Screening for Obstructive Sleep Apnea and Associated Risk Factors in Adolescents and Adults With Isolated Robin Sequence.

OBJECTIVE: To investigate the subjective risk for obstructive sleep apnea (OSA) in adolescents and young adults with isolated Robin sequence (IRS). Additionally, to investigate the association of OSA risk with respiratory signs/symptoms, and retrognathia. DESIGN: Prospective, observational, and cross-sectional study. SETTING: Tertiary reference hospital for the rehabilitation of craniofacial anomalies. PARTICIPANTS: Adolescents and adults (n = 30) with IRS were clinically evaluated and screened through the Berlin Questionnaire (BQ) and Respiratory Symptoms Questionnaire. The maxillomandibular relationship was assessed on lateral cephalograms of those that reached skeletal maturity (n = 13). Polysomnography (PSG) was performed in a subgroup of 4 individuals. RESULTS: The mean age of the sample was 18.2 (±3.4) years, 17 (56.7%) were adolescents (14-19 years), and 16 were (53.3%) female, all presented a repaired cleft palate. CLINICAL PARAMETERS: Systemic arterial pressure (118.0 ± 4.1/76.3 ± 4.9 mmHg), body mass index (BMI) (20.9 ± 2.8 kg/m2), neck (33.2 ± 2.3 cm), and waist circumferences (72.0 ± 5.8 cm) were within normal ranges. A skeletal class I pattern was observed in 61.5% of the participants while a class II was seen in 15.4% of them. A high risk for OSA was detected in 16.7%, and it was associated with nasal obstruction, snoring and drowsiness, and a skeletal class II pattern (P ≤ .05). One patient presented with mild OSA (apnea-hypopnea index [AHI] = 10.1 events/hour) at the PSG exam. CONCLUSIONS: A high risk for OSA can be observed with a moderate frequency among adolescents and young adults with IRS, especially among those who are concurrently suffering from nasal obstruction, snoring and retrognathia.

Tomographic Evaluation of the Upper Cervical Spine in Patients with Cleft lip and Palate and Class III Malocclusion.

OBJECTIVE: To perform a morphometric analysis of the upper cervical spine (UCS) by means of cone-beam computed tomography (CBCT) for the diagnosis of malformations or craniocervical instabilities in patients with cleft lip and palate (CLP) and class III malocclusion. MATERIALS AND METHODS: A total of 72 CBCTs from adult patients (48 male and 24 female) with Angle Class III malocclusion were divided into three groups: 1) Unilateral cleft lip and palate (UCLP) (n = 29; male = 65.5%; age = 24, 2 ± 4.2 years); 2) Bilateral cleft lip and palate (BCLP) (n = 18; male = 83.3%; age = 26.4 ± 6.0 years); 3) Control group (CON) (n = 25; male = 56.0%; age = 27.8 ± 9.3 years). The version 11.7 of the Dolphin® software (Chatsworth, California, USA) was used to evaluate the morphometric measurements and anomalies of the UCS. Data were analyzed by descriptive and inferential statistics (p ≤ 0.05). RESULTS: For the UCLP, BCLP and CON groups, respectively, the measures were: atlantodental interval (2.1 ± 0.5; 2.1 ± 0.4; 2.0 ± 0.3 mm), basion-opisthion (35.9 ± 3.2; 36.4 ± 3.0; 34.7 ± 1.9 mm), hyoid-C3 (34.5 ± 3.7; 34.5 ± 5.2; 35.3 ± 4.5 mm), and hyoid-sella (108.1 ± 9.8; 111.3 ± 9.2; 109.7 ± 10 mm); clivus-canal angle (152.3 ± 13; 150.3 ± 10; 150.7 ± 10°) and Torg-Pavlov index (1.0 ± 0.2; 1.0 ± 0.1; 1.1 ± 0.2). Potentially unstable anomalies and malformations were more prevalent in the UCLP group (34,4%). CONCLUSION: Subjects with UCLP presented compressive or unstable anomalies on upper cervical spine, more frequently than controls and BCLP, despite the lack of statistically significant differences among groups. Future studies could increase the safety of patients and healthcare professionals specialized in craniofacial anomalies.

Assessment of Internal Nasal Dimensions of Individuals With Cleft Lip and Palate and Obstructive Sleep Apnea Syndrome by Computed Tomography.

To evaluate nasal cavity (NC) dimensions of individuals with cleft lip and/or palate (CL/P), obstructive sleep apnea (OSA), and primary snoring, by tomographic image analysis, compared to individuals with OSA without CL/P (N-CL/P).Cross-sectional and retrospective.Tertiary referral center.Patients were divided into 2 groups: (G1) CL/P + OSA or primary snoring, n = 11; (G2) N-CL/P + OSA, n = 13.NC tomographic images were reconstructed using ITK-SNAP software, and measurements were obtained from these three-dimensional models using SpaceClaim software.Total NC volumes, right and left NC volumes, and volumes of the nostril to the nasal valve (V1) and from the nasal valve to the superior limit of the nasopharynx (V2), cross-sectional areas, and perimeters.NC volumes (total, right, and left sides), V1, and V2, though smaller in the CL/P + OSA, did not differ significantly from the N-CL/P + OSA. Cross-sectional areas and perimeters of the superior limit of the nasopharynx, in the CL/P + OSA, presented significantly higher values compared to the N-CL/P + OSA (P ≤ .05).The internal nasal dimensions of patients with CL/P do not seem to be part of the etiopathogenesis, nor constitute a risk factor for OSA with greater severity, in this special group of patients.

