tipo de relación con la percepción de dolor. El objetivo de este estudio es determinar si la prevalencia de dolor en pacientes sometidos a polisomnografía Métodos: Estudio de corte transversal, en el que se mide con la escala de McGill de dolor la prevalencia de dolor en pacientes a los que se realiza estudio polisomnográfico. Resultados:Se entrevistó a 259 pacientes; se encontró una prevalencia de dolor del 69% y una prevalencia de SAHOS del 81%; en los pacientes con SAHOS, la prevalencia fue del 70% y en los pacientes sin esta enfermedad, del 64%. Conclusiones: Se encontró una alta prevalencia de dolor en esta población, posiblemente relacionada con que era una población muy específica, con la forma de realizar la medición y con no haber controlado por variables como otras enfermedades relacionadas con dolor.
Background and objectives: Sleep disturbances apparently have a negative effect on pain or the appearance of pain itself. This suggests the need to determine whether there could be a relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and this phenomenon. The objective of this study was to determine the pain prevalence in a population who underwent polysomnography. Method: A cross-sectional study of patients who underwent polisomnography, pain prevalence was measured with Mcgill pain questionnaire. Results: Data was obtained from 259 patients, and it was found that 69% suffered pain, and there was a prevalence of 81% OSAHS. Those with OSAHS had a 70% pain prevalence, with 64% for those without OSAHS. Conclusions: A high pain prevalence was found this population, possibly related to the characteristic of the population, how the information was gathered, and not controlling for other illnesses related with pain.
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Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Apneia Obstrutiva do Sono , Percepção da Dor , Apneia , Sono , Síndrome , Medição da Dor , Estudos TransversaisRESUMO
BACKGROUND AND OBJECTIVES: Sleep disturbances apparently have a negative effect on pain or the appearance of pain itself. This suggests the need to determine whether there could be a relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and this phenomenon. The objective of this study was to determine the pain prevalence in a population who underwent polysomnography. METHOD: A cross-sectional study of patients who underwent polisomnography, pain prevalence was measured with Mcgill pain questionnaire. RESULTS: Data was obtained from 259 patients, and it was found that 69% suffered pain, and there was a prevalence of 81% OSAHS. Those with OSAHS had a 70% pain prevalence, with 64% for those without OSAHS. CONCLUSIONS: A high pain prevalence was found this population, possibly related to the characteristic of the population, how the information was gathered, and not controlling for other illnesses related with pain.
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Introducción: el síndrome de apnea/hipopnea del sueño infantil se asocia a numerosos resultados adversos a nivel cognitivo y conductual. El factor de riesgo más comúnmente identificado para presentar síndrome de apnea/hipopnea del sueño es la hipertrofia adenoamigdaliana, para el cual el tratamiento primario es la adenoamigdalectomía. Objetivo: evaluar la eficacia de la adenoamigdalectomía temprana versus la conducta expectante, en lo que respecta a factores cognitivos, conductuales, calidad de vida y sueño, en niños con síndrome de apnea/hipopnea del sueño. Pacientes y método: se analiza críticamente el artículo de Marcus (2013), estudio multicéntrico, enmascarado simple, aleatorizado, controlado, en siete centros de estudio del sueño. Resultados: en un seguimiento a siete meses, la proporción de remisión espontánea en el grupo control de parámetros polisomnográficos sugiere que 46 por ciento de los niños revierten espontáneamente las alteraciones, efecto que se observó en 79 por ciento de los niños en el grupo intervenido. Conclusión de los revisores: la cirugía adenoamigdaliana para el tratamiento de la apnea obstructiva del sueño en escolares no mejora significativamente la atención o la función ejecutiva, pero sí mejora algunos desenlaces de comportamiento, calidad de vida y variables polisomnográficas. Sin embargo, esta mejoría se aprecia en una alta proporción de niños que no recibieron el tratamiento, mejoría principalmente evidenciada en las variables polisomnográficas. Por lo tanto, no sería un requisito indispensable el realizar esta cirugía para revertir dicho cuadro clínico.
