Obstructive sleep apnea (OSA) and asthma are potentially linked at several levels. The pathophysiology of these two conditions seems to overlap significantly, as airway obstruction, inflammation, obesity, and several other factors are implicated in the development of both diseases. Gastroesophageal reflux disease (GERD), cardiovascular complications, obesity itself, and the underlying inflammatory processes are all complex contributory factors that provide hypothetical links. Furthermore, a collateral rise in prevalence of both OSA and asthma has been noticed during the past few years, occurring in association with the emerging epidemic of obesity, a common risk factor for both conditions. OSA and asthma share many other risk factors as well. We propose a hypothetical OSA-asthma relationship that has implications on the diagnosis and management of patients presenting with either condition singly. Clinicians should be aware that OSA might complicate asthma management. Based on this hypothesis, we suggest that the treatment of the individual patient who experiences both asthma and OSA needs to be multidisciplinary and comprehensive. This hypothetical association of asthma and OSA, though described anecdotally, has not been systematically studied. In particular, the influence of continuous positive airway pressure therapy (for sleep apnea) on asthma outcomes (such as quality of life, steroid utilization, emergency room visits) and fatality needs to be studied further.

INTRODUÇÃO: Os recém-nascidos pré-termos principalmente aqueles de muito baixo peso são na maioria das vezes, submetidos a procedimentos para assistência respiratória invasiva e não invasiva durante sua internação na UTI Neonatal. OBJETIVO: 1- Verificar a incidência de maloclusão na dentição decídua de pré-escolares, que nasceram prematuramente, de muito baixo peso e que receberam assistência respiratória através de ventilação mecânica invasiva com Intubação orotraqueal e do Continuous Positive Airway Pressure (CPAP) enquanto estiveram internados na UTI neonatal; 2- Verificar a relação entre aleitamento materno, mamadeira, uso da chupeta nos mesmos préescolares. MÉTODOS: Foram estudados 34 pré-escolares no período de 2 a 5 anos de idade. Avaliação: Relação de plano terminal dos 2º molares decíduos; Presença de espaço primata; Mordida aberta anterior; Mordida aberta posterior; Mordida cruzada anterior e/ou posterior; Giroversão; Apinhamento na dentição decídua completa. RESULTADOS: O Tempo de IOT e CPAP não esteve relacionado com o tipo relação terminal dos molares. Não houve correlação entre dispositivos de assistência respiratória com mordida aberta. Destaca-se que houve efeito significativo entre o tempo de IOT em relação à presença de mordida aberta anterior (p=0,009). CONCLUSÕES: Em nossa casuística constatamos que a relação dos segundos molares não sofreu interferência da prematuridade, do peso ao nascimento, e nem da necessidade de assistência respiratória recebida durante a internação na UTI neonatal. O aleitamento materno foi um fator positivo para a presença dos espaços primatas. Crianças que foram submetidas à ventilação mecânica invasiva, apresentaram correlação com mordida cruzada anterior. Nas 34 crianças acompanhadas observamos que a prematuridade, o tipo de parto, o tipo de assistência respiratória recebida durante a internação na UTI neonatal, não influenciaram na presença de mordida aberta anterior / INTRODUCTION: Newborns preterm, especially those born with very low birth weight are most often subjected to invasive and non-invasive procedures for respiratory care during their stay in the NICU. OBJECTIVE: 1- To know the incidence of malocclusion in the primary dentition of preschool children who were born prematurely, with very low birth weight, who had received respiratory support through invasive mechanical ventilation (IMV) and with Continuous Positive Airway Pressure (CPAP) while they were admitted to the neonatal intensive care unit; 2- To investigate the relationship between breastfeeding, use of baby bottle and use of pacifier in the same preschool children. METHODS: 34 preschool children between 2 and 5 years were studied. Evaluation: Terminal plan ratio of 2nd primary molars; Presence of primate space; anterior open bite; posterior open bite; anterior and / or posterior cross bite; giroversion; crowding in the complete deciduous dentition. RESULTS: The IMV time and CPAP is not related to the type of terminal molar relationship. There was no correlation between respiratory assistance devices with open bite. It is noted that are significant effects between the time of IMV and the presence of anterior open bite (p = 0.009). CONCLUSIONS: The second molar relationship does not suffer interference of prematurity or birth weight, neither of respiratory assistance received during hospitalization in the NICU. The presence of primate spaces is positive correlated to breastfeeding. Children who undergo IMV are correlated to anterior cross bite. Preterm birth, type of birth and the type of respiratory care received during hospitalization in the neonatal ICU do not influence the presence of anterior open bite in all 34 children studied

