Impacto econômico da implementação de políticas públicas para distúrbios de sono no Brasil: uma revisão integrativa / Economic impact of the implementation of public policies for sleep disorders in Brazil: an integrative review

Objetivo: Identificar estudos sobre políticas públicas, ações de saúde e análises econômicas relacionados aos distúrbios de sono no Brasil e discutir os seus resultados para o sistema de saúde, gestores de políticas públicas e a sociedade. Métodos: Revisão integrativa da literatura nas bases de dados Lilacs (via BVS), SciELO e PubMed (via Medline), incluindo estudos publicados nos idiomas português, inglês e espanhol, entre os anos de 1960-2023; foram excluídos estudos que não apresentaram a perspectiva brasileira ou aqueles cuja versão integral não estava disponível (seja gratuitamente ou na versão paga). Resultados: A busca retornou 536 resultados, dos quais apenas dois atendiam aos critérios de inclusão e mais cinco trabalhos foram incluídos manualmente, após consulta com especialistas de sono (todos abordaram apneia obstrutiva do sono, sendo: um relato sobre alteração na legislação de trânsito focada em prevenção de acidentes por sonolência excessiva; uma revisão de escopo sobre análises de custo-efetividade do tratamento da doença com uso de CPAP; dois relatos sobre linha de cuidado em um município e outros três em Secretarias Estaduais de Saúde). Conclusões: A revisão integrativa encontrou poucas evidências acerca do tema e aponta para a necessidade de futuros estudos que visem a suprir essa lacuna científica e de que seja necessário o desenvolvimento de futura linha de cuidado que amplie o acesso ao tratamento de doenças do sono no Sistema Único de Saúde.

Objective: To identify studies on public policies, health actions, and economic analyses related to sleep disorders in Brazil and discuss their results for public policy managers and society. Methods: Integrative literature review using Lilacs (via BVS), SciELO, and PubMed (via Medline) databases, including studies published in Portuguese, English, and Spanish languages, between years of 1960-2023; studies that did not present the Brazilian perspective or whose full version was not available were excluded (free or paid version). Results: The search returned 536 results, of which only two met the inclusion criteria, and five more studies were included manually after consulting sleep experts (all addressing obstructive sleep apnea, namely: a report on changes in traffic legislation focused on preventing accidents caused by excessive sleepiness; a scoping review on cost-effectiveness analysis of CPAP for sleep apnea treatment; two reports on care lines in one municipality and another three in State Secretariats). Conclusions: The integrative review found few evidences on the topic and points to the need for future studies aimed at filling this scientific gap and the development of a care line that expands access to sleep disorder treatment in Brazilian Public Health System.

Tooth wear due to dental attrition among 12-year-old adolescents / Desgaste dentário por atrição entre adolescentes de 12 anos de idade

Aim: To evaluate the prevalence and distribution of tooth wear due to dental attrition among 12-year-old adolescents according to their gender, reports of tooth grinding during sleep/while awake (bruxism), and sleep features related to sleep-disordered breathing. Methods: A cross-sectional study was conducted with 172 adolescents from southeast Brazil. Parents/caregivers answered questions about sociodemographic characteristics; reports of adolescents' tooth grinding during sleep, and sleep features (e.g. sleep duration and position, snoring, drooling on the pillow) in the previous two weeks. Adolescents self-reported the occurrence of tooth clenching/grinding while awake in the previous two weeks. Tooth wear due to dental attrition was assessed by a previously calibrated researcher, using a validated 5-point analogical ordinal occlusal/incisal tooth wear grading scale, with scores ranging from 0 (no wear) to 4 (loss of crown height ≥ 2/3), depending on tooth wear severity. Descriptive statistics and the Mann-Whitney test (p < 0.05) were performed to identify differences in tooth wear due to the distribution of dental attrition, according to adolescents' characteristics. Results: Most adolescents were female (58.0%) and 81.6% of the participants presented tooth wear due to dental attrition within the enamel. Adolescents who snored had a higher number of incisors with tooth wear due to dental attrition (p = 0.035). Females showed a higher number of canines with tooth wear due to dental attrition (p = 0.020). Adolescents whose parents reported tooth grinding during sleep presented a higher number of bicuspids with tooth wear due to dental attrition (p = 0.001). Conclusion:Tooth wear due to dental attrition within the enamel was observed in most adolescents. The distribution, depending on specific groups of teeth, was higher among female adolescents, adolescents' whose parents reported tooth grinding, and adolescents who snored during sleep.

Objetivos: Avaliar a prevalência e distribuição de DDA entre adolescentes de 12 anos de acordo com o sexo, relato de ranger de dentes durante o sono e vigília (bruxismo) e características relacionadas a desordens respiratórias do sono.Método: Desenvolveu-se um estudo transversal com 172 adolescentes do sudeste do Brasil. Seus pais/responsáveis responderam um questionário contendo informações sociodemográficas, relato sobre os filhos rangerem os dentes durante o sono e hábitos do sono dos filhos (duração do sono, posição que dorme, roncar, babar no travesseiro) nas duas últimas semanas. Adolescentes relataram ocorrência de ranger/apertar de dentes durante a vigília nas duas últimas semanas. DDA foi avaliado por um pesquisador previamente calibrado através de uma escala analógica ordinal de cinco pontos de desgaste dentário para faces oclusal/incisal previamente validada, com escores variando de 0 (sem desgaste) a 4 (perda da coroa em altura ≥ 2/3), dependendo da gravidade do desgaste. Análises descritivas e teste de Mann-Whitney (p < 0,05) foram realizados para identificar as diferenças na distribuição de DDA de acordo com as características dos adolescentes.Resultados: A maioria dos adolescentes eram meninas (58,0%) e 81,6% dos participantes apresentaram DDA em esmalte em algum elemento dentário. Adolescentes que rocavam apresentavam mais incisivos com DDA (p = 0.035). Meninas apresentaram maior número de caninos com DDA (p = 0.020). Adolescentes que rangiam os dentes durante a noite apresentaram maior número de pré-molares com DDA (p = 0.001).Conclusão: Desgaste dentário por atrição em esmalte foi observado na maioria dos adolescentes. A distribuição, dependendo de grupos de dentes específicos, foi maior entre meninas, adolescentes que roncavam durante o sono e que rangiam os dentes durante o sono.

