Análise da gravidade da Síndrome da Apneia Obstrutiva do Sono e a presença de Comorbidades : um estudo entre os gêneros e o envelhecimento

Tese (doutorado)—Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, 2015.Introdução: A síndrome da apnéia obstrutiva do sono (SAOS) é caracterizada pelo colapso das vias aéreas, resultando em episódios recorrentes de cessação de respiração durante o sono, com consequente hipoxemia e fragmentação do sono. Estudos populacionais mostram que os homens têm duas a três vezes mais probabilidade de ter SAOS do que as mulheres. Pacientes com SAOS não tratada podem ter múltiplas comorbidades crônicas, que afetam sua condição funcional e qualidade de vida. Pesquisas sugerem que estas comorbidades se apresentam de forma diferente entre os gêneros e a idade. Objetivo: Avaliar a gravidade da SAOS e a presença de comorbidades entre os gêneros e a faixa etária, considerando os dados antropométricos e polissonográficos, queixas, sintomas e diagnósticos referidos. Método: Investigação epidemiológica quantitativa, transversal, retrospectiva de cunho descritivo de um grupo de indivíduos não obesos com SAOS definida. Considerou-se como estatisticamente significativo o valor de p < 0,05 em testes bicaudais Os dados foram analisados pelo SPSS. Resultados: Foram analisados 735 prontuários de indivíduos com SAOS definida, sendo 478 (65%) homens. Entre as mulheres, a média de idade foi de 56,32±9,80 anos; entre os homens foi de 54,8±10,76 anos. O IMC para as mulheres foi de 26,41kg/m2±2,63 kg/m2 e para os homens 28,90 kg/m2 ±2,23 kg/m2. A média de N2 nas mulheres foi de 67,65±10,67% e nos homens de 71,46±10,53%. O N3 em mulheres foi 8,68 ± 6,99%, nos homens de 5,95±6,10%. A latência de sono nas mulheres foi 16,68±24,3 min, nos homens 11,23±16,59 min. A FC em mulheres foi de 66,57±8,85 bpm e em homens 63,63±9,42 bpm. A SpO2min nas mulheres 79,78±7,2% e em homens foi de 78,43± 8,39%. O IAH em mulheres apresentou um valor de 18,56±21,67 eventos/h, já nos homens 26,05±19,14 eventos/h. O Índice de microdespertares nas mulheres foi de 22,18±13,34 eventos/h e nos homens atingiu 30,08±18,87 eventos/h. A maior prevalência de queixas em mulheres foram o ronco, a insônia, o acordar assustado repentinamente com medo e ataque de sono incontrolável durante o dia. Para os homens apenas a apneia observada na faixa etária de 40 a 49 anos e sonolência diurna na faixa etária de 60 a 69 anos. Todas as comorbidades estudadas foram mais frequentes nas mulheres em todas as faixas etárias. Conclusão: A SAOS é mais prevalente e mais grave nos homens quando comparados às mulheres. As mulheres apresentam maior prevalência de queixas e comorbidades do que os homens. Com o envelhecimento: o IMC tem menor influência na gravidade da SAOS, os homens apresentam maior superficialização do sono do que as mulheres e a frequencia das comorbidades se assemelha entre os gêneros.Introduction: Obstructive sleep apnea syndrome (OSAS) is characterized by airway collapse, resulting in recurrent episodes of breathing cessation during sleep, with consequent hypoxemia and sleep fragmentation. Population studies have shown that men have two to three times more probability to have OSA than women. Many people with untreated OSA have multiple chronic co-morbidities, which could affect functional status and quality of life. Researches suggest that these co-morbidities are presented differently between genders and age group. Objective: To evaluate the severity of OSA and the presence of comorbidities between genders and age group, considering anthropometric, polysomnographic, complaints and symptoms data and those diagnoses. Method: It is a quantitative epidemiological, cross-sectional descriptive nature of retrospective of a group of non-obese subjects with untreated OSA. Data were analyzed using SPSS. It was considered as statistically significant when p <0.05 in two-tailed tests. Results: We analyzed 735 medical records of individuals with defined OSA, 478 (65%). The mean age women was 56.32 ± 9.80 years; among men, was 54.8 ± 10.76 years. Women a BMI of 26,41±2,63 kg/m2, BMI men of 28.90 ± 2.23 kg/m2. The mean N2 women was 67.65 ± 10.67%, and in men was 71.46 ± 10.53%. The N3 women, 8.68 ± 6.99% in men and 5.95 ± 6.10%. Sleep latency in women was 16.68 ± 24.3 min, and men 11.23 ± 16.59 min. HR in women was 66.57 ± 8.85 bpm and men 63.63 ± 9.42 bpm. The SpO2min in women 79.78 ± 7.2% and in men was 78.43 ± 8.39%. The AHI in women a value of 18.56 ± 21.67 events/h and in men, 26.05 ± 19.14 events/h. The arousals in women was 22.18 ± 13.34 events/h in men reached 30.08 ± 18.87 events/h. The higher prevalence of women in complaints were snoring, insomnia, waking suddenly scared and sleep attacks uncontrollably during the day, as for men only observed apnea aged 40 - 49 years and daytime sleepiness aged 60 - 69 years. All co-morbidities studied were more common in women of all ages. Conclusion: OSAS is more prevalent and more severe in men than in women. Women have a higher prevalence of complaints and comorbidities than men. With aging: the BMI has less influence on the severity of OSAS, men have higher superficial sleep than women and the frequency of comorbidities is similar between genders

