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1.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(11): 832-837, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31694093

RESUMO

Objective: To compare clinical characteristics between patients with chronic obstructive pulmonary disease (COPD) and COPD -OSA overlap, and to analyze the risk factors for OSA in patients with COPD. Methods: A total of 431 patients with COPD were divided into a COPD-OSA group with AHI>15 events/h or a COPD group with AHI ≤ 15 events/h according to the results of polysomnography, and their clinical characteristics were summarized. Risk factors for OSA overlap in COPD patients were identified by univariate and multivariate logistic regression analyses. Results: There were no significant differences in gender composition, dyspnea scale (mMRC) score, the numbers of acute exacerbations and hospitalizations in the last year, prevalence of coronary heart disease, or cor pulmonale or diabetes mellitus in the two groups (all P>0.05). Age, BMI, neck circumference, smoking index, COPD assessment test (CAT) score, the values of FEV(1) or FEV(1)%, FEV(1)/FVC ratios, and the prevalence of hypertension in the COPD-OSA group with AHI>15 events/h were significantly higher than in the COPD group with AHI ≤15 events/h, while the duration of COPD and the proportion of severe COPD were lower than the COPD group with AHI≤ 15 (P<0.05). The scores of Charlson Comorbidity Index, Epworth Sleepiness Scale (ESS) and Sleep Apnea Clinical Score (SACS) in the COPD-OSA group were significantly higher than in the COPD group with AHI≤ 15, with all P values<0.05. Risk factors for AHI>15 OSA coinciding in patients with COPD included BMI, neck circumference, ESS, SACS and CAT (P<0.05). Furthermore, BMI, ESS and CAT were independent risk factors for OSA in COPD patients (P<0.05). Compared with mild or moderate COPD cases, patients with severe COPD (FEV(1)%<50%) had a lower risk of having OSA (ß=-0.459, OR=0.632, 95% CI 0.401-0.997, P=0.048). Conclusions: Compared to COPD patients with AHI ≤ 15 events/h, OSA-COPD overlap patients (AHI>15 events/h) had a worse quality of life, more daytime sleepiness and higher prevalence of hypertension. BMI, ESS and CAT were independent risk factors for AHI>15 OSA in patients with COPD. The risk of having OSA in severe COPD patients was lower than cases with mild or moderate COPD.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Qualidade de Vida , Apneia Obstrutiva do Sono/epidemiologia , Comorbidade , Humanos , Hipertensão/epidemiologia , Polissonografia , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/psicologia , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/psicologia , Sonolência
2.
Zhonghua Yi Xue Za Zhi ; 99(38): 2994-2999, 2019 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-31607031

RESUMO

Objective: To evaluate the utility of a portable monitor at home for diagnosis of obstructive sleep apnea (OSA) in Chinese adults. Methods: Eighty nine patients suspected of OSA underwent overnight, unattended home sleep apnea testing (HSAT) with a portable monitor (Nox-T3, Nox Medical Inc. Iceland)followed by an in-laboratory polysomnogram (PSG) with simultaneous portable monitor (PM) recording within one week. PSG and PM recorder were scored according to recommended guidelines by independent technicians. The correlation between PSG apnea hypopnea index (AHI) and PM respiratory disturbance index (RDI) were evaluated. Results: Sleep testing showed RDI was (30.0±20.9) events/h on HSAT, and (33.4±22.4) events/h on in-laboratory PM recording. Apnea-hypopnea index (AHI) on PSG was (35.1±23.7) events/h. There was significantly statistical difference among the three group (P<0.001). Both RDI on HSAT and RDI on in-laboratory PM correlated significantly with AHI on PSG (r=0.877, P<0.001 and r=0.962, P<0.001, respectively). Bland-Altman analysis of AHI on PSG versus RDI on HSAT showed a mean difference of 4.4 events/h; limits of agreement was -17.6 to 26.5 events/h. Closer agreements were present when comparing the simultaneous recordings, with AHI on PSG versus RDI on in-laboratory PM showing a mean difference of 1.4 events/h, and limits of agreement was -11.3 to 14.2 events/h. Based on a threshold of AHI≥5 events/h, RDI on HSAT had 98.8% sensitivity, 40.0% specificity. Using an AHI ≥ 15 events/h, RDI on HSAT had 91.5% sensitivity, 76.5% specificity. Conclusion: Type 3 PM has a good diagnostic value for adult OSA patients and there is close agreement between the Type 3 portable monitor and PSG.


