The role of upper airway and facial skeleton anatomy in the evolution of obstructive sleep apnea: an 8-year follow-up.

PURPOSE: To evaluate the role of anatomic alterations of the upper airway and facial skeleton in the evolution of obstructive sleep apnea (OSA) in a prospective population-based study with an 8-year follow-up. METHODS: This was a population-based, longitudinal, prospective study, which took place from 2007 to 2015 at the Instituto do Sono, Sao Paulo, Brazil. In 2007, type I polysomnography (PSG), otorhinolaryngological examination, and collection of anthropometric measurements of all volunteers were performed. Volunteers were classified according to their anatomical features of the upper airway and facial skeleton. After 8 years, volunteers were invited for reevaluation. The relationship between anatomical characteristics and polysomnographic evolution was evaluated. RESULTS: The study included 554 patients. After 8 years of follow-up, there was an increase in neck circumference and body mass index of the participants. There was a worsening in all polysomnographic parameters analyzed, with an increase in the apnea-hypopnea index, a decrease in minimum saturation values, and an increase in the percentage of sleep time with peripheral oxyhemoglobin saturation <90%. There was no statistical relationship between the anatomical findings considered unfavorable and the worsening of polysomnographic parameters. CONCLUSIONS: In a sample of the general population, after 8 years, we did not find any relationship between upper airway and facial skeleton characteristics and the progression of OSA.

Immediate impact of pharyngeal surgery on respiratory parameters in adults with obstructive sleep apnea.

PURPOSE: One of the concerns regarding surgical treatment of the obstructive sleep apnea syndrome (OSAS) has been the possibility that these patients may experience a higher rate of perioperative complications, which could be aggravated by the upper airway edema caused by surgical trauma. The purpose of this study was to evaluate the immediate impact of pharyngeal surgery on the respiratory parameters of adult patients with OSAS. METHODS: Twenty-three adults with moderate to severe OSAS and indications for pharyngeal surgery (with or without nasal surgery) were consecutively selected. The subjects underwent surgical treatment and monitoring of sleep parameters preoperatively (by type I polysomnography, PSG) and in the immediate postoperative period (arterial tonometry). RESULTS: Twenty-two subjects, aged 20 to 59 years (mean ± SD, 38.0 ± 12.1 years), were included in the study. Nineteen (86.4%) were male. The mean apnea-hypopnea index (AHI) was 59.3 ± 26.0 events/h. Comparison between preoperative PSG and postoperative arterial tonometry revealed statistically significant reductions in AHI (p = 0.03), respiratory disturbance index (RDI) (p = 0.05), and oxygen desaturation index (p = 0.001), as well as increases in nadir oxyhemoglobin saturation (p = 0.003) and percentage of REM sleep (p = 0.01). CONCLUSIONS: In this sample of patients with moderate and severe OSAS who underwent pharyngeal surgery, the vast majority of patients did not exhibit any deterioration of respiratory parameters in the immediate postoperative period. Conversely, there was a significant improvement in the parameters.

Laryngopharyngeal reflux and dysphagia in patients with obstructive sleep apnea: is there an association?

INTRODUCTION: There is evidence that patients with obstructive sleep apnea (OSA) tend to have a high prevalence of laryngopharyngeal reflux (LPR) and dysphagia. These diseases are known to share the same risk factors and may be interrelated, but there is a lack of studies evaluating their co-occurrence. OBJECTIVES: To evaluate whether the presence of signs and symptoms suggestive of LPR may be associated with the presence of dysphagia in patients with moderate and severe obstructive sleep apnea (OSA), as well as assess the additional impact of these diseases on quality of life in patients with OSA. METHODS: Seventy adult patients with moderate or severe OSA were included in the study. The RSI (Reflux Symptom Index) and Swallowing Quality of Life (SWAL-QOL) in dysphagia questionnaires were administered, laryngoscopy was performed to calculate the Reflux Finding Score (RFS), and fiber-optic endoscopic evaluation of swallowing (FEES) was conducted. RESULTS: The prevalence of LPR was 59.7%, and the prevalence of dysphagia was 27.3%. The association between LPR and dysphagia was present in 17.9% of patients, but with no statistically significant difference. Lower SWAL-QOL scores were observed in several domains in patients with LPR and in only one domain in patients with evidence of dysphagia on FEES. CONCLUSIONS: Although 17.9% of patients presented with findings suggestive of concomitant LPR and dysphagia, there was no statistically significant association between these two conditions. Patients with LPR had worse scores in several domains of dysphagia-related quality of life, while FEES evidence of dysphagia was associated with worse quality of life in only one domain.

