Publications (16)22.24 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Introduction: The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS). Objective: To assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS. Methods: Prospective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared. Results: 28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p=0.02), smaller cervical circumference (p=0.05), and lower AHI at baseline (p=0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p=0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence. Conclusion: MAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities.
- [Show abstract] [Hide abstract] ABSTRACT: Inspiratory flow limitation (IFL) is defined as a "flattened shape" of inspiratory airflow contour detected by nasal cannula pressure during sleep and can indicate increased upper airway resistance especially in mild sleep-related breathing disorders (SRBD). The objective of this study was to investigate the association between upper airway abnormalities and IFL in patients with mild SRBD. This study was derived from a general population study consisting of selected individuals with apnea-hypopnea index (AHI) below 5 events/h of sleep, ("no obstructive sleep apnea" group) and individuals with AHI between 5 and 15 events/h ("mild obstructive sleep apnea" group). A total of 754 individuals were divided into four groups: group 1: AHI <5/h and <30 % of total sleep time (TST) with IFL (515 individuals), group 2: AHI <5/h and >30 % of TST with IFL (46 individuals), group 3: AHI: 5-15/h and <30 % of TST with IFL (168 individuals), and group 4: AHI: 5-15/h and >30 % of TST with IFL (25 individuals). Individuals with complains of oral breathing demonstrated a risk 2.7-fold larger of being group 4 compared with group 3. Abnormal nasal structure increased the chances of being in group 4 3.2-fold in comparison to group 1. Individuals with voluminous lateral wall demonstrated a risk 4.2-fold larger of being group 4 compared with group 3. More than 30 % of TST with IFL detected in sleep studies was associated with nasal and palatal anatomical abnormalities in mild SRBD patients.
- [Show abstract] [Hide abstract] ABSTRACT: To investigate the anatomy of the upper airway (UA) of a representative sample of the adult population of São Paulo city, Brazil, and to identify factors associated with the presence of obstructive sleep apnea syndrome (OSAS), as confirmed using full-night polysomnography (PSG). Cross-sectional study. Population-based sample. A 3-stage sampling procedure was used to proportionally recruit adult residents of São Paulo city according to gender, age, and socioeconomic status. A complete evaluation was performed, including a systematic evaluation of the UA prior to conducting PSG. Nine-hundred ninety-three (90.2%) of the participants were seen by an ear, nose, and throat (ENT) specialist. Individuals who were diagnosed with OSAS (32.9%) presented a higher frequency of nasal symptoms and structural abnormalities (both nasal and oropharyngeal) compared with those without OSAS. No anatomical differences were observed in the facial skeleton. An abnormal nasal structure visible via anterior rhinoscopy was the only UA factor predicting OSAS after adjustments for the other common OSAS risk factors (male sex, aging, obesity, and increased neck circumference). This is the first study in which a systematic evaluation of the UA was followed by a sleep study in a population-based sample. In a sample of the general population that had not previously been screened for OSAS, having an abnormal nasal structure was found to be a risk factor for OSAS, in conjunction with other well-established clinical and demographic factors, such as male gender, increased age, increased neck circumference, and body mass index. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
- [Show abstract] [Hide abstract] ABSTRACT: Introdução o sucesso da cirurgia faríngea no tratamento da síndrome da apnéia obstrutiva do sono (SAOS) depende da adequada seleção de pacientes. Objetivo propor um novo estadiamento para indicação de cirurgia faríngea na SAOS. Método estudo retrospectivo, onde foram inclusos, 54 pacientes submetidos a amigdalectomia ampliada, divididos em 6 estádios. Estádio I: pacientes com tonsilas palatinas graus 3/4 e índice de Mallampati modificado (IMM) 1/2; Estádio II: tonsilas palatinas 3/4 e IMM 3/4; Estádio III: tonsilas palatinas 1/2 e IMM 1/2; Estádio IV: tonsilas palatinas 1/2 e IMM 3/4; Estádio V: IMC (índice de massa corpórea) ≥ com tonsilas palatinas 3/4 e IMM 1,2,3 ou 4. Estádio VI: IMC ≥ kg/m2 com tonsilas palatinas 1ou2 e IMM 1, 2, 3, ou 4. Resultados as taxas de sucesso cirúrgico foram de 88,9%; 75,0%; 35,7%; 38,5% e 100,0% nos estádios I a V. Conclusão a presença de tonsilas palatinas hipertróficas foi o fator anatômico em comum nos estádios de maior sucesso (I, II e V), independente do IMC. Apesar do IMM classe III e IV diminuir a taxa de sucesso da cirurgia em pacientes com tonsilas hipertróficas (estádio II), a presença de IMM classe I e II não favoreceu o sucesso cirúrgico em pacientes com tonsilas normotróficas (estádio III).