Effects of organic and inorganic compounds of diesel exhaust particles on the mucociliary epithelium: An experimental study on the frog palate preparation.

The toxic actions of acute exposition to different diesel exhaust particles (DEPA) fractions on the mucociliary epithelium are not yet fully understood due to different concentrations of organic and inorganic elements. These chemicals elements produce damage to the respiratory epithelium and exacerbate pre-existent diseases. In our study we showed these differences in two experimental studies. Study I (dose-response curve - DRCS): Forty frog-palates were exposed to the following dilutions: frog ringer, intact DEPA diluted in frog-ringer at 3mg/L, 6mg/L and 12mg/L. Study II (DEPF) (DEPA fractions diluted at 12mg/L): Fifty palates - Frog ringer, intact DEPA, DEPA treated with hexane, nitric acid and methanol. Variables analyzed: relative time of mucociliary transport (MCT), ciliary beating frequency (CBF) and morphometric analysis for mucin profile (neutral/acid) and vacuolization. The Results of DRCS: Group DEPA-12mg/L presented a significant increase in the MCT (p<0.05), proportional volume of acid mucus (p<0.05) and decreased proportional volume of neutral mucus and vacuoles (p<0.05). In relation of DEPF: A significant increase in the MCT associated to a decrease in the proportional volume of neutral mucus was founded in nitric acid group. In addition, a significant increase in the proportional volume of acid mucus was found in methanol group. We concluded that: 1) Increasing concentrations of intact DEPA can progressively increase MCT and promote an acidification of intra-epithelial mucins associated to a depletion of neutral mucus. 2) Intact DEPA seem to act as secretagogue substance, promoting mucus extrusion and consequently reducing epithelial thickness. 3) Organic fraction of low polarity seems to play a pivotal role on the acute toxicity to the mucociliary epithelium, by promoting a significant increase in the MCT associated to changes in the chemical profile of the intracellular mucins.

Nasal Airway Dimensions of Children With Repaired Unilateral Cleft Lip and Palate.

OBJECTIVE: To measure cross-sectional areas of the main nasal constrictions as a function of the distance into the nose in children with repaired unilateral cleft lip and palate, as compared with children without cleft, by acoustic rhinometry. DESIGN: Prospective analysis. SETTING: Craniofacial anomalies hospital. PARTICIPANTS: A total of 39 children with repaired unilateral cleft lip and palate and 34 healthy controls without cleft, of both genders, aged 6 to 9 years. Interventions/Variables : Nasal cross-sectional areas measured at the three main deflections of the rhinogram (CSA1, CSA2, CSA3) and distances from the nares (dCSA1, dCSA2, dCSA3) were assessed by means of an Eccovision Acoustic Rhinometer, before and after nasal decongestion. Differences were analyzed at a significance level of 5%. RESULTS: At the cleft side, mean CSA1, CSA2, and CSA3 values ± standard deviation obtained before nasal decongestion were 0.17 ± 0.12, 0.29 ± 0.20, and 0.40 ± 0.28 cm(2), respectively, and dCSA1, dCSA2, and dCSA3 values ± standard deviation were 2.02 ± 0.40, 3.74 ± 0.51, and 5.50 ± 0.44 cm, respectively. At the noncleft side, these were 0.33 ± 0.11, 0.65 ± 0.28, and 0.90 ± 0.43 cm(2), respectively, and 1.69 ± 0.48, 3.67 ± 0.53, and 5.60 ± 0.70 cm, respectively. Increased cross-sectional area means were seen after nasal decongestion in the control and cleft groups. Mean cross-sectional area values at the cleft side were significantly smaller than noncleft side and control values, and the mean dCSA1 value was smaller at the noncleft side before and after decongestion. CONCLUSIONS: Objective assessment of internal nasal dimensions has shown that children with unilateral cleft lip and palate have a significant impairment of nasal patency due to the reduced cross-sectional areas seen at the cleft side.

Effects of 3D Airway Geometry on the Airflow of Adults with Cleft Lip and Palate and Obstructive Sleep Apnea: A Functional Imaging Study.

Objective Individuals with cleft lip and palate (CLP) are at a high risk of developing obstructive sleep apnea (OSA). Hypothetically, the severity of OSA might be associated with the morphology of the upper airway (UAW) and the characteristics of the airflow. Thus, the present study aimed to assess and compare, in adults with CLP and skeletal class-III discrepancy, with or without OSA, simulations of airflow resistance and pressure according to the geometrical characteristics of the UAW and cephalometric parameters. Materials and Methods According to the results of type-I polysomnography tests, the sample ( n = 21) was allocated in 2 groups: 1) without OSA (N-OSA; n = 6); and 2) with OSA (OSA; n = 15). Cephalometric measurements were performed on the cone-beam computed tomography (CBCT) scans of the groups. After three-dimensional (3D) reconstructions, the volume (V) and minimal cross-sectional area (mCSA) of the UAW were generated. Computational fluid dynamics (CFD) simulations were used to assess key airflow characteristics. The results were presented at a significance level of 5%. Results The UAW pressure values and airway resistance did not differ between the groups, but there was a tendency for more negative pressures (26%) and greater resistance (19%) in the OSA group. Volume and mCSA showed a moderate negative correlation with resistance and pressure. The more inferior the hyoid bone, the more negative the pressures generated on the pharyngeal walls. Conclusion The position of the hyoid bone and the geometry of the UAW (V and mCSA) exerted effects on the airway-airflow resistance and pressure. However, key airflow characteristics did not differ among subjects with CLP, were they affected or not by OSA.

