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1.
Eur J Paediatr Dent ; 23(2): 128-130, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35722851

RESUMO

AIM: Obstructive sleep apnoea syndrome (OSAS) is a common clinical condition in which the throat narrows or collapses repeatedly during sleep, causing obstructive sleep apnoea events. This disorder is present in the paediatric population with a prevalence estimated between 1.2% and 5.8%. Down Syndrome (DS) is the most common chromosomal alteration associated with mental disability and characterised by other clinical manifestations, and its incidence is estimated at 1/800 births worldwide. Most of the craniofacial features typical of DS represent a risk factor for the development of OSAS. Routine screening has been recommended in some countries but it is still not a standard practice. The aim of this study is the Italian linguistic validation of a questionnaire for the diagnosis of OSAS in children with Down Syndrome. METHODS: After careful review of the existing scientific literature, a specific questionnaire was selected for the diagnosis of OSAS in children with DS. The questionnaire was then translated into Italian and administered to 111 parents of children with Down syndrome, for online completion. The last part of the questionnaire was dedicated to the comprehension of the questionnaire itself, with a specific focus on its clarity, accuracy and difficulty in completing it. CONCLUSION: The positive feedback registered in the comprehension part of the questionnaire, certified the good quality of the Italian translation and confirmed the questionnaire as a useful screening method to identify the comorbidity of OSAS and DS.


Assuntos
Síndrome de Down , Apneia Obstrutiva do Sono , Criança , Síndrome de Down/complicações , Síndrome de Down/diagnóstico , Síndrome de Down/epidemiologia , Humanos , Linguística , Faringe , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Inquéritos e Questionários
2.
Carbohydr Polym ; 300: 120243, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36372478

RESUMO

Biomedical materials are in high demand for transplantation in cases of diseased or damaged bone tissue. Hydrogels are potential candidates for bone defect repair; however, traditional hydrogels lack the necessary strength and multiple functions. Herein, we effectively synthesized a cellulose nanofiber (CNF)-reinforced oxidized alginate (OSA)/gelatin (Gel) semi-interpenetrating network hydrogel through a facile one-step approach without a cross-linker by using the synergistic effects of dynamic imine bonds and hydrogen bonds. The OSA/Gel/CNF sample showed a notable compressive modulus (up to 361.3 KPa). The gelation time (~150 s) ensured excellent injectability. Self-healing exhibited a high efficiency of up to 92 %, which would enable minimally invasive, dynamic adjustments and personalized therapies. Furthermore, the OSA/Gel/CNF hydrogel showed excellent biomineralization (Ca/P ratio ~ 1.69) and enhanced preosteoblast cell (MC3T3-E1) viability (over 96 %), proliferation, and osteogenic differentiation. Thus, this multifunctional hydrogel has promising potential for using in the bone tissue repairs.


Assuntos
Nanofibras , Apneia Obstrutiva do Sono , Humanos , Hidrogéis/farmacologia , Hidrogéis/química , Alginatos/química , Celulose/farmacologia , Osteogênese , Gelatina/química
3.
Ann Otol Rhinol Laryngol ; 132(1): 69-76, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35172622

RESUMO

OBJECTIVE: No national study to date has specifically evaluated the predictive variables associated with extended hospitalization and other postoperative complications following laryngeal surgery in children with obstructive sleep apnea (OSA). The goals of this study were to identify perioperative risk factors and provide a descriptive analysis of surgical outcomes in these children using the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) database. METHODS: Patients aged 0 to 18 years who underwent laryngeal surgery with a postoperative diagnosis of OSA were queried via the 2014-2018 NSQIP-P database using Current Procedural Terminology code 31541. Variables collected included age, sex, ethnicity, body mass index (BMI), medical comorbidities, American Society of Anesthesiologists (ASA) physical classification, operative time, and concurrent procedures. Endpoints of interest were length of stay, unplanned reoperation, readmission, reintubation, and postoperative complications. Univariate and multivariate linear regression analyses were performed. RESULTS: A total of 181 cases were identified (57.5% male and 42.5% female, mean age 4.36 years, range 14 days-17.7 years). Body mass index (P = .015, OR = 0.96), structural CNS abnormality (P = .034, OR = 1.95), preoperative oxygen supplementation (P = .043, OR = 1.28), operative time (P = .019, OR = 1.84, 95% CI = 1.28-2.54), and concurrent procedure (P < .001, OR = 2.21) were all independently associated with LOS. Postoperative complications had no significantly associated variables, with an overall low incidence of readmission (5.0%), reoperation (1.7%), and reintubation (1.1%). CONCLUSION: In this data set, children with OSA undergoing laryngeal surgery experienced minimal postoperative complications. Recognition of the factors associated with increased LOS could lead to improvement in the quality of care for children with OSA.


