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1.
J Morphol ; 285(6): e21741, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38837268

RESUMO

It is largely unknown how the tongue base and soft palate deform to alter the configuration of the oropharyngeal airway during respiration. This study is to address this important gap. After live sleep monitoring of five Yucatan and two Panepinto minipigs to verify obstructive sleep apnea (OSA), eight and four ultrasonic crystals were implanted into the tongue base and soft palate to circumscribe a cubic and square region, respectively. The 3D and 2D deformational changes of the circumscribed regions were measured simultaneously with electromyographic activity of the oropharyngeal muscles during spontaneous respiration under sedated sleep. The results indicated that both obese Yucatan and Panepinto minipigs presented spontaneous OSA, but not in three nonobese Yucatan minipigs. During inspiration, the tongue base showed elongation in both dorsal and ventral regions but thinning and thickening in the anterior and posterior regions, respectively. The widths showed opposite directions, widening in the dorsal but narrowing in the ventral regions. The soft palate expanded in both length and width. Compared to normal controls, obese/OSA ones showed similar directions of deformational changes, but the magnitude of change was two times larger in the tongue base and soft palate, and obese/OSA Panepinto minipigs presented 10 times larger changes in all dimensions of both the tongue base and the soft palate. The distance changes between the dorsal surface of tongue base and soft palate during inspiration increased in normal but decreased in obese OSA minipigs.


Assuntos
Obesidade , Palato Mole , Apneia Obstrutiva do Sono , Porco Miniatura , Língua , Animais , Suínos , Apneia Obstrutiva do Sono/fisiopatologia , Língua/fisiopatologia , Palato Mole/fisiopatologia , Obesidade/fisiopatologia , Obesidade/complicações , Obesidade/patologia , Fenômenos Biomecânicos , Eletromiografia , Respiração , Masculino
2.
Biomed Eng Online ; 23(1): 57, 2024 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-38902671

RESUMO

OBJECTIVE: Our objective was to create a machine learning architecture capable of identifying obstructive sleep apnea (OSA) patterns in single-lead electrocardiography (ECG) signals, exhibiting exceptional performance when utilized in clinical data sets. METHODS: We conducted our research using a data set consisting of 1656 patients, representing a diverse demographic, from the sleep center of China Medical University Hospital. To detect apnea ECG segments and extract apnea features, we utilized the EfficientNet and some of its layers, respectively. Furthermore, we compared various training and data preprocessing techniques to enhance the model's prediction, such as setting class and sample weights or employing overlapping and regular slicing. Finally, we tested our approach against other literature on the Apnea-ECG database. RESULTS: Our research found that the EfficientNet model achieved the best apnea segment detection using overlapping slicing and sample-weight settings, with an AUC of 0.917 and an accuracy of 0.855. For patient screening with AHI > 30, we combined the trained model with XGBoost, leading to an AUC of 0.975 and an accuracy of 0.928. Additional tests using PhysioNet data showed that our model is comparable in performance to existing models regarding its ability to screen OSA levels. CONCLUSIONS: Our suggested architecture, coupled with training and preprocessing techniques, showed admirable performance with a diverse demographic dataset, bringing us closer to practical implementation in OSA diagnosis. Trial registration The data for this study were collected retrospectively from the China Medical University Hospital in Taiwan with approval from the institutional review board CMUH109-REC3-018.


Assuntos
Eletrocardiografia , Aprendizado de Máquina , Processamento de Sinais Assistido por Computador , Síndromes da Apneia do Sono , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes da Apneia do Sono/diagnóstico , Feminino , Adulto , Idoso , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia
3.
Aust J Gen Pract ; 53(6): 358-362, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38840373

RESUMO

BACKGROUND: Obstructive sleep apnoea (OSA) is a highly prevalent condition associated with significant adverse health consequences affecting multiple organ systems. As the first point of contact for most patients with OSA, general practitioners (GPs) have an important role in the diagnosis of this common sleep disorder. OBJECTIVE: The aim of this paper is to improve awareness of common risk factors for and clinical presentation of OSA in primary care to improve patient health outcomes. We seek to understand how screening tools, such as the OSA50 questionnaire and the Epworth Sleepiness Scale, can help GPs identify patients who are at high risk for OSA with significant daytime sleepiness. DISCUSSION: Patients at high risk of symptomatic moderate-severe OSA should proceed to further investigation with sleep study testing. Referral to a sleep physician should be considered for patients with complex presentations or other suspected sleep disorders, commercial drivers, and those who fail to comply with or respond to initial OSA treatments.


