Dissertations / Theses on the topic 'Sleep disordered breathing (SDB)'
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kuo, Tracy F. "Sleep-disordered breathing (SDB) and neuropsychological function: A community sample study." Diss., The University of Arizona, 2000. http://hdl.handle.net/10150/284215.
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This is a case-control study investigating the relationship of sleep-disordered breathing (SDB) to neuropsychological functioning. Participants were recruited from the Tucson Sleep Heart Health Study (SHHS), which is a population-based study examining cardiovascular consequences of SDB. A sample of 103 men and women, ages 40-75, consisting of 51 controls (CTL group) and 52 persons with SDB (SDB group), matched by age (± 5 years) and sex, was enrolled. CTL subjects had a respiratory disturbance index (RDI), a measure of SDB, ≤ 5 while the SDB subjects had a RDI 20 to 50, inclusive. All participants had an overnight in-home polysomnography (PSG) prior to undergoing a neuropsychological evaluation. Psychological functioning was assessed and the areas of cognitive functioning that were tested included general intelligence, attention and working memory, psycho-visuo-motor efficiency, manual dexterity, and frontal/executive function. The SDB group performed significantly worse on the Stroop Color-Word test, made more errors on the Controlled Oral Word Association test, and overestimated time elapsed. The SDB group also demonstrated a statistical trend ( p ≤ 0.10) for worse performance on Wechsler Adult Intelligence Scale - III Digit Span, Letter-Number Sequencing and Digit Symbol Coding subtests, and the non-dominant hand performance on the Grooved Pegboard. Factor analyses were performed to reduce the number of neuropsychological variables and measures of SDB. Controlling for IQ, multiple regression analyses showed a significant negative association between a "nocturnal hypoxemia" factor and both "manual dexterity" and "semantic memory" factors. The results suggest that persons with moderate SDB, compared to controls, did not report increased depression or other aspects of psychological distress. SDB is, however, associated with subtle neuropsychological decrements in frontal/executive function, psycho-visuo-motor efficiency, and working memory. The performance decrement in tasks of frontal executive function and manual dexterity was primarily associated with nocturnal hypoxemia and not to the frequency of sleep fragmentation.
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Davies, Robert J. O. "Sleep disordered breathing and the cardiovascular system." Thesis, University of Southampton, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.404009.
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Smith, Lindsay Anne. "Sleep-disordered breathing and chronic heart failure." Thesis, University of Edinburgh, 2009. http://hdl.handle.net/1842/29371.
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Methods: Patients with stable symptomatic chronic heart failure were screened for sleep-disordered breathing by home sleep study. Daytime sleepiness was assessed by Epworth Sleepiness Scale and heart failure severity by symptom class, left ventricular ejection fraction and serum N-terminal pro-brain natriuretic peptide concentrations. In a subset of patients, synchronous in-laboratory limited sleep studies and polysomonography, and home limited sleep studies, were performed prospectively. Patients with obstructive sleep apnoea and stable symptomatic chronic heart failure were randomised to nocturnal auto-titrating continuous positive airway pressure or sham for six weeks each in crossover design. Results: In the era of modern therapy, sleep-disordered breathing is common in patients with stable symptomatic chronic heart failure, predominantly obstructive in aetiology, without clear relationship to heart failure severity and is difficult to diagnose because of major overlap in symptomatology. Limited sleep studies compare well diagnostically to polysomnography when tested under identical patient and environmental conditions but less so when tested in the home setting. Auto-titrating continuous positive airway pressure improves daytime sleepiness is patients with obstructive sleep apnoea and chronic heart failure but not other subjective or objective measures of heart failure severity. Conclusions: Sleep-disordered breathing is difficult to detect clinically in patients with chronic heart failure, and as such, the diagnosis is reliant on accurate sleep studies. However, the clinical utility of limited sleep studies in detection and diagnosis of sleep-disordered breathing is restricted by a number of technical and situational factors which are exacerbated in patients with chronic heart failure. The potential therapeutic benefits of continuous positive airway pressure in patients with obstructive sleep apnoea and chronic heart failure are achieved by alleviation of obstructive sleep apnoea rather than by improvement in cardiac function.
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Pirilä-Parkkinen, K. (Kirsi). "Childhood sleep-disordered breathing – dentofacial and pharyngeal characteristics." Doctoral thesis, Oulun yliopisto, 2011. http://urn.fi/urn:isbn:9789514296024.
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Abstract The aim of this work was to examine distinct dentofacial and pharyngeal features in children with sleep-disordered breathing (SDB). A further aim was to test the validity of the conventional methods used in orthodontics for recognition of obstructed airways. Seventy children (36 girls, 34 boys, age range 4.2–11.9 years), who were diagnosed as having SDB during the years 2000–2002, constituted the source of subjects for four separate studies. The study protocol included otorhinolaryngological and orthodontic examinations. Dental impressions and lateral cephalograms were taken. In addition, upper airway was imaged in 36 children in different head postures by magnetic resonance imaging (MRI). Age- and gender-matched healthy children were used as controls. The results showed that children with SDB had increased overjet, smaller overbite, narrower upper and shorter lower dental arches and higher incidence of anterior open bite and distal molar relationship when compared with control children. The severity of the obstruction correlated with larger deviations from normal in the dental characteristics. There were more children with crowding and with anterior open bite with increased severity of the disorder. Children with SDB displayed an increased sagittal jaw relationship, a more vertical growth pattern of the mandible, a longer and thicker soft palate, a lower hyoid bone position, larger craniocervical angles and narrower pharyngeal airway measured at multiple levels, when compared with the controls. Deviation in pharyngeal variables showed highest correlation with the severity of SDB. MRI indicated a smaller than normal oropharyngeal airway in children with SDB. The effect of head posture on pharyngeal airway dimensions differed in children with SDB when compared with the controls. These findings verify that the developmental course of occlusal characteristics and craniofacial structures may be modulated by breathing pattern, and, on the other hand, that certain features may predispose to the development of the disorder. It is important to recognize these signs in order to guide further development in a more favorable direction. The results confirmed that cephalometry is a valid screening tool when assessing nasopharyngeal and retropalatal airway dimensions. Clinical examination of tonsillar size was found reliable when retroglossal airway size was evaluatedTiivistelmä Väitöskirjatyön tarkoituksena oli selvittää lasten unenaikaisten hengityshäiriöiden yhteyttä kasvojen ja leukojen kasvuun, purennan kehitykseen sekä ylempien hengitysteiden rakenteeseen. Lisäksi tutkittiin, kuinka luotettavasti hammaslääkäreiden käytössä olevin menetelmin pystytään arvioimaan lasten ahtautuneita ilmateitä. Tutkimusaineistossa oli mukana 70 lasta (36 tyttöä, 30 poikaa, ikä 4.2–11.9 vuotta), joilla diagnosoitiin unenaikainen obstruktiivinen hengityshäiriö vuosina 2000–2002. Lapsille tehtiin kliiniset tutkimukset oikojahammaslääkärin ja korva-, nenä- ja kurkkutautien erikoislääkärin toimesta sekä otettiin lateraalikallokuva ja hampaistosta kipsimallijäljennökset. Lisäksi ylempien hengitysteiden magneettitutkimus suoritettiin 36 lapselle eri pään asennoissa. Verrokkiryhmässä oli sama ikä- ja sukupuolijakauma kuin tutkimusryhmässä. Tulokset osoittivat, että unenaikaisista hengityshäiriöistä kärsivillä lapsilla horisontaalinen ylipurenta oli suurentunut, vertikaalinen ylipurenta oli pienentynyt, ylähammaskaari oli kapeampi ja alahammaskaari lyhyempi kuin terveillä verrokeilla. Alaetualueen ahtaus ja etualueen avopurenta olivat yleisempiä niillä lapsilla, joilla oli vaikeampiasteinen hengityshäiriö. Lasten unenaikaiset hengityshäiriöt liittyivät suurentuneeseen leukojen väliseen kokoepäsuhtaan, alaleuan avautuvaan kasvumalliin, pidempään ja paksumpaan pehmeään suulakeen, kieliluun alempaan asentoon, kohonneeseen pään asentoon sekä ahtaampiin nielun ilmatilan mittoihin verrattaessa terveisiin lapsiin. Häiriön vaikeusaste korreloi suurempiin poikkeamiin nielun mitoissa. Lapsilla, joilla todettiin unenaikainen hengityshäiriö, magneettitutkimukset osoittivat nielun olevan ahdas. Pään asennon vaikutukset ilmatien rakenteeseen poikkesivat unenaikaisista hengityshäiriöistä kärsivillä lapsilla. Saadut tulokset osoittivat, että hengitystapa voi vaikuttaa hampaiston, kasvojen ja leukojen rakenteiden kehitykseen. Tietyt kasvojen ja leukojen piirteet puolestaan saattavat altistaa häiriön kehittymiselle. On tärkeää tunnistaa nämä merkit, jotta kehitystä voidaan ohjata suotuisampaan suuntaan. Tutkimukset osoittivat, että kefalometrinen analyysi on luotettava arvioitaessa nenänielun sekä pehmeän suulaen takana olevan ilmatilan kokoa. Nielurisojen kliinisen koon arviointi on luotettava arvioitaessa alemman suunielun ilmatilan kokoa
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Aran, Reza. "Craniofacial morphology and sleep disordered breathing in children." Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/44379.
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Objective: The aim of this study is to understand how craniofacial morphology and the severity of a malocclusion can contribute to sleep disordered breathing (SDB) symptoms in children when controlled for age, gender and body mass index (BMI).
Methods: A total of 301 subjects with complete records were included in this study. Two hundred and thirty-seven were preadolescents, of which 97 were male and 140 were female (mean age 9.9±1.6); 64 were adolescents, of which 24 were male and 40 were female (mean age 13.8±0.9). All the subjects’ parents were asked to complete a SDB questionnaire. Lateral cephalometric images were analyzed to assess the position of the hyoid bone, length of the soft palate, and the maxillary and mandibular dental and skeletal relationship. A clinical examination was performed to determine the Angle classification, Mallampati score, tonsil size (Brodesky), and BMI.
Results: Data from 301 children that completed the questionnaires and underwent a cephalometric analysis were evaluated. Subjects were divided into two groups based on their age and each group was further divided based on gender. By comparing preadolescents with adolescents we found that preadolescents presented a significantly higher incidence of hyperactivity, morning headaches, more frequent snoring, and bedwetting. Adolescents exhibited significantly higher daytime sleepiness, difficulty getting up, and impaired daytime function. When comparing female and male subjects, we found that frequent snoring, and morning headaches were more prevalent among females, while daytime sleepiness, and hyperactivity were more common among males. Craniofacial features that have a significant relationship with SDB symptoms are, a lower position of the hyoid bone, retruded mandible, steeper mandibular plane angle, and retroclined lower incisors. There was no statistically significant relationship between Angle classifications, tonsil size, Mallampati score, and BMI with SDB symptoms in this sample.
Conclusion: This study suggests that craniofacial morphology, but not severity of malocclusions, could be a potential contributing factor to SDB symptom severity.
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Kaminska, Marta. "Sleep-disordered breathing and fatigue in multiple sclerosis." Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=103496.
