Obstructive sleep apnea syndrome (OSAS), a chronic respiratory disorder affecting as many as 1 in 5 adults, is associated with repetitive collapse of the upper airway during sleep and results in fragmented sleep and intermittent periods of hypoxia and hypercapnia. If left untreated, OSAS increases the risk for hypertension, insulin resistance, metabolic syndrome (MetS) in a manner that is independent of obesity in mid-adulthood. However, it is still unknown if evidence of these relationships is apparent in young adults with OSAS who are otherwise healthy and free of other chronic comorbidities. Objectives: To determine if functional and biochemical evidence of insulin resistance, MetS, and vascular endothelial dysfunction (VED) exists in young, overweight men with OSAS and if the combined effects of obesity and OSAS augments the evidence of chronic disease pathogenesis beyond the effects of obesity alone. Subjects: Subjects were 12 overweight men with OSAS (age = 22.8 ± 0.8; BMI = 32.4 ± 1.0; apnea-hypopnea index (AHI) = 25.4 ± 5.4), 17 overweight men without OSAS (age = 22.5 ± 0.7; BMI = 31.6 ± 1.1; AHI = 2.2 ± 0.3), and 18 normal weight men without OSAS (age = 21.1 ± 0.5; BMI = 22.4 ± 0.4; AHI = 1.9 ± 0.3). Methods: Subjects were evaluated for OSAS using an unsupervised, portable polysomnography test. Total fat and central abdominal fat (CAF) were assessed using dual energy x-ray absorptiometry (DEXA). Fasting blood samples were used to quantify biochemical markers for insulin resistance (glucose, insulin, adiponectin, IL-6, and TNF-á) and endothelial dysfunction (CRP, VEGF, and VEGFR2) using ELISA, RIA, and flow cytometry. MetS was defined according to Adult Treatment Panel III (ATP III) clinical standards. Triglycerides, HDL cholesterol, and glucose were measured using a commercial lipid panel. Resting blood pressure was obtained manually via auscultation. VED was measured via strain gauge plethysmography, with endothelium-dependent vasodilatation being assessed from forearm reactive hyperemia after a 5-minute period of upper arm occlusion. Statistics: One-way ANOVA was used to determine group differences in variables. Two-way ANOVA was used to evaluate group x time interactions during the 2-minute recovery period following upper arm occlusion. Pearson partial correlation was used to assess relationships between continuous variables, with analyses being controlled for CAF or OSAS severity. Spearman correlation was used to assess relationships between number of MetS components present and both indices of adiposity and OSAS severity. Stepwise multiple linear regression analysis was used to determine significant predictors of OSAS severity, insulin resistance, components of the MetS, and endothelial dysfunction. Results: Overweight subjects with OSAS had more CAF, higher fasting triglycerides, and lower serum adiponectin concentrations than both overweight and normal weight non-apneic controls. Furthermore, fasting triglycerides were directly correlated to OSAS severity, even after the influence of central abdominal fat was removed. OSAS severity was an independent predictor of triglyceride levels, and vice versa. Insulin resistance, leptin, insulin, and CRP were all higher in overweight subjects than controls, but no further differences were attributable to severity of OSAS. No differences in IL-6, TNF-á, ADMA, and expression of VEGFR2 were noted between any groups. No group or group x time interaction differences existed in regards to postocclusive reactive hyperemia responses. Conclusions: Young men with OSAS exhibit several unique anthropometric and biochemical abnormalities that may indicate early pathogenesis of or increased risk for future development for cardiovascular and metabolic disorders. Identification and treatment of OSAS at this age may be critical to prevent the onset and progression of these chronic disorders. / Ph. D.

