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Gurgel M, Cevidanes L, Costa F, Pereira R, Cunali P, Bittencourt L, Ruellas A, Gonçalves J, Bianchi J, Chaves C. Three-dimensional comparison between the effects of mandibular advancement device and maxillomandibular advancement surgery on upper airway. BMC Oral Health 2023; 23:436. [PMID: 37391785 PMCID: PMC10314553 DOI: 10.1186/s12903-023-03125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/10/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The efficacy of mandibular advancement devices (MAD) and maxillomandibular advancement (MMA) in improving upper airway (UA) patency has been described as being comparable to continuous positive airway pressure (CPAP) outcomes. However, no previous study has compared MAD and MMA treatment outcomes for the upper airway enlargement. This study aimed to evaluate three-dimensionally the UA changes and mandibular rotation in patients after MAD compared to MMA. METHODS The sample consisted of 17 patients with treated with MAD and 17 patients treated with MMA matched by weight, height, body mass index. Cone-beam computed tomography from before and after both treatments were used to measure total UA, superior/inferior oropharynx volume and surface area; and mandibular rotation. RESULTS Both groups showed a significant increase in the superior oropharynx volume after the treatments (p = 0.003) and the MMA group showed greater increase (p = 0.010). No statistical difference was identified in the MAD group considering the inferior volume, while the MMA group showed a significantly gain (p = 0.010) and greater volume (p = 0.024). Both groups showed anterior mandibular displacement. However, the mandibular rotation were statistically different between the groups (p < 0.001). While the MAD group showed a clockwise rotation pattern (-3.97 ± 1.07 and - 4.08 ± 1.30), the MMA group demonstrated a counterclockwise (2.40 ± 3.43 and 3.41 ± 2.79). In the MAD group, the mandibular linear anterior displacement was correlated with superior [p = 0.002 (r=-0.697)] and inferior [p = 0.004 (r = 0.658)] oropharynx volume, suggesting that greater amounts of mandibular advancement are correlated to a decrease in the superior oropharynx and an increase in the inferior oropharynx. In the MMA group, the superior oropharynx volume was correlated to mandibular anteroposterior [p = 0.029 (r=-0.530)] and vertical displacement [p = 0.047 (r = 0.488)], indicating greater amounts of mandibular advancement may lead to a lowest gain in the superior oropharynx volume, while a great mandibular superior displacement is correlated with improvements in this region. CONCLUSIONS The MAD therapy led to a clockwise mandibular rotation, increasing the dimensions of the superior oropharynx; while a counterclockwise rotation with greater increases in all UA regions were showed in the MMA treatment.
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Affiliation(s)
- Marcela Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Fabio Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil.
| | - Rowdley Pereira
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo Cunali
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Lia Bittencourt
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joao Gonçalves
- Department of Pediatric Dentistry, School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Brazil
| | - Jonas Bianchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
- Department of Pediatric Dentistry, School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Brazil
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, United States of America
| | - Cauby Chaves
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil
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Tempaku P, D´;Almeida V, Silva S, Bittencourt L, Belangero S, Tufik S. Study of the Effect of Obstructive Sleep Apnea on Telomere Length and its Associated Mechanisms. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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3
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Jin CX, Sutherland K, Gislason T, Thorarinsdottir EH, Bittencourt L, Tufik S, Singh B, McArdle N, Cistulli P, Bin YS. Influence of social jetlag on daytime sleepiness in obstructive sleep apnea. J Sleep Res 2022; 32:e13772. [PMID: 36345137 DOI: 10.1111/jsr.13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/14/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
Social jetlag is the discrepancy between socially determined sleep timing on workdays and biologically determined sleep timing on days free of social obligation. Poor circadian timing of sleep may worsen sleep quality and increase daytime sleepiness in obstructive sleep apnea (OSA). We analysed de-identified data from 2,061 participants (75.2% male, mean [SD] age 48.6 [13.4] years) who completed Sleep Apnea Global Interdisciplinary Consortium (SAGIC) research questionnaires and underwent polysomnography at 11 international sleep clinic sites. Social jetlag was calculated as the absolute difference in the midpoints of sleep between weekdays and weekends. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Linear regression analyses were performed to estimate the association between social jetlag and daytime sleepiness, with consideration of age, sex, body mass index, ethnicity, insomnia, alcohol consumption, and habitual sleep duration as confounders. Of the participants, 61.5% had <1 h of social jetlag, 27.5% had 1 to <2 h, and 11.1% had ≥2 h. Compared to those with <1 h of social jetlag, those with ≥2 h of social jetlag had 2.07 points higher ESS (95% confidence interval [CI] 0.77-3.38, p = 0.002), and those with 1 to <2 h of social jetlag had 0.80 points higher ESS (95% CI 0.04-1.55, p = 0.04) after adjustment for potential confounding. Interaction with OSA severity was observed; social jetlag appeared to have the greatest effect on daytime sleepiness in mild OSA. As social jetlag exacerbates daytime sleepiness in OSA, improving sleep timing may be a simple but novel therapeutic target for reducing the impact of OSA.
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Affiliation(s)
- Charley Ximing Jin
- Sleep Research Group, Charles Perkins Centre University of Sydney Camperdown New South Wales Australia
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre University of Sydney Camperdown New South Wales Australia
- Department of Respiratory and Sleep Medicine Royal North Shore Hospital Camperdown New South Wales Australia
| | - Thorarinn Gislason
- Faculty of Medicine University of Iceland Reykjavik Iceland
- Department of Sleep Landspitali University Hospital Reykjavik Iceland
| | - Elin Helga Thorarinsdottir
- Faculty of Medicine University of Iceland Reykjavik Iceland
- Primary Health Care of the Capital Area Reykjavik Iceland
| | | | - Sergio Tufik
- Universidade Federal de São Paulo São Paulo Brazil
| | - Bhajan Singh
- Department of Pulmonary Physiology and Sleep Medicine West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital Nedlands Western Australia Australia
- Faculty of Human Sciences University of Western Australia Crawley Western Australia Australia
| | - Nigel McArdle
- Department of Pulmonary Physiology and Sleep Medicine West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital Nedlands Western Australia Australia
- Faculty of Human Sciences University of Western Australia Crawley Western Australia Australia
| | - Peter Cistulli
- Sleep Research Group, Charles Perkins Centre University of Sydney Camperdown New South Wales Australia
- Department of Respiratory and Sleep Medicine Royal North Shore Hospital Camperdown New South Wales Australia
| | - Yu Sun Bin
- Sleep Research Group, Charles Perkins Centre University of Sydney Camperdown New South Wales Australia
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Tempaku P, Silva L, Guimarães T, Vidigal T, D'Almeida V, Andersen M, Bittencourt L, Tufik S. 0712 Cluster analysis for the association between obstructive sleep apnea phenotypes: a population-based longitudinal study. Sleep 2022. [DOI: 10.1093/sleep/zsac079.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The identification of subgroups of obstructive sleep apnea (OSA) is critical to understand disease causality and ultimately develop optimal care strategies customized for each subgroup. In this sense, we aimed to perform a cluster analysis to identify subgroups of individuals with OSA based on clinical parameters. Furthermore, we aimed to analyze whether subgroups remain after 8 years.
Methods
We used data derived from the São Paulo Epidemiologic Sleep Study (EPISONO) cohort, which was followed over 8 years. All individuals underwent polysomnography, answered questionnaires and had their blood collected for biochemical exams. OSA was defined according to AHI≥ 15 events/hour. Cluster analysis was performed using latent class analysis (LCA).
Results
Of the 1,042 individuals in the EPISONO cohort, 68.3% accepted to participate in the follow-up study (n=712). We were able to replicate the OSA 3-cluster solution observed in previous studies: disturbed sleep, minimally symptomatic and excessively sleepy in both baseline (35.5%, 45.4% and 19.1%, respectively) and follow-up studies (41.9%, 43.3% and 14.8%, respectively). 44.8% of the participants migrated clusters between the two evaluations and the factor associated with this was a greater delta-AHI (B=-0.033, df=1, p=0.003). The optimal cluster solution for our sample based on Bayesian information criterion (BIC) was 2 cluster for baseline (disturbed sleep and excessively sleepy) and 3 clusters for follow-up (disturbed sleep, minimally symptomatic and excessively sleepy).
Conclusion
The results found replicate and confirm previously identified clinical clusters in OSA even in a longitudinal analysis.
Support (If Any)
This work was supported by grants from AFIP and FAPESP.
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Gurgel M, Cevidanes L, Pereira R, Costa F, Ruellas A, Bianchi J, Cunali P, Bittencourt L, Chaves Junior C. Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes. Clin Oral Investig 2022; 26:875-887. [PMID: 34273012 PMCID: PMC8761785 DOI: 10.1007/s00784-021-04066-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/29/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aims to assess craniofacial dimensions in obstructive sleep apnea (OSA) patients treated with a mandibular advancement device (MAD) and to identify anatomic influences on OSA severity and MAD therapy outcomes. MATERIALS AND METHODS Twenty patients with OSA were prospectively treated with MAD. Clinical, cone-beam computed tomography, and polysomnography exams were performed before treatment and 4-6 months after achieving the MAD therapeutic position. Polysomnographic exams and three-dimensional maxillary, mandibular, and upper airway (UA) measurements were evaluated. Pearson's correlation and t-tests were applied. RESULTS Before MAD treatment, the transverse width measured at the frontomaxillary suture and the angle between the mandibular ramus and Frankfurt horizontal were statistically correlated with apnea and the hypopnea index (AHI), while the gonial angle was correlated with therapeutic protrusion. After MAD treatment, all patients showed a significant AHI reduction and an improvement in minimum oxyhemoglobin saturation. The UA total volume, superior and inferior oropharynx volume, and area were statistically correlated with MAD therapeutic protrusion. The UA total area showed a statistical correlation with the improvement in AHI, and the superior oropharynx volume and area increased significantly. CONCLUSIONS The transversal frontomaxillary suture width and the mandibular ramus facial angle may influence OSA severity. The gonial angle, volume, and area of all UA regions may indicate the amount of protrusion needed for successful MAD treatment. CLINICAL RELEVANCE The craniofacial characteristics reported as important factors for OSA severity and MAD treatment outcomes impact therapy planning for OSA patients, considering individual anatomic characteristics, prognosis, and cost benefits.