A Pilot Study on the Efficacy of Continuous Positive Airway Pressure on the Manifestations of Dysphagia in Patients with Obstructive Sleep Apnea.

There is evidence in the literature demonstrating that patients with obstructive sleep apnea (OSA) may present with dysphagia, but few studies have evaluated whether this complaint can be reversed with treatment of OSA. To assess whether findings of dysphagia in patients with OSA can be reversed with the use of continuous positive airway pressure (CPAP) devices. Seventy adult patients (age 18-70 years) with moderate or severe OSA were included in the study. All patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) and completed the SWAL-QOL questionnaire on quality of life in dysphagia. Patients with visible abnormalities on FEES were treated with CPAP and reassessed after 3 months. The prevalence of dysphagia was 27.3% (18 patients). Premature spillage was the main finding. On comparison of groups with and without dysphagia, the SWAL-QOL score was significantly worse in the dysphagia group in domain 2 (eating duration and eating desire, p = 0.015), with no impact on overall score (p = 0.107). Of the 18 patients with dysphagia, 12 were started on CPAP; 11 exhibited satisfactory adherence and remained in the study. Abnormal FEES findings resolved in 81% (n = 9/11) of patients who started CPAP (p = 0.004), and dysphagia-specific quality of life also improved significantly (overall SWAL-QOL score, p = 0.028). In this sample of patients with OSA, the overall prevalence of dysphagia (as demonstrated by premature spillage on FEES) was 27.3%. Treatment of OSA with CPAP was able to reverse the endoscopic findings of swallowing dysfunction and to improve quality of life as measured by the SWAL-QOL.

Myofunctional therapy improves adherence to continuous positive airway pressure treatment.

PURPOSE: Few studies have investigated myofunctional therapy in patients with obstructive sleep apnea syndrome (OSAS). The objective of this study was to evaluate the effect of myofunctional therapy on continuous positive airway pressure (CPAP) adherence. METHODS: The study was registered at ClinicalTrials.gov (NCT01289405). Male patients with OSAS were randomly divided into four treatment groups: placebo, patients undergoing placebo myofunctional therapy (N = 24); myofunctional therapy, undergoing myofunctional therapy (N = 27); CPAP, undergoing treatment with CPAP (N = 27); and combined, undergoing CPAP therapy and myofunctional therapy (N = 22). All patients underwent evaluations before and after 3 months of treatment evaluation and after 3 weeks of washout. Evaluations included Epworth sleepiness scale (ESS), polysomnography, and myofunctional evaluation. RESULTS: The 100 men had a mean age of 48.1 ± 11.2 years, body mass index of 27.4 ± 4.9 kg/m2, ESS score of 12.7 ± 3.0, and apnea-hypopnea index (AHI) of 30.9 ± 20.6. All treated groups (myofunctional therapy, CPAP, and combined myofunctional therapy with CPAP) showed decreased ESS and snoring, and the myofunctional therapy group maintained this improvement after the "washout" period. AHI reduction occurred in all treated groups and was more significant in CPAP group. The myofunctional therapy and combined groups showed improvement in tongue and soft palate muscle strength when compared with the placebo group. The association of myofunctional therapy to CPAP (combined group) showed an increased adherence to CPAP compared with the CPAP group. CONCLUSIONS: Our results suggest that in patients with OSAS, myofunctional therapy may be considered as an adjuvant treatment and an intervention strategy to support adherence to CPAP.

