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Le syndrome d’apnées obstructives du sommeil (SAOS) se caractérise par des collapsus récurrents des voies aériennes supérieures pendant le sommeil, entraînant des épisodes d’hypoxie/hypercapnie. Par ces variations gazeuses, le SAOS entraîne des altérations cardiorespiratoires, représentant ainsi un danger de vie pour les patients, mais dont certaines sont moins marquées chez les patientes. La prévalence chez les hommes est plus élevée que celle des femmes pré-ménopausées et elle est augmentée par l’obésité.L’objectif de ce doctorat était de caractériser les dimorphismes sexuels dans la neuroplasticité associée au SAOS, à l’origine des altérations cardiorespiratoires. Pour cela, nous avons soumis des souris à un protocole d’hypoxie intermittente chronique (HIC), ce modèle récapitulant l’hypoxie récurrente du SAOS. Dans l’encéphale de ces souris, nous avons pu apprécier des atteintes différentielles entre les souris mâles et femelles au sein de structures cardiorespiratoires avec un profil de neuroplasticité réservé aux femelles qui pourrait atténuer chez ces dernières les effets de l’HIC. Cela ouvre des pistes explicatives des différences sexuelles retrouvées chez les patients et patientes SAOS. Nous avons également caractérisé une souche de souris obèses (New Zealand Obese) en tant que modèle du SAOS. Nous fournissons ainsi le premier modèle murin naturel du SAOS lié à l’obésité. Enfin, ce travail contribue à une meilleure connaissance des différences sexuelles observées dans le SAOS et fournit un modèle facilement accessible qui offre la possibilité de réaliser des études plus complètes de la pathologie du SAOS. / The obstructive sleep apnea syndrome (OSAS) is characterized by recurrent collapse of the upper airways during sleep, generating episodes of hypoxia/hypercapnia. Thus, OSAS leads to life-threatening cardiorespiratory comorbidities, but of which some are less severe in female patients. The prevalence in men is higher than that of pre-menopausal women and it is increased by obesity. This doctoral thesis aimed to characterize sex differences in the neuroplasticity related to cardi-orespiratory comorbidities found in OSAS. In this context, we submitted mice to a protocol of chronic intermittent hypoxia, a model that recapitulates episodic hypoxia of OSAS. On isolated brain sections, we observed differential implication of cardiorespiratory structures between male and female mice with a specific neuroplastic pattern in females that could possibly explain sex differences observed in OSAS patients. In parallel, we have characterized an obese mouse strain (New Zealand Obese) as a model of OSAS. Thus, we provide the first naturel mouse model for OSAS related to obesity. The work presented in this thesis provides better understanding of sex differences observed in OSAS and provides a new model of OSAS that should allow more complete studies of the pathology of OSAS.

Snores are breath sounds that most people produce during sleep and they are reported to be a risk factor for various sleep disorders, such as obstructive sleep apnea syndrome (OSAS). Diagnosis of sleep disorders relies on the expertise of the clinician that inspects whole night polysomnography recordings. This inspection is time consuming and uncomfortable for the patient. There are surgical and therapeutic treatments. However, evaluation of the success of these methods also relies on subjective criteria and the expertise of the clinician. Thus, there is a strong need for a tool to analyze the snore sounds automatically, and to produce objective criteria and to assess the success of the applied treatment by comparing these criteria obtained before and after the treatment. In this thesis, we proposed a new algorithm to detect snoring episodes from the sleep sound recordings of the individuals, and created a user friendly interface to process snore recordings and to produce simple objective criteria to evaluate the results. The algorithm classifies sleep sound segments as snores and nonsnores according to their subband energy distributions. It was observed that inter- and intra-individual spectral energy distributions of snore sounds show significant similarities. This observation motivated the representation of the feature vectors in a lower dimensional space which was achieved using principal component analysis. Sleep sounds can be efficiently represented and classified as snore or nonsnore in a two dimensional space. The sound recordings were taken from patients that are suspected of OSAS pathology while they were connected to the polysomnography in G&uuml / lhane Military Medical Academy Sleep Studies Laboratory. The episodes taken from 30 subjects (18 simple snorers and 12 OSA patients) with different apnea/hypopnea indices were classified using the proposed algorithm. The system was tested by using the manual annotations of an ENT specialist as a reference. The system produced high detection rates both in simple snorers and OSA patients.

