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.

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.

Effects of chronic obstructive pulmonary disease patients complicated with OSAHS on hypercapnia and related factors / 中华健康管理学杂志

Objective:To analyze the effects of chronic obstructive pulmonary disease (COPD) combined with obstructive sleep apnea hypopnea syndrome (OSAHS) on hypercapnia and its related factors.Methods:In this cross-sectional study, patients with stable COPD were continuously recruited from July 2016 to December 2018 in the Respiratory Department of Peking University Third Hospital. General clinical data of patients were collected, and lung function test, arterial blood gas analysis and portable sleep monitoring were also conducted. Patients with COPD complicated with apnea hypopnea index (AHI)≥10 times/h and apnea events being mainly blockage-type events, accompanied by snoring, sleep apnea, daytime sleepiness and other symptoms were defined as overlapping group, patients with COPD complicated with AHI<10 times/h were defined as simple COPD group. Correlation analysis and logistic regression model were used to explore the determinants of daytime hypercapnia in patients with COPD.Results:Compared with simple COPD group, the median arterial partial pressure of carbon dioxide (PaCO 2) was significantly higher in the overlapping group (42.00 vs 38.95 mmHg (1 mmHg=0.133 kPa), P<0.001), and the rate of daytime hypercapnia was significantly higher (23.3% vs 3.3%, P=0.002). PaCO 2 was correlated with forced vital capacity (FVC), percent predicted forced expiratory volume in one second (FEV 1%pred), the ratio of residual volume (RV) to total lung capacity (TLC), AHI, nocturnal average transcutaneous oxygen saturation (SpO 2), nocturnal minimum SpO 2 and the total sleep time spent with SpO 2≤90% (T90) (all P<0.05). In logistic regression analysis, after adjusting for age, sex, and body mass index (BMI), only severe OSAHS, GOLD Ⅲ-Ⅳ grade (FEV 1%pred<50%), and T90>1% were independent risk factors for hypercapnia. Conclusions:OSAHS can increase the risk of hypercapnia in patients with COPD. AHI, lung function injury and T90 are closely related to hypercapnia.

Voltage Dependent Anion Channel 1 Mediated Inflammation and Obstructive Sleep Apnea Syndrome / 中山大学学报(医学科学版)

VDAC1（voltage dependent anion channel 1）is an important channel protein on the outer mitochondrial outer membrane， which regulates mitophagy， participates in the regulation of inflammatory cytokines and the activation of the inflammasome， hence being crucial to the inflammatory response. Patients with obstructive sleep apnea syndrome （OSAS） suffer neuroinflammation due to intermittent hypoxia and increased oxidative stress， leading to chronic damage and neuronal cell apoptosis， and eventually develop cognitive impairment. Since OSAS patients' cognitive impairment is significantly influenced by inflammation， and VDAC1 regulates the activation of the inflammasome， the relationship between OSAS and VDAC1， mitophagy， as well as inflammation are reviewed here. We hope that this study can provide a new breakthrough in mitophagy and inflammation in patients with cognitive dysfunction caused by OSAS.

Clinical thinking of acupuncture for snoring based on "disharmony qi leads to restlessness" / 中国针灸

This study summarizes the clinical thinking of acupuncture for snoring based on "disharmony qi leads to restlessness". According to the pathological characteristics of qi stagnation and blood stasis, phlegm dampness and internal obstruction in snoring patients, combined with the etiology, pathogenesis and location of the disease, the innovative viewpoint of "disharmony qi leads to restlessness" is proposed. It is believed that the key to snoring treatment lies in "regulating qi ". In clinical practice, acupuncture can directly regulate the qi of the disease's location, regulate the qi of the organs and viscera, and regulate the qi of the meridians to achieve overall regulation of the body's internal and external qi, smooth circulation of qi and blood, and ultimately achieve the therapeutic goal of harmonizing qi, stopping snoring, and improving sleep quality.

Prevalence and risk factors of sleep apnea in patients with Alzheimer's disease / 公共卫生与预防医学

Objective To analyze the prevalence and risk factors of sleep apnea syndrome (SAS) in patients with Alzheimer's disease (AD), and to provide theoretical basis for the prevention of SAS in AD patients. Methods A total of 130 AD patients admitted to the Department of Neurology of Guang'an People's Hospital of Sichuan Province from January 2019 to September 2022 were selected and divided into control group (without SAS) and observation group (with SAS) according to whether the patients were complicated with SAS{AHI ≥5 times/h}. Snoring, waking at night, dry mouth in the morning, AHI and SaO2 values were compared between the two groups. Clinical data of AD patients, including age, gender, body mass index (BMI), AD course, tobacco and alcohol history, and neurodegenerative diseases, were collected by self-made questionnaire and consulting the patient's electronic medical record bed. Univariate analysis and logistic regression were used to analyze the independent risk factors for SAS in AD patients. Results Among 130 AD patients, 43 cases (33.08%) of SAS occurred. The proportion of snoring, awakening at night, dry mouth in the morning and AHI value in the observation group were significantly lower than those in the control group (P2, PSQI score >16 points and CDR score ≥2 points were independent risk factors for SAS in AD patients (P2, PSQI score >16 and CDR score. Polysomnosis monitoring should be performed regularly to prevent SAS.