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Fatigue is common and disabling in multiple sclerosis (MS). It is distinct from sleepiness. Both fatigue and sleepiness have been associated with sleep-disordered breathing, particularly obstructive sleep apnea (OSA) in other populations. While fatigue in MS is probably multi-factorial, OSA may play an important role. The main objectives of this project were to evaluate the relationship of OSA to fatigue and sleepiness in MS patients vs. normal controls, and to evaluate predictors of severe fatigue in MS subjects. Stable, ambulatory MS patients without known sleep disorders were recruited from the Montreal Neurological Hospital MS clinic. Normal controls were age and sex frequency-matched. All participants underwent diagnostic overnight polysomnography and a multiple sleep latency test (objective measure of daytime sleepiness). Fatigue was measured with the Fatigue Severity Scale (FSS) and the Multidimensional Fatigue Inventory (MFI), and subjective sleepiness with the Epworth Sleepiness Scale (ESS). Covariates included age, sex, body mass index, MS disability level, depression, pain and restless legs syndrome severity. OSA, defined as an apnea-hypopnea index (AHI) ≥ 15, was found in 36 of 62 (58%) MS subjects and 15 of 32 (47%) control subjects – OR (95% CI) 1.57 (0.67, 3.74). After adjusting for confounders, severe fatigue (FSS > 5) and the MFI-mental fatigue scale (> group median) were associated with AHI and respiratory-related arousals, in MS but not in control subjects. MFI-mental fatigue, in MS subjects, was also associated with intermittent hypoxemia. Subjective and objective sleepiness were not related to OSA in either group. In a multivariate model for MS subjects alone, the significant predictors of severe fatigue were the MS disability level – OR (95% CI) 1.88 (1.18, 3.33) and severe OSA (AHI ≥ 30) – OR (95% CI) 19.55 (2.31, 322.09). In summary, while OSA was not more frequent in MS than in control subjects, it was associated with severe fatigue only in MS subjects. No association was found with sleepiness. Severe fatigue in MS subjects showed a marked association with severe OSA, and a less pronounced association with MS disability level. In that OSA is a treatable condition, these findings open the door to further research that may lead to important changes in management of severely fatigued MS subjects.La fatigue est fréquente et incapacitante dans la sclérose en plaque (SP). Elle est distincte de la somnolence. La fatigue et la somnolence ont été associées aux troubles respiratoires du sommeil, particulièrement à l'apnée obstructive du sommeil (AOS). La fatigue dans la SP est vraisemblablement multifactorielle, mais l'AOS pourrait y jouer un rôle important. Les principaux objectifs de ce projet étaient d'évaluer le rapport entre l'AOS et la fatigue ainsi que la somnolence chez les patients atteints de SP comparativement au sujets témoins, et d'évaluer les facteurs associés à la fatigue sévère chez les sujets atteints de SP. Des patients atteints de SP stables et ambulatoires sans troubles du sommeil connus ont été recrutés à la clinique de SP de l'Hôpital Neurologique de Montréal. Le groupe de sujets contrôle a été assorti en âge et sexe. Tous les participants ont passés une polysomnographie diagnostique et un test itératif de latence à l'endormissement (mesure objective de la somnolence diurne). La fatigue fut mesurée par la 'Fatigue Severity Scale' (FSS) et le 'Multidimensional Fatigue Inventory' (MFI), et la somnolence subjective avec l'échelle de somnolence Epworth (ESS). Les autres variables étaient l'âge, le sexe, l'indice de masse corporel, le niveau d'incapacité lié à la SP, la dépression, la douleur et la sévérité du syndrome des jambes sans repos. L'AOS, défini par un indice d'apnée-hypopnée (IAH) ≥ 15, a été retrouvée chez 36 des 62 (58%) sujets SP et 5 des 32 (47%) sujets témoins – rapport de cote (RC, IC 95%) 1.57 (0.67, 3.74). Après ajustement pour les facteurs confondants, la fatigue sévère (FSS > 5) et le MFI – fatigue mentale (> médiane du groupe) étaient associés avec l'IAH et les micro-éveils respiratoires, chez les sujets SP mais non chez les sujets contrôle. Le MFI – fatigue mentale, chez les sujets SP, était aussi associé à l'hypoxémie intermittente. Ni la somnolence subjective, ni objective n'étaient associées à l'AOS dans aucun des 2 groupes. Dans un modèle à plusieurs variables pour les sujets SP seulement, les seules variables prédisant la fatigue sévère étaient le niveau d'incapacité – RC (IC 95%) 1.88 (1.18, 3.33) et l'AOS sévère (IAH ≥ 30) – RC (IC 95%) 19.55 (2.31, 322.09). En résumé, quoique l'AOS n'aie pas été plus fréquente dans la SP que chez les sujets témoins, elle était associée à la fatigue sévère chez les sujets SP seulement. Aucune association avec la somnolence n'a été mise en évidence. La fatigue sévère chez les sujets SP était associée de façon marquée à l'AOS sévère, et de façon moins prononcée au niveau d'incapacité. Comme l'AOS est une condition qui se traite, ces résultats ouvrent la porte à des recherches plus poussées qui pourraient ultérieurement changer la prise en charge des patients atteints de SP avec fatigue sévère.
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Johnston, Christopher David. "Sleep-disordered breathing : a cephalometric and clinical study." Thesis, Queen's University Belfast, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.313925.
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Bruyneel, Marie. "Ambulatory diagnostic and monitoring techniques for sleep disordered breathing." Doctoral thesis, Universite Libre de Bruxelles, 2015. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/216824.
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Techniques ambulatoires de diagnostic et de monitoring des troubles respiratoires liés au sommeil.Le syndrome d’apnées obstructives du sommeil (SAOS) est un trouble du sommeil très fréquent, fortement lié à l’obésité, ce qui explique sa prévalence en pleine expansion. En parallèle, la demande d’examens polysomnographiques (PSG) en laboratoire du sommeil, méthode diagnostique de référence, est en croissance. Comme l’accès à cette technique est peu aisé, de nombreux appareils simplifiés d’enregistrement de sommeil ont été récemment développés, mais restent imparfaits (mauvaise évaluation du temps de sommeil, sous-estimation de la sévérité du SAOS, faux négatifs, taux d’échec élevé) et sont d’un apport limité pour le diagnostic du SAOS. La PSG au domicile (PSG-d) est une alternative bien plus informative, permettant d’éviter nombre des désavantages rencontrés par l’usage d’appareils simplifiés. Nous l’avons dès lors étudiée pour le diagnostic du SAOS, au travers d’une étude randomisée comparant la PSG-d vs la PSG hospitalière. En termes d’efficacité diagnostique, les résultats sont excellents, avec un faible taux d’échec d’examens à domicile (4.7 vs 1.5%). Les patients préfèrent être enregistrés dans leur propre environnement où la qualité de leur sommeil est d’ailleurs meilleure. Nous avons ensuite voulu faire le point sur la littérature récente au travers d’un article de revue, en analysant les études prospectives randomisées comparant la PSG-d et au labo du sommeil. Les résultats de ces études concordent pour démontrer que la PSG-d constitue une excellente alternative aux tests réalisés à l’hôpital. Outre le SAOS, l’outil permet le diagnostic d’autres troubles du sommeil, comme les mouvements périodiques des jambes durant le sommeil, les troubles du rythme circadien, Une question restée jusqu’ici sans réponse était l’influence de la localisation du branchement des PSG-d, à l’hôpital ou à domicile. Une étude prospective randomisée nous a permis d’établir que la localisation du branchement des PSG-d n’influençait pas la qualité globale de l’examen, ce qui simplifiera l’utilisation de cet outil à l’avenir. Enfin, nous avons utilisé des techniques de télé monitoring (TM) pour contrôler, en temps réel, la qualité des PSG-d. Dans une première étude pilote, la faisabilité a été confirmée, malgré quelques difficultés techniques. Nous avons voulu appliquer la technique à une population de patients souffrant d’un syndrome coronarien aigu, incapables d’être enregistrés au labo du sommeil. Nous avons étudié la qualité du screening du SAOS par PSG vs polygraphie (PG). Les résultats se sont révélés surprenants :82% de cette population présentait des troubles respiratoires liés au sommeil, principalement centraux. La PSG était nettement plus sensible que la PG, et le TM améliorait la qualité des PSG. Chez les patients traités pour SAOS, nous avons ensuite utilisé un outil de monitoring, l’actigraphie (Act), afin d’observer, dans la vie de tous les jours, les changements de schémas de sommeil et d’activité physique engendrés par la pression positive continue (PPC). Dans un premier travail, rétrospectif, nous avons observé ces paramètres chez des SAOS avant traitement, puis au travers d’une étude prospective multicentrique, nous avons suivi 150 patients avant et après PPC, et observé chez eux une augmentation de temps de sommeil, mais pas de l’activité physique. En conclusion, nous avons démontré dans cette thèse l’intérêt clinique de deux excellents outils ambulatoires, la PSG-d et l’Act, pour la prise en charge du SAOS. Les implications potentielles sont une meilleure accessibilité diagnostique pour le SAOS, une initiation thérapeutique plus précoce et un suivi plus précis des SAOS traités, dans des conditions ambulatoires, plus confortables et plus adéquates pour les patients.Ambulatory diagnostic and monitoring techniques for sleep disordered breathingSleep disordered breathing (SDB), including obstructive sleep apnea syndrome (OSAS), is directly related to obesity. Significant morbi-mortality is associated with OSAS, explaining the increasing demand for in-hospital polysomnography (PSG), the reference diagnostic method. As this technique is complex and time-consuming, many simplified portable monitoring (PM) devices for home sleep testing have been developed. However, the ability of PM devices to detect OSA remains limited: sleep time is not correctly assessed, OSA severity is underestimated, false negative results occur and the failure rate of the tests is high, up to 30%. Home-PSG (H-PSG) is an interesting alternative, avoiding many of these drawbacks. In the first part of this work, we studied the tool in an original study comparing H-PSG and in-lab PSG. Diagnostic efficacy was good and the failure rate low (4.7 vs 1.5%). Patients slept in their own environment and thus sleep quality was better. We were then interested by reviewing recent literature data regarding prospective randomised trials comparing H-PSG and in-lab PSG. We concluded that H-PSG is an excellent alternative for in-lab PSG, allowing not only OSA detection but also diagnosis of a large panel of other sleep disorders (periodic leg movements during sleep, circadian disorders,). As the best place to perform set-up for H-PSG remained unknown, we studied, in another prospective randomised study, the recording’s quality obtained in both settings. As no difference was observed, lab set up was found to be the simpler option for performing H-PSG. We then tested, in a prospective pilot study, real-time telemonitoring (TM) of H-PSG in order to enhance recording quality. Results were encouraging but we faced some technical problems. In a second study, we applied TM coupled with PSG to detect SDB in acute coronary syndrome, in patients too unstable to come in the sleep lab. We compared also PSG results to polygraphy (PG). Surprisingly, 82% of patients suffered from SDB. PSG was much more sensitive than PG to screen SDB in this population and TM improves recording quality. In the second part of this work, we have used actigraphy (Act) to assess sleep and physical activity in OSA patients in real-life conditions. Firstly, in a retrospective study, we documented these parameters before treatment. In a second multicentre study, we evaluated the changes in sleep schemes and physical activity under continuous positive airway pressure (CPAP) in 150 OSA patients. We observed that sleep time was increased under CPAP, but physical activity was not improved, contrarily to sleepiness and quality of life. In conclusion, we have shown through these works the clinical interest of two excellent ambulatory tools, H-PSG and Act, for OSA management. Potential clinical implications include enhanced healthcare accessibility, earlier treatment initiation and a closer follow-up of treated patients, through ambulatory tools, in a comfortable environment for the patients.
Doctorat en Sciences médicales (Médecine)
info:eu-repo/semantics/nonPublished
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Wang, David. "Sleep disordered breathing in stable methadone maintenance treatment patients /." Connect to thesis, 2006. http://eprints.unimelb.edu.au/archive/00002992.
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Sutton, Amy M. "Executive Function in the Presence of Sleep Disordered Breathing." Digital Archive @ GSU, 2008. http://digitalarchive.gsu.edu/cps_diss/16.
