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Tyrimo metu apibendrinti ir išanalizuoti 74 knarkiančiųjų bei lengvu ir vidutinio sunkumo obstrukcinės miego apnėjos hipopnėjos sindromu (OMAHS) sergančių pacientų klinikiniai duomenys, ir įvertinta 38 jų miego partnerių emocinė būklė prieš pacientų gydymą ir praėjus 2–4 mėn. po pacientams taikyto knarkimo ir OMAHS gydymo – radiodažnuminės termoabliacijos (RDTA). Šio darbo uždaviniai: 1. Ištirti ir palyginti knarkiančiųjų bei sergančių lengvu ir vidutinio sunkumo OMAHS pacientų viršutinių kvėpavimo takų anatomines ir funkcines savybes, apnėjų hipopnėjų indeksą, nusiskundimus sveikata ir emocinę būklę. 2. Įvertinti knarkiančiųjų bei sergančių lengvu ir vidutinio sunkumo OMAHS pacientų gyvenimo kokybę prieš pradedant gydymą ir po gydymo RDTA. 3. Įvertinti su RDTA operacijomis susijusių pacientų nusiskundimų intensyvumą ir pooperacinių komplikacijų dažnį. 4. Ištirti ir įvertinti knarkiančiųjų bei sergančių lengvu ir vidutinio sun¬kumo OMAHS pacientų nusiskundimus ir apnėjų hipopnėjų indeksą po gydymo RDTA. 5. Ištirti ir įvertinti knarkiančiųjų bei sergančių lengvu ir vidutinio sunkumo OMAHS pacientų emocinę būklę po gydymo RDTA. 6. Ištirti ir įvertinti knarkiančiųjų bei sergančių lengvu ir vidutinio sunkumo OMAHS miego partnerių emocinę būklę ir jos pokyčius po pacientų gydymo RDTA. Po pacientų gydymo RDTA nustatytas pacientų nusiskundimų intensyvumo ir apnėjų hipopnėjų indekso sumažėjimas bei emocinės būklės pagerėjimas, ir pacientų miego part¬ne¬rių depresiškumo sumažėjimas... [toliau žr. visą tekstą] / A total of 74 snoring and mild to moderate obstructive sleep apnea hypopnea syndrome (OSAHS) patients underwent complete full night polysomnography (PSG) and clinical examination and were treated with two sessions of radiofrequency tissue ablation (RFTA). The emotional state of 38 bed partners of snoring and mild to moderate OSAHS patients were evaluated at the baseline and 2–4 months after the patients completed the treatment. Objectives of the study: 1. To examine and evaluate the relationship between complaints, anatomical features, PSG results, and emotional state of snoring and mild to moderate OSAHS patients. 2. To assess the quality of life among snoring and mild to moderate OSAHS patients before and after the RFTA treatment. 3. To analyze the morbidity and the rate of postoperative compli¬ca¬tions of RFTA. 4. To evaluate the influence of RFTA on the objective (PSG results) and subjective (complaints) outcomes in snoring and mild to moderate OSAHS patients. 5. To evaluate the influence of RFTA on the outcomes of anxiety and depression in snoring and mild to moderate OSAHS patients. 6. To examine the emotional state and to evaluate the effect of RFTA on anxiety and depression in bed partners of snoring and mild to moderate OSAHS patients. A remarkable improvement in patients’ complaints, PSG results and emotional state after RFTA was observed. RFTA therapy resulted in improved depression scores for the bed partners of snoring and mild to moderate OSAHS patients.

Snoring is a highly prevalent disorder affecting 20-40% of adult population. Snoring is also a major indicative of obstructive sleep apnea (OSA). Despite the magnitude of effort, the acoustical properties of snoring in relation to physiological states are not yet known. This thesis explores statistical properties of snoring sounds and their association with OSA. First, an unsupervised technique was developed to automatically extract the snoring sound segments from the lengthy recordings of respiratory sounds. This technique was tested over 5665 snoring sound segments of 30 participants and the detection accuracy of 98.6% was obtained. Second, the relationship between anthropometric parameters of snorers with different degrees of obstruction and their snoring sounds’ statistical characteristics was investigated. Snoring sounds are non-Gaussian in nature; thus second order statistical methods such as power spectral analysis would be inadequate to extract information from snoring sounds. Therefore, higher order statistical features, in addition to the second order ones, were extracted. Third, the variability of snoring sound segments within and between 57 snorers with and without OSA was investigated. It was found that the sound characteristics of non-apneic (when there is no apneic event), hypopneic (when there is hypopnea), and post-apneic (after apnea) snoring events were significantly different. Then, this variability of snoring sounds was used as a signature to discriminate the non-OSA snorers from OSA snorers. The accuracy was found to be 96.4%. Finally, it was observed that some snorers formed distinct clusters of snoring sounds in a multidimensional feature space. Hence, using Polysomnography (PSG) information, the dependency of snoring sounds on body position, sleep stage, and blood oxygen level was investigated. It was found that all the three variables affected snoring sounds. However, body position was found to have the highest effect on the characteristics of snoring sounds. In conclusion, snoring sounds analysis offers valuable information on the upper airway physiological state and pathology. Thus, snoring sound analysis may further find its use in determining the exact state and location of obstruction.

