Efeito da pressão positiva aguda na cavidade nasal

Detalhes bibliográficos
Autor(a) principal: Balsalobre Filho, Leonardo Lopes [UNIFESP]
Data de Publicação: 2018
Tipo de documento: Tese
Idioma: por
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6465626
https://repositorio.unifesp.br/handle/11600/52813
Resumo: Introduction: Many studies have shown the influence of nasal obstruction on sleep disorders and adaptation to continuous positive airway pressure (CPAP). However, data are lacking on the impact of continuous positive pressure on the nasal cavity – whether in healthy individuals or patients with allergic rhinitis – and on the effect, if any, of topical corticosteroids on nasal patency after exposure to CPAP. In addition, it has been hypothesized that increasing interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis may decrease polyp size. Objective: The overarching goal of this series of studies was to evaluate the effect of continuous positive pressure on the nasal cavity of healthy individuals, subjects with allergic rhinitis, and subjects with nasal polyposis by objective and subjective methods. Methods: Three studies were carried out. The first included 27 subjects who were exposed to 2 hours of positive nasal pressure by CPAP via nasal mask with a pressure of 20 cm/H2O. A questionnaire on nasal allergic symptoms was applied, and participants were subsequently divided into two groups: with and without nasal allergic symptoms. Four methods were applied immediately before and after exposure to positive pressure: a visual analogue scale (VAS) of nasal obstruction; the Nasal Obstruction Symptom Evaluation (NOSE) scale; peak nasal inspiratory flow (PNIF) measurement; and acoustic rhinometry (AcRh). For the second study, 10 patients with nasal allergic rhinitis were exposed to 1 hour of positive nasal pressure by CPAP via nasal mask with a pressure of 15 cm/H2O. VAS, NOSE, PNIF, and AcRh measurements were obtained immediately before exposure to positive pressure. Topical intranasal budesonide therapy (400 mcg/day) was administered for 4 weeks, and the aforementioned tests were performed again, now before and after exposure to positive pressure. For the third study, 12 patients with nasal polyposis and 27 controls without polyposis were exposed to CPAP (20 cm/H2O) for 2 hours. VAS, NOSE, PNIF, AcRh, and nasal endoscopy (for polyp grading with the Meltzer Clinical Scoring System) were performed before and after the intervention. Results: In the first study, an increase in nasal obstruction was observed both on subjective parameters (VAS and NOSE) and on objective evaluation (reduction of nasal cavity volume on AcRh and lower PNIF). Deterioration of indicators of nasal patency was worse in subjects with nasal allergic complaints. In the second study, comparison of VAS, NOSE, PNIF, and AcRh findings after and before topical budesonide therapy and after exposure to positive pressure showed a statistically significant improvement in nasal obstruction scores and indicators of nasal patency. In the third study, for the polyposis group, VAS, NOSE and AcRh findings did not differ significantly (p=0.72, p=0.73, and p=0.17, respectively), but PNIF worsened (p=0.04) after exposure to CPAP. There was a statistically significant reduction in nasal polyp volume (p=0.04). The control group experienced deterioration of all measured parameters of nasal obstruction. Conclusion: Acute exposure to positive pressure via CPAP impairs nasal patency. This effect is even more pronounced in individuals with nasal allergic symptoms. Topical corticosteroid therapy was able to mitigate the irritant effects of CPAP on the nasal mucosa, leading to improvement of nasal patency parameters. In patients with nasal polyposis, CPAP exposure reduced the size of nasal polyps, but also reduced nasal patency as measured by PNIF. However, it had no significant effects on acoustic rhinometry findings or clinical symptoms of nasal obstruction.
