Дисертації з теми "Upper airways obstruction"
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Faria, Cindy. "A Síndrome da Apneia/Hipopneia Obstrutiva do Sono (SAHOS) e seu tratamento com cirurgia ortognática." Master's thesis, [s.n.], 2013. http://hdl.handle.net/10284/4146.
Повний текст джерелаA Síndrome da Apneia/Hipopneia Obstrutiva do Sono (SAHOS) é uma síndrome com grande prevalência na sociedade actual, constituíndo um grande problema de saúde pública. A SAHOS ocorre pelo repetido estreitamento ou colapso das vias aéreas superiores (VAS) durante o sono provocando como principal síntoma uma hipersonolência diurna exessiva. Os factores de riscos mais comuns incluem o sexo masculino, a obesidade, um palato mole alongado e uma retrognatia maxilar e/ou mandibular. A fisiopatologia da síndrome é multifactorial decorrente, em parte, de alterações das estruturas craniofaciais e dos tecidos moles das VAS associadas a alterações neuromusculares da faringe e a uma maior complacência da faringe. Relativamente ao tratamento, existem actualmente várias modalidades, tanto comportamentais, clínicas e cirúrgicas que devem ser individualizadas e criteriosamente seleccionadas para a situação clínica de cada paciente. Acredita-se que a SAHOS resulta na maioria das vezes de um estreitamento difuso da faringe. Para o seu tratamento é importante detectar os diferentes padrões de obstrução das VAS que parecem determinar o sucesso ou a falha do tratamento cirúrgico. As novas tecnologias permitem a criação de imagems tridimensionais a partir de imagems obtidas por ressonância magnética e tomografia computorizada juntamente com programas de reconstrução em 3 dimensões. Estas imagems tridimensionais possibilitam a avaliação dos locais de obstrução bem como proporcionam medições volumétricas das VAS. A cirurgia de avanço maxilo-mandibular (AMM) é um movimento em cirurgia ortognática que permite o avanço bi-maxilar, aumentando o volume das VAS a nível da velo-oro-hipofaringe. Tem sido descrita como sendo o tratamento cirúrgico mais efetivo para a SAHOS (excluíndo a traqueostomia) com índices de sucesso acima dos 80%. Vários autores comprovaram a eficiência da cirurgia de AMM no aumento do espaço faríngeo, diminuindo ou mesmo eliminando os episódios de colapsos respiratórios e melhorando significativemente a qualidade do sono e de vida dos pacientes. As palavras chaves utilizadas foram: “obstructive sleep apnea syndrome”, “maxillomandibular advancement” e “upper airway obstruction” que foram associados de múltiplas formas. Obstructive Sleep Apnea/Hipopnea Syndrome (OSAH) is a highly prevalent syndrome in the society, characterized as a public health burden. OSAH occurs by recurrent episodes of upper airway (UA) obstruction or collapse during sleep with daytime somnolence as the major symptom. The principal risks factors are : male, obesity, elongated soft palate and maxillary and/or mandibular retrognathia. Pathophysiology of OSAH is multifactorial, due partly to abnormalities of craniofacial stuctures and UA soft tissue associated with neuromuscular alterations of the pharynx and increased UA compliance. Behavioral, clinical and surgical options are available for the treatment of OSAH, which must be individualized and carefully selected for the clinical situation of each patient. Over the time, OSAH has been recognized as an obstructive process with a diffuse narrowing of the pharynx. For its treatment it is important te detect the different patterns of UA obstruction that seems to determine the sucess or failure of surgical treatment. New technologies allow the creation of tridimensional images achieved from magnetic resonance and computed tomography with reconstruction program. This tridimensional images enable the evaluation of obstruction sites and provide volumetric measurments of UA. Maxillomandibular advancement (MMA) is a movement on orthognatic surgery which allows bi-maxillary advancement, increasing the volume of UA at the level of velo-oro-hypopharynx. It has been described as the most effective surgical treatment for OSAH (excluding tracheostomy) with success rates above 80%. Several authors have demonstrated the effectiveness of AMM surgery on increasing the AMM pharyngeal space, reducing or eliminating episodes of respiratory collapse and improving sleep quality and life of patients. The keys words were : “obstructive sleep apnea syndrome”, “maxillomandibular advancement” e “upper airway obstruction” which have been associated in multiple ways.
Siekemeyer, Leah C. "Inspiratory Muscle Strength Training in Upper Airway Obstruction." Miami University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=miami1306417918.
Повний текст джерелаBerg, Søren. "Assessment of increased upper airway resistance in snorers methodological and diagnostic considerations /." Lund : Dept. of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Lund, 1997. http://catalog.hathitrust.org/api/volumes/oclc/39752216.html.
Повний текст джерелаSchwietering, Laura Ann. "Speech and Breathing Characteristics in Patients with Upper Airway Disorders: A Comparative Study." Miami University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=miami1367278513.
Повний текст джерелаFujimura, Shintaro. "Discrimination of “Hot Potato Voice” Caused by Upper Airway Obstruction Utilizing a Support Vector Machine." Kyoto University, 2020. http://hdl.handle.net/2433/252976.
Повний текст джерелаMehra, Puneet. "Fluid-Structure Interaction Modeling of Human Upper Airway Collapse in Obstructive Sleep Apnea." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563873512457421.
Повний текст джерелаTetlow, George A. "Modelling human upper-airway dynamics and dysfunction." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/1867.
Повний текст джерелаNg, Andrew Tze Ming Clinical School St George Hospital Faculty of Medicine UNSW. "Effect of mandibular advancement splint therapy on upper airway structure and function in obstructive sleep apnoea." Awarded by:University of New South Wales. Clinical School - St George Hospital, 2009. http://handle.unsw.edu.au/1959.4/44845.
Повний текст джерелаAnderson, Peter J. "Modeling the fluid-structure interaction of the upper airway : towards simulation of obstructive sleep apnea." Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/50162.
Повний текст джерелаApplied Science, Faculty of
Mechanical Engineering, Department of
Graduate
Kita, Hideo. "Effects of nasal continuous positive airway pressure therapy on respiratory parameters of upper airway patency in patients with obstructive sleep apnea syndrome." Kyoto University, 1999. http://hdl.handle.net/2433/156997.
