Prevalencia de trastornos respiratorios del sueño en pacientes asmáticos que se controlan en el Hospital Roberto del Río: estudio piloto / Prevalence of sleep breathing disorders in asthmatic patients monitored at Roberto del Río Hospital: a pilot study

Introducción. El asma es una de las enfermedades crónicas más frecuentes en niños. Múltiples estudios han sugerido que en la infancia presenta una asociación significativa con los trastornos respiratorios del sueño, con una prevalencia en niños asmáticos de un 24%. El objetivo fue determinar la prevalencia de trastornos respiratorios del sueño (TRS) en pacientes con asma controlados en un hospital pediátrico (6-15 años). Pacientes y Método. Estudio transversal descriptivo. Se aplicaron los cuestionarios de sueño pediátrico validado en español (pediatric sleep questionnaire, PSQ) y el Cuestionario de Control del Asma en Niños (CAN) a los padres de los niños con diagnósticos de asma controlados en Hospital Roberto del Río, vía telefónica y vía email. Resultados: La prevalencia de TRS fue de 34,8%. Un 20% presenta mal control de asma definido como CAN >8. Un 58,1% de los padres reportaron sobrepeso en los pacientes Conclusiones: la prevalencia de TRS en los niños estudiados es alta y obliga a investigar en cada consulta por estos síntomas. Aplicar la encuesta en cada consulta, de forma online podría aportar al conocimiento de estos pacientes y mantener la prevalencia del problema actualizada, para focalizar las intervenciones apropiadas.

Introduction. Asthma is one of the most frequent chronic diseases in children, multiple studies have suggested that in childhood it presents a significant association with sleep-disordered breathing, with a prevalence in asthmatic children of 24%.The objective was to determine the prevalence of sleep-disordered breathing (RRT) in patients with asthma controlled in a pediatric hospital (6-15 years). Patients and Methods. Descriptive cross-sectional study. The pediatric sleep questionnaire (PSQ) and the Child Asthma Control Questionnaire (CAN) were applied to the parents of children with controlled asthma diagnoses at Hospital Roberto del Río, by telephone and via e-mail. Results: The prevalence of RRT was 34.8%. 20% have poor asthma control defined as CAN> 8. 58.1% of parents reported overweight in patients Conclusions: the prevalence of RRT in the children studied is high and makes it necessary to investigate these symptoms at each visit. Applying the survey in each consultation, online, could contribute to the knowledge of these patients and keep the prevalence of the problem updated, in order to focalized the interventions.

Cirugía del sueño: Definición de una especialidad emergente, propuesta de una clasificación anatomofuncional integral e indicaciones

Resumen Los trastornos respiratorios del sueño (ronquido primario y síndrome de apnea-hipopnea obstructiva del sueño) han sido tratados mediante múltiples modalidades a lo largo de la historia. Sin embargo, la cirugía de la vía aérea superior siempre ha estado presente, dando cabida a la aparición de múltiples técnicas para este fin. El estudio adecuado de los sitios anatómicos de estrechez o colapso de la vía aérea superior y sus contribuyentes (bajo el concepto de topodiagnóstico) y el mejor entendimiento de los mecanismos de acción de los diferentes procedimientos descritos, ha permitido el nacimiento de una nueva disciplina, dedicada al manejo quirúrgico planificado de este grupo de patologías: la cirugía del sueño.

Abstract Sleep-related breathing disorders (primary snoring and obstructive sleep apnea-hypopnea syndrome) have been treated with multiple modalities throughout history. However, upper airway surgery has always been present, giving appearance of multiple techniques for this purpose. The adequate study of the anatomical sites of upper airway narrowness or collapse and its contributors (under the concept of topodiagnosis) and a better understanding of the different procedures, has allowed the birth of a new discipline, dedicated to a planned surgical management for this group of pathologies: sleep surgery.

