Ronco e apneia do sono pdf

Thamos de Tebas. Oscar Costa. Liliana Ponte. Maise Sampaio Dermatologista. Roger Monteiro. Claudio Solano. Fred Hazin. Ode Matase. Cemec Cursos. Marina Xavier. Victor Pessoa. Aglair Lopes. Pedro Xavier. Sthefany Jarumy Sato Aguirre. Guilherme Guerra. Gleyci Cavalcante. Hertiquiano Santos. Sabrina Sousa. Mais de Antonio Sarmento. Antonio Sarmento. Acacio Minango Acacio. Paula Ferrao. Carlos Rocha. Download Download PDF. Translate PDF. Braz J Otorhinolaryngol.

Sociedade Brasileira de Cardiologia Brazilian Society of B: Experimental or observational trials of lesser consistency. Cardiology C: Case reports non-controlled trials. Sociedade Brasileira de Pediatria Brazilian Society of Pediatrics D: Opinions without critical evaluation, based on consensus- Sociedade Brasileira de Pneumologia e Tisiologia Brazilian Society es, physiological studies, or animal models.

June 11, Respiratory events tionnaire, physical examination, body mass index, circumfer- trigger intermittent disorders of blood gases hypoxemia and ence, Mallampati, noise, pharynx, airway, Jaw, Diagnosis, Mass hypercapnia and can lead to sympathetic system activation.

It is also considered an independent nea, Obstructive; Sleep Initiation and Maintenance Disorders, risk factor for cardiovascular disease and ischemic stroke. Fac- ic; Questionnaires, survey Ambulatory, home care services, lab- tors that tend to narrow the pharynx lumen include mucosal oratory techniques and procedures, complications, adverse ef- adhesive forces, vasomotor tone, neck lexion, jaw open- fects, Obesity, Overweight, Cardiovascular Diseases, Diabetes ing and lower dislocation, force of gravity, increased nasal Mellitus, Stroke, Ischemic Attack, Transient; Gastroesophageal resistance, Bernoulli effect the physics principle that ex- Relux, Pulmonary Disease, Chronic Obstructive, Pre-Eclampsia, plains the tendency of pharyngeal collapse , and increased DOI: The in- formation contained in this project must be submitted for the assessment and analysis of the physician in charge of treatment, considering the reality and clinical status of each patient.

Published by Elsevier Editora Ltda. All rights reserved. S2 dynamic compliance. Other common symptoms include morning head- the thoracic caudal traction by increased pulmonary volume aches, unrefreshing sleep, fatigue, and cognitive alterations. Snoring and nocturia are common complaints in OSA2 Despite showing considerable variation between individ- B. Other clinical parameters such as body mass index uals, there are components of the disease physiopathology BMI , age, and gender are evaluated in Table 1.

The sensitivity to identify non-apneic individuals was This association of criteria is the best way to attain the clinical diagnosis of OSAS. When considering the 1.

How important are questionnaires? However, for the assessment of patients associated with other clinical parameters4,10,17,18 B. The a sensitivity of However, less than half of patients with moder- in sleep centers identiied The as high-risk for OSA and Children with report in the population at high risk for OSA and patients with sys- of loud and frequent snoring have a 3.

Having SAH resistant to clinical treatment is a of presenting learning disorders and of male gender. Category 1 Category 2 1. Do you snore? How often do you feel tired or fatigued after your Yes sleep? Your snoring is: Never or nearly never Slightly louder than breathing? As loud as talking 7. During your waking time, do you feel tired, fatigued or Louder than talking?

Very loud - can be heard in adjacent rooms? Nearly every day times a week 3. How often do you snore? Have you ever nodded off or fallen asleep while driving a vehicle? Never or nearly never Yes 4. Has your snoring ever bothered other people? No Yes No Category 3 5. Has anyone noticed that you quit breathing during your 9. Do you have high blood pressure? Final result: two or more positive categories indicate high risk for OSA.

