VALERIA MENDES
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Resumo IPEN-doc 30476 Um efeito inesperado do tratamento do distúrbio respiratório do sono2023 - MENDES, V.; AZEVEDO, L.H.; ZEZELL, D.M.Alguns trabalhos tem vinculado de forma questionável, a nômina de tratamento do ronco à abordagem terapêutica para tratamento dos distúrbios respiratórios do sono (DRS). Este trabalho busca verificar se os resultados obtidos de melhora no quadro respiratório com o tratamento do DRS, levam sempre à melhora do ronco. De acordo com a polissonografia e achados clínicos, o paciente do sexo masculino, 39 anos de idade, apresentava quadro compatível com ronco primário. Recebeu tratamento não ablativo com lasers Nd꞉YAG e Er꞉YAG em três sessões de aproximadamente 20 minutos, nos momentos 0, 14 e 28 dias. O paciente foi avaliado por exame de polissonografia, antes e após o tratamento. Apesar da melhora nos parâmetros de índice de dessaturação de oxihemoglobina (IDO꞉ de 3,7 para 3,1) e saturação mínima de oxihemoglobina (SpO2꞉ de 84% para 90%), que indicam melhora do quadro respiratório, houve piora da roncopatia (tempo de sono com ronco꞉ de 3% para 13%), visto que a complacência tecidual é apenas um dos fatores de risco para o surgimento e progressão dos DRS. Com os resultados obtidos, notamos que o remodelamento tecidual pelo tratamento do DRS com lasers, favorece o restabelecimento da patência faríngea, melhorando o fluxo aéreo da respiração durante o sono, observado pela melhora nos parâmetros de saturação de oxihemoglobina em polissonografia, podendo entretanto, aumentar o evento ruidoso. Portanto, o ronco pode ser visto como sinal clínico do distúrbio respiratório do sono, mas não deve ser utilizado como parâmetro exclusivo de avaliação do tratamento ou progressão da doença.Resumo IPEN-doc 30470 Effectiveness of non-ablative treatment for snoring and obstructive sleep apnea with two high-intensity pulsed lasers2023 - MENDES, VALERIA; AZEVEDO, LUCIANE H.; ZEZELL, DENISE M.Primary snoring and obstructive sleep apnea (OSA) represent different severity degrees of the same disorder, which affects one billion people worldwide. Increased cardiovascular risk, emergence of chronic diseases and use of medications result from disease worsening and represent a major challenge for health systems. A palatopharyngeal muscle tone dysregulation plays a significant role in this disorder. All therapeutic approaches have limitations. Speech therapy exercises show improvement in muscle tone, reducing snoring and OSA, positively signaling laser treatment, which can contribute to improvement of sleep breathing disorder (SBD). This study aims to evaluate the treatment of SDB with high-intensity non-ablative irradiation with 2 pulsed lasers: Nd:YAG laser (1064 nm) and Er:YAG laser (2940 nm), comparing results before and after the intervention. After obtaining the approval of research ethics committee, 30 volunteers from primary snoring to moderate OSA were treated in 3 sessions of laser irradiation, 14 days apart. Upper airway lumen was analyzed, according to modified Mallampati index by 3 independent, blinded and calibrated evaluators. Oxyhemoglobin desaturation index (ODI), severity of snoring and sleep quality were also evaluated. The observation of variability for each outcome allowed for the analysis of difference between the experimental periods in relation to baseline for each variable and the behavior of laser group in relation to control. Then, classification “Reduced” or “Didn’t Reduce” was assigned to the variation above, making it possible to apply the χ2 test corrected by Fisher, with a significance level of α = 5%. The main clinical result obtained is the expansion of upper airways lumen (control and laser group variation: (0.0 ±0.0); (–25.0 ±50.0) with p = 0.00060). Therefore, the improvement of ODI (19.6 ±67.6); (–18.1 ±88.2) with p = 0.018; snoring time (64.8 ±179.1); (–1.5 ±85.0) with p = 0.034; snoring peak amplitude (–8.3 ±12.3); (–12.4 ±15.8) with p = 0.029 were observed. Non-ablative laser treatment is effective in rehabilitation of patients with SBD. In the protocol used in this work, the procedure is performed without need of medication or anesthesia. The expansion of upper airways lumen by decreasing tissue compliance leads to improved sleep quality, snoring severity and daytime sleepiness (p = 0.00026, p = 0.02171 and p = 0.027, respectively), contributing to the improvement of observed health parameters.Resumo