Implementation of a physiotherapy protocol in the treatment of obstructive sleep apnea at Hospital Alemão Oswaldo Cruz – São Paulo, Brazil
DOI:
https://doi.org/10.1590/Keywords:
Obstructive Sleep Apnea, Continuous Positive Airway Pressure, Physical Therapy Department, Hospital, InpatientsAbstract
Obstructive sleep apnea (OSA) is a high
prevalence sleep-disordered breathing associated with
cardiovascular and metabolic complications. Adherence
to continuous positive airway pressure (CPAP) therapy is
crucial to treatment success and efficiency. Patients are
frequently diagnosed during hospitalization, and they do
not have access to the right support or orientation about
the risks associated with this disorder and the importance
of treatment. In this scenario, it is relevant to standardize a
protocol of excellence in the OSA treatment. The primary
aim of this report is to describe the OSA treatment protocol
implemented in a tertiary care hospital. As a secondary aim,
to describe the characteristics of the patients included. This
is a descriptive and retrospective study, via the analysis
of electronic medical records of the patients, who were
included in the OSA treatment protocol designed by the
sleep physical therapy group, in the Inpatient Units of a
hospital in São Paulo during a five years-period. During the Obstructive sleep apnea (OSA) is a high
prevalence sleep-disordered breathing associated with
cardiovascular and metabolic complications. Adherence
to continuous positive airway pressure (CPAP) therapy is
crucial to treatment success and efficiency. Patients are
frequently diagnosed during hospitalization, and they do
not have access to the right support or orientation about
the risks associated with this disorder and the importance
of treatment. In this scenario, it is relevant to standardize a
protocol of excellence in the OSA treatment. The primary
aim of this report is to describe the OSA treatment protocol
implemented in a tertiary care hospital. As a secondary aim,
to describe the characteristics of the patients included. This
is a descriptive and retrospective study, via the analysis
of electronic medical records of the patients, who were
included in the OSA treatment protocol designed by the
sleep physical therapy group, in the Inpatient Units of a
hospital in São Paulo during a five years-period. During the study period, 126 patient were analyzed, and 108 were included and
had their profiles described. According to the reviewed medical
records, the average age of patients was 73 years with 70% males.
The most prevalent comorbidity was hypertension (80%) followed
by diabetes (50%). In total, 74% were adherents to therapy with
CPAP during hospitalization. It is feasible to implement a protocol
for treatment of hospitalized patients with the diagnosis of OSA.
Keywords | Obstructive Sleep Apnea; Continuous Positive Airway
Pressure; Physical Therapy Department; Hospital; Inpatients.
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References
Malhotra A, White DP. Obstructive sleep apnoea. Lancet.
;360:237-45. doi: 10.1016/S0140-6736(02)09464-3
Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries
D, et al. Prevalence of sleep-disordered breathing in the
general population: the HypnoLaus study. Lancet Respir Med.
;3:310-8. doi: 10.1016/S2213-2600(15)00043-0
Benjafield AV., Ayas NT, Eastwood PR, Heinzer R, Ip MSM, et al.
Estimation of the global prevalence and burden of obstructive
sleep apnoea: a literature-based analysis. Lancet Respir Med.
;7:687-98. doi: 10.1016/S2213-2600(19)30198-5
Tufik S, Santos-Silva R, Taddei JA, Rita L, Bittencourt A. Obstructive
sleep apnea syndrome in the Sao Paulo epidemiologic sleep study.
Sleep Med. 2010;11(5):441-6. doi: 10.1016/j.sleep.2009.10.005
McDaid C, Durée KH, Griffin SC, Weatherly HLA, Stradling JR,
et al. A systematic review of continuous positive airway pressure
for obstructive sleep apnoea-hypopnoea syndrome. Sleep Med
Rev. 2009;13:427-36. doi: 10.1016/J.SMRV.2009.02.004
Gay P, Weaver T, Loube D, Iber C. Evaluation of positive airway
pressure treatment for sleep related breathing disorders in
adults. Sleep. 2006;29:381-401. doi: 10.1093/SLEEP/29.3.381
Quan SF, Budhiraja R, Kushida CA. Associations between sleep
quality, sleep architecture and sleep disordered breathing and
memory after continuous positive airway pressure in patients
with obstructive sleep apnea in the apnea positive pressure
long-term efficacy study (APPLES). Sleep Sci. 2018;11:231-8.
doi: 10.5935/1984-0063.20180037
Dunietz GL, Chervin RD, Burke JF, Conceicao AS, Braley TJ.
