Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 4 uppsatser.

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.

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.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / Introduction: Obstructive Sleep Apnea Syndrome (OSAS) in children, as defined by the American Thoracic Society, is a disorder of breathing during sleep characterized by prolonged partial airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns. Objective: This study aimed to investigate retrospectively the prevalence of OSAS among children aged 6 to 12 years old, evaluated through polysomnography and sleep questionnaires between 2011 and 2012, analyzing severity, symptoms and associated risk factors. Methods: We evaluated 63 children referred to the Sleep Laboratory of the Dell Childrenâs Hospital in Austin, Texas (USA) with suspition of Sleep Disordered Breathing. The patients were submitted to a pre-sleep questionnaire and to polysomnography. Results: The mean age was 8,8 Â1,9 years old, and 55,6% of the children were male. Children without OSAS accounted for 30,2% of the sample. The OSAS observed in the remainder was mild in 49,2%, moderate in 11,1% and severe in 9,5%. Gender and age were not associated with OSAS. Hispanic and African-American children were at higher risk for OSAS. Twenty two hispanic children presented OSAS ( 88%) and ten African-american children presented OSAS (83,3%). In children with OSAS, the most common symptoms were: snoring (86%), periodic limb movements (64,3%), arousals during sleep (60,5%) and restless sleep (58,1%). Excessive daytime sleepiness was reported in only 33,3% of the patients. Bruxism was more prevalent among the patients without OSAS (52,6%) than in the patients with OSAS (31%). Overweight children were at higher risk for OSAS. Conclusions: Overweight children are at a higher risk for developing OSAS. Hispanic and African American children presented a higher risk for developing OSAS. Age and gender were not associated to the diagnose of OSAS. Bruxism was more prevalent among the children who did not present OSAS. / IntroduÃÃo: Em crianÃas, a SÃndrome da Apneia Obstrutiva do Sono (SAOS) à um distÃrbio respiratÃrio caracterizado por obstruÃÃo parcial prolongada e/ou episÃdios intermitentes de obstruÃÃo completa da via aÃrea superior, que interrompe a ventilaÃÃo normal e o padrÃo normal de sono. Objetivo: Este trabalho buscou investigar a prevalÃncia de SAOS entre crianÃas de seis a doze anos de idade, avaliadas por meio de polissonografia e questionÃrio sobre o sono, no perÃodo de 2011 a 2012, avaliando gravidade, sintomatologia e fatores de risco associados. MÃtodos: Foram estudadas 63 crianÃas encaminhadas ao LaboratÃrio do Sono do Dell Childrenâs Hospital em Austin, Texas (EUA) com suspeita de Transtornos RespiratÃrios do Sono. Os pais preencheram um questionÃrio sobre o sono, jà rotineiramente utilizado como padrÃo para todos os pacientes encaminhados para polissonografia no Dell Childrenâs Hospital (ApÃndice A). Em seguida, as crianÃas foram submetidas ao exame polissonogrÃfico. Resultados: A idade mÃdia foi de 8,8Â1,9 anos, sendo 55,6% das crianÃas do sexo masculino. NÃo apneicos corresponderam a 30,2% dos investigados. SÃndrome da Apneia Obstrutiva do Sono em grau leve ocorreu em 49,2%, moderado em 11,1% e grave em 9,5%. NÃo foi encontrada diferenÃa entre a incidÃncia de SAOS entre meninos e meninas. Observou-se uma associaÃÃo estatisticamente significante entre raÃa e presenÃa/ausÃncia de SAOS, sendo que as crianÃas negras e hispÃnicas apresentaram maior risco de SAOS do que as crianÃas brancas. Entre os hispÃnicos, 88% dos pacientes apresentaram SAOS (n=22); nos negros 83,3% (n=10) e nos brancos 46,7% (n=7). Dentre as crianÃas diagnosticadas com SAOS, os sintomas mais frequentes foram: ronco (86%) movimentos periÃdicos de membros (64,3%), despertares durante o sono (60,5%) e sono agitado (58,1%). SonolÃncia excessiva foi relatada apenas em 33,3% dos casos. O bruxismo foi relatado com maior frequÃncia no grupo sem SAOS (52,6%) do que no grupo de pacientes com diagnÃstico de SAOS (31%). CrianÃas com sobrepeso apresentaram maior risco de desenvolver SAOS (100%) (Testes Qui quadrado e exato de Fisher). ConclusÃes: Sobrepeso à um fator de risco para SAOS. CrianÃas da raÃa hispÃnica e negra apresentaram maior risco a SAOS. Sexo e idade nÃo se associaram a SAOS. O bruxismo foi mais frequentemente relatado por pacientes que nÃo demonstraram SAOS.

Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 4 uppsatser.

Orientador: Altair Antoninha Del Bel Cury / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-05T09:25:29Z (GMT). No. of bitstreams: 1 Ribeiro_CynthiaValeriaSilvaGomes_M.pdf: 3852161 bytes, checksum: 491f5853c6ba25e4f30b324e92d65238 (MD5) Previous issue date: 2005 / Resumo: Distúrbios respiratórios do sono são condições patológicas freqüentes. Dentre estes, destaca-se o Ronco Primário que quase sempre causa conflitos sociais e familiares, podendo ocorrer isoladamente ou fazendo parte de um quadro clínico mais severo, a Síndrome da Apnéia Obstrutiva do Sono. Esta por sua vez, além da presença do ronco que ocorre em mais de 90% dos casos, é também caracterizada por paradas respiratórias, microdispertares, dessaturações de oxigênio sanguíneo, desestruturação do sono, sonolência diurna importante, aumento da possibilidade de hipertensão arterial sistêmica, infarto do miocárdio, acidente vascular encefálico, envolvimento em acidentes de trabalho e de trânsito, assim como comprometimento da memória, cognição e atenção. A Síndrome da Apnéia Obstrutiva do Sono pode ser subdividida em três níveis (leve, moderada e grave), considerando o índice de apnéia/hipopnéia. As formas de tratamento incluem principalmente a cirurgia, pressão aérea positiva contínua (CPAP) e aparelhos intraorais. Este estudo investigou com o exame de polissonografia, os efeitos do uso de aparelho intraoral de protrusão mandibular, em onze voluntários com idade entre 23 e 62 anos, sendo 63,6% do gênero masculino e 36,4% feminino. Destes, dois apresentavam ronco primário, dois apnéia grave, quatro apnéia moderada e três apnéia leve. Os pacientes foram avaliados através de polissonografia, antes e após o uso do aparelho intraoral, tendo sido estudadas as seguintes variáveis: índices de apnéia/hipopnéia, dessaturação de oxigênio, número de apnéias, número de hipopnéias e ronco. Este foi avaliado quanto à intensidade e freqüência esporádica ou ausente. Na Análise Estatística foi utilizado o teste t de Student para as variáveis: índice de Apnéia e Hipopnéia, Saturação Mínima de Oxigênio, Número total de Apnéias e Número Total de Hipopnéias. As variáveis Escala de Graduação do Ronco, Grau de Sonolência Diurna e Ruído do Ronco, foram analisadas pelo Teste de Wilcoxon das ordens assinaladas, com intervalo de confiança de 95%. Em todas as análises foi adotado um nível de significância de 5% (a =0,05). Os resultados mostraram que todos os voluntários tiveram redução significativa nas variáveis estudadas. Todos os indivíduos com Ronco Primário obtiveram resolução completa do problema. No grupo de Apnéia leve, todos os voluntários passaram a apresentar exame de polissonografia normais; Apnéia moderada, 75% também obtiveram exame normal e em 25% a apnéia passou de grau moderado para leve. Considerando os que apresentavam Apnéia grave, 50% passaram a apresentar apnéia moderada e 50% apnéia leve. Dessa forma pode-se concluir que o uso de aparelho intraoral é uma forma de tratamento eficiente para o ronco primário e apnéia obstrutiva do sono / Abstract: Snoring is a noise that occurs during sleep when the people are breathing in and there is some blockage of air passing through the back of the mouth and it is a frequent pathological conditions called Primary Snore. This snore can be or not be associated with more serious problems, such as obstructive sleep apnea syndrome (OSAS), frequent arousals from sleep, or inability of the lungs to breathe in sufficient oxygen. It is also characterized by excessive daytime sleepiness or fatigue. Patients also may complain of difficulty with concentration, morning headaches, impotence, difficulty sleeping, or restless sleep. Obstructive Sleep Syndrome Apnea can be subdivided in three levels (Iight, moderate and serious), considering the apnea/hipopnea index. The treatment forms include surgery, positive aerial pressure continuous (CPAP) and oral appliance. This study investigated the effects of the use of oral appliance by moving either the tongue or the mandible anteriorly, partially relieving apneas in eleven volunteers with age between 23 and 62 years, being 63,6% of the male gender and 36,4% of female. The volunteers were undergo polysomnography exam, Scale of Graduation of the Snore, Epworth Sleepiness Scale and Snore. After these exams two volunteers were diagnosed as primary snore, two serious apnea, four moderate apnea and three light apnea. The patients were appraised through ali exams before (TO) and after (T1) the use of the oral appliance. The data were statistically analyzed by t Student test for Apnéia I Hypopnea Index, Minimum Saturation of Oxygen, total Number of Apneas and Total Number of Hypopneas and by Wilcoxon signaled orders test to Scale of Graduation of the Snore, Epworth Sleepiness Scale and Snore, they were analyzed by the Test of Wilcoxon with 95% levei of confidence. The results showed that ali the volunteers had significant reduction in the studied variables. Ali the individuais with Primary Snore obtained complete resolution of their problem. Also the volunteers suffering from OSAS had a reduction in their polysomnography exams. Within the limits of this study, it can be concluded that the use of oral appliance was efficient treatment to the Primary Snore and Obstructive Sleep Syndrome Apnea / Mestrado / Protese Dental / Mestre em Clínica Odontológica

