Background: Obstructive sleep apnea has become recognized as one of the most common, under-diagnosed chronic diseases. Recently studies have shown increased numbers among the pediatric and adolescent population. OSA in children is associated with behavioral problems, poor school achievements, and in severe cases, pulmonary hypertension. OSA is often the Achilles heel of pediatric sedation and analgesic programs; during sedation, children with OSA have an increased vulnerability of their airway undergoing pharyngeal collapse and of having upper airway obstruction. Consequently, pediatric dentists who practice sedation dentistry should exercise extra precautions when treating patients with risk of sleep apnea. Currently there is no screening tool used in pediatric dentistry for diagnosing OSA during the pre-operative appointment or consultation for patients undergoing minimal and moderate oral conscious sedation. The purpose of this study was to develop and test a concise and easy-to-use questionnaire as a screening tool to aid in the diagnosis of OSA in pediatric patients. Materials and Methods: A retrospective chart review of 180 patients under the age of 18, who completed a polysomnogram at the VCU Center for Sleep Medicine between February 2011 and February 2013. A validated adult questionnaire, STOPBANG, was modified using more typical pediatric risk factors for OSA: presence of snoring (S), tonsillar hypertrophy (T1), tiredness; pESS>10 (T2), observed obstruction (O), neuroPsych-behavioral symptoms such as ADHD or daytime irritability (P), BMI percentile for age (B), age at diagnostic screening (A), presence of neuromuscular disorder (N), and presence of genetic/congenital disorder (G). A positive scoring from these variables was measured against the standard OSA measure, Apnea-Hypopnea Index. A multiple logistic regression analysis tested for relationships. Results: There was a statistically significant relationship P= .0007 for the S(T1)OPBANG scale, with a minimum of 4 variables needed to have a sensitivity of 57% and a specificity of 78%. There was also a statistically significant relationship P= .0040 for the S(T2)OPBANG, the cutoff>5 yielding sensitivity=36%, and specificity=90%. Only obstruction, BMI, and age showed a strong significant relationship to OSA. The presence of an obstruction was positively related to apnea (P = 0.0010). Most of the other components had an odds-ratio larger than one (indicating a nominally positive relationship). Conclusions: While both STOPBANG screening tools showed a statistically significant relationship, only obstruction, BMI, and age showed a predictive relationship to OSA. Consequently, consideration of other risk factors may be beneficial for future studies.

"This thesis presents a real-time noncontact system that can monitor an infant's respiration and detect apnea when it occurs. For infants, bedside monitoring of respiratory signals using non-contact sensors is desirable at the hospital and for in-home care. Traditional approach employs acoustic sensors which can hardly detect infant breathing due to low SNR. In this thesis, a novel method is introduced by using a ultra-wideband (UWB) radar that obtains breathing signal from an infant's weak chest vibration. Furthermore, advanced signal processing techniques are proposed to monitor the breathing signal and to detect apnea. Since an infant may move in the crib, a location algorithm is applied periodically to track the current location of the infant's chest. An apnea warning is issued when the respiration is absent for a pre-defined period of time."

Nonalcoholic fatty liver disease (NAFLD) afflicts approximately a quarter of the world’s general population and more than half of the world’s obese population. The disease is characterized by a spectrum of liver pathologies, ranging from simple steatosis or the accumulation of fat within hepatic tissue to steatohepatitis comprised of inflammation and fibrosis, also known as NASH. Simple steatosis is relatively asymptomatic and is considered benign, but NASH poses great risk for advanced forms of liver disease, such as cirrhosis and hepatocellular cancer. Obstructive sleep apnea(OSA) is a respiratory disorder involving the recurrent collapse of the upper airway during sleep. Consequently, the patient experiences constant arousals due to constant blockage followed reopening of the airway. Aside from poor quality and disruption of sleep, chronic intermittent hypoxia (CIH) is also present during OSA. The presence of CIH leaves many vital organs deprived of adequate oxygen to carry out normal physiological function. In response to this hypoxic state, the body upregulates many transcription factors, many of which control inflammatory processes. In recent studies, chronic and recurrent hypoxia generated from OSA has been implicated in the onset and progression of NAFLD. The pathogenesis of NAFLD is believed to be associated with metabolic imbalances, mainly obesity and insulin resistance, both of which also overlap with OSA. These conditions are the main factors in predisposing a patient suffering from OSA to the effects of CIH. Multiple lines of evidence suggest that CIH may accelerate the development of NAFLD through 1) Lipolysis of hepatic adipose tissue and increased hepatic free fatty acids; 2) Upregulation of lipid biosynthetic through CIH; 3) Upregulation of hypoxia-inducible factor 1-alpha by CIH inducing liver inflammation and fibrosis. The primary focus of this thesis will attempt to determine a possible link between OSA and NAFLD. Through citation of prior scientific studies, it will formulate the theory of OSA as a predisposing factor in the heightened risk of NAFLD pathogenesis and development to more severe, terminal stages. Primarily, the review of literature will highlight the metabolic imbalances of obesity and insulin resistance and how each is related to OSA and NAFLD. Ultimately, deposition of fat and inflammation triggered through various chemical factors connected to OSA will depict both the generation and progression of NAFLD.

