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1.
Sleep Med Clin ; 15(3S): e1-e7, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33008491

RESUMO

Prior to the COVID-19 pandemic, few pediatric sleep medicine clinicians routinely engaged in telemedicine visits because thorough examinations were difficult to perform; there was lack of consistent reimbursement; and many clinicians were busy with their in-office practices. This article reviews how telemedicine has been explored in pediatric sleep medicine prior to the pandemic, current applications of telemedicine, challenges, and reimagining pediatric sleep within the realm of telemedicine.


Assuntos
Pediatria , Medicina do Sono , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/terapia , Telemedicina/métodos , Betacoronavirus , Criança , Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus , Humanos , Otolaringologia , Pandemias , Pneumonia Viral , Polissonografia , Encaminhamento e Consulta , Síndrome das Pernas Inquietas/diagnóstico , Síndrome das Pernas Inquietas/terapia , Sono , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/terapia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia
2.
Curr Opin Ophthalmol ; 31(6): 508-513, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009084

RESUMO

PURPOSE OF REVIEW: The aim of this article is to summarize up-to-date research on the effects of obstructive sleep apnea (OSA) on retinal vascular conditions. RECENT FINDINGS: OSA is associated with the development of diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy. The severity of OSA and biomarkers such as the apnea-hypopnea index (AHI) correlate with the severity of retinal disease. Dysregulation of circadian locomotor output cycles kaput (CLOCK) genes that govern circadian rhythm is associated with development of proliferative retinal disease. SUMMARY: OSA and retinal vascular disease have a high cost burden on the healthcare system. OSA creates systemic changes and hypoxic conditions that may incite or exacerbate retinal vascular diseases. Retinal changes may be the first clinical manifestation of otherwise undiagnosed OSA, so it is important to refer patients with new-onset retinal vascular disease for appropriate sleep testing.


Assuntos
Oftalmopatias/complicações , Apneia Obstrutiva do Sono , Biomarcadores , Ritmo Circadiano , Humanos , Polissonografia , Doenças Retinianas/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/fisiopatologia
3.
Artigo em Chinês | MEDLINE | ID: mdl-33040505

RESUMO

Objective:The STOP-Bang(S-B) questionnaire is widely used for screening patients with OSA. However, BMI and NC cutoff value in the original S-B questionnaire is 35 kg/m²and 40cm, the BMI and NC value in the young and middle-aged female patients in China is lower than that. We aimed to establish a more appropriate modified STOP-Bang(MS-B) questionnaire. Method:A total of 523 cases with suspected OSA in the young and middle-aged female were included in this study. All patients were asked to completed the S-B, MS-B questionnaire and undergo overnight polysomnography(PSG). The BMI and NC value of the MS-B were determined by the optimal operating points of the ROC. The ability of S-B and MS-B were assessed by ROC and McNemar's test. Result:BMI=28 kg/m²and NC=36 cm as alternative cutoff is to refine S-B questionnaire. When taking apnea hypopnea index(AHI) ≥5 times/h, ≥15 times/h and ≥30 times/h as cut-offs, MS-B had higher sensitivity(88.7% vs 86.7%, 92.8% vs 87.7%, 95.0% vs 90.1%, respectively) and the area under the curve(0.74 vs 0.706, 0.734 vs 0.703, 0.739 vs 0.699, respectively) than S-B. There were significant differences in McNemar test(P<0.05). Conclusion:This study examined the clinical utility of MS-B. MS-B may improve predictive performance of S-B questionnaire in the young and middle-aged female with OSA.


Assuntos
Apneia Obstrutiva do Sono , China/epidemiologia , Feminino , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Inquéritos e Questionários
4.
Medicine (Baltimore) ; 99(34): e21915, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846859