- [Show abstract] [Hide abstract] ABSTRACT: A large goiter can cause a series of compressive symptoms such as dyspnea and dysphagia, and previous case reports have indicated the coexistence of obstructive sleep apnea syndrome (OSAS) in these patients. The aim of this study was to evaluate the impact of thyroidectomy on the control of OSAS in patients with large goiters. Twenty-four patients with euthyroid goiters larger than 100 ml were consecutively selected. Of these, 17 (70.8 %) presented OSAS and formed the research group. The protocol consisted of sleep questionnaires, physical examination, and polysomnography in baseline and after 3 months of surgery. The average age of the patients was 58.3 ± 9.9 years, and there were 5 (29.4 %) males and 12 (70.6 %) females. The significant findings in the postoperative period included a reduced neck circumference (p = 0.041), reduced Epworth sleepiness score (p = 0.025), decreased percentage of high-risk OSAS cases according to the Berlin questionnaire (p < 0.001), and a tendency for a significant reduction in snoring (p = 0.052). However, polysomnographic respiratory parameters showed no significant improvement after surgery. Despite the high prevalence of OSAS in patients with large goiters and the improvement of OSAS symptoms, thyroidectomy showed no significant impact on the polysomnographic parameters.
- [Show abstract] [Hide abstract] ABSTRACT: Background: The few studies that examine the effect of nasal abnormalities on continuous positive airway pressure device (CPAP) adherence are controversial. The aim of this study was to evaluate the contribution of nasal abnormalities in CPAP adherence. Methods: We included patients with moderate to severe OSA. The patients were submitted to rhinoscopy, nasofibroscopy, nasal inspiratory peak flow, and acoustic rhinometry. The patients who used a CPAP for 4 h or more per night for at least 70 % of the nights over a 6-month period were considered to have good adherence. Results: Thirty-four patients finished the study. Eleven (33.4 %) were female and 23 (67.6 %) were male. Sixteen (47.1 %) patients had good adherence. The body mass index (p = 0.030), neck circumference (p = 0.006), and apnea-hypopnea index (p = 0.032) were higher, and the oxyhemoglobin saturation minimum was lower (p = 0.041) in the good adherence group. Nasal parameters showed no differences between good and poor adherence groups. In Spearman's correlation, surprisingly, there was a negative correlation between the highest number of hours of CPAP use with smaller values of nasal minimal cross-sectional areas in the supine position (r, 0.375; p = 0.029). In the linear regression model, the nasal findings that predicted increased of the CPAP use were the following: lower scores of nasal symptoms (p = 0.007) and lower nasal volume in supine position (p = 0.001). Conclusions: The majority of the nasal parameters evaluated in this study did not influence CPAP adherence.
- [Show abstract] [Hide abstract] ABSTRACT: Introduction: Goiters cause a series of compressive symptoms, including dyspnea and dysphagia. There have been reports of the coexistence of this syndrome with obstructive sleep apnea (OSA). The objective of this study was to evaluate the prevalence of OSA in a group of patients with goiters. Methods: Twenty-four patients with a mean age of 52.7 ± 12.7 years, including five males (20.8 %) and 19 (79.2 %) females, who were diagnosed with euthyroid goiters with volumes exceeding 100 ml were consecutively selected. The protocol consisted of sleep questionnaires, physical examinations, and baseline polysomnography measurements. Patients were divided into two groups, OSA and NOSA (no OSA), and all findings were compared between the two groups. Results: Of the studied patients, 70.8 % had OSA (p = 0.004). Regarding clinical parameters, age (p = 0.001), Epworth Sleepiness Scale scores (p = 0.039) and complaints of habitual snoring (p < 0.001) had higher values in the OSA group. Regarding physical examination parameters, body mass index (p = 0.012), neck circumference (p = 0.009) and the presence of tracheal compression (p = 0.021) had higher values in the OSA group. The polysomnographic parameters that were significantly different between the two groups were the greater apnea and hypopnea index per hour of sleep (p < 0.001) and the lower minimum oxyhemoglobin saturation in the OSA group (p = 0.011). Conclusions: There is a high prevalence of OSA in patients with goiters. The main findings that were associated with the presence of OSA are known clinical predictors of OSA and the presence of tracheal compression.
