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      Apneia obstrutiva do sono e ronco primário: tratamento Translated title: Obstructive sleep apnea and primary snoring: treatment

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          Adenotonsillectomy for obstructive sleep apnea in obese children: a meta-analysis.

          The purpose of this study was to determine the effectiveness of adenotonsillectomy (T&A) for treating obstructive sleep apnea (OSA) in obese children. PubMed and Ovid databases. A meta-analysis of studies that reported sleep parameters in obese children with OSA before and after T&A. Data were analyzed using the random effects model. Statistical significance was P < or = 0.05. Data from four studies that included 110 children were analyzed. The mean sample size was 27.5 (range, 18-33). The mean body mass index z score was 2.81. The mean pre- and postoperative apnea-hypopnea index (AHI) was 29.4 (range, 22.2-34.3) and 10.3 (range, 6.0-12.2), respectively. The weighted mean difference between pre- and postoperative AHI was a significant reduction of 18.3 events per hour (95% confidence interval [CI], 11.2-25.5). The mean pre- and postoperative oxygen saturation nadir was 78.4 percent (range, 73.9%-81.1%) and 85.7 percent (range, 83.6%-89.9%), respectively. The weighted mean difference was a significant increase of the oxygen saturation nadir of 6.3 percent (95% CI, 3.9-8.7). Forty-nine percent of children had a postoperative AHI <5, 25 percent of children had a postoperative AHI <2, and 12 percent of children had a postoperative AHI <1. T&A improves but does not resolve OSA in the majority of obese children. The efficacy and role of additional therapeutic options require more study. The high incidence of obesity in children makes this a public health priority.
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            Efficacy of the 'tennis ball technique' versus nCPAP in the management of position-dependent obstructive sleep apnoea syndrome.

            Avoidance of sleep in the supine position is recommended in the management of position-dependent OSA hypopnoea syndrome (OSAHS). Our aim was to evaluate the efficacy of a thoracic anti-supine band (TASB), designed to mimic the so-called 'tennis ball technique', compared with nasal CPAP (nCPAP). Twenty adults with mild to moderately severe position-dependent OSAHS (mean AHI +/- SD) 22.7 +/- 12.0/H (range 6.0-51.2); AHI supine, 59.6 +/- 27.5/H, were included in a randomized cross-over trial. Portable sleep studies were undertaken at baseline and after 1 month on each treatment. A successful treatment outcome was defined as AHI
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              The role of mometasone furoate aqueous nasal spray in the treatment of adenoidal hypertrophy in the pediatric age group: preliminary results of a prospective, randomized study.

              We evaluated the efficacy of mometasone furoate aqueous nasal spray in decreasing adenoid size and reducing the severity of chronic nasal obstruction symptoms in children affected by adenoidal hypertrophy. Sixty children were recruited in a 2-stage, randomized, placebo-controlled trial. All patients complained of chronic nasal obstruction symptoms, and nasal endoscopy showed >75% choanal obstruction attributable to adenoid pads. In the first stage, 30 patients (group A) underwent mometasone treatment (50 microg per nostril per day) for 40 days, and 30 children (group B) received placebo. In the second stage, at the end of the first 40-day treatment period, patients in group A who showed subjective and objective clinical improvement were divided into 2 subgroups; group A1 (11 children) received topical intranasal steroid treatment on alternate days for the first 2 weeks per month, whereas group A2 (10 children) continued daily mometasone treatment for the first 2 weeks per month. After 3 months, all children were reassessed. Fifty-seven children completed the study according to the protocol. After the first treatment period, the severity of symptoms and adenoid size decreased for 21 patients (77.7%) in group A. No improvement was observed in the placebo group. After 3 months of additional therapy, group A2 patients demonstrated a more-pronounced reduction in adenoid size compared with group A1 patients. No statistically significant change in symptoms was identified. Mometasone treatment was well tolerated by all patients. Mometasone furoate aqueous nasal spray may be considered useful in decreasing adenoid pad size and the severity of symptoms related to adenoidal hypertrophy. Children with adenoidal hypertrophy that is not associated with tonsillar hypertrophy should be considered for intranasal mometasone treatment before surgery is planned.
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                Author and article information

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                Journal
                bjorl
                Brazilian Journal of Otorhinolaryngology
                Braz. j. otorhinolaryngol.
                Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial (São Paulo )
                1808-8686
                January 2014
                : 80
                : 1 suppl 1
                : 17-28
                Article
                S1808-86942014000800017
                10.5935/1808-8694.2014S002
                7c2e0e37-afbc-46b8-88f1-4940ce3c293d

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1808-8694&lng=en
                Categories
                OTORHINOLARYNGOLOGY

                Otolaryngology
                Otolaryngology

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