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Los trastornos del sueño son comunes en pacientes con fibrosis quística y afectan significativamente su calidad de vida. Estos pacientes experimentan una reducción en la calidad del sueño, hipoxemia nocturna, alteraciones en la polisomnografía y una alta prevalencia de síndrome de apneahipopnea obstructiva del sueño. Los factores que contribuyen a estas alteraciones incluyen la tos crónica, los síntomas digestivos, las rutinas de tratamiento y, posiblemente, la disfunción del canal CFTR. Sin embargo, el impacto de los moduladores de CFTR en la mejora de los trastornos del sueño aún no está claramente establecido, lo que resalta la necesidad de más estudios para comprender mejor su papel en el manejo del sueño en pacientes con fibrosis quística.

Sleep disorders are common in patients with cystic fibrosis and significantly affect their quality of life. These patients experience reduced sleep quality, nocturnal hypoxemia, polysomnography alterations, and a high prevalence of obstructive sleep apnea-hypopnea syndrome. Contributing factors include chronic cough, digestive symptoms, treatment routines, and potentially CFTR channel dysfunction. However, the impact of CFTR modulators on improving sleep disorders is not yet clearly established, highlighting the need for further studies to better understand their role in sleep management in cystic fibrosis patients.

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(1) Background: Home sleep apnea testing, known as polysomnography type 3 (PSG3), underestimates respiratory events in comparison with in-laboratory polysomnography type 1 (PSG1). Without head electrodes for scoring sleep and arousal, in a home environment, patients feel unfettered and move their bodies more naturally. Adopting a natural position may decrease obstructive sleep apnea (OSA) severity in PSG3, independently of missing hypopneas associated with arousals. (2) Methods: Patients with suspected OSA performed PSG1 and PSG3 in a randomized sequence. We performed an additional analysis, called reduced polysomnography, in which we blindly reassessed all PSG1 tests to remove electroencephalographic electrodes, electrooculogram, and surface electromyography data to estimate the impact of not scoring sleep and arousal-based hypopneas on the test results. A difference of 15 or more in the apnea-hypopnea index (AHI) between tests was deemed clinically relevant. We compared the group of patients with and without clinically relevant differences between lab and home tests (3) Results: As expected, by not scoring sleep, there was a decrease in OSA severity in the lab test, similar to the home test results. The group of patients with clinically relevant differences between lab and home tests presented more severe OSA in the lab compared to the other group (mean AHI, 42.5 vs. 20.2 events/h, p = 0.002), and this difference disappeared in the home test. There was no difference between groups in the shift of OSA severity by abolishing sleep scoring in the lab. However, by comparing lab and home tests, there were greater variations in supine AHI and time spent in the supine position in the group with a clinically relevant difference, either with or without scoring sleep, showing an impact of the site of the test on body position during sleep. These variations presented as a marked increase or decrease in supine outcomes according to the site of the test, with no particular trend. (4) Conclusions: In-lab polysomnography may artificially increase OSA severity in a subset of patients by inducing marked changes in body position compared to home tests. The location of the sleep test seems to interfere with the evaluation of patients with more severe OSA.

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BACKGROUND: Obstructive sleep apnea (OSA) affects nearly 1 billion people globally, and has established links with cardiovascular and neurocognitive complications. Although it has some limitations, the apnea-hypopnea index (AHI) is commonly used to gauge OSA severity and therapeutic response. Homocysteine (Hcy) metabolism, when impaired, can elicit cellular senescence mechanisms that may be shared with OSA. Hence, our objective was to explore the role of Hcy concentrations both as a predictor of AHI values and as a potential risk factor for OSA. METHODS: Involving 1042 volunteers aged 20 to 80 years, the initial study (2007) included polysomnographic evaluations, questionnaires on sleep and general health, as well as biochemical analyses. After an 8-year interval, 715 participants from the initial study were invited for a follow-up assessment in 2015. RESULTS: Our findings showed that Hcy was a predictor for an increased AHI, and AHI increased over time. Individuals with plasma Hcy concentrations ≥ 15 µmol/L experienced an average AHI increase of 7.43 events/hour ([beta coefficient] ß = 7.43; 95%CI 2.73 to 12.13) over time, compared to those with plasma concentrations < 10 µmol/L. A similar trend was apparent in those with plasma Hcy concentrations between 10 ≥ and < 15 µmol/L, who had an AHI increase with an average beta coefficient of 3.20 events/hour (95%CI 1.01 to 5.39) compared to those with plasma Hcy concentrations < 10 µmol/L. CONCLUSIONS: In summary, our study suggests that increased plasma Hcy concentrations could be considered a risk factor for the development of OSA. These findings highlight that elevated plasma Hcy concentrations can predict the severity of OSA, underscoring their correlation with the AHI.