En el presente seminario se estudian las características y el comportamiento que han tenido las Opciones de Suscripción de Acciones (OSAS) emitidas por diferentes empresas transadas en Bolsa, durante el período 2000-2003, y como objetivo central , se realizará un ejercicio de valoración para estos instrumentos, mediante la utilización del modelo de valoración de warrants de Galai y Schneller (1978). Una OSA, de la misma forma que un warrant, al momento de su ejercicio, hace que la compañía emita nuevas acciones, diluyendo de esta forma parte de la propiedad que tienen los antiguos accionistas en ella. Esta aplicación permitirá medir el grado de ajuste entre los precios de mercado y los reportados por el modelo de valoración. Los resultados obtenidos para la muestra de OSAS estudiadas, indican que el valor teórico subvalora para todos los casos el verdadero valor que presenta la OSA en el mercado

INTRODUCTION: Characterized by recurrent episodes of partial or total obstruction of the upper airway during sleep apnea syndrome and obstructive sleep hypopnea syndrome (OSAHS) is the most common form of sleep-related breathing disorder that is considered an important cause of morbidity and mortality. The intermittent hypoxia and reoxygenation are increasing the activity of the sympathetic nervous system, on the other hand increase the blood pressure, altering the oxidative balance, inducing the formation of free radicals and consequent atherogenesis. The disease is classified in level of severity the according to the quantification of respiratory events per hour of sleep (AHI - apnea-hypopnea) as light, when they occur 5 to 15 events / hour sleep, moderate, 15 to 30 , and severe above 30. OBJECTIVE: This study was performed to verify the correlation between the severity of OSA, blood pressure in 24 hours, during waking and sleep, and serum lipids and glucose. MATERIAL AND METHOD: We studied 32 patients. These were assessed by completing a questionnaire, in addition to being weighed and measured. In the first assessment, was checked blood pressure (BP), the examination and ENT requested laboratory tests, including total cholesterol, LDL, HDL, triglycerides, total lipids and fasting glucose, polysomnography and ambulatory blood pressure monitoring (ABPM). Patients were divided into four groups according to the AHI: control group (AHI <5), Group I (AHI 5-15), Group II (AHI 15-30), Group III (AHI> 30). RESULTS: There was no significant variation with respect to mean age between cases and controls (p = 0.749) and with a body weight (p = 0.075), despite having been an increase of body mass directly proportional to the severity of the disease. There was no statistically significant difference between groups with respect to the first assessment of BP (p = 0.339 for systolic and p = 0.238 for diastolic BP). There was no increase in blood pressure in groups cases, the verification of systolic (p = 0,429) and diastolic (p = 0,475) blood pressure in 24 hours, systolic (p = 0,277) and diastolic (p = 0,143) blood pressure during wakefulness, and systolic (p = 0,394) and diastolic (p = 0,703) blood pressure during sleep in the control group. When implementing the Spearman correlation test, was not observed a correlation directly proportional to the severity of the disease. Regarding the level of serum total cholesterol (p = 0,092), LDL (p = 0,242), HDL (p = 0,517), triglycerides (p = 0,947), total lipids (p = 0,602) and glucose (0,355), there was no statistically