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

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.

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

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.

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.

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.

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.

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.

Síndrome de apnea obstructiva del sueño persistente en niños adenoamigdalectomizados: artículo de revisión

Resumen El síndrome de apnea e hipoapnea obstructiva del sueño (SAHOS) en niños forma parte del espectro de trastornos respiratorios del sueño en la infancia. Tiene una prevalencia entre un 0,69% y 4,7% en la población infantil con una mayor incidencia entre los 2 y 6 años debido principalmente a la hiperplasia adenoamigdaliana y constituye una importante causa de morbilidad neurocognitiva y conductual en quienes lo padecen. El principal tratamiento quirúrgico del SAHOS infantil lo constituye la adenoamigdalectomía, cirugía que logra la resolución de los síntomas entre un 20% y 75% de los pacientes. Los pacientes con comorbilidades asociadas tales como obesidad, enfermedades neuromusculares y alteraciones craneofaciales, entre otras, tienen mayor riesgo de SAHOS persistente. En la presente revisión de la literatura abordaremos el diagnóstico, enfrentamiento, estudio y tratamiento del SAHOS persistente posadenoamigdalectomía en niños.

Abstract Obstructive sleep apnea syndrome (OSA) in children is part of the spectrum of respiratory sleep disorders in childhood. It has a prevalence between 0.69 and 4.7% in pediatric population, with a higher incidence between 2 and 6 years old, mainly due to adenotonsillar hyperpla-sia. OSA constitutes an important cause of neurocognitive and behavioral morbidity. The main surgical treatment for childhood OSA is adenotonsi-llectomy, which resolves symptoms in 20%-75% of patients. Patients with associated comorbidities such as obesity, neuromus-cular diseases, and craniofacial malformations are at higher risk of having persistent OSA. In this literature review, we will discuss the diagnosis, evaluation and treatment of persistent OSA after adenotonsillectomy in children.

Progress on basic and clinical research of immunology in lung transplantation / 器官移植

The quality of life of organ transplant recipients is closely correlated with immune status. Compared with those undergoing other solid organ transplantation, the long-term prognosis of lung transplant recipients is worse. The underlying immune mechanism is complex with both similarities and characteristics. Therefore, in-depth understanding of the immune mechanism in the process of immune response of allogeneic lung transplantation plays a critical role in improving the long-term survival of the recipients. In this article, the unique composition of immune cells in the lung, the characteristics of rejection after lung transplantation, the early warning and differential diagnosis of pathogen infection in lung transplantation and postoperative complications after lung transplantation were investigated. Research progress on clinical diagnosis and basic studies related to immunology in allogeneic lung transplantation were summarized, aiming to elucidate the immunological characteristics of lung transplantation and provide theoretical basis for improving the longterm survival of lung transplant recipients and prevention and treatment of allograft dysfunction.

The effects of combining aerobic training with resistance training on the heart rate and exercise capacity of persons with obstructive sleep apnea / 中华物理医学与康复杂志

Objective:To explore the effect of individualized aerobic training combined with resistance training on heart rate recovery and exercise capacity among patients with obstructive sleep apnea syndrome (OSAS) and explore possible mechanisms.Methods:Forty middle-aged patients with moderate to severe OSAS were randomly assigned to an observation group (OG, n=20) or a control group (CG, n=20). Both groups were given routine health guidance and motor training, while the OG additionally underwent individualized aerobic exercise training at 60%~75% of their peak power and resistance training loaded at 60%~80% of their ten-times maximum repetition figure. The training was three times a week for 3 months. Both groups underwent cardiopulmonary exercise testing and polysomnography before and after the 12-week intervention. The changes in their sleep apnea hypopnea index (AHI), oxygen desaturation index (ODI) and lowest oxygen saturation (L-SAO 2) were collected. Exercise capacity indicators such as peak oxygen uptake (VO 2peak), peak power, anaerobic threshold and sitting heart rate recovery (HRR) 1, 2 and 3 minutes after the test were recorded (denoted as HRR-1, HRR-2 and HRR-3). Results:There were no significant differences between the two groups in any of the measurements before the intervention. Afterward the average AHI, ODI and L-SAO 2 values of the observation group had all improved significantly compared with those before the training and compared with the control group′s values after the training. After the training, the VO 2peak and peak power of the observation group had also improved significantly compared with before the training and compared with the control group. HRR-1, HRR-2 and HRR-3 were all significantly higher in the observation group than before the training and higher than the control group′s values after the training. Conclusion:Combining aerobic and resistance training can improve the exercise ability and heart rate of middle-aged patients with moderate to severe OSAS, and also reduce the severity of their OSAS to some extent.

