Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Introduction: L’expansion palatine du maxillaire a beaucoup d’effets positifs sur la respiration et la qualité du sommeil, mais peu d'études ont examiné ces données sur des adultes ayant dépassé l’âge permettant de bénéficier d'une expansion palatine conventionnelle. Le but de cette recherche est d’évaluer la stabilité de l’EPRAC (expansion palatine rapide assistée chirurgicalement) et son effet sur les troubles respiratoires après l’ablation des appareils orthodontiques. Méthodes: Neuf patients (Âge moyen 21, entre 16-39 ans) nécessitant une EPRAC ont passé des nuits dans un laboratoire de sommeil, et ce avant l’EPRAC, après l’EPRAC, et après l’ablation des appareils fixes. Les radiographies céphalométriques postéroantérieures ainsi que les modèles d’étude ont été pris pendant ces trois périodes de temps. Résultats: L’analyse des modèles d’étude a démontré une récidive significative au niveau des distances inter-molaires et inter-canines au niveau du maxillaire seulement. Les analyses céphalométriques ont démontré une récidive au niveau de la largeur maxillaire. Aucun changement important n'a été observé dans les stades de sommeil, mais une réduction importante dans l’index de ronflement a été notée. De plus, il y avait moins de changements entre les stades de sommeil. Conclusions: La récidive squelettique est minime et cliniquement non significative. Par contre, les changements dans les distances intermolaires et intercanines sont cliniquement importants. Il semble également qu'une EPRAC ait un effet positif sur la qualité de sommeil par la réduction de l’indice de ronflement ainsi que sur la diminution des changements entre les stades de sommeil. / Introduction: Orthopedic expansion appears to have several positive effects on respiration as well as sleep quality, but a lack of studies examine these findings using SARPE on skeletally mature individuals. The aim of this study was to evaluate post-SARPE stability as well as its effect on sleep disordered breathing after completing full fixed orthodontics. Methods: 9 patients (average age 21, range 16-39) requiring SARPE underwent polysomnographic testing in sleep laboratory before SARPE (T0), after SARPE (T1), and after removal of full fixed appliances (T2). Study models and anteroposterior cephalometric radiographs were also taken at the 3 time points. Results: Study model analysis showed significant relapse for intermolar and intercanine widths. Anteroposterior cephalometric results were significant only for effective maxillary width. There were no significant changes in any sleep stages, however a dramatic reduction in snoring as well as fewer stage shifts were observed. Conclusions: Although statistically significant relapse was observed on study models and anteroposterior cephalometric radiographs, the dental relapse appears to be more clinically significant than the skeletal relapse. SARPE appears to have a positive effect on sleep quality by reducing the snoring index as well as reducing transitions between sleep stages.

Made available in DSpace on 2014-12-17T15:16:05Z (GMT). No. of bitstreams: 1 MarizeJG.pdf: 1501362 bytes, checksum: 8f9c4ae91001822e07351c0f246be869 (MD5) Previous issue date: 2009-07-30 / Background: Obesity impairment to the pulmonary function related to the magnitude of adiposity and is associated with excessive daytime sleepiness (EDS) and snoring, among others symptoms of respiratory disorders related to sleep. It is possible that obese individuals with excessive daytime sleepiness may make changes in lung function on spirometry monitored during the day as a consequence of fragmented sleep or episodes of nocturnal hypoventilation that cause respiratory and changes that can persist throughout the day. The combination of these findings alone sleepiness observed by subjective scales with pulmonary function in obese patients is unknown. Objective: To assess the influence of EDS and snoring on