USE OF MUSIC DURING PHYSICAL THERAPY INTERVENTION IN A NEONATAL INTENSIVE CARE UNIT: A RANDOMIZED CONTROLLED TRIAL

Introduction: Previous studies have shown music therapy as a way to improve the clinical status of premature infants, improving vital signs and decreasing crying episodes. Objective: Compare the effects of music on vital signs of premature infants undergoing respiratory physiotherapy. Methods: We performed a randomized clinical trial consisting of 26 premature infants, divided into control group (N=12) and study group (N=14), carried out in a Neonatal Intensive Care Unit. All newborn infants undergone standard practice physiotherapy for 15 minutes: vibration and aspiration. On the study group they were exposed to classical music three minutes before the standard physiotherapy, and finished three minutes after the end of these procedures. A recorder was placed inside the incubator with an intensity of 25 decibels. Measurements of heart and respiratory rate and oxygen saturation were measured before, during and after each sessions of respiratory physiotherapy for two groups. Results: When comparing control and study groups regarding heart rate frequency and oxygen saturation, there was no statistically significant difference, but the inclusion of music determined clinically the variability of these data and 30% of the variation in respiratory rate was due to the inclusion of music during and after the physiotherapy, and the neonatal noninvasive ventilation showed less variation in their respiratory rate when compared to the neonatal on oxygen therapy. Conclusion: The results have showed a beneficial effect of music, showing lower respiratory rate in newborn infants during and after respiratory physiotherapy procedure

Functioning and Disability Profile of Children with Microcephaly Associated with Congenital Zika Virus Infection

Introduction: The increase in the number of cases of microcephaly in Brazil and its association with the Zika virus (ZIKV) is a global public health problem. The International Classification of Functioning Disability and Health (ICF) model is a powerful tool and extremely relevant in managing disability. Objective: Describe the functioning profile of children with microcephaly associated with ZIKV in two states of northeastern Brazil. Methods: This is a descriptive cross-sectional study. The sociodemographic characteristics, head circumference, and other clinical data were collected from medical charts, physical examinations, measuring instruments, and interviews with the children and their parents. The Brazilian Portuguese version of the Brief Common ICF Core Set for cerebral palsy (CP) was used. Each ICF category was assigned a qualifier, which ranged from 0 to 4 (no problem, mild problem, moderate problem, severe problem, complete problem). For environmental factors, 0 represents no barrier and 4 represents complete barrier; +0, no facilitator and +4, complete facilitator. Results: A total of 34 children with microcephaly caused by ZIKV were recruited (18 girls and 16 boys) at four rehabilitation facilities in Rio Grande do Norte and Para&iacute;ba states, Brazil. The average age of the participants was 21 months, monthly income was &asymp;USD 300.00, and head circumference z-scores ranged between 0.92 and &minus;5.51. The functioning profile revealed complete disability in most of the body function categories (b). The activity and participation areas (d) were highly impacted, particularly in mobility-related categories. With respect to environmental factors (e), most of the sample reported a complete facilitator for the immediate family, friends, and health services, systems, and policies, as well as a complete barrier to societal attitudes. Conclusion: This is the first study that describes the functioning profile of children with microcephaly associated with ZIKV, using a tool based on the ICF in Brazil. Our findings reinforce the need to maximize health care and access to information, based on the ICF, for multiprofessional teams, administrators, family members, and children

Growth and Development of Children with Microcephaly Associated with Congenital Zika Virus Syndrome in Brazil

The outbreak of Zika virus in Latin America in the period 2015&ndash;2016 has caused a sudden increase in the number of severe manifestations and reports of congenital changes in newborns in Brazil. This is the first study that evaluated and compared the growth and cognitive and motor development of children with microcephaly due to Congenital Zika Virus Syndrome (CZS) in relation to typical children. It was an observational, analytical, cross-sectional study with 8 children with CZS and 16 typical children, with a mean age of 20.5 months (&plusmn;2.1), in a region of northeastern Brazil. Considering the mean, children with CZS presented extremely low performance in the motor domain and in the cognitive development domain, whereas typical children presented average performance in the cognitive and motor development domains. Children with CZS presented a mean growth rate (head circumference and weight) lower than typical children. Therefore, children with CZS are at risk for growth retardation and development compared to typical children