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2.
Expert Rev Respir Med ; 16(8): 917-929, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35949101

RESUMO

INTRODUCTION: The recent continuous positive airway pressure (CPAP) crisis has highlighted the need for alternative obstructive sleep apnea (OSA) therapies. This article serves to review OSA pathophysiology and how sleep apnea mechanisms may be utilized to individualize alternative treatment options. AREAS COVERED: The research highlighted below focuses on 1) mechanisms of OSA pathogenesis and 2) CPAP alternative therapies based on mechanism of disease. We reviewed PubMed from inception to July 2022 for relevant articles pertaining to OSA pathogenesis, sleep apnea surgery, as well as sleep apnea alternative therapies. EXPERT OPINION: Although the field of individualized OSA treatment is still in its infancy, much has been learned about OSA traits and how they may be targeted based on a patient's physiology and preferences. While CPAP remains the gold-standard for OSA management, several novel alternatives are emerging. CPAP is a universal treatment approach for all severities of OSA. We believe that a personalized approach to OSA treatment beyond CPAP lies ahead. Additional research is needed with respect to implementation and combination of therapies longitudinally, but we are enthusiastic about the future of OSA treatment based on the data presented here.


Assuntos
Terapias Complementares , Apneia Obstrutiva do Sono , Terapias Complementares/métodos , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Medicina de Precisão , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia
4.
Acta Otorhinolaryngol Ital ; 42(3): 273-280, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35880367

RESUMO

Objective: This study reports our experience in a selected cohort of patients affected by mild-moderate OSAS, without tonsillar obstruction, and treated with pharyngoplasty. Methods: In a case-control retrospective study, we compared modified expansion sphincter pharyngoplasty (MESP) to modified barbed reposition pharyngoplasty (MBRP) in adult patients with oropharyngeal transversal collapse with a BMI ≤ 30 kg/m2, and mild-moderate obstructive sleep apnoea syndrome (OSAS). A clinical evaluation, including collection of anthropometric data and sleep endoscopy, was performed. Six months after surgery, symptoms recording, clinical evaluation and polysomnography (PSG) were repeated. Results: We enrolled 20 patients: 10 treated with MESP and 10 treated with MBRP. Mean apnoea-hypoapnoea index (AHI) was 22.8 (± 5.63). We observed in both groups a significant reduction of AHI and oropharyngeal obstruction (p = 0.01), with a success rate, according with Sher's criteria, of 90% for MESP and 80% for MBRP, respectively. Post-surgical pain and snoring reduction were significantly lower with MBRP. Conclusions: We recorded similar success rates for both techniques. MBRP may be considered better than MESP due to less surgical time, no potential mucosal damage, absence of knots, and faster recovery with less pain.


Assuntos
Faringe , Apneia Obstrutiva do Sono , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Humanos , Faringe/fisiopatologia , Faringe/cirurgia , Polissonografia , Estudos Retrospectivos , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/cirurgia , Ronco/prevenção & controle , Resultado do Tratamento
9.
Biomed Res Int ; 2022: 7242667, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35224099

RESUMO

Obstructive sleep apnea (OSA) is a sleep disorder characterized by periodic episodes of partial or complete upper airway obstruction caused by narrowing or collapse of the pharyngeal airway despite ongoing breathing efforts during sleep. Fall in the blood oxygen saturation and cortical arousals are prompted by this reduction in the airflow which lasts for at least 10 seconds. Impaired labor performance, debilitated quality of life, excessive daytime sleepiness, high snoring, and tiredness even after a whole night's sleep are the primary symptoms of OSA. In due course, the long-standing contributions of OSA culminate in hypertension, arrhythmia, cerebrovascular disease, and heart failure. The traditional diagnostic approach of OSA is the laboratory-based polysomnography (PSG) overnight sleep study, which is a tedious and labor-intensive process that exaggerates the discomfort to the patient. With the advent of computer-aided diagnosis (CAD), automatic detection of OSA has gained increasing interest among researchers in the area of sleep disorders as it influences both diagnostic and therapeutic decisions. The research literature on sleep apnea published during the last decade has been surveyed, focusing on the varied screening approaches accustomed to identifying OSA events and the developmental knowledge offered by multiple contributors from the software perspective. The current study presents an overview of the pathophysiology of OSA, the detection methods, physiological signals related to OSA, the different preprocessing, feature extraction, feature selection, and classification techniques employed for the detection and classification of OSA. Consequently, the research challenges and research gaps in the diagnosis of OSA are identified, critically analyzed, and presented in the best possible light.


