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SELF-ASSESSMENT AND IMPACT ON VOCAL QUALITY AFTER 3 MONTHS OF CONTINUOUS USE OF CPAP
Patients with Obstructive Sleep Apnea - OSA may have laryngopharyngeal symptoms that interfere in quality of voice. Continuous Positive Airway Pressure – CPAP therapy is the gold standard treatment for OSA. CPAP with humidifier has the highest indication and the least adverse effects and could also bring benefits even to the vocal quality since it reduces nocturnal gastroesophageal reflux and prevents snoring and upper airway dryness. However, the relationship between vocal quality associated with the use of CPAP is controversial.
To verify patients' perception and clinical assessment of vocal quality in patients with OSA before and after continuous use of CPAP.
Controlled and randomized clinical trial; 37 male participants with OSA (apnea-hypopnea index ≥20 / hour), age between 35-65 years old and body mass index <35 kg / m2; randomly allocated in two groups: CPAP (n = 25) or sham-CPAP (n = 12). The participants answered a protocol twice: pre-therapy and after 3 months. The analyzed outcomes were: 1. Epworth Sleepiness Scale - ESS, 2. Pittsburgh Sleep Quality Index - PSQI, 3. Voice Handicap Index - VHI-10, 4. Laryngopharyngeal Reflux Symptoms Index - LPRSI and 5. Visual Analogue Scale - VAS for oral dryness. Their voices were recorded at three times - pre-therapy, after 1 month (initial therapy) and after 3 months (minimum therapy) of continuous use of CPAP; the degree of voice deviation was quantified by the Acoustic Voice Quality Index - AVQI.
At the pre-therapy moment, the AVQI score indicated vocal deviation (mean = 1.51 ± 1.29); after 1 month the score reduced to the normal value (mean = 1.08 ± 0.94); however, after 3 months of treatment, the mean score returned to the initial value (mean = 1.40 ± 1.17); statistical analysis failed to show differences between moments (p = 0.493) or between groups (p = 0.115). After 3 months of treatment, it was possible to observe a treatment effect on ESS (p = 0.017) for the CPAP group, which was expected. There was also a difference for the PSQI due to the moment of assessment (p <0.001) regardless of the intervention group. There was no difference between groups or between moments for the vocal parameters evaluated.
There was an improvement in the quality of self-reported sleep in both groups; the CPAP group showed a higher reduced sleepiness than the Sham-CPAP group. There is no evidence that CPAP therapy interferes with the vocal quality.
Voice; Vocal Quality; Self-assessment; AVQI; CPAP
UNIFESP - São Paulo - Brasil
Bruna Rainho Rocha, Vanessa Veis Ribeiro, Dalva Lúcia Rollemberg Poyares, Mara Rocha Behlau