Bianca Marcondes

Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome

RATIONALE Upper airway muscle function plays a major role in maintenance of the upper airway patency and contributes to the genesis of obstructive sleep apnea syndrome (OSAS). Preliminary results suggested that oropharyngeal exercises derived from speech therapy may be an effective treatment option for patients with moderate OSAS. OBJECTIVES To determine the impact of oropharyngeal exercises in patients with moderate OSAS. METHODS Thirty-one patients with moderate OSAS were randomized to 3 months of daily ( approximately 30 min) sham therapy (n = 15, control) or a set of oropharyngeal exercises (n = 16), consisting of exercises involving the tongue, soft palate, and lateral pharyngeal wall. MEASUREMENTS AND MAIN RESULTS Anthropometric measurements, snoring frequency (range 0-4), intensity (1-3), Epworth daytime sleepiness (0-24) and Pittsburgh sleep quality (0-21) questionnaires, and full polysomnography were performed at baseline and at study conclusion. Body mass index and abdominal circumference of the entire group were 30.3 +/- 3.4 kg/m(2) and 101.4 +/- 9.0 cm, respectively, and did not change significantly over the study period. No significant change occurred in the control group in all variables. In contrast, patients randomized to oropharyngeal exercises had a significant decrease (P < 0.05) in neck circumference (39.6 +/- 3.6 vs. 38.5 +/- 4.0 cm), snoring frequency (4 [4-4] vs. 3 [1.5-3.5]), snoring intensity (3 [3-4] vs. 1 [1-2]), daytime sleepiness (14 +/- 5 vs. 8 +/- 6), sleep quality score (10.2 +/- 3.7 vs. 6.9 +/- 2.5), and OSAS severity (apnea-hypopnea index, 22.4 +/- 4.8 vs. 13.7 +/- 8.5 events/h). Changes in neck circumference correlated inversely with changes in apnea-hypopnea index (r = 0.59; P < 0.001). CONCLUSIONS Oropharyngeal exercises significantly reduce OSAS severity and symptoms and represent a promising treatment for moderate OSAS. Clinical trial registered with www.clinicaltrials.gov (NCT 00660777).

The Effects of Continuous Positive Airway Pressure on Prehypertension and Masked Hypertension in Men With Severe Obstructive Sleep Apnea

Obstructive sleep apnea and hypertension are common conditions that frequently coexist. Continuous positive airway pressure (CPAP) reduces blood pressure in patients with obstructive sleep apnea and sustained hypertension. However, the impact of CPAP on patients with obstructive sleep apnea and prehypertension and masked hypertension, conditions associated with increased cardiovascular risk, is unknown. Thirty-six male patients (age, 43±7 years; body mass index, 28.8±3.0 kg/m2) with untreated severe obstructive sleep apnea (apnea–hypopnea index, 56±22 events/hr on polysomnography) with diagnostic criteria for prehypertension and/or masked hypertension, based on office and 24-hour ambulatory blood pressure monitoring, respectively, were studied. The patients randomized to no treatment (control; n=18) or CPAP (n=18) for 3 months had similar frequency of prehypertension and masked hypertension at study entry. There were no significant changes in blood pressure in patients randomized to the control group. In contrast, patients randomized to CPAP presented significant reduction in office systolic (from 126±5 to 121±7 mm Hg; P=0.001) and a trend for diastolic blood pressure (from 75±7 to 73±8 mm Hg; P=0.08) as well as a significant decrease in daytime and nighttime systolic and diastolic blood pressure (P<0.05 for each comparison). There was a significant reduction in the frequency of prehypertension (from 94% to 55%; P=0.02) and masked hypertension (from 39% to 5%; P=0.04) only in the CPAP group. In conclusion, effective CPAP therapy promotes significant reduction in the frequency of prehypertension and masked hypertension by promoting significant blood pressure reductions in patients with severe obstructive sleep apnea.

Obstructive sleep apnea, masked hypertension, and arterial stiffness in men.

