Evaluation of the upper airway in obstructive sleep apnoea.

The evaluation of the upper airway (UA) includes the physical examination of pharyngeal structures and a number of imaging techniques that vary from the mostly used lateral cephalometry and computed tomography to more sophisticated methods such as tri-dimensional magnetic resonance image (MRI). Other complex techniques addressing UA collapsibility assessed by measurement of pharyngeal critical pressure and negative expiratory pressure however are not routinely performed. These methods provide information about anatomic abnormalities and the level of pharyngeal narrowing or collapse while the patient is awake or asleep. Data suggest that individual patients have different patterns of UA narrowing. So, the best method for evaluating obstruction during obstructive events remains controversial. In general, in clinical practice physical examination including a systematic evaluation of facial morphology, mouth, nasal cavity and the pharynx as well as simple imaging techniques such as nasopharyngoscopy and cephalometry have been more routinely utilized. Findings associated with obstructive sleep apnoea (OSA) are UA narrowing by the lateral pharyngeal walls and enlargements of tonsils, uvula and tongue. Additionally cephalometry identifies the most significant craniofacial characteristics associated with this disease. MRI studies demonstrated that lateral narrowing of UA in OSA is due to parapharyngeal muscle hypertrophy and/or enlargement of non adipose soft tissues. The upper airway evaluation has indubitably contributed to understand the pathophysiology and the diagnosis of OSA and snoring. Additionally, it also helps to identify the subjects with increased OSA risk as well as to select the more appropriate modality of treatment, especially for surgical procedures.

Enfermedades respiratorias del sueño y patología vascular cerebral / Respiratory-related sleep disorder and cerebral vascular disease

Las patologías respiratorias del sueño (PRS), especialmente las Apneas del tipo Obstructivo, tienen una alta prevalencia en pacientes con Accidente Cerebrovascular y en Enfermedades Cardiacas. Numerosos estudios publicados en la literatura hasta la fecha, sugieren y confirman que estas patologías respiratorias del sueño constituyen hoy en día un factor de riesgo independiente de morbilidad y mortalidad para eventos isquémicos cerebrales y cardiogénicos. Existen mecanismos fisiopatológicos como la hipoxemia, activación simpática, estados de hipercoagubilidad y daño de la pared endotelial que explican la relación existente entre patologías respiratorias del sueño y enfermedades cardiocerebrovasculares. Por otra parte, para aquellos pacientes que están cursando con un evento isquémico cerebral en fase aguda, las Apneas del Sueño se asocian a una alta mortalidad y a un peor pronóstico funcional. Identificar y tratar precozmente estas patologías respiratorias del sueño, puede constituirse en una estrategia terapéutica crucial para reducir la morbi-mortalidad asociada a los AccidentesVasculares Cerebrales y a las Enfermedades Cardiacas. El instaurar políticas de salud de prevención primaria será quizás la principal herramienta de trabajo que permitirá en un futuro cercano mantener un mejor control y reducir el alto riesgo de salud de los pacientes portadores de Apneas del Sueño.

Respiratory-related sleep disorders, especially type Obstructive Apnea have a high prevalence in patients with stroke and heart disease. Numerous studies published in the literature to date, confirm and suggest that these respiratory disorders of sleep are now an independent risk factor for morbidity and mortality and cardiogenic cerebral ischemic events. There are pathophysiological mechanisms such as hypoxemia, sympathetic activation, blood coagulation abnormalities and damage to the endothelial wall that explain the relationship between respiratory diseases of sleep and vascular diseases. On the other hand, for those patients who are attending an event with ischemic stroke in acute phase, the sleep apnea is associated with high mortality and a worse functional prognosis To identify and treat these diseases early respiratory sleep, can become a crucial therapeutic strategy to reduce morbidity and mortality associated with stroke and heart disease. The institute health policies for primary prevention is perhaps the main working tool that will in the near future to maintain better control and reduce the high risk of health of patients with sleep apnea.

Síndrome da apnéia e da hipopnéia obstrutiva do sono em crianças / Obstructive sleep apnea syndrome in children

Os autores fazem uma revisão bibliográfica atualizada sobre a Síndrome de Apnéia e Hipopnéia Obstrutivas do Sono (SAHOS) em crianças. Sua incidência, etiopatogenia, diagnóstico, conseqüências relacionadas à doença, manejo e prognóstico são abordados

Estudo cefalométrico de dimensöes esqueléticas e de tecidos moles, em normas lateral e frontal, de pacientes portadores da síndrome das apnéias obstrutivas do sono, examinados nas posiçöes sentada e supina / Cephalometric study of skeletic dimensions and the soft tissues, in lateral and frontal rules, of the subjects with sindrom of the destructive break respiration of dreams, examinated in the sit down and supine positions

Para avaliar se existe um padräo cefalométrico predictivo para a síndrome das apnéias obstrutivas do sono (S.A.O.S.), na presente pesquisa säo comparadas as diferenças das médias de dimensöes esqueléticas e de tecidos moles, nas normas frontal e lateral, em amostra constituída por 30 indivíduos, dividida em três grupos: roncadores, portadores de S.A.O.S. moderada e portadores de S.A.O.S severa, previamente submetidos a estudo polissonográfico. A dimensäo transversal da mandíbula, medida sobre radiografia cefalométrica em norma frontal, está negativamente correlacionada ao número de apnéias (=0,01) e apresenta-se significativamente menor (p=0,01) no grupo de pacientes apnéicos severos, e o comprimento da língua, medido em norma lateral, apresenta-se significativamente maior (p=0,05) neste mesmo grupo. As médias das demais dimensöes cefalométricas selecionadas, inclusive sua variaçäo em funçäo da posiçäo do paciente para a tomada radiográfica (sentada e supina), näo apresentam diferenças significativas. Estes resultados levam à conclusäo de que näo existe um padräo cefalométrico predictivo para esta patologia