Sleep-disordered breathing (SDB) has been associated with a greater incidence and mortality of ca... more Sleep-disordered breathing (SDB) has been associated with a greater incidence and mortality of cancer, although such findings are inconsistent. However, no large studies are currently available to investigate this association in patients with a specific type of cancer. This study seeks to assess potential relationships between SDB severity and aggressiveness markers of cutaneous melanoma. Four hundred and forty-three patients with a diagnosis of melanoma underwent a sleep study within 6 months of diagnosis. General demographics were collected, along with melanoma characteristics and polygraphic parameters consisting of the apnea-hypopnea index (AHI) and indices of both continuous and intermittent night-time oxyhemoglobin desaturation (DI4%). An exploration of independent relationships between SDB and various objective melanoma aggressiveness markers (Breslow index, presence of ulceration, presence of regression, mitotic index, stage of severity, damage to the sentinel lymph, and spr...
Rationale: Noninvasive ventilation (NIV) is an effective treatment in patients with obesity hypov... more Rationale: Noninvasive ventilation (NIV) is an effective treatment in patients with obesity hypoventilation syndrome (OHS) who have severe obstructive sleep apnea (OSA). However, there is paucity of evidence on the efficacy of NIV in OHS patients without severe OSA. Objective: We performed a multicenter randomized clinical trial to determine the efficacy of NIV versus lifestyle modification (control group) using daytime PaCO 2 as the main outcome measure. Methods: Sequentially screened OHS patients without severe OSA were randomized to NIV versus lifestyle modification and were followed for two-months. Arterial blood gas parameters, symptoms, health-related quality-of-life tests, polysomnography, spirometry, six-minute walk distance test, blood pressure measure, and healthcare resource utilization were evaluated. Statistical analysis used intention-to-treat analysis. Results: 365 patients were screened and 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomized. NIV led to significantly larger improvement in serum bicarbonate and PaCO 2 (-6±5.5 mmHg versus -2.8±5 mmHg, p>0.001). Sleepiness, some health-related quality-of-life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification. Additionally, there was a tendency toward lower healthcare resource utilization in the NIV group. Conclusion: NIV was more effective than lifestyle modification in improving daytime PaCO 2 , sleepiness and polysomnographic parameters. Long-term randomized trials are necessary to demonstrate if NIV decreases healthcare resource utilization, cardiovascular events, and mortality.
Background Non-invasive ventilation (NIV) is an effective form of treatment in patients with obes... more Background Non-invasive ventilation (NIV) is an effective form of treatment in patients with obesity hypoventilation syndrome (OHS) who have concomitant severe obstructive sleep apnoea (OSA). However, there is a paucity of evidence on the efficacy of NIV in patients with OHS without severe OSA. We performed a multicentre randomised clinical trial to determine the comparative efficacy of NIV versus lifestyle modification (control group) using daytime arterial carbon dioxide tension (PaCO 2) as the main outcome measure. Methods Between May 2009 and December 2014 we sequentially screened patients with OHS without severe OSA. Participants were randomised to NIV versus lifestyle modification and were followed for 2 months. Arterial blood gas parameters, clinical symptoms, health-related quality of life assessments, polysomnography, spirometry, 6-min walk distance test, blood pressure measurements and healthcare resource utilisation were evaluated. Statistical analysis was performed using intention-to-treat analysis. Results A total of 365 patients were screened of whom 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomised. NIV led to a significantly larger improvement in PaCO 2 of −6 (95% CI −7.7 to −4.2) mm Hg versus −2.8 (95% CI −4.3 to −1.3) mm Hg, (p<0.001) and serum bicarbonate of −3.4 (95% CI −4.5 to −2.3) versus −1 (95% CI −1.7 to −0.2 95% CI) mmol/L (p<0.001). PaCO 2 change adjusted for NIV compliance did not further improve the inter-group statistical significance. Sleepiness, some health-related quality of life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification. Additionally, there was a tendency towards lower healthcare resource utilisation in the NIV group. Conclusions NIV is more effective than lifestyle modification in improving daytime PaCO 2 , sleepiness and polysomnographic parameters. Long-term prospective studies are necessary to determine whether NIV reduces healthcare resource utilisation, cardiovascular events and mortality. Trial registration number NCT01405976; results.