Inter-examiner agreement of the systematic physical examination in patients with obstructive sleep disorders.

PURPOSE: The goal of this study was to investigate the agreement between examiners who were or were not trained in the physical examination of the upper airway (UA) and the craniofacial skeleton of individuals with obstructive sleep disorders (OSD). METHOD: A systematic assessment of the UA and craniofacial skeleton was performed on 55 individuals with OSD. The participants were consecutively assessed by three otorhinolaryngologists who specialized in sleep medicine for at least 1 year (trained examiners) and two doctors who were attending a residency program in otorhinolaryngology (untrained examiners). RESULTS: When analyzing all of the parameters assessed, the concordance was better in the trained group (k = 0.694, which is considered "good") compared to the untrained group (k = 0.475, "fair") (p < 0.001). The inter-examiner agreement was also better in the trained compared to the untrained group, as follows: craniofacial (k = 0.643 vs. 0.349), nasal (k = 0.657 vs. 0.614), and pharyngeal (k = 0.729 vs. 0.276) abnormalities (p < 0.05). CONCLUSION: The overall concordance of the physical examination of the UA and craniofacial skeleton was "good" among the trained specialists and "fair" among examiners without appropriate training, despite its subjectivity.

New insights on the pathophysiology of inspiratory flow limitation during sleep.

INTRODUCTION: Inspiratory flow limitation (IFL) is defined as a "flattened shape" of inspiratory airflow contour detected by nasal cannula pressure during sleep and can indicate increased upper airway resistance especially in mild sleep-related breathing disorders (SRBD). The objective of this study was to investigate the association between upper airway abnormalities and IFL in patients with mild SRBD. METHODS: This study was derived from a general population study consisting of selected individuals with apnea-hypopnea index (AHI) below 5 events/h of sleep, ("no obstructive sleep apnea" group) and individuals with AHI between 5 and 15 events/h ("mild obstructive sleep apnea" group). A total of 754 individuals were divided into four groups: group 1: AHI <5/h and <30 % of total sleep time (TST) with IFL (515 individuals), group 2: AHI <5/h and >30 % of TST with IFL (46 individuals), group 3: AHI: 5-15/h and <30 % of TST with IFL (168 individuals), and group 4: AHI: 5-15/h and >30 % of TST with IFL (25 individuals). RESULTS: Individuals with complains of oral breathing demonstrated a risk 2.7-fold larger of being group 4 compared with group 3. Abnormal nasal structure increased the chances of being in group 4 3.2-fold in comparison to group 1. Individuals with voluminous lateral wall demonstrated a risk 4.2-fold larger of being group 4 compared with group 3. CONCLUSION: More than 30 % of TST with IFL detected in sleep studies was associated with nasal and palatal anatomical abnormalities in mild SRBD patients.

Impact of thyroidectomy on the control of obstructive sleep apnea syndrome in patients with large goiters.

PURPOSE: A large goiter can cause a series of compressive symptoms such as dyspnea and dysphagia, and previous case reports have indicated the coexistence of obstructive sleep apnea syndrome (OSAS) in these patients. The aim of this study was to evaluate the impact of thyroidectomy on the control of OSAS in patients with large goiters. METHODS: Twenty-four patients with euthyroid goiters larger than 100 ml were consecutively selected. Of these, 17 (70.8%) presented OSAS and formed the research group. The protocol consisted of sleep questionnaires, physical examination, and polysomnography in baseline and after 3 months of surgery. RESULTS: The average age of the patients was 58.3±9.9 years, and there were 5 (29.4%) males and 12 (70.6%) females. The significant findings in the postoperative period included a reduced neck circumference (p=0.041), reduced Epworth sleepiness score (p=0.025), decreased percentage of high-risk OSAS cases according to the Berlin questionnaire (p<0.001), and a tendency for a significant reduction in snoring (p=0.052). However, polysomnographic respiratory parameters showed no significant improvement after surgery. CONCLUSION: Despite the high prevalence of OSAS in patients with large goiters and the improvement of OSAS symptoms, thyroidectomy showed no significant impact on the polysomnographic parameters.