Obstructive sleep apnea treatment and dementia risk in older
adults. Sleep. 2021;44(9):zsab076. doi: 10.1093/SLEEP/ZSAB076
Wang ML, Wang C, Tuo M, Yu Y, Wang L, et al. Cognitive
effects of treating obstructive sleep apnea: a meta-analysis
of randomized controlled trials. J Alzheimers Dis. 2020;75:705-
doi: 10.3233/JAD-200088
Drager LF, Pedrosa RP, Diniz PM, Diegues-Silva L, Marcondes B,
et al. The effects of continuous positive airway pressure on
prehypertension and masked hypertension in men with severe
obstructive sleep apnea. Hypertension. 2011;57:549-55. doi:
1161/HYPERTENSIONAHA.110.165969
Fu Y, Xia Y, Yi H, Xu H, Guan J, et al. Meta-analysis of all-cause
and cardiovascular mortality in obstructive sleep apnea with
or without continuous positive airway pressure treatment.
Sleep Breath. 2017;21:181-9. doi: 10.1007/S11325-016-1393-1
Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term
cardiovascular outcomes in men with obstructive sleep
apnoea-hypopnoea with or without treatment with continuous
positive airway pressure: an observational study. Lancet.
;365:1046-53. doi: 10.1016/S0140-6736(05)71141-7
Sharma SK, Agrawal S, Damodaran D, Sreenivas V, Kadhiravan T,
et al. A. CPAP for the metabolic syndrome in patients with
obstructive sleep apnea. N Engl J Med. 2011;365:2277-86. doi:
1056/NEJMOA1103944
Weaver TE, Mancini C, Maislin G, Cater J, Staley B, et al. Continuous
positive airway pressure treatment of sleepy patients with milder
obstructive sleep apnea: results of the CPAP Apnea Trial North
American Program (CATNAP) randomized clinical trial. Am J Respir
Crit Care Med. 2012;186:677-83. doi: 10.1164/RCCM.201202-0200OC
Van Zeller M, Severo M, Santos AC, Drummond M. 5-Years
APAP adherence in OSA patients: do first impressions matter?
Respir Med. 2013;107:2046-52. doi: 10.1016/J.RMED.2013.10.011
Popescu G, Latham M, Allgar V, Elliott MW. Continuous positive
airway pressure for sleep apnoea/hypopnoea syndrome:
usefulness of a 2 week trial to identify factors associated with long
term use. Thorax. 2001;56:727-33. doi: 10.1136/THORAX.56.9.727
Ghosh D, Allgar V, Elliott MW. Identifying poor compliance with
CPAP in obstructive sleep apnea: a simple prediction equation
using data after a two week trial. Respir Med. 2013;107:936-42.
doi: 10.1016/J.RMED.2012.10.008
Budhiraja R, Parthasarathy S, Drake CL, Roth T, Sharief I, et
al. Early CPAP use identifies subsequent adherence to CPAP
therapy. Sleep. 2007;30:320-4. doi: 10.1093/SLEEP/30.3.320
Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP.
Pathophysiology of sleep apnea. Physiol Rev. 2010;90:47-112.
doi: 10.1152/PHYSREV.00043.2008
Maldonado-Marcos E, Caula-Freixa C, Planellas-Giné P,
Rodríguez-Hermosa JI, López-Ben S, et al. Impact of Sars-
COV-2 pandemic on elective and emergency surgery in a
university hospital. Cir Esp. 2021;99:368-73. doi: 10.1016/J.
CIRESP.2020.07.013
Søreide K, Hallet J, Matthews JB, Schnitzbauer AA, Line PD,
et al. Immediate and long-term impact of the covid-19 pandemic
on delivery of surgical services. British Journal of Surgery.
