Estudio de la vía aérea superior frente a apneas obstructivas del sueño persistentes en pediatría / An approach to the upper airway evaluation in pediatric persistent obstructive sleep apnea

El síndrome de apneas obstructivas del sueño (SAOS) en pediatría constituye un trastorno asociado a múltiples consecuencias en el espectro cognitivo y comportamental. El principal factor de riesgo asociado es la hipertrofia amigdalina y las vegetaciones adenoideas. La adenoamigdalectomía es el tratamiento de primera línea. La incidencia del SAOS persistente varía entre un 15 % y un 75 % según las comorbilidades. Este se presenta como un desafío a la hora de tratarlo; requiere un abordaje integral para su diagnóstico y tratamiento adecuado. El objetivo de esta revisión bibliográfica es proponer un abordaje diagnóstico y terapéutico para el SAOS persistente.

In pediatrics, obstructive sleep apnea syndrome (OSAS) is a disorder associated with multiple consequences at the cognitive and behavioral level. The main associated risk factor is the presence of tonsillar hypertrophy and adenoids. An adenotonsillectomy is the first-line treatment. The incidence of persistent OSAS varies from 15% to 75%, depending on comorbidities. This is a challenge in terms of management; it requires a comprehensive approach for an adequate diagnosis and treatment. The objective of this bibliographic review is to propose a diagnostic and therapeutic approach for persistent OSAS.

Late effects of caffeine use on sleep of infants born prematurely / Efeitos tardios do uso de cafeína no sono de crianças nascidas prematuras

ABSTRACT Objective: This study aimed to evaluate whether the therapeutic use of caffeine for premature newborns is associated with changes in sleep habits and the presence of obstructive sleep apnea in childhood. Methods: This is a cross-sectional single-center study in which the caretakers of 87 children aged 5-10 years, born full-term or preterm, treated or not with caffeine in the neonatal period, answered questionnaires to screen for obstructive sleep apnea (Pediatric Obstructive Sleep Apnea Screening Tool [PosaST]) and to characterize the sleep habits (Children's Sleep Habits Questionnaire [CSHQ]) of their children. ANOVA and linear regression tests were performed to verify possible differences between the groups. Results: Children born prematurely who were treated with caffeine woke up significantly later on weekdays than those born at term (09h±00h58 and 07h43±1h15, respectively, p=0.022) and had longer total daily sleep time also compared to those born at term (10h24±1h08 and 09h29±1h08, respectively, p<0.001). There was no significant difference between the three groups in overall PosaST and CSHQ scores. Conclusions: Caffeine use in the neonatal period did not impair sleep habits later in life and did not lead to increased obstructive sleep apnea scores in prematurely born children compared to those born at term.

RESUMO Objetivo: Avaliar se o uso terapêutico de cafeína para recém-nascidos prematuros se associa a alterações nos hábitos de sono e à presença de apneia obstrutiva do sono na infância. Métodos: Este é um estudo unicêntrico transversal no qual os responsáveis por 87 crianças com idades entre cinco e dez anos, nascidas a termo ou pré-termo e tratadas ou não com cafeína no período neonatal responderam a questionários para triagem de apneia obstrutiva do sono (Pediatric Obstructive Sleep Apnea Screening Tool - PosaST) e para a caracterização dos hábitos de sono (Children's Sleep Habits Questionnaire - CSHQ) de seus filhos. Foram realizados testes de variância (ANOVA) e de regressão linear para verificar possíveis diferenças entre os grupos. Resultados: As crianças nascidas prematuras que foram tratadas com cafeína acordaram significativamente mais tarde nos dias de semana do que as nascidas a termo (09h±00h58 e 07h43±1h15, respectivamente, p=0,022) e tiveram maior tempo total de sono diário também comparadas às nascidas a termo (10h24±1h08 e 09h29±1h08, respectivamente, p<0,001). Não houve diferença significativa entre os três grupos na pontuação geral dos questionários PosaST e CSHQ. Conclusões: O uso de cafeína no período neonatal não prejudicou tardiamente os hábitos de sono e não levou ao aumento dos escores de apneia obstrutiva do sono de crianças nascidas prematuras quando comparadas com crianças nascidas a termo.