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The purpose of the study was to investigate whether sleep-disordered breathing (SDB) impairs executive functioning in children. Additionally, the study sought to identify the executive functions at risk in SDB and the contribution of daytime sleepiness. SDB represents a spectrum of upper airway conditions that can be mild, such as snoring, or severe, such as obstructive sleep apnea (OSA). Children with these problems may present with excessive sleepiness, failure to thrive, and a variety of cognitive and behavioral dysfunctions including impaired executive functioning. Beebe and Gozal (2002) developed a theoretical model to explain the impact of sleepiness and hypoxia on executive functioning. This model provided a framework to examine links between the medical disorder and the neuropsychological consequences. Twenty-seven children with suspected SDB were tested with polysomnography (PSG) and a neuropsychological battery. Parents completed subjective measures of cognitive function and sleep symptoms. The children were ages 8 to 18 and had no congenital or acquired brain damage. They were matched for age and gender with 21 healthy controls. The executive function protocol included subtests from the Delis-Kaplan Executive Function System (D-KEFS), the digit span subtest from the Wechsler Intelligence Scale for Children (WISC-IV), the Tower of London-II-Drexel University (TOL-II), the Behavioral Rating Inventory of Executive Functioning (BRIEF), and the Conners’ Continuous Performance Test (CPT-II). Statistical analysis was performed using 2 statistical software packages, SAS and NCSS. Regression analysis was used to evaluate all variables. Due to significant group differences in socio-economic status (SES), SES was included as a covariate, along with IQ. No group differences in IQ were found. Significantly less robust executive function in children with SDB was identified in the domains of cognitive flexibility and impulsivity. Additionally, poorer executive planning and overall inattentiveness was also associated with SDB. Level of significance was set at 0.05 and trends (0.05 < p < 0.10) were acknowledged. Other areas of executive function, including working memory, behavioral and emotional inhibition, and processing speed were not associated with SDB. Moreover, academic functioning was significantly lower in children with SDB, although the differences can be shared equally with SDB, SES and IQ.
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Ross, Kristie R. "Sleep Disordered Breathing, Obesity, and Asthma Severity in Children." Case Western Reserve University School of Graduate Studies / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=case1291296902.
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Nahapetian, Ryan, Graciela E. Silva, Kimberly D. Vana, Sairam Parthasarathy, and Stuart F. Quan. "Weighted STOP-Bang and screening for sleep-disordered breathing." SPRINGER, 2015. http://hdl.handle.net/10150/623579.
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STOP-Bang is a tool for predicting the likelihood for sleep-disordered breathing (SDB). In the conventional score, all variables are dichotomous. Our aim was to identify whether modifying the STOP-Bang scoring tool by weighting the variables could improve test characteristics.
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Ward, Neil Robert. "Diagnosis of sleep-disordered breathing in chronic heart failure." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/9597.
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Sleep-disordered breathing (SDB) is prevalent but underdiagnosed in chronic heart failure (CHF). The aim of this thesis was to investigate the utility of simple portable monitoring and clinical features to identify CHF patients with SDB. In addition, the influence of scoring criteria on diagnosis and classification of SDB in CHF was investigated. In the first study, clinical characteristics in CHF patients with SDB were compared to those without SDB. No specific symptom, anthropometric characteristic or measure of heart failure severity was reliably able to identify CHF patients with SDB. In the second study, the accuracy of heart rate variability (HRV) analysis and overnight pulse oximetry for diagnosis of SDB in CHF were investigated. The percent very low frequency increment (%VLFI) of HRV had low accuracy for diagnosis of SDB. In contrast, the >3% oxygen desaturation index measured by pulse oximetry had a high diagnostic accuracy, with sensitivity 0.97 and negative likelihood ratio 0.08 at a prespecified cutoff of >7.5 desaturations per hour. In the third study, the impact of hypopnoea scoring criteria on SDB diagnosis in CHF was evaluated. The prevalence of SDB changed significantly from 29% when hypopnoeas were scored with a corroborative ≥4% oxygen desaturation, to 46% when hypopnoeas were scored with a corroborative ≥3% oxygen desaturation or arousal from sleep (p<0.001). Respiratory event scoring criteria did not influence the classification of SDB as obstructive or central sleep apnoea. In summary, this thesis has shown that clinical features and HRV analysis can not be used to identify CHF patients with SDB. Overnight pulse oximetry has a high diagnostic accuracy and would be of greatest clinical use to rule out SDB in patients with CHF. The criteria used to score respiratory events during sleep studies can have a significant impact on the diagnosis and prevalence of SDB in CHF.
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Theorell-Haglöw, Jenny. "Sleep and Sleep-disordered Breathing in Women : Associations with Daytime Symptoms and Metabolism." Doctoral thesis, Uppsala universitet, Lungmedicin och allergologi, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-99080.
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Obstructive sleep apnea (OSA) is characterized by snoring, apneas and excessive daytime sleepiness (EDS). Although commonly present in OSA, factors relating to daytime sleepiness are not fully elucidated. OSA is associated with obesity and with cardiovascular disease, type 2 diabetes mellitus and the metabolic syndrome. In this population-based study 7,051 women answered a questionnaire on sleep and health. Psychological distress, insomnia and somatic disease were the factors most strongly related to both EDS and fatigue independent of other factors. Snoring was independently associated with both EDS and fatigue, but the associations were relatively weak. In addition, 400 of the women underwent polysomnography and an oral glucose tolerance test. OSA was associated with changes in glucose metabolism independently of confounders such as central obesity. Moreover, low minimal saturation was independently associated with reduced insulin sensitivity. In women sleeping <6-7 hours there was a substantial increase in waist circumference and short sleep duration remained associated with central obesity, even after adjusting for body mass index (BMI). The most pronounced negative influence of short sleep duration and also reduced duration of slow-wave sleep (SWS) or rapid eye movement (REM) sleep was seen in women <50 years. All measures of OSA were related to the metabolic syndrome after adjustments. In addition, the relationship remained after adjusting for central or general obesity. Hypoxia was independently associated with hypertriglyceridemia, even after adjusting for BMI. In conclusion, OSA may have significant impact on insulin sensitivity and metabolism in women, and the relationship could, to some extent, be mediated through hypoxia. Moreover, reduced sleep duration and loss of SWS and REM sleep may influence central obesity; a strong risk factor for OSA. Daytime sleepiness was most strongly related to psychological distress, insomnia and somatic disease although snoring was also a risk factor. This finding indicates that sleep apnea is only one factor contributing to daytime sleepiness in women.
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Nau, Jeffrey A. "Association Between Age-Related Macular Degeneration and Sleep-Disordered Breathing." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3463.
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Age-related macular degeneration (AMD) is a chronic, irreversible disease that robs individuals of vision, quality of life, and independence. It is the leading cause of blindness in industrialized countries. Sleep-disordered breathing (SDB) is a condition characterized by repeated episodes of apnea and/or hypopnea, insomnia, short sleep duration, and/or sleep disturbances (snoring, gasping, etc.). Because SDB has been shown to cause chronic hypoxia resulting in oxidative stress on the retina, it has been proposed that SDB may be associated with AMD. Based on the life course theory of chronic disease, this quantitative, cross-sectional study used data from the 2005-2008 National Health and Nutrition Examination Survey to study whether there was an association between SDB and AMD, including neovascular AMD and geographic atrophy in adults 40 years and older. Descriptive statistics and logistic regression analyses were used. The results suggest that AMD is associated with diagnosed sleep disorders, including sleep apnea and insomnia, as well as sleep apnea symptoms of gasping snoring, snorting, and stopping breathing. The findings of this study highlight the importance of diagnostic screening and therapeutic intervention to treat SDB. Early diagnosis and therapy for SDB could address not only the comorbidities associated with SDB, but could also prevent or slow the progression of AMD. In turn, this would yield lower rates of vision loss, reduced comorbidities associated with vision loss, and reduced impact of AMD on the health care system and social and financial costs to society.
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Vazir, Ali. "Prevalence and characteristics of sleep disordered breathing in mild heart failure." Thesis, Imperial College London, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.437371.
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Brady, Emer Margaret. "Investigating the relationship between sleep disordered breathing, glycaemic control and inflammation." Thesis, University of Leicester, 2009. http://hdl.handle.net/2381/9926.
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Metabolic Syndrome (MetS), Type 2 Diabetes (T2DM) and obesity related sleep disorders like Sleep Disordered Breathing (SDB) share common features including visceral adiposity, impaired glycaemic control and increased cardiovascular disease (CVD) risk. As sub-clinical inflammation is considered a key player in these conditions they are thought to be interrelated. We aimed to further investigate this putative interrelationship. In a multi-ethnic population with a spectrum of glucose tolerance (sub-study of the ADDITION-study), we report that abdominal obesity underpins the association between SDB and systemic inflammation. South Asians with SDB had significantly higher levels of leptin, poorer glycaemic control but lower levels of oxidative stress than their Caucasian counterparts. These data suggest that the pathogenesis of SDB is different between these ethnic groups and may aid in understanding why South Asians are at increased risk of T2DM and CVD. Furthermore, SDB is independently associated with increased likelihood of MetS. However, no differences in cardiovascular markers, inflammatory biomarkers or anthropometric measures were observed between those with excessive daytime sleepiness or sleep disturbances as determined by the Epworth Sleepiness Scale and the Sleep Assessment Questionnaire, respectively. This suggests that these questionnaires are broad and insensive in identifying these sleep parameters. Obstructive Sleep Apnoea (OSA) is a severe form of SDB which can be successfully treated with Continuous Positive Airway Pressure (CPAP). Reported results on the effects of CPAP therapy on glycaemic control are inconsistent thus no difinative conclusion could be made from the systematic review carried out to answer this research question. Thus 'The Leicester Sleep and Sugar Study' was conducted to further establish whether CPAP-therapy impacts glycaemic control or systemic inflammation in subjects with established T2DM and newly diagnosed OSA. We report a clinically significant improvement in glycaemic control (HbA1c -0.8%) and a significant reduction in waist circumference with improved psychological well being 6 months post CPAP-therapy. It is evident that OSA is associated with T2DM and MetS although the direction of cause and effect has not been elucidated to date. The results reported here suggest that OSA negatively impacts on glycaemic control. Additionally we report a possible ethnic difference in the pathophysiology of SDB with inflammation playing a key role. Further research is required in this area to further establish these findings.
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Atalla, Angela. "Sleep disordered breathing in chronic heart failure : causes, consequences and treatment." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/11672.
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Chronic heart failure (HF) is a prevalent clinical syndrome in which both central and obstructive sleep disordered breathing (SDB) have been described. The aim of this research was to investigate the mechanisms causing central SDB, their consequences with reference to sleep and physical activity, and the way in which treatment modalities may modify these. The first study of this thesis is the SERVE-HF study, a randomised controlled trial of adaptive servoventilation (ASV) to treat central SDB in patients with CHF. This study is ongoing and aims to test the hypothesis that patients randomised to ASV will have a reduction in mortality compared to controls. Data regarding those randomised at the Royal Brompton Hospital are presented alongside data on ventilator compliance in the ASV group. The second study investigated ventilatory control, in HF patients both with and without SDB. It tested the hypothesis that those with central SDB had heightened chemosensitivity (assessed by the hypercapnic ventilatory response, HCVR) compared to those with no SDB and older healthy controls. The third study explored the effect of treatment on ventilatory control by testing the hypothesis that the implantation of a cardiac-resynchronisation therapy pacemaker would be associated with a reduction in the HCVR from baseline to 3 months post implantation. The fourth study investigated the consequences of SDB in CHF. Physical activity, subjective sleepiness and sleep were assessed in patients with CHF and older healthy controls to test the hypothesis that physical activity would be reduced in those with central SDB compared to those without SDB, and reduced in both patient groups compared to the controls. In summary, this thesis investigated the mechanisms underlying central SDB in patients with HF, to elucidate their consequences, both by day and night and to address the ways in which treatment modalities may modify these pathophysiological mechanisms. [For supplementary files please contact author].
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Kimura, Kaku. "Sleep-disordered breathing at an early stage of amyotrophic lateral sclerosis." Kyoto University, 1999. http://hdl.handle.net/2433/181697.
