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1.
Sensors (Basel) ; 19(15)2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31370241

RESUMO

Sleep monitoring in an unattended home setting provides important information complementing and extending the clinical polysomnography findings. The validity of a wearable textile electrocardiography (ECG)-belt has been proven in a clinical setting. For evaluation in a home setting, ECG signals and features were acquired from 12 patients (10 males and 2 females, showing an interquartile range for age of 48-59 years and for body mass indexes (BMIs) of 28.0-35.5) over 28 nights. The signal quality was assessed by artefacts detection, signal-to-noise ratio, and Poincaré plots. To assess the validity, the data were compared to previously reported data from the clinical setting. It was found that the artefact percentage was slightly reduced for the ECG-belt from 9.7% ± 14.7% in the clinical setting, to 7.5% ± 10.8% in the home setting. The signal-to-noise ratio was improved in the home setting and reached similar values to the gel electrodes in the clinical setting. Finally, it was found that for artefact percentages above 3%, Poincaré plots are instrumental to evaluate the origin of artefacts. In conclusion, the application of the ECG-belt in a home setting did not result in a reduction in signal quality compared to the ECG-belt used in the clinical setting, and thus provides new opportunities for patient pre-screening or follow-up.


Assuntos
Eletrocardiografia/métodos , Monitorização Fisiológica , Polissonografia/métodos , Síndromes da Apneia do Sono/diagnóstico , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Processamento de Sinais Assistido por Computador , Razão Sinal-Ruído , Sono/fisiologia , Síndromes da Apneia do Sono/fisiopatologia , Têxteis , Dispositivos Eletrônicos Vestíveis
2.
Behav Ther ; 50(5): 994-1001, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31422853

RESUMO

Discrepancy between objective and subjective sleep parameters is a frequent symptom in persons suffering from insomnia. Since it has an impairing effect on daytime well-being and neglects possible positive objective improvements, it would be useful if it was treated. Apart from hypnotics, cognitive behavior therapy (CBT-I) is the therapy of choice for chronic forms of insomnia. However, there is limited information about whether CBT-I can also improve subjective-objective sleep discrepancy. We investigated a large sample of patients showing chronic forms of insomnia regarding their subjective-objective sleep discrepancy pre and post CBT-I. Objective sleep data were obtained from 3 nights (2 baseline nights and 1 night after therapy) using polysomnography in our sleep laboratory. All 92 patients participated in a 14-day inpatient program with CBT-I including psychoeducation about subjective-objective sleep discrepancy. Repeated measures analyses showed an improvement in subjective-objective sleep discrepancy parameters after CBT-I. Those parameters were also correlated with perceived quality of sleep. We conclude that CBT-I is a useful tool to improve subjective-objective sleep discrepancy in patients showing chronic forms of insomnia.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Distúrbios do Início e da Manutenção do Sono/terapia , Vigília/fisiologia , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Distúrbios do Início e da Manutenção do Sono/psicologia , Resultado do Tratamento
3.
Sensors (Basel) ; 19(15)2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31366102

RESUMO

Recently, various studies have been conducted on the quality of sleep in medical and health care fields. Sleep analysis in these areas is typically performed through polysomnography. However, since polysomnography involves attaching sensor devices to the body, accurate sleep measurements may be difficult due to the inconvenience and sensitivity of physical contact. In recent years, research has been focused on using sensors such as Ultra-wideband Radar, which can acquire bio-signals even in a non-contact environment, to solve these problems. In this paper, we have acquired respiratory signal data using Ultra-wideband Radar and proposed 1D CNN (1-Dimension Convolutional Neural Network) model that can classify and recognize five respiration patterns (Eupnea, Bradypnea, Tachypnea, Apnea, and Motion) from the signal data. Also, in the proposed model, we find the optimum parameter range through the recognition rate experiment on the combination of parameters (layer depth, size of kernel, and number of kernels). The average recognition rate of five breathing patterns experimented by applying the proposed method was 93.9%, which is about 3%~13% higher than that of conventional methods (LDA, SVM, and MLP).