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PURPOSE: The use of continuous positive airway pressure (CPAP) is one of the therapeutic modalities for obstructive sleep apnea (OSA). Manual titration polysomnography and the 90th or 95th percentiles of pressure titrated by automatic CPAP (APAP) are the current standard for determining fixed pressure. Pressures programmed at an arbitrary fixed value, or at preset values based on body mass index (BMI) or by predictive formulas, are presented as alternative forms. This study aimed to evaluate the residual apnea-hypopnea index (r-AHI) in polysomnography with CPAP therapy using pressure determined by formula and assess its feasibility to start treatment. METHODS: Patients referred for CPAP therapy were followed up in three outpatient assessments and underwent polysomnography study with pressure CPAP obtained by formula. RESULTS: The study sample consisted of 80 patients, 41 women; age 58.6 ± 11.3 years, BMI 34.1 ± 7.5 kg/m2 and cervical circumference 42.0 ± 4.2 cm. Most patients (74%) had severe OSA and Epworth sleepiness scale (ESS) of 12.0 ± 5.7 points. The calculated average pressure was 7.8 ± 2.1 cmH2O. Polysomnography studies showed an r-AHI of 6.1 ± 5.2 events/h and reduction of 84% from baseline AHI. The r-AHI in the REM-supine was 8.4 ± 9.9 events/h. At 30- and 120-day follow-up assessment, adherence to CPAP was 78% and 75% and the ESS score was 6.9 and 6.1 points, respectively. CONCLUSION: Results suggest that a formula provides an effective initial pressure in the majority of patients (73%). This simplified approach appears to be a viable alternative, with reductions in waiting lists and time from diagnosis to initiation of therapy.

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PURPOSE: To examine potential clinical, demographic, anthropometric, and polysomnographic predictors of successful auto-adjusting continuous positive airway pressure (CPAP) titration for treatment of obstructive sleep apnea (OSA). METHODS: This cross-sectional study was conducted in adults diagnosed with moderate-to-severe OSA (baseline apnea-hypopnea index [AHI] ≥ 15.0/h), who underwent auto-adjusting CPAP titration (S9 or S10 AutoSet ResMed®) in a sleep laboratory setting while wearing a nasal or pillow mask. Participants were then grouped into two groups: optimal CPAP titration (residual AHI < 5.0/h) or suboptimal CPAP titration (residual AHI ≥ 5.0/h). Multivariate logistic regression analysis was used to assess possible independent predictive factors for suboptimal CPAP titration. RESULTS: A total of 1222 adults consisting of 874 subjects with optimal CPAP titration (71.5%) and 348 subjects with suboptimal CPAP titration (28.5%) were evaluated. Multivariate analysis resulted in a model with an adequate calibration (Hosmer-Lemeshow chi-square-test: 7.088; p = 0.527), with male sex, higher values of baseline AHI, therapeutic pressure (95th percentile), and mask leak (95th percentile) emerging as significant and independent predictors for suboptimal CPAP titration: adjusted odds ratio (OR): 1.456 (95% confidence interval [CI] 1.076-1.971; p = 0.015), OR: 1.009 (95% CI 1.002-1.016; p = 0.013), OR: 1.281 (95% CI 1.206-1.361; p < 0.001), and 1.035 (1.026-1.043; p < 0.001), respectively. CONCLUSIONS: In a large cohort of adults undergoing auto-adjusting CPAP titration due to moderate-to-severe OSA, male sex, increased values of baseline AHI, pressure requirements, and mask leak were significant predictors for less than optimal CPAP titration.

