Objective: To examine the effect of nasal bilevel positive airway pressure (BiPAP) treatment for concurrent sleep-related breathing disorders (SRBDs) and attention-deficit hyperactivity disorder ...(ADHD) on electrophysiological measures of spontaneous brain activity and auditory stimulus processing.
Methods: Nineteen children diagnosed with both SRBD and ADHD participated. Electroencephalogram (EEG) activity was recorded during a resting period and an auditory oddball task before beginning BiPAP treatment, after 6 months on treatment, and after a subsequent 1 week non-treatment period. Treatment effects on EEG and event-related potentials (ERPs) to target stimuli were examined via topographic analysis.
Results: Thirteen of the initial 19 children completed 6 months of BiPAP therapy, with six lost mainly due to compliance problems. Children on BiPAP therapy showed a significant decrease in slow-wave (delta and theta) and an increase in fast wave (beta) EEG activity. The P3 component of the ERP showed treatment effects in amplitude and latency.
Conclusions: The electrophysiological data suggest that SRBDs may contribute to ADHD symptomatology. Treatment of SRBD with BiPAP therapy in children with concurrent ADHD can lead to significant changes, in the direction of normalization, of the typical electrophysiological features of ADHD.
This article reviews the history of dental therapy as it has led up to currently available options for the treatment of sleep-related breathing disorders with an emphasis on oral appliance therapy. ...Over the last 20 years and in particular the last 5 to 7 years the contribution as well as the effectiveness of oral appliances has impacted the treatment of sleep apnea and at the same time provides an alternative for many patients. The focus here is to examine oral appliances and the role they have as it may be delivered by the dentist with an interest as well as the expertise in dental sleep medicine.
A 43‐year‐old woman presented with dull headache, left tinnitus and dizziness. Neurological examination revealed down‐beat gaze nystagmus, left tinnitus, positive Romberg sign, poor standing on the ...left foot, poor tandem gait, left spastic gait and positive pathological reflexes in the bilateral upper and lower extremities. Plain X‐ray of the skull and cervical vertebrae demonstrated basilar impression and atlantoaxial fusion. Magnetic resonance imaging of the brain and cervical spine showed cerebellar tonsil descent and syringomyelia located in the left side of the spine at the II‐III vertebral level which communicated with the fourth ventricle. The patient was diagnosed as having cervical syringomyelia, Arnold‐Chiari type I malformation and basilar impression. Preoperative polysomnography showed dysrhythmic breathing and bradypnea during sleep. Abnormal breathing improved after suboccipital decompression craniotomy and upper cervical laminectomy. It was suggested that dysrhythmic breathing was caused by a disorder of the medullary respiratory center. Herniation of the cerebellar tonsil and syringomyelia might have compressed the medulla.
The aim of this study was to find out whether there are specific facial types and a specific hyoid bone position in preschool children with sleep-related breathing disorder (SBD). A total of 69 ...children were divided into 4 groups based on the mandibular line/Frankfurt horizontal angle and apnea index. There were 19 children with hyperdivergent facial type and SBD and 19 children with neutral facial type and SBD, all of them with documented 0 < AI < 5. Ten children had hyperdivergent facial type and non-SBD, and 21 children neutral facial type and non-SBD. The present findings show that SBD may be associated with both hyperdivergent and neutral facial type. Furthermore, we could not find any specific hyoid bone position related to SBD, non-SBD, or to facial type. In conclusion, it is important to note that while evaluation based on facial type (mandibular shape or position) does not necessarily distinguish between children with SBD and children without SBD (non-SBD), important differences are found in the pharynx. Short nasal floor length, long soft palate, and particularly short upper pharyngeal width can be considered indicators of SBD.
The facial patterns of 29 children under the age of 15 years with tonsil and/or adenoid and sleep disorder problems was analysed. The lateral‐cephalograms of these patients was digitized in a ...zero‐based computer program using Ricketts analysis to examine facial patterns. Results of the analysis were compared with the mean of the control group, n = 41 (9‐year‐old Japanese children). There were significant
differences (P < 0.01–0.001) between the patient group and the control group when comparing the facial axis, lower facial height, mandibular arc, total facial height, and McNamara–Pogonion. The facial pattern of children with sleep breathing disorders was discovered to be the dolico facial pattern.
