Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

Apnea Obstructiva del Sueño

 

Ronquido, Eventos Respiratorios y Cardíacos Después de la Colocación de un Dispositivo de Avance Mandibular. Snoring, Respiratory And Cardiac Events After The Placement Of A Mandibular Advancement Device.

Objective: To compare snoring levels, respiratory and cardiac events before and after the placement of a new mandibular advancement device (MAD) designed for snoring control, placed as an option for the control of pathological mechanisms respiratory disorders that have been associated with cognitive dysfunction, excessive daytime sleepiness and as an aggravator of the development of Alzheimer’s and Parkinson’s.

Methodology: Study of a case series that considered 12 snoring adults initially identified with the Roncolab® App. A clinical history of sleep and initial (A) and final (D) polysomnography (PSG) was performed. A new design of intra-oral mandibular advancement device for snoring control was placed, which was reviewed every 20 days for two months. Neurophysiological, cardio-pulmonary and sleep parameters were analyzed. The statistical differences between the variables were established according to the distribution of the data with tests of t-student or Mann-Whitney U.

Results: The average snoring events according to PSG were (A: 198; D: 260) with p> 0.05; according to Roncolab® (A: 73.6; D: 22.6) with a p <0.05. There were no differences between the oximetry averages (A: 0.84; D: 0.83) or heart rate (A: 65; D: 66.9).

Conclusions: There was no statistically significant difference in respiratory, cardiac events, oximetry nor apnea episodes according to PSG, after the placement of the manufactured DAM. Roncolab® registered a significant decrease in snoring events.

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Palabras clave: Apnea Obstructiva del Sueño, Disfunciones cognitivas, Férulas oclusales, Ronquido,

Keywords: Cognitive Dysfunction, Obstructive apnea, Occlusal splints, Sleep apnea syndrome, Snoring,

Ausencia de Asociación Entre la Posición de la Lengua Tipo IV de Friedman y Apnea Obstructiva de Sueño en Adultos Mayores con Ancestro Amerindio. Lack Of Association Between The Friedman’s Tongue Position Type IV And Obstructive Sleep Apnea In Older Adults Of Amerindian Ancestry.

Background: The burden of obstructive sleep apnea (OSA) in rural settings is unknown. In these regions, devices needed for OSA diagnosis are not available, and mass screening with field instruments may be complicated due to cross-cultural factors and illiteracy. The association between the Friedman’s tongue position (FTP) and OSA has been assessed in people from different ethnic groups but not in Amerindians.

Objective: We aimed to assess whether a FTP type IV is associated with OSA severity and with the apnea-hypopnea index (AHI) in community-dwelling older adults of Amerindian ancestry living in rural Ecuador.

Methods: A total of 201 Atahualpa residents aged ≥60 years, who underwent tongue position assessment, brain MRI, and polysomnography were included. After adjusting for relevant confounders, ordinal logistic regression models were fitted to assess the association between the presence of a FTP type IV and OSA categories (none, mild, and moderate-to-severe), and generalized linear models with a Gaussian link were fitted to assess the association between the presence of a FTP type IV and the continuous AHI.

Results: A FTP type IV was identified in 153 (76%) individuals, the mean AHI per hour was 11.9 ± 12.4, and 49 (24%) individuals had moderate-to-severe OSA, 88 (44%) had mild OSA, and the remaining 64 (32%) had no OSA. Fully-adjusted generalized linear models showed no independent association between the investigated exposure and the AHI (β: 0.09; 95% C.I.: -1.56 – 1.76; p=0.909). Likewise, ordinal logistic regression models showed no independent association between the investigated exposure and categories of OSA (β: 0.42; 95% C.I.: -0.47 – 1.31; p=0.357).

Conclusion: A FTP type IV is not associated with the AHI or the severity of OSA in this population of Amerindians. This lack of association could be related to phenotypic characteristics of people from this ethnic group (mostly their elliptic hard palate).

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Palabras clave: Apnea Obstructiva del Sueño, Índice apnea-hipopnea, posición de la lengua de acuerdo con Friedman,

Keywords: Amerindians, Apnea-hypopnea index, Friedman’s tongue position, Obstructive Sleep Apnea,

Apnea Obstructiva del Sueño y Neumatización Aberrante de Huesos del Cráneo. Obstructive Sleep Apnea And Aberrant Pneumatization Of Skull Bones.

Objective: We aimed to assess the association between obstructive sleep apnea (OSA) and aberrant pneumatization of skull bones in Amerindians living in rural Ecuador.

Methods: A random sample of community-dwelling individuals aged ≥60 years enrolled in the Atahualpa Project, were invited to undergo a single diagnostic night polysomnography (PSG) at the sleep unit of the Atahualpa Project Community Center. Exams were performed with an Embletta® X100™ Comprehensive Portable PSG System. A board-certified sleep neurologist carried out analyses of sleep efficiency, architecture, arousal indexes, apnea/hypopnea index, oxygen saturation, heart rate and motor activity. CT readings were focused on the presence and distribution of pneumatization of intracranial bones, as assessed by CT with bone window settings.

Results: Thirty-eight participants were included. Mean age was 74.5 ± 6.8 years and 25 (66%) were women. The apnea/hypopnea index ranged from 0.2 to 56 (mean 15.7 ± 14.6) episodes per hour. Fifteen persons (39%) had ≥10 episodes per hour and were considered to have OSA. Abnormal pneumatization of skull bones was noticed in six persons, included five out of 15 (33%) with OSA and one out of 23 (4%) without (p=0.027). Air was found in the temporal squamas in five (bilateral in four), the occipital bones in one, and in both the temporal squamas and the occipital bones in the remaining person.

Conclusion: This study shows a significant association between OSA and aberrant pneumatization of skull bones. These findings are of potential clinical relevance, since these individuals could be at increased risk of painless fractures from minor trauma or may be prone to develop spontaneous cerebrospinal fluid leaks.

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Palabras clave: Amerindios, Apnea Obstructiva del Sueño, maniobra de Valsalva, neumatización de huesos del cráneo,

Keywords: Obstructive sleep apnea; pneumatization of skull bones; Valsalva maneuver; Amerindians,

Trastornos del Sueño: Conocimiento de Apnea Obstructiva del Sueño en Médicos no Neurólogos y su Manejo Perioperatorio.

Objective: Obstructive sleep apnea syndrome (OSA) is a common sleep-related disorder that has been associated with a higher perioperative risk. Our purpose is to determine the level of knowledge and attitudes towards OSA among surgeons and traumatologists, knowing their important role in the prevention of potential perioperative complications in these patients.

Material and Method: Crosssectional survey study, using the “Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire” (OSAKA), administered to 105 surgeons and traumatologists and 27 surgery residents to measure the level of knowledge and attitudes towards OSA.

Results: Knowledge scores ranged from 3 (14%) to 17 (81%). The mean value for surgeons and traumatologists was below 62% (p=0.04), and lower than 48% (p=0.02) for residents. There is a positive correlation between the level of knowledge and the importance of identifying patients with OSAS (r = 0.26), and the confidence in themselves to identify this patients (r = 0.38). There was a negative correlation between knowledge and years of practice (r= -0.23).

Conclusion: Obstructive Sleep Apnea Syndrome is widely unknown among Surgeons and Traumatologists from Guayaquil. We recommend educational interventions that improve the level of knowledge and promote the use of guidelines in the management of patients in the perioperative period to decrease the risk of complications.

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Palabras clave: Apnea Obstructiva del Sueño, aptitud, Conocimiento, cuestionario,

Keywords: attitude, Knowledge, Obstructive Sleep Apnea, questionnaire,
 
 
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