Obstruktivt sömnapnésyndrom (OSAS) innebär upprepade andningsuppehåll under natten tillsammans med extrem dagen efter-trötthet. Fortfarande finns det många personer med ett odiagnostiserat OSAS. Syftet med litteraturstudien var att belysa hur personer med obstruktivt sömnapnésyndrom upplever sin livskvalitet. I metoden har 18 artiklar bearbetats. Resultatet visar på en försämrad livskvalitet hos personer med OSAS. Livskvaliteten påverkas av fysiska, psykiska och sociala aspekter. Personer med OSAS påverkades i sitt vardagliga liv då tröttheten begränsar deras livsstil. En efterfrågan av relevant information kan upptäckas i denna patientgrupp. Genom CPAP-behandling kan livskvaliteten öka. Sjuksköterskan kan genom extra stöd och undervisning i samband med diagnostisering och behandling, ytterligare öka patientens livskvalitet. Mer kunskap behövs hos sjukvårds¬personalen om OSAS och CPAP-behandlingar. Detta för att kunna ge undervisning och stöd till patient och anhöriga. Genom en utvecklad sömnanamnes skulle fler patienter med OSAS kunna upptäckas och få hjälp. Det finns ett behov av mer forskning om OSAS ur ett sjuksköterskeperspektiv samt om patienters upplevelser av OSAS.

El síndrome de apnea obstructiva del sueño (SAOS) es un trastorno respiratorio del sueño, cuya prevalencia está en incremento mundialmente y la importancia de su diagnóstico radica en su asociación con eventos vasculares cardiacos y cerebrales, trastornos metabólicos, deterioro en algunas funciones mentales, accidentes laborales, accidentes de tránsito e incremento de mortalidad. En los últimos 20 años se ha obtenido evidencia importante de la relación entre SAOS y uno de los principales factores de riesgo cardiovascular, la hipertensión arterial; que a la vez es un factor etiológico de ictus isquémico. Posteriormente la evidencia de la asociación entre SAOS e ictus isquémico ha ido en aumento. Hemos revisado los trabajos mas importantes sobre el tema, con el objetivo de establecer cual es relación entre ambas patologías, los mecanismos fisiopatogénicos propuestos y las evidencias para sustentar si el tratamiento del SAOS tiene algún impacto en la ocurrencia del ictus isquémico y en modificar la evolución clínica post ictus. / Obstructive sleep apnea syndrome (OSAS) is a respiratory sleep disorder, whose prevalence is increasing worldwide and the importance of its diagnosis lies in the association with cardiac and cerebral vascular events, metabolic disorders, impairment of some mental functions, work accidents, traffic accidents and increased mortality. In the last 20 years, important evidence has been obtained of the relationship between OSAS and one of the main cardiovascular risk factors, arterial hypertension; which at the same time is an etiological factor of ischemic stroke. Subsequently, evidence of the association between OSAS and ischemic stroke has been increasing. We have reviewed the best evidence to establish the relationship between the two pathologies, the proposed pathophysiological mechanisms and the evidence to support whether the treatment of OSAS has any impact on the occurrence of ischemic stroke and on modify the clinical evolution after stroke

Sleep apnea impacts one's mental and physical health, and has social consequences which affect all of society. Not only is there is a weak correlation between the severity of sleep apnea and daytime sleepiness as reported on the Epworth Sleepiness Scale (ESS), but there is also a weak correlation between the severity of sleep apnea and prescribed treatment as indicated by 95th percentile pressure on a continuous positive airway pressure (CPAP) machine. This poses difficulty for providers as well as patients throughout screening and treatment. The purpose of this study was to use a biopsychosocial approach to perform a within-subjects analysis in order to quantitatively investigate methods of calculating the severity of sleep apnea. The study included historical data of 75 participants, each diagnosed with obstructive sleep apnea, prescribed Automatic CPAP therapy, and compliant with treatment. The Apnea Hypopnea Index (AHI) was calculated in the current fashion and also while considering the length of a respiratory event, type of respiratory event, and the combination of these two factors. Linear regression was used to determine if there is a significant difference in the relationships between the AHI and the ESS as well as the AHI and the 95th percentile CPAP pressure. Results endorsed neither a strong relationship between the AHIs and the ESS nor a strong relationship between the AHIs and 95th percentile CPAP pressure either. However, the relationships were somewhat stronger when considering the length and type of the respiratory event. Findings support a need for future research to explore these relationships and offer more accurate screening and treatment of individuals with sleep apnea. Ultimately, those with sleep apnea will experience an improvement in mental, physical and social functioning which may positively impact those without sleep apnea.