Can intraoral and facial photos predict obstructive sleep apnea in the general and clinical population?

STUDY OBJECTIVES: This study aimed to evaluate and compare measurements of standardized craniofacial and intraoral photographs between clinical and general population samples, between groups of individuals with an apnea-hypopnea index (AHI) ≥ 15 and AHI < 15, and their interaction, as well as the relationship with the presence and severity of obstructive sleep apnea (OSA). METHODS: We used data from 929 participants from Sleep Apnea Global Interdisciplinary Consortium, in which 309 patients from a clinical setting and 620 volunteers from a general population. RESULTS: AHI ≥ 15 were observed in 30.3% of the total sample and there were some interactions between facial/intraoral measures with OSA and both samples. Mandibular volume (p < 0.01) and lateral face height (p = 0.04) were higher in the AHI ≥ 15 group in the clinical sample compared to the AHI ≥ 15 group in the general population and AHI < 15 group in the clinical sample. When adjusted for sex and age, greater mandible width (p < 0.01) differed both in the clinical and in the general population samples, reflecting AHI severity and the likelihood of OSA. The measure of smaller tongue curvature (p < 0.01) reflected the severity and probability of OSA in the clinical sample and the higher posterior mandibular height (p = 0.04) showed a relationship with higher AHI and higher risk of OSA in the general population. When adjusted for sex, age, and body mass index, only smaller tongue curvature (p < 0.01) was associated with moderate/severe OSA. CONCLUSIONS: Measures of greater tongue and mandible were associated with increased OSA risk in the clinical sample and craniofacial measurement was associated in the general population sample.

Clinical and polysomnographic findings of patients with large goiters: polysomnographic findings of large goiters.

INTRODUCTION: Goiters cause a series of compressive symptoms, including dyspnea and dysphagia. There have been reports of the coexistence of this syndrome with obstructive sleep apnea (OSA). The objective of this study was to evaluate the prevalence of OSA in a group of patients with goiters. METHODS: Twenty-four patients with a mean age of 52.7 ± 12.7 years, including five males (20.8 %) and 19 (79.2 %) females, who were diagnosed with euthyroid goiters with volumes exceeding 100 ml were consecutively selected. The protocol consisted of sleep questionnaires, physical examinations, and baseline polysomnography measurements. Patients were divided into two groups, OSA and NOSA (no OSA), and all findings were compared between the two groups. RESULTS: Of the studied patients, 70.8 % had OSA (p = 0.004). Regarding clinical parameters, age (p = 0.001), Epworth Sleepiness Scale scores (p = 0.039) and complaints of habitual snoring (p < 0.001) had higher values in the OSA group. Regarding physical examination parameters, body mass index (p = 0.012), neck circumference (p = 0.009) and the presence of tracheal compression (p = 0.021) had higher values in the OSA group. The polysomnographic parameters that were significantly different between the two groups were the greater apnea and hypopnea index per hour of sleep (p < 0.001) and the lower minimum oxyhemoglobin saturation in the OSA group (p = 0.011). CONCLUSIONS: There is a high prevalence of OSA in patients with goiters. The main findings that were associated with the presence of OSA are known clinical predictors of OSA and the presence of tracheal compression.

The influence of nasal abnormalities in adherence to continuous positive airway pressure device therapy in obstructive sleep apnea patients.

