A utilização de placas oclusais estabilizadoras para controle do Bruxismo do Sono (BS) é uma prática muito comum entre os odontólogos, no entanto, muitos profissionais fazem uso desta medida terapêutica sem avaliar a possibilidade do paciente ter, ou vir a desenvolver, outro distúrbio do sono associado, como a Síndrome da Apneia Obstrutiva do Sono (SAOS). Esta síndrome compromete a qualidade de vida pois aumenta o risco para doença cardiovascular assim como o risco para acidentes automotivos. Além disso, estudos sugerem que a utilização de placas oclusais poderia agravar o quadro da SAOS, uma vez que favoreceria à retrusão mandibular com consequente diminuição do espaço para a língua. Como a literatura ainda é inconclusiva e o questionamento clínico permanece, o objetivo do estudo foi avaliar os efeitos da utilização de uma placa miorrelaxante por, no mínimo, 2 meses sobre o sono de 11 pacientes com SAOS. Para tanto, foram aplicados questionários como o da Escala de Sonolência de Epworth (ESE) e o Índice de qualidade do sono de Pittsburgh (IQSP), também foram realizadas polissonografias (PSG) antes, e durante, a utilização da placa. A média de idade desses pacientes foi de 47 anos (mín 33/ máx 61) sendo que 63.6% era do gênero masculino. Os resultados dos questionários não revelaram diferença significante para os dois momentos da análise. No entanto, os dados polissonográficos evidenciaram aumento no Índice de Apneia e hipopneia (16,6-28,32 eventos por hora, p=0,003) e no Índice de Distúrbios Respiratórios (20,14-33,96 eventos por hora, p=0,003) quando da utilização da placa. Foi observado, também, uma dessaturação da oxiemoglobina mínima (85,55-79,36, p=0,026) e um aumento do tempo de saturação abaixo de 90% medido em minutos (1,43-3,98; p= 0,025). Foi possível concluir que a utilização da placa miorrelaxante, por um período de 2 meses, em pacientes portadores da SAOS, pode estar associada ao agravamento deste distúrbio. / The use of stabilization occlusal splints for Sleep Bruxism (SB) control is a very common practice among Dentists. However many professionals use this therapy without evaluating the possibility of their patients having, or developing other associated sleep disorders, such as Obstructive Sleep Apnea (OSA). This syndrome affects the quality of life, increases the risk of cardiovascular disease as well as traffic accidents. In addition, studies suggest that the use of occlusal splints may make OSA worse, once mandibular retrusion and decrease of tongue space may occur. Since literature is inconclusive and the clinical question remains, the objective of this study was to evaluate the effects over sleep of 11 OSA patients when using an occlusal stabilization splint for at least 2 months. Therefore, questionnaires such as Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI), in addition to polysomnography (PSG) were performed before, and during, splints use. Patients\' average age was 47 years old (33±61) and 63.6% were male. The questionnaire results revealed no significant difference for the two stages of analysis. However, polysomnographic data showed an increase in the apnea-hypopnea index (16.6 to 28.32 events per hour, p = 0.003) and respiratory disorders Index (20.14 to 33.96 events per hour, p = 0.003) when patients were using the occlusal splints. It was also observed a decrease of minimum oxyhemoglobin desaturation (85.55 to 79.36, P = 0.026) and an increase in saturation time below 90%, measured in minutes (from 1.43 to 3.98; p = 0.025). It was concluded that the use of occlusal splints for a period of 2 months in patients with OSA may be associated to aggravation of such disorder.

Objective The goal of this project was to define and measure human volumetric airway dimensions with radiographic volumetric three-dimensional imaging and digital reconstruction of the pharynx using cone beam computed tomography to directly correlate these measurements with both normal and developmentally deficient jaw joints and their positions. The volume of the oropharynx was measured by creating a superior border connecting the 3-D midpoint of sella turcica and the posterior nasal spine and extending inferiorly to the level connecting the most infero-anterior point of C3 and the anterior hyoid bone as seen in the multi-planar views of the cone beam computed tomography image. The calculations were accomplished by using 3dMD software. Further extrapolation of this study'a data may be useful to establish the direct association of obstructive sleep apnea and deficiencies of jaw growth and airway development. Design In this retrospective study, 250 subjects were randomly selected from a pool of 800 referred for dental imaging at ddi Imaging Center in Sacramento, California. Digital images were captured using a low-radiation, rapid scanning cone beam computed tomography system (iCAT). Results A total of 250 subjects, 163 females and 87 males, were included in this study. Descriptive statistics were applied to the following variables: 1. Assessment of the relationship between total airway volume and several categorically independent variables: * For total airway volume, no significant difference was found between males and females; between the right temporomandibular positions; between right temporomandibular integrity; or between the left temporomandibular integrity. * There was a significant difference found between the left temporomandibular positions for total airway volume. 2. Assessment of the relationship between total airway volume and each cephalometric measurement: * Based on the Spearman correlation test, there were significant increasing relationships between total airway volume and several of the cephalometric measurements (p<0.05). * Correlation coefficients ranged from 0.13 to 0.22 indicating there were weak correlations between the two variables. 3. Assessment of the relationship between total airway volume and age: * Based on the Spearman correlation test, there was no significant relationship between total airway volume and age (p=0.8304). In addition, Spearman correlation showed no correlation between total airway volume and sex and skeletal growth pattern tendencies. Conclusions Three dimensional images of the airway offer the opportunity to serially examine individuals, acquire airway patency information, and improve the evaluation of sites of airway obstruction. Further studies to determine the effects of pharyngeal stenosis and other regional changes to the oropharynx upon physiologic response may be key to understanding the effects of biomechanical influences upon craniofacial form. Comprehension of structural inter-relationships will also help develop an understanding of how and why adaptive changes in airway shape and volume occur. Airway patency is related to many variables: head posture, the direction of mandibular rotation during growth and development, and hyoid bone position. Further studies may offer an increased understanding of these structural and positional interrelationships.

