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"Tesis ini disusun untuk menilai pengaruh latihan penguatan otot-otot ekspirasi dalam mengurangi gejala sleep apnea pada pasien Obstructive Sleep Apnea dengan obesitas menggunakan metode penelitian Evidence-Based Case Report (EBCR). Pencarian literatur dilakukan pada Pubmed, ProQuest, EBSCOHost, Scopus dan Cochrane sesuai dengan pertanyaan klinis. Penelitian ini menggunakan Randomized Controlled Trial pada satu jurnal yang didapat untuk menilai kualitasnya berdasarkan validitas, kepentingan dan aplikabilitasnya. Dari hasil Randomized Controlled Trial didapatkan bahwa subjek penelitian adalah pasien Obstructive Sleep Apnea dengan obesitas. Kesimpulan penelitian ini adalah latihan penguatan otot-otot ekspirasi dapat mengurangi gejala sleep apnea dengan menurunkan nilai Apnea-Hypopnea Index pada pasien Obstructive Sleep Apnea

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This thesis was designed to assess the effect of expiratory muscle strengthening exercises in reducing sleep apnea symptoms in Obstructive Sleep Apnea patients with obesity using an evidence-based case report (EBCR) research method. A literature search was performed on Pubmed, ProQuest, EBSCOHost, Scopus and Cochrane according to clinical questions. This study uses a Randomized Controlled Trial in one journal obtained to assess its quality based on its validity, importance and applicability. From the results of the Randomized Controlled Trial, it was found that the research subjects were Obstructive Sleep Apnea patients with obesity. The conclusion of this study is that expiratory muscle strengthening exercises can reduce sleep apnea symptoms by reducing the Apnea-Hypopnea Index value in Obstructive Sleep Apnea patients"

"ABSTRAKObstructive sleep apnea (OSA) is a disease with recurrent episodic of partial or total upper airway collapse during sleep. Snoring is a main symptom of OSA because it may be caused by upper airway collapse during sleep. Several risk factors has been identified as risk factors for OSA. They are male gender, increased of age, overweight or obesity, big neck, craniofacial abnormality, upper airway disease or abnormality, smoking, gene, menopause, nasal congestion, and alcohol consumption. Overweight or obesity are major risk factor of OSA. Obesity also increased progressivity of OSA. "

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Latar belakang: Penggunaan aminofilin intravena masih merupakan terapi pilihan untuk mengatasi apnea of prematurity (AOP) pada bayi prematur di Indonesia karena obat tersebut lebih mudah diperoleh dan harganya lebih murah walaupun mempunyai jendela terapi yang sempit. Pemeriksaan kadar teofilin serum perlu dilakukan untuk menilai efektifitas dan keamanan obat tersebut. Faktor-faktor yang memengaruhi efektifitas dan keamanan penggunaan aminofilin intravena pada bayi prematur dalam pengobatan apnea of prematurity di unit Neonatologi belum jelas. 

Tujuan: Mengetahui efektifitas dan keamanan penggunaan aminofilin sebagai terapi apnea of prematurity dan faktor-faktor yang memengaruhinya.

Metode: Penelitian ini merupakan penelitian analitik dengan desain cohort prospektif. Subjek penelitian adalah 40 bayi prematur dengan usia gestasi kurang atau sama dengan 30 minggu di Unit Neonatologi Rumah Sakit Cipto Mangunkusumo (RSCM) di Jakarta pada bulan April 2019 hingga Oktober 2019. Bayi tersebut mendapat terapi aminofilin intravena dosis rumatan sebanyak lima kali dan dilakukan pemeriksaan kadar teofilin serum dengan menggunakan metode reversed phase high performance liquid chromatography diode array detector (RP-HPLC-DAD). Selanjutkan dilakukan pemantauan efektifitas dan efek samping yang terjadi selama pemberian aminofilin intravena. Analisis data dengan uji Kai kuadrat dan regresi logistik, hasil signifikan bila nilai p < 0,05.

Hasil: Pemberian aminofilin intravena 67,5% efektif sebagai terapi AOP pada bayi usia gestasi kurang dari 30 minggu. Faktor-faktor yang memengaruhi efektifitas penggunaan aminofilin intravena sebagai terapi AOP adalah berat lahir dan kadar teofilin serum dengan nilai p = 0,006 dan 0,022. Efek samping yang ditemukan pada pemberian aminofilin intravena adalah takikardi (37,5%) dan peningkatan diuresis (27,5%) pada kadar teofilin serum lebih dari 12 mg/mL. Faktor yang memengaruhi keamanan penggunaan terapi aminofilin intravena pada bayi prematur adalah kadar teofilin serum dengan nilai p < 0,001. 

