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1.
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
2.
Hum Cell ; 33(4): 1036-1045, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32779153

RESUMO

The obstructive sleep apnea syndrome (OSAS) is a common sleep-related breathing disorder and an important cause of refractory hypertension. MicroRNAs (miRNAs) are involved in the development of hypertension, but their role in OSAS with hypertension (OSAS-hypertension) has been little studied. Evidence indicates that miR-126a-3p expression is lower in patients with OSAS-hypertension compared with the patients with OSAS alone. However, its role in the pathogenesis of OSAS-hypertension remains unclear. Therefore, this study aims to investigate the role of miR-126a-3p in OSAS-hypertension and to determine whether HIF-1α is involved in this process. Sprague Dawley rats were exposed to chronic intermittent hypoxia (CIH) for 8 weeks to induce OSAS-hypertension. Rat aortic smooth muscle cells (A7r5) were cultured under hypoxia as an in vitro model. Our results showed that rats exposed to 8 week CIH exhibited decreased miR-126a-3p and increased HIF-1α expression. Furthermore, administration of recombinant adeno-associated virus expressing miR-126a-3p (rAAV-miR-126a) counteracted the CIH-induced systolic blood pressure upregulation, oxidase stress, inflammation, and heart and abdominal aorta vascular remodeling. Moreover, the mechanism was associated with its targeted suppression of HIF-1α. These findings suggest that miR-126a-3p might be a novel potential therapeutic target for the treatment of OSAS-hypertension.


Assuntos
Expressão Gênica , Hipertensão/genética , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , MicroRNAs/genética , MicroRNAs/metabolismo , Apneia Obstrutiva do Sono/genética , Animais , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/genética , Células Cultivadas , Hipertensão/etiologia , Hipertensão/terapia , Hipóxia/complicações , Hipóxia/fisiopatologia , Masculino , MicroRNAs/administração & dosagem , MicroRNAs/farmacologia , Terapia de Alvo Molecular , Ratos Sprague-Dawley , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/terapia , Remodelação Vascular/efeitos dos fármacos , Remodelação Vascular/genética
3.
J Oral Maxillofac Surg ; 78(11): 2061-2069, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32763149

RESUMO

PURPOSE: The aim of this study was to assess the impact of isolated mandibular setback surgery on the risk of obstructive sleep apnea (OSA), using the STOP-BANG questionnaire (SBQ). PATIENTS AND METHODS: The authors implemented a double-blinded prospective quasi-experimental study. All healthy patients with skeletal Class III deformity older than 18 years were included in this study. They were candidates for isolated mandibular setback surgery. The SBQ was completed by the pulmonologist, 1 week preoperatively (T0), and 1 and 6 months postoperatively (T1 and T2, respectively). The mandibular setback displacement was the study intervention. The risk of OSA on the basis of the SBQ was the outcome variable. Descriptive and bivariate statistics were computed and the significance level was set at .05. RESULTS: The sample comprised 30 patients (15 females, 15 males) with the average age of 25.77 ± 4.76. The mean score of SBQ at T0 was 1.37 ± 0.85, which increased to 2.33 ± 1.52 at T1 interval. However, it decreased significantly to 1.47 ± 1.17 at T2 interval (P < .001). T0-T1 and T0-T2 score differences were observed to be higher in the group with a mandibular setback repositioning greater than or equal to 5 mm (P < .005). CONCLUSIONS: An isolated mandibular setback surgery less than 5 mm does not increase the risk for OSA in a young healthy nonsmoker Class III patient, according to the SBQ. Moreover, there was a significant increase in the risk for OSA when the setback was greater than or equal to 5 mm, measured at the mandibular incisor edge. Therefore, clinicians should be careful and discuss this potential increased risk with the patients, when this movement is required by the treatment plan. Further clinical trials are needed to support the relevancy.