significant difference between groups (p> 0.05 for all parameters), there is a correlation between their values and severity of obstructive sleep apnea. CONCLUSION: there is no correlation between the severity of apnea and hypopnea syndrome Obstructive Sleep and blood pressure levels in 24 hours, during daytime, during the sleep and serum levels of LDL and HDL cholesterol. / INTRODUÇÃO: Caracterizada por episódios recorrentes de obstrução parcial ou total da via aérea superior durante o sono, a Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS) é a forma mais freqüente de distúrbio respiratório relacionado ao sono, sendo considerada uma causa importante de morbidade e mortalidade. A hipóxia e reoxigenação intermitentes, além de aumentarem a atividade do Sistema Nervoso Simpático elevando a pressão arterial sistêmica, costumam alterar o balanço oxidativo, induzindo a formação de radicais livres e conseqüente aterogênese. A doença é classificada em grau de severidade de acordo com a quantificação dos eventos respiratórios por hora de sono (IAH índice de apnéia e hipopnéia) em: leve, quando ocorrem de 5 a 15 eventos/hora sono; moderada, de 15 a 30; e severa, acima de 30. OBJETIVO: Este estudo foi realizado a fim de se verificar a correlação existente entre a gravidade da SAHOS, a pressão arterial em 24 horas, durante a vigília e durante o sono, e os níveis séricos lipídicos e glicêmicos. MATERIAL E MÉTODO: Participaram da pesquisa 32 pacientes. Estes foram avaliados mediante preenchimento de um questionário, além de serem pesados e medidos. Ainda na primeira avaliação, era verificada a pressão arterial (PA), realizado o exame otorrinolaringológico e solicitados os exames laboratoriais, dentre eles o colesterol total, LDL, HDL, triglicerídeos, lipídios totais e glicemia de jejum, a polissonografia e a monitorização ambulatorial da pressão arterial (MAPA). Os pacientes foram divididos em 4 grupos conforme o IAH: Grupo Controle (IAH < 5) ; Grupo I (IAH 5 - 15); Grupo II (IAH 15 - 30); Grupo III (IAH > 30). RESULTADOS: Não houve variação significante com relação a média da idade entre os casos e o controle (p = 0,749) bem como com relação ao peso corporal (p = 0,075), apesar de ter sido observado aumento da massa corpórea diretamente proporcional à gravidade da doença. Também não houve diferença estatisticamente significante entre os grupos com relação a primeira avaliação da PA (p = 0,339 para PA sistólica e p = 0,238 para PA diastólica). Também não houve aumento dos níveis pressóricos nos grupos de casos, nas verificações da PA sistólica (p = 0,429) e diastólica (p = 0,475) em 24 horas, PA sistólica (p = 0,277) e diastólica (p = 0,143) durante a vigília, e PA sistólica (p = 0,394) e diastólica (p = 0,703) durante o sono, em relação ao grupo controle Ao ser aplicado o teste de correlação de Spearman, não foi observado existência de uma correlação diretamente proporcional à gravidade da doença. Quanto ao nível sérico do colesterol total (p = 0,092), suas frações LDL (p = 0,242) e HDL (p = 0,517), triglicerídeos (p = 0,947), dos lipídios totais (p = 0,602) e da glicose (p = 0,355), também não houve diferença estatisticamente significante entre os grupos, não havendo uma correlação entre seus valores e a gravidade da Apnéia Obstrutiva do Sono. CONCLUSÃO: não há correlação entre a gravidade da Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono e os níveis tensionais em 24 horas,durante a vigília e durante o sono.e os níveis séricos do LDL e HDL colesterol.

