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BACKGROUND: Obstructive sleep apnoea (OSA) is a disabling health condition, and there is no disease-specific patient-reported outcome instrument to assess individuals with OSA. OBJECTIVES: To evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with OSA. METHODS: One hundred individuals with OSA responded to the WHODAS 2.0 version of 36 items, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the 12-item health survey (SF-12). Internal consistency, convergent and discriminative validity, and responsiveness to continuous positive airway pressure (CPAP) were the psychometric properties tested. RESULTS: Cronbach's α values indicate good internal consistency (0.91 - 0.73), except for the self-care domain (α = 0.52). Convergent validity indicated an excellent correlation (r = -0.80) between the domains of functioning and quality of life. Discriminative validity showed no association between OSA severity and functioning (p = 0.90). The responsiveness to CPAP treatment showed a large effect size (r = 0.82; p < 0.05) CONCLUSIONS: The WHODAS 2.0 instrument is valid, reliable, and responsive for assessing individuals with OSA.
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Pressão Positiva Contínua nas Vias Aéreas , Avaliação da Deficiência , Psicometria , Qualidade de Vida , Apneia Obstrutiva do Sono , Organização Mundial da Saúde , Humanos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Masculino , Feminino , Brasil , Reprodutibilidade dos Testes , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Qualidade de Vida/psicologia , Inquéritos e Questionários , Adulto , Índice de Gravidade de Doença , Idoso , Polissonografia/métodosRESUMO
PURPOSE: To investigate a possible association between the risk of obstructive sleep apnoea (OSA) and disability in individuals with cardiovascular or cerebrovascular diseases. METHODS: Cross-sectional study was conducted with 373 individuals (313 with cardiovascular or cerebrovascular diseases and 60 healthy). Disability was assessed by the 12-item World Health Organization Disability Assessment Schedule (WHODAS), and the risk of OSA was assessed by STOP-BANG. Anxiety and depression symptoms, daytime sleepiness, and cognition were assessed by the Hospital Anxiety and Depression Scale (HADS), Epworth Sleepiness Scale (ESS), and Mini Mental State Examination (MMSE). RESULTS: Greater disability was found in individuals with intermediate or high risk of OSA, considering healthy individuals (p=0.03), or individuals diagnosed with arrhythmia (p<0.01) or coronary artery disease (p=0.04). A high risk of OSA and higher WHODAS scores was significant among women as well as between OSA risk categories (p<0.01). Cognitive deficit and level of education also showed differences between OSA risk categories. Age, depression, and sleepiness were also associated with the subjects' disability (p<0.01). Gamma regression model showed higher WHODAS scores in female, in those with intermediate and high risk of OSA, and in those with depressive symptoms and cognitive deficit. Age also showed a correlation with higher WHODAS scores. The presence of all investigated cardio and cerebrovascular diseases showed an increase in the WHODAS score, implying a greater disability compared to healthy individuals. CONCLUSION: Moderate and high risk of OSA is associated with disability, as well as gender, age, depressive symptoms, cognitive deficit, and cardiovascular diseases.
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Doenças Cardiovasculares , Transtornos Cerebrovasculares , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/diagnóstico , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Transversais , Doenças Cardiovasculares/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Idoso , Avaliação da Deficiência , Adulto , Fatores de Risco , ComorbidadeRESUMO
Background Obstructive sleep apnoea (OSA) has been described as a risk factor for arterial hypertension (HT). One of the proposed mechanisms linking these conditions is non dipping (ND) pattern in nocturnal blood pressure, however evidence is variable and based on specific populations with underlying conditions. Data for OSA and ND in subjects residing at high altitude are currently unavailable. Objective Identify the prevalence and association of moderate to severe OSA with HT and ND pattern in hypertensive and non-hypertensive otherwise healthy middle-aged individuals in residing at high altitude (Bogotá:2640 mt) Methods Adult individuals with diagnosis of moderate to severe OSA underwent 24 hour- ambulatory blood pressure monitoring (ABPM) between 2015 and 2017. Univariable and multivariable logistic regression analysis were performed to identify predictors of HT and ND pattern. Results Ninety-three (93) individuals (male 62.4% and median age 55) were included in the final analysis. Overall, 30.1% showed a ND pattern in ABPM and 14.9% had diurnal and nocturnal hypertension. Severe OSA (higher apnea-hiponea index [AHI]) was associated with HT (p = 0.006), but not with ND patterns (p = 0.54) in multivariable regression. Smoking status and lowest oxygen saturation during respiratory events where independently associated with ND pattern (p = 0.04), whereas age (p = 0.001) was associated with HT. Conclusions In our sample, one in three individuals with moderate to severe OSA have non dipping patterns suggesting lack of straight association between OSA and ND. Older individuals who have higher AHI are more likely to have HT, and those who smoke have a higher risk of ND. These findings add aditional information to the multiple mechanisms involved in the relationship between OSA and ND pattern, and questions the routine use of 24-hour ABPM, particullary in our region, with limited resources and healthcare acces. However, further work with more robust methodology is needed to draw conclusions.
