Fernanda Louise Martinho

Association of Systematic Head and Neck Physical Examination With Severity of Obstructive Sleep Apnea—Hypopnea Syndrome†

Objectives/Hypothesis To identify upper airway and craniofacial abnormalities is the principal goal of clinical examination in patients with obstructive sleep apnea–hypopnea syndrome. The aim was to identify anatomical abnormalities that could be seen during a simple physical examination and determine their correlation with apnea–hypopnea index (AHI).

Head and Neck Physical Examination: Comparison Between Nonapneic and Obstructive Sleep Apnea Patients†

Study Objectives: The purpose of this study was to apply a systematic physical examination, used to evaluate obstructive sleep apnea (OSA) patients, in nonapneic patients.

Systematic head and neck physical examination as a predictor of obstructive sleep apnea in class III obese patients

Our aim was to determine if anatomical abnormalities of the upper airway (UA) and facial skeleton of class III severely obese patients are related to the presence and severity of obstructive sleep apnea syndrome (OSAS). Forty-five patients (69% females, mean age 46.5 +/- 10.8 years) with a body mass index (BMI) over 40 kg/m(2) underwent UA and facial skeletal examinations as well as polysomnography. Mean BMI was 49 +/- 7 kg/m(2) and mean neck circumference was 43.4 +/- 5.1 cm. Polysomnographic findings showed that 22% had a normal apnea-hypopnea index (AHI) and 78% had an AHI over 5. The presence of OSAS was associated with younger age (P = 0.02), larger neck circumference (P = 0.004), presence of a voluminous lateral wall (P = 0.0002), posteriorized soft palate (P = 0.0053), thick soft palate (P = 0.0014), long uvula (P = 0.04), thick uvula (P = 0.0052), and inferior turbinate hypertrophy (P = 0.04). A larger neck circumference (P = 0.02), presence of a voluminous lateral wall (P = 0.04), posteriorized soft palate (P = 0.03), and thick soft palate (P = 0.04) were all associated with OSAS severity. The prevalence of OSAS in this group was high. A larger neck circumference and soft tissue abnormalities of the UA were markers for both the presence and severity of OSAS. Conversely, no abnormalities in the facial skeleton were associated with OSAS in patients with morbid obesity.

Indicação cirúrgica otorrinolaringológica em um ambulatório para pacientes com síndrome da apnéia e hipopnéia obstrutiva do sono

AIM: Otolaryngology surgical procedure is an option for obstructive sleep apnea-hypopnea syndrome (OSAHS) treatment. The objective of this study is to show which procedures can be done well as their indications. STUDY DESIGN: Clinical retrospective. METHOD: 223 patients with OSAHS were studied in Otolaryngology Department of UNIFESP. Every patient had a previous polissonography, and they were analyzed and treatment options were proposed. The treatment options were divided in no surgical (CPAP, dental appliance and general measures) and surgical procedures (pharynx surgery, rhinosurgery and maxillofacial surgery). RESULT: 100 patients (44,8%) had surgery indication, and 168 procedures were proposed. The majority uvulopalatopharyngoplasty and radiofrequency of the soft palate were indicated in mild and moderate OSAHS cases and maxillomandibular surgery were indicated in severe cases. Tonsillectomy and rhinosurgery were indicated independently of OSAHS severity. CONCLUSION: The otolaryngological surgery is an option in OSAHS treatment, and your indication depends on OSAHS severity. The surgical procedure can be done whit curative intetion or to avoid CPAP use.

A comparison of public and private obstructive sleep apnea clinics.

