- Email: [email protected]
HYPOPNEAS (OSAH)
S66
Abstracts of 3rd International Congress of the Association of Sleep Medicine (WASM) / Sleep Medicine 10, Suppl. 2 (2009) S1–S83
well recognized in adults. The influence of each component of the lateral pharyngeal wall in the genesis of OSA, including fat tissue, muscles, tonsils and blood vessels, is currently under investigation. Although the subjective measurement of the tonsils is an easy and simple task on its own, this measurement, which is based upon airway geometry, may be influenced by weight and pharyngeal geometry. To the best of our knowledge, the correlation of objective tonsil volume with its subjective measurement and OSA severity has not been evaluated in adults. Objective: The purpose of this study is to evaluate the correlation between the objective and subjective measurement of palatine tonsil volume and its influence on OSA severity in adults. Patients and Methods: The patient cohort consisted of 130 patients, of whom 92 were men, who underwent pharyngeal surgeries that included tonsillectomy to treat simple snoring or OSA. The physical and clinical characteristics of each patient were obtained by a chart review. An evaluation was performed to identify the correlations between objective tonsil volume and multiple parameters, which included the following: i) subjective tonsil grade; ii) oropharyngeal parameters, including the Malampatti and Friedman stages; iii) anthropometric measurements, including age and body mass index (BMI); and iv) polysomnographic parameters, including OSA severity, apnea-hypopnea index (AHI), and oxyhemoglobin nadir. Results: Tonsil volume was significantly associated with tonsil grade (P=0.005) and the Friedman stage (P<0.001) and positively correlated with AHI (s=0.18, P=0.04). Although tonsil volume showed a tendency to correlate with the OSA rank of severity (P=0.053), there was no association between tonsil grade and the actual severity of OSA. Multivariate linear regression showed that the majority of tonsil volume variations were related to tonsil grade, with very little influence of age or BMI. Neither the OSA rank of severity nor the AHI have an influence on the variations in tonsil volume. Conclusion: In adult snorers and OSA patients, there is a very good correlation between subjective tonsil grade and objective tonsil volume. There was no association between tonsil grade and the severity rank of OSA, and none of the polysomnographic parameters that influence or determine OSA severity account for any variations in tonsil volume. Therefore, tonsil volume does not appear to have a relevant role in the lateral pharyngeal wall alterations that are found in OSA.
243
SLEEP-RELATED BREATHING DISORDERS IN SCHOOLCHILDREN AND THEIR ASSOCIATION WITH OBESITY AND SCHOOL PERFORMANCE
J. Carrillo 1 , C. Aranda 1 , R. Barna 1 , C. Borel 2 . 1 UA; 2 HLCM Introduction: Sleep-related breathing disorders (SRBDs) constitute a public health problem. International studies with children show an association between symptoms of snoring at night and learning difficulties, cognitive deficits and socially inappropriate behavior. This study represents the first investigation of the prevalence of these disorders and their associated factors in Chile. Objective: To elucidate the epidemiological aspects of SRBDs and their potential association with obesity and poor school performance. Methods: We performed a study with first-grade students at elementary schools in the municipal district of San Miguel in Santiago. A total of 120 parents (or students’ proxies) were administered the Pediatric Sleep Questionnaire prior to physical examination of the children. We measured their height and weight then computed the Body Mass Index (BMI) for each age and sex. At the end of the school year, we collected data on the school performance of the subjects. Results: In the sample, 71% did not snore or did so occasionally; 29% did so always or more than 50% of the time. Obese schoolchildren presented a relative risk (RR) of 2.27 (p<0.01) of snoring. Schoolchildren that snore presented an RR equal to 3.14 (p<0.01) of having poor academic results (averages grades <5.1) in comparison to non-snoring students (averages grades >6). In both comparison groups, we did not find any gender-related differences. Conclusion: Our results show that obese children are more likely to be snorers and that they, in turn, are more likely of having poorer academic performance than non-snorers.