pulmonary function in morbidly obese and distinguish between different anthropometric markers, the snoring and sleepiness which the best predictors of spirometric function and respiratory muscle strength and endurance of these patients. Methods: We evaluated 40 morbidly obese markers on the anthropometric, spirometric respiratory variables, maximal inspiratory and expiratory pressures (MIP and MEP) and maximal voluntary ventilation (MVV) and the measured excessive daytime sleepiness (the Epworth sleepiness scale) and snoring (snoring scale of Stanford). The data were treated when the differences between the groups of obese patients with and without sleepiness, whereas the anthropometric variables, respiratory and snoring. Pearson's correlation was performed, and multiple regression analysis assessed the predictors of pulmonary function. For this we used the software SPSS 15.0 for windows and p <0.05. Results: 39 obese patients were included (28 women), age 36.92+11.97y, body mass index (BMI) 49.3+5.1kg/m?, waist-hip ratio (WHR) 0.96+0.07 and neck circumference (NC) 44.1+4.2 cm. Spirometric values and respiratory pressures were up 80% of predicted values, except for endurance (MVV <80%). Obese with EDS have lower tidal volume. Positive correlation was observed between BMI and EDS, EDS and NC and between snoring and BMI, and negative correlation between EDS and tidal volume (TV), and between snoring and snoring FVC and FEV1. In linear regression the best predictor of pulmonary function was snoring, followed by NC. NC has more obese with higher strength (MEP, p = 0.031) and endurance (MVV p = 0.018) respiratory muscle. Conclusion: Obese with EDS tend to have lower TV. In addition, snoring and NC can better predict pulmonary function in obese when compared with other anthropometric markers or EDS. Obese patients with higher NC tend to have greater capacity for overall strength of respiratory muscles, but may have low muscle endurance / Introdu??o: A obesidade acarreta preju?zo na fun??o pulmonar relacionada ? magnitude da adiposidade e se associa a sonol?ncia diurna excessiva (SDE) e ronco como sintomas de dist?rbios respirat?rios relacionados ao sono. ? poss?vel que indiv?duos obesos com sonol?ncia diurna excessiva possam apresentar altera??o na fun??o pulmonar monitorados na espirometria durante o dia como conseq??ncia da fragmenta??o do sono ou de epis?dios de hipoventila??o noturnos que ocasionam modifica??es respirat?rias e que podem persistir durante o dia. A associa??o destes achados isolados de sonol?ncia, observados atrav?s de escalas subjetivas com a fun??o pulmonar em obesos, ? desconhecida. Objetivos: Avaliar a influencia da SDE e do ronco na fun??o pulmonar em obesos m?rbidos e distinguir entre os distintos marcadores antropom?tricos, o ronco e a SDE quais os melhores preditores da fun??o espirom?trica e da for?a e resist?ncia muscular respirat?ria destes pacientes. M?todos: Foram avaliados 40 obesos m?rbidos quanto aos marcadores antropom?tricos, as vari?veis respirat?rias espirom?tricas, press?es inspirat?ria e expirat?ria m?ximas (PIM?x e PEM?x) e ventila??o volunt?ria m?xima (VVM) e mensuradas a sonol?ncia diurna excessiva (Escala de Sonol?ncia de Epworth) e ronco (Escala de Ronco de Stanford). Os dados foram tratados quando as diferen?as entre os grupos de obesos com e sem sonol?ncia, considerando as vari?veis antropom?tricas, respirat?rias e o ronco. A correla??o de Pearson foi realizada e a an?lise de Regress?o M?ltipla avaliou os preditores da fun??o pulmonar. Para tal foi utilizado o software SPSS 15.0 para windows e p<0,05. Resultados: 39 obesos foram inclu?dos (28 mulheres), idade 36,92+11,97a, ?ndice de massa corporal (IMC) 49,3+5,1kg/m?, rela??o cintura-quadril (RCQ) 0,96+0,07 e Circunfer?ncia do Pesco?o (CP) 44,1+4,2cm. Os valores espirom?tricos e de press?es respirat?rias encontravam-se acima de 80% dos valores preditos, exceto a resist?ncia (VVM<80%). Obesos com SDE apresentam menor volume corrente. Foi