INTRODUCTION: Studies relating otorhinolaryngological with phonoaudiological and polysomnographic assessments in patients with the obstructive sleep apnea syndrome (OSAS) are rare, and the paucity of information on this topic is apparent when outlining treatments for the OSAS. Objectives: The purpose of this investigation was to thoroughly describe possible alterations in orofacial motricity structure and function in the OSAS patients by means of a phonoaudiological evaluation model.
METHODS: Orofacial structures and functions were examined in male OSAS patients with respect to anthropometric, otorhinolaryngological, and phonoaudiological parameters.
RESULTS: A total of 22 patients was recruited, with an average age of 47±11 years old, body mass index of 26.2±4.9 kg/m2, and cervical circumference of 43.9±3.4 cm. The otorhinolaryngological and phonoaudiological assessments revealed that 73% of patients had reductions related to tongue tension; 64% of them showed an elevated genioglossus with the tip of the tongue laying behind the inferior central incisive teeth; 55% showed failed teething; 27% exhibited normal occlusion; 18% had class II occlusions; 100% had facial asymmetry; 36% had a narrow, deep, hard palate; 55% had nasal obstruction; 100% presented with oropharynx alterations; 72% showed unilateral chewing; 63% had ineffective chewing, and 83% exhibited advanced tongue projection during swallowing.
CONCLUSIONS: The phonoaudiological model adopted in this study produced relevant findings about modifications in orofacial motricity in the treatment of OSAS patients.
Keywords: sleep apnea, obstructive; polysomnography; myofunctional therapy; speech, language and hearing sciences.
INTRODUCTION: Obstructive Sleep Apnea Syndrome (OSAS) has cardiovascular and cognitive repercussions that differ according to age. The aim of the present study was to demonstrate clinical and polysomnographic differences among three different age groups of patients with OSAS.
METHODS: We studied 130 adult patients with OSAS. The study protocol consisted on questionnaires, a physical examination, and polysomnography. Patients were distributed into three age groups: below 35 years-old (Group A), 35 to 65 years-old (Group B), and above 65 years-old (Group C).
RESULTS: Group A had 22 (16.9%) patients, B had 92 (70.7%), and C had 16 (12.3%). Systemic arterial hypertension (p=0.01) and cardiopathy (p=0.02) were significantly more frequent in Group C, while smoking (p=0.04) was more frequent in Group A. There were no differences between groups on polysomnography measures or Epworth Sleepiness Scale scores. Upon physical examination, there were significantly more posterior soft palate (p=0.004) and a greater use of dental prosthesis in Group C (p=0.03), along with a greater number of hypertrofic palatine tonsils in Group A (p=0.01).
CONCLUSION: Most OSAS patients were in the 35 to 65 years-old age range. Clinical findings show that the disease may have different aggravating factors depending on the patient's age.
Keywords: sleep apnea, obstructive; snoring; physical examination; polysomnography; aged.
OBJECTIVE: To investigate whether poor sleep quality is related to night work, either currently or in the past.
METHODS: A cross-sectional study was performed with female nursing workers. Sleep problems were evaluated through questions on difficulty in falling asleep and in maintaining sleep, early morning awakening, insomnia complaint, and unsatisfactory sleep. Experience on night work (past and current experience), night work 'dose' in the past (three to nine years, more than nine years), and time left after leaving night work (up to five years, more than five years) were analyzed. Those with no experience on night work were considered as the Reference Group. The association between each independent variable and sleep problems was tested through the binomial logistic regression.
RESULTS: Former night workers had a greater chance of reporting difficulty in maintaining sleep (OR=1.72), and a general complaint of insomnia (OR=1.60). Workers who had spent ten years or more on night work had twice more chances to report early morning awakening, difficulty in maintaining sleep, and a general complaint of insomnia. Workers who had left night work for up to five years were at a greater chance of reporting difficulty in maintaining sleep, general complaint of insomnia and nonsatisfactory sleep (OR=1.87, 1.63 and 1.70, respectively). Reporting difficulty in maintaining sleep was also more frequent among those who left night work more than five years before data collection (OR=1.72).
CONCLUSIONS: Evidence on long-term effects of night work on sleep contributes to the scientific debate on the impact of night work on health and well-being.
