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Impact of continuous positive pressure (CPAP) treatment in patients with systemic arterial hypertension (SAH) and obstructive sleep apnea syndrome (OSAS): case report
The association between hypertension and OSAS it is considered worrying because they involve conditions that lead to serious cardiovascular problems with consequent increase in deaths, if not properly treated. It has been reported that in hypertensive patients the prevalence of OSAS is 35%, so it is relevant to consider the appropriate therapy for this association. The treatment of isolated hypertension is known to involve the selection of medications and an increase in lifestyle change. However, in OSAS, CPAP predilection is considered the ideal standard; however, there is no consensus on the exact CPAP values to lower systolic and diastolic pressures.
To demonstrate the management of CPAP treatment in two patients with refractory hypertension and severe and moderate OSAS.
study of two cases, a 53-year-old man (A) and another 68-year-old woman (B) from medical services and referred after polysomnography examination to a specialized sleep physiotherapy service in the metropolitan region of Porto Alegre/RS. Patient A's hypopnea apnea index (AHI) was 113 events with a minimum SatO2 of 85%, and patient B had AHI of 23 events and a minimum SatO2 of 81%. Both had symptoms of excessive sleepiness, complaints of memory loss and poor occupational and home-based performance. Self-titration exam (automatic equipment) was performed for 6 nights accompanied by physiotherapist. Satisfactory when considered to be 4 hours per night / use, without significant leakage,> 24 liters per minute for, ≥ 30% of use time and a residual AHI (measured by the device) ≤ 5 events / hour.
After titration, follow-up and educational guidance (explanation about the disease, equipment, treatment and adherence factors), patient A evolved with 13 cm H2O fixed pressure equipment and 3.5 events AHI, maintaining 80% adherence in 49 patients. days of use and patient B with a fixed pressure of 7 cmH20, AHI of 5 and 77% adherence at 89 days of use. Both had a reduction in blood pressure values documented by an attending physician.
Self-titration accompanied by professional, educational guidelines were able to ensure treatment and adherence of the association of hypertension and OSAS.
Hypertension, Sleep Apnea, Adherence, Treatment, Continuous Positive Pressure
Relato de Caso
FACTUM - Rio Grande do Sul - Brasil
VERONICA SILVA PAIVA