Повний текст джерелаKyoto University (京都大学)
0048
新制・課程博士
博士(医学)
甲第7578号
医博第2065号
新制||医||704(附属図書館)
UT51-99-D195
京都大学大学院医学研究科内科系専攻
(主査)教授 一山 智, 教授 人見 滋樹, 教授 泉 孝英
学位規則第4条第1項該当
Pretorius, Vincent. "Juvenile onset Recurrent Respiratory Papillomatosis (JoRRP) at Red Cross War Memorial Children’s Hospital, Cape Town: A 2-year review." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30877.
Повний текст джерелаKoike, 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.
Повний текст джерела"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。
Pelteret, Jean-Paul. "A computational neuromuscular model of the human upper airway with application to the study of obstructive sleep apnoea." Doctoral thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/9519.
Повний текст джерелаNumerous challenges are faced in investigations aimed at developing a better understanding of the pathophysiology of obstructive sleep apnoea. The anatomy of the tongue and other upper airway tissues, and the ability to model their behaviour, is central to such investigations. In this thesis, details of the construction and development of a three-dimensional finite element model of soft tissues of the human upper airway, as well as a simplified fluid model of the airway, are provided. The anatomical data was obtained from the Visible Human Project, and its underlying micro-histological data describing tongue musculature were also extracted from the same source and incorporated into the model. An overview of the mathematical models used to describe tissue behaviour, both at a macro- and microscopic level, is given. Hyperelastic constitutive models were used to describe the material behaviour, and material incompressibility was accounted for. An active Hill three-element muscle model was used to represent the muscular tissue of the tongue. The neural stimulus for each muscle group to a priori unknown external forces was determined through the use of a genetic algorithm-based neural control model. The fundamental behaviour of the tongue under gravitational and breathing-induced loading is investigated. The response of the various muscles of the tongue to the complex loading developed during breathing is determined, with a particular focus being placed to that of the genioglossus. It is demonstrated that, when a time-dependent loading is applied to the tongue, the neural model is able to control the position of the tongue and produce a physiologically realistic response for the genioglossus. A comparison is then made to the response determined under quasi-static conditions using the pressure distribution extracted from computational fluid-dynamics results. An analytical model describing the time-dependent response of the components of the tongue musculature most active during oral breathing is developed and validated. It is then modified to simulate the activity of the tongue during sleep and under conditions relating to various possible neural and physiological pathologies. The retroglossal movement of the tongue resulting from the pathologies is quantified and their role in the potential to induce airway collapse is discussed.
Morgenstern, de Muller Christian Rudolf. "Invasive and non-invasive assessment of upper airway obstruction and respiratory effort with nasal airflow and esophageal pressure analysis during sleep." Doctoral thesis, Universitat Politècnica de Catalunya, 2010. http://hdl.handle.net/10803/6206.
Повний текст джерелаEl objetivo principal de esta tesis es la presentación de nuevos métodos para la estimación automático, invasiva y no-invasiva del esfuerzo respiratorio y cambios en la obstrucción de las vías aéreas superiores (VAS). En especial, la aplicación de estos métodos debería permitir, entre otras cosas, la diferenciación automática invasiva y no-invasiva de eventos centrales y obstructivos durante el sueño.
Con este propósito se diseñó y se obtuvo una base de datos de PSG nocturna completamente nueva de 28 pacientes con medición sistemática de presión esofágica (Pes). La Pes está actualmente considerada como el gold-standard para la estimación del esfuerzo respiratorio y la identificación de eventos respiratorios en los TRS. Es sin embargo una técnica invasiva y altamente compleja, lo cual limita su uso en la rutina clínica. Esto refuerza el valor de nuestra base de datos y la dificultad que ha implicado su adquisición. Todos los métodos de procesado propuestos y desarrollados en esta tesis están consecuentemente validados con la señal gold-standard de Pes para asegurar su validez.
En un primer paso, se presenta un sistema automático invasivo para la clasificación de limitaciones de flujo inspiratorio (LFI) en los ciclos inspiratorios. La LFI se ha definido como una falta de aumento en flujo respiratorio a pesar de un incremento en el esfuerzo respiratorio, lo cual suele resultar en un patrón de flujo respiratorio característico (flattening). Un total de 38,782 ciclos respiratorios fueron automáticamente extraídos y analizados. Se propone un modelo exponencial que reproduzca la relación entre Pes y flujo respiratorio de una inspiración y permita la estimación objetiva de cambios en la obstrucción de las VAS. La capacidad de caracterización del modelo se estima mediante tres parámetros de evaluación: el error medio cuadrado en la estimación de la resistencia en la presión pico, el coeficiente de determinación y la estimación de episodios de LFI. Los resultados del modelo son comparados a los de los dos mejores modelos en la literatura. Los resultados finales indican que el modelo exponencial caracteriza la LFI y estima los niveles de obstrucción de las VAS con la mayor exactitud y objetividad.
Las anotaciones gold-standard de LFI obtenidas, fueron utilizadas para entrenar, testear y validar un nuevo clasificador automático y no-invasivo de LFI basa en la señal de flujo respiratorio nasal. Se utilizaron las técnicas de Discriminant Analysis, Support Vector Machines y Adaboost para la clasificación no-invasiva de inspiraciones con las características extraídas de los dominios temporales y espectrales de los patrones de flujo inspiratorios. Este nuevo clasificador automático no-invasivo también identificó exitosamente los episodios de LFI, alcanzando una sensibilidad de 0.87 y una especificidad de 0.85.
