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1.
Nutrients ; 13(10)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34684490

RESUMO

This review examines the effects of two popular intermittent fasting regimens on sleep in adults with overweight and obesity. Specifically, the effects of time restricted eating (TRE; eating all food within a 4-10 h window) and alternate day fasting (ADF; 600 kcal fast day alternated with ad libitum feast day) on sleep quality, sleep duration, sleep latency, sleep efficiency, insomnia severity, and risk of obstructive sleep apnea, will be summarized. The role of weight loss will also be discussed. Results from our review reveal that the majority of these trials produced weight loss in the range of 1-6% from baseline. Sleep quality and sleep duration remained unaltered with TRE and ADF, as assessed by the Pittsburgh Sleep Quality Index (PSQI). The effects of intermittent fasting on sleep latency and sleep efficiency are mixed, with one study showing worsening of these parameters, and others showing no effect. Insomnia severity and the risk of obstructive sleep apnea remained unchanged in the trials assessing these metrics. Taken together, these preliminary findings suggest that TRE and ADF produce mild to moderate weight loss (1-6%) but their effects on sleep remain unclear. Solid conclusions are difficult to establish since participants in the studies had healthy sleep durations and no clinical insomnia at baseline, leaving little room for improvement in these metrics. Moreover, none of the trials were adequately powered to detect statistically significant changes in any measure of sleep. Future well-powered trials, conducted in individuals with diagnosed sleep disturbances, will be necessary to elucidate the effect of these popular diets on sleep.


Assuntos
Restrição Calórica/efeitos adversos , Jejum/efeitos adversos , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Sono/fisiologia , Adulto , Restrição Calórica/métodos , Ensaios Clínicos como Assunto , Jejum/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/dietoterapia , Sobrepeso/complicações , Sobrepeso/dietoterapia , Apneia Obstrutiva do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Perda de Peso/fisiologia
2.
BMJ Case Rep ; 14(9)2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34531229

RESUMO

A 34-year-old woman with a history of congenital hypothyroidism and 15 years of obstructive sleep apnoea was admitted with a left submandibular swelling secondary to a dental infection. A CT scan of the neck identified an incidental 27 mm tongue base mass and the absence of any cervical thyroid tissue. This mass was not observable on examination of the oropharynx but was seen on fine nasendoscopy while thyroid function tests showed good thyroid stimulating hormone suppression. Her acute dental infection was treated and, following multidisciplinary team discussion, she was diagnosed with an ectopic lingual thyroid. She was offered different management options including no intervention and radio-iodide treatment but opted for transoral robotic resection. The lesion was resected en bloc with clear margins and histology confirmed lingual thyroid tissue. Since the procedure, she has remained free of sleep apnoea with a significantly improved quality of life.


Assuntos
Tireoide Lingual , Procedimentos Cirúrgicos Robóticos , Robótica , Apneia Obstrutiva do Sono , Adulto , Feminino , Humanos , Tireoide Lingual/diagnóstico , Tireoide Lingual/diagnóstico por imagem , Qualidade de Vida , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/cirurgia
3.
Ann Afr Med ; 20(3): 206-211, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34558450

RESUMO

Context: Obstructive sleep apnea (OSA)-related hypoxemia stimulates release of acute-phase proteins and reactive oxygen species that exacerbate insulin resistance and lipolysis and cause an augmented prothrombotic and proinflammatory state which can leads to premature death. Aims: This study aims to study the prevalence of OSA in diabetic patients. Setting and Design: It was a cross-sectional study, done over a period of 1 year in a tertiary care hospital. Materials and Methods: A total of 149 type 2 diabetic patients were enrolled after taking written consent. All patients were subjected to STOP BANG questionnaire and patients falling in intermediate-high risk (score 3-8), were taken for overnight polysomnography to confirm the diagnosis of OSA (apnea hypopnea index ≥ 5). Statistical Analysis Used: Statistical Package for Social Sciences (SPSS) Version 21.0 statistical analysis software. Results: Fifty-five percent of our diabetic population were having OSA. The age of patients enrolled in the study ranged between 30 and 86 years and prevalence increases with an increase in age groups. Majority (61.7%) of our cases were males. Incremental trend in weight, body mass index (BMI), neck circumference, and waist circumference of OSA cases were found with increasing in severity of OSA. Mean levels of raised blood sugar and HbA1c were higher in severe OSA cases. Conclusions: OSA has a high prevalence in patients with type 2 diabetes mellitus. Patients with type 2 diabetes should be screened for OSA, even in the absence of symptoms, especially in individuals with higher waist circumference and BMI.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Índia/epidemiologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Polissonografia , Prevalência , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Ronco/complicações , Inquéritos e Questionários , Adulto Jovem
4.
Sci Rep ; 11(1): 15821, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34349139