INTRODUÇÃO: Os recém-nascidos pré-termos principalmente aqueles de muito baixo peso são na maioria das vezes, submetidos a procedimentos para assistência respiratória invasiva e não invasiva durante sua internação na UTI Neonatal. OBJETIVO: 1- Verificar a incidência de maloclusão na dentição decídua de pré-escolares, que nasceram prematuramente, de muito baixo peso e que receberam assistência respiratória através de ventilação mecânica invasiva com Intubação orotraqueal e do Continuous Positive Airway Pressure (CPAP) enquanto estiveram internados na UTI neonatal; 2- Verificar a relação entre aleitamento materno, mamadeira, uso da chupeta nos mesmos préescolares. MÉTODOS: Foram estudados 34 pré-escolares no período de 2 a 5 anos de idade. Avaliação: Relação de plano terminal dos 2º molares decíduos; Presença de espaço primata; Mordida aberta anterior; Mordida aberta posterior; Mordida cruzada anterior e/ou posterior; Giroversão; Apinhamento na dentição decídua completa. RESULTADOS: O Tempo de IOT e CPAP não esteve relacionado com o tipo relação terminal dos molares. Não houve correlação entre dispositivos de assistência respiratória com mordida aberta. Destaca-se que houve efeito significativo entre o tempo de IOT em relação à presença de mordida aberta anterior (p=0,009). CONCLUSÕES: Em nossa casuística constatamos que a relação dos segundos molares não sofreu interferência da prematuridade, do peso ao nascimento, e nem da necessidade de assistência respiratória recebida durante a internação na UTI neonatal. O aleitamento materno foi um fator positivo para a presença dos espaços primatas. Crianças que foram submetidas à ventilação mecânica invasiva, apresentaram correlação com mordida cruzada anterior. Nas 34 crianças acompanhadas observamos que a prematuridade, o tipo de parto, o tipo de assistência respiratória recebida durante a internação na UTI neonatal, não influenciaram na presença de mordida aberta anterior / INTRODUCTION: Newborns preterm, especially those born with very low birth weight are most often subjected to invasive and non-invasive procedures for respiratory care during their stay in the NICU. OBJECTIVE: 1- To know the incidence of malocclusion in the primary dentition of preschool children who were born prematurely, with very low birth weight, who had received respiratory support through invasive mechanical ventilation (IMV) and with Continuous Positive Airway Pressure (CPAP) while they were admitted to the neonatal intensive care unit; 2- To investigate the relationship between breastfeeding, use of baby bottle and use of pacifier in the same preschool children. METHODS: 34 preschool children between 2 and 5 years were studied. Evaluation: Terminal plan ratio of 2nd primary molars; Presence of primate space; anterior open bite; posterior open bite; anterior and / or posterior cross bite; giroversion; crowding in the complete deciduous dentition. RESULTS: The IMV time and CPAP is not related to the type of terminal molar relationship. There was no correlation between respiratory assistance devices with open bite. It is noted that are significant effects between the time of IMV and the presence of anterior open bite (p = 0.009). CONCLUSIONS: The second molar relationship does not suffer interference of prematurity or birth weight, neither of respiratory assistance received during hospitalization in the NICU. The presence of primate spaces is positive correlated to breastfeeding. Children who undergo IMV are correlated to anterior cross bite. Preterm birth, type of birth and the type of respiratory care received during hospitalization in the neonatal ICU do not influence the presence of anterior open bite in all 34 children studied

INTRODUÇÃO: A síndrome da apneia e hipopneia obstrutiva do sono (SAHOS) é uma doença crônica que se caracteriza por ronco e apneias que causam microdespertares e fragmentação do sono. O impacto da doença sobre o humor e a qualidade de vida não é bem conhecido. OBJETIVO: Avaliar o impacto do uso da pressão positiva contínua nas vias aéreas (CPAP) sobre sintomas depressivos e qualidade de vida em pacientes com SAHOS. MATERIAL E MÉTODOS: Pacientes com diagnóstico polissonográfico de SAHOS foram avaliados antes e seis meses após o tratamento com CPAP. Foram coletadas as seguintes medidas antropométricas: peso, altura, índice de massa corporal (IMC), circunferência do pescoço, medida da cintura e do quadril. A sonolência foi avaliada pela escala de sonolência diurna de Epworth, o sono pelo índice de qualidade do sono de Pittsburgh, a qualidade de vida através dos questionários SF-36 e FOSQ e os sintomas depressivos pelo inventário de depressão de Beck. RESULTADOS: Foram estudados 61 pacientes, sendo 42 homens e 19 mulheres, com índice de apneias e hipopneias (IAH) de 40,3 ± 27,2 eventos/hora. A média de idade foi de 53,2 ± 9,0 anos e do IMC 30,36 ± 3,93 kg/m², sendo que 96,7% dos pacientes apresentavam sobrepeso ou obesidade. Valores acima do normal para a circunferência do pescoço foram observados em 73,8% e da cintura em 72% dos indivíduos. Com o tratamento com CPAP observou-se redução da