Assuntos
Procedimentos Cirúrgicos Ortognáticos , Apneia Obstrutiva do Sono , Adulto , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Estudos Prospectivos , Apneia Obstrutiva do Sono/etiologia , Inquéritos e Questionários , Adulto Jovem
4.
Saudi Med J ; 41(7): 740-745, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32601643

RESUMO

OBJECTIVES: To determine the prevalence of obstructive sleep apnea in female patients with fibromyalgia (FM)presenting to physical therapy outpatient clinics. METHODS: The 36-item short form health survey (SF-36) questionnaire, Berlin test, and epworth sleepiness scale were administered, along with a polysomnography to 38 female patients. This cross-sectional study comprised diagnosed with FM according to the diagnostic criteria of the American College of Rheumatology, between March 2017 and August 2019, at the Faculty of Medicine Hospital, Çanakkale Onsekiz Mart University, Çanakkale, Turkey. RESULTS: Of the participants, 65.9% were found to have obstructive sleep apnea (OSA). Patients with OSA were older and had a higher disease activity score for FM. A strong positive correlation was identified between the apnea-hypopnea index (AHI) and the FA disease activity score. A negative correlation was found between AHI and the subscales of SF-36. CONCLUSION: A clinical assessment of female patients with FM requires a multidisciplinary approach, and patients with excessive daytime sleepiness in particular are recommended to undergo polysomnography. The authors believe that the early detection and treatment of accompanying OSA will contribute not only to the quality of life, but also to the survival of patients with FM.


Assuntos
Fibromialgia/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Fibromialgia/complicações , Humanos , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Prevalência , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/etiologia , Turquia/epidemiologia
5.
Stud Health Technol Inform ; 270: 1381-1382, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570669

RESUMO

Using big data science we employ NLP and a novel interface the BMI Investigator to answer clinically meaninful questions. The use case presented is the association between Rosacea and Obstructive Sleep Apnea.


Assuntos
Rosácea , Apneia Obstrutiva do Sono , Índice de Massa Corporal , Humanos , Estudos Retrospectivos , Rosácea/complicações , Apneia Obstrutiva do Sono/etiologia
6.
Medicine (Baltimore) ; 99(24): e20589, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541492

RESUMO

BACKGROUND: This study will explore the effectiveness and safety of respiratory muscle training therapy (RMTT) for the treatment of patients with obstructive sleep apnea syndrome (OSAS) after stroke. METHODS: In this study, we will systematically and comprehensively search Cochrane Library, PubMed, EMBASE, WANGFANG, VIP, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for relevant literature from their inception to March 1, 2020 without any limitations to language and publication status. We will consider any randomized controlled trials focusing on the effectiveness and safety of RMTT for the treatment of patients with OSAS after stroke. The study quality will be checked using Cochrane risk of bias tool, and statistical analysis will be performed utilizing RevMan 5.3 software. RESULTS: This study will summarize and synthesize the current evidence of RMTT for the treatment of patients with OSAS following stroke. CONCLUSION: The findings of this study will assess the present evidence for the benefits and harms of RMTT for treating OSAS after stroke, and will inform clinical practice and future research. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020170355.


Assuntos
Exercícios Respiratórios , Metanálise como Assunto , Projetos de Pesquisa , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/terapia , Acidente Vascular Cerebral/complicações , Revisões Sistemáticas como Assunto , Exercícios Respiratórios/efeitos adversos , Humanos , Resultado do Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-32443526

RESUMO

Upper airway abnormalities increase the risk of pediatric morbidity in infants. A multidisciplinary approach to obstructive sleep apnea syndrome (OSAS) poses challenges to clinical practice. The incidence and causes of OSA are poorly studied in children under 2 years of age. To fill this gap, we performed this retrospective observational study to determine the causes of obstructive sleep apnea (OSA) in children admitted to our hospital between January 2016 and February 2018, after a brief unexplained event (BRUE) or for OSA. We reviewed the medical charts of 82 patients (39 males; BRUE n = 48; OSAS n = 34) and divided them into two age groups: < 1 year old (1-12 months; n = 59) and >1 year old (>12-24 months; n = 23). Assessment included nap polysomnography, multichannel intraluminal impedance-pH, and nasopharyngoscopy. Sleep disordered breathing was comparable between the two groups. Omega-shaped epiglottis, laryngomalacia, and nasal septum deviation were more frequent in the younger group, and nasal congestion in older group. Tonsillar and adenoidal hypertrophy was more frequent in the older group, while laryngomalacia and gastroesophageal reflux was more frequent in the younger group. Tonsil and adenoid size were associated with grade of apnea-hypopnea index severity in the older group, and laryngomalacia and gastroesophageal reflux in the younger group. The main causes of respiratory sleep disorders differ in children before or after age 1 year. Our findings have potential clinical utility for assessing the pathophysiology of obstructive sleep disordered breathing in patients less than 2 years old.