Continuous positive airway pressure treatment on blood pressure rhythm in hypertension patients with obstructive sleep apnea / 中华老年医学杂志

Objective:To investigate the effect of continuous positive airway pressure(CPAP)on blood pressure and blood pressure rhythm in hypertensive patients with sleep apnea syndrome.Methods:Hypertensive patients with obstructive sleep apnea syndrome consecutively recruited between 2020 and 2022 were randomly divided into two groups, the CPAP group and the control group.Both groups were routinely treated with antihypertensive drugs, and patients in the CPAP group were additionally treated with CPAP for more than 4 hours at night.24-hour ambulatory blood pressure monitoring was conducted following 12 weeks of treatment, and the blood pressure rhythm was analyzed according to blood pressure results.Results:A total of 104 patients(40-73 years old)were enrolled in the study, with 51 patients(mean age: 57.3±9.1)in the CPAP group(58.8% male)and 53 patients(mean age: 58.3±8.1)in the control group(54.7% male). The results of 24-hour ambulatory blood pressure monitoring showed that, compared with the control group, the CPAP group achieved more effective blood pressure reduction in mean systolic blood pressure(SBP)[(134.6±8.4)mmHg vs.(138.2±5.9)mmHg, t=-2.54, P=0.013], mean DBP[(72.4±9.3)mmHg vs.(77.0±9.0), t=-2.56, P=0.012], mean nighttime SBP[(117.2±5.1)mmHg vs.(122.0±6.2)mmHg, t=-4.283, P<0.01]and mean nighttime DBP[(63.7±6.4)mmHg vs.(66.9±5.1)mmHg, t=-2.812, P<0.01). There was a significant increase in blood pressure dippers in the CPAP group(37.25% vs.18.87%, χ2=4.370, P=0.037). Conclusions:CPAP can significantly reduce 24-hour mean blood pressure and nocturnal blood pressure, and improve blood pressure rhythm in hypertensive patients with sleep apnea syndrome.

Clinical study of acupuncture of Zhukeyuanluo principle combined with Buzhong Yiqi Decoction for the patients with obstructive sleep apnea hypopnea syndrome / 国际中医中药杂志

Objective:To evaluate the effect of acupuncture of Zhukeyuanluo principle and Buzhong Yiqi Decoction on obstructive sleep apnea hypopnea syndrome (OSAHS).Methods:Randomized controlled trial. A total of 104 patients with OSAHS in our hospital from January 2017 to January 2022 who met the inclusion criteria were divided into 2 groups according to random number table method, with 52 patients in each group. The Traditional Chinese Medicine (TCM) group was treated with Buzhong Yiqi Decoction on the basis of conventional western medicine treatment, and the acupuncture and medicine group was treated with the combination of primary and primary collaterals and acupoints. Both groups were treated continuously for 2 months. Epworth Lethargy Scale and Stanford Self-Rated Lethargy Scale (SSS) were used to assess the degree of lethargy. The serum levels of TNF-α, IL-6 and IL-8 were detected by ELISA. The hemoglobin, RBC and mean RBC volume levels were detected by automatic blood cell analyzer. apnea hypopnea index (AHI), apnea index (AI), hypopnea index (HI) and arterial oxygen saturation (SaO 2) were monitored by polysomnographic sleep monitor to evaluate the clinical effect. Results:The total effective rate was 94.2% (49/52) in the acupuncture group and 82.7% (43/52) in the TCM group, and there was significant difference between the two groups ( χ2=6.73, P=0.035). After treatment, the Epworth Lethargy Scale and SSS scores in the acupuncture and medicine group were significantly lower than those in the TCM group ( t=-8.19 and -5.48, respectively, P<0.01); AHI [(15.64±2.81) times/h vs. (19.82±3.05) times/h, t=-7.27], HI [(5.53±1.28) times/h vs. (7.37±1.34) times/h, t=-7.16], AI [(8.13±1.95) times/h vs. (10.98±2.26) times/h, t=-6.89] in the acupuncture and medicine group were significantly lower than those in the TCM group ( P<0.01), SaO 2 [(92.77±2.91) % vs. (89.53±2.44) %, t=6.15] in the acupuncture and medicine group was significantly higher than that of the TCM group ( P<0.01). The levels of TNF-α, IL-6 and IL-8 in serum in the acupuncture and medicine group were significantly lower than those in the TCM group ( t=-2.62, -3.14 and -6.58, P<0.01). The levels of hemoglobin, RBC and mean red blood cell volume were in the acupuncture and medicine group were significantly lower than those in the TCM group ( t=-2.11, -2.92, -2.48, P<0.05 or P<0.01). Conclusion:The acupuncture of Zhukeyuanluo principle combined with Buzhong Yiqi Decoction can reduce the serum inflammatory cytokines level in OSAHS patients, increase SaO 2, reduce AHI, HI, AI and lethargy degree, and improve clinical effects.