Accessibility to manage the obstructive sleep apnea within the Brazilian Unified Health System

Abstract Objective To measure the average time for the diagnosis and for the therapeutic prescription of Continuous Positive Airway Pressure (CPAP) at a hospital in Botucatu Medical School - State University São Paulo, UNESP. Method A retrospective observational study was carried out by collecting data from the electronic medical records of patients over 18-years of age, who had a diagnostic polysomnography testing scheduled between January and December 2017. Result Of the 347 patients eligible for the study, 94 (27.1%) missed follow-up and 103 (29.7%) had a referral for CPAP use. Until February 2021, only 37 (35.9%) of these patients had already acquired and were using the device, the remaining 66 (64.1%) were waiting or gave up the therapy. The mean value of the waiting time interval between the referral of the diagnostic test and its performance was equivalent to 197 days (6.5 months). The mean time between diagnostic polysomnography and CPAP prescription was 440-days (14.5-months), with a total mean time of 624 days (21-months). Conclusion As in other services, the diagnostic-therapeutic flow proved to be highly inefficient, with a long waiting period, difficult access to treatment and a high dropout rate. These findings highlight the need to establish new patient-centered strategies with measures that speed up the flow and facilitate access to CPAP, in order to reduce the morbidity and mortality associated with this condition. Level of evidence Level 3 - Non-randomized controlled cohort/follow-up study Recommendation B.

Aspects clinico-neurophysiologiques des troubles du sommeil dans une population d'adultes jeunes entre 18-35 ans / Clinical-neurophysiological aspects of sleep disorders in a population of young adults aged 18-35 years

Contexte et objectifs : L'accès aux tests neurophysiologiques pour le diagnostic des Troubles du Sommeil (TS) est très limité dans les pays d'Afrique subsaharienne. La présente étude avait pour objectif de déterminer les caractéristiques épidémiologiques, cliniques et neurophysiologiques des (TS) dans un groupe de jeunes adultes. Méthodes : Il s'est agi d'une étude descriptive d'une série de cas, réalisée au centre de Médecine du sommeil et des maladies respiratoires de l'hôpital de la Croix-Rousse de Lyon du 1er janvier au 31 mars 2019. Les patients hospitalisés pendant cette période pour l'exploration d'un (TS) ont été sélectionnés. Etaient éligibles ceux dont l'âge était compris entre 18 et 35 ans, des deux sexes, ayant renseigné un questionnaire et ayant bénéficié au minimum d'une polysomnographie (PSG). Résultats : Quatre-vingt-onze patients étaient examinés. Les femmes étaient les plus affectées (59,3 %). Leur âge moyen était de 26,6 ± 5 ans. La PSG a incriminé le Syndrome d'Apnée Hypopnée Obstructive du sommeil (SAHOS) comme étiologie principale (66 %). Pour les patients sans SAHOS, 38,7 % avaient une PSG normale et la PSG avec d'autres tests de sommeil ont objectivé, pour le reste (61,3 %), d'autres types de (TS). La dépression (50,7 %) et la fatigue chronique (84,6 %) étaient très fréquentes. L'indice d'efficacité du sommeil était faible pour 70 % des patients avec SAHOS. Il y avait un déséquilibre de la durée des stades du sommeil, augmentée pour le sommeil lent léger et diminuée pour le sommeil lent profond dans la population avec SAHOS, tandis que la durée du sommeil paradoxal chez ceux sans SAHOS était augmentée. Conclusion Le SAHOS est fréquent dans cette formation hospitalière, avec des répercussions significatives à type de dépression et de fatigue chronique. Il est important que des mesures rendant accessible l'usage des tests d'exploration du sommeil particulièrement en Afrique au sud du Sahara, soient mises en place pour diagnostiquer ces troubles

Context and objective. Access to neurophysiological tests for diagnostic of sleep disorders (SD) is very limited in Sub-Saharan Africa countries. The objective was to determine the epidemiological, clinical and neurophysiological characteristics of SD in a young adult group. Methods. This was a descriptive serial cases study carried out at the Sleep Medicine and Respiratory Diseases Center of the CroixRousse hospital of Lyon between January 1st and March 31th, 2019. Patients hospitalized during this period with tests for SD were selected. Eligible were those aged between 18 and 35 years, both sexes, who completed a questionnaire and who received at least a polysomnography (PSG). Results. Ninety-one patients were involved. Women remained the most affected (59.3%). Mean age was 26.6±5 years. PSG incriminated obstructive sleep apnea (OSA) syndrome as the primary etiology (66%). For patients without OSA, 38.7% had normal PSG. For the remaining 61.3% of patients, other types of SD were found using PSG with various sleep tests. Depression (50.7%) was an important comorbidity, and chronic fatigue (84.6%) was the most frequent complaint. Sleep efficiency index was low for 70% of sleep apnea patients. There was an imbalance in the duration of sleep stages, with an increase in light slow-wave sleep in the OSA population and a decrease in their deep slow-wave sleep, while REM sleep duration in patients without OSA was increased. Conclusion: OSA was the primary etiology in our study, with significant repercussions like depression and chronic fatigue. Public health measures such as increasing access to the use of sleep exploration tests, especially in subSaharan Africa, should be put in place for the diagnosis of these sleep disorders and their consequences

Research progress on the diagnosis and treatment of pediatric malocclusion combined with obstructive sleep apnea-hypopnea syndrome / 口腔疾病防治

