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Sahlin, Carin. "Sleep apnea and sleep : diagnostic aspects." Doctoral thesis, Umeå : Umeå universitet, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-18959.
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Lam, Chung-mei Jamie, and 林頌眉. "Obstructive sleep apnea and cardiometabolic complications." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43085854.
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Mariscal, Norma Linda, and Norma Linda Mariscal. "Management of Postoperative Obstructive Sleep Apnea." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624558.
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Background: Obstructive sleep apnea (OSA) is a sleep disorder characterized by episodes of cessation of breathing (apnea) during sleep. Unfortunately, a significant number of surgical patients are unaware they are afflicted with this disorder increasing the risks of postoperative complications. The lingering effect of general anesthesia causes an increase in frequency of airway collapse, leading to longer periods of apnea. This increasingly common sleep disorder is concerning for many anesthesia providers.
Purpose: The purpose of this study was to evaluate the anesthesia provider's knowledge and postoperative management of patients with suspected or diagnosed OSA.
Setting: The study setting was a local urban hospital Mountain Vista Medical Center (MVMC) in Gilbert, AZ. The study included (N=7) participants, who were predominantly male (85%) and a majority of the participants were Master’s prepared (85%) anesthesia providers.
Method: An online survey was disseminated to participants via email. The survey included questions regarding the anesthesia provider's knowledge and postoperative practice habits of patients with suspected or diagnosed OSA at MVMC.
Results: The response rate was (24%). All the respondents acknowledged that OSA was a risk factor for postoperative complications. Over half of the respondents (85%) reported encountering postoperative complications such as desaturation and apnea in their patients with OSA. The main complication that was encountered was postoperative apnea (50%), followed by decreased in saturations (33.33%), and one respondent (16.67%) encountered re-intubation during the postoperative period. However, the most important finding of the study is that over half of the providers did not routinely include continued positive airway pressure (CPAP)/noninvasive positive pressure ventilation (NIPPV) in their postoperative management of patients with suspected or known OSA due to the time needed to initiate the therapy.
Conclusion: The study illustrates that a majority of anesthesia providers at MVMC agreed OSA is a significant risk factor for postoperative complications, but time constraints limited the implementation of noninvasive ventilation (NIV) therapies. Recommended strategies would be to establish a task force to examine this barrier to therapy and develop plans to address it.
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Lam, Chung-mei Jamie. "Obstructive sleep apnea and cardiometabolic complications." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43085854.
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Wimms, Alison Jane. "Gender Differences in Obstructive Sleep Apnea." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21632.
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The overall aim of this thesis was to understand gender differences in obstructive sleep apnea (OSA) and use this information to develop a tailored therapy for female patients. Specific aims were to determine whether gender differences commonly reported in the literature are present in mild OSA and upper airway resistance syndrome (UARS) patient groups, and whether symptoms could be linked to respiratory parameters in these groups. The final aim was to develop, test and validate a new AutoSet treatment for female OSA patients. CHAPTER 1 of this thesis provides a detailed review of gender differences in the prevalence, symptoms, clinical experience, and health outcomes of OSA and UARS patients, with a focus on the implications of different scoring rules. CHAPTER 2 reviews of quality of life questionnaires from 259 untreated patients with mild OSA. Females reported statistically significantly higher levels of sleepiness, fatigue, insomnia, and anxiety/depression compared to males. CHAPTER 3 of this thesis reviews polygraphy data from patients with mild OSA. Male patients were found to have significantly more breathing disturbances than females, however many of these difference disappeared when updated scoring criteria were used. Some weak correlations were found between respiratory parameters and symptoms; however, no clear conclusions could be drawn. CHAPTER 4 outlines the development of a new AutoSet device designed for female- specific breathing patterns. The remaining chapters (CHAPTER 5, and CHAPTER 6) of this thesis describe the testing and validation activities undertaken on the AutoSet F, including a clinical trial to test efficacy; a bench test to compare performance against other commercially available devices; a controlled product launch to validate the features of the algorithm; and finally a clinical trial which demonstrated improvements in sleep efficacy and quality of life over a three-month usage period. In summary, this thesis has shown that at the mild end of the OSA spectrum females are more symptomatic than males, even though respiratory differences in the genders are less pronounced than those described in moderate-to-severe patients. An AutoSet designed specifically for female OSA patients was successful in demonstrating efficacy and clinical effectiveness.
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Karci, Ersin. "Detection Of Post Apnea Sounds And Apnea Periods From Sleep Sounds." Master's thesis, METU, 2011. http://etd.lib.metu.edu.tr/upload/12612964/index.pdf.
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Obstructive Sleep Apnea Syndrome (OSAS) is defined as a sleep related breathing disorder that causes the body to stop breathing for about 10 seconds and mostly ends with a loud sound due to the opening of the airway. OSAS is traditionally diagnosed using polysomnography, which requires a whole night stay at the sleep laboratory of a hospital, with multiple electrodes attached to the patient's body. Snoring is a symptom which may indicate presence of OSAS
thus investigation of snoring sounds, which can be recorded in the patient'
s own sleeping environment, has become popular in recent years to diagnose OSAS. In this study, we aim to develop a new method to detect post-apnea snoring episodes with the goal of diagnosing apnea or creating a new criteria similar to apnea / hypopnea index. In this method, first segmentation is done to eliminate the silence parts and only deal with active. Then these episodes are represented by distinctive features
some of these features are available in literature but some of them are novel. Finally, these episodes are classified using supervised and unsupervised methods. We are especially interested in detecting post apnea episodes, hence the apnea periods. False alarm rates are reduced by adding additional constraints into the detection algorithm. These methods are applied to snoring sound signals of OSAS patients, recorded in Gulhane Military Medical Academy, to verify the success of our algorithms.
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Appelberg, Jonas. "Ventilation and Lung Volume During Sleep and in Obstructive Sleep Apnea." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3363.
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Ulander, Martin. "Psychometric aspects of obstructive sleep apnea syndrome." Doctoral thesis, Linköpings universitet, Avdelningen för neurovetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-97475.
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Introduction: Obstructive sleep apnea (OSA) is a common chronic disorder consisting of episodes with impaired breathing due to obstruction of the upper airways. Treatment with Continuous Positive Airway Pressure (CPAP) is a potentially effective treatment, but adherence is low. Several potential factors affecting adherence, e.g., subjective sleepiness and personality, are only quantifiable through questionnaires. Better knowledge about psychometric properties of such questionnaires might improve future research on CPAP adherence and thus lead to better treatment options. Aim: Study I: To describe the devlopment and initial testing of the Side Effects of CPAP treatment Inventory (SECI) questionnaire. Study II: To describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. Study III: To study whether any of the items in the Epworth Sleepiness Scale (ESS) exhibit differential item functioning and, if so, to which degree. Study IV: To examine the evolution of CPAP side effects over time; and prospectively assess correlations between early CPAP side effects and treatment adherence. Patients and Methods: In study I, SECI items were based on a literature review, an expert panel and interviews with patients. It was then mailed to 329 CPAP-treated OSAS patients. Based on this, a principal component analysis was performed, and SECI results were compared between adherent and non-adherent patients. In study II, the population consisted of 247 OSAS patients with ongoing CPAP treatment. The DS14 was used to assess the prevalence of type D personality, and SECI and adherence data from medical records were used to correlate Type D personality to side effects and adherence. In study III, the population consisted of pooled data from 1,167 subjects who had completed the ESS in five other studies. Ordinal regression and Rasch analysis were used to assess the existence of differential item functioning for age and gender. The cutoff for age was 65 years in the Rasch analysis. In study IV, SECI was sent to 186 subjects with newly diagnosed OSAS three times during the first year on CPAP. SECI results were followed over time within subjects, and were correlated to treatment dropout during the first year and machine usage time after 6 months. Results: SECI provides a valid and reliable instrument to measure side effects, and non-adherent patients have higher scores (i.e., were more bothered by side effects) than adherent patients (study I). Type D personality was prevalent in approximately 30 % of CPAP treated OSAS patients, and was associated to poorer objective and subjective adherence as well as more side effects (study II). Differential item functioning was present in items 3, 4 and 8 for age in both DIF analyses, and to gender in item 8 the Rasch analysis (study III). Dry mouth and increased number of awakenings were consistently associated to poorer adherence in CPAP treated patients. Side effects both emerged and resolved over time (study IV). Conclusions: Differences in previous research regarding side effects and CPAP adherence might be explained by differences in how side effects and adherence are defined. While some side effects are related to adherence, others are not. Side effects are furthermore not stable over time, and might be related to personality. ESS scores are also related to CPAP adherence according to previous research, but might be affected by other factors than sleepiness, such as age and possibly gender.
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gaddam, sathvika, Ali Bokhari, and Deepika 7471363 Nallala. "ACROMEGALY TREATMENT AND RESOLUTION OF SLEEP APNEA." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/41.
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Introduction
Acromegaly is an endocrine disorder characterized by excessive growth hormone production.The most common cause is a benign pituitary adenoma, which can be an isolated tumor or part of a group of concomitant endocrine neoplasms. We present a case of a middle aged woman with sleep apnea and a newly diagnosed acromegaly secondary to a pituitary macroadenoma.