Syfte: Att utvärdera patientnyttan av behandling med apnébettskena vid obstruktivt sömnapnésyndrom (OSAS) på avdelningen för Orofacial smärta och käkfunktion på Odontologiska fakulteten, Malmö Universitet, samt att undersöka vilka subjektiva och kliniska faktorer som kan förutsäga ett lyckat behandlingsutfall samt om behandlingsbiverkningar uppstår. Material och metod: I en retrospektiv kvalitetsstudie utvärderades 183 konsekutiva patientjournaler mellan 2017/01–2020/05. Data från journalerna granskades avseende subjektiva symtom och kliniska fynd för att kunna besvara på befintliga frågeställningar. Data inhämtades från ett standardiserat formulär och klinisk undersökning från baseline (n=183), 3 månader (n=143) samt 1 årsuppföljning (n=93). Datamaterialet analyserades i SPSS 27. Resultat: En god behandlingseffekt rapporterades av 66% vid 3 månaders och 64% vid 1 årsuppföljningen. En signifikant kvarstående förbättring av morgontrötthet (p&lt;0,000), dagtrötthet (p&lt;0,000) och sömnighet (p&lt;0,000) registrerades. Sömnighet graderades med Epworths sömnighetsskala. Antal uppvaknande per natt minskade (p&lt;0,000). Följsamheten var god, 71% använde skenan 6–7 nätter i veckan. Den vanligaste biverkningen var övergående smärta i tuggsystemet. Bettavvikelser i form av minskad vertikal och horisontell överbitning förekom hos 22 respektive 14 patienter vid 3 månaders uppföljningen. Inga predikterande faktorer för en positiv behandlingseffekt kunde registreras i denna studie. Slutsats: Majoriteten av patienter upplevde en god behandlingseffekt, hade minskad morgon och dagtrötthet och uppvisade en god följsamhet av att använda apnébettskenan. Inga prediktiva värden kunde identifieras för gott behandlingsutfall. Smärta och bettavvikelse rapporterades av var femte patient, minskad horisontell och/eller vertikal överbitning registrerades hos ungefär var 10:e patient / Aim: To evaluate the long-term effect of treatment with an oral appliance in patients withobstructive sleep apnea syndrome (OSAS) at the Department of Orofacial Pain and JawFunction, Faculty of odontology, Malmö University, and to investigate which subjective andclinical factors can predict a successful treatment outcome and whether side effects occur. Material and method: In a retrospective quality study, 183 consecutive patient records wereevaluated between 2017/01-2020/05. Data from the records were examined for subjectivesymptoms and clinical findings in order to answer stated questions. Data were obtained froma standardized inquiry and a clinical examination from baseline (n=183), 3 months (n=143)and a one-year follow-up (n=93). The data material was analysed with SPSS 27. Results: A good treatment effect was reported by 66% at 3 months and 64% at 1 year followup. A significant sustained improvement in morning sleepiness(p&lt;0.000), daytime sleepiness(p&lt;0.000), and sleepiness (p&lt;0.000) was recorded. Sleepiness was graded according to theEpworth sleep index. The number of awakenings per night decreased (p&lt;0.000). Compliancewas good, 71% of patients used the splint 6-7 nights a week. Most common dental sideeffects were transient pain in the masticatory system. Dental side-effects in the form ofreduced vertical and horizontal overbite occurred in 22 respectively 14 patients at the 3months follow up. No predictive factors could be found in this study. Conclusion: The majority of patients experienced a good treatment effect, had reducedmorning fatigue and daytime sleepiness and showed a good consistency of using an oralappliance. No predictive values could be identified for good treatment outcomes. Pain anddental changes were reported by one in five patients, decreased overbite and/or overjet wasrecorded in approximately one in 10 patients.

No description available.

Pediatric sleep problems are among the most common yet significant pediatric health issues faced by families. Sleep problems can impact social-emotional and academic functioning of schoolchildren. Once identified, pediatric sleep problems and disorders are treatable with effective and rapid behavioral and medical interventions. The purpose of the current study was to determine the prevalence rates of symptoms of sleep disorders in a diverse school-based sample as well as the relationship between symptoms of sleep disorders and school behavior, academic achievement, and quality of life. The present study examined the relationship between the independent variables of No Sleep Disorders symptoms and Sleep Disorders symptoms derived from the Sleep Disorders Inventory for Students, Children's Form (SDIS-C) and the dependent variables Externalizing and Internalizing scales of the Behavior Assessment System for Children, Second Edition (BASC-2), Curriculum-based Measurement Re ading (R-CBM), Curriculum-based Measurement Math (M-CBM), PedsQL TM 4.0, and Students' Life Satisfaction Scale (SLSS). A Multivariate analysis of variance (MANOVA) was used to identify a significant difference between students with and without symptoms of sleep disorders on behavior, academics, and quality of life. Follow-up analyses using a modified Bonferroni adjustment determined significant differences between students with and without symptoms of sleep disorders on R-CBM, externalizing behaviors and internalizing behaviors. Medium effect sizes were reported for R-CBM, externalizing and internalizing behaviors and M-CBM. Very small effect sizes were found for PedsQL TM 4.0 and SLSS. Implications for School Psychologists and directions for future practice and research are discussed including understanding prevention, early identification and intervention, broadening the scope of school psychology training at the preservice and inservice levels and educating locally and nationall y.