La diferenciación entre eventos respiratorios centrales y obstructivos es una de las acciones más recurrentes en el diagnostico de los TRS. Sin embargo únicamente la medición de Pes permite la diferenciación gold-standard de este tipo de eventos. Recientemente se han propuesto nuevas técnicas para la diferenciación no-invasiva de apneas e hipopneas. Sin embargo su adopción ha sido lenta debido a su limitada validación clínica, ya que la creación manual por expertos humanos de sets gold-standard de validación representa un trabajo laborioso. En esta tesis se propone un nuevo sistema para la diferenciación gold-standard automática y objetiva entre hipopneas obstructivas y centrales. Expertos humanos clasificaron manualmente un total de 769 hypopneas en 28 pacientes para crear un set de validación gold-standard. Como siguiente paso se extrajeron características específicas de cada hipopnea para entrenar y testear clasificadores (Discriminant Analysis, Support Vector Machines y adaboost) para diferenciar entre hipopneas centrales y obstructivas mediante la señal gold-standard Pes. El sistema de diferenciación automática alcanzó resultados prometedores, obteniendo una sensibilidad, una especificad y una exactitud de 0.90. Por lo tanto este sistema parece prometedor para la diferenciación automática, gold-standard de hipopneas centrales y obstructivas.
Finalmente se propone un sistema no-invasivo para la diferenciación automática de hipopneas centrales y obstructivas. Se propone utilizar la señal de flujo respiratorio para la diferenciación utilizando características de los ciclos inspiratorios de cada hipopnea, entre ellos los patrones flattening. Este sistema automático no-invasivo es una combinación de los sistemas anteriormente presentados y se valida mediante las anotaciones gold-standard obtenidas mediante la señal de Pes por expertos humanos. Los resultados de este sistema son comparados a los resultados obtenidos por expertos humanos que utilizaron un nuevo algoritmo no-invasivo para la diferenciación manual de hipopneas. Los resultados del sistema automático no-invasivo son prometedores y muestran la viabilidad de la metodología empleada. Una vez haya sido validado extensivamente, se ha propuesto este algoritmo para su utilización en dispositivos de terapia de TRS desarrollados por uno de los socios cooperantes en este proyecto.
The assessment of respiratory effort during sleep is of major importance for the correct identification of respiratory events in sleep-disordered breathing (SDB), the correct diagnosis of SDB-related pathologies and the consequent choice of treatment. Currently, respiratory effort is usually assessed in night polysomnography (NPSG) with imprecise techniques and manually evaluated by human experts, resulting in a laborious task with significant limitations and missclassifications.
The main objective of this thesis is to present new methods for the automatic, invasive and non-invasive assessment of respiratory effort and changes in upper airway (UA) obstruction. Specifically, the application of these methods should, in between others, allow the automatic invasive and non-invasive differentiation of obstructive and central respiratory events during sleep.
For this purpose, a completely new NPSG database consisting of 28 patients with systematic esophageal pressure (Pes) measurement was acquired. Pes is currently considered the gold-standard to assess respiratory effort and identify respiratory events in SDB. However, the invasiveness and complexity of Pes measurement prevents its use in clinical routine, underlining the importance of this new database. . . All the processing methods developed in this thesis will consequently be validated with the gold-standard Pes-signal in order to ensure their clinical validity.
In a first step, an (invasive) automatic system for the classification of inspiratory flow limitation (IFL) in the inspiratory cycles is presented.
IFL has been defined as a lack of increase in airflow despite increasing respiratory effort, which normally results in a characteristic inspiratory airflow pattern (flattening). A total of 38,782 breaths were extracted and automatically analyzed. An exponential model is proposed to reproduce the relationship between Pes and airflow of an inspiration and achieve an objective assessment of changes in upper airway obstruction. The characterization performance of the model is appraised with three evaluation parameters: mean-squared-error when estimating resistance at peakpressure,
coefficient of determination and assessment of IFL episodes. The model's results are compared to the two best-performing models in the literature. The results indicated that the exponential model characterizes IFL and assesses levels of upper airway obstruction with the highest accuracy and objectivity.
The obtained gold-standard IFL annotations were then employed to train, test and validate a new automatic, non-invasive IFL classification system by means of the nasal airflow signal. Discriminant Analysis, Support Vector Machines and Adaboost algorithms were employed to objectively classify breaths non-invasively with features extracted from the time and frequency domains of the breaths' flow patterns. The new non-invasive automatic classification system also succeeded identifying IFL episodes, achieving a sensitivity of 0.87 and a specificity of 0.85.
The differentiation between obstructive and central respiratory events is one of the most recurrent tasks in the diagnosis of sleep disordered breathing, but only Pes measurement allows the gold-standard differentiation of these events. Recently new techniques have been proposed to allow the non-invasive differentiation of hypopneas. However, their adoption has been slow due to their limited clinical validation, as the creation of manual, gold-standard validation sets by human experts is a cumbersome procedure. In this study, a new system is proposed for an objective automatic, gold-standard differentiation between obstructive and central hypopneas with the esophageal pressure signal. An overall of 769 hypopneas of 28 patients were manually scored by human experts to create a gold-standard validation set. Then, features were extracted from each hypopnea to train and test classifiers (Discriminant Analysis, Support Vector Machines and adaboost classifiers) to differentiate between central and obstructive hypopneas with the gold-standard esophageal pressure signal. The automatic differentiation system achieved promising results, with a sensitivity of 0.82, a specificity of 0.87 and an accuracy of 0.85. Hence, this system seems promising for an automatic, goldstandard differentiation between obstructive and central hypopneas.
Finally, a non-invasive system is proposed for the automatic differentiation of central and obstructive hypopneas. Only the airflow signal is used for the differentiation, as features of the inspiratory cycles of the hypopnea, such as the flattening patterns, is used. The automatic, non-invasive system represents a combination of the systems that have been presented before and it was validated with the gold-standard scorings obtained with the Pes-signal by human experts. The outcome is compared to the results obtained by human scorers that applied a new non-invasive algorithm for the manual differentiation of hypopneas. The non-invasive system's results are promising and show the viability of this technique. Once validated, this algorithm has been proposed to be used in therapy devices developed by one of the partner institutions cooperating in this project.
Karlea, Audrey. "Cost Analysis of Mandibular Distraction Versus Tracheostomy for Infants with Pierre Robin Sequence and Upper Airway Obstruction: A One-Year Analysis." Cincinnati, Ohio : University of Cincinnati, 2007. http://rave.ohiolink.edu/etdc/view.cgi?acc_num=ucin1179503013.
Повний текст джерелаAdvisor: Dr. Robert Hopkin. Title from electronic thesis title page (viewed June 30, 2010). Includes abstract. Keywords: Pierre Robin Sequence; Mandibular Distraction; Tracheostomy; cost; infant. Includes bibliographical references.