observada correla??o positiva entre SDE e IMC, SDE e CP e entre ronco e IMC; e correla??o negativa entre SDE e Volume Corrente, ronco e CVF e entre ronco e VEF1. Na regress?o linear o melhor preditor da fun??o pulmonar foi o ronco, seguido da CP. Obesos com maior CP tem maior for?a (PEM; p=0,031) e resist?ncia (VVM; p=0,018) muscular respirat?ria. Conclus?o: Obesos com SDE tendem a ter menor VC. Al?m disso, o ronco e a CP podem melhor predizer a fun??o pulmonar em obesos quando comparados aos demais marcadores antropom?tricos e a SDE. Obesos com maior CP tendem a ter maior capacidade de geral for?a dos m?sculos respirat?rios, entretanto podem apresentar baixa resist?ncia muscular

O avançar da idade é reconhecidamente um fator de risco para a Síndrome da Apneia Obstrutiva do Sono (SAOS). O motivo dessa constatação está associado à diminuição do tônus da musculatura orofaringeana e à redução da Dimensão Vertical de Oclusão (DVO), esta última atribuída às perdas dentárias. A abordagem odontológica, no tratamento da SAOS, refere-se ao uso de Aparelho de Avanço Mandibular (AAM), que impede a obstrução, parcial ou total, da passagem do ar pela via respiratória alta, durante o sono. Os pacientes desdentados, no entanto, têm sido negligenciados, nos estudos atualmente realizados. Pelo exposto, este trabalho objetivou avaliar os efeitos do tratamento em variáveis polissonográficas, ronco, sonolência, qualidade do sono e ainda os efeitos colaterais pelo uso do AAM titulável, em pacientes idosos e desdentados portadadores de SAOS. A metodologia envolveu inicialmente, cinquenta pacientes, dos quais dezesseis realizaram polissonografia de noite inteira, com gravação do ronco, por meio de um Roncômetro, visando investigação objetiva do sono. Analisaram-se subjetivamente frequência e intensidade do ronco, por questionários. A Escala Visual Analógica de Ronco (EVAR), aplicada ao parceiro de quarto, permitiu, igualmente, que fosse avaliada a intensidade desse sintoma. A sonolência diurna foi quantificada pela Escala de Sonolência de Epworth e a qualidade do sono, pelo Índice de Qualidade do Sono de Pittsburgh. Confecção individualizada dos AAMs respeitou os princípios biológicos relativos à DVO. Durante uma semana após a instalação, os pacientes utilizavam o AMM sem qualquer avanço mandibular, visando redução de quaisquer desconfortos. Subsequentemente, o protocolo estabelecia titulação gradual e progressiva (30%, 50% e 70%) do aparelho. Transposta a etapa de adaptação, após um período superior a quinze dias, as avaliações iniciais foram repetidas Os efeitos colaterais pelo uso do AAM e adesão ao tratamento foram investigados, a partir de questionários. Doze pacientes completaram o estudo (83,3% mulheres), sendo a media de idade 68 anos e índice de massa corporal médio de 28,3 kg/m2. Os resultados permitiram observar reduções significantes no índice de dessaturação de O2 (17,710,1 eventos/h, p=0,05) e índice de apneia (3,10,9 eventos/h, p=0,02). O uso do AAM evidenciou também diminuições na latência do sono REM, movimentos períodicos de perna, saturação mínima de O2, índice de apneia e hipopneia, na posição supina (p>0,05). O estudo objetivo do ronco apontou redução de 49,522,6 eventos/h (p=0,07). Além do mais, as avaliações subjetivas de frequência (p=0,024) e intensidade (p=0,007) do ronco, EVAR (p=0,003), qualidade do sono (p=0,008), efeitos colaterais e adesão ao AAM foram estatisticamente significantes. Foi possível concluir pela eficácia do tratamento sobre algumas variáveis polissonográficas estudadas, parâmetros subjetivos do ronco e qualidade do sono. Ademais, os sintomas relatados, pelo uso do AAM, reduziram-se ao longo do tempo, o que permitiu, com vantagem, que houvesse maior adesão ao tratamento por parte dos pacientes inseridos nesta pesquisa. / Aging process is well known as a risky factor to Obstructive Sleep Apnea Syndrome (OSAS). Concomitant with this process, the reduction of orofacial and pharyngeal musculature