Assuntos
Readmissão do Paciente , Apneia Obstrutiva do Sono , Humanos , Masculino , Criança , Feminino , Recém-Nascido , Reoperação/efeitos adversos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/complicações , Estudos Retrospectivos
4.
Clin EEG Neurosci ; 54(1): 12-20, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35369784

RESUMO

As a universal, evolutionarily conserved phenomenon, sleep serves many roles, with an integral role in memory. This interplay has been examined in a variety of research. The purpose of this article will be to review the literature of sleep, aging, cognition, and the impact of two common clinical conditions (obstructive sleep apnea and insomnia) on cognitive impairment. This article will review data from meta-analyses, population studies, smaller cohort studies, neuropsychological studies, imaging, and bench data. Considerations are given to the current data trends and their limitations. This paper will explore the impact of sleep on cognitive impairment. Finally, we will conclude with integrating the separate mechanisms towards more generalized common pathways: disruption of sleep quality and reduction in sleep quantity lead to excessive neuronal activity without sufficient time for homeostasis. Sleep apnea and chronic insomnia can lead to oxidative stress and neuronal damage. These changes predispose and culminate in the development of cognitive impairment.


Assuntos
Disfunção Cognitiva , Apneia Obstrutiva do Sono , Distúrbios do Início e da Manutenção do Sono , Humanos , Eletroencefalografia , Cognição/fisiologia , Sono , Apneia Obstrutiva do Sono/complicações
5.
Oral Maxillofac Surg Clin North Am ; 35(1): 49-59, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36336592

RESUMO

Obstructive sleep apnea (OSA) involves obstruction or reduction of an individual's airway during sleep and is associated with several comorbidities. Patient evaluation includes detailed history, clinical and radiographic examination, endoscopy, and polysomnography. Management may be nonsurgical or surgical, and Phase II of the Stanford Protocol of surgical management involves maxillomandibular advancement (MMA). Surgical considerations (eg, degree of movement, timing of surgery) and potential complications specific to MMA are discussed in this review. With adequate planning and communication with the patient, MMA is effective in treating OSA, as measured with objective and subjective measures.


Assuntos
Avanço Mandibular , Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/cirurgia , Polissonografia , Maxila/cirurgia
6.
J Clin Anesth ; 84: 110993, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36347195

RESUMO

IMPORTANCE: Obstructive sleep apnea (OSA) is prevalent in surgical patients and is associated with an increased risk of adverse perioperative events. STUDY OBJECTIVE: To determine the effectiveness of positive airway pressure (PAP) therapy in reducing the risk of postoperative complications in patients with OSA undergoing surgery. DESIGN: Systematic review and meta-analysis searching Medline and other databases from inception to October 17, 2021. The search terms included: "positive airway pressure," "surgery," "post-operative," and "obstructive sleep apnea." The inclusion criteria were: 1) adult patients with OSA undergoing surgery; (2) patients using preoperative and/or postoperative PAP; (3) at least one postoperative outcome reported; (4) control group (patients with OSA undergoing surgery without preoperative and/or postoperative PAP therapy); and (5) English language articles. PATIENTS: Twenty-seven studies included 30,514 OSA patients undergoing non-cardiac surgery and 837 OSA patients undergoing cardiac surgery. INTERVENTION: PAP therapy MAIN RESULTS: In patients with OSA undergoing non-cardiac surgery, PAP therapy was associated with a decreased risk of postoperative respiratory complications (2.3% vs 3.6%; RR: 0.72, 95% CI: 0.51-1.00, asymptotic P = 0.05) and unplanned ICU admission (0.12% vs 4.1%; RR: 0.44, 95% CI: 0.19-0.99, asymptotic P = 0.05). No significant differences were found for all-cause complications (11.6% vs 14.4%; RR: 0.89, 95% CI: 0.74-1.06, P = 0.18), postoperative cardiac and neurological complications, in-hospital length of stay, and in-hospital mortality between the two groups. In patients with OSA undergoing cardiac surgery, PAP therapy was associated with decreased postoperative cardiac complications (33.7% vs 50%; RR: 0.63, 95% CI: 0.51-0.77, P < 0.0001), and postoperative atrial fibrillation (40.1% vs 66.7%; RR: 0.59, 95% CI 0.45-0.77, P < 0.0001). CONCLUSION: In patients with OSA undergoing non-cardiac surgery, PAP therapy was associated with a 28% reduction in the risk of postoperative respiratory complications and 56% reduction in unplanned ICU admission. In patients with OSA undergoing cardiac surgery, PAP therapy decreased the risk of postoperative cardiac complications and atrial fibrillation by 37% and 41%, respectively.