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Lazareck, Lisa. "Investigation of breathing-disordered sleep quantification using the oxygen saturation signal." Thesis, University of Oxford, 2008. https://ora.ox.ac.uk/objects/uuid:63671d89-e3a4-49e6-a486-3f605cacd1c1.
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This thesis investigates the feasibility of using the non-invasive biomedical signal of oxygen saturation, or SpO2 , to diagnose a sleep disorder known as Obstructive Sleep Apnoea Hypopnoea Syndrome (OSAHS). Epidemiologically, OSAHS is the most common condition investigated by sleep clinics. In a patient suspected of having the disorder, the upper airway is obstructed during sleep and a cessation in respiration results. An apnoea is defined as a temporary cessation of breathing. Similarly, a hypopnoea is defined as any reduction in breathing (i.e., less severe than an apnoea). The work has three main objectives; the first being to establish automated evaluation procedures for methods of quantifying apnoeic activity from the SpO2 signal, the second being to accurately identify apnoeic and normal activity on a minute-by-minute basis, the third being to create a Respiratory Disturbance Index (RDI) based on the analysis which is comparable to the gold-standard Apnoea Hypopnoea Index (AHI) derived by experts. The detection of apnoeic activity is determined using three separate analyses: time domain, frequency domain, and autoregressive modelling with an incorporated amplitude criterion. A training dataset is utilised for algorithm development, and an independent dataset is employed for testing . All three methods result in comparable overall classification accuracies of: 81.2% (time domain), 82.1% (frequency domain), and 80.0% (autoregressive modelling with amplitude). In addition, particular attention is given to the resultant sensitivity, specificity, and accuracy values partitioned according to patient category; i.e., patients with OSAHS may be divided into normal, mild, moderate and severe. Lastly, a simple RDI is computed based on the automated analyses; i.e., the number of apnoeic segments detected divided by the total number of segments used. A comparison between computed RDI and AHI values for the test database show correlation values above 0.8. In conclusion, this thesis shows that through the automated analysis of the SpO2 signal, OSAHS severity in patients suspected of having the disorder can be quantified. The AR-modelling with an incorporated amplitude criterion, in particular, shows the most promise for further work in this area.
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Harbison, Joseph Augustine. "The course, associations and clinical significance of sleep disordered breathing following stroke." Thesis, University of Newcastle upon Tyne, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.270779.
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Mahadevan, Anandi. "Ischemic Feature Identification and Its Relation to Sleep Disordered Breathing in Sleep Heart Health Study Subjects." University of Akron / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=akron1384984982.
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Cohen, Jeffrey M. "Sleep Disordered Breathing and Sleep Duration and the Risk of Psoriasis and Melanoma in the United States." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:15821589.
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Sleep disordered breathing (snoring and obstructive sleep apnea (OSA)) has been associated with negative health outcomes including diabetes mellitus, cardiovascular disease, and reduced quality of life, presumably due to systemic inflammation. Long and short sleep duration have been associated with morbidity, all-cause mortality, and cancer-specific mortality. No large prospective studies exist to explore the relationship between sleep disordered breathing and sleep duration and psoriasis and melanoma risk.
This study prospectively evaluated the association between OSA and snoring and incident psoriasis in the Nurses’ Health Study (NHS; 1997-2008) and the association between sleep duration and melanoma risk in the NHS (1986-2012), NHS II (2001-2009), and Health Professionals Follow-Up Study (HPFS; 2000-2012). Cox proportional hazards were used to calculate age-adjusted and multivariate risk ratios.
Over the follow-up period, there were 524 cases of psoriasis among the women who were assessed for sleep apnea. Women with OSA were more likely to have a higher BMI, be hypertensive, work night shifts, and have type 2 diabetes mellitus. The age-adjusted relative risk (RR) of psoriasis among women with OSA was 2.19 (95% CI, 1.39-3.45). The multivariate RR adjusting for night shift work and hypertension, cardiovascular disease, and type 2 diabetes mellitus was 1.91 (95% CI, 1.20-3.05). There was no effect modification by BMI (p=0.52), hypertension (p=0.34), or snoring (p=0.91). Sleep apnea was not associated with an increased risk of psoriatic arthritis. Although women with sleep apnea were more likely to be snorers, we did not find a statistically significant relationship between snoring and psoriasis risk.
In the three cohorts, there was no relationship between sleep duration and melanoma risk. The multivariate RRs were 0.90 (95% CI, 0.67-1.20) for ≤6 hours, 1.30 (95% CI, 1.08-1.56) for 8 hours, and 0.76 (95% CI, 0.51-1.12) for ≥9 hours (p trend=0.09) in the NHS and NHS II and 1.08 (95% CI, 0.77-1.51) for ≤6 hours, 0.95 (95% CI, 0.69-1.30) for 8 hours, and 1.06 (95% CI, 0.68-1.67) for ≥9 hours (p trend=0.71) in the HPFS. In the NHS, there was no association between OSA and melanoma risk (RR 1.04 (95% CI, 0.42-2.55)) and there was also no association between snoring status and melanoma risk in the three cohorts.
In this prospective study, we found that OSA was associated with an approximately two-fold increased risk of psoriasis among US women and we found no association between sleep duration, sleep apnea, or snoring and melanoma risk among US women and men.
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Takegami, Misa. "Simple four-variable screening tool for identification of patients with sleep-disordered breathing." 京都大学 (Kyoto University), 2009. http://hdl.handle.net/2433/126592.
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Kyoto University (京都大学)0048
新制・課程博士
博士(社会健康医学)
甲第15000号
社医博第27号
新制||社医||6(附属図書館)
27450
UT51-2009-R724
京都大学大学院医学研究科社会健康医学系専攻
(主査)教授 今中 雄一, 教授 川上 浩司, 教授 三嶋 理晃
学位規則第4条第1項該当
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Felix, Moscoso Monica, Galvan Jack Denegri, Loayza Fernando Ortega, and Adrian V. Hernandez. "Respiratory Therapy in Chronic Heart Failure Patients Complicated With Sleep-Disordered Breathing: Potential Study Bias." Journal of the Japanese Circulation Society, 2016. http://hdl.handle.net/10757/611825.
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MacLeod, Kendra Deanne. "Evaluating Adherence to Continuous Positive Airway Pressure Therapy in Children with Sleep-Disordered Breathing." University of Cincinnati / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1235768185.
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Mulvaney, Shelagh. "Behavioral and cognitive correlates of sleep-disordered breathing in a community sample of school children." Diss., The University of Arizona, 2002. http://hdl.handle.net/10150/280100.
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Sleep disordered breathing has been related to problems with memory, attention, executive function and mood disturbance in adults. Similar cognitive as well as behavioral deficits have been hypothesized as daytime consequences of SDB in children. The cognitive and behavioral manifestation of SDB in children may appear similar to ADHD with decrements in attention and increased behavioral impulsivity and hyperactivity. SDB is ideally measured using some combination of reduced airflow, hypoxemia, and sleep fragmentation from overnight polysomnography, although some researchers have used parent report to create research samples. Currently, few pediatric studies exist that examine behavior and cognition in the presence of overnight polysomnographic data. The present study was derived from the Tucson Children's Assessment of Sleep Apnea (TuCASA) which was broadly designed to determine the prevalence of SDB and it's correlates in normal school children ages 6-12. The present analyses were designed to relate SDB as a whole as well as its components to sustained attention and behavior in that population. In addition, the relationship between sleepiness and hyperactivity was examined, as these are two seemingly incongruent manifestations of SDB. Measures of attention and behavior included the Test of Everyday Attention for Children (TEACh), the PVT-192, and the Conners' Parent Rating Scales-Revised. Results indicated that for children with elevated respiratory disturbance indexes (RDI), problems of attention and behavior did not reach clinically relevant levels. However, children were much more likely to show significantly higher levels of a variety of behavioral problems given an elevated RDI. In general linear models, the interaction of two components of SDB predicted performance on two measures of sustained attention, and predicted parent rated levels of Psychosomatic Complaints and Perfectionism. Sleepiness and hyperactivity were not related to each other. Behavioral manifestations of SDB tended to vary with age. Older children showed increased behavior problems at the highest levels of SDB while younger children showed decreased behavior problems. Overall, these results indicate that even in healthy children variation in sleep related breathing may be related to daytime cognition function and behavioral regulation.
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SUKEGAWA, MAYO, AKIKO NODA, TARO SOGA, YUKI ADACHI, YOSHINARI TSURUTA, NORIO OZAKI, YASUO KOIKE, and 真代 助川. "COMPARISON OF SLEEP-DISORDERED BREATHING AND HEART RATE VARIABILITY BETWEEN HEMODIALYSIS AND NON-HEMODIALYSIS DAYS IN HEMODIALYSIS PATIENTS." Nagoya University School of Medicine, 2008. http://hdl.handle.net/2237/10544.
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Goodwin, III James Lester. "The natural history of sleep disordered breathing in 6-11 year old Caucasian and Hispanic children." Diss., The University of Arizona, 2002. http://hdl.handle.net/10150/280181.
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Sleep disordered-breathing (SDB) including obstructive sleep apnea syndrome (OSAS) is increasingly recognized as an important cause of morbidity in children. Clinical symptoms of OSAS in children include snoring, nocturnal arousals, restlessness during sleep, enuresis, daytime sleepiness and hyperactivity. Evidence also suggests that the adverse effects of SDB include behavioral, learning, and personality problems. No large epidemiological study using polysomnography has been conducted to determine the prevalence and correlates of SDB in young children. The Tucson Children's Assessment of Sleep Apnea study (TuCASA) is a prospective cohort study designed to determine the prevalence of objectively documented SDB in pre-adolescent children and to investigate its relationship to symptoms, performance on neurobehavioral measures, and physiologic and anatomic risk factors. Hispanic and Caucasian children were recruited to participate in TuCASA by soliciting the cooperation of elementary schools in the Tucson Unified School District (TUSD). Through the use of a screening survey completed by parents, the TuCASA study has shown that children between 4-11 years of age with learning problems (LP) are more likely to have habitual snoring (SN) and excessive daytime sleepiness (EDS). Additionally, Hispanic children in this age group are more likely to have parental report of EDS, witnessed apnea (WA), and SN. Similar to studies in adults, girls 4-11 years of age are more likely to have parental report of daytime sleepiness than boys. Furthermore, the TuCASA study has demonstrated the feasibility of collecting high quality unattended multi-channel polysomnography in children ages 5 to 12 years. More importantly, the TuCASA study has documented the relationships between respiratory disturbance indices based on polysomnography and parental report of clinical symptoms of SDB in children ages 6-11. There are threshold values of respiratory disturbance index (RDI) associated with an increase in the prevalence of clinical symptoms of SDB. Until now, data linking objective indices of RDI severity to the presence of clinical symptoms have been lacking. Additionally, these findings contribute much needed information for determining clinically significant levels of RDI based on differing definitions of respiratory events. Therefore, these results represent an important step towards examining the natural history of SDB and the relationship between SDB severity and specific clinical outcomes in pre-adolescent children.
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Badgley, Jennifer Ayala Chute Douglas L. "Sleep-disordered breathing in children and adolescents with Systemic Lupus Erythematosus and its association with executive functioning /." Philadelphia, Pa. : Drexel University, 2008. http://hdl.handle.net/1860/2802.
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Mietchen, Jonathan James. "Parent-Reported Deficits in Executive Function and Sleep-Disordered Breathing in Adolescent Behavioral Weight Loss Program Participants." BYU ScholarsArchive, 2016. https://scholarsarchive.byu.edu/etd/6386.
