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.

Using craniofacial characteristics to predict optimum airway pressure in obstructive sleep apnea treatment / Uso de características craniofaciais para predizer a pressão ideal nas vias aéreas notratamento da apneia obstrutiva do sono

Abstract 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 35 kg/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 ± 3.4 kg/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.

Resumo Introdução: A titulação manual é o padrão-ouro para determinar a pressão ideal para o tratamento com a pressão positiva contínua nas vias aéreas; e a predição da pressão ideal é importante para evitar retardos na sua prescrição. Objetivo: Verificar se as avaliações clínicas antropométricas, polissonográficas, cefalométricas e das vias aéreas superiores podem predizer a configuração ideal da pressão do aparelho de pressão positiva contínua nas vias aéreas para pacientes com apneia obstrutiva do sono. Método: Foram selecionados 50 homens entre 25 e 65 anos, com índice de massa corporal menor ou igual a 35 kg/m2. Todos os pacientes fizeram polissonografia basal, seguida de avaliações clínicas cefalométricas e otorrinolaringológicas. Na segunda noite, foi feita polissonografia de titulação para estabelecer a pressão ideal. Resultados: A média de idade dos pacientes foi de 43 ± 12,3 anos, com índice de massa corporal médio de 27,1 ± 3,4 kg/m2 e índice de apneia-hipopneia de 17,8 ± 10,5 eventos por hora. Menor comprimento mandibular (p = 0,03), menor distância atlas-maxila (p = 0,03) e a presença de Mallampati III e IV (p = 0,02) foram preditores de pressão mais elevada. A fórmula para a pressão positiva contínua nas vias aéreas foi: 17,24 - (0,133 × comprimento da mandíbula) + (0,969 × classificação de Mallampati III e IV) - (0,926 × distância atlas-mandíbula). Conclusão: Em uma amostra de homens com apneia obstrutiva do sono leve a moderada, a pressão positiva contínua nas vias aéreas foi predita com o comprimento mandibular, a distância atlas-mandíbula e a classificação de Mallampati.

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.

Effects of unilateral stereotactic posterior striatotomy on harmaline-induced tremor in rats.

Although long known and the most prevalent movement disorder, pathophysiology of essential tremor (ET) remains controversial. The most accepted hypothesis is that it is caused by a dysfunction of the olivocerebellar system. Vilela Filho et al. [2001; Stereotact Funct Neurosurg 77:149-150], however, reported a patient with unilateral hand ET that was completely relieved after a stroke restricted to the contralateral posterior putamen and suggested that ET could be the clinical manifestation of posterior putamen hyperactivity. The present study was designed to evaluate this hypothesis in the most often used model of ET, harmaline-induced tremor in rats. Fifty-four male Wistar rats were randomly distributed into three groups: experimental (EG), surgical control (SCG), and pharmacological control (PCG) groups. EG animals underwent stereotactic unilateral posterior striatotomy. SCG rats underwent sham lesion at the same target. PCG served exclusively as controls for harmaline effects. All animals received, postoperatively, intraperitoneal harmaline, and the induced tremor was video-recorded for later evaluation by a blind observer. Thirteen animals were excluded from the study. Limb tremor was reduced ipsilaterally to the operation in 20 of 21 rats of EG and in two of nine of SCG, being asymmetric in one of 10 of PCG rats. Comparisons between EG × SCG and EG × PCG were statistically significant, but not between SCG × PCG. Limb tremor reduction was greater in anterior than in posterior paws. Lateral lesions yielded better results than medial lesions. These results suggest that the posterior striatum is involved with harmaline-induced tremor in rats and support the hypothesis presented.

[Congenital transient hypothyroidism: characteristics of children identified at Newborn Screening Program of the State of Minas Gerais, Brazil]. / Hipotiroidismo congênito transitório: perfil das crianças identificadas no Programa Estadual de Triagem Neonatal de Minas Gerais, Brasil.

Early diagnosis and treatment of congenital hypothyroidism are the main goals of the neonatal screening programs. A retrospective analysis was carried out to assess the characteristics and etiologies of congenital transient hypothyroidism (CTH) in the Newborn Screening Program of the State of Minas Gerais, Brazil. To reach a diagnosis of CTH, altered screening and serum confirmatory T4 and TSH tests and normal serum free T4 and TSH at 4 and 8 weeks after the withdrawal of levothyroxine were used. We studied 21 children with CTH who represented 4.23% of the whole group with detected hypothyroidism and followed them up in the Screening Program. These patients received LT4 therapy for a variable period of one month to three years. Serum confirmatory TSH levels varied from 10.4 to 583.4 microUI/mL. Maternal antibodies, TRAB and anti-TPO, were associated to CTH in two children and iodine overload in one of them. We concluded that CTH is an important component in neonatal screening and hormonal treatment during the first months of the life is essential. The TSH initial levels are not relevant to determine whether the thyroid dysfunction is transient or permanent.