Assuntos
Fibrilação Atrial , Procedimentos Cirúrgicos Cardíacos , Cardiopatias , Apneia Obstrutiva do Sono , Adulto , Humanos , Fibrilação Atrial/etiologia , Fatores de Risco , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/cirurgia , Período Pós-Operatório , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Cardiopatias/etiologia
7.
J Atten Disord ; 27(1): 3-13, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36113004

RESUMO

OBJECTIVE: Obstructive sleep apnea (OSA), with daytime drowsiness, nocturnal hypoxia, could result in systemic inflammation and oxidative damage. We hypothesize that parental OSA, with chronic systemic inflammation and oxidative stress, might contribute to children's neurodevelopmental disorders, such as ADHD. METHOD: By linking National Birth Registry with the National Health Insurance Research Database, Taiwan, we identified 2006-2015 birth cohort, which comprised 1,723,873 singleton live births, and conducted a nested case-control study. We included children with ADHD and compared them with non-ADHD controls matched with ADHD case on index date. Conditional logistic regression was utilized to calculate adjusted odds ratio (aOR) when investigating the association between parental diseases with risk of ADHD in their offspring. RESULTS: The aOR (95% CI) of offspring's ADHD was 1.758 (1.458-2.119) with paternal OSA and 2.159 (1.442-3.233) with maternal OSA. The subgroup analysis revealed different effects of parental diseases among children's gender. CONCLUSION: Our study demonstrates an association in parental OSA and offspring ADHD, which could inspire further research to clarify the mechanisms.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Apneia Obstrutiva do Sono , Criança , Masculino , Humanos , Estudos de Casos e Controles , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/complicações , Pai , Inflamação/complicações , Taiwan/epidemiologia , Fatores de Risco
8.
Rev. Odontol. Araçatuba (Impr.) ; 43(3): 61-67, set.-dez. 2022. tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1381326

RESUMO

Atualmente, o tratamento do ronco primário e da Síndrome da Apnéia/Hipopnéia Obstrutiva do Sono (SAHOS)1 através de aparelhos intra-orais (AIO) tem recebido a atenção dos pesquisadores pela comprovada eficácia destes dispositivos. Os aparelhos mais indicados são os reposicionadores de mandíbula que promovem um avanço mandibular, afastando os tecidos da orofaringe superior, o que evita a obstrução parcial ou total da área. Sua indicação é para casos de ronco primário e apnéias leves e moderadas2, no entanto é necessário que os candidatos apresentem número de dentes suficientes com saúde periodontal para a ancoragem do aparelho. Por ser uma doença de consequências sistêmicas graves, o tratamento da SAHOS é em sua essência de responsabilidade do médico especialista na área, porém o cirurgião dentista deve ter conhecimento para diagnosticar e tratar, quando o AIO for a opção terapêutica. A interpretação da polissonografia, exame que diagnostica e conduz para a escolha correta do tratamento, e dos dados cefalométricos são os principais quesitos ao Cirurgião Dentista que se propõe a tratar portadores da SAHOS. Nesse trabalho foi elaborado um questionário e aplicado aos cirurgiões dentistas de três diferentes cidades do Estado de São Paulo para que fosse possível avaliar o conhecimento desses profissionais a respeito do diagnóstico e tratamento da SAHOS. 70 Cirurgiões Dentistas foram entrevistados e os resultados mostraram que 70% destes têm interesse em trabalhar com os AIOs. Esse grupo se relacionou estatisticamente significante com aqueles que afirmaram já terem sido alguma vez questionado por algum paciente a respeito desse tratamento. Quanto à criação de uma especialidade para essa área, os profissionais da área de prótese e implante se mostraram mais interessados. E, do número total de entrevistados, apenas 25% já tiveram contato com esse tipo de aparelho, mas não conhece o protocolo de atendimento para o tratamento desses pacientes(AU)


