Anthropometric measures and obstructive sleep apnea in children and adolescents: a systematic review of the literature and meta-analysis.

BACKGROUND: Anthropometric measurements can be used to identify children at risk of developing obstructive sleep apnea (OSA). The study aimed to assess which anthropometric measurements (AMs) are most associated with an increased predisposition to develop OSA in healthy children and adolescents. METHODS: We performed a systematic review (PROSPERO #CRD42022310572) that searched eight databases and gray literature. RESULTS: In eight studies with low-to-high risk of bias, investigators reported the following AMs: body mass index (BMI), neck circumference, hip circumference, waist-to-hip ratio, neck-to-waist ratio, waist circumference, waist-to-height ratio, and facial AMs. The meta-analysis showed that the OSA group had an average of 1.00 cm greater for the neck circumference (p < 0.001; Cohen's d = 2.26 [0.72, 5.23]), 3.07 cm greater for the waist circumference (p = 0.030; Cohen's d = 0.28 [0.02, 0.53]), 3.96 cm greater for the hip circumference (p = 0.040; Cohen's d = 0.28 [0.02, 0.55]), 5.21° greater for the cervicomental angle (p = 0.020; Cohen's d = 0.31 [0.03, 0.59]), and 1.23° greater for maxillary-mandibular relationship angle (p < 0.001; Cohen's d = 0.47 [0.22, 0.72]) than the control group. The mandibular depth angle had a reduction of 1.86° (p = 0.001; Cohen's d = -0.36° [-0.65, -0.08]) in control than in patients with OSA. The BMI (p = 0.180), waist-to-hip ratio (p = 0.280), neck-to-waist ratio (p = 0.070), maxillary depth angle (p = 0.250), and upper/lower face height ratio (p = 0.070) showed no significant differences between groups. CONCLUSIONS: Compared to the control group, the OSA group exhibited a greater mean difference in neck circumference, the only anthropometric measurement with high certainty of evidence.

Mandibular advancement device in obstructive sleep apnea treatment: what happens to the condyle position and patient response?

BACKGROUND: This study aims primarily to assess the mandibular condyles and patient response to MAD therapy using cone-beam computed tomography (CBCT). Also, the study proposes to analyze whether variations in condylar position, OSA severity and mandibular protrusion influence patient response. METHODS: 23 patients diagnosed with mild/moderate OSA and treated with MAD comprised the sample. Clinical, CBCT, and PSG assessments were conducted at baseline and with MAD in therapeutic protrusion (4-6 months of MAD use). The condyle position was vertically and horizontally evaluated at baseline and at the therapeutic protrusion. RESULTS: The condyle position significantly changed with MAD, showing anterior (7.3 ± 2.8 mm; p < 0.001) and inferior (3.5 ± 1 mm; p < 0.001) displacement. Patients with mild OSA required more protrusion (p = 0.02) for improvement. Responders exhibited a significantly prominent (p = 0.04) anterior baseline condyle position. A negative modest correlation was found between treatment response and baseline condyle anterior position (p = 0.03; r=-0.4), as well as between OSA severity and the percentage of maximum protrusion needed for therapeutic protrusion (p = 0.02; r=-0.4). The patient protrusion amount did not predict condylar positional changes. Neither condyle position, OSA severity, nor therapeutic protrusion were predictors of MAD treatment response. CONCLUSION: MAD resulted in anterior and inferior condylar displacement, and the amount of protrusion did not predict condylar positional changes. Responders showed a more anterior baseline condyle position. OSA severity and mandibular protrusion did not predict treatment response.

Evaluation of condylar and mandibular movements on the upper airway during the use of mandibular advancement device for obstructive sleep apnea treatment.

OBJECTIVES: To evaluate the temporomandibular joint (TMJ), condylar and mandibular movements in obstructive sleep apnea (OSA) patients treated with mandibular advancement device (MAD) and to identify the influence of these anatomic factors on upper airway (UA) volume and polysomnographic outcomes after treatment. MATERIALS AND METHODS: Twenty OSA patients were prospectively treated with MAD. Clinical examinations, cone-beam computed tomography, and polysomnography were performed before MAD treatment and after achieving therapeutic protrusion. Polysomnographic variables and three-dimensional measurements of the TMJ, mandible, and upper airway were statistically analyzed. RESULTS: Condylar rotation, anterior translation, and anterior mandibular displacement were directly correlated with total UA volume, while vertical mandibular translation was inversely correlated with the volume of the inferior oropharynx. MAD treatment resulted in an increase in the volume and area of the superior oropharynx. There was no statistically significant correlation between condylar rotation and translation and polysomnographic variables. With MAD, there was a significant increase in vertical dimension, changes in condylar position (rotation and translation), and mandibular displacement. The central and medial lengths of the articular eminence were inversely correlated with condylar rotation and translation, respectively. The lateral length of the eminence was directly correlated with condylar translation, and the lateral height was directly correlated with condylar rotation and translation. CONCLUSION: Condylar and mandibular movements influenced UA volume. The articular eminence played a role in the amount of condylar rotation and translation. CLINICAL RELEVANCE: Individualized anatomical evaluation of the TMJ proves to be important in the therapy of OSA with MAD.