Introduction. Obstructive sleep apnea hypopnea syndrome (OSAHS) in children is associated with numerous adverse cognitive and behavioral consequences. The most common risk factor identified for OSAHS is tonsillar enlargement, and primary treatment is adenotonsillectomy. Aim. To compare the efficacy of early adenotonsillectomy versus watchful waiting, on cognitive, behavioral, quality of life and sleep outcomes in children with OSAHS. Patients and Methods. We critically appraised the Marcus (2013) article, a multicenter, single masked, randomized, controlled study in seven sleep centers. Results. After a seven month follow-up, the rate of spontaneous remission in polysomnographic parameters control group shows that 46 percent of children spontaneously revert untoward outcomes, compared to 79 percent of children in the intervention group. Reviewers conclusion. Adenotonsillar surgery for the treatment of obstructive sleep apnea in school-age children does not significantly improve attention or executive function, but it does improve some behavioral outcomes, quality of life, and polysomnographic variables. However, this improvement was also observed in a high proportion of children who received no treatment, mainly regarding polysomnographic variables. Thus surgery does not appear to be necessary to reduce symptoms.
Assuntos
Criança , Adenoidectomia/métodos , Medicina Baseada em Evidências , Literatura de Revisão como Assunto , Síndromes da Apneia do Sono/cirurgia , Tonsilectomia/métodos , Reprodutibilidade dos Testes , Resultado do TratamentoRESUMO
FUNDAMENTO: O papel do estresse oxidativo em pacientes idosos hipertensos com síndrome de apneia-hipopneia obstrutiva do sono (SAHOS) é desconhecido. Objetivo: O objetivo foi avaliar os níveis de Big Endotelina-1 (Big ET-1) e Óxido Nítrico (NO) em pacientes idosos hipertensos com e sem SAHOS moderada a grave. MÉTODOS: Os voluntários permaneceram internados durante 24 horas. Obtivemos os seguintes dados: índice de massa corporal (IMC), Monitorização Ambulatorial da Pressão Arterial (MAPA) - 24 horas, e medicação atual. Sangue arterial foi coletado às 7:00 h e às 19:00 h para determinar níveis plasmáticos de NO e Big ET-1. A oximetria de pulso foi realizada durante o sono. A correlação de Pearson, Spearman e análise de variância univariada foram utilizadas para a análise estatística. RESULTADOS: Foram estudados 25 sujeitos com SAHOS (grupo 1) e 12 sem SAHOS (grupo 2), com idades de 67,0 ± 6,5 anos, 67,8 ± 6,8 anos, respectivamente. Não foram observadas diferenças significativas entre os grupos em IMC; no número de horas de sono; PA diastólica e sistólica em 24 h; PA de vigília; PA no sono; ou medicamentos usados para controlar a PA. Não foram detectadas diferenças nos níveis de NO e Big ET-1 plasmáticos às 19:00 h, mas às 7:00 h os níveis de de Big ET-1 foram mais altos (p = 0,03). No grupo 1, correlação negativa também foi observada entre a saturação de oxihemoglobina arterial média e a PA sistólica - 24 horas (p = 0,03, r = -0,44), e Big ET-1 (p = 0,04, r = 0,41). CONCLUSÕES: Na comparação entre idosos hipertensos com e sem SAHOS com PA e IMC semelhantes, observou-se níveis mais elevados de Big ET-1 após o sono no grupo SAHOS. Os níveis de NO não diferiram entre os pacientes hipertensos com ou sem SAHOS.
BACKGROUND: The role of oxidative stress in hypertensive elderly patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) is unknown. OBJECTIVE: The purpose was to evaluate the levels of big endothelin-1 (Big ET-1) and nitric oxide (NO) in elderly hypertensive patients with and without moderate to severe OSAHS. METHODS: Volunteers were hospitalized for 24 h. We obtained the following data: body mass index (BMI); 24-ambulatory blood pressure monitoring; and current medication. Arterial blood was collected at 7pm and 7am for determining plasma NO and Big ET-1 levels. Pulse oximetry was performed during sleep. Pearson's or Spearman's correlation and univariate analysis of variance were used for statistical analysis. RESULTS: We studied 25 subjects with OSAHS (group 1) and 12 without OSAHS (group 2) aged 67.0 ± 6.5 years and 67.8±6.8 years, respectively. No significant differences were observed between the groups in BMI; number of hours of sleep; 24-h systolic and diastolic BPs; awake BP, sleep BP and medications to control BP between groups. No differences were detected in plasma Big ET-1 and NO levels at 19:00 h, but plasma Big ET-1 levels at 7:00 h were higher in group 1 (p =0.03). In group 1, a negative correlation was also observed between the mean arterial oxyhemoglobin saturation level, 24-h systolic BP (p = 0.03, r = -0.44), and Big ET-1 (p = 0.04, r = -0.41). CONCLUSIONS: On comparing elderly hypertensive patients with and without OSAHS having similar BP and BMI, we observed higher Big ET-1 levels After sleep in the OSAHS group. NO levels did not differ between the hypertensive patients with or without OSAHS.