Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-11-20T16:00:06Z No. of bitstreams: 1 476332 - Texto Parcial.pdf: 183531 bytes, checksum: ea697ef5b7144b539d0c8a032872b93c (MD5) / Made available in DSpace on 2015-11-20T16:00:06Z (GMT). No. of bitstreams: 1 476332 - Texto Parcial.pdf: 183531 bytes, checksum: ea697ef5b7144b539d0c8a032872b93c (MD5) Previous issue date: 2015-05-28 / It is well known that Oral Appliance (OA) are efficient for the treatment of Obstructive Sleep Apnea (OSA) in adults. However, evidence for its use in children is still debated. Although surgery is the standard treatment for OSA in this population, OA may be an alternative in situations where there are no clinical conditions for surgical procedures or when this is not an immediate option. Positioning the jaw in a protrusive position during sleep, the devices prevent the collapse of the pharynx. The objective of the present study was to evaluate the efficacy of an OA for the treatment of OSA in pediatric patients. Patients aged between 5 and 12 years, on the waiting list for adenoamigdalectomy, were selected in the outpatient clinic of otorhinolaryngology of two university hospitals. Dental conditions, as well as sleep bruxism (SB), signs and symptoms of temporomandibular disorders, according to the Research Diagnostic Criteria (RDC/TMD) were analyzed, and a sleep questionnaire was applied. The clinical diagnosis of OSA was confirmed through an exam of home portable polysomnography (ApneaLink?, version 9.00, ResMed Corporation). All the exams were revised by one of the researchers, following the 2005 guidelines of the American Academy of Sleep Medicine. After the diagnosis was confirmed, the OA was made in the School of Odontology. A new portable study was performed after 60 days of use of the OA. Eighteen individuals were evaluated; mean age was 8.39 years. Initial mean respiratory disorder index (RDI) was 10 events/hour (interval 3-39 events/hour), when compared to 3 events/hour (interval 0-11 events/hour) using the IOD (p<0.001, Wilcoxon Signed-Rank Test). The SpO2 Nadir increased from 83.5% (interval of 65%-93%) to 89.5% (interval of 79-95%), after the use of OA (P 0.002). The number of episodes of snoring also decreased with the treatment (p<0.001). No complaints were reported during the follow-up. With regard to the BiteStrip, a reduction of 66 % was observed in the prevalence of patients with SB. The report of parents when answering the sleep questionnaire showed significant improvement in all aspects analyzed. In special or individualized circumstances, OA may be considered an alternative for the treatment of children with OSA. / Os aparelhos intraorais (AIO) s?o reconhecidamente eficientes para tratamento da Apneia Obstrutiva do Sono (SAOS) em adultos. Entretanto, as evid?ncias para seu uso em crian?as ainda s?o discutidas. Embora a cirurgia seja o tratamento padr?o para a SAOS nesta popula??o, o AIO pode ser uma alternativa em situa??es onde n?o existem condi??es cl?nicas para procedimentos cir?rgicos ou esta n?o ? uma op??o imediata. Posicionando a mand?bula numa posi??o protrusiva durante o sono, os parelhos impedem o colapso da faringe. O objetivo deste estudo foi avaliar a efic?cia de um AIO para o tratamento da SAOS e o efeito dessa terapia no bruxismo noturno (BS) em pacientes pedi?tricos. Pacientes com idade de 5 a 12 anos de idade, na lista de espera para cirurgia de adenoamigdalectomia, foram selecionados no ambulat?rio de otorrinolaringologia de dois hospitais universit?rios. As condi??es dent?rias, bruxismo do sono (BS), sinais e sintomas de desordens temporomandibulares segundo os Crit?rios Diagn?sticos de Pesquisa (RDC / TMD) foram analisadas e um question?rio de sono foi aplicado. O diagn?stico cl?nico da SAOS foi confirmado atrav?s de um exame de monitoriza??o cardiorespirat?ria port?til domiciliar (ApneaLink ?, vers?o 9.00, ResMed). Todos os exames foram revisados por um dos pesquisadores, de acordo com a Academia Americana de Medicina do Sono diretrizes de 2012. Ap?s o diagn?stico confirmado, o AIO foi confeccionado na Faculdade de Odontologia. Um novo estudo port?til foi realizado ap?s de 60 dias de uso do AIO. Durante as duas avalia??es cardiorrespirat?rias os pacientes utilizaram o adesivo Bite Strip? para avalia??o de SB. Foram avaliados 18 indiv?duos, com uma m?dia de 8,39 anos de idade. ?ndice m?dio de dist?rbio respirat?rio (RDI) inicial foi de 10 eventos / hora (intervalo 3-39 eventos / hora), em compara??o com 3 eventos / hora (intervalo 0-11 eventos / hora) usando o AIO (p <0,001, Wilcoxon Signed Rank Test). Nadir SpO2 aumentou de 83,5% (intervalo de 65 para 93%) a 89,5% (intervalo de 79-95%), ap?s o uso do AIO (P 0,002). O n?mero de epis?dios de ronco tamb?m diminuiu com o tratamento (p <0,001). Os sinais e sintomas de DTM n?o aumentaram ap?s o uso do AIO. No que diz respeito ao BiteStrip, uma redu??o de 66% foi observada na preval?ncia de pacientes com BS. N?o houve queixas durante o acompanhamento. O relato dos pais ao responder o question?rio do sono demonstrou melhora significativa em todos os aspectos analisados. Em circunst?ncias especiais ou individualizada, a AIO pode ser considerado como uma alternativa para o tratamento de crian?as com SAOS.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-06-30T17:23:31Z No. of bitstreams: 1 TES_PAULO_ROBERTO_CASTRO_MATTIA_PARCIAL.pdf: 360391 bytes, checksum: 09001741931b57c50fd6b7240b6295d7 (MD5) / Made available in DSpace on 2016-06-30T17:23:31Z (GMT). No. of bitstreams: 1 TES_PAULO_ROBERTO_CASTRO_MATTIA_PARCIAL.pdf: 360391 bytes, checksum: 09001741931b57c50fd6b7240b6295d7 (MD5) Previous issue date: 2016-03-30 / The use of complete dentures during sleep is still under debate. The use is indicated or not quite empirically, based only on controlling stomatitis caused by fungal infections. The objective was to evaluate the impact of maxillary edentulism and consequent use of complete dentures during sleep in the quality of life, sleep quality, sleep bruxism, temporomandibular dysfunction, level of sleepiness and apnea index in patients. For this, 20 patients from the researcher?s private practice were selected, 90% women and 10% men, average age of 61 years. The subjects must have complete upper dentures and fixed lower implant-supported dentures made in a standardized way. Patients were submitted to anamnesis, and validated questionnaires of sleep quality (PSQI-BR / The Pittsburgh Sleep Quality Index BR; SAQ / Sleep Assessment Questionnaire), sleepiness (ESS-BR / Epworth Sleepiness Scale BR, bruxism (QABN / Questionnaire nocturnal bruxism evaluation) and temporomandibular disorders (RDC / TMD axis I / Research Diagnostic Criteria for temporomandibular Disorders). The sleep bruxism was also measured with the validated myographic device BiteStrip. After sleeping one night with cardiorespiratory portable type 3 monitor ApneaLink? (ResMed, Australia) using the upper denture at home, a washout period of at least 7 days was respected and all questionnaires were repeated. Then, the patient slept again with the portable monitor and without the upper denture. The RDC / TMD axis I detected 95% of absence of muscle disorders in both tests. There was no significant difference in the SAQ global score between before and after according to the Wilcoxon signed rank test (2tail). PSQI-BR and ESS-BR also showed no significant differences between the two tests, except for the component number 5 of the PSQI-BR. Regarding sleep bruxism, the QABN and the myographic device BiteStrip also showed no significant differences between measurements with and without the use of dentures. Regarding cardiorespiratory monitoring in any of the indexes there was no significant