Purpose The use of continuous positive airway pressure (CPAP) is one of the therapeutic modalities for obstructive sleep apnea (OSA). Manual titration polysomnography and the 90th or 95th percentiles of pressure titrated by automatic CPAP (APAP) are the current standard for determining fixed pressure. Pressures programmed at an arbitrary fixed value, or at preset values based on body mass index (BMI) or by predictive formulas, are presented as alternative forms. This study aimed to evaluate the residual apnea-hypopnea index (r-AHI) in polysomnography with CPAP therapy using pressure determined by formula and assess its feasibility to start treatment. Methods Patients referred for CPAP therapy were followed up in three outpatient assessments and underwent polysomnography study with pressure CPAP obtained by formula. ResultsThe study sample consisted of 80 patients, 41 women; age 58.6 ± 11.3 years, BMI 34.1 ± 7.5 kg/m 2 and cervical circumference 42.0 ± 4.2 cm. Most patients (74%) had severe OSA and Epworth sleepiness scale (ESS) of 12.0 ± 5.7 points. The calculated average pressure was 7.8 ± 2.1 cmH 2 O. Polysomnography studies showed an r-AHI of 6.1 ± 5.2 events/h and reduction of 84% from baseline AHI. The r-AHI in the REM-supine was 8.4 ± 9.9 events/h. At 30-and 120-day follow-up assessment, adherence to CPAP was 78% and 75% and the ESS score was 6.9 and 6.1 points, respectively. Conclusion Results suggest that a formula provides an effective initial pressure in the majority of patients (73%). This simplified approach appears to be a viable alternative, with reductions in waiting lists and time from diagnosis to initiation of therapy.
Agradecimento especial à Luciana, Alessandro e Íris, por todo apoio na realização dos exames de polissonografia.A todos os médicos, médicos residentes, demais profissionais de saúde e funcionários da Seção de Pneumologia, do Setor de Neurofisiologia e Medicina do Sono e do Setor de Otorrinolaringologia (Casa 20 e CEOF) do HCFMRP/USP, pelo convívio e apoio durante esses anos.Ao pessoal da secretaria da pós-graduação de Clínica Médica. Aos componentes da banca examinadora.A todos os pacientes que voluntariamente participaram do estudo.A Deus.
Introduction: Sarcoidosis is defined as a multisystem granulomatous disease of unknown cause. It affects the lung in 90% of cases, but it can affect any part of the body. It can be self-limiting or chronic, with progression to terminal fibrosis. Its diagnosis is based on the compatible clinical-radiological correlation, in addition to the histopathological finding of non-caseating granuloma. Objective: To report a case of sarcoidosis from initial suspicion to diagnostic confirmation and treatment. Description of case: This is a male patient with a dry, dragging cough and unintentional weight loss. After investigation, diagnosis was made. Conclusion: Because it is a disease with diverse symptoms, including asymptomatic individuals or with unspecific symptoms, diagnosis is a challenge in clinical practice. The prognosis is usually favorable, but up to 25% of patients develop severe disability. Therefore, it becomes evident the importance of an early diagnosis for adequate management and continuous and multidisciplinary follow-up to avoid a chronic course. The prognosis is usually favorable, but up to 25% of patients develop severe disability. Therefore, it becomes evident the importance of an early diagnosis for adequate management and continuous and multidisciplinary followup to avoid a chronic and progressive course of the disease.
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