Assuntos
Atenção Primária à Saúde , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Fatores de Risco , Inquéritos e Questionários , Polissonografia/métodos
4.
Aust J Gen Pract ; 53(6): 363-369, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38840374

RESUMO

BACKGROUND: Obstructive sleep apnoea (OSA) is common in the community and is increasing in prevalence. Primary care plays a pivotal role in the diagnosis and management of OSA. OBJECTIVE: This article focuses on the management options for a patient with an established diagnosis of OSA and provides a guide for driving licensing requirements. Indications for continuous positive airway pressure (CPAP) are discussed and tips provided to consider when conducting a review appointment, including trouble shooting. DISCUSSION: There are several treatment options available for patients with an established diagnosis of OSA. Selecting the optimal therapy involves aligning the symptoms and severity of OSA with the presence of comorbidities. CPAP is a highly effective therapy for symptomatic adults with moderate-to-severe OSA and for some symptomatic patients with mild OSA. Early trouble shooting of side effects and using supportive interventions increases the probability of long-term adherence, which is key to symptomatic improvement.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Atenção Primária à Saúde , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico , Pressão Positiva Contínua nas Vias Aéreas/métodos
5.
Brain Behav ; 14(6): e3546, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38844423

RESUMO

OBJECTIVE: Rapid eye movement (REM)-dependent obstructive sleep apnea syndrome (OSAS) is a specific subtype of OSAS having some phenotypic characteristics like a preference for a younger age, female gender, and milder severity. Such favorable features could make it possible to consider an overall benign course for this phenotype. However, accumulating data introduced its association with several cardiometabolic and vascular disorders recently. The primary objective of this study was to address the disease from the inflammation perspective and evaluate the potential inflammatory status in this variant via two accessible blood parameters: platelet distribution width (PDW) and systemic immune-inflammation index (SII). The secondary aim was to investigate whether this status, together with other disease characteristics, demonstrates consistency under different definitions of REM-dependent OSAS published previously. PATIENTS AND METHODS: The medical records of 35 patients with mild-to-moderate REM-dependent OSAS, 35 age- and sex-matched patients with REM-independent OSAS, and 25 non-OSA controls were retrospectively analyzed. Baseline features, polysomnographic characteristics, PDW, and SII were compared between the groups. Secondly, the analyses were repeated using different definitions of REM-dependent OSAS. Bivariate analyses were performed, and a multiple stepwise regression model was applied to adjust for body mass index (BMI) and cardiovascular risk (CVR) factors.  RESULTS: Mean PDW and SII were increased in patients with REM-dependent OSAS as compared to non-OSA controls (p = .022 and .029). The significance remained stable after adjustment for BMI and CVRs and was consistent according to different definitions. The Comparison of patients with REM-independent OSAS and non-OSA controls, as well as the two different subtypes of OSAS, did not yield significance. CONCLUSION: Based on the current findings, patients with REM-dependent OSAS appear to be susceptible to inflammation and should be carefully monitored for the negative consequences of that issue. To our knowledge, this study is the first to evaluate SII and PDW in REM-dependent OSAS.


Assuntos
Inflamação , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/sangue , Masculino , Feminino , Pessoa de Meia-Idade , Inflamação/sangue , Inflamação/fisiopatologia , Adulto , Estudos Retrospectivos , Sono REM/fisiologia , Polissonografia , Idoso , Índice de Massa Corporal
6.
CNS Neurosci Ther ; 30(6): e14786, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38828694

RESUMO

PURPOSE: To investigate dynamic functional connectivity (dFC) within the cerebellar-whole brain network and dynamic topological properties of the cerebellar network in obstructive sleep apnea (OSA) patients. METHODS: Sixty male patients and 60 male healthy controls were included. The sliding window method examined the fluctuations in cerebellum-whole brain dFC and connection strength in OSA. Furthermore, graph theory metrics evaluated the dynamic topological properties of the cerebellar network. Additionally, hidden Markov modeling validated the robustness of the dFC. The correlations between the abovementioned measures and clinical assessments were assessed. RESULTS: Two dynamic network states were characterized. State 2 exhibited a heightened frequency, longer fractional occupancy, and greater mean dwell time in OSA. The cerebellar networks and cerebrocerebellar dFC alterations were mainly located in the default mode network, frontoparietal network, somatomotor network, right cerebellar CrusI/II, and other networks. Global properties indicated aberrant cerebellar topology in OSA. Dynamic properties were correlated with clinical indicators primarily on emotion, cognition, and sleep. CONCLUSION: Abnormal dFC in male OSA may indicate an imbalance between the integration and segregation of brain networks, concurrent with global topological alterations. Abnormal default mode network interactions with high-order and low-level cognitive networks, disrupting their coordination, may impair the regulation of cognitive, emotional, and sleep functions in OSA.