Continuous positive airway pressure (CPAP) is the primary therapy administered for those afflicted with obstructive sleep apnea (OSA). We examined the effects of CPAP therapy on physiological variables during a ramped exercise. The five male, OSA patients had mean values and standard deviations for RDI=60.7 +/- 19.1, BMI=29.9 +/- 2.9, and age=56 +/- 16.1 yr. Subjects were examined before and after 4 wk of CPAP therapy. After 4 wk of CPAP therapy, patient responses to exercise showed a 17.6%, (p<0.05) improvement in rating of perceived exertion (RPE) at identical power outputs (60% of the individual's apparent functional capacity). Statistical significance was not attained (p>0.05) upon analysis of the following parameters at 60% of the individuals maximum workload although there was a trend showing a decrease in these variables: heart rate (6% improvement), VO2 (11.7% improvement) systolic blood pressure (4% improvement), and rate pressure product (8.6% improvement). This data shows that the decrease in RPE during 60% of the individual's maximum predicted HR reserve corresponded with an increase in sleep quality (mean increase of 40%, 3.2 units) as measured by the Pittsburgh Sleep Quality Index before and after 4 wk of CPAP therapy. It was concluded that the improvement in exercise tolerance could be attributed to the subjective feelings of improved sleep quality after 4 wk of CPAP therapy. Key Words: Obstructive sleep apnea---CPAP--- exercise---physiological responses. / Master of Science

In order to clarify the effects of a single night of CPAP titration on various cardiovascular, gas exchange, and perceptual measures, we conducted submaximal ramping exercise tests to an intensity of ~75% of the heart rate reserve in five male subjects. Means and standard deviation for their age and BMI were 57.0±14.7 years and 30.5±7.2, respectively. The baseline exercise test was administered immediately after the patients arose from bed, following an overnight PSG diagnostic evaluation. The exercise test was repeated within ~2 weeks of completion of an overnight CPAP evaluation trial. Patients reported experiencing improved sleep quality (50%) after the CPAP titration, based on comparison of morning questionnaire responses from the diagnostic PSG vs. CPAP titration. Statistical significance was not attained (p>0.05) upon analysis of the following parameters at 60% of the individuals maximum workload although there were changes in the mean values of the variables from the diagnostic PSG vs CPAP titration. The following changes were noted: heart rate increased by 6%, systolic blood pressure decreased by 6%, and the rate pressure product decreased by 5.8%. Respiratory variables changed as follows: VO2 decreased by 5.3% and VE decreased by 8.5%. The perceptual measure rate of perceived exertion (RPE) decreased by 17.5%. These preliminary findings demonstrate that self-reports of sleep quality in patients with diagnosed OSA improved after a single night of CPAP titration, even in a setting wherein the total time of CPAP sleep and reduction of apneas, hypopneas, and hypoxemic episodes are highly variable. Additionally, sleep structure revealed a marked increase in slow wave (53.2%) and REM (30.4%) sleep with CPAP titration in comparison to the diagnostic PSG. It was concluded that CPAP titration effectively improves sleep structure and patient ratings of sleep quality, but does not have significant effects on cardiorespiratory responses to submaximal endurance exercise. / Master of Science