Restless legs syndrome (RLS) and Obstructive sleep apnoea syndrome (OSAS) are two sleep disorders that affect daily life with symptoms such as sleepiness and fatigue. It was therefore hypothesised that the skeletal muscle could be affected as symptoms from skeletal muscle are common. The overall aim of the thesis was to investigate aerobic capacity and structure of skeletal muscle in patients with OSAS and RLS and an age matched control group to provide information regarding the underlying mechanisms. The specific aims were to investigate muscle fibre composition, capillary network, capillary proliferation and sings of local inflammation in musculus tibialis anterior of RLS and OSAS.OSAS and RLS patients had a significantly lower predicted VO2 max expressed in ml/min/kg compared with the control group and in the OSAS group apnoes-hyponea index (AHI) was inversely correlated to maximal oxygen uptake Fibre type composition and muscle fibre cross sectional area in the tibialis anterior muscle was equal in all groups with a predominant proportion of slow type I fibres and a smaller fibre area in slow type I fibres compared to fast type II fibres. The distribution of fast fibres (I/IIA, IIA) did not differ except for the group IIX and IIA/IIX where OSAS and RLS had a significantly higher percentage. OSAS patients had a significantly higher number of capillaries per fibre (CAF) for slow type I fibres and CAF per fibre area (CAFA) for fast type II fibres. CFPE- index (capillary to fibre perimeter exchange) and LC/PF-index (length of capillary/perimeter of fibre) were higher in both patient groups. Vascular endothelial growth factor (VEGF) and proliferating endothelial cells were analysed by double-immunofluorescence staining and were presented to a greater extent in the patient groups compared with the healthy controls. Based on normal amounts of T-cells and macrophages in the histological picture it was also demonstrated that local inflammation was not present in the tibialis anterior muscle of RLS and OSAS whish was also supported by the absence of expression of major histocompatibility complex class I molecules (MHC class I) on the surface of the tibialis anterior muscle fibres.In conclusion, the low predicted VO2 max together with higher percentage of type IIX and IIA/IIX muscle fibres indicates a low central capacity in the patient groups. The increased capillary network and the absence of inflammation indicate the occurrence of local hypoxia in tibialis anterior muscle in patients OSAS and RLS.

The aim of this thesis is to highlight the severity of sleep-disordered breathing at risk pregnancies, as these disorders have a high share on the occurrence of cardiovascular problems at a later age. In the group of high-risk pregnant patients, breathing disorders in sleep lead to higher morbidity of patient as well as newborns. Currently, there are increasing risk factors in the population of pregnant women. Risk factors for the development of OSAS, which are examined in detail in this thesis in pregnant women, include BMI, age, pregestational and gestational hypertension and diabetes mellitus. The theoretical part of the thesis contains the findings of the risk pregnancies. The most serious unit is preeclampsia. For that reason, the greatest attention within high- risk pregnancies is aimed to the incidency, ethiopathogenesis, diagnosis and treatment of preeclampsia. Furthermore, the theoretical part includes findings related to sleep- disordered breathing and focuses on OSAS and its health complications. In the special part of the thesis, there is an assessment of results regarding risk pregnant women with the presence of OSAS and without present OSAS. Keywords Preeclampsia, hypertension, OSAS, pregnancy, risk factors