Assuntos
Polissonografia/métodos , Radar , Respiração , Algoritmos , Apneia/fisiopatologia , Humanos , Movimento (Física) , Processamento de Sinais Assistido por Computador , Taquipneia/fisiopatologia
4.
Rev Assoc Med Bras (1992) ; 65(7): 995-1000, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389512

RESUMO

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


Assuntos
Apneia Obstrutiva do Sono/diagnóstico , Inquéritos e Questionários/normas , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Distribuição por Sexo , Apneia Obstrutiva do Sono/fisiopatologia , Ronco/diagnóstico , Adulto Jovem
5.
Medicina (Kaunas) ; 55(7)2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31330779

RESUMO

Background and Objective: Obstructive sleep apnea (OSA) is a common chronic disorder worldwide, which can adversely affect the cardiovascular system among non-communicable disease (NCD) patients. It is underdiagnosed-or rather not diagnosed-in primary care settings due to the costly diagnostic techniques involved. This study aimed to assess the number of study participants at risk of developing OSA and to assess and quantify the risk factors associated with this disorder. Materials and Methods: A cross-sectional study was performed in an NCD clinic of a rural health training center, Karikalampakkam, Puducherry of South India from August 2018 to October 2018. A Modified Berlin Questionnaire (MBQ) was used to screen the study participants at risk for OSA. Four-hundred-and-seventy-three people aged 18 years and above were included in the study, using systematic random sampling. Respondents' socio-demographic and morbidity characteristics, as well as clinical and anthropometric parameters including body weight, height, blood pressure, neck, hip and waist circumference were collected. Data was captured using Epicollect5 and analyzed using SPSS version 20.0. Results: One-fourth (25.8%) of the respondents were at high risk of developing OSA. In terms of gender, 27.9% of the men and 23.8% of the women were at high risk for OSA. In univariate analyses, the risk of developing OSA was significantly associated with a history of diabetes mellitus, hypertension, dyslipidemia and gastro-esophageal reflux disease, weight, body mass index, neck, waist and hip circumference, waist-hip ratio, and systolic and diastolic blood pressure. Multivariate logistic regression analysis showed that a history of dyslipidemia (aOR, 95% CI = 2.34, 1.22-4.48), body mass index (aOR, 95% CI = 1.15, 1.06-1.22) and waist circumference (aOR, 95% CI = 1.10, 1.07-1.14) emerged as significant predictors of risk for OSA. Conclusions: A considerable proportion of NCD patients with easily detectable attributes are at risk of developing OSA, but still remain undiagnosed at a primary health care setting. The results obtained using MBQ in this study were comparable to studies performed using polysomnography. Dyslipidemia, body mass index and waist circumference were independent risk factors for predicting a risk of developing OSA. Prospective studies are needed to confirm whether a reduction in these risk factors could reduce the risk for OSA.


Assuntos
Medição de Risco/métodos , Apneia Obstrutiva do Sono/classificação , Adulto , Idoso , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Antropometria/instrumentação , Antropometria/métodos , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/prevenção & controle , Polissonografia/métodos , Fatores de Risco , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia
6.
Rev Port Cardiol ; 38(6): 451-455, 2019 06.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31320221

RESUMO

INTRODUCTION: Sleep Apnea Syndrome (SAS) is a prevalent respiratory disease with marked expression in the population with cardiovascular disease. The diagnosis is based on polysomnography. In patients with cardiac implantable electronic devices (CIED), the prevalence of SAS may reach 60%. The objective of this study was to evaluate the value of DEC in the SAS screening. METHODS: Prospective study that included patients with CIED with sleep apnea algorithm. The frequency response function was activated and simplified polygraphy was performed. The data of the device were collected on the day of the polygraph. RESULTS: The sample included 29 patients, with a mean age of 76.1 years, 71.4% of the male gender. The prevalence of SAS was 77%. For SAS, the agreement between polysomnography and the Pacemaker was Kappa = 0.54 (p = 0.001), 95% CI (0.28, 0.81) (moderate agreement); for moderate to severe SAS, the agreement was Kappa = 0.73 (p <0.001), 95% CI (0.49, 0.976) (substantial agreement). Severe SAS was obtained: sensitivity 60%, specificity 100%, positive predictive value 100%, negative predictive value 60% and diagnostic accuracy 75%; for moderate to severe SAS: sensitivity of 90%, specificity of 83%, positive predictive values of 90% and negative of 87.5%, with a diagnostic accuracy of 87.5%. CONCLUSION: SAS is highly prevalent in patients with CIED. The values obtained through these devices have a strong positive correlation with the Apnea-Hypopnea Índex, which makes them a good tool for the screening of severe SAS.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/efeitos adversos , Insuficiência Cardíaca/terapia , Polissonografia/métodos , Síndromes da Apneia do Sono/diagnóstico , Idoso , Algoritmos , Feminino , Seguimentos , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Síndromes da Apneia do Sono/etiologia
7.
Nature ; 571(7764): 198-204, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31292557