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spelling Efeito da pressão positiva aguda na cavidade nasalEffects of acute positive pressure on the nasal cavityNasal polypNasal obstructionChronic rhinosinusitisPólipo nasalCPAPObstrução nasalRinossinusite crônicaIntroduction: Many studies have shown the influence of nasal obstruction on sleep disorders and adaptation to continuous positive airway pressure (CPAP). However, data are lacking on the impact of continuous positive pressure on the nasal cavity – whether in healthy individuals or patients with allergic rhinitis – and on the effect, if any, of topical corticosteroids on nasal patency after exposure to CPAP. In addition, it has been hypothesized that increasing interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis may decrease polyp size. Objective: The overarching goal of this series of studies was to evaluate the effect of continuous positive pressure on the nasal cavity of healthy individuals, subjects with allergic rhinitis, and subjects with nasal polyposis by objective and subjective methods. Methods: Three studies were carried out. The first included 27 subjects who were exposed to 2 hours of positive nasal pressure by CPAP via nasal mask with a pressure of 20 cm/H2O. A questionnaire on nasal allergic symptoms was applied, and participants were subsequently divided into two groups: with and without nasal allergic symptoms. Four methods were applied immediately before and after exposure to positive pressure: a visual analogue scale (VAS) of nasal obstruction; the Nasal Obstruction Symptom Evaluation (NOSE) scale; peak nasal inspiratory flow (PNIF) measurement; and acoustic rhinometry (AcRh). For the second study, 10 patients with nasal allergic rhinitis were exposed to 1 hour of positive nasal pressure by CPAP via nasal mask with a pressure of 15 cm/H2O. VAS, NOSE, PNIF, and AcRh measurements were obtained immediately before exposure to positive pressure. Topical intranasal budesonide therapy (400 mcg/day) was administered for 4 weeks, and the aforementioned tests were performed again, now before and after exposure to positive pressure. For the third study, 12 patients with nasal polyposis and 27 controls without polyposis were exposed to CPAP (20 cm/H2O) for 2 hours. VAS, NOSE, PNIF, AcRh, and nasal endoscopy (for polyp grading with the Meltzer Clinical Scoring System) were performed before and after the intervention. Results: In the first study, an increase in nasal obstruction was observed both on subjective parameters (VAS and NOSE) and on objective evaluation (reduction of nasal cavity volume on AcRh and lower PNIF). Deterioration of indicators of nasal patency was worse in subjects with nasal allergic complaints. In the second study, comparison of VAS, NOSE, PNIF, and AcRh findings after and before topical budesonide therapy and after exposure to positive pressure showed a statistically significant improvement in nasal obstruction scores and indicators of nasal patency. In the third study, for the polyposis group, VAS, NOSE and AcRh findings did not differ significantly (p=0.72, p=0.73, and p=0.17, respectively), but PNIF worsened (p=0.04) after exposure to CPAP. There was a statistically significant reduction in nasal polyp volume (p=0.04). The control group experienced deterioration of all measured parameters of nasal obstruction. Conclusion: Acute exposure to positive pressure via CPAP impairs nasal patency. This effect is even more pronounced in individuals with nasal allergic symptoms. Topical corticosteroid therapy was able to mitigate the irritant effects of CPAP on the nasal mucosa, leading to improvement of nasal patency parameters. In patients with nasal polyposis, CPAP exposure reduced the size of nasal polyps, but also reduced nasal patency as measured by PNIF. However, it had no significant effects on acoustic rhinometry findings or clinical symptoms of nasal obstruction.Introdução: A influência da obstrução nasal nos distúrbios do sono e na adaptação ao CPAP tem sido amplamente demonstrada. Entretanto, poucos estudos mostram o impacto da pressão positiva contínua na cavidade nasal, seja em indivíduos normais, ou em pacientes com rinite alérgica; assim como o efeito do corticosteroide tópico na patência nasal após a exposição ao CPAP. Além disso, despeito dos poucos dados, acreditase que o aumento da pressão hidrostática intersticial nos pólipos de pacientes com rinossinusite crônica com pólipos nasais possa diminuir o volume dos mesmos Objetivo: Esta linha de pesquisa teve como objetivo geral avaliar o efeito da pressão positiva contínua na cavidade nasal de indivíduos normais, com rinite alérgica e com pólipos nasais, por meio de métodos objetivos e subjetivos. Método: Três pesquisas foram realizadas. A primeira incluiu 27 indivíduos que foram expostos a pressão positiva nasal por 2 horas por meio de CPAP e