Bakgrund: Obstruktivt sömnapnésyndrom (OSAS) är en vanlig sömnrelaterad andningsstörning som innebär att patienten får apnéer (totalt andningsflödesstopp) och/eller hypoapnéer (delvis andningsflödesstopp) under nattsömnen. Dessa leder till störd nattsömn, vilket leder till kroppslig påverkan. OSAS ger både fysisk och psykisk påverkan, vilket i sin tur resulterar i att många patienter upplever sämre livskvalité. En av de vanligaste behandlingarna för OSAS är CPAP (Continuous Positive Airway Pressure) som med hjälp av övertrycksandning hjälper till att hålla de övre luftvägarna öppna under sömn.   Syfte: Syftet med litteraturöversikten var att undersöka hur patienters livskvalité påverkas av behandling med CPAP samt om det finns vetenskapligt bevisade omvårdnadsåtgärder som underlättar för patienter att uppnå god livskvalité vid CPAP-behandling. Metod: En systematisk litteraturöversikt baserad på 10 kvantitativa originalartiklar. Resultat: Majoriteten av de genomgångna studierna visade att användning av CPAP minskar psykiska och fysiska symptom och därmed förbättrar patienternas livskvalité. Genom att följa upp patienter i sjukvården, erbjuda dem utbildningar samt gruppdiskussioner främjar man deras hälsa och höjer livskvalitén. Studierna visade också att grunden för en god omvårdnad är att sjuksköterskan har evidensbaserade kunskaper för att kunna planera och genomföra omvårdnadsåtgärder samt följa upp hur CPAP-behandlingen påverkar patienternas livskvalité. Slutsats: Användningen av CPAP förbättrar OSAS-patienternas livskvalité, bland annat genom att minska symptom. Det är av stor vikt att sjuksköterskan har tillräckliga kunskaper för att kunna undervisa samt informera patienten om sin sjukdom och behandling. Detta hjälper patienter till en bättre egenvård, vilket har en stor betydelse för livskvalitet.

Objective: To investigate the experiences of ambulance nurses when using Boussignac CPAPcompared to their previous model, and their suggestions for possible improvements in the use of CPAP in the care of patients with pulmonary oedema. Method: A qualitative study with a descriptive and exploratory approach. Data was collected through ten semi-structured interviews with ambulance nurses, seven men and three women. The analysis was conducted using Lundman and Graneheim’s content analysis. Results: Three categories were identified: Usage, Treatment and Development. Boussignac CPAP is described as easy to use and with fewer elements than the previous model. With this model it is particularly appreciated to have the opportunity to be able to regulate the resistance without fixed settings. Boussignac CPAP is regarded as more convenient in the handover of the patient. The potential for increased use, with the possibility of adjustment without fixed settings of resistance for Boussignac CPAP, is not perceived to be fully realized. Conclusion: Boussignac CPAP is, by the ambulance nurses, perceived to have made the handling of equipment easier and increased quality of care. To make further use of the potential of Boussignac CPAP more training and changes in the guidelines may be needed. / Syfte: Att undersöka ambulanssjuksköterskors upplevelser av Boussignac CPAP jämfört med deras föregående modell, samt ambulanssjuksköterskors eventuella förslag till möjliga förbättringar vid användandet av CPAP i vården av patienter med lungödem. Metod: En kvalitativ studie med deskriptiv och utforskande ansats. Data utgörs av tio semistrukturerade intervjuer med ambulanssjuksköterskor, sju män och tre kvinnor. Materialet har analyserats med Lundman och Graneheims innehållsanalys. Resultat: Tre kategorier identifierades: Användning, Behandling samt Utveckling. Boussignac CPAP beskrivs som lättanvänd och med färre moment än föregående modell. Med modellen uppskattas särskilt möjligheten att steglöst reglera motståndet. Boussignac CPAP upplevs som lättare då masken eller dess delar inte behöver plockas av patienten vid överlämnandet från ambulansverksamheten. Förutsättningarna till ökat användningsområde, i och med möjligheten att steglöst ändra motståndet för Boussignac CPAP upplevs inteutnyttjas fullt ut. Slutsats: Boussignac CPAP upplevs av ambulanssjuksköterskorna ha underlättat hanteringen av utrustningen samt ökat vårdkvaliteten för patienten. För att vidare kunna utnyttja potentialen med Boussignac CPAP kan mer utbildning och förändringar i riktlinjer behövas.