Assuntos
Simulação por Computador , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Humanos
13.
J Diabetes Res ; 2022: 4950528, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35187177

RESUMO

AIMS: We aimed to explore whether visceral adiposity indices were significantly associated with obstructive sleep apnea (OSA) in type 2 diabetes (T2DM) patients. METHODS: 100 patients with T2DM who underwent overnight polysomnography were analyzed in this study. Anthropometric data, lipid profiles, and glycemic parameters were recorded. Body fat percentage (BFP) and visceral adipose tissue area (VAT area) were collected from a whole body scan using dual-energy X-ray absorptiometry (DXA). Multivariate logistic regression analysis was performed to explore the associations of AHI with BFP, VAT area, and CVAI. RESULTS: The prevalence rate of OSA was 80%, and the mean (±SD) of age was 47.0 ± 13.6 years. Apnea-hypopnea index (AHI) was significantly and positively associated with either VAT area (r = 0.433, p ≤ 0.001) or Chinese visceral adiposity index (CVAI) (r = 0.355, p ≤ 0.001) but not for BFP (r = 0.107, p = 0.294). Multivariate logistic regression analyses showed that VAT area and CVAI were significantly associated with increased risk of OSA, and the adjusted ORs were (95% CI) 1.025 (1.003-1.047, p = 0.023) and 1.018 (1.002-1.034, p = 0.030), respectively. However, there was no significant association between BFP and increased risk of OSA. CONCLUSIONS: VAT area and CVAI were independent risk factors of OSA in the patients with T2DM.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Gordura Intra-Abdominal , Apneia Obstrutiva do Sono/etiologia , Absorciometria de Fóton/métodos , Absorciometria de Fóton/estatística & dados numéricos , Adulto , Análise de Variância , China/epidemiologia , Correlação de Dados , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Polissonografia/estatística & dados numéricos , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Estatísticas não Paramétricas
15.
Med Sci Monit ; 28: e933448, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34975145

RESUMO

BACKGROUND Obstructive sleep apnea (OSA) is a common disease that can lead to intermittent hypoxia, increased sympathetic overdrive, and excessive oxidative stress, and eventually lead to cardiovascular/cerebrovascular diseases and metabolic disorders. The prevalence of OSA is reported to be higher in people with certain cardiovascular diseases (CVD). Therefore, the relationship between OSA and CVD has been gradually favored by researchers. MATERIAL AND METHODS Data were downloaded from the Web of Science Core Collection database. Citespace was used to remove duplicated data and construct knowledge visual maps. RESULTS A total of 7047 publications were obtained. The USA was the largest contributor as well as an important player in the cooperation network between nations. The leading institution was the Mayo Clinic. Our study ultimately identified the top 5 hotspots and 4 research frontiers in this field. Top 5 hotspots were: the specific types of obstructive sleep apnea-related cardiovascular and metabolic co-morbidities, the curative effects of CPAP on these co-morbidities, the specific mechanisms of co-morbidities, the importance of polysomnography on OSA and its co-morbidities with CVD, and the prevalence of OSA and its co-morbidities with CVD in particular populations. The top 4 frontiers were: the relationship between OSA and resistant hypertension, the molecular mechanisms of OSA and its co-morbidities with CVD, specific medications and treatment guidelines for the co-morbidities, and the mainstream research methods in this field. CONCLUSIONS This study provides insight and valuable information for researchers and helps to identify new perspectives concerning potential collaborators and cooperative institutions, hot topics, and research frontiers in this field.