Terapia con cánula nasal de alto flujo en pacientes pediátricos en domicilio / High flow nasal cannula therapy in pediatric patients at home

Se realiza comentario de estudio de Israel en el cual analizan 75 pacientes pediátricos que utilizaron cánula nasal de alto flujo (CNAF) en domicilio, evaluando la seguridad, las indicaciones, los parámetros de utilización, la duración del tratamiento, los resultados clínicos y la satisfacción de los padres. Se acompaña de una revisión de la literatura del tema.

A comment is made on a study conducted in Israel analyzing 75 pediatric patients who used high-flow nasal cannula at home, evaluating safety, indications, utilization parameters, treatment duration, clinical outcomes, and parental satisfaction. It is accompanied by a literature review on the topic.

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.

Obstructive sleep apnea syndrome on the severity of adult asthma / 公共卫生与预防医学

Objective To evaluate the effect of obstructive sleep apnea syndrome (OSAS) on the degree of bronchial asthma (BA) in adults, and to analyze the potential relationship between the two. Methods A retrospective study was used to collect 90 patients with BA patients who were admitted to Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 2018 to June 2022. All patients received polysomnography (PSG) to calculate the apnea hypopnea index (AHI). Patients were divided into mild OSAS (AHI30) according to AHI value. In addition, BA related indicators of patients were measured, such as forced expiratory volume in the first second (FEV1), FEV1%, FEV1/forced vital capacity (FVC), exhaled nitric oxide (FeNO), total airway resistance (R5), central airway resistance (R20) and peripheral elastic resistance (X5). Analysis of variance was used to compare the differences in BA related indicators in patients with different degrees of OSAS, and Pearson linear correlation analysis was used to analyze the correlation between AHI and the measured values of BA indicators. Results There was 1 case (1.11%) in AHI30. There was no difference in gender composition among different AHI groups, but the AHI value of BA patients aged 70 years and above was higher, and the age difference was statistically significant (P<0.05). The results of different AHI groups showed that the patients with moderate to severe OSAS received higher step-up treatment for asthma, most of which were in step 3 and step 4, with a statistically significant difference (2=90.085，P<0.001). The variance analysis results showed that the more severe the OSAS, the lower the ratio of FEV1/FVC (%) (F=2.600, P=0.011), and the higher the FeNO and R5 measurements values (F=-6.454 , F=-3.291, P<0.001). Pearson linear correlation analysis showed that AHI was negatively correlated with FEV1% (r=-0.356, P<0.05) and FEV1/FVC% (r=-0.289, P<0.001), but AHI was positively correlated with R5 (r=0.447, P<0.05). Conclusion BA patients with OSAS have significantly abnormal respiratory function-related indicators, and with the aggravation of OSAS, BA will further deteriorate

Changes of FeNO, CRP and PCT levels in patients with bronchial asthma complicated with sleep apnea syndrome in Shanghai / 公共卫生与预防医学

Objective The changes and risk factors of FeNO, CRP and PCT in patients with bronchial asthma complicated with sleep apnea syndrome (SAS) in Shanghai area were analyzed to provide theoretical basis for the prevention and treatment of SAS in patients with bronchial asthma. Methods A total of 436 patients with bronchial asthma admitted to our hospital from January 2019 to June 2022 were selected and divided into control group and experimental group according to whether SAS occurred during hospitalization. The experimental group was divided into three subgroups according to the apnea hypopnea index (AHI) values: mild group (AHI>15 times /h or 15 times /h or 28 kg/m2(OR=5.629),allergic rhinitis(OR=6.166)and neck circumference>40 cm(OR=5.265)were independent risk factors for SAS in patients with bronchial asthma(P<0.05);Pearson correlation analysis showed that AHI was positively correlated with serum FeNO,CRP and PCT levels in patients with bronchial asthma and SAS(r=0.471,0.436,0.502,P<0.05). Conclusions Patients with old bronchial asthma in Shanghai area have a higher risk of SAS, and the severity of the disease is positively correlated with the levels of FeNO, CRP and PCT. In particular, obese patients with allergic rhinitis should be given early intervention to reduce the risk of SAS.