As cirurgias de ressecção pulmonar se incluem no grupo das cirurgias que podem predispor o paciente a apresentar complicações pulmonares no pós-operatório. Complicações como o aumento na produção de secreções brônquicas, pneumonia e atelectasia, estão quase sempre associadas à diminuição da função pulmonar neste período. A ventilação por pressão positiva contínua nas vias aéreas vem sendo constantemente utilizada como terapêutica nesses pacientes tentando-se minimizar esses efeitos prejudiciais sobre a função pulmonar. O objetivo desse estudo é quantificar os efeitos da ventilação com pressão positiva contínua nas vias aéreas (CPAP) sobre a função pulmonar no pós-operatório de ressecção pulmonar. Foram selecionados 30 (trinta) pacientes da disciplina de Cirurgia Torácica do Hospital Universitário Pedro Ernesto. A seleção dos pacientes para o grupo controle e experimental foi feita de forma randomizada. Os pacientes foram submetidos na fase pré-operatória a uma avaliação da função pulmonar (pico de fluxo expiratório, força muscular respiratória, teste de caminhada de 6 minutos/ TC6, gasometria arterial e espirometria). Após a realização do procedimento cirúrgico foram submetidos a um protocolo de intervenção, como se segue: grupo experimental: 15 (quinze) pacientes submetidos à ventilação não-invasiva, de forma intermitente, com um sistema CPAP (ACRIFLUX-CPAP, Criticalmed, Industries Inc, Brasil), iniciado no primeiro dia de pós-operatório (nas primeiras 24 horas após a extubação), 2 vezes ao dia, por um período de 30 minutos; grupo controle: 15 (quinze) pacientes submetidos a um programa de fisioterapia respiratória, orientado e supervisionado, iniciado no primeiro dia de pós-operatório (nas primeiras 24 horas após a extubação), com uma freqüência de 2 vezes ao dia. A reavaliação na fase pós-operatória seguiu a mesma metodologia utilizada na fase pré-operatória. As reavaliações ocorreram em dois momentos: no primeiro dia de pós-operatório (PO-I) onde foram reavaliados o pico de fluxo expiratório, força muscular respiratória, gasometria arterial; prova de função pulmonar com 48 horas de pós-operatório. Ao sétimo dia de pós-operatório (PO-II) foram reavaliados novamente as variáveis do PO-I e o teste de caminhada de 6 minutos. Os resultados da espirometria, gasometria arterial, pico de fluxo espiratório e força muscular respiratória entre os grupos foi semelhante, sem diferença significativa, porém, a variável TC6 foi estatisticamente significante no grupo que realizou CPAP precoce, com p=0,0001. Não foi observado fuga aérea pelo dreno de tórax no grupo tratado com CPAP, demonstrando a segurança do método. Desta forma, ambas as terapias foram eficazes, porém a CPAP precoce foi mais eficaz, sugerindo que se possa aplicar de forma precoce no pós-operatório de ressecção pulmonar beneficamente. / Pulmonary resection surgery belongs to the postoperative surgery group with predispositions respiratory complications, as enhance of bronchial secretions, atelectasis, pneumonia, that are at most related to low pulmonary function at this period. The continuous positive airway pressure (CPAP) has been used therapeutically at these patients to minimize the deleterious effects at lung function in this period. The goal of this study is quantify the effects of CPAP at lung function in the postoperative lung resection period. 30 (thirty) patients wereselected from the Thoracic Surgery discipline of Pedro Ernesto University Hospital. The selection to standard group and control were randomized. Preoperative phase was composed by pulmonary function evaluation (expiratory peak flow, respiratory muscle force, 6 minutes walk test/ TC6, arterial blood gas analysis, lung function test). Postoperative period was established as follow: experimental group: 15 (fifteen) patients were conducted under non invasive ventilation intermittently by a CPAP system (ACRIFLUX-CPAP, Criticalmed, Industries Inc, Brasil) since the first postoperative day (at the first 24 hours after extubation), twice a day, for 