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Obstructive sleep apnoea (OSA), characterized by chronic intermittent hypoxia (CIH), is considered to be an independent risk for hypertension. The pathological cardiorespiratory consequences of OSA have been attributed to systemic oxidative stress, inflammation and sympathetic overflow induced by CIH, but an emerging body of evidence indicates that a nitro-oxidative and pro-inflammatory milieu within the carotid body (CB) is involved in the potentiation of CB chemosensory responses to hypoxia, which contribute to enhance the sympathetic activity. Accordingly, autonomic and cardiovascular alterations induced by CIH are critically dependent on an abnormally heightened CB chemosensory input to the nucleus of tractus solitarius (NTS), where second-order neurons project onto the rostral ventrolateral medulla (RVLM), activating pre-sympathetic neurons that control pre-ganglionic sympathetic neurons. CIH produces oxidative stress and neuroinflammation in the NTS and RVLM, which may contribute to the long-term irreversibility of the CIH-induced alterations. This brief review is mainly focused on the contribution of nitro-oxidative stress and pro-inflammatory molecules on the hyperactivation of the hypoxic chemoreflex pathway including the CB and the brainstem centres, and whether the persistence of autonomic and cardiorespiratory alterations may depend on the glial-related neuroinflammation induced by the enhanced CB chemosensory afferent input.
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Corpo Carotídeo , Apneia Obstrutiva do Sono , Humanos , Corpo Carotídeo/fisiologia , Doenças Neuroinflamatórias , Hipóxia , Inflamação/metabolismo , Estresse OxidativoRESUMO
ABSTRACT Obstructive sleep apnea (OSA) is a public health problem with a great economic impact. It is estimated that the prevalence of patients with OSA ranges from 4% to 6% of men and 2% to 4% of women in the general population. Strong evidence suggests that both sleep disorders and heart failure (HF) are related. Continuous positive airway pressure (CPAP) is the gold standard non-pharmacological treatment for this population. However, there is still a gap in the literature and its effects in patients with OSA and HF are not entirely clear. This study aimed to evaluate, by randomized clinical trials, the effects of positive pressure on cardiorespiratory function in patients with OSA and HF. Randomized clinical trials were included, with publication in the MEDLINE, PEDro, Cochrane Library, SciELO and PubMed databases and the risk bias was assessed using the PEDro scale. Six articles were included in this study, involving 165 participants. Our findings demonstrate that CPAP in the treatment of OSA in patients with HF promotes an increase in left ventricular ejection fraction, oxygen saturation and a reduction in blood pressure, apnea/hypopnea indices and awakenings from sleep during the night. We conclude that treatment with CPAP promotes an improvement in cardiorespiratory outcomes in patients with OSA and HF, improving the prognosis and reducing the risk of sudden death. However, their data must be cautiously interpreted considering the bias of the studies and their limitations.
