Congenital choanal stenosis as a risk factor for the syndrome of Upper Airway Resistance (UARS) is not well described. The report case aim is to analyze disorders of sleep microstructure in a patient with choanal stenosis and UARS.

Man, 22 years, mouth breathing, with diagnosis of allergic rhinitis, Attention Deficit Hyperactivity Disorder and insomnia. Adenoid face, tonsils 2 + / 4 by Brodsky Classification, Modified Mallampati 1, high-arched palate, no craniofacial deformities. Obese Grade 1, 40cm of neck circumference, 98cm of waist circumference. Nasal endoscopy with bilateral choanal stenosis without other malformations. Epworth Sleepiness Scale = 2. In Polysomnography (PSG), there were null AHI, 9/h of respiratory disturbance index, by elevated RERA index. No oxyhemoglobin desaturation, reduced sleep efficiency, reduced percentage of REM sleep. Increased arousal rate (16/h), nasal cannula with permanent flattening of the curve and Cyclic Alternating Pattern (CAP) in stage 2 non-REM sleep.

The congenital bilateral nasal stenosis undiagnosed in the neonatal period is relevant. The consequence of this adaptation to airflow limitation in the upper airway is noticed by the adenoid face, neuromuscular and cognitive changes. Nasal flow is not well defined as a risk factor for Obstrutive Sleep Apnea Disorders. Also it is not related to significant oxyhemoglobin desaturation, or apnea / hypopnea. However, it can improve CPAP adaptation. The microstructure of sleep shows arousals and CAP. The later is an event of cerebral electrical activity with periods of activation and inhibition during the second phase of non-REM sleep. It’s a partial activation of the brain and indicates instability of sleep, being related to reduce quality of sleep and also insomnia. It’s possible that the increased number of awakenings compromises REM quality and quantity, causing a possibly non-restorative sleep and sleep fragmentation.

CAP inclusion in AASM manual may increase PSG sensitivity and diagnosis neglected disorders

The BODE index is an important component that assesses the systemic manifestations of COPD. Patients with this disease have impaired quality of life; an important component that measures the quality of life is the SF-36 Questionnaire. This study aimed to verify the changes of the index BODE occurred in the period of 1 year in Pulmonary Rehabilitation and current analysis of their quality of life. The study was attended by ten patients with COPD in staging me, II, III and IV, of both gender, average age 71.6 ± 9.1, participants of the PRP in the period of 1 year. The results showed that BMI, BDI and DP6 had a small increase, the FEV1 and handgrip a small reduction, but without significant difference. The index BODE and values on the scale of the MMRC decreased, but this decline is a factor for improvement. Patients with severe disease III and IV received greater airflow obstruction, BODE index higher quality of life and more damaged. Reconnecting the index BODE with areas of the SF-36 Questionnaire, we found that the larger the field SA, the more peripheral muscle strength, and how much better mental health, lower intensity of dyspnea. A lower score in the BODE index showed relationship with greater functional capacity. We conclude that patients with more advanced staging of the disease (III and IV) have bigger commitments spirometry and scores of the index BODE and impaired quality of life more than patient with staging II and I.

Our aim was to measure the loss and the compliance of the pulmonary vessels in the different GOLD stages of COPD and to assess the relationship between these and the Pulmonary Artery Pressure (PAP). Patients affected by COPD with Pulmonary Hypertension (PH) (n=39, FEV1 39±15%, PaO2 60±12 mmHg, PaCO2 46±10 mmHg, PAP 33±8 mmHg) and without PH (n=39, FEV1 43±21%, PaO2 62±12 mmHg, PaCO2 39±9 mmHg, PAP17±5 mmHg) were studied in stable state and divided in three groups belonging to stage I-II, III and IV GOLD stage respectively. Each subset was compared to healthy people (n=13). PAP and pressure / flow relationship (PAP/Q) were measured by catheterization of pulmonary artery and effort test. Vessels loss was measured by perfusive scintigraphy. Lung vessels loss is significant even in former stages, showing a progressive trend (20±4, 28±4, 30±5 in stages I-II, III and IV resp.; 3±1% in healthy people (h.p.)) and a significant relationship with airways obstruction. In patients with PH it was higher even in I stage (30%). The apico-basal gradient of perfusion was significantly inverted (1.87±0.4 in COPD, 1.86±0.6 in COPD+PH and 0.625±0.2 in h.p.). Compliance was slightly higher in PH (PAP/Q= 1.8+1.2 mmHg/L/m vs 1.6+0.9 in COPD and h.p.). Vessels loss was found not to be significantly related to PH. Under effort higher pressures due to lesser vessel recruitment and a leftward shift of P/Q trace could be observed. Vascular rarefaction is an early feature of COPD. PH looks not dependent solely upon vessels loss but upon different pathways such as organic remodelling and vasospastic response to hypoxia.