Snoring is a highly prevalent disorder affecting 20-40% of adult population. Snoring is also a major indicative of obstructive sleep apnea (OSA). Despite the magnitude of effort, the acoustical properties of snoring in relation to physiological states are not yet known. This thesis explores statistical properties of snoring sounds and their association with OSA. First, an unsupervised technique was developed to automatically extract the snoring sound segments from the lengthy recordings of respiratory sounds. This technique was tested over 5665 snoring sound segments of 30 participants and the detection accuracy of 98.6% was obtained. Second, the relationship between anthropometric parameters of snorers with different degrees of obstruction and their snoring sounds’ statistical characteristics was investigated. Snoring sounds are non-Gaussian in nature; thus second order statistical methods such as power spectral analysis would be inadequate to extract information from snoring sounds. Therefore, higher order statistical features, in addition to the second order ones, were extracted. Third, the variability of snoring sound segments within and between 57 snorers with and without OSA was investigated. It was found that the sound characteristics of non-apneic (when there is no apneic event), hypopneic (when there is hypopnea), and post-apneic (after apnea) snoring events were significantly different. Then, this variability of snoring sounds was used as a signature to discriminate the non-OSA snorers from OSA snorers. The accuracy was found to be 96.4%. Finally, it was observed that some snorers formed distinct clusters of snoring sounds in a multidimensional feature space. Hence, using Polysomnography (PSG) information, the dependency of snoring sounds on body position, sleep stage, and blood oxygen level was investigated. It was found that all the three variables affected snoring sounds. However, body position was found to have the highest effect on the characteristics of snoring sounds. In conclusion, snoring sounds analysis offers valuable information on the upper airway physiological state and pathology. Thus, snoring sound analysis may further find its use in determining the exact state and location of obstruction.

Background: Obstructive sleep apnea is a common disorder, especially in men. Patients with this condition often snore and suffer from excessive daytime sleepiness. It is a treatable condition related to cardiovascular disease, road traffic accidents and obesity. Aims: To study whether snoring and witnessed sleep apnea are related to diabetes mellitus and whether sleepy subjects who snore or report sleep apneas drive more than others. To investigate whether sleep apnea is related to stroke, mortality and myocardial infarction in patients with coronary artery disease. To study the effect of ambient temperature on sleep apnea, morning alertness and sleep quality in patients with obstructive sleep apnea. Methods and results: Questions on snoring, sleep apnea, daytime sleepiness and yearly driving distance were included in the northern Sweden component of the WHO MONICA study. Analyzed were 7905 randomly selected men and women aged 25-79 years. Snoring and witnessed sleep apnea were related to diabetes mellitus in women, (OR 1.58, p = 0.041 and OR 3.29, p = 0.012 respectively), independent of obesity, age and smoking, but not in men. Sleepy snoring men drove a mean of 22566 km per year which was more than others who drove 17751 km per year independent of age, BMI, smoking and physical activity (p = 0.02). Sleepy men reporting sleep apnea also drove more (p = 0.01). 392 men and women with coronary artery disease referred for coronary angiography were examined with overnight sleep apnea recordings and followed for 10 years. Sleep apnea was recorded in 211 (54%) of patients at baseline. Stroke occurred in 47 (12%) patients at follow up. Sleep apnea was associated with an increased risk of stroke (HR 2.89, 95% CI 1.37 - 6.09, p = 0.005) independent of age , BMI, left ventricular function, diabetes mellitus, gender, intervention, hypertension, atrial fibrillation, a previous stroke or TIA and smoking. The risk of stroke increased with the severity of sleep apnea. 40 patients with obstructive sleep apnea were investigated with overnight polysomnography in ambient temperatures of 16°C, 20°C and 24°C in random order. Total sleep time was a mean of 30 minutes longer (p = 0.009), sleep efficiency higher (p = 0.012), patients were more alert in the morning (p = 0.028), but sleep apnea was more severe when sleeping in 16°C (p = 0.001) and 20°C (p = 0.033) vs. 24°C. The AHI was 30 ± 17 in 16ºC room temperature, 28 ± 17 in 20°C and 24 ± 18 in 24°C. Conclusions: Snoring and witnessed sleep apneas are related to diabetes mellitus in women. Sleepy men who snore or report sleep apnea drive more than others. Sleep apnea is independently associated with the risk of stroke among patients with coronary artery disease. Subjects with obstructive sleep apnea sleep longer, are more alert in the morning after a night’s sleep, but sleep apnea is more severe when sleeping in a colder environment.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2009. / Härtill 3 uppsatser.