@#Pediatric malocclusion is common in dentistry. Some children with malocclusion combined with obstructive sleep apnea-hypopnea syndrome (OSAHS) often fail to receive appropriate treatment due to a lack of multidisciplinary diagnosis and treatment. It can cause abnormal ventilation during sleep, affecting the central nervous system and cardiovascular development and even causing neurological and behavioral problems. Pediatric OSAHS is caused by the narrowing of the upper respiratory tract, characterized by specific facial bone characteristics and neuromuscular factors and correlated with malocclusion. Due to its diverse clinical manifestations and etiology, the diagnosis and treatment of pediatric OSAHS require an interdisciplinary, personalized, and specialized approach. Questionnaires and physical examinations can be used for preliminary screening. Moreover, children's stomatology and otorhinolaryngology examinations are the basis for disease diagnosis. Polysomnography (PSG) is currently the direct diagnostic method. There are various treatment methods for OSAHS in children, and for OSAHS caused by adenoid tonsil hypertrophy, adenoidectomy and tonsillectomy are the main treatments. Othodontic treatment including mandibular advancement and rapid maxillary expansion et al is also effective for OSAHS in children with malocclusion. Currently, there is limited research on the correlation between childhood malocclusion and OSAHS, and multidisciplinary combination therapy may improve the cure rate, but there is a lack of sufficient evidence. In the future, the pathogenesis of OSAHS should be further elucidated, and research on multidisciplinary combination therapy should be promoted to achieve early intervention and treatment for potential and existing patients.

Advances in the study of mesenchymal stem cells in obstructive sleep apnea hypoventilation syndrome / 中国临床药理学与治疗学

Mesenchymal stem cells (MSCs) are self-regenerating, rapidly proliferating pluripotent stem cells that depend primarily on their derived pro-angiogenic, inflammatory regulatory, and trophic factors to exert beneficial effects that attenuate deleterious inflammatory responses, reduce vascular damage, and promote tissue repair and regeneration. Obstructive sleep apnea hypoventilation syndrome (OSAHS) is a chronic disorder marked by oropharyngeal collapse during sleep, resulting in transient reduced airflow, large fluctuations in intrathoracic pressure, and intermittent hypoxia and hypercapnia. OSAHS subsequently cytokine-mediated inflammatory cascades, oxidative stress, and ischemia, recruit MSCs from inflamed and damaged tissues through MSCs-derived of anti-inflammatory and pro-angiogenic factor activity, reduce hypoxia, suppress inflammation, promote regeneration, and prevent fibrosis in OSAHS-injured tissues. In this paper, we will describe the pathogenesis of inflammation, oxidative stress, fibrosis and ischemia from the perspective of OSAHS, highlighting the current research progress on MSCs-dependent regulation of OSAHS-related pathology.

Research progress of pharmacologic therapy in obstructive sleep apnea / 中国临床药理学与治疗学

Obstructive sleep apnea (OSA) is a common sleep disordered breathing disorder. As a major global public health problem, untreated OSA can lead to a variety of adverse health outcomes, including various cardiovascular and cerebrovascular diseases, metabolic disorders, and psychiatric disorders such as anxiety and depression. Traditional OSA therapies such as positive airway pressure (PAP), weight loss, oral appliance, upper airway surgery, and postural therapy focus on the anatomical factors of OSA. However, the pathogenesis of OSA is heterogeneous, and non-anatomical factors also play an important role in most patients. Although there is no drug with exact efficacy for the treatment of OSA, with the deepening understanding of the pathophysiological mechanism of OSA, more and more clinical studies are devoted to the study of drug treatment of OSA and its complications, and a series of results have been achieved. The following is a review of the relevant studies on drug treatment of OSA in recent years, hoping to provide literature support and theoretical basis for future research on drug treatment of OSA.

Study on Syndrome Research of Ischemic Stroke Combined with Obstructive Sleep Apnea-hypopnea Syndrome Based on Implicit Structure Method / 中国实验方剂学杂志