RESUMO

Slow-wave sleep and rapid eye movement (or paradoxical) sleep have been found in mammals, birds and lizards, but it is unclear whether these neuronal signatures are found in non-amniotic vertebrates. Here we develop non-invasive fluorescence-based polysomnography for zebrafish, and show-using unbiased, brain-wide activity recording coupled with assessment of eye movement, muscle dynamics and heart rate-that there are at least two major sleep signatures in zebrafish. These signatures, which we term slow bursting sleep and propagating wave sleep, share commonalities with those of slow-wave sleep and paradoxical or rapid eye movement sleep, respectively. Further, we find that melanin-concentrating hormone signalling (which is involved in mammalian sleep) also regulates propagating wave sleep signatures and the overall amount of sleep in zebrafish, probably via activation of ependymal cells. These observations suggest that common neural signatures of sleep may have emerged in the vertebrate brain over 450 million years ago.


Assuntos
Neurônios/fisiologia , Sono/fisiologia , Peixe-Zebra/fisiologia , Animais , Evolução Biológica , Encéfalo/citologia , Encéfalo/efeitos dos fármacos , Encéfalo/fisiologia , Encéfalo/fisiopatologia , Epêndima/citologia , Movimentos Oculares , Fluorescência , Frequência Cardíaca , Hipnóticos e Sedativos/farmacologia , Hormônios Hipotalâmicos/metabolismo , Melaninas/metabolismo , Neurônios/efeitos dos fármacos , Pigmentação/fisiologia , Hormônios Hipofisários/metabolismo , Polissonografia/métodos , Sono/efeitos dos fármacos , Privação do Sono/fisiopatologia , Sono REM/efeitos dos fármacos , Sono REM/fisiologia , Sono de Ondas Lentas/efeitos dos fármacos , Sono de Ondas Lentas/fisiologia
8.
Handb Clin Neurol ; 160: 371-379, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277861

RESUMO

Actigraphy involves acquisition of data using a movement sensor worn continuously on the nondominant wrist, typically for a week or more. Computer-based algorithms estimate sleep episodes by analysis of continuous minutes of no to low movement, or spans of time when movement is relatively low compared with movements during presumed ambulatory wakefulness. Inherent advantages of actigraphy over polysomnography include its noninvasive nature, cost-effectiveness, lesser burden on patients/research participants, and ability to collect data over multiple days/nights, thereby allowing examination of sleep-wake patterning. Therefore, actigraphy is emerging as a common method to objectively assess sleep parameters providing estimates of sleep duration and continuity. Modes of actigraphy data collection, scoring algorithms, sleep quality/disturbance measures, validation studies, and clinical and research applications are discussed.


Assuntos
Actigrafia/métodos , Polissonografia/métodos , Fases do Sono/fisiologia , Transtornos do Sono-Vigília/fisiopatologia , Actigrafia/tendências , Humanos , Polissonografia/tendências , Transtornos do Sono-Vigília/diagnóstico
9.
Handb Clin Neurol ; 160: 381-392, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277862

RESUMO

Polysomnography refers to a systematic process used to collect physiologic parameters during sleep. A polysomnogram (PSG) is a procedure that utilizes electroencephalogram, electro-oculogram, electromyogram, electrocardiogram, and pulse oximetry, as well as airflow and respiratory effort, to evaluate for underlying causes of sleep disturbances. PSG is considered to be the gold standard for diagnosing sleep-related breathing disorders, which include obstructive sleep apnea (OSA), central sleep apnea, and sleep-related hypoventilation/hypoxia. PSG can also be utilized to evaluate for other sleep disorders, including nocturnal seizures, narcolepsy, periodic limb movement disorder, and rapid eye movement sleep behavior disorder. With recent technological developments, home sleep apnea testing can be done to confirm a diagnosis in patients with a high risk for moderate to severe OSA in the absence of comorbid medical conditions or other suspected sleep disorders.


