RESUMEN
BACKGROUND: Severe obstructive sleep apnea (OSA) is an independent risk factor for perioperative complications. Clinical scores such as Snoring, Tiredness, Observed apnea, high blood Pressure, Body Mass Index (BMI) higher than 35 kg m-2, Age older than 50 years, Neck circumference larger than 40 cm, and male gender (STOP-Bang), perioperative sleep apnea prediction (P-SAP), and OSA50 have been proposed for detecting OSA. We recently proposed a new score based on morphological metrics only, the DES-OSA score. This study compared the DES-OSA score to the three other ones with regard to their ability to detect OSA. Obese patients are particularly at risk of OSA. METHODS: Following informed consent and institutional review board (IRB) approval, 1584 consecutive adults were. Should the STOP-Bang be indicative of increased risk of severe OSA, the patient was referred to complementary polysomnography (PSG). Eventual already existing recent PSG data were also collected. The abilities of the four scores to predict OSA severity were compared using sensitivity, specificity, Cohen's kappa coefficient (CKC), and area under ROC curve (AUROC) analysis. RESULTS: PSG was performed in 150 patients. For detecting severe OSA, OSA50 had the highest sensitivity [value (95 % CI) 0.98 (0.90-1)]. STOP-Bang was significantly less sensitive than P-SAP and OSA50. In that respect, DES-OSA was significantly more specific than the three other ones [0.75 (0.65-0.83)]. The AUROC of DES-OSA was significantly the largest [0.9 (0.84-0.95)]. The highest CKC at detecting severe OSA was 0.62 (0.49-0.74) for DES-OSA. Similar results were obtained for moderate to severe OSA prediction. CONCLUSIONS: DES-OSA, which is the only exclusively morphological score available, appears to surpass the three other scores in their ability to predict moderate to severe and severe OSA, at least in our setting and in our screened population. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov NCT02051829.
Asunto(s)
Cuidados Preoperatorios/métodos , Apnea Obstructiva del Sueño/diagnóstico , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Fatiga/etiología , Femenino , Humanos , Hipertensión/etiología , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad Mórbida/complicaciones , Polisomnografía/métodos , Valor Predictivo de las Pruebas , Factores de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/complicaciones , Ronquido/epidemiología , Adulto JovenRESUMEN
Postoperative development or worsening of obstructive sleep apnea is a potential complication of anesthesia. The objective of this study was to study the effects of a premedication with alprazolam on the occurrence of apneas during the immediate postoperative period. Fifty ASA 1 - 2 patients undergoing a colonoscopy were recruited. Patients with a history of obstructive sleep apnea (OSA) were excluded. Recruited patients were randomly assigned to one of two groups: in Group A, they received 0.5 mg of alprazolam orally one hour before the procedure; and in Group C, they received placebo. Anesthesia technique was identical in both groups. Patients were monitored during the first two postoperative hours to establish their AHI (apnea hypopnea index, the number of apneas and hypopneas per hour). Nine patients were excluded (4 in group A and 5 in group C) due to technical problems or refusal. Interestingly, premedication by alprazolam did not change intra-operative propofol requirements. During the first two postoperative hours, the AHI was significantly higher in group A than in group C (Group A: 20.33 ± 10.97 h-1, C: 9.63 ± 4.67 h-1). These apneas did not induce significant arterial oxygen desaturation, or mandibular instability. Our study demonstrates that a premedication with 0.5 mg of alprazolam doesn't modify intra-operative anesthetic requirements during colonoscopy, but is associated with a higher rate of obstructive apneas during at least three and a half hours after ingestion. No severe side effects were observed in our non-obese population. Our results must be confirmed on a larger scale.
Asunto(s)
Alprazolam/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Apnea Obstructiva del Sueño/inducido químicamente , Adulto , Anciano , Alprazolam/uso terapéutico , Analgésicos/uso terapéutico , Anestésicos Intravenosos/uso terapéutico , Colonoscopía , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Hipnóticos y Sedantes/uso terapéutico , Ketamina/uso terapéutico , Masculino , Persona de Mediana Edad , Propofol/uso terapéuticoRESUMEN
Today, insomnia is predominantly treated by pharmacotherapy. Yet, cognitive-behavioral therapy has better long-term outcomes. In this paper, we describe the basic principles of this short-term psychotherapeutic treatment. It combines methods of sleep restriction and stimulus control, the learning of relaxation techniques, advices on sleep hygiene and cognitive therapy techniques applied to cognitions that overwhelm insomniac moments.