Respiratory sleep disorders, nasal obstruction and enuresis in children with non-syndromic Pierre Robin sequence.

INTRODUCTION: Obstructive sleep apnea is highly prevalent in non-syndromic Pierre Robin sequence patients. Studies have found a probable relationship between obstructive sleep apnea and nasal obstruction and between obstructive sleep apnea and enuresis. Assessment of the relationship between these variables in non-syndromic Pierre Robin sequence patients is scarce. OBJECTIVE: The present study aims to evaluate the relationship between symptoms of obstructive sleep apnea, nasal obstruction and enuresis, determining the prevalence of symptoms suggestive of these conditions, in schoolchildren with non-syndromic Pierre Robin sequence, and describe the prevalence of excessive daytime sleepiness habitual snoring and voiding dysfunction symptoms associated with enuresis. METHODS: This was a prospective analytical cross-sectional study developed at a reference center. Anthropometric measurements and a structured clinical interview were carried out in a sample of 48 patients. The instruments "sleep disorders scale in children" "nasal congestion index questionnaire" (CQ-5), and the "voiding dysfunction symptom score questionnaire" were used. Statistical analysis was performed for p < 0.05. RESULTS: Positive "sleep disorders scale in children" scores for obstructive sleep apnea and CQ-5 for nasal obstruction were observed in 38.78% and 16.33%, respectively. Enuresis was reported in 16.33% of children, being characterized as primary in 71.43% and polysymptomatic in 55.55%; according to the "voiding dysfunction symptom score questionnaire". There was a significant relationship between nasal obstruction and obstructive sleep apnea symptoms (p < 0.05), but no significance was found between obstructive sleep apnea symptoms and enuresis, and between nasal obstruction and enuresis. The prevalence of excessive daytime sleepiness was 12.24% and of habitual snoring, 48.98%. A family history of enuresis, younger age in years and a positive "voiding dysfunction symptom score questionnaire" score were associated with a higher prevalence of enuresis (p < 0.05). CONCLUSION: Children with non-syndromic Pierre Robin sequence are at high risk for obstructive sleep apnea symptoms and habitual snoring, with a correlation being observed between nasal obstruction and obstructive sleep apnea symptoms. In addition, the study showed that non-syndromic Pierre Robin sequence, obstructive sleep apnea and nasal obstruction symptoms were not risk factors for enuresis in these patients.

Web survey during COVID-19 pandemic in São Paulo state: how are medical students sleeping and living?

Objectives: This study aimed at characterizing medical students' sleep and life quality during the COVID-19 pandemic in São Paulo (SP) state. Material and Methods: All public higher education institutions (HEIs) of SP state were invited to participate. From a list of 56 private HEIs, 16 were randomly selected. The web survey collected: sociodemographic data; factors related to COVID-19; sleep self-assessment; scores in the Epworth sleepiness scale, Pittsburgh sleep quality index, and student and resident life in the health area - questionnaire. Results: The HEIs' acceptance rate was 25% (8), resulting in 200 participants (response rate 5.04%), aged ≥18 years, 60.5% females. Concerning COVID-19, 89.00% never showed symptoms and/or tested positive, 82.00% declared full adherence to epidemiological measures to prevent the infection's spread, and 45.00% completed the vaccination schedule against SARS-CoV-2. Sleep deprivation was accompanied by a drop of self-perceived sleep quality from 8 to 6 (in a Likert scale) during COVID-19 pandemics (p≤0.0001), 76.50% were poor sleepers, and 40.00% had drowsiness, especially women (p≤0.05). They also had lower quality of life and unfavorable psychological and physical outcomes than men (p≤0.05). Internship students had a more negative perception of the educational environment (p≤0.05), characterized by an excessive workload. Discussion: Women and internship students are a representative fraction that requires special attention and focused strategies to cope with sleep problems and medical education during COVID-19 pandemics.

Are reduced internal nasal dimensions a risk factor for obstructive sleep apnea syndrome?

INTRODUCTION: Obstructive sleep apnea syndrome is a high-prevalence disorder found in the population. Studies have shown a possible association between nasal obstruction and obstructive sleep apnea syndrome, but the existence of a association between the degree of nasal obstruction and obstructive sleep apnea syndrome severity has not yet been proven. OBJECTIVE: To evaluate the internal nasal dimensions of adults with primary snoring and obstructive sleep apnea syndrome by acoustic rhinometry and to correlate the findings with obstructive sleep apnea severity. METHODS: Twenty-one male Caucasian subjects with complaints of snoring and/or respiratory pauses during sleep, aged between 18 and 60 years of age, were evaluated. After clinical evaluation, otorhinolaryngological examination and flexible nasopharyngolaryngoscopy, all patients underwent type III polysomnography. The participants were divided into two groups according to symptom severity: group 1, primary snoring and/or mild obstructive sleep apnea syndrome(n = 9) and group 2, moderate/severe obstructive sleep apnea syndrome (n = 12). Internal nasal dimensions were measured by acoustic rhinometry, analyzing minimum cross sectional area (CSA) and three nasal segment volumes. RESULTS: The respiratory event index corresponded to 8.1 ±â€¯4.0 in group 1 and 47.5 ±â€¯19.1 in group 2. In group 1, the cross-sectional areas values, in cm2, corresponded to: CSA 1 = 1.1 ±â€¯0.4; CSA 2 = 2.1 ±â€¯0.9; CSA 3 = 3.5 ±â€¯1.8 and, in group 2: CSA 1 = 1.2 ±â€¯0.3, CSA 2 = 2.0 ±â€¯0.5; CSA 3 = 2.8 ±â€¯0.7. In group 1, volumes (V), in cm3, corresponded to: V1 = 3.5 ±â€¯1.0; V2 = 9.3 ±â€¯5.0; V3 = 40.2 ±â€¯21.5 and in group 2 a: V1 = 3.6 ±â€¯0.5; V2 = 7.6 ±â€¯1.5; V3 = 31.5 ±â€¯6.7. Cross-sectional area and volume ​​did not differ between groups. CONCLUSION: There were no significant differences in the cross-sectional areas and nasal volumes between individuals with primary snoring-mild obstructive sleep apnea syndrome and moderate-severe obstructive sleep apnea syndrome. Differently to the raised hypothesis, our results suggest that there is no association between internal nasal dimensions and severity of obstructive sleep apnea syndrome.