Automatic multi-anatomical skull structure segmentation of cone-beam computed tomography scans using 3D UNETR.

The segmentation of medical and dental images is a fundamental step in automated clinical decision support systems. It supports the entire clinical workflow from diagnosis, therapy planning, intervention, and follow-up. In this paper, we propose a novel tool to accurately process a full-face segmentation in about 5 minutes that would otherwise require an average of 7h of manual work by experienced clinicians. This work focuses on the integration of the state-of-the-art UNEt TRansformers (UNETR) of the Medical Open Network for Artificial Intelligence (MONAI) framework. We trained and tested our models using 618 de-identified Cone-Beam Computed Tomography (CBCT) volumetric images of the head acquired with several parameters from different centers for a generalized clinical application. Our results on a 5-fold cross-validation showed high accuracy and robustness with a Dice score up to 0.962±0.02. Our code is available on our public GitHub repository.

A retrospective study of the influence of obesity on polysomnography and cephalometric parameters in males with obstructive sleep apnea.

OBJECTIVE: Evaluate the influence of obesity on the polysomnographic and cephalometric parameters in obstructive sleep apnea (OSA). METHODS: Fifty records of male patients with OSA, containing information on dental, medical, polysomnographic, and cephalometric exams were selected. The degree of obesity was based on Body Mass Index (BMI). Group I comprised normal or overweight individuals (BMI ≤ 29.9 kg/m2), whereas Group II consisted of obese individuals (BMI ≥ 29.9 kg/m2). RESULTS: BMI significantly correlated with apnea and hypopnea index (p < 0.0005), minimal oxyhemoglobin saturation (p < 0.0005), and two cephalometric variables (soft palate length, p = 0.01 and width, p = 0.01). Group II showed a significant correlation with the position of the hyoid bone (p = 0.02). Soft palate length and width significantly differed between groups (p = 0.014; 0.016). CONCLUSION: Obese males present wider and longer soft palate dimensions, and patients with a greater BMI present a more inferiorly positioned hyoid bone.

COVID-19 and dental sleep medicine: risks, precautions and patient guidance.

COVID-19 is the offcial name for the disease caused by SARS-CoV-2, which has become a pandemic, infecting more than 5 million people worldwide. Transmission occurs by inhaling droplets generated when an infected person coughs, sneezes or exhales, or by touching contaminated surfaces and then rubbing their hands over their eyes, nose or mouth. Some infected people become seriously ill, while others have no symptoms, but even though they are asymptomatic, they can still transmit the virus. As vaccines and effective medications do not yet exist, the only way to handle the devastating consequences of the pandemic is prevention. Quality of sleep is essential for the immune system to be prepared to receive, fight and restore itself after a viral infection. Therefore, patients with obstructive sleep apnea (OSA) should continue treatment, and only suspend or change the therapeutic modality under the guidance of a sleep physician. In the era of COVID-19, due to the high probability of contamination promoted by CPAP, the mandibular repositioning device has been considered as the first choice for patients with OSA. However, as the dental approach is at high risk of contamination, due to the proximity of the dental surgeon to the patient, it is essential that the professional who works in this field knows the risks to which they are exposed. Precautions must be adopted and patients should be guided in order to control and use of their intraoral devices.

Dental alterations on panoramic radiographs of patients with osteogenesis imperfecta in relation to clinical diagnosis, severity, and bisphosphonate regimen aspects: a STROBE-compliant case-control study.