Case presentation
A 51-year-old woman was seen in the endocrinology clinic for evaluation of hyperparathyroidism and mild hypercalcemia. She had no symptoms related to hypercalcemia. However, she complained of enlargement of her fingers and toes. She also reported galactorrhea and breast engorgement. There was no hyperhidrosis or frontal bossing present and she denied headaches or vision symptoms. Past medical history was significant for obstructive sleep apnea. Insulin like growth factor level was 630 ng/ml (reference 53 - 190 ng/ml), prolactin level was 109 ng/ml (reference 1.9- 25 ng/ml), and Follicular stimulating hormone was 0.4mIU/ml (reference 1.2 - 21.0 mIU/ml). TSH, free T4, ACTH, and cortisol were normal. The labs were consistent with pituitary macroadenoma secreting growth hormone (GH) and prolactin. MRI pituitary showed a 1.9 cm macroadenoma with no evidence of optic nerve compression. Due to the coexisting diagnoses of hyperparathyroidism and pituitary adenoma, CT abdomen was done to evaluate for neuroendocrine tumor and to rule out Multiple Endocrine Neoplasia (MEN) Type 1. She then underwent transsphenoidal resection of the pituitary, with immunostaining reflecting diffuse prolactin and patchy GH expression. Post-surgery IGF, prolactin, thyroid function tests were normal. She was started on hydrocortisone replacement due to abnormal ACTH and cortisol. Her calcium levels normalized, and further genetic testing for MEN was abandoned. Her repeat sleep study also showed resolution of sleep apnea. She did not suffer from further symptoms of acromegaly and was scheduled for periodic surveillance for thyroid axis dysfunction.
Discussion
Dysregulated growth hormone production seen in acromegaly leads to increased GH and IGF-1 levels. It has many ramifications including debilitating arthritis from osteoarthropathy, glucose intolerance due to insulin resistance, higher propensity for GI neoplasms, and macroglossia with prognathism causing sleep apnea. Average lifespan is decreased by 30% due to cardiovascular and pulmonary dysfunction. Treatment is aimed at decreasing IGF levels and controlling any mass effect or metabolic abnormalities caused by the tumor. Treatment options include invasive procedures for good surgical candidates and medical therapy via somatostatin analogue for patients who are not. Residual or unresectable tumors can be treated with medical therapy or radiation therapy if there is no response to medication.
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Foldvary-Schaefer, Nancy. "SLEEP APNEA AND EPILEPSY: WHO’S AT RISK?" Case Western Reserve University School of Graduate Studies / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=case1291236630.
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PERGER, ELISA. "SLEEP APNEA AND HYPOXIA: NEW THERAPEUTIC PROSPECTIVES." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2023. https://hdl.handle.net/10281/404617.
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Un terzo della popolazione europea è affetta da apnee ostruttive del sonno (OSA), patologia che ha conseguenze negative su morbilità cardiovascolare e qualità della vita. L’OSA è caratterizzata da ripetuti episodi di collasso delle alte vie respiratorie che determinano ipossia intermittente, modifiche della pressione intratoracica e risvegli corticali. L’ipossia intermittente ha un ruolo chiave nel determinare le conseguenze cardiovascolari dei disturbi del respiro nel sonno e può sovrapporsi, peggiorandone la prognosi, a condizioni caratterizzate da ipossia tonica quali l’alta quota o le patologie respiratorie croniche o infettive, esacerbando lo stress ossidativo, l’angiogenesi e quindi l’attivazione del sistema nervoso simpatico con conseguenti incrementi della pressione arteriosa, della frequenza cardiaca e dell’infiammazione.
Il trattamento gold standard per l’OSA è la terapia ventilatoria che risulta però non tollerata dalla metà dei pazienti che ne fanno uso. Nuove strategie terapeutiche sono pertanto auspicabili.
Recentemente sono stati identificati specifici fattori fisiopatologici che contribuiscono allo sviluppo dell’OSA: un’elevata collassabilità delle vie aeree superiori, l’instabilità del sistema di controllo del respiro, una ridotta soglia di arousal ed una ridotta risposta compensatoria dei muscoli dilatatori della faringe. Quest’ultima è dovuta alla perdita di attività noradrenergica e aumento delle influenze muscariniche alle alte vie aeree. Il riconoscimento di questi tratti fisiopatologici ha permesso di ipotizzare e sviluppare nuove strategie terapeutiche per l’OSA.
Obiettivo: Valutare l’efficacia della somministrazione per 1 settimana della combinazione di reboxetina (noradrenergico) ed ossibutinina (antimuscarinico) sul trattamento dell’OSA e dell’effetto dei farmaci sugli endotipi fisiopatologici.
Metodi: E’ stato condotto uno studio randomizzato controllato cross-over in doppio cieco per comparare 4mg di reboxetina più 5mg di ossibutinina (reb-oxy) in pazienti con OSA. I pazienti sono stati sottoposti ad una polisonnografia basale (PSG), una dopo 7 notti di assunzione di reb-oxy ed una dopo 7 notti di assunzione di placebo per confrontare l’indice di apnea-ipopnea (AHI–outcome primario). Outcome secondari comprendevano il carico ipossico, modifiche degli endotipi, la variabilità della frequenza cardiaca, test di vigilanza.
Risultati: Hanno completato lo studio 16 pazienti con età 57 [51-61] anni (mediana [range interquartilico]) ed indice di massa corporea 30 [26-36] kg/m2. Reb-oxy ha determinato una riduzione di AHI da 49 [35-57] eventi/h al basale a 18 [13-21] eventi/h (59% di riduzione mediana) e 39 [29-48] eventi/h (6% riduzione mediana) confrontato con il placebo (p<0·001). La frequenza cardiaca mediana durante la PSG è stata 65 [60-69] bpm al basale ed è aumentata fino a 69 [64-77] bpm dopo reb-oxy e 66 [59-70] bpm dopo placebo (p=0.02). La somministrazione di reb-oxy non ha comportato modifiche di variabilità della frequenza cardiaca, pressione arteriosa nelle 24 ore. Il test di vigilanza si è ridotto da 250 [239-312] ms al basale a 223 [172-244] ms dopo reb-oxy versus 264 [217-284] ms dopo placebo (p<0·001).
Conclusioni: Il miglioramento delle conoscenze della fisiopatologia dell’OSA ha permesso di identificare la responsività muscolare delle alte vie come target principale di strategia terapeutica per l’OSA, predisponendo il percorso verso la medicina di precisione anche nel contesto dei disturbi del respiro nel sonno. Il nostro studio ha evidenziato il dato pionieristico dell’effetto positivo della somministrazione di reboxetina più ossibutinina sulla gravità dell’OSA e sull’ipossia associata agli eventi ostruttivi nel sonno. I risultati del nostro studio sottolineano la possibilità di una terapia personalizzata con farmaci per trattare l’OSA ed il carico ipossico ad essa relato.Introduction: Obstructive sleep apnea (OSA) affects one third of the population in Europe and has major negative consequences for cardiovascular disease and quality of life. OSA is characterized by recurrent episodes of apneas and hypopneas associated with repetitive episodes of intermittent hypoxemia, intrathoracic pressure changes, and arousals. Intermittent hypoxemia, particularly with concomitant hypercapnia, activates the sympathetic nervous system and it is the major contributor to negative cardiovascular consequences. Intermittent hypoxia might also worsen concomitant tonic hypoxia due to high altitude or due to acute or chronic respiratory diseases by promoting oxidative stress and angiogenesis, thus increasing sympathetic activation with blood pressure elevation, inflammation and endothelial dysfunction. Although OSA and its hypoxic consequence are effectively alleviated with positive airways pressure, this treatment is yet unsatisfactory, being poorly tolerated by up to half of patients. Thus, new treatment strategies are strongly needed. With the aim of better understand OSA physiopathology, key contributors of its development have been identified and include upper airway collapsibility, ventilatory instability, low arousal threshold and reduced pharyngeal dilator muscle responsiveness during sleep, due to loss of noradrenergic drive and enhanced muscarinic influences to upper airway muscles. The recognition of these pathophysiological traits permitted to advance the research in the field of OSA new therapeutic perspectives. Aim: The aim of this study was to evaluate the effect of 1-week of reboxetine (a noradrenergic) plus oxybutynin (an antimuscarinic) on OSA severity (primary outcome) and their effect on endotypic traits and cardiovascular autonomic modulation. Methods: We performed a randomized, placebo-controlled, double-blind, crossover trial comparing 4 mg reboxetine plus 5 mg oxybutynin (reb–oxy) to placebo in OSA subjects. After a baseline in-lab polysomnogram (PSG), patients performed PSGs after 7 nights of reb-oxy and 7 nights of placebo to compare apnea-hypopnea index (AHI, primary outcome). Secondary outcomes included hypoxic burden, heart rate variability, blood pressure and heart rate changes and psychomotor vigilance test. Home oximetry evaluated overnight oxygen desaturation throughout treatment. Results: 16 subjects aged 57[51-61] years (median [interquartile range]) with body mass index 30[26-36] kg/m2 completed the study. Reb-oxy lowered AHI from 49[35-57] events/h at baseline to 18[13-21] events/h (59% median reduction) compared with 39[29-48] events/h (6% median reduction) on placebo (p<0·001). Response rate for reb-oxy was 81% versus 13% for placebo p<0·001). Median nocturnal heart rate during the PSG was 65 [60-69] bpm at baseline and increased to 69 [64-77] bpm on reb-oxy vs 66 [59-70] bpm on placebo (p=0.02). Reb-oxy administration was not associated with any modification in heart rate variability, 24-hour, day-time and night-time systolic and diastolic blood pressure. The psychomotor vigilance test decreased from 250[239-312] ms on baseline to 223[172-244] ms on reb-oxy versus 264[217-284] ms on placebo (p<0·001). Home oximetry illustrated acute and sustained improvement in oxygen desaturation index on reb-oxy versus placebo. Conclusions: The recent understanding of OSA pathophysiological mechanisms brought to hypothesize that, among the others, muscle responsiveness would be the main target to develop a precision medicine to treat OSA. We demonstrated that OSA severity and OSA-related hypoxic consequences are greatly decrease by the administration of reboxetine-plus-oxybutynin. These results highlight potential possibilities for personalized medicine with pharmacological therapy to treat OSA and its related hypoxic burden.
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Wong, Keith K. H. "Measuring sleep and neurobiological functional parameters in patients with obstructive sleep apnea." Connect to full text, 2007. http://hdl.handle.net/2123/2245.
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Thesis (Ph. D.)--University of Sydney, 2008.Title from title screen (viewed Mar. 12, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Discipline of Medicine, Faculty of Medicine. Degree awarded 2008; thesis submitted 2007. Includes bibliography. Also issued in print.