A necessidade do uso da prótese total durante o sono ainda não está bem definida pela literatura, apenas algumas evidências sobre a relação entre a presença de estomatite protética e o uso contínuo das próteses. O objetivo do estudo clínico randomizado foi avaliar se o uso da prótese total durante o sono interfere ou não nos eventos obstrutivos respiratórios durante o sono. Pacientes idosos edentulos com suspeita de Síndrome da Apnéia-hipopnéia Obstrutiva do Sono (SAOS) foram selecionados. Novas próteses totais foram confeccionadas seguindo o protocolo da FOUSP. A cavidade oral foi avaliada com relação ao exame de Mallampati e a presença de reabsorção óssea. A qualidade do sono foi avaliada pelo PSQI (Pittsburgh Sleep Quality Index) e pela Escala de Sonolência Diurna de Epworth (ESS), as polissonografias foram efetuadas em laboratório especializados durante duas noites em duas situações cruzadas: pacientes dormindo com as próteses e sem as mesmas. Vinte e três pacientes foram avaliados e a média de idade foi de 69,6 ± 5,1 anos e 74% eram do sexo feminino. Os pacientes com severidade leve, apresentaram um índice de apnéia-hipopnéia (IAH) significantemente menor quando os dormiram sem as próteses totais (8,9 ± 2,4 eventos por hora) comparado quando dormiram com as próteses (16,6 ± 6,9 eventos por hora). Os pacientes do grupo moderado a severo, não apresentaram diferença estatisticamente significante entre os IAHs quando dormiram com e sem as próteses. Em uma avaliação separada na posição supina, os pacientes do grupo leve, apresentaram uma média do IAH na posição supina menor quando dormiram sem as próteses do que quando dormiram com elas, apresentando uma média de 12,7 ± 8,4 eventos por hora e 51,9 ± 28,6 eventos por hora respectivamente. Pode-se concluir que os pacientes edentulos com severidade leve de SAOS apresentaram um menor índice de apnéia-hipopnéia obstrutiva quando dormiram na posição supina sem as próteses totais. / Summary: There is no evidence based in the literature about complete denture use during sleep, only some evidences about denture stomatits association and the change in apneic events. The goal of this randomized clinical study was to asses if the complete denture wear during sleep influence apneic events and quality of sleep. Elderly edentulous Obstructive Sleep Apnea Syndrome (OSAS) patients from a complete denture clinic were enrolled and received new complete dentures. The oral condition was evaluated according to bone resorption and Mallampati exam. The sleep quality was assed by the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and the polysomnographys were performed at the sleep laboratory for the patients sleeping with and without dentures the dentures. Twenty-three patients were evaluated with mean age 69.6 (SD±5.1) years and 74% female. In the mild (5AHI<30) OSAS group the apnea-hypopnea index decreased significantly when patients slept without dentures (8.9±2.4) compared when patients slept with the dentures (16.6±6.9). In a separated analysis, mild group in supine position presented a mean apnea-hypopnea index significant lower when patients slept without dentures from 12.7 (SD ± 8.4) to 51.9 (SD ± 28.6) sleeping with dentures. There was no significant difference in moderate to severe patients variables. This study shows that mild OSAS edentulous patients had a lower apnea-hypopnea index when sleeping without dentures in supine position.

Objetivo: O propósito deste estudo consiste em avaliar a relação entre Força de Língua e medidas do posicionamento do hioide em crianças com diagnóstico de SAOS. Casuística e Método: Foram selecionadas crianças entre 07 e 12 anos, de ambos os gêneros, com história de roncos, apneias noturnas e respiração bucal crônica. Todas as crianças tiveram SAOS confirmada pela presença dos sintomas e pela polissonografia e foram divididas em dois grupos: pré-operatório e pós-operatório (pacientes que tinham diagnóstico de SAOS antes da adenotonsilectomia, e foram reavaliados 12 meses depois. Ambos os grupos foram submetidos à avaliação de força de língua isométrica máxima (FLIM), aplicada na posição de ponta e dorso de língua, através do dinamômetro (kgf) e por meio da radiografia lateral foi realizada avaliação craniofacial e posicionamento do hioide. Resultados: Na regressão linear em pacientes pré- operatório a medida cefalometrica D vert. H apresentou forte e significativa (p= 0,0083) relação negativa com a força em ponta de língua. Já em dorso de língua antes da cirurgia não foi significativa, para nenhuma das variáveis. Nos pacientes pós-operatório a FLIM do dorso e ponta foram significativamente (p<0,0330 e p<0,0098 respectivamente) relacionadas à medida cefalométrica C3-H. A comparação de medidas cefalométricas entre os grupos pré e pósoperatórios e entre o subgrupo residual e curados, não tiveram diferença na altura do hioide (HYS, HYMP, D Vert.H) e na relação ântero-posterior do hioide (D Horiz.H, C3-H). Em relação a FLIM da musculatura extrínseca da língua ao se compararem a média e desvio padrão nos pacientes pré e pós-operatório, observou-se que houve diferença para as medidas de força de língua (p= 0,0016 para dorso e p=0,0041 para ponta) entre eles. Não houve diferença entre os sub-grupos residual e curados. Conclusão: No presente estudo podemos concluir que existe relação entre a força do musculo lingual e a posição do osso hiode em crianças com SAOS. Ou seja, aumento na força dos músculos dilatadores da faringe pode influenciar a altura do hioide em crianças com SAOS. / Objective: The purpose of this study is to assess the relation between Force of the Tongue and measures of hyoid\'s positioning in children diagnosed with OSAS. Casuistry and Method: Were selected children between 07 and 12 years, from both genders, with snoring history, nocturnal apnea and chronic mouth breathing. All the children had OSAS confirmed by the sympton\'s presence and by the polysomnography and were divided into two groups: preoperative and postoperative (pacients that had OSAS diagnosed before the adenotonsillectomy,and were revaluated 12 months after. Both groups were submitted to maximum isometric tongue force, applied in the tip and in the back of the tongue, through the dynamometer and through the lateral radiography was performed a craniofacial evaluation and hyoid positioning. Results: In preoperative patients on linear regression the cephalometric measure D. vert. H presented strong and significant (p= 0,0083) negative relation with the tip of the tongue force. Whereas the back of the tongue before the surgery was not significant, for none of the variables. In postoperative patients the maximum isometric tongue force from the back and from the tip were significantly (p<0,0330 e p<0,0098 respectively) related to the cephalometric measure C3-H. The comparison between the cephalometric measures between the preoperative and postoperative groups and between the residual sub group and the healed ones, did not have difference in the hyoid\'s height (HYS, HYMP, D Vert.H) and on the hyoid\'s anteroposterior relation (D Horiz.H, C3-H). In regards to the maximum isometric tongue force from the extrinsic tongue musculature when compared to the average and standard deviation in patients pre and post surgery, it was noticed that there was difference for the tongue force measures (p= 0,0016 for the back and p=0,0041 for the tip) between them. There was no difference between the sub groups residual and healed. Conclusion: In the present study we can conclude that there is relation between the force of the lingual muscle and hyoid bone\'s position in children with OSAS. In other words, an increase on the pharynx dilator muscles\' strength can influence the hyoid\'s height in children with OSAS.

<p><strong>Abstract</strong></p><p><strong>Background:</strong> Obstructive Sleep Apnea Syndrome (OSAS) is prevalent and the syndrome is associated with increased risk of health related problems. A positive effect of behavioral change programs to reduce weight is expected. More research is needed to identify barriers and facilitators to behavior change.</p><p><strong>Aim:</strong> To identify prerequisites for eating behavior change in obese patients with OSAS.</p><p><strong>Method:</strong> Semi-structured interviews were conducted on 15 obese patients living with OSAS. Data were analyzed using qualitative content analysis.</p><p><strong>Result:</strong> The categories identified as barriers to change in eating behavior in the analysis were desire and craving, influenced by mental state, low self-confidence, insufficient support, social acceptance, complexity of coping with new eating behaviors in daily routines, costs, lack of knowledge, perceived helplessness and low susceptibility. Categories that were identified as facilitators to change in eating behavior were high value of outcome expectations, support and control, external premises, applicable behavior change strategies, self-worth and being triggered by weight increase.</p><p><strong> Conclusion:</strong> To motivate patients living with OSAS to change their eating behavior it is necessary to address both barriers and facilitators. The categories low susceptibility as a barrier and high value of outcome expectations as a facilitator appears to be important for this patient group.</p> / <p><strong>Sammanfattning</strong></p><p><strong>Bakgrund:</strong> Obstruktiv sömnapnésyndrom (OSAS) är vanligt förekommande och syndromet är associerat med hälsorelaterade problem. Det finns en förväntad positiv effekt av beteende förändrande interventioner som syftar på viktminskning. Mera forskning behövs för att identifiera hinder och underlättande faktorer.