Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea

Alterações nas vias aéreas superiores avaliadas por TC multidetectores durante a vigília e o sono em indivíduos saudáveis e em pacientes com apneia do sono durante eventos obstrutivos

Ula Lindoso Passos1,a, Pedro Rodrigues Genta1,b, Bianca Fernandes Marcondes2,c, Geraldo Lorenzi-Filho2,d, Eloisa Maria Mello Santiago Gebrim1,e

J Bras Pneumol.2019;45(4):e20180264-e20180264

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position. Methods: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states. Results: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p < 0.001) and in the control group (p < 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p < 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects. Conclusions: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.

 


Keywords: Multidetector computed tomography; Oropharynx; Sleep apnea, obstructive; Polysomnography; Diagnostic imaging; Sleep.

 


Effects of continuos positive airway pressure on nasal and pharyngeal symptoms in patients with obstructive sleep apnea

Efeitos da pressão positiva contínua em vias aéreas sobre os sintomas nasofaríngeos em pacientes com a síndrome da apnéia obstrutiva do sono

Adelaide Cristina de Figueiredo, Maria Cecília Lorenzi, Simone Prezzoti, Marília Montenegro Cabral, Luiz Ubirajara Sennes, Geraldo Lorenzi-Filho

J Bras Pneumol.2004;30(6):535-539

Abstract PDF PT PDF EN

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. Objectives: 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. Conclusions: 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.

 


Keywords: Obstructive sleep apnea syndrome. Nasal obstruction. Continuous positive airway pressure, compliance.

 


Effects of yoga breathing exercises on pulmonary function in patients with Duchenne muscular dystrophy: an exploratory analysis

Efeitos de exercícios respiratórios de ioga na função pulmonar de pacientes com distrofia muscular de Duchenne: uma análise exploratória

Marcos Rojo Rodrigues, Celso Ricardo Fernandes Carvalho, Danilo Forghieri Santaella, Geraldo Lorenzi-Filho, Suely Kazue Nagahashi Marie

J Bras Pneumol.2014;40(2):-

Abstract PDF PT PDF EN Portuguese Text

Objective: Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in children, and children with DMD die prematurely because of respiratory failure. We sought to determine the efficacy and safety of yoga breathing exercises, as well as the effects of those exercises on respiratory function, in such children. Methods: This was a prospective open-label study of patients with a confirmed diagnosis of DMD, recruited from among those followed at the neurology outpatient clinic of a university hospital in the city of São Paulo, Brazil. Participants were taught how to perform hatha yoga breathing exercises and were instructed to perform the exercises three times a day for 10 months. Results: Of the 76 patients who entered the study, 35 dropped out and 15 were unable to perform the breathing exercises, 26 having therefore completed the study (mean age, 9.5  2.3 years; body mass index, 18.2  3.8 kg/m2). The yoga breathing exercises resulted in a significant increase in FVC (% of predicted: 82.3  18.6% at baseline vs. 90.3  22.5% at 10 months later; p = 0.02) and FEV1 (% of predicted: 83.8  16.6% at baseline vs. 90.1  17.4% at 10 months later; p = 0.04). Conclusions: Yoga breathing exercises can improve pulmonary function in patients with DMD.

 


Keywords: Respiratory therapy; Forced expiratory volume; Vital capacity; Muscular dystrophy, Duchenne; Complementary therapies.

 


O espírito do Jornal de Pneumologia

Geraldo Lorenzi-Filho

J Bras Pneumol.2003;29(6):335-

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Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea

O impacto do tipo de máscara na eficácia e na adesão ao tratamento com pressão positiva contínua nas vias aéreas da apneia obstrutiva do sono

Rafaela Garcia Santos de Andrade, Vivien Schmeling Piccin, Juliana Araújo Nascimento, Fernanda Madeiro Leite Viana, Pedro Rodrigues Genta, Geraldo Lorenzi-Filho

J Bras Pneumol.2014;40(6):658-668

Abstract PDF PT PDF EN Portuguese Text

Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (OSA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to OSA treatment. We searched the PubMed database using the search terms "CPAP", "mask", and "obstructive sleep apnea". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter OSA treatment effectiveness or adherence. In contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP OSA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.

 


Keywords: Sleep apnea, obstructive; Continuous positive airway pressure; Masks.

 


My time at the JBP

O JBP que vivi

Geraldo Lorenzi-Filho1

J Bras Pneumol.2015;41(5):401-401

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O Jornal Brasileiro de Pneumologia e a Internet

Geraldo Lorenzi-Filho

J Bras Pneumol.2004;30(5):412-412

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O JP de cara nova

Geraldo Lorenzi-Filho

J Bras Pneumol.2004;30(1):1-1

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O sonho dos mil gatos

Geraldo Lorenzi-Filho

J Bras Pneumol.2002;28(6):305-306

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International participation in collaborative studies published in pulmonology journals: where does the Brazilian Journal of Pulmonology rank?

Participação internacional em estudos colaborativos publicados em revistas de pneumologia: onde está o Jornal Brasileiro de Pneumologia?

Rodrigo Abensur Athanazio, Samia Zahi Rached, Pedro Rodrigues Genta, Geraldo Lorenzi-Filho

J Bras Pneumol.2011;37(6):826-828

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Obstructive sleep apnea syndrome in truck drivers

Síndrome da apneia obstrutiva do sono em motoristas de caminhão

Lucia Castro Lemos, Elaine Cristina Marqueze, Fernanda Sachi, Geraldo Lorenzi-Filho, Claudia Roberta de Castro Moreno

J Bras Pneumol.2009;35(6):500-506

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of obstructive sleep apnea syndrome (OSAS), as well as to identify factors associated with a greater risk of developing OSAS, among truck drivers. Methods: The study population comprised 209 truck drivers (mean age, 38.8 years; 98.5% males) at two branches of a transportation company. The mean body mass index was 26.5 ± 4.4 kg/m2. The participants completed questionnaires regarding sociodemographic data, physical activity and OSAS. The prevalence of OSAS was estimated using the Berlin Questionnaire, associations between OSAS and the factors studied being assessed through univariate and multivariate regression analysis. Results: The prevalence of OSAS in the population was 11.5%. Of the 209 truck drivers, 72 (34.5%) reported having fallen asleep while driving and 81 (38.7%) reported snoring. The following variables were found to present statistically significant associations with OSAS: informal employment (OR = 0.27; p = 0.01); body mass index ≥ 25 kg/m2 (OR = 13.64; p = 0.01); and poor sleep quality (OR = 3.00; p = 0.02). Conclusions: The prevalence of OSAS in this study was lower than that reported in other studies of truck drivers and yet higher that that observed for the general population. In addition, our results suggest that work characteristics, such as employment status, are associated with OSAS. These data show the relevance of considering work activity in studies of factors associated with OSAS.

 


Keywords: Sleep apnea, obstructive; Sleep disorders; Questionnaires.

 


Thirty years of the Brazilian Journal of Pulmonology: 100% growth in 2 years points to a promising future

Trinta anos de Jornal Brasileiro de Pneumologia: Crescimento de 100% em 2 anos apontam futuro promissor

Geraldo Lorenzi-Filho

J Bras Pneumol.2004;30(6):499-499

Abstract PDF PT PDF EN Portuguese Text

This will be my last editorial as the editor of the Jornal Brasileiro de Pneumologia (JBP, Brazilian Journal of Pulmonology).

 



 

 


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