Στα πλαίσια αυτής της εργασίας παρουσιάζεται ένα ενσωματωμένο σύστημα χαμηλού κόστους το οποίο καταγράφει, αποθηκεύει και επεξεργάζεται αναπνευστικό σήμα που έχει ληφθεί κατά τη διάρκεια ανθρώπινου ύπνου. Στα κεφάλαια που ακολουθούν αναλύεται η δομή ,οι επιμέρους συνιστώσες του συστήματος καθώς και μέθοδοι επεξεργασίας του σήματος. Αρχικά λοιπόν ορίζεται το ιατρικό και θεωρητικό υπόβαθρο πάνω στο οποίο στηρίζονται οι ισχυρισμοί και μέθοδοι που ακολουθούνται. Εν συνεχεία, γίνεται εισαγωγή στους στοιχειώδεις ορισμούς όπως αυτοί του μικροελεγκτή και ενσωματωμένου συστήματος και γίνεται μια πρώτη αναφορά στο μικροελεγκτή ADuC 7026 της Analog Devices που χρησιμοποιήσαμε και στα περιφερειακά αυτού. Επίσης γίνεται και ανάλυση των στοιχειωδών χαρακτηριστικών του περιβάλλοντος μVision της Keil που μας επιτρέπουν να κάνουμε προσομοιώσεις με μηδενικό υλικό στη διάθεσή μας. Στο επόμενο κεφάλαιο γίνεται αναλυτική επεξήγηση του μικροελεγκτή μας και δίνονται επιπλέον ενδεικτικά παραδείγματα με τα οποία γίνεται κατανοητές βασικές δυνατότητες που προσφέρει αυτός και στις οποίες θα στηριχθούμε για να δομήσουμε το δικό μας πρόγραμμα. Σημειώνουμε εδώ πως ο προγραμματισμός του μικροελεγκτή και των περιφερειακών του έγινε σε γλώσσα προγραμματισμού C. Στο τέταρτο κεφάλαιο επεξηγούμε τον αλγόριθμο που χρησιμοποιήσαμε για την επεξεργασία του σήματος και τους λόγους επιλογής του. Έπειτα παραθέτουμε αναλυτικά τον κώδικα της εφαρμογής μας και τέλος καταλήγουμε σε αποτελέσματα και συμπεράσματα. / Within this thesis, we present a low cost embedded system that records, stores and processes the respiratory signal of snores obtained during human sleep. In the following chapters we analyze the structure, each component of the system and the methods being implemented. Initially we define the medical and theoretical background on which we are based to build in our program and apply our methods. Moreover, we give the basic definitions such as the microcontroller's and the embedded system’s, and we make the first presentation of The next the microcontroller ADuC 7026 of Analog Devices and its peripherals that will be used for implementation. We also present the μVision Keil environment which enables us to emulate the microcontroller having at our disposal zero hardware. The next section gives a detailed explanation of this microcontroller and some basic examples of its programming possibilities are presented that will help us with the application. The programming of the microcontroller and its peripherals was done in C programming language. In the fourth chapter we explain the algorithm that will be used for the signal processing and the reasons for its selection. Afterwards the programming of the microcontroller is given and explained in detail and finally we conclude with the results.