Assuntos
Obstrução das Vias Respiratórias , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Idoso , Obstrução das Vias Respiratórias/complicações , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Polissonografia , Estudos Retrospectivos , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/fisiopatologia
8.
Medicine (Baltimore) ; 99(19): e20055, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384469

RESUMO

INTRODUCTION: Sleep apnea-hypopnea syndrome (SAHS) is a multifactorial disease characterized by recurrent hypopnea or respiratory interruption during sleep, which causes intermittent hypoxemia, hypercapnia, and sleep structure disturbances. An association between ankylosing spondylitis (AS) and the type of SAHS has rarely been reported in the literature. Here, we present a case of SAHS in a patient with AS and discuss the possible mechanism underlying the type of SAHS. PATIENT CONCERNS: A 46-year-old man presented with a 15-year history of AS. He had been receiving sulfasalazine for symptomatic relief and had never been on immunosuppressive therapy. DIAGNOSIS: The patient was diagnosed with SAHS in addition to AS. INTERVENTIONS: We instituted treatment with methylprednisolone (5 mg, oral, daily), leflumomide (20 mg, oral, daily), bicyclol tablets (25 mg, oral, 3 times a day), and ursodeoxycholic acid tablets (10 mg/kg, oral, daily). The patient received etanercept (50 mg, sc, once a week) as his condition deteriorated. In addition, for management of SAHS symptoms, the patient received nasal continuous positive airway pressure (CPAP) during sleep. OUTCOMES: Six months after commencement of the treatment, the clinical manifestations of SAHS and AS had significantly improved. CONCLUSIONS: We hypothesize that patients with AS are prone to sleep apnea due to airway compression, central depression of respiration, abnormal inflammatory responses. Hence, careful assessment toward potential SAHS symptoms should be considered especially in patients with AS.


Assuntos
Apneia Obstrutiva do Sono/etiologia , Espondilite Anquilosante/complicações , Humanos , Masculino , Pessoa de Meia-Idade
10.
JAMA ; 323(14): 1389-1400, 2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32286648

RESUMO

Importance: Obstructive sleep apnea (OSA) affects 17% of women and 34% of men in the US and has a similar prevalence in other countries. This review provides an update on the diagnosis and treatment of OSA. Observations: The most common presenting symptom of OSA is excessive sleepiness, although this symptom is reported by as few as 15% to 50% of people with OSA in the general population. OSA is associated with a 2- to 3-fold increased risk of cardiovascular and metabolic disease. In many patients, OSA can be diagnosed with home sleep apnea testing, which has a sensitivity of approximately 80%. Effective treatments include weight loss and exercise, positive airway pressure, oral appliances that hold the jaw forward during sleep, and surgical modification of the pharyngeal soft tissues or facial skeleton to enlarge the upper airway. Hypoglossal nerve stimulation is effective in select patients with a body mass index less than 32. There are currently no effective pharmacological therapies. Treatment with positive airway pressure lowers blood pressure, especially in patients with resistant hypertension; however, randomized clinical trials of OSA treatment have not demonstrated significant benefit on rates of cardiovascular or cerebrovascular events. Conclusions and Relevance: OSA is common and the prevalence is increasing with the increased prevalence of obesity. Daytime sleepiness is among the most common symptoms, but many patients with OSA are asymptomatic. Patients with OSA who are asymptomatic, or whose symptoms are minimally bothersome and pose no apparent risk to driving safety, can be treated with behavioral measures, such as weight loss and exercise. Interventions such as positive airway pressure are recommended for those with excessive sleepiness and resistant hypertension. Managing asymptomatic OSA to reduce cardiovascular and cerebrovascular events is not currently supported by high-quality evidence.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Exercício Físico , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Avanço Mandibular/instrumentação , Prognóstico , Fatores de Risco , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/cirurgia , Perda de Peso
11.
Biochim Biophys Acta Mol Basis Dis ; 1866(6): 165753, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32126269