Assuntos
Cerebelo , Rede Nervosa , Apneia Obstrutiva do Sono , Humanos , Masculino , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Cerebelo/fisiopatologia , Pessoa de Meia-Idade , Adulto , Rede Nervosa/diagnóstico por imagem , Rede Nervosa/fisiopatologia , Imageamento por Ressonância Magnética , Conectoma , Vias Neurais/fisiopatologia , Vias Neurais/diagnóstico por imagem , Rede de Modo Padrão/fisiopatologia , Rede de Modo Padrão/diagnóstico por imagem
7.
Zhonghua Jie He He Hu Xi Za Zhi ; 47(6): 504-508, 2024 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-38858200

RESUMO

Heart failure is strongly associated with obstructive and central sleep apnea. The landmark 2015 SERVE-HF trial showed that using adaptive servo-ventilation (ASV) for central sleep apnea (CSA) management was associated with an increased risk of all-cause and cardiovascular mortality among heart failure patients with reduced ejection fractions. Based on the result, the American Academy of Sleep Medicine and the European Society of Cardiology have recommended against the use of ASV for the treatment of CSA in patients with heart failure with an ejection fraction≤45%. Recently, the results from the ADVENT-HF trial have been formally published, indicating that ASV does not increase adverse outcomes and can improve patients' quality of life. Here, we go over these findings in detail.


Assuntos
Insuficiência Cardíaca , Apneia do Sono Tipo Central , Humanos , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/complicações , Apneia do Sono Tipo Central/terapia , Qualidade de Vida , Síndromes da Apneia do Sono/terapia , Síndromes da Apneia do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Volume Sistólico
8.
Zhonghua Jie He He Hu Xi Za Zhi ; 47(6): 554-559, 2024 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-38858207

RESUMO

Obstructive sleep apnea (OSA) is primarily characterized by intermittent nocturnal hypoxia and sleep fragmentation. Arousals interrupt sleep continuity and lead to sleep fragmentation, which can lead to cognitive dysfunction, excessive daytime sleepiness, and adverse cardiovascular outcome events, making arousals important for diagnosing OSA and reducing the risk of complications, including heart disease and cognitive impairment. Traditional arousal interpretation requires sleep specialists to manually score PSG recordings throughout the night, which is time consuming and has low inter-specialist agreement, so the search for simple, efficient, and reliable arousal detection methods can be a powerful tool to clinicians. In this paper, we systematically reviewed different methods for recognizing arousal in OSA patients, including autonomic markers (pulse conduction time, pulse wave amplitude, peripheral arterial tone, heart rate, etc.) and machine learning-based automated arousal detection systems, and found that autonomic markers may be more beneficial in certain subgroups, and that deep artificial networks will remain the main research method for automated arousal detection in the future.


Assuntos
Nível de Alerta , Polissonografia , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Nível de Alerta/fisiologia , Polissonografia/métodos , Aprendizado de Máquina
9.
Sleep Med ; 119: 229-233, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38704870

RESUMO

OBJECTIVE: Although manual scoring has been classically considered the gold standard to identify periodic leg movements (PLM), it is a very time consuming and expensive process, also subject to variability in interpretation. In the last decades, different authors have observed reasonably good agreement between automated PSG scoring algorithms and manual scoring in adults, according to established criteria. We aim to compare the automatic software analysis of our polysomnogram with the manual staging in children with sleep-disordered breathing. METHODS: We performed a semiautomatic method, in which an experienced technician watched the video recording and removed from the automatic analysis those movements that did not correspond to true candidate leg movement (LM). RESULTS: A total of 131 PSGs were studied; applying the established criteria, 65 children were diagnosed of obstructive sleep apnea, and 66 presented snoring but with no sleep apnea. The mean age was 6.7 years (±1.7) and twenty-five children (19.08 %) had a PLMI >5/h. Statistical differences were found not only for PLMI (manual: 2.20 (0.7, 4.1) vs automatic (6.4 (3.85,9.5); p < 0.001), but for almost of all indexes assessed between the automatic and the manual scoring analysis. The level of concordance was only moderate for PLM index (0.63 [0.51-0.72]); showing that, unlike the articles published in the adult population, automatic analysis is not accurate in children and, manually or semi-automatically analysis as ours need to be done. CONCLUSION: It seems that PLM detection algorithm might work accurately but, the real need would be a true LM detection algorithm.