The association of sleep-related breathing disorders among pediatric patients with allergic rhinitis: A cross-sectional study in a university hospital

@#<p style="text-align: justify;"><strong>Introduction:</strong> Allergic rhinitis is a common condition in children linked to sleep-related breathing disorders (SRBD). Because of nasal congestion, it can cause obstructive sleep apnea, sleep fragmentation, and excessive fatigue. Studies regarding its association with SRBD is limited.</p><p style="text-align: justify;"><strong>Objectives:</strong> To determine the association of allergic rhinitis with sleep-related breathing disorders.</p><p style="text-align: justify;"><strong>Methodology:</strong> A cross-sectional analytical study involving pediatric patients diagnosed with allergic rhinitis was conducted. Allergic rhinitis severity was evaluated with the ARIA classification. SRBD was identified using the validated Filipino version of the pediatric sleep questionnaire. Potential association between allergic rhinitis and SRBD were assessed using the student's t-test, Fisher's exact test and odds ratio.</p><p style="text-align: justify;"><strong>Results:</strong> A total of 66 children with mean age 8.2 years were included in the study. The mean age, weight, height, and BMI were comparable among participants who were positive or negative for obstructive sleep apnea (OSA). Among the perceived problems related to sleeping disorders, snoring loudly, heavy breathing, dry mouth of awakening, not listening, and difficulty organizing showed different responses (p<0.05) among the subgroups of allergic rhinitis. The odds ratio of snoring loudly, not listening, difficulty organizing, heavy breathing, and unfreshened in the morning were more likely among patients with mild persistent allergic rhinitis compared to patients with mild intermittent allergic rhinitis.</p><p style="text-align: justify;"><strong>Conclusion:</strong> There was sufficient evidence to prove the association of SRBD with severity of allergic rhinitis using the validated Filipino version of the Pediatric Sleep Questionnaire. OSA shows a greater likelihood among patients with mild persistent allergic rhinitis compared to those with mild intermittent allergic rhinitis.</p>

Effects of enriched-potassium diet on cardiorespiratory outcomes in experimental non-ischemic chronic heart failure

BACKGROUND: Chronic heart failure (CHF) is a global health problem. Increased sympathetic outflow, cardiac arrhythmogenesis and irregular breathing patterns have all been associated with poor outcomes in CHF. Several studies showed that activation of the renin-angiotensin system (RAS) play a key role in CHF pathophysiology. Interestingly, potassium (K+) supplemented diets showed promising results in normalizing RAS axis and autonomic dysfunction in vascular diseases, lowering cardiovascular risk. Whether subtle increases in dietary K+ consumption may exert similar effects in CHF has not been previously tested. Accordingly, we aimed to evaluate the effects of dietary K+ supplementation on cardiorespiratory alterations in rats with CHF. METHODS: Adult male Sprague-Dawley rats underwent volume overload to induce non-ischemic CHF. Animals were randomly allocated to normal chow diet (CHF group) or supplemented K+ diet (CHF+K+ group) for 6 weeks. Cardiac arrhythmogenesis, sympathetic outflow, baroreflex sensitivity, breathing disorders, chemoreflex function, respiratory- cardiovascular coupling and cardiac function were evaluated. RESULTS: Compared to normal chow diet, K+ supplemented diet in CHF significantly reduced arrhythmia incidence (67.8 ± 15.1 vs. 31.0 ± 3.7 events/hour, CHF vs. CHF+K+), decreased cardiac sympathetic tone (ΔHR to propranolol: - 97.4 ± 9.4 vs. - 60.8 ± 8.3 bpm, CHF vs. CHF+K+), restored baroreflex function and attenuated irregular breathing patterns. Additionally, supplementation of the diet with K+ restores normal central respiratory chemoreflex drive and abrogates pathological cardio-respiratory coupling in CHF rats being the outcome an improved cardiac function. CONCLUSION: Our findings support that dietary K+ supplementation in non-ischemic CHF alleviate cardiorespiratory dysfunction.

