Rapid maxillary expansion and obstructive sleep apnea: a review and meta-analysis

Background: OSAS during childhood leads to significant physical and neuropsychomotor impairment. Thus, it needs to be recognized and treated early in order to avoid or attenuate the chronic problems associated with OSAS, which are deleterious to a child’s development. Adenotonsillectomy and, in select cases, continuous positive airwaypressure (CPAP) have been the preferred treatments for OSAS in children, and yet they are ineffective at fully ameliorating the disease. Minimally invasive treatments have recently been proposed, comprising intra-oral and extra-oral devices as well as speech therapy. Objetive: to conduct a meta-analysis on studies from around the world that used rapid maxillary expansion (RME) to treat OSAS in children. Material and Methods: We performed a meta-analysis of studies using RME for OSA treatment in children. A literature survey was conductedusing PubMed and Medline for English articles published up to December 2014 with the following descriptors: Sleep Apnea, Obstructive, Children, Treatment, Orthodontic, Othopaedic, Maxillaryexpansion. Studies were included in the meta-analysisif they were case-controlled studies, randomized, and involved non-syndromic children aged 0 to 12years old diagnosed with OSA by the polysomnography apneahypopnea index (AHI) before and after the intervention, submitted RME only. Results: In all, 10 articles conformed to the inclusion criteria and were included in this meta-analysis. The total sample size across all these articles was 215 children, having a mean age of 6.7 years,of whom58.6%were male. The mean AHI during the follow-up was -6.86 (p <0.0001). Conclusions: We concluded that rapid maxillary expansion (RME) in children with OSAS appears to be an effective treatment for this syndrome. Further randomized clinical studies are needed to determine the effectiveness of RME in adults

Randomized controlled study of a mandibular advancement appliance for the treatment of obstructive sleep apnea in children: a pilot study

Background: The current limited evidence may be suggestive that mandibular advancement appliance (MAAs) result in improvements in AHI scores, but it is not possible to conclude that MAAs are effective to treat paediatric OSA. There are significant weaknesses in the existing evidence due primarily to absence of control groups, small sample sizes, lack of randomization and short-term results. Aim: the objective of the present study was to evaluate MAAs in children with OSA. Material and Methods: Children presenting an apnea-hypopnea index (AHI) greater than or equal to one event per hour were considered to be apneic. This group of children with AHI greater than or equal to one was randomly divided through a draw into two subgroups: half of them in an experimental subgroup and half of them in a control subgroup. In the experimental subgroup, molds of each of these children’s maxillary and mandibular arches were taken using standard molds and molding material. The control group did not use any intraoral device and did not undergo any type of treatment for OSAS. The MAAs used in this study had the aim of achieving mandibular advancement, thereby correcting the mandibular position and dental occlusion, and perhaps increasing the airway and treating OSAS. After 12 consecutive months of use of the mandibular advancement devices, polysomnography examinations using the same parameters as in the initial examinations were requested for both the experimental and the control subgroup. Results: There was a decrease in AHI in the experimental group and an increase in the control group, with statistical significance. These data were used to calculate the sample size, which was 28 children in total in the groups. Conclusions: There was a decrease in AHI one year after implementing use of mandibular advancement devices, in comparison with the group that did not use these devices

Sleep duration, health status, and subjective well-being: a population-based study

OBJECTIVE: To evaluate, in a population-based approach, the association of extreme sleep duration with sociodemographic factors, health, and well-being. METHODS: We analyzed the data from the 2014/2015 Health Survey in the city of Campinas, State of São Paulo, Brazil (ISACamp), performed with 1,969 individuals (≥ 20 years old). Associations between the independent variable and short (≤ 6 hours) and long (≥ 9 hours) sleep were determined using the Rao-Scott chi-square test. The analyses were adjusted with multinomial logistic regression models. RESULTS: Men, individuals aged 40 to 59, those with higher schooling, those who have one (OR = 1.47, 95%CI 1.02–2.12), two (OR = 1.73, 95%CI 1.07–2.80), or three or more (OR = 1.62, 95%CI 1.16–2.28) chronic diseases, and those with three or more health problems (OR = 1.96, 95%CI 1.22–3.17) were more likely to have a short sleep. The chance of long sleep was higher in widowers and lower in those who have more years of schooling, with higher income, worked, lived with more residents at home, and reported three or more diseases (OR = 0.68, 95%CI 0.48–0.97) and health problems. The chance of either short (OR = 2.41, 95%CI 1.51–3.87) or long sleep (OR = 2.07, 95%CI 1.23–3.48) was higher in unhappy individuals. CONCLUSIONS: These findings highlight the higher chance of short sleep duration among men, among persons in productive age, and among those with a higher level of schooling in a Brazilian city. The association of short sleep with comorbidities and the association of happiness with extremes of sleep duration were also important results to understand the relation of sleep duration with health and well-being