- [Show abstract] [Hide abstract] ABSTRACT: Background Studies have shown a high occurrence of nasal alterations in patients with obstructive sleep apnea syndrome (OSAS), but no studies have used different methods to evaluate the nose of patients with OSAS. The objective of this study was to evaluate the nose of patients with OSAS, compare them to controls, and correlate the different methods used to evaluate the nose. Methods Forty-seven patients with moderate/severe OSAS and 20 controls who were matched for gender, age, and body mass index were included. Questionnaires regarding sleep and nasal symptoms, physical examination, rhinoscopy, nasofibroscopy, nasal inspiratory peak flow (NIPF), and acoustic rhinometry (AR) measurements were performed. Results In the OSAS group, 33 (70.2%) were male, with a mean age of 53.2 ± 9.1 years. In the control group, 13 (65%) were male, with a mean age of 53.7 ± 9.7 years. The OSAS group had a higher score on the nasal symptoms scale (p < 0.01) and a higher frequency of nasal alterations [presence of septal deviation, clinical complaints (p = 0.01) and hypertrophy of the inferior nasal turbinate (p < 0.01)]. The NIPF and AR parameters could not differentiate between the OSAS and control groups. There were no significant correlations among the different methods used to evaluate the nose. Lower NIPF values were capable of predicting higher apnea–hypopnea index scores (p = 0.007). Conclusion Clinical complaints and nasal alterations as measured by rhinoscopy and nasofibroscopy were associated with the presence of OSAS, which was not the case for the NIPF and AR parameters. The results of different evaluation methods were not correlated with each other.
- [Show abstract] [Hide abstract] ABSTRACT: To study the prevalence of otorhinolaryngologic symptoms and findings of physical examination of the upper airway (UA) of a representative sample of the adult population of São Paulo, Brazil, and the association between these findings. Cross-sectional survey. Population sample. A total of 1101 randomly selected volunteers representing the adult population of São Paulo according to sex, age, and socioeconomic class were included in this study. Otorhinolaryngological evaluation included investigation of nasal complaints, physical examination of the UA, and a facial inspection. A total of 993 volunteers (53.9% women), with a mean age of 41.8 ± 0.89 years, underwent otorhinolaryngologic examination. The most prevalent symptoms were the following: symptoms suggestive of rhinitis (44.9%), snoring (42.8%), mouth breathing (39.3%), and nasal obstruction (33.3%). In physical examination, the most common findings were a web palate (redundant posterior pillar; 62.9%), septum deviation (56.9%), and inferior turbinate hypertrophy (37.7%). Significant associations were found between nasal obstruction and septum deviations, inferior turbinate hypertrophy, high-arched palate, and class II dental occlusion; between symptoms of rhinitis and inferior turbinate hypertrophy; and between snoring and obstructive deviated septum, modified Mallampatti grades III and IV, increased neck circumference, and age greater than or equal to 50 years. The prevalence of otorhinolaryngologic symptoms and alterations in physical examination of the UA were high in the adult population of São Paulo, Brazil. The snoring and nasal symptoms were significantly associated with findings from UA physical examination and inspection of the facial skeleton.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: 1) Study the prevalence of otolaryngologic symptoms and findings of physical examination of upper airway of a representative sample of the adult population of São Paulo, Brazil. 2) Correlate subjective symptoms with physical findings.