Yoo, Paul B. "SELECTIVE STIMULATION AND RECORDING OF THE CANINE HYPOGLOSSAL NERVE FOR THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA." Case Western Reserve University School of Graduate Studies / OhioLINK, 2004. http://rave.ohiolink.edu/etdc/view?acc_num=case1081536516.
Повний текст джерелаGiralt, Hernando María. "Three-dimensional Impact of orthognathic surgery on the upper airway and the apnea-hypopnea index." Doctoral thesis, Universitat Internacional de Catalunya, 2021. http://hdl.handle.net/10803/672154.
Повний текст джерелаPayne, Richard J. 1973. "Upper airway dysfunction in obstructive sleep apnea and its relationship to laryngopharyngeal reflux and postoperative morbidities in cancer of the oral cavity and cancer of the oropharynx." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=82403.
Повний текст джерелаBronfman, Caroline Nemetz. "Avaliação das vias aéreas superiores por meio de tomografia computadorizada Cone-beam em pacientes Classe III submetidos à cirurgia bimaxilar." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/25/25144/tde-16092016-150643/.
Повний текст джерелаIntroduction: Depending on the extend of Class III malocclusion, it becomes difficult to be treated only with orthodontic correction. Both mandibular setback surgery as bimaxillary surgery, promote an improvement in occlusion, masticatory function and facial aesthetics, correcting the position of the mandible and/or maxilla. But an important aspect of orthognathic surgery that cant be overlooked, are the effects that the skeletal movements of the bone bases causes in the airway space, since they change the position of the hyoid bone and tongue. The narrowing of the pharingeal airway space (PAS) may impair the patient\'s sleep and predispose to the development of obstructive sleep apnea (OSA). Purpose: This study aims to evaluate surgical changes in the airway volume and minimal cross-sectional area in the pharyngeal airway space (PAS) in patients with skeletal Class III malocclusion, submitted to bimaxillary surgery, using a Le Fort I maxillary osteotomy and bilateral sagittal split ramus osteotomy technique. Material and Methods: The evaluations were made through Cone-beam computed tomography (CBCT), using Dolphin Imaging program version 11.7. The CT scans of 50 patients of both genders, with a mean age of 33.40 (± 9.38), were analyzed pre and postoperatively and volume and minimum axial area were measured. Paired t test was used and tests were performed using Statistica 7.0 software, adopting a 5% significance level. Results: Method error were done and no random or systematic errors were found (p> 0.05 for all measures). Bimaxillary surgery for skeletal Class III correction promoted an increase of 16.68% (± 22.61) in volume and 23.58% (± 31.46) at the minimum axial area. Conclusion: Even if the effects of the maxillary advancement and mandibular setback surgery on the airway are not completely predictable, we observed that most patients didnt have pharyngeal airway anatomy damage, that could result decreased on airway volume and minimum axial area predisposing to OSA development.
Shahid, Muhammad Laiq Ur Rahman [Verfasser], Lars [Akademischer Betreuer] [Gutachter] Linsen, Horst Karl [Gutachter] Hahn, Henry [Gutachter] Völzke, and Tatyana [Gutachter] Ivanovska. "Upper Airway Segmentation and Interactive Visual Analysis to Investigate Obstructive Sleep Apnea in a Cohort Study / Muhammad Laiq Ur Rahman Shahid ; Gutachter: Lars Linsen, Horst Karl Hahn, Henry Völzke, Tatyana Ivanovska ; Betreuer: Lars Linsen." Bremen : IRC-Library, Information Resource Center der Jacobs University Bremen, 2016. http://d-nb.info/1122825374/34.
Повний текст джерелаHagot, Pascal. "Evaluation de l’interaction fluide-structure dans les Voies Aériennes Supérieures par Imagerie par Résonance Magnétique." Thesis, Paris 11, 2015. http://www.theses.fr/2015PA112059/document.
Повний текст джерелаObstructive Sleep Apnea (OSA) is a common disorder occurring in almost 3 million French people. However, current diagnosis methods are not sufficient to precisely define obstructing sites and doesn't take into account the fluid structure coupling which plays an important role during upper airway closing. During this thesis, we developed a series of tools exploring upper airway closing process. On the one hand, a screening tool of the structure and the mechanical properties of the upper airway, and on the other hand, a screening tool exploring with dynamic images of inert gases flow into the upper airway, were obtained using conventional hydrogen MRI coupled to magnetic resonance elastography (MRE) and helium-3 or fluor-19 gases MRI, respectively. Geometric and biomechanical data obtained using MRI/MRE are injected into a numerical model given the compliance and the state law of upper airway. Contributions of anatomical restriction on airway collapse are also investigated using a multi-compartmental two-dimensional fluid structure interaction model during a breath inspiration to predicted airway mechanical changes and collapse pressures. Furthermore, helium 3 and sulfur hexafluoride flow was modeled at steady state using commercial finite volume software to evaluate potential feasibility to image upper airway collapsibility during OSA. First dynamic MR imaging using sulfur hexafluoride (SF6) was obtained showing the feasibility of this technique. Using SF6, 6 times denser than air, shows a higher sensibility to upper airway obstruction. This thesis opens a new imaging modality to probe and to diagnose upper airway obstruction
Attali, Valérie. "Stabilité des voies aériennes supérieures et intégration centrale." Thesis, Paris 6, 2015. http://www.theses.fr/2015PA066450.
Повний текст джерелаThe obstructive sleep apnoea syndrome (OSAS) involves recurrent sleep-related upper airways (UA) collapse. UA mechanical properties and neural control are altered imposing a mechanical load on inspiration. UA collapse does not occur during wakefulness, hence arousal-dependent compensation. Three studies in healthy and apnoeic patients allowed characterizing it. From upper-airway pressure-flow relationships, the first study described local compensation mechanisms, before and after a neurovegetative modulation based on ptérygopalatin node compression. The second study showed a respiratory-related cortical activity that could contribute to the increased neural drive to upper airway and to inspiratory muscles that has previously been described in OSAS, and could therefore contribute to the arousal-dependent compensation of upper airway abnormalities. The third study showed a sensory gating-out process of breathing sensations in OSAS that could be reversed by mandibular advancement device, allowing linking upper-airway stability improvement to central integration of respiratory sensations. Finally, upper-airway pressure-flow relationship was approached by two models
Rocha, Thais Lima. "Avaliação das alterações nas vias aéreas superiores através de tomografia computadorizada Cone-Beam em pacientes submetidos à cirurgia ortognática de avanço bimaxilar." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/25/25144/tde-16092016-150120/.
