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

Objective: To follow a cohort of children from age 4-6-12 with respect to sleep disordered breathing (SDB) and orofacial development. Questionnaires were completed about sleep, snoring, apneas, enuresis, sucking habits, and adenotonsillar surgery and, from age 12, about allergies, asthma, and general health. Children snoring regularly had an ENT- examinations including sleep studies (at ages 4 and 12) and an orthodontic evaluation. Development of biometric data in snoring children and not snoring controls was studied in relation to adenotonsillar surgery. Result: Of the original group of 615 children, 509 (83%) participated at age 6 and 393 (64%) at age 12. 27 snored regularly and 231 did not snore at age 12. Differences between groups were seen on all answers. From age 4–12 the prevalence of OSA decreased from 3.1% to 0.8%, and the minimum prevalence of snoring regularly from 5.3% to 4.2%. The odds for a child who snored regularly at four or six to be snoring regularly at age 12 was 3.7 times greater than for a not snoring child in spite of surgery (OR 3.7, 95% CI 2.4-5.7). 63 children were operated for snoring by age 12, of them 14 never snored and 17 snored regularly at age 12. Cross-bite was more common among snoring children at ages 4, 6 and 12 as was a narrower maxilla. In most cases, surgery cured the snoring temporarily, but the maxillar width was still smaller by age 12—even when nasal breathing was attained. Children snoring regularly at age 12, operated or not operated, showed long face anatomy and were oral breathers; the seven cases who were not operated and the five who were still snoring in spite of surgery, did not have reduced maxillary arch width. Conclusion: The prevalence of children snoring regularly is about the same from age four to twelve in a cohort where adenotonsillar surgery has been performed on obstructed cases, but the prevalence of OSA decreases considerably. The children snoring regularly have a more narrow maxilla compared to children not snoring—a condition that is not changed by adenotonsillar surgery regardless of symptom relief.

Snores are breath sounds that most people produce during sleep and they are reported to be a risk factor for various sleep disorders, such as obstructive sleep apnea syndrome (OSAS). Diagnosis of sleep disorders relies on the expertise of the clinician that inspects whole night polysomnography recordings. This inspection is time consuming and uncomfortable for the patient. There are surgical and therapeutic treatments. However, evaluation of the success of these methods also relies on subjective criteria and the expertise of the clinician. Thus, there is a strong need for a tool to analyze the snore sounds automatically, and to produce objective criteria and to assess the success of the applied treatment by comparing these criteria obtained before and after the treatment. In this thesis, we proposed a new algorithm to detect snoring episodes from the sleep sound recordings of the individuals, and created a user friendly interface to process snore recordings and to produce simple objective criteria to evaluate the results. The algorithm classifies sleep sound segments as snores and nonsnores according to their subband energy distributions. It was observed that inter- and intra-individual spectral energy distributions of snore sounds show significant similarities. This observation motivated the representation of the feature vectors in a lower dimensional space which was achieved using principal component analysis. Sleep sounds can be efficiently represented and classified as snore or nonsnore in a two dimensional space. The sound recordings were taken from patients that are suspected of OSAS pathology while they were connected to the polysomnography in G&uuml / lhane Military Medical Academy Sleep Studies Laboratory. The episodes taken from 30 subjects (18 simple snorers and 12 OSA patients) with different apnea/hypopnea indices were classified using the proposed algorithm. The system was tested by using the manual annotations of an ENT specialist as a reference. The system produced high detection rates both in simple snorers and OSA patients.

Snoring is a sleep disruption that can lead to obstructive sleep apnea (OSA), which interrupts breathing by obstructing the airway. Injecting a protein crosslinker, such as genipin, into the soft palate could decrease the severity of snoring and OSA by stiffening the soft palate. Equine soft palates modeled human palates due to a high incidence of awake snoring and apnea. The pilot in vivo study treated six horses with two 100 mM injections of the buffered genipin reagent. The efficacy phase horses underwent respiratory audio recordings to document snoring changes using Matlab and ImageJ in the time and frequency domains. Histological analysis was completed on the safety phase palates post treatment. All horses were successfully treated with the genipin injections. At least one horse showed high frequency amplitude reductions, and all horses had low frequency amplitude reductions, correlating to a reduction in palatal displacement and snoring loudness. One efficacy horse appears to have been completely cured. The histological analysis presented tissue damage, mucosal tissue damage, and mild inflammation due to palate expansion and errant injections. Different injection volumes and techniques should be investigated next. Applying this treatment to human studies for snoring and OSA applications is the ultimate goal.