RESUMO

This study aimed to investigate the correlation between monocyte to high-density lipoprotein cholesterol ratio (MHR) and obstructive sleep apnea (OSA) in patients with hypertension. A total of 246 hypertensive patients (67 controls, 65 mild, 51 moderate, and 63 severe OSA) were included. The relationship between MHR and OSA was analyzed. MHR correlated positively with apnea-hypopnea index (AHI), while negatively with mean SpO2 (P < 0.01). MHR was higher in OSA group than the control group (9.2 ± 2.6 vs. 10.8 ± 3.6, P < 0.001). Moreover, MHR in severe OSA group was the highest among all groups (9.2 ± 2.6, 10.2 ± 3.2, 10.4 ± 4.0, and 11.8 ± 3.4 in control, mild, moderate, and severe OSA group, respectively, P < 0.001). Logistic regression analysis demonstrated that MHR was an independent predictor of the presence of OSA (OR = 1.152, P < 0.01) and severe OSA (OR = 1.142, P < 0.01). Area under the curve of MHR was 0.634 (P < 0.05) and 0.660 (P < 0.05) for predicting OSA and severe OSA respectively in the ROC analysis. In conclusion, MHR increased with the severity of OSA. As a practical and cost-effective test, MHR was expected to be an available marker in evaluating OSA risk and severity in hypertensive patients.


Assuntos
Biomarcadores/sangue , HDL-Colesterol/sangue , Hipertensão/complicações , Monócitos/citologia , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Estudos de Casos e Controles , China/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia
5.
Plast Reconstr Surg ; 148(2): 387-398, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398089

RESUMO

BACKGROUND: The purpose of this study was to evaluate the comparative incidence of obstructive sleep apnea following velopharyngeal insufficiency surgery in the United States. METHODS: A retrospective analysis of cleft and noncleft pediatric patients who underwent velopharyngeal insufficiency surgery was performed using the IBM MarketScan Commercial Database. Patients were tracked longitudinally from 2007 to 2016 to evaluate the incidence of obstructive sleep apnea. Multivariable regression was used to evaluate predictors of postoperative obstructive sleep apnea and surgical revision. RESULTS: A total of 1098 patients underwent a pharyngeal flap (61.0 percent), sphincter pharyngoplasty (22.2 percent), or palatal lengthening with or without island flaps (16.8 percent). Diagnoses were predominantly cleft lip and/or palate (52.8 percent) and congenital oropharyngeal anomalies (42.6 percent). Eighty patients (7.3 percent) developed obstructive sleep apnea at an average of 10.2 months postoperatively. Predictors of obstructive sleep apnea included older age (p = 0.014) and head and neck neoplasm (p = 0.011). The obstructive sleep apnea rate following sphincter pharyngoplasty was 11.1 percent, compared to 7.2 percent after pharyngeal flap surgery. Compared to sphincter pharyngoplasty, pharyngeal flap surgery was associated with a lower risk of further surgery (OR, 0.43; p = 0.010). Of patients with cleft lip and/or palate, 35 developed obstructive sleep apnea (6.0 percent) without a significant association with procedure type. CONCLUSIONS: In this national claims database analysis of cleft and noncleft pediatric patients, the rate of obstructive sleep apnea following velopharyngeal insufficiency surgery was not significantly different for pharyngeal flap compared to sphincter pharyngoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Apneia Obstrutiva do Sono/epidemiologia , Insuficiência Velofaríngea/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Apneia Obstrutiva do Sono/etiologia , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/transplante , Resultado do Tratamento , Estados Unidos/epidemiologia , Esfíncter Velofaríngeo/cirurgia
7.
Arch Dis Child ; 106(10): 954-960, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34244167