O risco de síndrome de apneia obstrutiva do sono em pacientes com doença hepática gordurosa não alcoólica está associado à obesidade e à presença de NASH / Obstructive sleep apnea syndrome risk in patients with non-alcoholic fatty liver disease is associated with obesity and presence of nash

ABSTRACT Background: Non-alcoholic fatty liver disease (NAFLD) is the most common form of liver disease and refers to a wide spectrum of histological abnormalities ranging from simple steatosis (HE) to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis and hepatocellular carcinoma. Objective: To assess the risk of obstructive sleep apnea syndrome (OSAS) and relating it to demographic, biochemical and histological data in patients with non-alcoholic fatty liver disease. Methods: Cross-sectional cohort study in individuals with biopsy-proven NAFLD. Anthropometric and biochemical parameters, presence of metabolic syndrome and insulin resistance were evaluated. The Berlin Questionnaire (BQ) was applied to assess the risk of apnea and a food record was requested. Based on the BQ, participants were classified as high or low risk for OSAS. In the correlation of sleep apnea with the severity of NAFLD, presence of nonalcoholic steatohepatitis (NASH) and the degree of liver fibrosis were evaluated. Statistical analysis used the chi-square test, Student's t and bivariate logistic regression; values were expressed as mean ± standard deviation. This research project was approved by the Ethics Committee. Results: Regarding the parameters evaluated, significant differences were observed between the groups in terms of body mass index (BMI), waist and neck circumference. In the histological evaluation, patients classified as high risk were more likely to have fibrosis and NASH. In bivariate regression, the BMI, presence of fibrosis and steatohepatitis in the biopsy were independently associated with an elevated risk of the syndrome. Conclusion: A high prevalence of risk for OSAS was observed in the studied group, with a higher risk being independently associated with BMI and presence of steatohepatitis, suggesting that it is a factor associated with the severity of the disease.

RESUMO Contexto: A doença hepática gordurosa não alcoólica (DHGNA) é a forma mais comum de doença hepática e se refere a um amplo espectro de anormalidades histológicas que variam de esteatose simples a esteato-hepatite não alcoólica (EHNA), fibrose, cirrose e carcinoma hepatocelular. Objetivo: Avaliar o risco de síndrome da apneia obstrutiva do sono (SAOS) e relacioná-lo com dados demográficos, bioquímicos e histológicos em pacientes com doença hepática gordurosa não alcoólica. Métodos: Estudo de coorte transversal em indivíduos com DHGNA comprovada por biópsia. Foram avaliados parâmetros antropométricos e bioquímicos, presença de síndrome metabólica e resistência à insulina. O Questionário de Berlim (QB) foi aplicado para avaliar o risco de apneia e um registro alimentar foi solicitado. Com base no QB, os participantes foram classificados como de alto ou baixo risco para SAOS. Na correlação da apneia do sono com a gravidade da DHGNA, avaliou-se a presença de EHNA e o grau de fibrose hepática. Na análise estatística foram utilizados: o teste qui-quadrado, t de Student e regressão logística bivariada; os valores foram expressos como média ± desvio padrão. Este projeto de pesquisa foi aprovado pelo Comitê de Ética. Resultados: Em relação aos parâmetros avaliados, foram observadas diferenças significativas entre os grupos em relação ao índice de massa corporal (IMC), cintura e circunferência do pescoço. Na avaliação histológica, os pacientes classificados como de alto risco tiveram maior chance de apresentar fibrose e EHNA. Na regressão bivariada, o IMC, a presença de fibrose e esteato-hepatite na biópsia foram independentemente associados a um risco elevado da síndrome. Conclusão: Observou-se alta prevalência de risco para SAOS no grupo estudado, sendo o maior risco associado de forma independente ao IMC e à presença de esteato-hepatite, sugerindo que seja um fator associado à gravidade da doença.

Dispositivos de Avance Mandibular para el Manejo del Ronquido y la Apnea del Sueño. Actitudes de los Odontólogos Generales y los Especialistas Médicos para Proporcionarlos

RESUMEN: El objetivo de este estudio fue determinar las actitudes y la conciencia de los odontólogos y especialistas médicos sobre la provisión de dispositivos de avance mandibular (DAM) para el tratamiento de los ronquidos y la apnea del sueño. Se llevó a cabo un estudio observacional descriptivo de corte transversal, donde se seleccionaron por conveniencia 53 odontólogos (generales y especialistas) y 5 médicos especialistas en medicina del sueño en la ciudad de Guadalajara, México. Quienes respondieron un cuestionario específico desarrollado por Jauhar et al. (2008) dirigido a conocer la actitud de los odontólogos y médicos especialistas para la provisión de los DAM y otros aspectos relacionados con el ronquido y la apnea obstructiva del sueño (AOS). El 94 % de los odontólogos respondió estar interesado en capacitarse en ronquido y AOS. Y en el grupo de los médicos especialistas se encontró que el 80 % cree que los odontólogos sí tienen un papel para ayudar a los pacientes con ronquido y AOS, el 60 % cree que los odontólogos pueden contribuir con la realización de DAM y el 40 % considera que los odontólogos deben remitir a un especialista del sueño. Existe una actitud muy positiva de los odontólogos para ser parte del grupo interdisciplinario para el tratamiento del ronquido y de la apnea obstructiva del sueño, pero este estudio nos muestra además que a pesar de la disposición para utilizar los DAM, la formación y capacitación no es suficiente. Por otra parte, hay una actitud positiva de los médicos especialistas que consideran que los odontólogos juegan un papel importante en ayudar a los pacientes con ronquidos o con apnea del sueño, pero se evidencia que en su gran mayoría no usan los DAM como parte de un posible tratamiento.