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Children and adolescents with obesity and overweight are at increased risk for developing sleep disordered breathing (SDB) and SDB has been associated with cognitive deficits and executive dysfunction. The aim of this study was to examine the relationship between executive functioning and SDB among adolescents participating in a behavioral weight loss intervention. Adolescents (n = 37) and their caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) and caregivers completed the Pediatric Sleep Questionnaire (PSQ). Using the Sleep Related Breathing Disorder scale on the PSQ adolescents were classified as at risk or not at risk for SDB. Correlations were calculated to evaluate associations between executive function and SDB. MANOVA analyses were also conducted to determine whether significant differences in executive function exist between adolescents at risk for SDB, and those not at risk. Significant correlations were found between SDB and executive functioning (r = 0.75; < .001). Significant differences were observed between SDB risk and non-SDB risk groups on the BRIEF parent report (F (1, 35) = 3.73; < 0.01). Differences in parent-report BRIEF scores across risk groups represent a large effect (d = 1.73). However, these differences were not replicated on the BRIEF self-report (F (1, 35) = 1.24; p < 0.05). Adolescents with overweight or obesity participating in behavioral weight loss interventions may be at increased risk for SDB and those adolescents at risk for SDB may have executive dysfunction. These deficits may have implications for treatment.
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Muscat, Vanessa. "Improving the diagnosis of obstructive sleep disordered breathing in infants by incorporating esophageal manometry into conventional polysomnography." Title page and summary only, 1999. http://web4.library.adelaide.edu.au/theses/09SB/09sbm985.pdf.
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Thesis (B. Sc.(Hons.))--University of Adelaide, Dept. of Physiology, 2000?Spine title: Diagnosing obstructive sleep disordered breathing in infants. Includes bibliographical references (leaves 32-35).
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Minami, Takuma. "Impact of sleep-disordered breathing on glucose metabolism among individuals with a family history of diabetes: the Nagahama study." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/263558.
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Harada, Yuka. "Differences in Associations between Visceral Fat Accumulation and Obstructive Sleep Apnea by Sex." Kyoto University, 2014. http://hdl.handle.net/2433/189343.
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Hernandez, A. V., Adrian V. Hernandez, Anne Jeon, Jack Denegri-Galvan, Fernando Ortega-Loayza, Monica Felix-Moscoso, Vinay Pasupuleti, and Roop Kaw. "Use of adaptive servo ventilation therapy as treatment of sleep-disordered breathing and heart failure: a systematic review and meta-analysis." Springer, 2020. http://hdl.handle.net/10757/651733.
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Purpose: Adaptive servoventilation (ASV) has been reported to show improvement in patients with sleep-disordered breathing (SDB) and heart failure (HF); however, its role as a second-line or adjunctive treatment is not clear. We conducted a systematic review and meta-analysis of new existing data including cardiac mechanistic factor, geometry, and cardiac biomarkers. Methods: We systematically searched for randomized controlled trials (RCTs) and cohort studies that assessed the efficacy or effectiveness of ASV compared to conventional treatments for SDB and HF in five research databases from their inception to November 2018. Random-effects meta-analyses using the inverse variance method and stratified by study design were performed. Results: We included 15 RCTs (n = 859) and 5 cohorts (n = 162) that met our inclusion criteria. ASV significantly improved left ventricular ejection fraction (LVEF) in cohorts (MD 6.96%, 95% CI 2.58, 11.34, p = 0.002), but not in RCTs. Also, the ASV group had significantly lower apnea-hypopnea index (AHI) in both cohorts (MD − 26.02, 95% CI − 36.94, − 15.10, p < 0.00001) and RCTs (MD − 21.83, 95% CI − 28.17, − 15.49, p < 0.00001). ASV did not significantly decrease the E/e′ ratio in RCTs or in cohorts. Finally, ASV significantly decreased brain natriuretic peptide (BNP) in the cohorts (SMD − 121.99, CI 95% − 186.47, − 57.51, p = 0.0002) but not in RCTs. ASV did not have a significant effect on systolic blood pressure, diastolic blood pressure, and cardiac diameters. Conclusions: ASV therapy is associated with improvements of AHI in comparison to alternative treatments in patients with SDB and HF. ASV did not improve LVEF or E/e′ ratios in randomized trials; other intermediate outcomes did not improve significantly.Revisión por pares
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Spörndly-Nees, Søren. "Physical activity and eating behaviour in sleep disorders." Doctoral thesis, Uppsala universitet, Sjukgymnastik, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-308395.
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Sleep-disordered breathing and insomnia are common sleep disorders and associated with an increased risk of morbidity. The aim of this thesis was to study the contribution of a behavioural sleep medicine perspective on sleep-disordered breathing and insomnia. More specific, factors considered important for changing eating behaviour and the impact of physical activity were studied. Methods: In study I, semi-structured interviews of participants with obstructive sleep apnoea and obesity (n = 15) were analysed using a qualitative content analysis. A population-based female cohort was followed prospectively over ten years in study II and III using a postal questionnaire on two occasions (n = 4,851 and n = 5062, respectively). In study IV, a series of five experimental single-case studies was conducted testing how an aerobic exercise intervention affected selected typical snores, following an A1B1A2B2A3 design over nine days and nights (n = 5). Results: Facilitators and barriers towards eating behaviour change were identified. A low level of self-reported leisure-time physical activity was a risk factor among women for future habitual snoring complaints, independent of weight, weight gain alcohol dependence or smoking. Maintaining higher levels or increasing levels of leisure-time physical activity over the ten-year period partly protected from snoring complaints (study II). Further, a low level of self-reported leisure-time physical activity is a risk factor for future insomnia among women. Maintaining higher levels or increasing levels of leisure-time physical activity over the ten-year period partly protect against self-reported insomnia, independent of psychological distress, age, change in body mass index, smoking, alcohol dependence, snoring status or level of education (study III). Single bouts of aerobic exercise did not produce an acute effect on snoring the following nights in the studied individuals. A pronounced night-to-night variation in snoring was identified (study IV). Conclusion: Women with sleep disorders would benefit from a behavioural sleep medicine perspective targeting their physical activity in the prevention and management of snoring and insomnia. This is motivated by the protective effects of physical activity confirmed by this thesis. Knowledge was added about facilitators and barriers for future eating behaviour change interventions.
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Tideström, Löfstrand Britta. "Sleep Disordered Breathing and Orofacial Morphology in Relation to Adenotonsillar Surgery : Development from 4-12 Years in a Community Based Cohort." Doctoral thesis, Uppsala universitet, Institutionen för kirurgiska vetenskaper, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-108031.
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Objective: To follow a cohort of children from age 4-6-12 with respect to sleep disordered breathing (SDB) and orofacial development. Questionnaires were completed about sleep, snoring, apneas, enuresis, sucking habits, and adenotonsillar surgery and, from age 12, about allergies, asthma, and general health. Children snoring regularly had an ENT- examinations including sleep studies (at ages 4 and 12) and an orthodontic evaluation. Development of biometric data in snoring children and not snoring controls was studied in relation to adenotonsillar surgery. Result: Of the original group of 615 children, 509 (83%) participated at age 6 and 393 (64%) at age 12. 27 snored regularly and 231 did not snore at age 12. Differences between groups were seen on all answers. From age 4–12 the prevalence of OSA decreased from 3.1% to 0.8%, and the minimum prevalence of snoring regularly from 5.3% to 4.2%. The odds for a child who snored regularly at four or six to be snoring regularly at age 12 was 3.7 times greater than for a not snoring child in spite of surgery (OR 3.7, 95% CI 2.4-5.7). 63 children were operated for snoring by age 12, of them 14 never snored and 17 snored regularly at age 12. Cross-bite was more common among snoring children at ages 4, 6 and 12 as was a narrower maxilla. In most cases, surgery cured the snoring temporarily, but the maxillar width was still smaller by age 12—even when nasal breathing was attained. Children snoring regularly at age 12, operated or not operated, showed long face anatomy and were oral breathers; the seven cases who were not operated and the five who were still snoring in spite of surgery, did not have reduced maxillary arch width. Conclusion: The prevalence of children snoring regularly is about the same from age four to twelve in a cohort where adenotonsillar surgery has been performed on obstructed cases, but the prevalence of OSA decreases considerably. The children snoring regularly have a more narrow maxilla compared to children not snoring—a condition that is not changed by adenotonsillar surgery regardless of symptom relief.
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Tideström, Löfstrand Britta. "Sleep disordered breathing and orofacial morphology in relation to adenotonsillar surgery development from 4-12 Years in a community based cohort /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-108031.
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Krenn, Marion [Verfasser], Michael [Akademischer Betreuer] Arzt, and Thomas [Akademischer Betreuer] Kühnel. "Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study / Marion Krenn. Betreuer: Michael Arzt ; Thomas Kühnel." Regensburg : Universitätsbibliothek Regensburg, 2011. http://d-nb.info/1048725677/34.
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Johansson, Peter. "Health‐related quality of life, depression, sleep and breathing disorders in the elderly : With focus on those with impaired systolic function/heart failure." Doctoral thesis, Linköpings universitet, Kardiologi, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-15784.
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The overall aim of this thesis was to describe the prevalence of depressive symptoms, sleep disordered breathing (SDB) and sleep complaints, as well as to investigate the prognostic value of health-related quality of life (Hr-QoL) and depressive symptoms on mortality in an elderly community living population with a focus on those with impaired systolic function/heart failure (HF). Descriptive, prognostic and explorative study designs were used to examine if a single question about global perceived health (GPH) is associated with the domains of Hr-QoL as assessed by the SF-36 (I), as well as to evaluate whether GPH provided prognostic information concerning cardiovascular mortality (II). The aim was also to evaluate if depressive symptoms are associated with mortality (III), and to describe the prevalence of SDB and its relationship to impaired systolic function, different insomnia symptoms, as well as excessive daytime sleepiness (IV). In primary care elderly patients with HF, GPH correlated to the physical and mental aspects of Hr-QoL. Patients who rated poor GPH also scored worse physical and mental Hr-QoL compared to patients with good GPH, but the mental aspect of Hr-QoL was however not significant (p<0.07) (I). Moreover, GPH also had an independent association with cardiovascular mortality during a ten-year follow-up. Compared to patients with good GPH, those who scored poor GPH had a four times increased risk for cardiovascular mortality (II). A total of 24% of the patients with HF suffered from depressive symptoms, not significantly different compared to 19% among those without HF. Depressive symptoms were a poor prognostic sign during the six-year follow-up and HF patients with depressive symptoms had the highest risk for cardiovascular mortality compared to HF patients without depressive symptoms (III). SDB is common among elderly people living in the community, almost one quarter (23%) had moderate or severe SDB. However, people with moderate impaired systolic function had a median apnea hypopnea index that was more than twice as high compared to those with normal systolic function (10.9 vs. 5.0, p<0.001). No obvious associations between SDB and excessive daytime sleepiness or the insomnia symptoms; difficulties maintaining sleep; non-restorative sleep; or early morning awakenings were detected. Difficulties initiating sleep were however more common in those with moderate or severe SDB (IV). GPH can be used as a simple tool in clinical routine practice as an aid in identifying patients in need of additional management. SDB is a common phenomenon among elderly people and associated with impaired systolic function, but with a limited impact on subjective sleep complaints. Depressive symptoms were shown to be a poor prognostic sign and may amplify the patient’s experience of suffering. Screening for depressive symptoms could therefore be an important action in the management of patients with HF.
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Hill, Elizabeth Anne. "Prevalence and treatment of obstructive sleep apnoea/hypopnoea syndrome in adults with Down syndrome." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/22917.