Assuntos
Síndrome da Mioclonia Noturna , Polissonografia , Humanos , Polissonografia/métodos , Criança , Masculino , Feminino , Síndrome da Mioclonia Noturna/diagnóstico , Síndrome da Mioclonia Noturna/fisiopatologia , Algoritmos , Pré-Escolar , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Gravação em Vídeo , Software
10.
Sleep Med ; 119: 234-243, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38704871

RESUMO

STUDY OBJECTIVES: Increased reactive oxygen species associated with loss of mitochondrial function affect synaptic activity, which is an important mechanism underlying cognitive decline. This study assesses the role of mitochondrial proteins in neuron-derived exosomes (NDEs) on cognitive impairment in patients with obstructive sleep apnea (OSA) without dementia. METHODS: Analyses were conducted in 268 study participants with complete polysomnography data, cognitive tests, and important clinical data available. NDEs were isolated immunochemically for enzyme-linked immunosorbent assay quantification of mitochondrial proteins, i.e., humanin and mitochondrial open reading frame of the 12S rRNA-c (MOTS-c), and synaptic protein, i.e., neurogranin (NRGN). A mediation analysis of the relationship between sleep parameters and cognition was performed using humanin, MOTS-c, and NRGN values as a mediating factor. Twenty-two patients with moderate to severe OSA who received CPAP therapy were followed up, and humanin, MOTS-c and NRGN levels were reassessed after 1 year of treatment. RESULTS: All participants were divided into the OSA + MCI group (n = 91), OSA-MCI group (n = 89), MCI group (MCI without OSA) (n = 38) and control group (normal cognitive state without OSA) (n = 50). The mean CD63-normalized NDE levels of humanin, MOTS-c, and NRGN in the OSA + MCI group were higher than those in the OSA-MCI and control groups. The NDE levels of humanin, MOTS-c, and NRGN in the MCI group were lower than those in controls. The odds of cognitive impairment in patients with OSA were higher with higher NDE levels of humanin, MOTS-c, and NRGN (odds ratio (OR): 2.100, 95 % confidence interval (CI): 1.646-2.679, P < 0.001; OR: 5.453, 95 % CI: 3.112-9.556, P < 0.001; OR: 3.115, 95 % CI: 2.163-4.484, P < 0.001). The impaired cognitive performance was associated with higher NDE levels of humanin (ß: 0.505, SE: 0.048, P < 0.001), MOTS-c (ß: 0.580, SE: 0.001, P < 0.001), and NRGN (ß: 0.585, SE: 0.553, P < 0.001). The relationship between sleep parameters (mean SaO2 and T90) and MoCA scores was mediated by the NDE levels of humanin, MOTS-c, and NRGN with the proportion of mediation varying from 35.33 % to 149.07 %. Receiver operating characteristic curve revealed an area under the curve of 0.905 for humanin, 0.873 for MOTS-c, and 0.934 for NRGN to predict MCI in OSA patients without dementia. Increased humanin, MOTS-c, and NRGN levels significantly decreased after CPAP treatment. CONCLUSIONS: Mitochondrial dysfunction is implicated in cognitive impairment in OSA patients without dementia, and mainly mediates the association between intermittent hypoxia and cognitive impairment in adults with OSA without dementia. Mitochondrial dysfunction can be partially reversible by CPAP treatment. Mitochondrial proteins can be used as markers of cognitive impairment in patients with OSA.


Assuntos
Disfunção Cognitiva , Polissonografia , Apneia Obstrutiva do Sono , Humanos , Masculino , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Feminino , Disfunção Cognitiva/etiologia , Pessoa de Meia-Idade , Idoso , Proteínas Mitocondriais , Mitocôndrias/metabolismo , Testes Neuropsicológicos/estatística & dados numéricos , Peptídeos e Proteínas de Sinalização Intracelular
11.
Sleep Med ; 119: 250-257, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38704873

