Introdução: A utilidade de questionários para o diagnóstico de apneia obstrutiva do sono está bem estabelecida em adultos, mas permanece indefinida em idosos. Objetivo: Avaliar as propriedades preditivas dos questionários mais comumente empregados na população em geral em idosos fisicamente independentes. Desenho: Transversal. Local: Unidade de cuidados primários de saúde pública filiada a hospital universitário. Participantes: Roncadores fisicamente independentes com idade entre 65 a 80 anos cadastrados em um hospital universitário foram abordados por telefone e convidados a participar. Métodos: Os participantes foram submetidos à polissonografia portátil. Sensibilidade, especificidade, razão de verossimilhança positiva e negativa, área sob a curva ROC e psicometria clássica foram utilizados para avaliar a precisão e a medição de propriedades diagnósticas de três instrumentos validados para uso na população geral, sendo incerta sua utilização em idosos. Resultados: A amostra de 131 idosos fisicamente independentes, 50% homens, 58% aposentados, foram incluídos. Epworth>6 apresentou uma precisão de 61% para identificar IAH≥15. Epworth>10, ponto de corte usualmente empregado em adultos, apresentou pior desempenho diagnóstico. Sexo masculino e ser aposentado tiveram menor probabilidade de estarem associados com apneia obstrutiva do sono grave. Para prever IAH≥15, a área sob a curva ROC para Epworth>6 foi significativa, mas não para STOP-bang>2 e Atenas>5. Na regressão logística para prever IAH≥15, controlando para diversos fatores, apenas Epworth>6 e Atenas>5 permaneceram significativas no modelo. Conclusão: Em idosos independentes, uma escala de sonolência de Epworth com ponto de corte de 6 tem melhor desempenho diagnóstico do que questionários comumente empregados para prever um IAH≥15. / Background: The usefulness of questionnaires for diagnosis of sleep apnea is well established in adults, but remains undefined in the elderly population. Objective: To evaluate the predictive properties of the most commonly employed questionnaires in physically independent elderly people from the general population. Design: Cross-sectional. Setting: Public health primary care unit affiliated to university hospital. Participants: Physically independent snorers aged 65 to 80 years adscript to a university hospital were approached by telephone and invited to participate. Measurements: Participants underwent portable polysomnography. Sensitivity, specificity, positive and negative likelihood ratios, area under the ROC curve, and classical psychometrics were used to assess diagnostic accuracy and measurement properties of three validated instruments for use in the general population, making their usability in elderly populations uncertain. Results: A sample of 131 independently-living elderly people, 50% male, 58% retired, was included. For identifying AHI≥15, an Epworth>6 had an accuracy of 61%. Epworth>10, the usually employed cut-off point in adults, had poorer diagnostic performance. Male gender and retirement were protective of more severe OSA. For predicting AHI≥15, the area under the ROC curve for Epworth>6 was significant, but not for STOP-Bang>2 and Athens>5. In logistic regression to predict AHI≥15, after controlling for several confounders, Epworth>6, and Athens>5 were the only variables that remained significant in the model. Conclusion: In independent elderly, an Epworth sleepiness scale cut-point of 6 has better diagnostic performance than commonly employed questionnaires to predict an AHI≥15.

Background: Obstructive Sleep Apnea (OSA) is a chronic breathing disorder that is estimated to affect 20% of the US adult population. Intermittent hypoxia and sleep fragmentation caused by OSA likely affects cardiometabolic function. Individuals with OSA might be at risk of developing hypertension and type 2 diabetes (T2DM), with a dose-response relationship related to OSA severity. The objective of this study was to estimate the association between severity of OSA at diagnosis with 1) incidence of hypertension incidence of hypertension and 2) incidence of T2DM. Methods: We conducted a retrospective cohort study of Kaiser Permanente members diagnosed with OSA during 2000-2005. Adults without baseline hypertension or T2DM were eligible. Patients were excluded if hypertension or T2DM was diagnosed within one year prior to OSA diagnosis, and right censored at the end of follow-up or at the time Kaiser Permanente membership ended. Kaplan-Meier curves and Cox Proportional Hazard models were used to estimate the association between OSA severity and incident hypertension and incident diabetes. Results: Overall 719 patients were diagnosed with OSA during the study periods; 614 were included as those at risk of developing either hypertension (N=265) or T2DM (N=489). Overall, 261 had severe OSA at diagnosis. Those with severe OSA were more likely to be middle aged, overweight, and have prevalent hypertension or T2DM. Among those without prevalent hypertension at OSA diagnosis, 47.4% (126/266) were subsequently diagnosed with hypertension. Among those without prevalent T2DM at OSA diagnosis, 16.3% (80/491) were subsequently diagnosed with T2DM. After adjusting for BMI and prevalent T2DM, the hazard rate of incident hypertension among patients with severe OSA was 1.35 (95%CI: 0.88-2.06) compared to the rate among patients with mild OSA. The hazard rate of incident T2DM among patients with severe OSA was 1.49 (95%CI: 0.83-2.67) compared to the rate among patients with mild OSA after adjusting for BMI and prevalent hypertension. Discussion: We found high incidence rates of hypertension and T2DM among adults diagnosed with OSA. Severe OSA at diagnosis was associated with increased risk of either incident hypertension or T2DM, but not significantly (for p≤0.05).