RESUMEN La apnea obstructiva del sueño (APS) es un problema de salud pública con gran impacto económico. Se estima que la prevalencia de portadores de AOS es del 4% al 6% en los hombres y del 2% al 4% en las mujeres en la población general. Existe una fuerte evidencia de que tanto los trastornos del sueño como la insuficiencia cardíaca (IC) tienen una asociación entre sí. La presión positiva continua en las vías respiratorias (CPAP) es el tratamiento no farmacológico estándar de oro para esta población. Sin embargo, aún existe un vacío en la literatura y sus efectos en pacientes con AOS e IC no están del todo claros. Ante esto, el objetivo de este estudio es evaluar, mediante ensayos clínicos aleatorizados, los efectos de la CPAP sobre la función cardiorrespiratoria en pacientes con AOS e IC. Se incluyeron seis ensayos clínicos aleatorizados, con publicación en las bases de datos MEDLINE, PEDro, Cochrane Library, SciELO y PubMed, con un total de 165 participantes. El riesgo de sesgo se evaluó mediante la escala PEDro. Nuestros hallazgos demuestran que la CPAP en el tratamiento de la AOS en pacientes con IC promueve un aumento de la fracción de eyección del ventrículo izquierdo y de la saturación de oxígeno, y una reducción de la presión arterial, de los índices de apnea/hipopnea y de los despertares nocturnos. Se concluye que el tratamiento con CPAP promueve una mejora en los resultados cardiorrespiratorios en pacientes con AOS e IC, mejorando el pronóstico y reduciendo el riesgo de muerte súbita. Sin embargo, sus datos deben interpretarse con cautela considerando el sesgo de los estudios y sus limitaciones.
RESUMO A apneia obstrutiva do sono (AOS) é um problema de saúde pública de grande impacto econômico. Estima-se que a prevalência de portadores de AOS seja de 4% a 6% entre os homens e de 2% a 4% entre as mulheres da população em geral. Há fortes evidências de que os distúrbios do sono e a insuficiência cardíaca (IC) estão relacionados. A pressão positiva contínua nas vias aéreas (CPAP) é o tratamento não farmacológico padrão ouro para essa população. No entanto, ainda há uma lacuna na literatura, e seus efeitos em pacientes com AOS e IC não estão plenamente estabelecidos. Assim, o objetivo deste estudo foi avaliar através da revisão de ensaios clínicos randomizados os efeitos da CPAP na função cardiorrespiratória em pacientes com AOS e IC. Foram incluídos seis ensaios clínicos randomizados, publicados nas bases de dados MEDLINE, PEDro, Cochrane Library, SciELO e PubMed, totalizando 165 participantes. O risco de viés foi avaliado através da escala PEDro. Nossos achados demonstraram que a CPAP no tratamento da AOS em pacientes com IC promove um aumento da fração de ejeção do ventrículo esquerdo e da saturação de oxigênio e uma redução da pressão arterial, dos índices de apneia/hipopneia e dos despertares durante a noite. Concluímos que o tratamento com CPAP promove uma melhora nos desfechos cardiorrespiratórios em pacientes com AOS e IC, beneficiando o prognóstico e reduzindo os riscos de morte súbita. Porém, os resultados devem ser interpretados com cautela, considerando o viés dos estudos e suas limitações.
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Background and Objective: Obstructive sleep apnoea (OSA) is characterized by nocturnal repetitive upper airway (UA) collapse. For sleep physicians, the recognition of UA collapse characteristics is critical for understanding OSA mechanisms and developing individualized treatment plans. Drug-induced sleep endoscopy (DISE) is an exam during simulated sleep that allows the dynamic assessment of the UA of individuals with OSA. The initial recognition of DISE was to locate the sites of UA obstruction and direct the surgical selection of OSA since it was introduced in the 1990s. After approximately 30 years of studies, based on advances in endoscopic operative techniques and innovative treatments of OSA, DISE had been performed to explore mechanisms and comprehensive treatments related to UA collapse. Methods: This article reviewed contemporary DISE advances, including indications and contraindications, technique of induced sleep, endoscopic operation, UA characteristics classification.Results and Conclusions: Precise selection based on the association between collapse patterns and treatment modalities, such as continuous positive airway pressure, oral appliance, positional therapy, robotic surgery and neurostimulator implanting, is the future research prospect based on DISE.Key messagesDISE provides sleep physicians with valuable information about the upper airway collapse characteristics and dynamic changes during sleep.The studies based on DISE findings improve the selectivity and efficiency of treatment modalities, including classical therapies such as continuous positive airway pressure, oral appliance, positional therapy, and innovative therapies such as neurostimulator implanting and robotic surgery, promote the advancement of OSA precision medicine.