A Sindrome da Apneia Hipopneia obstrutiva do sono (SAHOS) é caracterizada por episódios repetidos de obstrução parcial (hipopneia) ou completa (apneia) das vias aéreas superiores durante o sono. Os efeitos clínicos da SAHOS estão relacionados aos efeitos cumulativos da exposição à asfixia periódica e à fragmentação do sono causada por apneias e hipopnéias, como o aumento do risco de hipertensão, disritmias noturnas, insuficiência ventricular, infarto do miocárdio e acidente vascular cerebral. O padrão ouro para o diagnóstico de SAHOS é a Polissonografia (PSG), na qual requer que o paciente permaneça durante a noite inteira no laboratorio de sono, conectado a diferentes sensores biológicos e sob a supervisão de um técnico. Além do desconforto causado pelos sensores invasivos, a necessidade de um ambiente clínico e infraestrutura altamente especializada resulta em uma longa lista de espera nos laboratórios do sono e altos custos, restringindo assim o acesso ao diagnóstico e tratamento. Para melhorar o monitoramento da evolução da OSA, o acesso ao diagnóstico e o acompanhamento do tratamento, propõe-se uma solução baseada em Mobile Health (mHealth) para utilizar os recursos do smartphone a fim de desenvolver uma estimativa não invasiva da gravidade da SAHOS. Utiliza-se o áudio gravado através de um smartphone para detectar automaticamente os eventos de ronco durante a noite e, através da análise desses eventos, estimar a necessidade do paciente para o tratamento de Pressão Positiva Contínua nas Vias Aéreas (CPAP). Para isso, dividimos nossa solução em duas fases: (i) uma solução completamente não supervisionada para detectar automaticamente os eventos de ronco em um ambiente não controlado e (ii) a análise das características acústicas dos eventos de ronco para estimativa de gravidade da SAHOS. Na primeira fase, podemos comprovar a viabilidade de gravar o áudio e detectar os eventos de ronco usando um smartphone em um ambiente suscetível a ruídos aleatórios. Na segunda fase, mostramos que um conjunto de características acústicas globais dos eventos de ronco pode prever a necessidade do paciente para o tratamento com CPAP. Nossa solução proposta foi avaliada em ambiente não controlado (domicílio do paciente) e controlado (laboratório do sono), atingindo resultados satisfatórios na detecção de eventos de ronco e classificação do paciente de acordo com a necessidade de tratamento com CPAP. / Obstructive Sleep Apnea (OSA) is characterized by repeated episodes of partial (hypopnea) or complete (apnea) obstruction of the upper airway during sleep. The clinical effects of OSA are related to the cumulative effects of exposure to periodic asphyxia and sleep fragmentation caused by apneas and hypopneas, such as an increased risk of hypertension, nocturnal dysrhythmias, ventricular failure, myocardial infarction, and stroke. The current gold standard for diagnosing OSA is the overnight Polysomnography (PSG), which requires a full-night sleep laboratory stay, attached to different biological sensors and under the supervision of a technician. Besides the discomfort caused by the invasive sensors, the necessity of a clinical setting and highly specialized infrastructure results in a long waiting list in sleep laboratories and high costs, thus restricting the access to diagnosis and treatment. To improve monitoring of OSA evolution, access to diagnosis and treatment follow up, we propose a Mobile Health (mHealth) solution to take advantage of the smartphone capabilities to deploy a non-invasive OSA severity estimation. We make use of the audio recorded through a smartphone to automatically detect snoring events throughout the night and through the analysis of such events estimate patient’s necessity for Continuous Positive Airway Pressure (CPAP) therapy. For that, we have divided our solution into two phases: (i) a completely unsupervised solution to automatically detect the snoring events in an uncontrolled environment and (ii) the analysis of acoustical features of the snoring events for OSA severity estimation. In the first phase, we can prove the viability of recording the audio and detect the snoring events using a smartphone under an environment susceptible to random noises. In the second phase, we show that a set of global acoustical features from the snoring events can predict the patient’s need for the CPAP therapy. Our proposed solution was evaluated in an uncontrolled (patient’s home) and controlled (sleep laboratory center) environment, reaching satisfactory results in snoring events detection and patient’s classification according to the need for CPAP therapy.

Orientador: Luciana Pinato / Resumo: 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 s... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: 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 ge... (Complete abstract click electronic access below) / Mestre