published_or_final_version / Nursing Studies / Master / Master of Nursing

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / O objetivo deste estudo foi verificar a presenÃa de parÃmetros morfolÃgicos maxilares na SÃndrome da ApnÃia Obstrutiva do Sono (SAOS) A amostra consistiu nos modelos de gesso da maxila de 23 indivÃduos (11 masculinos e 12 femininos) com diagnÃstico polissonogrÃfico de SÃndrome da ApnÃia Obstrutiva do Sono leve 34 indivÃduos (17 masculinos e 17 femininos) com sÃndrome moderada e 17 indivÃduos com sÃndrome grave (14 masculinos e 3 femininos) O grupo controle era composto por modelos de gesso da maxila de 50 jovens brasileiros de ambos os sexos com oclusÃo normal e sem indÃcios de SÃndrome da ApnÃia Obstrutiva do Sono Os resultados encontrados demonstraram que os parÃmetros morfolÃgicos da maxila avaliados nÃo apresentaram associaÃÃo com o Ãndice de apnÃia e hipopnÃia (IAH) mas ocorreram menores dimensÃes transversais da arcada dentÃria superior principalmente ao nÃvel de molares associado a um aumento da dessaturaÃÃo de oxi-hemoglobina (SaO2mÃn)IndivÃduos com SÃndrome da ApnÃia Obstrutiva do Sono tambÃm apresentaram dimensÃes transversais da maxila mais estreitas e maior profundidade do palato na regiÃo de prÃ-molares e molares quando comparados ao grupo controle / The objective of this study was to verify the presence of maxillary morphologic parameters on the Obstructive Sleep Apnea Syndrome (OSA) The sample was consisted on maxilla dental models of 23 individuals (11 males and 12 females) with the polyssonographic diagnosis of mild SAOS, 34 individuals (17 males and 17 females) with moderate SAOS and 17 individuals with severe SAOS (14 males and 3 females) Measures of maxilla dental models of 50 young Brazilians were used for the control group, both males and females and with normal occlusion and without any indication OSA The results found show that the maxillary morphologic parameters evaluated didnât show the association with the apnea/hypopnea index (AHI) but minor transversal dimensions of the maxilla mainly at the level of the molars associated to the increase of the dessaturation of oxyhemoglobin (minSaO2) The individuals with OSA also presented maxilla transversal dimensions narrower and more height on the palate at the region of pre-molars and molars when compared to the control group

Abstract not available

Doctor of Philosophy (Medicine) / Sleepiness is an important source of morbidity in the community, with potentially catastrophic consequences of occupational or driving injuries or accidents. Although many measures of sleepiness exist, there is no gold standard. The electroencephalograph (EEG) has been studied as an indicator of sleep pressure in the waking organism, or sleep depth. A mathematical model has been developed, relating the observed EEG to interactions between groups of neurons in the cortex and thalamus (Robinson, Rennie, Rowe, O'Connor, & Gordon, 2005; Robinson, Rennie, & Wright, 1997). These interactions are thought to be important in the transition from wake to sleep. Sleepiness is common in obstructive sleep apnea (OSA). The measurement of sleepiness would have great utility in quantifying the disease burden, measuring treatment response, or determining fitness for work or driving. This study will evaluate parameters derived from the EEG mathematical model as a measure of sleepiness. It is divided into the following four parts: 1. Subjects with likely OSA based on symptoms and demographics from an international database were compared with matched non-OSA controls. The OSA group showed deficits in executive function and abnormalities on evoked response potential testing. 2. Outcomes from a cross-sectional study in a sleep-clinic OSA population were aggregated by factor analysis into a five summary variables relevant to sleepiness: subjective sleepiness, mood & anxiety, memory & learning, driving, and executive functioning. 3. EEG mathematical model parameters from wake EEG recordings were related to the five summary outcomes. Executive function correlated with a parameter Z, representing the negative feedback loop between the thalamic reticular nucleus and the thalamocortical relay nuclei. 4. EEG model parameters during first NREM sleep cycle of 8 subjects with regular sleep architecture were studied. Net cortical excitation (parameter X) is predicted to increase across the cycle, while there was, as predicted, a greater inhibitory effect of the thalamic reticular nucleus upon thalamocortical relay cells (parameter Z). In this preliminary assessment, EEG model parameters reflecting thalamocortical interactions are sensitive to prefrontal lobe tasks such as executive function, which are known to be vulnerable to sleep loss and sleepiness, and these parameters also show variation with increasing sleep depth.