Assuntos
Apneia Obstrutiva do Sono , Humanos , Laboratórios , Polissonografia , Sensibilidade e Especificidade , Sono , Apneia Obstrutiva do Sono/diagnóstico
4.
Rev Med Suisse ; 15(662): 1620-1624, 2019 Sep 11.
Artigo em Francês | MEDLINE | ID: mdl-31508913

RESUMO

Obstructive sleep apnea syndrome (OSAS) and arterial hypertension (HT) are two frequent, often concomitant diseases, who are both associated with an increased cardiovascular risk. In the last years, an association between these two entities has been established. The purpose of this article is to review the current knowledge about the link between HT and OSAS, the pathophysiological mechanisms involved in the common genesis of the two conditions and the characteristics suggesting an underlying OSAS in a hypertensive subject. We will also update readers about the current screening of OSAS in which primary care physicians are directly involved, and review the pros and cons of different treatment options for HT in OSAS.


Assuntos
Hipertensão/complicações , Hipertensão/terapia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Humanos , Hipertensão/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia
5.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 33(9): 862-865;869, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31446706

RESUMO

Objective:To explore the relationship between smoking and the severity of OSA. Method:There were 719 patients included in the study, who were accompanied by snoring, daytime sleepiness and other symptoms. Laboratory-based polysomnographic variables (including AHI, oxygen desaturation index and microarousal index, etc.), and anthropometric measurements (including weight, neck circumference, waist circumference, hip circumference etc.) were collected for all participants. The severity of OSA was determined by AHI. No OSA was defined as AHI<5, mild OSA as AHI of 5 to 15,moderate OSA as AHI of >15 to 30, and severe OSA as AHI of >30. Smoking severity was determined by the smoking index (SI). Light smoke was defined as SI<200, moderate smoke was as SI 200 to 400, and severe smoke as SI>400. Result:There were 138 cases of non-OSA and 581 cases of OSA. There were 381 non-smokers, 279 smokers and 59 quit smokers. The smoking rate of OSA group was significantly higher than that of non-OSA group (41.5% vs. 27.5%,P<0.01). After excluding 59 quit smokers, the remaining 660 subjects were divided into four groups according to the severity of smoking, then each group was further divided into four groups according to OSA severity. Unadjusted analysis showed that OSA severity positively correlated with smoking severity (r=0.203,P<0.01). The positive correlation remained significant after further adjustment for age, BMI and waist-hip ratio. In addition, logistic regression analysis showed that compared to non-smokers, the odd ratios for OSA in moderate smokers were 1.72 (95%CI 1.08-2.75) and in severe smokers were 2.68 (95%CI 1.61-4.46), after adjustment for age, BMI and waist-hip ratio. Conclusion:The severity of smoking significantly correlated with the severity of OSA. There was increased risk of OSA in patients with severe smoke. The correlation was independent of some confounders such as age and obesity.