RESUMO

INTRODUCTION: Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with cognitive impairment and physiological complications, necessitating further understanding of its mechanisms. This study investigates the relationship between glymphatic system function, brain network efficiency, and cognitive impairment in OSAHS patients using diffusion tensor image analysis along the perivascular space (DTI-ALPS) and resting-state fMRI. MATERIALS AND METHODS: This study included 31 OSAHS patients and 34 age- and gender-matched healthy controls (HC). All participants underwent GE 3.0T magnetic resonance imaging (MRI) with diffusion tensor image (DTI) and resting-state fMRI scans. The DTI-ALPS index and brain functional networks were assessed. Differences between groups and correlations with clinical characteristics were analyzed. Additionally, the mediating role of brain network efficiency was explored. Finally, receiver operating characteristics (ROC) analysis assessed diagnostic performance. RESULTS: OSAHS patients had significantly lower ALPS-index (1.268 vs. 1.431, p < 0.0001) and moderate negative correlation with Apnea Hypopnea Index (AHI) (r = -0.389, p = 0.031), as well as moderate positive correlation with Montreal Cognitive Assessment (MoCA) (r = 0.525, p = 0.002). Moreover, global efficiency (Eg) of the brain network was positively correlated with the ALPS-index and MoCA scores in OSAHS patients (r = 0.405, p = 0.024; r = 0.56, p = 0.001, respectively). Furthermore, mediation analysis showed that global efficiency partially mediated the impact of glymphatic system dysfunction on cognitive impairment in OSAHS patients (indirect effect = 4.58, mediation effect = 26.9 %). The AUROC for identifying OSAHS and HC was 0.80 (95 % CI 0.69 to 0.91) using an ALPS-index cut-off of 1.35. CONCLUSIONS: OSAHS patients exhibit decreased ALPS-index, indicating impaired glymphatic system function. Dysfunction of the glymphatic system can affect cognitive function in OSAHS by disrupting brain functional network, suggesting a potential underlying pathological mechanism. Additionally, preliminary findings suggest that the ALPS-index may offer promise as a potential indicator for OSAHS.


Assuntos
Imagem de Tensor de Difusão , Sistema Glinfático , Imageamento por Ressonância Magnética , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/complicações , Masculino , Sistema Glinfático/diagnóstico por imagem , Sistema Glinfático/fisiopatologia , Feminino , Imagem de Tensor de Difusão/métodos , Pessoa de Meia-Idade , Encéfalo/fisiopatologia , Encéfalo/diagnóstico por imagem , Cognição/fisiologia , Adulto , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/diagnóstico por imagem , Estudos de Casos e Controles
12.
Curr Atheroscler Rep ; 26(7): 249-262, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38795275

RESUMO

PURPOSE OF REVIEW: Sleep is an important component of cardiovascular (CV) health. This review summarizes the complex relationship between sleep and CV disease (CVD). Additionally, we describe the data supporting the treatment of sleep disturbances in preventing and treating CVD. RECENT FINDINGS: Recent guidelines recommend screening for obstructive sleep apnea in patients with atrial fibrillation. New data continues to demonstrate the importance of sleep quality and duration for CV health. There is a complex bidirectional relationship between sleep health and CVD. Sleep disturbances have systemic effects that contribute to the development of CVD, including hypertension, coronary artery disease, heart failure, and arrhythmias. Additionally, CVD contributes to the development of sleep disturbances. However, more data are needed to support the role of screening for and treatment of sleep disorders for the prevention of CVD.


Assuntos
Doenças Cardiovasculares , Transtornos do Sono-Vigília , Sono , Humanos , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Transtornos do Sono-Vigília/fisiopatologia , Transtornos do Sono-Vigília/complicações , Sono/fisiologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Qualidade do Sono , Fatores de Risco
13.
Chem Senses ; 492024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38818785

RESUMO

Only a few studies have investigated olfactory function in patients with obstructive sleep apnea syndrome (OSAS) using psychophysical testing, and there is a scarcity of data regarding taste evaluation in the existing literature. The primary objectives of this study were to assess both smell and taste in patients with OSAS and to explore the correlation between the severity of symptoms and sensory perception. A total of 85 OSAS patients and a control group comprising 81 subjects were enrolled. Initial assessments included anamnesis, nasal endoscopy, and the completion of questionnaires (Epworth Sleepiness Scale, Visual Analogue Scale, Questionnaire of Olfactory Disorders, and the importance of olfaction questionnaire). The diagnosis of OSAS was confirmed by polysomnography, while nasal airflow was evaluated using rhinomanometry. Olfaction was assessed using the Sniffin' Sticks test, and the Threshold-Discrimination-Identification (TDI) score was calculated. Taste evaluation was conducted in a subgroup of participants (42 patients, 38 controls) using taste strips. The mean TDI score was 31 ±â€…5.6 for OSAS patients and 35 ±â€…4.6 for controls, indicating a significant difference (P < 0.001). Similarly, the taste score was 7 ±â€…3.0 for OSAS patients and 12.6 ±â€…3.2 for controls (P < 0.001). No correlations were observed between TDI and Apnea Hypopnea Index (AHI) (r = -0.12; P = 0.28), as well as between the taste score and AHI (r = -0.31; P = 0.22). However, a weak but significant correlation between TDI score and Epworth Sleepiness Scale was detected (r = -0.05; P = 0.002). The study revealed a significant decrease in sensory perception among patients with OSAS, though open questions persist about the pathophysiology.