É crescente a preocupação com as doenças do sono e o seu impacto na saúde da população em geral. Pouco ainda é conhecido e explorado na região Sul de Santa Catarina. Embora a literatura reforce a necessidade de uma avaliação objetiva, existem bons instrumentos clínicos que podem ser utilizados em estudos epidemiológicos. Foi realizado um estudo transversal e observacional com o objetivo de estimar a prevalência de sintomas relacionados a apneia obstrutiva do sono em um grupo de pacientes atendidos no Ambulatório de Clínicas Integradas da Universidade do Extremo Sul Catarinense, um ambulatório geral secundário, na cidade de Criciúma. Foram avaliados 101 pacientes através da aplicação de questões de sintomas de apneia validadas pelo estudo PLATINO e da Escala de Sonolência de Epworth. A amostra estudada tinha 73 (72,3%) mulheres; 47 (48,6%) indivíduos estudados tinham entre 40 e 59 anos. O ronco esteve presente em 65 (64,4%) pacientes e 20 (19,8%) relataram apneias. Dos indivíduos entrevistados, 31 (30,7%) relataram já terem sido questionados pelo seu médico a respeito do seu sono. Quanto ao resultado da ESE, 14 (13,9%) tiveram pontuação superior a 10. No sexo masculino, foi encontrada uma relação entre a presença de ronco e apneia e escores na ESE acima de 10 (p< 0,01). Concluímos que em uma população não selecionada o ronco foi um sintoma bastante prevalente, assim como o relato de apneias. As questões referentes ao sono, sobretudo relacionadas à apneia do sono, ainda são pouco abordadas pelos médicos em consultas gerais. / This observational cross-sectional study was conducted to determine the prevalence of symptoms related to obstructive sleep apnea in a group of patients attending Clínicas Integradas da Universidade do Extremo Sul Catarinense Ambulatory, a secondary ambulatory, in Criciuma, Brazil. Inclusion criteria was age 18 years or older. 101 patients were interviewed, and it were apllied questions related to obstructive apnea symptoms, previously validated in the PLATINO study and Epworth Sleepiness Scale. The sample was compounded by 73 (72,3%) women. 47 (48,6%) individuals were between 40 and 59 years old. Snores were present in 65 (64,4%) patients and 20 (19,8%) referred witnessed apneas during sleep. Thirty one (30,7%)of the participants said their physician have ever asked about sleep. The result on Epworth Sleepiness Scale was greater than 10 in 14 (13,9%) individuals. There was a significant relation between snore, witnessed apneas and Epworth Sleepiness Scale results greater than 10 in males (p<0,01). The prevalence of obstructive sleep apnea symptoms are high in this population, but Epworth Sleepiness Scale values are low. Besides, physicians still don’t ask much about sleep.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / Introduction: Obstructive Sleep Apnea Syndrome (OSAS) in children, as defined by the American Thoracic Society, is a disorder of breathing during sleep characterized by prolonged partial airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns. Objective: This study aimed to investigate retrospectively the prevalence of OSAS among children aged 6 to 12 years old, evaluated through polysomnography and sleep questionnaires between 2011 and 2012, analyzing severity, symptoms and associated risk factors. Methods: We evaluated 63 children referred to the Sleep Laboratory of the Dell Childrenâs Hospital in Austin, Texas (USA) with suspition of Sleep Disordered Breathing. The patients were submitted to a pre-sleep questionnaire and