Повний текст джерелаIntroduction: Facial aesthetics dissatisfaction is considered the most common motivating factor in the search for orthognathic surgery. This procedure may be used in cases of severe dental and skeletal discrepancies in adult patients. The restricted space anatomy of the upper airway space (UAS) allows features such as obesity, muscular hypotonia and mandibular deficiency favor clogging, which may lead to obstructive sleep apnea (OSA), characterized by recurrent episodes of partial or complete obstruction of the UAS during sleep. Surgeries of bimaxillary advancement are associated with increased UAS, however, the morphological and volumetric changes are not well known. Objectives: to evaluate changes in 3D pharyngeal airway in front of orthognathic surgery procedures of skeletal Class I and II subjects. Material and Methods: 3D pharyngeal airway was evaluated preoperative (T0) and postoperative (T1), with the aid of the analysis of the minimum axial area and airway volume. Fifty-six patients 21 male and 35 female, with a mean age of 35.8 (± 10.7) years undergo bimaxillary advancement by the technique of bilateral sagittal split osteotomy of the mandible associated with maxillary advancement through Le Fort I osteotomy. Measurements were made using Cone-beam Computed Tomography, using the Dolphin Imaging program 11.7. Paired t test was used to compare to the data between T0 and T1. All tests were performed with the Statistica Program, adopting a 5% significance level. Results: In the method error of the study, there was no casual or systematic error between the first and second measurement variables (p > 0.05 for all measures). The bimaxillary advancement surgery showed an average of 73.6% (± 74.75%) of increase in volume and 113.5% (±123.87%) increase in the minimum axial area. Conclusions: We concluded that the maxillomandibular advancement surgery provides a significant increase in volume in the UAS as well as the minimum axial area; however, this gain is not always in the same magnitude for all patients.
Martínez, Novoa Mª Dolores. "Estudio sobre el papel de la videofibrosomnoscopia en los resultados terapéuticos del paciente con síndrome de Apnea-‐Hipopnea Obstructiva del Sueño." Doctoral thesis, Universitat Rovira i Virgili, 2015. http://hdl.handle.net/10803/312828.
Повний текст джерелаEl diagnóstico de síndrome de Apnea-Hipopnea Obstructiva del Sueño (SAHOS) se efectúa mediante la demostración objetiva de la alteración respiratoria que provoca la obstrucción de las vías respiratorias superiores durante el sueño y los despertares relacionados con los esfuerzos respiratorios. La valoración clínica y exploración física exhaustivas no predicen adecuadamente ni la presencia o ausencia de apneas o hipopneas nocturnas, ni la severidad, si existe, del SAHOS. Por otra parte, la subjetividad de la evaluación y la variabilidad de la nomenclatura de los hallazgos clínicos dificultan su comparación. La Videofibrosomnoscopia proporciona información sobre la dinámica de la vía aérea superior en los pacientes con Trastornos Respiratorios del Sueño, mejorando las indicaciones terapéuticas. Sin embargo, aún no ha podido demostrarse que mejore el éxito terapéutico. El objetivo principal de esta tesis ha sido comprobar si esta técnica diagnóstica mejora los resultados terapéuticos en pacientes con síndrome de Apnea-Hipopnea Obstructiva del sueño. Nuestros resultados indican que hay diferencias en las indicaciones terapéuticas de los pacientes evaluados con y sin videofibrosomnoscopia. A pesar de ello, no podemos afirmar que este método exploratorio mejore los resultados terapéuticos en pacientes con síndrome de Apnea-Hipopnea Obstructiva del sueño, aunque lo consideramos útil en algunos casos seleccionados.
The diagnosis of Obstructive Sleep Apnea-hypopnea syndrome (OSAS) is effected by the objective demonstration of a respiratory disorder that causes obstruction of the upper airway during sleep and the awakenings (cessations of sleep)related to respiratory effort. Using clinical and physical assessment it is not easy to predict the presence or absence of apneas or nocturnal hypopneas, nor the severity of OSAS. Moreover, the subjectivity of the evaluation and the variability of the nomenclature of clinical findings make it difficult to make comparisons. The DISE (drug induced sleep endoscopy) provides information on the dynamics of the upper airway in patients with sleep-disordered breathing, improving the therapeutic indications. However, it has not been demonstrated that it improves therapeutic success. The main objective of this thesis was to determine whether this diagnostic technique improves treatment outcomes in patients with obstructive apnea-hypopnea sleep syndrome. Our results indicate that there are differences in the therapeutic indications of patients evaluated with and without DISE. However, we cannot claim that this screening method improves treatment outcomes in patients with obstructive sleep apnea-hypopnea syndrome, although we consider it useful in selected cases.
Palma, Carlota Gil da. "Overground endoscopy findings in thoroughbred racehorses presented for poor performance or/and respiratory noise." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2017. http://hdl.handle.net/10400.5/14036.
Повний текст джерелаThe respiratory system plays a limiting role for maximum performance in exercising horses, actually, noncontagious respiratory diseases rank second as a cause of poor performance. Most of the functional obstructions of the airway are only accurately diagnosed at exercise. With the introduction of overground endoscopy, dynamic upper respiratory tract (URT) obstructions are now easier to diagnose, particularly due to its ease of application, safety, tolerance by the horse and its ability to image the upper airway during normal working conditions. Nowadays, overground endoscopy is widely used in Thoroughbred racehorses, representing a fundamental tool to diagnose and develop clinical treatment. The aim of this study was to characterize a population of 81 Thoroughbred racehorses presented for poor performance and/or respiratory noise, the protocol exam, the diagnostic findings, its prevalence and also, the relation between findings and symptoms. The results were comparable to most of the pre-existing studies, with a high prevalence of URT findings, where most horses were affected by multiple disorders, being the dorsal displacement of the soft palate the most represented one. In conclusion, this study subscribed the importance of the URT assessment in performing horses, enforcing the value of dynamic examinations to reach maximum welfare, health and performance.