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Affiliation(s)
- Marcela Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Fortaleza, Brazil
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Rowdley Pereira
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Fabio Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Fortaleza, Brazil
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonas Bianchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America.,Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, United States of America
| | - Paulo Cunali
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Lia Bittencourt
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Cauby Chaves Junior
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Fortaleza, Brazil
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Guimarães TM, Poyares D, Oliveira E Silva L, Luz G, Coelho G, Dal Fabbro C, Tufik S, Bittencourt L. The treatment of mild OSA with CPAP or mandibular advancement device and the effect on blood pressure and endothelial function after one year of treatment. J Clin Sleep Med 2021; 17:149-158. [PMID: 32964829 DOI: 10.5664/jcsm.8822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES To evaluate and compare the effects of continuous positive airway pressure (CPAP), use of a mandibular advancement device (MAD), and no treatment on 24-hour ambulatory blood pressure monitoring and peripheral arterial tonometry at 6 and 12 months follow-up in individuals with mild obstructive sleep apnea (OSA), and in a subgroup who had an apnea-hypopnea index of < 5 events/h and adherence of ≥ 4 hours per night (effective-treatment subgroups). METHODS The inclusion criteria were individuals with mild obstructive sleep apnea, any sex, age between 18 and 65 years, and a body mass index of ≤ 35 kg/m². Patients were randomized into CPAP, MAD, and no-treatment groups. The evaluations included physical examination, full polysomnography, 24-hour ambulatory blood pressure monitoring, and peripheral arterial tonometry at baseline and after 6 and 12 months. A generalized linear mixed model was used for comparisons. RESULTS The CPAP and MAD groups had lower apnea-hypopnea indexes than the control group at 6 and 12 months, and the CPAP group had higher blood oxygen levels (SpO₂) than the MAD group. The MAD group had more hours of treatment per night and better adaptation to treatment than the CPAP group (MAD: 5.7 ± 2.7 h/night; CPAP: 3.8 ± 3.4 h/night; MAD: 16% did not adapt; CPAP: 42% did not adapt). No differences were found in the total sample and effective treatment in relation to peripheral arterial tonometry or 24-hour ambulatory blood pressure monitoring outcomes. CONCLUSIONS Treatment of mild obstructive sleep apnea with CPAP or MAD did not improve blood pressure or endothelial function after 1 year, even in patients with effective treatment. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Continuous Positive Airway Pressure and Oral Appliances Treatments in Mild Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT01461486; Identifier: NCT01461486.
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Affiliation(s)
| | - Dalva Poyares
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | | | - Gabriela Luz
- Departamento de Pneumologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Glaury Coelho
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Cibele Dal Fabbro
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
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Qin H, Keenan BT, Mazzotti DR, Vaquerizo-Villar F, Kraemer JF, Wessel N, Tufik S, Bittencourt L, Cistulli PA, de Chazal P, Sutherland K, Singh B, Pack AI, Chen NH, Fietze I, Gislason T, Holfinger S, Magalang UJ, Penzel T. Heart rate variability during wakefulness as a marker of obstructive sleep apnea severity. Sleep 2021; 44:6121869. [PMID: 33506267 DOI: 10.1093/sleep/zsab018] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/15/2021] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES Patients with obstructive sleep apnea (OSA) exhibit heterogeneous heart rate variability (HRV) during wakefulness and sleep. We investigated the influence of OSA severity on HRV parameters during wakefulness in a large international clinical sample. METHODS 1247 subjects (426 without OSA and 821 patients with OSA) were enrolled from the Sleep Apnea Global Interdisciplinary Consortium. HRV parameters were calculated during a 5-minute wakefulness period with spontaneous breathing prior to the sleep study, using time-domain, frequency-domain and nonlinear methods. Differences in HRV were evaluated among groups using analysis of covariance, controlling for relevant covariates. RESULTS Patients with OSA showed significantly lower time-domain variations and less complexity of heartbeats compared to individuals without OSA. Those with severe OSA had remarkably reduced HRV compared to all other groups. Compared to non-OSA patients, those with severe OSA had lower HRV based on SDNN (adjusted mean: 37.4 vs. 46.2 ms; p < 0.0001), RMSSD (21.5 vs. 27.9 ms; p < 0.0001), ShanEn (1.83 vs. 2.01; p < 0.0001), and Forbword (36.7 vs. 33.0; p = 0.0001). While no differences were found in frequency-domain measures overall, among obese patients there was a shift to sympathetic dominance in severe OSA, with a higher LF/HF ratio compared to obese non-OSA patients (4.2 vs. 2.7; p = 0.009). CONCLUSIONS Time-domain and nonlinear HRV measures during wakefulness are associated with OSA severity, with severe patients having remarkably reduced and less complex HRV. Frequency-domain measures show a shift to sympathetic dominance only in obese OSA patients. Thus, HRV during wakefulness could provide additional information about cardiovascular physiology in OSA patients. CLINICAL TRIAL INFORMATION A Prospective Observational Cohort to Study the Genetics of Obstructive Sleep Apnea and Associated Co-Morbidities (German Clinical Trials Register - DKRS, DRKS00003966) https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003966.
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Affiliation(s)
- Hua Qin
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Jan F Kraemer
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Peter A Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Philip de Chazal
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney Sydney, Australia
| | - Kate Sutherland
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ning-Hung Chen
- Division of Pulmonary, Critical Care Medicine and Sleep Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thorarinn Gislason
- Department of Sleep Medicine, Landspitali University Hospital, Reykjavik, Iceland.,Medical Faculty, University of Iceland, Reykjavik, Iceland
| | - Steven Holfinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Bittencourt L, Javaheri S, Servantes DM, Pelissari Kravchychyn AC, Almeida DR, Tufik S. In patients with heart failure, enhanced ventilatory response to exercise is associated with severe obstructive sleep apnea. J Clin Sleep Med 2021; 17:1875-1880. [PMID: 33949944 DOI: 10.5664/jcsm.9396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients with chronic heart failure (CHF) while undergoing exercise test, frequently exhibit elevated ratio of minute ventilation over CO₂ output (VE/VCO₂ slope). One of the factors contributing to this elevated slope is increased chemosensitivity to CO₂, as this slope significantly correlates with the slope of the ventilatory response to CO₂ rebreathing at rest. A previous study in patients with CHF and central sleep apnea (CSA) has shown the highest VE/VCO2 slope during exercise was associated with the most severe CSA. In the current study, we tested the hypothesis that in patients with CHF and obstructive sleep apnea (OSA), the highest VE/VCO₂ slope is also associated with most severe OSA. If correct, it implies that in CHF, augmented instability in the negative feedback system controlling breathing predisposes to both OSA and CSA. METHODS This preliminary study involved 70 patients with stable CHF and spectrum of OSA severity who underwent full night polysomnography, echocardiography, and cardiopulmonary exercise testing. Peak oxygen consumption (VO₂ max) and VE/VCO₂ slope were calculated. RESULTS There were significant positive correlations between apnea hypopnea index (AHI) and VE/VCO₂ slope (r= 0.359; p=0.002). In the regression model, involving relevant variable, age, body mass index, gender, VE/VCO₂ slope, VO₂, and left ventricular ejection fraction, AHI retained significance with VE/VCO₂. CONCLUSIONS In patients with CHF, the VE/VCO₂ slope obtained during exercise correlates significantly to the severity of OSA suggesting that an elevated CO₂ response should increase suspicion for presence of severe OSA, a treatable disorder that is potentially associated with excess mortality. CLINICAL TRIAL REGISTRATION: REGISTRY ClinicalTrials.gov; Title: Comparison Between Exercise Training and CPAP Treatment for Patients With Heart Failure and Sleep Apnea; Identifier: NCT01538069; URL: https://clinicaltrials.gov/ct2/show/record/NCT01538069.
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Affiliation(s)
- Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Sérgio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
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Polesel DN, Nozoe KT, Bittencourt L, Tufik S, Andersen ML, Fernandes MTB, Hachul H. Waist-to-height ratio and waist circumference as the main measures to evaluate obstructive sleep apnea in the woman's reproductive life stages. Women Health 2021; 61:277-288. [PMID: 33390097 DOI: 10.1080/03630242.2020.1862386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder. In women, the frequency of OSA increases substantially during and after the menopause, as does the prevalence of obesity in this reproductive life stage. This cross-sectional study uses data from the Sao Paulo Epidemiologic Sleep Study (EPISONO, 2007), and comprises a sample of 500 women aged 20-80 years. Multiple logistic regression analysis was used to assess the factors associated with OSA in premenopausal and postmenopausal women. All participants underwent polysomnography, and obesity was assessed using the waist-to-height ratio (WHtR), body mass index, neck and waist circumference, measured using standard methods. WHtR was the factor most associated with a significant increase in risk of OSA in premenopausal women. Waist circumference was the factor most associated with OSA in postmenopausal women, for all severities of the disease. Anthropometric factors presented a high rate of accuracy in the classification of women with OSA. The study found that different obesity-related anthropometric measures should be considered in the diagnosis of OSA, according to the woman's reproductive stage.
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Affiliation(s)
| | - Karen Tieme Nozoe
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Lia Bittencourt
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Sergio Tufik
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Monica Levy Andersen
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | | | - Helena Hachul
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
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10
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E Silva LO, Guimarães TM, Pontes G, Coelho G, Badke L, Fabbro CD, Tufik S, Bittencourt L, Togeiro S. The effects of continuous positive airway pressure and mandibular advancement therapy on metabolic outcomes of patients with mild obstructive sleep apnea: a randomized controlled study. Sleep Breath 2021; 25:797-805. [PMID: 33394328 DOI: 10.1007/s11325-020-02183-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/27/2020] [Accepted: 06/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Moderate and severe obstructive sleep apnea (OSA) have been independently associated with dyslipidemia. The results of metabolic improvement with continuous positive airway pressure (CPAP) have been controversial. Less evidence exists regarding this issue in mild OSA. A current treatment for mild OSA is mandibular advancement device (MAD) therapy, but its effectiveness on the metabolic profile needs to be compared with CPAP. The purpose of this study was to compare MAD vs CPAP vs no treatment on the metabolic profile during 6 and 12 months of follow-up in patients with mild OSA. METHODS The inclusion criteria were patients with mild OSA, both genders, ages 18 to 65 years, and body mass index (BMI) of < 35 Kg/m2. Patients were randomized in 3 groups (CPAP, MAD, and control). The evaluations included physical examination, metabolic profile, and full polysomnography at baseline, 6 months, and 12 months of follow-up. RESULTS Seventy-nine patients with mild OSA were randomized in three treatment groups, with mean age (± SD) of 47 ± 9 years, 54% men, and AHI 9.5 ± 2.9 events/h. MAD and CPAP reduced AHI at 6 and 12 months compared to the control group. MAD adherence was higher than CPAP at 6 and 12 months. Despite lower adherence compared to MAD, CPAP was more effective in reducing total cholesterol over 12 months (baseline 189.3 ± 60.2 mg/dl to 173.4 ± 74.3 mg/dl) and low-density lipoprotein cholesterol (LDL-c, baseline 112.8 ± 54.9 mg/dl to 94.5 ± 67.4 mg/dl). CONCLUSIONS After 1 year of treatment, CPAP was superior to MAD in reducing total cholesterol and LDL-c in patients with mild OSA.
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Affiliation(s)
- Luciana Oliveira E Silva
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, Vila Clementino, São Paulo, CEP 04021-002, Brazil
| | - Thais Moura Guimarães
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, Vila Clementino, São Paulo, CEP 04021-002, Brazil
| | - Gabriela Pontes
- Departamento de Pneumologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Glaury Coelho
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, Vila Clementino, São Paulo, CEP 04021-002, Brazil
| | - Luciana Badke
- Departamento de Pneumologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Cibele Dal Fabbro
- Instituto do Sono, São Paulo, Brazil.,Center for Advanced Research in Sleep Medicine, Research Center of Faculty of Dental Medicine, Université de Montréal, Montréal, Canada
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, Vila Clementino, São Paulo, CEP 04021-002, Brazil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, Vila Clementino, São Paulo, CEP 04021-002, Brazil
| | - Sonia Togeiro
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, Vila Clementino, São Paulo, CEP 04021-002, Brazil. .,Departamento de Pneumologia, Universidade Federal de São Paulo, São Paulo, Brazil.