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Introducción: La obesidad es una enfermedad epidémica multifactorial en constante aumento en los últimos años. Asocia el desarrollo de múltiples patologías con aumento de la morbimortalidad, entre ellas el síndrome de apneas e hipopneas obstructivas del sueño (SAHOS). Objetivo: Estudiar la prevalencia de SAHOS en una población de obesos pertenecientes a un Programa de Obesidad y Cirugía Bariátrica de un hospital público de Montevideo. Metodología: Estudio observacional descriptivo de cohorte transversal. Se incluyeron pacientes en valoración preoperatoria desde abril 2015 a marzo 2020. Se les realizó una polisomnografía. Se evaluó la prevalencia de SAHOS y la relación con otros factores de riesgo cardiovascular. El análisis estadístico se realizó con SPSS versión 25.0. Resultados: Se estudiaron 358 pacientes con predominio del sexo femenino (86,3%), edad media de 42,8 ± 10,7 años y un índice de masa corporal (IMC) promedio de 50,1 ± 11,4 kg/m2. Se evidenció una prevalencia de SAHOS de 69%: 43,3% leve; 23,9% moderada y 32,8% severo. El Índice apnea hipopnea (IAH) se correlacionó positivamente con IMC (p ≤ 0,001). Se demostró la asociación de SAHOS con hipertensión arterial (HTA), diabetes 2 (DM2), sexo masculino e hipertrigliceridemia. Conclusiones: El SAHOS es altamente prevalente en la obesidad. Este estudio sugiere la realización de un screening en todos los obesos, así como su estudio con polisomnografía o poligrafía respiratoria a aquellos que vayan a someterse a una cirugía bariátrica.

Introduction: Obesity is a multifactorial epidemic disease that has been constantly increasing in recent years. It associates the development of multiple pathologies with increased morbidity and mortality, including obstructive sleep apnea and hypopnea syndrome (OSAHS). Objective: To study the prevalence of OSAHS in a population of obese patients belonging to an Obesity and Bariatric Surgery Program of a public hospital in Montevideo. Methodology: Observational descriptive cross-sectional study. Patients in preoperative evaluation were included from April 2015 to March 2020. A polysomnography was performed. The prevalence of OSAHS and the relationship with other cardiovascular risk factors were evaluated. Statistical analysis was performed with SPSS version 25.0. Results: 358 patients were studied, predominantly female (86.3%), mean age of 42.8 ± 10.7 years and mean BMI of 50.1 ± 11.4 kg/m2. A prevalence of OSAHS of 69% was evidenced: 43.3% mild; 23.9% moderate and 32.8% severe. The Apnea Hypopnea Index (AHI) was positively correlated with the Body Mass Index (BMI) (p=<0.001). The association of OSAHS with arterial hypertension (AHT), diabetes 2 (DM2), male gender and hypertriglyceridemia was demonstrated. Conclusions: OSAHS is highly prevalent in obesity. This study suggests screening all obese people, as well as polysomnography or respiratory polygraphy for those who are going to undergo bariatric surgery.

Introdução: A obesidade é uma doença epidêmica multifatorial que vem aumentando constantemente nos últimos anos. Associa o desenvolvimento de múltiplas patologias ao aumento da morbimortalidade, incluindo a síndrome da apneia e hipopneia obstrutiva do sono (SAHOS). Objetivo: Estudar a prevalência de SAHOS em uma população de pacientes obesos pertencentes a um Programa de Obesidade e Cirurgia Bariátrica de um hospital público de Montevidéu. Metodologia: Estudo observacional descritivo transversal. Os pacientes em avaliação pré-operatória foram incluídos de abril de 2015 a março de 2020. Foi realizada polissonografia. A prevalência de SAHOS e a relação com outros fatores de risco cardiovascular foram avaliadas. A análise estatística foi realizada com SPSS versão 25.0. Resultados: Foram estudados 358 pacientes, predominantemente do sexo feminino (86,3%), idade média de 42,8 ± 10,7 anos e IMC médio de 50,1 ± 11,4 kg/m2. Evidenciou-se prevalência de SAHOS de 69%: 43,3% leve; 23,9% moderado e 32,8% grave. O Índice de Apnéia e Hipopnéia (IAH) correlacionou-se positivamente com o Índice de Massa Corporal (IMC) (p=<0,001). Foi demonstrada a associação da SAHOS com hipertensão arterial (HA), diabetes 2 (DM2), sexo masculino e hipertrigliceridemia. Conclusões: A SAHOS é altamente prevalente na obesidade. Este estudo sugere a triagem de todos os obesos, bem como a polissonografia ou poligrafia respiratória para aqueles que serão submetidos à cirurgia bariátrica.