Gender differences in patients with obesity hypoventilation syndrome. Protective cardiovascular e... more Gender differences in patients with obesity hypoventilation syndrome. Protective cardiovascular effect of sleep apnea severity in obesity hypoventilation syndrome. Health use in individuals with obesity and chronic hypoxemia treated for sleep disordered breathing. Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome. Postoperative Complications in Patients With Unrecognized Obesity Hypoventilation Syndrome Undergoing Elective Noncardiac Surgery. Positive airway pressure improves nocturnal beat-to-beat blood pressure surges in obesity hypoventilation syndrome with obstructive sleep apnea. Efficacy of Different Treatment Alternatives for Obesity Hypoventilation Syndrome. Pickwick Study. Obesity hypoventilation syndrome in Japan and independent determinants of arterial carbon dioxide levels
Medicina Oral Patología Oral y Cirugia Bucal, 2015
Background: Evaluation of the efficacy and safety of a mandibular advancement device (MAD) (Klear... more Background: Evaluation of the efficacy and safety of a mandibular advancement device (MAD) (KlearwayTM) in the treatment of mild-to-moderate obstructive sleep apnea and chronic roncopathy. Material and Methods: A randomized, placebo-controlled, double blinded, and crossover clinical trial was conducted. Placebo device (PD) defined as a splint in the centric occlusion that did not induce a mandibular advancement served as a control. The mandible was advanced to the maximum tolerable distance or to a minimum of 65% of the maximum protrusion. After each sequence of treatment, patients were assessed by questionnaires, conventional polysomnography, and objective measurement of snoring at the patient's own home. Results: Forty two patients participated in the study and 38 completed the study. Patients mean age was 46 ±9 years and the 79% were males. The mean mandibular advancement was 8.6 ±2.8 mm. Patients used the MAD and the PD for 6.4 +2.4 hours and 6.2 +2.0 hours, respectively. Secondary effects (mostly mild) occurred in the 85.7% and the 86.8% of the users of MAD and PD, respectively. The MAD induced a decrease in the apnea-hypopnea index (AHI) from 15.3 +10.2 to 11.9 +15.5. The 50% reduction in the AHI was achieved in the 46.2% and the 18.4% of the patients treated with MAD and PD, respectively. The use of the MAD induced a reduction in the AHI by 3.4 +15.9 while the PD induced an increase by 10.6 +26.1. The subjective evaluation of the roncopathy indicated
Sleep-disordered breathing (SDB) has been associated with a greater incidence and mortality of ca... more Sleep-disordered breathing (SDB) has been associated with a greater incidence and mortality of cancer, although such findings are inconsistent. However, no large studies are currently available to investigate this association in patients with a specific type of cancer. This study seeks to assess potential relationships between SDB severity and aggressiveness markers of cutaneous melanoma. Four hundred and forty-three patients with a diagnosis of melanoma underwent a sleep study within 6 months of diagnosis. General demographics were collected, along with melanoma characteristics and polygraphic parameters consisting of the apnea-hypopnea index (AHI) and indices of both continuous and intermittent night-time oxyhemoglobin desaturation (DI4%). An exploration of independent relationships between SDB and various objective melanoma aggressiveness markers (Breslow index, presence of ulceration, presence of regression, mitotic index, stage of severity, damage to the sentinel lymph, and spr...
Rationale: Noninvasive ventilation (NIV) is an effective treatment in patients with obesity hypov... more Rationale: Noninvasive ventilation (NIV) is an effective treatment in patients with obesity hypoventilation syndrome (OHS) who have severe obstructive sleep apnea (OSA). However, there is paucity of evidence on the efficacy of NIV in OHS patients without severe OSA. Objective: We performed a multicenter randomized clinical trial to determine the efficacy of NIV versus lifestyle modification (control group) using daytime PaCO 2 as the main outcome measure. Methods: Sequentially screened OHS patients without severe OSA were randomized to NIV versus lifestyle modification and were followed for two-months. Arterial blood gas parameters, symptoms, health-related quality-of-life tests, polysomnography, spirometry, six-minute walk distance test, blood pressure measure, and healthcare resource utilization were evaluated. Statistical analysis used intention-to-treat analysis. Results: 365 patients were screened and 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomized. NIV led to significantly larger improvement in serum bicarbonate and PaCO 2 (-6±5.5 mmHg versus -2.8±5 mmHg, p>0.001). Sleepiness, some health-related quality-of-life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification. Additionally, there was a tendency toward lower healthcare resource utilization in the NIV group. Conclusion: NIV was more effective than lifestyle modification in improving daytime PaCO 2 , sleepiness and polysomnographic parameters. Long-term randomized trials are necessary to demonstrate if NIV decreases healthcare resource utilization, cardiovascular events, and mortality.