Simpulan: Pemberian aminofilin intravena sebagai terapi AOP pada bayi prematur dengan usia kurang dari 30 minggu efektif dan aman. Namun perlu dilakukan pemantauan kadar teofilin serum mengingat pemberian aminofilin intravena sering menimbulkan efek samping.

 

Keywords: apnea of prematurity, aminofilin, efektifitas dan keamanan

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Background: Intravenous aminophylline still plays the role as the therapy of choice for apnea of prematurity (AOP) in Indonesia because the drug is easier
to obtain and the price is cheaper despite having a narrow window of therapy. An examination of serum theophylline levels needs to be performed to assess the effectiveness and safety of the drug. Factors that influence the effectiveness and safety in the treatment of apnea of prematurity in the Neonatology Unit remain unclear.

Aim: To determine the effectiveness and safety of using aminophylline as apnea of prematurity therapy and their influencing factors.

Methods: This research is an analytical study with a prospective cohort design. Subjects were 40 premature infants with gestational age less than or equal to 30 weeks in the Neonatology Unit of Cipto Mangunkusumo Hospital (RSCM) in Jakarta from April 2019 to Oktober 2019. The infants received intravenous 
aminophylline maintenance dosages five times and the levels of serum theophylline were examined using the reversed phase high performance liquid chromatography diode array detector (RP-HPLC-DAD) method. The follow up was set to monitor the effectiveness and side effects that occur during intravenous aminophylline administration. Data were analyzed using the Chi-square test and logistic regression. The results were considered significant if the p-value < 0,05.

Results: The administration of intravenous aminophylline 67.5% was effective as AOP therapy in infants of less than 30 weeks gestation. Factors that 
influence the effective use of intravenous aminophylline as AOP therapy are birth weight and serum theophylline levels with p = 0,006 and 0,022. Side effects that occurred were tachycardia (37.5%) and increased diuresis (27.5%) in serum theophylline levels of more than 12 mcg/mL. Factors that influence the safety of the use of intravenous aminophylline therapy in preterm infants are serum theophylline levels with p < 0,001.

Conclusion: Administration of intravenous aminophylline as AOP therapy in premature infants less than 30 weeks of age is effective and safe. However, it is necessary to monitor serum theophylline levels due to its frequent side 
effects occurence.

 

Keywords: apnea of prematurity, aminophylline, effectiveness and safety

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"Pendahuluan Bagi seorang pilot, OSA dapat berdampak terhadap keselamatan penerbangan dengan menimbulkan fatigue dan gangguan kognitif pada memori, atensi, perencanaan, kemampuan memecahkan masalah dan multitasking. Salah satu faktor predisposisi utama terjadinya OSA adalah peningkatan berat badan, serta faktor pekerjaan juga dapat mempengaruhi timbulnya risiko OSA.  Penelitian ini bertujuan untuk mengetahui hubungan antara obesitas dan faktor-faktor lainnya terhadap risiko OSA pada pilot sipil di Indonesia.Metode Penelitian ini menggunakan disain potong lintang dan dilakukan di Balai Kesehatan Penerbangan. Responden diminta mengisi kuesioner STOP-BANG untuk menilai risiko OSA, kuesioner Epworth Sleepiness Scale untuk mengukur Excessive Daytime Sleepiness, kuesioner Nasal Obstruction Symptom Evaluation untuk mengukur obstruksi di hidung, dan kuesioner Global Physical Activity Questionnaire untuk mengukur aktifitas fisik. Kemudian dilakukan pengukuran antropometri berupa body mass index dan lingkar leher.Hasil Didapatkan 176 responden dengan prevalensi risiko tinggi OSA sebesar 35,8%. Kemudian, obesitas dan lingkar leher ditemukan mempunyai hubungan bermakna dengan risiko tinggi OSA (p<0,05). Untuk faktor lainnya, ditemukan juga bahwa usia, tekanan darah, obstruksi hidung, penyempitan orofaring, dan merokok ditemukan hubungan bermakna dengan risiko tinggi OSA (p<0,05). Tidak terdapat hubungan bermakna antara faktor pekerjaan dengan risiko OSA (p>0,05). Untuk faktor-faktor yang paling berhubungan dengan risiko OSA ialah lingkar leher, penyempitan orofaring, dan obstruksi nasal (p<0,05).Kesimpulan Terdapat hubungan yang bermakna antara faktor antropometri yaitu BMI dan lingkar leher; faktor demografi yaitu usia; faktor komorbid yaitu tekanan darah, obstruksi hidung, dan penyempitan rongga orofaring; dan juga faktor kebiasaan yaitu merokok dengan risiko OSA. Tidak terdapat hubungan bermakna antara faktor pekerjaan dengan risiko OSA.