Assuntos
Apneia Obstrutiva do Sono/diagnóstico , Fumar/efeitos adversos , Humanos , Polissonografia , Índice de Gravidade de Doença , Ronco
6.
Rev Assoc Med Bras (1992) ; 65(7): 995-1000, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389512

RESUMO

OBJECTIVES: Assess the performance of the Stop-Bang questionnaire in Brazilian patients for the screening of OSA. METHODS: A cross-sectional study with historical and consecutive analysis of all patients who underwent polysomnography tests in the Sleeping Sector of the Ear, Nose, and Throat, and Cardiopulmonary (LabSono) Departments of the Gaffrée and Guinle University Hospital (HUGG), from 10/17/2011 to 04/16/2015. The variables relating to the SB questionnaire were collected by direct research from the medical records of patients. RESULTS: In a series of 83 patients, we found that our sample were similar to other studies conducted in specialized centers of Sleep Medicine, and the population presented characteristics similar to those found by studies in Latin America. Men and women only behaved similarly in relation to the presence of Observed Apnea and body mass index, with a predominance of women who had systemic hypertension over men. In our study, the discriminatory value of 4 or more positive answers to the questionnaire had the best performance in identifying patients with an hourly Apnea-Hypopnea Index greater than 15/h, with a sensitivity of 72.97% (55.9% - 86.2%) and specificity of 67.39% (52.0% - 80.5%). CONCLUSIONS: The Stop-Bang questionnaire proved to be, in our sample, a good screening instrument for diagnosing OSA Syndrome.


Assuntos
Apneia Obstrutiva do Sono/diagnóstico , Inquéritos e Questionários/normas , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Distribuição por Sexo , Apneia Obstrutiva do Sono/fisiopatologia , Ronco/diagnóstico , Adulto Jovem
7.
Medicine (Baltimore) ; 98(32): e16687, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393370

RESUMO

Obstructive sleep apnea (OSA) has a high prevalence in patients with obesity. Only patients with clinical symptoms of OSA are admitted to polysomnography; however, many patients with OSA are asymptomatic. We aimed to create and validate a population-based risk score that predicts the severity of OSA in patients with obesity.We here report the cross-sectional analysis at baseline of an ongoing study investigating the long-term effect of bariatric surgery on OSA. One-hundred sixty-one patients of the Obesity Center of the Catholic University Hospital in Rome, Italy were included in the study. The patients underwent overnight cardiorespiratory monitoring, blood chemistry analyses, hepatic ultrasound, and anthropometric measurements. The patients were divided into 2 groups according OSA severity assessed by the apnea-hypopnea index (AHI): AHI < 15 = no or mild and AHI ≥ 15 moderate to severe OSA. A statistical prediction model was created and validated. C statistics was used to evaluate the discrimination performance of the model.The prevalence of OSA was 96.3% with 74.5% of the subjects having moderate/severe OSA. Sex, body mass index, diabetes, and age were included in the final prediction model that had excellent discrimination ability (C statistics equals to 83%). An OSA risk chart score for clinical use was created.Patients with severe obesity are at a very high risk for moderate or severe OSA in particular if they are men, older, more obese, and/or with type 2 diabetes. The OSA risk chart can be useful for general practitioners and patients as well as for bariatric surgeons to select patients with high risk of moderate to severe OSA for further polysomnography.


Assuntos
Obesidade Mórbida/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Obesidade Mórbida/epidemiologia , Prevalência , Curva ROC , Análise de Regressão , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores Sexuais
9.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(8): 591-595, 2019 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-31378020

RESUMO

Objective: To explore the change of hypothalamic-pituitary-thyroid axis hormones and it's role in depression in obstructive sleep apnea-hypopnea syndrome. Methods: Seventy-three male OSAHS patients [age (39±11) years] and 13 male controls [age (36±7.5) years] were enrolled from August 2013 to May 2017 in the 1(st) Hospital of China Medical University. Overnight polysomnography and depression were assessed. The serum TRH, TSH, FT4 and FT3 levels were measured on the next morning. The relationship between depression and hypothalamic-pituitary-thyroid axis was analyzed. Results: Compared with the control group, severe hypoxia group had higher serum FT3 level [(4.5±0.6) ng/L vs. (5.4±0.7)ng/L, P<0.05)] and depression score (30±7 vs. 40±10, P<0.05). Further analysis revealed that serum FT3 level (5.0±0.5 ng/L vs. 5.5±0.7ng/L, P<0.05) and FT4 level [(16.2±1.9) ng/L vs. (18.2±2.3) ng/L, P<0.05] were lower in the patients with depression than those without. Conclusion: The decrease of serum FT3 and FT4 levels in OSAHS patients with severe hypoxia was closely related to the occurrence of depression.