</p><p><strong>Syfte:</strong> Att identifiera förutsättningar för att ändra matvanor hos feta patienter med OSAS.</p><p><strong>Metod:</strong> Semistrukturerade intervjuer utfördes på 15 feta patienter med OSAS och kategorier identifierades med hjälp av en innehållsanalys.</p><p><strong>Resultat:</strong> Följande kategorier identifierades de som hinder till förändrade matvanor i analysen; begär och sug, påverkan av sinnestillstånd, lågt självförtroende, otillräcklig stöd, social acceptans, komplexiteten i att klara av nya beteenden i dagliga rutiner, kostnader, brist på kunskap, upplevd hjälplöshet och låg mottaglighet. De kategorier som underlättade ändrade matvanor i studien var följande: högt värde av förväntningar, stöd och kontroll, externa faktorer, användbara strategier för ändringar i beteende, självkänsla och viktökning som utlösare.</p><p><strong>Slutsats:</strong> För att framgångsrikt motivera patienter med OSAS att ändra sina matvanor måste hänsyn tas både till hinder och till faktorer som underlättar ett förändrat beteende. Kategorierna ”låg mottaglighet” som ett hinder och ” högt värde av förväntningar” som underlättande faktor tycks vara viktiga för denna patientgrupp.</p>

Abstract Background: Obstructive Sleep Apnea Syndrome (OSAS) is prevalent and the syndrome is associated with increased risk of health related problems. A positive effect of behavioral change programs to reduce weight is expected. More research is needed to identify barriers and facilitators to behavior change. Aim: To identify prerequisites for eating behavior change in obese patients with OSAS. Method: Semi-structured interviews were conducted on 15 obese patients living with OSAS. Data were analyzed using qualitative content analysis. Result: The categories identified as barriers to change in eating behavior in the analysis were desire and craving, influenced by mental state, low self-confidence, insufficient support, social acceptance, complexity of coping with new eating behaviors in daily routines, costs, lack of knowledge, perceived helplessness and low susceptibility. Categories that were identified as facilitators to change in eating behavior were high value of outcome expectations, support and control, external premises, applicable behavior change strategies, self-worth and being triggered by weight increase. Conclusion: To motivate patients living with OSAS to change their eating behavior it is necessary to address both barriers and facilitators. The categories low susceptibility as a barrier and high value of outcome expectations as a facilitator appears to be important for this patient group. / Sammanfattning Bakgrund: Obstruktiv sömnapnésyndrom (OSAS) är vanligt förekommande och syndromet är associerat med hälsorelaterade problem. Det finns en förväntad positiv effekt av beteende förändrande interventioner som syftar på viktminskning. Mera forskning behövs för att identifiera hinder och underlättande faktorer. Syfte: Att identifiera förutsättningar för att ändra matvanor hos feta patienter med OSAS. Metod: Semistrukturerade intervjuer utfördes på 15 feta patienter med OSAS och kategorier identifierades med hjälp av en innehållsanalys. Resultat: Följande kategorier identifierades de som hinder till förändrade matvanor i analysen; begär och sug, påverkan av sinnestillstånd, lågt självförtroende, otillräcklig stöd, social acceptans, komplexiteten i att klara av nya beteenden i dagliga rutiner, kostnader, brist på kunskap, upplevd hjälplöshet och låg mottaglighet. De kategorier som underlättade ändrade matvanor i studien var följande: högt värde av förväntningar, stöd och kontroll, externa faktorer, användbara strategier för ändringar i beteende, självkänsla och viktökning som utlösare. Slutsats: För att framgångsrikt motivera patienter med OSAS att ändra sina matvanor måste hänsyn tas både till hinder och till faktorer som underlättar ett förändrat beteende. Kategorierna ”låg mottaglighet” som ett hinder och ” högt värde av förväntningar” som underlättande faktor tycks vara viktiga för denna patientgrupp.

A necessidade do uso da prótese total durante o sono ainda não está bem definida pela literatura, apenas algumas evidências sobre a relação entre a presença de estomatite protética e o uso contínuo das próteses. O objetivo do estudo clínico randomizado foi avaliar se o uso da prótese total durante o sono interfere ou não nos eventos obstrutivos respiratórios durante o sono. Pacientes idosos edentulos com suspeita de Síndrome da Apnéia-hipopnéia Obstrutiva do Sono (SAOS) foram selecionados. Novas próteses totais foram confeccionadas seguindo o protocolo da FOUSP. A cavidade oral foi avaliada com relação ao exame de Mallampati e a presença de reabsorção óssea. A qualidade do sono foi avaliada pelo PSQI (Pittsburgh Sleep Quality Index) e pela Escala de Sonolência Diurna de Epworth (ESS), as polissonografias foram efetuadas em laboratório especializados