Obstructive sleep apnea (OSA) severity is strongly associated with the degree of overnight peripharyngeal fluid accumulation. We hypothesized that intravenous fluid loading would cause upper airway (UA) narrowing or increase the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index; AHI). We employed a controlled, randomized double-crossover experiment in 9 healthy men aged 23-46 years. In the control, subjects were administered approximately 80 ml of normal saline intravenously during sleep. In the intervention, subjects were administered approximately 1850 ml of saline during sleep while wearing compression stockings to localize fluid rostrally. The intervention induced nuchal fluid accumulation, resulting in an increase in neck circumference (+0.1 cm during control, +0.6 cm during intervention, P< 0.01 ) and a decrease in UA cross-sectional area (-0.08 cm2 during control, -0.43 cm2 during intervention, P = 0.023). Although the intervention did not increase the AHI (control AHI = 19.5, intervention AHI = 30.3, P = 0.249), the AHI during the intervention correlated with age (r = 0.8, P < 0.01). Thus, intravenous saline loading during sleep can narrow the UA, which in older men may induce or worsen OSA. Further studies are needed to test this hypothesis.

Obstructive sleep apnea (OSA) severity is strongly associated with the degree of overnight peripharyngeal fluid accumulation. We hypothesized that intravenous fluid loading would cause upper airway (UA) narrowing or increase the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index; AHI). We employed a controlled, randomized double-crossover experiment in 9 healthy men aged 23-46 years. In the control, subjects were administered approximately 80 ml of normal saline intravenously during sleep. In the intervention, subjects were administered approximately 1850 ml of saline during sleep while wearing compression stockings to localize fluid rostrally. The intervention induced nuchal fluid accumulation, resulting in an increase in neck circumference (+0.1 cm during control, +0.6 cm during intervention, P< 0.01 ) and a decrease in UA cross-sectional area (-0.08 cm2 during control, -0.43 cm2 during intervention, P = 0.023). Although the intervention did not increase the AHI (control AHI = 19.5, intervention AHI = 30.3, P = 0.249), the AHI during the intervention correlated with age (r = 0.8, P < 0.01). Thus, intravenous saline loading during sleep can narrow the UA, which in older men may induce or worsen OSA. Further studies are needed to test this hypothesis.

This thesis aimed at developing and evaluating a tailored behavioural sleep medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome (OSAS) and overweight. Participants with moderate or severe OSAS (apnea-hypopnea index ≥15) and obesity (Studies I-II) or overweight (Studies III-IV), treated with continuous positive airway pressure (CPAP) (Studies I-II) or admitted to CPAP treatment (Studies III-IV), were recruited from the sleep clinic at Uppsala University Hospital, Sweden. Semi-structured individual interviews were analysed using qualitative content analysis (Study I). Data on moderate-to-vigorous physical activity (MVPA) and sedentary time were collected with three measurement methods and analysed regarding the level of measurement agreement (Study II). Potential disease-related and psychological correlates for the amount of MVPA, daily steps and sedentary time were explored using multiple linear regression (Study III). Physical activity and eating behaviour changes were examined after a six month behaviour change trial (Study IV). A tailored behavioural sleep medicine intervention targeting physical activity and healthy eating in combination with first- time CPAP treatment was compared with CPAP treatment and advice on the association between weight and OSAS. According to participants’ conceptions, a strong incentive is needed for a change in physical activity and bodily symptoms, external circumstances and thoughts and feelings influence physical activity engagement (Study I). Compared with accelerometry, the participants overestimated the level of MVPA and underestimated sedentary time when using self-reports (Study II). The participants spent 11 hours 45 minutes (71.6% of waking hours) while sedentary. Fear of movement contributed to the variation in steps and sedentary time. Body mass index was positively correlated to MVPA (Study III). The experimental group increased intake of fruit and fish and reduced more weight and waist circumference compared with controls. There were no changes in physical activity (Study IV). The novel tailored behavioural sleep medicine intervention combined with first-time CPAP facilitated eating behaviour change, with subsequent effects on anthropometrics, but it had no effects on physical activity and sedentary time. Fear of movement may be a salient determinant of sedentary time, which has to be further explored in this population. The results confirm sedentary being a construct necessary to separate from the lower end of a physical activity continuum and highlight the need of developing interventions targeting sedentary behaviours specifically.