Assuntos
Apneia Obstrutiva do Sono , Olfato , Paladar , Humanos , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Olfato/fisiologia , Paladar/fisiologia , Inquéritos e Questionários , Polissonografia , Transtornos do Olfato/fisiopatologia , Transtornos do Olfato/diagnóstico , Idoso
14.
Sleep Med Clin ; 19(2): 211-218, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38692746

RESUMO

Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive narrowing and collapse of the upper airways during sleep. It is caused by multiple anatomic and nonanatomic factors but end-expiratory lung volume (EELV) is an important factor as increased EELV can stabilize the upper airway via caudal traction forces. EELV is impacted by changes in sleep stages, body position, weight, and chronic lung diseases, and this article reviews the mechanical interactions between the lungs and upper airway that affect the propensity to OSA. In doing so, it highlights the need for additional research in this area.


Assuntos
Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/complicações , Pulmão/fisiopatologia , Pneumopatias/fisiopatologia , Doença Crônica
15.
Sleep Med Clin ; 19(2): 339-356, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38692757

RESUMO

An emerging body of literature describes the prevalence and consequences of hypercapnic respiratory failure. While device qualifications, documentation practices, and previously performed clinical studies often encourage conceptualizing patients as having a single "cause" of hypercapnia, many patients encountered in practice have several contributing conditions. Physiologic and epidemiologic data suggest that sleep-disordered breathing-particularly obstructive sleep apnea (OSA)-often contributes to the development of hypercapnia. In this review, the authors summarize the frequency of contributing conditions to hypercapnic respiratory failure among patients identified in critical care, emergency, and inpatient settings with an aim toward understanding the contribution of OSA to the development of hypercapnia.


Assuntos
Cuidados Críticos , Hipercapnia , Insuficiência Respiratória , Apneia Obstrutiva do Sono , Humanos , Hipercapnia/complicações , Insuficiência Respiratória/terapia , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Cuidados Críticos/métodos , Pacientes Internados , Pacientes Ambulatoriais
16.
Codas ; 36(3): e20230119, 2024.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38808857

RESUMO

PURPOSE: To investigate oropharyngeal structures and functions in a pediatric population with Down Syndrome (DS) and obstructive sleep apnea (OSA) and to correlate with the apnea/hypopnea index (AHI) and sleep questionnaires. METHODS: 12 Children with DS and OSA, between the age of 4 and 12 years old, underwent polysomnography (PSG); sleep questionnaires, Pediatric Sleep Questionnaire (PSQ) and Obstructive Sleep Apnea-18 (OSA-18); and speech-language evaluation using the Short Evaluation of Orofacial Myofunctional Protocol (ShOM). RESULTS: There was a positive correlation between ShoM higher scores and the apnea-hypopnea index (AHI) and between ShoM and the number of hypopneas. The orofacial myofunctional alterations observed in the studied group were: oral breathing, alteration in lip tonus and competence, tongue posture at rest and in swallowing, and occlusal alteration. There was also an increased risk for OSA according to the sleep questionnaires, as well as the presence of obesity and overweight, but without correlation with the severity of OSA. CONCLUSION: All DS children show alterations in orofacial characteristics, higher scores being associated to severe OSA. Orofacial myofunctional evaluation may help to identify different phenotypes in Down syndrome children with Obstructive sleep Apnea, enhancing the need for a multidisciplinary approach.