tone, as well as the decrease of Vertical Occlusion Dimension (VOD), the latter attributed to tooth loss, have been considered as probable causal agents involved in OSAS pathogenesis. The Dentistry approach for OSAS treatment is commonly related to the use of Mandibular Advancement Devices (MAD), which could prevent partial or complete upper airway obstruction during sleep. However, this treatment has been scarcely used in toothless patients. The aim of this study was to assess the effects of a titratable MAD in polysomnographic (PSG) variables, snoring, sleepiness, sleep quality and side effects, in edentulous elderly patients with OSAS. Sixteen out of fifty patients assessed have been selected and have undergone an overnight polysomnographic study. Snoring was recorded by using suitable equipment, so that an objective assessment of sleep patterns could be made. The frequency and intensity of snoring have also been subjectively assessed by means of questionnaires. The Snoring Visual Analogic Scale (SVAS), posed to a bed partner, was also assessed to evaluate snoring intensity. Excessive daytime sleepiness and the quality of sleep have also been investigated by Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, respectively. The patients went through the whole process for individually manufacturing of the MAD following the biological principles of the VDO. A week after using the MAD, at 0% of mandibular advancement, the patients were invited to return in order to undergo a new evaluation according to their adaptation to MAD. Subsequently, a titration protocol was gradually established at 30%, 50% and 70% for mandibular advancement. After a period of at least fifteen days, which should correspond to an adjustment of patients to their devices, the same initial assessment procedures were repeated. The MAD collateral effects as well as the treatment acceptance have been investigated through questionnaires. Twelve patients (83,3% females) completed the study, with an average age of 68 years, body mass index of 28,3 kg/m2. The results showed a significant reduction in O2 desaturation index (17,710,1 event/h, p=0,05) and also in AI (3,10,9 events/h, p=0,02). The use of the MAD also represented reductions in the latency to REM sleep, periodical leg movements, minimum O2 saturation, apnea and hypopnea index (AHI) in supine position (p>0,05). The objective assessment of snoring showed a reduction, with no statistical relevance of the Snoring Index (49,522,6 events per hour of recording, p=0,07). The subjective assessment of frequency (p=0,024) and intensity of snoring (p=0,007), EVAR (p=0,003), sleep quality (p=0,008) and the MAD collateral effects as well as the treatment acceptance were also statistically significant. We observed that the OSAS treatment with MAD was effective in some polysomnografic variables studied as well as in the subjective parameters of snoring and sleep quality in edentulous elderly patients. The reported symptoms due to MAD use decreased over the time.

INTRODUÇÃO: A apnéia obstrutiva do sono (AOS) é caracterizada como uma doença crônica, progressiva, incapacitante, com alta morbidade e mortalidade cardiovascular, sendo causada pela obstrução dinâmica repetitiva da via aérea superior (VAS). As repercussões geram necessidade de tratamento. Dentre os tratamentos disponíveis e com efetividade comprovada, há a opção de uso dos aparelhos intraorais. Neste estudo, avaliou-se a eficácia de um tipo de aparelho intraoral (AIO) monobloco, assim como suas complicações e intercorrências em longo prazo, em hospital de ensino. MÉTODOS: 20 pacientes participaram do presente estudo. Foram incluídos pacientes com diagnóstico polissonográfico prévio de AOS leve ou moderada (5 >IAH< 30), com idade até 60 anos, e não obesos. O critério de exclusão foi para pacientes em uso de medicamentos psicotrópicos, não condição oral para suporte do AIO e IMC e idade acima do proposto. Após 60 dias de uso do AIO realizou-se nova polissonografia (PSG), e acompanhamento pelo questionário RDC/TMD e ficha clínica EDOF/HC basal, 60 e 180 dias. RESULTADOS: Dentre os 20 pacientes, 11 eram do sexo masculino e nove do sexo feminino, com média de idade de 51 anos, e a média do IMC foi de 27,76. O índice de apnéia e hipopnéia (IAH) apresentou decréscimo de 19,23 para 7,51 eventos/hora de sono (p= 0,001). O eixo I e II do RDC/TMD não apresentou alterações significativas nos três momentos avaliados, porém o eixo II mostrou que os pacientes desta amostra apresentam maior grau de sintomas físicos e depressivos do que o padrão. CONCLUSÕES: No período estudado houve redução significativa do índice de apnéia e hipopnéia com o uso do aparelho intra-oral monobloco e foi eficaz total ou parcialmente no tratamento de 80% dos pacientes. As complicações não foram homogêneas e mostraram-se transitórias. / INTRODUCTION: Obstructive sleep apnea (OSA) is characterized as a chronic, progressive, disabling condition with high cardiovascular morbidity and mortality, and with repetitive episodes of upper airway (UA) obstruction. Its impact generates need for treatment. Among the treatments available and with demonstrated effectiveness, there is the option of using the oral appliances. In this study, we evaluated the effectiveness of a type of monoblock oral appliance (OA), as well as its complications and long-term complications in teaching hospital. METHODS: 20 patients participated in this study. We included patients with polysomnographic diagnosis of OSA prior mild or moderate (5> AHI <30), aged up to 60 years and not obese. The exclusion criteria were patients using psychotropic drugs, not oral condition to support the AIO and BMI and age above proposed. After 60 days of use of OA underwent a polysomnography (PSG) exam and follow-up by clinical record EDOF/HC and questionnaire RDC/TMD at baseline, 60 and 180 days. RESULTS: 11 male and nine female, mean age 51 years, and mean BMI was 27.76. The apnea-hypopnea index (AHI) showed a decrease of 19.23 to 7.51 events/hour of sleep (p = 0.001). Axis I and II of the RDC / TMD was not significantly changed in the three moments, but the axis II showed that patients in this sample have a higher degree of physical symptoms and depression than the standard. CONCLUSIONS: Oral appliance therapy for obstructive sleep apnea over the period reduced significantly the AHI and was totally or partially effective in treating 80% of patients. Complications were not homogeneous and were transient.

Abstract The prevalence of self-reported obstructive sleep apnea syndrome (OSAS), habitual snoring (HS), daytime sleepiness (DS) and restless legs syndrome (RLS), and their associations with cardiovascular risk factors and depressive symptoms as well as the natural course and associated factors of habitual snoring and restless legs syndrome over a ten-year period were studied. Two different birth cohorts in Northern Finland were investigated. In the Oulu 35 longitudinal research programme study subjects participated in two subsequent surveys conducted in 1996–1998 and 2007–2008 (61–63 and 72–73 years old subjects, respectively). The Oulu 45 study population was examined in 2001–2002 (56–57 years old subjects). The data were gathered by questionnaires, as well as laboratory and clinical measurements. In the Oulu35 study, of the 831 baseline participants, 593 (73%) participated in the first follow-up in 1996–1998 and 457 (55%) participated in both follow-up studies. In the Oulu 45 study, the target population comprised 1 332 subjects, 995 (75%) of whom participated. The prevalence of OSAS was 8% in the 56–57 year-old population, 4% in the 61–63 year old population, and 3% in the 72–73 year old population. These figures were 31%, 26% and 19% for HS, 16%, 9% and 11% for DS, and 18%, 21% and 15% for RLS, respectively. In a ten-year period, half of those who snored in 1996–1998 stopped snoring, and half of those who suffered from restless legs 3–7 nights/week in 1996–98 