Assuntos
Polissonografia/métodos , Transtornos do Sono-Vigília/fisiopatologia , Sono/fisiologia , Eletroencefalografia/métodos , Eletromiografia/métodos , Humanos , Transtornos do Sono-Vigília/diagnóstico
10.
Handb Clin Neurol ; 160: 393-403, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277864

RESUMO

The measurement of daytime sleepiness is important in the evaluation of patients with excessive sleepiness. The multiple sleep latency test (MSLT) is an objective test that measures the tendency to fall asleep under controlled conditions. It is based on the notion that sleep latency reflects underlying physiological sleepiness. The MSLT consists of four to five naps given 2h apart during the day, following a standardized procedure. The mean sleep latency from all naps is used as the measure of sleepiness. The test has been shown to be valid and reliable and is part of the diagnostic criteria for narcolepsy and idiopathic hypersomnia. However, the MSLT is affected by numerous variables including insufficient sleep, drugs, activity, and arousal level. Adherence to the established protocol is necessary to limit the effect of these extraneous factors on the MSLT. While the test is a valuable and widely used diagnostic tool for narcolepsy and idiopathic hypersomnia, the use of MSLT in other sleep disorders is not well established.


Assuntos
Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/fisiopatologia , Polissonografia/métodos , Latência do Sono/fisiologia , Sonolência , Humanos , Narcolepsia/diagnóstico , Narcolepsia/fisiopatologia , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/fisiopatologia
11.
Acta Otolaryngol ; 139(9): 793-797, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31268381

RESUMO

Background: Obstructive sleep apnea (OSA) is associated with several cardiovascular comorbidities including hypertension, arteriosclerosis, and heart failure. Uvulopalatopharyngoplasty (UPPP) is a frequently performed surgical treatment for OSA. Aims/Objectives: To analyze if UPPP can improve cardiac parameters associated with atherosclerosis and reduce the cardiac burden in OSA patients. Material and methods: A prospective cohort study was performed at a single tertiary care center where OSA patients undergoing UPPP were evaluated. Preoperative and 6-month postoperative cardiac parameters namely carotid artery intima-media thickness (CIMT), arterial stiffness parameters, echocardiography, and polysomnography (PSG) results were compared. Results: Fifty three patients were included in the study. The success and response rate of UPPP was 60.4%. Following the surgery, significant reduction in arterial stiffness index (ß) (12.4 ± 4.1 vs. 11.2 ± 4.0, p = .01), and elasticity modulus (Ep) (172.8 ± 68.3 vs. 156.6 ± 55.3, p = .05) was noticed. Additionally, echocardiographic parameters namely velocity across aortic valve (121.9 ± 22.9 vs. 109.4 ± 17.7, p = .01) and velocity across pulmonary valve (107.4 ± 16.4 vs. 94.2 ± 16.9, p < .01) significantly decreased following UPPP. Conclusions and significance: UPPP significantly improves parameters related to carotid atherosclerosis and has the potential to reduce cardiac burden in OSA patients.


Assuntos
Aterosclerose/epidemiologia , Doenças Cardiovasculares/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Úvula/cirurgia , Adulto , Aterosclerose/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Espessura Intima-Media Carotídea , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Palato Mole/cirurgia , Faringe/cirurgia , Polissonografia/métodos , Estudos Prospectivos , Medição de Risco , Apneia Obstrutiva do Sono/diagnóstico , Centros de Atenção Terciária , Resultado do Tratamento
12.
Acta Otolaryngol ; 139(9): 777-782, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31268404