durante duas noites em duas situações cruzadas: pacientes dormindo com as próteses e sem as mesmas. Vinte e três pacientes foram avaliados e a média de idade foi de 69,6 ± 5,1 anos e 74% eram do sexo feminino. Os pacientes com severidade leve, apresentaram um índice de apnéia-hipopnéia (IAH) significantemente menor quando os dormiram sem as próteses totais (8,9 ± 2,4 eventos por hora) comparado quando dormiram com as próteses (16,6 ± 6,9 eventos por hora). Os pacientes do grupo moderado a severo, não apresentaram diferença estatisticamente significante entre os IAHs quando dormiram com e sem as próteses. Em uma avaliação separada na posição supina, os pacientes do grupo leve, apresentaram uma média do IAH na posição supina menor quando dormiram sem as próteses do que quando dormiram com elas, apresentando uma média de 12,7 ± 8,4 eventos por hora e 51,9 ± 28,6 eventos por hora respectivamente. Pode-se concluir que os pacientes edentulos com severidade leve de SAOS apresentaram um menor índice de apnéia-hipopnéia obstrutiva quando dormiram na posição supina sem as próteses totais. / Summary: There is no evidence based in the literature about complete denture use during sleep, only some evidences about denture stomatits association and the change in apneic events. The goal of this randomized clinical study was to asses if the complete denture wear during sleep influence apneic events and quality of sleep. Elderly edentulous Obstructive Sleep Apnea Syndrome (OSAS) patients from a complete denture clinic were enrolled and received new complete dentures. The oral condition was evaluated according to bone resorption and Mallampati exam. The sleep quality was assed by the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and the polysomnographys were performed at the sleep laboratory for the patients sleeping with and without dentures the dentures. Twenty-three patients were evaluated with mean age 69.6 (SD±5.1) years and 74% female. In the mild (5AHI<30) OSAS group the apnea-hypopnea index decreased significantly when patients slept without dentures (8.9±2.4) compared when patients slept with the dentures (16.6±6.9). In a separated analysis, mild group in supine position presented a mean apnea-hypopnea index significant lower when patients slept without dentures from 12.7 (SD ± 8.4) to 51.9 (SD ± 28.6) sleeping with dentures. There was no significant difference in moderate to severe patients variables. This study shows that mild OSAS edentulous patients had a lower apnea-hypopnea index when sleeping without dentures in supine position.

Objetivo: O propósito deste estudo consiste em avaliar a relação entre Força de Língua e medidas do posicionamento do hioide em crianças com diagnóstico de SAOS. Casuística e Método: Foram selecionadas crianças entre 07 e 12 anos, de ambos os gêneros, com história de roncos, apneias noturnas e respiração bucal crônica. Todas as crianças tiveram SAOS confirmada pela presença dos sintomas e pela polissonografia e foram divididas em dois grupos: pré-operatório e pós-operatório (pacientes que tinham diagnóstico de SAOS antes da adenotonsilectomia, e foram reavaliados 12 meses depois. Ambos os grupos foram submetidos à avaliação de força de língua isométrica máxima (FLIM), aplicada na posição de ponta e dorso de língua, através do dinamômetro (kgf) e por meio da radiografia lateral foi realizada avaliação craniofacial e posicionamento do hioide. Resultados: Na regressão linear em pacientes pré- operatório a medida cefalometrica D vert. H apresentou forte e significativa (p= 0,0083) relação negativa com a força em ponta de língua. Já em dorso de língua antes da cirurgia não foi significativa, para nenhuma das variáveis. Nos pacientes pós-operatório a FLIM do dorso e ponta foram significativamente (p<0,0330 e p<0,0098 respectivamente) relacionadas à medida cefalométrica C3-H. A comparação de medidas cefalométricas entre os grupos pré e pósoperatórios e entre o subgrupo residual e curados, não tiveram diferença na altura do hioide (HYS, HYMP, D Vert.H) e na relação ântero-posterior do hioide (D Horiz.H, C3-H). Em relação a FLIM da musculatura extrínseca da língua ao se compararem a média e desvio padrão nos pacientes pré e pós-operatório, observou-se que houve diferença para as medidas de força de língua (p= 0,0016 para dorso e p=0,0041 para ponta) entre eles. Não houve diferença entre os sub-grupos residual e curados. Conclusão: No presente estudo podemos concluir que existe relação entre a força do musculo lingual e a posição do osso hiode em crianças com SAOS. Ou seja, aumento na força dos músculos dilatadores da faringe pode influenciar a altura do hioide em crianças com SAOS. / Objective: The purpose of this study is to assess the relation between Force of the Tongue and measures of hyoid\'s positioning in children diagnosed with OSAS. Casuistry and Method: Were selected children