ObjectiveTo explore the common syndrome elements of cerebral ischemic stroke （CIS） complicated with obstructive sleep apnea-hypopnea syndrome （OSAHS）， reveal the characteristics of traditional Chinese medicine （TCM） syndromes of the disease， clarify the syndrome differentiation and syndrome types， provide evidence for clinical syndrome differentiation， and provide reference for establishing the TCM syndrome type standards of CIS complicated with OSAHS. MethodThe clinical information form of CIS complicated with OSAHS formulated by the research group was used for syndrome survey， and the four-examination information of 300 patients with CIS complicated with OSAHS was collected. The four-examination information of patients was analyzed by latent structure method and comprehensive cluster analysis， and the common syndrome elements of CIS complicated with OSAHS were extracted by combining the TCM basic theory and clinical experience. On this basis， the characteristics of TCM syndromes and the syndrome types in line with reality were summarized. ResultThe top five syndrome elements in patients with CIS and OSAHS are sleep snoring， open mouth breathing， physical obesity， night awakening and dizziness. The top five tongue and pulse manifestations are enlarged tongue， slippery pulse， slippery coating， thick and white coating and purple tongue. The disease locations are the lung， spleen， stomach， kidney， liver and brain. The nature of disease includes deficiency， depression， blood stasis， phlegm， dampness and fire. The clinical syndrome types include the syndrome of stagnation of phlegm and dampness， syndrome of phlegm-dampness blocking the mind， syndrome of spleen deficiency with dampness， syndrome of Yin deficiency leading to fire hyperactivity， syndrome of Qi depression blocking collaterals， syndrome of liver depression and blood stasis， syndrome of Qi deficiency with dampness， and syndrome of Yang deficiency induced water retention. ConclusionIn addition to the common phlegm-， dampness- and blood stasis-related syndromes in patients with CIS and OSAHS， there are also depression- and deficiency-related syndromes. The main etiology and pathogenesis is the disturbance of Qi movement. In clinical practice， attention should be paid to the specific situation of individual patients to differentiate between deficiency and excess， and the treatment should be performed by the method of soothing and reinforcing， or unblocking and clearing， or both.

Síndrome de apnea del sueño en población colombiana con epilepsia empleando la escala de apnea del sueño del cuestionario de trastornos del sueño / Sleep apnea syndrome in a Colombian population with epilepsy using the Sleep Apnea Scale of the Sleep Disorders Questionnaire

Introducción: La epilepsia es un desorden caracterizado por la predisposición a generar crisis epilépticas, mientras que el síndrome de apnea del sueño (SAOS) ha sido reconocido como un desorden crónico de colapso intermitente de la vía aérea que genera hipoxia recurrente. En este trabajo se aplicó la escala de trastornos del sueño (Sleep Apnea Scale of the Sleep Disorders Questionnaire SA-SDQ), previamente validada en inglés para pacientes con epilepsia, a fin de determinar su capacidad para detectar apnea de sueño en nuestra población. Materiales y métodos: En una primera etapa se realizó la adaptación transcultural de la escala SA-SDQ en castellano, provista por los autores, al español colombiano. Luego se recopiló la información de los pacientes en quienes se realizó polisomnografía entre mayo y agosto del 2022 y se determinó el valor de corte para diagnosticar SAOS con la escala SA-SDQ. Resultados: Cuarenta pacientes pudieron realizarse la polisomnografía, de los cuales 30 (75 %) tuvieron índices de apnea-hipopnea superiores a 5, lo que indica SAOS. El área bajo la curva fue 0,790 y la puntuación SA-SDQ de 21 proporcionó una sensibilidad del 73,3 % (IC 53,83-87,02 %) y una especificidad del 80 % (IC 44,2-96,5 %). La consistencia interna fue aceptable (α = 0,713). Conclusiones: La escala SA-SDQ es un instrumento útil para tamizar SAOS en la población colombiana que padece epilepsia. Nuestros resultados indican que los puntos de corte sugeridos anteriormente (2936 para hombres y 26-32 para mujeres) pueden ser demasiado altos para nuestra población. Sugerimos un punto de corte de 21 para ambos.

Introduction: Epilepsy is a disorder characterized by a predisposition to have epileptic seizures, while sleep apnea syndrome (OSAS) has been recognized as a chronic disorder of intermittent collapse of the airway that generates recurrent hypoxia. In this work, the sleep disorders scale (SA-SDQ) previously validated in English for patients with epilepsy was applied to determine its ability to detect sleep apnea in our population. Materials and methods: In the first stage, the cross-cultural adaptation of the SA-SDQ scale in Spanish provided by the authors was carried out into Colombian Spanish. then the information of the patients in whom polysomnography was performed between May and August 2022 was collected and the cut-off value was determined to diagnose OSAS with the SA-SDQ scale. Results: 40 patients were able to undergo polysomnography, of which 30 (75 %) had apnea-hypopnea indices greater than five, indicating OSAS. The area under the curve was 0.790 and the SA-SDQ score of 21 provided a sensitivity of 73.3 % (CI 53.83-87.02 %) and a specificity of 80 % (CI 44.2-96, 5 %). The internal consistency was acceptable (α = 0.713). Conclusions: The SA-SDQ scale is a useful instrument for screening OSAS in the Colombian population suffering from epilepsy. Our results indicate that the previously suggested cut-off points (29-36 for men and 26-32 for women) may be too high in our population. We suggest a cutoff of 21 for both.

Obstructive Sleep Apnea and Hearing Loss: Is There Any Correlation?