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Wong, Keith Keat Huat. "Measuring sleep and neurobiological functional parameters in patients with obstructive sleep apnea." University of Sydney, 2008. http://hdl.handle.net/2123/2245.
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Doctor of Philosophy (Medicine)Sleepiness is an important source of morbidity in the community, with potentially catastrophic consequences of occupational or driving injuries or accidents. Although many measures of sleepiness exist, there is no gold standard. The electroencephalograph (EEG) has been studied as an indicator of sleep pressure in the waking organism, or sleep depth. A mathematical model has been developed, relating the observed EEG to interactions between groups of neurons in the cortex and thalamus (Robinson, Rennie, Rowe, O'Connor, & Gordon, 2005; Robinson, Rennie, & Wright, 1997). These interactions are thought to be important in the transition from wake to sleep. Sleepiness is common in obstructive sleep apnea (OSA). The measurement of sleepiness would have great utility in quantifying the disease burden, measuring treatment response, or determining fitness for work or driving. This study will evaluate parameters derived from the EEG mathematical model as a measure of sleepiness. It is divided into the following four parts: 1. Subjects with likely OSA based on symptoms and demographics from an international database were compared with matched non-OSA controls. The OSA group showed deficits in executive function and abnormalities on evoked response potential testing. 2. Outcomes from a cross-sectional study in a sleep-clinic OSA population were aggregated by factor analysis into a five summary variables relevant to sleepiness: subjective sleepiness, mood & anxiety, memory & learning, driving, and executive functioning. 3. EEG mathematical model parameters from wake EEG recordings were related to the five summary outcomes. Executive function correlated with a parameter Z, representing the negative feedback loop between the thalamic reticular nucleus and the thalamocortical relay nuclei. 4. EEG model parameters during first NREM sleep cycle of 8 subjects with regular sleep architecture were studied. Net cortical excitation (parameter X) is predicted to increase across the cycle, while there was, as predicted, a greater inhibitory effect of the thalamic reticular nucleus upon thalamocortical relay cells (parameter Z). In this preliminary assessment, EEG model parameters reflecting thalamocortical interactions are sensitive to prefrontal lobe tasks such as executive function, which are known to be vulnerable to sleep loss and sleepiness, and these parameters also show variation with increasing sleep depth.
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Wong, Keith Keat Huat. "Measuring sleep and neurobiological functional parameters in patients with obstructive sleep apnea." Thesis, The University of Sydney, 2007. http://hdl.handle.net/2123/2245.
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Sleepiness is an important source of morbidity in the community, with potentially catastrophic consequences of occupational or driving injuries or accidents. Although many measures of sleepiness exist, there is no gold standard. The electroencephalograph (EEG) has been studied as an indicator of sleep pressure in the waking organism, or sleep depth. A mathematical model has been developed, relating the observed EEG to interactions between groups of neurons in the cortex and thalamus (Robinson, Rennie, Rowe, O'Connor, & Gordon, 2005; Robinson, Rennie, & Wright, 1997). These interactions are thought to be important in the transition from wake to sleep. Sleepiness is common in obstructive sleep apnea (OSA). The measurement of sleepiness would have great utility in quantifying the disease burden, measuring treatment response, or determining fitness for work or driving. This study will evaluate parameters derived from the EEG mathematical model as a measure of sleepiness. It is divided into the following four parts: 1. Subjects with likely OSA based on symptoms and demographics from an international database were compared with matched non-OSA controls. The OSA group showed deficits in executive function and abnormalities on evoked response potential testing. 2. Outcomes from a cross-sectional study in a sleep-clinic OSA population were aggregated by factor analysis into a five summary variables relevant to sleepiness: subjective sleepiness, mood & anxiety, memory & learning, driving, and executive functioning. 3. EEG mathematical model parameters from wake EEG recordings were related to the five summary outcomes. Executive function correlated with a parameter Z, representing the negative feedback loop between the thalamic reticular nucleus and the thalamocortical relay nuclei. 4. EEG model parameters during first NREM sleep cycle of 8 subjects with regular sleep architecture were studied. Net cortical excitation (parameter X) is predicted to increase across the cycle, while there was, as predicted, a greater inhibitory effect of the thalamic reticular nucleus upon thalamocortical relay cells (parameter Z). In this preliminary assessment, EEG model parameters reflecting thalamocortical interactions are sensitive to prefrontal lobe tasks such as executive function, which are known to be vulnerable to sleep loss and sleepiness, and these parameters also show variation with increasing sleep depth.
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Cloonan, Yona Keich. "Sleep outcomes in children with craniofacial microsomia /." Thesis, Connect to this title online; UW restricted, 2007. http://hdl.handle.net/1773/10877.
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Patel, Mayur Mahendra. "A comparison of the edentulous and dentate prosthodontic patient for the occurrence of obstructive sleep apnea." Morgantown, W. Va. : [West Virginia University Libraries], 2004. https://etd.wvu.edu/etd/controller.jsp?moduleName=documentdata&jsp%5FetdId=3321.
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Thesis (M.S.)--West Virginia University, 2004.Title from document title page. Document formatted into pages; contains vii, 47 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 30-31).
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Lee, Kevin Chien-Hsun. "Dentofacial morphology in children with obstructive sleep apnea." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/54507.
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Objectives: Altered dentofacial morphology has been suggested as an etiology for childhood OSA. Nevertheless, existing reports on the dentofacial characteristics of children with OSA vary significantly and are limited by the infrequent use of polysomnography (PSG) for diagnosis. Therefore, the objective of this study is to establish the prevalence of dentofacial morphology in children with OSA diagnosed using PSG.
Methods: The sample comprised 64 children between the ages of 4-16 who were referred to BC Children’s Hospital for PSG. Diagnosis of OSA was provided by an overnight, in-laboratory PSG. Malocclusion was assessed clinically by one orthodontist (K.L.), blinded to PSG results.
Results: Children with previous orthodontic treatment were excluded and children with craniofacial syndromes were analyzed separately. The 17 patients with craniofacial syndromes presented a significantly different dentofacial features and higher prevalence of OSA when compared to the non-syndromic children. The remaining 39 patients were divided into an OSA group (AHI ≥ 2; n=17) and a non-OSA group (AHI < 2; n=22). There were no statistically significant differences in frequency of any dentofacial features between the two groups, although the OSA group had a lower prevalence of convex profile, Class II molar relationship, and overjet (OJ) ≥ 5mm.
Subjects in the OSA group were further divided into a lower AHI (AHI between 2-5; n=9) group and a higher AHI group (AHI ≥ 5; n=8). There was no statistically significant difference in frequency of any dentofacial features between the three groups. Nevertheless, subjects in the higher AHI group had a lower prevalence of convex profile and poster crossbite, with less crowding and smaller OJ on average.
Conclusions: In this patient population of 39 children between the ages of 4-16 who were referred to BCCH for an overnight sleep study, no statistically significant differences in dentofacial morphology and occlusal characteristics were found between children diagnosed with and without OSA. It is likely that children with OSA have a highly variable presentation of anatomical features, and future studies with a larger sample size and a true control group is needed to establish the dentofacial morphology of this population.Dentistry, Faculty of
Graduate
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Kalra, Maninder. "Genetic Susceptibility to Obstructive Sleep Apnea in Children." University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1226552538.
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Shewinvanakitkul, Prapan. "Automated Detection and Prediction of Sleep Apnea Events." Case Western Reserve University School of Graduate Studies / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1486490112558014.
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Aihara, Kensaku. "Local and systemic inflammation in obstructive sleep apnea." Kyoto University, 2013. http://hdl.handle.net/2433/170073.
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Gagnon, Victoria Lee. "Obstructive sleep apnea syndrome and associated health risks /." Abstract Full Text (HTML) Full Text (PDF), 2008. http://eprints.ccsu.edu/archive/00000538/02/1986FT.htm.
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Thesis (M.S.) -- Central Connecticut State University, 2008.Thesis advisor: Ruth Rollin. "... in partial fulfillment of the requirements for the degree of Master of Science in Biology." Includes bibliographical references (leaves 39-41). Also available via the World Wide Web.
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Huhtakangas, J. (Jaana). "Evolution of obstructive sleep apnea after ischemic stroke." Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526224343.