RESUMO

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated to intermittent hypoxia (IH) and is an aggravating factor of non-alcoholic fatty liver disease (NAFLD). We investigated the effects of hypoxia in both in vitro and in vivo models of NAFLD. METHODS: Primary rat hepatocytes treated with free fatty acids (FFA) were subjected to chemically induced hypoxia (CH) using the hypoxia-inducible factor-1 alpha (HIF-1α) stabilizer cobalt chloride (CoCl2). Triglyceride (TG) content, mitochondrial superoxide production, cell death rates, cytokine and inflammasome components gene expression and protein levels of cleaved caspase-1 were assessed. Also, Kupffer cells (KC) were treated with conditioned medium (CM) and extracellular vehicles (EVs) from hypoxic fat-laden hepatic cells. The choline deficient L-amino acid defined (CDAA)-feeding model used to assess the effects of IH on experimental NAFLD in vivo. RESULTS: Hypoxia induced HIF-1α in cells and animals. Hepatocytes exposed to FFA and CoCl2 exhibited increased TG content and higher cell death rates as well as increased mitochondrial superoxide production and mRNA levels of pro-inflammatory cytokines and of inflammasome-components interleukin-1ß, NLRP3 and ASC. Protein levels of cleaved caspase-1 increased in CH-exposed hepatocytes. CM and EVs from hypoxic fat-laden hepatic cells evoked a pro-inflammatory phenotype in KC. Livers from CDAA-fed mice exposed to IH exhibited increased mRNA levels of pro-inflammatory and inflammasome genes and increased levels of cleaved caspase-1. CONCLUSION: Hypoxia promotes inflammatory signals including inflammasome/caspase-1 activation in fat-laden hepatocytes and contributes to cellular crosstalk with KC by release of EVs. These mechanisms may underlie the aggravating effect of OSAS on NAFLD. [Abstract word count: 257].


Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Hipóxia/genética , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Hepatopatia Gordurosa não Alcoólica/genética , Apneia Obstrutiva do Sono/genética , Animais , Caspase 1/genética , Deficiência de Colina/genética , Deficiência de Colina/metabolismo , Deficiência de Colina/patologia , Cobalto/toxicidade , Modelos Animais de Doenças , Vesículas Extracelulares/genética , Vesículas Extracelulares/metabolismo , Vesículas Extracelulares/patologia , Ácidos Graxos não Esterificados/farmacologia , Regulação da Expressão Gênica/efeitos dos fármacos , Hepatócitos/metabolismo , Hepatócitos/patologia , Humanos , Hipóxia/induzido quimicamente , Hipóxia/metabolismo , Hipóxia/patologia , Inflamassomos/genética , Inflamação/induzido quimicamente , Inflamação/genética , Inflamação/metabolismo , Inflamação/patologia , Interleucina-1beta/genética , Macrófagos do Fígado/metabolismo , Macrófagos do Fígado/patologia , Camundongos , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/patologia , Ratos , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/metabolismo , Apneia Obstrutiva do Sono/patologia , Triglicerídeos/genética
12.
J Craniofac Surg ; 31(4): e356-e359, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32217860

RESUMO

Robin sequence with cleft mandible and limb anomalies, known as Richieri-Costa-Pereira syndrome (RCPS), is an autosomal recessive acrofacial dysostosis characterized by mandibular cleft and other craniofacial anomalies and respiratory complications. The aim of this cross-sectional study was to describe the hyoid and head posture of 9 individuals with RCPS using cephalometric measurements and provide a discussion about its implications in obstructive sleep apnea syndrome (OSAS). The study was conducted on lateral cephalograms of patients with RCPS and 9 selected age-matched controls in tertiary cleft center in Brazil. The cephalograms were digitized and analyzed on a software to obtain the vertical and horizontal hyoid position, its relationship with the mandible and the relation of the cranial base and postvertebral line. The t test was used for analysis of means and Levene's test for equality of variances.Cephalometric measurements H-S (vertical distance between hyoid bone and sella) (Supplemental Digital Content, Figure 1, http://links.lww.com/SCS/B247) and H-C4lp (horizontal position of the hyoid in relation to the post-pharyngeal space) showed statistically significant difference compared to controls (P < 0.05). Therefore, the hyoid bone was more inferiorly and posteriorly positioned in the study group compared with the control group. The vertebrae measurements did not present differences compared to controls. The described position of hyoid bone could be involved in the severe OSAS of RCPS patients.


