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      Efeitos da pressão positiva contínua em vias aéreas sobre os sintomas nasofaríngeos em pacientes com a síndrome da apnéia obstrutiva do sono Translated title: Effects of continuos positive airway pressure on nasal and pharyngeal symptoms in patients with obstructive sleep apnea

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          Abstract

          INTRODUÇÃO: Sintomas nasofaríngeos são comuns em pacientes com a síndrome da apnéia obstrutiva do sono (SAOS) em tratamento com pressão positiva contínua em vias aéreas (CPAP). No entanto, sintomas nasofaríngeos são também comuns em pacientes com SAOS antes do início do tratamento. OBJETIVO: Determinar o impacto do tratamento com CPAP nasal sobre os sintomas nasofaríngeos em pacientes com SAOS. MÉTODO: Foram avaliados 35 pacientes (28 homens), com idade de 54 ±10 anos portadores de SAOS moderada a grave diagnosticada através de polissonografia. Os sintomas nasofaríngeos (espirros, coriza, prurido, obstrução, sangramento e ressecamento nasal e de garganta) foram quantificados através de questionário aplicado antes e depois de pelo menos 3 meses de tratamento com CPAP nasal. RESULTADOS: O índice de apnéia + hipopnéia foi de 50±25 eventos por hora. Ao menos um sintoma nasofaríngeo estava presente em 26 pacientes (74%) antes do tratamento. A obstrução nasal foi o sintoma mais comum, presente em 18 pacientes (51%). Dentre os pacientes inicialmente assintomáticos (n = 9), 78% apresentaram alguma reação nasofaríngea adversa com o tratamento. Em contraste, nos pacientes inicialmente sintomáticos, houve redução significativa da intensidade da obstrução, do ressecamento nasal e de garganta e do sangramento nasal após o tratamento. CONCLUSÃO: Sintomas nasofaríngeos são freqüentes em pacientes com SAOS. O uso de CPAP pode tanto desencadear sintomas nasofaríngeos em pacientes assintomáticos, como reduzir sua intensidade nos pacientes com sintomas prévios.

          Translated abstract

          BACKGROUND: Nasal and pharyngeal symptoms are common in patients with obstructive sleep apnoea (OSA) treated with nasal continuous positive airway pressure (CPAP). However, these symptoms are common in OSA patients even before the treatment. OBJECTIVE: Determine the impact of nasal CPAP on nasal and pharyngeal symptoms in OSA patients. METHOD: Thirty-five adult patients (28 males), age 54±10 years old, with OSA diagnosed by polissonography. All patients answered to a questionnaire about the presence and quantification of sneezing, rhinorrhea, nasal pruritus, obstruction and bleeding, nasal and pharyngeal dryness. The questionnaire was answered before and after at least three months of CPAP therapy. RESULTS: The apnea-hypopnea index was 50±25 events per hour. Twenty six patients (74%) presented at least one naso-pharingeal symptom before treatment. Nasal obstruction was the most common symptom, being referred by 18 patients (51%). Among the patients that were initially assymptomatic (n=9), 78% developed adverse nasal reactions to CPAP. In contrast, among the patients that presented nasal symptoms before treatment, there was a significant reduction in nasal obstruction, nasal and throat dryness scores as well as nasal bleeding after CPAP therapy. CONCLUSION: Nasal na pharyngeal symptoms are frequent in OSAS patients. CPAP therapy may originate nasal symptoms in patients previously assymptomatic, as well as reduce the intensity of these symptoms in patients that are previously symptomatic.

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          Effect of nasal or oral breathing route on upper airway resistance during sleep.

          Healthy subjects with normal nasal resistance breathe almost exclusively through the nose during sleep. This study tested the hypothesis that a mechanical advantage might explain this preponderance of nasal over oral breathing during sleep. A randomised, single-blind, crossover design was used to compare upper airway resistance during sleep in the nasal and oral breathing conditions in 12 (seven male) healthy subjects with normal nasal resistance, aged 30+/-4 (mean+/-SEM) yrs, and with a body mass index of 23+/-1 kg x m2. During wakefulness, upper airway resistance was similar between the oral and nasal breathing routes. However, during sleep (supine, stage two) upper airway resistance was much higher while breathing orally (median 12.4 cmH2O x L(-1) x s(-1), range 4.5-40.2) than nasally (5.2 cmH2O x L(-1) x s(-1), 1.7-10.8). In addition, obstructive (but not central) apnoeas and hypopnoeas were profoundly more frequent when breathing orally (apnoea-hypopnoea index 43+/-6) than nasally (1.5+/-0.5). Upper airway resistance during sleep and the propensity to obstructive sleep apnoea are significantly lower while breathing nasally rather than orally. This mechanical advantage may explain the preponderance of nasal breathing during sleep in normal subjects.
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            Nasopharyngeal Symptoms and Nasal Continuous Positive Airway Pressure Therapy in Obstructive Sleep Apnoea Syndrome

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              Sleep Apnea Syndrome

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                jbpneu
                Jornal Brasileiro de Pneumologia
                J. bras. pneumol.
                Sociedade Brasileira de Pneumologia e Tisiologia (São Paulo )
                1806-3756
                December 2004
                : 30
                : 6
                : 535-539
                Article
                S1806-37132004000600008
                10.1590/S1806-37132004000600008
                f1f9e8aa-6154-437f-b512-8ca55c24d442

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

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1806-3713&lng=en
                Categories
                RESPIRATORY SYSTEM

                Respiratory medicine
                Obstructive sleep apnea syndrome,Nasal obstruction,Continuous positive airway pressure, compliance,Síndrome da apnéia obstrutiva do sono,Sintomas nasofaríngeos,Obstrução nasal,Máscara de pressão positiva contínua em vias aéreas superiores

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