OBJECTIVE: This study aimed to assess the prevalence of dental findings on panoramic radiographs (PRs) of patients with osteogenesis imperfecta (OI) and correlate these results with epidemiologic and medical data. STUDY DESIGN: A case-control study was conducted with 24 patients with OI and 48 sex- and age-matched controls. Demographic, clinical, and bisphosphonate regimen-related data were recorded. The outcome variables were the presence or absence of dental alterations in PRs. Mann-Whitney U test, Pearson's χ2 test, and multinomial logistic regression analysis (95% confidence interval) were used (significance level of 5%). RESULTS: OI type 4 demonstrated a high prevalence (62.5%), followed by type 1 (37.5%). With regard to prevalence associated with severity, the moderate form was the most prevalent (P = .028). The mean time of intravenous pamidronate regimen was 6.6 ± 4.4 years. Dentinogenesis imperfecta was observed in 75% of patients with OI, and this group showed a high prevalence of dental abnormalities in comparison with controls (P < .05). Bisphosphonate therapy was associated with ectopic teeth (P = .007) and tooth impaction (P = .033). Pulp obliteration was significant with bisphosphonate treatment over a period of 7 years (P = .026). CONCLUSIONS: This study found a significant prevalence of dental alterations in patients with OI, and certain alterations were associated with bisphosphonate therapy, indicating its influence on the dentin-related physiopathology.

Avaliação da sonolência e queixas de sono dos estudantes de odontologia da Universidade Federal do Ceará / Evaluation of sleepness and sleep complaints among dentistry students from the federal University of Ceará / Evaluación de somnolencia y quejas de sueño en estudiantes de odontología de la Universidad Federal de Ceará

O sono é um estado essencial para sobrevivência humana, ele exerce função biológica, restauradora e de conservação energética do organismo, promovendo equilíbrio físico e mental. Alta prevalência da má qualidade de sono e sonolência diurna excessiva (SDE) têm sido relatadas por estudantes universitários de diversos cursos, ocasionando prejuízos na concentração e queda dos rendimentos acadêmicos. O objetivo deste trabalho foi avaliar a qualidade de sono, a SDE e suas possíveis associações com sintomas depressivos em estudantes de odontologia. Foi realizado um estudo transversal e descritivo com 251 alunos do curso de odontologia da Faculdade de Farmácia, Odontologia e Enfermagem da Universidade Federal do Ceará. Os instrumentos utilizados foram o Índice de Qualidade de Sono de Pittsburgh (IQSP), Escala de Sonolência de Epworth (ESE) e Inventário de Depressão de Beck (IDB). Verificou-se uma alta prevalência de má qualidade de sono (53,4%) e SDE (35,1%) entre os estudantes, sem diferença significante em relação ao sexo para ambas. Foi encontrada correlação positiva entre IDB com IQSP e ESE (r = 0,478; p = 0,000 e r = 0,202; p = 0,000, respectivamente). Os resultados mostraram uma alta prevalência de má qualidade de sono e SDE e ambos os achados apresentaram associação com sintomas depressivos.

Sleep is an essential state for human survival. It has a biological, restorative and energy conservation function for the organism, promoting physical and mental balance. A high prevalence of poor sleep quality and excessive daytime sleepiness (EDS) has been reported among university students from different courses, causing impaired concentration and a drop in academic performance. This study evaluates sleep quality, EDS and their possible associations with depressive symptoms in dentistry students. A cross-sectional descriptive research was conducted with 251 students from the Dentistry Course at the School of Pharmacy, Dentistry and Nursing, Federal University of Ceará. Variables of interest were assessed by Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Beck Depression Inventory (BDI). Results show a high prevalence of poor sleep quality (53.4%) and EDS (35.1%) among students, with no significant difference regarding gender. BDI had a positive correlation with PSQI and ESS (r= 0.478, p= 0.000; and r= 0.202, p =0.000, respectively). Both findings were associated with depressive symptoms.

El sueño es un estado esencial para la supervivencia humana, tiene una función biológica, reparadora y de conservación de energía para el organismo, favoreciendo el equilibrio físico y mental. Se ha reportado una alta prevalencia de mala calidad del sueño y somnolencia diurna excesiva (SDE) en estudiantes universitarios de diferentes carreras que provoca alteración de la concentración y caída del rendimiento académico. El objetivo de este trabajo fue evaluar la calidad del sueño, la SDE y sus posibles asociaciones con síntomas depresivos en estudiantes de odontología. Se realizó un estudio descriptivo transversal con 251 estudiantes de la carrera de Odontología de la Facultad de Farmacia, Odontología y Enfermería de la Universidad Federal de Ceará. Los instrumentos utilizados fueron el Índice de Calidad del Sueño de Pittsburgh (PSQI), la Escala de Somnolencia de Epworth (ESS) y el Inventario de Depresión de Beck (BDI). Hubo una alta prevalencia de mala calidad del sueño (53,4%) y SDE (35,1%) entre los estudiantes, sin diferencia significativa en relación con el género para ambos. Se encontró una correlación positiva entre BDI con PSQI y ESS (r= 0,478; p= 0,000 y r= 0,202; p = 0,000, respectivamente). Los resultados mostraron una alta prevalencia de mala calidad del sueño y SDE, y ambos hallazgos se asociaron con síntomas depresivos.