to polysomnography. Results: The mean age was 8,8 Â1,9 years old, and 55,6% of the children were male. Children without OSAS accounted for 30,2% of the sample. The OSAS observed in the remainder was mild in 49,2%, moderate in 11,1% and severe in 9,5%. Gender and age were not associated with OSAS. Hispanic and African-American children were at higher risk for OSAS. Twenty two hispanic children presented OSAS ( 88%) and ten African-american children presented OSAS (83,3%). In children with OSAS, the most common symptoms were: snoring (86%), periodic limb movements (64,3%), arousals during sleep (60,5%) and restless sleep (58,1%). Excessive daytime sleepiness was reported in only 33,3% of the patients. Bruxism was more prevalent among the patients without OSAS (52,6%) than in the patients with OSAS (31%). Overweight children were at higher risk for OSAS. Conclusions: Overweight children are at a higher risk for developing OSAS. Hispanic and African American children presented a higher risk for developing OSAS. Age and gender were not associated to the diagnose of OSAS. Bruxism was more prevalent among the children who did not present OSAS. / IntroduÃÃo: Em crianÃas, a SÃndrome da Apneia Obstrutiva do Sono (SAOS) à um distÃrbio respiratÃrio caracterizado por obstruÃÃo parcial prolongada e/ou episÃdios intermitentes de obstruÃÃo completa da via aÃrea superior, que interrompe a ventilaÃÃo normal e o padrÃo normal de sono. Objetivo: Este trabalho buscou investigar a prevalÃncia de SAOS entre crianÃas de seis a doze anos de idade, avaliadas por meio de polissonografia e questionÃrio sobre o sono, no perÃodo de 2011 a 2012, avaliando gravidade, sintomatologia e fatores de risco associados. MÃtodos: Foram estudadas 63 crianÃas encaminhadas ao LaboratÃrio do Sono do Dell Childrenâs Hospital em Austin, Texas (EUA) com suspeita de Transtornos RespiratÃrios do Sono. Os pais preencheram um questionÃrio sobre o sono, jà rotineiramente utilizado como padrÃo para todos os pacientes encaminhados para polissonografia no Dell Childrenâs Hospital (ApÃndice A). Em seguida, as crianÃas foram submetidas ao exame polissonogrÃfico. Resultados: A idade mÃdia foi de 8,8Â1,9 anos, sendo 55,6% das crianÃas do sexo masculino. NÃo apneicos corresponderam a 30,2% dos investigados. SÃndrome da Apneia Obstrutiva do Sono em grau leve ocorreu em 49,2%, moderado em 11,1% e grave em 9,5%. NÃo foi encontrada diferenÃa entre a incidÃncia de SAOS entre meninos e meninas. Observou-se uma associaÃÃo estatisticamente significante entre raÃa e presenÃa/ausÃncia de SAOS, sendo que as crianÃas negras e hispÃnicas apresentaram maior risco de SAOS do que as crianÃas brancas. Entre os hispÃnicos, 88% dos pacientes apresentaram SAOS (n=22); nos negros 83,3% (n=10) e nos brancos 46,7% (n=7). Dentre as crianÃas diagnosticadas com SAOS, os sintomas mais frequentes foram: ronco (86%) movimentos periÃdicos de membros (64,3%), despertares durante o sono (60,5%) e sono agitado (58,1%). SonolÃncia excessiva foi relatada apenas em 33,3% dos casos. O bruxismo foi relatado com maior frequÃncia no grupo sem SAOS (52,6%) do que no grupo de pacientes com diagnÃstico de SAOS (31%). CrianÃas com sobrepeso apresentaram maior risco de desenvolver SAOS (100%) (Testes Qui quadrado e exato de Fisher). ConclusÃes: Sobrepeso à um fator de risco para SAOS. CrianÃas da raÃa hispÃnica e negra apresentaram maior risco a SAOS. Sexo e idade nÃo se associaram a SAOS. O bruxismo foi mais frequentemente relatado por pacientes que nÃo demonstraram SAOS.