RESUMO

This retrospective study aimed at identifying the predictors of oxygen desaturation (OD) (i.e., SpO2 < 95%) in patients with obstructive sleep apnea (OSA) requiring deep sedation and developing an algorithm to predict OD.We studied 66 OSA patients undergoing propofol-induced deep sedation for drug-induced sleep endoscopy (DISE). The patients were divided into prediction (n = 35) and validation (n = 31) groups. Patient characteristics and polysomnographic parameters were analyzed with receiver operating characteristic curve and Chi-squared test to identify significant predictors of OD for developing an algorithm in the prediction group. The predictive accuracy, sensitivity, positive predictive value, and negative predictive value of the algorithm were determined in the validation group.Six polysomnographic predictors of OD were identified, including Apnea-Hypopnea Index of total sleep time (AHI-TST), AHI at the stage of rapid eye movement (AHI-REM), percentage of time with oxygen saturation <90% (mO2 < 90%), average SpO2, lowest SpO2, and desaturation index. Stepwise multiple logistic regression analysis demonstrated that low average SpO2 (<95.05%) and high AHI-REM (>16.5 events/h) were independent predictors of OD. The algorithm thus developed showed that patients with an average SpO2 < 95.05% and those with an average SpO2 ≥ 95.05% together with an AHI-REM > 16.5 events/h would be at risk of OD under sedation. The predictive accuracy, sensitivity, positive predictive value, and negative predictive value were 84%, 100%, 83%, 100%, respectively.For patients with OSA, average SpO2 and AHI-REM may enable clinicians to predict the occurrence of oxygen desaturation under deep sedation. Future large-scale studies are needed to validate the findings.


Assuntos
Algoritmos , Sedação Profunda/efeitos adversos , Oxigênio/sangue , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/fisiopatologia , Adulto , China/epidemiologia , Sedação Profunda/métodos , Endoscopia/métodos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Polissonografia/instrumentação , Valor Preditivo dos Testes , Propofol/administração & dosagem , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Sono REM
5.
Am J Orthod Dentofacial Orthop ; 158(4): 564-571.e2, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32829973

RESUMO

INTRODUCTION: The clinical choice of diagnostic tests or treatment options is determined by the probability that the value of their execution (called the warrant for the test) exceeds their cost, and by their usefulness. The purpose of this study was to determine the warrant and usefulness of STOP-Bang, an obstructive sleep apnea screening questionnaire, and cone-beam computed tomography (CBCT) information about the minimal cross-sectional area for referring a mouth-breathing patient to a sleep specialist and for modifying planned orthodontic treatment. METHODS: A branching survey was used to identify the prominence of paths between the presenting situation, 2 diagnostic tests, and 2 referral and/or treatment options. A description was given of a hypothetical patient: an overweight, mouth-breathing female teenager. Path analysis was used as a method for quantifying diagnostic warrant and usefulness. RESULTS: There was a wide variation among the 125 orthodontists who responded to the survey. All paths were chosen. The use of tests altered the referral (χ2 = 8.039; P = 0.03) and/or treatment decisions (χ2 = 12.636; P = 0.005). Ownership of a CBCT system significantly influenced the use of this diagnostic test, with owning a CBCT system resulting in greater use in-office (χ2 = 50.416; P <0.001) and greater use in the study (χ2 = 22.959; P <0.001). The usefulness of the diagnostic tests could not be determined directly because common values were used for each test, but the variation in the use of this standard stimulus was very large, indicating personal differences in the interpretation of actual data. CONCLUSIONS: Wide variation in the choice and interpretation of diagnostic tests for referral and orthodontic treatment modification relative to airway condition exists among orthodontists. Diagnostic path analysis is a potentially useful model for studying how practitioners make decisions independent of research evidence.


Assuntos
Respiração Bucal/diagnóstico por imagem , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Adolescente , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Boca , Inquéritos e Questionários
6.
PLoS One ; 15(8): e0237359, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790789

RESUMO

BACKGROUND: Patients diagnosed with obstructive sleep apnea (OSA), who also consume prescription opioids, have a greater likelihood of morbidity and mortality. This study evaluated whether a primary care team, focused on chronic pain care management, could use a validated questionnaire (STOP-Bang) and motivational follow-up, to increase identification and treatment of OSA. METHODS: This study was a retrospective, dual arm, pre/post controlled study. Participants of this study included the complete chronic pain management sub group treated by this primary care team. Participants were ≥ 18 years old and prescribed daily opioids for treatment of chronic pain. All participants had a multifaceted, individualized, educational meeting that included completing a STOP-Bang questionnaire. Participants who received a score ≥ three were advised to follow up with their primary care physician. Participants were seen quarterly throughout the study. RESULTS: The primary outcome of this study was that 65% of participants with likely OSA were using CPAP for a minimum of 12 months (range of 12-25 months, 18-month average) post-intervention vs. 37% CPAP-use in the control group (12 months of observation), both groups were chronic opioid users with OSA. This was a 28% relative improvement (p = 0.0034). A secondary outcome was that 8.9% of non-prior CPAP users obtained CPAP post- intervention; a 56.7% pre-post improvement (p = 0.0064, x2 = 10.08 with 1 degree of freedom). Also, participants who were likely to have OSA (STOP-Bang score ≥ 3 or had a positive polysomnography (AHI >5 with comorbidities)) compared to those unlikely to have OSA (STOP-Bang score <3 or had a negative polysomnography (AHI <5)) in this study were more likely to be male, have a higher BMI, have hypertension, have cardiovascular disease and/or have diabetes (all types). CONCLUSION: Team based care management for participants taking prescription opioids, where STOP-Bang questionnaires were completed, were associated with an increase in the identification and treatment of OSA.


