Oxidative stress and quality of life in elderly patients with obstructive sleep apnea syndrome: are there differences after six months of Continuous Positive Airway Pressure treatment?

OBJECTIVES: This study evaluated the effect of Continuous Positive Airway Pressure treatment on oxidative stress parameters and the quality of life of elderly patients with obstructive sleep apnea syndrome. METHODS: In total, 30 obstructive sleep apnea syndrome patients and 27 subjects without obstructive sleep apnea syndrome were included in this study. Both groups underwent quality of life and oxidative stress evaluations at baseline and after six months. Polysomnography was performed in both groups at baseline and a second time in the obstructive sleep apnea syndrome group after six months of Continuous Positive Airway Pressure treatment. All of the variables were compared between the control and obstructive sleep apnea syndrome groups in this prospective case-control study. RESULTS: The baseline concentrations of the antioxidant enzyme catalase were higher in the obstructive sleep apnea syndrome group than the control group. After Continuous Positive Airway Pressure treatment, the obstructive sleep apnea syndrome group exhibited a reduction in the level of oxidative stress, as indicated by a decrease in the level of lipid peroxidation measured by the malondialdehyde (MDA) concentration [pre: 2.7 nmol malondialdehyde/mL (95% 1.6-3.7) vs. post: 1.3 nmol MDA/mL (0.7-1.9),

Oxidative stress and quality of life in elderly patients with obstructive sleep apnea syndrome: are there differences after six months of Continuous Positive Airway Pressure treatment?

OBJECTIVES: This study evaluated the effect of Continuous Positive Airway Pressure treatment on oxidative stress parameters and the quality of life of elderly patients with obstructive sleep apnea syndrome. METHODS: In total, 30 obstructive sleep apnea syndrome patients and 27 subjects without obstructive sleep apnea syndrome were included in this study. Both groups underwent quality of life and oxidative stress evaluations at baseline and after six months. Polysomnography was performed in both groups at baseline and a second time in the obstructive sleep apnea syndrome group after six months of Continuous Positive Airway Pressure treatment. All of the variables were compared between the control and obstructive sleep apnea syndrome groups in this prospective case-control study. RESULTS: The baseline concentrations of the antioxidant enzyme catalase were higher in the obstructive sleep apnea syndrome group than the control group. After Continuous Positive Airway Pressure treatment, the obstructive sleep apnea syndrome group exhibited a reduction in the level of oxidative stress, as indicated by a decrease in the level of lipid peroxidation measured by the malondialdehyde (MDA) concentration [pre: 2.7 nmol malondialdehyde/mL (95% 1.6-3.7) vs. post: 1.3 nmol MDA/mL (0.7-1.9), p<0.01]. Additionally, improvements were observed in two domains covered by the SF-36 questionnaire: functional capacity [pre: 77.4 (69.2-85.5) vs. post: 83.4 (76.9-89.9), p = 0.002] and pain [pre: 65.4 (52.8-78.1) vs. post: 77.8 (67.2-88.3), p = 0.004]. CONCLUSION: Our study demonstrated that the use of Continuous Positive Airway Pressure to treat obstructive sleep apnea syndrome in elderly patients reduced oxidative stress and improved the quality of life

The impact of the treatment of obstructive sleep apnea with continuous airway pressure on perceived health, tiredness, attractiveness, and age: a prospective randomized crossover placebo-controlled study

