Atuação da Fisioterapia no tratamento dos distúrbios respiratórios do sono
The role of Physical Therapy in the treatment of sleep-disordered breathing
Flávia Baggio Nerbass, Vivien Schmeling Piccin, Bruno Burigo Peruchi, Daiana Moreira Mortari, Daisy Satomi Ikeda, Fabrício Olinda de Souza Mesquita
Resumo
Introdução: O termo distúrbios respiratórios do sono (DRS) refere-se a padrões de respiração anormal ou redução anormal da troca gasosa que ocorrem durante o sono. Incluem a apneia obstrutiva do sono, a hipoventilação e a apneia central do sono. Quando não diagnosticados e não tratados, os DRS constituem um grave problema de saúde pública, dada a sua alta prevalência e suas graves consequências para a saúde. A pressão positiva na via aérea (PAP) é o tratamento de primeira linha para os DRS moderados a graves. Muitas vezes, o uso da PAP requer a associação de outras estratégias ventilatórias, ou até mesmo o uso de oxigenoterapia suplementar por doenças concomitantes aos DRS. Objetivo: abordar aspectos importantes dos DRS, incluindo: conceitos, implicações clínicas, métodos diagnósticos e opções de tratamentos. Resultados e Conclusões: O papel do fisioterapeuta, dentro da equipe multidisciplinar que atua para o tratamento dos DRS, é discutido amplamente, inclusive como sendo o profissional mais indicado para adaptar o paciente à PAP. Essa atribuição se dá pelo amplo conhecimento desse profissional sobre a fisiologia e fisiopatologia do sistema respiratório, e sobre os efeitos da pressão positiva na interação coração-pulmão. Além disso, destaca-se que o fisioterapeuta respiratório com experiência na área do sono atua não somente na adaptação do paciente à PAP, mas também orienta sobre o cuidado com o equipamento e acessórios, cuidados com higiene do sono, posicionamento durante o sono e, principalmente, no acompanhamento do paciente durante todo o tratamento, resolvendo problemas e melhorando a adesão e o sucesso terapêutico. Por final, são apresentados os atuais desafios para o tratamento dos DRS e medidas da Associação Brasileira de Fisioterapia Cardiorrespiratória e Fisioterapia em Terapia Intensiva (ASSOBRAFIR), para incentivar a atuação e a formação de fisioterapeutas na área do sono, com destaque para o reconhecimento da Fisioterapia Aplicada aos Distúrbios do Sono.
Palavras-chave
Abstract
Backgroud: The term sleep-disordered breathing (SDB) refers to abnormal breathing patterns or abnormal reduction in gas exchange that occur during sleep. It includes obstructive sleep apnea, hypoventilation and central sleep apnea. When undiagnosed and untreated, SDB constitutes a serious public health problem given its high prevalence and serious consequences for health. Positive airway pressure (PAP) is the first- line treatment for moderate to severe SDB. Oftentimes the PAP requires association with other ventilatory strategies, or even supplemental oxygen therapy due to concomitant diseases. Objective: to discuss relevant aspects of SDB, including: concepts, clinical implications, diagnostic and treatment options for SDB. Results and Conclusions: The role of the physiotherapist in a multidisciplinary team is widely discussed, including the fact that the physiotherapist appears to be the most appropriate professional to adapt the patient to PAP. It is attributed to his vast knowledge of physiology and pathophysiology of the respiratory system, and of the effects of PAP on heart-lung interactions. Furthermore, the article emphasizes that the respiratory physiotherapist with expertise in sleep disorders works not only in the patients adaptation to PAP, but also instructs them in taking care of equipment and accessories, sleep hygiene, sleep positioning and, especially works monitoring the patient throughout the treatment, solving problems and improving adherence and treatment success. Finally, the current challenges of SDB treatment and actions of the Brazilian Association of Cardiorespiratory Physical Therapy and Intensive Care Physical Therapy (ASSOBRAFIR) to encourage training of physiotherapists in sleep care are presented, highlighting the importance of the recognition of the Physical Therapy for Sleep Disorders.
Keywords
Referências
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