suffered from this syndrome less than once a week in 2007–2008. The 10-year incidence of new cases of both HS and RLS was 7%. In subjects aged 56–57 and 61–63, the components of the metabolic syndrome and depressive symptoms associated with OSAS and HS, while in the follow-up study, the role of these associations diminished. Male gender was the strongest predictor of the new cases of HS, while depressive symptoms and waist circumference predicted the permanence or incidence of HS. Depressive symptoms, DS and, weakly, waist circumference were associated with RLS in both the 56–57 year-old and in 61–63 year-old populations. Depressive symptoms were also predictive of the permanence and incidence of new RLS cases. Waist circumference also predicted new cases of RLS in the 72–73 year-old population. Sleep disorders were quite common in 56–73 year-old subjects and their prevalence seemed to diminish as subjects aged. The components of metabolic syndrome associated with sleep disorders in middle-aged subjects, but these associations lost their significance in older age groups. Depressive symptoms predicted incidence of restless legs syndrome. / Tiivistelmä Tutkimuksessa selvitettiin unenaikaisten hengityshäiriöiden, päiväaikaisen väsymyksen ja levottomien jalkojen esiintyvyyttä ja yhteyksiä sydän- ja verisuonitautien riskitekijöihin sekä depressioon. Jokaöisen kuorsaamisen ja levottomien jalkojen luonnollista kulkua ja siihen vaikuttavia tekijöitä selvitettiin 10 vuoden seuranta-aikana. Tutkimusaineisto koostui kahdesta eri-ikäisestä pohjoissuomalaisesta väestöstä. Oulu35-seurantatutkimukset tehtiin vuosina 1996–1998 ja 2007–2008 (61–63- ja 72–73-vuotiaat tutkittavat). Oulu45-poikkileikkaustutkimus tehtiin vuosina 2001–2002 (56–57-vuotiaat tutkittavat). Aineisto kerättiin kyselylomakkeilla, laboratorio- ja kliinisillä tutkimuksilla. Oulu35-tutkimuksessa 593 henkilöä (73&#160;%) 831 kutsutusta osallistui ensimmäiseen seurantatutkimukseen v. 1996–1998 ja molempiin seurantatutkimuksiin osallistui 457 (55&#160;%) henkilöä. Oulu45 -tutkimukseen osallistui 995 henkilöä (75&#160;%) 1332 kutsutusta. Obstruktiivisen uniapnean esiintyvyys 56–57-vuotiaalla väestöllä oli 8&#160;%, 61–63-vuotiailla 4&#160;% ja 72–73-vuotiailla 3&#160;%. Jokaöisen kuorsaamisen esiintyvyys oli vastaavissa ikäluokissa 31&#160;%, 26&#160;% ja 19&#160;%, päiväaikaisen väsymyksen 16&#160;%, 9&#160;% ja 11&#160;% ja levottomien jalkojen 18&#160;%, 21&#160;% ja 15&#160;%. Kymmenen vuoden seurannassa jokaöinen kuorsaaminen vähentyi puoleen niillä henkilöillä, jotka kuorsasivat v. 1996–1998. Vastaavasti 10 vuoden kuluttua niillä henkilöillä, joilla esiintyi levottomia jalkoja 3–7 yönä viikossa v. 1996–1998, esiintyvyys oli vähentynyt alle 1 kertaan viikossa puolella tutkituista. 10 vuoden ilmaantuvuus sekä jokaöiselle kuorsaamiselle että levottomille jaloille oli 7&#160;%. Metabolisen oireyhtymän osatekijät ja depressiiviset oireet olivat yhteydessä obstruktiiviseen uniapneaan ja jokaöiseen kuorsaamiseen sekä 56–57-vuotiailla että 61–63-vuotiailla. Kymmenen vuoden seurannassa näiden tekijöiden vaikutus näytti kuitenkin vähentyvän. Miessukupuoli ennusti vahvimmin jokaöisen kuorsaamisen ilmaantuvuutta. Myös depressiiviset oireet ja vyötärönympärys ennustivat jokaöisen kuorsaamisen ilmaantuvuutta ja pysyvyyttä. Depressiiviset oireet, päiväaikainen väsymys ja vyötärönympärys olivat yhteydessä levottomien jalkojen esiintyvyyteen sekä 56–57- että 61–63-vuotiaassa että väestössä. Depressiiviset oireet ennustivat myös levottomien jalkojen ilmaantuvuutta ja tilan pysyvyyttä ja vyötärönympärys levottomien jalkojen ilmaantuvuutta 72–73-vuotiaana. Unihäiriöt olivat varsin yleisiä 56–73-vuotiaissa väestöissä, ja niiden ilmaantuvuus näyttäisi vähentyvän iän mukana. Metabolisen oireyhtymän osatekijät olivat yhteydessä unihäiriöihin keski-ikäisillä, mutta vanhemmissa ikäluokissa näiden yhteyksien merkitys väheni. Depressiiviset ennustivat levottomat jalat -oireyhtymän ilmaantuvuutta.