RESUMO - ACHADOS À ENDOSCPIA DINÂMICA EM PURO SANGUE INGLESES DE CORRIDA REFERIDOS POR MAU DESEMPENHO DESPORTIVO OU/E RUÍDO RESPIRATÓRIO - O trato respiratório representa um fator limitante na performance de cavalos de desporto, sendo que as doenças respiratórias não contagiosas são a segunda maior causa de mau desempenho desportivo. A maioria das obstruções funcionais das vias aéreas só são diagnosticadas durante o exercício. Com a introdução da endoscopia dinâmica, obstruções dinâmicas do trato respiratório superior (TRS) tornaram-se mais fáceis de diagnosticar, especialmente devido à sua fácil utilização, segurança, tolerância pelo cavalo e pela sua capacidade de filmar o TRS durante condições normais de trabalho. Atualmente, a endoscopia dinâmica é largamente utilizada em cavalos de corrida, representando uma ferramenta fundamental de diagnóstico e desenvolvimento do tratamento. O objetivo deste estudo foi caraterizar uma população de 81 cavalos puro sangue ingleses de corrida com mau desempenho desportivo ou/e ruído respiratório, o protocolo, os diagnósticos, a sua prevalência e a sua relação com os sintomas. Os resultados obtidos foram similares aos da maioria dos estudos pré-existentes, com uma grande prevalência de diagnósticos do TRS, onde a maioria dos cavalos foi afetada por múltiplas patologias, sendo que o deslocamento dorsal do palato mole foi a mais comum. Concluindo, este estudo reforçou a importância da avaliação do TRS em cavalos de desporto, fortalecendo o valor das avaliações dinâmicas com o fim de atingir máximo bem-estar, saúde e performance.
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Launois, Claire. "Propriétés neurophysiologiques des voies aériennes supérieures à l'éveil chez le sujet sain et le patient ayant un syndrome d'apnées obstructives du sommeil : influence du décubitus dorsal." Thesis, Sorbonne université, 2018. http://www.theses.fr/2018SORUS582.
Повний текст джерелаThe obstructive sleep apnea syndrome (OSAS) is characterized by recurrent upper airway (UA) collapse during sleep. It involves UA anatomical abnormalities accompanied by increased inspiratory load and defect in compensatory neuromuscular response to this load during sleep. UA collapse does not occur during wakefulness, suggesting that wakefulness-dependant neuromuscular response compensates for the increased inspiratory load. This thesis investigates these compensatory mechanisms by studying the response to the load imposed by the supine position in healthy subjects and OSAS patients during wakefulness. We found in 42% of awake OSAS patients studied in sitting position, a respiratory-related cortical activity (pre-inspiratory potentials, PIP). This activity was absent in healthy subjects (study 1) and could correspond to an increased neural drive in response to UA abnormalities. Moving to supine position was associated with the occurrence of PIP in 46% of healthy subjects probably related to an increase in fluid shift from the legs to the neck (study 2). Conversely, in OSAS patients, supine position was associated with a significant decrease in the incidence of PIP but with an increase in the genioglossus activity, an UA dilator muscle, (study 3), probably reflex to the increase in pharyngeal negative pressure induced by the load imposed by supine position. These data show a different cortical response of healthy subjects and OSAS patients to an increased load induced by supine position. It contributes to better understand the respiratory control of UA and the pathophysiology of OSAS
Coussens, Scott Wade. "An examination of the nature of sleep fragmentation in children with upper airway obstruction." Thesis, 2015. http://hdl.handle.net/2440/101558.
Повний текст джерелаThesis (Ph.D.) (Research by Publication) -- University of Adelaide, School of Medicine, 2015.
Yu, Chia-Ling, and 余佳玲. "Influences of nasal continuous positive airway pressure on the upper airway in obstructive sleep apnea patients." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/32504382484000996950.
Повний текст джерела國立臺灣大學
臨床牙醫學研究所
97
Objectives The narrowing of the upper airway caliber during sleep is believed to be essential to the pathogenesis of obstructive sleep apnea syndrome (OSAS). Nasal continuous positive airways pressure (nCPAP) is the therapy of choice especially for treating severe OSAS patients. We hypothesized that after continuous using of nCPAP, it could yield some persist changes of the upper airway. The aim of this study was to evaluate the changes of upper airway and its surrounding soft tissues of severe OSAS patients before and after nCPAP therapy. Material and method 76 severe OSAS patients were randomly assigned into two groups. In experimental group the patients have received nCPAP treatment with optimal pressure, i.e. effective nCPAP; and nCPAP with sub-therapeutic pressure, i.e. sham nCPAP, in control group. Static and dynamic MRI were used to image the upper airways in awakening supine posture of all subjects at baseline and 3 months after nCPAP therapy. The volume of the upper airway and the lateral pharyngeal wall were measured by using the serial static MRI. The area changes of the upper airway caliber sectioned at retro-palatal and retro-glossal levels were obtained from dynamic MRI to represent the collapsibility of the upper airway. The possible persist effects of nCPAP therapy on the upper airway were then analyzed by using these measurements. Results 35 subjects in the experimental group and 27 subjects in the control group have completed all the measurements. The total and retro-palatal upper airway volume were significantly increased after using effective nCPAP, but not occurred in controls. The retro-palatal upper airway volume was also correlated with the optimal pressure of the nCPAP (r=0.314, p<0.05). The volume of the lateral pharyngeal wall was significantly correlated with neck circumference (r=0.456) and BMI (0.590); and the lateral pharyngeal volume seemed not to be changed after both effective and sham nCPAP treatments. By comparing the maximal, minimal, and mean area of the upper airway caliber, effective nCPAP treatment didn’t yield collapsibility change in the retro-palatal level but in the retro-glossal level. The collapsibility of the airway both in the retro-palatal and retro-glossal levels were significantly correlated with the optimal pressure of the nCPAP. Conclusion In severe OSAS patients, the upper airway volume but not the lateral pharyngeal volume was increased after 3 months of effective nCPAP treatments. It seemed to indicate that such improvement might be due to strengthening of the tissue tone. The collapsibility of the upper airway in the retro-glossal level seemed to be also improved, but our study is not able to provide explanations. The upper airway resistance seemed to be correlated with the ratio between minimal and mean upper airway caliber. Its clinical implication needs future studies.