244
SEASONAL VARIATION OF SLEEP DISORDERED-BREATHING EVENTS: EVIDENCE FROM MORE THAN TEN THOUSAND POLYSOMNOGRAPHIES
C.M. Cassol 1 , C.Z. Fiori 1 , C. Klein 1 , D. Massierer 1 , G.N.S. Pires 2 , L. Rahmeier 3 , M.C.S. Lenz 3 , D. Martinez 4 . 1 Division of Cardiology - Hospital de Clinicas de Porto Alegre (HCPA) - UFRGS; 2 UFCSPA; 3 LIPS-UFRGS; 4 Division of Cardiology, Hospital de Clinicas de Porto Alegre (HCPA) - UFRGS Introduction: Sleep-disordered breathing (SDB) is worsened by factors which patients may suffer during seasonal variation, such as body weight, rhinitis, and pharyngeal permeability. This association could be explained by allergic responses or obstructive events. Objectives: To assess the seasonal variation of SDB events in polysomnographies. Methods: We used a database with 10,550 polysomnographies (PSG) carried out since 1986 in Porto Alegre city, at the 30°S parallel, where mean temperatures range from 14°C in July to 25°C in January. The following variables were analyzed: sleep efficiency (SEf); sleep latency (SLat); duration of sleep stages (N1, N2, N3, REM); number of central (NC), obstructive (NO) and mixed (NM) apneas; longest apnea (LA); apnea-hypopnea index (AHI); and minimum SaO2 (SaO2min). Results: Of the variables analyzed on a monthly basis, we found differences in N1 to be shorter in January (32±18 min) compared to all other months; and AHI to be significantly lower in January (23±25 AH/hour) as compared to July (28±27/h; p=0.021), August (30±29/h; p=0.000009), September (28±27/h; p=0.043), and October (28±26/h; p=0.006). Analyzing on a seasonal basis, we found significant differences in N1, N2, NO, LA, AHI, and SaO2min. The mean total night number of obstructive apneas in summertime is 95±136, significantly less than in wintertime (111±144; p=0.0004) and in springtime (109±140; p=0.004). Cosinor analysis showed significant seasonality of obstructive events. We did not find significant differences either seasonally or monthly in NC and NM. Conclusions: In Porto Alegre, wintertime is related to increased obstructive, but not central or mixed, SDB events. This may explain variations in cardiovascular and respiratory outcomes that are recognized as primarily seasonal, but may be secondary to SDB.
245
USE AND REFUSE OF NASAL CPAP IN OBSTRUCTIVE SLEEP APNEAS/HYPOPNEAS (OSAH)
J.L. Castillo 1 , F. Araya 2 , G. Bustamante 3 , C. Torres 3 , L. Montecino 3 , S. Oporto 3 , L. Segovia 4 . 1 Dpto. Neurological Sciences. Universidad de Chile; 2 Servicio de Neurología, Hospital del Salvador; 3 Dpto Neurological Sciences. Universidad de Chile; 4 Clinica Santa Maria Background: CPAP is the principal therapy for Obstructive Sleep Apnea Syndrome (OSAS). Aim: To assess CPAP titration using split-night polysomnography (PSG) and to determine patients’ acceptance of use of the device. Patients and Methods: Patients sent to PSG with diagnosis of OSAS were queried by means of a sleep questionnaire and the Epworth sleep scale. Patients with 15 or more apneas/hypopneas in the first hours of the night were manually titrated with CPAP. Six months later, patients were interviewed in phone calls during which they were asked to report the use of PAP. Results: Between September 2007 and February 2008, 95 patients completed the study and 42 patients were titrated with CPAP. An optimal or good titration was obtained in 27 (64.3%) patients. In 15 (35.7%) patients, CPAP titration was considered unsatisfactory. Out of 42 patients, 35 were contacted through phone calls six months later; only 9 (25.7%) were using CPAP regularly and perceived an improvement in their symptoms. A total of 26 (74.3%) patients refused this treatment. Conclusion: An organized approach to CPAP therapy, including education and clinical and technical support of patients and clinicians attending this syndrome, is necessary to improve acceptance and adherence.