Assuntos
Manejo da Dor/métodos , Dor/patologia , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Índice de Massa Corporal , Doença Crônica , Feminino , Humanos , Hipertensão/patologia , Masculino , Pessoa de Meia-Idade , Dor/complicações , Dor/tratamento farmacológico , Polissonografia , Atenção Primária à Saúde , Estudos Retrospectivos , Fatores Sexuais , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Inquéritos e Questionários
7.
PLoS One ; 15(7): e0236284, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687512

RESUMO

OBJECTIVE: To investigate the frequency distribution of various craniofacial skeletal patterns in a large Korean adult obstructive sleep apnea (OSA) population, and to find a relationship between craniofacial risks and respiratory and sleep characteristics. METHODS: A total of 1226 OSA patients (mean age of 44.9±13.3 years) were included in this retrospective cross-sectional study. All subjects were evaluated for gender and age using fourteen polysomnographic, five cephalometric, two comorbid variables, and three self-reported indexes. Frequency analysis was used to screen the distribution of main skeletal patterns and subtypes. Intergroup comparisons were performed using independent t-test, chi-square test or analysis of variance. Univariable regression analysis was done to find a relationship between skeletal risks and OSA characteristics. RESULTS: The frequency distribution of skeletal patterns was as follows: sagittally 57.2%, 32.3%, and 10.5% of Class II, Class I, and Cass III; vertically 54.0%, 26.7%, and 19.3% of hyperdivergent, normodivergent, and hypodivergent type, respectively. Polysomnographic, symptomatic, and comorbid variables showed no differences among patients with different skeletal patterns. Conversely, skeletal variables showed no differences according to OSA severity. The prevalence of highly risky skeletal pattern of hyperdivergent Class II was more likely to be females (OR 4.52, P < .01) and less obese (OR 3.21, P < .01), irrelevant to OSA and sleep characteristics. CONCLUSION: Characteristic frequency distributions of skeletal patterns and subtypes were observed in adult OSA patients however, no statistical association was found between the skeletal patterns and OSA characteristics due to the large interindividual variation.


Assuntos
Cefalometria/estatística & dados numéricos , Cabeça/anatomia & histologia , Obesidade/epidemiologia , Testes de Função Respiratória/estatística & dados numéricos , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Grupo com Ancestrais do Continente Asiático , Variação Biológica da População , Comorbidade , Estudos Transversais , Feminino , Cabeça/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Polissonografia , República da Coreia/epidemiologia , Fenômenos Fisiológicos Respiratórios , Estudos Retrospectivos , Fatores de Risco , Autorrelato , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia
8.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(2): 137-146, jun. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1115828

RESUMO

INTRODUCCIÓN: La planificación de cirugías para el manejo del síndrome de apneahipopnea obstructiva del sueño (SAHOS) ha incrementado su precisión desde la introducción de la endoscopía del sueño inducido por fármacos (DISE). OBJETIVO: Evaluar la técnica de faringoplastía de reposición con suturas barbadas (BRP) para el colapso velofaríngeo y/o de paredes laterales orofaríngeas evaluado mediante DISE en pacientes con SAHOS. MATERIAL Y MÉTODO: Ochenta y ocho pacientes fueron evaluados para cirugía mediante antropometría, escala de somnolencia de Epworth (ESS) y poligrafía respiratoria. Veinte y seis de 88 pacientes fueron seleccionados. De los 26, 14 accedieron al tratamiento quirúrgico, el que se seleccionó en base a la DISE. En todos los casos, se realizó BRP. RESULTADOS: A los 3 meses de la cirugía hubo mejoría en 10/14 pacientes (criterios de Sher, disminución del índice de apnea-hipoapnea a <20 o 50% del basal). La ESS bajó en promedio de 12 a 5 puntos (p <0,05). No se reportaron incidentes en el posoperatorio y no han ocurrido eventos adversos. CONCLUSIÓN: La técnica de BRP es una técnica sencilla y útil para la expansión anterior y lateral del paladar blando y orofaringe, con una tasa de éxito similar en esta cohorte a la reportada internacionalmente.