difference between the before and after moments. The indexes measured were respiratory disturbance index (RDI), baseline oxygen saturation (%), average (%) and minimum (%), and oxygen saturation time < 90%, oxygen saturation percentage < 90% and the Oxygen desaturation index (ODI). It was noticed in RDI a difference in absolute numbers that could translate into statistically significant results if the sample were larger. Finally, no significant differences were recorded between before and after, neither in the questionnaires nor in the myographic device and the cardiorespiratory monitoring. Thus, further studies are needed in order to establish a more exact relationship between the use of complete dentures and their influence on sleep quality, sleepiness, temporomandibular disorders (TMD) and sleep bruxism. / A utiliza??o de pr?teses totais durante o sono ? ainda alvo de discuss?o. O uso ? indicado ou n?o de maneira bastante emp?rica, baseando-se apenas no controle de estomatites causadas principalmente por infec??es f?ngicas. O objetivo foi avaliar o impacto do edentulismo superior e consequente uso de pr?teses totais durante o sono na qualidade de vida, qualidade de sono, bruxismo do sono, disfun??o temporomandibular, n?vel de sonol?ncia e ?ndice de apneia em pacientes. Para isso, foram selecionados 20 pacientes da cl?nica particular do pesquisador, 90% mulheres e 10% homens, com idade m?dia de 61 anos. Os indiv?duos apresentaram Pr?teses Totais Convencionais superiores e Pr?teses Totais fixas Implantossuportadas inferiores adequadas e confeccionadas de maneira padronizada. Os pacientes foram submetidos ? anamnese, e a question?rios validados de qualidade de sono (PSQI-BR/The Pittsburgh Sleep Quality Index BR; SAQ/Sleep Assessment Questionnaire), sonol?ncia (ESS-BR/Epworth Sleepiness Scale BR, bruxismo (QABN/Question?rio de Avalia??o de Bruxismo Noturno) e disfun??o temporomandibular (RDC/TMD eixo I/Research Diagnostic Criteria for Temporomandibular Disorders). O bruxismo noturno tamb?m foi aferido com o dispositivo miogr?fico validado BiteStrip. Ap?s, dormiram uma noite com monitor cardiorrespirat?rio port?til tipo 3 ApneaLink? (ResMed, Australia) utilizando a pr?tese total superior em seu domic?lio. Respeitou-se um per?odo de washout de no m?nimo 7 dias para que todos os question?rios fossem repetidos e o paciente dormisse novamente com o monitor port?til e sem a pr?tese total. O RDC/TMD eixo I detectou 95% de aus?ncia de desordens musculares em ambos os exames. N?o houve diferen?a significativa no escore global do SAQ entre o antes e depois de acordo com o Wilcoxon signed ranks test (2tail). PSQI-BR e ESS-BR tamb?m n?o apresentaram diferen?as significativas entre os dois exames, com exce??o do componente 5 do PSQI-BR. Em rela??o ao bruxismo do sono, o QABN e o dispositivo miogr?fico BiteStrip tamb?m n?o apresentaram diferen?as significativas entre as medi??es com ou sem a utiliza??o da dentadura. Em rela??o ? monitora??o cardiorrespirat?ria, em nenhuma dos ?ndices houve diferen?a significativa entre o antes e o depois. As medi??es foram de ?ndice de Dist?rbios Respirat?rios (IDR), Satura??o de oxig?nio basal (%), m?dia (%) e m?nima (%), al?m de Tempo de satura??o de oxig?nio < 90%, porcentagem de satura??o de oxig?nio < 90% e o ?ndice de Dessatura??o de Oxig?nio (IDO). Percebeu-se no IDR uma diferen?a em n?meros absolutos que poderia se traduzir em estatisticamente significativa se a amostra fosse maior. Por fim, n?o foram registradas diferen?as significativas entre o antes e o depois, tanto nos question?rios quanto no dispositivo miogr?fico e monitoriza??o cardiorrespirat?ria port?til. Assim, mais estudos s?o necess?rios para que se estabele?a uma rela??o mais exata entre o uso de dentaduras completas e sua influ?ncia na qualidade de sono, sonol?ncia, desordens temporomandibulares (DTM) e bruxismo do sono.