Impact of CPAP treatment for a short period in moderate-to-severe OSAS patients: a randomized double-blind clinical trial.

INTRODUCTION: Obesity is the most frequent reversible agravating factor of obstructive sleep apnea syndrome, with physical activity very important for its control. Continuous positive air pressure during sleep is the "gold standard" treatment for obstructive sleep apnea syndrome. OBJECTIVE: we aimed to investigate if the use of continuous positive air pressure for a short period (7 days), would improve sleep quality, daytime sleepiness, and the disposition for physical activity. METHODS: Eighty obstructive sleep apnea syndrome patients were randomly assigned as follows: group I - continuous positive air pressure with a steady pressure of 4 cm H2O; group II - ideal therapeutic pressure. After filling out the questionnaires related to the studied variables (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index), patients underwent a baseline pulmonary function test and continuous positive air pressure titration. After continuous positive air pressure therapy for 4≥ hours a night for 7 consecutive days, patients returned and filled out new (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index) forms. New spirometry was carried out. RESULTS: 39 patients completed the study. The mean age was 52 ±â€¯11 years old and 28 patients (71.79%) were obese. Both groups were similar for all variables studied at baseline. After Continuous positive air pressure use, patients of group II presented more significant improvements (p <  0.05) for sleep quality and diurnal sleepiness. Time spent with physical activities did not change. Spirometric data were at normal range at baseline. Solely the variable FEF 25%-75% was significantly enhanced (p <  0.05) in group II. CONCLUSION: Continuous positive air pressure therapy for 1 week, with ideal pressure, improves daytime sleepiness and sleep quality, enhances pulmonary function, but does not change the mean time spent with physical activities.

Reduced pharyngeal dimensions and obstructive sleep apnea in adults with cleft lip/palate and Class III malocclusion.

Objective: To three-dimensionally evaluate the upper airway of individuals with cleft lip and palate (CLP) and Class III malocclusion and the occurrence of obstructive sleep apnea (OSA).Methods: Twenty-one CLP individuals with Class III malocclusion, 20-29 years of age, who underwent computed tomography for orthognathic surgery planning, were prospectively evaluated. All participants underwent polysomnography, and the apnea-hypopnea index ≥ 5 events/hour was considered indicative of OSA. The total upper airway and its subdivisions volumes, as well as the minimum pharyngeal cross-sectional area (CSA), were assessed using Mimics software.Results: Among the 21 individuals analyzed, 6 (29%) presented with OSA. The total upper airway and the oropharynx mean volumes were significantly decreased in subjects with OSA when compared to individuals without OSA. Mean CSA was not statistically different between groups.Conclusion: CLP individuals with Class III malocclusion and OSA have an upper airway significantly smaller than individuals without OSA.

Nasal mucus transportability in children with cleft palate.

OBJECTIVES: Children with cleft palate (CP) have a high prevalence of sinusitis. Considering that nasal mucus properties play a pivotal role in the upper airway defense mechanism, the aim of the study was to evaluate nasal mucus transportability and physical properties from children with CP. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, School of Dentistry, University of São Paulo, Bauru, SP, Brazil and Laboratory of Experimental Air Pollution, School of Medicine, University of São Paulo, São Paulo, SP, Brazil. METHODS: Nasal mucus samples were collected by nasal aspiration from children with CP and without CP (non-CP). Sneeze clearance (SC) was evaluated by the simulated sneeze machine. In vitro mucus transportability (MCT) by cilia was evaluated by the frog palate preparation. Mucus physical surface properties were assessed by measuring the contact angle (CA). Mucus rheology was determined by means of a magnetic rheometer, and the results were expressed as log G* (vectorial sum of viscosity and elasticity) and tan delta (relationship between viscosity and elasticity) measured at 1 and 100 rad/s. RESULTS: Mucus samples from children with CP had a higher SC than non-CP children (67+/-30 and 41+/-24 mm, respectively, p<0.05). Mucus samples from children with CP had a lower CA (24+/-16 degrees and 35+/-11 degrees , p<0.05) and a higher tan delta 100 (0.79+/-0.24 and 0.51+/-0.12, p<0.05) than non-CP children. There were no significant differences in mucus MCT, log G* 1, tan delta 1 and log G* 100 obtained for CP and non-CP children. CONCLUSIONS: Nasal mucus physical properties from children with CP are associated with higher sneeze transportability. The high prevalence of sinusitis in children with CP cannot be explained by changes in mucus physical properties and transportability.