The aim of the present study was to compare the clinical findings and polysomnography results obtained at public and private clinics in Brazil, the follow-up after diagnosis, and the therapeutic aspects related to continuous positive airway pressure. Patients who snore and who have obstructive sleep apnea were retrospectively divided into two groups, i.e., public clinic (N=307) and private clinic (N=317). Data concerning age, sex, body mass index (BMI), neck circumference, medical history, sleepiness scale, follow-up after diagnosis, and acceptance of continuous positive airway pressure therapy were collected. Mean age was 50 +/- 12 (range: 15-80) for public patients and 48 +/- 12 years (range: 19-91) for private patients. Mean BMI was 30 +/- 6 (range: 19-67) for public patients and 31 +/- 6 kg/m (range: 21-59) for private patients. The public clinic had a significantly higher frequency of women than the private clinic (M:F ratio of 2.0:1 and 6.9:1, respectively). The condition of private patients (apnea-hypopnea index=31 +/- 25) was more severe than that of public patients (apnea-hypopnea index=25 +/- 24 events/h; P=0.0004). In the public and private clinics, 19 and 15% of patients were snorers, respectively, and 81 and 85% of them had sleep apnea. After diagnosis, follow-up was longer in the private group. The continuous positive airway pressure acceptance was similar for both groups (32 vs 35%), but patients from the public clinic abandoned treatment more than private ones (65 vs 13%). Social status was significant in terms of the severity of obstructive sleep apnea age and gender distribution. Private patients look for a diagnosis earlier in the course of the disease than public patients, adhere more to follow-up, and abandon continuous positive airway pressure treatment less than public patients do.

Clinical and polysomnographic findings in class III obese patients

UNLABELLED The Obstructive Sleep Apnea/Hipopnea Syndrome (OSAHS) is closely related to obesity; a linear relation, however, has not been established, particularly in morbid obesity patients. AIM To evaluate clinical and polysomnographic findings in a group of class III obese patients, and to relate these findings with the presence or absence of OSAHS. MATERIAL AND METHOD Forty five patients with body mass index (BMI) over 40Kg/m2 were selected consecutively. A clinical history, the anthropometric examination and polysomnography were undertaken in all patients. The results of a study group and a control group (with no OSAHS) were compared. RESULTS The sample consisted of 68.9% female and 31.1% male patients. The average age was 46.5 years (SD - 10.8 years); the average BMI was 49 (SD - 7 Kg/m2) and the average neck circumference was 43.4 cm (SD - 5.1 cm). All subjects were habitual snorers and 48.9% had daytime drowsiness. Polysomnography showed that 77.8% had an apnea/hipopnea index over 5. The findings associated with OSAHS were: younger age (p=0,02) and an increased neck circumference (p=0.004). CONCLUSION The prevalence of OSAHS was very high, which emphasizes the importance of investigating this syndrome in patients sent for bariatric surgery. The neck circumference was the best OSAHS marked in this group of patients.

Achados clínicos e polissonográficos em pacientes com obesidade classe III

A Sindrome da apneia/hipopneia obstrutiva do sono (SAHOS) apresenta estreita correlacao com a obesidade, porem nao esta estabelecida uma relacao linear de gravidade principalmente em relacao aos extremos como na obesidade morbida. OBJETIVO: Avaliar os achados clinicos e polissonograficos em pacientes com obesidade classe III e correlacionar esses achados com a presenca da SAHOS. MATERIAIS E METODOS: Foram selecionados consecutivamente 45 pacientes com indice de massa corporea superior a 40Kg/m2. Todos foram submetidos a anamnese, exame fisico antropometrico e polissonografia. Os achados foram comparados entre os pacientes com e sem SAHOS. RESULTADOS: 68,9% dos pacientes eram do sexo feminino e 31,1% do masculino. A idade media foi de 46,5 DP 10,8 anos, a media do IMC foi 49 DP 7Kg/m2 e a media da circunferencia cervical foi 43,4 DP 5,1cm. Todos os pacientes eram roncadores habituais e 48,9% tinham queixa de hipersonolencia diurna. Os achados polissonograficos mostraram que 77,8% apresentaram indice de apneia/hipopneia superior a cinco. Apresentaram correlacao com a presenca da SAHOS: idade mais jovem (p=0,02) e maior circunferencia cervical (p=0,004). CONCLUSAO: A prevalencia de SAHOS foi elevada, ressaltando a importância da sua investigacao em pacientes referenciados para cirurgia bariatrica. O principal marcador da SAHOS foi a circunferencia cervical.