Asunto(s)
Terapia Cognitivo-Conductual , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Enfermedad Crónica , Humanos , Terapia por RelajaciónRESUMEN
BACKGROUND: Obstructive Sleep Apnea (OSA) increases the perioperative risk of complications. Chronic use of Continuous Positive Airway Pressure (CPAP) by patients decreases the importance of comorbidities caused by the OSA. However, many patients do not adhere to the treatment. Given the postoperative complications, it is important for the anesthesiologist to identify non-adherent patients. This prospective study was designed to identify factors that would predict patient adherence. METHODS: Ninety patients who were treated by CPAP for more than one year were recruited. Among them, and based on objective criteria such as length of use of CPAP during the night, 75 were considered as being adherent to CPAP, while the other 15 were not. Sixty-two potential causes of non-adherence were investigated (some have not been tested before), and further divided into five categories. Those categories included cultural, intellectual, or economic factors, OSA comorbidities, patient belief about health, ENT-related problems, and pathophysiological features estimating the degree of improvement afforded by CPAP introduction. RESULTS: Multivariate binary logistic regression analysis identified one criterion of non-adherence to treatment, namely the feeling of breathlessness, and three criteria of adherence, namely awareness of the risk of complications, awareness of treatment efficacy, and feeling of being less tired with CPAP therapy. CONCLUSIONS: These four new criteria should preoperatively be sought, in order to detect non-adherent patients more efficiently.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Cooperación del Paciente/estadística & datos numéricos , Apnea Obstructiva del Sueño/terapia , Anciano , Anestesia , Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Periodo Perioperatorio , Cuidados Preoperatorios , Estudios Prospectivos , Factores SocioeconómicosRESUMEN
BACKGROUND: Intraoperative recruitment manoeuvres (RMs) combined with PEEP reverse the decrease in functional residual capacity (FRC) associated with anaesthesia and improve intraoperative oxygenation. Whether these benefits persist after operation remains unknown. We tested the hypothesis that intraoperative RMs associated with PEEP improve postoperative spirometry including FRC and reduce the incidence of postoperative hypoxaemia in morbidly obese (MO) patients undergoing laparoscopic gastric bypass. METHODS: After IRB approval and informed consent, 50 MO patients undergoing laparoscopic gastric bypass under volume-controlled ventilation (tidal volume 6 ml kg(-1) of IBW) were randomly ventilated with either 10 cm H2O PEEP or with 10 cm H2O PEEP and one RM carried out after induction of pneumoperitoneum, and another after exsufflation. Anaesthesia and analgesia were standardized. Spirometry was assessed before operation and 24 h after surgery. Postoperative oxygenation and the apnoea-hypopnoea index (AHI) were recorded during the first postoperative night. RESULTS: Age, BMI, and STOP BANG score were similar in both groups. FRC decrease after surgery was minimal [0.15 (0.14) litre in control and 0.38 (0.19) litre in the RM group] and similar between the groups (P=0.35). FVC, FEV1, mean [Formula: see text], percentage of time spent with [Formula: see text] below 90%, and AHI did not differ significantly between the groups. CONCLUSIONS: This study demonstrates that when added to a protective mechanical ventilation combining low tidal volume and high PEEP, two RMs do not improve postoperative lung function including FRC, arterial oxygenation, and the incidence of obstructive apnoea in MO patients after laparoscopic upper abdominal surgery. CLINICAL TRIAL REGISTRATION: EudraCT 2011-000999-33.
Asunto(s)
Derivación Gástrica/métodos , Hipoxia/prevención & control , Cuidados Intraoperatorios/métodos , Obesidad Mórbida/cirugía , Respiración con Presión Positiva/métodos , Complicaciones Posoperatorias/prevención & control , Adulto , Anciano , Dióxido de Carbono/análisis , Femenino , Capacidad Residual Funcional/fisiología , Humanos , Hipoxia/complicaciones , Hipoxia/fisiopatología , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Espirometría/métodos , Espirometría/estadística & datos numéricos , Volumen de Ventilación Pulmonar/fisiología , Adulto JovenRESUMEN
Diagnostic criteria and pathophysiology of narcolepsy-cataplexy have evolved considerably over the last 10 years. The main cause, already mentioned in a previous paper, in the Revue Médicale de Liège (65), in 2002, is based, in human beings, on a destruction of specific cells located in the lateral and posterior part of the hypothalamus (the perifornical nuclei, containing some 70,000 neurons), producing peptides which stimulate the central nervous system; they are called hypocretins or orexins. The role of autoimmunity in their disappearance becomes more evident. The treatment is simplified, but remains symptomatic. It is mainly based on Sodium Oxybate or Gamma-Hydroxybutyrate, syrup, prescribed for the night. The authors report on their own experience in this regard and on future therapeutics more targeted towards the cause of the disease.