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Atualmente, o tratamento do ronco primário e da Síndrome da Apnéia/Hipopnéia Obstrutiva do Sono (SAHOS)1 através de aparelhos intra-orais (AIO) tem recebido a atenção dos pesquisadores pela comprovada eficácia destes dispositivos. Os aparelhos mais indicados são os reposicionadores de mandíbula que promovem um avanço mandibular, afastando os tecidos da orofaringe superior, o que evita a obstrução parcial ou total da área. Sua indicação é para casos de ronco primário e apnéias leves e moderadas2, no entanto é necessário que os candidatos apresentem número de dentes suficientes com saúde periodontal para a ancoragem do aparelho. Por ser uma doença de consequências sistêmicas graves, o tratamento da SAHOS é em sua essência de responsabilidade do médico especialista na área, porém o cirurgião dentista deve ter conhecimento para diagnosticar e tratar, quando o AIO for a opção terapêutica. A interpretação da polissonografia, exame que diagnostica e conduz para a escolha correta do tratamento, e dos dados cefalométricos são os principais quesitos ao Cirurgião Dentista que se propõe a tratar portadores da SAHOS. Nesse trabalho foi elaborado um questionário e aplicado aos cirurgiões dentistas de três diferentes cidades do Estado de São Paulo para que fosse possível avaliar o conhecimento desses profissionais a respeito do diagnóstico e tratamento da SAHOS. 70 Cirurgiões Dentistas foram entrevistados e os resultados mostraram que 70% destes têm interesse em trabalhar com os AIOs. Esse grupo se relacionou estatisticamente significante com aqueles que afirmaram já terem sido alguma vez questionado por algum paciente a respeito desse tratamento. Quanto à criação de uma especialidade para essa área, os profissionais da área de prótese e implante se mostraram mais interessados. E, do número total de entrevistados, apenas 25% já tiveram contato com esse tipo de aparelho, mas não conhece o protocolo de atendimento para o tratamento desses pacientes(AU)

Currently, the treatment of primary snoring and Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS)1 through intraoral appliances (OA) has received the attention of researchers due to the proven effectiveness of these devices. The most suitable devices are jaw repositioning devices that promote mandibular advancement, moving the tissues away from the upper oropharynx, which prevents partial or total obstruction of the area. Its indication is for cases of primary snoring and mild to moderate apnea2, however it is necessary that candidates have a sufficient number of teeth with periodontal health to anchor the appliance. As it is a disease with serious systemic consequences, the treatment of OSAHS is, in essence, the responsibility of the specialist in the area, but the dental surgeon must have the knowledge to diagnose and treat, when OA is the therapeutic option. The interpretation of polysomnography, na exam that diagnoses and leads to the correct choice of treatment, and cephalometric data are the main requirements for the Dental Surgeon who proposes to treat patients with OSAHS. In this work, a questionnaire was developed and applied to dentalsurgeons from three different cities in the State of São Paulo so that it was possible to assess the knowledge of these professionals regarding the diagnosis and treatment of OSAHS. 70 Dental Surgeons were interviewed and the results showed that 70% of them are interested in working with AIOs. This group had a statistically significant relationshipwith those who stated that they had already been asked by a patient about this treatment. Regarding the creation of a specialty for this area, professional in the area of ??prosthesis and implant were more interested. And, of the total number of respondents, only 25% have already had contact with this type of device, but do not know the care protocol for the treatment of these patients(AU)

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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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OBJECTIVES: To evaluate the efficiency of maxillomandibular advancement using aggregated individual patient data from multiple studies. MATERIALS AND METHODS: This overview was structured according to the PICO strategy. It adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist and was recorded on the international prospective register of systematic reviews (PROSPERO-CRD42020206135). Searches were conducted in the PubMed/MEDLINE, Scopus, Embase, Web of Science, LILACS, and Cochrane databases for studies published until January 1, 2021. Data from the included studies were collected by one author, while another reviewed the compilation. RESULTS: Twelve systematic reviews were included. The outcome measures studied were the apnea-hypopnea index, respiratory disturbance index, mean oxygen saturation, lowest oxygen saturation, sleepiness data, posterior air space, sella-nasion point A angle, sella-nasion point B angle, surgical success, and surgical cure in patients who underwent surgery. The AMSTAR scale presented moderate evaluations, with grades varying between 6 and 10 points. The Glenny scale revealed that the study selection did not include all languages. Only three reviews identified quality assessments conducted by at least two reviewers and only five related possible searches for unpublished data. CONCLUSIONS: Bimaxillary advancement surgery improved respiratory indicators, sleepiness data, and increased upper airway size. However, it is necessary to standardize the surgical criteria to establish measurable efficiency of the procedure. CLINICAL RELEVANCE: This overview makes a critical analysis of the results of the selected systematic reviews with the aim of presenting the most clinically relevant data on the maxillomandibular advancement for treating obstructive apnea syndrome, with a focus on improving respiratory, anatomical, and quality of life indices. There are no overviews that approach this theme from a well-structured perspective.