246
EFFICACY OF AN ORAL APPLIANCE (OA) COMPARED TO NCPAP WITH RESPECT TO QUALITY OF LIFE AND NEUROCOGNITIVE FUNCTIONING IN OSAS PATIENTS
C. Dal-Fabbro, S.A. Garbuio, V. D’Almeida, S. Tufik, L.R.A. Bittencourt. UNIFESP Introduction: OSAS patients can present both neurobehavioral functioning
Abstracts of 3rd International Congress of the Association of Sleep Medicine (WASM) / Sleep Medicine 10, Suppl. 2 (2009) S1–S83
well recognized in adults. The influence of each component of the lateral pharyngeal wall in the genesis of OSA, including fat tissue, muscles, tonsils and blood vessels, is currently under investigation. Although the subjective measurement of the tonsils is an easy and simple task on its own, this measurement, which is based upon airway geometry, may be influenced by weight and pharyngeal geometry. To the best of our knowledge, the correlation of objective tonsil volume with its subjective measurement and OSA severity has not been evaluated in adults. Objective: The purpose of this study is to evaluate the correlation between the objective and subjective measurement of palatine tonsil volume and its influence on OSA severity in adults. Patients and Methods: The patient cohort consisted of 130 patients, of whom 92 were men, who underwent pharyngeal surgeries that included tonsillectomy to treat simple snoring or OSA. The physical and clinical characteristics of each patient were obtained by a chart review. An evaluation was performed to identify the correlations between objective tonsil volume and multiple parameters, which included the following: i) subjective tonsil grade; ii) oropharyngeal parameters, including the Malampatti and Friedman stages; iii) anthropometric measurements, including age and body mass index (BMI); and iv) polysomnographic parameters, including OSA severity, apnea-hypopnea index (AHI), and oxyhemoglobin nadir. Results: Tonsil volume was significantly associated with tonsil grade (P=0.005) and the Friedman stage (P<0.001) and positively correlated with AHI (s=0.18, P=0.04). Although tonsil volume showed a tendency to correlate with the OSA rank of severity (P=0.053), there was no association between tonsil grade and the actual severity of OSA. Multivariate linear regression showed that the majority of tonsil volume variations were related to tonsil grade, with very little influence of age or BMI. Neither the OSA rank of severity nor the AHI have an influence on the variations in tonsil volume. Conclusion: In adult snorers and OSA patients, there is a very good correlation between subjective tonsil grade and objective tonsil volume. There was no association between tonsil grade and the severity rank of OSA, and none of the polysomnographic parameters that influence or determine OSA severity account for any variations in tonsil volume. Therefore, tonsil volume does not appear to have a relevant role in the lateral pharyngeal wall alterations that are found in OSA.
243
SLEEP-RELATED BREATHING DISORDERS IN SCHOOLCHILDREN AND THEIR ASSOCIATION WITH OBESITY AND SCHOOL PERFORMANCE
J. Carrillo 1 , C. Aranda 1 , R. Barna 1 , C. Borel 2 . 1 UA; 2 HLCM Introduction: Sleep-related breathing disorders (SRBDs) constitute a public health problem. International studies with children show an association between symptoms of snoring at night and learning difficulties, cognitive deficits and socially inappropriate behavior. This study represents the first investigation of the prevalence of these disorders and their associated factors in Chile. Objective: To elucidate the epidemiological aspects of SRBDs and their potential association with obesity and poor school performance. Methods: We performed a study with first-grade students at elementary schools in the municipal district of San Miguel in Santiago. A total of 120 parents (or students’ proxies) were administered the Pediatric Sleep Questionnaire prior to physical examination of the children. We measured their height and weight then computed the Body Mass Index (BMI) for each age and sex. At the end of the school year, we collected data on the school performance of the subjects. Results: In the sample, 71% did not snore or did so occasionally; 29% did so always or more than 50% of the time. Obese schoolchildren presented a relative risk (RR) of 2.27 (p<0.01) of snoring. Schoolchildren that snore presented an RR equal to 3.14 (p<0.01) of having poor academic results (averages grades <5.1) in comparison to non-snoring students (averages grades >6). In both comparison groups, we did not find any gender-related differences. Conclusion: Our results show that obese children are more likely to be snorers and that they, in turn, are more likely of having poorer academic performance than non-snorers.