RESUMO

INTRODUCTION: Obstructive sleep apnoea (OSA) and feeding difficulties are key problems for Pierre Robin sequence (PRS) infants. OSA management varies between treatment centres. Sleep positioning represents the traditional OSA treatment, although its effectiveness remains insufficiently evaluated. DESIGN: To complete a polysomnographic (PSG) evaluation of effect of sleep position on OSA in PRS infants less than 3 months of age. We analysed a 10-year national reference centre dataset of 76 PRS infants. PSG was performed as daytime recordings for 67 in the supine, side and prone sleeping position when possible. In most cases, recording included one cycle of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep in each position. RESULTS: One-third of infants (9/76, 12%) had severe OSA needing treatment intervention prior to PSG. During PSG, OSA with an obstructive apnoea and hypopnoea index (OAHI) >5 per hour was noted in 82% (55/67) of infants. OSA was most severe in the supine and mildest in the side or in the prone positions. The median OAHI in the supine, side and prone positions were 31, 16 and 19 per hour of sleep (p=0.003). For 68% (52/67) of the infants, either no treatment or positional treatment alone was considered sufficient. CONCLUSIONS: The incidence of OSA was 84% (64/76) including the nine infants with severe OSA diagnosed prior to PSG. For the most infants, the OSA was sleep position dependent. Our study results support the use of PSG in the evaluation of OSA and the use of sleep positioning as a part of OSA treatment.


Assuntos
Posicionamento do Paciente , Síndrome de Pierre Robin/complicações , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/terapia , Estatura , Peso Corporal , Desenvolvimento Infantil , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Posicionamento do Paciente/efeitos adversos , Polissonografia , Decúbito Ventral/fisiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Decúbito Dorsal/fisiologia
9.
Sleep Med ; 85: 147-149, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34329898

RESUMO

OBJECTIVE/BACKGROUND: Obesity and obstructive sleep apnea (OSA) are consequential conditions with significant overlap in the pediatric population. Early studies documented catch-up growth in underweight children after adenotonsillectomy, but more recent studies suggested that normal and even overweight children may experience excess weight gain after adenotonsillectomy. We performed a secondary analysis of Childhood Adenotonsillectomy Trial (CHAT) data to test whether there was an effect of early adenotonsillectomy on undesirable weight gain, defined as an increase in body mass index (BMI) Z score in an already overweight or obese child or a change from baseline normal or underweight to a follow up BMI Z score classified as overweight. PATIENTS/METHODS: We included 398 children with moderate OSA and complete anthropomorphic data randomized to adenotonsillectomy versus watchful waiting with supportive care. Pearson's χ2 and independent t tests were used to compare demographic, activity, sleep and anthropomorphic characteristics between children who did and did not experience undesirable weight gain over seven months. Logistic regression was used to test for an association between adenotonsillectomy and undesirable weight gain, both unadjusted and adjusted for age, sex, Black race, average parent-reported weekly activity level, mother's body mass index, average nightly sleep duration and either baseline or follow up AHI (in separate models). RESULTS: Forty three percent (n = 172) experienced undesirable weight gain. A similar percentage of children in both arms experienced undesirable weight gain (45% adenotonsillectomy vs 41% watchful waiting). Neither unadjusted nor adjusted regression analysis demonstrated a significant effect of adenotonsillectomy on undesirable weight gain. CONCLUSION: Adenotonsillectomy may not be an independent risk factor for undesirable weight gain in children.


Assuntos
Apneia Obstrutiva do Sono , Tonsilectomia , Adenoidectomia , Criança , Humanos , Polissonografia , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia/efeitos adversos , Ganho de Peso
10.
Sci Rep ; 11(1): 13528, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34188172

RESUMO

Obstructive sleep apnea (OSA) is much common and associated with worse clinical outcomes in patients with hypertrophic cardiomyopathy (HCM), however, the diagnosis of OSA in HCM is still insufficient. We aim to investigate the clinical predictors of OSA in a large series of patients with HCM. A total of 589 patients with HCM who underwent sleep evaluations were retrospectively enrolled. Data from clinical characteristics and polysomnography studies were recorded. OSA was present in 346 patients (58.7%). Patients who had OSA were older, more likely to be male and had more clinical comorbidities such as hypertension, atrial fibrillation and cardiac remodeling. Multivariate logistic analyses showed that male, age, body mass index, hypertension and left ventricular outflow tract obstruction were significant factors associated with OSA. The area under the ROC curve (AUC) was 0.78 (95% CI 0.74-0.82; P < 0.001). These factors were also able to identify moderate to severe OSA with an AUC of 0.77 (95% CI 0.73-0.81; P < 0.001). These findings suggest that identifying HCM patients with high risk for OSA is feasible using characteristics from clinical practices and clinicians should have no hesitate to conduct sleep test in these patients.