OBJETIVO: Investigar as estruturas e funções orofaríngeas de uma população pediátrica com Síndrome de Down (SD) e apneia obstrutiva do sono (AOS) e correlacionar com o índice de apneia/hipopneia (IAH) e questionários do sono. MÉTODO: 12 Crianças com SD e AOS, entre 4 e 12 anos, foram submetidas à polissonografia (PSG); questionários do sono, Pediatric Sleep Questionnaire (PSQ) e Obstructive Sleep Apnea-18 (OSA-18); e triagem fonoaudiológica por meio do Short Evaluation of Orofacial Myofunctional Protocol (ShOM). RESULTADOS: Verificou-se uma correlação positiva entre pontuações mais elevadas no ShOM e o índice de apneia hipopneia (IAH) e entre o ShOM e número de hipopneias. As alterações miofuncionais orofaciais observadas no grupo estudado foram: respiração oral, alteração no tônus e competência labial, na postura de língua em repouso e na deglutição e alteração oclusal. Verificou-se também, um risco aumentado para AOS conforme os questionários do sono, bem como presença de obesidade e sobrepeso, mas sem correlação com a gravidade da AOS. CONCLUSÃO: Todas as crianças apresentaram alterações miofuncionais orofaciais, sendo que escores mais altos no ShOM, ou seja, um maior comprometimento miofuncional orofacial, estavam associados à maior gravidade de AOS, sugerindo que a avaliação miofuncional orofacial dentro de uma abordagem multidisciplinar pode auxiliar na identificação de fatores de risco para AOS em crianças com SD.


Assuntos
Síndrome de Down , Polissonografia , Apneia Obstrutiva do Sono , Humanos , Síndrome de Down/fisiopatologia , Síndrome de Down/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico , Criança , Projetos Piloto , Masculino , Feminino , Pré-Escolar , Inquéritos e Questionários , Índice de Gravidade de Doença , Respiração Bucal/fisiopatologia , Respiração Bucal/complicações , Língua/fisiopatologia , Músculos Faciais/fisiopatologia , Estudos Transversais
17.
Eur J Pharmacol ; 975: 176659, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-38762158

RESUMO

Obstructive sleep apnea syndrome (OSAS), characterized by repeated narrow or collapse of the upper airway during sleep, resulting in periodic reductions or cessations in ventilation, consequent hypoxia, hypercapnia, increased sympathetic activity and sleep fragmentation, places a serious burden on society and health care. Intermittent hypoxia (IH), which cause central nervous system (CNS) inflammation, and ultimately lead to neuropathy, is thought to be a crucial contributor to cognitive impairment in OSAS. Wnt signaling pathway exerts an important role in the regulation of CNS disorders. Particularly, it may be involved in the regulation of neuroinflammation and cognitive dysfunction. However, its underlying mechanism remains poorly understood. Accumulating evidence demonstrated that Wnt signaling pathway may inhibited in a variety of neurological disorders. Recently studies revealed that SUMOylation was participated in the regulation of neuroinflammation. Members of Wnt/ß-catenin pathway may be targets of SUMOylation. In vitro and in vivo molecular biology experiments explored the regulatory mechanism of SUMOylation on Wnt/ß-catenin in IH-induced neuroinflammation and neuronal injury, which demonstrated that IH induced the SUMOylation of ß-catenin, microglia mediated inflammation and neuronal damage. Moreover, SENP1 regulated the de-SUMOylation of ß-catenin, triggered Wnt/ß-catenin pathway, and alleviated neuroinflammation and neuronal injury, thus improving IH-related mice cognitive dysfunction.


Assuntos
Disfunção Cognitiva , Cisteína Endopeptidases , Hipóxia , Microglia , Sumoilação , Via de Sinalização Wnt , Animais , Microglia/metabolismo , Microglia/patologia , Disfunção Cognitiva/metabolismo , Disfunção Cognitiva/etiologia , Camundongos , Cisteína Endopeptidases/metabolismo , Hipóxia/complicações , Hipóxia/metabolismo , Masculino , beta Catenina/metabolismo , Camundongos Endogâmicos C57BL , Doenças Neuroinflamatórias/metabolismo , Inflamação/metabolismo , Inflamação/patologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/metabolismo , Apneia Obstrutiva do Sono/fisiopatologia , Humanos , Modelos Animais de Doenças
18.
Vestn Otorinolaringol ; 89(2): 109-112, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38805473

RESUMO

The article presents a case of pharyngeal dysphagia and obstructive sleep apnea syndrome caused by degenerative-dystrophic changes in the cervical spine with the formation of large cervical osteophytes at the C3-C6 level. Osteophytes caused deformation of the posterior wall of the hypopharynx and narrowing of its lumen by 20-25% from the level of the arytenoid cartilages to the upper parts of the epiglottis. CT scan also showed the intervertebral disc heights lost, as well as osteophytes at the posterolateral margins of the vertebral bodies (disc osteophyte complex). Osteosclerosis in combination with facet arthrosis caused spinal and foraminal stenosis.