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O valor inestimável ao sono, devido a estudos que comprovaram sua importância à saúde e à qualidade de vida. Tais conhecimentos levaram a identificação de doenças específicas, dentre elas a Síndrome de Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS). Esta doença incide na obstrução das vias aéreas superiores durante o sono, acarretando paradas na respiração e consequências sistêmicas. Estudos atuais e características que interferem na qualidade de vida dos sujeitos, tal como produtividade. O objetivo deste trabalho é o profissional saber que com atitudes cotidianas podemos anemizar o quadro necessitando dessa forma de um tratamento mais brando e de melhor acesso a todos(AU)

The priceless value of sleep, due to studies that have proven its importance to health and quality of life. Such knowledge led to the identification of specific diseases, among them the Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS). This disease focuses on obstruction of the upper airways during sleep, causing breathing stops and systemic consequences. Current studies and characteristics that inter the quality of life of subjects, such as productivity. The objective of this work is for the professional to know that with everyday attitudes we can anemize the condition, thus needing a milder treatment and better access to all(AU)

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Ter um sono de qualidade é imprescindível para a saúde. Cada pessoa sabe a quantidade que a repara melhor. Dessa forma, sono em fora de hora de sesta pode ser problemas em potencial. Um paciente que adormeci em um tratamento dentário pode estar com um déficit de sono que o adormecer durante um tratamento dentário é uma situação inusitada que, pode ser um paciente que precisa de uma a polissonografia e um possível tratamento para o possível presente ronco primário e Síndrome da Apneia e Hipopneia Obstrutiva do Sono (SHAOS). O Cirurgião Dentista deve conhecer os sinais e sintomas mais comuns dos pacientes com problemas de sono para poder indicá-los corretamente a um médico especialista em sono. Dessa forma já se tem como certo que esse é um problema médico, no entanto o Cirurgião Dentista é um profissional importante nas modalidades de tratamento que temos para a síndrome. O simples ato da indicação e acompanhamento do tratamento faz o Cirurgião Dentista, importante nessa cadeia de tratamento(AU)

Getting quality sleep is essential for health. Each person knows the amount that repairs them best. So sleep outside of nap time can be potential problems. A patient who fell asleep in a dental treatment may have a sleep deficit that falling asleep during a dental treatment is an unusual situation that, may be a patient who needs a polysomnography and a possible treatment for the possible present primary snoring and syndrome. Obstructive Sleep Apnea and Hypopnea (SHAOS). The Dental Surgeon must know the most common signs and symptoms of patients with sleep problems in order to correctly refer them to a sleep specialist. Thus, it is already taken for granted that this is a medical problem, however the Dental Surgeon is an important professional in the treatment modalities we have for the syndrome. The simple act of indicating and monitoring the treatment makes the Dental Surgeon important in this treatment chain(AU)

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El síndrome de apneas e hipoapneas obstructivas del sueño se asocia con una disminución de la calidad de vida, bajo rendimiento escolar y, hasta en el 40% de los niños, trastornos de conducta como hiperactividad, enuresis, ansiedad y depresión. Varios estudios demostraron que la adenoamigdalectomía es efectiva para mejorar o resolver los trastornos respiratorios del sueño. Si bien esta cirugía tiene resultados beneficiosos, no está exenta de riesgos. El dolor y el sangrado posoperatorio son las dos causas principales de morbilidad. Otras complicaciones de la cirugía son las náuseas y los vómitos posoperatorios, el retraso en la alimentación, la deshidratación, la otalgia referida, los cambios en la voz y, raras veces, la muerte.En este artículo se realizan recomendaciones sobre el cuidado posoperatorio de los niños con adenoamigdalectomía

Obstructive sleep apnea and hypopnea syndrome is associated with decreased quality of life, poor school performance and, in up to 40% of children, behavioral problems such as hyperactivity, enuresis, anxiety and depression. Several studies have shown that adenoamygdalectomy is effective in improving or resolving sleep-disordered breathing. While this surgery has beneficial results, it is not without risks. Postoperative pain and bleeding are the two main causes of morbidity. Other complications of surgery include postoperative nausea and vomiting, delayed feeding, dehydration, referred earache, voice changes, and, rarely, death. Recommendations on postoperative care for children undergoing adenoamygdalectomy are mentioned in this article.