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11
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Chaggar G, Sutherland K, Han F, Fietze I, Penzel T, Benediktsdóttir B, Gislason T, Magalang U, Pack AI, Singh B, McArdle N, Bittencourt L, Li QY, Chen NH, de Chazal P, Cistulli PA, Bin YS. Is snoring during pregnancy a predictor of later life obstructive sleep apnoea? A case-control study. Sleep Med 2020; 79:190-194. [PMID: 33279414 DOI: 10.1016/j.sleep.2020.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) appears common in pregnancy. Complications of pregnancy such as gestational diabetes and hypertension predispose women to cardiometabolic disease in later life. It is unknown if snoring during pregnancy is a risk marker for later-life OSA. METHODS We analysed data from N = 897 women in the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), which recruited patients attending sleep clinics at 11 sites. There were 577 cases with current OSA and 320 controls. Cases were further categorised into mild, moderate, and severe OSA based on apnoea-hypopnoea index. Retrospective self-report of snoring during pregnancy was the exposure of interest and was reported by 2.9% of cases and 3.4% of controls. RESULTS Multinomial regression demonstrated that snoring during a previous pregnancy was not significantly associated with mild (OR 0.34, 95% CI 0.09-1.25, p = 0.10), moderate (OR 0.69, 95% CI 0.21-2.19, p = 0.52), or severe OSA (OR 1.86, 95% CI 0.77-4.48, p = 0.17) compared to no snoring during pregnancy. Results were unchanged after adjustment for age, body mass index, and ethnicity. 79% of women reported current snoring but all who snored during pregnancy reported current snoring. CONCLUSIONS Women who snore during pregnancy continue snoring in later-life but do not appear more likely to develop OSA. These findings are limited by self-reported data, recall bias, and small numbers of women who reported snoring during pregnancy. A prospective study with objective measurement of sleep and snoring during pregnancy is needed to examine the links between sleep disorders in pregnancy with health in later life.
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Affiliation(s)
- Gurpreet Chaggar
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Fang Han
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Ingo Fietze
- Charité University Hospital, Berlin, Germany
| | - Thomas Penzel
- Charité University Hospital, Berlin, Germany; Saratov State University, Saratov, Russia
| | - Bryndís Benediktsdóttir
- University of Iceland, Faculty of Medicine, Reykjavík, Iceland; Landspitali University Hospital, Reykjavík, Iceland
| | - Thorarinn Gislason
- University of Iceland, Faculty of Medicine, Reykjavík, Iceland; Landspitali University Hospital, Reykjavík, Iceland
| | | | - Allan I Pack
- University of Pennsylvania, Philadelphia, PA, United States
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia; University of Western Australia, Perth, Australia
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia; University of Western Australia, Perth, Australia
| | | | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Philip de Chazal
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Yu Sun Bin
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia.
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12
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Bittencourt L, Barbosa M, Bisi TL, Lailson-Brito J, Azevedo AF. Anthropogenic noise influences on marine soundscape variability across coastal areas. Mar Pollut Bull 2020; 160:111648. [PMID: 32920255 DOI: 10.1016/j.marpolbul.2020.111648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/18/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
Acoustic data was collected across 15 sites distributed through the coastal area of Rio de Janeiro, Brazil, encompassing regions of different natural characteristics. Noise levels and the acoustic complexity index were calculated. Quantity and composition of anthropogenic sound sources varied across recording sites, with at least one type of sound source being registered in each location. A cluster analysis using third-octave levels from eight frequency bands divided recording sites into two groups, one considered as impacted by anthropogenic noise and the other as less-impacted. The noisiest recording locations were those with higher numbers of anthropogenic sound sources, specifically large ships. It was evidenced that anthropogenic noise affects not only noise levels, but also low-frequency acoustic complexity, which decreased in the presence of vessel traffic. The constant noise input of human activities tended to mask natural variability in the soundscape at lower frequencies.
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Affiliation(s)
- L Bittencourt
- Laboratório de Mamíferos Aquáticos e Bioindicadores "Professora Izabel M. G. do N. Gurgel" - MAQUA, Faculdade de Oceanografia, Universidade do Estado do Rio de Janeiro, Brazil; Programa de Pós-Graduação em Oceanografia da Universidade do Estado do Rio de Janeiro, Brazil.
| | - M Barbosa
- Laboratório de Mamíferos Aquáticos e Bioindicadores "Professora Izabel M. G. do N. Gurgel" - MAQUA, Faculdade de Oceanografia, Universidade do Estado do Rio de Janeiro, Brazil
| | - T L Bisi
- Laboratório de Mamíferos Aquáticos e Bioindicadores "Professora Izabel M. G. do N. Gurgel" - MAQUA, Faculdade de Oceanografia, Universidade do Estado do Rio de Janeiro, Brazil
| | - J Lailson-Brito
- Laboratório de Mamíferos Aquáticos e Bioindicadores "Professora Izabel M. G. do N. Gurgel" - MAQUA, Faculdade de Oceanografia, Universidade do Estado do Rio de Janeiro, Brazil
| | - A F Azevedo
- Laboratório de Mamíferos Aquáticos e Bioindicadores "Professora Izabel M. G. do N. Gurgel" - MAQUA, Faculdade de Oceanografia, Universidade do Estado do Rio de Janeiro, Brazil; Programa de Pós-Graduação em Oceanografia da Universidade do Estado do Rio de Janeiro, Brazil
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13
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Lucena L, Polesel DN, Poyares D, Bittencourt L, Andersen ML, Tufik S, Hachul H. The association of insomnia and quality of life: Sao Paulo epidemiologic sleep study (EPISONO). Sleep Health 2020; 6:629-635. [DOI: 10.1016/j.sleh.2020.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 01/04/2023]
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14
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Ruiz FS, Rosa DS, Zimberg IZ, Dos Santos Quaresma MV, Nunes JO, Apostolico JS, Weckx LY, Souza AR, Narciso FV, Fernandes-Junior SA, Gonçalves B, Folkard S, Bittencourt L, Tufik S, Tulio de Mello M. Night shift work and immune response to the meningococcal conjugate vaccine in healthy workers: a proof of concept study. Sleep Med 2020; 75:263-275. [PMID: 32866895 DOI: 10.1016/j.sleep.2020.05.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND It is well-established that sleep regulates immune functions. Immunological functions are dependent on circadian rhythms and regular sleep as both have an impact on the magnitude of immune responses following antigenic challenge (eg, in vaccination). Here we investigated whether nocturnal shift work can influence post-vaccination response. METHODS Thirty-four healthy workers (23 females) working either nocturnal or diurnal shifts (17 in each group) received the meningococcal C meningitis vaccine. Sleep was recorded polysomnographically (PSG) and with actigraphy. Humoral and cellular responses were assessed after vaccination. RESULTS Night workers showed decreased N3 stage and REM sleep duration, increased inflammatory mediators (TNF-α and IL-6 levels), and a weak specific humoral response to vaccination associated with reduced CD4 T lymphocytes, reduced plasmacytoid dendritic cells, reduced prolactin levels, increased TReg and increased IL-10 levels. In addition, the decrease in total sleep time and circadian rhythm alterations were associated with a reduced humoral response post-vaccination. CONCLUSIONS Our findings provide novel evidence concerning immune alterations of shift work on workers' health based on real-life circumstances. In association with circadian components, sufficient sleep time and rhythm synchronization were important for the development of the Ag-specific immune response, suggesting that the humoral response to vaccination may be impaired in individuals with chronic sleep restriction and circadian misalignment.
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Affiliation(s)
- Francieli S Ruiz
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.
| | - Daniela S Rosa
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ioná Z Zimberg
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Jethe Of Nunes
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Juliana S Apostolico
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Lily Y Weckx
- Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Alessandra R Souza
- Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Fernanda V Narciso
- Escola de Educação Física, Fisioterapia e Terapia Ocupacional (EEFFTO), Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Bruno Gonçalves
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, Brazil
| | | | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marco Tulio de Mello
- Escola de Educação Física, Fisioterapia e Terapia Ocupacional (EEFFTO), Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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15
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Togeiro S, Oliveira LS, Guimaraes TM, Luz GP, Coelho G, Badke LN, Tufik S, Bittencourt L. 0663 The Longterm Effect of CPAP Compared to Mandibular Advancement Device on Metabolic Profile in Mild Obstructive Sleep Apnea. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Moderate and severe Obstructive Sleep Apnea (OSA) have been independently associated to dyslipidemia with controversial results of improvement with CPAP. Less evidence exists regarding this issue in mild OSA. A current treatment for mild OSA is Mandibular Advancement Device (MAD), however its effectiveness on metabolic profile needs to be compared to CPAP.Our aim was to compare MAD with CPAP and no treatment on metabolic profile during one year in mild OSA.
Methods
Cross sectional analyses included 79 mild OSA patients randomized in CPAP group (n: 31), MAD group (n. 25) and Control group (n: 23). Metabolic profile was investigated before and after 6 and months.
Results
Mean age: 47± 9 years, BMI: 28±3.7 kg/m AHI: 9.5±2.9/h. There were no differences in anthropometric data, total cholesterol (TCT) HDL-C, LDL-C, Triglycerides (TC) and glycated Hemoglobin (Hb1c) among groups. MAD and CPAP reduced AHI at 6 and 12 months (9.3 ± 5.2 to 4.2 ± 9.1 to 3.8 ± 12.6 / 10.0 ± 4.6 to 1.2 ± 9.9 to 1.7 ± 14.2, p: 0.01 respectively). BMI did not change in groups at 6 and 12 months. MAD adherence was higher than CPAP at 6 months (5.8 ± 2.8 hs/day vs 3.8 ± 3.0 hs/day; p: 0.01) and 12 months 5.7 ± 2.7 hs/day vs 3.8 ± 3.4 hs/day; p: 0.01). Despite of lower adherence than MAD, CPAP was effective in reduce TCT and LDL- CT at 6 and 12 months (Intention to treat analyses TCT: 189.3±51.4 mg/dl to 186.1±51.4 mg/dl to 174.6±51 mg/dl; p: 0.03 / 112.8±48.7 mg/dl to 110.5±48.7 mg/dl to 95.8±48.7mg/dl; p: 0.03 respectively), however HDL-C, TG and Hbc didn′t change.
Conclusion
Long term CPAP treatment was effective in reducing cholesterol in mild OSA.
Support
Associação Fundo Incentivo à Psicobiologia (AFIP)
CAPES
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Affiliation(s)
- S Togeiro
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - L S Oliveira
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - T M Guimaraes
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - G P Luz
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - G Coelho
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - L N Badke
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - S Tufik
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - L Bittencourt
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
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16
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Tempaku PF, Silva LO, Guimaraes TM, Vidigal TA, D’Almeida V, Andersen ML, Bittencourt L, Tufik S. 0577 Cluster Analysis for the Association Between Obstructive Sleep Apnea Phenotypes: A Population-Based Longitudinal Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The identification of subgroups of obstructive sleep apnea (OSA) is critical to understand disease causality and ultimately develop optimal care strategies customized for each subgroup. In this sense, we aimed to perform a cluster analysis to identify subgroups of individuals with OSA based on clinical parameters. Furthermore, we aimed to analyze whether subgroups remain after 8 years.