Abstract Introduction Obstructive sleep apnea (OSA) is a breathing disorder related to sleep that has a negative effect on the behavior and health of people around the globe. Chronic hypoxemia and variations in the concentration of oxygen in the blood noticed in OSA individuals may have adverse effects on the process of auditory transduction and transmission. Objective To assess the effect of OSA on hearing and to find out the parameters that have more influence on hearing recorded during polysomnography of patients with OSA. Methods The present is a hospital-based, observational, analytical, cross-sectional study conducted over a period of one year. After application of the exclusion criteria, the patients were then submitted to the application of the Berlin questionnaire, as well as polysomnography, impedance, and pure tone audiometry (PTA). Results A total of 58 individuals were studied. Age, gender, and height were comparable among cases and controls, while weight, body mass index (BMI), and neck circumference were significantly higher in cases in comparison to controls. The mean PTA was significantly higher at 10 kHz or higher frequencies in cases in comparison to controls. Conclusion We observed that there is evidence that the auditory mechanism is affected in OSA patients. We recommend early auditory screening of OSA patients for timely diagnosis and to raise awareness about its prevention.

Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review

Abstract Objective To compare polysomnographic parameters with others from the literature in order to provide more accurate information about Rapid Maxillary Expansion (RME) for treating Obstructive Sleep Apnea (OSA) in children, through raising the question: Is RME a good option for treating OSA in children? Prevention of mouth breathing during children's growth remains a challenge with significant clinical consequences. In addition, OSA induces anatomofunctional changes during the critical period of craniofacial growth and development. Methods The Medline, PubMed, EMBASE, CINAHL, Web of Science, SciELO and Scopus electronic databases were searched up to February 2021 for systematic reviews with meta-analysis in the English language. Among 40 studies on RME for treating OSA in children, we selected seven in which polysomnographic measurements of the Apnea-Hypopnea Index (AHI) had been made. Data were extracted and examined in order to clarify whether any consistent evidence exists for indicating RME as a treatment for OSA in children. Results We found no consistent evidence favoring RME for long-term treatment of OSA in children. All the studies presented considerable heterogeneity due to variability of age and length of follow-up. Conclusion Through this umbrella review, the need for methodologically better studies on RME is supported. Moreover, it can be considered that RME is not recommended for treating OSA in children. Further studies and more evidence identifying early signs of OSA are necessary in order to achieve consistent healthcare practice.

Geniohyoid Muscle: Anatomy and Clinical Implications in Dentistry / Músculo Geniohioideo: Anatomía e Implicaciones Clínicas en Odontología

SUMMARY: The geniohyoid muscle is one of the suprahyoid muslces, and arises from the inferior mental spine and inserts into the hyoid bone. The muscle is a narrow paired one and its main action is pulling the hyoid upward and forward. Its function is very important in deglutition as well as respiration. Therefore, this muscle has been extensively researched, especially in the context of dysphagia and sleep apnea. This review deals with the general anatomic features, main functions, and abnormal states of the geniohyoid muscle, and the clinical implications of these.

El músculo geniohioideo es uno de los músculos suprahioideos que surge de la espina mental inferior y se inserta en el hueso hioides. Son un par de músculo delgados y su acción principal es elevar y estirar el hueso hioides hacia arriba y hacia adelante. Su función es importante tanto en la deglución como en la respiración. Por lo tanto, este músculo ha sido ampliamente investigado, especialmente en el contexto de la disfagia y la apnea del sueño. Esta revisión trata de las características anatómicas generales, funciones principales y estados anormales del músculo geniohioideo, y las implicaciones clínicas de estos.

Screening for Obstructive Sleep Apnea in truck drivers / Rastreio de Síndrome de Apneia Obstrutiva do Sono em motoristas

Abstract Professional drivers show a higher prevalence of obstructive sleep apnea (OSA) compared with the general population. OSA has been widely associated with an increased risk of traffic accidents. This article aims to investigate the presence of risk factors for OSA, its prevalence and the value of screening tools in a truck drivers' cohort. Descriptive and analytical prospective study. Demographic, anthropometric, Epworth Sleepiness Scale, STOP-Bang and Berlin Questionnaire were used to select subjects with suspicion of OSA. Polysomnography (PSG) was performed in individuals with positive screening. Mean age was 44.6±7 years, mean body mass index was 28.7±4 kg/m². Of the 281 truck drivers screened, 88 were positive for potential OSA. Of these, 63 completed PSG study and the diagnosis was confirmed in 85.7% (prevalence of 19.2%). The following variables showed a positive correlation with the apnea-hypopnea index: neck circumference and STOP-Bang. The combination of a predominantly male population, obesity, age distribution and lifestyle could account for the high prevalence of OSA in this specific population. Questionnaires proved to be a valuable screening tool. Screening, treatment, and management of OSA should be a priority as a public safety policy.

