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Authors
Advisor(s)
Abstract(s)
Introdução e objetivos: A adesão ao tratamento do Síndrome da Apneia Obstrutiva do Sono
(SAOS), através do uso de uma pressão positiva na via aérea, tem-se revelado eficaz, mas de
difícil manutenção. Por isto, foi implementada a Consulta Diferenciada de Distúrbios
Respiratórios do Sono (CDDRS) no Hospital da Luz Arrábida, na qual se prevê a avaliação do
doente ao longo do tempo (consulta inicial, 3, 6 e 12 meses) por uma equipa multidisciplinar,
sendo esperado que esta metodologia de acompanhamento promova uma maior adesão e
eficácia do tratamento. Com este trabalho, pretende-se analisar o desempenho deste modelo
inovador, de forma a que se consiga avaliar o impacto e o contributo desta nova modalidade no
doente com Distúrbio Respiratório do Sono (DRS). Adicionalmente pretende-se identificar fatores
preditores da adesão nestes doentes, estabelecendo uma proposta de protocolo de
acompanhamento de modo a que possa ser implementada pelo Hospital da Luz Arrábida no
seguimento desta tipologia de doentes.
Metodologia: Foi realizado um estudo longitudinal, observacional e retrospetivo, analisando
variáveis antropométricas, clínicas, de diagnóstico e relacionadas com o tratamento de acordo
com um cronograma predefinido (consulta inicial, 3, 6 e 12 meses). Para a análise dos dados,
utilizaram-se medidas de estatística descritiva na caracterização inicial da amostra. Para
modelação dos dados foram utilizados modelos de regressão linear de efeitos mistos, sendo
considerado um nível de significância a = 0.05.
Resultados: Foram analisados 133 doentes. A gravidade da SAOS foi: grave (70.0%),
moderada (22.0%) e ligeira (8.0%). O modo ventilatório mais prevalente foi o Auto-CPAP (86%),
com uso de interface nasal (65.0%) e as pressões prescritas mais frequentes foram de 4-12
cmH2O. A adesão efetiva ≥ 90% do tempo foi de 66.0% na consulta inicial, 69.0% aos 3 meses,
71.0% aos 6 meses e 69.0% aos 12 meses. A adesão noturna ≥ 4h / noite foi de 70.0% na
consulta inicial, 81.0% aos 3 meses, 90.0% aos 6 meses e 88.0% aos 12 meses. A adesão
noturna ≥ 4h / noite apresentou ainda uma tendência crescente com o tempo de terapia,
comparando o momento inicial com os 3 meses, 6 meses e 12 meses (p <0.001). O IAH e a ESS
melhoraram significativamente, para valores normais, ao longo dos momentos de avaliação (p
<0.001). As complicações mais frequentes foram a fuga excessiva, a obstrução nasal, a pressão
excessiva e a boca seca. A análise multivariável mostrou que valores mais elevados de adesão
(adesão noturna ≥ 4h / noite) estão associados a idades mais elevadas, maior índice de
dessaturação de oxigénio e ausência de complicações (p≤0.001).
Conclusão: Este modelo inovador de acompanhamento do doente com Distúrbio Respiratório
do Sono revelou um contributo significativo para eficácia do tratamento, com baixa prevalência
de complicações e melhorias significativas da adesão noturna.
