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Tratamento da apnéia obstrutiva do sono com pressão positiva ...

Tratamento da apnéia obstrutiva do sono com pressão positiva ...

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Silva RZM, Duarte RLM, Silveira FJM . Pressão <strong>positiva</strong> e <strong>apnéia</strong> <strong>do</strong> <strong>sono</strong><br />

Nguyen e colabora<strong>do</strong>res 26 realizaram um ensaio clínico<br />

ran<strong>do</strong>miza<strong>do</strong> <strong>com</strong> um pequeno grupo de pacientes<br />

<strong>com</strong> SAOS que não possuíam sinais clínicos de coronariopatia<br />

utilizan<strong>do</strong> CPAP e CPAP-placebo por três meses.<br />

Utilizan<strong>do</strong> a ressonância magnética <strong>com</strong> ga<strong>do</strong>líneo em<br />

repouso e stress <strong>com</strong> adenosina [para avaliar perfusão<br />

miocárdica], a angiorressonância <strong>da</strong> coronária direita<br />

<strong>com</strong> exposição ao nitrato [para avaliar reserva coronariana]<br />

e a variação <strong>do</strong> diâmetro e fluxo <strong>da</strong> artéria braquial<br />

direita em resposta a nitroglicerina [para avaliar função<br />

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86 Pulmão RJ 2010;19(3-4):83-87<br />

en<strong>do</strong>telial], foi demonstra<strong>do</strong> que estes indivíduos já possuíam<br />

alterações funcionais as quais melhoraram significativamente<br />

no grupo <strong>com</strong> tratamento.<br />

Tomfohr e colabora<strong>do</strong>res 27 avaliaram a melhora nas<br />

queixas de fadiga e <strong>sono</strong>lência de pacientes em início de<br />

uso <strong>do</strong> CPAP, utilizan<strong>do</strong> para isto escalas: Multidimensional<br />

fatigue symptom inventory e <strong>sono</strong>lência de Epworth.<br />

Após três semanas de tratamento, houve melhora significativa<br />

em to<strong>do</strong>s os analisa<strong>do</strong>s, principalmente nos pacientes<br />

mais graves.<br />

Claustrophobia and adherence to CPAP treatment. West<br />

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disorders in adults. Sleep. 2006; 29(3):381-401.<br />

15. Massie CA, Hart RW, Peralez K, Richards GN. Effects of<br />

humidification on nasal symptoms and <strong>com</strong>pliance in<br />

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pressure. Chest. 1999; 116(2):403-8.<br />

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18. *Worsnop CJ, Miseski S, Rochford PD. Routine use of<br />

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pressure. Intern Med J. 2010;40(9):650-6.<br />

O uso rotineiro de umidifica<strong>do</strong>r acopla<strong>do</strong> ao CPAP, nos<br />

pacientes <strong>com</strong> <strong>apnéia</strong> <strong>do</strong> <strong>sono</strong>, promoveu redução <strong>do</strong>s<br />

sintomas nasais, porém não teve influência aumentan<strong>do</strong><br />

a aderência a este tratamento.<br />

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of heated humidification and topical steroids on<br />

<strong>com</strong>pliance, nasal symptoms, and quality of life in<br />

patients with obstructive sleep apnea syndrome using<br />

nasal continuous positive airway pressure. J Clin Sleep<br />

Med. 2009; 5(5):422-7.<br />

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RP. Treatment adherence and out<strong>com</strong>es in flexible vs<br />

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Chest. 2005; 127(6):2085-93.<br />

21. Duarte RLM, Magalhães <strong>da</strong> Silveira FJ, Faria AC, Biagini<br />

Jr. JC. Adesão e eficácia <strong>do</strong> tratamento <strong>da</strong> síndrome de<br />

<strong>apnéia</strong>/hipopnéia <strong>obstrutiva</strong> <strong>do</strong> <strong>sono</strong> <strong>com</strong> CPAP. J Bras<br />

Pneumol. 2008; supl. 2R:A509.<br />

22. Berry RB, Hill G, Thompson T, McLaurin V. Portable<br />

monitoring and autotitration versus polysomnography<br />

for the diagnosis and treatment of sleep apnea. Sleep.<br />

2008; 31(10):1423-31.<br />

23. Kakkar RK, Berry RB. Positive airway pressure treatment<br />

for obstructive sleep apnea. Chest. 2007; 132(3):1057-72.<br />

24. **Durán-Cantolla J, Aizpuru F, Montserrat JM,<br />

Ballester E, Terán-Santos J, Aguirregomoscorta JI, et al.<br />

Continuous positive airway pressure as treatment for<br />

systemic hypertension with obstructive sleep apnoea:<br />

Ran<strong>do</strong>mised controlled trial. BMJ. 2010; 341:c5991.<br />

Estu<strong>do</strong> <strong>com</strong> 340 pacientes que foram dividi<strong>do</strong>s em 2 grupos:

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