RESUMO

Aims/objectives: To examine the effects of surgery for unilateral sinonasal lesions on sleep-disordered breathing (SDB). Material and methods: Oxygen desaturation index (3%ODI) as a marker of SDB and bilateral/unilateral nasal resistance were measured before and after surgery for 18 patients with unilateral sinonasal lesions. Various parameters were compared between those who achieved 60% or less decrease of 3%ODI and those who did not. Results: Bilateral nasal resistance as well as that of the surgical side five days after surgery was significantly lower than those of pre-operative value. Preoperative 3%ODI (times/hour) was 10.08 ± 7.32, which significantly decreased to 7.67 ± 5.79 five days after surgery. Even in unilateral patients, sinonasal surgery could reduce the bilateral nasal resistance, resulting in a decrease in 3%ODI. Age was younger and postoperative nasal resistance of the surgical side was significantly lower in the group who achieved 60% or less decrease in 3%ODI than those who did not. Conclusions and significance: SDB is influenced by even unilateral nasal obstruction. Surgery for unilateral lesion can improve the respiration during sleep as well as bilateral nasal resistance. Favorable outcome by surgery could be brought about in younger patients and those for whom sufficient improvement of nasal resistance was expected by surgery.


Assuntos
Obstrução Nasal/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Recuperação de Função Fisiológica/fisiologia , Síndromes da Apneia do Sono/etiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/complicações , Obstrução Nasal/diagnóstico , Polissonografia/métodos , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/diagnóstico , Resultado do Tratamento
13.
Am J Orthod Dentofacial Orthop ; 156(1): 13-28.e1, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256826

RESUMO

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


Assuntos
Ortodontia/métodos , Ortodontia/normas , Ortodontistas , Apneia Obstrutiva do Sono/terapia , Academias e Institutos , Humanos , Aparelhos Ortodônticos , Médicos , Polissonografia/métodos , Prevalência , Radiografia Dentária , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Cirurgiões , Resultado do Tratamento , Estados Unidos
14.
Rev Chil Pediatr ; 90(3): 309-315, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31344191

RESUMO

INTRODUCTION: The early diagnosis of Sleep Disordered Breathing (SDB) may allow proper intervention. Currently, polygraphy (PG) is a reliable and accessible alternative. OBJECTIVE: To describe and analyze the PG of children > 1 year old with suspicion of SDB. PATIENTS AND METHOD: PG of children > 1 year old and adolescents from Concepcion, Chile, with suspected SDB were included, from December 2011 to Au gust 2017. Demographic, clinical and polygraphic variables were collected. It was used descriptive sta tistics, expressing results in median and range. The association between apnea-hypopnea index (AHI) and oxygen saturation was determined by Spearman's Rho, considering significance of p < 0.05. Re sults: 190 studies were analyzed. Age 7.9 years old (1.0-20.6), 61% males. DIAGNOSIS: neuromuscular disease (NMD) (24.2%), chronic lung damage (21.1%), upper airway obstruction (UAO) (19.5%), neurological damage (11%), Down syndrome (8.9%), upper airway malformations (7.4%), central hypoventilation (3.7%), obesity (2.6%), and others (1.6%). 55.3% were altered PG, with 53.3% of mild Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS), 30.5% moderate, and 16.2% severe. There were no significant differences in AHI between groups of pathologies (p = 0.032), highlighting a higher AHI in obese patients 9 (0.41-51), and those with NMD 23.9 (0.4-36.6). It was found asso ciation between AHI and oxygen saturation parameters: mean saturation (rho = -0.425; p = 0.001), minimum (rho = -0.654; p = 0.001), and oxygen saturation below 90% (rho = 0.323; p = 0.001) in the whole sample. DISCUSSION: There was a high percentage of OSAHS in at-risk pediatric patients, especially in those with NMD and obesity. PG is an accessible and implementable tool in a public hospital, a situation that can potentially be extrapolated to other healthcare centers.


