ABSTRACT
RESUMEN Introductión El síndrome de apneas e hipopneas obstructivas del sueño (SAHOS) afecta al 2%-4% de las personas adultas. El CPAP es la principal terapia en casos moderados y severos, pero sólo es tolerado en el 50%-70% de los pacientes. La terapia miofuncional orofaríngea (TMO) ayuda a reducir el colapso de la via aérea superior mediante ejercicios de fortalecimiento de la musculatura orofaríngea. En la última década ha demostrado una buena eficacia en grupos variados de pacientes con SAHOS. Objetivo Estudiar efectividad de la TMO en pacientes con SAHOS. Material y método Revisamos retrospectivamente 12 pacientes con SAHOS leve y moderado tratados con TMO. Los datos demográficos y polisomnográficos se analizaron antes y después de la terapia. Resultados Edad media: 65 ±9,0 años, el 58,3% eran mujeres, el 33,3% eran obesos. Observamos una disminución significativa del IAH (13,64 ±1,99 vs 10,13 ±2,09, p =0,008); una mejoría en la eficiencia del sueño, los porcentajes de etapas N3-REM y del índice de microdespertares. También observamos una reducción clínicamente significativa en las puntuaciones de la escala de somnolencia de Epworth, del Mallampatti y el perímetro cervical. Conclusión La TMO fue eficaz en la mayoría de los pacientes con SAHOS leve y moderado. Cada unidad de sueño en centros de salud públicos en Chile debe considerar este tratamiento.
ABSTRACT Introduction The obstructive sleep apnea syndrome (OSA) affects about 2%-4% of adults. CPAP is the first indication to treat moderate and severe cases, however the treatment is tolerated in only 50%-70% of patients. Therapy with myofunctional oropharyngeal (TMO) exercises helps to reduce upper airway collapsibility by strengthening the oropharyngeal musculature, and in the last decades had demonstrated good efficacy in variated groups of OSA patients. Aim: To study TMO effectivity in OSA patients. Material and method: We reviewed retrospectively the clinical records of 12 (7 female) mild and moderate unselected OSA patients. Clinical and polysomnographic data were analyzed before and after TMO. Results: The mean age of patients was 65.0 ±9.0 years and median BMI was 26.7 kg/m2. TMO was associated to a significant reduction in median of Epworth somnolence scale (11.0 vs. 7.0), median apnea hypopnea index (13.4 vs 9.0 events/h), and decrease in cervical circumference. There was a tendency to improve quality of NREM sleep with increases in N3 stage and decrease in arousal index. Conclusion: In a real clinical context, TMO reduced the severity of OSA in 41.6% in the studied patients. Because of its safety and low cost, TMO should be introduced as a therapeutic option in public sleep units in Chile.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Myofunctional Therapy , Sleep Apnea, Obstructive/therapy , Snoring , Chile , Polysomnography , SleepinessABSTRACT
Neural mechanisms involved in sleep and wakefulness generation are widely distributed in the central nervous system. Current models emphasize the pivotal role of the hypothalamus incontrolling the activation and inhibition of the ascending activating system and thlamo-cortical networks during wakefulness and restorative sleep respectively. The restorative properties of sleep, the duration and the timing of sleep occurrence is determined by at least two families of processes; (i) circadian rhythms generated at the hypothalamic pacemaker, that favorssleep and wakefulness at determined phases of the day; and (ii) homeostatic mechanisms that maintain the adequate daily sleep quotas, by compensating sleep debts and excesses. It is a current focus of clinical and basic research the effect of transient or chronic disruption of sleep architecture on performance and wellbeing.