ABSTRACT: The objective of this study was to determine the attitudes and awareness of dentists and medical specialists on the provision of mandibular advancement devices (MAD) for the treatment of snoring and sleep apnea. This is a cross-sectional descriptive observational study, where 53 dentists (general and specialists) and 5 sleep medicine specialists in the city of Guadalajara, Mexico were selected for convenience. The selected group answered a specific questionnaire developed by Jauhar et al., to know the attitude of dentists and medical specialists for the provision of MAD and other aspects related to snoring and obstructive sleep apnea (OSA). 94 % of dentists responded to be interested in training in snoring and OSA. And of the group of medical specialists, 80 % consider that dentists have a role in helping patients with snoring and OSA, 60 % believe that dentists can contribute to MAD and 40 % believe that dentists should refer a sleep specialist. There is a very positive attitude by the dentists to be part of the interdisciplinary group for the treatment of snoring and obstructive sleep apnea, but this study also shows that despite the willingness to use MAD, education and training is not enough. There is a positive attitude of specialist doctors who consider that dentists play an important role in helping patients with snoring or with sleep apnea, but it is evident that the majority do not use MAD as part of a possible treatment.

Effects of obstructive sleep apnea on brain electrical activity in children / 中华实用儿科临床杂志

Objective:To explore the brain electrical activity and its correlation with polysomnography monitoring parameters in children with obstructive sleep apnea syndrome (OSAS) and primary snoring.Methods:It was a prospective observational study involving children aged 6-12 years who presented to the Sleep Center of Beijing Children′s Hospital, Capital Medical University for polysomnography monitoring due to snoring at sleep from July 1 to December 31, 2019.Clinical data, polysomnography monitoring and 6-min measurement of brain electrical activity were collected from all the subjects.According to the results of polysomnography monitoring, the subjects were divided into the primary snoring group and the OSAS group at varying degrees.Based on the electroencephalogram (EEG) wavelet analysis, the brain injury index obtained by EEG synchronization and complexity analysis was used to reflect the changes of brain electrical activity in children in the resting state.Rank sum test was used to test the differences in brain injury index and the percentage of each frequency band of brainwave.Multivariate linear regression method was used to analyze risk factors for EEG activity.Results:A total of 149 children were recruited, including 110 males and 39 females.There was no significant difference in the proportions of α, θ, β and δ waves among OSAS children at varying degrees(all P>0.05). The brain injury index of the primary snoring group, mild OSAS group, moderate OSAS group and severe OSAS group was 0 (0, 3), 14 (9, 16), 26 (24, 28), and 34(30, 44), respectively.There were statistically significant differences in the brain injury index among groups ( H=129.70, P<0.01). The brain injury index gradually increased from the primary snoring group to the severe OSAS group.Multivariate linear regression analysis showed that the obstructive apnea hypopnea index (OAHI), mean oxygen saturation and minimum oxygen saturation were independently correlated with the brain injury index (all P<0.05). Conclusions:There were no significant differences in the ratios of α, θ, β and δ waves among OSAS children at varying degrees, while the EEG complexity and synchronicity varied a lot.With the increase of OAHI, the brain injury index gradually increased.The brain injury index was independently correlated with OAHI, mean oxygen saturation and minimum oxygen saturation.

Clinical effect observation of esketamine combined with dexmedetomidine for drug-induced sleep endoscopy / 中国药房

OBJECTIVE To investigate the effects of esketamine combined with dexmedetomidine used for drug-induced sleep endoscopy in patients with obstructive sleep apnea syndrome. METHODS Totally 60 patients with obstructive sleep apnea syndrome were randomly divided into control group and observation group ，with 30 cases in each group. Anesthesia induction scheme of control group included loading dose of dexmedetomidine 1 μg/kg，pumped for 10 min，maintained at 1 μg（/ kg·h），and intravenous administration of propofol at a constant rate of 3 mg（/ kg·h）until the patient snored. That of observation group included same administration route and dose of dexmedetomidine as control group ，intravenous administration of esketamine 1 mg/kg at a constant rate of 0.5 mg/（kg·h）until the patient snored. Sleep endoscopy was performed when the bispectral index （BIS）was lower than 75 and the alert /sedation（OAA/S）score was higher than 1. The vital signs ，BIS and OAA/S scores of patients in awake state （T0），10 min load dose of dexmedetomidine infusion （T1），at the time of examination （T2）and at the end of examination （T3） were recorded ，as well as the patient ’s medication （including the one-time success rate of examination ，the number of additional drugs due to physical movement during examination ），and the occurrence of adverse events after medication. RESULTS In the comparison between groups ，the pulse oxygen saturation （SpO2）and BIS of patients in the observation group were significantly higher than those in the control group at T1，T2 and T3；the heart rates and mean arterial pressures （MAP）at T2 and T3 were significantly lower than those in the control group ；and the OAA/S score at T1 and T2 were significantly higher than those in the control group （P＜0.05）. Comparison within the group ，the heart rates at T1，T2 and T3 in the observation group were significantly lower than those at T0，and the MAP at T2 and T3 were significantly lower than that at T1（P＜0.05）；in control group ，compared with T0，SpO2 decreased significantly at T1，T2 and T3，heart rate decreased significantly at T1，and MAP increased significantly at T2（P＜0.05）. Sixty patients successfully completed drug-induced sleep endoscopy after medication. The one-time success rate of examination in the observation group was significantly higher （No.191460443） than control group （P＜0.05），and the number of additional drugs due to physical movement during examination was significantly less than control group （P＜0.05）. There was no significant difference in the incidence of adverse events between 2 groups（P＞0.05）. CONCLUSIONS Esketamine combined with dexmedetomidine has less respiratory inhibition and less effect on hypoxia hemodynamics in patients with obstructive sleep apnea syndrome. It has less intervention times in the process of sleep endoscopy ，and has more advantages than propofol.