Diurnal variation of serum hypoxia inducible factor-1 α in obese patients with obstructive sleep apnea / 国际外科学杂志

Objective:To observe the diurnal changes of serum hypoxia inducible factor-1α (HIF-1α) and its relationship with polysomnography (PSG) parameters in obese patients with obstructive sleep apnea (OSA).Methods:In this study, 64 obese subjects with OSA (experimental group) and 24 normal subjects (control group) were included. PSG monitoring was performed in all subjects, and peripheral blood samples were collected at night and next early morning to detect the expression level of HIF-1 α mRNA and protein concentration in serum. The data were analyzed by SPSS25.0 software. The counting data was represented by n(%), and t-tests were used for inter group comparisons. The measurement data of normal distribution adopted mean ± standard deviation ( ± s), and the inter group comparison adopted Chi-square. Serum HIF-1α mRNA levels and protein concentrations in the two groups were compared and analyzed by Two-way ANOVA, and Spearman rank correlation was used to analyze the correlation. Results:The ratio of male to female in the control group was 15: 9 and the average age was (39.25 ±10.58) years old, while that in the experimental group was 41∶24 with an average age of (41.31 ±15.20) years. The body mass index (BMI) of experimental group was higher, while all the relevant parameters recorded by PSG were significantly different between two groups ( P<0.001). The results showed that there was no significant difference in the expression of HIF-1α mRNA between the control group and the experimental group ( P=0.914), or between night and morning ( P=0.167). The concentration of HIF-1α protein in the control group was significantly lower than that in the experimental group ( P<0.001), but there was no significant difference in the concentration of HIF-1α protein in the same group at night and in the morning ( P=0.798). The results of correlation analysis showed that there was a significant correlation between PSG related indexes(AHI, minimum blood oxygen, mean blood oxygen and SIT90), night and morning mRNA expression and protein concentration ( P<0.05). Conclusions:Compared with normal people, the concentration of serum HIF-1 α protein in obese patients with OSA is higher, but there is no difference between night and morning. The process of HIF-1 α induced by CIH may be involved in post-translational regulation rather than transcription, and other compensatory mechanisms may also be involved.

Obstructive sleep apnea: a review for the orthodontist

ABSTRACT Introduction: Obstructive sleep apnea (OSA) affects an important part of the population and is characterized by recurrent total or partial obstruction of the upper airway (UA) during sleep, negatively affecting the quality of life of patients in the short and long terms, and constituting an important public health problem for the society. The field of expertise of orthodontists is closely related to the UA, placing them in a strategic position to diagnose air passage failures and intervene when necessary. Orthodontists, as health professionals, must know how to recognize respiratory problems and manage them appropriately, when indicated. Objective: Thus, this paper aims to review and critically evaluate the related literature, to provide orthodontists with updated knowledge on the diagnosis and therapy related to OSA. Science and technology are constantly evolving; thus, the literature was also reviewed considering new technologies available in consumer-targeted applications and devices for the diagnosis, monitoring, and treatment of sleep-disordered breathing.

RESUMO Introdução: A apneia obstrutiva do sono (AOS) afeta uma importante parcela da população e caracteriza-se pela obstrução total ou parcial recorrente da via aérea superior (VAS) durante o sono, o que afeta negativamente a qualidade de vida dos pacientes no curto prazo e no longo prazo, e constitui importante problema de saúde pública para a sociedade. A área de atuação do ortodontista está em íntima relação com a VAS, o que o coloca em uma posição estratégica para diagnosticar falhas na passagem de ar e intervir quando necessário. É imperativo que o ortodontista, como profissional da saúde, saiba reconhecer problemas respiratórios e manejá-los de maneira apropriada, quando indicado. Objetivo: O objetivo desse artigo é revisar e avaliar criticamente a literatura pertinente, para proporcionar ao ortodontista conhecimento atualizado sobre o diagnóstico e terapêutica relacionados à AOS. Ciência e tecnologia estão em constante evolução; portanto, a literatura também foi revisada considerando as novas tecnologias disponíveis em aplicativos e dispositivos direcionados aos consumidores para o diagnóstico, monitoramento e tratamento dos distúrbios respiratórios do sono.

A clinical trial on 3D CT scan and polysomnographyc changes after rapid maxillary expansion in children with snoring

Abstract Objective: The present prospective clinical study aimed to investigate the effects of rapid maxillary expansion on the airway, correlating airway volumes obtained on multi-slice computed tomography and polysomnography assessment of oxygen saturation and apnea/hypopnea index. Methods: Twenty-four patients (11 with obstructive sleep apnea and 13 with residual snoring, mean age 10.0 (1.8), were enrolled in the study. Each patient underwent multislice computed tomography and nocturnal polysomnography before rapid maxillary expansion and after removal of maxillary expansion after six months. Airway regions were segmented, and volumes were computed. Results: The increase in oropharyngeal volume was significant in both groups. Oxygen saturation and apnea/hypopnea index were not statistically significant. No correlation was found between total airway volume, oxygen saturation, and apnea/hypopnea index changes between the time points examined. Conclusions: This study showed that when rapid maxillary expansion is performed in individuals with sleep-disordered breathing, there were statistically significant differences in oropharyngeal volume between pre- and post-rapid maxillary expansion, but there was no correlation between oxygen saturation values and oropharyngeal volume increase. Level of evidence: The article is classified as Evidence Level 3 (Three).

Rinitis alérgica, apnea-hipopnea obstructiva del sueño y sensibilización a ácaros / Allergic rhinitis, obstructive sleep apnea-hypopnea and mite sensitization