Assuntos
Depressão/psicologia , Sistema Hipotálamo-Hipofisário/patologia , Apneia Obstrutiva do Sono/psicologia , Glândula Tireoide/patologia , China , Humanos , Masculino , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue
12.
Artigo em Chinês | MEDLINE | ID: mdl-31434371

RESUMO

Objective: To compare the changes of genioglossus electromyography (GGEMG) with and without continuous positive airway pressure (CPAP) ventilation in moderate to severe obstructive sleep apnea (OSA) patients. Methods: Each of subjects, including male snorers and non-snorers, underwent polysomnography (PSG) with synchronous GGEMG recording with intra-oral bipolar silver ball electrodes at the Sleep Center of Beijing Tsinghua Changgung Hospital from August 2016 to Sepember 2017. Manual CPAP pressure titration and with GGEMG were performed in patients diagnosed moderate to severe OSA. T-test was used to compare the changes of GGEMG in OSA group (n=12, AHI (65.90+23.67) events/h) and control group (n=6, AHI(2.30+1.93) events/h) before and after CPAP treatment. Results: Variables of GGEMG (including tonic, peak and phasic GGEMG) were higher in OSA group than in control group during both wakefulness and non rapid eye movement(NREM) sleep. However, with CPAP treatment, the GGEMG variables were significantly decreased in OSA group during NREM sleep(tonic GGEMG: 1.23%±0.73% vs. 2.54%±1.12%, t=4.024, P=0.002; peak GGEMG: 12.37%±13.19% vs. 26.98%±15.52%, t=2.795, P=0.017; phasic GGEMG: 3.81%±2.47% vs. 8.82%±3.84%, t=5.113, P<0.001). Conclusions: CPAP treatment can eliminate respiratory events and maintain airway patency. It is helpful to normalize the excessive GGEMG response in OSA patients during sleep, which has therapeutic significance to alleviate and prevent genioglossal neuromuscular lesions.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/terapia , Eletromiografia , Humanos , Masculino , Polissonografia , Respiração , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Língua
13.
Artigo em Chinês | MEDLINE | ID: mdl-31434375

RESUMO

Objective: To investigate the effect of nasal cavity ventilation expansion techniques in treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) with nasal obstruction. Methods: Thirty-two OSAHS patients with nasal obstruction hospitalized from January 2017 to January 2018 in Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital Affiliated to Anhui Medical University were selected, with 28 males and 4 females, aged 40.3±8.5 years old (x±s), and treated with individualized nasal cavity ventilation expansion techniques. Nasal acoustic reflex and resistance examination, polysomnography (PSG) monitoring were performed before and three months after operation. Nasal obstruction symptom evaluation (NOSE) and Quebec sleep questionnaire (QSQ) were completed as well. The nasal acoustic reflex, nasal resistance, NOSE, QSQ score, apnea hypopnea index (AHI) and lowest arterial oxygen saturation (LSaO(2)) before and after operation were compared and analyzed. SPSS 22.0 software was used for statistical analysis. Results: After the operation, the total nasal resistance and total score of NOSE scale of patients decreased significantly as well as the total score of QSQ scale increased significantly ((0.140±0.043) kPa·s/L vs (0.277±0.067) kPa·s/L, 9.84±4.11 vs 53.00±11.57, 5.67±0.43 vs 3.86±0.46, t value was 10.687, 18.035, -16.904, respectively, all P<0.05), and the scores of five dimensions increased in varying degrees. Among the indexes of PSG, there was no significant difference in AHI and LSaO(2) values before and after operation, but AHI decreased and LSaO(2) increased. Conclusion: Nasal cavity ventilation expansion techniques can effectively alleviate the symptoms of nasal obstruction in OSAHS patients and improve their sleep and quality of life.