Currently, the treatment of primary snoring and Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS)1 through intraoral appliances (OA) has received the attention of researchers due to the proven effectiveness of these devices. The most suitable devices are jaw repositioning devices that promote mandibular advancement, moving the tissues away from the upper oropharynx, which prevents partial or total obstruction of the area. Its indication is for cases of primary snoring and mild to moderate apnea2, however it is necessary that candidates have a sufficient number of teeth with periodontal health to anchor the appliance. As it is a disease with serious systemic consequences, the treatment of OSAHS is, in essence, the responsibility of the specialist in the area, but the dental surgeon must have the knowledge to diagnose and treat, when OA is the therapeutic option. The interpretation of polysomnography, na exam that diagnoses and leads to the correct choice of treatment, and cephalometric data are the main requirements for the Dental Surgeon who proposes to treat patients with OSAHS. In this work, a questionnaire was developed and applied to dentalsurgeons from three different cities in the State of São Paulo so that it was possible to assess the knowledge of these professionals regarding the diagnosis and treatment of OSAHS. 70 Dental Surgeons were interviewed and the results showed that 70% of them are interested in working with AIOs. This group had a statistically significant relationshipwith those who stated that they had already been asked by a patient about this treatment. Regarding the creation of a specialty for this area, professional in the area of ??prosthesis and implant were more interested. And, of the total number of respondents, only 25% have already had contact with this type of device, but do not know the care protocol for the treatment of these patients(AU)


Assuntos
Apneia Obstrutiva do Sono , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/diagnóstico por imagem , Modelos Dentários , Ronco , Polissonografia , Avanço Mandibular , Odontólogos
9.
Minerva Dent Oral Sci ; 71(5): 287-292, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36321622

RESUMO

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a complex disorder with significant clinical consequences for people with Down Syndrome (DS). OSAS is frequently seen in individuals with DS and, when present, tends to be more severe than in individuals without this syndrome. EVIDENCE ACQUISITION: The analysis was carried out on PubMed, Google Scholar and Cochrane library databases. The literature review identified nine studies suitable for our evaluations according to the established inclusion criteria. EVIDENCE SYNTHESIS: The results of the study suggest that OSAS may be a common comorbidity in adolescents with DS; according to literature evidences a widespread screening and treatment in children with DS is undoubtedly useful. There is also evidence about an association between sleep disturbance and functional activities of daily living in children with DS. CONCLUSIONS: The studies reviewed confirm that OSAS appears to occur at higher rates and greater severity in the population of children with DS. However, at present, there are no reliable clinical predictors of OSAS for this population of children.


Assuntos
Síndrome de Down , Apneia Obstrutiva do Sono , Adolescente , Criança , Humanos , Atividades Cotidianas , Comorbidade , Síndrome de Down/epidemiologia , Polissonografia/métodos , Apneia Obstrutiva do Sono/diagnóstico
11.
Sci Rep ; 12(1): 19387, 2022 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-36371504