Accumulating evidence suggests that volume overload in drug-resistant hypertension (RH) may contribute to the high prevalence of obstructive sleep apnea-hypopnea (OSAH). Upon recumbency, leg fluid volume moves rostrally causing an increase in nuchal and peripharyngeal fluid content, subsequently obstructing airflow. Rostral fluid displacement following lower body positive pressure (LBPP) application and occurring spontaneously overnight were evaluated in subjects with RH (n = 25) and controlled hypertension (n = 15). In both groups, the reduction in mean upper airway cross-sectional area with LBPP strongly related to the amount of fluid displaced from the legs (R2 = 0.41; p<0.0001), although its magnitude was greater in the RH group (p=0.001; adjusted for propensity score). In both groups, the apnea-hypopnea index strongly related to the amount of fluid spontaneously displaced from the legs during sleep (R2 = 0.56; p<0.0001), although its magnitude was greater in the RH group (p=0.01; adjusted for propensity score).

Accumulating evidence suggests that volume overload in drug-resistant hypertension (RH) may contribute to the high prevalence of obstructive sleep apnea-hypopnea (OSAH). Upon recumbency, leg fluid volume moves rostrally causing an increase in nuchal and peripharyngeal fluid content, subsequently obstructing airflow. Rostral fluid displacement following lower body positive pressure (LBPP) application and occurring spontaneously overnight were evaluated in subjects with RH (n = 25) and controlled hypertension (n = 15). In both groups, the reduction in mean upper airway cross-sectional area with LBPP strongly related to the amount of fluid displaced from the legs (R2 = 0.41; p<0.0001), although its magnitude was greater in the RH group (p=0.001; adjusted for propensity score). In both groups, the apnea-hypopnea index strongly related to the amount of fluid spontaneously displaced from the legs during sleep (R2 = 0.56; p<0.0001), although its magnitude was greater in the RH group (p=0.01; adjusted for propensity score).

Even though the sleep apnea breathing occurs during the sleep,but it also affects the daytime's physiological status.Since sleep apnea breathing increases the risk of getting cardiovascular diseases,sleep disordered breathing has attracted significant amount attention.Conventional diagnosis processes for sleep disorder breathing is complex and time-consuming,therefore many efforts have been made in developing simplified physiological signal feature to detect sleep disorder breathing.To simplify the process of diagnosis,this study uses the ECG signals to differentiate patients and healthy subjects.In addition to traditional HRV features,this study also test a newly proposed ECG feature called degree of spectrum concentration which characterizes the degree of periodicity of the ECG waveform. Our experimental results show that sleep apnea patients have higher degree of spectrum concentration than healthy subjects.This work also tests the mutliscale entropy of this degree of spectrum concentration signal.The results demonstrate that complexity of the degree of spectrum concentration signal of the patients is higher than that of the healthy subjects.Finally,our results also detect differences between different age groups.

The diagnosis of obstructive sleep apnea (OSA) syndrome is overnight PSG (mutli-channel system). But it¡¦s hard to be popularized for the general population (about twenty channel signals). In recent decades, several researches were devoted to a replacement system with only one channel signal (oxyhemoglobin saturation). However, it¡¦s hard to match PSG system¡¦s report without EEG wake information. Consequently, two channels (oxyhemoglobin saturation and EEG) were used of this study to enhance the AHI (estimation index for sleep apnea) prediction performance. After surveying the most recent studies, this work proposes a new basleline removal technique for oxygen saturation signal (SpO2) by using median filter. It was proved this technique improves the diagnostic accuracy for OSA. Furthermore, it is also found that by removing the wake periods, diagnostic accuracy can be improved further. By counting the number of times that the desaturation level has dropped more than 2% for at least 3 seconds, the correlation coefficient between AHI and proposed feature is 0.9218. In addition, by removing the wake period, this correlation increases to 0.9425. By using this feature to classify patients with AHI value larger than 5, the proposed approach achieves 93.78% accuracy, 95.94% sensitivity, 78.87% specificity f. Such results demonstrate the feasibility of using single SpO2 channel system for OSA diagnosis.