"The contribution of neuromechanical mechanisms to the pathogenesis of upper airway obstruction during sleep." THE JOHNS HOPKINS UNIVERSITY, 2007. http://pqdtopen.proquest.com/#viewpdf?dispub=3262363.
Повний текст джерелаGabriel, Joseph. "Effect of Intravenous Saline Infusion and Venous Compression Stockings on Upper Airway Size and Obstruction." Thesis, 2011. http://hdl.handle.net/1807/30600.
Повний текст джерелаChang, Tan-yi, and 張丹怡. "Virtual surgery and simulation analyses on human upper airway of obstructive sleep apnea patients." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/9f3p4w.
Повний текст джерела國立清華大學
動力機械工程學系
103
Numerical method is employed to simulate the muscle material characteristics of obstructive sleep apnea (OSA) patients. A set of averaged muscle material characteristics for the range of body mass index (BMI) examined is concluded to predict the expansion of the patient’s upper airway after surgery for the clinic reference before the surgery. Firstly, the mandibular bone, chin, neck and upper airway models of three patients, whose BMI are similar, are reconstructed based on the computed tomography (CT) images before and after surgery. Then, the model structures before and after “virtual surgery” are simulated by computational solid mechanics (CSM) with the assumptions of elasticity, anisotropy and homogeneous muscle material characteristics. Iterations are subsequently performed through comparing the model outlines obtained by “virtual surgery” simulation and the clinical surgery to acquire the appropriate muscle material characteristics of patients. A set of proper muscle material characteristics of patients is thus attained for 21
Hsieh, Yuh Jia, and 謝育佳. "Changes in Upper Airway and Surrounding Structures After Maxillomandibular Advancement for Obstructive Sleep Apnea." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/94692130613996049641.
Повний текст джерела長庚大學
顱顏口腔醫學研究所
100
Background and Purpose: Maxillomandibular advancement (MMA) is effective in treating obstructive sleep apnea (OSA). This study aimed to assess changes in upper airway, facial skeletal and surrounding structural position after MMA, and their association with OSA improvement. Materials and Methods: Sixteen adults with moderate-to-severe OSA underwent primary MMA. Polysomnography and CT of the head and neck were performed before and at least 6 months after MMA. The upper airway caliber, facial skeleton, and surrounding structures were measured with image analysis software. Results: After MMA there was a significant reduction in apnea-hypopnea index (AHI) (31.2±18.8 n/h, p=0.001). Airway volume significantly increased in the velo-, oro-, and hypopharynx (2.3±2.4, 2.1±2.6 and 1.7±1.1 cm3, respectively, all p<0.01) and airway length significantly reduced (3.1±3.5 mm, p<0.01). The soft palate, tongue, and hyoid significantly moved anteriorly (4.4±2.0, 7.5±2.8 and 5.7±5.0 mm, respectively, p<0.01), and these movements were related to the maxillary and mandibular advancement (r=0.6-0.8, all p<0.01). The AHI improvement was associated with anterior movements of the soft palate and hyoid (both r=0.7, p<0.01). Conclusions: MMA increases upper airway volume and reduces upper airway length. OSA improvement is associated with anterior movements of the soft palate and hyoid, which are related to maxillary and mandibular advancement.
Lin, Che-Yi, and 林哲儀. "Evaluation of Upper Airway Structures by Using Ultrasonography in Children with Obstructive Sleep Apnea." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/8cwmpp.
Повний текст джерела國立臺灣大學
臨床醫學研究所
105
Introduction: Obstructive sleep apnea (OSA) in children includes a spectrum of respiratory disorders characterized by upper airway collapse during sleep. The pathophysiology is mainly due to adenotonsillar hypertrophy, neuromuscular disorder, craniofacial anomaly and genetic defect. Several studies had revealed that the dynamic anatomy in upper airway, including superior constriction sphincter, fat pad deposition, lymphoid tissue and muscle tone of pharyngeal wall were all related to the collapsibility of upper airway during sleep in adults. Especially, the thicknesses of lateral pharyngeal wall (LPW) in OSA subjects are significantly different from non-OSA ones. However, there is still limited study addressed the dynamic upper airway structures in children with OSA by ultrasonography. The aims of this study are to measure the upper airway structures by ENT head and neck ultrasonography in children with OSA, and to elucidate the association between the ultrasonographic and polysomnographic parameters in these children. Methods: In this prospective cohort study, children with symptoms of sleep-disordered breathing received overnight sleep study (polysomnography, PSG) were invited to join this research after written informed consents obtained from each child or their parents. ENT head and neck ultrasonography were performed before surgery on the first date of admission. All the ultrasonographic and PSG parameters were compared and analyzed. Results: From January 2016 to February 2017, eighty-two children, including twenty primary snorer and sixty-two OSA subjects, received the ultrasound measurement pre-operatively. There were no significant differences in age, gender, BMI, neck circumference, tonsillar and adenoid grades between these two groups. Among the ultrasonographic parameters of upper airway structures, there were no differences in tonsil-related dimensions and volumes. However, the total LPW thickness was significantly higher in OSA children than primary snorers in both resting position (24.9±4.4 vs. 21.3±2.6 mm, p=0.001) and under Müller’s maneuver (29.9±5.5 vs. 24.1±2.9 mm, p<0.001). There was also significant correlation between the thickness of LPW and AHI in both resting and under Müller’s status. The total LPW thickness in resting and Müller’s status were independent factors of OSA severity in children by logistic regression analysis after adjusted with age, gender, BMI percentile, tongue position, tonsillar grade, and adenoidal size (OR 1.47, 1.09~1.96, p=0.011; OR 1.63, 1.14~2.34, p=0.007). Conclusions: Ultrasonography is a useful diagnostic tool to evaluate the dynamic upper airway structures in children with sleep-disordered breathing. By ultrasonography, the tonsil-related parameters dose not significantly relate to childhood OSA. However, LPW is significantly thicker in OSA children than non-OSA ones, and the thickness of LPW is significantly increasing under Müller’s maneuver in OSA children when comparing to non-OSA ones.