Asunto(s)
Narcolepsia/diagnóstico , Narcolepsia/terapia , Diagnóstico Diferencial , Humanos , Narcolepsia/epidemiología , Narcolepsia/fisiopatologíaRESUMEN
The progress of medical imaging over the last decades has led to a better understanding of the upper airway structure in sleep-disordered patients. The Obstructive Sleep Apnea Syndrome (OSA) is attributed to a functional narrowing of the upper airway, particularly of the oropharynx, during sleep. This narrowing is multifactorial. We have shown that in 60% cases, the maxilla (nasal pyramid) seems too narrow. A mandible retroposition may also play a dominant role in 30% of the cases. Both scenarios can be combined. Cone Beam Computed Tomography (CBCT) is a new medical imaging technique that permits to visualize the upper airway with less ionizing radiation than the conventional scanner. To date, only five authors have performed an upper airway's 3D analysis of sleep apnea patients with cone beam. A better understanding of the affected segment of the upper airway should help refine treatment options.
Asunto(s)
Tomografía Computarizada de Haz Cónico/métodos , Imagenología Tridimensional , Sistema Respiratorio/diagnóstico por imagen , Apnea Obstructiva del Sueño/diagnóstico por imagen , Cefalometría/métodos , HumanosRESUMEN
Lateral teleradiography is a standard and quick examination. It has enabled us to define differences as regards to the craniofacial morphology between 20 acromegalic patients and 20 control subjects. The height of the mandibular ramus (from the posterior condyle point to the gonion point) increases significantly with the acromegalic patient and the cranial base angle (basion-superior tuberculum sellae-M point) is more extended. As acromegalic patients are more subject to sleep apnea (30% prevailing), the relationship between the amount of sleep apnea and hypopnea (AHI) in an acromegalic patient and his bone, tissue and hormone factors has been researched, in order to act on the causes of sleep apnea. It has emerged that confronting craniofacial bones and soft tissues factors enables a good prediction of the apnea and hypopnea index. Of course, we can find again the potential action of growth hormone (GH) but only in fifth place in importance order. The tongue, which increases in volume with the GH impact, is in a too short "lingual enclosure" (reduced length of the mandibular horizontal branch).
Asunto(s)
Acromegalia/complicaciones , Cefalometría , Síndromes de la Apnea del Sueño/etiología , Acromegalia/diagnóstico , Adulto , Anciano , Anomalías Craneofaciales/diagnóstico por imagen , Huesos Faciales/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía , Radiografía , Síndromes de la Apnea del Sueño/diagnósticoRESUMEN
Paradoxical sleep (PS or REM sleep) is traditionally a matter for neurophysiology, a science of the brain. Dream is associated with neuropsychology and sciences of the mind. The relationships between sleep and dream are better understood in the light of new methodologies in both domains, particularly those of basic neurosciences which elucidate the mechanisms underlying SP and functional imaging techniques. Data from these approaches are placed here in the perspective of rather old clinical observations in human cerebral lesions and in the phylogeny of vertebrates, in order to support a theory of dream. Dreams may be seen as a living marker of a cognitivo-emotional process, called here "eidictic process", involving posterior brain and limbic structures, keeping up during wakefulness, but subjected, at that time, to the leading role of a cognitivo-rational process, called here "thought process". The last one is of instrumental origin in human beings. It involves prefrontal cortices (executive tasks) and frontal/parietal cortices (attention) in the brain. Some clinical implications of the theory are illustrated.