Assuntos
Cardiomiopatia Hipertrófica , Apneia Obstrutiva do Sono , Adulto , Fatores Etários , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Índice de Massa Corporal , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/epidemiologia , Cardiomiopatia Hipertrófica/fisiopatologia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/fisiopatologia
11.
J Plast Reconstr Aesthet Surg ; 74(10): 2674-2682, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34112566

RESUMO

INTRODUCTION: Obstructive sleep apnea (OSA) is frequently present in patients with syndromic craniosynostosis. The aim of this study is to determine the long-term effectiveness of our OSA treatment protocol in our tertiary center in a cohort of children with syndromic craniosynostosis. METHODS: Children with syndromic craniosynostosis born between January 2005 and December 2013 were eligible for inclusion (n = 114). Data from ambulatory and inhospital polysomnographies were used. The obstructive-apnea/hypopnea index was used for OSA classification. RESULTS: Polysomnographies were performed in 83 patients. Mild OSA was diagnosed in 19, moderate in six, and severe in seven children. Of the 32 patients with OSA, 12 patients (37.5%) initially received expectant care of which OSA resolved spontaneously in nine without recurrence. Twenty patients were surgically treated. Adenotonsillectomy (ATE) had a 90% success rate with no OSA recurrence. Monobloc surgery was performed in four patients with mild OSA, although not OSA-indicated. Monobloc was performed for moderate or severe OSA in six patients, in four patients in combination with ATE and with mandibular distraction in one. Monobloc surgery for moderate or severe OSA had a 100% success rate in treating OSA and decannulation. CONCLUSION: Expectant care is often sufficient to resolve mild OSA in patients with syndromic craniosynostosis, and should also be considered in patients with moderate OSA with close follow-up. ATE has an important role in the OSA treatment protocol. Monobloc surgery, combined with mandibular distraction on indication, is effective in resolving moderate to severe OSA with a stable long-term result.


Assuntos
Craniossinostoses/complicações , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/terapia , Adenoidectomia , Criança , Pré-Escolar , Protocolos Clínicos , Feminino , Seguimentos , Humanos , Lactente , Masculino , Mandíbula/cirurgia , Osteogênese por Distração , Polissonografia , Estudos Prospectivos , Recidiva , Índice de Gravidade de Doença , Tonsilectomia , Resultado do Tratamento , Conduta Expectante
12.
Life Sci ; 280: 119702, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34111462

RESUMO

AIMS: Nearly a third of U.S. veterans who deployed in support of the 1990-1991 Persian Gulf War are affected by Gulf War illness (GWI). Here we aimed to characterize whether subjective sleep complaints in GWI veterans are associated with objective sleep EEG disturbances relative to healthy veterans and controls; and whether Gulf War veterans show alterations in neural activity during sleep that differentiate them from healthy subjects. MAIN METHODS: We used high-density EEG (HDEEG) to assess regional patterns of rapid eye movement (REM) sleep and non-REM (NREM) sleep between three groups: Gulf War male veterans with fatigue and GWI, Gulf War male veterans without fatigue or GWI, and control males. The groups were matched relative to age, sex and obstructive sleep apnea. Topographic comparisons of nocturnal NREM and REM sleep were made between groups for all frequency bands. KEY FINDINGS: Topographic analysis revealed a broadband reduction in EEG power in a circumscribed region overlying the frontal lobe in both groups of Gulf War veterans, regardless of GWI and fatigue. This frontal reduction in neural activity was present, to some extent, across all frequency bands in NREM and REM sleep. SIGNIFICANCE: Given that our findings were observed in all Gulf War veterans, it appears unlikely that frontal sleep HDEEG power reductions prove wholly responsible for fatigue symptoms. These results provide avenues for research which may someday contribute to improved clinical care of formerly deployed veterans of the Persian Gulf War.