máscara nasal com pressão de 20cm/H2O. Um questionário sobre sintomas alérgicos nasais foi aplicado e 2 grupos foram estabelecidos – com e sem sintomas alérgicos nasais. Imediatamente antes e após a exposição à pressão positiva, escores de obstrução nasal foram obtidos pela escala visual analógica (EVA), pela escala de sintomas de obstrução nasal (NOSE), pelo pico de fluxo nasal inspiratório e por rinometria acústica. No segundo estudo, 10 pacientes com rinite alérgica nasal foram expostos a pressão positiva nasal por 1 hora com CPAP e máscara nasal com pressão de 15cm/H2O. Os mesmos testes foram aplicados imediatamente antes e após exposição à pressão positiva. Após tratamento com budesonida tópica nasal na dose de 400mcg/dia por 4 semanas os testes foram novamente realizados antes e após a exposição à pressão positiva. No terceiro estudo, 12 pacientes com rinossinusite crônica com pólipos nasais e 27 controles foram expostos a CPAP (20cm/H2O) por 2 horas. Os testes para mensuração dos escores de obstrução nasal, assim como a endoscopia nasal (graduação de pólipos de Meltzer) foram realizados antes e depois da intervenção. Resultados: No primeiro estudo, observouse aumento da obstrução nasal tanto nos testes subjetivos (EVA e NOSE) como nas avaliações objetivas, mostrando redução do volume da cavidade nasal na rinometria acústica e diminuição do pico de fluxo nasal inspiratório. Indivíduos com queixas alérgicas nasais, apresentaram uma piora mais acentuada nos parâmetros da permeabilidade nasal. No segundo estudo, a comparação entre os testes antes e após o uso da budesonida tópica e após a exposição à pressão positiva mostrou uma melhora nos escores de obstrução nasal e patência nasal, estatisticamente significantes. No terceiro estudo, para o grupo de pacientes com rinossinusite com pólipos nasais, EVA, NOSE e rinomanometria não diferiram significantemente (p = 0,72, p = 0,73 e p = 0,17, respectivamente), mas os valores do pico de fluxo nasal inspiratório pioraram (p = 0,04) após a exposição ao CPAP. Houve redução estatisticamente significante nos pólipos nasais (p = 0,04). O grupo controle apresentou piora dos parâmetros de obstrução nasal em todos os testes utilizados. Conclusão: A exposição aguda à pressão positiva com CPAP, deteriora a patência nasal e em indivíduos com sintomas alérgicos nasais, a piora é ainda mais acentuada. O uso do corticoide tópico é capaz de mitigar os efeitos irritativos na mucosa nasal da pressão positiva, levando a uma melhora dos parâmetros da patência nasal. Pacientes com rinossinusite crônica com pólipos nasais expostos a CPAP apresentam redução do volume dos pólipos nasais, embora a patência nasal, estabelecida pelo pico de fluxo nasal inspiratório e pela rinometria acústica não determine efeitos significativos nos sintomas de obstrução nasalDados abertos - Sucupira - Teses e dissertações (2018)Coordenação de Aperfeiçoamento de Pesquisa de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP)Fujita, Reginaldo Raimundo [UNIFESP]Gregório, Luís Carlos [UNIFESP]http://lattes.cnpq.br/3121718741179338http://lattes.cnpq.br/3164472905601886Universidade Federal de São Paulo (UNIFESP)Balsalobre Filho, Leonardo Lopes [UNIFESP]2020-03-25T12:10:33Z2020-03-25T12:10:33Z2018-10-25info:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/publishedVersion68 f.application/pdfhttps://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=64656262018-0757.pdfhttps://repositorio.unifesp.br/handle/11600/52813porSão Pauloinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-02T18:38:21Zoai:repositorio.unifesp.br/:11600/52813Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-08-02T18:38:21Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Efeito da pressão positiva aguda na cavidade nasal
Effects of acute positive pressure on the nasal cavity
title Efeito da pressão positiva aguda na cavidade nasal
spellingShingle Efeito da pressão positiva aguda na cavidade nasal
Balsalobre Filho, Leonardo Lopes [UNIFESP]
Nasal polyp
Nasal obstruction
Chronic rhinosinusitis
Pólipo nasal
CPAP
Obstrução nasal
Rinossinusite crônica
title_short Efeito da pressão positiva aguda na cavidade nasal
title_full Efeito da pressão positiva aguda na cavidade nasal
title_fullStr Efeito da pressão positiva aguda na cavidade nasal
title_full_unstemmed Efeito da pressão positiva aguda na cavidade nasal
title_sort Efeito da pressão positiva aguda na cavidade nasal
author Balsalobre Filho, Leonardo Lopes [UNIFESP]
author_facet Balsalobre Filho, Leonardo Lopes [UNIFESP]
author_role author
dc.contributor.none.fl_str_mv Fujita, Reginaldo Raimundo [UNIFESP]
Gregório, Luís Carlos [UNIFESP]
http://lattes.cnpq.br/3121718741179338
http://lattes.cnpq.br/3164472905601886
Universidade Federal de São Paulo (UNIFESP)
dc.contributor.author.fl_str_mv Balsalobre Filho, Leonardo Lopes [UNIFESP]
dc.subject.por.fl_str_mv Nasal polyp