Methods
We used data derived from the Sao Paulo Epidemiologic Sleep Study (EPISONO) cohort, which was followed over 8 years. All individuals underwent polysomnography, answered questionnaires and had their blood collected for biochemical exams. OSA was defined according to an AHI equal or greater than 15 events per hour. Cluster analysis was performed using latent class analysis (LCA).
Results
Of the 1,042 individuals in the EPISONO baseline cohort, 68.3% accepted to participate in the follow-up study (n=712). We were able to replicate the OSA 3-cluster solution observed in previous studies: disturbed sleep, minimally symptomatic and excessively sleepy in both baseline (35.5%, 45.4% and 19.1%, respectively) and follow-up studies (41.9%, 43.4% and 14.8%, respectively). 44.8% of the participants migrated clusters between the two evaluations and the factor associated with this was a greater delta-AHI (B=-0.033, df=1, p=0.003). The optimal cluster solution for our sample based on Bayesian information criterion (BIC) was 2 clusters for baseline (disturbed sleep and excessively sleepy) and 3 clusters for follow-up (disturbed sleep, minimally symptomatic and excessively sleepy).
Conclusion
The results found replicate and confirm previously identified clinical clusters in OSA even in a longitudinal analysis.
Support
This work was supported by grants from AFIP, FAPESP and CAPES.
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Affiliation(s)
- P F Tempaku
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - L O Silva
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - T M Guimaraes
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - T A Vidigal
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - V D’Almeida
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - M L Andersen
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - L Bittencourt
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - S Tufik
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
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17
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Hachul H, Castro LS, Bezerra AG, Poyares D, Andersen ML, Bittencourt L, Tufik S. 0831 Hot Flashes and Insomnia Throughout the Life Span of Women from the Episono Cohort. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Hormonal changes may trigger sleep disturbances in women. Insomnia affects one in every three-to-four of them, most likely during pre to post menopause, and especially in association with hot flashes. Thus, the present study aimed to investigate the occurrence of hot flashes among women with and without insomnia and on different reproductive stages.
Methods
Sampling procedure was a three-stage clustering of the population of Sao Paulo, Brazil according to gender, age (20-80 years), and socio-economic status. A total of 574 women were interviewed, underwent polysomnographic recording (PSG), and had fasting-blood samples collected. Hormone levels and a gynecological questionnaire were used to classify reproductive stages. Premenopausal women were classified either in the follicular, luteal, or periovulatory stage or as anovulatory or under hormonal contraceptives; whereas those menopausal were classified in perimenopause or in early or late stages. Individuals reporting frequent and persistent insomnia symptoms accompanied by relevant daytime impairment were classified with insomnia syndrome. Objective insomnia was defined by increased sleep onset latency and/or awake after sleep onset, decreasing sleep duration.
Results
The final sample included 550 women, representing 53% of the EPISONO cohort (n=1,042). Hot flashes were reported by 9% of the premenopausal women (n=339) and by 42% of the menopausal. Complaints were more frequent among women in perimenopause (67%) and those in use of hormonal therapy (60%), and it tended to decrease in later stages (33%); whereas before menopause, hot flashes were especially reported by anovulatory women (26%), while significantly less by those using contraceptives (6%). Hot flashes were associated with a 2-fold increase in insomnia symptoms and while it predicted objective sleep alterations among premenopausal women, they did not after menopause, when alterations in sleep were better explained by an effect of aging.
Conclusion
Our current findings suggest that hot flashes are associated with irregular menstrual cycles among premenopausal women, and particularly with early stages of menopause, predicting both subjective and objective sleep alterations.
Support
This research was supported by fellowships from Associação Fundo de Incentivo à Pesquisa (AFIP) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001.
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Affiliation(s)
- H Hachul
- Universidadede Federal de Sao Paulo - Department of Psychobiology, Sao Paulo, BRAZIL
| | - L S Castro
- Universidadede Federal de Sao Paulo - Department of Psychobiology, Sao Paulo, BRAZIL
| | - A G Bezerra
- Universidadede Federal de Sao Paulo - Department of Psychobiology, Sao Paulo, BRAZIL
| | - D Poyares
- Universidadede Federal de Sao Paulo - Department of Psychobiology, Sao Paulo, BRAZIL
| | - M L Andersen
- Universidadede Federal de Sao Paulo - Department of Psychobiology, Sao Paulo, BRAZIL
| | - L Bittencourt
- Universidadede Federal de Sao Paulo - Department of Psychobiology, Sao Paulo, BRAZIL
| | - S Tufik
- Universidadede Federal de Sao Paulo - Department of Psychobiology, Sao Paulo, BRAZIL
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18
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Behar JA, Palmius N, Zacharie S, Chocron A, Penzel T, Bittencourt L, Tufik S. Single-channel oximetry monitor versus in-lab polysomnography oximetry analysis: does it make a difference? Physiol Meas 2020; 41:044007. [DOI: 10.1088/1361-6579/ab8856] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Rizzatti FG, Mazzotti DR, Mindel J, Maislin G, Keenan BT, Bittencourt L, Chen NH, Cistulli PA, McArdle N, Pack FM, Singh B, Sutherland K, Benediktsdottir B, Fietze I, Gislason T, Lim DC, Penzel T, Sanner B, Han F, Li QY, Schwab R, Tufik S, Pack AI, Magalang UJ. Defining Extreme Phenotypes of OSA Across International Sleep Centers. Chest 2020; 158:1187-1197. [PMID: 32304773 DOI: 10.1016/j.chest.2020.03.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Extreme phenotypes of OSA have not been systematically defined. RESEARCH QUESTION This study developed objective definitions of extreme phenotypes of OSA by using a multivariate approach. The utility of these definitions for identifying characteristics that confer predisposition toward or protection against OSA is shown in a new prospective sample. STUDY DESIGN AND METHODS In a large international sample, race-specific liability scores were calculated from a weighted logistic regression that included age, sex, and BMI. Extreme cases were defined as individuals with an apnea-hypopnea index (AHI) ≥ 30 events/hour but low likelihood of OSA based on age, sex, and BMI (liability scores > 90th percentile). Similarly, extreme controls were individuals with an AHI < 5 events/hour but high likelihood of OSA (liability scores < 10th percentile). Definitions were applied to a prospective sample from the Sleep Apnea Global Interdisciplinary Consortium, and differences in photography-based craniofacial and intraoral phenotypes were evaluated. RESULTS This study included retrospective data from 81,338 individuals. A total of 4,168 extreme cases and 1,432 extreme controls were identified by using liability scores. Extreme cases were younger (43.1 ± 14.7 years), overweight (28.6 ± 6.8 kg/m2), and predominantly female (71.1%). Extreme controls were older (53.8 ± 14.1 years), obese (34.0 ± 8.1 kg/m2), and predominantly male (65.8%). These objective definitions identified 29 extreme cases and 87 extreme controls among 1,424 Sleep Apnea Global Interdisciplinary Consortium participants with photography-based phenotyping. Comparisons suggest that a greater cervicomental angle increases risk for OSA in the absence of clinical risk factors, and smaller facial widths are protective in the presence of clinical risk factors. INTERPRETATION This objective definition can be applied in sleep centers throughout the world to consistently define OSA extreme phenotypes for future studies on genetic, anatomic, and physiologic pathways to OSA.
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Affiliation(s)
- Fabiola G Rizzatti
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; Departamento de Medicina, Universidade Federal de São Carlos, São Paulo, Brazil
| | - Diego R Mazzotti
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jesse Mindel
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Greg Maislin
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ning-Hung Chen
- Division of Pulmonary, Critical Care Medicine and Sleep Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Peter A Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Frances M Pack
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Kate Sutherland
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Bryndis Benediktsdottir
- Department of Sleep Medicine, Landspitali University Hospital, Reykjavík, Iceland; Medical Faculty, University of Iceland, Reykjavik, Iceland
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Thorarinn Gislason
- Department of Sleep Medicine, Landspitali University Hospital, Reykjavík, Iceland; Medical Faculty, University of Iceland, Reykjavik, Iceland
| | - Diane C Lim
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany; Saratov State University, Saratov, Russia
| | - Bernd Sanner
- Department of Pulmonary Medicine, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal, Germany
| | - Fang Han
- Department of Respiratory Medicine, Peking University, Beijing, China
| | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Richard Schwab
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH.
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20
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Chaggar G, Sutherland K, Han F, Penzel T, Gislason T, Magalang U, Pack A, Schwab R, Singh B, McArdle N, Bittencourt L, Li Q, Chen N, de Chazal P, Cistulli P, Bin Y. Snoring during pregnancy as a predictor of future obstructive sleep apnoea: a case-control study. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Van Ryswyk E, Anderson CS, Antic NA, Barbe F, Bittencourt L, Freed R, Heeley E, Liu Z, Loffler KA, Lorenzi-Filho G, Luo Y, Margalef MJM, McEvoy RD, Mediano O, Mukherjee S, Ou Q, Woodman R, Zhang X, Chai-Coetzer CL. Predictors of long-term adherence to continuous positive airway pressure in patients with obstructive sleep apnea and cardiovascular disease. Sleep 2019; 42:5581969. [DOI: 10.1093/sleep/zsz152] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 05/12/2019] [Indexed: 11/12/2022] Open
Abstract
AbstractStudy ObjectivesPoor adherence to continuous positive airway pressure (CPAP) commonly affects therapeutic response in obstructive sleep apnea (OSA). We aimed to determine predictors of adherence to CPAP among participants of the Sleep Apnea and cardioVascular Endpoints (SAVE) trial.MethodsSAVE was an international, randomized, open trial of CPAP plus usual care versus usual care (UC) alone in participants (45–75 years) with co-occurring moderate-to-severe OSA (≥12 episodes/h of ≥4% oxygen desaturation) and established cardiovascular (CV) disease. Baseline sociodemographic, health and lifestyle factors, OSA symptoms, and 1-month change in daytime sleepiness, as well as CPAP side effects and adherence (during sham screening, titration week, and in the first month), were entered in univariate linear regression analyses to identify predictors of CPAP adherence at 24 months. Variables with p <0.2 were assessed for inclusion in a multivariate linear mixed model with country, age, and sex included a priori and site as a random effect.ResultsSignificant univariate predictors of adherence at 24 months in 1,121 participants included: early adherence measures, improvement in daytime sleepiness at 1 month, fixed CPAP pressure, some measures of OSA severity, cardiovascular disease history, breathing pauses, and very loud snoring. While observed adherence varied between countries, adherence during sham screening, initial titration, and the first month of treatment retained independent predictive value in the multivariate model along with fixed CPAP pressure and very loud snoring.ConclusionsEarly CPAP adherence had the greatest predictive value for identifying those at highest risk of non-adherence to long-term CPAP therapy.Clinical Trial RegistrationSAVE is registered with clinicaltrials.gov (NCT00738179).