Distúrbios respiratórios do sono: relação com as doenças cardiovasculares / Respiratory sleep disorders: relation with cardiovascular diseases

Introdução: A síndrome da apneia e hipopneia obstrutiva do sono (SAHOS) é caracterizada pela obstrução parcial ou completa da via aérea superior durante o sono, e está relacionada ao início, progressão e gravidade das doenças cardiovasculares. Objetivos: Avaliar os sintomas de SAHOS em pacientes em acompanhamento de doenças cardiovasculares. Métodos: Avaliação de 3 questionários - índice de qualidade de sono de Pittsburgh (Anexo 2), questionário de Berlin (Anexo 3) e escala de sonolência de Epworth (ESE) (Anexo 4) contemplando sexo, faixa etária, IMC, CC, queixas relacionadas a distúrbios do sono, doenças sistêmicas como HAS, DM, cardiopatia e quantidade de medicamentos utilizados. Resultados: Total de 231 pacientes participantes, 66,23% apresentando baixa qualidade do sono, 24,68% com risco de SAHOS e 31,7% com sonolência diurna excessiva. Discussão: A associação entre SAHOS e doenças cardiovasculares é cada vez maior devido ao aumento dos diagnósticos de SAHOS, que apesar de ser uma doença sistêmica comum, ainda permanece subdiagnosticada. O combate aos fatores de risco comportamentais associados ao tratamento dos fatores de risco intermediários e da SAHOS levam à redução do risco cardiovascular. Conclusão: A prevalência de sintomas relacionados à SAHOS se mostrou moderadamente prevalente nos pacientes com doenças cardiovasculares ou com seus fatores de risco.

Objectives: To evaluate symptoms related to Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) in patients with cardiovascular disease (CVD) and its relation with personal characteristics and medication use. Methods: The Pittsburgh sleep quality index (PSQI), Berlin questionnaire (BQ) and Epworth sleepiness scale (ESS) were used, including variables such as gender, body mass index, systemic arterial hypertension, cardiopathy and amount of medicines used, from January to October/2017, and performed data analysis. Results: A total of 231 patients participated, 66.23% presented poor sleep quality; 24.68% high risk of OSAHS and 31.7% excessive daytime sleepiness (EDS). The BQ showed a higher chance of a high risk for OSAHS in pre-obese and obese I-degree. The ESS showed an increase in EDS with the reduction of 1 medication for cardiopathy. The PSQI showed a higher chance of poor sleep quality in females than not male. Discussion: Other than this study, the literature shows that EDS can result from the use of drugs for heart disease and hypertension. The literature shows that overweight and obesity increase the chance of systemic arterial hypertension, moreover, this research showed that weight also had a greater influence on the high risk of OSAHS. This shows that overweight and obesity are risk factors for systemic arterial hypertension, OSAHS and CVD. This study evidenced, as well as the literature, poorer sleep quality in females.

Narcolepsia na infância: a atuação multidisciplinar com a psicologia do sono do diagnóstico ao tratamento em um relato de caso / Child narcolepsy: the multidisciplinary approach with sleep psychology from diagnostics to treatment in a case report / Narcolepsia en la infancia: actuación multidisciplinar con la psicología del sueño desde el diagnóstico hasta el tratamiento en un caso clínico

A narcolepsia, distúrbio neurológico crônico caracterizado pela sonolência diurna excessiva, pode ser associada à cataplexia, fragmentação do sono, alucinações relacionadas ao sono e paralisia do sono. Frequentemente, é confundida com outros transtornos, como Transtorno do Déficit de Atenção com Hiperatividade (TDAH), epilepsia e até esquizofrenia, assim, por vezes, é diagnosticada inadequadamente. Objetiva-se relatar o diagnóstico diferencial bem-sucedido da narcolepsia na infância e suas dificuldades, realizado por uma equipe multidisciplinar, enfocando a atuação da psicologia do sono em avaliação e intervenção. Um menino de 10 anos foi recebido no Ambulatório de Narcolepsia e Apneia do Sono Infantil (AMBNAP), alocado no Hospital Universitário Onofre Lopes da Universidade Federal do Rio Grande do Norte (UFRN) com queixas de sonolência diurna excessiva, sono fragmentado e episódios de perda de tônus muscular. Foi submetido a entrevistas psiquiátrica e psicológica pormenorizadas, a exames, aplicação de escalas específicas para rastreio e diagnóstico de transtornos de sono e diário de sono, solicitação de recursos de mídia e de relatório escolar e avaliação neurológica. A partir da investigação multidisciplinar, o diagnóstico foi de Narcolepsia e Síndrome da Apneia Obstrutiva do Sono (SAOS). O paciente foi submetido a técnicas da Terapia Cognitivo-Comportamental (TCC) e segue em acompanhamento, apresentando resultados satisfatórios. Este estudo evidencia que uma equipe multidisciplinar especializada na área de sono atuando em conjunto com a Psicologia do Sono oportuniza o diagnóstico e intervenções precoces eficazes para o tratamento do distúrbio do sono na infância.(AU)