Assuntos
Lobo Frontal/fisiopatologia , Síndrome do Golfo Pérsico/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Sono , Adulto , Estudos de Casos e Controles , Eletroencefalografia , Fadiga/etiologia , Fadiga/fisiopatologia , Guerra do Golfo , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Golfo Pérsico/complicações , Polissonografia , Estudos Prospectivos , Apneia Obstrutiva do Sono/etiologia
13.
Heart Fail Clin ; 17(3): 369-376, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051969

RESUMO

It is generally considered that obstructive sleep apnea is a potential cause of heart failure (HF), and insomnia and central sleep apnea are results of HF. However, the number of reports describing the bidirectional relationship between sleep disorder and HF has increased. Sleep disorder may contribute to left ventricular diastolic dysfunction via left atrial overload, left ventricular remodeling, pulmonary hypertension, and atrial fibrillation, which lead to HF with preserved left ventricular ejection fraction. Overnight rostral fluid shift and lung congestion may lead to airflow obstruction in the upper pharynx and stimulate pulmonary irritant receptors, which induce hyperventilation and sleep disorder.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Insuficiência Cardíaca/complicações , Humanos , Apneia Obstrutiva do Sono/etiologia
14.
BMC Endocr Disord ; 21(1): 77, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882916

RESUMO

BACKGROUND: Understanding the causes and risk factors of metabolic syndrome is important for promoting population health. Oxidative stress has been associated with metabolic syndrome, and also obstructive sleep apnea. These are two diseases which have common prognostic characteristics for heart disease. The aim of this study was to examine the role of oxidative stress in the concurrent presence of metabolic syndrome and obstructive sleep apnea in a working population. METHODS: Participants were 163 artisan bakers in Shahroud, Iran, routinely exposed to significant heat stress and other oxidative stress indicators on a daily basis as part of their work. Using a cross-sectional design, data relevant to determining metabolic syndrome status according to International Diabetes Federation criteria, and the presence of obstructive sleep apnea according to the STOP-Bang score, was collected. Analyses included hierarchical binary logistic regression to yield predictors of the two diseases. RESULTS: Hierarchical binary logistic regression showed that oxidative stress - alongside obesity, no regular exercise, and smoking - was an independent predictor of metabolic syndrome, but not obstructive sleep apnea. Participants who were obese were 28 times more likely to have metabolic syndrome (OR 28.59, 95% CI 4.91-63.02) and 44 times more likely to have obstructive sleep apnea (OR 44.48, 95% CI 4.91-403.28). Participants meeting metabolic syndrome criteria had significantly higher levels of malondialdehyde (p <  0.05) than those who did not. No difference in oxidative stress index levels were found according to obstructive sleep apnea status. CONCLUSIONS: Our findings suggest that oxidative stress contributes to the onset of metabolic syndrome, and that obstructive sleep apnea is involved in oxidative stress. Whilst obesity, exercise, and smoking remain important targets for reducing the incidence of metabolic syndrome and obstructive sleep apnea, policies to control risks of prolonged exposure to oxidative stress are also relevant in occupations where such environmental conditions exist.


Assuntos
Síndrome Metabólica/epidemiologia , Estresse Oxidativo/fisiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Indústria Alimentícia , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Síndrome Metabólica/etiologia , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/metabolismo , Fatores de Risco , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/metabolismo
15.
Int J Pediatr Otorhinolaryngol ; 144: 110699, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33823467

RESUMO

BACKGROUND: Recent studies have shown that a short lingual frenulum is a potential risk factor for obstructive sleep apnea syndrome (OSAS) in children. A short frenulum leads to abnormal orofacial development and may consequently contribute to sleep-disordered breathing by narrowing the upper airways and increasing the risk of upper-airway collapsibility. The aim of this study was to assess the impact of a short lingual frenulum on the risk of OSAS in children. METHODS: Children from pre-, primary, secondary, and high school, aged 3-17 years, were included in the study. Parents/guardians were asked to fill in the Pediatric Sleep Questionnaire (PSQ), and then, children at risk of OSAS were enrolled in the study group. A control group was established randomly from patients with negative PSQ results. A physical examination, including measurements of head-forward posture (HFP) and length of the free tongue, inter-incisor distance and subjective high-arched palate evaluation was performed in children from both groups. RESULTS: A total of 1,500 PSQ questionnaires were distributed, and less than half (713) were returned correctly filled in. In the second part of the study, 135 children were evaluated: 67 in the study group and 68 in the control group. The mean ages were 9.4 ± 3.0 and 9.5 ± 3.1 years, respectively. Children in the study group had significantly shorter lingual frenula, higher HFP measures, and had a higher prevalence of a high-arched palate. Based on statistical analysis, a short lingual frenulum (OR 5.02 [1.58-15.94]). CONCLUSIONS: The study identified a relationship between a short lingual frenulum and the risk of OSAS in children. Detecting and addressing ankyloglossia in children is necessary before it leads to orofacial changes, malocclusion, and consequently, sleep apnea. Furthermore, OSAS was associated with higher HFP, but no relationship was found between the two parameters.