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Obstrução das Vias Respiratórias , Apneia Obstrutiva do Sono , Humanos , Polissonografia/métodos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/cirurgia , Endoscopia/métodos , Sono , Obstrução das Vias Respiratórias/cirurgiaRESUMO
Introduction: Fibromyalgia syndrome (FMS) is characterized by chronic musculoskeletal pain, fatigue, and the sense of waking unrefreshed. Obstructive sleep apnoea syndrome (OSAS) and FMS have symptoms in common and the association of OSAS in these patients could confuse the diagnosis and worsen the severity and prognosis of FMS. The objective of this study was to establish the presence of OSAS in patients with FMS and sleep complaints in a sleep clinic. Methods: A cross-sectional study was conducted in patients aged 18 and above with FMS who were referred by rheumatology to a sleep clinic to confirm OSAS with polysomnography from 2015 to 2018. Descriptive statistics tools were applied. Results: Polysomnographic investigations were performed in 51 patients with FMS. OSAS was detected in 82% of patients. The mean age was 65 years. Of the patients studied, 82% were women and 78% of them had OSAS. All the male patients with FM had OSAS. Of the patients, 27.5% were normal weight and 45% were overweight. Of the patients, 23% had severe OSAS, 31% moderate and 45% mild. Conclusion: We found a high frequency of OSAS in this group of FMS patients. Since the 2 diseases share symptoms, it is interesting to delve deeper into the investigation of common pathophysiological mechanisms. The coexistence of the 2 pathologies poses diagnostic and therapeutic challenges that implies the need for further study at local level.
Introducción: La fibromialgia (FM) se caracteriza por dolor crónico, cansancio y sueno no reparador. El síndrome de apnea hipopnea obstructiva del sueño (SAHOS) tiene síntomas en común con la FM y su presencia puede confundir el diagnóstico y empeorar la gravedad y el pronóstico de la FM. El objetivo de este estudio fue establecer la presencia de SAHOS en pacientes con FM y alteraciones del sueño en una clínica de sueño. Métodos: Estudio observacional, de corte transversal, en pacientes mayores de 18 arios con FM remitidos por Reumatología a una clínica de sueño para confirmar SAHOS por medio de polisomnografía, entre el 2015 y el 2018. Se aplicaron herramientas de estadística descriptiva. Resultados: Se realizó polisomnografía completa a 51 pacientes con FM y se confirmó SAHOS en el 82%. La edad media fue de 65 años. El 82% de los pacientes estudiados fueron mujeres y, de estas, el 78% tuvo SAHOS. Al 100% de los hombres con FM se les diagnosticó SAHOS. El 27,5% tuvo un peso normal y el 45% sobrepeso. El 23% de los pacientes tuvo SAHOS grave, el 31% moderado y el 45% leve. Conclusiones: Encontramos una alta frecuencia de SAHOS en este grupo de pacientes con FM. Las 2 enfermedades comparten síntomas, por lo que es interesante profundizar más en la investigación de mecanismos fisiopatológicos comunes. La coexistencia de las 2 patologías plantea retos diagnósticos y terapéuticos que vislumbran la necesidad de estudios más profundos a escala local.
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Humanos , Pessoa de Meia-Idade , Idoso , Doenças Respiratórias , Reumatologia , Fibromialgia , Doenças Musculoesqueléticas , Ocupações em Saúde , Medicina , Doenças MuscularesRESUMO
Background: Effective treatments for obstructive sleep apnoea (OSA) include positive pressure, weight loss, oral appliances, surgery, and exercise. Although the involvement of the respiratory muscles in OSA is evident, the effect of training them to improve clinical outcomes is not clear. We aimed to determine the effects of respiratory muscle training in patients with OSA. Methods: A systematic review was conducted in seven databases. Studies that applied respiratory muscle training in OSA patients were reviewed. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. Results: Of the 405 reports returned by the initial search, eight articles reporting on 210 patients were included in the data synthesis. Seven included inspiratory muscle training (IMT), and one included expiratory muscle training (EMT). Regarding IMT, we found significant improvement in Epworth sleepiness scale in −4.45 points (95%CI −7.64 to −1.27 points, p = 0.006), in Pittsburgh sleep quality index of −2.79 points (95%CI −4.19 to −1.39 points, p < 0.0001), and maximum inspiratory pressure of −29.56 cmH2O (95%CI −53.14 to −5.98 cmH2O, p = 0.01). However, the apnoea/hypopnea index and physical capacity did not show changes. We did not perform a meta-analysis of EMT due to insufficient studies. Conclusion: IMT improves sleepiness, sleep quality and inspiratory strength in patients with OSA.