Cone beam computed tomography in assessment on pharynx effects of orthopedic-surgical treatment - a review of the literature.

The cone beam computed tomography (CBCT) image provides clear differentiation of soft tissues from empty spaces. This paper presents a literature review to evaluate the effects of orthopedic and surgical treatment on the pharyngeal dimension by CBCT. It was concluded that treatments involving dentofacial orthopedics and orthognathic surgery have been related with an increase in the upper airway volume. Standardized capturing of tomographic images and more controlled and randomized studies are necessary.

Severe obstructive sleep apnea treatment with mandibular advancement device: A case report.

Mandibular advancement device (MAD) has been described as an alternative treatment to the severe obstructive sleep apnea (OSA), once it is not as effective as the continuous positive airway pressure therapy (CPAP) in reducing the apnea and hypopnea index (AHI). The objective of this study is to report a case using a MAD in a CPAP-intolerant patient suffering from severe OSA. Polysomnography exams were performed before and after treatment. Five months after fitting and titrating the MAD, the AHI was reduced from 80.5 events/hour to 14.6 events/hour and the minimum oxyhemoglobin saturation (SpO2) increased from 46% to 83%. A two-year assessment of therapy revealed an AHI of 8 events/hour and SpO2 of 85%.

Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review.

INTRODUCTION: Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. OBJECTIVE: This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. METHODS: An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. RESULTS: A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. CONCLUSION: The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.

Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review

ABSTRACT Introduction: Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. Objective: This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. Methods: An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. Results: A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. Conclusion: The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.

RESUMO Introdução: efeitos colaterais oclusais e o desenvolvimento de dor e/ou disfunção do complexo temporomandibular podem levar à baixa adesão ou ao abandono do tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular. Objetivo: fornecer uma revisão abrangente da literatura sobre os efeitos colaterais craniofaciais do tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular. Métodos: foram realizadas buscas eletrônicas sistematicamente no PubMed e na Biblioteca Virtual em Saúde até outubro de 2016. Foram incluídos apenas Ensaios Controlados Randomizados, com o objetivo primário de mensurar objetivamente os efeitos colaterais no complexo craniofacial associados ao uso de aparelhos de avanço mandibular no tratamento do ronco e da apneia obstrutiva do sono. Os pacientes estudados deveriam ter 20 anos de idade ou mais. A avaliação do risco de viés dos trabalhos selecionados seguiu as recomendações do The Cochrane Risk of Bias. Resultados: no total, 62 artigos completos foram avaliados em relação à elegibilidade. Após o processo de revisão, apenas 6 atenderam aos critérios de inclusão. Todos os estudos foram julgados como tendo alto risco de viés. Os efeitos colaterais mais frequentemente encontrados foram de natureza dentária e incluíram uma diminuição do overjet e do overbite. O risco de desenvolvimento de dor ou disfunção do complexo temporomandibular pareceu limitado na avaliação de longo prazo do uso do aparelho de avanço mandibular. Conclusão: as evidências disponíveis são limitadas e sugerem que o tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular resulta em alterações craniofaciais predominantemente dentárias, especialmente nas avaliações de longo prazo. Considerando-se que a apneia obstrutiva do sono é crônica e que os aparelho intrabucais se constituem em uma forma de tratamento contínuo e por tempo indefinido, é necessário um acompanhamento individualizado para monitorar possíveis efeitos colaterais no complexo craniofacial. Também é importante informar aos pacientes sobre esses possíveis efeitos, especialmente àqueles nos quais são esperadas maiores alterações oclusais ou nos quais elas sejam desfavoráveis. Ainda são necessárias avaliações de longo prazo dos efeitos colaterais do tratamento com aparelhos intrabucais, com amostras maiores e mais homogêneas.

Neck circumference, a bedside clinical feature related to mortality of acute ischemic stroke.

