Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia
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There is a recognized association between obstructive sleep apnea syndrome and metabolic syndrome, designated syndrome Z. The criteria for metabolic syndrome include at least three of the following factors: central obesity (waist circumference ≥ 102 cm for males and ≥ 88 cm for females); triglycerides ≥ 150 mg/dL; HDL cholesterol < 40 mg/dL for males and < 50 mg/dL for females; arterial blood pressure ≥ 130/85 mmHg; and fasting glucose ≥ 100 mg/dL. Central obesity is associated with OSAS and metabolic syndrome, and there is evidence that obstructive sleep apnea is an independent risk factor for obesity, glucose intolerance and insulin resistance. ⋯ Despite such evidence, the results are controversial regarding the benefits of treating sleep apnea with CPAP in the presence of these metabolic alterations. In addition, the few studies that have addressed sleep apnea as a risk factor for dyslipidemia have presented conflicting results. Population-based, longitudinal controlled studies are necessary in order to elucidate the interaction between sleep apnea and metabolic consequences so that these individuals are properly treated.
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Although obstructive sleep apnea syndrome is a common disease, it often goes undiagnosed. The signs and symptoms of the syndrome are mostly subjective. ⋯ Scales and tables that have good sensitivity and include the most relevant clinical symptoms and physical examination results can suggest a diagnosis of obstructive sleep apnea syndrome. The diagnosis is confirmed by polysomnography, which is considered the gold standard method.
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Cognitive and performance impairment is well established in patients with obstructive sleep apnea syndrome (OSAS), having a significant impact on the quality of life and the risk of accidents in these individuals. The severity of the impairment correlates with that of the OSAS, which explains the apparent discrepancy between studies using patients from sleep clinics and population-based studies in terms of the reported frequency and severity of such impairment. ⋯ The potential effect of daytime sleepiness on the performance of these patients on various cognitive tests has yet to be determined, as does that of common comorbidities, such as diabetes, systemic arterial hypertension, cardiovascular disease, and obesity. There is compelling evidence that CPAP treatment can improve performance and cognition, particularly in mild to moderate cases, although further studies on the long-term impact of this type of treatment are still needed.
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In view of the pandemic caused by a new virus, influenza A (H1N1), we report the case of a 56-year-old patient without relevant risk factors and with severe acute respiratory syndrome resulting from infection with this virus. We present the results of laboratory tests and the imaging findings (chest X-ray and CT scans). The evolution was favorable, and the patient was discharged after 14 days.
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To evaluate breathing pattern and thoracoabdominal motion during breathing exercises. ⋯ Among the breathing exercises evaluated, incentive spirometry with the volume-oriented device provided the best results, because it allowed slower, deeper inhalation.