Objetivos: Comparar os efeitos de um mês de tratamento com aparelho de pressão aérea positiva (CPAP) e com placebo sobre a aparência e características objetivas da pele da face de pacientes com apneia obstrutiva do sono (AOS), num estudo randomizado e cruzado. Métodos: Foram incluídos pacientes consecutivos com AOS grave e sonolentos. Os pacientes realizaram três polissonografias (PSG): a primeira para confirmação da AOS e outras duas adicionais com uso de placebo (dilatador nasal) e para titulação de CPAP, antes do início de cada tratamento. Todos os pacientes foram aleatoriamente alocados em dois grupos de tratamento: 1) uso do placebo e 2) uso do CPAP. Após um mês com o primeiro tratamento e 15 dias de washout, houve cruzamento para o segundo tratamento. A face dos pacientes foi fotografada de modo padronizado nos três momentos experimentais. As fotografias foram apresentadas, em ordem aleatória, pelo Qualtrics Survey Software, e avaliadas on-line por 704 observadores para quantificação da aparência saudável (nada saudável até extremamente saudável), atraente (nada atraente até extremamente atraente) e cansada (nada cansada até extremamente cansada). A idade aparente também foi perguntada para cada observador. Foram realizadas avaliações quantitativas das características da pele da face dos pacientes, em cada momento experimental, incluindo a presença de acne, manchas, porosidade, rugas, textura, e uniformidade do tom da pele, por meio da captação de imagens pelo equipamento VISIATM System. Resultados: Foram avaliados 30 pacientes (idade=46±9 anos; 21 homens). Os pacientes utilizaram o placebo em 98% das noites do período de tratamento e a adesão ao CPAP foi de 94% das noites, com média de 6,0 ± 1,7 horas de uso por dia de tratamento. Após o tratamento com CPAP, em comparação ao momento basal e após tratamento placebo, foi observada melhora na qualidade objetiva do sono, sonolência, qualidade de vida e sintomas depressivos (P < 0,05). A avaliação das fotografias pelos observadores mostrou que os pacientes foram identificados como mais jovens após o uso de CPAP (P < 0,001), mas não foram observadas alterações quantitativas das características da pele da face, em comparação com o momento basal e após o uso de placebo. A análise de regressão linear identificou que a quantidade de dias de tratamento com CPAP, o tempo total de sono e a porcentagem do tempo total de sono com saturação de oxihemoglobina abaixo de 90% foram preditores da diminuição da idade atribuída após o uso de CPAP. Conclusão: Os pacientes com AOS graves e sonolentos apresentaram aparência mais jovem após um mês de tratamento com CPAPObjectives: To compare the effects of one month with continuous positive airway pressure (CPAP) treatment and placebo intervention on the appearance and objective facial skin characteristics of patients with obstructive sleep apnea (OSA) in a randomized crossover study. Methods: Consecutive sleepy patients with severe OSA were included. The patients underwent three polysomnograms (PSG): first one to confirm OSA and two additional ones using placebo (nasal dilator) and for CPAP titration before starting each treatment period. All patients were randomly included into two treatment groups: 1) placebo use and 2) CPAP use. After one month with the first treatment and 15 days of washout, patients were crossed-over for the second treatment. Photographs from the patients\' faces were obtained in the three experimental moments. The photographs were presented in a random order by the Qualtrics Survey Software, and were evaluated online by 704 observers for quantifying healthy appearance (unhealthy to extremely healthy), attractive (unattractive to extremely attractive) and tired (not tired to extremely tired). Apparent age was also rated for each observer. Quantitative evaluations of the skin characteristics of the patients\' faces were also carried out at each experimental moment, including the presence of acne, patches, porosity, wrinkles, texture, and skin tone uniformity, through the capture of images by VISIATM System equipment. Results: 30 patients (age = 46±9 years, 21 men) were evaluated. During treatment period, the patients wearing placebo intervention on 98% of the nights and adherence to CPAP was 94%, with a mean of 6.0 ± 1.7 hours of use per day of treatment. After CPAP treatment, compared to baseline and after placebo treatment, improvement in the objective sleep quality, sleepiness, quality of life and depressive symptoms were observed (P <0.05). Observational assessment of the photographs showed that patients were evaluated as being younger after using CPAP (P < 0.001), but no quantitative changes in face skin characteristics were observed compared to the baseline and after the use of placebo. Linear regression analysis identified the number of days with CPAP treatment, total sleep time and percentage of total sleep time with oxyhemoglobin saturation below 90% were predictors of decreasing of rated age after CPAP treatment. Conclusion: Sleepy patients with severe OSA had a younger appearance after one month of CPAP treatmen

Effect of CPAP on oxidative stress and quality of life in adults and elderly patients with obstructive sleep apnea syndrome