Assuntos
Doenças Cardiovasculares , Pesquisa , Apneia Obstrutiva do Sono , Bibliometria , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Comorbidade , Pressão Positiva Contínua nas Vias Aéreas/métodos , Gerenciamento Clínico , Humanos , Cooperação Internacional , Redes e Vias Metabólicas , Polissonografia/métodos , Prevalência , Pesquisa/organização & administração , Pesquisa/estatística & dados numéricos , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/metabolismo , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia
16.
Int J Mol Sci ; 23(2)2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-35054894

RESUMO

Obstructive sleep apnea (OSA) is a chronic condition characterized by recurrent pauses in breathing caused by the collapse of the upper airways, which results in intermittent hypoxia and arousals during the night. The disorder is associated with a vast number of comorbidities affecting different systems, including cardiovascular, metabolic, psychiatric, and neurological complications. Due to abnormal sleep architecture, OSA patients are at high risk of circadian clock disruption, as has been reported in several recent studies. The circadian clock affects almost all daily behavioral patterns, as well as a plethora of physiological processes, and might be one of the key factors contributing to OSA complications. An intricate interaction between the circadian clock and hypoxia may further affect these processes, which has a strong foundation on the molecular level. Recent studies revealed an interaction between hypoxia-inducible factor 1 (HIF-1), a key regulator of oxygen metabolism, and elements of circadian clocks. This relationship has a strong base in the structure of involved elements, as HIF-1 as well as PER, CLOCK, and BMAL, belong to the same Per-Arnt-Sim domain family. Therefore, this review summarizes the available knowledge on the molecular mechanism of circadian clock disruption and its influence on the development and progression of OSA comorbidities.


Assuntos
Biomarcadores , Ritmo Circadiano/genética , Suscetibilidade a Doenças , Regulação da Expressão Gênica , Apneia Obstrutiva do Sono/genética , Relógios Circadianos/genética , Retroalimentação Fisiológica , Humanos , Fator 1 Induzível por Hipóxia/metabolismo , Transtornos Mentais/etiologia , Transtornos Mentais/metabolismo , Doenças Neurodegenerativas/etiologia , Doenças Neurodegenerativas/metabolismo , Fotoperíodo , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia
17.
PLoS One ; 17(1): e0262240, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35045111

RESUMO

An automatic non-contact cough detector designed especially for night audio recordings that can distinguish coughs from snores and other sounds is presented. Two different classifiers were implemented and tested: a Gaussian Mixture Model (GMM) and a Deep Neural Network (DNN). The detected coughs were analyzed and compared in different sleep stages and in terms of severity of Obstructive Sleep Apnea (OSA), along with age, Body Mass Index (BMI), and gender. The database was composed of nocturnal audio signals from 89 subjects recorded during a polysomnography study. The DNN-based system outperformed the GMM-based system, at 99.8% accuracy, with a sensitivity and specificity of 86.1% and 99.9%, respectively (Positive Predictive Value (PPV) of 78.4%). Cough events were significantly more frequent during wakefulness than in the sleep stages (p < 0.0001) and were significantly less frequent during deep sleep than in other sleep stages (p < 0.0001). A positive correlation was found between BMI and the number of nocturnal coughs (R = 0.232, p < 0.05), and between the number of nocturnal coughs and OSA severity in men (R = 0.278, p < 0.05). This non-contact cough detection system may thus be implemented to track the progression of respiratory illnesses and test reactions to different medications even at night when a contact sensor is uncomfortable or infeasible.