Background: Adherence to PAP treatment is a mainstay in the management of patients with Obstructive Sleep Apnea (OSA), although this is often difficult to attain and to maintain in the long term. For this reason, the Differentiated Respiratory Sleep Disorders Consultation (CDDRS) was implemented at Hospital da Luz Arrábida, in which the patient is evaluated over time (initial, 3, 6 and 12 months) by a multidisciplinary team. This monitoring methodology is expected to promote greater adherence and treatment effectiveness. With this work, we intend to analyze the performance of this innovative model, in order to be able to assess the impact and contribution of this new modality on patients with Sleep Respiratory Disorder (DRS). Additionally, it is intended to identify predictive factors for adherence in these patients, establishing a follow-up protocol proposal, so that it can be implemented by Hospital da Luz Arrábida in the follow-up of this type of patient. Methods: An observational and retrospective longitudinal study was conducted analyzing age, anthropometric, clinical, diagnostic and treatment-related variables over a predefined timeline (initial, 3, 6 and 12 months). For data analysis, descriptive statistical measures were used in the initial characterization of the sample. For data modeling, multilevel mixed-effect linear regression models, with a significance level, a = 0.05, were used. Results: Were analyzed 133 patients (pts). OSA severity was: severe (70.0%), moderate (22.0%) and mild (8.0%). Effective adherence ≥ 90% of the time was 66.0% at the initial consultation, 69.0% at 3 months, 71.0% at 6 months and 69.0% at 12 months. Nighttime adherence ≥ 4h / night was 70.0% at the initial consultation, 81.0% at 3 months, 90.0% at 6 months and 88.0% at 12 months. Nighttime adherence ≥ 4h / night also shows an increasing trend with the time of therapy, comparing the initial moment with 3 months, 6 months and 12 months (p <0.001). AIH and ESS have been significantly improved to normal values (p <0.001). The most frequent complications were excessive leakage, nasal obstruction, excessive pressure and dry mouth. Multivariable analysis showed that higher adherence values (usage ≥ 4h/night) are associated with older ages, higher O2 desaturation index and absence of complications (p≤0.001). Conclusion: Our program has a good performance regarding treatment efficacy, with a low prevalence of complications and a significative improved in-night adherence.
Background: Adherence to PAP treatment is a mainstay in the management of patients with Obstructive Sleep Apnea (OSA), although this is often difficult to attain and to maintain in the long term. For this reason, the Differentiated Respiratory Sleep Disorders Consultation (CDDRS) was implemented at Hospital da Luz Arrábida, in which the patient is evaluated over time (initial, 3, 6 and 12 months) by a multidisciplinary team. This monitoring methodology is expected to promote greater adherence and treatment effectiveness. With this work, we intend to analyze the performance of this innovative model, in order to be able to assess the impact and contribution of this new modality on patients with Sleep Respiratory Disorder (DRS). Additionally, it is intended to identify predictive factors for adherence in these patients, establishing a follow-up protocol proposal, so that it can be implemented by Hospital da Luz Arrábida in the follow-up of this type of patient. Methods: An observational and retrospective longitudinal study was conducted analyzing age, anthropometric, clinical, diagnostic and treatment-related variables over a predefined timeline (initial, 3, 6 and 12 months). For data analysis, descriptive statistical measures were used in the initial characterization of the sample. For data modeling, multilevel mixed-effect linear regression models, with a significance level, a = 0.05, were used. Results: Were analyzed 133 patients (pts). OSA severity was: severe (70.0%), moderate (22.0%) and mild (8.0%). Effective adherence ≥ 90% of the time was 66.0% at the initial consultation, 69.0% at 3 months, 71.0% at 6 months and 69.0% at 12 months. Nighttime adherence ≥ 4h / night was 70.0% at the initial consultation, 81.0% at 3 months, 90.0% at 6 months and 88.0% at 12 months. Nighttime adherence ≥ 4h / night also shows an increasing trend with the time of therapy, comparing the initial moment with 3 months, 6 months and 12 months (p <0.001). AIH and ESS have been significantly improved to normal values (p <0.001). The most frequent complications were excessive leakage, nasal obstruction, excessive pressure and dry mouth. Multivariable analysis showed that higher adherence values (usage ≥ 4h/night) are associated with older ages, higher O2 desaturation index and absence of complications (p≤0.001). Conclusion: Our program has a good performance regarding treatment efficacy, with a low prevalence of complications and a significative improved in-night adherence.
Description
Trabalho final de mestrado para obtenção do grau de Mestre em Engenharia Biomédica
Keywords
SAOS OSA Adesão Adherence Follow-up Follow-up VNI NIV Eficácia Efficacy Distúrbio respiratório do sono Sleep disorders
Citation
LOPES, Ana Daniela Francela - Abordagem multidisciplinar do doente com síndrome de apneia obstrutiva do sono no seguimento e tratamento sob ventilação por pressão positiva. Lisboa: Instituto Superior de Engenharia de Lisboa - Escola Superior de Tecnologia da Saúde de Lisboa, 2020. Dissertação de mestrado.
Publisher
Instituto Superior de Engenharia de Lisboa - Escola Superior de Tecnologia da Saúde de Lisboa