Assuntos
Pé Torto Equinovaro , Deformidades Congênitas da Mão , Cabeça , Osso Hioide , Síndrome de Pierre Robin , Postura , Adolescente , Cefalometria , Criança , Pé Torto Equinovaro/diagnóstico por imagem , Pé Torto Equinovaro/genética , Estudos Transversais , RNA Helicases DEAD-box/genética , Fator de Iniciação 4A em Eucariotos/genética , Deformidades Congênitas da Mão/diagnóstico por imagem , Deformidades Congênitas da Mão/genética , Humanos , Lactente , Masculino , Síndrome de Pierre Robin/diagnóstico por imagem , Síndrome de Pierre Robin/genética , Apneia Obstrutiva do Sono/etiologia
13.
Plast Reconstr Surg ; 145(4): 803e-813e, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221229

RESUMO

BACKGROUND: Macroglossia, a cardinal feature of the (epi)genetic disorder Beckwith-Wiedemann syndrome, is associated with obstructive sleep apnea, speech and/or feeding difficulties, and dental or jaw malalignment. These sequelae may be treated and/or prevented with tongue reduction surgery; the authors sought to determine whether certain Beckwith-Wiedemann syndrome patients may benefit from early surgical intervention before age 12 months. METHODS: The authors conducted a retrospective review of patients with Beckwith-Wiedemann syndrome who underwent tongue reduction from 2014 to 2019. The authors assessed primary outcomes of change in obstructive sleep apnea by polysomnography, respiratory support required, and feeding route before and after tongue reduction, and reviewed postoperative complications and the need for repeated tongue reduction. RESULTS: Of the 36 patients included, the median age at tongue reduction was 9.5 months (interquartile range, 3.8 to 22.8 months). For those with severe obstructive sleep apnea, there was a significant reduction in the obstructive apnea hypopnea index from 30.9 ± 21.8 per hour to 10.0 ± 18.3 per hour (p =0.019) and improvement in nadir oxyhemoglobin saturation from 72 ± 10 percent to 83 ± 6 percent (p =0.008). Although there was no significant change in overall supplemental feeding tube or respiratory support, there were specific patients who experienced clinically meaningful improvement. Of note, these positive outcomes applied equally to those who underwent surgery at a younger age (<12 months). To date, only one patient required a repeated tongue reduction. CONCLUSION: Based on improved polysomnographic findings and rarity of surgical complications or repeated surgery, the authors' data support the safety and efficacy of this early intervention when clinical indications are present and an experienced multidisciplinary team is available for consultation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Síndrome de Beckwith-Wiedemann/cirurgia , Glossectomia/métodos , Macroglossia/congênito , Complicações Pós-Operatórias/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Síndrome de Beckwith-Wiedemann/complicações , Síndrome de Beckwith-Wiedemann/genética , Pré-Escolar , Estudos de Viabilidade , Métodos de Alimentação/estatística & dados numéricos , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/prevenção & controle , Feminino , Seguimentos , Glossectomia/efeitos adversos , Humanos , Lactente , Macroglossia/complicações , Macroglossia/genética , Macroglossia/cirurgia , Masculino , Polissonografia/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Sistema de Registros/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controle , Tempo para o Tratamento , Língua/cirurgia , Resultado do Tratamento
14.
Rev. neurol. (Ed. impr.) ; 70(5): 179-182, 1 mar., 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193287

RESUMO

INTRODUCCIÓN: La estimulación del nervio vago (ENV) es una terapia utilizada en casos de epilepsia refractaria. Sus efectos secundarios son, con frecuencia, leves; sin embargo, se han descrito previamente alteraciones respiratorias durante el sueño. Casos clínicos. Los tres casos incluidos son representativos de alteraciones respiratorias durante el sueño (apnea del sueño y estridor) que surgen a consecuencia de la actividad de la ENV. CONCLUSIONES: Dada la elevada prevalencia del síndrome de apnea/hipopnea durante el sueño en pacientes con epilepsia refractaria, debería estudiarse su posible preexistencia en candidatos a ENV y considerarse su potencial aparición como consecuencia de la ENV en el seguimiento de pacientes con ENV activa