Resumo A prevalência de Síndrome de Apneia Obstrutiva do Sono (SAOS) em motoristas profissionais é superior à da população geral e esta tem sido amplamente associada ao risco aumentado de acidentes rodoviários. Este artigo tem por objetivos investigar fatores de risco de SAOS, estimar a sua prevalência e o valor de instrumentos de rastreio numa amostra de motoristas de pesados. Estudo prospetivo descritivo e analítico. Rastreio realizado com recurso a dados demográficos, antropométricos, Escala de Sonolência de Epworth, STOP-Bang e Questionário de Berlim. Nos indivíduos com rastreio positivo foi realizada polissonografia (PSG). A idade média era de 44,6±7 anos, índice de massa corporal 28,7±4 kg/m². Dos 281 motoristas incluídos, 88 apresentavam risco elevado de SAOS. Destes, 63 realizaram PSG, com confirmação diagnóstica em 85,7% (prevalência de 19,2%). O perímetro cervical e STOP-Bang apresentaram correlação positiva com o índice de apneia-hipopneia. A combinação de género predominantemente masculino, obesidade, distribuição de idade e estilo de vida pode justificar a elevada prevalência de SAOS nesta população. O uso de questionários é uma medida eficaz de rastreio. Nos motoristas, o rastreio e tratamento de SAOS deveria ser uma medida de saúde pública prioritária.

The Effect of Tonsillectomy and Adenoidectomy on Upper Airway Obstruction Patterns in Children with Obstructive Sleep Apnea

Abstract Introduction Alterations in upper airway flow dynamics and sites of airway obstruction immediately after tonsillectomy and adenoidectomy (TA) have not been assessed. Identification of the changes in airway obstruction patterns after TA potentially improves the surgical management of children with obstructive sleep apnea (OSA). Objectives To evaluate the effect of TA on upper airway obstruction patterns detected with drug-induced sleep endoscopy (DISE). Methods The medical records of patients who underwent pre-TA DISE during the induction of anesthesia and post-TA DISE at the end of TA were reviewed. Data pertaining to polysomnography and DISE findings were analyzed. Results Twenty-seven patients (15 male and 12 females aged between 2 and 18 years old) were identified. All patients had obstruction at multiple sites of the upper airway. Prior to TA, airway obstruction was at the level of the velum in 27 patients, of the oropharynx/lateral walls in 27, of the tongue in 7, and of the epiglottis in 4. After TA, airway obstruction was at the level of the velum in 24 patients, of the oropharynx/lateral walls in 16, of the tongue in 6, and of the epiglottis in 4. The degree of obstruction at the levels of the velum and oropharynx/lateral walls after TA was significantly decreased. Conclusions Drug-induced sleep endoscopy performed prior to TA revealed that most of the sites of airway obstruction persisted after TA in OSA children with multiple sites of airway obstruction. Further studies in larger group of children with OSA are needed to establish the value of DISE findings in predicting residual OSA after TA, surgical planning, determining the need for post TA sleep study, and counseling caregivers.

Upper airway modifications after weight loss: a systematic review

Abstract Objective: Weight loss is one of the most often prescribed treatments to reduce the level of sleep apnea severity; however, objective assessment of airway alterations after loss of weight has only been studied in the last decades. This study aimed at evaluating alterations after weight loss reported in the literature. Methods: A literature review was performed in the medical databases: PubMed, Web of Science, Scopus and Embase. A total of 681 articles were found in the databases and after evaluation only 10 studies were selected for data extraction. Results: Most studies observed an increase of the area in the retropalatal region; some indicating that this increase occurred mostly in the lateral pharyngeal region. Studies with volumetric reconstruction showed a significant reduction in parapharyngeal fat deposits, lateral wall and tongue fat, and volumetric reduction in all soft tissues of the pharynx, pterygoid and genioglossus muscles. Studies evaluating craniofacial bone structures showed a reduction in the airway height by bringing the hyoid closer to the posterior nasal spine and a reduction in the distance from the hyoid to the chin. Conclusion: There is a limited number of studies with a good level of scientific evidence evaluating changes in the upper airways after weight loss and how these changes impact obstructive sleep apnea. The studies included in this review indicate that weight loss increases the airways space by reducing the volume of the parapharyngeal structures, particularly at the retropalatal site, where there is an apparent gain in the lateral area of the airway and hyoid relocation.