Qualidade do sono, saúde e bem-estar em estudo de base populacional

OBJETIVO: Estimar a prevalência de sono autoavaliado como ruim e identificar os subgrupos da população mais susceptíveis ao problema. MÉTODOS: Trata-se de estudo transversal, de base populacional, desenvolvido com dados de Inquérito de Saúde conduzido no município de Campinas (ISACamp 2014/2015). Foram analisados dados de amostra representativa de 1.998 indivíduos com 20 anos ou mais de idade. A qualidade autoavaliada do sono foi analisada segundo características sóciodemográficas, morbidades, comportamentos de saúde e sentimentos de bem-estar. Analisou-se também a associação da qualidade do sono com diferentes queixas e características do sono. Foram estimadas razões de prevalências e desenvolvido modelo de regressão múltipla de Poisson, considerando-se nas análises os pesos amostrais. RESULTADOS: A prevalência de sono autoavaliado como ruim foi 29,1% e mostrou-se significativamente mais elevada nas mulheres, em indivíduos de 40 a 50 anos de idade, migrantes, sem ocupação, fisicamente inativos em contexto de lazer, com transtorno mental comum (RP = 1,59), com maior número de problemas de saúde (RP = 2,33), com saúde autoavaliada como ruim (RP = 1,61) e que manifestavam insatisfação com a vida. Sono ruim esteve fortemente associado com relatos de dificuldade de iniciar o sono (RP = 4,17), de manter o sono (RP = 4,40) e com nunca ou quase nunca se sentir bem-disposto ao acordar (RP = 4,52). CONCLUSÕES: Os resultados identificam os segmentos da população com má qualidade do sono que merecem maior atenção e destacam a necessidade de avaliar, além da presença de comorbidades, a saúde mental e a presença de sentimentos de bem-estar no processo de cuidado dos pacientes com problemas de sono e no planejamento de intervenções voltadas à promoção de sono saudável.OBJECTIVE: To estimate the prevalence of poor self-rated sleep and to identify the population subgroups most susceptible to the problem. METHODS: This is a cross-sectional, population-based study developed with data from the Health Survey conducted in the city of Campinas (ISACamp 2014/2015). Data from a sample of 1,998 individuals aged 20 years or older were analyzed. The self-rated quality of sleep was analyzed according to socio-demographic characteristics, morbidities, health behaviors and feeling of well-being. The association of sleep quality with different complaints and characteristics of sleep was also analyzed. Adjusted prevalence ratios were estimed using Poisson multiple regression model allowing for the sample weights. RESULTS: Prevalence of poor self-rated sleep was 29.1% and showed to be significantly higher in women, in individuals aged from 40 to 50 years, migrants, without occupation, physically inactive in leisure context, with common mental disorder (PR = 1.59), with greater number of health problems (PR = 2.33), poor self-rated health (PR = 1.61), and life dissatisfaction. Poor sleep was strongly associated with reports of difficulty in initiating sleep (PR = 4.17), in maintaining sleep (PR = 4.40) and with never or almost never feeling well when waking up (PR = 4.52). CONCLUSIONS: The results identify the population subgroups with poor quality of sleep that deserve greater attention. It also highlight the need to consider, in addition to the presence of comorbidities, mental health and the feeling of well-being in the care of patients with sleep problems and in the interventions planed for promoting healthy sleep

A apneia obstrutiva do sono impede a esperada diferença de crescimento cranofacial de meninos e meninas

OBJECTIVES: It was to compare cephalometric measures of mouth-breather boys and girls and with the cephalometric pattern observed in obstructive sleep apnea syndrome (OSAS) patients. METHODS: Craniofacial measurements of lateral cephalometric radiographs obtained from 144 children aged 7-14 years were compared between boys and girls, and both were compared to cephalometric pattern of OSAS patients. RESULTS: Mouth-breather boys and girls had no gender differences regarding to craniofacial morphology while nose-breather boys and girls showed those expected differences. Nose-breather boys presented a more retruded mandible and proinclined upper incisor when compared to nose-breather girls, but mouth-breather boys and girls had no differences. The measure NS.GoGn was the only variable with an interaction with gender and breathing. CONCLUSIONS: There were no cephalometric difference in mouth breather-boys and girls related to normal growth, suggesting that oral breathing make the same craniofacial morphology and both have craniofacial morphology close to that of OSAS patients.OBJETIVOS: Foi comparar medidas cefalométricas entre meninos e meninas respiradores bucais com o padrão cefalométrico de pacientes com síndrome da apneia obstrutiva do sono (SAOS). MÉTODOS: Medidas craniofaciais de radiografias cefalométricas laterais de 144 crianças com idade entre 7 e 14 anos foram comparadas entre meninos e meninas, e estas comparadas com o padrão cefalométrico de pacientes com SAOS. RESULTADOS: Meninos e meninas respiradores bucais não apresentaram diferenças em relação à morfologia craniofacial, enquanto meninos e meninas respiradores nasais mostraram as diferenças fisiologicamente esperadas. Meninos respiradores nasais apresentaram mandíbula mais retraída e incisivos superiores inclinados para frente quando comparados com meninas respiradoras nasais, mas os respiradores bucais não apresentaram diferenças. A medida NS.GoGn foi a única variável com interação entre gênero e tipo de respiração. CONCLUSÕES: Não houve diferença cefalométrica entre os respiradores bucais em relação ao crescimento craniofacial, sugerindo que a respiração bucal determina a mesma morfologia, e ambos os gêneros têm morfologia craniofacial semelhante àquela dos pacientes com SAOS.Universidade Federal de Sào Paulo São Paulo Hospital Department of NeurologySciEL