Objectifs : L’objectif principal de cette étude est d’établir si la santé parodontale des femmes enceintes ayant un DG est moindre que celle des femmes enceintes sans DG. L’objectif secondaire est d’évaluer l’association entre la fréquence et l’intensité du ronflement avec la santé parodontale chez les femmes enceintes ayant un DG. Méthodologie : Une étude de type cas-contrôle a été conduite parmi des femmes enceintes suivies au CHU Sainte-Justine. Le diagnostic de DG a été recueilli dans le dossier médical des participantes. Le volet 1 de l’étude incluait des mesures autorapportées par des questionnaires. Un sous-groupe de femmes enceintes était ensuite invité au volet 2 qui incluait un examen buccal permettant d’évaluer la santé parodontale des participantes. Les associations entre le DG et le ronflement, l’apnée obstructive du sommeil (AOS) et les maladies parodontales ont été évaluées à l’aide d’analyses bivariées. Résultats : Douze femmes enceintes avec DG et 85 femmes enceintes sans DG ont rempli les questionnaires du volet 1. De ces femmes, trois avec DG et sept sans DG ont participé au volet 2. Les femmes enceintes avec le DG étaient moins nombreuses à travailler à temps plein (p=0.032), avaient un revenu individuel (p=0.039) et familial (p=0.050) plus faible, faisaient moins d’activité physique (p=0.004) et allaient moins chez le dentiste (p=0.002) que les femmes enceintes sans DG. Il n’y avait pas de différence statistiquement significative entre les deux groupes pour le ronflement, l’AOS et les maladies parodontales. Conclusions : Les résultats préliminaires de l’étude n’ont pas établi si la santé parodontale des femmes enceintes avec DG est moindre ni démontré une association avec les troubles respiratoires obstructifs du sommeil. Pour atteindre les objectifs de l’étude, l’augmentation de la taille d’échantillon prévue à n=200 est requise. / Introduction Gestational diabetes mellitus (GDM) affects one in six pregnancies worldwide. Several short- and long-term complications affecting the mother and child can result from GDM. A few studies have shown a positive association between periodontal disease and GDM. Periodontal disease is also associated with adverse effects on pregnancy. In addition to potentially affecting fetal health and maternal insulin resistance, periodontal diseases are associated with obstructive sleep-disordered breathing. However, the relationship between these two entities in the context of GDM has not yet been studied. Objectives: The primary objective of this study is to establish whether the periodontal health of pregnant women with GDM is less than the one of pregnant women without GDM. The secondary objective is to assess the association between snoring frequency and intensity with periodontal health in pregnant women with GDM. Methodology: A case-control study was conducted among pregnant women followed at Sainte-Justine Hospital. The diagnosis of GDM was collected from the participants' medical records. The first phase of the study included self-reported measures by questionnaires. A subgroup of pregnant women was then invited to a second clinical phase. This included an oral examination to assess the participants' periodontal health. The associations between GDM and snoring, obstructive sleep apnea (OSA), and periodontal disease were evaluated using bivariate analyses. Results: Twelve pregnant women with GDM and 85 pregnant women without GDM completed the questionnaires in the first phase of the study. Of these women, three with GDM and seven without GDM participated in the second phase. Pregnant women with GDM worked less full-time (p=0.032), had lower individual (p=0.039) and family (p=0.050) income, engaged in less physical activity (p=0.004), and went to the dentist less often (p=0.002) than pregnant women without GDM. There was no statistically significant difference between the two groups for snoring, OSA and periodontal disease. Conclusions: Preliminary results of the study did not establish whether periodontal health in pregnant women with GDM is poorer, nor did they demonstrate an association with obstructive sleep-disordered breathing. To achieve the study objectives, the increase in sample size to n=200 is required.

