RESUMO
Obstructive Sleep Apnoea Syndrome (OSAS) is believed to be associated with craniofacial and neuromuscular changes, although the interplay among these variables still is poorly recognised. The objective of this study was to identify hyoid, muscular and swallowing changes associated with OSAS, and to correlate these alterations with OSAS severity. Cross-sectional study, in a tertiary referral centre. Seventy-two adult individuals participated in this study: 12 controls (without apnoea) and 60 patients with apnoea (mild, moderate and severe OSAS-20 individuals in each group). All participants were initially evaluated by otorhinolaryngologist and neurologist and underwent polysomnography for OSAS stratification. Cephalometric data, clinical myofunctional status and swallow videofluoroscopy exam were assessed. A hybrid effect model was used to analyse swallowing parameters; dependent variables were age, body mass index (BMI) and cephalometric measures. Individuals with OSAS presented lower hyoid position and narrower posterior airway distance when compared to controls. These parameters correlated to OSAS severity. Additionally, OSAS patients exhibited significantly lower myofunctional scores. Both velum and hyoid contraction times were significantly lower in the OSAS group at videofluoroscopy, regardless of its severity. Premature leakage into pharynx was more common in OSAS groups. Laryngeal penetration phenomenon occurred only in two patients (both from OSAS group). Our results suggest that hyoid bone position is associated with OSAS severity. Muscular pattern and swallowing are impaired in OSAS patients, irrespective of OSAS severity and facial profile. These findings indicate a higher predisposition of OSAS patients to present an inferior hyoid positioning, accompanied by myofunctional and swallowing disorders.
Assuntos
Cefalometria , Transtornos de Deglutição/fisiopatologia , Deglutição/fisiologia , Osso Hioide/fisiologia , Polissonografia , Apneia Obstrutiva do Sono/fisiopatologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Feminino , Fluoroscopia , Humanos , Osso Hioide/diagnóstico por imagem , Masculino , Projetos Piloto , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico por imagemRESUMO
The professionals and patients involved in dental examinations are at risk for infection by various disease-causing bacteria, viruses, and fungi, such as those responsible for hepatitis, tuberculosis, herpes, and AIDS. It is known that aerosols and spatter containing pathogenic microorganisms can spread during an examination. Nevertheless, some dental clinics are designed to have multiple examination areas in the same room, with no physical barriers between them. The objective of this study was to verify the reach of spatter resulting from the use of a triple syringe and high-rotation turbine during five simulated exams in a collective clinic, bearing in mind that spatter can contain the patient's saliva and blood. To facilitate tracking of the spatter, aniline dye (pink, blue, yellow, green, and brown) was added to the water in the appropriate receptacle in each of the five units. The room, the equipment, and the patient's and operator's clothing were covered with white paper. A high concentration of spatter was observed on the chair, the operator, and the floor of each unit, and it also appeared on the chairs and trays of the surrounding units. The maximum distance reached by spatter was 1.82 m from a point on the chair corresponding to the position of the patient's mouth. During real simultaneous examinations, the surrounding chairs and their patients and operators, as well as the trays containing sterilized instruments, are within spatter range. Therefore, there is a real possibility of cross-infection, and physical barriers should be placed between the units. This study also confirmed the need for protection of the operator's face, body, hair, and arms, since these regions were heavily affected by spatter.
Assuntos
Doenças Transmissíveis/transmissão , Assistência Odontológica , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Cirurgia Bucal , Microbiologia do Ar , Infecções Bacterianas/microbiologia , Infecções Bacterianas/transmissão , Doenças Transmissíveis/microbiologia , Doenças Transmissíveis/virologia , Humanos , Exposição Ocupacional , Viroses/transmissão , Viroses/virologiaRESUMO
The effect of noradrenaline (NA) injection (20 or 40 nmol) into the preoptic area (POA) on plasma glucose and insulin was studied in male and female rats. The rats were implanted with chronic jugular catheters for blood sampling and unilateral intracerebral cannulas placed just above the POA. Blood samples were taken before and at 5, 10, 15, 30 and 60 min after NA injection. As early as 5 min after NA injection, plasma glucose levels rose rapidly in both male and female rats, reaching a peak at 15 min poststimulus. NA injection into the POA caused a dose-dependent hyperglycemic response in both male and female rats, although the response was more intense and longer lasting in females than in males. However, NA injection into the POA induced an increase in plasma insulin concentration in male but not in female rats. In addition, the increase in plasma glucose induced by 40 nmol NA injection in males preceded that of insulin. Plasma levels of glucose after POA injection of NA were already significantly elevated (p < 0.01) within the first experimental interval (5 min), whereas a plasma insulin increase were first detected 15 min post injection. We conclude that, when administered locally into the POA, NA can activate the sympathetic outflow expressed by a neurally mediated hyperglycemia which is more intense in females than in males. These data demonstrate that the POA has a sexually differentiated function in the regulation of glycemia.