30 minutes; control group: 15 (fifteen) patients under supervised and oriented respiratory physiotherapy program applied since the first postoperative day (at the first 24 hours after extubation), twice a day. Postoperative evaluation was the same as preoperative phase and was taken at two moments: Postoperative first day (PO-I) with new evaluation of expiratory peak flow, respiratory muscle force, arterial blood gas analysis; postoperative second day with new lung function. Postoperative seventh day (PO-II) was composed by the same parameters of (POI) and the TC6. The results of expiratory peak flow, respiratory muscle force, arterial blood gas analysis between the groups were the same, with no significance difference, however, TC6 parameter has shown statistically significance at the group submitted at early CPAP program therapy, with p= 0,0001. No airway leak by thoracic drain was observed at this CPAP therapy group, showing the efficacy of the therapy. Both therapies were efficient, but earlier CPAP therapy has shown more effective, suggesting that it can be applied earlier at the postoperative lung resection with benefits.

As cirurgias de ressecção pulmonar se incluem no grupo das cirurgias que podem predispor o paciente a apresentar complicações pulmonares no pós-operatório. Complicações como o aumento na produção de secreções brônquicas, pneumonia e atelectasia, estão quase sempre associadas à diminuição da função pulmonar neste período. A ventilação por pressão positiva contínua nas vias aéreas vem sendo constantemente utilizada como terapêutica nesses pacientes tentando-se minimizar esses efeitos prejudiciais sobre a função pulmonar. O objetivo desse estudo é quantificar os efeitos da ventilação com pressão positiva contínua nas vias aéreas (CPAP) sobre a função pulmonar no pós-operatório de ressecção pulmonar. Foram selecionados 30 (trinta) pacientes da disciplina de Cirurgia Torácica do Hospital Universitário Pedro Ernesto. A seleção dos pacientes para o grupo controle e experimental foi feita de forma randomizada. Os pacientes foram submetidos na fase pré-operatória a uma avaliação da função pulmonar (pico de fluxo expiratório, força muscular respiratória, teste de caminhada de 6 minutos/ TC6, gasometria arterial e espirometria). Após a realização do procedimento cirúrgico foram submetidos a um protocolo de intervenção, como se segue: grupo experimental: 15 (quinze) pacientes submetidos à ventilação não-invasiva, de forma intermitente, com um sistema CPAP (ACRIFLUX-CPAP, Criticalmed, Industries Inc, Brasil), iniciado no primeiro dia de pós-operatório (nas primeiras 24 horas após a extubação), 2 vezes ao dia, por um período de 30 minutos; grupo controle: 15 (quinze) pacientes submetidos a um programa de fisioterapia respiratória, orientado e supervisionado, iniciado no primeiro dia de pós-operatório (nas primeiras 24 horas após a extubação), com uma freqüência de 2 vezes ao dia. A reavaliação na fase pós-operatória seguiu a mesma metodologia utilizada na fase pré-operatória. As reavaliações ocorreram em dois momentos: no primeiro dia de pós-operatório (PO-I) onde foram reavaliados o pico de fluxo expiratório, força muscular respiratória, gasometria arterial; prova de função pulmonar com 48 horas de pós-operatório. Ao sétimo dia de pós-operatório (PO-II) foram reavaliados novamente as variáveis do PO-I e o teste de caminhada de 6 minutos. Os resultados da espirometria, gasometria arterial, pico de fluxo espiratório e força muscular respiratória entre os grupos foi semelhante, sem diferença significativa, porém, a variável TC6 foi estatisticamente significante no grupo que realizou CPAP precoce, com p=0,0001. Não foi observado fuga aérea pelo dreno de tórax no grupo tratado com CPAP, demonstrando a segurança do método. Desta forma, ambas as terapias foram eficazes, porém a CPAP precoce foi mais eficaz, sugerindo que se possa aplicar de forma precoce no pós-operatório de ressecção pulmonar beneficamente. / Pulmonary resection surgery belongs to the postoperative surgery group with predispositions respiratory complications, as enhance of bronchial secretions, atelectasis, pneumonia, that are at most related to low pulmonary function at this period. The continuous positive airway pressure (CPAP) has been used therapeutically at these patients to minimize the deleterious effects at lung function in this period. The goal of this study is quantify the effects of CPAP at lung function in the postoperative lung resection period. 