This refers to your usual way of life in recent times. They may also have alter- B , but it does not allow for a deinite diagnosis of OSA by ations in growth, central auditory processing, and nocturnal itself12 A. The ESS, along with other clinical parameters, helps to Table 1 compares the diagnostic values of different signs identify patients with OSA4,10,17,18 B.

Although the preva- and symptoms suggestive of OSAS. Recommendation 2. What are the most important indings during There is an increased likelihood of OSA diagnostic certainty physical examination of patients with OSA and pri- in adults when the presence of symptoms is associated with mary snoring? There are dif- the degree of obesity and OSAS severity is still controver- ferences between men and women older than 50 years re- sial31,32 B.

This prevalence is modiied when studying premenopausal Children with SDB are more likely to have behavioral women 0.

The neck circumference alone has a sensitivity of Figure 1 Retrognathia. When applying the Kushida morphometric model to the Brazilian population, it was observed that the mean value of Figure 2 Class II dental occlusion Angle. In the Brazilian population, class II dental occlusion retropositioned lower dental arch was observed in The most common indings Figure 3 Grading system for palatine tonsils.

In a Brazilian study, the most frequent indings in patients with OSA were the alterations in the soft palate S6 pharynx anatomy are related to OSA presence and severity assessments in the same patient at day intervals is poor in Brazilians38 B. The preva- with AHI ranging from 5 to 15, it is necessary to associate lence of OSA in patients with class III obesity was shown to the PSG results with the medical history and physical ex- be greater than in the general population32 B.

In a study amination indings. Associating the subjective impression, in the Brazilian population, signiicant predictive factors for which includes the medical history with physical examina- OSA in class III obese individuals were: mean age Considering the pop- In tertiary care, pa- circumference measurements28 B , male gender B , tients with the same alteration in neck circumference and as there is a 3.

The most relevant asso- alterations29 B. When should PSG evaluation be indicated? The presence of snoring has been associated to the OSA Depending on the parameter alteration found during the ex- diagnosis, presenting a sensitivity of Overall, PSG provides a diagnostic dictive value of Another study demonstrated a correla- examination41,42 B.

It does not assess Recommendation sleep stages and does not differentiate whether the events occur during the periods of wakefulness or sleep. It demon- PSG should be indicated in patients with clinical suspicion of strates and differentiates only respiratory events, not al- OSA and the presence of snoring44,45 B associated or unas- lowing for the diagnosis of other events, such as lower-limb sociated with EDS assessed by ESS19,23 B , neck circumfer- movements.

In a B , especially in the context of dificult-to-control hyper- study of Brazilian patients, when indices were compared to tension14 A 15 B. Another equipment The differential diagnosis between primary snoring and model presented similar results61 B. OSA can only be established after sleep monitoring39,43 B. Type IV monitoring uses one to two channels, and one of them must be oximetry. It does not assess sleep stag- 4. What are the sleep monitoring modalities and es and does not differentiate between apnea types, but when should they be requested?

It does not allow for the eval- uation of any data related to sleep D 58 B. Due to the fact that it Monitoring with one or two channels, of which one is is easy to repeat, three assessments were performed with oximetry a portable monitor on three consecutive nights, with no signiicant differences found between the values in these The gold standard type-I PSG examination consists of the three examinations63 B.

If these types of monitoring do not diagnose gram, body position, and snoring. The choice of number of capture channels available in each device. There is a protocol for the gradual in- A major limitation is the loss of monitoring channels due to crease in positive pressure associated with the placement of failure, or loosening or disconnection of sensors, which has appropriate interfaces mask. Measures of adherence to airlow, respiratory effort, heart rate, and oxygen satura- long-term treatment also depend on the type of titration tion.

It allows for the identiication of the different sleep to which the patient was submitted. When com- ment and remove it on the following day, but if a channel is paring the two methods, it can be observed that both allow disconnected during the examination, there is no replace- for improvements in AHI and sleepiness ESS , with no dif- ment D 57 D.