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Childhood OSA is increasingly recognized to be associated with a variety of complications including neurocognitive and cardiovascular diseases. The intermediate link between OSA and end organ damage has been suggested to be inflammation, and both local airway and systemic inflammation have been described in adults with OSA. A non-invasive technique of sputum induction was utilised to show that children with OSA also have airway inflammation, as characterized by a significant increase in neutrophils, and the severity of OSA also correlated significantly with the degree of neutrophilic inflammation (Chapter 7). This finding may lead to research on the use of anti-inflammatory therapeutic agents or antibiotics for the treatment of childhood OSA. Another marker of inflammation, C-reactive protein (CRP) was measured in a cohort of children with OSA before and after treatment (Chapter 8). Children with OSA had higher CRP levels compared to their non-OSA counterparts, and the raised CRP decreased significantly following treatment suggesting that the inflammatory response is potentially reversible. The cardiovascular risk factors of insulin levels and blood pressure (BP) were evaluated and children with OSA had higher serum insulin and greater systolic and diastolic BP compared to healthy controls (Chapters 9 and 10). These findings suggest that children with OSA may be at risk of developing metabolic syndrome and its devastating consequence. (Abstract shortened by UMI.) / The original research studies undertaken were based on nocturnal sleep examinations to explore childhood OSA in two main aspects, namely its assessment, and a better understanding of its complications in children. The gold standard for diagnosing OSA is overnight polysomnography (PSG), which is an expensive investigation that is not routinely available at all public hospitals in Hong Kong. Alternative valid assessment tools for OSA that are more cost-effective are needed. The feasibility of using radiographic techniques to assess severity of OSA was explored, and the size of the upper airway, as reflected by the tonsillar pharyngeal (TP) ratio obtained from lateral neck radiograph, correlated well with the severity of OSA (Chapter 4). A defined TP cutoff could accurately predict moderate-to-severe OSA with high sensitivity and specificity. This method could be used in clinical practice to prioritize patients with suspected OSA for further evaluation. A locally applicable questionnaire scale was examined for its validity and accuracy in diagnosing children with OSA (Chapter 5). The presence of three symptoms (snoring, mouth breathing and nocturnal sweating) was found to have high predictive value in correctly identifying children with the condition. The question of whether a single night PSG study is adequate in diagnosing OSA was examined together with the assessment for the presence of night-to-night variability in PSG and respiratory parameters in childhood sleep (Chapter 6). Forty-four obese children and 43 age and sex-matched healthy controls underwent two consecutive nights PSG examination. Although a first night effect was clearly documented, a single night PSG study would have correctly identified over 80% of children with OSA. This finding has significant resource implications. / Albert Martin Li. / Adviser: Tony Nelson. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3420. / Thesis (M.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves xxxv-lxxx). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English only. / School code: 1307.