Correlation between cephalometric data and severity of sleep apnea

AbstractIntroductionObstructive sleep apnea syndrome has a high prevalence among adults. Cephalo- metric variables can be a valuable method for evaluating patients with this syndrome.ObjectiveTo correlate cephalometric data with the apnea-hypopnea sleep index.MethodsWe performed a retrospective and cross-sectional study that analyzed the cephalo- metric data of patients followed in the Sleep Disorders Outpatient Clinic of the Discipline of Otorhinolaryngology of a university hospital, from June 2007 to May 2012.ResultsNinety-six patients were included, 45 men, and 51 women, with a mean age of 50.3 years. A total of 11 patients had snoring, 20 had mild apnea, 26 had moderate apnea, and 39 had severe apnea. The distance from the hyoid bone to the mandibular plane was the only variable that showed a statistically significant correlation with the apnea-hypopnea index.ConclusionCephalometric variables are useful tools for the understanding of obstructive sleep apnea syndrome. The distance from the hyoid bone to the mandibular plane showed a statisti- cally significant correlation with the apnea-hypopnea index

Home sleep testing for Obstructive Sleep Apnea Syndrome: an accuracy study

Introdução: A Sindrome da Apneia Obstrutiva do Sono (SAOS) e prevalente e necessita exames complementares para o diagnostico e avaliacao da gravidade. A Monitorizacao Portatil do Sono pode ser realizada na casa do paciente e custa menos que a polissonografia convencional. OBJETIVO: Comparar a monitorizacao assistida no laboratorio com a nao assistida domiciliar utilizando o mesmo equipamento. MATERIAL E METODOS: Quarenta pacientes com alta probabilidade de apresentarem SAOS foram submetidos a 02 monitorizacoes do sono em dias consecutivos com a seguinte montagem: 02 canais de eletroencefalografia (EEG), eletromiograma (EMG), eletro-oculograma (EOG), canula nasal e esforco respiratorio com cintas pletismograficas no torax e abdome, posicao corporal, frequencia cardiaca e oximetria. Metade dos pacientes foi randomizada para comecar na residencia (exame nao assistido) e a outra metade no laboratorio (exame assistido), usando o equipamento Embletta X100®. As principais variaveis do sono, o IAH, a preferencia pelo local de exame e os custos foram comparados. A analise dos exames foi realizada por observador cego ao procedimento. RESULTADOS: Dos 40 pacientes incluidos, em 06 pacientes houve perda dos dados. Dentre os 34 pacientes, 24 eram homens e 10 mulheres com idade media de 40,6 anos, IMC medio 28,02Kg/m2, Escala de Sonolencia de Epworth media de 10,2. Catorze pacientes (09 homens e 05 mulheres) comecaram o exame em casa e 20 no laboratorio (15 homens e 05 mulheres). A efiCiência do sono media foi 77,8% em casa e no laboratorio 80,4%. A comparacao quanto a distribuicao das fases nao demonstrou diferenca significante. Para os eventos respiratorios, o Coeficiente de Correlacao foi 0,89. Adotando-se o IAH com corte em 15 eventos/hora, observamos as seguintes proporcoes de concordancia: 1) Com o IAH &#8804; 15 eventos/hora: foram 20 em casa e 24 no laboratorio; 2) Com IAH &#8805; 15/hora, 12 em casa e 10 no laboratorio. Quando nao houve concordancia, a diferenca media no IAH foi de 11,5%. A sensibilidade e especificidade da monitorizacao domiciliar comparada a laboratorial foi 0,80 e 0,83 respectivamente. A saturacao da oxi-hemoglobina nao diferiu entre os grupos. O exame domiciliar foi a preferencia de 90 % dos pacientes. A monitorizacao domiciliar teve custo 25,1% menor que a laboratorial. CONCLUSAO: A monitorizacao portatil do sono assistida em laboratorio, em pacientes com chance de apresentar SAOS, apresenta excelente correlacao com a monitorizacao nao assistida domiciliar. A alta sensibilidade e especificidade e o menor custo do exame domiciliar sugerem que a utilizacao deste procedimento seja util na abordagem da SAOS, uma doenca de alta prevalencia e graves consequencias a SaúdeBV UNIFESP: Teses e dissertaçõe