BACKGROUND Obstructive sleep apnea (OSA) is an established cause of hypertension. However, it is not clear whether the frequency of masked hypertension in patients with OSA and whether OSA have an independent role on arterial stiffness taking into account ambulatory blood pressure (BP) monitoring (ABPM). METHODS We evaluated 61 male normotensive participants as determined by casual clinic BP level <140/90 mm Hg without clinical evidence of cardiovascular disease and on no medications (43 patients with moderate-to-severe OSA (apnea-hypopnea index (AHI) > or = 15 events/hour by polysomnography) and 18 age- and body mass index-matched controls without OSA (AHI <5 events/hour)). Pulse wave velocity (PWV), an index of arterial stiffness, and 24-h ABPM were performed in a blinded fashion. Masked hypertension was defined when abnormal daytime ABPM was > or = 135 or > or = 85 mm Hg. RESULTS The AHI and lowest oxygen saturation were 2.6 +/- 1.6 and 90 +/- 2 vs. 52.8 +/- 21.0 events/hour and 75 +/- 10% for controls and OSA patients, respectively; P < 0.001. Compared with controls, patients with OSA had higher office systolic BP (113 +/- 9 vs. 118 +/- 10 mm Hg; P = 0.05) and a higher unadjusted proportion of masked hypertension (2 controls (11.1%) vs. 13 patients (30.2%); P < 0.05). PWV was 8.7 +/- 0.7, 9.4 +/- 1.0, and 10.6 +/- 1.1 m/s in the control, OSA without and with masked hypertension groups, respectively (P < 0.01 for each comparison). Multiple regression showed that systolic daytime ABPM and the lowest oxygen saturation were independently related to PWV (adjusted R2 = 0.34; P < 0.01). CONCLUSIONS Patients with OSA presented a higher unadjusted rate of masked hypertension than matched controls. Lowest oxygen saturation has an independent association with arterial stiffness.

Improvements in the 6-Min Walk Test and Spirometry Following Thoracentesis for Symptomatic Pleural Effusions

BACKGROUND Impairment in pulmonary capacity due to pleural effusion compromises daily activity. Removal of fluid improves symptoms, but the impact, especially on exercise capacity, has not been determined. METHODS Twenty-five patients with unilateral pleural effusion documented by chest radiograph were included. The 6-min walk test, Borg modified dyspnea score, FVC, and FEV(1) were analyzed before and 48 h after the removal of large pleural effusions. RESULTS The mean fluid removed was 1,564 ± 695 mL. After the procedure, values of FVC, FEV(1), and 6-min walk distance increased (P < .001), whereas dyspnea decreased (P < .001). Statistical correlations (P < .001) between 6-min walk distance and FVC (r = 0.725) and between 6-min walk distance and FEV(1) (r = 0.661) were observed. Correlations also were observed between the deltas (prethoracentesis × postthoracentesis) of the 6-min walk test and the percentage of FVC (r = 0.450) and of FEV(1) (r = 0.472) divided by the volume of fluid removed (P < .05). CONCLUSION In addition to the improvement in lung function after thoracentesis, the benefits of fluid removal are more evident in situations of exertion, allowing better readaptation of patients to routine activities.

Reduction of central sleep apnea in heart failure patients with beta-blockers therapy