INTRODUCTION: Vagus nerve stimulation (VNS) is indicated in cases of refractory epilepsy. Its side effects are frequently minor, however, breathing disturbances during sleep have been previously reported. CASE REPORTS. Our three cases are representative of sleep-disordered breathing that occurred as a consequence of VNS activity in patients with refractory epilepsy. Sleep apnoea was observed in two patients and stridor in one patient. CONCLUSIONS: Given the high prevalence of sleep apnoea-hypopnoea syndrome in patients with refractory epilepsy, implantation of VNS should be ideally preceded by an assessment of the breathing during sleep. Furthermore, sleep-disordered breathing should be considered as a rare complication of VNS, and sleep apnoea should be investigated alongside data regarding VNS firing


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estimulação do Nervo Vago/efeitos adversos , Epilepsia/terapia , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/diagnóstico
15.
Int J Pediatr Otorhinolaryngol ; 133: 109967, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32120133

RESUMO

OBJECTIVE: Laryngomalacia is the most common cause of infant stridor, and obstructive sleep apnea (OSA) is sometimes found concurrently in patients with laryngomalacia. OSA has been shown to improve after surgical treatment of laryngomalacia, but the majority of laryngomalacia patients have spontaneous resolution of symptoms. It is unknown whether their comorbid OSA also resolves. This study seeks to define the incidence of OSA in laryngomalacia and assess for resolution of OSA with polysomnography data. METHODS: Retrospective cohort study at a tertiary care academic medical center. All pediatric patients with diagnoses of laryngomalacia or stridor were reviewed, and patients with laryngomalacia confirmed by Otolaryngologist exam were included. All patients with laryngomalacia were recommended to undergo polysomnography. RESULTS: A total of 108 patients had laryngomalacia confirmed by an Otolaryngologist. Of those patients, 56 completed a polysomnogram, and 44 (79%) were diagnosed with OSA. Among the OSA patients, 34 had no surgery, 5 underwent supraglottoplasty, and 5 underwent adenoidectomy or adenotonsillectomy. Follow-up polysomnograms were performed for 9 non-surgical patients, 4 supraglottoplasty patients, and 4 adenoidectomy or adenotonsillectomy patients. Mean change in AHI was -2.81 without surgery, -8.18 after supraglottoplasty, and -2.94 after adenoidectomy or adenotonsillectomy. CONCLUSION: OSA is often present in patients who have laryngomalacia, and the proportion in this population was higher than previous reports. The only significant predictor for obstructive sleep apnea was race, specifically Black/African American. Among patients with follow-up polysomnograms, the largest OSA improvement was in supraglottoplasty patients, but all patients improved.


Assuntos
Laringomalácia/complicações , Apneia Obstrutiva do Sono/etiologia , Adenoidectomia , Criança , Pré-Escolar , Feminino , Seguimentos , Glote/cirurgia , Humanos , Incidência , Lactente , Laringomalácia/cirurgia , Masculino , Polissonografia , Remissão Espontânea , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Tonsilectomia , Resultado do Tratamento
16.
Int J Pediatr Otorhinolaryngol ; 133: 109968, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32126418