INTRODUCTION: Surgical planning for the management of obstructive sleep apneahypopnea syndrome (OSAHS) has changed since the introduction of drug induced sleep endoscopy (DISE). AIM: To evaluate the technique of barbed sutures reposition pharyngoplasty (BRP) for velopharyngeal collapse and/or oropharyngeal lateral walls after DISE evaluation in OSAHS patients. MATERIAL AND METHOD: 88 patients were evaluated for surgery by anthropometry, Epworth sleepiness scale (ESS) and respiratory polygraphy. 26 of 88 patients were selected. Of the 26, 14 agreed to surgical treatment, which was selected on DISE findings. In all cases, BRP was performed. RESULTS: Three months after surgery there was improvement in 10/14 patients (Sher criteria, apnea-hypopnea index reduction at <20 or 50% of baseline). The ESS improved on average 12 to 5 (p <0.05). No incidents were reported in the post-operative period and no adverse events were reported. CONCLUSION: The BRP technique is a simple and useful technique for the anterior and lateral expansion of the soft palate and oropharynx, with a similar success rate in this cohort to that internationally reported.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Faringe/cirurgia , Técnicas de Sutura , Apneia Obstrutiva do Sono/cirurgia , Endoscopia/métodos , Insuficiência Velofaríngea/cirurgia , Índice de Massa Corporal , Antropometria , Apneia Obstrutiva do Sono/diagnóstico , Sonolência , Hipnóticos e Sedativos/administração & dosagem
9.
Pneumologie ; 74(8): 509-514, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32492719

RESUMO

INTRODUCTION: Snoring was monitored in patients with obstructive sleep apnea (OSA) using the LEOSound-Monitor and simultaneously polysomnographic (PSG) recording. In obstructive apneas snoring is normally apparent after apnea termination and the beginning of ventilation. We wanted to know how often obstructive apneas are terminated by ventilation in combination with snoring. METHODS AND INTENTION: In 40 patients with OSA (AHI > 15/h) simultaneous polysomnographic recordings were performed amongst long-term respiratory sound monitoring using the LEOSound monitor. Patients' average age was 57 ±â€Š11 years. Average weight was 100 ±â€Š19 kg by a mean body  mass  index (BMI) of 33 ±â€Š7 kg/m2. 12 out of 40 recordings had to be rejected for further analysis because of artifacts. Snoring recorded by polysomnography was compared with snoring monitored by LEOSound. RESULTS: 3778 obstructive apnea episodes were monitored. LEOSound identified snoring in 1921 (51,0 %), polysomnography in 2229 (58,8 %) obstructive apneas. Only in one patient there was a higher difference in snoring episodes between PSG and LEOSound. DISCUSSION: In nearly 60 % of obstructive apnea events we found snoring during apnea-terminating hyperpnoea. LEOSound is a good diagnostic tool to monitor snoring. It is necessary to clarify why only 60 % of all obstructive events/hyperpnoea develop snoring. From a pathophysiological point of view opening of collapsed upper airway should lead in a very high percentage to turbulences in airstream and committed snoring.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Polissonografia/métodos , Apneia Obstrutiva do Sono/fisiopatologia , Ronco/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Respiração , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Ronco/etiologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-32549340