Assuntos
Cavidade Nasal/cirurgia , Obstrução Nasal/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Apneia Obstrutiva do Sono/cirurgia , Adulto , Técnicas de Diagnóstico do Sistema Respiratório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico , Polissonografia , Qualidade de Vida , Reflexo Acústico , Apneia Obstrutiva do Sono/diagnóstico
14.
Artigo em Chinês | MEDLINE | ID: mdl-31327204

RESUMO

Objective:The aim of this study is to compare the night sleep hypoxia degree and sleep structure of young and middle-aged and elderly patients with OSA, so that PSG has more important application value.Method:A total of 438 patients diagnosed with OSA from February 2017 to January 2019 were selected,including 119 patients in the youth group with an average age of (28.5±5.1)years,and 319 patients in the middle and elderly group with an average age of (45.8±2.7)years.The results recorded by PSG in the two groups were retrospectively analyzed. Result:①The AHI, ODI, OAI, MAI and ASaO2of OSA patients in the junior group were significantly higher than those in the middle-aged and elderly group, while CAI was not statistically significant between the two groups (P=0.419).②The NREM stage Ⅰ (61.1±4.3)% in the junior group was significantly higher than that in the junior group (53.3±3.4)%.NREM stage Ⅱ (33.2±2.3)% and NREM stage Ⅲ+Ⅳ (4.3±1.3)% in the junior group were higher than those in the middle-aged group (29.2±3.9)% and stage Ⅲ+Ⅳ (2.6±0.9)%, while the percentage of REM stage and microarousal index were not statistically significant between the two groups.③Young OSA patients were associated with hypertension and 47.0% middle-aged and elderly patients were associated with hypertension.There was no statistical difference between the two groups in whether hypertension was associated with hypertension or not.Conclusion:The NREM phase is particularly susceptible to age, and age affects slow wave sleep. The sleep structure of middle-aged and older people demonstrates their sleep characteristics: reduced total sleep time,slow wave sleep,low sleep efficiency,and delayed sleep. The young people's nighttime hypoxia is more serious. AHI,ODI,OAI,MAI,ASaO2 and other indicators are significantly higher than the middle-aged and elderly people, but the sleep structure 2 groups are similar, indicating that young people have strong sleep physiological compensation and Adjustment ability.


Assuntos
Fatores Etários , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sono , Adulto Jovem
15.
Artigo em Chinês | MEDLINE | ID: mdl-31327210

RESUMO

Objective:To discuss the changes and rules of nighttime blood pressure in obstructive sleep apnea(OSA) patients without hypertension.Method:Eighty-nine non-hypertensive patients whose office blood pressure was lower than 130/85 mmHg and diagnose with OSA by PSG in sleep monitoring room were choose as the research group.Forty non-hypertensive and polyp of vocal cord or vocal nodules patients whose office blood pressure was lower than 130/85 mmHg and diagnose with non-OSA by PSG were choose as matched group.All the patients were in treatment in our hospital from December 2017 to June 2018. All the patients got PSG,and the same time got the ambulatory blood pressure monitoring based on pulse transit time all night.Compared the mean value of systolic blood pressure,the mean value of diastolic blood pressure.Higher than 12 mmHg blood pressure rise index,the mean rise in blood pressure. The highest increase in blood pressure, maximum systolic pressure between the study group and the marched group all night.Result:The difference of all the test index between the study group and the marched group was significant(P<0.05).In OSA patients.The difference of all the test index between the severe OSA group and the mild OSA group or the moderate OSA group was significant(P<0.05).In severe OSA group.The difference between the fluctuation of blood pressure caused by respiratory events and spontaneous blood pressure fluctuation was significant(P=0.004).The difference of the mean value of diastolic blood pressure(P=0.032) blood pressure rise index(P=0.037) the mean rise in blood pressure(P=0.045) between age 55 or older patients and under 55years old patients.Conclusion:Ambulatory blood pressure monitoring synchronizatied in PSG contribute to the early diagnosis and prevention of hypertension in OSA patients.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Apneia Obstrutiva do Sono/diagnóstico , Correlação de Dados , Humanos , Hipertensão
16.
Artigo em Chinês | MEDLINE | ID: mdl-31262106