sonolência (13,2 ± 4,8 vs 7,9 ± 3,3 pontos; p=0,0001), melhora da qualidade do sono (escore 10,1 ± 4,5 vs 4,1 ± 2,5; bons dormidores pré 9 vs 36 pós; p<0, 01), melhora da qualidade de vida em todos os domínios do FS-36 (p<0,01) e do FOSQ (81,9 ± 19,5 vs 91,7 ± 14,4 pontos; p=0,00001). Os sintomas depressivos melhoraram após o uso do CPAP (12,0 ± 8,6 vs 7,5 ± 5,1; p<0,01), os quais estavam presentes em 33 pacientes antes do tratamento e em 19 após 6 meses de seguimento. Não houve associação entre sintomas depressivos e sonolência. Houve correlação fraca entre sintomas depressivos e IAH (r=0,28; p=0,02), e moderada a forte com todos os domínios do SF-36 (r entre -0,58 e - 0,72; p=0,0001). CONCLUSÕES: Nosso estudo demonstra que a terapia com CPAP tem impacto positivo sobre a sonolência, qualidade do sono e melhora a qualidade de vida e os sintomas depressivos dos portadores de SAHOS. Os sintomas depressivos não se relacionaram com a sonolência e com a gravidade da doença, mas se associaram com a qualidade de vida. / INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by snoring and apneas that cause microarrousals and sleep fragmentation. The effects of the disease on mood and health related quality of life is not well known. OBJECTIVE: To evaluate the impact of the use of continuous positive airway pressure (CPAP) on depressive symptoms and quality of life in patients with OSAS. MATERIAL AND METHODS: Patients with OSAS diagnosed by polyssomnography underwent evaluation before and after 6 months treatment with CPAP. Weight, height, body mass index (BMI), neck, waist and hip circumference were measured. Daytime sleepiness was evaluated using the Epworth scale, sleep quality using the Pittsburgh sleep quality index and quality of life using SF-36 and FOSQ. Depressive symptoms were detected through the Beck Depression Inventory. Data were analized by Student T test, McNemar test and Pearson correlation test. RESULTS: We studied 61 patients with OSAS, 42 males and 19 females, with apnea hypopnea index (AHI) of 40.3 ± 27.2 events/hour. The mean age was 53.2 ± 9.0 years, BMI was 30.4 ± 3.9 kg/m², and 90.7% of the patients were overweight or obese. Abnormal neck and waist circumference were observed in 73.8% and 72% of patients, respectively. After treatment with CPAP there was a decrease in daytime sleepiness (13.2 ± 4.8 vs 7.9 ± 3.3 points; p=0.0001), an increase in sleep quality (10.1 ± 4.5 vs 4.1 ± 2.5; the number of good sleepers 9 before vs 36 after CPAP; p<0.01), and in quality of life as shown by SF-36 (p<0.01) and FOSQ (81.9 ± 19.5 vs 91.7 ± 14.4 points; p=0.00001). Depressive symptoms improved after use of CPAP (12.0 ± 8.6 vs 7.5 ± 5.1; p<0,01), they were reported by 33 patients before treatment and by 19 after six months of follow up. There was a weak correlation between depressive symptoms and AHI (r=0.28; p=0.02) and no association between depressive symptoms and daytime sleepiness. The correlation among depressive symptoms and SF-36 domains varied from r=-0.58 and r=-0.72 (p=0.0001). CONCLUSIONS: Our study demonstrates that the CPAP therapy has a positive impact on daytime sleepiness and sleep quality and improves quality of life and depressive symptoms in patients with OSAS. Depressive symptoms were not related to daytime sleepiness or disease severity, but were associated with quality of life.

INTRODUÇÃO: A síndrome da apneia e hipopneia obstrutiva do sono (SAHOS) é uma doença crônica que se caracteriza por ronco e apneias que causam microdespertares e fragmentação do sono. O impacto da doença sobre o humor e a qualidade de vida não é bem conhecido. OBJETIVO: Avaliar o impacto do uso da pressão positiva contínua nas vias aéreas (CPAP) sobre sintomas depressivos e qualidade de vida em pacientes com SAHOS. MATERIAL E MÉTODOS: Pacientes com diagnóstico polissonográfico de SAHOS foram avaliados antes e seis meses após o tratamento com CPAP. Foram coletadas as seguintes medidas antropométricas: peso, altura, índice de massa corporal (IMC), circunferência do pescoço, medida da cintura e do quadril. A sonolência foi avaliada pela escala de sonolência diurna de Epworth, o sono pelo índice de qualidade do sono de Pittsburgh, a qualidade de vida através dos questionários SF-36 e FOSQ e os sintomas depressivos pelo inventário de depressão de Beck. RESULTADOS: Foram estudados 61 pacientes, sendo 42 homens e 19 mulheres, com índice de apneias e hipopneias (IAH) de 40,3 ± 27,2 eventos/hora. A média de idade foi de 53,2 ± 9,0 anos e do IMC 30,36 ± 3,93 kg/m², sendo que 96,7% dos pacientes apresentavam sobrepeso ou obesidade. Valores acima do normal para a circunferência do pescoço foram observados em 73,8% e da cintura em 72% dos indivíduos. Com o tratamento com CPAP observou-se redução da sonolência (13,2 ± 4,8 vs 7,9 ± 3,3 pontos; p=0,0001), melhora da qualidade do sono (escore 10,1 ± 4,5 vs 4,1 ± 2,5; bons dormidores pré 9 vs 36 pós; p<0, 01), melhora da qualidade de vida em todos os domínios do FS-36 (p<0,01) e do FOSQ (81,9 ± 19,5 vs 91,7 ± 14,4 pontos; p=0,00001). Os sintomas depressivos melhoraram após o uso do CPAP (12,0 ± 8,6 vs 7,5 ± 5,1; p<0,01), os quais estavam