OBJECTIVE: The aim of this study was to evaluate clinical/demographic factors, sleep alterations and one year mortality in acute ischemic stroke. METHODS: This was a prospective study of 89 consecutive patients (mean age 64.39 ± 8.51 years) with acute ischemic stroke. High risk of obstructive sleep apnea (OSA) was evaluated by the Berlin questionnaire, daytime somnolence by the Epworth Sleepiness Scale (> 10) and subjective sleep quality by the Pittsburgh Sleep Quality Index (> 5). Clinical and anthropometric data including body mass index, hip-waist ratio, neck circumference (NC) were obtained. Increased NC was defined if > 43 cm in men and > 38 cm in women. Stroke severity was estimated by the Barthel Index and the modified Rankin Scale. The end-point was death after 12 months follow-up. RESULT: One-year mortality was 8.9%. Non-survivors were older (p = 0.006) and had larger NC (p = 0.02). Among all cases, large NC was related to high risk of OSA, diabetes and hypertension (Fisher's exact test). Compared to men, women showed relatively larger NC. Overall, family history of stroke (74.2 %), diabetes (33.7%) and hypertension (78.6%) were frequent; obesity (11.2%) was uncommon. Daytime sleepiness (34.8 %), poor sleep quality (65.2%) and risk of OSA (58.42%) were frequently found. CONCLUSION: Poor sleep quality, excessive daytime sleepiness and high risk of OSA are frequent in this sample with acute ischemic stroke. One-year mortality was related to older age and large NC. As obesity is uncommon in acute stroke patients, a large NC should be taken as a significant clinical sign related to mortality.

Correlação entre variáveis cefalométricas e polissonográficas em indivíduos com apneia / Correlation between cephalometric and polysomnographic variables in individuals with obstructive sleep apnea

Indivíduos portadores de Apneia Obstrutiva do Sono (AOS) podem apresentar alterações do esqueleto craniofacial e do espaço aéreo faríngeo que influenciam no padrão de sono e na gravidade da AOS. A cefalometria radiográfica é um exame de imagem rotineiramente usado pelos ortodontistas que permite a avaliação da anatomia craniocervicofacial, incluindo o espaço aéreo faríngeo. Objetivo: avaliar se os componentes anatômicos cefalométricos têm alguma correlação com parâmetros polissonográficos de indivíduos com AOS. Materiais e Métodos: A casuística deste estudo foi composta de 50 indivíduos com diagnóstico polissonográfico de AOS moderada e grave. Todos os voluntários foram submetidos à avaliação polissonográfica de noite inteira e a avaliação cefalométrica em norma lateral. Resultados: Foram encontradas correlações significantes entre a variável polissonográfica Índice de Apneia e Hipopneia (IAH) e as grandezas cefalométricas correspondentes à largura do palato mole (p<0,01) e a distância do hióide à terceira vértebra cervical (p<0,01). A variável polissonográfica Saturação Mínima de Oxihemoglobina (SpO2) apresentou correlação significante com as duas variáveis cefalométricas acima citadas e também com a variável correspondente ao comprimento do palato mole (p<0,05). Conclusão: Algumas variáveis cefalométricas demonstraram correlação com parâmetros polissonográficos, mas não se deve afirmar que a cefalometria possa ser usada como preditora da gravidade da AOS. (AU)

Individuals with Obstructive Sleep Apnea (OSA) may present changes in the craniofacial skeleton and pharyngeal airway space that have an influence in sleep pattern and OSA severity. Radiographic cephalometry is an imaging test routinely used by orthodontists that allows assessment of the craniocervical facial anatomy including the pharyngeal airway spa-ce. Objective: To evaluate if the cephalometric anatomical components have any correlation with polysomnographic parameters of individuals with OSA. Materials and Methods: The study sample consisted of 50 individuals with polysomnographic diagnosis of moderate and severe OSA. All volunteers underwent a full-night polysomnographic evaluation and a lateral cephalometric radiographic examination. Results: Significant correlations were found between the polysomnographic variable Apnea and Hypopnea Index (AHI) and the cephalometric variablecorresponding to the width of the soft palate (p <0.01) and the distance from the hyoid to the third cervical vertebra (p <0.01). The polysomnographic variable Oxyhemoglobin Minimal Saturation (SpO2) showed a significant correlation with the two cephalometric variables mentioned above, as well as with the variable corresponding to the length of the soft palate (p<0,05). Conclusion: Some cephalometric variables correlate with polysomnographic parameters, but we cannot say that cephalometry can be used as a predictor of OSA severity. (AU)

Consenso brasileiro de ronco e apneia do sono: aspectos de interesse aos ortodontistas / Brazilian consensus of snoring and sleep apnea: aspects of interest for orthodontists

O objetivo deste artigo é explicitar o posicionamento das sociedades médicas que, reunidas, estabeleceram consenso sobre os parâmetros clínico-laboratoriais que envolvem os distúrbios respiratórios do sono, em especial o ronco e a síndrome da apneia obstrutiva do sono (SAOS). Os ortodontistas, que vêm ocupando gradativamente seu espaço em equipes multidisciplinares que atuam na área do sono humano, pouco conhecem sobre essa uniformização coordenada pela Associação Brasileira de Sono. Os trabalhos clínicos e as pesquisas científicas oriundos da Odontologia, e em particular da Ortodontia, também devem observar e seguir esses critérios de diagnóstico e tratamento estabelecidos pela comunidade médica brasileira.