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Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is characterised by repeated cycles of upper airway obstruction during sleep, leading to diurnal symptoms. Individuals with Down syndrome (DS) are predisposed to this as the DS phenotype overlaps with OSAHS risk factors. Around 2-4% of the general adult population and 55% of children with DS have OSAHS but, to date, no large-scale study has assessed OSAHS prevalence or efficacy of treatment in DS adults. This study aimed to: 1) Systematically assess subjective and objective OSAHS prevalence; 2) Assess the effectiveness of continuous positive airway pressure (CPAP) in an adult DS population. Standard questionnaires including pictorial Epworth Sleepiness Scale (pESS) and Developmental Behaviour Checklist for Adults (DBC-A) were sent to UK adults aged ≥16yr with DS and their caregivers. All questionnaire responders were invited to undergo home polygraphy. Symptomatic adults with DS with ≥10 apnoeas/hypopnoeas per hour in bed (AH) on home polygraphy were invited to participate in a prospective randomised controlled trial (RCT) of CPAP v. lifestyle advice, with review at 1, 3, 6 and 12m. Participants in the lifestyle arm were offered CPAP at 1m. Standard measurements of sleepiness, behaviour, cognitive function and general health were undertaken. Standard statistical analyses were conducted, with significance set at p < 0.001 to control for multiple testing. Of 5270 questionnaires sent, 1105 responses were valid (21%). Responders (55% males) were overweight/obese young adults: mean BMI 29.0±6.8kg/m2; mean age 28±9 years. Women had a higher BMI (p < 0.0001), but collar size was greater in men (p < 0.0001). Mean pESS scores were broadly within the normal range (7±5/24). No significant gender differences in OSAHS symptoms were noted. Individuals with probable OSAHS had higher pESS and DBC-A scores, and significantly more symptoms of OSAHS. Subjective OSAHS prevalence was estimated at 35%. Of the 790 individuals invited, 149 underwent polygraphy, with 134 valid studies obtained: mean AH 21.8(10.9-42.7); mean oximetry desaturation index (ODI) 6.6(2.3-20.0). No significant gender differences were observed. Forty-two percent of participants met standard clinical diagnostic criteria for OSAHS. Twenty-eight eligible adults with DS (19 male) were randomised: age 28±9yr; BMI 31.5±7.9kg/m2; AH 28.6(14.8-47.9); ODI 7.3(1.8-21.9); pESS 11±6/24. Groups did not differ significantly at baseline. By 12m, 4 participants had withdrawn (all remaining participants on CPAP). The pESS (p=0.001), DBC-A Disruptive (p < 0.0001) and Kaufmann Brief Intelligence Test verbal subscale (p=0.001) scores improved significantly. This first large study of OSAHS prevalence in the adult DS population estimates a prevalence of 35-42% - around 10 times higher than in the general adult population. Sustained, significant improvements in sleepiness, cognitive function and behavioural/emotional outcomes with CPAP use over a 12m period were demonstrated during this first RCT of CPAP in adults with DS. A larger trial of CPAP in this population is warranted.
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John, Angela Beatriz. "Determinação de padrões ventilatórios e avaliação de estratégias de rastreamento de transtornos respiratórios durante o sono em pacientes candidatos à cirurgia bariátrica." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/139775.
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Introdução: A obesidade é um problema de saúde pública em crescimento, sendo o principal fator de risco para os transtornos respiratórios durante o sono (TRS), como a apneia obstrutiva do sono (AOS) e a hipoventilação noturna. A cirurgia bariátrica se consolidou como possibilidade terapêutica para a obesidade significativa. A identificação precoce dos TRS na fase pré-operatória é essencial, pois acarretam um risco aumentado de complicações perioperatórias. Diversas propostas de triagem dos TRS com abordagens mais simplificadas em relação à polissonografia (PSG) têm surgido na literatura nos últimos anos, nem todas avaliadas em uma população de pacientes obesos. Objetivo: Determinar os padrões ventilatórios em obesos candidatos à cirurgia bariátrica e avaliar três estratégias de rastreamento de TRS nessa população. Métodos: Os critérios de inclusão foram pacientes com idade ≥18 anos com obesidade graus III [índice de massa corporal (IMC) ≥40 kg/m2] ou II (IMC ≥35 kg/m2) com comorbidades relacionadas à obesidade encaminhados para avaliação para cirurgia bariátrica. Foram excluídos pacientes com cardiopatia e/ou pneumopatia graves ou descompensadas. Foram avaliados 91 pacientes através de três estratégias: (1) Clínica [Escala de Sonolência de Epworth e questionários STOP-Bang, Berlim e Sleep Apnea Clinical Score (SACS), acrescidos de gasometria arterial (GA)]; (2) Oximetria (holter de oximetria durante o sono e GA) e (3) Portátil [monitorização portátil (MP) durante o sono e capnografia)]. Todos os testes realizados foram comparados com o teste padrão, a PSG, para o diagnóstico de AOS. Resultados: A amostra estudada foi composta por 77 mulheres (84,6%) com média de idade de 44,7 ± 11,5 anos e de IMC de 50,1 ± 8,2 kg/m2. Os padrões ventilatórios identificados foram ronco, hipoxemia isolada durante o sono, AOS e hipoventilação noturna em associação com AOS. Os dados polissonográficos evidenciaram AOS em 67 de 87 pacientes (77%), sendo 26 com transtorno leve, 19 moderado e 22 grave. Vinte pacientes (23%) tiveram diagnóstico de ronco e dois deles também apresentaram hipoxemia isolada durante o sono sem AOS ou hipoventilação concomitantes. Hipoventilação noturna associada com AOS foi identificada por capnografia em um paciente. Na Estratégia Clínica, o melhor resultado alcançado foi com o escore STOP-Bang ≥6 em pacientes com índice de apneia hipopneia (IAH) ≥30 (acurácia total de 82,8%). Na Estratégia Oximetria, os pontos de corte com maior sensibilidade e especificidade para IAH ≥5, ≥10, ≥15 e ≥30 foram tempo total de registro com saturação periférica de oxigênio (SpO2) <90% por, pelo menos, 5 minutos; índice de dessaturação (ID)3% ≥22 dessaturações/hora de registro e ID4% ≥10 e ≥15 dessaturações/hora de registro. Todas as áreas sobre a curva (ASC) situaram-se acima de 0,850. Para um IAH ≥5, o ID4% ≥10 apresentou sensibilidade de 97%, especificidade de 73,7%, valor preditivo positivo de 92,8% e negativo de 87,5% e acurácia total de 91,8%. Na Estratégia Portátil, o índice de distúrbios respiratórios (IDR) foi um bom preditor de AOS nos variados pontos de corte de IAH (ASC de 0,952 a 0,995). As melhores sensibilidades e especificidades foram alcançadas em pontos de corte semelhantes de IDR e IAH, especialmente nos extratos de IAH ≥10 e ≥30. A acurácia total máxima foi de 93,9% para IDR ≥5, ≥10 e ≥30 nos seus correspondentes IAH. Baseados nesses resultados, foram testadas estratégias combinadas compostas pelo questionário STOP-Bang ≥6 com ID4% ≥10 ou ≥15. O melhor equilíbrio entre sensibilidade e especificidade e a maior acurácia foram obtidos com a estratégia STOP-Bang ≥6 com ID4% ≥15 em AOS grave. Conclusões: A frequência de ocorrência de TRS nos obesos em avaliação para cirurgia bariátrica foi alta, sendo a AOS o transtorno mais encontrado. Os questionários disponíveis até o momento, isoladamente, parecem ser insuficientes para o rastreamento de AOS nessa população, à exceção do STOP-Bang ≥6 em pacientes com AOS grave. O uso de uma medida fisiológica objetiva expressa pelo holter de oximetria foi útil para rastrear AOS em pacientes obesos. A MP apresentou acurácia aumentada, especialmente nos extremos de valores de IAH, com resultados comparáveis aos da PSG. A PSG poderia ser reservada apenas para confirmação diagnóstica em casos selecionados.Introduction: Obesity is a growing public health problem and the main risk factor for sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) and nocturnal hypoventilation. Bariatric surgery has become an option for the treatment of significant obesity. Early detection of SDB preoperatively is essential, since these disorders are associated with an increased risk of perioperative complications. Several screening tools for SDB, with a more simplified approach than polysomnography (PSG), have been proposed in recent years, but not all of them have been evaluated in a population of obese patients. Objective: To determine ventilatory patterns in obese candidates for bariatric surgery and evaluate three SDB screening strategies in this population. Methods: Eligible participants were all patients aged ≥18 years with grade III (body mass index [BMI] ≥ 40kg/m2) or grade II (BMI ≥35 kg/m2) obesity and obesity-related comorbidities who were referred for evaluation for bariatric surgery. Exclusion criteria were heart disease and/or severe or decompensated pulmonary disease. Ninety-one patients were evaluated by three strategies: (1) Clinical (Epworth Sleepiness Scale and STOP-Bang questionnaire, Berlin questionnaire and Sleep Apnea Clinical Score [SACS] plus blood gas analysis [BGA]); (2) Oximetry (overnight Holter-oximeter monitoring and BGA); and (3) Portable (overnight portable monitoring and capnography). All tests were compared with the gold standard, PSG, for the diagnosis of OSA. Results: The sample consisted of 77 women (84.6%) with a mean (SD) age of 44.7 (11.5) years and BMI of 50.1 (8.2) kg/m2. The ventilatory patterns identified were snoring, isolated nocturnal hypoxemia, OSA, and nocturnal hypoventilation associated with OSA. Polysomnographic data showed OSA in 67 of 87 patients (77%), 26 with mild, 19 with moderate and 22 with severe disorder. Twenty patients (23%) had a diagnosis of snoring, and two of them also had isolated nocturnal hypoxemia without concomitant OSA or hypoventilation. Nocturnal hypoventilation associated with OSA was detected by capnography in one patient. In the Clinical Strategy, the best result was obtained with the STOP-Bang score ≥6 in patients with an apnea-hypopnea index (AHI) ≥30 (overall accuracy of 82.8%). In the Oximetry Strategy, the cutoff values with the highest sensitivity and specificity for AHI ≥5, ≥10, ≥15, and ≥30 were total recording time with peripheral oxygen saturation (SpO2)< 90% for at least 5 minutes, 3% oxygen desaturation index (ODI) ≥22 desaturations/hour of recording, and 4%ODI ≥10 and ≥15 desaturations/hour of recording. All areas under the curve (AUC) were above 0.850. For AHI ≥5, 4%ODI ≥10 had a sensitivity of 97%, specificity of 73.7%, positive predictive value of 92.8%, negative predictive value of 87.5%, and overall accuracy of 91.8%. In the Portable Strategy, the respiratory disturbance index (RDI) was a good predictor of OSA in various cutoff values of AHI (AUC of 0.952 to 0.995). The highest sensitivity and specificity were obtained at similar cutoff values for RDI and AHI, especially for AHI ≥10 and ≥30. The maximum overall accuracy was 93.9% for RDI ≥5, ≥10, and ≥30 in their corresponding AHI. Based on these results, combined strategies were tested consisting of the STOP-Bang score ≥6 combined with 4%ODI ≥10 or ≥15. The best balance between sensibility and specificity and the maximum accuracy were achieved with the strategy composed by STOP-Bang ≥6 and 4%ODI ≥15 in patients with severe OSA. Conclusions: The frequency of occurrence of SDB in obese individuals undergoing evaluation for bariatric surgery was high, and OSA was the most frequent occurrence. Currently available questionnaires were insufficient to screen for OSA in this population, with the exception for the STOP-Bang score ≥6 in patients with severe OSA. The use of an objective physiological measure, such as Holter-oximetry monitoring, was useful as a screening tool for OSA in obese patients. Portable monitoring showed increased accuracy, especially in extreme AHI values, with results comparable to those obtained with PSG. The PSG could be reserved only for certain cases where diagnostic confirmation is necessary.
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Koike, Yasuo, Seiichi Nakata, 聖子 宮田, Seiko Miyata, Akiko Noda, Hidehito Yagi, Eriko Yanagi, et al. "Daytime polysomnography and portable recording device for diagnosis and CPAP therapy in patients with obstructive sleep apnea syndrome." Thesis, Springer Berlin, 2007. http://hdl.handle.net/2237/11067.