between 07 and 12 years, from both genders, with snoring history, nocturnal apnea and chronic mouth breathing. All the children had OSAS confirmed by the sympton\'s presence and by the polysomnography and were divided into two groups: preoperative and postoperative (pacients that had OSAS diagnosed before the adenotonsillectomy,and were revaluated 12 months after. Both groups were submitted to maximum isometric tongue force, applied in the tip and in the back of the tongue, through the dynamometer and through the lateral radiography was performed a craniofacial evaluation and hyoid positioning. Results: In preoperative patients on linear regression the cephalometric measure D. vert. H presented strong and significant (p= 0,0083) negative relation with the tip of the tongue force. Whereas the back of the tongue before the surgery was not significant, for none of the variables. In postoperative patients the maximum isometric tongue force from the back and from the tip were significantly (p<0,0330 e p<0,0098 respectively) related to the cephalometric measure C3-H. The comparison between the cephalometric measures between the preoperative and postoperative groups and between the residual sub group and the healed ones, did not have difference in the hyoid\'s height (HYS, HYMP, D Vert.H) and on the hyoid\'s anteroposterior relation (D Horiz.H, C3-H). In regards to the maximum isometric tongue force from the extrinsic tongue musculature when compared to the average and standard deviation in patients pre and post surgery, it was noticed that there was difference for the tongue force measures (p= 0,0016 for the back and p=0,0041 for the tip) between them. There was no difference between the sub groups residual and healed. Conclusion: In the present study we can conclude that there is relation between the force of the lingual muscle and hyoid bone\'s position in children with OSAS. In other words, an increase on the pharynx dilator muscles\' strength can influence the hyoid\'s height in children with OSAS.

Obesity is a worldwide epidemic increasing at an alarming rate among youth who are facing similar health problems as adults. Sleep Apnea Syndrome (SAS) is an underdiagnosed comorbidity of obesity, characterized by repetitive nocturnal interruptions in breathing. Obesity is associated with delayed skeletal maturation in overweight youth, but mechanisms contributing to this problem are unclear. Obesity and SAS both have been shown to disrupt regulatory hormones and cytokines that influence bone accretion during adolescence. PURPOSE: The purpose of this study was to assess the combined effects of excess body weight and SAS on bone mineral density (BMD) and content (BMC), bone turnover, and on the regulatory hormones leptin and IGF-1 known to potentially influence bone accretion during adolescence. METHODS: Men aged 18-28 years were assigned to groups as follows: normal weight controls (CON: AHI <3, n=8); overweight without SAS (OWT: BMI < 26 kg/m2 and AHI <3, n=9); and overweight with SAS (SAS: BMI >26 kg/m2 and AHI >5, n=8). The apnea/hypopnea index (AHI) expresses the score for disrupted nighttime breathing events/hr and was obtained in this study with results from a home sleep screening test. Health history and Epworth Sleepiness Scale (ESS) questionnaires also were administered. Bone mineral parameters and body composition variables were measured with dual-energy X-ray absorptiometry. Serum osteocalcin, leptin, IGF-1, and NTx-1 were measured, respectively, by radioimmunoassay and enzyme-linked immunoabsorbent assay. RESULTS: Fat-free mass, intra-abdominal fat, and fat mass were higher in the SAS and OWT groups (p<0.03). ESS scores revealed that SAS individuals were sleepier than CON and OWT groups (p<0.009). Total body and site-specific BMD and BMC values (lumbar spine, hip, and forearm) were similar between groups and did not relate to the estimated AHI score. Serum OC and NTx-1 did not differ between groups. Leptin levels were 30% higher in OWT and SAS than in the CON group (p<0.02), but did not correlate with the AHI score. Across all subjects (n=25), only lumbar spine BMC (p<0.005) was correlated to AHI (r=-.52; p<0.01). The preponderance of this relationship between AHI and lumbar spine BMC was attributable to the close inverse association of these two variables within the SAS group (r = -.81; p<0.001). CONCLUSION: The effects of SAS were not influenced by the amount of whole-body, intra-abdominal adiposity or lean body mass. Neither leptin nor IGF-1 predicted bone status across all groups. Daytime fatigue and sleepiness, a cardinal symptom of SAS, combined with overweight may contribute to lower lumbar BMC by chronically reducing weight-bearing physical activity and thereby reduce exposure time for mechanical loading of the spine in affected individuals. Further research is needed to explore the biochemical, physiological, and apparently the physical activity implications of SAS on skeletal status and turnover. / Master of Science