Assuntos
Polissonografia/métodos , Síndromes da Apneia do Sono/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Adolescente , Criança , Pré-Escolar , Chile/epidemiologia , Feminino , Humanos , Lactente , Masculino , Doenças Neuromusculares/epidemiologia , Oxigênio/metabolismo , Obesidade Pediátrica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Síndromes da Apneia do Sono/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia
15.
Eur Arch Otorhinolaryngol ; 276(7): 2097-2104, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31172276

RESUMO

PURPOSE: Adenotonsillectomy is one of the most common surgical procedures performed in children. The indications for surgery are either frequent recurrent throat infections or hypertrophy of the tonsils/adenoid vegetation, which can cause obstructive sleep apnea (OSA). There is disagreement regarding the need for sleep studies before adenotonsillectomy to confirm a diagnosis of OSA. Several studies have evaluated questionnaires and physical examination as tools to identify OSA, with conflicting results. The aim of this study was to evaluate the prevalence of OSA among children referred for adenotonsillectomy and whether questionnaires or physical examination can help identify OSA. METHODS: This is a prospective cohort study of children aged 2-6 years, referred for adenotonsillectomy. Polysomnography and an otorhinological examination were performed. Tonsillar size and the oral cavity were graded using Friedman's classification and Mallampati score, respectively. The Pediatric Sleep Questionnaire (PSQ) and OSA-18 were also completed. RESULTS: 100 children were included. The prevalence of OSA was 87%, with 52% having moderate to severe OSA. The usefulness of the PSQ and OSA-18 for detecting OSA was evaluated using multiple cutoff points, but none yielded acceptable values for both sensitivity and specificity. In logistic regression analyses predicting different levels of OSA severity, age, Friedman tonsillar size and Mallampati score were weakly associated with OSA. CONCLUSIONS: The prevalence of OSA is high among children referred for adenotonsillectomy and questionnaires and clinical characteristics are not sensitive enough to detect the presence or severity of OSA.


Assuntos
Adenoidectomia/métodos , Doenças Nasofaríngeas , Tonsila Palatina/patologia , Polissonografia/métodos , Apneia Obstrutiva do Sono , Tonsilectomia/métodos , Criança , Pré-Escolar , Feminino , Humanos , Hipertrofia/diagnóstico , Hipertrofia/cirurgia , Masculino , Boca/diagnóstico por imagem , Doenças Nasofaríngeas/complicações , Doenças Nasofaríngeas/cirurgia , Tamanho do Órgão , Prevalência , Estudos Prospectivos , Sensibilidade e Especificidade , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Inquéritos e Questionários
16.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(6): 413-418, 2019 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-31189226

RESUMO

Objective: To analyze the polysomnography and clinical characteristics of Tibetan and Han residents with obstructive sleep apnea syndrome (OSAS) in high altitude areas of Tibet, and to explore whether nationality difference existed. Methods: The clinical data of 425 OSAS patients admitted to the Tibet Autonomous Region People's Hospital from November 2011 to February 2018 were retrospectively analyzed, which were divided into Tibetan group and Han group. Information including sex, age, body mass index (BMI), neck circumference, waist circumference and hip circumference was collected, and apnea-hyponea index (AHI), mean oxygen saturation (MSaO(2)) during sleep, lowest oxygen saturation (LSaO(2)) during sleep, sleep phases and Epworth scores were compared between Tibetan and Han groups. Results: No significant difference was found in AHI between Tibetan and Han patients. AHI was positively correlated with BMI, neck circumference and waist circumference. Oxygen saturation in the daytime was not significantly different between groups. However, MSaO(2) and LSaO(2) during sleep were lower in Tibetan group compared with Han group (79% vs 82%, 65% vs 69%, respectively, P=0.000). Subgroup analysis showed no significant difference in MSaO(2) in mild OSAS patients, while the LSaO(2) in mild OSAS patients, the MSaO(2) and LSaO(2) in moderate and severe OSAS patients all showed significant differences between groups. Adjusted for BMI, the LSaO(2) in moderate OSAS patients, the MSaO(2) and LSaO(2) in severe OSAS patients in Tibetan group were still significantly lower than Han group. Stage-1 non-rapid eye movement was prolonged in moderate OSAS patients in Tibetan group compared with Han group (P=0.033), while other sleep phases and Epworth scores showed no significant difference between groups. Conclusion: In the circumstances of similar AHI, the MSaO(2) and LSaO(2) in moderate and severe OSAS patients were significantly lower in Tibetan group than in Han group, and the differences partially remained after adjusting for BMI, and the mechanisms needed to be further investigated in high altitude areas.


