Thesis Ph.D. - University of Queensland, 2005. / Includes bibliographical references.

Thesis (M.D.)--University of Hong Kong, 2006.

The present study examined the neuropsychological relevance of poor sleep in a sample of community dwelling healthy older adults and a clinical sample of patients with untreated obstructive sleep apnea (OSA) between 40 and 90 years of age. The cognitive performance of 67 patients with obstructive sleep apnea (OSA) was compared to those of 46 controls screened for OSA using a portable device called ApneaLinkTM. The current study identified common neuropsychological variables associated with poor sleep quality in general (i.e., as a result of daytime sleepiness) and neuropsychological variables unique to only OSA patients (i.e., manifesting oxygen desaturation at night in addition to daytime sleepiness). Results indicated executive functions were related to hypoxemia and sustained attention was related to sleep fragmentation in the current study. A medical sequelae model and a neuropsychological sequelae model were tested. The neuropsychological sequelae model predicted whether one was a control or an OSA patient 70% accurately based on the predictors (scores on Wisconsin Card Sorting Test perseverance error, vigilance task, WAIS III forward digit span, WAIS III Block Design, phonemic and semantic fluency, and WAIS III backward digit span). The medical sequelae model predicted OSA status 89% accurately based on the predictors (BMI, depression, subjective sleep quality, age, hypertension, diabetes, total mood disturbance, gender, and general health). The current study provides further justification for OSA screening in the general population during middle age and late adulthood especially in those most at risk (i.e., overweight, male, hypertensive, and poor subjective sleep quality).