30 (thirty) patients wereselected from the Thoracic Surgery discipline of Pedro Ernesto University Hospital. The selection to standard group and control were randomized. Preoperative phase was composed by pulmonary function evaluation (expiratory peak flow, respiratory muscle force, 6 minutes walk test/ TC6, arterial blood gas analysis, lung function test). Postoperative period was established as follow: experimental group: 15 (fifteen) patients were conducted under non invasive ventilation intermittently by a CPAP system (ACRIFLUX-CPAP, Criticalmed, Industries Inc, Brasil) since the first postoperative day (at the first 24 hours after extubation), twice a day, for 30 minutes; control group: 15 (fifteen) patients under supervised and oriented respiratory physiotherapy program applied since the first postoperative day (at the first 24 hours after extubation), twice a day. Postoperative evaluation was the same as preoperative phase and was taken at two moments: Postoperative first day (PO-I) with new evaluation of expiratory peak flow, respiratory muscle force, arterial blood gas analysis; postoperative second day with new lung function. Postoperative seventh day (PO-II) was composed by the same parameters of (POI) and the TC6. The results of expiratory peak flow, respiratory muscle force, arterial blood gas analysis between the groups were the same, with no significance difference, however, TC6 parameter has shown statistically significance at the group submitted at early CPAP program therapy, with p= 0,0001. No airway leak by thoracic drain was observed at this CPAP therapy group, showing the efficacy of the therapy. Both therapies were efficient, but earlier CPAP therapy has shown more effective, suggesting that it can be applied earlier at the postoperative lung resection with benefits.

The consequences of sleep disordered breathing (SDB) in women are fatigue, morning headaches, insomnia, depression, low functional status, daytime sleepiness, mood disturbances, and poor neuro-behavioural performance. Women appear to be more symptomatic at lower disease severity than men. When CPAP is prescribed, women use it less than men, they reduce their usage within the first week of treatment, and they discontinue it more than men. There is a need to understand the factors influencing CPAP therapy uptake and usage in women to meaningfully address their needs. The purpose of this qualitative evidence synthesis was to identify and synthesize the factors influencing the uptake and use of CPAP in women by conducting a qualitative evidence synthesis guided by the Bargaining and Balancing Life with CPAP theory for content, and the Theoretical Domains Framework for data analysis. Twenty-one studies were included. Barrier domains were Skills, Emotions, Social/Professional Role and Identity, and Beliefs about Capabilities, while facilitator domains were Reinforcement, Social Influences, Goals, and Optimism. Seven themes emerged : 1) Expectations about CPAP, 2) Learning to use my CPAP machine, 3) The burden of the technology, 4) Improvement of SDB symptoms, 5) Not feeling (or looking) like myself, 6) Receiving support, and 7) Choosing my attitude. To ensure appropriate and meaningful SDB care for women, practices must be based on knowledge relevant to women with SDB. Findings from this thesis can inform the design and development of interventions to support women with CPAP therapy uptake and usage. Research on this topic is urgently needed because there was no study eligible with a sample comprised of women only.