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Affiliation(s)
- Emer Van Ryswyk
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- The George Institute China at Peking University Health Science Center, Beijing, China
| | - Nicholas A Antic
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
| | - Ferran Barbe
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Lleida, Spain
- CIBERES, Madrid, Spain
| | - Lia Bittencourt
- Instituto do Sono, AFIP, Sao Paulo, Brazil
- Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Ruth Freed
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Emma Heeley
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Zhihong Liu
- Department of Cardiology, Fuwai Hospital, Beijing, China
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
| | | | - Yuanming Luo
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Maria J Masdeu Margalef
- Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Olga Mediano
- University Hospital of Guadalajara, Guadalajara, Spain
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Qiong Ou
- Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
| | - Xilong Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
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22
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Shoukri B, Prieto J, Ruellas A, Yatabe M, Sugai J, Styner M, Zhu H, Huang C, Paniagua B, Aronovich S, Ashman L, Benavides E, de Dumast P, Ribera N, Mirabel C, Michoud L, Allohaibi Z, Ioshida M, Bittencourt L, Fattori L, Gomes L, Cevidanes L. Minimally Invasive Approach for Diagnosing TMJ Osteoarthritis. J Dent Res 2019; 98:1103-1111. [PMID: 31340134 PMCID: PMC6704428 DOI: 10.1177/0022034519865187] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study's objectives were to test correlations among groups of biomarkers that are associated with condylar morphology and to apply artificial intelligence to test shape analysis features in a neural network (NN) to stage condylar morphology in temporomandibular joint osteoarthritis (TMJOA). Seventeen TMJOA patients (39.9 ± 11.7 y) experiencing signs and symptoms of the disease for less than 10 y and 17 age- and sex-matched control subjects (39.4 ± 15.2 y) completed a questionnaire, had a temporomandibular joint clinical exam, had blood and saliva samples drawn, and had high-resolution cone beam computed tomography scans taken. Serum and salivary levels of 17 inflammatory biomarkers were quantified using protein microarrays. A NN was trained with 259 other condyles to detect and classify the stage of TMJOA and then compared to repeated clinical experts' classifications. Levels of the salivary biomarkers MMP-3, VE-cadherin, 6Ckine, and PAI-1 were correlated to each other in TMJOA patients and were significantly correlated with condylar morphological variability on the posterior surface of the condyle. In serum, VE-cadherin and VEGF were correlated with one another and with significant morphological variability on the anterior surface of the condyle, while MMP-3 and CXCL16 presented statistically significant associations with variability on the anterior surface, lateral pole, and superior-posterior surface of the condyle. The range of mouth opening variables were the clinical markers with the most significant associations with morphological variability at the medial and lateral condylar poles. The repeated clinician consensus classification had 97.8% agreement on degree of degeneration within 1 group difference. Predictive analytics of the NN's staging of TMJOA compared to the repeated clinicians' consensus revealed 73.5% and 91.2% accuracy. This study demonstrated significant correlations among variations in protein expression levels, clinical symptoms, and condylar surface morphology. The results suggest that 3-dimensional variability in TMJOA condylar morphology can be comprehensively phenotyped by the NN.
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Affiliation(s)
- B. Shoukri
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - J.C. Prieto
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - A. Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - M. Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - J. Sugai
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - M. Styner
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - H. Zhu
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - C. Huang
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - S. Aronovich
- Department Oral and Maxillofacial Surgery and Hospital Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - L. Ashman
- Department Oral and Maxillofacial Surgery and Hospital Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - E. Benavides
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - P. de Dumast
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - N.T. Ribera
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - C. Mirabel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - L. Michoud
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Z. Allohaibi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - M. Ioshida
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - L. Bittencourt
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - L. Fattori
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - L.R. Gomes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - L. Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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23
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Nogueira JF, Poyares D, Simonelli G, Leiva S, Carrillo-Alduenda JL, Bazurto MA, Terán G, Valencia-Flores M, Serra L, de Castro JR, Santiago-Ayala V, Pérez-Chada D, Franchi ME, Lucchesi L, Tufik S, Bittencourt L. Accessibility and adherence to positive airway pressure treatment in patients with obstructive sleep apnea: a multicenter study in Latin America. Sleep Breath 2019; 24:455-464. [PMID: 31240542 DOI: 10.1007/s11325-019-01881-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/15/2019] [Accepted: 06/18/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Information on access and adherence to positive airway pressure (PAP) treatment is lacking at the regional level in Latin America. This study characterized access and adherence to PAP in patients with moderate-severe obstructive sleep apnea (OSA) in Latin America. METHODS Cross-sectional study, conducted at 9 sleep centers across Argentina, Brazil, Chile, Colombia, Mexico, and Peru. Adults diagnosed with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15/h) in the previous 12-18 months were eligible. Anthropometrics, health coverage, and OSA severity data were collected. Data on access to therapy, barriers to access, adherence, and factors related to non-compliance were obtained via standardized telephone survey. RESULTS Eight hundred eighty patients (70% male, 54 ± 13 years, AHI 49 ± 28/h, body mass index 32 ± 7 kg/m2) were included. Four hundred ninety patients (56%) initiated PAP, 70 (14%) discontinued therapy during the first year (mainly due to intolerance), and 420 (48%) were still using PAP when surveyed. Health insurance was private in 36.9% of patients, via the social security system in 31.1%, and via the state in 13.3%, and 18.7% did not have any coverage; 49.5% of patients had to pay all equipment costs. Reasons for not starting PAP were unclear or absent indication (42%), coverage problems (36%), and lack of awareness of OSA burden (14%). Patients with better adherence were older (55.3 ± 13 vs 52 ± 13; p = 0.002) and had more severe OSA (AHI 51.8 ± 27 vs 45.6 ± 27; p = 0.001). CONCLUSIONS Less than half moderate-severe OSA patients started and continue to use PAP. Unclear or absent medical indication and financial limitations were the most relevant factors limiting access to therapy.
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Affiliation(s)
| | - Dalva Poyares
- Universidade Federal de São Paulo-SP, São Paulo, Brazil
| | - Guido Simonelli
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Sebastián Leiva
- Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Guadalupe Terán
- Universidad Autónoma Metropolitana (UAM), Ciudad de México, Mexico
| | - Matilde Valencia-Flores
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Leonardo Serra
- Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | - Victoria Santiago-Ayala
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | | | | | | | - Sergio Tufik
- Universidade Federal de São Paulo-SP, São Paulo, Brazil
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24
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Behar JA, Palmius N, Li Q, Garbuio S, Rizzatti FP, Bittencourt L, Tufik S, Clifford GD. Feasibility of Single Channel Oximetry for Mass Screening of Obstructive Sleep Apnea. EClinicalMedicine 2019; 11:81-88. [PMID: 31317133 PMCID: PMC6611093 DOI: 10.1016/j.eclinm.2019.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The growing awareness for the high prevalence of obstructive sleep apnea (OSA) coupled with the dramatic proportion of undiagnosed individuals motivates the elaboration of a simple but accurate screening test. This study assesses, for the first time, the performance of oximetry combined with demographic information as a screening tool for identifying OSA in a representative (i.e. non-referred) population sample. METHODS A polysomnography (PSG) clinical database of 887 individuals from a representative population sample of São Paulo's city (Brazil) was used. Using features derived from the oxygen saturation signal during sleep periods and demographic information, a logistic regression model (termed OxyDOSA) was trained to distinguish between non-OSA and OSA individuals (mild, moderate, and severe). The OxyDOSA model performance was assessed against the PSG-based diagnosis of OSA (AASM 2017) and compared to the NoSAS and STOP-BANG questionnaires. FINDINGS The OxyDOSA model had mean AUROC = 0.94 ± 0.02, Se = 0.87 ± 0.04 and Sp = 0.85 ± 0.03. In particular, it did not miss any of the 75 severe OSA individuals. In comparison, the NoSAS questionnaire had AUROC = 0.83 ± 0.03, and missed 23/75 severe OSA individuals. The STOP-BANG had AUROC = 0.77 ± 0.04 and missed 14/75 severe OSA individuals. INTERPRETATION We provide strong evidence on a representative population sample that oximetry biomarkers combined with few demographic information, the OxyDOSA model, is an effective screening tool for OSA. Our results suggest that sleep questionnaires should be used with caution for OSA screening as they fail to identify many moderate and even some severe cases. The OxyDOSA model will need to be further validated on data recorded using overnight portable oximetry.
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Affiliation(s)
- Joachim A. Behar
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Qiao Li
- Departments of Biomedical Informatics & Biomedical Engineering, Emory University & Georgia Institute of Technology, Atlanta, GA, USA
| | - Silverio Garbuio
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Departamento de Medicina, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gari D. Clifford
- Departments of Biomedical Informatics & Biomedical Engineering, Emory University & Georgia Institute of Technology, Atlanta, GA, USA
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25
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Sutherland K, Keenan BT, Bittencourt L, Chen NH, Gislason T, Leinwand S, Magalang UJ, Maislin G, Mazzotti DR, McArdle N, Mindel J, Pack AI, Penzel T, Singh B, Tufik S, Schwab RJ, Cistulli PA. A Global Comparison of Anatomic Risk Factors and Their Relationship to Obstructive Sleep Apnea Severity in Clinical Samples. J Clin Sleep Med 2019; 15:629-639. [PMID: 30952214 DOI: 10.5664/jcsm.7730] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a global health issue and is associated with obesity and oropharyngeal crowding. Global data are limited on the effect of ethnicity and sex on these relationships. We compare associations between the apnea-hypopnea index (AHI) and these risk factors across ethnicities and sexes within sleep clinics. METHODS This is a cross-sectional, multicenter study of patients with OSA from eight sleep centers representing the Sleep Apnea Global Interdisciplinary Consortium (SAGIC). Four distinct ethnic groups were analyzed, using a structured questionnaire: Caucasians (Australia, Iceland, Germany, United States), African Americans (United States), Asians (Taiwan), and South Americans (Brazil). Regression analyses and interaction tests were used to assess ethnic and sex differences in relationships between AHI and anthropometric measures (body mass index [BMI], neck circumference, waist circumference) or Mallampati score. RESULTS Analyses included 1,585 individuals from four ethnic groups: Caucasian (60.6%), African American (17.5%), Asian (13.1%), and South American (8.9%). BMI was most strongly associated with AHI in South Americans (7.8% increase in AHI per 1 kg/m2 increase in BMI; P < .0001) and most weakly in African Americans (1.9% increase in AHI per 1 kg/m2 increase in BMI; P = .002). In Caucasians and South Americans, associations were stronger in males than females. Mallampati score differed between ethnicities but did not influence AHI differently across groups. CONCLUSIONS We demonstrate ethnic and sex variations in associations between obesity and OSA. For similar BMI increases, South American patients show greatest AHI increases compared to African Americans. Findings highlight the importance of considering ethnicity and sex in clinical assessments of OSA risk.