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Obstructive sleep apnea and hypopnea syndrome is associated with decreased quality of life, poor school performance and, in up to 40 % of children, behavioral problems such as hyperactivity, enuresis, anxiety and depression. Several studies have shown that adenoamygdalectomy is effective in improving or resolving sleepdisordered breathing. While this surgery has beneficial results, it is not without risks. Postoperative pain and bleeding are the two main causes of morbidity. Other complications of surgery include postoperative nausea and vomiting, delayed feeding, dehydration, referred earache, voice changes, and, rarely, death. Recommendations on postoperative care for children undergoing adenoamygdalectomy are mentioned in this article.

El síndrome de apneas e hipoapneas obstructivas del sueño se asocia con una disminución de la calidad de vida, bajo rendimiento escolar y, hasta en el 40 % de los niños, trastornos de conducta como hiperactividad, enuresis, ansiedad y depresión. Varios estudios demostraron que la adenoamigdalectomía es efectiva para mejorar o resolver los trastornos respiratorios del sueño. Si bien esta cirugía tiene resultados beneficiosos, no está exenta de riesgos. El dolor y el sangrado posoperatorio son las dos causas principales de morbilidad. Otras complicaciones de la cirugía son las náuseas y los vómitos posoperatorios, el retraso en la alimentación, la deshidratación, la otalgia referida, los cambios en la voz y, raras veces, la muerte. En este artículo se realizan recomendaciones sobre el cuidado posoperatorio de los niños con adenoamigdalectomía.

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Background: Human respiratory physiology changes significantly in high altitude settings and these changes are particularly marked during sleep. It is estimated that 170 million people live above 2,500 m in environments where normal sleep parameters differ from those established at sea level or low altitude. Methods: We conducted a systematic review of publications reporting sleep studies in healthy children living at high altitude. For this purpose, data from PubMed, EMBASE, SciELO and Epistemomikos bases were retrieved up to August 2021. Results: Six articles met specified inclusion criteria; all reporting data were from South America involving 245 children (404 sleep studies) in children aged 0.6 months to 18 years, at altitudes between 2,560 to 3,775 m. The main results were: (1) Central apnea index decreased as the age increased. (2) The obstructive apnea/hypopnea index showed a bimodal profile with an increase in young infants up to age of 4 months, decreasing to 15 months of age, and then a second peak in children aged 4 to 9 years of age, dropping in older schoolchildren and adolescents. (3) Periodic breathing in the first months of life is more marked with increasing altitude and decreases with age. Conclusions: There are few studies of sleep physiology in children living at high altitude. The international parameters defining normal apnea indices currently used at low altitude cannot be applied to high altitude settings. The interpretation of sleep studies in children living at high altitude is complex because there are important developmental changes across childhood and a wide range of altitude locations. More normative data are required to determine thresholds for respiratory pathology at a variety of high altitude settings.

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Introduction: The presence of obstructive sleep apneas (OSA) is a prevalent disease, whose severity is determined from the Apnea- Hypopnea Index (AHI). Very severe OSA (vsOSA) is defined by an AHI ≥ 60 events/hour; with clinical characteristics that could be different. The purpose of this study was to describe the clinical characteristics of patients with sOSA and compare them with less severe manifestations of this disease. Materials and Methods: Retrospective study of patients referred to a specialized hypertension center who met clinical criteria for the study of OSA. Patients were analyzed by means of a respiratory polygraphy, Ambulatory Monitoring of Arterial Pressure (AMAP), questionnaires and laboratory tests. We used non-parametric tests for the analysis of the results. Results: Of the 115 patients with OSA included in the study, 57 showed moderate OSA (mOSA), 48 sOSA and 10 vsOSA. No statistically significant differences were observed in age, Body Mass Index (BMI), glycemia, percentage of diabetic patients, or waist or neck diameter. We observed that the proportion of patients with arterial hypertension became higher as the severity of the OSA increased. This increase was significant only regarding the value of diastolic arterial pressure in very severe patients (vsOSA: 94.0 ± 7.7 mmHg vs. sOSA: 87.9 ± 8.7 mmHg and mOSA: 84.4 ± 8.2 mmHg; p < 0.05 and p < 0.01, respectively). Conclusions: In agreement with previous studies, our patients with vsOSA showed a higher degree of diastolic hypertension with clinical characteristics similar to less severe manifestations of OSA.