Orientadores: Luis Augusto Passeri / Texto em português e inglês / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T05:58:07Z (GMT). No. of bitstreams: 1 Rodrigues_MarcosMarques_M.pdf: 3650782 bytes, checksum: df078c3da580a9e227359e7addaff54e (MD5) Previous issue date: 2014 / Resumo: Introdução: A apneia obstrutiva do sono (AOS) ocorre por colapsos recorrentes da via aérea superior durante o sono o que resulta em redução total (apneia) ou parcial (hipopneia) do fluxo aéreo. Tem íntima relação com as alterações na via aérea superior (VAS). A tomografia de feixe cônico permite a análise da VAS e do seu volume, por meio de reconstrução tridimensional. Objetivo: Avaliar as alterações volumétricas da via aérea superior em pacientes com apneia obstrutiva do sono. Metodologia: Dissertação desenvolvida a partir de dois artigos científicos. Ambos são estudos retrospectivos, por meio da revisão de 33 prontuários de pacientes adultos com queixas sugestivas de AOS. Resultados: Foram avaliados 19 pacientes do gênero masculino e 14 do gênero feminino, com índice de massa corpórea (IMC) médio de 30,38kg/m2 e idade média de 49,35 anos. Destes, 14 apresentavam AOS grave, 7 moderada, 7 leve e 5 indivíduos não eram portadores da patologia. No artigo 1 foi avaliada a relação entre o volume da via aérea e a gravidade da AOS. O índice de correlação de Spearman entre o volume da VAS e o Índice de Apneia e Hipopnéia foi de -0,100 com p= 0,580. O teste de Mann-Whitney entre as categorias da AOS e o volume teve p = 0,4630. O artigo 2 avaliou a relação entre o volume da VAS e o Sistema de Estagiamento de Friedman (SEF). O teste de ANOVA comparando o Volume com o SEF foi de 0,018. Conclusão: O volume da via aérea superior não apresenta relação linear com a gravidade da Apneia Obstrutiva do Sono, quando avaliada pelo Índice de Apneia e Hipopneia. O volume da via aérea superior apresentou uma relação significativa e inversa com o Sistema de Estadiamento de Friedman, ou seja, quanto maior a classificação de Friedman menor o volume da via aérea superior. Introdução: A apneia obstrutiva do sono (AOS) ocorre por colapsos recorrentes da via aérea superior durante o sono o que resulta em redução total (apneia) ou parcial (hipopneia) do fluxo aéreo. Tem íntima relação com as alterações na via aérea superior (VAS). A tomografia de feixe cônico permite a análise da VAS e do seu volume, por meio de reconstrução tridimensional. Objetivo: Avaliar as alterações volumétricas da via aérea superior em pacientes com apneia obstrutiva do sono. Metodologia: Dissertação desenvolvida a partir de dois artigos científicos. Ambos são estudos retrospectivos, por meio da revisão de 33 prontuários de pacientes adultos com queixas sugestivas de AOS. Resultados: Foram avaliados 19 pacientes do gênero masculino e 14 do gênero feminino, com índice de massa corpórea (IMC) médio de 30,38kg/m2 e idade média de 49,35 anos. Destes, 14 apresentavam AOS grave, 7 moderada, 7 leve e 5 indivíduos não eram portadores da patologia. No artigo 1 foi avaliada a relação entre o volume da via aérea e a gravidade da AOS. O índice de correlação de Spearman entre o volume da VAS e o Índice de Apneia e Hipopnéia foi de -0,100 com p= 0,580. O teste de Mann-Whitney entre as categorias da AOS e o volume teve p = 0,4630. O artigo 2 avaliou a relação entre o volume da VAS e o Sistema de Estagiamento de Friedman (SEF). O teste de ANOVA comparando o Volume com o SEF foi de 0,018. Conclusão: O volume da via aérea superior não apresenta relação linear com a gravidade da Apneia Obstrutiva do Sono, quando avaliada pelo Índice de Apneia e Hipopneia. O volume da via aérea superior apresentou uma relação significativa e inversa com o Sistema de Estadiamento de Friedman, ou seja, quanto maior a classificação de Friedman menor o volume da via aérea superior / Abstract: Introduction : Obstructive Sleep Apnea (OSA) occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea) or partial (hypopnea)reduction of airflow and has relationship with changes in upper airway (UA). The cone beam tomography allows the analysis of UA¿s volume (UAV) by three-dimensional reconstruction. Objective: Evaluate the volumetric changes of the upper airway in patients with obstructive sleep apnea. Methodology: Dissertation developed from two scientific articles. Both are retrospective studies by reviewing the medical records of 33 adult patients with complaints suggestive of OSA. Results: We evaluated 19 male and 14 female, with average body mass index (BMI) of 30.38 kg/m2 and mean age of 49.35 years. Among them, 14 had severe OSA, 7 moderate, 7 mild and 5 subjects were heatlhy. In article 1 the relationship between the UAV and severity of OSA was evaluated. The index Spearman correlation between UAV and the Apnea-Hypopnea Index was -0.100 with p=0.580. The Mann-Whitney between categories of OSA and UAV was p=0.4630. Article 2 evaluated the relationship between UAV and the Friedman Staging System (FSS). The ANOVA test comparing the volume with the FSS was 0.018. Conclusion: The volume of the upper airway has no linear relationship with the severity of obstructive sleep apnea, as measured by the apnea-hypopnea index. The volume of the upper airway showed a significant inverse relationship with Friedman Staging System, high FSS is found in subjects with low volume of the upper airway / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Abstract Seventy-eight prepubertal children 3 to 10 years old (mean age 5,67 years, range 2.4 - 10.5 years), with symptoms suggestive of obstructive sleep apnea syndrome (OSAS) were studied. Based on overnight polysomnography (PSG) results, 32 children were classified as having OSAS, whereas 46 children were considered as primary snorers (PSs'), when an obstructive apnea-hypopnea index (AHIO) of over one was considered abnormal. Symptoms, signs and findings in these two groups were compared in a cross-sectional study. Fifty-eight of the children were retrieved for a follow-up visit, which was scheduled six months from the first visit. The children with an initial AHIO of 2 or over (n = 21) had been subjected to adenotonsillectomy swiftly after the first visit, whereas the others (n = 37) were observed without intervention. The changes in symptoms, signs and findings were analysed within and between these groups. Relative risk (RR) ratios were calculated in order to find clinical symptoms and signs predicting OSAS in snoring children. Observed apneas, restless sleep, constant snoring and tonsillar hypertrophy were significantly associated with an increased risk of OSAS. Dental arch measurements indicated that AHIO was significantly associated with the amount of overjet, suggesting that altered breathing may affect the dentofacial morphology. Nasalance measurements revealed no group differences between the OSAS children and PSs'. Adenotonsillectomy had no significant influence on the nasalence scores. Measurements of nasalance seem to contribute little to the diagnostics of OSAS in children. At the first visit the mean circulating concentrations of insulin-like growth factor-1 (IGF-1) were of the same magnitude in the OSAS children, the PSs' and the age-matched control group, but both the OSAS children and the PSs' had lower IGF-binding protein-3 (IGFBP-3) concentrations than the control subjects. At the second visit a significant increase of the peripheral concentrations of IGF-1 and IGFBP-3, along with increases in weight for height and BMI were observed in the surgically treated children, whose respiratory parameters and symptoms had improved highly significantly, as well. These results indicate that the growth of children with obstructed nighttime breathing is potentially affected through impaired growth hormone secretion. None of the primary snorers developed OSAS during the observation period, which finding suggests a favorable prognosis for primary snoring in children.

No description available.