Assuntos
Vértebras Cervicais , Transtornos de Deglutição , Humanos , Vértebras Cervicais/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
19.
Europace ; 26(6)2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38758963

RESUMO

AIMS: Pulmonary vein isolation (PVI) is the corner stone of modern rhythm control strategies in patients with atrial fibrillation (AF). Sleep-disordered breathing (SDB) is prevalent in more than 50% of patients undergoing AF ablation, and studies have indicated a greater recurrence rate after PVI in patients with SDB. Herein, we study the effect of catheter-based PVI on AF in a pig model for SDB. METHODS AND RESULTS: In 11 sedated spontaneously breathing pigs, obstructive apnoeas were simulated by 75 s of intermittent negative upper airway pressure (INAP) applied by a negative pressure device connected to the endotracheal tube. Intermittent negative upper airway pressures were performed before and after PVI. AF-inducibility and atrial effective refractory periods (aERPs) were determined before and during INAP by programmed atrial stimulation. Pulmonary vein isolation prolonged the aERP by 48 ± 27 ms in the right atrium (RA) (P < 0.0001) and by 40 ± 34 ms in the left atrium (LA) (P = 0.0004). Following PVI, AF-inducibility dropped from 28 ± 26% to 0% (P = 0.0009). Intermittent negative upper airway pressure was associated with a transient aERP-shortening (ΔaERP) in both atria, which was not prevented by PVI (INAP indued ΔaERP after PVI in the RA: -57 ± 34 ms, P = 0.0002; in the LA: -42 ± 24 ms, P < 0.0001). Intermittent negative upper airway pressure was associated with a transient increase in AF-inducibility (from 28 ± 26% to 69 ± 21%; P = 0.0008), which was not attenuated by PVI [INAP-associated AF-inducibility after PVI: 58 ± 33% (P = 0.5)]. CONCLUSION: Transient atrial arrhythmogenic changes related to acute obstructive respiratory events are not prevented by electrical isolation of the pulmonary veins, which partially explains the increased AF recurrence in patients with SDB after PVI procedures.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Modelos Animais de Doenças , Veias Pulmonares , Animais , Veias Pulmonares/cirurgia , Veias Pulmonares/fisiopatologia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Fibrilação Atrial/prevenção & controle , Fibrilação Atrial/diagnóstico , Suínos , Ablação por Cateter/métodos , Apneia Obstrutiva do Sono/fisiopatologia , Falha de Tratamento , Frequência Cardíaca , Átrios do Coração/fisiopatologia , Átrios do Coração/cirurgia
20.
Sleep Med ; 119: 296-311, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38723575

RESUMO

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is the most prevalent sleep and respiratory disorder. This syndrome can induce severe cardiovascular and cerebrovascular complications, and intermittent hypoxia is a pivotal contributor to this damage. Vascular pathology is closely associated with the impairment of target organs, marking a focal point in current research. Vascular lesions are the fundamental pathophysiological basis of multiorgan ailments and indicate a shared pathogenic mechanism among common cardiovascular and cerebrovascular conditions, suggesting their importance as a public health concern. Increasing evidence shows a strong correlation between OSAHS and vascular lesions. Previous studies predominantly focused on the pathophysiological alterations in OSAHS itself, such as intermittent hypoxia and fragmented sleep, leading to vascular disruptions. This review aims to delve deeper into the vascular lesions affected by OSAHS by examining the microscopic pathophysiological mechanisms involved. Emphasis has been placed on examining how OSAHS induces vascular lesions through disruptions in the endothelial barrier, metabolic dysregulation, cellular phenotype alterations, neuroendocrine irregularities, programmed cell death, vascular inflammation, oxidative stress and epigenetic modifications. This review examines the epidemiology and associated risk factors for OSAHS and vascular diseases and subsequently describes the existing evidence on vascular lesions induced by OSAHS in the cardiovascular, cerebrovascular, retinal, renal and reproductive systems. A detailed account of the current research on the pathophysiological mechanisms mediating vascular lesions caused by OSAHS is provided, culminating in a discussion of research advancements in therapeutic modalities to mitigate OSAHS-related vascular lesions and the implications of these treatment strategies.


Assuntos
Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/complicações , Fatores de Risco , Doenças Vasculares/fisiopatologia , Doenças Vasculares/complicações , Doenças Vasculares/epidemiologia , Doenças Cardiovasculares/epidemiologia
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