IPEN-doc 30431 Non-ablative laser treatment for snoring and obstructive sleep apnea2024 - MENDES, V.; AZEVEDO, L.; ZEZELL, D.Introduction: By preventing the progression of sleep breathing disorder (SBD) , the risk of developing chronic diseases highly prevalent in society, such as hypertension and type 2 diabetes, is reduced. This study aimed to clinically evaluate the effect of non-ablative treatment with Nd:YAG (1064 nm) and Er:YAG lasers (2940 nm) in sleep breathing disorder (SBD), in a longitudinal, interventional and prospective study. Materials and Methods: After approval from the Research Ethics Committee (CEP FOUSP CAAE: 44068621.8.0000.0075) and clinical trial registration - WHO - Rebec UTN code: U1111-1284-3764, thirty volunteers, in the city of São Paulo, Brazil, with clinical status from snoring to moderate OSA, both sexes, 25 to 65 years old, BMI < 40kg/m2 were blinded and randomized in control and laser groups. Patients received three treatment sessions, 14 days apart. In the control group (12 volunteers), only a guide light was used without delivering laser energy. 18 volunteers of laser group were treated with non-ablative high-intensity irradiation with the association of Nd:YAG and Er:YAG lasers. Entire soft palate, uvula, palatoglossal and palatopharyngeal arches were punctually irradiated with four to five shoots per point and six scans in each line. Parameters were selected to deliver energy efficiently and safely in a five-step sequence wich enable tissue thermal sensitization, gradually. Outcome measures were performed before, after treatment and at three and six months follow up visits, including photographic record, type IV polysomnography and analysis of snoring noise. The main outcome of the study, analysis of the upper airway lumen variation according to the Modified Mallampati Index was performed independently and blinded and as well as the statical analysis. Oxyhemoglobin desaturation index (ODI), snoring time during sleep and peak amplitude of snoring noise were also analysed. Observation of the variability of each outcome allowed analysis of the differences between experimental periods compared to baseline for each variable and the behavior of the laser group compared to the control group. Fisher's corrected chi-square test with a significance level of α = 5% was applied. Results: The main clinical outcome is the expansion of the upper airway lumen, in all study periods analyzed after irradiation [variation between control and laser groups: (0.0 ± 0.0); (-25.0 ± 50.0) with p = 0.00060]. Therefore, improvement in ODI [variation between control and laser groups: (19.6 ± 67.6); (-18.1 ± 88.2) with p = 0.018]; improvement in snoring time (64.8 ± 179.1); (-1.5 ± 85.0) with p = 0.034 and in snoring noise peak amplitude (-8.3 ± 12.3); (-12.4 ± 15.8) with p = 0.029. No major adverse events or side effects were observed. Conclusion: Non-ablative laser treatment is effective in rehabilitation of patients with Sleep Breathing Disorder. In the protocol used in this study, the procedure is performed in outpatiente basis, without medication or anesthesia. Increasing the lumen of the upper airway by decreasing tissue flaccidity, leads to the improvement of oxyhemoglobin desaturation index (ODI), snoring time during sleep and peak amplitude of snoring noise.Resumo IPEN-doc 29997 Lasers não-ablativos de alta intensidade na apneia obstrutiva do sono2022 - MENDES, VALERIA; AZEVEDO, LUCIANE H.; ZEZELL, DENISE M.INTRODUÇÃO: O ronco primário e apneia grave representam as diferentes gravidades do mesmo distúrbio fisiopatológico, que afeta em torno de um bilhão de pessoas em todo o mundo. É mais frequentemente em homens e idosos. O ruído é causado pela vibração dos tecidos moles na área mais constrita das vias aéreas superiores. As opções terapêuticas usuais apresentam limitações e as publicações em literatura sobre os efeitos clínicos do uso de laser no manejo do ronco e AOS são escassas e pouco exploradas. OBJETIVOS: Após determinar as melhores condições de irradiação, este estudo tem como objetivo, avaliar o tratamento do ronco com irradiação de alta intensidade, sequencial e não-ablativa de dois lasers pulsados: Nd:YAG e Er:YAG (Lightwalker, Fotona). Os resultados obtidos com o tratamento são comparados às condições em linha de base. METODOLOGIA: Um estudo longitudinal, intervencionista e prospectivo está em andamento com a aprovação do comitê de ética em pesquisa. Até o momento, 32 de 40 