A população idosa possui alta prevalência de edentulismo e, conseqüentemente, é afetada pelos problemas a ele associados. A perda da dimensão vertical de oclusão (DVO) é um destes problemas que compromete, entre outros fatores, o desempenho do sistema estomatognático. Logo, doenças relacionadas ao colapso da musculatura da via aérea superior (VAS), como a síndrome da apnéia obstrutiva do sono (SAOS), tornam-se enfermidades relevantes para pacientes nesta faixa etária. Sendo assim, medidas terapêuticas eficazes e de baixo custo, como a utilização de aparelhos intraorais (AIOs) para liberação do fluxo aéreo, podem ser empregadas contribuindo para a qualidade do sono destes pacientes. O objetivo deste estudo foi avaliar parâmetros subjetivos e objetivos do sono, em 10 pacientes idosos portadores de Próteses totais (PTs) bimaxilares, após a utilização de novas PTs confeccionadas no Programa Envelhecer Sorrindo e após o uso de dois AIOs: um dispositivo intraoral (DIO), especialmente desenvolvido para aumentar a DVO sem provocar avanço mandibular, e um aparelho de avanço mandibular (AAM). Para isso, questionários de rastreamento da qualidade do sono e polissonografias (PSGs) foram realizados, em quatro momentos distintos: sem as PTs, com as PTs, com o DIO e com o AAM. Foram realizadas, também, telerradiografias em norma lateral (TNL) dos pacientes com as PTs, com o DIO e com o AAM a fim de avaliar alterações no diâmetro da VAS e o posicionamento mandibular nesses três momentos. Concluiu-se que, o AAM testado promove maior porcentagem de sono no estágio 1, podendo contribuir para a melhora na qualidade subjetiva do sono dos pacientes, uma vez que ajudou a diminuir o tempo necessário para iniciar o sono, além de facilitar a manutenção do estado de vigília. / There is a high prevalence of edentulism and problems associated to it in the elderly population. A decrease in vertical dimension of occlusion (VDO) is one of these problems that may compromise the stomatognathic system. Therefore, it is important to investigate diseases related to upper airway (UA) musculature collapse, such as the syndrome of obstructive sleep apnea (OSAS). Therapeutic measures of low cost and high efficacy, such as intraoral appliances (IAs) to release the air flow may be employed, contributing to patients sleep quality. The aim of this study was to evaluate subjective and objective sleep parameters in 10 elderly patients who wore maxilar and mandibular complete dentures (CD). The analyses were performed after the use of a new pair of CD and after using two IAs: an intraoral device (ID), especially developed to increase the VDO without causing mandibular advance, and a mandibular advance device (MAD). For this purpose, questionnaires and polysomnography (PSG) were performed in four distinct stages: patients not wearing CD, wearing CD, wearing ID and wearing MAD. In addition, lateral cephalograms (LC) of patients wearing FD, wearing ID and wearing MAD were performed to assess changes in UAs diameter and in the mandibular positioning. It was concluded that the MAD tested promotes higher percentage of stage 1 sleep and and may contribute to the improvement in patients subjective sleep quality, as it helped to decrease the time needed to fall asleep, and facilitate the maintenance of wakefulness.

O avançar da idade é reconhecidamente um fator de risco para a Síndrome da Apneia Obstrutiva do Sono (SAOS). O motivo dessa constatação está associado à diminuição do tônus da musculatura orofaringeana e à redução da Dimensão Vertical de Oclusão (DVO), esta última atribuída às perdas dentárias. A abordagem odontológica, no tratamento da SAOS, refere-se ao uso de Aparelho de Avanço Mandibular (AAM), que impede a obstrução, parcial ou total, da passagem do ar pela via respiratória alta, durante o sono. Os pacientes desdentados, no entanto, têm sido negligenciados, nos estudos atualmente realizados. Pelo exposto, este trabalho objetivou avaliar os efeitos do tratamento em variáveis polissonográficas, ronco, sonolência, qualidade do sono e ainda os efeitos colaterais pelo uso do AAM titulável, em pacientes idosos e desdentados portadadores de SAOS. A metodologia envolveu inicialmente, cinquenta pacientes, dos quais dezesseis realizaram polissonografia de noite inteira, com gravação do ronco, por meio de um Roncômetro, visando investigação objetiva do sono. Analisaram-se subjetivamente frequência e intensidade do ronco, por questionários. A Escala Visual Analógica de Ronco (EVAR), aplicada ao parceiro de quarto, permitiu, igualmente, que fosse avaliada a intensidade desse sintoma. A sonolência diurna foi quantificada pela Escala de Sonolência de Epworth e a qualidade do sono, pelo Índice de Qualidade do Sono de