Made available in DSpace on 2016-04-27T18:11:57Z (GMT). No. of bitstreams: 1 Gloria Oti Camara.pdf: 405067 bytes, checksum: 323c2e09cb729ace98efc4c7151ed534 (MD5) Previous issue date: 2012-07-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: mouth breathing prevents the natural passage of air through nose and usually brings several consequences for certain functions. The temporary disruption of respiratory function during sleep generally causes losses in its capacity. Mouth breathing and snoring are characteristics present in various sleep disorders. Learn about specific aspects of breathing and snoring can help speechlanguage intervention. Objective: characterize and compare aspects related to snoring in a group of mouth breathing children and adolescents. Method: were selected 130 children and adolescents from the database of an institution, in Sao Paulo, reference in the field. This sample had children and adolescent males and females. The age range of 5 to 14 years was divided into two groups: group 1 (5 years to 9 years and 5 months) and group 2 (9 years and 6 months to 14 years). The sample was divided into two groups mouth breathers who snore (MBS) and mouth breathers who do not snore (MB). The database contained information of clinical history and exam MBGR protocol. Were selected aspects related to snoring as: tonsils, hard palate, soft palate, uvula, velum and tongue posture, tone and mobility. For statistical analysis responses of the protocol were reorganized and renamed. Results: MBS group (64.6%) was higher compared to the MB group (35.4%) with statistically significant difference. In males 53.6% of subjects belonged to the MBS group and 69,6% to the MB; in females 46,4% to the MBS and 30,4% to the MB. In age group 1 was found 70.2% of the MBS and 58.7% of the MB; in group 2, 29.8% MBS and 41,3% MB. There was no statistically significant difference in: hard palate, uvula, velum and tongue posture, tone and mobility. However, MBS group showed change in greater number in comparison MB. Other features that were statistically significant were: tonsils altered in males and group 2 and soft palate for males. Conclusion: in the group studied snoring was a feature present in most mouth breathers children and adolescents. The characteristics that most differed between the group of mouth breathers snore and not snore were tonsils for males and aged 9 years and 6 months to 14 years and the soft palate for males / Introdução: a respiração oral impede a passagem natural do ar pelo nariz e costuma trazer várias consequências para determinadas funções. A interrupção temporária da função respiratória durante o sono, geralmente ocasiona prejuízos na sua qualidade. A respiração oral e o ronco são características presentes em diversos distúrbios do sono. Nesse sentido, conhecer aspectos específicos da relação respiração e ronco, pode auxiliar a atuação fonoaudiológica. Objetivo: caracterizar e comparar aspectos relacionados ao ronco em um grupo de crianças e adolescentes respiradores orais. Método: foram selecionadas 130 crianças e adolescentes do banco de dados de uma instituição, na cidade de São Paulo, referência na área de motricidade orofacial. Essa amostra apresentou crianças e adolescentes do sexo masculino e feminino, com faixa etária entre 5 e 14 anos, essa para cruzamento foi dividida em dois grupos: grupo 1 (de 5 anos a 9 anos e 5 meses) e grupo 2 (de 9 anos e 6 meses a 14 anos). A amostra foi dividida em dois grupos: respiradores orais que roncam (ROR) e respiradores orais que não roncam (RO). O banco de dados continha informações da anamnese e do exame do protocolo MBGR. Foram selecionados aspectos relacionados ao ronco como: tonsilas palatinas, palato duro, palato mole, úvula, véu palatino e postura, tônus e mobilidade de língua. Para realização da análise estatística as respostas do protocolo foram reorganizadas e renomeadas. Resultados: o grupo ROR (64,6%) foi maior em comparação ao grupo RO (35,4%) com diferença estatisticamente significante. No sexo masculino, 53,6% dos sujeitos pertenciam ao grupo ROR e 69,6% ao RO; no feminino 46,4% de ROR e 30,4% de RO. Na faixa etária o grupo 1 foi observado 70,2% de ROR e 58,7% de RO; no grupo 2, 29,8% de ROR e 41,3% de RO. Não houve diferença estatística significativa em: palato duro, úvula, véu palatino e postura, tônus e mobilidade de língua. No entanto, o grupo de ROR apresentou alteração em maior número quando comparado ao RO. Outras características que se mostraram estatisticamente significantes foram: tonsilas palatinas alteradas no sexo masculino e para o grupo 2 e palato mole para o sexo masculino. Conclusão: no grupo estudado o ronco foi uma característica presente na maioria das crianças e adolescentes respiradores orais. As características que mais se diferenciaram entre os grupos de respiradores orais que rocam e que não roncam foram as tonsilas palatinas para o sexo masculino e na faixa etária de 9 anos e 6 meses a 14 anos e no palato mole para o sexo masculino

