Snoring is extremely common in the general population and may indicate OSA. However, snoring is not objectively measured during polysomnography, and no standard treatment is available for primary ...snoring or when snoring is associated with mild forms of OSA. This study determined the effects of oropharyngeal exercises on snoring in minimally symptomatic patients with a primary complaint of snoring and diagnosis of primary snoring or mild to moderate OSA.
Patients were randomized for 3 months of treatment with nasal dilator strips plus respiratory exercises (control) or daily oropharyngeal exercises (therapy). Patients were evaluated at study entry and end by sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and full polysomnography with objective measurements of snoring.
We studied 39 patients (age, 46 ± 13 years; BMI, 28.2 ± 3.1 kg/m2; apnea-hypopnea index (AHI), 15.3 ± 9.3 events/h; Epworth Sleepiness Scale, 9.2 ± 4.9; Pittsburgh Sleep Quality Index, 6.4 ± 3.3). Control (n = 20) and therapy (n = 19) groups were similar at study entry. One patient from each group dropped out. Intention-to-treat analysis was used. No significant changes occurred in the control group. In contrast, patients randomized to therapy experienced a significant decrease in the snore index (snores > 36 dB/h), 99.5 (49.6-221.3) vs 48.2 (25.5-219.2); P = .017 and total snore index (total power of snore/h), 60.4 (21.8-220.6) vs 31.0 (10.1-146.5); P = .033.
Oropharyngeal exercises are effective in reducing objectively measured snoring and are a possible treatment of a large population suffering from snoring.
ClinicalTrials.gov; No.: NCT01636856; URL: www.clinicaltrials.gov.
Background CPAP is the gold standard treatment for OSA and was conceived to be applied through a nasal interface. This study was designed to determine the acute effects of changing the nasal CPAP ...route to oronasal and oral in upper airway patency during sleep in patients with OSA. We hypothesized that the oronasal route may compromise CPAP’s effectiveness in treating OSA. Methods Eighteen patients (mean ± SD age, 44 ± 9 years; BMI, 33.8 ± 4.7 kg/m2 ; apnea-hypopnea index, 49.0 ± 39.1 events/hour) slept with a customized oronasal mask with nasal and oral sealed compartments connected to a multidirectional valve. Sleep was monitored by using full polysomnography and induced by low doses of midazolam. Nasal CPAP was titrated up to holding pressure. Flow route was acutely changed to the oronasal (n = 18) and oral route (n = 16) during sleep. Retroglossal area was continuously observed by using nasoendoscopy. Results Nasal CPAP (14.8 ± 4.1 cm H2 O) was able to stabilize breathing in all patients. In contrast, CPAP delivered by the oronasal and oral routes promoted obstructive events in 12 (66.7%) and 14 (87.5%) patients, respectively. Compared with stable breathing during the nasal route, there was a significant and progressive reduction in the distance between the epiglottis and tongue base and the retroglossal area when CPAP was delivered by the oronasal and oral routes. Conclusions CPAP delivered through the oronasal route may compromise CPAP’s effectiveness in treating OSA.
Background
There is a lack of non-invasive methods for monitoring the upper airway patency during sleep. Electrical impedance tomography (EIT) is a non-invasive, radiation-free tool that has been ...validated to monitor lung ventilation. We hypothesized that electrical impedance tomography (EIT) can be used for monitoring upper airway patency during sleep.
Methods
Sleep was induced in 21 subjects (14 males, age 43 ± 13 years, body mass index 32.0 ± 5.3 kg/m
2
) with suspected obstructive sleep apnea (apnea-hypopnea index: 44 ± 37 events/h, range: 1–122 events/h) using low doses of midazolam. Patients wore a nasal mask attached to a modified CPAP device, allowing variable and controlled degrees of upper airway obstruction. Confirmation of upper airway patency was obtained with direct visualization of the upper airway using nasofibroscopy (
n
= 6). The changes in total neck impedance and in impedance in four cranio-caudal regions of interest (ROIs) were analyzed.