Asunto(s)
Sueños/fisiología , Sueño REM/fisiología , HumanosRESUMEN
The field of neurology was long infamous for a lack of therapeutic options. How many of you have once thought: "Neurologists don't cure the disease, they admire it". But those days have passed into history, and the field is now vibrant with new treatments and hope even for patients with the worst neurodegenerative diseases. We summarized in the present review the latest major advances in therapeutic principles and practice for some of the most frequent chronic neurological disorders such as headaches, epilepsy, multiple sclerosis, dementias, Parkinson's disease, sleep/wake disturbances and peripheral neuropathies. We cannot cure or prevent, but we can now halt or control symptoms and disease progression to provide physical and psychological relief, and a better quality of life for patients who suffer from these otherwise devastating neurological conditions.
Asunto(s)
Enfermedades del Sistema Nervioso/terapia , Cefalalgia Histamínica/terapia , Epilepsia/terapia , Humanos , Trastornos Migrañosos/terapia , Esclerosis Múltiple/tratamiento farmacológico , Enfermedad de Parkinson/terapia , Enfermedades del Sistema Nervioso Periférico/terapia , Trastornos del Sueño-Vigilia/terapiaRESUMEN
Bright light therapy is a treatment that emerged in the eighties of the last century. It can be used in different pathologies such as seasonal affective disorders, major depressions, and many disorders of the wake-sleep rhythm, whether they are of primary or secondary origin. Important progress made at the basic neuroscience levels, allows today a sound understanding of the bright light mode of action. Moreover, the main indications are now the subject of consensus reports and meta-analyses which show good levels of evidence-based medicine. Bright light therapy constitutes a first choice indication in seasonal affective disorder. It is also perfectly possible to prescribe bright light therapy in the major depression disorders. It has been demonstrated that the effect size is the same as with antidepressants of reference. It is admitted nowadays that bright light therapy may be at least, an adjunct to pharmacotherapy, in order to accelerate the antidepressant effect onset, or to prolong this effect after withdrawal of the drug. Bright light therapy can also be viewed as an alternative to the pharmacological approach especially when this one is impossible, not tolerated or not accepted by the patient. The contraindications are rare.
Asunto(s)
Fototerapia , Ritmo Circadiano , Depresión/terapia , Humanos , Fototerapia/métodosRESUMEN
A complaint of insomnia has to be analysed, and differentiated from hypochondria and, overall, from hypersomnia. Once confirmed and assessed as acute or chronic, it is often considered a disorder of hyperarousal, that is an imbalance between a central nervous system activating and a central nervous system inhibiting system with subcontinuous overflow from the former. An acute insomnia is less than one month of duration. As a disease, insomnia has to be categorized as a secondary or a primary disorder. Thereafter, it remains to assess the extent of social, psychological and economical interactions. These factors intervene as consequences or perpetuating factors. The capacity to assess the whole situation is really the great strength of the general practitioner who, more than anybody else, is on home ground. Laboratory findings and specialist examination come only as supporting evidence for causal links. A polysomnography realized in a sleep disorder center provides data reinforcing or correcting the diagnosis. From a sound assessment of the disease, the treatment has to be deduced by following a rigorous reasoning, devoid of guilty feelings as they are suggested to patients by mass-media talking, as well as freed from fashionable non medical practices. Today, we know that chronic insomnia is a disease with potential severe consequences and that it does not heal spontaneously.
Asunto(s)
Trastornos del Inicio y del Mantenimiento del Sueño , Enfermedad Aguda , Enfermedad Crónica , Medicina Familiar y Comunitaria , Humanos , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Trastornos del Inicio y del Mantenimiento del Sueño/terapiaRESUMEN
Since two decades, sleep breathing disorders are more wisely recognized by the Belgian medical community. Among these, the Obstructive Sleep Apnea Syndrome (OSA) is the best known but its frontiers with others syndromes such as the Upper Airway Resistance Syndrome (UARS), the Central Sleep Apnea Syndrome (CSAS) or the Overlap Syndrome are still matter of discussion. Its causes are plurifactorial, and many recent publications draw the attention to its long term effects in the cardiovascular and neuropsychiatric fields. This article summarizes the present definitions and features associated with OSA, from clinical and neurophysiological perspectives, and the different consequences to which untreated or underdiagnosed patients are exposed.