Obstructive Sleep Apnea Syndrome (OSAS) is defined as a sleep related breathing disorder that causes the body to stop breathing for about 10 seconds and mostly ends with a loud sound due to the opening of the airway. OSAS is traditionally diagnosed using polysomnography, which requires a whole night stay at the sleep laboratory of a hospital, with multiple electrodes attached to the patient&#039 / s body. Snoring is a symptom which may indicate presence of OSAS / thus investigation of snoring sounds, which can be recorded in the patient&#039 / s own sleeping environment, has become popular in recent years to diagnose OSAS. In this study, we aim to develop a new method to detect post-apnea snoring episodes with the goal of diagnosing apnea or creating a new criteria similar to apnea / hypopnea index. In this method, first segmentation is done to eliminate the silence parts and only deal with active. Then these episodes are represented by distinctive features / some of these features are available in literature but some of them are novel. Finally, these episodes are classified using supervised and unsupervised methods. We are especially interested in detecting post apnea episodes, hence the apnea periods. False alarm rates are reduced by adding additional constraints into the detection algorithm. These methods are applied to snoring sound signals of OSAS patients, recorded in Gulhane Military Medical Academy, to verify the success of our algorithms.

No description available.

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.

Objective: We aim to improve our understanding of sleep physiology by describing the changes in mandibular position during sleep in normal subjects. Methods: We developed a novel method for mapping mandibular position simultaneously in three dimensions (anteroposterior, vertical and lateral) using magneto-resistive sensors strategically placed around 3 different moving joints on an external apparatus attached to the head and mandible. Spherical coordinates derived from these sensors provided information of jaw position in each of the three measurement planes. We assessed changes in jaw position in twelve healthy subjects (6 male, 6 female) aged (mean ± SD) 23 ± 7 years, Body Mass Index 22.5 ± 3.4 kg/m2, and with nasal resistance 3.24 ± 0.67 cmH2O/L/s by recording mandibular position simultaneously with overnight sleep polysomnography. Results: Jaw position was significantly influenced by sleep stage (p<0.001). The transition from wake to light sleep (stage one) was accompanied by significant jaw closure and jaw protrusion (p<0.05). As non-rapid-eye-movement (NREM) sleep deepened from stages 1 through slow wave sleep (SWS), vertical jaw opening (p<0.05) and posterior jaw movement progressively increased (p<0.05). REM sleep was associated with the greatest degree of jaw opening of all sleep stages (p<0.05). Lateral jaw position was not significantly different between sleep stages. Conclusion: This study describes, for the first time, an accurate method of measuring changes in mandibular position during sleep in all three dimensions. The observed changes during sleep in healthy subjects suggest a simultaneous modulation of upper airway muscular tone, which may be important in the understanding of upper airway occlusion in Obstructive Sleep Apnea. / Thesis (Master, Physiology) -- Queen's University, 2008-08-29 14:27:57.726

Objectif: Le syndrome d'apnée obstructive du sommeil (SAOS) est de plus en plus présent en Amérique du Nord et a été associé avec certaines maladies chroniques, particulièrement les maladies cardiaques. En première ligne, là où la prévalence de cooccurrence de maladies chroniques est très élevée, l'association potentielle avec l'apnée du sommeil est inconnue. L'objectif de cette étude était d'explorer l'association entre l'apnée obstructive du sommeil et 1) la présence et la gravité de la multimorbidité (cooccurrence de plusieurs maladies chroniques), et 2) des sous-catégories de multimorbidité. Méthode La technique d'échantillonnage en grappe a été utilisée pour recruter 120 patients atteints de SAOS à différents niveaux de gravité et ce, à partir de la base de données d'un laboratoire de sommeil. La gravité de la maladie a été établie grâce aux résultats de la polysomnographie. Les patients, qui furent invités à participer, ont reçu, par la poste, un questionnaire de renseignements sociodémographiques et le questionnaire auto-rapporté Disease Burden Morbidity Assessment (DBMA). L'envoi incluait un formulaire de consentement permettant l'accès au dossier médical afin d'obtenir plusieurs autres informations essentielles. Le DBMA a été utilisé pour avoir un score global de multimorbidité et des sous-scores de maladies qui affectent divers systèmes. Résultats Les analyses bivariées n'ont pas permis de démontrer une association entre l'apnée obstructive du sommeil et la multimorbidité (r = 0,117; p = 0,205). Par contre, le SAOS grave a été associé à la multimorbidité (odds ratio ajustés = 7,3 [1,7-32,2] ; p = 0,05). Le SAOS est modérément corrélé avec des sous-scores de multimorbidité vasculaire (r = 0,26 ; p = 0,01) et de syndrome métabolique (r = 0,26 ; p = 0,01). Conclusion Cette étude démontre que la gravité du SAOS est associée à la gravité de la multimorbidité et à des sous-scores de multimorbidité. Cette recherche ne permet pas d'établir un lien de causalité, d'autres recherches s'imposent pour confirmer ces associations. Toutefois, les intervenants de santé en première ligne devraient être au fait de cette association potentielle et devraient investiguer la présence de l'apnée du sommeil quand cela leur semble approprié.