Narcolepsy is a chronic neurologic disorder characterized by excessive daytime sleepiness which can be associated with cataplexy, sleep fragmentation, sleep-related hallucinations, and sleep paralysis. This sleep disorder is often confused with other disorders such as Attention Deficit Hyperactivity Disorder (ADHD), epilepsy, and even schizophrenia, and is, thus, misdiagnosed. This study aims to report the successful differential diagnosis for childhood narcolepsy carried out by a multidisciplinary team and its challenges, with a focus on the role of sleep psychology in assessment and intervention. A 10-year-old child was received at the Child Narcolepsy and Sleep Apnea Clinic (AMBNAP), located at the Onofre Lopes University Hospital of the Federal University of Rio Grande do Norte (UFRN), with complaints of hypersomnolence, fragmented sleep, and episodes of loss of muscle tone. He underwent detailed psychiatric and psychological interviews, analysis of exams, application of specific scales for screening and diagnosis of sleep disorders and sleep diary, request of media resources and school report, and neurological assessment. From the multidisciplinary investigation, excluding of other neurological diagnoses, the diagnosis was Narcolepsy and Obstructive Sleep Apnea Syndrome (OSAS). The patient was submitted to Cognitive Behavioral Therapy (CBT) techniques, such as psychoeducation, scheduled naps, cognitive therapy for dysfunctional beliefs, and sleep hygiene strategies, and continues to be followed up, with satisfactory results since the first two months of intervention. The findings presented in this study show that a multidisciplinary team specialized in the sleep area, acting alongside Sleep Psychology provides early diagnosis and interventions for the sleep disorder treatment in childhood.(AU)

La narcolepsia es un trastorno neurológico crónico caracterizado por somnolencia diurna excesiva que puede asociarse con cataplejía, fragmentación del sueño, alucinaciones relacionadas con el sueño y parálisis del sueño. El trastorno del sueño a menudo se confunde con otros trastornos como el TDAH, la epilepsia e incluso la esquizofrenia, y se diagnostica erróneamente. El objetivo es presentar el diagnóstico diferencial exitoso de la narcolepsia en la infancia y sus dificultades, realizado por un equipo multidisciplinario, con foco en el papel de la psicología del sueño en la evaluación e intervención. El estudiante de 10 años fue recibido en la Clínica de Narcolepsia Infantil y Apnea del Sueño (AMBNAP), ubicada en el Hospital Universitario Onofre Lopes de la Universidad Federal de Rio Grande do Norte, con quejas de hipersomnolencia, sueño fragmentado y episodios de pérdida de tono muscular. Se sometió a entrevistas psiquiátricas y psicológicas detalladas, análisis de exámenes, aplicación de escalas específicas para la detección y diagnóstico de trastornos del sueño y el diario del sueño, solicite recursos de medios y informe escolar y evaluación neurológica. La investigación multidisciplinaria, el diagnóstico fue Narcolepsia y SAOS. El paciente fue sometido a técnicas de terapia cognitivo-conductual (TCC), como psicoeducación, siestas programadas, terapia cognitiva por creencias disfuncionales y estrategias de higiene del sueño, y se le dio seguimiento con resultados satisfactorios. Los resultados demostraron que un equipo multidisciplinario especializado en el campo del sueño, actuando en conjunto con la psicología del sueño, proporciona el diagnóstico y las intervenciones tempranas para el trastorno del sueño de la narcolepsia en la infância.(AU)

Impacto del síndrome de apneas obstructivas del sueño en accidentes de tránsito en Chile