BACKGROUND Sleep apneas are frequent in patients with heart failure (HF). Estimate of the pre-beta blocker age (BB) point out to 45% of central apneas in these patients. OBJECTIVE Assess the influence of BB in central apneas and their interference in the quality of sleep and life of patients with heart failure. METHODS 65 patients with heart failure underwent diagnostic polysomnography. Polysomnography have been assessed according to the use or not of BB. On the day of examination, the patients answered the Minnesota questionnaire for quality of life with HF. After 6 and 12 months from the polysomnography date, all patients were contacted by phone, in order to repeat the Minnesota questionnaire. RESULTS The prevalence of sleep apnea (IAH > 15/h) hit 46.1% in the total population, however, central sleep apnea was identified in 18.4% of patients. The use of BB, in a multivariate analysis, was the only predictor of a minor index of central apnea and hypopnea (IAH) (p=0.002), greater saturation (p=0.02) and smaller average desaturation of oxygen (p=0.03). Additionally, the use of BB could predict a better quality of life after 6 and 12 months (p=0.002 and 0.001 respectively) and a smaller number admissions in these periods (p=0.001 and p=0.05 respectively). CONCLUSION The use BB reduced the rate of central sleep apnea in total population, if we compare to literature data. Additionally, the BB improved parameters of quality of sleep and life of patients with heart failure.FUNDAMENTO: As apneias do sono sao doencas frequentes em portadores de insuficiencia cardiaca (IC). Estimativas da era pre-betabloqueador (BB) apontam para uma prevalencia de 45% de apneias centrais nestes pacientes. OBJETIVO: Avaliar a influencia dos BB na prevalencia das apneias centrais e sua interferencia na qualidade do sono e de vida de portadores de IC. METODOS: 65 pacientes portadores de IC foram submetidos a polissonografia diagnostica.Os resultados da polissonografia foram avaliados de acordo com o uso ou nao de BB. No dia do exame os pacientes responderam ao questionario de Minessota para qualidade de vida com IC. Apos 6 e 12 meses da data da polissonografia, houve contato telefonico com todos os pacientes, para a repeticao do questionario de Minessota. RESULTADOS: A prevalencia de apneia do sono (IAH > 15/h) foi de 46,1% na populacao total, porem a apneia central foi identificada em apenas 18,4% dos pacientes. O uso de BB, em analise multivariada, foi o unico preditor de ocorrencia de menor indice de apneia e hipopneia (IAH) central (p=0,002), maior saturacao (p=0,02) e menor dessaturacao media de oxigenio (p=0,03). Alem disso, o uso de BB foi preditor de melhor qualidade de vida apos 6 e 12 meses (p=0,002 e 0,001 respectivamente) e de menor numero de hospitalizacoes nestes periodos (p=0,001 e p=0,05 respectivamente). CONCLUSAO: O uso de BB reduziu a incidencia de apneia central na populacao total, se compararmos com os dados da literatura. Alem disto, os BB melhoraram parâmetros da qualidade do sono e de vida de portadores de IC.

Redução da prevalência de apneia central em pacientes com insuficiência cardíaca sob uso de betabloqueador

BACKGROUND Sleep apneas are frequent in patients with heart failure (HF). Estimate of the pre-beta blocker age (BB) point out to 45% of central apneas in these patients. OBJECTIVE Assess the influence of BB in central apneas and their interference in the quality of sleep and life of patients with heart failure. METHODS 65 patients with heart failure underwent diagnostic polysomnography. Polysomnography have been assessed according to the use or not of BB. On the day of examination, the patients answered the Minnesota questionnaire for quality of life with HF. After 6 and 12 months from the polysomnography date, all patients were contacted by phone, in order to repeat the Minnesota questionnaire. RESULTS The prevalence of sleep apnea (IAH > 15/h) hit 46.1% in the total population, however, central sleep apnea was identified in 18.4% of patients. The use of BB, in a multivariate analysis, was the only predictor of a minor index of central apnea and hypopnea (IAH) (p=0.002), greater saturation (p=0.02) and smaller average desaturation of oxygen (p=0.03). Additionally, the use of BB could predict a better quality of life after 6 and 12 months (p=0.002 and 0.001 respectively) and a smaller number admissions in these periods (p=0.001 and p=0.05 respectively). CONCLUSION The use BB reduced the rate of central sleep apnea in total population, if we compare to literature data. Additionally, the BB improved parameters of quality of sleep and life of patients with heart failure.FUNDAMENTO: As apneias do sono sao doencas frequentes em portadores de insuficiencia cardiaca (IC). Estimativas da era pre-betabloqueador (BB) apontam para uma prevalencia de 45% de apneias centrais nestes pacientes. OBJETIVO: Avaliar a influencia dos BB na prevalencia das apneias centrais e sua interferencia na qualidade do sono e de vida de portadores de IC. METODOS: 65 pacientes portadores de IC foram submetidos a polissonografia diagnostica.Os resultados da polissonografia foram avaliados de acordo com o uso ou nao de BB. No dia do exame os pacientes responderam ao questionario de Minessota para qualidade de vida com IC. Apos 6 e 12 meses da data da polissonografia, houve contato telefonico com todos os pacientes, para a repeticao do questionario de Minessota. RESULTADOS: A prevalencia de apneia do sono (IAH > 15/h) foi de 46,1% na populacao total, porem a apneia central foi identificada em apenas 18,4% dos pacientes. O uso de BB, em analise multivariada, foi o unico preditor de ocorrencia de menor indice de apneia e hipopneia (IAH) central (p=0,002), maior saturacao (p=0,02) e menor dessaturacao media de oxigenio (p=0,03). Alem disso, o uso de BB foi preditor de melhor qualidade de vida apos 6 e 12 meses (p=0,002 e 0,001 respectivamente) e de menor numero de hospitalizacoes nestes periodos (p=0,001 e p=0,05 respectivamente). CONCLUSAO: O uso de BB reduziu a incidencia de apneia central na populacao total, se compararmos com os dados da literatura. Alem disto, os BB melhoraram parâmetros da qualidade do sono e de vida de portadores de IC.