El paciente ortodóncico en dentición mixta y los trastornos del sueño / The orthodontic patient with mixed dentition and sleep disorders

Los desórdenes respiratorios del sueño (DRS) y, principalmente, roncopatías y apneas obstructivas afectan aproximadamente al 7% de los pacientes ortodóncicos. Los DRS no solo son importantes por la cantidad de pacientes afectados, sino por la gravedad de los posibles efectos secundarios a nivel de la salud general del paciente. La obstrucción de las vías aéreas superiores (VAS) provoca alteraciones del crecimiento y deformaciones craneofaciales importantes, por lo que el tratamiento temprano y la prevención de la respiración oral es muy importante.El papel del ortodoncista es muy importante en el diagnóstico y en el tratamiento de los DRS, pero también en su prevención, realizando tratamientos que aumenten la dimensión y la permeabilidad de las VAS. El protocolo de exploración interdisciplinar en niños y adolescentes y la cefalometría de vías aéreas son importantes en el diagnóstico y deben ser tenidos en cuenta en el plan de tratamiento. Pero las pruebas más significativas, el CBCT de vías aéreas y la polisomnografía no son pruebas rutinarias por la dificultad logística y el precio de estas pruebas. En este artículo también se recomiendan los tratamientos de ortodoncia más indicados en estos casos y que tienden al aumento de la dimensión de las VAS (AU)

Sleep breathing disorders (SBD) and in the first place, roncopathy and obstructive apnea, affect approximately 7% of orthodontic patients. The SBD are not only important for the number of affected patients, but also for the severity of the possible side effects at the level of general health of a patient. The upper air ways (UAW) obstruction provokes important alterations in growth and craniofacial deformations, and this is why the early treatment and prevention of mouth breathing are very important. The role of an orthodontist in diagnosis and treatment of SBD is very important, but it is also in its prevention, carrying out the treatments which increase the dimension and permeability of UAW. The protocol of interdisciplinary examination.In children and adolescents and the air ways cephalometry analysis have an important role in diagnosis and they should be taken into account in treatment planning. But the most important tests, the air ways CBCT and polysomnography, are not routine tests due to the complicated logistics and their cost. In this article, the orthodontic treatments most indicated in these cases are recommended, because they tend to increase the UAW dimension (AU)

Case of a 19-Year-Old Male with Nocturnal Groaning (Catathrenia) / 수면정신생리

Catathrenia is a rare sleep disease characterized by monotonous groaning sounds that appear to be related with prolonged expiration, commonly experienced during rapid eye movement (REM) sleep. Catathrenia is also known as nocturnal groaning or sleep-related groaning and is currently categorized as a sleep-related breathing disorder. We present a rare case of a 19-year-old male with nocturnal groaning during non-REM sleep. We suggest that if catathrenia is suspected, polysomnography should be utilized to differentiate it from various sleep disorders such as snoring, central sleep apnea, sleep talking, parasomnia, and sleep-related movement disorders.

Research status of sleep disorders in children / 中华实用儿科临床杂志

Good sleep plays a key role in children's physical growth,mental development and personality matu-rity.Sleep disorders are common and most easily neglected problems in children.Early sleep problems of children can sustain from childhood to adulthood,not only have relevance to the children's physical,cognitive and behavioral development,but also to be the high risk factors of the adult obesity,hypertension,depression,anxiety and other chronic diseases.A deep study of sleep disorders in children is very important for the protection of children's physical and men-tal health.This article reviews the etiology,classification,diagnosis and treatment of sleep disorders in children.

Association between hypothyroidism and sleep breathing disorders in patients with coronary heart disease / 中华内科杂志

Objective@#To explore the association between hypothyroidism and sleep breathing disorders in patients with coronary heart disease (CHD).@*Methods@#A total of 784 patients with CHD were consecutively enrolled at the Emergency & Critical Care Center of Beijing Anzhen Hospital from June 2015 to May 2017. According to thyroid function test results, patients were divided into hypothyroidism group (79 cases) and non-hypothyroidism group (705 cases). All patients had undergone sleep monitoring. The sleep apnea status was compared between the two groups. Multivariate logistic regression and linear regression models were used to analyze the association between hypothyroidism and sleep breathing disorders in patients with CHD.@*Results@#The proportion of females, mean body weight and body mass index in the hypothyroidism group were higher than those in the non-hypothyroidism group [26.6% vs.16.2%, (78.6±11.6) kg vs. (75.7±12.0) kg, (27.7±3.2) kg/m2 vs. (26.6±3.5) kg/m2, all P<0.05]. Patients in hypothyroidism group had a decreased average oxygen saturation (SaO2) compared with patients in non-hypothyroidism group [ (93.2±2.9) % vs. (93.9±2.0) %, P=0.030]. In addition, events of hypoventilation in hypothyroidism group were significantly higher than those in non-hypothyroidism group[92.5 (45.8, 758.3) times vs. 68.0 (33.0, 125.0) times, P=0.013]. There were no significant differences in apnea hypopnea index, diagnosis of obstructive sleep apnea and other sleep breathing parameters between the two groups (P>0.05). A multiple linear regression analysis found that in patients with CHD, the correlation between hypothyroidism and average sleep SaO2 was significant (β=-0.508, 95%CI -0.989--0.026, P=0.039).@*Conclusions@#CHD patients with hypothyroidism had a lower sleep average SaO2, and a higher sleep hypopnea events. There is a correlation between hypothyroidism and sleep hypoxia in patients with CHD.@*Clinical trial registration@#clinicalTrials.gov, NCT03362385.