RESUMO

To illustrate a new technological advance in the standard drug-induced sleep endoscopy (DISE) model, a new machine was used, the Experimental 5 Video Stream System (5VsEs), which is capable of simultaneously visualizing all the decisional parameters on a single monitor, and recording and storing them in a single uneditable video. The DISE procedure was performed on 48 obstructive sleep apnea (OSA) or snoring patients. The parameters simultaneously recorded on a single monitor are (1) the pharmacokinetics and pharmacodynamics of propofol (through the target controlled infusion (TCI) pump monitor), (2) the endoscopic upper airway view, (3) the polygraphic pattern, and (4) the level of sedation (through the bispectral index (BIS) value). In parallel to the BIS recording, the middle latency auditory evoked potential (MLAEP) was also recorded and provided. Recorded videos from the 5VsEs machine were re-evaluated six months later by the same clinician and a second clinician to evaluate the concordance of the therapeutic indications between the two. After the six-month period, the same operator confirmed all their clinical decisions for 45 out of 48 videos. Three videos were no longer evaluable for technical reasons, so were excluded from further analysis. The comparison between the two operators showed a complete adherence in 98% of cases. The 5VsEs machine provides a multiparametric evaluation setting, defined as an "all in one glance" strategy, which allows a faster and more effective interpretation of all the simultaneous parameters during the DISE procedure, improving the diagnostic accuracy, and providing a more accurate post-analysis, as well as legal and research advantages.


Assuntos
Endoscopia , Hipnóticos e Sedativos , Propofol , Apneia Obstrutiva do Sono , Adulto , Feminino , Humanos , Hipnóticos e Sedativos/farmacocinética , Hipnóticos e Sedativos/farmacologia , Masculino , Propofol/farmacocinética , Propofol/farmacologia , Sono , Apneia Obstrutiva do Sono/diagnóstico , Ronco , Adulto Jovem
11.
PLoS One ; 15(5): e0231528, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32413035

RESUMO

The objective of our study was to characterize and analyze the associations between OSA (obstructive sleep apnea) and other clinical variables in adult patients referred for sleep evaluation by polysomnography at a referral center in Beirut, Lebanon, in terms of sociodemographic features, symptoms presentation and comorbidities, and evaluate the burden of comorbidities associated with this disease. All individuals with suspected Sleep Apnea referred (January 2010-September 2017) for a one-night polysomnography were included. Demographics, self-reported symptoms and comorbidities were documented. The relationship between OSA severity and the presence of symptoms and comorbidities were evaluated using multivariate logistic regression. Overall, 663 subjects were assessed. Of these, 57.3% were referred from chest physicians, and sleep test results were abnormal in 589 subjects (88.8%) of whom 526 patients (89.3%) fulfilled diagnostic criteria for OSA; 76.3% were men and women were on average older. OSA was severe in 43.2% and more severe in men. Almost all patients were symptomatic with ~2-4 symptoms per patient and women presented with symptoms that are more atypical. Comorbidities were significantly higher in women. In the multivariate analysis, age, male sex, obesity, symptoms of snoring, excessive daytime somnolence and witnessed apneas were associated with OSA severity. Only age and obesity were associated with self-reported diagnosis of hypertension and diabetes. This is the first study in Lebanon to explore the characteristics of patients with polysomnography-diagnosed OSA. High prevalence of severe OSA and low referral rates in the medical community support promoting awareness for an earlier diagnosis and more personalized approach in this country.


Assuntos
Hipertensão/fisiopatologia , Obesidade/fisiopatologia , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/epidemiologia , Ronco/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Líbano/epidemiologia , Masculino , Anamnese , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico , Adulto Jovem
12.
PLoS One ; 15(5): e0232596, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384092

RESUMO

STUDY OBJECTIVES: To determine the prevalence of obstructive sleep apnea (OSA) in adults with Down syndrome (DS), to investigate factors related to OSA severity and to identify which sleep questionnaire is the most appropriate for the screening of OSA in this population. METHODS: Cross-sectional study that consecutively included 60 adults with DS. All patients underwent type III polysomnography and clinical and laboratory data were collected; sleep assessment questionnaires were applied. Multiple linear regression models evaluated the associations between OSA severity (measured by the respiratory event index-REI) and clinical and laboratory data and sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, BERLIN and STOP-Bang questionnaires). RESULTS: Results show that 60 (100%) adults with DS had OSA, with moderate-severe OSA identified in 49 (81.6%). At the multivariate linear regression, REI significantly correlated with hematocrit levels, BMI and STOP-Bang questionnaire (SBQ) results (P <0.001). The positive STOP-Bang ≥3 points) showed 100% of sensitivity (95%CI: 92.75-100%), 45.45% of specificity (95%CI: 16.75-76.62), positive predictive value of 89.09% (95%CI: 82.64-93.34%), negative predictive value of 100%, accuracy of 90% (95%CI: 79.49-96.24%) and OR of 24.29. CONCLUSIONS: Adults with DS have a very high prevalence of OSA. Hematocrit levels, BMI and SBQ showed a strong correlation with OSA severity. The SBQ performed well in identifying moderate to severe OSA in this population. Considered together, these results point to the need to perform OSA screening in all adults with DS, and STOP-Bang may play a role in this screening.