The objective of this article is to clarify the positions of the medical societies that have worked together to establish a consensus regarding the clinical and laboratory parameters involved in sleep-disordered breathing, particularly snoring and obstructive sleep apnea syndrome (OSAS). Orthodontists have gradually come to take part in multidisciplinary teams that act in the area of human sleep, but few know about the uniformity coordinated by the Brazilian Association of Sleep. Clinical and scientific studies from the field of dentistry (particularly orthodontics) also must observe and follow these diagnosis and treatment criteria established by the Brazilian medical community.

Reabilitação ortodôntica e protética na agenesia de incisivos laterais superiores com prótese adesiva de fibra de reforço associada ao cerômero – relato de caso / Orthodontic and prosthetic rehabilitation in agenesis of lateral incisors with adhesive reinforcement fiber denture associated with ceromer – case report

O tratamento reabilitador de agenesia de incisivos laterais superiores envolve, quase sempre, uma abordagem interdisciplinar. O presente artigo propõe-se a expor uma solução terapêutica conservadora, através de ortodontia e reabilitação protética, em um caso de agenesia congênita bilateral de incisivos laterais permanentes. A escolha da melhor opção terapêutica, o domínio da mecânica ortodôntica e a utilização da técnica reabilitadora adequada influenciaram na qualidade do resultado do tratamento.

The rehabilitation treatment of agenesis of upper lateral incisors almost always involves an interdisciplinary approach. This article aims to describe a conservative therapeutic solution through orthodontics and prosthetic rehabilitation in a case of congenital bilateral agenesis of permanent lateral incisors. The choice of the best therapeutic option, the handling of orth-odontic mechanics and the use of appropriate rehabilitative technique influenced the quality of treatment outcome.

Efeitos do aparelho reposicionador mandibular no tratamento da apneia obstrutiva do sono / Effects of the mandibular repositioning appliance on the treatment of obstructive sleep apnea

Objetivou-se avaliar e quantificar, por meio de tomografias computadorizadas de feixe cônico (TCFC), as mudanças ocorridas na configuração anatômica da orofaringe de pacientes com Síndrome da Apneia Obstrutiva do Sono (SAOS) após a instalação de aparelho reposicionador mandibular, bem como avaliar se as possíveis alterações na faringe têm influência sobre os parâmetros polissonográficos de pacientes com SAOS. Foram triados dez pacientes com diagnóstico polissonográfico de SAOS leve/moderada. Medidas na via aérea superior foram realizadas a partir de imagens obtidas de TCFC antes da instalação do aparelho intraoral (AIO) (T1) e após atingir 85% do avanço mandibular máximo (T2). Nesses dois momentos também foram realizados os exames polissonográficos. Em relação às medidas de via aérea analisadas, houve alteração significativa apenas da região com mais constrição (p=0.019). Quanto aos valores polissonográficos, entre T1 e T2 houve uma diminuição significativa do índice de apneia e hipopneia (IAH) (p=0,000), elevação da saturação de oxiemoglobina média (p=0.005) e da saturação de oxiemoglobina mínima (p=0.010). Concluiu-se que o uso de aparelho intraoral de avanço mandibular não modificou significativamente a via aérea superior dos pacientes da amostra estudada, mas influenciou favoravelmente na melhora dos parâmetros polissonográficos.

The aim of this study was to evaluate and quantify, by means of computed tomography cone beam (CBCT), changes in the anatomical configuration of the oropharynx of patients with Obstructive Sleep Apnea Syndrome (OSAS) after mandibular repositioning appliance installation and assess whether the possible changes in the pharynx influence polysomnographic parameters of patients with OSAS. Ten patients were screened with polysomnographic diagnosis of mild OSA/moderate. Measurement from upper airway was performed using CBCT images obtained before oral appliance (OA) installation (T1) and after reaching 85% of the maximum mandibular advancement (T2). Polysomnographic exams were also performed at these same stages. The analysis of airway measures indicated significant change just in the most constricted area (p=0.019). As for the polysomnographic values between T1 and T2, there was a significant decrease in apnea and hypopnea index (AHI) (p=0.000), an increase on mean oxyhemoglobin saturation (p=0.005), and on minimum oxyhemoglobin saturation (P=0010). It was concluded that the use of intraoral mandibular advancement device did not result on significant changes on patients’ upper airway. However it had a favorable influence on the improvement of polysomnographic parameters.