Asunto(s)
Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/diagnóstico , Enfermedades Cardiovasculares/etiología , Cefalometría , Presión de las Vías Aéreas Positiva Contínua , Fatiga/etiología , Humanos , Tamizaje Masivo , Anamnesis , Obesidad/complicaciones , Examen Físico , Polisomnografía , Prevalencia , Pruebas de Función Respiratoria , Factores de Riesgo , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/clasificación , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/terapia , Encuestas y CuestionariosRESUMEN
The diagnosis of narcolepsy-cataplexy is based on three axes: 1) the medical history is strongly suggestive when diurnal sleep attacks (narcolepsy) and drop attacks (cataplexy) are reported or observed; 2) the polysomnography is mandatory and shows nocturnal and diurnal (multiple sleep latency test) REM sleep onsets; 3) HLA typing, practically helps to exclude the diagnosis when HLA DR15-DQB1*0602 is not present. New pathogenetic hypotheses have been proposed, mostly based the absence of hypocretin in narcoleptic cerebrospinal fluid. This neurotransmitter was previously known exclusively by its involvement in alimentary behaviours. The new therapies remain symptomatic, but they are powerful to prevent somnolence, daytime sleepiness, cataplexy and insomnia associated with this syndrome.
Asunto(s)
Péptidos y Proteínas de Señalización Intracelular , Narcolepsia/diagnóstico , Narcolepsia/terapia , Proteínas Portadoras/líquido cefalorraquídeo , Progresión de la Enfermedad , Antígenos HLA-DQ/análisis , Cadenas beta de HLA-DQ , Antígenos HLA-DR/análisis , Subtipos Serológicos HLA-DR , Prueba de Histocompatibilidad , Humanos , Anamnesis , Narcolepsia/epidemiología , Narcolepsia/etiología , Neuropéptidos/líquido cefalorraquídeo , Neuropéptidos/deficiencia , Orexinas , Polisomnografía , Prevalencia , Fases del SueñoRESUMEN
OBJECTIVE: We examine geniopexy efficacy in OSAS treatment. STUDY DESIGN: Seven patients, aged 36 to 61 years, were studied. The mean body mass index was normal. RESULTS: Surgical late complications (modified symphysis proprioception) occurred in 4 patients. No patient was improved in sleep problems. Retromaxilly and retromandibuly were found in all patients by cephalometric study. DISCUSSION: Our results are quite different from these described successfully by other centers. Geniopexy do not move maxillar and mandibular skeletal bones, which are retruded in our serie. This explains maybe our bad results. Actually, we propose for this patients maxillo-mandibular advancement.
Asunto(s)
Mentón/cirugía , Procedimientos Quirúrgicos Orales/métodos , Apnea Obstructiva del Sueño/cirugía , Adulto , Cefalometría , Humanos , Persona de Mediana Edad , Músculos del Cuello/cirugía , Procedimientos Quirúrgicos Orales/efectos adversos , Osteotomía/métodos , Polisomnografía , Trastornos Somatosensoriales/etiología , Insuficiencia del TratamientoRESUMEN
OBJECTIVE: To test the efficacy of dental treatment of bruxism on sleep quality, using slow wave sleep as the primary outcome parameter. METHODS: The study design consisted of an open label, unpaired comparison between normals and patients and a paired comparison between pre- and post-treatment patient recordings. Twenty patients suffering from bruxism (13 male, 7 female, mean age 35 years) and 6 normal volunteers (3 male, 3 female, mean age 30 years) participated in the study. Polysomnographic recordings were performed in a sleep laboratory in a general hospital both before and after treatment. The treatment was derived from a model that ascribes bruxism to a dental malocclusion, and consisted solely of dental therapy (Jeanmonood 1988). RESULTS: The untreated bruxism group had worse sleep than normals when comparing slow wave sleep (21% versus 32% slow wave sleep percentage in sleep period time) during the second polysomnographic recording, after one night adaptation. Therapy did not improve sleep quality; bruxism patients showed only minor, non-significant differences in sleep quality when comparing pre- and post-treatment recordings.