RESUMO

Objective: To investigate the effect of genioglossus (GG) activation at sleep onset on the outcome of velopharyngeal surgery in obstructive sleep apnea hypopnea syndrome (OSAHS) patients. Methods: Thirty-five patients between April 2014 and February 2015 in Beijing Tongren Hospital with OSAHS underwent overnight polysomnography with synchronous genioglossus electromyography (GGEMG) using intraoral electrodes. The upper airway (UA) anatomy was evaluated by three-dimensional computer tomography (3D-CT) in OSAHS patients. Then, all of the patients received velopharyngeal surgery, including revised uvulopalatopharyngoplasty (UPPP) with uvula preservation or UPPP combined transpalatal advancement pharyngoplasty. All patients were followed-up using polysomnography 3-6 months after surgery. T-test or Wilcoxon test were used to compare the variables between groups, and Spearman correlation analysis was used to test the correlation between parameters. Results: Thirty-five patients received velopharyngeal surgery. Twenty-two patients (62.86%) were responders, and 13 patients (37.14%) were non-responders. Responders had a higher mean GGEMG during sleep onset (15.31±3.74 vs. 9.92±2.93, t=4.504, P=0.001). The decreased AHI was significantly positively related to the sleep onset mean GGEMG (r=0.541, P=0.004) and the change in GGEMG (r=0.422, P=0.028). The decreased AHI was significantly negatively related to the minimal cross sectional airway area (mCSA,ρ=0.629,P=0.000) and the minimal lateral airway dimension (mLAT, ρ=0.484, P=0.009) at velopharynx. Conclusions: The outcome of velopharyngeal surgery was affected by the mean GGEMG during sleep onset. We speculated that the patient with higher GGEMG at sleep onset and narrower velopharynx were more suitable candidates for velopharyngeal surgery.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/cirurgia , Língua/fisiopatologia , Eletromiografia , Humanos , Imagem Tridimensional , Palato/diagnóstico por imagem , Palato/cirurgia , Faringe/diagnóstico por imagem , Faringe/cirurgia , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Tomografia Computadorizada por Raios X , Língua/diagnóstico por imagem , Resultado do Tratamento , Úvula/diagnóstico por imagem , Úvula/cirurgia
18.
Am J Orthod Dentofacial Orthop ; 156(1): 13-28.e1, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256826

RESUMO

The Board of Trustees of the American Association of Orthodontists asked a panel of medical and dental experts in sleep medicine and dental sleep medicine to create a document designed to offer guidance to practicing orthodontists on the suggested role of the specialty of orthodontics in the management of obstructive sleep apnea. This White Paper presents a summary of the Task Force's findings and recommendations.