Thesis (M.S.)--West Virginia University, 2004. / Title from document title page. Document formatted into pages; contains vii, 47 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 30-31).

BACKGROUND: In children, sleep-related airway obstruction by large tonsils and adenoids can cause obstructive sleep apnea (OSA). OSA may lead to poor growth, developmental delay, behaviour or learning problems. Recent evidence also suggests that children with OSA may develop cardiovascular complications, the mechanisms perhaps involving hypoxemia, the autonomic nervous system, apneas, and arousals. Surgical removal of tonsils and adenoids (adenotonsillectomy (T&A)) usually cures pediatric OSA. To diagnose OSA at all levels of severity, polysomnography is currently the best approach. The McGill Oximetry Score (MOS) is a validated measure based on nocturnal pulse oximetry. An abnormal MOS has a 97% positive predictive value at detecting moderate-severe OSA. Because the MOS was devised by measuring frequency of desaturations (<90%) and numbers of clusters of desaturations, it is not accurate at detecting OSA in children who do not have such drops in oxygen saturation. Accordingly, other measures applicable to a wider spectrum of children should be assessed. These measures should be simpler, less cumbersome, cheaper, and more accessible than polysomnography. / OBJECTIVES: To study alternative approaches that may be used to identify moderate-severe OSA in children, two studies were conducted. We examined one subjective measure - the OSA-18 parent questionnaire - and two objective measures - pulse rate and pulse rate variability. For the OSA-18 study, the goal was to determine whether it would accurately detect children with moderate-severe OSA as indicated by an abnormal MOS. For the pulse rate and pulse rate variability study, the goal was to determine if either or both would decrease after treatment with T&A for children with moderate-severe OSA. / METHODS: For the OSA-18 study, we used a cross-sectional design that included children 1-18 years old referred to a pediatric sleep laboratory for evaluation of suspected OSA. Alongside data from the OSA-18, we analyzed demographic and medical data (from a parent questionnaire) and information regarding adenotonsillar hypertrophy. We estimated sensitivity, specificity, positive and negative predictive values as well as receiver operating curves of the OSA-18 in detecting an abnormal MOS. We also conducted univariate and multivariate logistic regression analyses, using the MOS as the dependent variable and the OSA-18 score and others (age, gender, comorbidities, race) as independent variables. For the second study, we used a retrospective before-after design to compare pulse rate and pulse rate variability as measured by nocturnal pulse oximetry pre- and post-T&A of otherwise healthy children 1-18 years old with moderate-to-severe OSA. / RESULTS: For the OSA-18 study, we studied 334 children (58% male, mean age 4.6 +/- 2.2 years). The OSA-18 had a sensitivity of 40% and a negative predictive value of 73% for detecting an abnormal MOS. In addition, the area under the receiver operating curve was 0.611. While controlling for other independent variables in the logistic regression model, for each unit increase in the OSA-18 Score, the odds of having an abnormal MOS were increased by 2%. However, for each increase in age of 1 year, the odds of having an abnormal MOS were decreased by 17%. In the pulse rate and pulse rate variability study, 25 subjects (88% male; mean age 4.3 +/- 3.6 years) were enrolled. Following T&A, pulse rate and pulse rate variability decreased in 21 of 25 and 23 of 25 children, respectively. Mean pulse rate dropped from 99.7+/-11.2 to 90.1+/-10.7 bpm, p<0.001; age-standardized pulse rate (z-score) from 0.8 (0.4, 1.5) to 0.4 (0, 0.9), p=0.04). Pulse rate variability, as measured by the standard deviation of the pulse rate decreased from 10.3 +/- 2.1 to 8.2 +/- 1.6 bpm, p<0.001. As well, OSA symptomatology, parental concern about breathing during sleep and the MOS all improved. / CONCLUSIONS: Based on the first study we conclude that among children referred to a sleep laboratory, the OSA-18 does not accurately detect which children will have an abnormal MOS. The OSA-18 should not be used in place of objective testing to identify moderate-severe OSA in children. However, from the second study we conclude that measures of the autonomic nervous system such as pulse rate and pulse rate variability, as measured by pulse oximetry, decreased following surgical treatment of moderate-severe OSA. The results of this study potentially serve as important data for further work that would determine the accuracy of pulse rate and pulse rate variability measures and their diagnostic usefulness for OSA at all levels of severity.