BACKGROUND: The few studies that examine the effect of nasal abnormalities on continuous positive airway pressure device (CPAP) adherence are controversial. The aim of this study was to evaluate the contribution of nasal abnormalities in CPAP adherence. METHODS: We included patients with moderate to severe OSA. The patients were submitted to rhinoscopy, nasofibroscopy, nasal inspiratory peak flow, and acoustic rhinometry. The patients who used a CPAP for 4 h or more per night for at least 70 % of the nights over a 6-month period were considered to have good adherence. RESULTS: Thirty-four patients finished the study. Eleven (33.4 %) were female and 23 (67.6 %) were male. Sixteen (47.1 %) patients had good adherence. The body mass index (p = 0.030), neck circumference (p = 0.006), and apnea-hypopnea index (p = 0.032) were higher, and the oxyhemoglobin saturation minimum was lower (p = 0.041) in the good adherence group. Nasal parameters showed no differences between good and poor adherence groups. In Spearman's correlation, surprisingly, there was a negative correlation between the highest number of hours of CPAP use with smaller values of nasal minimal cross-sectional areas in the supine position (r, 0.375; p = 0.029). In the linear regression model, the nasal findings that predicted increased of the CPAP use were the following: lower scores of nasal symptoms (p = 0.007) and lower nasal volume in supine position (p = 0.001). CONCLUSIONS: The majority of the nasal parameters evaluated in this study did not influence CPAP adherence.

Subjective, anatomical, and functional nasal evaluation of patients with obstructive sleep apnea syndrome.

BACKGROUND: Studies have shown a high occurrence of nasal alterations in patients with obstructive sleep apnea syndrome (OSAS), but no studies have used different methods to evaluate the nose of patients with OSAS. The objective of this study was to evaluate the nose of patients with OSAS, compare them to controls, and correlate the different methods used to evaluate the nose. METHODS: Forty-seven patients with moderate/severe OSAS and 20 controls who were matched for gender, age, and body mass index were included. Questionnaires regarding sleep and nasal symptoms, physical examination, rhinoscopy, nasofibroscopy, nasal inspiratory peak flow (NIPF), and acoustic rhinometry (AR) measurements were performed. RESULTS: In the OSAS group, 33 (70.2%) were male, with a mean age of 53.2 ± 9.1 years. In the control group, 13 (65%) were male, with a mean age of 53.7 ± 9.7 years. The OSAS group had a higher score on the nasal symptoms scale (p < 0.01) and a higher frequency of nasal alterations [presence of septal deviation, clinical complaints (p = 0.01) and hypertrophy of the inferior nasal turbinate (p < 0.01)]. The NIPF and AR parameters could not differentiate between the OSAS and control groups. There were no significant correlations among the different methods used to evaluate the nose. Lower NIPF values were capable of predicting higher apnea-hypopnea index scores (p = 0.007). CONCLUSION: Clinical complaints and nasal alterations as measured by rhinoscopy and nasofibroscopy were associated with the presence of OSAS, which was not the case for the NIPF and AR parameters. The results of different evaluation methods were not correlated with each other.

Immediate and Medium-Term Follow-Up of Patients with Obstructive Sleep Apnea Undergoing Pharyngeal and Nasal Surgery: A Pilot Study.

Objectives To evaluate the evolution of obstructive sleep apnea (OSA), comparing data from preoperative, immediate postoperative and late postoperative, in patients undergoing pharyngeal surgery associated with nasal surgery, and to compare the findings of arterial tonometry and type 1 polysomnography in the late postoperative period. Methods Seventeen adults with moderate or severe OSA were included in the study. They underwent clinical evaluation, surgical intervention, and sleep study preoperatively, on the 1 st night after surgery, and after a minimum period of 3 months. The data for the three moments were compared. Results The mean age was 38.1 ± 12.5 years old (22 to 59 years old), and 82.3% were male. Body mass index (BMI) ranged from 25.6 to 45.1 kg/m2 (mean = 33.1 ± 5.8 kg/m 2 ). Fifteen patients (88.2%) were diagnosed with severe OSA. There was a progressive improvement, with a decrease in the indexes (AHI and RDI) and in the percentage of time with peripheral oxyhemoglobin saturation below 90% (tSpO < 90%), and an increase in nadir of SpO2. In the comparison between the 2 methods used in the late postoperative period - arterial tonometry and polysomnography - there was no difference in the indexes and in the tSpO < 90%. Discussion There was a progressive and favorable impact of pharyngeal surgery on the improvement of polysomnographic and clinical respiratory parameters; however, many patients maintained residual OSA, suggesting the need for a new sleep study in the postoperative period. The arterial tonometry showed similar findings to polysomnography, which can be considered as an option in postoperative follow-up of patients.