presentes em 33 pacientes antes do tratamento e em 19 após 6 meses de seguimento. Não houve associação entre sintomas depressivos e sonolência. Houve correlação fraca entre sintomas depressivos e IAH (r=0,28; p=0,02), e moderada a forte com todos os domínios do SF-36 (r entre -0,58 e - 0,72; p=0,0001). CONCLUSÕES: Nosso estudo demonstra que a terapia com CPAP tem impacto positivo sobre a sonolência, qualidade do sono e melhora a qualidade de vida e os sintomas depressivos dos portadores de SAHOS. Os sintomas depressivos não se relacionaram com a sonolência e com a gravidade da doença, mas se associaram com a qualidade de vida. / INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by snoring and apneas that cause microarrousals and sleep fragmentation. The effects of the disease on mood and health related quality of life is not well known. OBJECTIVE: To evaluate the impact of the use of continuous positive airway pressure (CPAP) on depressive symptoms and quality of life in patients with OSAS. MATERIAL AND METHODS: Patients with OSAS diagnosed by polyssomnography underwent evaluation before and after 6 months treatment with CPAP. Weight, height, body mass index (BMI), neck, waist and hip circumference were measured. Daytime sleepiness was evaluated using the Epworth scale, sleep quality using the Pittsburgh sleep quality index and quality of life using SF-36 and FOSQ. Depressive symptoms were detected through the Beck Depression Inventory. Data were analized by Student T test, McNemar test and Pearson correlation test. RESULTS: We studied 61 patients with OSAS, 42 males and 19 females, with apnea hypopnea index (AHI) of 40.3 ± 27.2 events/hour. The mean age was 53.2 ± 9.0 years, BMI was 30.4 ± 3.9 kg/m², and 90.7% of the patients were overweight or obese. Abnormal neck and waist circumference were observed in 73.8% and 72% of patients, respectively. After treatment with CPAP there was a decrease in daytime sleepiness (13.2 ± 4.8 vs 7.9 ± 3.3 points; p=0.0001), an increase in sleep quality (10.1 ± 4.5 vs 4.1 ± 2.5; the number of good sleepers 9 before vs 36 after CPAP; p<0.01), and in quality of life as shown by SF-36 (p<0.01) and FOSQ (81.9 ± 19.5 vs 91.7 ± 14.4 points; p=0.00001). Depressive symptoms improved after use of CPAP (12.0 ± 8.6 vs 7.5 ± 5.1; p<0,01), they were reported by 33 patients before treatment and by 19 after six months of follow up. There was a weak correlation between depressive symptoms and AHI (r=0.28; p=0.02) and no association between depressive symptoms and daytime sleepiness. The correlation among depressive symptoms and SF-36 domains varied from r=-0.58 and r=-0.72 (p=0.0001). CONCLUSIONS: Our study demonstrates that the CPAP therapy has a positive impact on daytime sleepiness and sleep quality and improves quality of life and depressive symptoms in patients with OSAS. Depressive symptoms were not related to daytime sleepiness or disease severity, but were associated with quality of life.

INTRODUÇÃO: A síndrome da apneia e hipopneia obstrutiva do sono (SAHOS) é uma doença crônica que se caracteriza por ronco e apneias que causam microdespertares e fragmentação do sono. O impacto da doença sobre o humor e a qualidade de vida não é bem conhecido. OBJETIVO: Avaliar o impacto do uso da pressão positiva contínua nas vias aéreas (CPAP) sobre sintomas depressivos e qualidade de vida em pacientes com SAHOS. MATERIAL E MÉTODOS: Pacientes com diagnóstico polissonográfico de SAHOS foram avaliados antes e seis meses após o tratamento com CPAP. Foram coletadas as seguintes medidas antropométricas: peso, altura, índice de massa corporal (IMC), circunferência do pescoço, medida da cintura e do quadril. A sonolência foi avaliada pela escala de sonolência diurna de Epworth, o sono pelo índice de qualidade do sono de Pittsburgh, a qualidade de vida através dos questionários SF-36 e FOSQ e os sintomas depressivos pelo inventário de depressão de Beck. RESULTADOS: Foram estudados 61 pacientes, sendo 42 homens e 19 mulheres, com índice de apneias e hipopneias (IAH) de 40,3 ± 27,2 eventos/hora. A média de idade foi de 53,2 ± 9,0 anos e do IMC 30,36 ± 3,93 kg/m², sendo que 96,7% dos pacientes apresentavam sobrepeso ou obesidade. Valores acima do normal para a circunferência do pescoço foram observados em 73,8% e da cintura em 72% dos indivíduos. Com o tratamento com CPAP observou-se redução da sonolência (13,2 ± 4,8 vs 7,9 ± 3,3 pontos; p=0,0001), melhora da qualidade do sono (escore 10,1 ± 4,5 vs 4,1 ± 2,5; bons dormidores pré 9 vs 36 pós; p<0, 01), melhora da qualidade de vida em todos os domínios do FS-36 (p<0,01) e do FOSQ (81,9 ± 19,5 vs 91,7 ± 14,4 pontos; p=0,00001). Os sintomas depressivos melhoraram após o uso do CPAP (12,0 ± 8,6 vs 7,5 ± 5,1; p<0,01), os quais estavam presentes em 33 pacientes antes do tratamento e em 19 após 6 meses de seguimento. Não houve associação entre sintomas depressivos e sonolência. Houve correlação fraca entre sintomas depressivos e IAH (r=0,28; p=0,02), e moderada a forte com todos os domínios do SF-36 (r entre -0,58 e - 0,72; p=0,0001). CONCLUSÕES: Nosso estudo demonstra que a terapia com CPAP tem impacto positivo sobre a