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Abstract In Finland, the costs of stroke are approximately 1.1 billion euros annually due to long disability and hospitalization episodes. Sleep apnea is a risk factor for stroke. The prevalence of sleep apnea among stroke patients is unknown because sleep recording is not usually performed on stroke patients. There are no previous studies investigating the association of thrombolysis on the prognosis of sleep apnea. The relation between sleep apnea and cardiovascular events is still unclear. In this prospective, observational study, I recruited voluntary, consecutive ischemic stroke patients over the age of 18 years who were or were not eligible for thrombolysis treatment. The investigators did not affect the treatment and patients were not randomized to thrombolysis. The final analysis included 204 patients; of these, 110 underwent thrombolysis therapy and 94 were treated without thrombolysis. Cardiorespiratory polygraphy was carried out with a portable three-channel device (ApneaLinkPlus™, Resmed, Sydney, Australia) at the ward within 48 hours after the onset of stroke symptoms. The cardiorespiratory polygraphy was repeated at home after a six-month follow-up. Both automatic scoring and manual scoring pointed out excellent agreement in arterial oxyhemoglobin decrease of > 4% (ODI4), lowest arterial oxyhemoglobin saturation (SaO2) or percentage of time spent below 90 percent saturation. The automated scoring underestimated the severity of sleep apnea, recognized poorly the type of event, and missed 18.6% of sleep apnea diagnoses. The total prevalence of sleep apnea in this study was 91.2% on admission to hospital. The stroke patients treated with thrombolysis had more, and more severe sleep apnea in the first sleep recording compared to those without thrombolysis therapy. After follow-up, the prevalence of sleep apnea still remained high, and sleep apnea was aggravated in two thirds of the stroke patients. The study patients without thrombolysis treatment had six-fold higher risk for incident sleep apnea after the follow-up. The stroke patients with thrombolysis therapy and visible stroke on CT had more nocturnal hypoxemia and higher obstructive apnea index than the patients without stroke lesion on follow-up CT 24 hours after thrombolysis treatment. The larger the ischemic stroke volume, the greater the time spent with saturation below 90%Tiivistelmä Aivoinfarkti on yleinen ja kansanterveydellisesti sekä taloudellisesti merkittävä sairaus, jonka aiheuttamat kustannukset Suomessa ovat noin 1.1 miljardia euroa pitkistä työkyvyttömyys- ja sairaalajaksoista johtuen. Uniapnea on aivoinfarktille altistava tekijä. Uniapnean esiintyvyys suomalaisilla aivoinfarktipotilailla ei ole arvioitavissa, koska aivoinfarktin sairastaneille ei yleensä tehdä unirekisteröintiä. Kannettavat yöpolygrafialaitteet saattaisivat olla vaihtoehto aivoinfarktipotilaiden uniapnean diagnosoinnille. Tutkittua tietoa liuotushoidon yhteydestä uniapnean ennusteeseen ei ole. Uniapnean sekä sydän- ja verisuonitapahtumien syy-yhteys on edelleen epäselvä. Rekrytoin prospektiiviseen tutkimukseeni vapaaehtoisia, peräkkäisiä yli 18-vuotiaita iskeemiseen aivoinfarktiin sairastuneita liuotushoidettuja ja liuotushoitoon soveltumattomia potilaita. Tutkimuksen lopullinen potilasmäärä oli 204, joista 110 sai liuotushoidon ja 94 hoidettiin ilman liuotusta. Kaikille potilaille tehtiin yöpolygrafia kannettavalla, kolmikanavaisella yöpolygrafialaitteella (Apnealink Plus, Resmed, Sydney, Australia) osastolla 48 tunnin kuluessa sairastumisesta. Yöpolygrafia toistettiin potilaan kotona kuuden kuukauden kuluttua. Sekä automaattitulos että manuaalisesti arvioitu unirekisteröintitulos olivat erittäin yhteneväisiä, kun arvion kohteena olivat happikyllästeisyyden neljän prosenttiyksikön suuruiset pudotukset tuntia kohti, matalin veren happikyllästeisyys tai alle 90 % happikyllästeisyyden osuus yöstä. Automaattianalyysi aliarvioi uniapnean vaikeuden, havaitsi huonosti hengityskatkosten tyypin eikä löytänyt 18,6 prosenttia uniapneadiagnooseista. Uniapnean esiintyvyys koko aineistossa oli sairaalaan tullessa 91,2 %. Liuotushoidetuilla potilailla todettiin ensimmäisessä rekisteröinnissä enemmän uniapneaa ja se oli vaikeampaa kuin ei-liuotushoidetuilla. Seurannassa uniapnean määrä pysyi edelleen korkeana ja uniapnea vaikeutui kahdella potilaalla kolmesta. Liuotushoitoon soveltumattomilla aivoinfarktipotilailla todettiin liuotushoidon saaneisiin verrattuna kuusinkertainen riski sairastua uniapneaan puolen vuoden aikana. Liuotushoidetuilla aivoinfarktipotilailla, joilla oli infarktimuutos kuvantamistutkimuksessa, oli yöllistä valtimoveren happikyllästeisyyden huononemista ja ylähengitysteiden ahtautumisesta johtuvia hengityskatkoksia enemmän kuin niillä potilailla, joilla ei todettu iskeemisiä muutoksia aivokuvantamisessa 24 tuntia liuotushoidon jälkeen. Mitä suurempi aivoinfarktin tilavuus, sitä suuremman osuuden yöstä veren happikyllästeisyys oli alle 90 %
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Revol, Bruno. "Pharmacoépidémiologie des apnées du sommeil Impact of concomitant medications on obstructive sleep apnoea Drugs and obstructive sleep apnoeas Diagnosis and management of central sleep apnea syndrome Baclofen and sleep apnoea syndrome: analysis of VigiBase® the WHO pharmacovigilance database Gabapentinoids and sleep apnea syndrome: a safety signal from the WHO pharmacovigilance database Valproic acid and sleep apnea: a disproportionality signal from the WHO pharmacovigilance database Ticagrelor and Central Sleep Apnea What is the best treatment strategy for obstructive sleep apnoea-related hypertension? Who may benefit from diuretics in OSA? A propensity score-matched observational study." Thesis, Université Grenoble Alpes, 2020. http://www.theses.fr/2020GRALV026.
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Avant leur mise sur le marché, l'évaluation clinique des médicaments repose sur des essais contrôlés randomisés. Bien qu'ils représentent la méthode de référence, leurs résultats sont nécessairement limités aux patients inclus dans ces essais. De plus, ils sont d’abord conçus pour mesurer l'efficacité des traitements, avant d’évaluer leurs effets indésirables. Concernant le syndrome d'apnées du sommeil (SAS), alors que de nombreux essais médicamenteux ont été menés, la plupart des résultats sont de faible niveau de preuve, voire contradictoires. Outre la durée et les effectifs limités de ces essais, une explication est que le SAS est une pathologie hétérogène en termes de symptômes et de physiopathologie, incluant divers "phénotypes" de patients. Des données de vie réelle sont donc nécessaires pour définir quels médicaments pourraient améliorer le SAS ou les comorbidités associées et quels patients pourraient en bénéficier. Au contraire, les cliniciens doivent être avertis que certains médicaments peuvent induire ou aggraver le SAS.La pharmacoépidémiologie fait désormais partie de toute enquête de pharmacovigilance, car elle permet une approche à la fois descriptive et comparative des notifications spontanées. Des associations entre l'exposition à un ou plusieurs médicaments et l'apparition d'effets indésirables peuvent ainsi être recherchées. Comme pour toutes les études observationnelles, la principale difficulté consiste à contrôler les facteurs de confusion. L'un des modèles couramment utilisés est l'analyse cas/non-cas, qui étudie la disproportionnalité entre le nombre d’effets indésirables rapportés avec le médicament d’intérêt, par rapport aux effets notifiés pour les autres médicaments. Nous avons ainsi montré des associations significatives entre l'utilisation de baclofène, des gabapentinoïdes ou de l'acide valproïque et la survenue de SAS dans la base de pharmacovigilance de l'OMS, suggérant le rôle du système GABAergique dans la pathogenèse des apnées centrales d’origine médicamenteuse. Un signal de disproportionnalité a également été observé pour le ticagrélor, reposant sur un mécanisme d'action différent.Les analyses pharmacoépidémiologiques permettent également d'étudier le bénéfice des médicaments en vie réelle. Le score de propension est utilisé pour minimiser les biais de sélection et recréer des conditions de comparabilité proches de celles des essais randomisés. À l'aide de ces méthodes statistiques, nous avons évalué l'intérêt potentiel de cibler le système rénine-angiotensine pour la prise en charge de l'hypertension artérielle chez les patients atteints d’apnées obstructives, en particulier avec l’utilisation des sartans. Chez ces mêmes patients apnéiques et hypertendus, nos travaux suggèrent que les diurétiques pourraient diminuer la sévérité des apnées, notamment en cas de surpoids ou d’obésité modérée. Des études prospectives sont désormais nécessaires afin de confirmer ces résultats, car les données de vie réelle ne peuvent se substituer aux essais cliniques contrôlésThe clinical evaluation of drugs before approval is based on randomized controlled trials. Although they are considered as the gold standard for testing drugs, their results are necessarily limited to patients included in the trials. Moreover, almost all clinical trials are primarily designed to assess the efficacy of a treatment, so safety is only a secondary concern. Regarding sleep apnea syndrome (SAS), while many drug trials have been conducted, most of the results are weak or even contradictory. In addition to limited trial duration and population size, one explanation is that the sleep apnea population is highly heterogeneous with respect to symptoms and physiological traits linked to disease pathogenesis, giving various patient “phenotypes”. Real-life data are therefore needed to define which drugs could improve SAS or associated comorbidities and who might benefit from them. On the contrary, clinicians need to be aware that some drugs may induce or worsen sleep apnea.Pharmacoepidemiology is now part of any pharmacovigilance survey, as it provides both descriptive and comparative approaches of spontaneous reports. Associations between the exposure to one or more drugs and the occurrence of adverse effects can thus be sought. As for all observational studies, the major difficulty is to control for confounding factors. One of the study designs commonly used, is the case/non-case analysis, which investigates disproportionality between the numbers of adverse drug reactions reported with the drug of interest compared to the number reported with all other drugs. In this way, we showed significant associations between the use of baclofen, gabapentinoids or valproic acid and the reporting of SAS in the WHO drug adverse event database, suggesting a role of the GABAergic system in the pathogenesis of drug-induced central sleep apnea. A disproportionality signal was also found for ticagrelor, based on a different mechanism of action.Pharmacoepidemiological analyses also make it possible to study the benefit of drugs in real-life. Propensity scores are used to minimize selection bias, leading to a comparability between the exposure groups close to that observed in randomized trials. Using these statistical methods, we have investigated the potential value of targeting the renin-angiotensin system for the management of hypertension in obstructive sleep apnea (OSA) patients, especially the use of sartans. For hypertensive apneic patients, our work suggests that diuretics could decrease the severity of OSA, particularly in the overweight or moderately obese. Prospective studies are now needed to confirm these findings, because real-life data cannot be a substitute for controlled clinical trials
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Montanari, Carolina Caruccio. "Acurácia diagnóstica de questionários para identificar apneia do sono em idosos." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/132142.