Resumen Introducción: Existe abundante evidencia para considerar al síndrome de apnea obstructiva del sueño (SAOS) como un factor de riesgo significativo en la ocurrencia de accidentes de tránsito. En el año 2018, los accidentes de tránsito en Chile provocaron 1.507 muertes, 60 mil lesionados, y generaron un costo país de US $5.985 millones al año (2,1% PIB). Sin embargo, se desconoce la prevalencia de SAOS en conductores, ni su impacto en la accidentabilidad a nivel nacional. Objetivo: Estimar la prevalencia de SAOS en conductores nacionales, y su importancia relativa en el número de accidentes, lesionados, muertes y costos asociados. Material y Método: Revisión de la literatura, análisis descriptivo con bases de datos secundarias. Estimación de prevalencia de riesgo de SAOS en conductores nacionales, profesionales, y cálculo de costos asociados a accidentabilidad. Resultados: Se estima prevalencia de SAOS moderado a severo en un 28,6% para conductores nacionales y 30,2% para conductores profesionales. Utilizando un odds ratio de 2,52 (IC 1,84-3,35) como estimador de riesgo, se obtiene un riesgo atribuible porcentual poblacional de 30,28%, que se traduce en que SAOS sería responsable de 27.046 accidentes, 17.545 lesionados, 456 muertes, y un costo país de US $1.812,4 millones al año atribuibles a SAOS para las cifras de accidentabilidad 2018. Conclusión: El presente trabajo es la primera aproximación al tema a nivel chileno. Se requieren estudios de prevalencia de SAOS en conductores para realizar estimaciones más precisas. Impresiona necesario colocar este tema en la agenda pública, por la posible reducción de riesgos.

Abstract Introduction: There is abundant evidence to consider obstructive sleep apnea syndrome (OSAS) as a significant risk factor in the occurrence of traffic accidents. In 2018, traffic accidents in Chile caused 1,507 deaths, 60 thousand injured, and generated a country cost of US $ 5,985 million per year (2.1% GDP). However, the prevalence of OSAS in national drivers, nor its impact on accident rate level is unknown. Aim: To estimate the prevalence of OSAS in Chilean drivers, and their relative importance in the number of accidents, injuries, deaths and associated costs. Material and Method: Literature review, descriptive analysis with secondary databases. Estimation of risk prevalence of OSAS in Chilean drivers, professional drivers, and calculation of costs associated with accident rates. Results: The prevalence of moderate to severe OSAS is estimated at 28,6% for national drivers, 30,2% for professional drivers. Using an OR of 2.52 (CI 1.84-3.35) as a risk estimator), a population attributable risk percentage of 30,28% is obtained, which translates to 27,046 accidents, 17,545 injured, 456 deaths, and a country cost of US $ 1,812.4 million per year attributable to OSAS for accidents in 2018. Conclusion: This paper is the first approach to the subject at the Chilean level. OSAS prevalence studies in drivers are required to make more accurate estimates. It is necessary to place this topic on the public agenda, due to the possible risk reduction.

Terapéutica del SAHOS (Síndrome de Apnea/Hipopnea Obstructiva del Sueño) desde el punto de vista Ortopédico y Ortodóntico: Revisión de literatura / Therapeutics of OSAHS (Obstructive sleep apnea-hypopnea syndrome (OSAHS) from the Orthopedic and Orthodontic point of view: A literature review

Antecedentes: El SAHOS es una afección respiratoria durante el sueño que constituye un conjunto de signos y síntomas causados por la configuración de algunas estructuras anatómicas del sistema estomatognático, derivando en graves alteraciones sistémicas. En los últimos años, las ramas odontológicas de Ortodoncia y Ortopedia han buscado desarrollar alternativas de tratamiento eficaces para mejorar la calidad de vida de estos pacientes. Objetivo:Describir y resumirlas terapias de ortopedia/ortodoncia para el tratamiento de pacientes con el síndrome de apnea/hipopnea obstructiva del sueño (SAHOS). Materiales y Métodos:Se realizó una búsqueda sistemática en las bases de datos Pubmed, Scielo, Semanthic Scholar y Science Direct de artículos científicos que estudiaron la eficacia de tratamientos ortodóncicos/ortopédicos en pacientes con SAHOS. Se incluyeron estudios en inglés tipo ensayos clínicos controlados publicados en los últimos 5 años. Resultados: Se encontraron en total 83 artículos, de los cuales solo 9 cumplían con los criterios de elegibilidad. Dentro del tratamiento ortodóncico/ortopédico para el SAHOS, se encontaron dispositivo de avance mandibular, terapia de aparatos orales, terapia posicional; algunos implican efectos adversos en ciertos pacientes Conclusión:En las terapias de ortodoncia/ortopedia para el tratamiento del SAHOS se observó que los signos y síntomas mejoraron considerablemente a pesar de presentar efectos adversos.

Background: OSAHS is a respiratory condition during sleep that constitutes a set of signs and symptoms caused by the configuration of some anatomical structures of the stomatognathic system, leading to serious systemic alterations. In recent years, the dental branches of Orthodontics and Orthopedics have sought to develop effective treatment alternatives to improve the quality of life of these patients. Objective:To describe and summarize orthopedic / orthodontic therapies for the treatment of patients with obstructive sleep apnea / hypopnea syndrome (OSAHS). Materials and methods:A systematic search was carried out in the Pubmed, Scielo, Semanthic Scholar and Science Direct databases for scientific articles that studied the efficacy of orthodontic / orthopedic treatments in patients with OSAHS. English-language controlled clinical trials studies published in the last 5 years were included. Results:A total of 83 articles were found, of which only 9 met the eligibility criteria. Within the orthodontic / orthopedic treatment for OSAHS, mandibular advancement device, oral appliance therapy, positional therapy were found; some involve adverse effects incertain patients. Conclusion:In the orthodontic / orthopedic therapies for the treatment of OSAHS, it was observed that the signs and symptoms improved considerably despite presenting adverse effects.