Objective: this study was aimed at characterizing the craniofacial structures, i.e. the facial skeleton, cranial base, dentition, pharyngeal airway space, and the hyoid bone position, in healthy ...preschool children without sleep-related breathing disorder.
Materials and methods: from lateral cephalometric radiographs taken of 92 children for diagnostic purposes, 45 were selected for the present investigation on the basis of head position, and divided according to the classification of Siriwat and Jarabak (Angle Orthod. 55 (1985) 127) into groups representing counter-clockwise (CC), straight downward (SD), and clockwise (C) facial types.
Results: the findings showed that, in comparison with the other groups, CC is associated with larger facial taper and posterior facial height, smaller mandibular line angle, ramus position, lower facial height and cranial base angle. By a similar comparison, C is associated with larger mandibular line, gonial angles and convexity, and with a smaller L–1 to mandibular line angle. There were no significant differences in hyoid bone position among the three groups. However, the distance of the lower pharynx was smaller in CC than in C, while the tongue base of CC was noted to be in a posterior position.
Conclusions: thus, the results indicate that there are significant differences in the madibular position and form among the present three groups of children. It is proposed that the objective of vertical facial control ought to be included in the treatment of preschool children with malocclusion and respiratory disorder.
Between September 1996 and January 1999 we used polysomnography (PSG) to examine 473 patients (involving a total of 662 records). The diagnosis was a sleep‐related breathing disorder in 256 patients, ...including sleep apnea syndrome (SAS) in 194 patients, sleep hypoxicemia in 18 and insomnia in the other four. The SAS consisted of three subtypes: central apnea (CA) in 56 patients, obstructive apnea (OA) in 124 and mixed apnea (MA) in eight. The ratio of central apnea was relatively higher than the national average. Among the 473 patients, the most common complication was heart disease (133 patients) while other complications included hypertension, and respiratory and cerebrovascular diseases. Concerning the therapy for these patients, continuous positive airway pressure therapy was the most commonly applied and was effective in each type of SAS (CA, OA, MA). Other therapies included prosthetic mandibular advancement, bilevel positive airway pressure, medication and ENT operations. In Koga Hospital, there are many patients with heart disease and/or respiratory disease. We examined those patients who presented with snoring and/or apnea using PSG. Among these patients, SAS was the most common sleep disorder. The relative ratio of CA was high and the average age was higher than those with OA.
In this article we summarize the available information regarding the epidemiology, the pathophysiology as well as the risk factors and complications of the sleep apnea syndrome (SAS). Central, ...obstructive and mixed forms of SAS are known, however, the obstructive form is (resulting from the actual high prevalence of obesity) definitely the most frequent. Latest years of experimental and clinical research have pointed towards the clinical importance of this sleep related breathing disorder. High prevalence in the population and especially the cardiovascular complications (e. g. systemic and pulmonary hypertension, atherosclerosis, arrhythmias) have contributed to the recent increase in knowledge about SAS. Nevertheless, there are numerous unsolved problems and unanswered questions in the pathophysiology of SAS. Future studies should, thus, provide us with more information and shed light on regarding the hidden mysteries of SAS.
We hypothesize that breathing disorder related arousal index (B‐ArI) can differentiate sleep breathing disorder from simple snorer when apnea hypopnea index (AHI) is low. We studied 54 patients using ...polysomnography. Breathing disorder related arousal (B‐Ar) was defined as arousal accompanied by apnea, hypopnea, desaturation or snort. Mean AHI was 44.2 ± 34.0/h, and B‐ArI correlated significantly with AHI, desaturation index, percentage total sleep time with SpO2 below 90%. Breathing disorder related arousal index was greater than AHI when AHI was below 20. In 11/54 patients, AHI was below 10, and B‐ArI more than 10. Nasal continuous positive airway pressure was applied to six patients and showed reduced B‐ArI. Breathing disorder related arousal index may be one of the useful indices for the diagnosis of sleep breathing disorder when AHI is less than 10.
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