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Introdução: A utilidade de questionários para o diagnóstico de apneia obstrutiva do sono está bem estabelecida em adultos, mas permanece indefinida em idosos. Objetivo: Avaliar as propriedades preditivas dos questionários mais comumente empregados na população em geral em idosos fisicamente independentes. Desenho: Transversal. Local: Unidade de cuidados primários de saúde pública filiada a hospital universitário. Participantes: Roncadores fisicamente independentes com idade entre 65 a 80 anos cadastrados em um hospital universitário foram abordados por telefone e convidados a participar. Métodos: Os participantes foram submetidos à polissonografia portátil. Sensibilidade, especificidade, razão de verossimilhança positiva e negativa, área sob a curva ROC e psicometria clássica foram utilizados para avaliar a precisão e a medição de propriedades diagnósticas de três instrumentos validados para uso na população geral, sendo incerta sua utilização em idosos. Resultados: A amostra de 131 idosos fisicamente independentes, 50% homens, 58% aposentados, foram incluídos. Epworth>6 apresentou uma precisão de 61% para identificar IAH≥15. Epworth>10, ponto de corte usualmente empregado em adultos, apresentou pior desempenho diagnóstico. Sexo masculino e ser aposentado tiveram menor probabilidade de estarem associados com apneia obstrutiva do sono grave. Para prever IAH≥15, a área sob a curva ROC para Epworth>6 foi significativa, mas não para STOP-bang>2 e Atenas>5. Na regressão logística para prever IAH≥15, controlando para diversos fatores, apenas Epworth>6 e Atenas>5 permaneceram significativas no modelo. Conclusão: Em idosos independentes, uma escala de sonolência de Epworth com ponto de corte de 6 tem melhor desempenho diagnóstico do que questionários comumente empregados para prever um IAH≥15.Background: The usefulness of questionnaires for diagnosis of sleep apnea is well established in adults, but remains undefined in the elderly population. Objective: To evaluate the predictive properties of the most commonly employed questionnaires in physically independent elderly people from the general population. Design: Cross-sectional. Setting: Public health primary care unit affiliated to university hospital. Participants: Physically independent snorers aged 65 to 80 years adscript to a university hospital were approached by telephone and invited to participate. Measurements: Participants underwent portable polysomnography. Sensitivity, specificity, positive and negative likelihood ratios, area under the ROC curve, and classical psychometrics were used to assess diagnostic accuracy and measurement properties of three validated instruments for use in the general population, making their usability in elderly populations uncertain. Results: A sample of 131 independently-living elderly people, 50% male, 58% retired, was included. For identifying AHI≥15, an Epworth>6 had an accuracy of 61%. Epworth>10, the usually employed cut-off point in adults, had poorer diagnostic performance. Male gender and retirement were protective of more severe OSA. For predicting AHI≥15, the area under the ROC curve for Epworth>6 was significant, but not for STOP-Bang>2 and Athens>5. In logistic regression to predict AHI≥15, after controlling for several confounders, Epworth>6, and Athens>5 were the only variables that remained significant in the model. Conclusion: In independent elderly, an Epworth sleepiness scale cut-point of 6 has better diagnostic performance than commonly employed questionnaires to predict an AHI≥15.
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Haddad, Diane. "Oxidative stress and endothelial dysfunction in obstructive sleep apnea." Connect to resource, 2010. http://hdl.handle.net/1811/45466.
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Brooks, Dina. "The effects of obstructive sleep apnea on blood pressure." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1996. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/NQ27881.pdf.
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Iliescu, Eduard Andrei. "Prevalence of proteinuria in the obstructive sleep apnea syndrome." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0018/MQ54460.pdf.
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Champagne, Katéri A. "The association of obstructive sleep apnea and gestational hypertension /." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=99328.
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Rationale. Hypertension occurs in 10% of pregnancies. Snoring is a marker for sleep apnea, and is a newly identified risk factor for gestational hypertension. Moreover, sleep apnea is an independent risk factor for hypertension in the non-pregnant population. I hypothesized that sleep apnea was associated with gestational hypertension.Hypothesis. The prevalence of sleep apnea is higher among pregnant women with hypertensive pregnancies than among those without hypertension during pregnancy.
Design. Case-control study of 17 pregnant women with gestational hypertension and 33 pregnant women without hypertension, with matching by gestational age. Sleep apnea was ascertained by polysomnography.
Results. The crude odds ratio for the presence of obstructive sleep apnea, given the presence of gestational hypertension, was 5.6. The odds ratio was 7.5 (95% CI 3.5-16), based on a logistic regression model with adjustment for maternal age, gestational age, nulliparity, first pregnancy, and body mass index.
Conclusion. Gestational hypertension was strongly associated with the presence of obstructive sleep apnea.
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Holmlund, Thorbjörn. "Evaluation of surgical methods for sleep apnea and snoring." Doctoral thesis, Umeå universitet, Institutionen för klinisk vetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-118944.
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Background: Snoring and obstructive sleep apnea (OSA) are both common disorders with a number of negative health effects. The safety and efficacy of treating snoring and OSA surgically have been questioned and there has been a lack of studies in the field. Aims: 1) To investigate the frequency of serious complications, including death, after surgery for the treatment of snoring and sleep apnea; 2) to evaluate the effect on daytime sleepiness after radiofrequency surgery of the soft palate in snoring men with mild or no OSA; 3) to evaluate the effect of tonsillectomy on sleep apnea in adults with OSA and tonsillar hypertrophy; 4) to investigate the morphology and cytoarchitecture of muscle fibers in human soft palatal muscles with immunohistochemical and morphological techniques. Methods and results: In paper 1, a retrospective database study. All Swedish adults who were treated surgically because of snoring or OSA from January 1997 to December 2005 were identified in the National Patient Register. None of the surgically treated patients died in the peri- and postoperative period. Severe complications were recorded in 37.1 of 1,000 patients treated with uvulopalatopharyngoplasty (UPPP), in 5.6 of 1,000 patients after uvulopalatoplasty (UPP) and in 8.8 of 1,000 patients after nasal surgery. In paper 2, the study was designed as a randomized, controlled trial. 35 snoring men with mild or no OSA were randomized to either radiofrequency or sham surgery of the soft palate. Radiofrequency surgery was not found to be effective since there was no significant difference between the two groups in relation to the Epworth Sleepiness Scale (ESS) or apnea-hypopnea index (AHI) at follow-up. Paper 3 was a prospective study, including 28 patients with an AHI of >10 and with large tonsils. In these patients, tonsillectomy was an effective treatment for OSA; the mean AHI was reduced from 40 units/h to 7 units/h (p<0.001), and the mean ESS was reduced from 10.1 to 6.0 (p<0.001) at the six-month follow-up after surgery. Minor and moderate swallowing dysfunction was found in seven of eight patients investigated before surgery and the swallowing function improved in 5 of them after surgery, while no one deteriorated. In paper 4, we investigated the morphology and cytoarchitecture in normal soft palate muscles. Human limb muscles were used as reference. The findings showed that the soft palate muscle fibers have a cytoskeletal architecture and cellmembrane complex that differs from that of the limb muscles. Conclusions No case of death related to surgery was found among 4,876 patients treated with UPPP, UPP or nasal surgery for snoring or OSA in Sweden between 1997 and 2005. Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring or apnea frequency in snoring men with mild or no OSA. Tonsillectomy can be an effective treatment for OSA in adults with large tonsils. A subgroup of muscle fibers in the human soft palate appears to have special biomechanical properties and their unique cytoarchitecture must be taken into account while assessing function and pathology in oropharyngeal muscles.Snarkning och obstruktiv sömnapné (OSA) är idag en global folksjukdom. Snarkning är det ”oljud” som uppstår när luftvägen under sömn förminskas och vävnaden börjar vibrera under andning. Vid obstruktiv sömnapné faller vävnaden samman och blockerar luftflödet till lungorna. Ett andningsuppehåll, en s.k. apné inträffar. Ett andningsuppehåll kan pågå allt ifrån några sekunder till mer än en minut och kan uppstå hundratals gånger per natt. För att klassificeras som en patologisk apné enligt internationell standard måste andningsuppehållet vara längre än 10 sek. Snarksjukdomen förvärras sannolikt över tid och övergår succesivt i obstruktiv sömnapné med ökande antal andningsuppehåll under sömn. Detta leder till ett stresspåslag för kroppen med oftast uttalad dagtrötthet och en mängd negativa hälsoeffekter. Snarksjukdom och sömnapné ökar risken för bl.a. högt blodtryck och hjärt-kärlsjukdom samt också för att den drabbade ska orsaka trafikolyckor på grund av försämrad koncentrationsförmåga och trötthet. En del av den negativa utvecklingen från snarkning till sömnapné anses bero på att snarkvibrationer kan ge neuromuskulära skador i gom och svalg. Dessa vävnadsskador anses också vara orsaken till att personer som snarkat länge ofta uppvisar störd sväljningsfunktion i form av felsväljning, där maten i uttalade fall hamnar i luftstrupen istället för i matstrupen. I dagsläget är förstahandsbehandling vid sömnapné CPAP, en mask som placeras över näsa och mun och som skapar ett övertryck i luftvägen vilket förhindrar att luftvägen faller samman och att andningsstopp uppstår. CPAP har enligt flera studier den bästa effekten mot andningsuppehåll. En annan vanlig behandling är en bettskena som för underkäken nedåt och framåt så att luftvägen bli mer öppen. Bettskenan är en vanlig och effektiv behandlingsmetod för personer utan kraftig övervikt vid vanemässig snarkning eller måttlig sömnapné. För ett tjugotal år sedan var kirurgi förstahandsmetoden vid behandling av snarkning och måttlig sömnapné. Man utförde då ofta operationer i svalg och gomm, s.k. gomplastiker. Bruket av kirurgisk behandling har dock minskat med tiden, dels p.g.a. biverkningar men också för att det saknades vetenskapliga studier som bevisade att kirurgin gav önskad och långsiktig effekt. Kirurgi utgör dock fortfarande ett komplement till behandling av snarkning och sömnapné när CPAP eller bettskena av olika skäl inte fungerar eller kan tolereras av patienten. 