Pittsburgh. Confecção individualizada dos AAMs respeitou os princípios biológicos relativos à DVO. Durante uma semana após a instalação, os pacientes utilizavam o AMM sem qualquer avanço mandibular, visando redução de quaisquer desconfortos. Subsequentemente, o protocolo estabelecia titulação gradual e progressiva (30%, 50% e 70%) do aparelho. Transposta a etapa de adaptação, após um período superior a quinze dias, as avaliações iniciais foram repetidas Os efeitos colaterais pelo uso do AAM e adesão ao tratamento foram investigados, a partir de questionários. Doze pacientes completaram o estudo (83,3% mulheres), sendo a media de idade 68 anos e índice de massa corporal médio de 28,3 kg/m2. Os resultados permitiram observar reduções significantes no índice de dessaturação de O2 (17,710,1 eventos/h, p=0,05) e índice de apneia (3,10,9 eventos/h, p=0,02). O uso do AAM evidenciou também diminuições na latência do sono REM, movimentos períodicos de perna, saturação mínima de O2, índice de apneia e hipopneia, na posição supina (p>0,05). O estudo objetivo do ronco apontou redução de 49,522,6 eventos/h (p=0,07). Além do mais, as avaliações subjetivas de frequência (p=0,024) e intensidade (p=0,007) do ronco, EVAR (p=0,003), qualidade do sono (p=0,008), efeitos colaterais e adesão ao AAM foram estatisticamente significantes. Foi possível concluir pela eficácia do tratamento sobre algumas variáveis polissonográficas estudadas, parâmetros subjetivos do ronco e qualidade do sono. Ademais, os sintomas relatados, pelo uso do AAM, reduziram-se ao longo do tempo, o que permitiu, com vantagem, que houvesse maior adesão ao tratamento por parte dos pacientes inseridos nesta pesquisa. / Aging process is well known as a risky factor to Obstructive Sleep Apnea Syndrome (OSAS). Concomitant with this process, the reduction of orofacial and pharyngeal musculature tone, as well as the decrease of Vertical Occlusion Dimension (VOD), the latter attributed to tooth loss, have been considered as probable causal agents involved in OSAS pathogenesis. The Dentistry approach for OSAS treatment is commonly related to the use of Mandibular Advancement Devices (MAD), which could prevent partial or complete upper airway obstruction during sleep. However, this treatment has been scarcely used in toothless patients. The aim of this study was to assess the effects of a titratable MAD in polysomnographic (PSG) variables, snoring, sleepiness, sleep quality and side effects, in edentulous elderly patients with OSAS. Sixteen out of fifty patients assessed have been selected and have undergone an overnight polysomnographic study. Snoring was recorded by using suitable equipment, so that an objective assessment of sleep patterns could be made. The frequency and intensity of snoring have also been subjectively assessed by means of questionnaires. The Snoring Visual Analogic Scale (SVAS), posed to a bed partner, was also assessed to evaluate snoring intensity. Excessive daytime sleepiness and the quality of sleep have also been investigated by Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, respectively. The patients went through the whole process for individually manufacturing of the MAD following the biological principles of the VDO. A week after using the MAD, at 0% of mandibular advancement, the patients were invited to return in order to undergo a new evaluation according to their adaptation to MAD. Subsequently, a titration protocol was gradually established at 30%, 50% and 70% for mandibular advancement. After a period of at least fifteen days, which should correspond to an adjustment of patients to their devices, the same initial assessment procedures were repeated. The MAD collateral effects as well as the treatment acceptance have been investigated through questionnaires. Twelve patients (83,3% females) completed the study, with an average age of 68 years, body mass index of 28,3 kg/m2. The results showed a significant reduction in O2 desaturation index (17,710,1 event/h, p=0,05) and also in AI (3,10,9 events/h, p=0,02). The use of the MAD also represented reductions in the latency to REM sleep, periodical leg movements, minimum O2 saturation, apnea and hypopnea index (AHI) in supine position (p>0,05). The objective assessment of snoring showed a reduction, with no statistical relevance of the Snoring Index (49,522,6 events per hour of recording, p=0,07). The subjective assessment of frequency (p=0,024) and intensity of snoring (p=0,007), EVAR (p=0,003), sleep quality (p=0,008) and the MAD collateral effects as well as the treatment acceptance were also statistically significant. We observed that the OSAS treatment with MAD was effective in some polysomnografic variables studied as well as in the subjective parameters of snoring and sleep quality in edentulous elderly patients. The reported symptoms due to MAD use decreased over the time.