La asociación de rinitis alérgica y el síndrome de apnea-hipopnea obstructiva del sueño se presenta en diferentes edades. En la rinitis alérgica y el síndrome de apnea-hipopnea obstructiva del sueño, puede estar involucrada la sensibilización a ácaros, principalmente: Dermatophagoides pteronyssinus, Dermatophagoides siboney y Blomia tropicalis. Con el objetivo de diagnosticar el síndrome de apnea-hipopnea obstructiva del sueño se seleccionaron 120 individuos del registro de alergia del Policlínico Previsora, Camagüey, Cuba, con diagnóstico presuntivo de rinitis alérgica y edad entre 5 y 15 años cumplidos. Todos tenían realizada la prueba de punción cutánea con Dermatophagoides pteronyssinus, Dermatophagoides siboney y Blomia tropicalis; algunos también, la poligrafía cardiorrespiratoria mediante el dispositivo ApneaLinkAirTM (Resmed Corp., RFA), utilizando el marcaje automático de eventos. La muestra fue de 40 casos (respiración oral, ronquidos) y 80 controles (sin respiración oral, ni ronquidos). La media del tamaño del habón fue de 7,9 mm en los casos y 4,1 mm en los controles (p꞊0,030). El índice de apnea-hipopnea fue positivo en 47 (39,1 por ciento) pacientes, de ellos, 36 (30 por ciento) casos y 11 (9,1 por ciento) controles (p=0,001). La sensibilidad y especificidad de la poligrafía cardiorrespiratoria mostró valores de 85,00 por ciento y 91,25 por ciento respectivamente que permiten afirmar el grado de eficacia de la prueba para diagnosticar apnea e hipopnea obstructiva del sueño. Los pacientes con síndrome de apnea-hipopnea obstructiva del sueño en los casos y controles presentaron incremento, con predominio para casos. La poligrafía cardiorrespiratoria con el dispositivo ApneaLink permite hacer el diagnóstico del síndrome de apnea-hipopnea obstructiva del sueño en rinitis alérgica(AU)

The association of allergic rhinitis and obstructive sleep apnea-hypopnea syndrome occurs at different ages. In allergic rhinitis and obstructive sleep apnea-hypopnea syndrome, sensitization to mites may be involved, mainly: Dermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis. With the objective to diagnose obstructive sleep apnea-hypopnea syndrome, 120 individuals were selected from the allergy registry of the Previsora Polyclinic, Camagüey, Cuba, with a presumptive diagnosis of allergic rhinitis and ages between 5 and 15 years old. All had the skin prick test with Dermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis; some also, cardio-respiratory polygraphy with the ApneaLink AirTM device (Resmed Corp., RFA), using automatic event marking. The sample consisted of 40 cases (oral breathing, snoring) and 80 controls (no oral breathing or snoring). The mean size of the wheal was 7.9 mm in the cases and 4.1 mm in the controls (p꞊0.030). The apnea and hypopnea index was positive in 47 (39.1 percent) patients, of which 36 (30 percent) were cases and 11 (9.1 percent) were controls (p=0.001). The sensitivity and specificity of the cardiorespiratory polygraphy showed values of 85.00 percent and 91.25 percent, respectively, which allow affirming the degree of efficacy of the test to diagnose obstructive sleep apnea-hypopnea. Patients with obstructive sleep apnea-hypopnea syndrome in cases and controls presented an increase, with a predominance for cases. Cardiorespiratory polygraphy with the ApneaLink device allows the diagnosis of obstructive sleep apnea-hypopnea syndrome in allergic rhinitis(AU)

Rastreamento da síndrome da apneia-hipopneia obstrutiva do sono em hipertensos na atenção primária à saúde / Screening of obstructive sleep apnea-hypopnea syndrome in hipertensive individuals in primary health care

Introdução: a síndrome da apneia-hipopneia obstrutiva do sono (SAHOS) é o distúrbio respiratório do sono mais comum, associado a condições facilmente identificáveis, como a hipertensão arterial sistêmica. Objetivo: determinar prevalência de rastreamento positivo para SAHOS e identificar fatores associados em hipertensos em serviço de Atenção Primária à Saúde (APS). Métodos: estudo transversal com 326 hipertensos adscritos a uma unidade de APS. Foram obtidas variáveis antropométricas, clínicas e sociodemográficas e utilizados os questionários Short Assessment of Health Literacy for Portuguese-Speaking Adults, para identificar o letramento em saúde; a Morisky Medication Adherence Scale, para a adesão medicamentosa e o Snoring, Tiredness, Observed Apnea, High Blood Pressure, Bodymass index, Age, Neck Circumference, and Gender -STOP-Bang, para rastreamentoda SAHOS. Resultados: o sexo feminino foi majoritário (66,3%). A média temporal de tratamento para hipertensão arterial sistêmica alcançou 12,51 ± 9,83 anos. Constatou-se prevalência de 86,5% de rastreio positivo para SAHOS e o sexo masculino e a obesidade como fatores associados a essa condição (p<0,01). Conclusão: o rastreamento sistemático da SAHOS na APS deve ser incorporado à prática dos profissionais de saúde, assim como é feito para outras doenças crônicas não transmissíveis 1.

Introduction: Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is the most common sleep breathing disorder, associated with easily identifiable conditions such as systemic arterial hypertension. Objective: To determine the prevalence of positive screening for Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) and to identify associated factors in the hypertensive population in the Primary Health Care (PHC) service. Method: This was a cross-sectional study with 326 hypertensive individuals assigned to a PHC unit in a medium-sized city in the state of Minas Gerais. Anthropometric, clinical, and sociodemographic variables were obtained. The Short Assessment of Health Literacy for Portuguese-Speaking Adults questionnaire was used to identify literacy in health; the Morisky Medication Adherence Scale was used for medication adherence; and the Snoring, Tiredness, Observed Apnea, High Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender -STOP-Bang questionnaire was used for the screening of OSAHS. Results: The majority was female (66.3%) and the treatment time average for high blood pressure was 12.51 ± 9.83 years. The study identified the prevalence of 86.5% of positive screening for OSAHS, and male sex and obesity as factors associated with this condition (p <0.01). Conclusion: The systematic screening of OSAHS in PHC services should be incorporated into the practice of health professionals, as itis done for other chronic non-communicable diseases.