Upper Airway Stimulation in Patients with Obstructive Sleep Apnea: Long-Term Surgical Success, Respiratory Outcomes, and Patient Experience

Abstract Introduction Upper airway stimulation (UAS) with electric activation of the hypo-glossal nerve has emerged as a promising treatment for patients with moderate-to-severe obstructive sleep apnea. Objective To retrospectively analyze objective and subjective outcome measures after long-term follow-up in obstructive sleep apnea patients receiving upper airway stimulation. Methods An observational retrospective single-center cohort study including a consecutive series of patients diagnosed with obstructive sleep apnea receiving upper airway stimulation. Results Twenty-five patients were included. The total median apnea-hypopnea index (AHI) significantly decreased from 37.4 to 8.7 events per hour at the 12-month follow-up (p < 0.001). The surgical success rate was 96%. Adverse events were reported by 28% of the patients. Conclusion Upper airway stimulation is an effective and safe treatment for obstructive sleep apnea in patients with continuous positive airway pressure (CPAP) failure or intolerance. However, it is possible that the existing in and exclusion criteria for UAS therapy in the Netherlands have positively influenced our results.

Screening Parameters for COPD-OSA Overlap Syndrome in COPD Patients: Indian Perspective

Introduction: As Indian patients have different predisposing morphological characteristics, we undertook this study to evaluate the clinical profile of overlap syndrome and compare them with COPD patients to find out the screening tools for obstructive sleep apnea (OSA) in Indian chronic obstructive pulmonary disease (COPD) patients. Aims and objectives: • To study the clinical profile of patients with overlap syndrome. • To compare them with COPD patients. • To develop screening tools for overlap syndrome in COPD. Materials and methods: A prospective case-control study was carried out in a tertiary care center. Overnight pulse oximetry was carried out for all COPD patients. Those having snoring or saw-tooth pattern on overnight oximetry were subjected to level 1 polysomnography. About 30 patients of overlap syndrome were compared with 65 COPD patients. Results: The mean age in overlap syndrome group (56.9 ± 6.86 years) was significantly lower (p < 0.01). The daytime PaO2 and lowest nocturnal saturation were significantly lower in overlap group. PaCO2 and forced expiratory volume at 1 second (FEV1) were significantly higher. For diagnosing overlap syndrome, the positive and the negative predictive values of snoring were 84.42 and 100%; of body mass index (BMI) ?25 kg/m2 were 86.67 and 98.88%; and of excessive daytime sleepiness were 37.57 and 97.86%, respectively. Conclusion: Absence of snoring and BMI <25 kg/m2 virtually rules out overlap syndrome. The EDS has a high false-positive rate for predicting OSA. Patients having overlap syndrome have poor daytime and nocturnal oxygenation despite good lung functions.

Sleep disorders are associated with both morning temporal and jaw pain among adults and elderly: a population-based study in Brazil / Distúrbios do sono estão associados à dor temporal matinal e à dor na mandíbula em adultos e idosos: um estudo de base populacional

Objective Purpose: To assess the influence of sleep disorders on temporal and jaw pain in the morning in adults and elderly people. Methods: Population-based study with representative individuals aged 18 years or over. Individuals were selected using a multistage sampling procedure. The outcomes of morning jaw pain and morning temporal pain were assessed. Sleep bruxism, obstructive sleep apnea, and sleep quality were evaluated as exposure variables. Adjusted analysis was conducted using Poisson regression. All analysis was sex stratified. Results: 820 individuals were studied. Female with sleep bruxism were 1.37 times more likely to have morning temporal pain (p=0.041). Male and female with bruxism had a prevalence 160% and 97%, respectively, higher of morning jaw pain (male: p=0.003; female: p<0.001). Women with obstructive sleep apnea were 1.52 times more likely to have morning temporal pain (p=0.023). Men with poor sleep quality had a prevalence 190% higher of morning temporal pain (p=0.005). Conclusion: Morning craniofacial pain is more frequent in individuals with sleep disorders, and there are differences between sexes. Since more than one sleep disorder can be present in the same individual, studies that adjust the analyses for possible confounders are important to avoiding possible overlap between them.

RESUMO Objetivo: Avaliar a influência dos distúrbios do sono nas dores temporais e mandibulares pela manhã em adultos e idosos. Métodos: Estudo de base populacional realizado com uma amostra representativa de indivíduos com 18 anos ou mais. Os participantes foram selecionados por meio de um processo amostral com múltiplos estágios. Os desfechos avaliados foram a dor matinal na mandíbula e a dor temporal matinal. Apneia obstrutiva do sono, bruxismo do sono e qualidade do sono foram as variáveis de exposição avaliadas. Análise ajustada foi realizada através da Regressão de Poisson e todas as análises foram estratificadas por sexo. Resultados: Foram estudados 820 indivíduos. Mulheres com bruxismo do sono tiveram 1,37 vezes mais chance de ter dor temporal matinal (p=0,041). Homens e mulheres com bruxismo tiveram uma prevalência 160% e 97%, respectivamente, maior de dor matinal na mandíbula (homens: p=0,003; mulheres: p<0,001). Mulheres com apneia obstrutiva do sono tiveram 1,52 vezes mais chance de ter dor temporal matinal (p=0,023). Homens com má qualidade do sono tiveram prevalência 190% maior de dor temporal matinal (p=0,005). Conclusão: Dor craniofacial matinal é mais frequente em indivíduos com distúrbios do sono e há diferenças entre os sexos. Uma vez que mais de um distúrbio do sono pode estar presente no mesmo indivíduo, estudos que ajustem as análises para possíveis confundidores são importantes para evitar uma possível sobreposição entre eles.