Results
Total neck impedance varied in concert with breathing cycles and peaked during expiration in all patients. Group data showed a high cross-correlation between flow and impedance curves (
r
= −0.817,
p
< 0.001). Inspiratory peak flow correlated with simultaneous neck impedance (
r
= 0.866,
p
< 0.001). There was a high correlation between total neck impedance and velopharynx area (
r
= 0.884,
p
< 0.001), and total neck impedance and oropharynx area (
r
= 0.891,
p
< 0.001).
Conclusions
Neck EIT is sensitive and captures pharyngeal obstruction under various conditions. Neck EIT is a promising method for real-time monitoring of the pharynx during sleep.
Objectives/Hypothesis:
Polysomnography (PSG) is the gold‐standard method for diagnosing obstructive sleep apnea (OSA). However, the gap between demand and capacity in performing PSG is a major ...health‐care problem. We sought to validate a short day‐time induced sleep for the diagnosis of OSA.
Study Design:
Prospective diagnostic method validation.
Methods:
We studied 25 consecutive patients referred to the sleep laboratory and 15 healthy volunteers. All subjects were evaluated by means of full overnight PSG (Full‐PSG) and short day‐time induced‐sleep PSG (Induced‐PSG). Sleep was monitored during both procedures (Embla, 16 channels). Sleep was induced by slow intravenous drip infusion of midazolam.
Results:
The population studied (N = 40) was 60% male (mean age, 42 ± 10 years; body mass index, 29 ± 6.5 kg/m2). Sleep was successfully induced in all subjects, and no complications were observed (midazolam doses, 6.2 ± 3.8 mg; time of induced sleep 41.5 ± 18.9 minutes). The apnea‐hypopnea index (AHI) and minimal oxygen saturation during Full‐PSG versus Induced‐PSG were similar: median AHI (with 25%–75% interquartile range) was 13 (3–35) events per hour versus 17 (4–36) events per hour, and median oxygen saturation was 84% (75–90) versus 85% (76–92); P =.89 and P =.53, respectively. The majority of the respiratory events during induced sleep were obstructive and similar to those observed during Full‐PSG. AHI and lowest oxygen saturation during Induced‐PSG correlated significantly with Full‐PSG (r = 0.67 and r = 0.77, respectively). Sensitivity and specificity for the diagnosis of OSA (AHI > 15 events per hour) by Induced‐PSG were 0.83 and 0.72, respectively.
Conclusions:
Induced‐PSG by midazolam during the day is safe and correlates with Full‐PSG; it therefore is a promising alternative method in the diagnosis of OSA.
BACKGROUND Snoring is extremely common in the general population and may indicate OSA. However, snoring is not objectively measured during polysomnography, and no standard treatment is available for ...primary snoring or when snoring is associated with mild forms of OSA. This study determined the effects of oropharyngeal exercises on snoring in minimally symptomatic patients with a primary complaint of snoring and diagnosis of primary snoring or mild to moderate OSA. METHODS Patients were randomized for 3 months of treatment with nasal dilator strips plus respiratory exercises (control) or daily oropharyngeal exercises (therapy). Patients were evaluated at study entry and end by sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and full polysomnography with objective measurements of snoring. RESULTS We studied 39 patients (age, 46 ± 13 years; BMI, 28.2 ± 3.1 kg/m2 ; apnea-hypopnea index (AHI), 15.3 ± 9.3 events/h; Epworth Sleepiness Scale, 9.2 ± 4.9; Pittsburgh Sleep Quality Index, 6.4 ± 3.3). Control (n = 20) and therapy (n = 19) groups were similar at study entry. One patient from each group dropped out. Intention-to-treat analysis was used. No significant changes occurred in the control group. In contrast, patients randomized to therapy experienced a significant decrease in the snore index (snores > 36 dB/h), 99.5 (49.6-221.3) vs 48.2 (25.5-219.2); P = .017 and total snore index (total power of snore/h), 60.4 (21.8-220.6) vs 31.0 (10.1-146.5); P = .033. CONCLUSIONS Oropharyngeal exercises are effective in reducing objectively measured snoring and are a possible treatment of a large population suffering from snoring. TRIAL REGISTRY ClinicalTrials.gov ; No.: NCT01636856; URL: www.clinicaltrials.gov