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, apneas and excessive daytime sleepiness (EDS). Obesity is a risk factor for snoring and sleep apnea, but data on other factors in relation to obesity are ambiguous. Symptoms of sleep apnea in women have not been fully elucidated. OSAS is an important risk factor for cardiovascular disease (CVD). A common feature in patients with CVD and sleep apnea is an increase in systemic inflammation. From the general population 7,051 women ≥ 20 years answered a questionnaire on snoring and sleep disturbances. Habitual snoring was found in 8% of the total population, and influenced by age, obesity and smoking. The highest prevalence (14%) was found in women 50-59 years. In lean women, alcohol dependence was associated with snoring, while physical inactivity was a risk factor for snoring in obese women. Further, 230 snoring women and 170 women regardless of snoring status were investigated with polysomnography, blood sampling and anthropometric measurements. Of these, 132 participants underwent an ocular and endoscopic examination of their upper airways. Several findings in the upper airways characterised normal-weight women with an apnea-hypopnea index (AHI) ≥ 10. In women with BMI of > 25, no pharyngeal characteristics predicted sleep apnea. When adjusting for age, obesity, smoking, AHI and sleep parameters, several aspects of daytime sleepiness correlated to snoring independently of AHI (EDS, falling asleep involuntarily during day, waking up unrefreshed and fatigue). No symptoms correlated to AHI independently of snoring. Blood samples were analysed for systemic inflammation (CRP, TNFα, IL-6, myeloperoxidase (MPO) and lysozyme). Strong correlations were found between obesity and inflammatory markers. AHI and nocturnal hypoxia correlated to all markers except MPO. When adjusting for age, obesity and smoking, only IL-6 and TNFα were independently associated with nocturnal hypoxia. In conclusion, age and obesity influence the prevalence of snoring and sleep apnea in women from the general population. Other risk factors differ according to BMI. Daytime symptoms are independently related to snoring per se. Despite a strong correlation between obesity and inflammation, an independent relationship between sleep apnea and inflammatory markers was found.

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.

Το ροχαλητό είναι ένα φαινόμενο που σπάνια προκαλεί ανησυχία στους ασθενείς του. Επιπλέον, η διάγνωση του ροχαλητού απαιτεί ακόμα και σήμερα εξέταση σε εργαστήριο πολυυπνογραφίας, μια διαδικασία που είναι ακριβή και επίπονη για τον ασθενή. Συνδυασμένα αυτά τα γεγονότα οδηγούν σε ένα τεράστιο ποσοστό μη διαγνωσμένων ασθενών που κινδυνεύουν να παρουσιάσουν ή παρουσιάζουν ήδη ψυχολογική επιβάρυνση, κάποια μορφή καρδιακής νόσου, μειωμένες επιδόσεις στις καθημερινές τους ασχολίες και άλλα παρεπόμενα του ροχαλητού. Πολλές μέθοδοι έχουν αναπτυχθεί για διάγνωση ροχαλητού με ακουστική ανάλυση των ήχων κατά τη διάρκεια του ύπνου με σκοπό να μετατρέψουν τη διάγνωση του ροχαλητού σε εύκολη και βολική για τον ασθενή διαδικασία. Αν και αυτές οι μέθοδοι φαίνεται να έχουν καλά αποτελέσματα σε πειράματα εργαστηρίου, πολλές φορές δεν είναι αρκετά ανθεκτικές και σταθερές και απαιτούν χρήση συγκεκριμένου εξοπλισμού για να λειτουργήσουν σε βέλτιστο επίπεδο. Αυτό έχει σαν αποτέλεσμα να μη λειτουργούν ικανοποιητικά αν υλοποιηθούν στα πλαίσια μιας καθημερινής συσκευής που ήδη έχει ο ασθενής και δε χρειάζεται να αγοράσει, όπως το κινητό του τηλέφωνο. Με αυτή τη διπλωματική γίνεται προσπάθεια ανάπτυξης και υλοποίησης μεθόδου αναγνώρισης ροχαλητού αρκετά ανθεκτικής ως προς το θόρυβο αλλά και την απόσταση της συσκευής ηχογράφησης από τον ασθενή, ώστε να μπορεί να χρησιμοποιηθεί ακόμα και με συσκευές κινητού τηλεφώνου. Επίσης, γίνονται πειραματισμοί για δημιουργία δύο μεθόδων για αναγνώριση ροχαλητού με αυτόματη εξαγωγή χαρακτηριστικών με χρήση Sparse Coding και Convolutional Predictive Sparse Decomposition Auto-encoders. / Snoring rarely is cause of alarms for its patients. In addition, in order to diagnose snoring, a patient has to pass the night at a polysomnography lab, a process that is both expensive and inconvenient. These two facts lead to a massive percentage of undiagnosed patients that might run the risk of being affected by mood swings, some kind of heart disease and other side effects of snoring. Many methods of acoustical analysis of sleep sounds have been developed in order to make snore diagnosis an easy and inexpensive process. Even though these methods seem to be good at diagnosing snore sounds in a lab environment, they sometimes fail when put in a home environment since they are not robust against noise and they are highly dependent on the equipment used for the recording of the sounds. Thus, they are not effective in most scenarios so that they can be implemented in devices that a patient might already own and replace polysomnography. In this thesis project it is attempted to develop and implement a snoring detection method that is robust enough to be used in practice. Moreover, methods of automatic feature extraction are experimented with using Sparse Coding and Convolutional Predictive Sparse Decomposition Auto-encoders.