This work examines sleep apnea syndrome, sleep physiology and self control of respiration during sleep. There is a review of respiration disorders during sleep and methods of monitoring sleep apnea syndrome. In another part the data of monitoration are processed and method of flow, saturation and snoring signal events detection is described, program algorithm is described and results are presented.

Introduction : Plusieurs effets secondaires sont associés au traitement de l’apnée obstructive du sommeil (AOS) par appareil d’avancement mandibulaire (AAM). Pour minimiser leur occurrence, plusieurs professionnels préconisent l’utilisation d’une attelle de repositionnement matinal (ARM) malgré le manque d’évidences valides soutenant cette approche. Objectifs : L’objectif principal de cette étude pilote randomisée contrôlée est d’évaluer l’utilisation d’une ARM comme moyen d’atténuer les effets secondaires à court terme associés au traitement par AAM. Méthode : 9 sujets souffrant d’AOS nécessitant un traitement par AAM ont été inclus et assignés aléatoirement au groupe témoin (n=5) et au groupe traitement (n=4). Tous les participants ont été traités avec un AAM fabriqué sur mesure et ajustable (SomnoDent Flex, SomnoMed, USA). Les sujets du groupe traitement ont également reçu une qu’ils devaient porter 1 heure le matin suivant le retrait de leur AAM. La participation comprenait 6 visites échelonnées sur une période approximative de 8 mois durant lesquelles plusieurs variables ont été évaluées, notamment les changements occlusaux, les effets secondaires et l’adhérence au traitement. Résultats : Des tendances de réduction des surplombs horizontaux et verticaux, de la distance intermolaire maxillaire et de la longueur d’arcade totale supérieure ont été observées uniquement au sein du groupe témoin (p=0,063). Six mois suivant la fin de la période de titration, les problèmes masticatoires étaient plus fréquemment rapportés dans le groupe témoin. 60% des sujets traités uniquement avec un AAM en rapportaient sur une base hebdomadaire comparativement à ceux recevant conjointement une ARM, où la survenue était rare, voire absente. Conclusion : Nos résultats suggèrent que l’ajout d’une ARM pourrait être bénéfique au traitement de l’AOS par AAM en réduisant la survenue de certains effets secondaires à court terme. D’autres études bien construites sont nécessaires pour confirmer nos observations. / Introduction: There are several side-effects associated with mandibular advancement devices (MAD) used to treat obstructive sleep apnea (OSA). Despite the lack of evidence supporting their use, some providers advocate the use of morning repositioning splints (MRS) to minimize these side effects. Objectives: The main objective of this randomized controlled pilot study is to evaluate MRS-use as a means of mitigating MAD-associated short-term side-effects. Methods: 9 subjects with OSA requiring MAD-use were included in this study and were randomized into a control group (n=5) and a treatment group (n=4). All participants were treated with a customized adjustable MAD (SomnoDent Flex, SomnoMed, USA). Subjects in the treatment group also received an MRS that was to be used every morning for 1 hour after removal of their MAD. Follow-up consisted of 6 appointments over approximately 8 months. During this time, variables including occlusal changes, side effects and treatment adherence were evaluated. Results: A tendency for overjet and overbite reduction as well as maxillary intermolar distance reduction and superior arch length shortening were observed in the control group only (P=0.063). Six months after completion of MAD titration, masticatory problems were more frequently reported by subjects in the control group. 60% of these subjects reported masticatory problems on a weekly basis whereas subjects in the treatment group never or rarely reported these issues. Conclusion: Our results suggest that MRS-use can minimize short-term side effects associated with MADs used to treat OSA. Additional, well-constructed, studies are needed to confirm these findings.