8 Även barn kan lida av snarkning och sömnapné men behandlingsprinciperna för barn skiljer sig från dem hos vuxna och berörs inte i avhandlingen. I denna avhandling studeras: i) biverkningsfrekvenser efter olika typer av snarkkirurgi, ii) effekten av radiovågsbehandling i mjuka gommen på vuxna män med snarkning, iii) effekten av att operera bort halsmandlarna på vuxna med sömnapné och stora halsmandlar, iv) muskelvävnadens struktur och molekylära uppbyggnad i mjuka gommen hos friska personer som inte snarkar. Avhandlingen består av fyra delstudier: 1. En registerstudie med kartläggning av svåra biverkningar efter kirurgi i form av uvulopalatopharyngoplastik, uvulupalatoplastik samt näskirurgi för behandling av sömnapné och snarkning och utfört i Sverige mellan åren 1997-2005. Studien omfattade 4 876 patienter. Inga dödsfall noterades. Komplikationsrisken var störst vid operationer där man tog bort delar av mjuka gommen samt halsmandlarna, där i snitt 37 av 1000 opererade fick biverkningar, framförallt p.g.a. infektioner eller blödningar. 2. I en prospektiv, randomiserad placebostudie utvärderades effekten av radiovågsbehandling i mjuka gommen vid snarkning och lindrig sömnapne. Trettiotvå patienter lottades till att få radiovågsbehandling eller placebo behandling. Patienterna visste inte vilken grupp de tillhörde. Vid uppföljning efter 12 månader var det inga statistiska belägg för att radiovågsbehandling minskade vare sig antal andningsuppehåll eller dagtrötthet. 3. Effekten av att ta bort halsmandlarna på patienter med stora halsmandlar och olika grad av sömnapné utvärderades i denna studie. Totalt deltog 28 patienter. Vid uppföljning 6 månader efter operationen hade antalet andningsuppehåll sjunkit drastiskt, från i snitt 40 till 7 andningsuppehåll per timme nattsömn. Inga allvarliga biverkningar uppstod. Dessa fynd talar för att man som förstahandsmetod ska erbjuda patienter med sömnapné och stora halsmandlar att ta bort halsmandlarna. 4. I detta projekt undersökte vi utseendet och uppbyggnaden av cellskelettet i två normala muskler i mjuka gommen hos friska personer utan känd snarkning och sömnapné. Muskler från armar och ben användes som referens. Fynden i studien visar att de normala muskelfibrernas uppbyggnad i mjuka gomen skiljer sig från jämförade muskler i armar och ben. Detta kan vara ett uttryck för en evolutionär utveckling för att möjligöra de komplexa funktioner som krävs av svalgets muskulatur. 9 Sammanfattningsvis kan vi konstatera: Att inga dödsfall har skett i Sverige efter operationer i gom, svalg eller näsa, utförda för att behandla snarkning och sömnapné under åren 1997 till 2005. Att radiovågsbehandling av mjuka gommen hos snarkande män med lindrig sömnapné inte har någon effekt på dagtrötthet, snarkning eller andningsuppehåll vid uppföljning efter 12 månader. Metoden kan därför inte rekommenderas. Att när man opererar bort stora halsmandlar på personer med andningsuppehåll så leder detta ofta till att andningsuppehållen minskar drastiskt. Metoden kan därför oftast rekommenderas som en förstahandsbehandling för denna patientgrupp. Att mjuka gommens muskelfibrer är uppbyggda på ett unikt sätt indikerar att deras specifika biomekaniska egenskaper skiljer sig från referens muskler i armar och ben.
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Chittenden, Thomas William. "Chronic Hypoxia and Cardiovascular Dysfunction in Sleep Apnea Syndrome." Diss., Virginia Tech, 2002. http://hdl.handle.net/10919/28718.
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The purpose of the current study was to test the hypothesis that chronic hypoxia associated with sleep-disordered breathing relates to abnormal Nitric Oxide (NO) production and vascular endothelial growth factor (VEGF) expression patterns that contribute to aberrancy of specific determinates of cardiovascular and cardiopulmonary function before, during, and after graded exercise. These patterns may further reflect pathologic alteration of signaling within the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt-1) transduction network. To this end, 7 medically diagnosed OSA patients (3 male, 4 female), mean age 48 years and 7 apparently healthy control subjects (3 male, 4 female), mean age 42 years, underwent baseline venous blood draws and maximal bicycle ergometry. Mononuclear cells isolated from peripheral blood were utilized as reporter cells for measurement of VEGF, Akt-1, hypoxia inducible factor-1 alpha (HIF-1 alpha), and vascular endothelial growth factor receptor-2 (VEGFR2) gene expression by redundant oligonucleotide DNA microarray and real-time PCR technologies. Circulating angiogenic progenitor cells expressing VEGFR2 were profiled by flow cytometry. Plasma and serum concentrations of VEGF, nitrates/nitrites, catecholamines, and dopamine were measured by enzyme-linked immunosorbent assay (ELISA) and high performance liquid chromatography (HPLC). Arterial blood pressure, cardiac output, oxygen consumption and total peripheral resistance were determined at Baseline, 100W, and peak ergometric stress by standard techniques. There were no apparent differences (p < .05) observed in biochemical markers relating to vascular function and adaptation including, serum nitrates/nitrites, norepinephrine, dopamine, and plasma VEGF. No differences were found relative to cardiac output, stroke volume, cardiopulmonary or myocardial oxygen consumption, expired ventilation, heart rate, arteriovenous oxygen difference, total peripheral resistance, and mean arterial pressure. Due to methodological issues related to the redundant oligonucleotide DNA microarray and real-time PCR gene expression analyses, results of these experiments were uninterpretable. Thus, the research hypothesis was rejected. Conversely, significant (p < .05) differences were observed in waist: hip ratios, recovery: peak systolic blood pressure ratio at 1 minute post-exercise and %VEGFR2 expression. OSA was associated with elevations in both waist: hip ratios and recovery: peak systolic blood pressure ratio at 1 minute post-exercise as well as significant depression of %VEGFR2 profiles. Moreover, significant negative correlations were found regarding waist: hip ratios and %VEGFR2 expression (r = -.69;p =.005) and recovery: peak systolic blood pressure ratio at 1 minute post-exercise and %VEGFR2 expression (r = -.65;p =.01). These findings did not provide evidence that NO-dependent vasoactive mechanisms are suppressed nor did they support the supposition that angiogenic mechanisms are pathologically activated in sleep-disordered breathing.Ph. D.
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Hlaing, EiEi. "Neuropsychological Sequelae of Obstructive Sleep Apnea in Later Adulthood." OpenSIUC, 2015. https://opensiuc.lib.siu.edu/dissertations/1043.
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The present study examined the neuropsychological relevance of poor sleep in a sample of community dwelling healthy older adults and a clinical sample of patients with untreated obstructive sleep apnea (OSA) between 40 and 90 years of age. The cognitive performance of 67 patients with obstructive sleep apnea (OSA) was compared to those of 46 controls screened for OSA using a portable device called ApneaLinkTM. The current study identified common neuropsychological variables associated with poor sleep quality in general (i.e., as a result of daytime sleepiness) and neuropsychological variables unique to only OSA patients (i.e., manifesting oxygen desaturation at night in addition to daytime sleepiness). Results indicated executive functions were related to hypoxemia and sustained attention was related to sleep fragmentation in the current study. A medical sequelae model and a neuropsychological sequelae model were tested. The neuropsychological sequelae model predicted whether one was a control or an OSA patient 70% accurately based on the predictors (scores on Wisconsin Card Sorting Test perseverance error, vigilance task, WAIS III forward digit span, WAIS III Block Design, phonemic and semantic fluency, and WAIS III backward digit span). The medical sequelae model predicted OSA status 89% accurately based on the predictors (BMI, depression, subjective sleep quality, age, hypertension, diabetes, total mood disturbance, gender, and general health). The current study provides further justification for OSA screening in the general population during middle age and late adulthood especially in those most at risk (i.e., overweight, male, hypertensive, and poor subjective sleep quality).
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Kidwai, Asif. "Technology Acceptance and Compliance in Obstructive Sleep Apnea Patients." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5209.
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The focus of this study is the problem of declining trend in obstructive sleep apnea (OSA) patient compliance. Studies reported improved compliance in patients with chronic diseases due to technology-based interventions. However, researchers have not investigated the advantages of technology to improve the compliance of OSA patients in detail. The specific problem was the lack of engagement between patients and healthcare managers, resulting in low compliance within OSA patients. The purpose of this qualitative study was to evaluate how technology-based interventions can improve OSA patient engagement with the healthcare managers resulting in improved compliance with treatment procedures. In this study, the technology acceptance model was used as the instrument in evaluating the information collected through interviews with 20 healthcare managers about their attitudes toward usage, perceived usefulness, and perceived ease of use. The transcribed interviews were open-coded using the RQDA library in R Studio. In general, results from this study indicated that the healthcare managers showed a positive attitude towards the use of technology for patient engagement and expressed that the technology is useful for patient engagement and is easier to use. However, they identified technology-related and patient-related challenges in implementing technology for patient engagement. Further, the respondents identified process-related and patient-related opportunities in using technology for patient engagement. Results from this study have practice and policy implications by enabling healthcare managers to devise better compliance plans for OSA patient management. The findings could have a social benefit by helping healthcare managers to implement technology-based interventions to better achieve a higher compliance resulting in better patient health at lower costs.
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Tung, Patricia, Yamini S. Levitzky, Rui Wang, Jia Weng, Stuart F. Quan, Daniel J. Gottlieb, Michael Rueschman, et al. "Obstructive and Central Sleep Apnea and the Risk of Incident Atrial Fibrillation in a Community Cohort of Men and Women." WILEY, 2017. http://hdl.handle.net/10150/625524.