Síndrome de apneas del sueño: revisión de 25 años de experiencia / Sleep apnea syndrome: review of 25 years of experience / Síndrome da apnéia do sono: revisão de 25 anos de experiência

El conocimiento científico y clínico sobre los trastornos respiratorios del sueño se ha desarrollado de manera acelerada en las últimas décadas. El objetivo de este estudio es presentar la experiencia adquirida en nuestro país, en el diagnóstico y tratamiento del síndrome de apneas del sueño de tipo obstructivo, durante el desarrollo de una nueva disciplina en el ámbito de la neumología. Se revisaron los registros de 3109 pacientes; 447 con historias clínicas electrónicas y cuestionarios para cuantificación de síntomas y 1779 polisomnografías de pacientes con apneas de tipo obstructivo. Se presenta la evolución de la referencia de pacientes, las características demográficas (en especial el aumento de la prevalencia en jóvenes) y los hallazgos clínicos más frecuentes. Se destacan los factores de riesgo relevantes: obesidad y su relación con la severidad, enfermedades endocrinas y desplazamiento cefálico de fluidos. Se destaca el modo de acceso y la adherencia al tratamiento. La implementación de unidades clínicas de sueño permitió la referencia de pacientes para el diagnóstico y el tratamiento, dando lugar a una nueva disciplina de la neumología. La prevalencia de las apneas obstructivas del sueño es muy elevada, con progresivo y sostenido incremento. El tratamiento con aplicación de presión nasal no invasiva es factible. Aunque con distintos grados de accesibilidad y adherencia, ha permitido la corrección del trastorno respiratorio del sueño más relevante.

Scientific and clinical knowledge on sleep-disordered breathing has developed at an accelerated pace in the last decades. The objective of this study is to present the experience gained in our country in the diagnosis and treatment of obstructive sleep apnea syndrome during the development of a new discipline in the field of pneumology. Clinical records of 3109 patients were reviewed; 447 with electronic medical records and questionnaires for quantification of symptoms and 1779 polysomnographies of patients with obstructive apneas. The time evolution of the patient referral, the demographic characteristics (especially the increase in the prevalence in young people) and the most frequent clinical findings are presented. We highlight the relevant risk factors: obesity and its relationship with severity, endocrine diseases and cephalic fluid displacement. Access mode and adherence to treatment are highlighted. The implementation of sleep clinics allowed the referral of patients for diagnosis and treatment, giving rise to a new discipline of pneumology. The prevalence of obstructive sleep apnea is high, with progressive and sustained increase. Treatment with non-invasive nasal pressure application is feasible. Although with different degrees of accessibility and adherence, it has allowed the correction of the most relevant respiratory sleep disorder

O conhecimento científico e clínico sobre os transtornos respiratórios do sono desenvolveu-se rapidamente nas últimas décadas. O objetivo deste estudo é apresentar a experiência adquirida em nosso país no diagnóstico e tratamento da síndrome da apneia obstrutiva do sono durante o desenvolvimento de uma nova disciplina no campo da pneumologia. Os registros de 3109 pacientes foram revisados; 447 com registros médicos eletrônicos e questionários para quantificação de sintomas e 1779 polissonografias de pacientes com apnéia obstrutiva. Apresentamos a evolução da referência do paciente, as características demográficas (especialmente o aumento da prevalência em jovens) e os achados clínicos mais freqüentes. Destacamos os fatores de risco relevantes: obesidade e sua relação com severidade, doenças endócrinas e deslocamento do cefálico de fluídos. O modo de acesso e a adesão ao tratamento são destacados. A implementação de unidades de sono clínicas permitiu a referência de pacientes para diagnóstico e tratamento, dando origem a uma nova disciplina de pneumologia. A prevalência da apneia obstrutiva do sono é muito alta, com aumento progressivo e sustentado. O tratamento com pressão nasal não invasiva é viável. Embora com diferentes graus de acessibilidade e adesão, permitiu a correção do transtorno do sono respiratório mais relevante.