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Introduction In pilots, OSA can impact flight safety as it can cause fatigue and cognitive impairment in memory, attention, planning, problem-solving skills, and multitasking. Increased body weight can predispose to OSA, and occupational factors may influence risk development. This study aims to determine the relationship between obesity and other factors on the risk of OSA in civilian pilots in Indonesia.

Methods This study used a cross-sectional design and was conducted at the Aviation Health Center. Respondents were asked to fill out the STOP-BANG questionnaire to assess OSA risk, the ESS questionnaire to measure EDS, the NOSE questionnaire to measure nasal obstruction, and the GPAQ questionnaire to measure physical activity. Then anthropometric measurements were taken in the form of BMI and neck circumference.

Results From 176 respondents, 35,8% had a high risk of OSA. Obesity and neck circumference, age, blood pressure, nasal obstruction, oropharyngeal narrowing, and smoking were found to have a significant association with a high risk of OSA (p<0.05). There is no significant relationship between occupational factors and OSA risk (p>0.05). The factors most associated with OSA risk were neck circumference, oropharyngeal narrowing, and nasal obstruction (p<0.05).

Conclusion There is a significant relationship between anthropometric factors such as BMI and neck circumference; demographic factors such as age; comorbid factors such as blood pressure, nasal obstruction, and narrowing of the oropharyngeal cavity; and habit factors such as smoking with the risk of OSA. There is no significant relationship between occupational factors and OSA risk."

"OSA berdampak terhadap keselamatan penerbangan dengan menimbulkan fatigue dan gangguan kognitif pada memori, atensi, perencanaan, kemampuan memecahkan masalah dan multitasking. Faktor predisposisi utama OSA adalah peningkatan berat badan, serta faktor pekerjaan juga dapat mempengaruhi timbulnya risiko OSA. Penelitian bertujuan untuk mengetahui hubungan antara obesitas dan faktor-faktor lainnya terhadap risiko OSA pada pilot sipil di Indonesia. Penelitian menggunakan disain potong lintang dan dilakukan di Balai Kesehatan Penerbangan. Responden mengisi kuesioner STOP-BANG untuk risiko OSA, kuesioner ESS untuk EDS, kuesioner NOSE untuk obstruksi di hidung, dan kuesioner GPAQ untuk aktifitas fisik. Kemudian dilakukan pengukuran antropometri berupa BMI dan lingkar leher. Didapatkan 176 responden dengan prevalensi risiko OSA 35,8%. Kemudian, obesitas, lingkar leher, usia, tekanan darah, obstruksi hidung, penyempitan orofaring, dan merokok ditemukan mempunyai hubungan bermakna dengan risiko tinggi OSA (p<0,05). Tidak terdapat hubungan bermakna antara faktor pekerjaan dengan risiko OSA (p>0,05). Faktor-faktor yang paling berhubungan dengan risiko OSA ialah lingkar leher, penyempitan orofaring, dan obstruksi nasal (p<0,05). Terdapat hubungan bermakna antara faktor antropometri yaitu BMI dan lingkar leher; faktor demografi yaitu usia; faktor komorbid yaitu tekanan darah, obstruksi hidung, dan penyempitan rongga orofaring; dan juga faktor kebiasaan yaitu merokok dengan risiko OSA.

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OSA can impact flight safety by causing fatigue and cognitive impairment in memory, attention, planning, problem-solving, and multitasking abilities. Increased body weight can predispose to OSA, and the risk development is affected by occupational factors. A cross-sectional study to determine the association between obesity and other factors on the risk of OSA in Indonesian civilian pilots was conducted at the Aviation Health Center. The respondents filled out the STOP-BANG questionnaire for OSA risk, the ESS questionnaire for EDS, the NOSE questionnaire for nasal obstruction, and the GPAQ questionnaire for physical activity. Anthropometric measurements (BMI and neck circumference) were measured. Of the 176 respondents, the prevalence of OSA risk was 35.8%. Obesity, neck circumference, age, blood pressure, nasal obstruction, oropharyngeal narrowing, and smoking were found to have a significant association with a high risk of OSA (p<0.05). There was no significant association between occupational factors and OSA risk (p>0.05). Neck circumference, oropharyngeal narrowing, and nasal obstruction were the factors most associated with OSA risk (p<0.05). There was a significant association between anthropometric factors (BMI and neck circumference), demographic factors (age), comorbid factors (blood pressure, nasal obstruction, and narrowing of the oropharyngeal cavity), and also smoking habits with the risk of OSA."