Assuntos
Síndrome de Down/complicações , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Polissonografia , Apneia Obstrutiva do Sono/complicações , Inquéritos e Questionários , Adulto Jovem
16.
Arch Phys Med Rehabil ; 101(9): 1497-1508, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32376325

RESUMO

OBJECTIVE: To describe the cost benefit of 4 different approaches to screening for sleep apnea in a cohort of participants with moderate to severe traumatic brain injury (TBI) receiving inpatient rehabilitation from the payor's perspective. DESIGN: A cost-benefit analysis of phased approaches to sleep apnea diagnosis. SETTING: Six TBI Model System Inpatient Rehabilitation Centers. PARTICIPANTS: Trial data from participants (N=214) were used in analyses (mean age 44±18y, 82% male, 75% white, with primarily motor vehicle-related injury [44%] and falls [33%] with a sample mean emergency department Glasgow Coma Scale of 8±5). INTERVENTION: Not applicable. MAIN OUTCOME: Cost benefit. RESULTS: At apnea-hypopnea index (AHI) ≥15 (34%), phased modeling approaches using screening measures (Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender [STOPBANG] [-$5291], Multivariable Apnea Prediction Index MAPI [-$5262]) resulted in greater cost savings and benefit relative to the portable diagnostic approach (-$5210) and initial use of laboratory-quality polysomnography (-$5,011). Analyses at AHI≥5 (70%) revealed the initial use of portable testing (-$6323) relative to the screening models (MAPI [-$6250], STOPBANG [-$6237) and initial assessment with polysomnography (-$5977) resulted in greater savings and cost-effectiveness. CONCLUSIONS: The high rates of sleep apnea after TBI highlight the importance of accurate diagnosis and treatment of this comorbid disorder. However, financial and practical barriers exist to obtaining an earlier diagnosis during inpatient rehabilitation hospitalization. Diagnostic cost savings are demonstrated across all phased approaches and OSA severity levels with the most cost-beneficial approach varying by incidence of OSA.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Programas de Rastreamento/economia , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Pesos e Medidas Corporais , Análise Custo-Benefício , Feminino , Escala de Coma de Glasgow , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Polissonografia , Fatores Sexuais , Ronco , Fatores Socioeconômicos
17.
Zhonghua Yi Xue Za Zhi ; 100(11): 817-822, 2020 Mar 24.
Artigo em Chinês | MEDLINE | ID: mdl-32234151

RESUMO

Objectives: To compare diagnostic consistency for chronic insomnia (CI) and obstructive sleep apnea (OSA) between cardiopulmonary coupling (CPC) and polysomnographm (PSG). Methods: Two hundred and twenty-one patients were enrolled from the Department of Sleep Disorders, Chaohu Hospital affiliated to Anhui Medical University from July 2018 to December 2019, and monitored with overnight CPC and PSG simultaneously. According to clinical representations and PSG results, there were 88 males and 80 females with CI and OSA, including chronic insomnia (CI group, 93 cases), OSA (OSA group, 36 cases) and comorbid OSA with CI (COI group, 39 cases). The consistency of sleep and OSA parameters measured with CPC and PSG were analyzed. Results: (1)For all patients and CI group, the total sleep time (TST), sleep efficiency (SE) and rapid eye movement (REM) sleep time measured by CPC were significantly higher than those measured with PSG, and the wake time after sleep onset (WASO) was significantly lower than that measured with PSG (the specific median comparisons were as follows 420.0 min vs 395.5 min, 93.7% vs 81.8%, 90.0 min vs 37.5 min, 18.0 min vs 63.0 min in CI group, respectively; 414.0 min vs 392.5 min, 91.9% vs 81.9%, 72.0 min vs 34.8 min, 24.0 min vs 58.4 min in all patients, respectively (all P≤0.001). However, in the OSA patients, the TST, SE, WASO, REM sleep time and NREM sleep time measured using two methods were similar (all P>0.05). (2) According to OSA criteria, the consistency between CPC and PSG was fair (κ=0.255). Only CPC has a certain degree of value for OSA screening when the AHI ≥ 20/h (κ=0.580, sensitivity: 0.85, specificity: 0.82, positive predictive value: 0.59, negative predictive value: 0.95, positive likelihood ratio: 4.72). Conclusion: CPC technology may overestimate the sleep quality of CI patients, and its consistency is fair compared with that of PSG in the diagnosis of OSA.