Nasal cavity geometry of healthy adults assessed using acoustic rhinometry.

UNLABELLED: Acoustic rhinometry (AR) has been used as a specific test for nasal patency. AIM: this study aimed to set the reference values for nasal cavity cross-section geometry in healthy adults through AR. STUDY DESIGN: this is a clinical prospective study. MATERIALS AND METHOD: thirty volunteers (14 males and 16 females) without signs of nasal obstruction and aged between 18 and 30 years were enrolled in this study. They were assessed before and after being treated topically with a nasal vasoconstrictor drug. Their nasal cross-sectional areas were measured at the three dips of the rhinogram, corresponding respectively to the nasal valve (CSA1), the anterior (CSA2), and the posterior (CSA3) region of the inferior and middle turbinate. RESULTS: the mean areas (+/-SD) for 60 nasal cavities before nasal vasoconstriction were: 0.54+/-0.13cm2 (CSA1), 0.98+/-0.31 cm2 (CSA2), and 1.42+/-0.44cm2 (CSA3). After vasoconstriction, the mean values of the three segments analyzed were significantly larger (p<0.05). Gender was not a statistically significant variable. CONCLUSION: The nasal cross-sectional areas obtained for adults may be used for control purposes when studying patients with nasal obstruction, in conjunction with the nasal volume values previously reported by our group.

Adult nasal volumes assessed by acoustic rhinometry.

UNLABELLED: Acoustic rhinometry allows an objective and non-invasive assessment of nasal geometry. AIM: The present study aimed at determining the volumes of specific segments of the nasal cavity in healthy adults including the nasopharynx, using acoustic rhinometry. STUDY DESIGN: A clinical prospective analysis. CASES AND METHOD: Thirty volunteers with no evidence of nasal obstruction, aged 18 to 30 years (14 males and 16 females) were analyzed. Volumes were measured at the nasal valve region (V1), the turbinates (V2), and the nasopharynx (V3), before and after application of a topical nasal vasoconstrictor. RESULTS: The mean volumes measured in 60 cavities before nasal decongestion, were: 1.81+/-0.35 cm(3) (V1), 4.02+/-1.41 cm(3) (V2), and 17.52+/-4.44 cm(3) (V3) for males, and 1.58+/-0.25 cm(3) (V1), 3.94+/-1.03 cm(3) (V2), and 17.80+/-2.73 cm(3) (V3) for females. Gender differences were only significant in V1 (p<0.05). After nasal decongestion, the volumes of all the analyzed segments were significantly larger (p<0.05), and the gender differences were significant for V1 and V2. CONCLUSION: Volumes of the three segments in adults with no evidence of nasal obstruction may be used as reference values for other studies.

Methods for studying mucociliary transport.

UNLABELLED: Mucociliary transport dysfunctions can impair the quality of life of patients suffering from chronic rhinossinusitis and lead to severe consequences such as alterations in respiratory physiology or even death as in cases of cystic fibrosis and primary ciliary dyskinesia. Therefore, it is crucial to understand the physiology of the mucociliary apparatus and how its components (cilia, mucus-periciliary layer and its interaction) affect the clearance of respiratory secretions. AIMS: This paper aims to review and to discuss different techniques for studying mucociliary transport and their clinical and experimental applicability. CONCLUSIONS: The methods listed in this revision provide us with valuable information about different aspects of the mucociliary transport. Some of the methods listed are more suitable for clinical practice and present reproducible results. Others, show only applicability in experimental settings due to technical difficulties or financial limitations. However, it is important to emphasize that up to now there is no method that can evaluate ciliary beating frequency (CBF) in vivo and in situ. Such a method would become a valuable tool in the scientific scenario and in the clinical practice, supporting the diagnosis of ciliary dyskinesias and avoiding the use of invasive procedures to corroborate the clinical suspicion.

Impact of CPAP treatment for a short period in moderate-to-severe OSAS patients: a randomized double-blind clinical trial / Impacto do tratamento com CPAP por um curto período em pacientes com SAOS moderada a grave: um estudo clínico duplo-cego randomizado

Abstract Introduction: Obesity is the most frequent reversible agravating factor of obstructive sleep apnea syndrome, with physical activity very important for its control. Continuous positive air pressure during sleep is the ‟gold standard" treatment for obstructive sleep apnea syndrome. Objective: we aimed to investigate if the use of continuous positive air pressure for a short period (7 days), would improve sleep quality, daytime sleepiness, and the disposition for physical activity. Methods: Eighty obstructive sleep apnea syndrome patients were randomly assigned as follows: group I - continuous positive air pressure with a steady pressure of 4cm H2O; group II - ideal therapeutic pressure. After filling out the questionnaires related to the studied variables (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index), patients underwent a baseline pulmonary function test and continuous positive air pressure titration. After continuous positive air pressure therapy for 4> hours a night for 7 consecutive days, patients returned and filled out new (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index) forms. New spirometry was carried out. Results: 39 patients completed the study. The mean age was 52 ±11 years old and 28 patients (71.79%) were obese. Both groups were similar for all variables studied at baseline. After Continuous positive air pressure use, patients of group II presented more significant improvements (p< 0.05) for sleep quality and diurnal sleepiness. Time spent with physical activities did not change. Spirometric data were at normal range at baseline. Solely the variable FEF 25%-75% was significantly enhanced (p< 0.05) in group II. Conclusion: Continuous positive air pressure therapy for 1 week, with ideal pressure, improves daytime sleepiness and sleep quality, enhances pulmonary function, but does not change the mean time spent with physical activities.