Hiperplasia congênita das supra-renais por deficiência da 21- hidroxilase: altura final de 27 pacientes com a forma clássica / Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: final Height in 27 patients with the classical form

OBJETIVO: Determinar a altura final (AF) de pacientes com hiperplasia supra-renal congênita e investigar fatores de melhor prognóstico de altura. METODOLOGIA: Estudamos 13 pacientes perdedores de sal (PS) e 14 virilizantes simples (VS). AF e altura-alvo (AA) foram transformadas em escores z. Os dados foram analisados de acordo com sexo, variante clínica, idade do início do tratamento e duração do tratamento até AF. RESULTADOS: O zAF (n= 27) foi -1,57 ± 1,01. Houve diferença entre AF (-1,50 ± 1,03) e AA (-0,78 ± 0,84) (n= 25, p< 0,001). Não houve diferença quanto a sexo, variante e início do tratamento, embora PS e pacientes com terapia precoce tivessem tendência a melhor AF; houve diferença (p= 0,018) entre a estatura de pacientes que atingiram a AF com menos de 5 anos de tratamento (-2,49 ± 1,03) em relação àqueles tratados por mais de 10 anos (-1,21 ± 0,88). CONCLUSÃO: Houve comprometimento na AF, e melhor prognóstico parece depender principalmente de diagnóstico e tratamento precoces.

Hipotiroidismo congênito transitório: perfil das crianças identificadas no programa estadual de triagem neonatal de Minas Gerais, Brasil / Congenital transient hypothyroidism: characteristics of children identified at newborn screening program of the state of Minas Gerais, Brazil

O diagnóstico e o tratamento precoces do hipotiroidismo congênito (HC) constituem os principais objetivos dos programas de triagem neonatal. Neste estudo avaliou-se o perfil hormonal e os possíveis fatores responsáveis pelo HC transitório (HCT). Os dados foram colhidos dos prontuários das crianças acompanhadas no Hospital das Clínicas da UFMG, triadas pelo Programa Estadual de Triagem Neonatal de Minas Gerais. Para o diagnóstico de HCT considerou-se: exames de triagem e sérico confirmatório alterados; TSH e T4 livre normais em 4 e 8 semanas após suspensão do tratamento hormonal para avaliação etiológica. As 21 crianças com HCT representavam 4,23 por cento das crianças acompanhadas pelo Programa e receberam tratamento com L-tiroxina por um mês a três anos. Os valores de TSH no primeiro exame sérico variaram de 10,4 a 583,4æUI/ml, não se correlacionando, portanto, à gravidade da doença. Possivelmente a presença de anticorpos maternos em duas crianças, anti-TPO (anticorpo anti-tireoperoxidase) em uma e o anticorpo anti-receptor de TSH associado à exposição ao iodo em outra foram responsáveis pelo hipotiroidismo. Concluímos que o HCT é uma entidade importante na triagem neonatal, sendo essencial o tratamento hormonal nos primeiros meses de vida e que os níveis iniciais de TSH não são úteis para definir se a disfunção tiroidiana será transitória ou permanente.

[Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: final height in 27 patients with the classical form]. / Hiperplasia congênita das supra-renais por deficiência da 21-hidroxilase: altura final de 27 pacientes com a forma clássica.

OBJECTIVE: To determine final height (FH) in congenital adrenal hyperplasia (CAH) patients and investigate conditions allowing better height outcome. METHODOLOGY: 13 salt-wasting (SW) and 14 simple virilizing (SV) patients were studied. FH and target height (TH) were transformed into standard deviation score (z). Data were analyzed according to sex, clinical form, age at treatment onset and length of treatment before attaining FH. RESULTS: zFH (n = 27) was -1.57 +/- 1.01. FH (-1.50 +/- 1.03) was below TH (-0.78 +/- 0.84) (n = 25, p < 0.001). FH has not differed according to sex, clinical form and age at therapy onset although there was a trend towards better FH in SW patients and in early treated cases; there was significant difference (p = 0.018) between patients treated for less than 5 years (-2.49 +/- 1.03) and those accompanied longer than 10 years (-1.21 +/- 0.88) before attaining FH. CONCLUSIONS: There was a FH impairment and adult height improvement seems to depend mainly on early diagnosis and treatment.