Sleep disorders in Down syndrome: a systematic review / Distúrbios do sono na síndrome de Down: revisão sistemática

ABSTRACT Background: Sleep disorders are commonly observed in children with Down syndrome (DS) and can lead to significant behavioral and cognitive morbidities in these individuals. Objective: To perform a systematic review evaluating sleep disorders in individuals with DS. Methods: Search strategies were based on combinations of keywords: "Down syndrome"; "trisomy 21"; "sleep disorders"; "dyssomnias"; "sleep apnea"; "obstructive"; "sleeplessness"; "insomnia"; "parasomnias"; and "excessive daytime sleepiness". PubMed and Science Direct were used. Only original studies and retrospective reviews in English published between January 2011 and March 2021 were included. Results: 52 articles were included, most of them involving children and adolescents under 18 years of age. The main sleep disorder associated with DS was obstructive sleep apnea (OSA). Some studies reported the presence of cognitive dysfunction in patients with DS and sleep-disordered breathing, and few have been found about parasomnia, insomnia, and daytime sleepiness in these patients. Movement disorders and unusual postures during sleep may be related to disordered sleep breathing in DS. The main treatment options for OSA are continuous positive airway pressure therapy (CPAP), surgery, and weight control. Computational modeling associated with MRI has been used to plan surgical interventions in these patients. Conclusions: Individuals with DS are at high risk of developing sleep-related breathing disorders. The main sleep disorder associated with DS was OSA. The presence of sleep-disordered breathing contributes to a worsening of cognitive function in patients with DS.

RESUMO Antecedentes: Os distúrbios do sono são comumente observados em crianças com síndrome de Down (SD) e podem levar a morbidades comportamentais e cognitivas significativas nesses indivíduos. Objetivo: Realizar uma revisão sistemática para avaliar os distúrbios do sono em indivíduos com SD. Métodos: As estratégias de busca foram baseadas em combinações de palavras-chave: "Síndrome de Down"; "trissomia 21"; "distúrbios do sono"; "dissonias"; "apneia do sono"; "obstrutivo"; "insônia"; "insônia"; "parassonias" e "sonolência diurna excessiva". PubMed e Science Direct foram usados. Apenas estudos originais e revisão retrospectiva de prontuários escritos em inglês e publicados de janeiro de 2011 a março de 2021 foram incluídos. Resultados: Foram selecionados 52 artigos, a maioria com crianças e adolescentes menores de 18 anos. O principal distúrbio do sono associado à SD foi a apneia obstrutiva do sono (AOS). Alguns estudos relatam a presença de disfunção cognitiva em pacientes com SD e distúrbios respiratórios do sono, e poucos foram encontrados sobre parassonia, insônia e sonolência diurna nesses pacientes. Distúrbios do movimento e posturas incomuns durante o sono podem estar relacionados ao distúrbio respiratório do sono na SD. As principais opções de tratamento para AOS são pressão positiva contínua nas vias aéreas (CPAP), abordagem cirúrgica e controle de peso. A modelagem computacional associada à ressonância magnética tem sido usada para planejar intervenções cirúrgicas nesses pacientes. Conclusões: Indivíduos com SD apresentam alto risco de desenvolver distúrbios respiratórios relacionados ao sono. O principal distúrbio do sono associado à SD foi a AOS. A presença de distúrbios respiratórios do sono contribui para a piora das funções cognitivas em pacientes com SD.

Relationship between sleep quality and slow-flow in patients with acute coronary syndrome during percutaneous coronary intervention and its impact on clinical prognosis / 中国医师杂志

Objective:To investigate the relationship between sleep quality and slow-flow in patients with acute coronary syndrome during percutaneous coronary intervention(PCI) and its impact on clinical prognosis.Methods:200 patients with ACS hospitalized in the cardiology department of Guangzhou First People's Hospital from January 2017 to October 2018 were selected. The Pittsburgh Sleep Quality Index (PSQI) was measured before elective PCI, and the sleep breathing of patients was monitored by micro motion sensitive mattress sleep monitoring system (MSMSMS). The patients were divided into normal sleep group (68 cases, PSQI≤7 points) and sleep disorder group (132 cases, PSQI>7 points). The levels of plasma endothelin-1 (ET-1) and nitric oxide (NO) were measured. The " slow-flow" that took place during PCI were also recorded. Major cardiac adverse events (MACE) of patients took placed during 12 months follow-up periods were recorded and compared between two groups.Results:Compared with normal sleep group, patients in sleep disorder group had higher ratio of sleep apnea-hypopnea syndrome (SAHS), hypoxemia and lower deep sleep (25.00% vs 10.29%, 25.76% vs 11.76%, 66.67% vs 48.53%, all P<0.05); lower level of NO and higher level of ET-1 [(28.65±3.26)μmol/L vs (30.24±4.08)μmol/L; (21.17±3.08)pg/ml vs (18.90±2.95)pg/ml, P<0.05]; more slow-flow events took place during PCI in sleep disorder group than normal sleep group (16.67 vs 5.88%, P<0.05); After 12 months of follow-up, Kaplan-Meier survival analysis showed patients of the two groups had significantly different cumulative non-events survival rates (19.70% vs 7.35%, Log rank=5.06, P=0.025). Conclusions:Sleep disorder increase the slow-flow phenomenon during PCI in patients with ACS and affect the clinical prognosis.

