FERNANDA MADEIRO LEITE VIANA WEAVER
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- 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.
- Oronasal mask may compromise the efficacy of continuous positive airway pressure on OSA treatment: is there evidence for avoiding the oronasal route?(2016) ANDRADE, Rafaela Garcia Santos; MADEIRO, Fernanda; GENTA, Pedro Rodrigues; LORENZI-FILHO, GeraldoPurpose of review Continuous positive airway pressure (CPAP) delivered by nasal mask is the gold standard treatment for obstructive sleep apnea (OSA). However, oral and oronasal masks are also available. We considered experimental evidence and reviewed clinical trials that evaluated the impact of oral and oronasal mask on OSA treatment. Recent findings One recent study in 18 OSA patients that slept with a customized oronasal mask with two sealed compartments showed that the change of CPAP flow from nasal to oronasal and oral caused upper airway obstruction because of posterior displacement of the tongue demonstrated by nasoendoscopy. Oral masks use a mouthpiece that may stabilize the jaw and the tongue and have shown to be effective. However, oral masks are not widely used in clinical practice. Four out of five observational studies and all five reviewed randomized studies showed a worse performance of oronasal when compared with nasal masks. Oronasal masks were associated with higher residual apnea-hypopnea index, lower adherence, more leaks, and less satisfaction than nasal mask in the majority of the studies. Summary Nasal CPAP must be the first choice to treat OSA. Patients on oronasal mask should be carefully followed.
conferenceObject Oral Route May Compromise Continuous Positive Airway Pressure (cpap) Effectiveness To Treat Obstructive Sleep Apnea(2014) ANDRADE, R. G. S.; VIANA, F. M.; GREGORIO, M. G.; SCHORR, F.; MORIYA, H. T.; PICCIN, V. S.; SARDINHA, P. S.; GENTA, P. R.; LORENZI-FILHO, G.- Impact of Acute Changes in CPAP Flow Route in Sleep Apnea Treatment(2016) ANDRADE, Rafaela G. S.; MADEIRO, Fernanda; PICCIN, Vivien S.; MORIYA, Henrique T.; SCHORR, Fabiola; SARDINHA, Priscila S.; GREGORIO, Marcelo G.; GENTA, Pedro R.; LORENZI-FILHO, GeraldoBACKGROUND: CPAP is the gold standard treatment for OSA and was conceived to be applied through a nasal interface. This study was designed to determine the acute effects of changing the nasal CPAP route to oronasal and oral in upper airway patency during sleep in patients with OSA. We hypothesized that the oronasal route may compromise CPAP's effectiveness in treating OSA. METHODS: Eighteen patients (mean +/- SD age, 44 +/- 9 years; BMI, 33.8 +/- 4.7 kg/m(2); apneahypopnea index, 49.0 +/- 39.1 events/hour) slept with a customized oronasal mask with nasal and oral sealed compartments connected to a multidirectional valve. Sleep was monitored by using full polysomnography and induced by low doses of midazolam. Nasal CPAP was titrated up to holding pressure. Flow route was acutely changed to the oronasal (n = 18) and oral route (n = 16) during sleep. Retroglossal area was continuously observed by using nasoendoscopy. RESULTS: Nasal CPAP (14.8 +/- 4.1 cm H2O) was able to stabilize breathing in all patients. In contrast, CPAP delivered by the oronasal and oral routes promoted obstructive events in 12 (66.7%) and 14 (87.5%) patients, respectively. Compared with stable breathing during the nasal route, there was a significant and progressive reduction in the distance between the epiglottis and tongue base and the retroglossal area when CPAP was delivered by the oronasal and oral routes. CONCLUSIONS: CPAP delivered through the oronasal route may compromise CPAP's effectiveness in treating OSA.
- 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.
- Transmission of Oral Pressure Compromises Oronasal CPAP Efficacy in the Treatment of OSA(2019) MADEIRO, Fernanda; ANDRADE, Rafaela G. S.; PICCIN, Vivien S.; PINHEIRO, George do Lago; MORIYA, Henrique T.; GENTA, Pedro R.; LORENZI-FILHO, GeraldoBACKGROUND: An oronasal mask is frequently used to treat OSA. In contrast to nasal CPAP, the effectiveness of oronasal CPAP varies by unknown mechanisms. We hypothesized that oral breathing and pressure transmission through the mouth compromises oronasal CPAP efficacy. METHODS: Thirteen patients with OSA, well adapted to oronasal CPAP, were monitored by full polysomnography, pharyngeal pressure catheter, and nasoendoscope. Patients slept with low doses of midazolam, using an oronasal mask with sealed nasal and oral compartments. CPAP was titrated during administration by the oronasal and nasal routes, and was then reduced to induce stable flow limitation and abruptly switched to the alternate route. In addition, tape sealing the mouth was used to block pressure transmission to the oral cavity. RESULT: Best titrated CPAP was significantly higher by the oronasal route rather than the nasal route (P = .005), and patients with > 25% oral breathing (n = 5) failed to achieve stable breathing during oronasal CPAP. During stable flow limitation, inspiratory peak flow was lower, driving pressure was higher, upper airway inspiratory resistance was higher, and retropalatal and retroglossal area were smaller by the oronasal rather than nasal route (P < .05 for all comparisons). Differences were observed even among patients with no oral flow and were abolished when tape sealing the mouth was used (n = 6). CONCLUSION: Oral breathing and transmission of positive pressure through the mouth compromise oronasal CPAP.