sonolência, qualidade do sono e melhora a qualidade de vida e os sintomas depressivos dos portadores de SAHOS. Os sintomas depressivos não se relacionaram com a sonolência e com a gravidade da doença, mas se associaram com a qualidade de vida. / INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by snoring and apneas that cause microarrousals and sleep fragmentation. The effects of the disease on mood and health related quality of life is not well known. OBJECTIVE: To evaluate the impact of the use of continuous positive airway pressure (CPAP) on depressive symptoms and quality of life in patients with OSAS. MATERIAL AND METHODS: Patients with OSAS diagnosed by polyssomnography underwent evaluation before and after 6 months treatment with CPAP. Weight, height, body mass index (BMI), neck, waist and hip circumference were measured. Daytime sleepiness was evaluated using the Epworth scale, sleep quality using the Pittsburgh sleep quality index and quality of life using SF-36 and FOSQ. Depressive symptoms were detected through the Beck Depression Inventory. Data were analized by Student T test, McNemar test and Pearson correlation test. RESULTS: We studied 61 patients with OSAS, 42 males and 19 females, with apnea hypopnea index (AHI) of 40.3 ± 27.2 events/hour. The mean age was 53.2 ± 9.0 years, BMI was 30.4 ± 3.9 kg/m², and 90.7% of the patients were overweight or obese. Abnormal neck and waist circumference were observed in 73.8% and 72% of patients, respectively. After treatment with CPAP there was a decrease in daytime sleepiness (13.2 ± 4.8 vs 7.9 ± 3.3 points; p=0.0001), an increase in sleep quality (10.1 ± 4.5 vs 4.1 ± 2.5; the number of good sleepers 9 before vs 36 after CPAP; p<0.01), and in quality of life as shown by SF-36 (p<0.01) and FOSQ (81.9 ± 19.5 vs 91.7 ± 14.4 points; p=0.00001). Depressive symptoms improved after use of CPAP (12.0 ± 8.6 vs 7.5 ± 5.1; p<0,01), they were reported by 33 patients before treatment and by 19 after six months of follow up. There was a weak correlation between depressive symptoms and AHI (r=0.28; p=0.02) and no association between depressive symptoms and daytime sleepiness. The correlation among depressive symptoms and SF-36 domains varied from r=-0.58 and r=-0.72 (p=0.0001). CONCLUSIONS: Our study demonstrates that the CPAP therapy has a positive impact on daytime sleepiness and sleep quality and improves quality of life and depressive symptoms in patients with OSAS. Depressive symptoms were not related to daytime sleepiness or disease severity, but were associated with quality of life.

Thesis (MMed) -- Stellenbosch University, 2010. / ENGLISH ABSTRACT: Introduction: Limited facilities exist at rural hospitals for the management of newborn infants with respiratory distress syndrome (RDS). Furthermore, the secondary and tertiary hospitals are under severe strain to accept all the referrals from rural hospitals. Many of these infants require intubation and ventilation with a resuscitation bag which must be sustained for hours until the transport team arrives. Not only is lung damage inflicted by the prolonged ventilation, but transferring the infant by helicopter and ambulance is expensive. CPAP (continuous positive airway pressure), a non-invasive form of ventilatory support, has been used successfully at regional (Level 2) and tertiary (Level 3) neonatal units, to manage infants with RDS. It is cost-effective for infants with mild to moderate grades of RDS to be managed at the rural hospital instead of being transferred to the regional secondary or tertiary hospital. CPAP was introduced to Ceres Hospital, a rural Level 1 hospital, in February 2008 for the management of infants with RDS. Aim: To determine the impact of CPAP on the management of infants with RDS in a rural level 1 hospital and whether it can reduce the number of referrals to regional hospitals. Study setting: Nursery at Ceres District Hospital, Cape Winelands District, Western Cape. Study design: Prospective cohort analytical study with an historic control group (HCG). Patients and Methods: The study group (SG) comprised all neonates with respiratory distress born between 27/02/2008 and 26/02/2010. The infants were initially resuscitated with a Neopuff® machine in labour-ward and CPAP was commenced for those with RDS. The survival and referral rates of the SG were compared to an historic control group (HCG) of infants born between 1/2/2006 to 31/01/2008 at Ceres Hospital. Results: During the 2 years of the study, 51 neonates received CPAP (34 <1800g, 17>1800g). Twenty (83%) of the SG infants between 1000g and 1800g and 23 (68%) of the infants between 500g and 1800g survived. Those <1800g that failed CPAP, had either a severe grade of RDS which required intubation and ventilation or were <1000g. Seventeen (33%) of the infants that received CPAP, were in the >1800g group. Thirteen (76%) of these infants were successfully treated with CPAP only. The four infants that failed CPAP suffered from congenital abnormalities and would not have benefited from CPAP. There was no statistically significant difference in the survival between the SG and HCG (80%) (p=0.5490) but the number of referrals decreased significantly from 21% in the HCG to 7% in the SG (p=0.0003). No complications related to CPAP treatment, such as pneumothorax, were noted. The nursing and medical staff quickly became proficient and confident in applying CPAP and were committed to the project. Conclusion: CPAP can be safely and successfully practised in infants with mild to moderate RDS in a rural Level 1 hospital. The survival rate stayed the same as the HCG, even though a higher risk infants were treated in the SG. The transfers were significantly reduced from 21% to 7%. This resulted in significant cost savings for the hospital. / AFRIKAANSE OPSOMMING: geen opsomming