Correlation between sleep-disordered breathing score and platelet function and stroke recurrence in patients with ischemic stroke / 国际脑血管病杂志

Objective:To investigate the effect of the possibility of sleep-disordered breathing (SDB) as assessed by the four-variable score on the platelet function and the risk of stroke recurrence in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke admitted to the Department of Neurology, Weihai Municipal Hospital from January 2020 to January 2021 were enrolled prospectively. Main inclusion criteria: admission within 24 h of onset; National Institutes of Health Stroke Scale score ≤3; Receiving aspirin + clopidogrel dual antiplatelet therapy. All patients were divided into a high possibility group and a low possibility group of SDB according to the four-variable score. 7±2 d after dual antiplatelet therapy, PL-12 multi-parameter platelet function analyzer was used to detect the maximum aggregation rate (MAR). The patients were followed up for 6 months after discharge and the recurrence of ischemic stroke was observed. The mediating effect model was established with the high possibility of SDB as the independent variable, MAR as the intermediary variable and stroke recurrence as the dependent variable. Firstly, MAR as the dependent variable and high probability of SDB as the independent variable were analyzed by linear regression; then, a binary logistic regression analysis was performed with ischemic stroke recurrence as the dependent variable and the high probability of SDB and MAR as independent variables. Results:A total of 213 patients were enrolled in the study. The average age of the patients was 62.70 ± 10.04 years old. There were 146 male (68.5%) and 121 patients (56.8%) were in the high possibility group (56.8%). During the follow-up period, 24 patients (11.3%) had stroke recurrence. Univariate analysis showed that arachidonic acid (AA) induced MAR (MAR-AA) and adenosine diphosphate (ADP) induced the MAR (MAR-ADP) in the high possibility group of SDB were significantly higher than those in the low possibility group (all P<0.05); MAR-AA and MAR-ADP in the recurrent group were significantly higher than those in the non-recurrent group (all P<0.05), and the proportion of high possibility of SDB in the recurrent group was significantly higher ( P=0.008). Binary logistic regression analysis showed that homocysteine (odds ratio 1.132, 95% confidence interval 1.048-1.223; P=0.002) and having high possibility of SDB (odds ratio 6.351, 95% confidence interval 1.134-35.566; P=0.035) were the independent risk factors for stroke recurrence in patients treated with dual antiplatelet therapy. Intermediary effect analysis showed that MAR had a significant intermediary effect on the risk of stroke recurrence in patients with high probability of SDB. Conclusion:The MAR and stroke recurrence rates in the high possibility group of SDB were significantly higher than those in the low possibility group, and its stroke risk was probably mediated by platelet hyperreactivity.

Clinical and anatomical characteristics associated with obstructive sleep apnea severity in children

Abstract Purpose To determine the clinical and anatomical characteristics associated with obstructive sleep apnea severity in children with adenotonsillar hypertrophy. Methods The authors conducted a cross-sectional multidisciplinary survey and selected 58 Brazilian children (4‒9 years old) with adenotonsillar hypertrophy, parental complaints of snoring, mouth-breathing, and witnessed apnea episodes. The authors excluded children with known genetic, craniofacial, neurological, or psychiatric conditions. Children with a parafunctional habit or early dental loss and those receiving orthodontic treatment were not selected. All children underwent polysomnography, and three were excluded because they showed an apnea-hypopnea index lower than one or minimal oxygen saturation higher than 92%. The sample consisted of 55 children classified into mild (33 children) and moderate/severe (22 children) obstructive sleep apnea groups. Detailed clinical and anatomical evaluations were performed, and anthropometric, otorhinolaryngological, and orthodontic variables were analyzed. Sleep disorder symptoms were assessed using the Sleep Disturbance Scale for Children questionnaire. All children also underwent teleradiography exams and Rickett's and Jarabak's cephalometric analyses. Results The mild and moderate/severe obstructive sleep apnea groups showed no significant differences in clinical criteria. Facial depth angle, based on Ricketts cephalometric analysis, was significantly different between the groups (p= 0.010), but this measurement by itself does not express the child's growth pattern, as it is established by the arithmetic mean of the differences between the obtained angles and the normal values of five cephalometric measurements. Conclusions The clinical criteria and craniofacial characteristics evaluated did not influence the disease severity.

Brazilian Thoracic Association Consensus on Sleep-disordered Breathing / Consenso em Distúrbios Respiratórios do Sono da Sociedade Brasileira de Pneumologia e Tisiologia

ABSTRACT Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.

RESUMO O sono é essencial para o adequado funcionamento de todos os indivíduos. Os distúrbios respiratórios do sono ocorrem em todas as faixas etárias, constituindo motivo frequente de consulta médica. O objetivo deste consenso foi atualizar os conhecimentos sobre os principais distúrbios respiratórios do sono tanto na população adulta quanto na pediátrica, com ênfase na apneia obstrutiva do sono. A apneia obstrutiva do sono é uma doença extremamente prevalente, porém frequentemente subdiagnosticada. Associa-se frequentemente a uma série de comorbidades, notadamente cardiovasculares, metabólicas e neurocognitivas, que impactam significativamente na qualidade de vida e na mortalidade. Por conta disso, o Departamento de Distúrbios Respiratórios do Sono da Sociedade Brasileira de Pneumologia e Tisiologia reuniu 14 especialistas com reconhecida e comprovada experiência em distúrbios respiratórios do sono para a elaboração deste documento.

Herramientas prácticas para SAOS: de la sospecha al seguimiento / OSA toolkit: from suspected diagnosis to follow up

El síndrome de apnea obstructiva del sueño (SAOS) es uno de los trastornos respiratorios del sueño más prevalente con consecuencias cardiovasculares y de calidad de vida conocidas. El presente artículo describe el uso de herramientas sencillas aplicables en la práctica clínica para el reconocimiento y objetivación de signos y síntomas para un correcto diagnóstico y seguimiento de pacientes con SAOS

Obstructive sleep apnea (OSA) is one of the most prevalent sleep respiratory disorders with well known cardiovascular disease and quality of life outcomes. This article describes a simple toolkit intended for clinical screening, diagnosis and follow up in OSA patients

Rastreamento e manejo da Síndrome da Apneia e Hipopneia Obstrutiva do Sono. Desafios para profissionais da Atenção Primária à Saúde / Screening and management of Obstructive Sleep Apnea and Hypopnea Syndrome. Challenges for Primary Health Care Professionals

A Síndrome da Apneia e Hipopneia Obstrutiva do Sono (SAHOS) é condição clínica importante com incidência crescente nos países desenvolvidos e em desenvolvimento. É condição negligenciada, com prevalência entre 30 e 56%, responsável por 80% dos casos de hipertensão arterial resistente, causa de sonolência diurna, hiperutilização de serviços de saúde, incapacidade laboral, sintomas depressivos, acidentes de trânsito e de trabalho e fator de risco para doenças cardiovasculares. Este artigo tem como objetivo atualizar informações e com isso alertar sobre a importância do rastreamento e manejo da SAHOS em população com hipertensão arterial sistêmica assistida na atenção primária à saúde.

Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) is an important clinical condition with increasing incidence in developed and developing countries. It is a neglected condition, with prevalence between 30 and 56%, responsible for 80% of cases of resistant hypertension, causes daytime sleepiness, hyper-utilization of health services, work incapacity, depressive symptoms, traffic and work accidents, and risk factor for cardiovascular diseases. The aim of this article is to update information and thus alert about the importance of the screening and management of OSAHS in a population with high blood pressure assisted in Primary Health Care.

Determinants of adherence to continuous positive airway pressure therapy in adults with obstructive sleep apnea / Determinantes de adherencia a presión positiva continua de la via aérea en adultos con apnea del sueño

ASBTRACT Objectives Adherence to continuous positive airway pressure (CPAP) devices in patients with obstructive sleep apnea (OSA) determines the effectiveness of the treat-ment. Likewise, the assessment of the control of the disease must consider the information referred by the patient, among other value-based health measures related to the satisfaction of the intervention. The objectives of this study were a) Determine the factors related to adherence to CPAP devices in subjects with OSA affiliated to an insurance company of the healthcare system in Colombia. b) Assess symptom control associated to the disease from the individual's perspective and his/her satisfaction with the treatment received. Materials and Methods 1,501 subjects with OSA were surveyed by telephone to explore: sociodemographic factors, habits and lifestyles, use of CPAP and its adverse events, control of the disease, comorbidities, access to care and therapy satisfaction. Using multilevel logistic regression techniques, the influence of the various factors on adherence to CPAP was analyzed, using Stata 13 software. Results Adherence to CPAP therapy was of 58% and the control of symptoms was of 41.7%. The factors that determined the use of CPAP were knowledge on how the device operates, and the disturbances during sleep due to the mask or nasal pad. The-rapy satisfaction was predominantly very good or good. Conclusion Even with moderate adherence values and a good experience with CPAP therapy, symptomatic control of the disease is poor. Many of the factors that affect the use of CPAP are modifiable with a proper approach by the devices' service provider.

RESUMEN Objetivos La adherencia a los dispositivos de presión positiva continua de la vía aérea (CPAP) en pacientes con síndrome de apnea obstructiva del sueño (SAOS) define la efectividad del tratamiento. Los objetivos de este estudio fueron: a) Determinar los factores relacionados con la adherencia al CPAP en pacientes con SAOS de una aseguradora del Sistema General de Seguridad Social en Salud colombiano y b) evaluar el control de los síntomas de la enfermedad desde la perspectiva del individuo y su satisfacción con la terapia. Materiales y Métodos Mediante encuesta telefónica a 1 501 pacientes con SAOS se exploraron factores sociodemográficos, hábitos y estilos de vida, uso del CPAP y eventos adversos relacionados, control de la enfermedad, comorbilidad, acceso a la atención y satisfacción con la terapia. Utilizando técnicas de regresión logística mul-tinivel, se analizó la influencia de los distintos factores sobre la adherencia al CPAP mediante el software Stata 13. Resultados La adherencia al CPAP fue del 58% y el control de los síntomas del 41,7%. Los factores que determinaron el uso del CPAP fueron el conocimiento del funcionamiento del equipo y la dificultad para dormir debida a la mascarilla o la almohadilla nasal. La satisfacción con la terapia fue buena o muy buena predominantemente. Conclusiones Aún con valores de adherencia moderados y una buena experiencia con la terapia CPAP, el control sintomático de la enfermedad es pobre, pues varios de los factores afectan el uso del CPAP. Dichos factores se pueden intervenir con un adecuado abordaje por parte del prestador de servicios del dispositivo.

Comparación de tres cuestionarios pronósticos de riesgo para síndrome obstructivo de apnea e hipopnea de sueño en adultos

Objetivo: Determinar las diferencias en el pronóstico del riesgo de presentar el síndrome obstructivo de apnea/hipopnea del sueño (SOAHS) al comparar los resultados de los cuestionarios de Berlín (CB), STOP-Bang (SB) y la Escala de somnolencia de Epworth (ESE) en pacientes internados en el Hospital Nacional Dos de Mayo durante el periodo 2019-2020. Materiales y métodos: Estudio clínico cuantitativo, observacional, descriptivo de pruebas diagnósticas, prospectivo y transversal. Se incluyó una muestra de 304 pacientes mayores de 18 años. Los resultados se presentan con frecuencias, medidas de tendencia central y de dispersión. Las variables se asociaron mediante la prueba de X2. Se midió la sensibilidad y especificidad del CB y ESE respecto a SB. El valor de p menor de 0,05 se consideró como significativo. Resultados: El promedio de edad fue de 52,89 ± 15,97 años, con predominio de los adultos menores de 50 años (40,50 %). El 60,50 % de los participantes fueron de sexo masculino. El promedio del IMC fue 30,74 ± 6,02 kg/m2 y la categoría más numerosa fue el sobrepeso (43,40 %). El 42,80 % tenía hipertensión. Según el SB, CB y la ESE, el 77,00 %, 62,50 % y 60,50 % tenían alto riesgo de presentar el SOAHS, respectivamente. Los cuestionarios mostraron una asociación entre edad, sexo, diagnóstico nutricional e hipertensión arterial con un elevado riesgo de presentar SOAHS (p < 0,05). Existe una débil correlación entre SB y CB (Kappa: 0,39) y SB y ESE (Kappa: 0,33). Conclusiones: Los cuestionarios son herramientas útiles con el potencial de pronosticar el riesgo de SOAHS. Presentan una correlación significativa, pero débil, entre su pronóstico de riesgo del síndrome. Sin embargo, deben ser considerados como pruebas de detección rápida y confiable.