"Latar Belakang. Apnea tidur obstruktif (ATO) banyak tidak disadari oleh klinisi dan prevalensinya di Indonesia cukup tinggi. Stroke merupakan penyebab kematian ke-2 di dunia dan Indonesia. ATO meningkatkan risiko kejadian stroke. Karakteristik klinis pasien ATO dengan stroke masih belum banyak diteliti. Tujuan. Mengetahui karakteristik klinis pasien kecurigaan tinggi ATO dengan stroke di RSCM. Metode. Penelitian potong lintang dengan metode consecutive dilakukan pada bulan Maret - Juni 2019 di RSCM (dari Poliklinik Neurologi dan data pencatatan pasien ATO Divisi Respirologi dan Penyakit Kritis Departemen Ilmu Penyakit Dalam). Kecurigaan tinggi ATO ditegakkan berdasarkan kuesioner Berlin-ID. Pasien dibedakan menjadi stroke dan bukan stroke. Pasien yang tidak kooperatif atau menolak penelitian dieksklusi dari penelitian. Usia, jenis kelamin, Indeks Massa Tubuh (IMT), tekanan darah, kadar HbA1c, dan lingkar leher dinilai pada setiap pasien. Ketebalan tunika intima media arteri karotis (CIMT) dinilai pada 23 subyek. Analisis data dilakukan dengan SPSS 24. Hasil Utama. Sebanyak 103 pasien kecurigaan tinggi ATO diikutsertakan dalam penelitian (34 dengan stroke dan 69 bukan stroke). Proporsi pasien kecurigaan tinggi ATO dengan stroke di RSCM adalah 33%. Pasien kecurigaan tinggi ATO dengan stroke dan bukan stroke di RSCM memiliki rerata usia 58,5 dan 57 tahun, 82,4% dan 94,2% mengalami gangguan mendengkur, 61,8% dan 36,2% laki-laki, 20,6% dan 10,1% overweight, 61,8% dan 63,8% obese, 58,8% dan 49,3% hipertensi (80% dan 85,3% tidak terkontrol), rerata CIMT kanan-kiri 0,66-0,71 mm dan 0,59-0,66 mm, 26,5% dan 34,8% diabetes melitus/DM (77,8% dan 64,7% memiliki HbA1c terkontrol), dan median lingkar leher 35,5 dan 34 cm (laki-laki 38 dan 39 cm, perempuan 33,5 dan 35 cm). Simpulan. Proporsi pasien stroke pada kecurigaan tinggi ATO di RSCM adalah 33%. Dibandingkan dengan bukan stroke, pasien kecurigaan tinggi ATO dengan stroke di RSCM memiliki rerata usia yang lebih tinggi, proporsi overweight lebih tinggi, proporsi hipertensi lebih tinggi, rerata CIMT lebih tinggi, proporsi DM dalam terapi dengan HbA1c terkontrol lebih tinggi, dan median lingkar leher lebih tinggi.

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Background. Obstructive sleep apnea (OSA) is not recognized by clinicians and its prevalence in Indonesia is quite high. Stroke is the second leading cause of death in the world and Indonesia. OSA increases the risk of stroke events. The clinical characteristics of OSA patients with stroke have not been widely studied. Objective. To know the clinical characteristics of high suspicious OSA patients with stroke in RSCM.. Method. A cross-sectional study using the consecutive method was carried out in March - June 2019 at RSCM (from Neurology Polyclinic and OSA patient record data of Respirology and Critical Illness Division of Internal Medicine Department). High suspicious OSA was diagnosed based on Berlin-ID questionnaire. Subjects were divided into stroke and not stroke. Subjects who were not cooperative or refuse the study were excluded. Age, gender, Body Mass Index, blood pressure, HbA1c levels, and neck circumference were assessed in each patient. The thickness of the carotid artery tunica intima (CIMT) was assessed in 23 subjects. Data analysis was performed with SPSS 24. Result. A total of 103 high suspicious OSA patients were included in the study (34 with stroke, 69 not stroke). The proportion of high suspicious OSA patients with stroke is 33%. Patients with high suspicious OSA with stroke and non-stroke in RSCM had an average age of 58.5 and 57 years, 82.4% and 94.2% experienced snoring disorders, 61.8% and 36.2% men, 20.6 % and 10.1% overweight, 61.8% and 63.8% obese, 58.8% and 49.3% hypertension (80% and 85.3% uncontrolled), mean right-left CIMT 0.66- 0.71 mm and 0.59-0.66 mm, 26.5% and 34.8% diabetes mellitus/DM (77.8% and 64.7% had controlled HbA1c), and the median neck circumferences were 35.5 and 34 cm (males 38 and 39 cm, females 33.5 and 35 cm). Conclusion. The proportion of stroke in high suspicious OSA patients is 33%. Compared with non-stroke, high suspicious OSA patients with stroke in RSCM had a higher mean age, higher overweight proportion, higher hypertension proportion, higher CIMT mean, higher DM in therapy with controlled HbA1c proportion, and higher median neck circumference."