The critical closing pressure (Pcrit) is the airway pressure at which the airway collapses and reflects the anatomical contribution to the genesis of obstructive sleep apnea. Pcrit is usually ...determined during non-rapid eye movement sleep at night, but has been determined under midazolam sedation during the day in the absence of sleep stage monitoring. Indeed, little is known about the effects of midazolam on sleep architecture. Moreover, deeper sedation with midazolam can decrease upper airway muscle activity and increase collapsibility compared with natural sleep. Pcrit under sedation has not been systematically compared with the usual method performed during natural sleep. Therefore, this study aimed to test the hypothesis that Pcrit following low doses of midazolam during the day would be comparable to Pcrit measured during natural sleep in the same patient. Fifteen men (age 54 ± 10 yr, body mass index 30 ± 4 kg/m(2)) with obstructive sleep apnea underwent a baseline standard overnight polysomnogram (apnea-hypopnea index 38 ± 22 events/h, range: 8-66 events/h), and Pcrit was determined during natural sleep and following midazolam. Sleep induction was obtained with low doses of midazolam (2.4 mg, range 2.0-4.4 mg), and sleep architecture was comparable to natural sleep. Natural sleep and induced sleep Pcrit were similar (-0.82 ± -3.44 and -0.97 ± 3.21 cmH(2)O, P = 0.663) and closely associated (intraclass correlation coefficient = 0.92; 95% confidence interval, 0.78-0.97, P < 0.001). Natural and midazolam-induced Pcrit correlated with obstructive sleep apnea severity, indicating that both Pcrit measures provided meaningful physiological information. Pcrit determined during the day with sleep induction is similar to natural overnight sleep and is a valid alternative approach in which to determine Pcrit.
The objective of this study is to report the experiences of PIBID Biology (Instituto Federal Goiano - Câmpus Urutaí), highlighting the actions performed in Activity of Biological Sciences; vision of ...supervisors fellows on the performance and contribution of the program at the school and contracted teacher training of undergraduates, as well as the vision of scholarship students about the importance of the subproject. To conduct this study we used a descriptive analytical methodology, through which the activities have been reported in a critical and reflective. The subproject of Biological Sciences (PIBID/IF Goiano - Câmpus Urutaí) currently has 15 scholarship students and 3 teachers supervisors Colégio Estadual Professor Ivan Ferreira (CEPIF), Pires do Rio, GO. In general, it can be said that the activities have positively affecting not only the scholarship students, but also the improvement of various aspects related to the teaching of biology in school contracted. The PIBID-biology has enabled its scholars an approximation of their future professional practice.
Acute and chronic dermatological injuries need rapid tissue repair due to the susceptibility to infections. To effectively promote cutaneous wound recovery, it is essential to develop safe, low-cost, ...and affordable regenerative tools. Therefore, we aimed to identify the biological mechanisms involved in the wound healing properties of the glycosaminoglycan dermatan sulfate (DS), obtained from ascidian Styela plicata, a marine invertebrate, which in preliminary work from our group showed no toxicity and promoted a remarkable fibroblast proliferation and migration. In this study, 2,4-DS (50 µg/mL)-treated and control groups had the relative gene expression of 84 genes participating in the healing pathway evaluated. The results showed that 57% of the genes were overexpressed during treatment, 16% were underexpressed, and 9.52% were not detected. In silico analysis of metabolic interactions exhibited overexpression of genes related to: extracellular matrix organization, hemostasis, secretion of inflammatory mediators, and regulation of insulin-like growth factor transport and uptake. Furthermore, in C57BL/6 mice subjected to experimental wounds treated with 0.25% 2,4-DS, the histological parameters demonstrated a great capacity for vascular recovery. Additionally, this study confirmed that DS is a potent inducer of wound-healing cellular pathways and a promoter of neovascularization, being a natural ally in the tissue regeneration strategy.
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