Master of Science (Medicine) / Clinical studies have demonstrated an arousal deficit in infants suffering Obstructive Sleep Apnoea (OSA), and that treatment to alleviate the symptoms of OSA appears to reverse the deficit in arousability. Some sudden infant deaths are thought to be contingent upon such an arousal deficit. This research utilised young piglets during early postnatal development, and exposed them to intermittent hypercapnic hypoxia (IHH) as a model of clinical respiratory diseases. Arousal responses of control animals were compared to the animals exposed to IHH. Comparisons were also made between successive exposures on the first and the fourth consecutive days of IHH. Time to arouse after the onset of the respiratory stimulus, and frequency of arousals during recovery, demonstrated that arousal deficits arose after successive exposures and that these were further exacerbated on the fourth study day. After an overnight recovery period, the arousal deficit was apparently dormant, and only triggered by HH exposure. These studies confirm that both acute and chronic deficits can be induced on a background of otherwise normal postnatal development, suggesting that deficits observed in the clinical setting may be a secondary phenomenon.

Hypoxia is a common feature of many respiratory disorders including acute severe asthma, chronic obstructive pulmonary disease and pneumonia. Hypoxia also occurs during sleep - disordered breathing in conditions such as sleep hypoventilation syndrome and sleep apnea. In most respiratory diseases hypoxia is coupled with increased respiratory load. Compensatory protective mechanisms are activated to oppose these impediments to respiration. However, hypoxia is associated with impaired neurocognitive function and recent studies have demonstrated that hypoxia suppresses respiratory load perception in healthy individuals and asthma patients. These recent findings raise the possibility that a variety of protective physiological reflex responses to increased respiratory load may be impaired during periods of hypoxia. The effects of hypoxia on several of these protective responses and possible mechanisms of respiratory sensory depression by hypoxia are explored in the experiments outlined in this thesis. In the first study, the respiratory related evoked potential ( RREP ) was used to investigate the mechanisms underlying hypoxia - induced suppression of respiratory load sensation in healthy individuals. As a positive control the effects of hypoxia on respiratory load perception to inspiratory resistive loads were also measured. The amplitude of the first and second positive peaks ( P1 and P2 ) of the RREP were significantly reduced during hypoxia. P1 is thought to reflect the arrival of the ascending respiratory signals to the somatosensory area of the cortex. The perceived magnitude of externally applied inspiratory resistive loads was also reduced during hypoxia. These data provide further support that hypoxia suppresses respiratory load perception and suggest that this is mediated, at least in part, by suppression of respiratory afferent information prior to its arrival at the cortex. In the second study, the effects of acute sustained hypoxia on the cough reflex threshold and cough tachyphylaxis to inhaled capsaicin were explored in healthy individuals. Acute sustained hypoxia suppressed cough reflex sensitivity to inhaled capsaicin. This finding raises the possibility that the cough reflex, important for protecting the lungs from inhalation or aspiration of potentially injurious substances and for clearing excess secretions, may be impaired during acute exacerbations of hypoxic - respiratory disease. In the third study, reflex responses of the genioglossus and scalene muscles to brief pulses of negative airway pressure were compared between hypoxia and normoxia during wake and sleep in healthy males in the supine position. Cortical RREPs to the same stimuli were also examined under these conditions. The genioglossus is the largest upper airway ( UA ) dilator muscle and can be reflexively augmented in response to negative UA pressure. A diminished response of this muscle during sleep has been postulated to be a contributing mechanism to obstructive sleep apnea ( OSA ) in individuals with an anatomically narrow UA. Cortical activation ( i.e. arousal ) to sudden airway narrowing in OSA is an important protective response to help restore ventilation during an obstructive event. In this study, genioglossus reflex responses to negative pressure pulse stimuli were maintained during mild overnight hypoxia. Conversely, reflex inhibition of the scalene muscle to the same stimuli was prolonged during hypoxia. In addition, a previously undescribed morphology of the genioglossus negative pressure reflex consisting of activation followed by suppression was observed with greater suppression during sleep than wake. The amplitude of the P2 component of the RREP was also significantly reduced during hypoxia. In summary, the potential mechanisms underlying hypoxia - induced suppression of respiratory load sensation and the effects of hypoxia on several protective respiratory responses have been investigated in healthy subjects. The potential implications of these findings for patients with hypoxic - respiratory disease are discussed. / Thesis (Ph.D.)--School of Molecular and Biomedical Science, 2006.

Bibliography: leaves 91-93.

Thesis (Ph. D.)--Case Western Reserve University, 2007. / [School of Medicine] Department of Epidemiology and Biostatistics. Includes bibliographical references. Available online via OhioLINK's ETD Center.

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