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名古屋大学博士学位論文 学位の種類:博士（医療技術学）（課程） 学位授与年月日:平成19年3月23日"Daytime polysomnography and portable recording device for diagnosis and CPAP therapy in patients with obstructive sleep apnea syndrome" Sleep and Breathing, v.11, n.2 (2007) pp.109-115 を、博士論文として提出したもの。
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Zhu, Kaixian. "Évaluation sur banc d'essai des algorithmes des machines ventilatoires." Thesis, Université Paris-Saclay (ComUE), 2016. http://www.theses.fr/2016SACLS021/document.
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Les troubles respiratoires du sommeil, notamment le syndrome d’apnée du sommeil, représentent un problème de santé publique. Ils contribuent aux symptômes diurnes comme la somnolence sévère et sont associés à des maladies chroniques.Depuis quelques années, une variété d’appareils de traitement ventilatoire a été développée pour traiter les troubles respiratoires du sommeil, principalement les maladies liées à l’obstruction de la voie aérienne supérieure (apnée obstructive) ou à la commande centrale (apnée centrale). Ces appareils fonctionnent suivant des principes différents, en raison de leurs propres algorithmes, qui sont souvent mal connus et protégés par les fabricants. Les évaluations des appareils de ventilation sont effectuées pendant les traitements cliniques chez des patients. Il est donc difficile de comparer ces différents appareils dans les mêmes conditions à cause des variabilités inter- et intra-patient. Un banc d’essai pourrait permettre de tester les réponses des appareils dans les conditions standardisées et reproductibles.Cette thèse a consisté à construire un banc d’essai qui permet de reproduire les signaux de patients et de respecter de la physiologie humaine. La réaction du banc d’essai prend aussi en compte la réaction de l’appareil à tester sur le système, i.e., ce modèle fonctionne en « boucle fermée ». Avec le banc d’essai construit, les différentes machines de pression positive continue (PPC) autopilotée disponibles sur le marché ont été évaluées pour leurs algorithmes ainsi pour leurs modes confort. De plus, trois machines de ventilation auto-asservie (ASV) ont été soumises aux différents événements respiratoires du sommeil créés par un autre modèle d’un principe similaire. Nous avons montré que les machines de PPC autopilotée ne sont pas équivalentes pour l’efficacité du traitement et la précision des données du rapport. Les modes confort pourraient éventuellement dégrader l’efficacité du traitement de PPC si la pression thérapeutique n’est pas ajustée lors de leur introduction au traitement. Pour les machines ASV, leurs réponses ne sont pas suffisantes pour normaliser la respiration et les réglages des machines peuvent influencer l’efficacité du traitement. Les résultats pourraient compléter les données cliniques et fournir une option complémentaire pour le processus futur de certification de ces dispositifs médicauxSleep disordered breathing including sleep apnea is a major public health problem. It contributes to daytime sleepiness and is associated with chronic diseases. In recent years, a variety of ventilation devices have been developed with the objective of treating sleep disorders related to the upper airway obstruction (obstructive apnea) or the central command (central apnea). These devices operate with different algorithms, which are little known and protected by the device manufacturers. Since most devices are evaluated during patient treatment, it is difficult to compare them in the same conditions due to inter- and intra-patient variability. Bench test has been proposed to evaluate the device responses in standardized and reproducible conditions. This thesis was aimed to develop a respiratory bench model able to reproduce patients’ signals and also in concordance with human physiology. The bench model can take into account the pressure responses of tested devices and works in a “closed loop” setting.With this bench model, several commercially available auto-titrating continuous positive airway pressure devices were evaluated for their auto-titration algorithms as well as their pressure-relief modes. Also, three adaptive servo-ventilation devices were evaluated by subjecting various sleep disordered breathing events that were generated by another bench model of a similar principle. We demonstrated that eleven auto-titrating continuous positive airway pressure devices were not equivalent in terms of their treatment efficacy and the data accuracy in the device report. The pressure-relief modes may attenuate the efficacy if not adjusted at the time of their introduction. The responses of adaptive servo-ventilation devices were not sufficient to normalize the breathing flow and their efficacy depended on the initial settings.The current certification process of these ventilatory devices, which focus mainly on clinical aspects, may be completed by the results of our bench
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Chaccur, Danilo Chucralla. "Avaliação da alteração da dimensão vertical na qualidade do sono em pacientes idosos portadores de prótese totais bimaxilares." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/23/23150/tde-18112010-110424/.
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A população idosa possui alta prevalência de edentulismo e, conseqüentemente, é afetada por problemas a ele associados. A perda da dimensão vertical de oclusão (DVO) é um destes problemas que compromete o desempenho do sistema estomatognático. Logo, doenças relacionadas ao colapso da musculatura, como a síndrome da apnéia obstrutiva do sono (SAOS), tornam-se enfermidades relevantes para pacientes nesta faixa etária. Sendo assim, medidas terapêuticas eficazes e de baixo custo, como a utilização de um dispositivo intraoral (DIO) para liberação do fluxo aéreo, devem ser empregadas contribuindo para a qualidade do sono destes pacientes. A intenção deste estudo foi avaliar a efetividade subjetiva e objetiva do aumento da DVO, em 19 pacientes idosos, portadores de próteses totais (PTs) bimaxilares, antes e depois da terapia com o dispositivo intraoral (DIO), especialmente desenvolvido para aumentar a DVO, sem provocar avanço mandibular. Para isso, questionários de rastreamento da qualidade do sono e polissonografias foram realizadas, em três momentos distintos: momento basal sem PTs, momento com PTs e momento com DIO. Concluiu-se que o DIO testado pode contribuir para uma melhor qualidade de sono dos pacientes e dos parceiros do sono, na medida em que levou à diminuição significativa do ronco e elevada preferência pelo uso do DIO para dormir. No entanto, a utilização do DIO, para esta amostra, não melhorou significativamente os parâmetros polissonográficos em relação ao momento basal (sem prótese) e, portanto, não pode ser indicado como tratamento para a SAOS. Assim sendo, novos estudos envolvendo análise do diâmetro da via aérea superior (VAS) e efeitos colaterais são necessários, para terapia de SAOS, em pacientes portadores de PTs bimaxilares.There is a high prevalence of edentulism and problems associated to it in the elderly population. A decrease in occlusal vertical dimension (OVD) is one of such problems which hinder the stomatognathic system. Therefore, it is important to investigate disorders associated with the weakening of musculature, such as the obstructive sleep apnea syndrome (OSAS), in such patients. Therapeutic measures of low cost and high efficacy, such as intraoral devices (ID), are needed in order to remove the obstruction of airway flow and improve the patients sleep quality. The present study aimed to assess the subjective and objective effectiveness of an ID, specially designed to increase OVD avoiding mandibular protrusion, in 19 elderly patients who wore upper and lower full dentures (FD), before and after therapy. For this purpose, sleep quality was analyzed using questionnaires and polysomnography at three distinct moments: baseline without FDs, with FDs, and with ID. It was possible to conclude that the ID tested can contribute to the improvement of the quality of sleep in patients as well as in their partners, as it significantly decreased snoring; the participants referred that they preferred to use the ID to sleep. However, the use of ID in this sample of people did not significantly improve the parameters assessed in polysomnography, when compared to the baseline (without FDs) and, therefore, should not be used as treatment for OSAS. Thus, further studies are needed in order to better evaluate dimensions of the upper airways as well as side effects for OSAS therapy in patients who wear upper and lower FDs.
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Cao, Xu [Verfasser], Georg [Akademischer Betreuer] Schmidt, Christof [Gutachter] Kolb, and Georg [Gutachter] Schmidt. "Risk prediction after myocardial infarction by cyclic variation of heart rate, a surrogate of sleep-disordered breathing assessed from Holter ECGs / Xu Cao ; Gutachter: Christof Kolb, Georg Schmidt ; Betreuer: Georg Schmidt." München : Universitätsbibliothek der TU München, 2020. http://d-nb.info/1241246777/34.
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Fiorott, Bruna Santos. "Alterações faciais anatômicas e funcionais em escolares do município de Vitória, ES." Universidade Federal do Espírito Santo, 2012. http://repositorio.ufes.br/handle/10/5871.
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Previous issue date: 2012-07-13Introduction: Mouth breathing pattern in children may have negative physical, psychological and social effects according to the intensity and duration. The relationship between mouth breathing and sleep-disordered breathing (SDB) is derived from clinical conditions ranging in increasing severity from primary snoring, to upper airway resistance syndrome and obstructive sleep apnea syndrome. The main cause of mouth breathing and SDB is associated to narrowing of the upper airway in varying degrees. This association is of concern due to its immediate or late clinical implications like disturbances in craniofacial growth, behavioral changes, impaired learning and cognitive functions, negatively influencing quality of life. Objective: Assess the prevalence of mouth breathers (MB) and the presence of facial anatomical changes that affect children with SDB, in addition to assessing self-perceived quality of life of MB. Methodology: A cross-sectional observational sample of 687 students from public schools, aged 6-12 years old, evaluated by medical history, clinical examination and lip seal tests. Self-perceived quality of life of MB was obtained through questionnaire (Ribeiro, 2006). Results: In the total sample, 520 (75,7%) students were nasal breathers and 167 (24,3%) were MB. Among MB, 40,1% had obstructive hypertrophy of the palatine tonsils, 26,4% had Mallampati score III and IV, 35,3% has excessive overjet, 23,4% had anterior open bite, 15,6% had posterior crossbite, 53.9% had atresic palate, 35.9% had interlabial gap, 31% reported problems related to sleep and 9,0% reported having the feeling of stop breathing while asleep. Conclusion: The prevalence of facial anatomical and functional changes in mouth breathers students was high, however the self-perception of quality of life was considered good. It is recommended the adoption of public health policies aimed at diagnosis, counseling and treatment of students at this age group, in which the relief of signs and symptoms can promote normal craniofacial growth and reduce future risk of SDB
Introdução: O padrão de respiração bucal em crianças pode gerar repercussões negativas de impacto físico, psicológico e social. A relação da respiração bucal com os distúrbios respiratórios obstrutivo do sono (DROS) é proveniente de condições clínicas que variam em gravidade crescente desde o ronco primário, a síndrome da resistência da via aérea superior até a síndrome da apneia obstrutiva do sono. A principal causa da respiração bucal e dos DROS está associada ao estreitamento da via aérea superior em diferentes graus. Essa associação é preocupante por apresentar repercussões clínicas imediatas e/ou tardias de distúrbios no crescimento e desenvolvimento craniofacial, alterações do comportamento, prejuízo do aprendizado e de funções cognitivas, influenciando negativamente a qualidade de vida. Objetivo: Verificar a prevalência de escolares respiradores bucais (RB) e a presença de alterações faciais comuns em crianças que apresentam DROS, além de avaliar a autopercepção da qualidade de vida. Metodologia: Estudo transversal, observacional com amostra de 687 escolares, na faixa etária de 6 a 12 anos de idade, matriculados em escolas municipais de ensino fundamental de Vitória, ES, avaliados através de anamnese, exame clínico e testes de permanência de selamento labial. O questionário de qualidade de vida do respirador bucal (Ribeiro, 2006) foi empregado para verificar a autopercepção da qualidade de vida dos escolares diagnosticados com respiração bucal. Resultados: Na amostra total, 520 (75,7%) escolares foram classificados como respiradores nasais (RN) e 167 como RB (24,3%). Dentre os RB, 40,1% apresentaram hipertrofia obstrutiva das tonsilas palatinas, 26,4% apresentaram índice de Mallampati graus III e IV e más oclusões como: sobressaliência exagerada (35,3%), mordida aberta anterior (23,4%), mordida cruzada posterior (15,6%), palato atrésico (53,9%), ausência de selamento labial (35,9%); além de 31% terem relatado problemas relativos ao sono e 9% relataram ter a sensação de parar de respirar enquanto dormia. Conclusão: A prevalência de alterações faciais anatômicas e funcionais nos RB foi elevada, entretanto a autopercepção da qualidade de vida foi considerada boa. Recomenda-se a adoção de políticas de saúde publica visando diagnóstico, orientação e tratamento de escolares nessa faixa etária, na qual o alivio dos sinais e sintomas proporciona o crescimento normal das estruturas craniofaciais e reduz os riscos de DROS no futuro
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Klein, Cristini. "Associação entre distúrbios respiratórios do sono, estresse oxidativo e doença arterial coronariana." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2010. http://hdl.handle.net/10183/24074.