Les technologies du sommeil connaissent une révolution numérique à laquelle nous avons apporté une validation avec pour objectif une meilleure analyse des troubles du sommeil en Unité de Soins Intensifs, dans la maladie d’Alzheimer et dans l’évaluation de l’hypovigilance en vol de longue durée en milieu militaire. Ainsi, nous avons évalué le temps de sommeil sur 24 heures en relation avec les nuisances sonores en soins intensifs. Cette évaluation a été réalisée à l’aide d’un nouveau polysomnographe l’Actiwave couplé à un polygraphe Nox T3 qui ont permis d’enregistrer les cycles du sommeil et les niveaux sonores sur les 24 heures dans une Unité de Soins Intensif. Nous avons montré que l’Actiwave est un outil performant pour enregistrer le sommeil dans de telles conditions. Combiné au Nox T3, il permet d’explorer l’impact des niveaux sonores sur la qualité et quantité du sommeil. Nous avons retrouvé un Temps Total de Sommeil médian de 6 heures par nuit et de 2,5 heures pendant la journée, la qualité de sommeil étant plus perturbée que sa quantité. Nous avons démontré que 60% des éveils intra-sommeil étaient associés à un bruit supérieur à 77 dB et identifié les sources sonores principales qui agissent sur la pathogénèse des troubles du sommeil en Unité de Soins Intensif, à savoir les alarmes des respirateurs mécaniques avec un risque relatif de 10.9 (9.8-11.9) et les alarmes des constantes vitales avec un risque relatif de 9.8 (8.6-11.3). Une deuxième étude, l’évaluation de l’hypovigilance en vol de longue durée, a été réalisée à l’aide de l’ActiWave. Pour cela, nos équipes ont conçu un algorithme d’analyse automatique de détection du sommeil. Nous avons montré que l’ActiWave est un polysomnographe fiable en conditions extrêmes, l’analyse automatique montrant une bonne concordance avec l’analyse manuelle de deux experts du sommeil (Kappa>80%). Nous démontrons donc qu’il est possible de coder automatiquement les stades de sommeil à l’aide du ratio (+)/ sur la région occipitale O1-M2 vs C3-M2 (p<0.05). Nous avons validé un nouvel actimètre le MotionWatch 8 pour l’évaluation du temps de sommeil chez 208 patients présentant la maladie d’Alzheimer. Ce travail a permis de montrer que le MotionWatch 8 est un outil fiable avec de bonnes sensibilité et spécificité dans l’évaluation des troubles du sommeil chez ces patients. Le Temps Total de Sommeil est dans la norme (TTS moyen 7h35 minutes) et est significativement associé au score d’apathie (7h46 minutes vs 7h26 minutes ; p=0.04). Le marqueur chrono-biologique SIJ est également associé à l’apathie (p=0.04) ainsi qu’aux troubles cognitifs (p=0.02). Finalement, la fragmentation de rythmes veille/sommeil (VIJ) est associée au score du handicap de la maladie d’Alzheimer (p=0.02). Dans une quatrième étude, nous nous sommes intéressés à la nouvelle technologie de télé-observance dans le traitement du syndrome d’apnées du sommeil par pression positive continue, qui permet d’alerter le médecin de la compliance du patient. Nous avons validé un nouveau dispositif médical de télé-observance du traitement du syndrome d’apnées du sommeil, le NOWAPI. Nous montrons que le NOWAPI mesure avec précision et de manière fiable les niveaux de pressions et de débits des PPC disponibles sur le marché et qu’il permet de calculer les indicateurs d'observance des patients souffrants du syndrome d’apnées du sommeil (IAH Nowapi de 2,5 (-1.4 ; 3.6)/h vs IAH Polygraphie respiratoire de 2,3 (1.2 ;3.4)/h). En conclusion, les études présentées ici mettent en exergue l’importance de l’innovation technologique dans le domaine du sommeil pour une meilleure prise en charge des patients. A l’ère du 21ème siècle, une nouvelle médecine commence à émerger, la médecine 2.0, avec pour corollaire l’eSanté. (...) / Scientific research into sleep over the past thirty years has progressed so speedily that it is now possible to speak of “Sleep Medicine”. This specialty is placed incontestably at the frontier of Science and Medicine. The issues have been recently driven by the advances in the technology of recording biological parameter and analysis of the data, in parallel with a deeper understanding of the physiopathology and therapeutic advances in sleep disorders. The subject of this thesis lies at the crossover of two areas of professional expertise; sleep technology and bio-engineering, with notably the aim of validating new tools in research as well as in the diagnosis and treatment of sleep disorders. We have