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Given the high prevalence of multiple non-communicable chronic diseases in Mexico, the aim of the present study was to assess the association between dietary patterns and sleep disorders in a national representative sample of 5076 Mexican adults (20-59 years) from the 2016 National Health and Nutrition Survey. Through a cross-sectional study, we used the Berlin sleep symptoms questionnaire to estimate the proportion of adults with insomnia, obstructive sleep apnoea (OSA) and other related problems such as daytime symptoms and inadequate sleep duration. Dietary data were collected through a seven-day semi-quantitative food frequency questionnaire, and dietary patterns were determined through cluster analysis. Associations between dietary patterns and sleep disorders were assessed by multivariate logistic regression models adjusted for age, sex, well-being, rural/urban area type, geographical region, tobacco use, physical activity level and energy intake. Three dietary patterns were identified: traditional (high in legumes and tortilla), industrialised (high in sugar-sweetened beverages, fast foods, and alcohol, coffee or tea) and mixed (high in meat, poultry, fruits and vegetables). Multivariate logistic regression showed that the industrialised pattern yielded higher odds for daytime symptoms (OR 1â 49; 95 % CI 1â 12, 1â 99) and OSA (OR 1â 63; 95 % CI 1â 21, 2â 19) compared with the traditional pattern. In conclusion, dietary patterns are associated with sleep disorders in Mexican adults. Further research is required to break the vicious cycle of poor-quality diet, sleep symptoms and health.
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Dieta , Apneia Obstrutiva do Sono , Transtornos do Sono-Vigília , Adulto , Estudos Transversais , Humanos , México/epidemiologia , Inquéritos Nutricionais , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologiaRESUMO
Obstructive sleep apnoea (OSA) constitutes a public health problem, with various systemic consequences that can increase cardiovascular morbidity and mortality as well as increase healthcare expenditure. This review discusses the rationale and effects of using general physical exercise, oropharyngeal exercises, and respiratory muscle training as an adjunctive treatment for patients with sleep apnoea. The recommended treatment for OSA is the use of continuous positive airway pressure, which is a therapy that prevents apnoea events by keeping the airways open. In the last decade, coadjuvant treatments that aim to support weight loss (including diet and physical exercise) and oropharyngeal exercises have been proposed to lower the apnoea/hypopnoea index among patients with OSA. Based on the available evidence, health professionals could decide to incorporate these therapeutic strategies to manage patients with sleep apnoea.
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AIM: To evaluate the thermographic characteristics of oro-facial structures and submental triangle of participants with obstructive sleep apnoea (OSA), as well as to investigate its correlation with the anatomy, posture and functions of the oro-facial structures. METHOD: Eighteen patients diagnosed with OSA by polysomnography (OSA group; 57.4 ± 15.8 years) and 13 healthy participants screened for OSA (control group; 57.8 ± 18.1 years) were included. All participants answered to questionnaires for OSA and excessive daytime sleepiness, and were submitted to infrared image thermography analysis of facial regions of interest (ROIs), oro-facial myofunctional evaluation (OMES-E protocol) and masticatory performance. Statistical analysis included one-way ANOVA and Pearson/Spearman correlation test. RESULTS: Obstructive sleep apnoea group showed lower thermographic measures in many ROIs in the frontal and lateral views of the face, including the submental triangle region, and lower scores of aspect/posture and performance of oro-facial structures, as well lower total score of OMES-E evaluation (P < .05). Scores of aspect/posture and mobility were correlated with the temperature of some ROIs in the frontal and lateral views. CONCLUSION: Lower facial skin and submental triangle region temperatures, measured by infrared thermography, and a worse oro-facial myofunctional condition were identified in the group of individuals with OSA. The higher temperatures of the ROIs were correlated with the better status of aspect/posture and performance of the oro-facial myofunctional structures.
