Quadro clinico e polissonografico da sindrome das apneias do sono

Este estudo foi realizado prospectivamente para descrever o quadro clinico e polissonografico de 300 pacientes, 269 homens e 31 mulheres, com diagn6stico de Sindrome das Apneias do Sono do tipo obstrutivo (SASO), atendidos no Laborat6rio do Sono da Santa Casa de Porto Alegre, no periodo de abril de 1985 a janeiro de 1990. Os dados de identifica~ao mostraram que a idade variou de 17 a 82 anos, a media e o desvio padrao foram 47±11 anos. A anamnese revelou que o familiar observou roncar noturno intense em 95,4% dos pacientes e apneias durante o sono em 82,5% dos pacientes. Obteve-se hist6ria de que o paciente adormecia muitas vezes ou sempre enquanto lendo, assistindo TV, viajando, dirigindo e trabalhando em respectivamente 71%, 77,8%o, 70,5~, 44 5% fo , e 46,5% dos cases; 15,3% dos pacientes referiram acidentes ou "quase acidentes" de autom6vel no passado. A duraiao media dos sintomas foi 14 anos e o desvio padrao foi 12 anos. Depressao foi referida por 47,5% dos pacientes, irritabilidade por 62,8% e redu~ao da libido por 62,3%; 62,3% dos pacientes eram tabagistas ou ex-tabagistas. 0 exame fisico mostrou que 90,7% dos pacientes eram obesos, com indice de massa corporal de 25 Kg/m2 ou mais. As pressoes arteriais sist6lica e diast6lica corrigidas foram (media±DP) 141±23 e 83~14 mmHg; 58% dos pacientes foram considerados hipertensos (pressao igual ou maior que 140/90 mmHg) e 65,8% apresentavam altera9oes hipertensivas retinianas; edema de membros inferiores foi observado em 71,1% dos casos. Mais de 90% dos pacientes tinham uvula ou palato anormais; 84,1% tinham aumento da lingua; 41,1% tinham aumento de amigdalas; somente 2 pacientes tinham orofaringe completamente normal. 0 registro dos movimentos respirat6rios feito por "respitrace" durante a polissonografia mostrou 5,7±12 apneias centrais, 206,5±165,5 apneias obstrutivas, 11,7±29,5 apneias mistas e 84,2±75 hipopneias. 0 indice de apneias/hipopneias foi (media±DP) 51,9±29,2. A qualidade do sono diminuiu a medida que aumentou o numero de eventos respirat6rios durante o sono. A lat~ncia ao sono foi menor que 10 minutos em 30,7% dos pacientes; o estagio 3-4 esteve ausente em 43,7% dos pacientes; a Sa02 media variou de 40 a 96% e a Sa02 minima de 0 a 95%. Arritmias cardiacas durante o sono foram observadas em 54,7% dos pacientes. Conclui-se que a SASO e uma doen9a cr8nica, predominante em homens de meia idade, obesos, e que esta associada a transtornos cardiacos.This study was prospectively conducted to describe the clinical and polysomnographic features of 300 patients~ 269 men and 31 women, with Obstructive Sleep Apnea Syndrome (OSAS), seen at the Sleep Laboratory of "Santa Casa de Misericordia de Porto Alegre" from April 1985 to January 1990. The identification data showed ages ranging from 17 to 82, meaniSD 47ill years. The medical history revealed that bedpartners had complained of loud snoring in 95.4% of patients and observed apneas in 82.5% of patients. Respectively 71%, 77.8%, 70.5%, 44.5% and 46.5% of patients referred falling asleep often or always while reading, watching TV, traveling, driving and at work; 15.3% referred automobile accidents or "near-accidents" in the past. Mean duration of symptoms was 14t12 years. Depression was identified in 47.5% of patients, irritability in 62.8%, and reduction of libido in 62.8%; 62.3% of patients were current smokers or ex-smokers. Physical examination pointed out obesity in 90.7% of the patients with body mass index (BMI) 25 Kg/m2 or above. Average corrected systolic and diastolic blood pressure were 14li23 and 83t14; 58% of patients were considered hypertensive and 65.8% had hypertensive retinal vascular changes; peripheral edema was detected in 71.1% of cases. More than 90% of patients had abnormal uvula and palate; 84.1% had large tongue; 41.4% had large tonsils; only 2 patients had a completely normal oropharynx. The respiratory measurements made by Respitrace during the polysomnography showed 5.7±12 central apneas. 206.5±165.5 obstructive apneas. 11.7±29.2 mixed apneas. 84.2±75 hypopneas. Apnea-hypopnea index (mean±SD) was 51.9±29.2. Sleep quality was impaired in proportion with the number of respiratory events. Sleep latency was shorter than 10 minutes in 30.7% of patients; stage 3-4 was absent in 43.7% of patients. Mean Sa02 ranged from 40 to 96% and lowest Sa02 from 0 to 95%. Cardiac arrhythmias were present during sleep in 54.7% of the patients. It was concluded that the OSAS is a chronic disease, mainly of middle-aged obese men and that it is associated with cardiac disorders