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TÍTULO: Associação entre Distúrbios Respiratórios do Sono, Estresse Oxidativo e Doença Arterial Coronariana. INTRODUÇÃO: Evidências sugerem associação entre a doença arterial coronariana (DAC) e os distúrbios respiratórios do sono (DRS), porém o mecanismo que explica essa associação é incerto. Episódios repetitivos de hipóxia e reoxigenação vivenciados pelos indivíduos com DRS levam ao aumento de espécies reativas de oxigênio (ERO). ERO no interior dos eritrócitos podem ser detoxificadas pelas enzimas antioxidantes glutationa peroxidase (GPx), catalase (CAT) e superóxido dismutase (SOD). Ainda no citoplasma as ERO podem ser detoxificadas pela vitamina C ou ácido úrico. O estresse oxidativo é caracterizado por um desequilíbrio entre os níveis de ERO e antioxidantes. Este desequilíbrio promove lesão oxidativa em biomoléculas, mecanismo este associado à fisiopatologia da DAC. OBJETIVOS: Verificar a relação entre o índice de apnéia hipopnéia (IAH) e a presença de DAC. Verificar a associação entre IAH, DAC e a atividade das enzimas antioxidantes: SOD, CAT, GPx e antioxidantes não enzimáticos, ácido úrico e vitamina C. Avaliar a relação entre IAH, DAC e os produtos de danos oxidativos em lipídios, proteínas. Entre os marcadores de estresse oxidativo identificar preditores para DAC. MATERIAIS E MÉTODOS: Estudo transversal. Entre junho de 2007 e maio de 2008 na Hemodinâmica do Hospital de Clínicas de Porto Alegre, triamos consecutivamente 519 indivíduos encaminhados para angiografia diagnóstica ou terapêutica. Incluímos 14 pacientes com DAC (≥ 50% diminuição do lúmen da coronária) e 30 controles com < 50% de obstrução. O IAH foi mensurado por meio de polissonografia portátil. Verificamos presença de DAC através da angiografia coronariana. A quantificação dos grupos carbonil no hemolisado e no plasma e as atividades das enzimas antioxidantes SOD, CAT e GPx foram verificadas por método espectrofotométrico. Mensuramos malondialdeído (MDA) e vitamina C por cromatografia líquida de alta eficiência. RESULTADOS: Este é o primeiro trabalho que evidencia correlação entre IAH e o aumento de carbonilação de proteínas eritrocitárias. Além disso, os resultados obtidos mostram que os indivíduos portadores de DAC apresentam níveis maiores de grupos carbonil no hemolisado quando comparados aos indivíduos controles. Em um modelo de regressão multivariado ajustado para idade, sexo e índice de massa corporal, buscando verificar preditores para DAC, verificamos que o aumento de uma unidade de carbonil aumenta 1,7% o risco para desenvolvimento de DAC, já uma unidade do IAH aumenta em 3,9% o risco de desenvolvimento de DAC. Não foi encontrada correlação entre IAH e os marcadores MDA, carbonil no plasma e os antioxidantes: SOD, CAT, GPx vitamina C e ácido úrico. Não verificamos correlação entre DAC e os marcadores MDA, carbonil no plasma e entre os antioxidantes SOD, CAT , GPx e ácido úrico. Pacientes com CAD significativa apresentaram níveis menores de vitamina C. Correlação positiva foi observada entre os níveis de vitamina C e a concentração de proteínas carboniladas no plasma. CONCLUSÃO: Foi evidenciado que a carbonilação de proteínas eritrocitárias e o IAH tem importância na fisiopatologia da DAC. Da mesma forma a vitamina C parece ter importância na prevenção da DAC.INTRODUCTION: Evidences suggest association between Coronary Artery Disease (CAD) and Sleeping Disordered Breathing (SDB), however the mechanism is uncertain. Repetitive episodes of hypoxia and reoxygenation experienced by individuals with SDB lead to an increase of Reactive Oxygen Species (ROS). ROS inside the erythocytes may be scavenging by glutathione peroxidase antioxidants enzymes (GPx), catalase (CAT) and superoxide dismutase (SOD). In the cytoplasm ROS may be inhibited by vitamin C, or uric acid. Oxidative stress is characterized by an unbalance between ROS and antioxidants. These unbalance promotes oxidative damage in biomolecules, this mechanism is associated to the CAD physiopathology . OBJECTIVE: Verify the relation between apnea hypopnea index (AHI) and CAD. Verify association between AHI, CAD and antioxidants enzymes activity: SOD, CAT, GPx and non enzymatic antioxidants, uric acid, and vitamin C. Evalute the relation between AHI, CAD and oxidative damage products in lipids and proteins. Among the oxidative stress markers identify the predictors for CAD. MATERIALS AND METHODS: Cross sectional study. Between June and May 2008 in the hemodinamic ward of Clinicas Hospital of Porto Alegre, we consecutively screened 519 individuals sent for diagnostic or therapeutic angiography. We included 14 cases with CAD (≥ 50% narrowing of coronary lumen) and 30 controls with < 50% narrowing. The AHI was measured by portable polisomnography. We found the presence of CAD through coronary angiography. Carbonyl groups quantification in the hemolysed and plasma and antioxidants enzyme activities of SOD, CAT and GPx were verified by spectophotometric method. Malondyaldeyde (MDA) and vitamin C were measured by HPLC. RESULTS: This work is the first one that shows correlation between AHI and increased erythrocytes protein carbonylation. In the same way evidences that individuals with significant CAD compared to controls present higher levels of carbonyl groups in the hemolysates. In a multivaried regression model adjusted to age, gender and body mass index to verify predictors for CAD, we verified that the carbonyl unit increased 1.7% the risk for development of CAD, while one unit of IAH increased in 3.9% the risk to develop CAD. We did not find correlation between AHI and the markers MDA, plasma carbonyl and the antioxidants: SOD, CAT, GPx vitamin C and uric acid. We didn’t verify correlation between CAD and the markers MDA, plasma carbonyl and the others antioxidants SOD, CAT , GPx and uric acid. Patients with significant CAD had lower levels of vitamin C. Positive correlation was observed between vitamin C and erythrocyte carbonyl concentration. CONCLUSION: We evidenced that erythrocytes protein carbonylation and AHI are important in the physiopathology of CAD. In the same way vitamin C appears important factor in CAD prevention.
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Vanbuis, Jade. "Analyse automatique des stades du sommeil à partir des voies électrophysiologiques et cardiorespiratoires." Thesis, Le Mans, 2021. http://cyberdoc-int.univ-lemans.fr/Theses/2021/2021LEMA1004.pdf.
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Le diagnostic des troubles du sommeil repose sur l'analyse de différents signaux enregistrés lors d'un examen du sommeil. Cette analyse est réalisée par un spécialiste du sommeil qui étudie la ventilation et, selon l'outil de diagnostic, la succession des stades de sommeil. Cette dernière tâche est particulièrement chronophage et complexe. Trois algorithmes d'aide au diagnostic et dédiés à cette tâche sont présentés.Le premier permet la classification éveil/sommeil lors de l'utilisation d'un nouvel outil de diagnostic. Il en découle la possibilité pour le médecin de diagnostiquer précisément le syndrome d'apnées du sommeil et à moindre coût.Le deuxième, fondé sur les voies électrophysiologiques, permet d'obtenir une classification de tous les stades de sommeil à partir de l'outil de diagnostic le plus complet. Il a été implémenté en considérant les limitations à l'utilisation d'un tel algorithme en routine clinique. L'architecture de cet algorithme reproduit ainsi le processus de classification réalisé manuellement par les médecins. Une fonction de seuillage auto-adaptatif a aussi été mise en place afin de fournir une classification patient-dépendante. Les résultats obtenus sont comparables avec ceux des médecins.Le troisième algorithme, fondé sur les voies cardio-respiratoires, permet de classifier les stades de sommeil à partir d'un outil de diagnostic très utilisé mais pour lequel il n'est normalement pas possible d'étudier les stades de sommeil. La tâche est complexe, mais les résultats obtenus sont satisfaisants vis-à-vis de la littérature.Les trois algorithmes, destinés aux différents outils de diagnostic, permettront d'aider les spécialistes à analyser le sommeilThe diagnostic of sleep-disordered breathing requires the analysis of various signals obtained while recording sleep. The analysis is carried by a sleep specialist, which studies the patient's ventilation and, depending on the diagnostic tool used for the record, sleep stages. Sleep stage scoring is a complex and time-consuming task. Three diagnosis support algorithms dedicated to this task are presented in this thesis.The first one provides a wakefulness versus sleep classification, designed for a new diagnostic tool. It results in the ability to make a precise diagnosis of sleep apnea syndrome, at low cost.The second algorithm, based on electrophysiological channels, provides a full sleep stage classification while using the most complete diagnosis tool. It was implemented considering the known limitations for the use of algorithms in clinical practice. Its architecture thus reproduces the manual scoring process. A self-adaptative thresholding function was also implemented to provide a patient-dependent classification. The obtained results are comparable with the ones from sleep experts.The third algorithm, based on cardio-respiratory channels, provides a sleep stage classification while using a diagnostic tool that is insufficient for a manual sleep scoring, yet still highly used. The task is challenging but the obtained results are satisfying compared to literature.All three algorithms, which were designed for various diagnostic tools, will help sleep experts analyzing sleep
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Huang, Yu-Shu 1964. "Sleep, sleep-disordered-breathing : cognition and prematurity." Doctoral thesis, 2017. http://hdl.handle.net/10451/34427.
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Tese de doutoramento, Medicina (Psiquiatria e Saúde Mental), Universidade de Lisboa, Faculdade de Medicina, 2018Prematurity leads to many handicaps, some of them are only recognized later in life and may impact the individuals for the rest of their life. The delivery date compared to the full term delivery time will be a measure of “indication of risks” of post-natal handicap risk, but this is only one of the many measurements that can be looked at. Many studies have investigated development of premature infants, based on different criteria at entry in the considered study. Our investigations are only a limited contribution to the investigation of premature infants. We included infants born as young as 24 weeks of gestational-age [GA] but none of the infants had major neurological syndromes recognized at birth. “Normal infants” defined as infants with more than 37 weeks of GA, birth-weight >2500g and absence of any indication of health problems born in the same hospital maternity at same time as premature infants were also recruited to serve as normal controls. As most newborn infants spend a large amount of time asleep, all the presented studies include investigation of sleep, and once sleep-time occurred mostly during the nocturnal period, it focused on the polygraphic monitoring of the nocturnal sleep. The premature cohort study was a longitudinal study and parents who signed informed consent approved by the Chang Gung Hospital and Medical College Ethic Committee, were asked to come back on a yearly basis for at least 5 years. This is an on-going study and not every child has been followed for such time. Furthermore, as in any longitudinal study, loss of patients occurred as parents did not bring children back. At entry 400 parents signed the informed consent, currently at 5 years follow-up 150 children have ended the follow-up period and about 215 at 4 years. The sample is a non-random convenience sample of children selected based on the parents` willingness to participate in the protocol and obtained with the help of neonatologist physicians in our NICUs. Most of the studies presented in the thesis come-out of this longitudinal study. The studies asked specific questions, particularly looking at development of abnormal obstructive breathing during sleep. But some of our studies looked also at children of older age as some of the findings that we observed in our premature cohort needed a different investigative approach, and prior validation on older children-premature and in non-premature infants. We have included these studies in our narrative as they become part of our research, and they are part of a general research program on “sleep- breathing-and-cognition” in children.