Expansión maxilar rápida para pacientes pediátricos con síndrome de apnea obstructiva del sueño / Rapid maxillary expansion in pediatric patients with obstructive sleep apnea syndrome

RESUMEN: Introducción: El síndrome de apnea obstructiva del sueño (SAOS) es un trastorno respiratorio del sueño frecuente, caracterizado por episodios de obstrucción parcial o total de las vías respiratorias durante el sueño. La expansión maxilar rápida se ha propuesto como un posible tratamiento de esta patología en niños ya que su uso aumentaría el volumen de la vía aérea superior. Sin embargo, su uso para el tratamiento de apnea obstructiva del sueño es controvertido. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos seis revisiones sistemáticas que en conjunto incluyeron 23 estudios primarios. Concluimos que no es posible establecer con claridad el efecto del uso de la expansión maxilar sobre el índice de apnea-hipoapnea, eficiencia y tiempo del sueño, y microdespertares por causa respiratoria, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja. No se encontraron estudios que evaluaran los efectos adversos ni la somnolencia diurna de los pacientes sometidos a expansión maxilar.

ABSTRACT: Introduction: Obstructive sleep apnea (OSA) is a frequent sleep disorder characterized by recurrent episodes of complete or partial obstruction of the upper airway during sleep. Since rapid maxillary expansion increases the volume of the upper airway, it has been proposed as a treatment option for OSA in children. However, its use is controversial. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified six systematic reviews including 23 studies overall. We are uncertain whether rapid maxillary expansion reduces apnea-hypopnea index and micro-awakenings, or improves sleep efficiency and total sleep time as the certainty of the evidence has been assessed as very low. No studies were found that looked at adverse effects or daytime sleepiness.

Surgical treatment in obstructive sleep apnea syndrome: an overview

Obstructive sleep apnea syndrome is a common pathology affecting pediatric and adult population. It is caused by an increase upper airway resistance due to augmented collapsibility that cause alteration in ventilation and oxygen saturation. Sleep oxygen desaturations have multi-organ implications. Since many years, OSAS, has been recognized as a risk factors for comorbid cardiovascular disease. Well-known is the causal link with cognitive impairment and atherosclerosis. Healthcare professionals, should be trained to recognize signs and symptoms of the disease in order to send the patients forward for specialist care in centers dealing with sleep-disordered breathing. However treatment knowledge is of pivotal importance in the cultural baggage of all the physicians.  Surgical and non-surgical therapies have undergone a great number of changes. Going along with the innovations in diagnostic evaluation and phenotyping of the patients, surgeries were heightened by new developments such as advances in tailoring procedures and technologies. The aim of this overview is to describe the evolution and main characteristics of encoded procedures classified into site of surgical correction.

Danger in traffic: patients with obstructive sleep apnea syndrome

Background: Author aimed to investigate the presence of a driver's license of patients with sleep apnea and obstructive sleep apnea syndrome (OSAS) and to prevent them from going into traffic until they are treated.Methods: In this study 645 hospitalized patients in the sleep lab for one night in 2017-2018 for polysomnography (PSG) test were questioned. We compared Apne Hipopne Indexes (AHI) and Body Mass Indexes (BMI). Patients who have risk for traffic accidents were identified.Results: Total 424 (66%) of 645 patients were above AHI> 15, moderate and severe Obstructive Sleep Apnea Syndrome (OSAS) was diagnosed. 221 patients (34.3%) obtained a driver's license because they have mild OSAS (The AHI <15). 162 patients with AHI 15-30 (25.1%) had severe OSAS with medium OSAS and 262 patients (40.6%) had AHI> 30. Also, 410 patients with a driver's license in 645 patients had BMI> 25 kg/m2 in 373 (91%). 340 (83%) of 645 patients with a driver's license were male; 70 (17%) of them are women. All of those with a heavy vehicle license are men and the number is 110.Conclusions: To prevent possible traffic accidents, driver patients with OSAS detected by a polysomnography test should be withdrawn from the driver's license until they receive treatment and receive an updated health report.