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Apneia Obstrutiva do Sono , Termografia , Face/diagnóstico por imagem , Humanos , Polissonografia , PosturaRESUMO
ABSTRACT Objective: To assess the effect of the continuous positive airway pressure (CPAP) treatment on basal metabolism rate (BMR) in patients with severe obstructive sleep apnoea syndrome (OSAS). Methods: Demographic characteristics, body mass index (BMI), apnoea-hypopnoea index (AHI) and smoking history of the patients were recorded. Basal metabolism rate was measured via indirect calorimetry in the morning following nights of polysomnography and CPAP titration. Basal metabolism rate, oxygen consumption (VO2) and carbon dioxide output (VCO2) levels were compared before and after CPAP administration. Results: A total of 25 patients with a mean age of 51.4 ± 13.7 years were included in the study: 6 (24%) female and 19 (76%) male. A significant reduction in the BMR (p = 0.049), VO2 (p = 0.042) and VCO2 (p = 0.008) values were observed after a single night administration of CPAP as compared to before treatment. Furthermore, it was detected that this reduction provided by CPAP treatment was more significant in current smokers, patients with AHI > 60 and BMI ≥ 30. Conclusion: It is suggested that there is a correlation between BMR and the severity of OSAS, and it is possible to provide a significant reduction in BMR with single night administration of CPAP depending on the patient's smoking history, degree of obesity and disease severity.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Metabolismo Basal/fisiologia , Apneia Obstrutiva do Sono/terapia , Pressão Positiva Contínua nas Vias Aéreas , Índice de Gravidade de Doença , Resultado do Tratamento , PolissonografiaRESUMO
O objetivo deste estudo foi avaliar a influência terapêutica dos dispositivos orais Hyrax e Bionator de Balters no tratamento da Síndrome da Apneia Obstrutiva do Sono (SAOS), sobre a melhora da SAOS observado pela polissonografia, atividade elétrica dos músculos masseter e temporal, força máxima de mordida, qualidade de vida, e diâmetro dos pontos cefalométricos. Foram selecionados 11 participantes de ambos os sexos, diagnosticados com SAOS através do exame polissonográfico tipo III e com necessidade de tratamento ortopédico facial. Foi feita a coleta dos dados, os responsáveis preencheram os questionários (Escala de Distúrbios do Sono em Crianças e OSA-18-PV), termo de consentimento livre e esclarecido aos responsáveis e para as crianças, documentação ortodôntica (incluindo a análise do diâmetro dos pontos cefalométricos - espaço nasofaríngeo anterior e posterior (NFA-NFP), assim como espaço bucofaríngeo anterior e posterior (BFA-BFP)), análises iniciais da eletromiografia dos músculos masseter e temporal e força máxima de mordida. Estas informações foram coletadas no início do tratamento e após 11 meses, assim como o exame polissonográfico tipo III. Os dados foram normalizados pelo apertamento com Parafilm M e submetidos à análise normalidade pelo teste de Kolmogorov-Smirnov, sendo observado os dados: valor de polissonografia; eletromiografia de masséter direito e esquerdo; eletromiografia de temporal direito e esquerdo; força de mordida em região de incisivo e molar esquerdo/direito, os questionários foram avaliados através de score e nota (0-10), e cefalometria (análise das distâncias NFA-NFP e BFABFP). Para estes dados, foi realizado o teste t de Student. Para os dados com distribuição não normal, foi realizado o teste de Wilcoxon. Todas as análises foram realizadas com nível de significância de 5%. Em relação ao exame polissonográfico e os questionários, houve diferença estatística evidenciando melhora na qualidade do sono dos indivíduos. A eletromiografia demonstrou que houve diferença estatística em repouso no músculo temporal direito, e na mastigação de uva passas, nos músculos masseter e temporal do lado direito. Na cefalometria, foi observada diferença estatística na distância entre os pontos NFA-NFP. Conclui-se que o uso dos dispositivos Hyrax e Bionator de Balters em crianças classe II e portadoras da SAOS é uma alternativa de tratamento segura e eficaz(AU)
The aim of the study was to evaluate the influence of oral devices Hyrax and Balters Bionator in the treatment of Obstructive Sleep Apnea Syndrome (OSAS), on the improvement of OSAS observed by polysomnography, electrical activity of the masseter and temporal muscles, maximum bite force, quality of life, and diameter of cephalometric points. Eleven participants of both genders, diagnosed with OSAS through type III polysomnographic examination and in need of facial orthopedic treatment, were selected. Data collection was performed, the guardians filled out the questionnaires (Sleep Disorders Scale in Children and OSA-18-PV), informed consent form to guardians and for children, cephalometric orthodontic documents - nasopharyngeal space anterior and posterior (NFA-NFP), as well as anterior and posterior buccopharyngeal space (BFA-BFP)), initial analysis of