Introduction: The effects of intermittent hypoxia and hypercapnia resulting from obstructive respiratory events Syndrome Obstructive Sleep Apnea (OSAS) in the generation of reactive oxygen species (ROS) has recently received particular attention because of its association with oxidative stress (OS) and aging process. Although the literature highlights the positive effects of Continuous Positive Air Pressure (CPAP) in sleep patterns, excessive daytime sleepiness and OS in adults are rare studies in the elderly. The aim of this study was to evaluate the effects of OS parameters in elderly patients, comparing them with an adult population and investigate the effect of CPAP treatment in elderly patients with OSAS and the impact on their quality of life. Methods: We selected individuals between 25 to 75 years old and divided into four groups: elder OSAS, elder controls, adult OSAS and adult controls. For the elderly group, 30 volunteers were selected with OSAS and 27 control volunteers matched for age. Data from 13 adult volunteers with OSA and 12 without OSA were used to compare with the elderly only at baseline. This study was prospective and comparative study between the group of elderly volunteers without OSA and the group of elderly patients with OSAS. The analysis was also made before and after use of CPAP for the OSAS group. All night polysomnography was used to determine sleep-disordered breathing AHI and the subsequent division of the groups. Questionnaires were applied to evaluate the subjective excessive daytime sleepiness (Epworth Sleepiness Scale) and quality of life (SF-36). Laboratory tests were conducted to evaluate parameters related to oxidative stress: allantoin, vitamin B12, folic acid, vitamin E, vitamin C, lipid peroxidation, catalase, superoxide dismutase, homocysteine and cysteine. A comparison was made between adults and elders and to evaluate the effect of CPAP in the elderly patients by means of appropriate statistical tests. Results: In the comparison between adults and elder, the levels of vitamin E, elder OSAS (22.2 ± 1.9 umol / L) had higher levels than the adult OSAS group (12.7 ± 1.7 umol / L) and elderly control (26.5 ± 1.7 umol / L) and adult control (19.2 ± 1.8 umol / L) showing an interaction of time and OSAS in the variable. As for the homocysteine levels, the adult OSAS group (17.2 ± 1.3 mmol / L) had higher levels than adult control (10.8 ± 1.4 mmol / L). In elderly patients with OSAS, CPAP treatment showed reversal of oxidative stress by decreasing lipid peroxidation expressed by the amount of malondialdehyde (MDA) [pre: 2.7 (95% 1,6-3,7) vs. post: 1.3 (0.7-1.9), p <0.01]. Treatment with CPAP in this group improved two areas of the questionnaire of quality of life SF-36: Functional Capacity [pre = 77.4 (69,2-85,5) vs. post = 83.4 (76,9-89,9), p = 0.04] and pain [pre = 65.4 (52,8-78,1) vs. post = 77.8 (67,2-88,3), p = 0.005]. Conclusion: Our study showed showed that adult OSAS group showed a reduction in the levels of vitamin E, indicating a reduction of antioxidant capacity compared to the older group (OSAS and control), suggesting that adults react heterogeneously to the effects of stress (intermittent hypoxia and reoxygenation) compared with the elderly. Treatment with CPAP in elderly patients with OSAS contributed to the reversal of oxidative stress by decreasing levels of MDA and improving the quality of life.Introdução: Os efeitos da hipóxia intermitente e da hipercapnia resultantes de eventos obstrutivos respiratórios da Síndrome da apnéia obstrutiva do sono (SAOS) na geração de espécies reativas de oxigênio(ERO) tem recebido recentemente particular atenção devido à sua associação com o estresse oxidativo (EO) e o processo do envelhecimento. Embora a literatura ressalte os efeitos positivos da Pressão Positiva Contínua Aérea (CPAP) no padrões de sono, sonolência excessiva diurna e EO nos adultos são raras os estudos na população idosa. O objetivo desse estudo foi avaliar os efeitos dos parâmetros de EO em pacientes idosos, compará-los com uma população adulta e verificar o efeito do tratamento com CPAP nos pacientes idosos com SAOS e o impacto na sua qualidade de vida. Métodos: Foram selecionados indivíduos com faixa etária entre 25 a 75 anos, distribuídos em quatro grupos: idosos SAOS (n=30), idosos controle (n=27), adultos SAOS (n=13) e adultos controle (n=12). Avaliaram-se os parâmetros de polissonografia, qualidade de vida (SF-36) e EO (ácido úrico, vitamina B12, ácido fólico, vitamina E, vitamina C, peroxidação lipídica, catalase, superóxido dismutase, homocisteína e cisteína) comparando-se adultos e idosos apenas no momento basal e antes e após uso do CPAP nos idosos com SAOS. Resultados: Na comparação entre adultos e idosos em relação aos níveis de Vitamina E, os idosos SAOS (22,2 ± 1,9 umol/L) apresentaram níveis maiores do que o grupo adultos SAOS (12,7 ± 1,7 umol/L) e houve também diferença entre os idosos controle (26,5 ± 1,7 umol/L) e os adultos controle (19,2 ± 1,8 umol/L). Quanto aos níveis de homocisteína, o grupo adultos SAOS (17,2 ± 1,3 μmol/L) apresentou níveis maiores que adultos controle (10,8 ± 1,4 μmol/L), observação não encontrada nos idosos. Nos idosos com SAOS, o tratamento com CPAP mostrou reversão do estresse oxidativo pela diminuição da peroxidação lipídica expressa pela quantidade de malondialdeído (MDA) [pré: 2,7 (IC95% 1,6-3,7) vs. pós: 1,3 (0,7-1,9); p<0,01]. O tratamento com CPAP, nesse grupo mostrou melhora em dois domínios do questionário de qualidade de vida SF-36: Capacidade Funcional [pré= 77,4 (69,2-85,5) vs. pós= 83,4 (76,9-89,9); p=0,04] e Dor [pré= 65,4 (52,8-78,1) vs. pós= 77,8 (67,2-88,3); p= 0,005]. Conclusão: Nosso estudo mostrou que o tratamento com CPAP em pacientes idosos contribuiu para a reversão do EO pelo decréscimo dos níveis de MDA e na melhora da qualidade de vida.Associação Fundo Incentivo A Psicofarmacologia (AFIP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)TEDEBV UNIFESP: Teses e dissertaçõe

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available