Morphological change analysis based on cone beam CT of the upper airway for obstructive sleep apnea syndrome patients treated with oral appliance in skeletal class Ⅱ malocclusion with different vertical patterns / 华西口腔医学杂志

OBJECTIVE@#To analyze the morphological changes in the upper airway of obstructive sleep apnea syndrome (OSAS) patients treated with oral appliance in skeletal class Ⅱ malocclusion with different vertical features by using cone beam CT (CBCT).@*METHODS@#Thirty-six patients diagnosed with OSAS by polysomnography and daytime sleepiness scale and skeletal class Ⅱ malocclusion were treated with oral appliance for 4 months. The changes based on CBCT in the morphology of glossopharyngeal and palatopharyngeal before and after treatment in OSAS patients with different vertical features were compared.@*RESULTS@#After treatment with oral appliance, the glossopharyngeal and palatopharyngeal morphologies of patients with mild OSAS showed significant changes. After treatment with oral appliance, the glossopharyngeal morphology of all patients showed significant changes (P<0.05). The palatopharyngeal morphology of patients in the lower and average groups also exhibited significant changes (P<0.05). Sagittal changes in the glossopharyngeal measurements of high-angle patients demonstrated significant difference, whereas the other measured values showed no significant difference.@*CONCLUSIONS@#The morphological changes in the upper airway were significant in OSAS patients with lower and average vertical patterns when treated with oral appliance, but the changes in high vertical patterns were not significant.

Relationship between obstructive sleep apnea syndrome and branch retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the relationship between obstructive sleep apnea syndrome(OSAS)and branch retinal vein occlusion(BRVO).<p>METHODS:Seventy consecutive patients with BRVO and 70 age- and sex-matched controls were evaluated retrospectively. All participants underwent Berlin questionnaire and full-night respiratory polysomnography(PSG)for estimating risk of OSAS and monitoring apnea-hypopnea index(AHI), minimal oxygen saturation(MOS).<p>RESULTS: Of the 70 BRVO patients, 49(70%)had OSAS,average AHI was(19.74±7.59), MOS was(82.45±9.17)%. For controls, only 23(33%)of 70 subjects had OSAS, average AHI was(13.69±6.35), average MOS was(88.44±8.72)% in controls. Incidence of OSAS, AHI and MOS between BRVO patients and controls were different significantly(χ2=19.331, <i>t</i>=5.115, 3.954, all <i>P</i><0.01). There was a positive correlation between OSAS and BRVO(<i>r</i>s=0.319, <i>P</i>=0.033). Of the 39 patients with acute BRVO, average AHI was(16.905±6.31), average MOS was(85.14±8.22)%. For the 31 patients with chronic BRVO, average AHI was(17.84±5.47), average MOS was(83.81±7.87)%. There were no significantly differences between acute BRVO patients and chronic BRVO patients in average AHI or MOS(<i>t</i>=0.653, 0.685, <i>P</i>=0.516, 0.496).<p>CONCLUSION: OSAS could be a trigger in the pathogenesis of BRVO or an important risk factor of CRVO development.

Correlation between severity of obstructive sleep apnea syndrome and red cell distribution width in elderly patients / 南方医科大学学报

OBJECTIVE@#To investigate the correlation between the severity of obstructive sleep apnea syndrome (OSAS) and red cell distribution width (RDW) in elderly patients.@*METHODS@#A cross-sectional study was conducted among 311 elderly patients diagnosed with OSAS in the snoring clinic between January, 2015 and October, 2016 and 120 healthy controls without OSAS from physical examination populations in the General Hospital of PLA. The subjects were divided into control group with apnea-hypopnea index (AHI) <5 (=120), mild OSAS group (AHI of 5.0-14.9; =90), moderate OSAS group (AHI of 15.0-29.9; =113) and severe OSAS group (AHI ≥ 30; =108). The clinical characteristics and the results of polysomnography, routine blood tests and biochemical tests of the subjects were collected. Multiple linear regression analysis was used to examine the correlation between OSAS severity and RDW.@*RESULTS@#The levels of RDW and triglyceride were significantly higher in severe OSAS group than in the other groups ( < 0.01). The levels of fasting blood glucose and body mass index were significantly higher in severe and moderate OSAS groups than in mild OSAS group and control group ( < 0.05 or < 0.01). Multiple linear regression analysis showed that AHI was positively correlated with body mass index (β=0.111, =0.032) and RDW (β=0.106, =0.029). The area under ROC curve of RDW for predicting the severity of OSAS was 0.687 (=0.0001).@*CONCLUSIONS@#The RDW increases as OSAS worsens and may serve as a potential marker for evaluating the severity of OSAS.