Resumo Introdução: A obesidade é o fator causal reversível mais frequente da síndrome da apneia obstrutiva do sono, a atividade física é muito importante para o seu controle. A pressão positiva contínua na via aérea, CPAP, durante o sono é o tratamento padrão ouro para essa condição clínica. Objetivo: Avaliar se o uso do CPAP na síndrome da apneia obstrutiva do sono por um curto período (7 dias) melhoraria a qualidade do sono, a sonolência diurna e a disposição para a prática de atividades físicas, além da função pulmonar. Método: Oitenta pacientes com síndrome da apneia obstrutiva do sono foram distribuídos aleatoriamente da seguinte forma: grupo I - CPAP com pressão constante de 4cm H2O; grupo II - pressão terapêutica ideal. Após o preenchimento dos questionários relacionados ao estudo das variáveis (PSQI, ESS e IPAQ-L), os pacientes foram submetidos a teste de função pulmonar basal e titulação da CPAP. Após terapia com CPAP por ≥ 4 horas por noite durante sete dias consecutivos, os pacientes retornaram e preencheram novos questionários PSQI, ESS e IPAQ-L. Nova espirometria foi feita. Resultados: Apenas 39 pacientes completaram o estudo. A média de idade foi de 52 ± 11 anos e 28 pacientes (71,79%) eram obesos. Ambos os grupos eram semelhantes quanto às variáveis avaliadas no início do estudo. Após o uso de CPAP, os pacientes do grupo II apresentaram melhorias mais significantes (p < 0,05) para qualidade do sono e sonolência diurna. O tempo gasto com atividades físicas não mudou. Os dados espirométricos estavam na faixa normal no início do estudo. Apenas a variável FEF 25%-75% aumentou significantemente (p < 0,05) no grupo II. Conclusão: A terapia com CPAP por uma semana, com pressão ideal, melhora a sonolência diurna e a qualidade do sono, melhora a função pulmonar, mas não altera o tempo médio despendido com atividades físicas.

Respiratory sleep disorders, nasal obstruction and enuresis in children with non-syndromic Pierre Robin sequence / Desordens respiratórias do sono, obstrução nasal e enurese em crianças com sequência de Pierre Robin não sindrômica

Abstract Introduction Obstructive sleep apnea is highly prevalent in non-syndromic Pierre Robin sequence patients. Studies have found a probable relationship between obstructive sleep apnea and nasal obstruction and between obstructive sleep apnea and enuresis. Assessment of the relationship between these variables in non-syndromic Pierre Robin sequence patients is scarce. Objective The present study aims to evaluate the relationship between symptoms of obstructive sleep apnea, nasal obstruction and enuresis, determining the prevalence of symptoms suggestive of these conditions, in schoolchildren with non-syndromic Pierre Robin sequence, and describe the prevalence of excessive daytime sleepiness habitual snoring and voiding dysfunction symptoms associated with enuresis. Methods This was a prospective analytical cross-sectional study developed at a reference center. Anthropometric measurements and a structured clinical interview were carried out in a sample of 48 patients. The instruments "sleep disorders scale in children" "nasal congestion index questionnaire" (CQ-5), and the "voiding dysfunction symptom score questionnaire" were used. Statistical analysis was performed for p< 0.05. Results Positive "sleep disorders scale in children" scores for obstructive sleep apnea and CQ-5 for nasal obstruction were observed in 38.78% and 16.33%, respectively. Enuresis was reported in 16.33% of children, being characterized as primary in 71.43% and polysymptomatic in 55.55%; according to the "voiding dysfunction symptom score questionnaire". There was a significant relationship between nasal obstruction and obstructive sleep apnea symptoms (p< 0.05), but no significance was found between obstructive sleep apnea symptoms and enuresis, and between nasal obstruction and enuresis. The prevalence of excessive daytime sleepiness was 12.24% and of habitual snoring, 48.98%. A family history of enuresis, younger age in years and a positive "voiding dysfunction symptom score questionnaire" score were associated with a higher prevalence of enuresis (p< 0.05). Conclusion Children with non-syndromic Pierre Robin sequence are at high risk for obstructive sleep apnea symptoms and habitual snoring, with a correlation being observed between nasal obstruction and obstructive sleep apnea symptoms. In addition, the study showed that non-syndromic Pierre Robin sequence, obstructive sleep apnea and nasal obstruction symptoms were not risk factors for enuresis in these patients.