Reducción de la prevalencia de apnea central en pacientes con insuficiencia cardiaca bajo uso de betabloqueante

BACKGROUND Sleep apneas are frequent in patients with heart failure (HF). Estimate of the pre-beta blocker age (BB) point out to 45% of central apneas in these patients. OBJECTIVE Assess the influence of BB in central apneas and their interference in the quality of sleep and life of patients with heart failure. METHODS 65 patients with heart failure underwent diagnostic polysomnography. Polysomnography have been assessed according to the use or not of BB. On the day of examination, the patients answered the Minnesota questionnaire for quality of life with HF. After 6 and 12 months from the polysomnography date, all patients were contacted by phone, in order to repeat the Minnesota questionnaire. RESULTS The prevalence of sleep apnea (IAH > 15/h) hit 46.1% in the total population, however, central sleep apnea was identified in 18.4% of patients. The use of BB, in a multivariate analysis, was the only predictor of a minor index of central apnea and hypopnea (IAH) (p=0.002), greater saturation (p=0.02) and smaller average desaturation of oxygen (p=0.03). Additionally, the use of BB could predict a better quality of life after 6 and 12 months (p=0.002 and 0.001 respectively) and a smaller number admissions in these periods (p=0.001 and p=0.05 respectively). CONCLUSION The use BB reduced the rate of central sleep apnea in total population, if we compare to literature data. Additionally, the BB improved parameters of quality of sleep and life of patients with heart failure.FUNDAMENTO: As apneias do sono sao doencas frequentes em portadores de insuficiencia cardiaca (IC). Estimativas da era pre-betabloqueador (BB) apontam para uma prevalencia de 45% de apneias centrais nestes pacientes. OBJETIVO: Avaliar a influencia dos BB na prevalencia das apneias centrais e sua interferencia na qualidade do sono e de vida de portadores de IC. METODOS: 65 pacientes portadores de IC foram submetidos a polissonografia diagnostica.Os resultados da polissonografia foram avaliados de acordo com o uso ou nao de BB. No dia do exame os pacientes responderam ao questionario de Minessota para qualidade de vida com IC. Apos 6 e 12 meses da data da polissonografia, houve contato telefonico com todos os pacientes, para a repeticao do questionario de Minessota. RESULTADOS: A prevalencia de apneia do sono (IAH > 15/h) foi de 46,1% na populacao total, porem a apneia central foi identificada em apenas 18,4% dos pacientes. O uso de BB, em analise multivariada, foi o unico preditor de ocorrencia de menor indice de apneia e hipopneia (IAH) central (p=0,002), maior saturacao (p=0,02) e menor dessaturacao media de oxigenio (p=0,03). Alem disso, o uso de BB foi preditor de melhor qualidade de vida apos 6 e 12 meses (p=0,002 e 0,001 respectivamente) e de menor numero de hospitalizacoes nestes periodos (p=0,001 e p=0,05 respectivamente). CONCLUSAO: O uso de BB reduziu a incidencia de apneia central na populacao total, se compararmos com os dados da literatura. Alem disto, os BB melhoraram parâmetros da qualidade do sono e de vida de portadores de IC.