Compliance with continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea among privately paying patients- a cross sectional study

Background: To evaluate the compliance, benefits and side effects associated with continuous positive airway pressure (CPAP) therapy among Pakistani patients treated for obstructive sleep apnea (OSA) in private sector.Methods: Patients diagnosed to have OSA based on overnight study who were recommended for CPAP therapy, between 1998 and 2003, were evaluated by telephonic survey and review of hospital notes. Compliance, benefits and side effects associated with CPAP therapy were assessed.Results: Out of 135 patients who were prescribed CPAP therapy, 75 could be contacted. Sixty (80%) started using CPAP within one month of diagnosis and 46 (61%) continued to use it long-term (beyond one year). Compliance with CPAP therapy was associated with higher body mass index, higher Epworth sleepiness scale score, history of witnessed apnea, and reduction in daytime sleepiness with CPAP therapy. OSA severity as assessed by apnea-hypopnea index did not affect compliance with CPAP therapy. Use of anti-depressants and CPAP induced sleep disturbances were associated with poor compliance with CPAP therapy.CONCLUSIONS: Obesity, excessive daytime sleepiness, witnessed apnea and improvement of daytime symptoms following use of CPAP were predictors of improved compliance. Use of antidepressants and CPAP induced sleep disturbances were predictors of poor compliance

Consenso brasileiro de ronco e apneia do sono: aspectos de interesse aos ortodontistas Brazilian consensus of snoring and sleep apnea: aspects of interest for orthodontists

O objetivo deste artigo é explicitar o posicionamento das sociedades médicas que, reunidas, estabeleceram consenso sobre os parâmetros clínico-laboratoriais que envolvem os distúrbios respiratórios do sono, em especial o ronco e a síndrome da apneia obstrutiva do sono (SAOS). Os ortodontistas, que vêm ocupando gradativamente seu espaço em equipes multidisciplinares que atuam na área do sono humano, pouco conhecem sobre essa uniformização coordenada pela Associação Brasileira de Sono. Os trabalhos clínicos e as pesquisas científicas oriundos da Odontologia, e em particular da Ortodontia, também devem observar e seguir esses critérios de diagnóstico e tratamento estabelecidos pela comunidade médica brasileira.<br>The objective of this article is to clarify the positions of the medical societies that have worked together to establish a consensus regarding the clinical and laboratory parameters involved in sleep-disordered breathing, particularly snoring and obstructive sleep apnea syndrome (OSAS). Orthodontists have gradually come to take part in multidisciplinary teams that act in the area of human sleep, but few know about the uniformity coordinated by the Brazilian Association of Sleep. Clinical and scientific studies from the field of dentistry (particularly orthodontics) also must observe and follow these diagnosis and treatment criteria established by the Brazilian medical community

Avaliação da escala de Epworth em pacientes com a Síndrome da apnéia e hipopnéia obstrutiva do sono Evaluation of Epworth Sleepiness Scale in patients with obstructive sleep apnea-hypopnea syndrome

A síndrome da apnéia e hipopnéia obstrutiva do sono (SAHOS) é, atualmente, considerada um problema de saúde pública por causar aumento da morbi-mortalidade cardiovascular e acidentes de trânsito. A polissonografia assistida é o padrão-ouro para o diagnóstico e acompanhamento destes pacientes. No entanto, por ser onerosa, demorada e de acesso restrito, outros métodos tem sido desenvolvidos. A escala de sonolência de Epworth (ESE) é uma avaliação subjetiva, porém, rápida, sem custos e simples de ser aplicada. OBJETIVO: Avaliar a correlação entre a pontuação da ESE e o índice de apnéia e hipopnéia (IAH) da polissonografia de pacientes com SAHOS. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: Revisão de prontuário de 66 pacientes com queixa de roncopatia que foram submetidos a procedimento cirúrgico (uvulopalatofaringoplastia com ou sem abordagem nasal). Avaliaram-se a pontuação da ESE e o IAH da polissonografia pré e pós-operatórios. RESULTADOS: 78,7% pacientes com grau normal de IAH tiveram pontuação de ESE menor do que 10 e 65% pacientes com grau severo de IAH tiveram pontuação maior do que 10. Não houve resultados estatisticamente significantes para os grupos moderado e leve. CONCLUSÃO: A escala de Epworth pode distinguir os graus normais e severos sem, no entanto, determinar os graus moderado e leve. Assim, pode ser utilizada para acompanhamento de pacientes com SAHOS sem, no entanto, substituir a polissonografia uma vez que não consegue avaliar todos os graus de severidade.<br>Today obstructive sleep apnea–hypopnea syndrome (OSAHS) is a public health issue, since it increases cardiovascular morbidity-mortality rate and the risk of car crashes. Overnight polysomnography is the gold standard for diagnosis and follow-up of affected patients. However, because the test is expensive, time-consuming and of difficult access, others methods have been proposed. Although the Epworth Sleepiness Scale (ESS) is subjective, the questionnaire is simple, easy to be applied and free of charge. AIM: to compare Epworth Sleepiness Scale scores and apnea-hypopnea index (AHI), measured by polysomnography, in patients diagnosed with OSAHS. STUDY DESIGN: clinical retrospective study. METHOD: chart analysis of 66 patients complaining from snoring, who underwent surgery (uvulopalatopharyngoplasty with/without nasal surgery). ESS score and AHI were evaluated before and after surgery. RESULTS: 78% of patients with normal AHI, scored < 10 in the ESS and 65% of patients with severe AHI scored >10. There were no statistically significant results for groups presenting mild and moderate apnea. CONCLUSION: ESS can detect normal and severe levels of apnea, but is not able to detect mild and moderate levels. Therefore, ESS can be used in the follow-up of patients with OSAHS, however, it cannot replace polysomnography because it does not detect all levels of apnea