Problemas de salud bucal relacionados al uso de medicamentos por vía inhalatoria en trastornos respiratorios / Oral health problems related to the use of medicines by inhalation in respiratory disorders

En el Uruguay la prevalencia de niños con problemas respiratorios no infecciosos es alta. El tratamiento medicamentoso de esas afecciones puede tener un impacto negativo en la salud bucal. El objetivo del presente estudio fue profundizar en los conocimientos sobre el asma en niños y adolescentes, de los fármacos y dispositivos terapéuticos utilizados y relacionarlos con los eventos adversos observados a nivel bucal. La revisión bibliográfica realizada demuestra que el uso de medicación por vía inhalatoria para las afecciones respiratorias no infecciosas se relaciona con reacciones adversas como la erosión, caries dental, gingivitis, halitosis, candidiasis y xerostomía. El relevamiento realizado en pacientes del Centro Hospitalario Pereira Rossell (2009-2010) mostró una correlación positiva entre los datos de la bibliografía revisada y lo observado en la clínica.Teniendo en cuenta estos antecedentes, es de importancia que el equipo de salud reconozca a la población que utiliza inhaladores como de alto riesgo potencial para el desarrollo de patologías bucales, enfatizando la necesidad de contar con programas educativo-preventivos específicos. La atención para la salud de los pacientes portadores de afecciones respiratorias requiere de un abordaje multidisciplinario.

The children prevalence of non-infectious respiratory disease in Uruguay is high. The medical management of this disease might be associated with adverse effects in oral health. The aim of this study was to increase the knowledge regarding asthma in children and adolescents, to review the medicines and therapeutic devices used and to depict possible associations between the use of inhalation therapy and specific oral diseases. The review of the literature showed that the use of inhalatory therapy for noninfectious respiratory disorders is associated with side effects such as tooth erosion, dental caries, gingivitis, halitosis, candidiasis and xerostomia. The survey of patients from the Pereira Rossell Hospital Centre showed a positive correlation between the available scientific evidence and the clinical observations that we made. Taking into account this background, it is important that the health care team recognizes people who use inhalers as a high risk potential for the development of oral pathologies, emphasizing the need for preventive-educative specific programs. Health care of patients with noninfectious respiratory diseases requires a multidisciplinary approach.

Menopause and Sleep Related Breathing Disorders / 대한폐경학회지

Women after the menopause appear to be more susceptible to sleep related breathing disorders (SBDs). The increased prevalence of SBDs in postmenopausal women may be related to weight gain and the decline in female sex hormones levels. These conditions may cause upper airway obstruction, which can result in sleep disruption. Other sleep disorders, such as insomnia, depression, and fibromyalgia must be ruled out with SBDs in postmenopausal women with sleep difficulties. Once SBD is strongly suspected through medical history and precise physical examinations, polysomnogram is required for confirmatory diagnosis. In addition, other examinations besides polysomnogram should be performed to detect obstructed regions. Treatment of SBD can be classified into surgical method and non-surgical method. Treatment options must be carefully selected by considering the patient's clinical examinations, patient's preference, age and life style.

Factores de riesgo asociados al bajo peso al nacer / Risk factors associated to low birth weight

Se efectuó un estudio de casos y controles de 210 puérperas cuyos hijos nacieron pesando menos de 2 500 gramos (grupo de estudio) en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el 2008, para identificar los factores de riesgo asociados al bajo peso al nacer. Los tomados como controles se escogieron a partir de un muestreo aleatorio sistemático por orden de consecutividad en dicho período. Entre los factores de riesgo causantes de ese déficit ponderal figuraron: procedencia rural, ganancia insuficiente de peso materno, período intergenésico menor de 2 años, hipertensión inducida por el embarazo y edad gestacional por debajo de 37 semanas. Las afecciones respiratorias y las infecciones vaginales constituyeron las principales causas de morbilidad; y la sepsis urinaria, de mortalidad.

