Search

ABSTRACT Objective: To evaluate lung function and inspiratory muscle strength, correlating them with exercise tolerance, in obese individuals with obstructive sleep apnea syndrome (OSAS). Methods: The sample comprised 31 adult subjects with moderate-to-severe OSAS diagnosed by polysomnography. We used spirometry to measure FVC, FEV1, and FVC/FEV1 ratio, using pressure manometry to measure MIP and MEP. The incremental shuttle walk test (ISWT) and the six-minute walk test (6MWT) were used in order to determine functional exercise capacity. Results: In this sample, the mean values for FVC (% of predicted), FEV1 (% of predicted): MIP, and MEP were 76.4 ± 12.3%, 80.1 ± 6.3%, 60.0 ± 21.9 cmH2O, and 81.3 ± 22.2 cmH2O, respectively. The mean distances covered on the ISWT and 6MWT were 221 ± 97 m and 480.8 ± 67.3 m, respectively. The ISWT distance showed moderate positive correlations with FVC (r = 0.658; p = 0.001) and FEV1 (r = 0.522; p = 0.003). Conclusions: In this sample of obese subjects with untreated OSAS, lung function, inspiratory muscle strength, and exercise tolerance were all below normal. In addition, we found that a decline in lung function, but not in respiratory muscle strength, was associated with exercise tolerance in these patients.

Introduction Portable respiratory monitoring (PM) has been used to diagnose obstructive sleep apnea (OSA) in the general population. However, its validation in patients with both OSA and chronic obstructive pulmonary disease (COPD), remains unclear.

ABSTRACT Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.

ABSTRACT Purpose: to compare nasal geometry between two groups of patients with different degrees of obstructive sleep apnea and to correlate apnea-hypopnea index, apnea severity and degree of daytime sleepiness with nasal areas and volume. Methods: a total of 20 adults (15 women and 5 men, mean age of 52.0±11.4 years old) without nasal obstruction were submitted to polysomnography. The subjects were divided into two groups: a) 10 individuals without apnea or with mild-grade apnea; b) 10 with moderate or severe apnea. Nasal geometry was evaluated by acoustic rhinometry. The volume, comprising the distance from the nasal valve to the posterior part of the middle nasal turbinate, and the three sectional areas corresponding to nasal valve, anterior part of the inferior nasal turbinate and posterior part of the inferior nasal turbinate, were considered. The Shapiro-Wilk, Mann-Whitney, Student’s t tests for independent samples and Spearman’s correlation coefficient were used for the analysis, with a significance level lower than 5%. Results: group 2 presented lower values in the area corresponding to the nasal valve (on the right), and higher values in the nasal turbinate areas. There was no correlation between the drowsiness scale and nasal areas and volumes. Conclusion: the area of the nasal valve was unilaterally smaller in the group with moderate and severe apnea. There was no correlation between volumes and nasal areas and excessive daytime sleepiness.

OBJETIVO: Determinar a eficácia do uso do volume expiratório forçado nos primeiros seis segundos (VEF6) como substituto da capacidade vital forçada (CVF) na triagem diagnóstica da doença pulmonar obstrutiva crônica (DPOC) através da comparação entre as medidas da relação VEF1/CVF e as medidas da relação VEF1/VEF6. MÉTODOS: No ano de 2003, durante o Dia Mundial da DPOC, realizamos uma campanha de triagem diagnóstica da DPOC. Os participantes da campanha respondiam ao questionário clínico do projeto Global Initiative for -Obstructive Lung Disease e aqueles que apresentavam pelo menos três respostas positivas submetiam-se a espirometria. RESULTADOS: Um total de 134 indivíduos respondeu positivamente a três questões e realizou espirometria. Destes, 59 foram excluídos: 45 por serem não fumantes e 14 pelo fato de seus exames não obedecerem aos critérios da American Thoracic Society para espirometria de qualidade. O número de resultados abaixo de 70% foi similar para VEF1/CVF e para VEF1/VEF6. A sensibilidade de VEF1/VEF6 para o diagnóstico de obstrução de vias aéreas definida por VEF1/CVF abaixo de 70% foi de 92% e a especificidade foi de 99%. O valor preditivo positivo foi de 100% e o valor preditivo negativo foi de 98%. O teste de correlação de Kendall mostrou r = 0,99 (p < 0,0001). O teste t para amostras pareadas mostrou correlação negativa: t = -5,93 (p < 0,0001). CONCLUSÃO: A relação VEF1/VEF6 se mostrou eficaz para uso na triagem diagnóstica da DPOC. Existe uma forte relação entre VEF1/CVF e VEF1/VEF6.OBJECTIVE: To determine the efficacy of using forced expiratory volume in six seconds (FEV6) as a surrogate for forced vital capacity (FVC) in the diagnostic screening for chronic obstructive pulmonary disease (COPD) by comparing FEV1/FVC ratios with FEV1/FEV6 ratios. METHODS: In November of 2003, on World COPD Day, we conducted a campaign of diagnostic screening for COPD. The participants completed the clinical questionnaire of the Global Initiative for Obstructive Lung Disease, and those who responded affirmatively to at least three questions underwent spirometry. RESULTS: A total of 134 individuals responded to three questions affirmatively and underwent spirometry. Of those, 59 were excluded: 45 for being non-smokers and 14 due to the fact that their tests did not meet the American Thoracic Society criteria for satisfactory spirometry. The number of tests in which the FEV1/FEV6 ratio was below 70% was similar to that found for the FEV1/FVC ratio. The sensitivity of FEV1/FEV6 in diagnosing airway obstruction (defined as FEV1/FVC below 70%) was 92%, and its specificity was 99%. The positive predictive value was 100%, and the negative predictive value was 98%. The Kendall correlation test revealed r = 0.99 (p < 0.0001). The t-test for paired samples revealed a negative correlation: t = -5.93 (p < 0.0001). CONCLUSION: The FEV1/FEV6 proved efficient for use in the diagnostic screening for COPD. There is a strong correlation between FEV1/FVC and FEV1/FEV6.

ABSTRACT Objective: To evaluate the construct validity and reproducibility of the six-minute step test (6MST) in individuals with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). Methods: We evaluated 48 volunteers diagnosed with OSA and treated with CPAP for at least two months. The volunteers underwent the six-minute walk test (6MWT) and the 6MST, in random order and on different days, with an interval of, at most, seven days between the two tests. Results: A moderate positive correlation was found between the distance walked on the 6MWT and the number of steps climbed on the 6MST (r = 0.520; p < 0.001). There was no significant difference between the two 6MSTs in terms of the number of steps climbed (121.7 ± 27.1 vs. 123.6 ± 26.7). Reproducibility for performance on the 6MST and for cardiovascular variables was considered excellent (intraclass correlation coefficient > 0.8). Regarding cardiovascular responses, the 6MST produced higher values than did the 6MWT for HR at six minutes, percent predicted maximum HR, and leg fatigue at six minutes, as well as for systolic blood pressure at six minutes and at one minute of recovery. Conclusions: The 6MST is valid and reproducible, producing greater cardiovascular stress than does the 6MWT. However, the 6MST is also characterized as a submaximal test for the assessment of exercise tolerance in individuals with OSA treated with CPAP.