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Background-Previous studies have documented a high prevalence of atrial fibrillation (AF) in individuals with obstructive sleep apnea (OSA). Central sleep apnea (CSA) has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have distinguished the associations of obstructive sleep apnea from CSA with AF in population studies. Methods and Results-We assessed the association of obstructive sleep apnea and CSA with incident AF among 2912 individuals without a history of AF in the SHHS (Sleep Heart Health Study), a prospective, community-based study of existing ("parent") cohort studies designed to evaluate the cardiovascular consequences of sleep disordered breathing. Incident AF was documented by 12-lead ECG or assessed by the parent cohort. obstructive sleep apnea was defined by the obstructive apnea-hypopnea index (OAHI). CSA was defined by a central apnea index >= 5 or the presence of Cheyne Stokes Respiration. Logistic regression was used to assess the association between sleep disordered breathing and incident AF. Over a mean of 5.3 years of follow-up, 338 cases of incident AF were observed. CSA was a predictor of incident AF in all adjusted models and was associated with 2-to 3-fold increased odds of developing AF (central apnea index >= 5 odds ratio [OR], 3.00, 1.40-6.44; Cheyne-Stokes respiration OR, 1.83, 0.95-3.54; CSA or Cheyne-Stokes respiration OR, 2.00, 1.16-3.44). In contrast, OAHI was not associated with incident AF (OAHI per 5 unit increase OR, 0.97, 0.91-1.03; OAHI 5 to <15 OR, 0.84, 0.59-1.17; OAHI 15 to <30 OR, 0.93, 0.60-1.45; OAHI >= 30 OR, 0.76, 0.42-1.36). Conclusions-In a prospective, community-based cohort, CSA was associated with incident AF, even after adjustment for cardiovascular risk factors.
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Lee, Ee Lin. "The correspondence between home and laboratory sleep measures in children with obstructive sleep apnea /." Title page and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09SB/09sbl447.pdf.
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Arroyo, Porras Igor Alfredo. "Developing an sleep scorer by using Biosignals in Matlab. : Evaluation for sleep apnea patients." Thesis, KTH, Skolan för teknik och hälsa (STH), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-179346.
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Nowadays, sleep disorders e.g. sleep apnea —the cessation of airflow at the nose and mouth lasting at least 10 second— are a broadly problem around the world. Direct and indirect costs associated to sleep problems are outsize and the quality of patient life is deteriorated because of it. In addition, Sleep is a fundamental part of everyday life, the lack of it or the poor quality of sleep may lead into the development of important diseases. Sleep studies are usually carried out by specialists by means of polysomnography. Polysomnography is a type of sleep study which is consisting of EEG, EOG, EMG, ECG, respiratory signals and/or many other biosignals which together can be used to determine the state of patient’s sleep and any other issue. Nowadays, visual inspection of these signals forms the “gold standard” in sleep clinics. The cost of monitoring a person overnight, the scarcity of beds available and the uncertainty of whether the results are representative of a normal nights’ sleep means that a move to home diagnostics is likely to be advantageous. Therefore, a necessity for home recorders systems capable of perform this kind of analysis has come out. A state machine based automatic scorer is developed and evaluated in Matlab by using 12 recordings of apnoeic patients from sleep heart health study (SHHS) database. By the analysis of EEG, EOG, EMG, Oxygen saturation (Sao2) and respiratory movements signals, the implemented algorithm is trained and evaluated to detect the five stages of subject’s sleep (Wake, N1, N2, N3, or REM) as well as apnoeic episodes according to guidelines from American Academy of Sleep Medicine (AASM). In the final evaluation of algorithms, the automatic scorer achieved 74±5.27% accuracy for all five stages and Cohen’s kappa of 0.5 for the overall set of 12 patients, being the accuracy better for healthier subjects and reaching in this case 78±4.05%. The analysis of the sleep apnea concluded with a sensitivity of 47.08%, a specificity of 83.38%, and an accuracy of 78.1%. Differences in the performance among patients according to their apnea/hypopnea index were significant. Key Words: Polysomnography, AASM, Sleep apnea/hypopnea.
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Simons, Lara Andrea da Silva. "Automatic sleep apnea detection and sleep classification using the ECG and the SpO2 signals." Master's thesis, FCT - UNL, 2009. http://hdl.handle.net/10362/2649.
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Dissertation for a Masters Degree in Computer and Electronic EngineeringThe present work describes the aspects to implement a system that can be used as a swift and accessible screening tool in patients whose complaints are compatible with OSAS (Obstructive Sleep Apnea Syndrome). This system only uses two signals, electrocardiogram (ECG) and the saturation of oxygen in arterial blood flow (SPO2). This system would be applied for the ambulatory automatic screening of OSAS, which currently are done in a Hospital environment, with a substantial waiting list. The system also would overcome the time consuming visual sleep scoring that contributes for the mentioned waiting list. We have developed a system that automatically detects OSAS based on the ECG and SpO2. However this system has to be paired up with another that detects the awake/sleep/REM periods (also based on the ECG), which is also part of this work. This last component has proved to produce results that are complex to classify,for which there is still a lack of research work. However we have described the necessary algorithms, and have used state-of-the-art signal processing tools, such as wavelets.
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Crisalli, Joseph A. M. D. "Baroreflex Sensitivity after Adenotonsillectomy in Children with Obstructive Sleep Apnea during Wakefulness and Sleep." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1384334068.
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Devita, Maria. "Neuropsychology of sleep and breathing: the effects of obstructive sleep apnea syndrome on cognition." Doctoral thesis, Università degli studi di Bergamo, 2018. http://hdl.handle.net/10446/102657.
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Obstructive Sleep Apnea Syndrome (OSAS) is a common sleep disorder that has drawn the attention of neuropsychologists because of its possible deleterious effects on cognition. Several are the causes of the impairments this syndrome can produce, like fragmentation of sleep, intermittent nocturnal hypoxia and daytime sleepiness. Apolipoprotein E4 (APOE4) may also play a role in OSAS and it has been suggested as a trigger of cognitive impairment and of dementia-like patterns.
This dissertation begins with a critical review of the literature, with the aim to provide the current overview of the main controversies about OSAS and its effects on brain and cognition. Three experimental studies aiming to shed light on the nature of the relationship between OSAS and cognition are then proposed. The first two studies focus on the effects of OSAS on information processing speed. Innovative measures have been proposed to clarify whether different components of information processing speed are impaired in OSAS (Study 1), and to evaluate the efficacy over time of the continuous positive airway pressure treatment (Study 2). Finally, Study 3 aims to evaluate the effects of APOE4 on psychometric performance, and to investigate at which sleep stage its presence could be a predictor of cognitive impairments in OSAS patients. Results show that OSAS is associated with impairment of the motor component of information processing speed, which can however be properly recovered after treatment. Furthermore, a retention memory deficit is reported in OSAS patients carrying APOE4, and NREM sleep fragmentation has been found to be directly involved in this impairment. This dissertation supports the hypothesis of a cognitive frailty associated with OSAS, however discouraging its irreversibility, and argues that APOE4 can be considered a risk factor for the memory loss observed in this syndrome.
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Craig, Sonya Elizabeth. "Cardiovascular consequences of obstructive sleep apnoea in minimally symptomatic patients." Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708448.
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Wichmann, Mark William. "A device for the treatment of adult Sleep Apnea Syndrome." Thesis, Virginia Tech, 1988. http://hdl.handle.net/10919/45960.
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An electronically-controlled positive-displacement bellows-type air pump has been developed in the Bio-medical Engineering Laboratory for the treatment of adult Sleep Apnea Syndrome (SAS). An electronically-controlled positive-displacement pump has been employed in order to eliminate the pressure regulator and accompanying noise of present therapeutic devices. The positive-displacement pump is found to quietly and effectively provide the required airway pressures for the treatment of adult Sleep Apnea Syndrome. New developments in the reduction of the size and noise levels of current therapeutic devices, however, preclude mass production of the bellows-type pump because of its size disadvantage. The custom nasal mask and exhalation valve, control system, pressure-monitoring alarm system, and the controlled humidifier of the positive-displacement pump should be incorporated within the present fanâ type Nasal Continuous Positive Airway Pressure (NCPAP) system to provide quieter, more comfortable, and safer NCPAP therapy. Before the design and development of the positive displacement NCPAP pump is detailed in this thesis, however, the problem of adult Sleep Apnea Syndrome is introduced, available therapies are investigated, and the current NCPAP therapy system is examined.
Master of Science
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Dingwall, Kylie. "Effects of medication on the sleep architecture of patients with obstructive sleep apnea syndrome (OSAS) /." [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe19264.pdf.
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JOFFE, David. "OBSTRUCTIVE SLEEP APNOEA: THE GENESIS OF DAYTIME SOMNOLENCE AND COGNITIVE IMPAIRMENT - AROUSALS, HYPOXIA AND CIRCADIAN RHYTHM." Thesis, The University of Sydney, 1997. http://hdl.handle.net/2123/382.
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Obstructive Sleep Apnoea (OSA) is a disease characterised by repetitive upper airway obstructions which are manifest by desaturation and arousal from sleep. It has been known for many years that this interruption to the normal architecture of sleep may present to the clinician as excessive daytime somnolence often with a complaint of difficulties with concentration and short term memory. Previous work had demonstrated a relationship between variables of cognitive dysfunction in patients with obstructive sleep apnoea, however, little was known about which components of the syndrome contributed to this outcome and whether specific clinical thresholds of sleep disordered breathing could be defined for the development of cognitive dysfunction. In the context of this body of work cognitive dysfunction is defined as: a level of cognitive performance below normal derived values for a given cognitive test, when the subjects performance is controlled for age, sex and level of education.
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JOFFE, David. "OBSTRUCTIVE SLEEP APNOEA: THE GENESIS OF DAYTIME SOMNOLENCE AND COGNITIVE IMPAIRMENT - AROUSALS, HYPOXIA AND CIRCADIAN RHYTHM." University of Sydney, Respiratory Medicine, Royal North Shore Hospital, 1997. http://hdl.handle.net/2123/382.