Assuntos
Polissonografia/métodos , Apneia Obstrutiva do Sono/etnologia , Fases do Sono/fisiologia , Humanos , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Tibet
17.
J Bras Pneumol ; 45(3): e20180085, 2019 Jun 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31241653

RESUMO

OBJECTIVE: To investigate the extent to which exercise is associated with symptoms in patients with severe obstructive sleep apnea (OSA). METHODS: We included subjects with an apnea-hypopnea index (AHI) > 30 events/h who completed validated sleep and exercise questionnaires. We compared symptom frequency/scores between exercisers and nonexercisers, adjusting for the usual confounders. RESULTS: The sample included 907 nonexercisers and 488 exercisers (mean age, 49 ± 14 years; mean AHI, 53 ± 20 events/h; 81% men). Nonexercisers and exercisers differed significantly in terms of obesity (72% vs. 54%), the mean proportion of sleep in non-rapid eye movement stage 3 sleep (9 ± 8% vs. 11 ± 6%), and tiredness (78% vs. 68%). Nonexercisers had a higher symptom frequency/scores and poorer sleep quality. Adjustment for exercise weakened the associations between individual symptoms and the AHI, indicating that exercise has a mitigating effect. In binary logistic models, exercise was associated with approximately 30% lower adjusted questionnaire1 score > 2, tiredness; poor-quality sleep, unrefreshing sleep, and negative mood on awakening. Although the odds of an Epworth Sleepiness Scale score > 10 were lower in exercisers, that association did not withstand adjustment for confounders. CONCLUSIONS: Exercise is associated with lower frequency/intensity of symptoms in patients with severe OSA. Because up to one third of patients with severe OSA might exercise regularly and therefore be mildly symptomatic, it is important not to rule out a diagnosis of OSA in such patients.


Assuntos
Terapia por Exercício/métodos , Exercício/fisiologia , Apneia Obstrutiva do Sono/prevenção & controle , Apneia Obstrutiva do Sono/fisiopatologia , Sono/fisiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Sonolência , Inquéritos e Questionários
18.
Respir Res ; 20(1): 125, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208424

RESUMO

BACKGROUND: Obstructive sleep apnoea (OSA) is one of the major sources of the excessive daily sleepiness, cognitive dysfunction, and it increases cardiovascular morbidity and mortality. Previous studies suggested a possible genetic influence, based on questionnaires but no objective genetic study was conducted to understand the exact variance underpinned by genetic factors. METHODS: Seventy-one Hungarian twin pairs involved from the Hungarian Twin Registry (48 monozygotic, MZ and 23 dizygotic, DZ pairs, mean age 51 ± 15 years) underwent overnight polysomnography (Somnoscreen Plus Tele PSG, Somnomedics GMBH, Germany). Apnoea hypopnea index (AHI), respiratory disturbance index (RDI) and oxygen desaturation index (ODI) were registered. Daytime sleepiness was measured with the Epworth Sleepiness Scale (ESS). Bivariate heritability analysis was applied. RESULTS: The prevalence of OSA was 41% in our study population. The heritability of the AHI, ODI and RDI ranged between 69% and 83%, while the OSA, defined by an AHI ≥5/h, was itself 73% heritable. The unshared environmental component explained the rest of the variance between 17% and 31%. Daytime sleepiness was mostly determined by the environment, and the variance was influenced in 34% by the additive genetic factors. These associations were present after additional adjustment for body mass index. CONCLUSION: OSA and the indices of OSA severity are heritable, while daytime sleepiness is mostly influenced by environmental factors. Further studies should elucidate whether close relatives of patients with OSA may benefit from early family risk based screening.