Objective: To determine the differences in the prediction of the risk of developing obstructive sleep apnea-hypopnea syndrome (OSAHS) by comparing the results of the Berlin Questionnaire (BQ), the STOP-Bang (SB) Questionnaire and the Epworth Sleepiness Scale (ESS) in patients admitted to the Hospital Nacional Dos de Mayo from 2019 to 2020. Materials and methods: A quantitative, observational, descriptive, prospective and cross-sectional clinical study of diagnostic tests. A sample of 304 patients older than 18 years was included in the research. The results are presented with frequencies, measures of central tendency and dispersion. The variables were associated using the chi-square test. The sensitivity and specificity of the BQ and ESS were measured against the SB Questionnaire. A p value less than 0.05 was considered as statistically significant. Results: The average age of the study population was 52.89 ± 15.97 years and adults under 50 years of age (40.5 %) prevailed. Sixty point five percent (60.5 %) of the participants were males. The average BMI was 30.74 ± 6.02 kg/m2, with the overweight category being the most numerous (43.40 %). Forty-two point eight percent (42.8 %) of the participants had hypertension. According to the SB Questionnaire, BQ and ESS, 77.0 %, 62.5 % and 60.5 % had a high risk of developing OSAHS, respectively. The questionnaires showed an association between age, sex, nutritional diagnosis and arterial hypertension, and a high risk of developing OSAHS (p < 0.05). There is a weak correlation between the SB Questionnaire and BQ (Kappa: 0.39), and between the SB Questionnaire and ESS (Kappa: 0.33). Conclusions: The abovementioned questionnaires are useful tools to predict the risk of developing OSAHS. They show a significant but weak correlation between them. However, they should be considered as rapid and reliable screening tests.

Respiración de Cheyne-Stokes en una adolescente con insuficiencia cardíaca secundaria a miocardiopatía dilatada que requirió trasplante cardíaco / Cheyne-Stokes respiration in an adolescent with heart failure secondary to dilated cardiomyopathy requiring heart transplantation

La respiración de Cheyne-Stokes es una variante cíclica o tipo de apnea central del sueño poco frecuente en la población pediátrica. Se describe a una paciente de 12 años con insuficiencia cardíaca grave relacionada con miocardiopatía dilatada que demostró trastornos del sueño con características de respiración de Cheyne-Stokes, que se resolvieron completamente después del trasplante cardíaco.

Cheyne-Stokes respiration is a cyclic variant or type of central sleep apnea rare in pediatric population. We describe a 12-year-old female patient with severe heart failure related to dilated cardiomyopathy who demonstrated sleep disorders with Cheyne-Stokes breathing features, which completely resolved following cardiac transplantation.

Avaliação da capacidade funcional, força muscular respiratória e pico de fluxo expiratório em pacientes com apneia obstrutiva do sono / Evaluation of functional capacity, respiratory muscular strength and expiratory flow peak in patients with obstructive sleep apnea

Introdução: A síndrome da apneia obstrutiva do sono (SAOS) é caracterizada pela obstrução das vias aéreas superiores durante o sono, o que causa efeitos sistêmicos durante a vigília. Objetivo: O objetivo deste estudo é avaliar a capacidade funcional, a força da musculatura respiratória e o pico de fluxo expiratório (PFE) de pacientes com SAOS. Métodos: Trata-se de um estudo transversal realizado na cidade de Patos de Minas/MG no ano de 2019, no qual foram incluídos 14 indivíduos que possuíam SAOS moderada e grave. Primeiramente os pacientes responderam a um questionário sociodemográfico elaborado pelos autores. Em seguida, foi realizada a manovacuometria, a mensuração do PFE e o teste de caminhada de seis minutos (TC6M). Resultados: A maioria dos pacientes eram homens (71,4%), obesos (78,6%) e hipertensos (57,1%). Como resultados dos testes obtivemos - PImáx obtida vs predita = 86,4 vs 102,8 (p = 0,004), PEmáx obtida vs predita = 98,5 vs 113,5 (p = 0,05), PFE obtido vs predito = 381,3 vs 495,8 (p < 0,001) e TC6M obtido vs predito = 485,3m vs 536,6m (p = 0,03). Conclusão: Nessa amostra de indivíduos com SAOS grave e moderada houve redução da força muscular respiratória, do PFE, e da capacidade funcional. (AU)

Introduction: Obstructive sleep apnea syndrome (OSAS) is characterized by upper airway obstruction during sleep, which causes systemic effects during wakefulness. Objective: The objective of this study is to assess functional capacity, respiratory muscle strength and peak expiratory flow (PEF) in patients with OSAS. Methods: This is a cross-sectional study held in the city of Patos de Minas/MG in the year of 2019, that included 14 individuals who had severe and moderate sleep apnea. First, the patients answered to a sociodemographic questionnaire prepared by the authors. Then, manovacuometry, PEF and six-minute walk test (6MWT) were performed. Results: Most patients were men (71.4%), obese (78.6%) and hypertensive (57.1%). As results of the tests we obtained - MIP obtained vs predicted = 86.4 vs 102.8 (p = 0.004), MPE obtained vs predicted = 98.5 vs 113.5 (p = 0.05), PEF obtained vs predicted = 381.3 vs 495.8 (p <0.001) and 6MWT obtained vs predicted = 485.3m vs 536.6m (p = 0.03). Conclusion: In this sample of individuals with severe and moderate OSAS, we observed a reduction in respiratory muscle strength, PEF, and functional capacity. (AU)