Assuntos
Anquiloglossia , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Criança , Humanos , Freio Lingual/cirurgia , Postura , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia
17.
Laryngoscope ; 131(9): E2603-E2608, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33764521

RESUMO

OBJECTIVE: To identify predictors of severe obstructive sleep apnea (OSA) in children under 3 years of age and to compare demographics, comorbidities, and polysomnographic characteristics of infants and toddlers with OSA. STUDY DESIGN: Retrospective case series. METHODS: We examined children under 3 years of age who had polysomnogram between August 2012 and March 2020. Demographics, clinical, and polysomnographic parameters were compared in children age 0-1 versus 1-3 years and 0-2 versus 2-3 years and severe versus mild-moderate OSA. Univariate analysis was used to compare age groups; multiple logistic regression for predictors of severe OSA. Significance was set at P < .05. RESULTS: Of the 413 children, 267 (65%) were male and 131 (32%) obese. The population included Hispanic (41%), African American (28%), and Caucasian (25%) children. A total of 98.5% had OSA and 35% had severe OSA. Children under 1 year of age more commonly had gastroesophageal reflux disease (GERD) (38% vs. 23%; P = .014); tonsillar hypertrophy was more common in children over 2 years of age (56% vs. 34%, P = .001). Down syndrome (odds ratio (OR): 3.16, 95% confidence interval (CI) = 1.14-8.68, P = .026) and tonsillar hypertrophy (OR: 1.97, 95% CI = 1.28-3.02, P = .002) were predictors of severe OSA. CONCLUSION: Children under 3 years of age with OSA are more likely to be male and have GERD. Down syndrome and tonsillar hypertrophy are predictors of severe OSA, and children with these conditions should be prioritized for polysomnography. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2603-E2608, 2021.


Assuntos
Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/etiologia , Texas
18.
Biochem Pharmacol ; 186: 114502, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33684391

RESUMO

OBJECTIVE: Obstructive sleep apnea (OSA) is a major risk factor for cardiovascular mortality. Apnea-induced chronic intermittent hypoxia (CIH) is a primary pathophysiological manifestation of OSA that promotes various cardiovascular alterations, such as aortic vascular remodeling. In this study, we investigated the association between angiopoietin-like proteins 8 (ANGPTL8) and CIH-induced aortic vascular remodeling in mice. METHODS: C57BL/6J male mice were divided into four groups: Normoxia group, ANGPTL8-/- group, CIH group, CIH + ANGPTL8-/- group. Mice in the normoxia group and ANGPTL8-/- group received no treatment, while mice in the CIH and CIH + ANGPTL8-/- group were subjected to CIH (21%-5% O2, 180 s/cycle, 10 h/day) for 6 weeks. At the end of the experiments, intima-media thickness (IMT), elastin disorganization, and aortic wall collagen abundance were assessed in vivo. Immunohistochemistry and Western-blot were used to detect endoplasmic reticulum stress (ERS) and aortic vascular smooth muscle cell proliferation. ANGPTL8 shRNA and ANGPL8 overexpression were used in aortic vascular smooth muscle cells to investigate the mechanism of ANGPTL8 in CIH. RESULTS: Compared to the control group, CIH exposure significantly increased intima-media thickness (IMT), elastic fibers disorganization, and aortic wall collagen abundance. CIH also significantly increased blood pressure, induced hyperlipidemia, as well as the expression of ERS protein activating transcription factor-6 (ATF6) and aortic vascular smooth muscle cell proliferation. Contrary, ANGPTL8-/- significantly mitigated the CIH-induced vascular remodeling; ANGPTL8-/- decreased CIH-induced hypertension and hyperlipidemia, inhibited the protein expression of ATF6, and aortic vascular smooth muscle cell proliferation. Moreover, our in vitro study suggested that CIH could induce ANGPTL8 expression via hypoxia-inducible factor (HIF-1α); ANGPTL8 induced proliferation of aortic vascular smooth muscle cells via the ERS pathway. CONCLUSION: ANGPTL8-/- can prevent CIH-induced aortic vascular remodeling, probably through the inhibition of the ERS pathway. Therefore, ANGPTL8 might be a potential target in CIH-induced aortic vascular remodeling.