RESUMO

The aim of this cross-sectional study was to objectively assess the salivary flow rate and composition and periodontal inflammation in obstructive sleep apnoea (OSA) patients. The subjects, who underwent whole-night polysomnography or polygraphy, were referred for saliva sampling and periodontal examination. According to the severity of OSA based on the Apnoea Hypopnea Index (AHI) value, the subjects were classified into groups: no OSA (AHI < 5; N = 17), mild to moderate OSA (AHI 5-29.9; N = 109), and severe OSA (AHI > 30; N = 79). Salivary flow rate, pH, salivary electrolytes, and cortisol were measured from collected saliva samples. Periodontal examination included assessment of the number of teeth, dental plaque, bleeding on probing and periodontal measurements: gingival recession, probing pocket depth, clinical attachment level (CAL) and periodontal inflamed surface area (PISA) score. There were no significant differences in salivary flow rate, salivary pH, salivary electrolyte concentrations or electrolyte ratios among the groups classified according to the severity of OSA. However, subjects without OSA had higher salivary cortisol concentrations than OSA groups (p < 0.001). Increased plaque scores were associated with a higher AHI (r = 0.26; p = 0.003). According to the salivary flow rate, subjects with hyposalivation and reduced salivation had higher concentrations of salivary electrolytes and lower salivary pH than subjects with normal salivation. Subjects with hyposalivation had an increased Mg/PO4 ratio (p < 0.001) and a reduced Ca/Mg ratio (p < 0.001). Furthermore, subjects with severe OSA tended to have higher CALs and plaque volumes. In conclusion, under pathological conditions, such as OSA, multiple interactions might impact salivary flow and electrolyte composition. Complex interrelationships might affect the integrity of oral health, especially considering OSA severity, inflammation, concomitant diseases and medications.


Assuntos
Apneia Obstrutiva do Sono , Xerostomia , Humanos , Hidrocortisona , Estudos Transversais , Apneia Obstrutiva do Sono/complicações , Inflamação/complicações
12.
BMC Geriatr ; 22(1): 855, 2022 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-36372874

RESUMO

BACKGROUND: Previous studies observed that sleep disorders potentially increased the risk of asthma and asthmatic exacerbation. We aimed to examine whether excessive daytime sleepiness (EDS), probable insomnia, objective short sleep duration (OSSD), and obstructive sleep apnea (OSA) affect all-cause mortality (ACM) in individuals with or without asthma. METHODS: We extracted relevant data from the Sleep Heart Health Study established in 1995-1998 with an 11.4-year follow-up. Multivariate Cox regression analysis with a proportional hazards model was used to estimate the associations between ACM and four sleep disorders among asthmatic patients and individuals without asthma. Dose-response analysis and machine learning (random survival forest and CoxBoost) further evaluated the impact of sleep disorders on ACM in asthmatic patients. RESULTS: A total of 4538 individuals with 990 deaths were included in our study, including 357 asthmatic patients with 64 deaths. Three multivariate Cox regression analyses suggested that OSSD (adjusted HR = 2.67, 95% CI: 1.23-5.77) but not probable insomnia, EDS or OSA significantly increased the risk of ACM in asthmatic patients. Three dose-response analyses also indicated that the extension of objective sleep duration was associated with a reduction in ACM in asthmatic patients compared to very OSSD patients. Severe EDS potentially augmented the risk of ACM compared with asthmatics without EDS (adjusted HR = 3.08, 95% CI: 1.11-8.56). Machine learning demonstrated that OSSD of four sleep disorders had the largest relative importance for ACM in asthmatics, followed by EDS, OSA and probable insomnia. CONCLUSIONS: This study observed that OSSD and severe EDS were positively associated with an increase in ACM in asthmatic patients. Periodic screening and effective intervention of sleep disorders are necessary for the management of asthma.


Assuntos
Asma , Distúrbios do Sono por Sonolência Excessiva , Apneia Obstrutiva do Sono , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Humanos , Pessoa de Meia-Idade , Idoso , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Transtornos do Sono-Vigília/diagnóstico , Asma/diagnóstico , Asma/complicações
13.
Sleep Med ; 100: 565-572, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36327585