The impact of Chronic Obstructive Pulmonary Disorder is material in the dentistry field which not only centers its efforts on managing the oral health of the afflicted patients, prescribing proper medications, but also on raising awareness mainly through dental hygiene and smoking cessation. This literature review will explore the status and accomplishments of the field of dentistry with regards to battling COPD. The first section of the paper discusses the nature and dynamics of the disease which ranks between the third and fourth most common cause of death in the United States alone. Certain data trends from 1970 until 2002 showed double the death rates caused by the disease, and that exposure to environmental or occupational risk factors (e.g. dust, fumes, etc.) must be seriously considered for the effective management of COPD. The pressure of COPD management is great among dental practitioners who must ensure the safety of patients by providing the most suitable drug regimen and having a well-coordinated dental practice (i.e. with other health practitioners) to avoid exacerbation of the disease which often leads to hospitalization. The latter is often the result of oral devices or materials that are often comprised of small objects which might be swallowed or aspirated into the oropharynx of the patient when proper positioning during dental check-ups is not properly performed. Dentists must also make sure that they are able to gain the patient’s confidence and to avoid patient reluctance during dental care. Numbers and statistics also reveal that an estimated 24 million of the population in the United States is afflicted by COPD, and that is from 2015 alone. It is also prevalent among the male population which has a death rate of 83 per 100,000, while the death rate among women is 57 per 100,000. Immediate treatment of COPD is also emphasized to prevent hospitalization rates from rising, and as far as dental practice is concerned, they are often aware of CODP patients which number approximately 130 out of 2000. Smoking cessation is considered the best preventive measure in COPD management. Educating patients on the real dangers involved with smoking will help encourage them to quit while promoting better oral health. The field of dentistry is constantly responding to the challenges of COPD, and significant breakthroughs have already been achieved due to research efforts on COPD management. Through professional coordination with other fields in the healthcare system, it is with great hope that dental practitioners will contribute more to the alleviation of patient conditions and providing improved quality of life.

AIMS: The aims of this study were to examine the cephalometric and airway measurements on children with Sleep Related Breathing Disorders (SRBD) and without SRBD, and to investigate the impact of maxillary expansion on these measurements. MATERIALS AND METHODS: This observational study utilized data from Boston University Orthodontics Department between 2016 and 2020. Lateral cephalograms, acoustic rhinometry and pharyngometry were obtained at two time points. SRBD was determined by a score of 0.33 or higher according to the Pediatric Sleep Questionnaire. Mann–Whitney U test and Spearman correlation analysis were used to analyze the data. Statistical significance was set at <0.05. RESULTS: A total of 163 children (61 male, 102 female) were included in this study. Certain airway measurements (Ph Volume p=0.02, Rh air resistance p=0.05, Rh minimum resistance p=0.001) were significantly higher in SRBD group compared to non-SRBD group. In the SRBD group there was a significant negative correlation between Ph Min Distance and SNA (p=0.001), SND (p=0.05), mandibular arc (p=0.03), U1-SN (p=0.02), U1-Apo (p=0.03). Positive. correlations were observed between Ph Volume with L1-NB (p=0.05) and Rh Min Distance Left with Pog- NB (p=-0.5), mandibular arc p=0.05, L1-NB (p=0.01), L1-Apo (p=0.01). Rh Min Cross-sectional left was positive correlated with overbite (p=0.03) and Rh Min cross-sectional right with posterior face height (p=0.05). Certain airway measurements and cephalometric measurements were statistically different across expansion and non-expansion groups (RhVolumeRt p=0.003. RhMinCrossSectionalLft p=0.03, RhMindistanceRt p=0.03, RhAirResistanceRt p=0.05, ANB p=0.0058, S-N (mm) p=0.05, U1 - NA (mm) p=0.04, U-Incisor Protrusion p=0.01, nterincisal Angle p=0.01, Upper Lip - S Line p= 0.005, Upper Lip to E-Plane p=0.01 CONCLUSION: Airway measurements and cephalometric measurements differ significantly between SRBD and non-SRBD subjects. Significant correlations were observed between cephalometric measurements and airway measurements in the SRBD children. Maxillary expansion can be a treatment option for improving certain airway and cephalometric values among those with sleep-disordered breathing.

Indiana University-Purdue University Indianapolis (IUPUI) / Efforts to encourage the medical community to prescribe exercise for disease prevention and management have increased significantly in recent years. In patients with obstructive sleep apnea (OSA), it is encouraging that exercise has been shown to improve sleep efficiency, daytime sleepiness, and disease severity. However, in order to better understand the dose-response relationship between exercise and OSA-related outcomes, accurate and reliable methods for assessing physical activity habits are needed. Purpose: To determine the test-retest reliability and validity of two self-report physical activity questionnaires [Physical Activity Vital Sign (PAVS); International Physical Activity Questionnaire-Short Form (IPAQ-SF)] in an OSA population. Methods: 39 adults with moderate-to-severe OSA wore an accelerometer for seven consecutive days and completed the PAVS and IPAQ-SF (twice within 10 d), along with questionnaires on quality of life, sleepiness, and treatment adherence. Test-retest reliability was determined using intraclass correlation coefficients (ICC). Criterion and construct validity were determined using Pearson (r) and Spearman correlation coefficients (ρ), respectively. Results: PAVS and IPAQ-SF scores were reported as total min/wk of moderate-vigorous physical activity (MVPA). Test-retest reliability for MVPA was excellent for PAVS (ICC = 0.982) and good for IPAQ-SF (ICC = 0.766). MVPA assessed via accelerometry was strongly correlated with PAVS (r = 0.802) and moderately with IPAQ-SF (r = 0.569). Both PAVS and IPAQ-SF were significantly correlated with body mass index (BMI) (ρ = -0.273 and -0.268, respectively), but no other variables. Conclusions: The PAVS and IPAQ-SF are reliable and valid PA questionnaires and may be utilized as a tool for accurately assessing physical activity levels in OSA patients.

No description available.