Background Non-invasive ventilation (NIV) is an effective form of treatment in patients with obes... more Background Non-invasive ventilation (NIV) is an effective form of treatment in patients with obesity hypoventilation syndrome (OHS) who have concomitant severe obstructive sleep apnoea (OSA). However, there is a paucity of evidence on the efficacy of NIV in patients with OHS without severe OSA. We performed a multicentre randomised clinical trial to determine the comparative efficacy of NIV versus lifestyle modification (control group) using daytime arterial carbon dioxide tension (PaCO 2) as the main outcome measure. Methods Between May 2009 and December 2014 we sequentially screened patients with OHS without severe OSA. Participants were randomised to NIV versus lifestyle modification and were followed for 2 months. Arterial blood gas parameters, clinical symptoms, health-related quality of life assessments, polysomnography, spirometry, 6-min walk distance test, blood pressure measurements and healthcare resource utilisation were evaluated. Statistical analysis was performed using intention-to-treat analysis. Results A total of 365 patients were screened of whom 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomised. NIV led to a significantly larger improvement in PaCO 2 of −6 (95% CI −7.7 to −4.2) mm Hg versus −2.8 (95% CI −4.3 to −1.3) mm Hg, (p<0.001) and serum bicarbonate of −3.4 (95% CI −4.5 to −2.3) versus −1 (95% CI −1.7 to −0.2 95% CI) mmol/L (p<0.001). PaCO 2 change adjusted for NIV compliance did not further improve the inter-group statistical significance. Sleepiness, some health-related quality of life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification. Additionally, there was a tendency towards lower healthcare resource utilisation in the NIV group. Conclusions NIV is more effective than lifestyle modification in improving daytime PaCO 2 , sleepiness and polysomnographic parameters. Long-term prospective studies are necessary to determine whether NIV reduces healthcare resource utilisation, cardiovascular events and mortality. Trial registration number NCT01405976; results.
Gender differences in patients with obesity hypoventilation syndrome. Protective cardiovascular e... more Gender differences in patients with obesity hypoventilation syndrome. Protective cardiovascular effect of sleep apnea severity in obesity hypoventilation syndrome. Health use in individuals with obesity and chronic hypoxemia treated for sleep disordered breathing. Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome. Postoperative Complications in Patients With Unrecognized Obesity Hypoventilation Syndrome Undergoing Elective Noncardiac Surgery. Positive airway pressure improves nocturnal beat-to-beat blood pressure surges in obesity hypoventilation syndrome with obstructive sleep apnea. Efficacy of Different Treatment Alternatives for Obesity Hypoventilation Syndrome. Pickwick Study. Obesity hypoventilation syndrome in Japan and independent determinants of arterial carbon dioxide levels
Medicina Oral Patología Oral y Cirugia Bucal, 2015
Background: Evaluation of the efficacy and safety of a mandibular advancement device (MAD) (Klear... more Background: Evaluation of the efficacy and safety of a mandibular advancement device (MAD) (KlearwayTM) in the treatment of mild-to-moderate obstructive sleep apnea and chronic roncopathy. Material and Methods: A randomized, placebo-controlled, double blinded, and crossover clinical trial was conducted. Placebo device (PD) defined as a splint in the centric occlusion that did not induce a mandibular advancement served as a control. The mandible was advanced to the maximum tolerable distance or to a minimum of 65% of the maximum protrusion. After each sequence of treatment, patients were assessed by questionnaires, conventional polysomnography, and objective measurement of snoring at the patient's own home. Results: Forty two patients participated in the study and 38 completed the study. Patients mean age was 46 ±9 years and the 79% were males. The mean mandibular advancement was 8.6 ±2.8 mm. Patients used the MAD and the PD for 6.4 +2.4 hours and 6.2 +2.0 hours, respectively. Secondary effects (mostly mild) occurred in the 85.7% and the 86.8% of the users of MAD and PD, respectively. The MAD induced a decrease in the apnea-hypopnea index (AHI) from 15.3 +10.2 to 11.9 +15.5. The 50% reduction in the AHI was achieved in the 46.2% and the 18.4% of the patients treated with MAD and PD, respectively. The use of the MAD induced a reduction in the AHI by 3.4 +15.9 while the PD induced an increase by 10.6 +26.1. The subjective evaluation of the roncopathy indicated
Uploads
Papers by Erika Miranda