RESUMO

OBJECTIVE: To compare the levels of different urinary catecholamines amongst paediatric patients with and without sleep-disordered breathing (SDB). METHODS: Literature searches were conducted on PubMed and EMBASE until 25/06/2022. Inclusion criteria were original human studies, English language, paediatric subjects diagnosed with SDB/obstructive sleep apnoea (OSA). The quality of studies was assessed by the Newcastle-Ottawa Quality Assessment (NOSGEN). The registered number of this study on the International Prospective Register of Systematic Reviews (PROSPERO) is CRD42022332939. The main outcome measured was standardised mean difference (SMD) of urinary catecholamine between subjects with and without SDB, between those with and without OSA, and also between subjects with mild OSA and those with moderate/ severe OSA. Sensitivity analyses were performed to avoid bias. RESULTS: 9 studies (8 cross-sectional and 1 cohort study) with a total of 838 subjects, were included in the quantitative analysis. Urine level of noradrenaline was higher in patients with SDB, which included primary snoring (PS), when compared to controls: SMD = 0.86 (95%CI=0.32-1.41; I2=85%, P=0.002). The levels of urinary noradrenaline and adrenaline were higher in children with OSA when compared to controls: SMD = 1.45 (95%CI=0.91-2.00; I2=75%, P < 0.001); SMD = 1.84 (0.00-3.67; I2=97%, P=0.05). Urine level of noradrenaline was higher in subjects with moderate/severe OSA compared to the mild OSA: SMD = 0.55 (95%CI=0.10-1.00; I2=0%, P=0.02). Urinary dopamine was not associated with SDB regardless of severity. CONCLUSIONS: Urinary noradrenaline was higher in all patients with SDB. Subjects with OSA, a more severe form of SDB, had higher urine levels of noradrenaline and adrenaline. Hence, noradrenaline and adrenaline may be markers of sympathetic overtone in patients with SDB and could potentially act as surrogate markers for SDB complications. Further studies are needed to assess this association.


Assuntos
Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Humanos , Criança , Catecolaminas , Estudos Transversais , Estudos de Coortes , Síndromes da Apneia do Sono/complicações , Apneia Obstrutiva do Sono/complicações , Biomarcadores/urina , Norepinefrina , Epinefrina
14.
Rehabil Psychol ; 67(4): 461-473, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36355639

RESUMO

PURPOSE/OBJECTIVE: To evaluate the feasibility of a psychological intervention designed to increase Positive Airway Pressure (PAP) adherence, adapted with cognitive accommodations for comorbid obstructive sleep apnea (OSA) and traumatic brain injury (TBI). RESEARCH METHOD/DESIGN: This was an open-label single arm (nonrandomized) study. Eligibility criteria were moderate-to-severe TBI, OSA diagnosis, prescribed PAP, nonadherent, and able to consent. Participants were recruited from inpatient and outpatient settings at a tertiary care hospital. The four-module manualized intervention was delivered primarily via telehealth. Feasibility aspects measured included eligibility, recruitment, and retention rates; session duration and attendance; and characteristics of outcome and process measures (e.g., completion rates, data distribution). Symptom measures included the Epworth Sleepiness Scale, Fatigue Severity Scale, Functional Outcomes of Sleep Questionnaire, Self-Efficacy Measure for Sleep Apnea, OSA Treatment Barriers Questionnaire (OTBQ), and Kim Alliance Scale-Revised. RESULTS: Of 230 persons screened, 14.3% were eligible. Recruitment rate (n = 17) was 51.5%. Retention rate (n = 13) was 76.5%. Treatment completers had no missing data. The OTBQ deviated from normality, but other measures had adequate skew (< 2.0) and kurtosis (< 7.0) and were free from significant floor and ceiling effects (<15%). Change score effect sizes were minimal to moderate (d = .10-.77). There were no adverse events. CONCLUSIONS/IMPLICATIONS: These results inform ways in which procedures should be modified to enhance the success of a future clinical trial testing the efficacy of this adherence intervention. Inclusion criteria should be reconsidered, and recruitment sites expanded, to capture eligible persons and adequately power an efficacy study. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Lesões Encefálicas Traumáticas , Apneia Obstrutiva do Sono , Humanos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Estudos de Viabilidade , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/psicologia , Cooperação e Adesão ao Tratamento , Lesões Encefálicas Traumáticas/complicações
15.
Neuropsychopharmacol Hung ; 24(3): 126-133, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36356195

