Prevalência de sintomas de distúrbios respiratórios do sono em escolares brasileiros The prevalence of symptoms of sleep-disordered breathing in Brazilian schoolchildren

OBJETIVO: Verificar a prevalência de sintomas de distúrbios respiratórios do sono em crianças de baixo nível socioeconômico no Sul do Brasil. MÉTODOS: Foi realizado um estudo transversal em Uruguaiana (RS), utilizando questionário específico sobre sintomas de distúrbios respiratórios do sono, respondido pelos pais, em uma amostra de escolares de 9 a 14 anos participantes do International Study of Asthma and Allergies in Childhood (ISAAC). RESULTADOS: Foram respondidos 998 questionários de um total de 1.011 escolares elegíveis. Relato de ronco habitual ocorreu em 27,6% das crianças, apnéia em 0,8%, respiração oral diurna em 15,5% e sonolência diurna excessiva em 7,8%. Crianças com sonolência diurna excessiva apresentaram maior risco de ronco habitual (OR = 2,7; IC95% 1,4-5,4), apnéia (OR = 9,9; IC95% 1,2-51), respiração oral (OR = 13,1; IC95% 6,2-27,4) e problemas de aprendizado (OR = 9,9; IC95% 1,9-51,0). Rinite, fumo materno e testes cutâneos alérgicos estiveram significativamente associados a ronco habitual e respiração oral diurna. CONCLUSÕES: A prevalência de sintomas de distúrbios respiratórios do sono é elevada em crianças de 9 a 14 anos na cidade de Uruguaiana. A prevalência de ronco habitual foi quase duas vezes maior que a descrita nessa faixa etária em outras populações. Crianças com sonolência diurna excessiva parecem ter quase 10 vezes mais risco de problemas de aprendizado.<br>OBJECTIVE: To identify the prevalence of symptoms of sleep-disordered breathing among children of low socioeconomic status in the South of Brazil. METHODS: This was a cross-sectional study, carried out in the city of Uruguaiana, RS, in which specific questionnaire about the symptoms of sleep-disordered breathing was completed by the parents of a sample of schoolchildren aged 9 to 14 years, enrolled on the International Study of Asthma and Allergies in Childhood (ISAAC). RESULTS: From the total of 1,011 eligible schoolchildren, 998 questionnaires were completed. The parents of 27.6% of the children reported habitual snoring, while 0.8% reported apnea, 15.5% described daytime mouth breathing and 7.8% complained of excessive daytime sleepiness. Children with excessive daytime sleepiness were at greater risk of habitual snoring (OR = 2.7; 95%CI 1.4-5.4), apnea (OR = 9.9; 95%CI 1.2-51), mouth breathing (OR = 13.1; 95%CI 6.2-27.4) and learning difficulties (OR = 9.9; 95%CI 1.9-51.0). Rhinitis, maternal smoking and positive allergy skin test results were significantly associated with habitual snoring and daytime mouth breathing. CONCLUSIONS: There is an elevated prevalence of symptoms of sleep-disordered breathing among children from 9 to 14 in the city of Uruguaiana. The prevalence of habitual snoring was almost twice that described in this age group in other populations. Children with excessive daytime sleepiness appear to have almost 10 times the risk of learning difficulties

Efficacy of Pirfenidone in the Context of Multiple Disease Progression Events in Patients With Idiopathic Pulmonary Fibrosis

Declines in percent predicted FVC (% predicted FVC), declines in 6-min walk distance (6MWD), and respiratory hospitalizations are events associated with disease progression and mortality in idiopathic pulmonary fibrosis. The incidence of multiple events in the same patient over 12 months of pirfenidone treatment is unknown. Patients who received pirfenidone 2,403 mg/d (n = 623) or placebo (n = 624) in the ASCEND (study 016; NCT01366209) and CAPACITY (studies 004 and 006; NCT00287716 and NCT00287729) phase III trials were included in this post hoc analysis. Disease progression events were defined as relative decline in % predicted FVC ≥ 10%, absolute decline in 6MWD ≥ 50 m, respiratory hospitalization, or death from any cause. The incidence of disease progression events over 12 months was assessed. The most frequent disease progression events were declines in % predicted FVC (pirfenidone vs placebo; 202 vs 304 events) and declines in 6MWD (pirfenidone vs placebo; 265 vs 348 events). Fewer patients who received pirfenidone had more than one progression event compared with placebo (17.0% vs 30.1%; P < .0001). Death following one or more progression event occurred less frequently in the pirfenidone group than in the placebo group (2.1% vs 6.3%; P = .0002). Pirfenidone significantly reduced the incidence of multiple progression events and death after a progression event over 12 months of treatment compared with placebo. These findings suggest that continued treatment with pirfenidone confers a benefit despite the occurrence of any single disease progression event. ClinicalTrials.gov; Nos. NCT01366209, NCT00287716, and NCT00287729; URL: www.clinicaltrials.gov

Effect of continued treatment with pirfenidone following clinically meaningful declines in forced vital capacity:Analysis of data from three phase 3 trials in patients with idiopathic pulmonary fibrosis

BACKGROUND: The assessment of treatment response in idiopathic pulmonary fibrosis (IPF) is complicated by the variable clinical course. We examined the variability in the rate of disease progression and evaluated the effect of continued treatment with pirfenidone in patients who experienced meaningful progression during treatment. METHODS: The source population included patients enrolled in the ASCEND and CAPACITY trials (N=1247). Pearson's correlation coefficients were used to characterise the relationship between changes in FVC during consecutive 6-month intervals in the placebo population. Outcomes following a ≥10% decline in FVC were evaluated by comparing the proportion of patients in the pirfenidone and placebo groups who experienced a ≥10% decline in FVC or death during the subsequent 6 months. RESULTS: A weak negative correlation was observed between FVC changes during consecutive intervals in the placebo population (coefficient, −0.146, p<0.001), indicating substantial variability. Thirty-four (5.5%) and 68 (10.9%) patients in the pirfenidone and placebo groups, respectively, experienced a ≥10% decline in FVC by month 6. During the subsequent 6 months, fewer patients in the pirfenidone group compared with placebo experienced a ≥10% decline in FVC or death (5.9% vs 27.9%; relative difference, 78.9%). There was one (2.9%) death in the pirfenidone group and 14 (20.6%) deaths in the placebo group (relative difference, 85.7%). CONCLUSIONS: Longitudinal FVC data from patients with IPF showed substantial intrasubject variability, underscoring the inability to reliably assess therapeutic response using serial FVC trends. In patients who progressed during treatment, continued treatment with pirfenidone resulted in a lower risk of subsequent FVC decline or death. TRIAL REGISTRATION NUMBERS: NCT01366209, NCT00287729, NCT00287716