Subject(s)
Humans , Male , Female , Circadian Rhythm , Sleep Stages/physiology , Sleep/physiology , Wakefulness/physiologyABSTRACT
A computer-based system that automates sleep studies, including sleep deprivation paradigms, is described. The system allows for total or REM-specific sleep deprivation and is based on a reliable, fast-responding, on-line state detection algorithm linked to a dependable intervention device. Behavioral state detection is achieved by dimension reduction of short-term EEG power spectrum. Interventions are made by serial outputs to servomotors that move a cage with different patterns and variable intensity. The system can adapt itself to individual characteristics and to changes in recording conditions. Customized protocols can be designed by defining the states or stages to be deprived, including scheduling temporal patterns. A detailed analysis of the relevant signals during and after deprivation is readily available. Data is presented from two experimental designs in rats. One consisted of specific REM-sleep short-term deprivation and the other of 10-hour total sleep deprivation. An outline of conceptual and practical considerations involved in the automation of laboratory set-ups oriented to biosignal analysis is provided. Careful monitoring of sleep EEG variables during sleep deprivation suggests peculiarities of brain functioning in that condition. A corollary is that sleep deprivation should not be considered to be merely a forced prolonged wakefulness.
Subject(s)
Animals , Male , Rats , Electroencephalography/methods , Signal Processing, Computer-Assisted , Sleep Deprivation/physiopathology , Sleep, REM/physiology , Electrodes, Implanted , Rats, Sprague-Dawley , Reaction Time , Time FactorsABSTRACT
Rest activity pattern was studied in wild-captured males of Octodon degus (n=9), Octodon bridgesi (n=3), and Spalacopus cyanus (n=6) (Rodentia: Octodontidae). Ten-minute resolution actograms were constructed from data obtained by an automated acquisition system. After two months of habituation to a stable light-dark schedule, recordings were performed in isolation chambers under a 12: 12 Light Dark schedule. A free-running period (constant darkness) was recorded for O. bridgesi and S. cyanus. O. degus displayed a crepuscular pattern of rest activity rhythm. Entrained O. bridgesi and S. cyanus displayed nocturnal preference, with rest anticipating light phase and without crepuscular activity bouts. Under constant darkness, active phase occurred at subjective night in O. bridgesi and S. cyanus. Wild-captured O. bridgesi and S. cyanus possess a circadian driven nocturnal preference, while wild O. degus displays a crepuscular profile. Diurnal active phase preference of wild S. cyanus colonies observed in the field could not be explained solely by photic entrainment, since social and/or masking processes appear to be operative. The genus Octodon includes species with diverse chronotypes. We propose that crepuscular diurnal pattern observed in O. degus is a recent acquisition among the octodontid lineage.
Subject(s)
Animals , Male , Circadian Rhythm/physiology , Rest/physiology , Rodentia/physiology , Adaptation, Physiological , PhotoperiodABSTRACT
Objetivo: Describir hallazgos clínicos y polisomnográficos en pacientes con Enfermedad de Parkinson (EP) y trastornos del sueño.Metodología: Se realizó: polisomnografía nocturna (PSG), una encuesta para pesquisar trastornos de sueño y otra para evaluar severidad de la EP a 5 pacientes con EPen tratamiento con antiparkinsonianos. Dos de ellos consultaron por trastornos de sueño y en 3 casos la PSG fue parte de la evaluación preoperatoria de cirugíaestereotáxica en pacientes parkinsonianos. Cuatro de nuestros pacientes tenían puntajes elevados en escalas de Hoehn-Yahr y UPDRS.Resultados: Todos referían insomnio y sueño poco reparador, 1 somnolencia diurna, 3 aumento de despertares nocturnos, 3 referían ®actuar¼ sus sueños y 3 consumían fármacos para dormir. La PSG mostró en todos baja eficiencia de sueño, prolongada latencia a su inicio y un sueño superficial. En 3 pacientes se observó movimientos periódicos de las piernas (10-28/hora), en 4 casos persistencia del tono muscular en REM y en uno se confirmó un trastorno de la conducta del sueño REM.Conclusión: Todos los pacientes presentaban trastornos del sueño, cuyo origen puede atribuirse a efectos de la EP y/o a los antiparkinsonianos. Enfatizamos la importancia de buscar dirigidamente dichos trastornos y la utilidad de la PSG.