RESUMO

The author presents a new psychosomatic stress model. All the elements of the hypothesis are well known but, in this context, are published first. The following are the most critical aspects of the recommended chronic stress model. 1/ Stress contains both sympathetic and parasympathetic elements, but the latter predominate. 2/ The mediator of stress is carbon dioxide, the substance that can turn the psyche into soma. 3/ In humans, chronic stress is mainly social; people cause it to each other. Chronic social stress is created frequently due to deviations in civilisation, education and tolerance. 4/ The freeze response (or freezing behaviour) plays a subordinate role in the animal world; it lasts mainly for a maximum of minutes, while in humans, it dominates and can continue for decades. 5/ The decisive step of freeze is apnea, hypopnea, which occurs due to aversive psychological eff ects. After a more extended existence, mild chronic respiratory acidosis develops and most often appears in the clinical form of obstructive sleep apnea. 6/ Chronic hypercapnia can shape the metabolism into metabolic syndrome. 7/ After that, various cardiovascular and metabolic complications (hypertension, atherosclerosis, type 2 diabetes, depression) may develop - partly due to genetic and lifestyle reasons. (Neuropsychopharmacol Hung 2022; 24(3): 126-133).


Assuntos
Diabetes Mellitus Tipo 2 , Síndrome Metabólica , Apneia Obstrutiva do Sono , Animais , Humanos , Hipercapnia/complicações , Síndrome Metabólica/complicações , Apneia Obstrutiva do Sono/complicações , Dióxido de Carbono/metabolismo
16.
BMC Pulm Med ; 22(1): 419, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36384528

RESUMO

BACKGROUND: Chronic cough is an extremely common clinical symptom of various diseases. However, the relationship between obstructive sleep apnea (OSA) and chronic cough in the general population has not been sufficiently studied. METHODS: Using the 2019 Korean National Health and Nutrition Examination Survey data, we identified a group at high-risk of OSA via the STOP-Bang questionnaire and determined the association between OSA and chronic cough by a regression model. RESULTS: Of the eligible 4,217 participants, 97.1% and 2.9% were classified into the non-chronic cough and chronic cough groups, respectively. The chronic cough group had higher STOP-Bang scores than those of the group without chronic cough (2.32 ± 1.38 vs. 2.80 ± 1.39; P < 0.001). In the group at high-risk of OSA, 40.4% and 52.0% of participants scored ≥ 3 in STOP-Bang, depending on the absence or presence of chronic cough (P = 0.012), respectively. Chronic cough independently correlated with impaired lung function (forced expiratory volume in one second ≥ 50-<80% predicted value, P = 0.001; <50, P < 0.001), low household income (P = 0.015), and a group at high-risk of OSA (STOP-Bang score 3-4, P = 0.004; 5-8, P < 0.001). Obesity I had a protective role against the occurrence of chronic cough (P = 0.023). CONCLUSION: A high-risk for OSA is a significant risk factor for chronic cough. OSA should be considered when evaluating chronic cough patients.


Assuntos
Tosse , Apneia Obstrutiva do Sono , Humanos , Polissonografia , Inquéritos Nutricionais , Tosse/epidemiologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/diagnóstico , República da Coreia/epidemiologia
17.
Eur Rev Med Pharmacol Sci ; 26(21): 8022-8029, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36394753

RESUMO

OBJECTIVE: This study aimed to investigate the relationship between baseline atherogenic index of plasma (AIP) and new-onset myocardial infarction (MI) in hypertensive patients with obstructive sleep apnoea (OSA). PATIENTS AND METHODS: 2,281 participants were included in this analysis after strict adherence to the inclusion and exclusion criteria. Hazard ratio (HR) and 95% confidence interval (CI) were estimated using multivariable Cox regression models. A generalized additive model was employed to determine nonlinear relationships. RESULTS: In multivariate-adjusted models, there was a positive association between AIP and new-onset MI (per SD increase; HR=1.42, 95% CI: 1.22-1.65). Smoothing curve fitting revealed a J-shaped association between AIP and new-onset MI, with a turning point of approximately -0.08. The addition of AIP to a model with established risk factors improved the C-index (p=0.007), integrated discrimination improvement (p=0.007), and continuous net reclassification improvement (p=0.027) for the new-onset MI. CONCLUSIONS: A J-shaped relationship was observed between AIP and new-onset MI.