Assuntos
Doenças em Gêmeos/genética , Distúrbios do Sono por Sonolência Excessiva/genética , Predisposição Genética para Doença/genética , Apneia Obstrutiva do Sono/genética , Sonolência , Adulto , Idoso , Doenças em Gêmeos/diagnóstico , Doenças em Gêmeos/epidemiologia , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Feminino , Predisposição Genética para Doença/epidemiologia , Humanos , Hungria/epidemiologia , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia
19.
Geriatr Gerontol Int ; 19(7): 604-610, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31044515

RESUMO

AIM: Obstructive sleep apnea (OSA) is associated with increased variability in nocturnal blood pressure (BP). Calcium channel blockers (CCB) are superior to other classes of antihypertensives in decreasing BP variability. We investigated whether OSA severity is associated with nocturnal BP variability in older hypertensive patients treated with CCB. METHODS: We measured home systolic and diastolic BP and pulse rate (PR) automatically during sleep at an interval of an hour once a week using an electronic sphygmomanometer in 29 hypertensive patients (aged ≥65 years) receiving CCB. We calculated the coefficient of variation (CV) from four consecutive measurements. All patients underwent a home-based portable sleep study. RESULTS: We found no difference in PR, BP or CV of BP between the patients with no-to-mild OSA and with moderate-to-severe OSA, categorized by the respiratory disturbance index (RDI) and 3% oxygen desaturation index (ODI). The CV of PR in patients with moderate-to-severe OSA was higher than the patients with no-to-mild OSA categorized by 3% ODI (P = 0.01). Body mass index was correlated with RDI and 3% ODI (r = 0.56 and 0.43, respectively). The CV of BP did not correlate to RDI or 3% ODI. The CV of PR was positively correlated both with RDI and with 3% ODI (r = 0.41 and 0.42, respectively). CONCLUSIONS: The severity of OSA was associated with PR variability, but not with BP variability, in older patients receiving CCB. Our results suggest the need for future studies to determine whether CCB can suppress the influence of OSA on BP fluctuation during sleep. Geriatr Gerontol Int 2019; 19: 604-610.


Assuntos
Bloqueadores dos Canais de Cálcio/uso terapêutico , Frequência Cardíaca , Hipertensão , Polissonografia/métodos , Apneia Obstrutiva do Sono , Idoso , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial/métodos , Correlação de Dados , Feminino , Determinação da Frequência Cardíaca/métodos , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia
20.
Medicine (Baltimore) ; 98(18): e15321, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045770

RESUMO

Patients with myotonic muscular dystrophy type 1 (DM1) tend to exhibit earlier respiratory insufficiency than patients with other neuromuscular diseases at similar or higher forced vital capacity (FVC). This study aimed to analyze several pulmonary function parameters to determine which factor contributes the most to early hypercapnia in patients with DM1.We analyzed ventilation status monitoring, pulmonary function tests (including FVC, maximal voluntary ventilation [MVV], and maximal inspiratory and expiratory pressure), and polysomnography in subjects with DM1 who were admitted to a single university hospital. The correlation of each parameter with hypercapnia was determined. Subgroup analysis was also performed by dividing the subjects into 2 subgroups according to usage of mechanical ventilation.Final analysis included 50 patients with a mean age of 42.9 years (standard deviation = 11.1), 46.0% of whom were male. The hypercapnia was negatively correlated with MVV, FVC, forced expiratory volume in 1 second (FEV1), and their ratios to predicted values in subjects with myotonic muscular dystrophy type 1. At the same partial pressure of carbon dioxide, the ratio to the predicted value was lowest for MVV, then FEV1, followed by FVC. Moreover, the P values for differences in MVV and its ratio to the predicted value between ventilator users and nonusers were the lowest.When screening ventilation failure in patients with DM1, MVV should be considered alongside other routinely measured parameters.


Assuntos
Hipercapnia/fisiopatologia , Pulmão/fisiopatologia , Ventilação Voluntária Máxima/fisiologia , Distrofia Miotônica/complicações , Adulto , Dióxido de Carbono/análise , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pressões Respiratórias Máximas/métodos , Pessoa de Meia-Idade , Distrofia Miotônica/classificação , Distrofia Miotônica/fisiopatologia , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/fisiopatologia , Polissonografia/métodos , Valor Preditivo dos Testes , Pressão , Estudos Prospectivos , Testes de Função Respiratória/métodos , Estudos Retrospectivos , Capacidade Vital/fisiologia
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