Assuntos
Afeto , Hipnose/estatística & dados numéricos , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Transtornos Somatoformes/diagnóstico , Humanos , Individualidade , Modelos Psicológicos , Transtornos Neuróticos/diagnóstico , Transtornos Neuróticos/psicologia , Inventário de Personalidade/estatística & dados numéricos , Psicometria , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos Somatoformes/psicologiaRESUMO
Nasal airway obstruction may exacerbate sleep apnea and is difficult to quantify on clinical examination. In this study, we examined the relationship among nasal patency, the frequency of sleep apnea events, and effective nasal continuous positive air pressures. Acoustic rhinometry was used as an objective measurement of nasal cross-sectional areas in 76 patients without nasal symptoms who underwent study with diagnostic polysomnography because of obstructive sleep apnea. Patients with persistent obstructive sleep apnea were titrated to nasal continuous positive air pressure in a split night study. All subjects had a mean apnea/hypopnea index of 28, and those with obstructive sleep apnea had a mean apnea/hypopnea index of 43. Mean cross-sectional areas 1 to 4 cm into the nose were 1.7, 1.1, 2.1, and 2.8 cm2, respectively (F = 39, p < 0.001). However, there was no correlation between the apnea/hypopnea index and the cross-sectional area at the four distances (r = 0.03, 0.06, 0.02, and 0.02, respectively, p = not significant). Correlations between nasal continuous positive air pressures and cross-sectional areas did not reveal a significant relationship at any of the four sites (r = 0.09, 0.07, -0.03, 0.00, respectively). Findings in patients with apnea were also compared with those in patients without apnea and significant differences were not found (F = 0.019, p = not significant). Although it would seem intuitive that increased nasal obstruction is associated with the severity of obstructive sleep apnea and difficulty with the use of nasal continuous positive air pressure, this study shows that nasal patency, as measured by acoustic rhinometry, does not correlate with the severity of obstructive sleep apnea, as determined by the apnea/hypopnea index or the effective nasal continuous positive air pressure.
Assuntos
Obstrução Nasal/terapia , Nariz/fisiopatologia , Respiração com Pressão Positiva , Síndromes da Apneia do Sono/terapia , Adulto , Fatores Etários , Anatomia Transversal , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico , Obstrução Nasal/patologia , Obstrução Nasal/fisiopatologia , Nariz/patologia , Polissonografia , Ventilação Pulmonar/fisiologia , Fatores Sexuais , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/patologia , Síndromes da Apneia do Sono/fisiopatologia , Som , Resultado do TratamentoRESUMO
Six patients diagnosed with obstructive sleep apnea completed titration of an adjustable oral appliance, called the Silencer, during a single night of polysomnography. This protocol allowed for rapid titration of the oral appliance and effective treatment of sleep apnea. Variables which showed improvement included frequency of obstructive events, oxyhemoglobin saturation and snoring. Dental appliance adjustments with the silencer device can be made within three minutes. We have demonstrated that incremental mandibular advancement and repositioning allow us to determine the most effective jaw position to treat sleep apnea and snoring, which is also most likely to be tolerated by the patient.