Assuntos
Proteínas Semelhantes a Angiopoietina/deficiência , Modelos Animais de Doenças , Hipóxia/metabolismo , Apneia Obstrutiva do Sono/metabolismo , Remodelação Vascular/fisiologia , Proteínas Semelhantes a Angiopoietina/genética , Animais , Células Cultivadas , Feminino , Humanos , Hipóxia/complicações , Hipóxia/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Gravidez , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/genética
19.
Medicine (Baltimore) ; 100(11): e25049, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725980

RESUMO

ABSTRACT: A recent report demonstrated that the prevalence of obstructive sleep apnea (OSA) is 67.6% among Caucasian and Chinese patients with primary aldosteronism (PA). Moreover, the report showed a significant association between plasma aldosterone concentration (PAC) and the severity of OSA in Caucasian patients. However, no studies have examined the prevalence of OSA with PA or the association of its severity with PAC in the Japanese population. We retrospectively evaluated the prevalence and severity of OSA in 71 newly diagnosed Japanese patients with PA. Thirty-nine (55%) of the 71 patients were diagnosed with OSA, and 69% of PA patients with OSA reported snoring. No correlation was found between the respiratory event index (REI), snoring index, and PAC and plasma renin activity (PRA). In contrast, REI correlated significantly with body mass index (BMI), which was significantly correlated with PRA. In conclusion, although the severity of OSA did not correlate with PAC and PRA, there was a high prevalence of OSA among Japanese patients with PA. Moreover, the severity of OSA was strongly affected by BMI. Thus, the examination of OSA in patients with PA and the proper management of OSA might be important for the Japanese population.


Assuntos
/estatística & dados numéricos , Hiperaldosteronismo/complicações , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Aldosterona/sangue , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Hiperaldosteronismo/etnologia , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Renina/sangue , Estudos Retrospectivos , Apneia Obstrutiva do Sono/etnologia , Apneia Obstrutiva do Sono/etiologia , Ronco/epidemiologia , Ronco/etnologia , Ronco/etiologia
20.
Arch Pediatr ; 28(3): 186-190, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33714673

RESUMO

OBJECTIVE: To assess the respiratory function and sleep characteristics of obese adults and children. METHODS: All patients with non-syndromic, severe obesity (BMI ≥3 z-scores for children and ≥40.00kg/m2 for adults), referred for pulmonary function tests at Lille University Hospital, were retrospectively included. RESULTS: A total of 69 children (mean±SD BMI 36.8±6.7 and mean BMI z-score 4.7±1.0) and 70 adults were included (mean BMI 45.7±6.2). Metabolic syndrome was diagnosed in 13 children (26%) and 40 adults (80%). Reduced lung volumes were observed in 34 children (50.0%) and 16 adults (24.0%) and both the mean functional residual capacity (FRC) and the mean residual volume (RV) were lower in children than in adults (FRC: -1.7±2.1 z-score in children vs. -1.0±1.1 in adults, P=0.026; and RV: -0.8±1.2 z-score in children vs. -0.1±1.1 in adults, P=0.002). The prevalence of severe obstructive sleep apnea syndrome was greater in adults (40.7% vs. 18.8%, P=0.007). Children had a higher average oxygen saturation (median of 96.0% [91.0-98.0] vs. 93.0% [76.0-97.0] in adults, P<0.0001). CONCLUSION: Obesity has consequences for lung volumes in children; however, a longitudinal study is needed to determine the impact on pulmonary expansion and growth.


Assuntos
Desenvolvimento Infantil , Pulmão/crescimento & desenvolvimento , Obesidade Mórbida/fisiopatologia , Obesidade Pediátrica/fisiopatologia , Apneia Obstrutiva do Sono/etiologia , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Polissonografia , Testes de Função Respiratória , Estudos Retrospectivos , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Adulto Jovem
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