"Latar belakang: Obstructive Sleep Apnea OSA berkorelasi dengan hipertensi. Pada OSA dengan hipertensi resisten ditemukan hiperaldosteronisme primer. Disfungsi gen Cryptochrome-1 Cry1 dan Cry2 menyebabkan peningkatan aldosteron dan hipertensi pada mencit. Neuroglobin Ngb diketahui mempengaruhi gen Per. Peneliti menduga penurunan kadar Cry pada OSA menyebabkan peningkatan aldosteron dan hipertensi, dan kadar neuroglobin serum mempengaruhi Cry.Metodologi: Subyek dikumpulkan secara konsekutif dari survei populasi Jakarta berusia 30-65 tahun yang menderita OSA sedang-berat dan hipertensi. OSA didiagnosis menggunakan portable monitor tipe 2 Alice Pdx unattended. Subyek didiagnosis hipertensi bila tekanan darah pagi hari lebih dari 140/90 mmHg atau minum obat anti hipertensi. Konsentrasi aldosteron, renin, neuroglobin, Cry1 dan Cry2 serum ditentukan dengan metode ELISA. Hiperaldosteronisme ditentukan dengan Aldosterone Renin Ratio ARR >20.Hasil Penelitian: Terdapat 40 subyek yang memenuhi kriteria, 26 laki-laki dan 14 perempuan dengan median usia 52,5 tahun, BMI 27,46 kg/m2, AHI 34.8 kali/jam. Ditemukan 16 subyek dengan hiperaldosteronisme primer HP dan 24 subyek nonHP. Tidak ditemukan perbedaan bermakna Cry1, Cry2 dan Ngb pada kedua kelompok. Walaupun secara statistik tidak bermakna terdapat kecenderungan penurunan kadar Cry1 dan Cry2 pada ARR tinggi pada HP, terutama Cry1. Ditemukan korelasi positif antara kadar Ngb dengan Cry1 pada HP Spearman rsquo;s rho= 0.455, p= 0.038 . Selain itu ditemukan hubungan bermakna antara Cry1 dan O2 nadir p= 0.026 . Cry1 menurun pada hipoksia berat. Pada HP terdapat kecenderungan penurunan Ngb pada kadar O2 nadir rendah, walaupun secara statistik tidak bermakna.Kesimpulan: Penurunan kadar Cry1 mungkin berhubungan dengan terjadinya kelebihan aldosteron pada OSA. Ngb tampak berperan pada penurunan Cry1.

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Background Obstructive Sleep Apnea OSA patients with resistant hypertension also had primary hyperaldosteronism. Cryptochrome 1 Cry1 and Cry2 dysfunction were associated with increased aldosterone and hypertension. Neuroglobin Ngb is known to influence Per gene. In this study we want to investigate whether Cry decrease in moderate to severe OSA causes aldosterone increase and hypertension, also the possible role of Ngb on Cry expression.Methods Subjects were recruited consecutively from a population study of OSA in Jakarta, subjects aged 30 65 years with moderate to severe OSA and hypertension. OSA was diagnosed using unattended type 2 portable monitor Alice Pdx , hypertension was established when morning blood pressure exceed 140 90 mmHg or on anti hypertensive drugs. Serum aldosterone, renin, neuroglobin, Cry1 and Cry2 were determined using ELISA method. Primary hyperaldosteronism was determined by Aldosterone Renin Ratio ARR 20.Results Of the 40 subjects recruited, there were 26 males and 14 females, with median age 52.5 years, BMI 27.46 kg m2, and AHI 34.8 times hour. We found 16 subjects with primary hyperaldosteronism PH and 24 nonPH. No difference in Cry1, Cry2 and Ngb levels was found in these groups. Although statistically not significant Cry1 and Cry2 concentration decrease with higher ARR in PH, especially Cry1. There was a positive correlation between Ngb and Cry1 in PH Spearman rsquo s rho 0.455, p 0.038 . There was relationship between Cry1 and nadir O2 p 0.026 . Cry1 was decreased in severe hypoxia. Although statistically not significant, serum Ngb decreased in severe hypoxia.Conclusions Cry1 decrease might be the cause of increased aldosterone in OSA. Ngb decrease is associated with Cry1 decrease."