Assuntos
Hipertensão , Infarto do Miocárdio , Apneia Obstrutiva do Sono , Humanos , Estudos de Coortes , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Hipertensão/epidemiologia , Fatores de Risco , Infarto do Miocárdio/epidemiologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-36404100

RESUMO

INTRODUCTION AND OBJECTIVES: Obstructive sleep apnea is the most frequent sleep disorder worldwide, with rising incidence. Pharyngoplasty is an alternative treatment in patients not suitable to continuous positive airway pressure devices (CPAP). The aim of this study is to compare different surgical techniques of pharyngoplasty for treatment of obstructive sleep apnea and evaluate its influence in surgical success. MATERIAL AND METHODS: Retrospective study of 92 patients that underwent pharyngoplasty for treatment of obstructive sleep apnea from 2001 to 2020. Included patients performed classic uvulopalatopharyngoplasty (UPPP), radiofrequency assisted uvulopalatopharyngoplasty (RF-UPPP) or barbed reposition pharyngoplasty (BRP). Surgical success was defined and outcomes and complications assessed for each procedure. RESULTS: Most patients were male, with a mean age of 49.36±9.6 years and a mean apnea hypopnea index (AHI) of 29.14±2.94events/h. Thirty-six patients performed classic UPPP, thirty-one underwent RF-UPPP and the remaining twenty-five performed BRP. BRP achieved the highest success rate (66%) in comparison with UPPP (57%) and RF-UPPP (54%) (p=0.032). Mean relative AHI reduction after surgery was not statistically different between three procedures (p=0.098), although there was a tendency for greater reduction with BRP. Most symptoms improved after surgery and snoring was the most recurrent symptom. BRP had less foreign body sensation after surgery, however, it was the procedure with highest rate of post-operative tonsillar bleeding. CONCLUSIONS: In our department, the introduction of recent techniques of velopharyngeal surgery, focused in functional and lateral muscular collapse, has translated into an increase in success rate after surgery. The relative ease of the procedure and reduction of long term complications make BRP an attractive alternative option for CPAP in OSA, in carefully selected patients.


Assuntos
Faringe , Apneia Obstrutiva do Sono , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Resultado do Tratamento , Faringe/cirurgia , Úvula/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/diagnóstico
19.
Artigo em Inglês | MEDLINE | ID: mdl-36404101

RESUMO

OBJECTIVE: Tongue base and hypopharynx are the major sites of obstruction in OSA patients with failed palatal surgery. In recent years, several minimally invasive procedures have been developed to address tongue base obstruction. However, the research focus has consistently been on the effectiveness of surgery in reducing obstructive sleep apnoea rather than on postoperative complications. In this systematic review and metanalysis we aim to review the complication rate of minimally invasive base of tongue procedures for OSAS in adults. DATA SOURCES: PubMed (Medline), the Cochrane Library, EMBASE, Scopus, SciELO and Trip Database. REVIEW METHODS: Data sources were checked by three authors of the YO-IFOS sleep apnoea study group. Three authors extracted the data. Main outcome was expressed as the complication rate and 95% confidence interval for each surgical technique. RESULTS: 20 studies (542 patients) met the inclusion criteria. The mean complication rate is 12.79%; 4.65% for minor complications, 6.42% if they are moderate, and 1.77% if severe. The most reported complication overall is infection, in 1.95% of cases, followed by transient swallowing disorder, occurring in 1.30% of the total sample. CONCLUSION: The heterogeneity amongst the included studies prevents us from obtaining solid conclusions. The available evidence suggests that minimally invasive base of tongue procedures may present a wide spectrum of complication rates, ranging from 4.4% in tongue base radiofrequency to up to 42.42% in tongue base ablation.


Assuntos
Laringe , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Adulto , Humanos , Língua/cirurgia , Polissonografia , Apneia Obstrutiva do Sono/cirurgia
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