A case-control study of 210 newly-delivered women whose children were born weighting less than 2 500 grams (study group) was carried out in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital from Santiago de Cuba, during the 2008, to identify the risk factors associated with low birth weight. The control group was chosen from a systematic random sampling by consecutive order in this period. Among the causative risk factors of that deficit there were: rural origin, low gain of maternal weight, period between pregnancies shorter than 2 years, pregnancy induced hypertension and gestational age under 37 weeks. Breathing disorders and the vaginal infections constituted the main morbidity causes; and the urinary sepsis, the main mortality cause.

Respiración periódica y apneas del sueño centrales en pacientes con insuficiencia cardíaca: hallazgos clínicos y fisiológicos

Introducción: los trastornos respiratorios del sueño son frecuentes en la población general y en especial entre los pacientes con insuficiencia cardíaca severa. La ocurrencia de respiración periódica de Cheyne-Stokes con apneas centrales (RPCS-AC) durante el sueño, agrava el pronóstico y aumenta significativamente la mortalidad a corto plazo. El objetivo de este estudio fue determinar la prevalencia de este trastorno y las características clínico-fisiológicas de los pacientes en nuestro medio. Material y método: se estudiaron 35 pacientes con insuficiencia cardíaca, sin respiración periódica en vigilia, a los que se les realizó polisomnografía, ecocardiograma, espirometría, gasometría arterial y evaluación de los resultados funcionales del sueño. Resultados: se diagnosticó RPCS-AC en 13 pacientes (37%). Los pacientes con RPCS-AC tuvieron un sueño significativamente más fragmentado (ID/h = 32,9 ± 19,4 versus 15,8 ± 14,3, p <0,001); más tiempo en sueño superficial (S1-2 = 77,4 ± 20,1% versus 63,0 ± 16,7%, p = 0,029); menos tiempo en sueño paradojal (REM = 9,9 ± 6,3% versus 16,6 ± 9,8%, p = 0,035) y mayor tiempo en hipoxia severa durante el sueño (TA<90% = 28,4 ± 29,0% versus 2,4 ± 4,7%, p = 0,008). No existieron diferencias en la función cardíaca, el ECG, la espirometría, los gases en sangre en vigilia, ni en las repercusiones funcionales del sueño. Conclusiones: la RPCS-AC es un trastorno frecuente en la insuficiencia cardíaca avanzada que determina repercusiones adversas sobre la estructura del sueño y la oxigenación arterial.

Introduction: sleep breathing disorders are common in general population and particularly among patients with severe heart failure. The occurrence of Cheyne Stokes periodic breathing with central apneas (RPCS-AC) during sleep, worsens the prognosis and significantly increases short term mortality. The objective of this study was to determine the prevalence of this disorder and the clinic-physiological features of patients in our hospital. Methods: thirty-five consecutive patients with heart failure, without periodic respiration during wakefulness were studied with polisomnography, echocardiogram, spirometry, arterial blood gases and functional outcomes of sleep. Results: thirteen patients were diagnosed with RPCS-AC (37%). Patients with RPCS-AC had significantly more fragmented sleep (ID)/h = 32,9 ± 19,4 versus 15,8 ± 14,3, p<0,001); more time in superficial sleep (S1-2 = 77,4 ± 20,1% versus 63,0 ± 16,7%, p = 0,029); less time in paradoxical sleep (REM = 9,9 ± 6,3% versus 16,6 ± 9,8%, p = 0,035) and more time in severe hypoxia during sleep (TA<90% = 28,4 ± 29,0% versus 2,4 ± 4,7%, p = 0,008). There were no differences in cardiac function, EGG, spirometry, arterial blood gases during wakefulness, neither in sleep functional outcomes. Conclusions: RPCS-AC is a frequent disorder in advanced heart failure patients, that causes adverse consequences on sleep structure and arterial oxygenation.