Carla Daltro

Clinical, Anthropometric and Upper Airway Anatomic Characteristics of Obese Patients with Obstructive Sleep Apnea Syndrome

Background: Obese subjects are at increased risk of developing obstructive sleep apnea syndrome (OSAS). However, the individual role of local (i.e., upper airway-related) and general (clinical and whole-body anthropometric) characteristics in determining OSAS in obese patients is still controversial. Objectives: To contrast the clinical, anthropometric and upper airway anatomical features of obese subjects presenting or not presenting with OSAS. Methods: Thirty-seven obese (BMI ≧30 kg/m2) males with OSAS and 14 age- and gender-matched obese controls underwent clinical and anthropometric (BMI, waist-to-hip ratio and neck circumference) evaluation. In a subgroup of subjects (18 and 11 subjects, respectively), magnetic resonance imaging (MRI) during wakefulness was used to study the upper airway anatomy. Results: OSAS patients showed significantly higher BMI, waist-to-hip ratio and neck circumference as compared to controls (p < 0.05). They also referred to nonrepairing sleep, impaired attention, and previous car accidents more frequently (p < 0.05). The transversal diameter of the airways (TDAW) at the retroglossal level by MRI was found to be an independent predictor of the presence and severity of OSAS (p < 0.05). Parapharyngeal fat increase, however, was not related to OSAS. A TDAW >12 mm was especially useful to rule out severe OSAS (apnea-hypopnea index >30, negative predictive value = 88.9%, likelihood ratio for a negative test result = 0.19). Conclusions: MRI of the upper airway can be used in association with clinical and anthropometric data to identify obese males at increased risk of OSAS.

Comorbid anxiety and depression disorders in patients with chronic pain

OBJECTIVE To evaluate the frequency of anxiety and depression disorders in patients with chronic pain. METHOD Patients receiving care at the pain clinic of the Federal University of Bahia between February 2003 and November 2006. The MINI PLUS--Mini International Neuropsychiatric Interview was used to evaluate the patients and establish psychiatric diagnoses. RESULTS 400 patients were evaluated mean age was 45.6+/-11.37 years; 82.8% were female, 17.3% male; 48.5% were married; 55.1% were Catholics; and 40.5% had only high school education. Of these 29.9% reported intense pain and 70.8% reported suffering pain daily. The most frequent medical diagnosis was herniated disc (24.5%), and 48.5% of patients had been undergoing treatment at the pain clinic for less than 3 months. Comorbidities found were depressive episodes (42%), dysthymia (54%), social phobia (36.5%), agoraphobia (8.5%) and panic disorder (7.3%). CONCLUSION Psychiatric comorbidities are prevalent in patients suffering chronic pain.

Sleep patterns and symptoms of anxiety and depression in patients with chronic pain

BACKGROUND Sleep disturbances and symptoms of anxiety and depression have been shown to be involved in the genesis and perpetuation of chronic pain. OBJECTIVE To evaluate sleep patterns and the prevalence of symptoms of anxiety and depression in patients with chronic pain. METHOD Four hundred consecutive patients referred to a chronic pain outpatient clinic were investigated using patient charts, the numerical Visual Analogue Scale for the evaluation of pain, the Hospital Anxiety and Depression scale and the Mini-Sleep Questionnaire. RESULTS The mean age of patients was 45.6+/-11.4 years. The most frequent medical diagnosis was myofascial pain followed by neuropathic pain. The prevalence of symptoms of anxiety was 72.8%, depression 93% and altered sleep patterns 93%. CONCLUSION This study revealed a high prevalence of symptoms of depression and anxiety and alterations in sleep patterns in patients with chronic pain, justifying investigation into these disturbances in this group of patients.

Síndrome da apnéia e hipopnéia obstrutiva do sono: análise cefalométrica

Obstructive sleep apnea and hypopnea syndrome (OSAHS) are characterized by repeated pauses in breathing during sleep, usually associated with sleep interruption and decreased oxyhemoglobin saturation. Cephalometric analysis has become an important method in diagnosis, reporting specific craniofacial characteristics such as posterior air pharyngeal space, tongue length and hyoid position, which may predispose some people to develop SAHOS. The purpose of this revision is to present several anatomic aspects by cephalometric analysis that may have a predisposition to the development of upper airway occlusion.