voluntários que transitam entre ronco primário e apneia obstrutiva do sono moderada foram tratados em três sessões de irradiação laser não-ablativa. O intervalo entre as sessões foi de14 dias. O volume do espaço orofaríngeo foi analisado por registro fotográfico, de acordo com o índice Mallampati modificado. Saturação de oxigênio, gravidade do ronco e qualidade do sono também serão avaliados. RESULTADOS ESPERADOS: O principal resultado clínico obtido será a expansão da luz da via aérea superior pela diminuição da complacência tecidual. Com isso, redução ou eliminação do ronco.Dissertação IPEN-doc 29487 Non-ablative treatment of sleep breathing disorders with the association of two high-intensity pulsed lasers2022 - MENDES, VALERIAPrimary snoring and obstructive sleep apnea (OSA) represent different severity degrees of the same chronic, complex and progressive disease, which affects about one billion people worldwide. It is more prevalent in elderly men. Historically, snoring is seen as a social problem, being considered the most benign form of sleep breathing disorders (SBD). Because of this, treatment is not prescribed. Snoring noise occurs as a result of soft tissue vibration in the region of upper airway (UA) greater constriction during sleep. Therapeutic options may involve medical treatments, use of devices, and surgical procedures. As for the results, all of them have limitations. Adherence to treatment and cases of relapse over time represent the greatest challenge in disease control. Increased cardiovascular risk, emergence of chronic diseases and use of medications result from worsening and disease progression. A dysregulation of palatopharyngeal muscle tone plays a significant role in this disorder. After determining the best irradiation conditions, this study aims to evaluate the treatment of SBD with high intensity non-ablative irradiation with two pulsed lasers: Nd:YAG laser (1064 nm) followed by Er:YAG laser (2940 nm), both from Fotona LightWalker platform, comparing results before and after the intervention. A controlled, randomized, double-blind clinical trial was performed with approval of the research ethics committee. Thirty volunteers that transitioned between primary snoring and moderate obstructive sleep apnea were treated in three sessions of non-ablative laser irradiation, with a 14-day interval between them. The upper airway lumen for airflow passage was analyzed by photographic record, according to modified Mallampati index. Oxyhemoglobin desaturation parameters, severity of snoring (noise amplitude and sleep time with snoring) as well as aspects of sleep quality were also evaluated. The main clinical result obtained is the expansion of the upper airways lumen by reduction of tissue compliance in an outpatient procedure. Therefore, improvement of sleep breathing disorder.Resumo IPEN-doc 29205 High-intensity non-ablative lasers in sleep-disordered breathing2022 - MENDES, V.; AZEVEDO, L.H.; ZEZELL, D.M.Primary snoring and severe apnea are considered sleep-disordered breathing and represent different degrees of severity of the same disorder which affects around one billion people worldwide. It is more common in men and the elderly. The noise is caused by the soft tissues's vibration in the regions of greatest constriction of the upper airways. Increased cardiovascular risk, emergence of chronic diseases and use of medications are due to the progression and evolution of the disease. After determining optimal irradiation conditions, this study aimed to evaluate the treatment of snoring with sequential high-intensity non-ablative irradiation with two pulsed lasers Nd:YAG and Er:YAG comparing the results before and after treatment. A randomized, double-blind, controlled clinical trial is underway with the approval of the research ethics committee. To date, 32 of 40 volunteers transitioning between primary snoring and moderate obstructive sleep apnea have been treated in three sessions of nonablative laser irradiation, 14 days apart. The volume of the oropharyngeal space for air passage was analyzed by photographic record according to the modified Mallampati index. Oxygen saturation, snoring severity and sleep quality will also be evaluated. The primary clinical outcome obtained was the expansion of the upper airway lumen by reducing tissue compliance and, therefore, reducing or eliminating snoring, in an outpatient procedure. The reduction of snoring is due to the decrease in tissue compliance.