Effect of the expiratory positive airway pressure on dynamic hyperinflation and exercise capacity in patients with COPD: a meta-analysis

Expiratory positive airway pressure (EPAP) is widely applicable, either as a strategy for pulmonary reexpansion, elimination of pulmonary secretion or to reduce hyperinfation. However, there is no consensus in the literature about the real benefts of EPAP in reducing dynamic hyperinfation (DH) and increasing exercise tolerance in subjects with chronic obstructive pulmonary disease (COPD). To systematically review the efects of EPAP application during the submaximal stress test on DH and exercise capacity in patients with COPD. This meta-analysis was performed from a systematic search in the PubMed, EMBASE, PeDRO, and Cochrane databases, as well as a manual search. Studies that evaluated the efect of positive expiratory pressure on DH, exercise capacity, sensation of dyspnea, respiratory rate, peripheral oxygen saturation, sense of efort in lower limbs, and heart rate were included. GRADE was used to determine the quality of evidence for each outcome. Of the 2,227 localized studies, seven studies were included. The results show that EPAP did not change DH and reduced exercise tolerance in the constant load test. EPAP caused a reduction in respiratory rate after exercise (− 2.33 bpm; 95% CI: − 4.56 to− 0.10) (very low evidence) when using a pressure level of 5 cmH2O. The other outcomes analyzed were not signifcantly altered by the use of EPAP. Our study demonstrates that the use of EPAP does not prevent the onset of DH and may reduce lower limb exercise capacity in patients with COPD. However, larger and higher-quality studies are needed to clarify the potential beneft of EPAP in this population

Hepatopulmonary syndrome has low prevalence of pulmonary vascular abnormalities on chest computed tomography

Purpose Hepatopulmonary syndrome (HPS) is defined as an arterial oxygenation defect induced by intrapulmonary vascular dilatations associated with hepatic disease. This study aimed to assess the prevalence of type 1 and 2 pulmonary vascular abnormalities on chest computed tomography (CT) in patients with cirrhosis and HPS and to characterize intra- and interobserver reliability. Materials and methods Two thoracic radiologists retrospectively evaluated chest CT scans from 38 cirrhosis patients with HPS. They classified the pulmonary vascular abnormalities as type 1 (multiple dilated distal pulmonary arteries), type 2(nodular dilatation or individual pulmonary arterial malformation), or absence of abnormality. Furthermore, they measured the diameters of the central pulmonary arteries and subsegmental pulmonary arteries and bronchi. We analyzed the prevalence, intraobserver reliability, and interobserver reliability of abnormal CT findings related to HPS, and the correlation of these findings with partial arterial oxygen pressure (PaO2). Results The overall prevalence of pulmonary vascular abnormalities was 28.9% (95% confidence intervals: 15.4%, 45.9%). Moreover, 26.3% of patients had type 1 abnormality (13.4%, 43.1%) and 2.6% of patients had type 2 abnormality (0.0%, 13.8%). The intraobserver reliability kappa value was 0.666 (0.40, 0.91) and the interobserver kappa value was 0.443 (0.12, 0.77). There was no correlation between pulmonary vascular abnormalities on CT and PaO2 values. Conclusions The prevalence of pulmonary vascular abnormalities on chest CT of patients with cirrhosis and HPS is low and not correlated with PaO2. These findings question the usefulness of chest CT for the evaluation of patients with cirrhosis and HPS