Keywords: sleep; occupational health; work schedule tolerance; workload; insomnia.
Snoring is highly prevalent, increases with age and is greater in men. The prevalence rates of snoring in the general population are variable, ranging from 20 to 60%. However, all population-based studies used the subjective analysis of snoring evaluated by questionnaires. Snoring is the major reported signal that may indicate obstructive sleep apnea (OSA). The polysomnography study, which is the golden standard test for the diagnosis of OSA, frequently uses the vibration recording by a sensor located on the patient's neck. However, this signal is not calibrated and has no correlation with sound intensity. To date, there is no consensus on the methodology of the acquisition and analysis of the snore signal. This review article evaluates methodological studies that report on snoring recording equipment and correlate the snoring signal with OSA. Using the keywords "Snoring" and "Obstructive Sleep Apnea" in PubMed, we found 602 articles, however there were only 11 studies (1.8%) that reported on technical aspects regarding snoring recording and analysis. The selected articles showed a wide variability in the method of recording, as well as analysis of the snoring signal. The lack of technical studies on snoring reflects a major gap in Sleep Medicine. Recent data obtained by objective measurements showed that snoring intensity correlates with OSA severity. In addition, snoring recordings represent a promising new noninvasive tool for the diagnosis of OSA. We conclude that snoring is a poorly monitored signal and that more studies are warranted in this fundamental area of Sleep Medicine.
Keywords: snoring; sleep apnea, obstructive/diagnosis; palate, soft/physiopathology; body mass index; polysomnography; respiratory sounds.
Obstructive sleep apnea syndrome is a prevalent disease that results in cardiovascular, metabolic, and cognitive complications. The major treatment modality has been the positive airway pressure device, but adherence to this form of treatment has been limited. For this reason, other forms of treatment may help to control this disease, such as the upper airway and cranial-facial surgical procedures. Therefore, the objective of this paper was to investigate surgical procedures that could be used for obstructive sleep apnea syndrome treatment in adults, as well as their indications and success rates. There are many proposed surgical procedures for the treatment of obstructive sleep apnea syndrome; these include upper airway and cranial-facial surgeries. Although few studies have confirmed the exact benefit of these procedures in the obstructive sleep apnea syndrome treatment, the presence of anatomical alterations in these sites and the severity of obstructive sleep apnea syndrome have been the main factors taken into consideration in the selection of patients to undergo this type of treatment.
Keywords: sleep apnea syndromes/surgery; uvula/surgery; palate, soft/surgery; pharynx/surgery; continuous positive airway pressure; bariatric surgery; pharyngeal muscles/surgery; nasal septum/surgery; treatment outcome; review.
There is scarce information on the global situation of Latin American Sleep Medicine. In the XII Congress of the Federation of Latin American Sleep Societies and the First Congress of the Peruvian Association of Sleep Medicine held in Lima, Peru, in October 2008, a meeting of representatives from different countries of Latin America was organized to implement a plan aimed to project the future. Thus, this article intended to collect information regarding sleep medicine human resources, physician and allied health professionals, educational activities, and infrastructure in selected countries of the Latin American region. Country delegates were prompted to make a presentation. These delegates brought current information to solve the following questions: Is there a national association dedicated to sleep medicine in each of their countries?; How many sleep medicine laboratories exist in their respective countries?; Is there a formal training system?; How are technologists training in each country?; What is the number of medical technologists in each individual country? and What activities related to sleep medicine are organized in each country? Participants from Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, Peru, and Uruguay described the organization of their societies, sleep study facilities, care and research in the area of sleep medicine, human resources and training events as well as their participation into education in each country. Very few countries like Argentina, Colombia, and Uruguay have health systems that cover polysomnographic studies or continuous positive airway pressure therapy. In the majority of countries, there is no formal training in sleep medicine, neither an inclusion of sleep medicine courses in medical school curricula. There is a very uneven development of sleep medicine in Latin America, with very variable availability of resources. The analysis of the region as a whole indicates a major deficiency in the practice of sleep medicine, an underserved population, and very few participation of sleep medicine in undergraduate and postgraduate medicine programs. Sleep medicine, as a field, is still young and with great development potential.
Keywords: sleep medicine specialty; societies, medical; Latin America.