Neck circumference, a bedside clinical feature related to mortality of acute ischemic stroke / Perímetro cervical, uma medida à beira do leito relacionada com a mortalidade no acidente vascular cerebral isquêmico

OBJECTIVE: The aim of this study was to evaluate clinical/demographic factors, sleep alterations and one year mortality in acute ischemic stroke. METHODS: This was a prospective study of 89 consecutive patients (mean age 64.39 ± 8.51 years) with acute ischemic stroke. High risk of obstructive sleep apnea (OSA) was evaluated by the Berlin questionnaire, daytime somnolence by the Epworth Sleepiness Scale (> 10) and subjective sleep quality by the Pittsburgh Sleep Quality Index (> 5). Clinical and anthropometric data including body mass index, hip-waist ratio, neck circumference (NC) were obtained. Increased NC was defined if > 43 cm in men and > 38 cm in women. Stroke severity was estimated by the Barthel Index and the modified Rankin Scale. The end-point was death after 12 months follow-up. RESULT: One-year mortality was 8.9 percent. Non-survivors were older (p = 0.006) and had larger NC (p = 0.02). Among all cases, large NC was related to high risk of OSA, diabetes and hypertension (Fisher's exact test). Compared to men, women showed relatively larger NC. Overall, family history of stroke (74.2 percent), diabetes (33.7 percent) and hypertension (78.6 percent) were frequent; obesity (11.2 percent) was uncommon. Daytime sleepiness (34.8 percent), poor sleep quality (65.2 percent) and risk of OSA (58.42 percent) were frequently found. CONCLUSION: Poor sleep quality, excessive daytime sleepiness and high risk of OSA are frequent in this sample with acute ischemic stroke. One-year mortality was related to older age and large NC. As obesity is uncommon in acute stroke patients, a large NC should be taken as a significant clinical sign related to mortality.

OBJETIVO: O objetivo do estudo é avaliar em pacientes com acidente vascular cerebral (AVC) isquêmico, os fatores clínico/demográficos, alterações do sono e a mortalidade após um ano. MÉTODOS: Trata-se de estudo prospectivo envolvendo 89 pacientes consecutivos (64,39 ± 8,51 anos) com AVC isquêmico agudo. Foram avaliados o risco elevado de apneia obstrutiva do sono (AOS) (questionário de Berlin), a sonolência diurna (Escala de Sonolência Epworth > 10) e a qualidade subjetiva do sono (Índice de Qualidade de Sono Pittsburgh > 5). O índice de massa corpórea, a relação cintura-quadril e o perímetro cervical (PC) foram estudados: PC aumentado foi definido se > 43 cm (homens) e > 38 cm (mulheres). Estimou-se a gravidade da doença pelo Índice de Barthel e pela Escala de Rankin modificada. O desfecho final foi o óbito após 12 meses. RESULTADOS: A mortalidade após um ano foi de 8,9 por cento. Os pacientes que foram a óbito eram mais idosos (p = 0,006) e apresentavam PC aumentado (p = 0,02). O PC aumentado relacionou-se com a presença de diabetes, hipertensão arterial e risco elevado de AOS (teste exato de Fisher). As mulheres apresentavam, relativamente, maior PC. Entre todos, história familiar de doença cerebrovascular (74,2 por cento), diabetes (33,7 por cento) e hipertensão (78,6 por cento) foram frequentes; obesidade (11,2 por cento) foi incomum. Sonolência diurna (34,8 por cento), má qualidade do sono (65,2 por cento) e risco de AOS (58,42 por cento) foram frequentes. CONCLUSÃO: Alterações do sono são frequentes no AVC isquêmico agudo. Mortalidade foi mais comum em pacientes mais idosos e com maior PC. No AVC isquêmico, o PC aumentado relaciona-se com a mortalidade e provavelmente constitui-se uma medida clínica importante a ser considerada.