Assessment of Laryngopharyngeal Reflux and Obstructive Sleep Apnea: A Population-Based Study.

OBJECTIVES/HYPOTHESIS: To evaluate the presence of laryngopharyngeal reflux (LPR) and the potential association between presence of LPR symptoms and obstructive sleep apnea (OSA) in a representative sample from a population-based study. STUDY DESIGN: Cross-sectional study. METHODS: Participants of the follow-up of the Epidemiological Sleep Study were evaluated. Sleep was assessed through questionnaires and polysomnography. The presence of LPR was based on the questionnaire Reflux Score Index (RSI), and scores higher than 13 were suggestive of LPR. A general linear model test was used for comparison of continuous data and Pearson's chi-square test was used to compare categorical variables. Predictors of LPR were obtained by regression analysis. RESULTS: 701 were enrolled (54.8% female, 45.2% male; mean age, 50.2 ± 13.3 years). The mean apnea-hypopnea index score was 17 ± 18.3 events/hr, and the mean RSI score was 7.0 ± 8.1. LPR was found in 17% of the volunteers, whereas OSA was present in 38.5% of the sample. Specifically, in those patients with OSA, the prevalence of LPR was 45.4%; however, there was no statistically significant association between LPR and the presence of OSA. The severity of OSA was not associated with RSI score. The presence of LPR was associated with older age, smoking, excessive daytime sleepiness and worse quality of life and sleep scores questionnaires. CONCLUSIONS: Age, smoking, but not body mass index, were associated with LPR. There was not statistically significant association of LPR with OSA. Individuals with symptoms of LPR had greater drowsiness and worse quality of life and sleep. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1877-1882, 2022.

Effect of speech therapy on quality of life in patients with spinocerebelar ataxia type 3.

BACKGROUND: Individuals with spinocerebellar ataxia type 3 (SCA3) present communication and swallowing disorders, and consequent deterioration in quality of life (QOL). OBJECTIVE: To evaluate the impact of a speech therapy rehabilitation program on the QOL of patients with SCA3. METHODS: All participants were randomly assigned to two groups, an intervention group receiving speech therapy (STG) and a control group (CG). The International Cooperative Ataxia Rating Scale scores were 32.4 ± 20.2, and the Scale for the Assessment and Rating of Ataxia scores were 11.8 ± 8.0. The intervention consisted of a 12-session speech therapy rehabilitation program with oral, pharyngeal, and laryngeal strengthening exercises-the so-called ATAXIA-Myofunctional Orofacial and Vocal Therapy (A-MOVT). They all were submitted to pre- and postintervention evaluations using the World Health Organization's Quality of Life (WHOQOL-BREF) assessment, as well as the Living with Dysarthria (LwD), Quality of Life in Swallowing Disorders (SWAL-QOL), and Food Assessment Tool (EAT-10). RESULTS: The study sample consisted of 48 patients with SCA3 (STG = 25; CG = 23), mean age was 47.1 ± 11.4 years; mean age at symptom onset was 36.9 ± 11.3 years; disease duration was 11.9 ± 13.3 years. After the 3-month intervention, there were significant changes in the QOL in the STG compared with the CG, when assessed by the LwD (179.12 ± 62.55 vs. 129.88 ± 51.42, p < 0.001), SWAL-QOL (869.43 ± 153.63 vs. 911.60 ± 130.90, p = 0.010), and EAT-10 (5.16 ± 7.55 vs. 2.08 ± 3.85, p = 0.018). CONCLUSIONS: Patients with SCA3 should receive continuous speech therapy as part of the A-MOVT program, because therapy helps to improve difficulty swallowing and dysarthria.