Submitted by Nathani Cristina da Silva (nathanics.plis@gmail.com) on 2018-06-13T21:01:42Z No. of bitstreams: 1 Dissertação Nathani Cristina da Silva_2018.pdf: 2533051 bytes, checksum: 7186545c4611a1c29ccb4ae9043a4719 (MD5) / Approved for entry into archive by Satie Tagara (satie@marilia.unesp.br) on 2018-06-14T13:24:33Z (GMT) No. of bitstreams: 1 silva_nc_me_mar.pdf: 2533051 bytes, checksum: 7186545c4611a1c29ccb4ae9043a4719 (MD5) / Made available in DSpace on 2018-06-14T13:24:33Z (GMT). No. of bitstreams: 1 silva_nc_me_mar.pdf: 2533051 bytes, checksum: 7186545c4611a1c29ccb4ae9043a4719 (MD5) Previous issue date: 2018-05-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: O acúmulo excessivo de gordura corporal resulta em maior propensão à Apneia Obstrutiva do Sono (AOS) devido à colapsabilidade faríngea e/ou alterações neuromusculares. Dentre as principais consequências da AOS estão problemas cardiovasculares, quadros depressivos e de ansiedade, disfunções metabólicas, alterações de funções executivas e motoras com destaque para a diminuição da qualidade de sono, que também agrava a saúde geral do indivíduo. Conhecido principalmente por modular a qualidade do sono o hormônio melatonina, em condições normais, é produzido de forma rítmica, porém, em diversos quadros patológicos, altos índices de citocinas inflamatórias podem reduzir a produção de melatonina. Em obesos, embora os mecanismos ainda não estejam esclarecidos, foi demonstrado diminuição no conteúdo de melatonina. Considerando-se as consequências dos transtornos de sono e AOS, a caracterização do padrão de sono e o entendimento sobre os mecanismos envolvidos nos transtornos de sono são essenciais para se estabelecer planos de prevenção e tratamento destes quadros. Objetivo: Caracterizar a presença de transtornos de sono, incluindo a AOS, e sua relação com a presença de ronco, características cefalométricas, a condição miofuncional orofacial, o conteúdo salivar de melatonina e de TNF em indivíduos obesos e/ou com sobrepeso. Material e Método: Participaram 102 indivíduos com idade entre 20 e 65 anos, sendo 29 indivíduos obesos, 21 com sobrepeso e 52 eutróficos, de ambos os sexos. Para avaliação do sono e da AOS foram aplicados de questionários sobre qualidade de sono e presença de ronco e polissonografia. Para associação com os parâmetros destas avaliações foram realizadas avaliações miofuncionais orofaciais por meio da Orofacial Scale for Obstructive Sleep Apnea (OFSOSA), otorrinolaringológicas, antropométricas e análises do conteúdo salivar de melatonina e da citocina TNF. Resultados e Discussão: Com relação à avaliação sobre a qualidade de sono, os indivíduos do GP (obesos+sobrepeso) apresentaram maior escore global do PSQI que os indivíduos do GC (eutróficos), o que representa pior qualidade de sono para o GP, sendo que quanto maior o IMC, maiores os valores de circunferência cervical e abdominal, e pior a qualidade do sono. O questionário de Berlim mostrou que tanto indivíduos obesos quanto indivíduos com sobrepeso apresentam maior risco para o desenvolvimento de AOS do que os controles. Com relação à avaliação polissonográfica observou-se presença de ronco em 80% dos indivíduos do GP. Destes, 25% apresentaram AOS de grau leve, 17% grau moderado e 58% grau grave. A avaliação miofuncional orofacial com o OFSOSA mostrou que 100% dos indivíduos do GP apresentaram pontuação correspondente a alterações oromiofuncionais. A avaliação nasofibroscópica mostrou que 47,6% dos indivíduos do GP apresentaram obstrução maior do que 75% de vias aéreas superiores a nível retropalatal e retrolingual. Quanto à análise do conteúdo salivar de melatonina, os indivíduos do GC apresentaram diferença entre os conteúdos dia e noite com pico à noite, ao contrário do GP onde não foi encontrada diferença entre os conteúdos dia e noite. Na análise dos níveis de citocinas inflamatórias, verificou-se que os indivíduos do GP apresentaram maior conteúdo diurno de TNF do que os indivíduos do GC no mesmo período. Conclusões: Quanto maior o IMC, maiores as circunferências cervical e abdominal, pior a qualidade do sono, maior a incidência de AOS e mais graves são as características miofuncionais orofaciais nesta população. Estes dados ressaltam a relevância da intervenção fonoaudiológica nos tratamentos multidisciplinares para a obesidade. Indivíduos obesos apresentaram menor conteúdo salivar de melatonina à noite e maior conteúdo diurno quando comparado ao grupo controle ambos correlacionados com maiores conteúdos de TNF. / Introduction: The excessive accumulation of body fat results in a higher propensity to Obstructive Sleep Apnea (OSA) due to pharyngeal collapsibility and/or neuromuscular alterations. Among its main consequences are cardiovascular problems, depressive and anxiety disorders, metabolic dysfunctions, changes in executive and motor functions, with a special emphasis on decreased sleep quality, which also influences the general health of the individual. Known mainly for modulating sleep quality, the hormone melatonin, under normal condition, is produced rhythmically, however, in several pathological conditions, high rates of inflammatory cytokines may reduce melatonin production. In obese patients, although the mechanisms have not yet been clarified, a decrease in melatonin content has been