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ABSTRACT Background: The burden of obstructive sleep apnea (OSA) in rural settings is unknown. In these regions, devices needed for OSA diagnosis are not available, and mass screening with field instruments may be complicated due to cross-cultural factors and illiteracy. The association between the Friedman's tongue position (FTP) and OSA has been assessed in people from different ethnic groups but not in Amerindians. Objective: We aimed to assess whether a FTP type IV is associated with OSA severity and with the apnea-hypopnea index (AHI) in community-dwelling older adults of Amerindian ancestry living in rural Ecuador. Methods: A total of 201 Atahualpa residents aged ≥60 years, who underwent tongue position assessment, brain MRI, and polysomnography were included. After adjusting for relevant confounders, ordinal logistic regression models were fitted to assess the association between the presence of a FTP type IV and OSA categories (none, mild, and moderate-to-severe), and generalized linear models with a Gaussian link were fitted to assess the association between the presence of a FTP type IV and the continuous AHI. Results: A FTP type IV was identified in 153 (76%) individuals, the mean AHI per hour was 11.9 ± 12.4, and 49 (24%) individuals had moderate-to-severe OSA, 88 (44%) had mild OSA, and the remaining 64 (32%) had no OSA. Fully-adjusted generalized linear models showed no independent association between the investigated exposure and the AHI (β: 0.09; 95% C.I.: -1.56 - 1.76; p=0.909). Likewise, ordinal logistic regression models showed no independent association between the investigated exposure and categories of OSA (β: 0.42; 95% C.I.: -0.47 - 1.31; p=0.357). Conclusion: A FTP type IV is not associated with the AHI or the severity of OSA in this population of Amerindians. This lack of association could be related to phenotypic characteristics of people from this ethnic group (mostly their elliptic hard palate).

RESUMEN Antecedentes: Se desconoce la prevalencia de la apnea obstructiva del sueño (AOS) en entornos rurales. En esas regiones, los equipos necesarios para el diagnóstico de AOS no están disponibles, y la detección de AOS con instrumentos de campo puede ser complicada debido a factores interculturales y analfabetismo. La asociación entre la posición de la lengua de Friedman (FTP) y AOS se ha evaluado en personas de diferentes grupos étnicos, pero no en Amerindios. Objetivo: Evaluar si al tipo IV de FTP está asociado con la severidad de la AOS y con el índice de apnea-hipopnea (IAH) en adultos mayores que viven en una comunidad de ascendencia Amerindia en zonas rurales de Ecuador. Métodos: Se incluyeron 201 residentes de Atahualpa de edad ≥60 años, que fueron sometidos a evaluación de la posición de la lengua, resonancia magnética cerebral y polisomnografía. Después de ajustar por factores de confusión relevantes, modelos de regresión logística ordinal evaluaron la probable asociación entre la presencia de un FTP tipo IV y las categorías AOS (ninguna, leve y moderada a grave), y se ajustaron modelos lineales generalizados con un enlace gaussiano para evaluar la asociación entre la presencia de un FTP tipo IV y el IAH continuo. Resultados: Se identificó un tipo IV de FTP en 153 (76%) individuos, el IAH promedio por hora fue de 11.9 ± 12.4 y 49 (24%) individuos tenían AOS de moderada a grave, 88 (44%) tenían AOS leve. y los 64 restantes (32%) no tenían AOS. Los modelos lineales generalizados, ajustados por confusores, no mostraron una asociación independiente entre la exposición investigada y el IAH (β: 0.09; 95% C.I.: -1.56 - 1.76; p = 0.909). Del mismo modo, los modelos de regresión logística ordinal no mostraron una asociación independiente entre la exposición investigada y las categorías de AOS (β: 0,42; 95% C.I.: -0,47 - 1.31; p = 0,357). Conclusión: El tipo IV de FTP no está asociado con el IAH o la gravedad de la AOS en esta población de Amerindios. Esta falta de asociación podría estar relacionada con las características fenotípicas de las personas de este grupo étnico (principalmente su paladar óseo de tipo elíptico).

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Introduction: Hypertension (HT) and obstructive sleep apnea-hypopnea syndrome (OSA) are prevalent and frequently related pathologies. The predictive value of screening questionnaires in cardiovascular settings is not totally clear and could be useful to select candidates for the sleep test. Materials and Methods: We performed a prospective study in adults with suspected HT referred to a day-care hospital. Epworth Sleepiness Scale (ESS), Berlin, and STOP-BANG (SBQ) questionnaire were checked against data from home-based respiratory polygraphy (RP). We calculated sensitivity (S) and specificity (Sp), positive and negative predictive values (PPV and NPV), and the area under the ROC curve (AUC-ROC) for each questionnaire and their combinations. Results: We analyzed 382 patients; 234 men (61.3%) and 148 women, mean age: 54.5 ± 13.7 years, body mass index (BMI): 33.1 ± 7.8 kg/m2, ESS: 7.4 ± 4.7. Seventy-eight percent had an apnea-hypopnea index (AHI) >5 events per hour (eV/h) and 58% presented >15 eV/h (mean: 17.5 ± 9.3 eV/h). With regard to clinically significant OSA (AHI > 15 eV/h), 5 SBQ components showed S: 100% (CI: 97-100) and Sp: 98% (CI: 95-99) with a NPV of 100, a PPV of 97.8, and an AUC-ROC of 0.90 (p < 0.0001). ESS > 10 + high-risk Berlin did not perform as effectively. Conclusion: In a population of HT patients, SBQ > 5 performed better at identifying patients with >15 eV/hour with a high discrimination power.

