JULIANA ARAUJO NASCIMENTO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina
4 resultados
Resultados de Busca
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- Predictors of oronasal breathing among obstructive sleep apnea patients and controls(2019) NASCIMENTO, Juliana A.; GENTA, Pedro R.; FERNANDES, Paulo H. S.; BARROSO, Lucia P.; CARVALHO, Tomas S.; MORIYA, Henrique T.; MADEIRO, Fernanda; LORENZI-FILHO, Geraldo; NAKAGAWA, Naomi KondoOronasal breathing may adversely impact obstructive sleep apnea (OSA) patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes. Predicting a preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and nine healthy subjects underwent overnight polysomnography with an oronasal mask with two sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common (P = <0.001) among OSA patients than controls while awake (62 +/- 44 vs. 5 +/- 6%) and during sleep (59 +/- 39 vs. 25 +/- 21%, respectively). Oronasal breathing was associated with OSA severity (P = 0.009), age (P = 0.005), body mass index (P = 0.044), and neck circumference (P = 0.004). There was no agreement between objective measurement and self-reported breathing route among OSA patients while awake (kappa = -0.12) and asleep (kappa = -0.02). The breathing route remained unchanged after 92% of obstructive apneas. These results suggest that oronasal breathing is more common among OSA patients than controls during both wakefulness and sleep and is associated with OSA severity and anthropometric measures. Self-reporting is not a reliable predictor of oronasal breathing and should not be considered an indication for oronasal CPAP. NEW & NOTEWORTHY Continuous positive airway pressure (CPAP) interface choice for obstructive sleep apnea (OSA) patients is often guided by nasal symptoms and self-reported breathing route. We showed that oronasal breathing can be predicted by anthropometric measurements and OSA severity but not by self-reported oronasal breathing. Self-reported breathing and nasal symptoms should not be considered for CPAP interface choice.
- Nasal vs Oronasal CPAP for OSA Treatment A Meta-Analysis(2018) ANDRADE, Rafaela G. S.; VIANA, Fernanda M.; NASCIMENTO, Juliana A.; DRAGER, Luciano F.; MOFFA, Adriano; BRUNONI, Andre R.; GENTA, Pedro R.; LORENZI-FILHO, GeraldoBACKGROUND: Nasal CPAP is the ""gold standard"" treatment for OSA. However, oronasal masks are frequently used in clinical practice. The aim of this study was to perform a meta-analysis of all randomized and nonrandomized trials that compared nasal vs oronasal masks on CPAP level, residual apnea-hypopnea index (AHI), and CPAP adherence to treat OSA. METHODS: The Cochrane Central Register of Controlled Trials, Medline, and Web of Science were searched for relevant studies in any language with the following terms: ""sleep apnea"" and ""CPAP"" or ""sleep apnea"" and ""oronasal mask"" or ""OSA"" and ""oronasal CPAP"" or ""oronasal mask"" and ""adherence."" Studies on CPAP treatment for OSA were included, based on the following criteria: (1) original article; (2) randomized or nonrandomized trials; and (3) comparison between nasal and oronasal CPAP including pressure level, and/or residual AHI, and/or CPAP adherence. RESULTS: We identified five randomized and eight nonrandomized trials (4,563 patients) that reported CPAP level and/or residual AHI and/or CPAP adherence. Overall, the random-effects meta-analysis revealed that as compared with nasal, oronasal masks were associated with a significantly higher CPAP level (Hedges' g, -0.59; 95% CI, -0.82 to -0.37; P < .001) (on average, +1.5 cm H2O), higher residual AHI (Hedges' g, -0.34; 95% CI, -0.52 to -0.17; P < .001) (+2.8 events/h), and a poorer adherence (Hedges' g, 0.50; 95% CI, 0.21-0.79; P = .001) (-48 min/night). CONCLUSIONS: Oronasal masks are associated with a higher CPAP level, higher residual AHI, and poorer adherence than nasal masks.
- Body Position May Influence Oronasal CPAP Effectiveness to Treat OSA(2016) NASCIMENTO, Juliana Araujo; CARVALHO, Tomas de Santana; MORIYA, Henrique Takachi; FERNANDES, Henrique Sousa; ANDRADE, Rafaela Garcia Santos de; GENTA, Pedro Rodrigues; LORENZI-FILHO, Geraldo; NAKAGAWA, Naomi KondoCPAP applied by a nasal mask is the gold standard treatment of obstructive sleep apnea. Oronasal masks are an alternative interface that can be used, especially in subjects with predominant oral breathing. However, oronasal masks have higher costs, are associated with larger leaks and higher residual apnea-hypopnea index, and in some cases may be ineffective.
- 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(2014) ANDRADE, Rafaela Garcia Santos de; PICCIN, Vivien Schmeling; NASCIMENTO, Juliana Araujo; VIANA, Fernanda Vladeiro Leite; GENTA, Pedro Rodrigues; LORENZI-FILHO, GeraldoContinuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (USA). 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 USA 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 USA 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 USA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.