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Affiliation(s)
- Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lia Bittencourt
- Disciplilna de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Ning-Hung Chen
- Sleep Center, Department of Pulmonary and Critical Care Medicine; Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali -The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sarah Leinwand
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Greg Maislin
- Division of Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Diego R Mazzotti
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital; University of Western Australia, Perth, Western Australia, Australia
| | - Jesse Mindel
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas Penzel
- Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital; University of Western Australia, Perth, Western Australia, Australia
| | - Sergio Tufik
- Disciplilna de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Richard J Schwab
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, Australia
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26
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Lucena LR, Polesel DN, Poyares D, Bittencourt L, Andersen ML, Tufik S, Hachul H. 0347 Insomnia and Quality of Life in Sleep Pattern: Sao Paulo Epidemiologic Sleep Study (EPISONO). Sleep 2019. [DOI: 10.1093/sleep/zsz067.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Leandro R Lucena
- Universidade Federal de Sao Paulo - Psychobiology, Sao Paulo, Brazil
| | - Daniel N Polesel
- Universidade Federal de Sao Paulo - Psychobiology, Sao Paulo, Brazil
| | - Dalva Poyares
- Universidade Federal de Sao Paulo - Psychobiology, Sao Paulo, Brazil
| | - Lia Bittencourt
- Universidade Federal de Sao Paulo - Psychobiology, Sao Paulo, Brazil
| | - Monica L Andersen
- Universidade Federal de Sao Paulo - Psychobiology, Sao Paulo, Brazil
| | - Sergio Tufik
- Universidade Federal de Sao Paulo - Psychobiology, Sao Paulo, Brazil
| | - Helena Hachul
- Universidade Federal de Sao Paulo - Psychobiology, Sao Paulo, Brazil
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27
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Tempaku PF, Santoro ML, Bittencourt L, D'Almeida V, Belangero SI, Tufik S. 0024 Genome-wide Association Study Reveals Two Novel Risk Alleles For Incident Obstructive Sleep Apnea In The Episono Cohort. Sleep 2019. [DOI: 10.1093/sleep/zsz067.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Lia Bittencourt
- Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vania D'Almeida
- Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Sergio Tufik
- Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
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28
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Keenan BT, Kim J, Singh B, Bittencourt L, Chen NH, Cistulli PA, Magalang UJ, McArdle N, Mindel JW, Benediktsdottir B, Arnardottir ES, Prochnow LK, Penzel T, Sanner B, Schwab RJ, Shin C, Sutherland K, Tufik S, Maislin G, Gislason T, Pack AI. Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis. Sleep 2019; 41:4791307. [PMID: 29315434 DOI: 10.1093/sleep/zsx214] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/01/2017] [Indexed: 12/11/2022] Open
Abstract
Study Objectives A recent study of patients with moderate-severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. Methods Using data on 972 patients with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes. Results The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6-54.5 years), obese (30.6-35.9 kg/m2), and had severe OSA (42.0-51.4 events per hour) on average. Conclusions Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.
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Affiliation(s)
- Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Jinyoung Kim
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.,School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Bhajan Singh
- Sir Charles Gairdner Hospital, Western Australian Sleep Disorders Research Institute, Nedlands, Western Australia, Australia
| | - Lia Bittencourt
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ning-Hung Chen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Peter A Cistulli
- Royal North Shore Hospital, Northern Clinical School, and Charles Perkins Centre University of Sydney, Australia
| | - Ulysses J Magalang
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nigel McArdle
- Sir Charles Gairdner Hospital, Western Australian Sleep Disorders Research Institute, Nedlands, Western Australia, Australia
| | - Jesse W Mindel
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Bryndis Benediktsdottir
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Erna Sif Arnardottir
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lisa Kristin Prochnow
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Bernd Sanner
- Department of Pulmonary Medicine, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal, Germany
| | - Richard J Schwab
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Chol Shin
- Pulmonary, Critical Care and Sleep Disorder Center, Korea University Medical Center Ansan Hospital, Seoul, South Korea
| | - Kate Sutherland
- Royal North Shore Hospital, Northern Clinical School, and Charles Perkins Centre University of Sydney, Australia
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Greg Maislin
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
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Guimarães TM, Bariani RC, Iafigliola SG, Guimarães CM, Chaves Junior CM, Ferraz O, Cappellette Junior M, Abraão-Cunha TC, Dal-Fabbro C, Rossi R, Bittencourt L, Fujita RR, Tufik S, Moreira G. Cone beam computed tomography in assessment on pharynx effects of
orthopedic-surgical treatment - a review of the literature. Sleep Sci 2019; 12:106-109. [PMID: 31879543 PMCID: PMC6922550 DOI: 10.5935/1984-0063.20190066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The cone beam computed tomography (CBCT) image provides clear differentiation of soft tissues from empty spaces. This paper presents a literature review to evaluate the effects of orthopedic and surgical treatment on the pharyngeal dimension by CBCT. It was concluded that treatments involving dentofacial orthopedics and orthognathic surgery have been related with an increase in the upper airway volume. Standardized capturing of tomographic images and more controlled and randomized studies are necessary.
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Affiliation(s)
- Thais Moura Guimarães
- UNIFESP, Departmento de Psicobiologia - São Paulo - São Paulo - Brazil
- Corresponding author: Thais Moura Guimarães. E-mail:
| | - Rita Catia Bariani
- UNIFESP, Departmento de otorrinolaringologia e cirurgia de cabeça e pescoço - São Paulo - São Paulo - Brazil
| | | | | | | | - Otávio Ferraz
- UNIFESP, Departmento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Mario Cappellette Junior
- UNIFESP, Departmento de otorrinolaringologia e cirurgia de cabeça e pescoço - São Paulo - São Paulo - Brazil
| | | | - Cibele Dal-Fabbro
- UNIFESP, Departmento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Rowdley Rossi
- UNIFESP, Departmento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Lia Bittencourt
- UNIFESP, Departmento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Reginaldo Raimundo Fujita
- UNIFESP, Departmento de otorrinolaringologia e cirurgia de cabeça e pescoço - São Paulo - São Paulo - Brazil
| | - Sergio Tufik
- UNIFESP, Departmento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Gustavo Moreira
- UNIFESP, Departmento de Psicobiologia - São Paulo - São Paulo - Brazil
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30
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Polesel DN, Nozoe KT, Tufik SB, Bezerra AG, Fernandes MTB, Bittencourt L, Tufik S, Andersen ML, Hachul H. Gender differences in the application of anthropometric measures for evaluation of obstructive sleep apnea. ACTA ACUST UNITED AC 2019; 12:2-9. [PMID: 31105888 PMCID: PMC6508944 DOI: 10.5935/1984-0063.20190048] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study aims to investigate anthropometric measures and their effectiveness as
screening method for diagnosing obstructive sleep apnea (OSA) in each gender. We
also evaluated which measures were associated with OSA in the adult population
of a large metropolitan city, Sao Paulo, Brazil. 552 women and 450 men were
submitted to polysomnography (PSG), and the anthropometric measurements as body
mass index (BMI), waist-to-height ratio, neck and waist circumference were
collected. The measurements were then compared with the OSA classification
established by the PSG. In women, waist circumference and waist-to-height ratio
were found to be the best predictor, while in men, the factors with great
potential for identification varied according to severity of the disease,
highlighting waist-to-height ratio, neck circumference and BMI had strongest
association. The accuracy of the classification in relation to mild-to-severe
OSA based on cut-off values of 92.5cm for waist circumference was greater than
72.9% in men, and 78.9% in women based on cut off values of 95cm. Regarding
severe OSA, cut-off values of 116.1cm were greater than 91.3% accurate in the
male population, and 95.1% in the female population with a cut-off value of
126.5cm. The study found waist circumference and waist-to-height ratio to be the
best measure to assess sleep-disordered breathing in women. Waist-to-height
ratio and neck circumferences were the best measures in men with mild OSA, but
BMI was more closely associated with severe OSA. The present study identified
the anthropometric variables with the highest risk for OSA and their respective
cutoff value, according to gender.
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Affiliation(s)
- Daniel Ninello Polesel
- Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Karen Tieme Nozoe
- Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Sergio Brasil Tufik
- Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Andreia Gomes Bezerra
- Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil
| | | | - Lia Bittencourt
- Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Sergio Tufik
- Universidade de São Paulo, Departamento de Pediatria - São Paulo - São Paulo - Brazil
| | - Monica Levy Andersen
- Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Helena Hachul
- Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil
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31
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Tempaku P, Hirotsu C, Mazzotti D, Xavier G, Maurya P, Brietzke E, Belangero S, Poyares D, Bittencourt L, Tufik S. Long Sleep Duration, Insomnia, and Insomnia With Short Objective Sleep Duration Are Independently Associated With Short Telomere Length. J Clin Sleep Med 2018; 14:2037-2045. [PMID: 30518442 DOI: 10.5664/jcsm.7532] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/31/2018] [Indexed: 12/30/2022]
Abstract
STUDY OBJECTIVES We aimed to determine the association between short telomere length, sleep parameters, and sleep disorders in an adult general population sample. METHODS As part of the EPISONO cohort (São Paulo, Brazil), 925 individuals answered questionnaires, underwent a full-night polysomnography and clinical assessment, and had peripheral blood collected for DNA extraction. Insomnia was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition; and obstructive sleep apnea was defined according to apnea-hypopnea index. For the objective insomnia phenotype, we combined insomnia diagnosis with total sleep time from polysomnography with a cutoff of 360 minutes, allowing the classification of six groups. Self-reported sleep duration was used to classify the individuals as short (< 6 hours), average (6 to 8 hours) and long (> 8 hours) sleepers. The leukocyte telomere length was measured using quantitative real-time polymerase chain reaction. Based on its distribution, we considered leukocyte telomere length < 10th percentile as short telomere and leukocyte telomere length ≥ 10th percentile as non-short telomere. RESULTS After adjusting for sex, age, and body mass index, only insomnia disorder (odds ratio [OR] = 2.654, 95% confidence interval [CI] = 1.025-6.873, P = .044), insomnia disorder total sleep time < 360 minutes (OR = 4.205, 95% CI = 1.097-16.117, P = .036) and long sleepers (OR = 2.177, 95% CI = 1.189- 3.987, P = .012) were associated with short telomere. CONCLUSIONS Our findings support the existence of an association among insomnia, insomnia phenotype, and self-reported long sleep duration with the maintenance of telomere length. COMMENTARY A commentary on this article appears in this issue on page 1975.