;107:1250-61. doi: 10.1002/BJS.11670
Sharma S, Chowdhury A, Tang L, Willes L, Glynn B, et al.
Hospitalized patients at high risk for obstructive sleep apnea
have more rapid response system events and intervention is
associated with reduced events. PLoS One. 2016;11(5):e0153790.
doi: 10.1371/JOURNAL.PONE.0153790
Sheikh M, Kuperberg S. An organ systems-based review
of outcomes associated with sleep apnea in hospitalized
patients. Medicine. 2021;100(34):E26857. doi: 10.1097/
MD.0000000000026857
Suen C, Wong J, Ryan CM, Goh S, Got T, et al. Prevalence
of undiagnosed obstructive sleep apnea among patients
hospitalized for cardiovascular disease and associated inhospital
outcomes: a scoping review. J Clin Med. 2020;9:989.
doi: 10.3390/JCM9040989
Spurr KF, Graven MA, Gilbert RW. Prevalence of unspecified sleep
apnea and the use of continuous positive airway pressure in
hospitalized patients, 2004 National Hospital Discharge Survey.
Sleep Breath. 2008;12:229-34. doi: 10.1007/S11325-007-0166-2
Van Dulmen S, Sluijs E, Van Dijk L, De Ridder D, Heerdink R, et al.
Patient adherence to medical treatment: a review of reviews.
BMC Health Serv Res. 2007;7:55. doi: 10.1186/1472-6963-7-55
Nerbass FB, Piccin VS, Peruchi BB, Mortari DM, Ikeda DS,
et al. Atuação da fisioterapia no tratamento dos distúrbios
respiratórios do sono. Cardioresp Physiother Crit Care Rehabil.
;6:13-30.
Frange C, Franco AM, Brasil E, organizadores. O papel da fisioterapia
no manejo dos distúrbios de sono: diretrizes da Associação
Brasileira do Sono 2022. São Paulo: Segmento Farma; 2022.
Askland K, Wright L, Wozniak DR, Emmanuel T, Caston J, et al.
Educational, supportive and behavioural interventions to improve
usage of continuous positive airway pressure machines in adults
with obstructive sleep apnea. Cochrane Database Syst Rev.
;4(4):CD007736. doi: 10.1002/14651858.CD007736.PUB3
Patil SP, Ayappa IA, Caples SM, John Kimoff R, Patel SR, et al.
Treatment of adult obstructive sleep apnea with positive airway
pressure: an american academy of sleep medicine clinical practice
guideline. J Clin Sleep Med. 2019;15:335-43. doi: 10.5664/JCSM.7640
Shapiro GK, Shapiro CM. Factors that influence CPAP adherence:
an overview. Sleep Breath. 2010;14:323-35. doi: 10.1007/
S11325-010-0391-Y
Engleman HM, Wild MR. Improving CPAP use by patients with
the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med
Rev. 2003;7:81-99. doi: 10.1053/smrv.2001.0197
Bouloukaki I, Giannadaki K, Mermigkis C, Tzanakis N, Mauroudi E,
et al. Intensive versus standard follow-up to improve
continuous positive airway pressure compliance. Eur Respir J.
;44:1262-74. doi: 10.1183/09031936.00021314
Andrade RGS, Viana FM, Nascimento JA, Drager LF, Moffa A,
et al. Nasal vs oronasal CPAP for OSA treatment: a meta-analysis.
Chest. 2018; 153: 665-74. doi: 10.1016/J.CHEST.2017.10.044
Genta PR, Kaminska M, Edwards BA, Ebben MR, Krieger
AC, et al. The importance of mask selection on continuous
positive airway pressure outcomes for obstructive sleep
apnea: an official american thoracic society workshop
report. Ann Am Thorac Soc. 2020;17:1177. doi: 10.1513/
ANNALSATS.202007-864ST
Drager LF, Malhotra A, Yan Y, Pépin JL, Armitstead JP, et al.
Adherence with positive airway pressure therapy for obstructive
sleep apnea in developing vs. developed countries: a big data
study. J Clin Sleep Med. 2021;17:7039. doi: 10.5664/JCSM.9008
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