tested a miniaturized polysomnographic new technology, the Actiwave, capable of detecting sleep and alert states in extreme conditions, notably in patients hospitalized in Intensive Care Units and in aircraft pilots in long duration military flights. In intensive care units, we have explored the relation between sleep and noise in the immediate environment of the patients. In brief, Total Sleep Time was not disturbed whereas the sleep quality was altered. Wake episodes after sleep onset were mostly associated with noise over 77 dB, and the main disturbances were triggered by the alarms of breathing machines and those from vital parameters. In military flights of long duration, we have explored the presence of hypovigilance episodes. This allowed us to validate the Actiwave for polysomnography in extreme conditions. In a third study, we have analyzed the sleep patterns in a total of 202 patients with Alzheimer’s disease by using a new actimeter, the MotionWatch8. We have shown that the latter device has a good sensitivity and specificity or evaluating sleep-wake parameters in these patients. In particular, we find that the TST is in the normal range and is associated with the aptathy score. The SIJ score is associated with the apathy score and also with the cognitive impairments. Finally, the sleep fragmentation is associated with the disability status. In a last study, we explored the parameter of sleep apneas in patients with SAS using the NOWAPI. We validated this new device by demonstrating that it provides on-line reliable data about pressure and flow levels of various CPAP. In conclusion, this thesis considers possible future avenues of research into sleep technology and discusses the crucial importance of a scientific approach capable of leading the development of appropriate and lasting diagnostic and therapeutic tools. The next step will be the era of the 2.0 medicine for which I am developing the iSommeil application that will allow patients to be the actual actors of their disease and also to facilitate the diagnostic and the prevention of sleep disorders.

Made available in DSpace on 2016-06-02T20:19:05Z (GMT). No. of bitstreams: 1 1354.pdf: 1194159 bytes, checksum: f55e476028028c44693b4da86ac5109f (MD5) Previous issue date: 2007-02-26 / Universidade Federal de Sao Carlos / The changes on the heart rate sympathetic-vagal balance caused to chronic obstructive pulmonary disease or chronic heart failure, as well as, the hemodynamics change induced by the non-invasive ventilation were unclear. In this context, we proposed to develop two studies. The first study was titled by The heart rate autonomic control in chronic obstructive pulmonary disease and chronic heart failure patients on the rest and during the respiratory sinusal arrhythmia maneuver . The purpose of this study was to evaluate the heart rate (HR) autonomic modulation in chronic obstructive pulmonary disease (COPD) patients as well as chronic heart failure (CHF) patients on the rest as well as during the respiratory sinus arrhythmia maneuver (M-RSA); and to correlation the HR autonomic modulation and seriousness levels of both pathologies. Twenty-seven male volunteers were subdivided in three groups: ten presented COPD (69±9 years); seven presented CHF (62±8 years) and; ten were healthy with 64±5 year-old (control). When resting, the three groups electrocardiography signal was obtained in three conditions: 1) lying position for 15 min; 2) lying position during the M-RSA for 4 min; and 3) sitting position for 15 min. The data was analyzed by the time (RMSSD and SDNN indexes) and the frequency domain, in total power, low frequency, high frequency absolute (ab) and normalized (nu) units and LF/HF ratio. Regarding the M-RSA indexes, the expiratory/inspiratory ratio (E/I) and the inspiratory/expiratory difference (&#8710;IE) were calculated. The main results showed that the CHF and the COPD patients presented lower E/I ratio values (0,03±0,01 vs 0,09±0,04 e 0,04±0,02 vs 0,09±0,04) and &#8710;I/E values (0,67±0,13 vs 1,09±0,13 e 0,81±0,20 vs 1,09±0,13), when compared to control group. Strong correlations were observed between the forced expiratory volume in the first second (FEV1) and the RMSSD (r=-0,73) and between the FEV1 and the BF absolute (r=-0,71) in the COPD patients. At same, strong correlations were observed between the ejecting fraction and the RMSSD (r=0,83) in CHF patients. Concluding, the results of this study suggest that both, the COPD and the CHF patients, presented parasympathetic activity reduction and there is a relation between the seriousness levels of both pathologies and the HR autonomic activity. The second study was titled to The acute effects of the continuous positive airway pressure (CPAP) in the heart rate autonomic control of chronic obstructive pulmonary disease and chronic heart failure patients . The purpose of this study was to evaluate the acute continuous positive pressure airway over the heart rate (HR) autonomic control and the respiratory variables behavior in COPD as well as CHF patients. Twenty-eight male volunteers were sub-divided in three groups: ten presented COPD (69±9 years); eight presented CHF (62±8 years) and; ten were healthy with 64±5 year-old (control). The electrocardiography signal was obtained for 10 min in the sitting position with spontaneous breath (SB) and following randomly conditions: CPAP Sham, CPAP 5, and CPAP 10 cmH2O. Additionally, the breath rate, the endtidal of carbon dioxide, and the peripheral oxygen saturation were obtained. The HR and it variability data were analyzed by the time and the frequency domain, in according with previous describe. The main results showed that the ETCO2 reduced in all groups during the CPAP application. COPD group were significantly lower values of the RMSSD index in the Sham (1.06), CPAP 5 (1.08), and CPAP 10 (1,01) than SB (1,22). In addition, they presented increased in the LFnu (1.60 vs 1.82) and decreased in the HFab (1.90 vs 1.55) from the SB to CPAP 10. The CHF group RMSSD index and TP increased to SB (1.31 and 2.62) to CPAP 5 (1.44 and 2.87) and the CPAP 10 (1.48 and 2.97), respectively. Concluding, the CPAP caused modification in the HR autonomic control and improvement in the alveolar ventilation of COPD, CHF patients and healthy individuals. / As modificações do balanço simpato-vagal da freqüência cardíaca (FC) provocadas com o curso da doença pulmonar obstrutiva crônica (DPOC) e da insuficiência cardíaca crônica (ICC), bem como, as que ocorrem em função dos ajustes hemodinâmicos induzidos pela aplicação da ventilação não invasiva são bastante contraditórias. Neste contexto, propusemos o desenvolvimento de dois estudos que poderiam contribuir com novas informações. O primeiro intitulado por Controle autonômico da freqüência cardíaca de pacientes com doença pulmonar obstrutiva crônica ou insuficiência cardíaca crônica em repouso e durante a manobra de acentuação arritmia sinusal respiratória teve por objetivos avaliar o controle autonômico da FC de pacientes com DPOC ou ICC em repouso e durante uma manobra de acentuação da arritmia sinusal respiratória (M-ASR), bem como, relacionar a atividade autonômica da FC com a gravidade das patologias. Vinte e sete voluntários do sexo masculino foram subdivididos em três grupos: 10 com DPOC (GD) e 69±9 anos; 7 com ICC (GI) e 62±8 anos; e 10 saudáveis (GC) com 64±5 anos. Em repouso, o sinal eletrocardiográfico foi obtido em três situações: 1) 15 min na posição supina; 2) 4 min durante M-ASR na posição supina; e 3) 15 min na posição sentada. Os dados foram analisados no domínio do tempo (índices RMSSD e SDNN) e da freqüência, pela densidade espectral total (DET), bandas de baixa (BF) e alta freqüências (AF) - absolutas (ab) e normalizadas (un), e a razão BF/AF. Durante M-ASR foram calculadas a razão expiração/inspiração (E/I) e a diferença inspiração/expiração (&#8710;IE). Os principais resultados em logaritmos decimais (média±desvio-padrão) mostraram que os pacientes com ICC e DPOC apresentaram menor razão E/I (0,03±0,01 vs 0,09±0,04 e 0,04±0,02 vs 0,09±0,04) e &#8710;IE (0,67±0,13 vs 1,09±0,13 e 0,81±0,20 vs 1,09±0,13), respectivamente, comparados ao GC durante a M-ASR. Correlações fortes foram observadas entre volume expiratório forçado no primeiro segundo com o RMSSD (r=-0,73) e com a BF absoluta (r=-0,71) nos pacientes com DPOC; e entre fração de ejeção e o RMSSD (r=0,83) nos pacientes com ICC. Em conclusão, os resultados sugerem que tanto a DPOC como a ICC levam a redução da atividade parassimpática e que a gravidade de ambas está relacionada com o controle autonômico da FC. O segundo estudo com o titulo: Efeitos da aplicação aguda da pressão positiva continua nas vias aéreas sobre o controle autonômico da freqüência cardíaca de pacientes com doença pulmonar obstrutiva crônica ou insuficiência cardíaca crônica , objetivou avaliar o efeito agudo da pressão positiva continua nas vias aéreas (CPAP) sobre o controle autonômico da freqüência cardíaca (FC) e o comportamento de variáveis respiratórias de pacientes com DPOC ou ICC. 28 homens foram subdivididos em três grupos: 10 com DPOC (GD) e 69±9 anos; 8 com ICC (GI) e 62±8 anos; e 10 saudáveis (GC) com 64±5 anos. O sinal eletrocardiográfico foi obtido por 10 min na posição sentada com respiração espontânea (RE) e randomicamente nas condições: CPAP sham, CPAP 5 e CPAP 10 cmH2O. Adicionalmente, foram obtidos os valores da freqüência respiratória, o volume de dióxido de carbono no final da expiração (ETCO2) e a saturação periférica de oxigênio. A FC e sua variabilidade foram analisadas no domínio do tempo e da freqüência, conforme descrito anteriormente. Os principais resultados mostraram que o ETCO2 reduziu em todos os grupos durante a aplicação da CPAP. O GD apresentou menores valores do RMSSD durante a CPAP sham (1,06), 5 (1,08) e 10 (1,01) em comparação a RE (1,22), bem como, aumento da BFun (1,60 vs 1,82) e redução da AFab (1,90 vs 1,55) da RE para a CPAP 10. No GI, o SDNN e a DET aumentaram da condição de RE (1,31 e 2,62) para CPAP 5 (1,44 e 2,87) e 10 (1.48 e 2,97), respectivamente. Os resultados sugerem que a CPAP melhorou a ventilação alveolar e provocou atenuação da atividade simpática sobre a FC de pacientes com ICC, bem como redução do tônus vagal de pacientes com DPOC.