Assuntos
Polissonografia , Apneia Obstrutiva do Sono , Distúrbios do Início e da Manutenção do Sono , Feminino , Frequência Cardíaca , Humanos , Masculino , Respiração , Sono , Apneia Obstrutiva do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/diagnóstico
18.
J Laryngol Otol ; 134(4): 354-361, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32284084

RESUMO

OBJECTIVE: To evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea. METHODS: A total of 124 male patients diagnosed with obstructive sleep apnoea by overnight polysomnography, who underwent upper airway computed tomography, were enrolled. The linear dimensions, cross-sectional area and volume of the upper airway region and the surrounding bony frame were measured. The association between ageing and upper airway morphology was analysed. RESULTS: Soft palate length, minimum cross-sectional area of the retroglossal region, lateral dimensions at the minimum cross-sectional area of the retropalatal and retroglossal regions, nasopharyngeal volume, and average cross-sectional area of the nasopharyngeal region were found to significantly increase with ageing in all patients, while the upper airway shape flattened with ageing. The volume of the retropalatal region increased with ageing among the patients with a body mass index of less than 24 kg/m2. The volume of parapharyngeal fat pad increased with ageing among patients with a body mass index greater than 28 kg/m2. CONCLUSION: A number of dimensional, cross-sectional and volumetric parameters of the pharynx increased with age, indicating that non-anatomical factors may play a more important role in the pathogenesis of obstructive sleep apnoea in aged patients.


Assuntos
Remodelação das Vias Aéreas/fisiologia , Nasofaringe/patologia , Palato Mole/patologia , Faringe/patologia , Apneia Obstrutiva do Sono/fisiopatologia , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , China/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nasofaringe/anatomia & histologia , Nasofaringe/diagnóstico por imagem , Palato Mole/anatomia & histologia , Palato Mole/diagnóstico por imagem , Faringe/anatomia & histologia , Faringe/diagnóstico por imagem , Polissonografia/métodos , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
19.
Rev. Odontol. Araçatuba (Impr.) ; 41(1): 63-68, jan.-abr. 2020.
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1102382

RESUMO

Os distúrbios do sono vem sendo cada dia mais estudados e evidenciados perante a medicina, sendo que muitos destes estão atrelados a fatores etiológicos ligados a diversas doenças sistêmicas, tais como, hipertensão arterial, problemas cardíacos e fator de risco para diabetes. Sendo assim, a utilização de Índices como o de Epworth, Berlim e Pittsburgh como auxiliadores anamnésicos, é de grande valia para um correto diagnóstico. Por meio deste, pudemos concluir que tais índices são de extrema importância por serem referências iniciais para a solicitação de exames mais complexos e de alto custo. Portanto, este trabalho tem por objetivo fazer uma revisão da literatura sobre a essência científica de tais índices, analisando a eficácia dos mesmos(AU)


Sleep wake disorders see being increasingly studied day and evidenced before the medicine, and many of these disorders are linked to etiological factors related to various systemic diseases such as, hypertension, heart disease and a risk factor for diabetes. Thus, the use of indices such as the Epworth, Berlin and Pittsburgh as amnesic helpers, is of great value to a correct diagnosis. Through this we can conclude that such indices are extremely important because they are initial references to the request for more complex tests and costly. Therefore, this study aims to review the literature on the scientific essence of such indices, analyzing effectiveness(AU)


Assuntos
Ronco/diagnóstico , Índice , Apneia Obstrutiva do Sono/diagnóstico , Transtornos do Sono-Vigília , Ronco , Apneia Obstrutiva do Sono
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