244
SEASONAL VARIATION OF SLEEP DISORDERED-BREATHING EVENTS: EVIDENCE FROM MORE THAN TEN THOUSAND POLYSOMNOGRAPHIES
C.M. Cassol 1 , C.Z. Fiori 1 , C. Klein 1 , D. Massierer 1 , G.N.S. Pires 2 , L. Rahmeier 3 , M.C.S. Lenz 3 , D. Martinez 4 . 1 Division of Cardiology - Hospital de Clinicas de Porto Alegre (HCPA) - UFRGS; 2 UFCSPA; 3 LIPS-UFRGS; 4 Division of Cardiology, Hospital de Clinicas de Porto Alegre (HCPA) - UFRGS Introduction: Sleep-disordered breathing (SDB) is worsened by factors which patients may suffer during seasonal variation, such as body weight, rhinitis, and pharyngeal permeability. This association could be explained by allergic responses or obstructive events. Objectives: To assess the seasonal variation of SDB events in polysomnographies. Methods: We used a database with 10,550 polysomnographies (PSG) carried out since 1986 in Porto Alegre city, at the 30°S parallel, where mean temperatures range from 14°C in July to 25°C in January. The following variables were analyzed: sleep efficiency (SEf); sleep latency (SLat); duration of sleep stages (N1, N2, N3, REM); number of central (NC), obstructive (NO) and mixed (NM) apneas; longest apnea (LA); apnea-hypopnea index (AHI); and minimum SaO2 (SaO2min). Results: Of the variables analyzed on a monthly basis, we found differences in N1 to be shorter in January (32±18 min) compared to all other months; and AHI to be significantly lower in January (23±25 AH/hour) as compared to July (28±27/h; p=0.021), August (30±29/h; p=0.000009), September (28±27/h; p=0.043), and October (28±26/h; p=0.006). Analyzing on a seasonal basis, we found significant differences in N1, N2, NO, LA, AHI, and SaO2min. The mean total night number of obstructive apneas in summertime is 95±136, significantly less than in wintertime (111±144; p=0.0004) and in springtime (109±140; p=0.004). Cosinor analysis showed significant seasonality of obstructive events. We did not find significant differences either seasonally or monthly in NC and NM. Conclusions: In Porto Alegre, wintertime is related to increased obstructive, but not central or mixed, SDB events. This may explain variations in cardiovascular and respiratory outcomes that are recognized as primarily seasonal, but may be secondary to SDB.
245
USE AND REFUSE OF NASAL CPAP IN OBSTRUCTIVE SLEEP APNEAS/HYPOPNEAS (OSAH)
J.L. Castillo 1 , F. Araya 2 , G. Bustamante 3 , C. Torres 3 , L. Montecino 3 , S. Oporto 3 , L. Segovia 4 . 1 Dpto. Neurological Sciences. Universidad de Chile; 2 Servicio de Neurología, Hospital del Salvador; 3 Dpto Neurological Sciences. Universidad de Chile; 4 Clinica Santa Maria Background: CPAP is the principal therapy for Obstructive Sleep Apnea Syndrome (OSAS). Aim: To assess CPAP titration using split-night polysomnography (PSG) and to determine patients’ acceptance of use of the device. Patients and Methods: Patients sent to PSG with diagnosis of OSAS were queried by means of a sleep questionnaire and the Epworth sleep scale. Patients with 15 or more apneas/hypopneas in the first hours of the night were manually titrated with CPAP. Six months later, patients were interviewed in phone calls during which they were asked to report the use of PAP. Results: Between September 2007 and February 2008, 95 patients completed the study and 42 patients were titrated with CPAP. An optimal or good titration was obtained in 27 (64.3%) patients. In 15 (35.7%) patients, CPAP titration was considered unsatisfactory. Out of 42 patients, 35 were contacted through phone calls six months later; only 9 (25.7%) were using CPAP regularly and perceived an improvement in their symptoms. A total of 26 (74.3%) patients refused this treatment. Conclusion: An organized approach to CPAP therapy, including education and clinical and technical support of patients and clinicians attending this syndrome, is necessary to improve acceptance and adherence.
246
EFFICACY OF AN ORAL APPLIANCE (OA) COMPARED TO NCPAP WITH RESPECT TO QUALITY OF LIFE AND NEUROCOGNITIVE FUNCTIONING IN OSAS PATIENTS
C. Dal-Fabbro, S.A. Garbuio, V. D’Almeida, S. Tufik, L.R.A. Bittencourt. UNIFESP Introduction: OSAS patients can present both neurobehavioral functioning