Nasal obstruction
Chronic rhinosinusitis
Pólipo nasal
CPAP
Obstrução nasal
Rinossinusite crônica
topic Nasal polyp
Nasal obstruction
Chronic rhinosinusitis
Pólipo nasal
CPAP
Obstrução nasal
Rinossinusite crônica
description Introduction: Many studies have shown the influence of nasal obstruction on sleep disorders and adaptation to continuous positive airway pressure (CPAP). However, data are lacking on the impact of continuous positive pressure on the nasal cavity – whether in healthy individuals or patients with allergic rhinitis – and on the effect, if any, of topical corticosteroids on nasal patency after exposure to CPAP. In addition, it has been hypothesized that increasing interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis may decrease polyp size. Objective: The overarching goal of this series of studies was to evaluate the effect of continuous positive pressure on the nasal cavity of healthy individuals, subjects with allergic rhinitis, and subjects with nasal polyposis by objective and subjective methods. Methods: Three studies were carried out. The first included 27 subjects who were exposed to 2 hours of positive nasal pressure by CPAP via nasal mask with a pressure of 20 cm/H2O. A questionnaire on nasal allergic symptoms was applied, and participants were subsequently divided into two groups: with and without nasal allergic symptoms. Four methods were applied immediately before and after exposure to positive pressure: a visual analogue scale (VAS) of nasal obstruction; the Nasal Obstruction Symptom Evaluation (NOSE) scale; peak nasal inspiratory flow (PNIF) measurement; and acoustic rhinometry (AcRh). For the second study, 10 patients with nasal allergic rhinitis were exposed to 1 hour of positive nasal pressure by CPAP via nasal mask with a pressure of 15 cm/H2O. VAS, NOSE, PNIF, and AcRh measurements were obtained immediately before exposure to positive pressure. Topical intranasal budesonide therapy (400 mcg/day) was administered for 4 weeks, and the aforementioned tests were performed again, now before and after exposure to positive pressure. For the third study, 12 patients with nasal polyposis and 27 controls without polyposis were exposed to CPAP (20 cm/H2O) for 2 hours. VAS, NOSE, PNIF, AcRh, and nasal endoscopy (for polyp grading with the Meltzer Clinical Scoring System) were performed before and after the intervention. Results: In the first study, an increase in nasal obstruction was observed both on subjective parameters (VAS and NOSE) and on objective evaluation (reduction of nasal cavity volume on AcRh and lower PNIF). Deterioration of indicators of nasal patency was worse in subjects with nasal allergic complaints. In the second study, comparison of VAS, NOSE, PNIF, and AcRh findings after and before topical budesonide therapy and after exposure to positive pressure showed a statistically significant improvement in nasal obstruction scores and indicators of nasal patency. In the third study, for the polyposis group, VAS, NOSE and AcRh findings did not differ significantly (p=0.72, p=0.73, and p=0.17, respectively), but PNIF worsened (p=0.04) after exposure to CPAP. There was a statistically significant reduction in nasal polyp volume (p=0.04). The control group experienced deterioration of all measured parameters of nasal obstruction. Conclusion: Acute exposure to positive pressure via CPAP impairs nasal patency. This effect is even more pronounced in individuals with nasal allergic symptoms. Topical corticosteroid therapy was able to mitigate the irritant effects of CPAP on the nasal mucosa, leading to improvement of nasal patency parameters. In patients with nasal polyposis, CPAP exposure reduced the size of nasal polyps, but also reduced nasal patency as measured by PNIF. However, it had no significant effects on acoustic rhinometry findings or clinical symptoms of nasal obstruction.
publishDate 2018
dc.date.none.fl_str_mv 2018-10-25
2020-03-25T12:10:33Z
2020-03-25T12:10:33Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/doctoralThesis
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format doctoralThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6465626
2018-0757.pdf
https://repositorio.unifesp.br/handle/11600/52813
url https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6465626
https://repositorio.unifesp.br/handle/11600/52813
identifier_str_mv 2018-0757.pdf
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dc.format.none.fl_str_mv 68 f.
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dc.coverage.none.fl_str_mv São Paulo
dc.publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
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reponame_str Repositório Institucional da UNIFESP
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repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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