Patient Intolerance and Compliance with Positive Airway Pressure Treatment Outpatient Consultations Profile in a Sleep Unit

Abstract Introduction: Treatment with positive pressure may cause adverse effects. In order to know the compliance and intolerance profile, we analyzed the behaviors established by physiotherapists of a Sleep Unit. Materials and Methods: Observational, retrospective, cross-sectional study. We included patients older than 18 years with positive pressure referred to the kinesiological consultation. Results: 244 patients were evaluated during four years: 165 men (67%), age 65.7 ± 11.6 years, BMI (Body Mass Index) 31.0 ± 5.4 (kg/m2), 61% of which used fixed CPAP (Continuous Positive Airway Pressure), 29% auto-adjusting CPAP, 8% bilevel devices, 147 (60%) nasal masks, 52 (21%) oronasal masks; 37 pads (15%), and 92 (36%) thermohumidifiers. Reasons for consultation were: therapy control, 239 (61%); intolerance, 67 (17%), and calibration, 51 (13%). Compliance (hours/night) was 4.61 ± 2.1, with a percentage of nights > 4 hours of 67 ± 36%. We didn't find any difference in the com pliance of the first and the second year (4.5 vs. 5.0 hours/night) p > 0.13, but the value was higher after 600 days of therapy (p < 0.05). 141 patients (57%) showed some complications, the most frequent being leaks (19%) or intolerance to the masks (10%). 97% of the patients resolved the intolerance with 194 behaviors: explanation of how to use the mask, 94 (48%); calibration, 44 (22%); information, 45 (23%); titration, 13 (6%), and referral to the pulmonologist, 14 (7%). Conclusions: Two thirds of the patients complied with the positive pressure treatment and half of the patients showed intolerance. The specialized kinesiological consultation can contribute to the identification and resolution of difficulties that may arise during therapy.

Perfil del paciente hipertenso con sospecha clínica de apnea obstructiva del sueño en el Centro de Diagnóstico y Medicina Avanzada y de Conferencias Médicas y Telemedicina (CEDIMAT) durante el período enero 2019 ­ febrero 2020, Santo Domingo, República Dominicana / Profile of the hypertensive patient with clinical suspicion of obstructive sleep apnea at the Center for Diagnosis and Advanced Medicine and Medical Conferences and Telemedicine (CEDIMAT) during the period January 2019 - February 2020, Santo Domingo, Dominican Republic

Introducción: la apnea obstructiva del sueño es una patología respiratoria caracterizada por paradas de la respiración de forma repetida durante el sueño. Esta patología está relacionada con los trastornos hipertensivos, pudiendo agravarlos. Objetivo: determinar el perfil de un paciente hipertenso bajo sospecha clínica de apnea obstructiva del sueño en el Centro de Diagnóstico y Medicina Avanzada y de Conferencias Médicas y Telemedicina (CEDIMAT) durante el periodo enero 2019 ­ febrero 2020. Material y métodos: se realizó un estudio observacional-descriptivo, transversal con datos retrospectivos. Se estudiaron 38 expedientes clínicos de pacientes hipertensos de la consulta de neumología y que cumplen con criterios de sospecha clínica de apnea obstructiva del sueño. Resultados: el rango de edad fue de 40-64 años con un 55.26 %. El 66 % son masculinos. 36.84 % son hipertensos grado I mientras que otro 34.21% tienen sus niveles tensionales normales. El 68.41 % son obesos y un 26.32 % están en sobrepeso. 63.16 % se clasifican como IV en la escala de Mallampati. Conclusión: el perfil de los pacientes hipertensos bajo sospecha clínica de apnea obstructiva del sueño es: sexo masculino, adultez media, obesidad, escala de mallampati categoría IV y el uso de múltiples fármacos en el control de la hipertensión

Introduction: Obstructive sleep apnea is a respiratory disease characterized by repeated stops of breathing during sleep. This pathology is related to hypertensive disorders, which can aggravate them. Objective: To determine the profile of a hypertensive patient under clinical suspicion of obstructive sleep apnea at the Center for Diagnosis and Advanced Medicine and Medical and Telemedicine Conferences (CEDIMAT) during the period January 2019 - February 2020. Material and methods: An observational study of descriptive, cross-sectional type with retrospective data. Thirty-eight clinical records of hypertensive patients from the pulmonology clinic and who meet the criteria for clinical suspicion of obstructive sleep apnea were studied. Results: The age range was 40-64 years with 55.26%. 66% are male. 36.84% are grade I hypertensive while another 34.21% have normal blood pressure levels. 68.41% are obese and 26.32% are overweight. 63.16% are classified as IV on the mallampati scale. Conclusion: The profile of hypertensive patients under clinical suspicion of obstructive sleep apnea is; male sex, middle adulthood, obesity, category IV of mallampati scale and the use of multiple drugs in the control of hypertension