RESUMO

INTRODUCTION: The prevalence of obstructive sleep apnea (OSA) in the pediatric population with Down syndrome (DS) is reported to be 45-76%. The criterion "gold" standard for diagnosing OSA is polysomnography (PSG). First-hand surgical treatment is adenotonsillectomy (ATE), and another option is adenopharyngoplasty (APP). The aims of this study were to determine the OSA prevalence among children with DS who had undergone PSG and to evaluate and compare the efficiency and results of ATE and APP treatments. METHODS AND MATERIALS: Children <18 years old with DS who underwent PSG at Karolinska University Hospital were included in this retrospective cohort study. Medical records were examined for patient age, sex, medical comorbidity diagnoses, and OSA treatment, and the results from PSG and the quality of life questionnaire OSA-18 were registered. The prevalence and degree of OSA were calculated. Results from a nonsystematic subgroup that underwent postoperative PSG and the OSA-18 were compiled to evaluate surgical efficiency. Pre- and postoperative results from APP and ATE patients were compared. RESULTS: In the study, 138 DS children were included. The OSA prevalence was 82.6%, and 39.9% had severe OSA, with a median (range) apnea hypopnea index (AHI) of 7.6 (0-104). Other comorbidity diagnoses were found for ear disease in 60%, circulatory disease in 51% and endocrine disease in 39% of patients. A nonsystematic subgroup of 33 patients underwent postoperative PSG, with a residual prevalence of moderate or severe OSA of 63.6%. Among the ATE and APP patients with pre- and postoperative PSG (n = 20), no difference between the groups was shown, but the values were significantly improved as a whole: the median AHI changed from 21.1 to 12.4 and the median OSA-18 rating changed from 54.0 to 35.0. CONCLUSIONS: In this population of children with DS, the OSA prevalence was over 80%, wherefore continued screening and treatment are strongly supported. Uncertain surgical efficiency was indicated, and no significant difference in the results for ATE and APP was shown. When interpreting the results, it should be taken into consideration that the frequency of postoperative PSG was low and nonsystematic and that the groups were unequal and small.


Assuntos
Adenoidectomia , Síndrome de Down/complicações , Apneia Obstrutiva do Sono/etiologia , Tonsilectomia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Polissonografia , Prevalência , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Inquéritos e Questionários , Resultado do Tratamento
17.
J Craniofac Surg ; 31(3): 716-719, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049900

RESUMO

BACKGROUND: Maxillomandibular advancement is an effective surgical option for obstructive sleep apnea (OSA) that achieves enlargement of the upper airway by physically expanding the facial skeleton. The authors sought to determine whether an advancement of 10 mm predicts surgical success and if any correlation existed between the magnitude of mandibular/maxillary advancement and improvement in polysomnography metrics using aggregated individual patient data from multiple studies. METHODS: A search of the PubMed database was performed to identify relevant articles that included preoperative and postoperative polysomnography data and measurements of the advancement of both the maxillary and mandibular portions of the face in patients with normal or class I malocclusion. Each patient was stratified into "Success" or "Failure" groups based on criteria defining a "Success" as a 50% preoperative to post-operative decrease in AHI or RDI and a post-operative AHI or RDI <20. RESULTS: A review of the PubMed database yielded 162 articles. Review of these resulted in 9 manuscripts and a total of 109 patients who met the inclusion criteria. There was no statistically significant difference in the amount of anterior advancement of either the mandible (P = 0.96) or the maxilla (P = 0.23) between the "Success" or "Failure" groups. CONCLUSIONS: While there is a paucity of individual data available, the current data does not support an ideal amount of maxillary or mandibular advancement that is required to obtain a surgical success in the treatment of OSA. Until a multicenter, prospective, randomized trial is performed, surgical planning should be tailored to patient-specific anatomy to achieve the desired result.


Assuntos
Má Oclusão de Angle Classe I/cirurgia , Apneia Obstrutiva do Sono/etiologia , Humanos , Má Oclusão de Angle Classe I/complicações , Mandíbula/fisiopatologia , Avanço Mandibular , Maxila/cirurgia , Polissonografia , Resultado do Tratamento
18.
BMJ Case Rep ; 13(2)2020 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-32041754

RESUMO

This case report presents an elderly male patient who on diagnosis with a large oropharyngeal tumour had no specific symptomatology apart from severe obstructive sleep apnoea. Histopathology revealed the tumour to be an adult rhabdomyoma, a rare but benign tumour arising from striated muscle cells. The tumour obstructed most of the oropharyngeal space and almost occluded the patient's airway when lying in a supine position. The patient was deemed operable, and the tumour was excised in toto using a transoral robotic surgery system. On follow-up, the patient had a severe reduction of apnoeas/hypopnoeas and felt subjectively 'reborn'. This is to our knowledge the first case where an adult rhabdomyoma is removed using a robot-assisted approach, thus presenting a new and viable option when considering removal of benign tumours of the pharynx leading to a very minor degree of morbidity for the patients.