ANTECEDENTES: Indivíduos com ataxia espinocerebelar tipo 3 (AEC3) apresentam distúrbios da comunicação e deterioração da deglutição e, consequentemente, na qualidade de vida (QV). OBJETIVO: Avaliar o impacto de um programa de reabilitação fonoaudiológica na QV em pacientes com AEC3. MéTODOS: Todos os participantes foram alocados aleatoriamente em dois grupos, um grupo intervenção que recebeu terapia fonoaudiológica (GTF) e um grupo controle (GC). As pontuações das escalas: International Cooperative Ataxia Rating Scale (ICARS) foram 32,4 ± 20,2 e da Scale for the Assessment and Rating of Ataxia (SARA) foram 11,8 ± 8,0. A intervenção consistiu em um programa de reabilitação fonoaudiológica de 12 sessões composto por exercícios de fortalecimento oral, faríngeo e laríngeo - denominados ATAXIA - Terapia Miofuncional Orofacial e Vocal (A-TMOV). Todos foram submetidos a avaliações pré e pós-intervenção por meio dos protocolos World Health Organization's Quality of Life (WHOQOL-BREF), Vivendo com Disartria (VcD), Quality of Life in Swallowing Disorders (SWAL-QOL) e Food Assessment Tool (EAT-10). RESULTADOS: A amostra foi composta por 48 pacientes com AEC3 (25 no GTF e 23 no GC), média de idade 47,1 ± 11,4anos; média de idade de início dos sintomas 36,9 ± 11,3anos; duração da doença 11,9 ± 13,3anos. Após intervenção de três meses, houve mudanças significativas na QV no GTF em comparação com o GC quando avaliado pelo VcD (179,12 ± 62,55 versus129,88 ± 51,42, p < 0,001), SWAL-QOL (869,43 ± 153,63 versus 911,60 ± 130,90, p = 0,010), EAT-10 (5,16 ± 7,55 versus 2,08 ± 3,85, p = 0,018). CONCLUSõES: Pacientes com AEC3 devem receber terapia fonoaudiológica contínua como parte do programa A-TMOV, pois a terapia ajuda a melhorar a dificuldade de deglutição e a disartria.

Individuals with peripheral vestibulopathy and poor quality of sleep are at a higher risk for falls.

INTRODUCTION: There is a lack of scientific studies on the assessment of patients with vestibular disorders associated with sleep quality disorders and its impact on the balance and overall quality of life. OBJECTIVES: to assess the impact of the sleep quality on the balance and quality of life of individuals with peripheral vestibulopathies. METHODS: 52 individuals with peripheral vestibulopathies underwent sleep quality assessment through the Pittsburgh sleep quality index, neurotological examination through dizziness handicap inventory and Tetrax posturography (Sunlight Medical Ltd.) in eight sensory conditions. Thirty-two healthy individuals (G3) participated as the control group. RESULTS: Fourteen individuals with vestibulopathy had good quality of sleep (G1) and 38 showed poor quality of sleep (G2) as demonstrated by the Pittsburgh sleep quality index global scores (p=0.001). The dizziness handicap inventory showed worse impact of the dizziness on the quality of life in G2 when compared to G1 (p=0.045). The G2 showed higher risk of falling in posturography when compared to G3 (p=0.012) and higher index of postural instability in five sensory conditions in comparison with G3. In the vestibulopathy groups, the worse the sleep quality, the higher the risk of falling (r=0.352) and the worse the quality of life (r=0.327). CONCLUSION: Individuals with peripheral vestibulopathies and poor quality of sleep demonstrate worse balance evidenced by increased postural instability, higher risk of falls and worse perceived quality of life. The quality of sleep is a predictive factor for worse perceived quality of life and for higher risk of falls in individuals with peripheral vestibulopathies.

Dysphagia in patients with moderate and severe obstructive sleep apnea.