Síndrome da apnéia e hipopnéia obstrutiva do sono: associação com obesidade, gênero e idade

Obstructive sleep apnea and hypopnea syndrome (OSAHS) has been the focus of extensive research because of its association with neurocognitive and cardiovascular complications. The aim of this study was to evaluate the frequency and association between OSAHS and the class of obesity, gender and age in outpatients referred to a sleep laboratory. We selected 1,595 patients, 71.7% male. Mean ± SD age was 46.7 ± 11.7 years, BMI was 28.1 ± 5.1 kg/m2 and AIH was 13.9 ± 15.5 events/ hour of sleep. The patients were considered apneic when the apnea-hypopnea index (AHI) was > 5 events/hour of sleep; OSAHS was present in: (1) 71.1% of men and 50.3% of women (p 55 years old (p< 0.001). We concluded that OSAHS was directly and strongly associated to the male gender, obesity class and to aging.

Arquitetura do sono e perfil respiratório polissonográfico de crianças e adolescentes com fibrose cística

OBJECTIVES To evaluate sleep architecture in children and adolescents with both cystic fibrosis (CF) and a clinical suspicion of sleep-disordered breathing (SDB), and to identify the respiratory polysomnographic profile of these patients. METHODS Parents or guardians of children with CF filled out a questionnaire designed to assess their clinical and sleep conditions. Children who were identified as having behaviors associated with SDB underwent polysomnography. After polysomnography, patients were grouped according to the obstructive apnea index (AI) obtained (either < 1 or ≥ 1), and a multiple correspondence factor analysis was used to analyze and identify the polysomnographic profile of patients. RESULTS Of the 74 patients who met inclusion criteria for this study, 67 underwent polysomnography, and 38 (56.7%) of the 67 patients showed an AI ≥ 1. Median age was 8 years. The group of patients with an AI ≥ 1 was characterized by total sleep time (TST) during stage 4 and rapid eye movement (REM) stage of sleep < 21 and 13%, respectively, REM sleep latency > 144 minutes, percentage of TST with pulse oxyhemoglobin saturation (SpO2) < 90% higher than 0.28 seconds, and an oxygen desaturation index higher than 0.92. CONCLUSION Results suggest that clinically stable pediatric patients with CF have a high prevalence of SDB and present frequent sleep complaints, significant changes in sleep architecture, and episodes of oxygen desaturation during sleep.OBJECTIVES: To evaluate sleep architecture in children and adolescents with both cystic fibrosis (CF) and a clinical suspicion of sleep-disordered breathing (SDB), and to identify the respiratory polysomnographic profile of these patients. METHODS: Parents or guardians of children with CF filled out a questionnaire designed to assess their clinical and sleep conditions. Children who were identified as having behaviors associated with SDB underwent polysomnography. After polysomnography, patients were grouped according to the obstructive apnea index (AI) obtained (either 1), and a multiple correspondence factor analysis was used to analyze and identify the polysomnographic profile of patients. RESULTS: Of the 74 patients who met inclusion criteria for this study, 67 underwent polysomnography, and 38 (56.7%) of the 67 patients showed an AI > 1. Median age was 8 years. The group of patients with an AI > 1 was characterized by total sleep time (TST) during stage 4 and rapid eye movement (REM) stage of sleep 144 minutes, percentage of TST with pulse oxyhemoglobin saturation (SpO2) < 90% higher than 0.28 seconds, and an oxygen desaturation index higher than 0.92. CONCLUSION: Results suggest that clinically stable pediatric patients with CF have a high prevalence of SDB and present frequent sleep complaints, significant changes in sleep architecture, and episodes of oxygen desaturation during sleep.

OSAS in children: clinical and polysomnographic respiratory profile

UNLABELLED Obstructive sleep apnea and hypopnea syndrome in children (osas) has an estimated prevalence of up to 3% and can be associated with neurocognitive and behavioural abnormalities, and also cardiovascular complications. This study may help pediatricians, who are unaware of the problem, to recognize osas. STUDY DESIGN series of cases. AIM to describe the clinical characteristics and polysomnographic respiratory findings in a population of children with obstructive sleep apnea and hypopnea syndrome referred to the sleep laboratory from january 2002 up to july 2003. METHODS we studied 93 patients between 2 and 10 years of age with polysomnographic diagnosis of obstructive sleep apnea and hypopnea syndrome. Age, gender, racial group and questions about the childrens health and sleep related disorders were evaluated. Apnea-hypopnea index, oxyhemoglobin desaturation, and arousal index were evaluated too. RESULTS males represented 61.3%, With a mean age of 5.2+/-2.1 (Years-old). The complaints that most commonly lead to the exams were snoring in 24.7% And restless sleep in 24.7%. Associated medical conditions frequently reported were allergic rhinitis (98.9%) And adenoid hypertrophy (50.6%). Mild apnea was found in 66%. The mean and sd of spo2 nadir was 89.1+/-3.5% And the mean and sd of the number of arousals was 8.4+/-3.5/Hour of sleep. CONCLUSION the results suggest the possibility that obstructive sleep apnea and hypopnea syndrome should be suspected in children with allergic diseases and adenoid and tonsil hypertrophy with snoring and restless sleep complaints.