Avaliação clínica e polissonográfica do aparelho BRD no tratamento da síndrome da apneia obstrutiva do sono / Clinical and polysomnographic assessment of the BRD appliance in the treatment of obstructive sleep apnea syndrome

OBJETIVOS: este trabalho de pesquisa teve o intuito de realizar uma avaliação clínica e polissonográfica do efeito de um aparelho intraoral (AIO) para tratamento da Síndrome da Apneia Obstrutiva do Sono (SAOS), desenvolvido e testado por duas universidades federais brasileiras. MÉTODOS: a amostra constou de 50 pacientes (idades entre 18 e 65 anos, sendo 33 homens e 17 mulheres) com diagnóstico polissonográfico inicial de SAOS de grau leve e moderado. Todos os pacientes submeteram-se a uma nova avaliação polissonográfica de noite inteira (em uso do AIO) aproximadamente 6 meses após a primeira avaliação. Baseado na diminuição dos eventos respiratórios obstrutivos, obtida com o uso do AIO, os pacientes foram então divididos em bons respondedores (redução de 50 por cento ou mais no índice de apneia e hipopneia (IAH), permanecendo abaixo de 10 eventos/hora) e maus respondedores (IAH permanecendo maior ou igual a 10 eventos/hora). RESULTADOS E CONCLUSÕES: em 54 por cento da amostra o IAH diminuiu para menos de cinco eventos/hora com o uso do AIO; em 38 por cento a redução do IAH foi maior do que 50 por cento, mas permaneceu acima de cinco eventos/hora; e em 6 por cento da amostra o IAH reduziu menos que 50 por cento. Os bons respondedores corresponderam a 86 por cento da amostra estudada, enquanto os maus respondedores a 14 por cento. Houve melhora significativa na escala de sonolência, no IAH, nos microdespertares e na saturação mínima de oxihemoglobina com a terapia utilizada. O Índice de Massa Corpórea elevado parece interferir desfavoravelmente no desempenho do aparelho em estudo.

OBJECTIVES: The current investigation aimed to carry out a clinical and polysomnographic assessment of treatment of Obstructive Sleep Apnea Syndrome (OSAS) with an oral appliance (OA) developed and tested by two Brazilian federal universities. METHODOLOGY: The sample was composed of 50 patients (aged between 18 and 65 years, 33 men and 17 women) with initial polysomnographic diagnosis of light to moderate OSAS. All patients underwent a second, full-night polysomnography with the use of the OA approximately 6 months after the first assessment. Based on the reduction of respiratory events obtained with the OA, patients were distributed in good responders (Apnea and Hypopnea Index/AHI under 10 and with reduction of at least 50 percent in relation to baseline); and poor responders (AHI of 10 or over with OA). RESULTS AND CONCLUSION: In 54 percent of the sample, AIH reduced to less than five events/hour with OA; in 38 percent the AHI reduction was more than 50 percent in relation to baseline (but more than five); and in 6 percent of the sample, the AHI reduced less than 50 percent. Good responders corresponded to 86 percent of the studied sample, while poor responders to 14 percent. We noticed significant improvement in somnolence, in AIH, in microarousals and also in minimum oxygen saturation with the treatment. Increased body mass index (BMI) seemed to interfere unfavorably in the performance of the OA studied.

Utilização da placa lábio ativa na dentadura mista – relato de caso / The use of lip bumper appliance in mixed dentition patient – case report

A placa lábio ativa é um aparelho mio-funcional utilizado frequentemente para terapia preventiva e interceptora de más oclusões. O objetivo deste trabalho foi relatar o uso clínico dessa placa na dentadura mista. O artigo é ilustrado com a sequência de tratamento do caso de um paciente em crescimento, que apresentava grande apinhamento anteroinferior e desvio de linha média. Os resultados alcançados demostraram que ocorreu verticalização dos molares inferiores e movimento para vestibular dos incisivos inferiores. A placa lábio ativa confirmou-se como uma alternativa eficaz na terapia de pacientes na dentadura mista que necessitam de ganhos de espaço para correção de apinhamento e coadjuvante aos aparelhos ortodônticos fixos para ajuste das linhas médias superior e inferior.

Lip bumper is a myofunctional appliance frequently used as preventive and interceptive therapy for malocclusions. The aim of the present work was to report the clinical use of a lip bumper appliance in mixed dentition stage of development. This article illustrates the treatment sequence carried out in a growing patient that presented great lower anterior crowding and dental midline shift. Treatment results showed verticalization of the lower molars and forward movement of lower incisors. The lip bumper appliance has been confirmed as an effective alternative to treat patients in the mixed dentition stage needing to regain arch space for dental crowding correction. In addition, this appliance may be a support to fixed orthodontics in the correction of upper and lower dental midline shifts.