Assuntos
Ortodontia/métodos , Ortodontia/normas , Ortodontistas , Apneia Obstrutiva do Sono/terapia , Academias e Institutos , Humanos , Aparelhos Ortodônticos , Médicos , Polissonografia/métodos , Prevalência , Radiografia Dentária , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Cirurgiões , Resultado do Tratamento , Estados Unidos
19.
J Stroke Cerebrovasc Dis ; 28(9): 2517-2524, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31296477

RESUMO

BACKGROUND: The purpose of this study was to validate and pilot the use of the four-variable screening tool (4V) and modified 4V tools to identify acute ischemic stroke and transient ischemic attack (TIA) patients at high risk of obstructive sleep apnea (OSA). METHODS: Two modified scales, 4V-1 (ie, using neck circumference instead body mass index, regardless of gender) and 4V-2 (ie, as above but scored differently according to gender) were designed. These tools were used in a consecutive cohort of 124 acute ischemic stroke/TIA patients, together with the 4V-1, 4V-2, 4V, as well as the STOP-BANG, the Berlin questionnaire, and the Epworth Sleepiness Scale (ESS). Objective level 2 or level 3 polysomnography was used to confirm OSA and its severity. Both questionnaires and polysomnography were completed within 1 week from symptom onset. RESULTS: Area under the curve (AUC) of 4V was 0.807 (P< .0001) while AUC of STOP-BANG, Berlin Questionnaire and ESS were .701 (P< .0001), .704 (P< .0001) and .576 (P = .1556), respectively. AUC of 4V was greater than of STOP-BANG (z = 2.200, P = .0220), Berlin (z = 2.024, P = .0430) and ESS (z = 3.363, P = .0003). AUC of modified 4V-1 and modified 4V-2 were .824 (P< .001) and .835 (P< .001), respectively. Performance of modified 4V-2 was higher versus modified 4V-1 (z = 2.111, P = .0348) and higher but not significantly so to regular 4V (z = 1.784, P = .0744). CONCLUSIONS: Neck circumference scored by gender is a useful substitution to body mass index in the 4V when screening OSA at early stages of ischemic stroke/TIA patients.


Assuntos
Isquemia Encefálica/diagnóstico , Técnicas de Apoio para a Decisão , Ataque Isquêmico Transitório/diagnóstico , Pescoço/patologia , Apneia Obstrutiva do Sono/etiologia , Acidente Vascular Cerebral/diagnóstico , Idoso , Pressão Sanguínea , Índice de Massa Corporal , Isquemia Encefálica/complicações , Isquemia Encefálica/fisiopatologia , Feminino , Humanos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Polissonografia , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Ronco/fisiopatologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Inquéritos e Questionários
20.
Neumol. pediátr. (En línea) ; 14(2): 92-94, jul. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1015009

RESUMO

Primary Ciliary Diskinesia (PCD) is a heterogeneous, rare genetic disease that can be present in up to 5% of the patients with recurrent respiratory infections. The underlying pathogenesis is disrupted ciliary function which results in delayed mucus transportation leading to chronic inflammation in the upper and lower respiratory tract. Almost all PCD patients have otolaryngologic manifestations, characterized by recurrent ear and sinus infections, chronic inflammation at this level, sensorioneural and conductive hearing loss, and sleep-disordered breathing. This article reviews the diagnostic and therapeutic aspects of these manifestations.


La Disquinesia Ciliar Primaria (DCP) es una enfermedad genética heterogénea rara que puede estar presente en hasta un 5% de los pacientes que presentan infecciones respiratorias a repetición. La patogenia es secundaria a una alteración de la función ciliar que a su vez provoca una alteración del transporte de moco, resultando en una condición inflamatoria crónica en la vía aérea superior e inferior. Las manifestaciones clínicas de la esfera otorrinolaringológica en los pacientes portadores de DCP están presentes prácticamente en la totalidad de los mismos, y se caracterizan por infecciones recidivantes de oídos y cavidades perinasales, inflamación crónica a este nivel, hipoacusia neurosensorial y conductiva, y alteraciones respiratorias durante el sueño. En este artículo se revisarán los aspectos diagnósticos y terapéuticos de dicho compromiso.


Assuntos
Humanos , Criança , Adulto , Otite Média/epidemiologia , Sinusite/epidemiologia , Rinite/epidemiologia , Síndrome de Kartagener/epidemiologia , Otite Média/terapia , Rinite/terapia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia
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