Antropometria craniana de recém-nascidos normais

OBJECTIVE: The study has been carried out through anthropometric measures of Bahian newborns, to define measures according with the reality of this region. METHOD: Study type transversal cut in term babies with the measures of cephalic perimeter, biauricular and anteroposterior distances, fontanel and cephalic index. RESULTS: 388 babies, 204 (52.6%) of males and 184 (47.4%) females had been evaluated. The cephalic perimeter varied between 31.0 and 38.0 cm, with 34.4 ± 1.2 average. The cephalic index varied between 0.75 and 1.06, with 0.91 ± 0.05 average. CONCLUSION: The anthropometric measures are surveyed aiming at precocious detention of anomalies. Possibly, these measures can be influenced by racial factors; however, the measures carried through in Brazil follow values of foreign authors. Thus, the study shows data of a Northeastern region and points out the importance of the accomplishment of multicentric studies.

Intensidade da dor em pacientes com síndrome do ombro doloroso

The aim of this study was to assess the severity of pain and its correlations to clinical characteristics in Painful Shoulder Syndrome (PSS) patients. A descriptive study was conducted using retrospective data from 77 medical record files. The Visual Numerical Scale (VNS) was used as an assessment instrument. The following variables of interest were considered: VNS (77), diagnosis (57), affected shoulder (77), sex (77), age (76), pain site (77), use of medications (59) and associated cervical pain (77). 53.2% of the patients were females and the mean age was 50.4±15.7 years. The right shoulder was the most affected side (57.1%). Severe pain was reported by 41.6% of patients, more frequently in women (56.1% vs 25.0%; p=0.006), and on left shoulder (57.7% vs 31.8%, p=0.034). Of the studied patients, 59 (81.3%) used medications, most frequently anti-inflammatory drugs. The rotator cuff syndrome was present in 80.7% (57) and associated cervical pain in 15.6% (77). Pain exclusively on the shoulder accounted for 76.5%. The rotator cuff syndrome was shown to be the most frequent cause of PSS, more commonly and severely affecting women close to 51 years old. EVN was shown to be a relevant instrument for measuring pain in PSS.

Associação entre hipertrofia adenotonsilar, tonsilites e crises álgicas na anemia falciforme

OBJETIVOS: Determinar a prevalencia da hipertrofia adenotonsilar obstrutiva em criancas e adolescentes portadores de anemia falciforme; investigar possivel associacao entre presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses e episodios de crise algica no mesmo periodo; e comparar a hemoglobina anual media entre os que apresentam e os que nao apresentam hipertrofia adenotonsilar obstrutiva. METODOS: Trata-se de estudo prospectivo, observacional do tipo corte transversal, com 85 criancas e adolescentes com anemia falciforme. Todos responderam questionario e avaliacao otorrinolaringologica, incluindo endoscopia nasossinusal. Para o diagnostico da hipertrofia adenotonsilar obstrutiva foram adotados os criterios de Brodsky. RESULTADOS: A prevalencia da hipertrofia adenotonsilar obstrutiva foi de 55,3%. A hipertrofia adenotonsilar obstrutiva associou-se a historia de dificuldade para alimentar-se (76,7 versus 23,5%; p = 0,003), presenca de mais de cinco episodios de tonsilites nos ultimos 12 meses (70,6 versus 29,4%; p = 0,021), roncar alto (73,0 versus 27,0%; p = 0,004) e apneia do sono assistida (71,8 versus 28,2%; p = 0,005). Portadores de hipertrofia adenotonsilar obstrutiva apresentaram maior numero de infeccoes das vias aereas superiores (62,5 versus 37,5; p = 0,010). Tambem foi observada associacao entre presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses e episodios de crise algica no mesmo periodo (mediana = 12 versus 2; p = 0,017). Nao houve diferenca significante da hemoglobina anual media entre portadores de hipertrofia adenotonsilar obstrutiva versus hipertrofia adenotonsilar nao-obstrutiva (7,6 versus 8,2 g/dL; p = 0,199). CONCLUSAO: A prevalencia da hipertrofia adenotonsilar obstrutiva foi de 55,3% em criancas e adolescentes com anemia falciforme. A presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses associaram-se com episodios de crise algica no mesmo periodo; e nao houve diferenca quanto ao valor da hemoglobina anual media entre os que apresentaram e os que nao apresentaram hipertrofia adenotonsilar obstrutiva.