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Affiliation(s)
- Priscila Tempaku
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Camila Hirotsu
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.,Center for Investigation and Research in Sleep, Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Diego Mazzotti
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia
| | - Gabriela Xavier
- LINC-Interdisciplinary Laboratory of Clinical Neurosciences, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Pawan Maurya
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Biochemistry, Central University of Haryana, Mahendergarh, India
| | - Elisa Brietzke
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sintia Belangero
- LINC-Interdisciplinary Laboratory of Clinical Neurosciences, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Dalva Poyares
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lia Bittencourt
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
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32
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Hirotsu C, Haba-Rubio J, Togeiro SM, Marques-Vidal P, Drager LF, Vollenweider P, Waeber G, Bittencourt L, Tufik S, Heinzer R. Obstructive sleep apnoea as a risk factor for incident metabolic syndrome: a joined Episono and HypnoLaus prospective cohorts study. Eur Respir J 2018; 52:13993003.01150-2018. [PMID: 30287472 DOI: 10.1183/13993003.01150-2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/24/2018] [Indexed: 11/05/2022]
Abstract
Cross-sectional studies have demonstrated that obstructive sleep apnoea (OSA) and metabolic syndrome (MetS) are often associated, but whether a temporal relationship exists is unknown. We aimed to investigate the effect of OSA on the risk of developing MetS in the general population.A prospective study was conducted combining two population-based samples: Episono (Brazil) and HypnoLaus (Switzerland). MetS was assessed according to unified criteria. Polysomnography (PSG) was performed at baseline and follow-up in Episono, and at baseline in HypnoLaus. OSA was defined according to the apnoea-hypopnoea index as mild (≥5- <15 events h-1) and moderate-to-severe (≥15 events·h-1). We included 1853 participants (mean±sd age 52±13 years, 56% female) without MetS at baseline.After mean±sd 6±1 years, 318 (17.2%) participants developed MetS. Moderate-to-severe OSA was independently associated with incident MetS (OR 2.58, 95% CI 1.61-4.11) and increased the number of MetS components from baseline to follow-up through mediation of the percentage of time with arterial oxygen saturation <90%. Subset analysis in Episono confirmed that the increase in this parameter between baseline and follow-up PSGs represented a risk factor for incident MetS (OR 1.42, 95% CI 1.04-1.95, for each 10% increase).OSA is independently associated with an increased risk of developing MetS through mediation of nocturnal hypoxaemia in the general population.
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Affiliation(s)
- Camila Hirotsu
- Dept of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,These two authors are joint first authors
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,These two authors are joint first authors
| | - Sonia M Togeiro
- Dept of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Pedro Marques-Vidal
- Dept of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Luciano F Drager
- Hypertension Unit, Heart Institute (InCor) and Renal Division, University of São Paulo Medical School, São Paulo, Brazil
| | - Peter Vollenweider
- Dept of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Gérard Waeber
- Dept of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Lia Bittencourt
- Dept of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sergio Tufik
- Dept of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,These two authors are joint last authors
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland .,Pulmonary Dept, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,These two authors are joint last authors
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33
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Caparroz FA, de Almeida Torres Campanholo M, Sguillar DA, Haddad L, Park SW, Bittencourt L, Tufik S, Haddad FLM. A Pilot Study on the Efficacy of Continuous Positive Airway Pressure on the Manifestations of Dysphagia in Patients with Obstructive Sleep Apnea. Dysphagia 2018; 34:333-340. [PMID: 30251146 DOI: 10.1007/s00455-018-9944-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/17/2018] [Indexed: 12/29/2022]
Abstract
There is evidence in the literature demonstrating that patients with obstructive sleep apnea (OSA) may present with dysphagia, but few studies have evaluated whether this complaint can be reversed with treatment of OSA. To assess whether findings of dysphagia in patients with OSA can be reversed with the use of continuous positive airway pressure (CPAP) devices. Seventy adult patients (age 18-70 years) with moderate or severe OSA were included in the study. All patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) and completed the SWAL-QOL questionnaire on quality of life in dysphagia. Patients with visible abnormalities on FEES were treated with CPAP and reassessed after 3 months. The prevalence of dysphagia was 27.3% (18 patients). Premature spillage was the main finding. On comparison of groups with and without dysphagia, the SWAL-QOL score was significantly worse in the dysphagia group in domain 2 (eating duration and eating desire, p = 0.015), with no impact on overall score (p = 0.107). Of the 18 patients with dysphagia, 12 were started on CPAP; 11 exhibited satisfactory adherence and remained in the study. Abnormal FEES findings resolved in 81% (n = 9/11) of patients who started CPAP (p = 0.004), and dysphagia-specific quality of life also improved significantly (overall SWAL-QOL score, p = 0.028). In this sample of patients with OSA, the overall prevalence of dysphagia (as demonstrated by premature spillage on FEES) was 27.3%. Treatment of OSA with CPAP was able to reverse the endoscopic findings of swallowing dysfunction and to improve quality of life as measured by the SWAL-QOL.
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Affiliation(s)
- Fabio Azevedo Caparroz
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Danilo Anunciatto Sguillar
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Leonardo Haddad
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sung Woo Park
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
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34
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Mazzotti DR, Lim DC, Sutherland K, Bittencourt L, Mindel JW, Magalang U, Pack AI, de Chazal P, Penzel T. Opportunities for utilizing polysomnography signals to characterize obstructive sleep apnea subtypes and severity. Physiol Meas 2018; 39:09TR01. [PMID: 30047487 DOI: 10.1088/1361-6579/aad5fe] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a heterogeneous sleep disorder with many pathophysiological pathways to disease. Currently, the diagnosis and classification of OSA is based on the apnea-hypopnea index, which poorly correlates to underlying pathology and clinical consequences. A large number of in-laboratory sleep studies are performed around the world every year, already collecting an enormous amount of physiological data within an individual. Clinically, we have not yet fully taken advantage of this data, but combined with existing analytical approaches, we have the potential to transform the way OSA is managed within an individual patient. Currently, respiratory signals are used to count apneas and hypopneas, but patterns such as inspiratory flow signals can be used to predict optimal OSA treatment. Electrocardiographic data can reveal arrhythmias, but patterns such as heart rate variability can also be used to detect and classify OSA. Electroencephalography is used to score sleep stages and arousals, but specific patterns such as the odds-ratio product can be used to classify how OSA patients responds differently to arousals. OBJECTIVE In this review, we examine these and many other existing computer-aided polysomnography signal processing algorithms and how they can reflect an individual's manifestation of OSA. SIGNIFICANCE Together with current technological advance, it is only a matter of time before advanced automatic signal processing and analysis is widely applied to precision medicine of OSA in the clinical setting.
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Affiliation(s)
- Diego R Mazzotti
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, United States of America
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35
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Martins ODFM, Chaves Junior CM, Rossi RRP, Cunali PA, Dal-Fabbro C, Bittencourt L. Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review. Dental Press J Orthod 2018; 23:45-54. [PMID: 30304153 PMCID: PMC6150709 DOI: 10.1590/2177-6709.23.4.045-054.oar] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/26/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. OBJECTIVE This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. METHODS An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. RESULTS A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. CONCLUSION The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.
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Affiliation(s)
- Olivia de Freitas Mendes Martins
- Universidade Federal do Piauí, Curso de Especialização em Ortodontia (Teresina/PI, Brazil).,Centro Universitário UNINOVAFAPI, Curso de Especialização em Ortodontia (Teresina/PI, Brazil)
| | | | | | - Paulo Afonso Cunali
- Universidade Federal do Paraná, Departamento de Odontologia (Curitiba/PR, Brazil)
| | - Cibele Dal-Fabbro
- Instituto do Sono de São Paulo, Curso de Odontologia do Sono (São Paulo/SP, Brazil)
| | - Lia Bittencourt
- Universidade Federal de São Paulo, Departamento de Psicobiologia (São Paulo/SP, Brazil)
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36
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Pak VM, Mazzotti DR, Keenan BT, Hirotsu C, Gehrman P, Bittencourt L, Pack AI, Tufik S. Candidate gene analysis in the São Paulo Epidemiologic Sleep Study (EPISONO) shows an association of variant in PDE4D and sleepiness. Sleep Med 2018; 47:106-112. [DOI: 10.1016/j.sleep.2017.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/30/2017] [Indexed: 12/24/2022]
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37
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Nicolau ZFM, Bezerra AG, Polesel DN, Andersen ML, Bittencourt L, Tufik S, Hachul H. Premenstrual syndrome and sleep disturbances: Results from the Sao Paulo Epidemiologic Sleep Study. Psychiatry Res 2018; 264:427-431. [PMID: 29704826 DOI: 10.1016/j.psychres.2018.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/19/2017] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
The aim of this study is to compare sleep characteristics between women with premenstrual syndrome (PMS) and a control group. The data were extracted from an epidemiologic survey conducted in Sao Paulo (EPISONO), Brazil, which used subjective assessments and objective polysomnography records to analyze subjects' sleep pattern. Subjective questionnaires used in this study were Women's Questionnaire, Pittsburgh Sleep Quality Index, Epworth sleepiness scale, Insomnia Severity Index and the general sleep questionnaire. The presence of PMS was obtained by a direct question in the Women's Questionnaire. The survey included 230 women, of whom 72.6% reported PMS. The PMS group had poorer sleep quality, a higher perception of unrefreshing sleep and more subthreshold insomnia. Participants with PMS had an increased total sleep time recorded by polysomnography and a lower saturation of peripheral oxygen. It is still unkown the mechanism behind PMS and the sleep-wake cycle. In the other hand, it is clear that PMS play a role in sleep, since women with this disorder has a poor quality of sleep and it is not refreshing. Better knowledge about this syndrome and its outcomes can help to improve their well-being and develop more precise therapeutic approaches.
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Affiliation(s)
- Zaira F M Nicolau
- Departmento of Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Andréia G Bezerra
- Departmento of Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Daniel N Polesel
- Departmento of Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Monica L Andersen
- Departmento of Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lia Bittencourt
- Departmento of Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Sergio Tufik
- Departmento of Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Helena Hachul
- Departmento of Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil; Departmento de Ginecologia, Casa de Saúde Santa Marcelina, Sao Paulo, SP, Brazil.