Assuntos
Acústica/instrumentação , Índice de Massa Corporal , Tosse/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Fases do Sono , Amplificadores Eletrônicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Valor Preditivo dos Testes
18.
Sleep Breath ; 26(1): 231-242, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-33961199

RESUMO

PURPOSE: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular diseases. The aim of the study was to assess the influence of OSAS on endothelial dysfunction and thrombosis biomarkers and to evaluate the effect of treatment with continuous positive airway pressure (CPAP) on biomarker levels. METHODS: NT-proBNP, sICAM-1, endothelin-1, von Willebrand factor, D-dimers, and thrombin-antithrombin complex (TAT) were measured in 50 patients diagnosed with moderate-to-severe OSAS. All patients underwent transthoracic echocardiography, and 38 months after the inclusion, 16 CPAP users and 22 non-CPAP users were reassessed. RESULTS: Sleep-related indices of apnea-hypopnea index (AHI) and mean SpO2 were associated with higher sICAM-1 levels (AHI < 30: 7.3 ± 4.7 vs. AHI ≥ 30: 19.5 ± 19.4 mg/ml, p = 0.04; SpO2 ≥ 90%: 11.9 ± 9.3 vs. SpO2 < 90%: 23.6 ± 25.8, p = 0.04). sICAM-1 levels were significantly higher in obese patients, particularly with BMI ≥ 40. Plasma levels of TAT were significantly correlated with the increased right ventricular size (right ventricular diameter ≤ 37 mm: 0.86 ± 0.70 vs. > 37 mm: 1.96 ± 1.20 ng/ml, p = 0.04). Endothelin-1 levels were higher in patients with decreased right ventricular function (right ventricle TDI-derived S' ≥ 12 cm/s: 11.5 ± 10.9 vs. < 12 cm/s: 26.0 ± 13.2 pg/ml, p = 0.04). An increase in NT-proBNP was related to impaired parameters of the right ventricular contractile function. There were no correlations between long-term CPAP therapy and the levels of biomarkers. CONCLUSION: Severe OSAS influences endothelial damage as manifested by an increase in sICAM-1 levels. Changes in right ventricular structure and function, observed mainly in patients with higher TAT and endothelin-1 levels, are also manifested by an increase in NT-proBNP levels. Long-term CPAP treatment does not seem to influence biomarkers in patients with moderate-to-severe OSAS, which may help to explain the lack of influence of CPAP on cardiovascular risk reduction.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Endotélio Vascular/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Apneia Obstrutiva do Sono/sangue , Resultado do Tratamento
19.
Sleep Breath ; 26(1): 315-323, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34089435

RESUMO

PURPOSE: To evaluate the influence of obstructive sleep apnea (OSA) on the P300 response of auditory event-related potentials (ERPs) and to correlate the electrophysiological findings with OSA severity. METHODS: Patients with no OSA and mild, moderate, and severe OSA according to polysomnography (PSG) with normal hearing and no comorbidities were studied. Individuals with a body mass index (BMI) ≥ 40 kg/m2, hypertension, diabetes, dyslipidemia, the use of chronic medications, and a risk of hearing loss were excluded. All patients underwent full PSG and auditory ERP measurement using the oddball paradigm with tone burst and speech stimuli. For P300 analysis (latencies and amplitudes), normal multiple linear regression models were adjusted with the groups (No OSA, Mild OSA, Moderate OSA, Severe OSA), age, BMI, and Epworth score as explanatory variables. RESULTS: We studied 54 individuals (47 males) aged 35 ± 8 years with a BMI of 28.4 ± 4.3 kg/m2. Patients were divided according to the apnea-hypopnea index (AHI) derived from PSG into no OSA (n = 14), mild (n = 16), moderate (n = 12), and severe OSA (n = 12) groups. Patients with severe OSA presented prolonged P300 latencies with tone burst stimuli compared to patients with no OSA and those with mild and moderate OSA. CONCLUSION: Severe OSA is associated with impairment of the P300 response of auditory ERPs, suggesting a decrease in the processing speed of acoustic information that may be mediated by the level of somnolence.


Assuntos
Potenciais Evocados Auditivos , Apneia Obstrutiva do Sono/fisiopatologia , Adulto , Correlação de Dados , Estudos Transversais , Fenômenos Eletrofisiológicos , Feminino , Humanos , Masculino , Polissonografia , Índice de Gravidade de Doença
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