demonstrated. Considering the consequences of sleep disorders and OSA, the characterization of the sleep pattern and the understanding of the mechanisms involved in sleep disorders are essential for plans for the prevention and treatment of these. Aim: To characterize the presence of sleep disorders, including the OSA, and their relationship to the presence of snoring, cephalometric characteristics, myofunctional orofacial condition, salivary content of melatonin and TNF in obese and/or overweight individuals. Material and methods: A total of 102 individuals aged between 20 and 65 years participated in this study, being 29 obese individuals, 21 overweight and 50 eutrophic individuals of both genders. To evaluate sleep and AOS were applied questionnaires on sleep quality and presence of snoring, and polysomnography. For association with the parameters of these evaluations, were evaluated the orofacial myofunctional pattern using the Orofacial Scale for Obstructive Sleep Apnea (OFSOSA), the otorhinolaryngological and anthropometric patterns, and salivary content analysis of melatonin and TNF cytokine. Results and Discussion: Regarding the evaluation of sleep quality, GP (obese+overweight) individuals had a higher overall PSQI score than the CG, which represents a worse quality of sleep for GP, and the higher the BMI, the higher the waist circumference and cervical circumference and higher the PSQI score indicating poor sleep quality. The Berlin questionnaire for snoring as an indication for OSA showed that both obese individuals and overweight individuals were at higher risk for OSA development than controls. Regarding the polysomnographic evaluation, there was presence of snoring in 80% of GP individuals. Of these, 25% had mild OSA, 17% moderate and 58% severe grade. The orofacial myofunctional evaluation with the OFSOSA showed that 100% of GP individuals had oromyofunctional changes. The nasofibroscopic evaluation showed that 47.62% of GP individuals presented obstruction greater than 75% of upper airways at retropalatal and retrolingual level. Regarding the analysis of the salivary content of melatonin, GC subjects presented a difference between day and night contents with peak at night, unlike GP where no difference was found between day and night contents. In the analysis of inflammatory cytokine levels, GP individuals had higher daytime TNF content than GC subjects in the same period. Conclusion: The higher the BMI, the greater the cervical and abdominal circumferences, the worse the quality of sleep, the higher the incidence of OSA, and the more serious myofunctional orofacial characteristics in this population. These data highlight the relevance of speech therapy intervention in multidisciplinary treatments for obesity. Obese individuals had lower salivary melatonin content at night and higher daytime contents when compared to the control group both correlated with higher TNF contents.

Sleep-disordered breathing and insomnia are common sleep disorders and associated with an increased risk of morbidity. The aim of this thesis was to study the contribution of a behavioural sleep medicine perspective on sleep-disordered breathing and insomnia. More specific, factors considered important for changing eating behaviour and the impact of physical activity were studied. Methods: In study I, semi-structured interviews of participants with obstructive sleep apnoea and obesity (n = 15) were analysed using a qualitative content analysis. A population-based female cohort was followed prospectively over ten years in study II and III using a postal questionnaire on two occasions (n = 4,851 and n = 5062, respectively). In study IV, a series of five experimental single-case studies was conducted testing how an aerobic exercise intervention affected selected typical snores, following an A1B1A2B2A3 design over nine days and nights (n = 5). Results:  Facilitators and barriers towards eating behaviour change were identified. A low level of self-reported leisure-time physical activity was a risk factor among women for future habitual snoring complaints, independent of weight, weight gain alcohol dependence or smoking. Maintaining higher levels or increasing levels of leisure-time physical activity over the ten-year period partly protected from snoring complaints (study II). Further, a low level of self-reported leisure-time physical activity is a risk factor for future insomnia among women. Maintaining higher levels or increasing levels of leisure-time physical activity over the ten-year period partly protect against self-reported insomnia, independent of psychological distress, age, change in body mass index, smoking, alcohol dependence, snoring status or level of education (study III). Single bouts of aerobic exercise did not produce an acute effect on snoring the following nights in the studied individuals. A pronounced night-to-night variation in snoring was identified (study IV). Conclusion: Women with sleep disorders would benefit from a behavioural sleep medicine perspective targeting their physical activity in the prevention and management of snoring and insomnia. This is motivated by the protective effects of physical activity confirmed by this thesis. Knowledge was added about facilitators and barriers for future eating behaviour change interventions.