the electromyography of the masseter and temporal muscles and maximum bite force. This information was collected at the beginning of treatment and after 11 months, as well as the type III polysomnographic exam. Data were normalized by tightening with Parafilm M and analysis of normality using the Kolmogorov-Smirnov test, observing the following data: polysomnography value; right and left masseter electromyography; right and left temporal electromyography; bite force in the left/right incisor and molar region, the questionnaires were obtained through score and grade (0-10), and cephalometry (analysis of the NFA-NFP and BFA-BFP distances). For these data, the Student test was performed. For data with non-normal distribution, the Wilcoxon test was performed. All analyzes were performed with a significance level of 5%. Regarding the polysomnographic exam and the questionnaires, there was a statistical difference showing an improvement in the sleep quality of the respondents. The electromyography required that there was a statistical difference at rest in the right muscle, and when chewing raisins, in the masseter and temporal muscles on the right side. In cephalometry, a statistical difference was observed in the distance between the NFA-NFP points. It can be concluded that the use of the Balters Hyrax and Bionator devices in class II children and children with OSAS is a safe and effective treatment alternative(AU)
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Humanos , Masculino , Feminino , Criança , Aparelhos Ortodônticos , Aparelhos Ativadores , Apneia Obstrutiva do Sono , Síndromes da Apneia do Sono , Força de Mordida , Eletromiografia , Má Oclusão Classe II de AngleRESUMO
ABSTRACT Objective: To assess the carotid and brachial arteries' intima-media thicknesses (IMTs) in cases with intermittent (obstructive sleep apnoea syndrome (OSAS)) and continuous (chronic obstructive pulmonary disease (COPD)) hypoxaemia together with other confounding demographic and biochemical factors. Methods: The study was prospectively performed on 197 patients allocated in three groups: 80 with severe OSAS, 80 with severe COPD patients and 37 healthy controls. These groups were compared in terms of demographics, biochemical markers and IMTs of the right and left carotid and brachial arteries. Results: Carotid and brachial arterial IMTs were found to be higher in both patient groups than the control group (p < 0.001). Similarly, levels of haemoglobin, haematocrit, cholesterol, triglycerides, low-density lipoproteins (LDL), C-reactive protein and D (domain)-dimer were significantly increased in patient groups. Oxygen saturations (p < 0.001) and ejection fractions (p = 0.001) were found to be worse and D-dimer levels (p = 0.010) were elevated more prominently in COPD patients, whereas, cholesterol (p < 0.001), hemoglobin (p = 0.004) and LDL (p = 0.001) levels were higher in the OSAS group. Except the right carotid IMT, which was increased significantly in OSAS patients, IMT measurements were similar in the OSAS and COPD groups (p < 0.001). Conclusion: We have shown that both intermittent and continuous hypoxia result in remarkable alterations in carotid IMT and brachial IMT. Further prospective trials are warranted to confirm and extend these findings, including the biochemical markers, which may aid in the diagnosis and follow-up of patients suffering from hypoxaemia.
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BACKGROUND: Excessive daytime sleepiness (EDS) is frequently reported as a symptom for obstructive sleep apnoea (OSA), leading to problems with concentration, mood and memory. Mandibular advance device (MAD) is considered as an effective therapy to control OSA, reducing EDS and improving sleep quality. OBJECTIVES: The present study aimed to investigate the effects MAD therapy on EDS of patients diagnosed with OSA. METHODS: Ten patients from the Sleep Medicine Service of the "Hospital Geral Sanatório" (Maceió, Alagoas, Brazil) were diagnosed with EDS, and a personalised MAD was made for each one of them. Nocturnal polysomnography (NPSG) and maintenance of wakefulness test (MWT) were applied before (baseline) and 3 months after the continuous use of the MAD. The number of arousals and micro-arousals at baseline and after treatment was also evaluated. RESULTS: All 10 patients completed the investigation. A significant decrease in the number of arousals and micro-arousals per night of sleep was observed after the use of MAD for three consecutive months (P = 0.0078; Wilcoxon signed-rank test). Also, there was a significant reduction on the apnoea/hypopnea index between baseline and post-treatment values (P = 0.0001; paired t test), as well as an increase in the mean latency for the onset of sleep (MSL) in the MTW (P = 0.0047; paired t test), indicating a significant difference among baseline and after treatment. CONCLUSION: We conclude that the improvement on EDS is associated with the used of MAD in patients diagnosed with OSA, improving their quality of sleep.
Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Brasil , Humanos , Polissonografia , SonolênciaRESUMO
BACKGROUND: Evidence suggests anthropometric indicators of obesity are associated with changes in sleep quality and quantity, and the presence of obstructive sleep apnoea (OSA). Investigations including diverse and objective evaluations of sleep and body composition are scarce. We aimed to evaluate the associations between indicators of sleep impairment and body composition states in a sample from a population-based study. METHODS: Participants of the first follow-up of the EPISONO (São Paulo, Brazil) >50 years were cross-sectionally evaluated. Sleep was assessed through questionnaires, actigraphy, and polysomnography. Body composition was evaluated by bioelectrical impedance analysis. Appendicular skeletal muscle mass adjusted for body mass index defined sarcopenia (men <0.789 and women <0.512). Total body fat defined obesity (men >30% and women >40%). The overlap between both conditions defined sarcopenic obesity (SO). Final results were obtained by multinomial logistic regression analysis. RESULTS: Three hundred fifty-nine adults [mean (standard deviation) age, 61 (8.8) years; 212 (59.1%) female] were enrolled. Obesity was detected in 22.6% of the sample, sarcopenia in 5.6%, and SO in 16.2%. After controlling for covariates, OSA was associated with SO [odds ratio = 3.14, 95% confidence interval (CI) = 1.49-6.61]. Additionally, nocturnal hypoxaemia was associated with both obesity (adjusted odds ratio = 2.59, 95% CI = 1.49-4.49) and SO (odds ratio = 2.92, 95% CI = 1.39-6.13). Other indicators of poor sleep/sleep disorders were not associated with body composition states. CONCLUSIONS: Sarcopenic obesity but not obesity alone was associated with OSA. Both obesity and SO but not sarcopenia were associated with nocturnal hypoxaemia. The findings suggest a complex pathophysiologic relationship between adverse body composition states and OSA. Upcoming research on risk factors and therapeutic interventions for OSA should target synchronically the lean and adipose body tissues.
Assuntos
Composição Corporal , Transtornos do Sono-Vigília/epidemiologia , Sono , Índice de Massa Corporal , Pesos e Medidas Corporais , Brasil/epidemiologia , Estudos Transversais , Suscetibilidade a Doenças , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Obesidade/complicações , Obesidade/epidemiologia , Razão de Chances , Vigilância em Saúde Pública , Fatores de Risco , Transtornos do Sono-Vigília/etiologiaRESUMO
Resumen El Síndrome de apnea - hipopnea obstructiva del sueño es una enfermedad con compromiso multisistémico, con especial repercusión en el sistema cardiovascular y por tanto con alto impacto en la morbimortalidad general. Se han demostrado múltiples mecanismos fisiopatológicos que explican y sugieren una asociación directa y proporcional al daño generado por esta entidad, en especial para las taquiarritmias, específicamente para fibrilación auricular y también para las bradiarrimias, con mejoría demostrada tras el tratamiento con presión positiva continua de la vía aérea. La asociación con aleteo auricular y arritmias ventriculares ha mostrado resultados contradictorios en algunos estudios, por lo que aún no es tan clara.
Abstract Obstructive sleep apnoea / hypopnoea syndrome is a disease of multisystemic involvement, with particular repercussions on the cardiovascular system, and thus a high impact on morbidity and mortality. Several pathophysiological mechanisms have been demonstrated that explain and suggest a direct and proportional relationship to the damaged caused by the condition, especially for tachyarrhythmias, specifically for atrial fibrillation, and also for bradyarrhythmias, with a demonstrated improvement with continuous positive airway pressure. As the association with atrial flutter and ventricular arrhythmias has shown contradictory results in some studies, the relationship is still not clear.