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Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for snoring, and daytime sleepiness had a clinical evaluation including collection of anthropometric data and ENT examination and rhinofibroscopy with Müller maneuver. The patients undergoing upper airway multilevel surgery and we selected for MESP the patients with an oropharyngeal transverse pattern of collapse at Müller maneuver. Results In the postoperative assessment, all of the patients reported a reduction in snoring scores and daytime sleepiness. We observed a reduction in the mean apnea-hypopnea index (AHI) of 57.5% of the sample, which decreased from a mean value of 41.7 ( ± 21.5) to 17.4 ( ± 8.9) (p< 0.05), with a success rate, according to the Sher criteria, of 65%. We observed very few postoperative complications. Conclusion Modified expansion sphincter pharyngoplasty in multilevel surgical therapy preceded by a careful selection of patients has proven to be effective in treating patients with moderate to severe syndromes.

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Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for snoring, and daytime sleepiness had a clinical evaluation including collection of anthropometric data and ENT examination and rhinofibroscopy with Müller maneuver. The patients undergoing upper airway multilevel surgery and we selected for MESP the patients with an oropharyngeal transverse pattern of collapse at Müller maneuver. Results In the postoperative assessment, all of the patients reported a reduction in snoring scores and daytime sleepiness. We observed a reduction in the mean apnea-hypopnea index (AHI) of 57.5% of the sample, which decreased from a mean value of 41.7 ( ± 21.5) to 17.4 ( ± 8.9) ( p < 0.05), with a success rate, according to the Sher criteria, of 65%. We observed very few postoperative complications. Conclusion Modified expansion sphincter pharyngoplasty in multilevel surgical therapy preceded by a careful selection of patients has proven to be effective in treating patients with moderate to severe syndromes.

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Los eventos de apnea o hipopnea durante el proceso del sueño se caracterizan por una disminución o bloqueo de la respiración induciendo a un estado orgánico de hipooxigenación que a su vez induce a microdespertares en reacción fi siológica de protección del organismo. Durante estos eventos, el individuo transita de una fase profunda del sueño a una más superfi cial. La repetición de los eventos de apnea/hipopnea provoca que el sueño no sea reparador física y emocionalmente, además de provocar una hiperactividad motora de los músculos masticadores. induciendo un incremento en la frecuencia e intensidad de movimientos rítmicos masticatorios que eventualmente pueden promover daños musculares, articulares, mucosos y dentales. El incremento de los movimientos rítmicos mandibulares también se observa en bruxismo nocturno, lo que abre la posibilidad que haya un efecto sumatorio entre ellos. Para ambos tipos de padecimientos, la polisomnografía empleada en tiempos modernos es un procedimiento para evaluar las alteraciones del sueño, que puede demostrar que los microdespertares preceden a un incremento de manifestaciones del sistema nervioso autónomo, incluida la hiperactividad muscular, la cual puede provocar alteraciones orgánicas de tipo sistémico, además de episodios de apretamiento y rechinamiento dental (AU)

The events of apnea or hypopnea during the sleep process are characterized by a decrease or obstruction of respiration inducing an organic state of hypooxygenation that in turn induces micro-arousals as a physiological reaction to protect the organism. During these events, the individual transits from a deep sleep phase to a more superfi cial phase. The repetition of apnea/hypopnea events causes a sleep that is nor physically neither emotionally repairing; furthermore inducing a motor hyperactivity of the masticatory muscles which increases the frequency and intensity of rhythmic masticatory movements that can eventually promote muscular, joint (TMJ), mucous and dental damage. That increase of the rhythmic masticatory movements is also observed in sleep bruxism, which leaves open the possibility of observing a summation eff ect with sleep apnea. For this type of conditions, polysomnography is a procedure that assesses sleep disturbances and demonstrates that micro-arousal precedes an increase autonomic changes, including muscle hyperactivity, which eventually could cause organic systemic alterations, as well episodes of clenching and dental grinding (AU)

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