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38
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Hirotsu C, Heinzer R, Poyares D, Haba-Rubio J, Coelho FM, Bittencourt L, Tufik S. 0951 Insomnia, Short-sleepers And Rem-related Sleep Disordered Breathing As Risk Factors For Incident Depression In The Episono Cohort. Sleep 2018. [DOI: 10.1093/sleep/zsy061.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Hirotsu
- Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, BRAZIL
| | - R Heinzer
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SWITZERL
| | - D Poyares
- Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, BRAZIL
| | - J Haba-Rubio
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SWITZERL
| | - F M Coelho
- Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, BRAZIL
| | - L Bittencourt
- Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, BRAZIL
| | - S Tufik
- Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, BRAZIL
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39
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Tempaku PF, Hirotsu C, Mazzotti DR, Xavier G, Maurya PK, Rizzo LB, Brietzke E, Belangero SI, Poyares D, Bittencourt L, Tufik S. 0035 Long-sleepers and Insomnia with Short Objective Sleep Duration are Independently Associated with Short Telomere Length in the EPISONO Cohort. Sleep 2018. [DOI: 10.1093/sleep/zsy061.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P F Tempaku
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - C Hirotsu
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | | | - G Xavier
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - P K Maurya
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - L B Rizzo
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - E Brietzke
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - S I Belangero
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - D Poyares
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - L Bittencourt
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - S Tufik
- Universidade Federal de São Paulo, São Paulo, BRAZIL
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40
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Araujo P, Polesel DN, Hachul H, Bittencourt L, Tufik S, Andersen ML. 0691 Oxygen Saturation During Sleep As A Predictor Of Inflammation In Anovulatory Women Compared To Women In Regular Menstrual Cycle Or Under Hormonal Contraceptive Use. Sleep 2018. [DOI: 10.1093/sleep/zsy061.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Araujo
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - D N Polesel
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - H Hachul
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - L Bittencourt
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - S Tufik
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - M L Andersen
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
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41
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Hachul H, Daniel PN, Nozoe KT, Bittencourt L, Andersen ML, Fernandes MT, Tufik S. 0715 Different Anthropometric Measures Should Be Used To Evaluate Obstructive Sleep Apnea In The Woman’S Reproductive Life Stages. Sleep 2018. [DOI: 10.1093/sleep/zsy061.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Hachul
- Universidadede Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - P N Daniel
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - K T Nozoe
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | | | - M L Andersen
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | | | - S Tufik
- Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
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42
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Tempaku PF, Mazzotti DR, Hirotsu C, Andersen ML, Xavier G, Maurya PK, Rizzo LB, Brietzke E, Belangero SI, Bittencourt L, Tufik S. The effect of the severity of obstructive sleep apnea syndrome on telomere length. Oncotarget 2018; 7:69216-69224. [PMID: 27690344 PMCID: PMC5342471 DOI: 10.18632/oncotarget.12293] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/23/2016] [Indexed: 12/17/2022] Open
Abstract
Aging is associated with an increase in the prevalence of obstructive sleep apnea syndrome (OSAS) as well as the shortening of telomeres. It is known that OSAS-related factors are stimuli that can contribute to the acceleration of cellular senescence. Thus, the present study aimed to compare the leukocyte telomere length (LTL) between OSAS patients and controls, as well as to verify the correlation between LTL and sleep parameters. We used DNA extracted of 928 individuals from EPISONO to measure the LTL by the quantitative real-time polymerase chain reaction. All individuals were subjected to one full-night polysomnography. LTL was significantly shorter in OSAS patients compared to controls. The results showed negative correlations between LTL and the following variables: apnea-hypopnea index, respiratory disturbance index, desaturation index and wake after sleep onset. LTL was positively correlated with sleep efficiency, total sleep time, basal, minimum and maximum oxygen saturation. Lastly, it was observed that OSAS severity was associated with shorter LTL even after adjusting for sex, age, years of schooling, body mass index, diabetes, stroke and heart attack. In conclusion, our study indicates the presence of an association between LTL and OSAS and a significant impact of severity of OSAS in telomeres shortening.
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Affiliation(s)
- Priscila Farias Tempaku
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Diego Robles Mazzotti
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Camila Hirotsu
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Gabriela Xavier
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil.,Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Pawan Kumar Maurya
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil.,Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Lucas Bortolotto Rizzo
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil.,Department of Psychiatry, University of Tuebingen, Tuebingen, Germany.,Grupo de Pesquisa em Neurociência Comportamental e Molecular do Transtorno Bipolar, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Elisa Brietzke
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil.,Grupo de Pesquisa em Neurociência Comportamental e Molecular do Transtorno Bipolar, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Sintia Iole Belangero
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil.,Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
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43
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Guimarães MDLR, Hermont AP, Guimarães TM, Dal-Fabbro C, Bittencourt L, Chaves Junior CM. Severe obstructive sleep apnea treatment with mandibular advancement device: A case report. Sleep Sci 2018; 11:118-122. [PMID: 30083300 PMCID: PMC6056071 DOI: 10.5935/1984-0063.20180022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mandibular advancement device (MAD) has been described as an alternative
treatment to the severe obstructive sleep apnea (OSA), once it is not as
effective as the continuous positive airway pressure therapy (CPAP) in reducing
the apnea and hypopnea index (AHI). The objective of this study is to report a
case using a MAD in a CPAP-intolerant patient suffering from severe OSA.
Polysomnography exams were performed before and after treatment. Five months
after fitting and titrating the MAD, the AHI was reduced from 80.5 events/hour
to 14.6 events/hour and the minimum oxyhemoglobin saturation (SpO2)
increased from 46% to 83%. A two-year assessment of therapy revealed an AHI of 8
events/hour and SpO2 of 85%.
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Affiliation(s)
| | - Ana Paula Hermont
- Universidade Federal de Minas Gerais, Faculdade de Odontologia -
Belo Horizonte, MG, Brasil
| | - Thais Moura Guimarães
- Universidade Federal de São Paulo, Departamento de
Psicobiologia - São Paulo, SP, Brasil
- Corresponding author: Cauby Maia Chaves Junior.
E-mail: E-mail:
| | - Cibele Dal-Fabbro
- Universidade Federal de São Paulo, Departamento de
Psicobiologia - São Paulo, SP, Brasil
| | - Lia Bittencourt
- Universidade Federal de São Paulo, Departamento de
Psicobiologia - São Paulo, SP, Brasil
| | - Cauby Maia Chaves Junior
- Universidade Federal do Ceará, Departamento de Clínica
odontológica - Fortaleza, CE, Brasil
- Corresponding author: Cauby Maia Chaves Junior.
E-mail: E-mail:
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44
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Palombini L, Godoy L, Hirotsu C, Bittencourt L, Poyares D, Guilleminault C, Tufik S. Upper airway resistance syndrome: validation of a definition based in long term outcomes. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Kim L, Hirotsu C, Esteves A, Bittencourt L, Andersen M, Tufik S. Prevalence and associated factors of restless legs syndrome and periodic limb movement in episono cohort. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Togeiro S, Oliveira e Silva L, Guimaraes T, Bittencourt L, Tufik S. Metabolic profile in patients with mild obstructive sleep apnea. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Vidigal T, Oliveira L, Moura T, Haddad F, Sutherland K, Cistulli P, Schwab R, Pack A, Magalang U, Leinwand S, Keenan B, Chen NH, Maislin G, Mazzotti D, Hirotsu C, Tufik S, Bittencourt L. Can intra-oral and facial photos predict OSA in the general and clinical population? Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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48
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Silva LOE, Guimarães TM, Luz GP, Coelho G, Badke L, Almeida IR, Millani-Carneiro A, Tufik S, Bittencourt L, Togeiro SM. Metabolic Profile in Patients with Mild Obstructive Sleep Apnea. Metab Syndr Relat Disord 2017; 16:6-12. [PMID: 29148894 DOI: 10.1089/met.2017.0075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mild obstructive sleep apnea (OSA) is a highly prevalent disorder in adults. However, it is not clear whether mild OSA has significant metabolic complications. This study examined the prevalence of metabolic syndrome (MS) in patients with mild OSA compared to control group. METHODS Adults (18-65 years of age) of both genders with a body mass index (BMI) ≤35 kg/m2 were included. The mild OSA group comprised of patients with an apnea-hypopnea index (AHI) score of ≥5 but ≤15 events/hr of sleep, independent of other symptoms. The control group (CG) comprised individuals with an AHI of <5 events/hr of sleep and an Epworth Sleepiness Scale score of <10. The following were used for both groups: two questionnaires on sleepiness, the maintenance of wakefulness test, and full-night polysomnography. Anthropometric measurements and fasting blood samples were obtained, including fasting glucose and insulin, total cholesterol and its subfractions [low-density lipoprotein, very low-density lipoprotein, and low-density lipoprotein cholesterol (HDL-c)], triglycerides (TG), and the TG/HDL-c ratio. In addition, the quantitative insulin sensitivity check index and homeostasis model assessment indices were calculated. RESULTS Thirty-two percent of mild OSA patients had MS, 43.5% of mild OSA patients had hypertension, 14% showed dyslipidemia, and 56% had prediabetes. The OSA group showed increased TG (CG: 90.0 ± 51.9 vs. OSA: 140.3 ± 78.2 mg/dL, P = 0.004), and TG/HDL-c (CG: 1.9 ± 1.4 vs. OSA: 3.1 ± 2.0, P = 0.05), independent of adjustments. Independent of obesity (BMI <30 kg/m2), there was a negative correlation between total cholesterol and TG with mean oxygen saturation, independent of obesity (BMI <30 kg/m2). CONCLUSIONS Our findings showed dysregulation in lipid profiles after adjustments for confounders in the mild OSA group, and there was a correlation between these parameters and sleep hypoxemia. The TG/HDL-c ratio in particular was high, suggesting that it might be investigated as a marker of a detrimental metabolic profile in these patients.
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Affiliation(s)
- Luciana Oliveira E Silva
- 1 Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo , São Paulo, Brazil
| | - Thais M Guimarães
- 1 Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo , São Paulo, Brazil
| | - Gabriela P Luz
- 2 Departamento de Pneumologia, Universidade Federal de São Paulo , São Paulo, Brazil
| | - Glaury Coelho
- 1 Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo , São Paulo, Brazil
| | - Luciana Badke
- 2 Departamento de Pneumologia, Universidade Federal de São Paulo , São Paulo, Brazil
| | - Ildonete R Almeida
- 1 Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo , São Paulo, Brazil
| | - Aline Millani-Carneiro
- 1 Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo , São Paulo, Brazil
| | - Sergio Tufik
- 1 Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo , São Paulo, Brazil
| | - Lia Bittencourt
- 1 Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo , São Paulo, Brazil
| | - Sonia M Togeiro
- 1 Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo , São Paulo, Brazil
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Chaves Junior CM, Dal Fabbro C, Machado MAC, Sales de Bruin VM, Carvalhedo de Bruin PF, Gurgel ML, Torgeiro SMGP, Cevidanes L, Haddad FLM, Bittencourt L. Use Of Mandibular Advancement Devices For Obstructive Sleep Apnoea Treatment In Adults. Int Arch Med 2017. [DOI: 10.3823/2502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
ABSTRACT
Introduction: This article is based on Clinical Guidelines for obstructive sleep apnoea (OSA) established by a taskforce coordinated by the Brazilian Sleep Association.
Objective: The aim of this article is to evaluate the available scientific evidence regarding the efficacy, adherence and safety of using mandibular advancement devices (MAD) as a therapeutic course for treating obstructive sleep apnoea in adult patients.
Method: Active searches were performed in the PubMed/MEDLINE, EMBASE, Scielo/LILACS and Cochrane Library databases. Methodological aspects were used to rank the levels of evidence according to the criteria of the Centre for Evidence-Based Medicine at Oxford.
Results: Mandibular advancement devices offer the best results for patients with primary snoring, upper airway resistance syndrome and mild or moderate OSA (Levels of Evidence I and II). Patients seem to exhibit greater adherence to oral appliances (MAD) than to continuous positive airway pressure (CPAP) devices, although the latter are more effective in controlling OSA (Level of Evidence I). The long-term side effects most observed after the use of MADs are related to changes in the mandibular and dental positions (Levels of Evidence I and II).
Conclusion: MAD constitute a therapeutic alternative for OSA and promote favourable results with good efficacy and adherence to treatment. Side effects can arise in the short, medium or long term. Patients must be informed about the possible occurrence of these adverse effects, and the orthodontist must be able to manage any side effects that occur due to the use of these devices.
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50
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Rizzatti FG, Mazzotti DR, Maislin G, Keenan B, Mindel J, Pack FM, Sutherland K, Cistulli P, Singh B, McArdle N, Chen N, Pack AI, Bittencourt L, Tufik S, Magalang U. 0460 DEFINING OSA EXTREME PHENOTYPES ACROSS THE WORLD: A SLEEP APNEA GLOBAL INTERDISCIPLINARY CONSORTIUM EFFORT. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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