Breik, Omar. "Mandibular distraction osteogenesis in the management of airway obstruction in children with micrognathia: a systematic review." Thesis, 2015. http://hdl.handle.net/2440/97968.
Повний текст джерелаThesis (M.Clin.Sc.) -- University of Adelaide, School of Translational Health Science, 2015
Schwarz, Peter Bogdan. "Dopaminergic Control of Trigeminal Motor Outflow to Upper Airway Muscles in Anaesthetized Rats." Thesis, 2009. http://hdl.handle.net/1807/17710.
Повний текст джерелаHuang, Xiao-Wen, and 黃筱雯. "Numerical study of air flow in upper airway with obstructive sleep apnea syndrome using large eddy simulation." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/m2hnn2.
Повний текст джерела國立臺灣科技大學
機械工程系
107
Obstructive sleep apnea syndrome (OSAS) is a common disorder of adults, which is caused by repeated obstruction the upper airway during sleep. The effects of OSAS are not only the sleep quality but also the occurrence of disease such as hypertension, stroke and myocardial infarction. Apnea-hypopnoea index (AHI) is an acceptable measure for the severity of OSAS. Lots of treatments for patients with OSAS, it usually takes long time to adapt and inconveniently uses in life. Subsequently, many patients may give up the treatments because of adjustment disorder. Most of treatments are continuous positive airway pressure (CPAP) which is considered to be the standard treatments for patients with moderate-to-severe. Therefore, the patients who are more serious and unable to adapt will select surgical operations as their treatments for OSAS. In the present study, the preoperative, post-operative and after a period of time operation CT scan of upper airway by Maxillomandibular advancement (MMA) operation from patients are re-constructed and converted to in vitro three-dimensional models. The transitional/turbulent flow simulations during inspiration and expiration are studied using the Large Eddy Simulation (LES) technique in the in vitro 3D models of upper airway. Furthermore, the results show that the pressure drop, velocity, flow resistance, jet angle and stenosis of upper airway are significantly reduced after surgery and this model may be further applied for clinical evaluation in future.
Stadler, Daniel Lajos. "Obesity effects on lung volume, transdiaphragmatic pressure, upper airway dilator and inspiratory pump muscle activity in obstructive sleep apnoea." 2010. http://hdl.handle.net/2440/60527.
Повний текст джерелаThesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2010
Le, Huquet ARIEL. "Jaw Movement During Sleep." Thesis, 2008. http://hdl.handle.net/1974/1403.
Повний текст джерелаThesis (Master, Physiology) -- Queen's University, 2008-08-29 14:27:57.726
Chu, Cheng-An, and 朱振安. "Identifying the Upper Airway Characteristic of Obstructive Sleep Apnea patient with Submental Ultrasound Imaging and Shear Wave Elastography." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/kcvxk2.
Повний текст джерела國立臺灣大學
臨床牙醫學研究所
107
Purpose: Obstructive Sleep Apnea syndrome (OSAs) is a sleep breathing disorders of upper airway collapsing during sleep. It mostly caused by the upper airway structure abnormality. According to the previously studies, volume enlargement and low elasticity of upper airway structure may correlate to the occurrence of OSAs. The medical imaging tools of evaluating upper airway included computed tomography (CT), Magnetic resonance imaging (MRI) and Cephalometric x-ray. However, their application was limited by the drawback such as radiation exposure, high cost and time consuming. Ultrasound imaging may benefit the observation of upper airway. The aim of this study was to establish a reliable submental ultrasound elastography protocol. And identified the upper airway structure characteristic of OSAs patients. Methods: We used ultrasound as a tool to verified the reliability of clinical submental in our study. Then total sixty-nine adults, with thirty-seven healthy adults and thirty-two OSAs patients, were included for submental ultrasound elastography. The tongue height and tongue elasticity of both sagittal and coronal view were measured to estimate the upper airway characteristic of OSAs patient. Results: Both Sagittal Tongue Height and Coronal Tongue Height shows significant increase in OSAs patient (Sagittal Tongue Height : 65.38±0.93mm VS 60.99±0.99mm, Odds ratio=1.150, p=0.0045;Coronal Tongue Height 63.70±0.98mm VS 57.72±0.96mm, Odds ratio=1.205, p=0.0005). And the Coronal Tongue Elasticity was lower compared to the healthy group (13.24±0.36 kPa VS 15.87±0.63 kPa, Odds ratio=0.701, p=0.0029). When compared within the OSAs group, Neither Tongue height or Elasticity were correlated to Apnea-Hypopnea Index (AHI) (p>0.05). Conclusion: Submental ultrasound elastography could be a reliable tool for upper airway structure evaluation. The OSAs patients showed larger Tongue Height and lower Tongue Elasticity when compared to healthy group. But Tongue height and Tongue elasticity could not be the parameter for severity determination in OSAs patients.
"Invasive and non-invasive assessment of upper airway obstruction and respiratory effort with nasal airflow and esophageal pressure analysis during sleep." Universitat Politècnica de Catalunya, 2010. http://www.tesisenxarxa.net/TDX-0302110-110525/.
Повний текст джерелаMorton, Paul. "Sleep-disordered breathing in the child and adolescent orthodontic patient." Thèse, 2008. http://hdl.handle.net/1866/8062.
Повний текст джерелаSedinová, Monika. "Význam fyzioterapie v prognóze pacientů s Pierre Robinovou sekvencí." Master's thesis, 2018. http://www.nusl.cz/ntk/nusl-387793.
Повний текст джерелаChassé, Véronique. "Analyse de la morphologie buccofaciale et des voies aériennes supérieures chez des porteurs de prothèses complètes souffrant des troubles du sommeil." Thèse, 2017. http://hdl.handle.net/1866/20727.
Повний текст джерела