Asunto(s)
Encéfalo/fisiología , Ferulas Oclusales , Bruxismo del Sueño/complicaciones , Bruxismo del Sueño/terapia , Sueño/fisiología , Adulto , Protocolos Clínicos , Electroencefalografía , Electromiografía , Femenino , Humanos , Masculino , Maloclusión/complicaciones , Maloclusión/fisiopatología , Músculos Masticadores/fisiopatología , Modelos Neurológicos , Contracción Muscular/fisiología , Bruxismo del Sueño/fisiopatología , Diseño de Software , Insuficiencia del TratamientoRESUMEN
Maxillomandibular advancement is an integral part of the surgical treatment of patients suffering from obstructive sleep apnea. A number of publications report its efficacy and have attempted to define predictive success criteria. However, few authors have shown an interest in the surgical specificity of this intervention and in the difficulties that can be encountered, which differ from those seen in conventional orthognathic surgery. In this article, a series of patients treated with maxillomandibular osteotomy to correct obstructive sleep apnea syndrome (n = 17) are compared with patients who underwent surgery for the correction of dentofacial disharmonies (n = 33). Observations emphasized the importance of respecting a strict surgical and postsurgical protocol to avoid any technical traps linked to maxillomandibular advancement, both in preoperative simulations and during and after surgery. Results concerning sleep parameters will be the subject of a future publication.
Asunto(s)
Avance Mandibular , Maxilar/cirugía , Osteotomía/métodos , Apnea Obstructiva del Sueño/cirugía , Adolescente , Adulto , Anciano , Pérdida de Sangre Quirúrgica , Protocolos Clínicos , Femenino , Predicción , Hospitalización , Humanos , Técnicas de Fijación de Maxilares , Tiempo de Internación , Masculino , Maloclusión/cirugía , Mandíbula/cirugía , Persona de Mediana Edad , Tabique Nasal/cirugía , Obesidad/complicaciones , Osteotomía Le Fort , Planificación de Atención al Paciente , Cuidados Posoperatorios , Resultado del TratamientoRESUMEN
Bright light therapy is a recent physical treatment in chronodisabled situations. The most recognized indication is the seasonal affective disorder. However, any disease or dysfunction where a misalignment of sleep-wake and circadian rhythms may be suspected is a potential tool for this treatment. Analyses of the literature throughout the interpretation methods of the evidence based medicine indicate that bright light therapy, if not a standard, could be recommended in a number of circadian rhythm sleep disorders, mainly the delayed and advanced sleep phase syndromes. Time aspects are essential for the success of phototherapy. From this point of view, easy and practical technological means or methods, allowing to shape a Phase Response Curve in each individual to be treated, should be clear progress. A future extension of indications will also depend on the checking of essential hypotheses linking circadian and sleep-wake rhythms in diseases such as psychophysiological insomnia, multiple sclerosis, brain dysgeneses or dementias. At last, a non negligible advantage of bright light therapy appears to be its relative safety.
Asunto(s)
Fototerapia , Trastornos del Sueño del Ritmo Circadiano/terapia , Humanos , Trastornos del Sueño del Ritmo Circadiano/diagnóstico , Resultado del TratamientoRESUMEN
The aim of this preliminary work is to determine an easy method to diagnose "buccal breather" children and "nasal breather" children. Then, to establish a possible connection with the syndrome of obstructive sleep apnea. 22 children agreed to participate. Clinical, orthophonic, orthodontic, postural and polysomnographical exams have been carried out. The proposed clinical exam turns out to be a good means of diagnosing between buccal breathers and nasal breathers. The aerophonoscope reveals velar inadequacies in buccal breathers. The latter also present osseous discrepancies mainly in the mandible. The polysomnography reveals a higher apnea/hypopnea index and more agitated sleep in buccal breathers. Mandibular lowering movements are more frequent and similar to those of adults suffering from apnea. These elements similar to those encountered in adults suffering from apnea make us think that buccal breathing could be the origin of obstructive sleep apnea, several decades later.
Asunto(s)
Respiración por la Boca/complicaciones , Síndromes de la Apnea del Sueño/etiología , Adolescente , Adulto , Cefalometría , Niño , Oclusión Dental , Femenino , Cabeza/anatomía & histología , Humanos , Masculino , Mandíbula/patología , Mandíbula/fisiopatología , Respiración por la Boca/diagnóstico , Respiración por la Boca/fisiopatología , Movimiento , Nariz/fisiología , Paladar Blando/fisiopatología , Polisomnografía , Postura/fisiología , Respiración , Habla/fisiologíaRESUMEN
This study details the role that the orthodontist can play, when faced with sleeping obstructive apneas and snoring phénomena. Of special importance are knowledge of cranio-facial growth, radiographic exam and cephalometric analysis: they mainly help to understand all the aspects of this specific syndrome, and reveal the interest for a neuro-orthodontic or a neuro-surgical orthodontic approach.