Assuntos
Neoplasias Orofaríngeas/diagnóstico , Neoplasias Orofaríngeas/cirurgia , Rabdomioma/diagnóstico , Rabdomioma/cirurgia , Apneia Obstrutiva do Sono/etiologia , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino
19.
PLoS One ; 15(2): e0228533, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32053609

RESUMO

This systematic review and meta-analysis examines the associations of allergic rhinitis with sleep duration and sleep impairment. Observational studies published before August 2019 were obtained through English language literature searches in the PubMed, Embase, and CINAHL databases. Mean differences and odds ratios with 95% confidence intervals were extracted and used for meta-analysis. Heterogeneity was confirmed by the I2-heterogeneity test. Subgroup analysis was conducted to evaluate the influence of study design. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine the level of evidence. In total, 2544 records were identified through database searches; 914 duplicate records were excluded, 1452 records were removed after screening of titles and abstracts, 151 records were excluded after full-text screening, and 27 articles were included in the final meta-analyses. A total of 240,706,026 patients (19,444,043 with allergic rhinitis) were considered. No significant difference in sleep duration between the allergic rhinitis and the control groups was found. Patients with allergic rhinitis presented with significantly higher sleep quality scores, sleep disturbances scores, and sleep latency scores; more frequent use of sleep medications; and lower sleep efficiency as measured by the Pittsburgh Sleep Quality Index and polysomnography. Meta-analyses for adjusted odds ratios showed that allergic rhinitis was also associated with higher risks of nocturnal dysfunctions, including insomnia, nocturnal enuresis, restless sleep, sleep-disordered breathing, obstructive sleep apnea, and snoring. Meta-analysis for adjusted odds ratio also showed that allergic rhinitis was associated with daytime dysfunction, including difficulty waking up, daytime sleepiness, morning headache, and the use of sleep medications. The overall quality of evidence ranged from low to very low, indicating that caution is required when interpreting these results. This study demonstrates that there is a significant association of AR with sleep characteristics.


Assuntos
Rinite Alérgica/epidemiologia , Rinite Alérgica/fisiopatologia , Transtornos do Sono-Vigília/epidemiologia , Sono/fisiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade , Estudos Observacionais como Assunto/estatística & dados numéricos , Polissonografia , Qualidade de Vida , Rinite Alérgica/complicações , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/etiologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/etiologia , Ronco/diagnóstico , Ronco/epidemiologia , Ronco/etiologia , Adulto Jovem
20.
Sci Rep ; 10(1): 2101, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32034229

RESUMO

Lateral pharyngeal wall appears to be a critical culprit of obstructive sleep apnea (OSA) subjects and relocation pharyngoplasty has been expected to be a promising surgical option to correct retropalatal circumferential narrowing in OSA patients. The purpose of our study is to evaluate the therapeutic outcomes of relocation pharyngoplasty and its clinical effectiveness in OSA patients with retropalatal circumferential narrowing. We performed relocation pharyngoplasty combined with nasal surgery in 133 OSA patients with the following characteristics: apnea-hypopnea index (AHI) over 10, retropalatal circumferential narrowing greater than grade I when awake, and redundant soft tissue around the lateral pharyngeal wall. The analysis of surgical success rate was performed with the data of 68 subjects who underwent pre and postoperative polysomnography. The objective success rate of relocation pharyngoplasty was 52.9%, and significant reduction of mean AHI with improvement of lowest SpO2 was seen in 69% of patients 3 months after the surgery. The median AHI was decreased from preoperative 37.3 to postoperative 21.4. Median lowest SpO2 changed from 78.4 to 84.1%. Total sleep time, daytime sleepiness, and visual analogue scale for snoring showed improvement as well. Postoperative complications including pain or bleeding were minimal in 133 subjects and a few patients complained of subtle taste loss. Our data demonstrate that relocation pharyngoplasty can be a favorable surgical option fighting against retropalatal circumferential narrowing.


Assuntos
Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Palato Mole/cirurgia , Faringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Palato Mole/patologia , Polissonografia , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/patologia , Resultado do Tratamento , Adulto Jovem
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