Full textAbstract:
Obstructive Sleep Apnoea (OSA) is a disease characterised by repetitive upper airway obstructions which are manifest by desaturation and arousal from sleep. It has been known for many years that this interruption to the normal architecture of sleep may present to the clinician as excessive daytime somnolence often with a complaint of difficulties with concentration and short term memory. Previous work had demonstrated a relationship between variables of cognitive dysfunction in patients with obstructive sleep apnoea, however, little was known about which components of the syndrome contributed to this outcome and whether specific clinical thresholds of sleep disordered breathing could be defined for the development of cognitive dysfunction. In the context of this body of work cognitive dysfunction is defined as: a level of cognitive performance below normal derived values for a given cognitive test, when the subjects performance is controlled for age, sex and level of education.
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Noguchi, Tetsuo. "Heat shock protein 72 level decreases during sleep in patients with obstructive sleep apnea syndrome." Kyoto University, 1997. http://hdl.handle.net/2433/202175.
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Ankrah, Naa Kwaduah. "The Improvement in Obstructive Sleep Apnea and Sleep Duration and its Association with Changes Macronutrient Intake in Adults." University of Akron / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=akron1279563986.
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Tsai, Willis Harvey. "A decision rule for diagnostic testing in obstructive sleep apnea." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0021/MQ48052.pdf.
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Hagander, Louise. "Quantitative sensory testing, obstructive sleep apnea and peripheral nervous lesions /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-780-4/.
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Chen, Tai-Quan, and 陳泰全. "Effects of sleep posture on obstructive sleep apnea." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/n3v72c.
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碩士國立中興大學
生命科學院碩士在職專班
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OBJECTIVE: To investigate the relationship between respiratory problem and sleeping posture in patients with obstructive sleep apnea syndrome. METHODS: In this study, we used retrospectively review data way to analyze. The database is from a sleep medicine center in Central District of Taiwan from January 2016 to June 2016. These databases came from multiple sleep physiological examinations, and we received 708 items. Based on the standard, the study group was divided into two parts, one is (Supine - AHI / Lateral AHI ≥ 2) that is positional patient (PP) group and the other (Supine - AHI / Lateral AHI ＜ 2) is non-positional patient (NPP). The groups were compared for age, body mass index (BMI), neck circumference (NC), total sleep time (TST), apnea hypopnea index (AHI),lowest oxygen saturation (LSaO2), Epworth Sleepiness Scale and other parameters. Each parameter in the group will be analyzed . Results:The results of this study show that AHI clusters’ parameters such as BMI, TST, Lowest oxygen saturation (LSaO2), and Epworth Sleepiness Scale have significant statistical differences (P＜ 0.05). In addition, some cases can use the change of sleep posture to improve the occurrence of sleep apnea. The NPP group and the PP group have significant statistical differences in BMI, neck circumference (NC), total sleep time (TST), apnea hypopnea index (AHI), lowest oxygen saturation (LSaO2), and Epworth Sleepiness Scale. Conclusion:The results show that in some cases of sleep apnea, there is a correlation between clinical sleep posture and the number of sleep apneas, and the change in sleep posture can effectively improve the occurrence of sleep apnea.
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Santos, Bárbara Vicente dos. "Aging and Obstructive Sleep Apnea." Master's thesis, 2019. http://hdl.handle.net/10316/88199.
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Dissertação de Mestrado em Biotecnologia Farmacêutica apresentada à Faculdade de FarmáciaA Síndrome Apneia Obstrutiva do Sono (SAOS) é reconhecida como uma das mais comunsperturbações do sono. Esta doença é caracterizada por episódios regulares de obstrução, parcialou completa, das vias aéreas superiores durante o sono. Estima-se que 80 a 90 % dos casos deSAOS não estejam diagnosticados, fundamentalmente devido ao diagnóstico tardio e baixoconhecimento da doença. A SAOS não tratada está associada a uma maior predisposição a váriosproblemas de saúde, bem como a uma maior mortalidade. Além disso, vários estudos demonstramuma associação entre a SAOS e comprometimento cognitivo e demência, que são frequentementeassociados ao envelhecimento. Neste caso, estas alterações são observadas em doentes comSAOS em idades precoces. Evidências sugerem que a SAOS pode promover/agravar oenvelhecimento através da indução de mecanismos celulares e moleculares associados a este.Neste contexto, os objetivos principais deste trabalho são:1) investigar se os doentes com SAOS apresentam alterações celulares e/ou molecularesperiféricas associadas ao envelhecimento; 2) avaliar se o tratamento da SAOS atenua essasalterações; 3) sensibilizar a população para os fatores de risco, consequências e falta dediagnóstico da SAOS.Uma coorte de 6 doentes Portugueses do sexo masculino [idade: 53 ± 4 anos; IMC: 32,1 ± 2,5]com diagnóstico de SAOS severa [60.9±12 apneias/hipopneia por hora – AHI] foramacompanhados desde o momento do diagnóstico com polissonografia – PSG (t0), após 4 meses(t4M) e 2 anos (t24M) de tratamento com o tratamento de referência – CPAP. Em cada fase doestudo (t0, t4M and t24M) foram realizadas colheitas de sangue aos doentes e controlos e isoladascélulas mononucleares do sangue periférico (PBMCs). Foram avaliadas características doenvelhecimento celular e molecular, nomeadamente a instabilidade genómica, a perda daproteostase e o encurtamento dos telómeros. Todos os resultados foram comparados comcontrolos de idades correspondentes [idade: 47 ± 7 anos: IMC: 25,6 ± 0,5; AHI: 4,7 ± 0,8] e comcontrolos jovens [idade: 24 ± 2 anos; IMC: 23,5 ± 2,8].Os resultados demonstram que em doentes com SAOS se verificam alterações ao nível dahomeostasia proteica, instabilidade genómica e encurtamento dos telómeros. O tratamento decurta duração não parecem ser suficientes para reverter as consequências da SAOS, enquantoque o tratamento a longo-termo com CPAP pode parcialmente restabelecer algumas dasalterações.Em suma, este trabalho sugere que a SAOS promove/agrava o envelhecimento e as doençasassociadas a este. Mais estudos são necessários que permitam descobrir novos biomarcadoresque permitam o diagnóstico precoce da SAOS, estratificação dos doentes e a monitorização daresposta ao tratamento. Por fim, o diagnóstico e tratamento numa fase precoce da SAOS podemconstituir uma nova estratégia para atenuar o envelhecimento.
Obstructive Sleep Apnea (OSA) has been recognized as one of the most common sleep disorders.OSA is characterized by regular episodes of complete or partial obstruction of the upper airwaysduring sleep. Nevertheless, it is estimated that 80 to 90 % of the OSA cases are undiagnosedmainly due to late diagnosis and lack of disease awareness. Untreated, OSA has been associatedwith an increased predisposition to several health problems and increased mortality. Moreover,there is sizable evidence showing the association of OSA with mild cognitive impairment anddementia, which are commonly associated with aging, but this alteration appear at younger agesin OSA patients. There are evidences that OSA might promote/aggravate aging by inducingcellular and molecular aging mechanisms. In this context, the main objectives of present work are:1) to investigate whether OSA patients show peripheral aging-related cellular and molecularimpairments; 2) to assess if OSA treatment can ameliorate such alterations; 3) to raise awarenessof the population to alert the risk factors, consequences and lack of diagnosis of OSA.A cohort of 6 Portuguese male patients [age: 53 ± 4 years; BMI: 32.1 ± 2.5] diagnosed with severeOSA [60.9 ± 12 apneas/hypopneas per hour - AHI] was followed from the moment of diagnosiswith polysomnography - PSG (t0), up to 4 months (t4M) and 2 years (t24M) of treatment withstandard treatment - CPAP. In each phase (t0, t4M and t24M), blood was collected from patients andcontrols subjects and peripheral blood mononuclear cells were isolated. Hallmarks of cellular andmolecular aging were evaluated, namely, genomic instability, loss of proteostasis and telomereshortening. All results were compared to age-matched controls [age: 47±7 years; BMI: 25.6 ± 0.5;AHI: 4.7 ± 0.8] and with younger controls [age: 24 ± 2 years; BMI: 23.5 ± 2.8].The results showed that OSA patients induce impairments in protein homeostasis, nucleargenomic instability and telomere shortening. Short-term treatment does not seem enough torecover from OSA consequences while long-term CPAP treatment might partially re-stablishsome alterations.Overall, this work suggests that OSA promotes/aggravates aging and aging-related diseases.Further investigations are needed to find new biomarkers allowing for OSA early diagnosis, patientstratification and treatment response monitoring. In the end, OSA early diagnosis and treatmentmay constitute a new strategy to delay ageing.
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Pardalejo, Ana Sofia Almeida. "Sleep@home: remote monitoring of sleep apnea syndrome patients." Master's thesis, 2008. http://hdl.handle.net/10316/12255.
Full textAbstract:
A apneia obstrutiva do sono é nos dias de hoje um distúrbio respiratório
com consequências graves que afectam a qualidade de vida das pessoas. A
percentagem de casos em crianças de idade pré-escolar é de cerca de 1-3%.
A Polissonografia é actualmente a técnica mais utilizada para o estudo do
sono, durante uma noite completa num hospital, em que inúmeros sinais vitais da
criança estão continuamente a ser monitorizados. O reduzido número de hospitais
pediátricos com este tipo de exame, a sua complexidade e custos elevados, promovem
o desenvolvimento de novos dispositivos.
O Sleep@Home é um sistema inovador e não invasivo, em que as crianças
podem ser monitorizadas a partir de suas casas, e a aquisição dos sinais é transmitida
remotamente para a unidade de saúde onde os dados podem ser consultados. O
objectivo deste sistema não é substituir a PSG, mas ser utilizado como um dispositivo
de rastreio menos estranho para as crianças. Para isso é necessária a realização de
mais testes clínicos a fim de validar o sistema.
Palavras-chave (Tema): Síndrome da Apneia Obstrutiva do Sono, saturação de oxigénio,
frequência cardíaca, monitorização no domicílio, apoio ao diagnóstico, crianças.
Palavras-chave (Tecnologias): Oxímetro, câmara de vídeo, bandas de esforço respiratório,
microfone.