PSM type II has shown similar results for ferences in sleep architecture and treatment concordance, AHI during at-home monitoring when compared to laborato- but with differences in treatment adherence68 B. This modali- In these two cases, before performing the irst PSG, the ty does not allow for an accurate patient diagnosis, as it neck circumference or the morphometric model should interrupts the evaluation halfway through the night and be investigated, as they both have a high positive likeli- attempts to ind the adequate pressure for the treatment hood ratio28 B , increasing diagnostic certainty.

It may in only half of the night. Portable sleep monitoring feres with the diagnostic certainty in the presence of any assessments still have the limitation of monitoring channel altered results; Table 3 compares the diagnostic possibil- loss due to failure, or loosening or disconnection of sen- ity among the four modalities of sleep monitoring, dif- sors57 D , and the need to perform a new PSG I or II to rule ferentiating pre-testing low prevalence from high prev- out false negatives in cases of high disease probability and alence.

There is a likelihood of OSA diagnostic certainty normal initial monitoring results56,57 D. Table 4 associates several diagnostic methods, such as signs and symptoms, physical examination, and two a PSG technician65,66 D.

A male patient satisfaction when comparing the whole-night PAP ti- individual who snores does not demonstrate diagnostic tration assisted by a technician with automatic titration certainty of OSA, even after PSG I is performed; similarly, B , but there are controversies regarding treatment adher- a male obese individual does not demonstrate diagnostic ence67,68 B.

Table 3 Diagnostic probability by polysomnography PSG. When should PSG be requested in children? Snoring is a common complaint reported by the parents; The American Academy of Sleep Medicine believes that however, the differentiation between primary snoring and the criteria of normality can be used up to the age of 18 OSA in children cannot be made solely based on clinical his- years77 D. Studies have demonstrated that between 13 tory data21,72,73 B.

Its diagnosis is import- ing PSG assessment in children. Differentiation of pictures of ant, as lack of treatment leads to learning and memory central origin and estimation of apnea severity are important dificulties and decreased weight and height growth rates. Moreover, tonsillar size is not always a depression79 D. Table 6 shows the sensitivity, speciicity, positive pre- PSG is recommended for all children with frequent snor- dictive value, and negative predictive values of the most ing and who need to be differentiated from patients with common symptoms in children75 B.

OSA21,72,73 B. Between the ages of 13 and Sleep endoscopy is not signiicantly relevant for the 18 years, the criteria recommended for children or the al- topographic diagnosis of OSA, which does not indicate irrel- ternative criteria for adults may be used without change in evance when assessing the apneic and snoring patient.

When comparing patients with OSA us- observed when considering only the group of patients with ing lexible video-nasoibrolaryngoscopy in wakefulness and apnea84 B. There was ob- to minimize the subjectivity of evaluation, subsequently struction in the hypopharynx during pharmacologically-in- comparing the results with MRI of the pharyngeal region. There is an agreement between the two methods of Patients with OSA who were using intraoral Furthermore, it is noteworthy that there is subjectivity and mandibular advancement devices underwent sleep endos- lack of homogeneity during this assessment, as the inspi- copy with and without the use of these devices.

It was ob- ratory force which the patients present varies signiicantly served that patients who used the device only those with and evaluation data are yet to be established.

However, patients in the apnea mitted to surgery91 B. Areas of the nasopharynx, orophar- group have greater mandibular discrepancy, a smaller inter- ynx, and hypopharynx were evaluated during inspiration nal mandibular length, and a smaller area in the mandibular and expiration, as well as the diameters of the uvula and basal plane than the control group. It was observed that the retropharyngeal tissue in apnea.

The volumes of the tongue, soft palate, and later- apneic patients presents more volume than in non-apneic al pharyngeal walls did not differ signiicantly between the patients, with Ultrafast MRI 0.

It was observed that, during tically signiicant differences91 B. Explorar Documentos. Enviado por wander. Denunciar este documento. Fazer o download agora mesmo. Pesquisar no documento. Saskia Barbosa. Israelle Felix. Adna Silva. Maikel Garcia. Paulo Gondim. Gabriel Pena Machado. Alberto Alves. Roberto Souza. Dani Bulbol Hayden. DrLuiz Henrique T Guerra. Lidio Neto. Paulo Eduardo.

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