Resumo Introdução A apneia obstrutiva do sono apresenta elevada prevalência na população com sequência de Pierre Robin não sindrômica. Estudos constataram provável relação entre apneia obstrutiva do sono e obstrução nasal e entre apneia obstrutiva do sono e enurese, é escassa a avaliação da relação entre essas variáveis na sequência de Pierre Robin não sindrômica. Objetivo Avaliar a relação entre sintomas de apneia obstrutiva do sono, obstrução nasal e enurese, determinar a prevalência de sintomas sugestivos dessas condições, em crianças em idade escolar com sequência de Pierre Robin não sindrômica, assim como descrever a prevalência de sonolência excessiva diurna, ronco habitual e sintomas de disfunção miccional associados à enurese. Método Estudo prospectivo transversal analítico desenvolvido em centro de referência. Fez‐se aferição antropométrica e entrevista clínica estruturada em amostra de 48 pacientes. Os instrumentos usados foram: "escala de distúrbios do sono em crianças", questionário "índice de congestão nasal" (CQ‐5) e questionário "sistema de escore de disfunção miccional". A análise estatística foi feita para p < 0,05. Resultados Escores positivos da "escala de distúrbios do sono em crianças" para apneia obstrutiva do sono e do CQ‐5 para obstrução nasal foram observados em 38,78% e 16,33%; respectivamente. Enurese foi relatada em 16,33% das crianças e foi caracterizada como primária em 71,43% e polissintomática em 55,55%; conforme "sistema de escore de disfunção miccional". Observou‐se relação significante entre obstrução nasal e sintomas de apneia obstrutiva do sono (p < 0,05), porém não significante entre sintomas de apneia obstrutiva do sono e enurese, e obstrução nasal e enurese. A prevalência de sonolência excessiva diurna foi de 12,24% e de ronco habitual, de 48,98%. História familiar de enurese, menor idade em anos e escore positivo na "sistema de escore de disfunção miccional" foram associados a maior prevalência de enurese (p < 0,05). Conclusão Crianças com sequência de Pierre Robin não sindrômica estão sob alto risco para sintomas de apneia obstrutiva do sono e ronco habitual, foi observada correlação entre obstrução nasal e sintomas de apneia obstrutiva do sono. Demonstrou‐se, também, que sequência de Pierre Robin não sindrômica, sintomas de apneia obstrutiva do sono e obstrução nasal não constituíram fator de risco para enurese na população estudada.

Are reduced internal nasal dimensions a risk factor for obstructive sleep apnea syndrome? / Dimensões internas nasais reduzidas constituem fator de risco para síndrome da apneia obstrutiva do sono?

Abstract Introduction Obstructive sleep apnea syndrome is a high-prevalence disorder found in the population. Studies have shown a possible association between nasal obstruction and obstructive sleep apnea syndrome, but the existence of a association between the degree of nasal obstruction and obstructive sleep apnea syndrome severity has not yet been proven. Objective To evaluate the internal nasal dimensions of adults with primary snoring and obstructive sleep apnea syndrome by acoustic rhinometry and to correlate the findings with obstructive sleep apnea severity. Methods Twenty-one male Caucasian subjects with complaints of snoring and/or respiratory pauses during sleep, aged between 18 and 60 years of age, were evaluated. After clinical evaluation, otorhinolaryngological examination and flexible nasopharyngolaryngoscopy, all patients underwent type III polysomnography. The participants were divided into two groups according to symptom severity: group 1, primary snoring and/or mild obstructive sleep apnea syndrome(n = 9) and group 2, moderate/severe obstructive sleep apnea syndrome (n = 12). Internal nasal dimensions were measured by acoustic rhinometry, analyzing minimum cross sectional area (CSA) and three nasal segment volumes. Results The respiratory event index corresponded to 8.1 ± 4.0 in group 1 and 47.5 ± 19.1 in group 2. In group 1, the cross-sectional areas values, in cm2, corresponded to: CSA 1 = 1.1 ± 0.4; CSA 2 = 2.1 ± 0.9; CSA 3 = 3.5 ± 1.8 and, in group 2: CSA 1 = 1.2 ± 0.3, CSA 2 = 2.0 ± 0.5; CSA 3 = 2.8 ± 0.7. In group 1, volumes (V), in cm3, corresponded to: V1 = 3.5 ± 1.0; V2 = 9.3 ± 5.0; V3 = 40.2 ± 21.5 and in group 2 a: V1 = 3.6 ± 0.5; V2 = 7.6 ± 1.5; V3 = 31.5 ± 6.7. Cross-sectional area and volume ​​did not differ between groups. Conclusion There were no significant differences in the cross-sectional areas and nasal volumes between individuals with primary snoring-mild obstructive sleep apnea syndrome and moderate-severe obstructive sleep apnea syndrome. Differently to the raised hypothesis, our results suggest that there is no association between internal nasal dimensions and severity of obstructive sleep apnea syndrome.