Determination of the risk of obstructive sleep apnea syndrome in individuals aged 18 years and above

SUMMARY OBJECTIVE: This study aimed to increase awareness by determining the risk of obstructive sleep apnea syndrome in individuals aged 18 years and above. METHODS: The study is a descriptive and cross-sectional study. A total of 633 individuals aged 18 years and above participated in the study. The data were collected online from individuals in the form of describing the demographic characteristics of individuals and with the Berlin survey. The IBM SPSS statistics 26.0 program was used in the analysis of the data. RESULTS: In this study, 38.9% of individuals were found to be at high risk for obstructive sleep apnea syndrome. A significant relationship was found between the risk of obstructive sleep apnea syndrome and gender, age, body mass index, education level, chronic obstructive pulmonary disease, diabetes, hypertension, presence of cardiovascular diseases, and smoking (p<0.05). CONCLUSION: The results of this study showed that male gender, increasing age, obesity, presence of chronic disease, and smoking increase the risk of obstructive sleep apnea syndrome. Defining the risk of obstructive sleep apnea syndrome, especially in risky groups, will be effective in planning health care, increasing the effectiveness of treatment, and improving the quality of life. It is recommended to include this diagnosis in health care protocols and to expand its use in order to plan and repeat trainings that will emphasize its importance.

Uso prolongado de cánula nasal de alto flujo en niños con problemas respiratorios / Prolonged use of high flow nasal cannula in children with respiratory problems

La cánula nasal de alto flujo (CNAF) es una modalidad ventilatoria no invasiva segura y efectiva, usada ampliamente en patología respiratoria aguda en adultos y niños. Objetivo: presentar casos clínicos pediátricos que utilizaron CNAF por tiempo prolongado por problemas respiratorios crónicos. Descripción de casos clínicos, revisión de fichas clínicas de 5 pacientes que utilizaron CNAF por más de 1 mes, entre los años 2017-2020 en el Complejo Asistencial Dr. Sótero del Río. Aprobado por Comité de Ética. Resultados: 5 pacientes varones de mediana 61 (44 a 212) días de edad al inicio del uso de CNAF. Diagnóstico de base: displasia broncopulmonar (2/5), síndrome de Treacher Collins (1/5), síndrome de cimitarra con hipoplasia pulmonar derecha (1/5) y traqueobroncomalacia severa (1/5). Todos requirieron previamente uso de ventilación invasiva o no invasiva con mediana de 59 (4 a 78) días. A todos se les realizó broncoscopia, saturometría contínua o poligrafía para diagnóstico y titulación de CNAF y oxígeno. Todos mejoraron clínicamente, la SpO2 y el número de apneas. Dos pacientes se enviaron a domicilio con uso de Airvo2 nocturno. La mediana de uso de CNAF fue 165 (34 a 445) días. Conclusiones: el uso prolongado de CNAF es útil en pacientes pediátricos seleccionados, bien tolerado y factible de utilizar en domicilio.

The high-flow nasal cannula (HFNC) is a safe and effective non-invasive ventilation support widely used in acute respiratory pathology in adults and children. Objective: To present pediatric clinical cases that used HFNC for an extended period due to chronic respiratory disease. Description of clinical cases, review of medical records of 5 patients who used HFNC for more than 1 month, between the years 2017-2020 at Complejo Asistencial Dr. Sótero del Río. Approved by the Ethics Committee. Results: 5 male patients with a median age of 61 (44 to 212) days at the start of HFNC use. Underlying diagnoses: bronchopulmonary dysplasia (2/5), Treacher Collins syndrome (1/5), Scimitar syndrome with right pulmonary hypoplasia (1/5), and severe tracheobronchomalacia (1/5). All of them previously required invasive or non-invasive ventilation for a median of 59 (4 to 78) days. All patients underwent bronchoscopy, continuous pulse oximetry or polygraphy for diagnosis and titration of HFNC and oxygen. All showed clinical improvement, including SpO2 levels and the number of apneas. Two patients were discharged with nocturnal use of Airvo 2 at home. The median duration of HFNC use was 165 (34 to 445) days. Conclusions: Prolonged use of HFNC is useful in selected pediatric patients, well tolerated, and feasible for home use.