INTRODUCTION: There is evidence that trauma caused by snoring in the pharynx could result in dysphagia in patients with obstructive sleep apnea, but the literature is still scarce to define the factors associated with the presence of dysphagia in these patients. OBJECTIVES: To analyze the occurrence of dysphagia and its clinical and polysomnographic features in patients with moderate and severe obstructive sleep apnea, in addition to verifying the impact of dysphagia on the quality of life of these patients. METHODS: Seventy patients with moderate or severe apnea (apnea and hypopnea index - AHI>15/hour) were selected. The patients underwent a sleep questionnaire, a quality of life in dysphagia questionnaire and a fiberoptic endoscopic evaluation of swallowing. RESULTS: A total of 70 patients were included in the study, of which 49 were men (70 %), with a mean age of 48.9 years. The fiberoptic endoscopic evaluation of swallowing was altered in 27.3 % and the most frequent alteration was the premature oral leakage with fluid. Comparing the groups with and without dysphagia, the female gender was the only clinical parameter that showed a trend of statistical significance in the group with dysphagia (p=0.069). There was no statistical difference regarding the polysomnographic features and in the global quality of life score in dysphagia in the comparison between the groups. CONCLUSIONS: The presence of dysphagia in patients with moderate to severe apnea is frequent and subclinical, reinforcing the need to investigate this symptom in this group of patients. However, the presence of dysphagia did not result in worsening in patients' quality of life, suggesting that, although frequent, its effect is mild. There was no relevance regarding the association of clinical and polysomnographic parameters with the presence of dysphagia.

Proposed management model for the use of telemonitoring of adherence to positive airway pressure equipment - position paper of the Brazilian Association of Sleep Medicine - ABMS.

This document "Proposed management model for the use of telemonitoring to positive airway pressure adherence" was prepared by a special commission of the Brazilian Association of Sleep Medicine, with the objective of recommending a follow-up model for patients undergoing positive airway pressure therapy using telemonitoring. This proposal was prepared based on a survey and analysis of the most up-to-date national and international literature and uses the best available evidence to facilitate the standardization of care by Sleep Science specialists with potential benefit for patients. Among the conclusions of the document, it is emphasized that telemonitoring is an important tool that allows health professionals trained in sleep-disordered breathing to remotely monitor PAP therapy, allowing prompt and, when necessary, daily adjustments to be made in order to increase adherence to treatment. The authors also conclude that the privacy of the data received and shared during the provision of telemonitoring must be respected by the physician or health professional trained in sleep, with the authorization of the patient and/or person responsible, who should be made aware of the short-, medium- and long-term provision of the service.

Using craniofacial characteristics to predict optimum airway pressure in obstructive sleep apnea treatment.

INTRODUCTION: Manual titration is the gold standard to determinate optimal continuous positive airway pressure, and the prediction of the optimal pressure is important to avoid delays in prescribing a continuous positive airway pressure treatment. OBJECTIVE: To verify whether anthropometric, polysomnographic, cephalometric, and upper airway clinical assessments can predict the optimal continuous positive airway pressure setting for obstructive sleep apnea patients. METHODS: Fifty men between 25 and 65 years, with body mass indexes of less than or equal to 35kg/m2 were selected. All patients had baseline polysomnography followed by cephalometric and otolaryngological clinical assessments. On a second night, titration polysomnography was carried out to establish the optimal pressure. RESULTS: The average age of the patients was 43±12.3 years, with a mean body mass index of 27.1±3.4kg/m2 and an apnea-hypopnea index of 17.8±10.5 events per hour. Smaller mandibular length (p=0.03), smaller atlas-jaw distance (p=0.03), and the presence of a Mallampati III and IV (p=0.02) were predictors for higher continuous positive airway pressure. The formula for the optimal continuous positive airway pressure was: 17.244-(0.133×jaw length)+(0.969×Mallampati III and IV classification)-(0.926×atlas-jaw distance). CONCLUSION: In a sample of male patients with mild-to-moderate obstructive sleep apnea, the optimal continuous positive airway pressure was predicted using the mandibular length, atlas-jaw distance and Mallampati classification.