Resumo Introdução A síndrome da apneia obstrutiva do sono é uma desordem de elevada prevalência na população. Estudos constataram possível associação entre obstrução nasal e síndrome da apneia obstrutiva do sono, porém a existência de uma relação entre a intensidade da obstrução nasal e a gravidade da síndrome da apneia obstrutiva do sono ainda não foi comprovada. Objetivo Avaliar as dimensões internas nasais de adultos com ronco primário e síndrome da apneia obstrutiva do sono por meio de rinometria acústica e correlacionar os achados com a gravidade da síndrome da apneia obstrutiva do sono. Método Foram avaliados 21 indivíduos com queixas de ronco e/ou pausas respiratórias durante o sono, gênero masculino, entre 18 e 60 anos, brancos. Após avaliação clínica, exame físico otorrinolaringológico e nasofaringolaringoscopia flexível, todos foram submetidos à polissonografia tipo III. Os participantes foram divididos em dois grupos de acordo com a gravidade dos sintomas: grupo 1, ronco primário e/ou síndrome da apneia obstrutiva do sono leve (n = 9) e grupo 2, síndrome da apneia obstrutiva do sono moderada/grave (n = 12). Dimensões internas nasais foram aferidas por rinometria acústica, foram consideradas para análise as áreas de secção transversa mínima e os volumes de três diferentes segmentos nasais. Resultados O índice de eventos respiratórios correspondeu a 8,1 ± 4,0 no grupo 1 e 47,5 ± 19,1 no grupo 2. No grupo 1, os valores de área de secção transversa, em cm2, corresponderam a: área de secção transversa 1 = 1,1 ± 0,4; área de secção transversa 2 = 2,1 ± 0,9; área de secção transversa 3 = 3,5 ± 1,8. No grupo 2: área de secção transversa 1 = 1,2 ± 0,3, área de secção transversa 2 = 2,0 ± 0,5; áre de secção transversa 3 = 2,8 ± 0,7. No grupo 1 os valores do volume, em cm3, corresponderam a: volume 1 = 3,5 ± 1,0; volume 2 = 9,3 ± 5,0; volume 3 = 40,2 ± 21,5 e no grupo 2 a: volume 1 = 3,6 ± 0,5; V2 = 7,6 ± 1,5; volume 3 = 31,5 ± 6,7. Os valores de área de secção transversa e volume não diferiram entre os grupos. Conclusão Não foram demonstradas diferenças significantes quanto às áreas seccionais transversas e os volumes nasais entre indivíduos com ronco primário e síndrome da apneia obstrutiva do sono leve e síndrome da apneia obstrutiva do sono moderada-grave. Contrariamente à hipótese levantada, os resultados sugerem não existir relação entre as dimensões internas nasais e o nível de gravidade da síndrome da apneia obstrutiva do sono.

Internal nasal dimensions of adults with nasal obstruction.

UNLABELLED: Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency. OBJECTIVE: To characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry. METHOD: This prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA1, CSA2, CSA3), the distance between them and the nostrils (dCSA1, dCSA2, dCSA3), and the volumes of segments 1.0-3.2 cm (V1), 3.3-6.4 cm (V2), and 7.0-12.0 cm (V3) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated. RESULTS: Mean values (standard deviation) before ND were: 0.83 ± 0.23 (CSA1), 1.66 ± 0.52 (CSA2), and 2.36 ± 0.77 (CSA3) cm2; 2.19 ± 0.20 (dCSA1), 4.01 ± 0.33 (dCSA2), and 5.85 ± 0.37 (dCSA3) cm; 2.77 ± 0.51 (V1), 6.52 ± 1.99 (V2), and 26.00 ± 9.62 (V3) cm3; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction. CONCLUSION: Most patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry.

Dimensoes internas nasais de adultos com obstrucao nasal / Internal nasal dimensions of adults with nasal obstruction

O desvio septal (DS) e a hipertrofia de conchas (HC) aumentam a resistência ao fluxo aéreo respiratório, podendo prejudicar a patência nasal. OBJETIVO: Caracterizar a geometria nasal de indivíduos com obstrução nasal (ON) por DS e/ou HC usando rinometria acústica. Forma de estudo: Clínico prospectivo. MÉTODO: Foram avaliados 30 adultos com queixa de ON e DS+HC (n = 24), DS (n = 5) ou HC (n = 1) ao exame clínico e determinadas as áreas seccionais transversas em três principais deflexões do rinograma (AST1, AST2, AST3), suas distâncias relativamente às narinas (dAST1, dAST2, dAST3) e os volumes dos segmentos 1,0-3,2 cm (V1), 3,3-6,4 cm (V2) e 7,0-12,0 cm (V3), pré e pós-descongestão nasal (DN). Foram consideradas, para análise, as somas de AST e V das cavidades direita e esquerda e a média de dAST. RESULTADOS: Os valores médios (± DP) pré-DN corresponderam a 0,83 ± 0,23 (AST1), 1,66 ± 0,52 (AST2) e 2,36 ± 0,77 (AST3) cm2, 2,19 ± 0,20 (dAST1), 4,01 ± 0,33 (dAST2) e 5,85 ± 0,37 (dAST3) cm, 2,77 ± 0,51 (V1), 6,52 ± 1,99 (V2), 26,00 ± 9,62 (V3) cm3, todos menores (p < 0,05) que valores de referência do laboratório. A DN causou aumentos proporcionalmente maiores neste grupo ON, sugerindo componente funcional associado. A análise individual mostrou 12 casos com resultados normais, apesar da ON. CONCLUSÃO: A maioria dos pacientes com ON estrutural apresentou resultados sugestivos de comprometimento da patência nasal ao exame rinométrico. .

Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency. OBJECTIVE: To characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry. METHOD: This prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA1, CSA2, CSA3), the distance between them and the nostrils (dCSA1, dCSA2, dCSA3), and the volumes of segments 1.0-3.2 cm (V1), 3.3-6.4 cm (V2), and 7.0-12.0 cm (V3) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated. RESULTS: Mean values (standard deviation) before ND were: 0.83 ± 0.23 (CSA1), 1.66 ± 0.52 (CSA2), and 2.36 ± 0.77 (CSA3) cm2; 2.19 ± 0.20 (dCSA1), 4.01 ± 0.33 (dCSA2), and 5.85 ± 0.37 (dCSA3) cm; 2.77 ± 0.51 (V1), 6.52 ± 1.99 (V2), and 26.00 ± 9.62 (V3) cm3; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction. CONCLUSION: Most patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry. .