- [Show abstract] [Hide abstract] ABSTRACT: Obstructive sleep apnea syndrome is a prevalent disease that results in cardiovascular, metabolic, and cognitive complications. The major treatment modality has been the positive airway pressure device, but adherence to this form of treatment has been limited. For this reason, other forms of treatment may help to control this disease, such as the upper airway and cranial-facial surgical procedures. Therefore, the objective of this paper was to investigate surgical procedures that could be used for obstructive sleep apnea syndrome treatment in adults, as well as their indications and success rates. There are many proposed surgical procedures for the treatment of obstructive sleep apnea syndrome; these include upper airway and cranial-facial surgeries. Although few studies have confirmed the exact benefit of these procedures in the obstructive sleep apnea syndrome treatment, the presence of anatomical alterations in these sites and the severity of obstructive sleep apnea syndrome have been the main factors taken into consideration in the selection of patients to undergo this type of treatment.
- [Show abstract] [Hide abstract] ABSTRACT: The treatment of choice for obstructive sleep apnea syndrome (OSAS) has been done with positive airway pressure devices, especially in moderate to severe cases. However, many patients do not adequately adhere to this therapy. Thus, other treatment modalities should be taken into consideration, including surgical procedures on the upper airway. This study describes the main techniques used on the soft palate and lateral pharyngeal wall to treat OSAS, as well as their indicators for success and their success rates. We also note the progress that has been made over the years in improving the surgical techniques that address the soft palate and lateral pharyngeal wall. We also highlight a critical selection of patients who have been treated using these procedures. When the indicators are carefully considered, surgical procedures may be beneficial in the treatment of OSAS.
- [Show abstract] [Hide abstract] ABSTRACT: Sleep apnea-hypopnea syndrome was described twenty years ago, and since then there have been doubts and controversies regarding it. Fiberoptic nasopharyngoscopy with Muller's maneuver, first described by Borowieck and Sassin (1983), is among them. AIM: Careful literature review on Muller's maneuver, regarding whether it can predict the sucess of uvulopalatopharyngoplasty, location of upper airway obstruction and severity of the disorder. DISCUSSION AND LITERATURE REVIEW: Literature has shown that there isn't a consensus about the use of Muller's maneuver. In spite of being technically easy, inexpensive and widely used, it is very unspecific and subjective. CONCLUSION: The importance of Muller's maneuver in evaluating apneic patients has been questioned, because there are controversies whether it can predict the success of uvulopalatopharyngoplasty, location of upper airway obstruction and severity of the disease.
- [Show abstract] [Hide abstract] ABSTRACT: RESUMO Neste manuscrito serão apresentadas as principais abordagens do paciente portador da síndrome da apneia obstrutiva do sono (SAOS). O diagnóstico deve ser reali- zado por meio de uma minuciosa história clínica voltada para as queixas de ronco, relato de paradas respiratórias e sonolência excessiva. O exame físico deve contemplar medidas antropométricas e avaliação sistemática da via aérea superior. Para a confirmação diagnóstica, se faz necessária a realização da polissonografia completa de noite inteira sob supervisão, visto que, em pacientes cuja suspeita clínica é alta, registros simplificados domiciliares podem ser uma alternativa. O tratamento da SAOS requer medidas gerais, uso de aparelhos de pressão positiva, sendo o CPAP o mais indicado a casos graves e aparelhos intraorais em casos mais leves. Os procedimentos cirúrgi- cos têm sua indicação quando alterações anatômicas são evidentes ou como auxílio aos demais tratamentos. PALAVRAS-CHAVE ABSTRACT In this manuscript the principal approaches will be presented in the patient with obstructive sleep apnea syndrome (OSAS). The diagnosis should be carried out through clinical history focused to the complaints of snore, report of breathing pauses and excessive sleepiness. The physical examination must contemplate measures anthropometrics and systematic evaluation of the upper airway. For diagnostic confirmation is necessary to per - form full night polissonography under supervision, being that in patients whose clinical suspicion is high, register simplified in home be an alternative. The treatment of OSAS applies for general measures, for use of appliances of positive pressure, being the CPAP most indicated in serious cases and oral appliances in more mild cases. The surgical proceedings have his indication when ana- tomical alterations are obvious or like help to too many treatments.
Universidade Federal de São Paulo
San Paulo, São Paulo, Brazil
- • Departamento de Psicobiologia
- • Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço