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Prevalence and predictors of sleep disordered breathing in patients undergoing chronic ambulatory intermittent hemodialysis
Abstracts / Sleep Medicine 14S (2013) e93–e164
(78.38%) vs 71 (62.28%), p = 0.07; heart failure 14 (87.5%) vs 86 (63.7%), p = 0.06; sleep suffocation 57 (73.08%) vs 43 (58.9%), p = 0.07. Receiver operating characteristics (ROC) analysis reveals statistic significance for: age (p < 0.01, AUC = 0.69, cut-off = 49 years), neck circumference (p < 0.01, AUC = 0.67, cut-off = 44 cm), abdominal circumference (p < 0.01, AUC = 0.70, cut-off = 112 cm), BMI (p < 0.01, AUC = 0.70, cut-off = 32.03 kg/m2), glycemia (p = 0.03, AUC = 0.59, cut-off = 93 mg/dl), supine AHI position (p = 0.03, AUC = 0.59, cut-off = 48 events/h), medium O2 saturation (p < 0.01, AUC = 0.70, cut-off <95%), oxygen desaturation index (p < 0.01, AUC = 0.63, cut-off = 17.88 ) and ESS (p = 0.03, AUC = 0.59, cut-off = 8). Multivariate analysis on logistic model on body mass index, neck circumference, age, abdominal circumference, glycemia, desaturation index, heart failure, medium O2saturation, snoring, sleep restless, sleep suffocation, supine AHI position and ESS retains only body mass index, neck circumference and age. Conclusion: 1. Arterial hypertension from OSAS is significantly influenced by body mass index, neck circumference and age. 2. An increase of BMI by 1 kg/m2 would entail the risk of hypertension by 2.4%. An increase of 1 cm neck circumference would entail the risk of hypertension by 0.6%. An increase in age by 10 years would entail the risk of hypertension by 7.8%. http://dx.doi.org/10.1016/j.sleep.2013.11.216
Neurophysiological evaluation of spinal excitability in patients affected by primitive restless legs syndrome P. Congiu 1, G. Milioli 2, G. Gioi 1, P. Tacconi 3, M. Fantini 4, M. Puligheddu 1 1 Sleep Disorder Center, University of Cagliari, Italy 2 Sleep Disorder Center, University of Parma, Italy 3 Neurology UOC, University of Cagliari, Italy 4 Dip di Neuroscienze, University of Torino, Italy
Introduction: Restless legs syndrome (RLS) is a frequent pathology, yet underrated and underestimated, affecting inasmuch as 5–10% of the population as a whole. However the pathophysiology has not been completely understood. The dopaminergic system has certainly a primary role, and some studies have highlighted a condition of spinal hyper-excitability. The aim of our study is to explore this hypothesis throughout the electrophysiological evaluation of the spinal and peripheral nervous system in primitives RLS patients. Materials and methods: Among the patients affected by primitive RLS admitted to our Sleep Centerlab, we selected 15 women, and compared them with 17 control subjects of the same sex and age. All subjects had undergone ENG evaluation to exclude any secondary causes of lower limb paresthesia and to evaluate spinal excitability. According to a previous study, we considered two parameters which can be easily extracted from the routine tests normally carried out in the neurophysiopathology labs, the duration of F waves (FWD) of the Internal Popliteal (IPN) and ulnar nerves, and the relationship between FWD and the duration of the corresponding CMAP (CMAPD). Results: None of the subjects (RLS and controls) included in our study presented alterations in the nerve conduction velocity. Compared to the control group, significantly higher values were found in the RLS patients for the FWD/CMAPD ratio average (p < 0.001 test Mann–Whitney) and for the FWD average for both nerves ulnar (p < 0.05 unpaired t-test) and IPN (p < 0.01 unpaired t-test). Conclusion: The results of our study confirm the absence of peripheral involvement in primitive RLS, while they indicate a spinal motorneuronal hyper-excitability, which seems widespread, as both IPN and ulnar nerve stimulation indicators are altered. Such condi-
e101
tion could be due mainly to an alteration of the modulation in the interneuronal system. Presently, RLS diagnosis is based exclusively on clinical criteria. The FWD/CMAPD ratio can help to shed light on the pathogenesis of RLS, and can be used as an instrumental diagnostic indicator, easily obtainable and useful especially in cases of lower leg discomfort at night of unclear interpretation. Acknowledgements: The authors would like to thank Prof. F. Marrosu and Dr. M. Fraschini, University of Cagliari, Italy, and Prof. L. Parrino, University of Parma, Italy, for their important contribution. http://dx.doi.org/10.1016/j.sleep.2013.11.217
Sleep breathing disorders screening in chilean miners J. Santin, P. Moya, P. Contreras, E. Pincheira Centro Médico del Sueño, Pontificia Universidad Catolica de Chile, Chile
Introduction: Sleep Breathing Disorders (SBD) constitute a risk factor for workplace accidents whose consequences have cost in human lives and environmental damage. Since they can be aggravated in high altitude its identification in mining workers is crucial. Objectives: to establish the relation between a screening practiced with night pulse oximetry, and Epworth and Berlin questionnaires in patients clinically suspicious of SDB and polysomnography results, performed in a high altitude chilean mine setting. Materials and methods: A group of 100 consecutive mining workers had an all-night oxymetry done at their work place, (a 2600 meters high camp); those with abnormal oximetries had a PSG performed at the same setting, as part of a ’’Prevention of fatigue and sleep disorders’’ program. They also answered the Epworth scale and Berlin questionnaire. Results: 78% of the workers had abnormal oxymetries and in 74 of them (94%) the PSG showed sleep apnea of different severity; in 24 of these patients (32%) it was related to posture. The average Epworth score was 4.28 while for the Berlin questionnaire it was 2.27. Conclusion: All nigh oximetry is a reliable predictor of SDB as shown by the PSG in chilean high altitude mine workers. SBD is highly prevalent in these type of patients. Epworth and Berlin questionnaires failed to suggest hypersomnolence or SDB; it is speculated that this latter finding can be explained by workers fear to lose their jobs if they recognize the presence of hypersomnolence or witnessed apneas. Acknowledgement: We thank technical personnel support for this research. http://dx.doi.org/10.1016/j.sleep.2013.11.218
Prevalence and predictors of sleep disordered breathing in patients undergoing chronic ambulatory intermittent hemodialysis F. Cornette 1, A. Ogna 1, V. Forni 2, M. Burnier 2, R. Heinzer 1 1 Center for Investigation and Research in Sleep (CIRS), CHUV, Switzerland 2 Department of Nephrology and Hypertension, CHUV, Switzerland
Introduction: Sleep disordered breathing (SDB) is a common finding in chronic hemodialysis (CHD) patients. Two recent American studies investigated the prevalence of SDB in patients with different degree of chronic kidney disease and reported a prevalence of 26– 57%. The purpose of this study is to evaluate the prevalence of SDB and to evaluate the predictive value of Berlin questionnaire, hemod-
e102
Abstracts / Sleep Medicine 14S (2013) e93–e164
ialysis frequency and duration, and biometric parameters in a large group of European patients undergoing CHD. Materials and methods: All the patients attending six CHD centers in the western part of Switzerland were screened. Eligible patients completed the Berlin questionnaire, a validated 11 items form used to evaluate the risk of obstructive sleep apnea and the Epworth Sleepiness Scale (ESS). All patients underwent a home nocturnal polygraphy (PG) using Apnea Link Plus system recording nasal pressure, oxygen saturation, thoracic movements and heart rate. Respiratory events were scored according to the AASM 99 criteria. Apnea-hypopnea index (AHI) was calculated by dividing the total number of apnea and hypopnea during the night by the recording time. Results: Among 166 screening patients, 98 were included and 71 completed the study (50 men, mean age 61.8 ± 15.4, neck circumference 40.6 ± 4.6 cm, BMI 25.7 ± 4.8 kg/m2). Mean AHI was 23.9 ± 20.4/ h (18% obstructive apnea, 8.5% central apnea, 2.4% mixed apnea). Among these 71 patients, 31% had severe SDB (AHI P 30/h), 23.9% had moderate SDB (AHI 15–30/h), 31% had mild SDB (AHI 5–15/h) and 14.1% were normal (AHI < 5/h). Berlin’s questionnaire showed a high risk of SDB in 62.5% of the patients with a sensitivity of 65%, a specificity of 39%, a positive predictive value of 58% and a negative predictive value of 47%. According to ESS, 18.5% of the patients had significant sleepiness (>10/24). Using a logistic regression model including age, sex, BMI, neck circumference, Berlin questionnaire, ESS, smoking, alcohol, number/week and duration of CHD session, the only independent predictor was neck circumference with odds ratio of 1.59 (p = 0.023). Conclusion: The prevalence of SDB in the CHD population is higher than expected. Berlin questionnaire is not useful to screen for SDB in CHD patients but neck circumference seems to be an independant predictor of SDB in this population. Acknowledgements: Supported by the Leenaards Foundation, Ligue Pulmonaire Vaudoise, Swiss National Foundation for Research, GSK. http://dx.doi.org/10.1016/j.sleep.2013.11.219
Orofacial myology therapy: a case report of upper airway resistance syndrome C. Corrêa, S. Megale, G. Berretin-Felix Bauru School of Dentistry, University of São Paulo, Brazil
Introduction: The orofacial myology area is important in changing muscle tonus that composes the oropharynx in cases of sleep disorders, with emphasis on subjects diagnosed with obstructive sleep apnea syndrome (OSAS). However, there are not observed reports of patients with upper airway resistance syndrome (UARS) who did not have polysomnographic characteristics of OSAS. Therefore, the aim of this study was to analyze the before-and-after results of orofacial myology therapy through a case report of UARS. Materials and methods: For this, we used the aspects of orofacial myology evaluation and quality of sleep in the Berlin Questionnaire and Epworth Sleepiness Scale (ESS). The patient is 61 years old, male, BMI 22.3, with high arterial blood. He swims regularly. He presented at the Clinic of Speech Pathology, Faculty of Dentistry of Bauru – University of São Paulo, with this complaint: ‘‘I wake up scared about six times during the night, and I feel tired during the day.’’ According to diagnosis of an otorhinolaryngologist, the patient had UARS. Results: In the orofacial myology evaluation, his observed neck circumference was 39 cm, Mallampati score IV, hypotonic tongue, increased size, altered mobility and tooth marks, hypotonic soft palate and altered mobility. He presented nasal breathing, lower–middle type, preferential unilateral chewing, contractions atypical of orbicu-
lar and menstrual in swallowing, and normal speech function. In terms of quality of sleep, he scored 13 points on the ESS and three positive categories in the Berlin Questionnaire, meaning high risk for sleep apnea. After 12 therapy sessions a week and exercising at home three times a day, orofacial myology revaluation was done, This was the only mode of treatment during the study period. Observed neck circumference was 37 cm, Mallampati score III, normal tonus, size and mobility of tongue, normal tonus and mobility of soft palate. Functions found nasal breathing, lower–middle type, simultaneous bilateral chewing, adequate swallowing and speech. The questionnaires result a score of 9 on the ESS and one positive category in the Berlin Questionnaire; therefore, a low risk for sleep apnea. Conclusion: Furthermore, the patient reported that he felt a significant improvement in quality of sleep, waking only three times during the night and realizing that he feels rested during the day. This clinical case showed that it is possible for orofacial myology to improve aspects of sleep quality. Acknowledgements: To the patient who engaged during months of therapy and entrusted in Speech-Language Pathologist work. http://dx.doi.org/10.1016/j.sleep.2013.11.220
Electronic tutor about obstructive sleep apnea syndrome: development and evaluation of a health collaborative network C. Corrêa, G. Berretin-Felix, A. Fukushiro, W. Blasca Bauru School of Dentistry, University of São Paulo, Brazil
Introduction: There are studies worldwide about the prevalence of obstructive sleep apnea syndrome (OSAS), including Brazil, where apnea was observed in 32.8% of general population. Although there is a high prevalence of OSAS, there is not always a diagnosis using the same scale because of the lack of information. The World Sleep Day, held on date, helped draw attention to the effects of sleep health; consequently, more people have become aware of the enormous importance of sleep for our health. The Cybertutor has valuable tools to promote sleep health through Interactive Teleducation. Such knowledge makes possible better dynamics, interactive access, and motivation. The aim of the present study was to develop and evaluate content about OSAS and sleep health for a Cybertutor. Materials and methods: We used textual resources, based on scientific publications, selecting, summarizing, and adapting the material language. In addition, we used audiovisual resources to make the educational material motivating and attractive. For evaluation of language, we used the Flesch Reading Facility Index (FRFI) that results in a percentage of a given document’s level of legibility; the higher the level of reading facility in the text, the better. Results: This study has resulted in the creation of three modules on sleep health: ‘‘Obstructive Sleep Apnea Syndrome’’ with nine topics, ‘‘Treatment’’ with nine topics, and ‘‘Prevention’’ with six topics. Related to the contents, the modules contained 19 static images, along with figures and diagrams, 14 videos, and links to two other websites. It was observed that the content of the modules obtained an average of 56% on the FRFI, corresponding to a ‘‘reasonably hard’’ level that requires users to have a minimum level of instruction in high school to ensure language comprehension. Conclusion: Therefore, it is important to carefully consider content development for the Cybertutor or other digital media and do evaluations of the language used to ensure adequate communication of the information and thus construct a health collaborative network. The results of this study were the creation of three modules about OSAS and sleep health, specific for use by a Cybertutor, which received an FRFI rating that indicated a language level corresponding to a minimum of high school instruction.
(78.38%) vs 71 (62.28%), p = 0.07; heart failure 14 (87.5%) vs 86 (63.7%), p = 0.06; sleep suffocation 57 (73.08%) vs 43 (58.9%), p = 0.07. Receiver operating characteristics (ROC) analysis reveals statistic significance for: age (p < 0.01, AUC = 0.69, cut-off = 49 years), neck circumference (p < 0.01, AUC = 0.67, cut-off = 44 cm), abdominal circumference (p < 0.01, AUC = 0.70, cut-off = 112 cm), BMI (p < 0.01, AUC = 0.70, cut-off = 32.03 kg/m2), glycemia (p = 0.03, AUC = 0.59, cut-off = 93 mg/dl), supine AHI position (p = 0.03, AUC = 0.59, cut-off = 48 events/h), medium O2 saturation (p < 0.01, AUC = 0.70, cut-off <95%), oxygen desaturation index (p < 0.01, AUC = 0.63, cut-off = 17.88 ) and ESS (p = 0.03, AUC = 0.59, cut-off = 8). Multivariate analysis on logistic model on body mass index, neck circumference, age, abdominal circumference, glycemia, desaturation index, heart failure, medium O2saturation, snoring, sleep restless, sleep suffocation, supine AHI position and ESS retains only body mass index, neck circumference and age. Conclusion: 1. Arterial hypertension from OSAS is significantly influenced by body mass index, neck circumference and age. 2. An increase of BMI by 1 kg/m2 would entail the risk of hypertension by 2.4%. An increase of 1 cm neck circumference would entail the risk of hypertension by 0.6%. An increase in age by 10 years would entail the risk of hypertension by 7.8%. http://dx.doi.org/10.1016/j.sleep.2013.11.216
Neurophysiological evaluation of spinal excitability in patients affected by primitive restless legs syndrome P. Congiu 1, G. Milioli 2, G. Gioi 1, P. Tacconi 3, M. Fantini 4, M. Puligheddu 1 1 Sleep Disorder Center, University of Cagliari, Italy 2 Sleep Disorder Center, University of Parma, Italy 3 Neurology UOC, University of Cagliari, Italy 4 Dip di Neuroscienze, University of Torino, Italy
Introduction: Restless legs syndrome (RLS) is a frequent pathology, yet underrated and underestimated, affecting inasmuch as 5–10% of the population as a whole. However the pathophysiology has not been completely understood. The dopaminergic system has certainly a primary role, and some studies have highlighted a condition of spinal hyper-excitability. The aim of our study is to explore this hypothesis throughout the electrophysiological evaluation of the spinal and peripheral nervous system in primitives RLS patients. Materials and methods: Among the patients affected by primitive RLS admitted to our Sleep Centerlab, we selected 15 women, and compared them with 17 control subjects of the same sex and age. All subjects had undergone ENG evaluation to exclude any secondary causes of lower limb paresthesia and to evaluate spinal excitability. According to a previous study, we considered two parameters which can be easily extracted from the routine tests normally carried out in the neurophysiopathology labs, the duration of F waves (FWD) of the Internal Popliteal (IPN) and ulnar nerves, and the relationship between FWD and the duration of the corresponding CMAP (CMAPD). Results: None of the subjects (RLS and controls) included in our study presented alterations in the nerve conduction velocity. Compared to the control group, significantly higher values were found in the RLS patients for the FWD/CMAPD ratio average (p < 0.001 test Mann–Whitney) and for the FWD average for both nerves ulnar (p < 0.05 unpaired t-test) and IPN (p < 0.01 unpaired t-test). Conclusion: The results of our study confirm the absence of peripheral involvement in primitive RLS, while they indicate a spinal motorneuronal hyper-excitability, which seems widespread, as both IPN and ulnar nerve stimulation indicators are altered. Such condi-
e101
tion could be due mainly to an alteration of the modulation in the interneuronal system. Presently, RLS diagnosis is based exclusively on clinical criteria. The FWD/CMAPD ratio can help to shed light on the pathogenesis of RLS, and can be used as an instrumental diagnostic indicator, easily obtainable and useful especially in cases of lower leg discomfort at night of unclear interpretation. Acknowledgements: The authors would like to thank Prof. F. Marrosu and Dr. M. Fraschini, University of Cagliari, Italy, and Prof. L. Parrino, University of Parma, Italy, for their important contribution. http://dx.doi.org/10.1016/j.sleep.2013.11.217
Sleep breathing disorders screening in chilean miners J. Santin, P. Moya, P. Contreras, E. Pincheira Centro Médico del Sueño, Pontificia Universidad Catolica de Chile, Chile
Introduction: Sleep Breathing Disorders (SBD) constitute a risk factor for workplace accidents whose consequences have cost in human lives and environmental damage. Since they can be aggravated in high altitude its identification in mining workers is crucial. Objectives: to establish the relation between a screening practiced with night pulse oximetry, and Epworth and Berlin questionnaires in patients clinically suspicious of SDB and polysomnography results, performed in a high altitude chilean mine setting. Materials and methods: A group of 100 consecutive mining workers had an all-night oxymetry done at their work place, (a 2600 meters high camp); those with abnormal oximetries had a PSG performed at the same setting, as part of a ’’Prevention of fatigue and sleep disorders’’ program. They also answered the Epworth scale and Berlin questionnaire. Results: 78% of the workers had abnormal oxymetries and in 74 of them (94%) the PSG showed sleep apnea of different severity; in 24 of these patients (32%) it was related to posture. The average Epworth score was 4.28 while for the Berlin questionnaire it was 2.27. Conclusion: All nigh oximetry is a reliable predictor of SDB as shown by the PSG in chilean high altitude mine workers. SBD is highly prevalent in these type of patients. Epworth and Berlin questionnaires failed to suggest hypersomnolence or SDB; it is speculated that this latter finding can be explained by workers fear to lose their jobs if they recognize the presence of hypersomnolence or witnessed apneas. Acknowledgement: We thank technical personnel support for this research. http://dx.doi.org/10.1016/j.sleep.2013.11.218
Prevalence and predictors of sleep disordered breathing in patients undergoing chronic ambulatory intermittent hemodialysis F. Cornette 1, A. Ogna 1, V. Forni 2, M. Burnier 2, R. Heinzer 1 1 Center for Investigation and Research in Sleep (CIRS), CHUV, Switzerland 2 Department of Nephrology and Hypertension, CHUV, Switzerland
Introduction: Sleep disordered breathing (SDB) is a common finding in chronic hemodialysis (CHD) patients. Two recent American studies investigated the prevalence of SDB in patients with different degree of chronic kidney disease and reported a prevalence of 26– 57%. The purpose of this study is to evaluate the prevalence of SDB and to evaluate the predictive value of Berlin questionnaire, hemod-
e102
Abstracts / Sleep Medicine 14S (2013) e93–e164
ialysis frequency and duration, and biometric parameters in a large group of European patients undergoing CHD. Materials and methods: All the patients attending six CHD centers in the western part of Switzerland were screened. Eligible patients completed the Berlin questionnaire, a validated 11 items form used to evaluate the risk of obstructive sleep apnea and the Epworth Sleepiness Scale (ESS). All patients underwent a home nocturnal polygraphy (PG) using Apnea Link Plus system recording nasal pressure, oxygen saturation, thoracic movements and heart rate. Respiratory events were scored according to the AASM 99 criteria. Apnea-hypopnea index (AHI) was calculated by dividing the total number of apnea and hypopnea during the night by the recording time. Results: Among 166 screening patients, 98 were included and 71 completed the study (50 men, mean age 61.8 ± 15.4, neck circumference 40.6 ± 4.6 cm, BMI 25.7 ± 4.8 kg/m2). Mean AHI was 23.9 ± 20.4/ h (18% obstructive apnea, 8.5% central apnea, 2.4% mixed apnea). Among these 71 patients, 31% had severe SDB (AHI P 30/h), 23.9% had moderate SDB (AHI 15–30/h), 31% had mild SDB (AHI 5–15/h) and 14.1% were normal (AHI < 5/h). Berlin’s questionnaire showed a high risk of SDB in 62.5% of the patients with a sensitivity of 65%, a specificity of 39%, a positive predictive value of 58% and a negative predictive value of 47%. According to ESS, 18.5% of the patients had significant sleepiness (>10/24). Using a logistic regression model including age, sex, BMI, neck circumference, Berlin questionnaire, ESS, smoking, alcohol, number/week and duration of CHD session, the only independent predictor was neck circumference with odds ratio of 1.59 (p = 0.023). Conclusion: The prevalence of SDB in the CHD population is higher than expected. Berlin questionnaire is not useful to screen for SDB in CHD patients but neck circumference seems to be an independant predictor of SDB in this population. Acknowledgements: Supported by the Leenaards Foundation, Ligue Pulmonaire Vaudoise, Swiss National Foundation for Research, GSK. http://dx.doi.org/10.1016/j.sleep.2013.11.219
Orofacial myology therapy: a case report of upper airway resistance syndrome C. Corrêa, S. Megale, G. Berretin-Felix Bauru School of Dentistry, University of São Paulo, Brazil
Introduction: The orofacial myology area is important in changing muscle tonus that composes the oropharynx in cases of sleep disorders, with emphasis on subjects diagnosed with obstructive sleep apnea syndrome (OSAS). However, there are not observed reports of patients with upper airway resistance syndrome (UARS) who did not have polysomnographic characteristics of OSAS. Therefore, the aim of this study was to analyze the before-and-after results of orofacial myology therapy through a case report of UARS. Materials and methods: For this, we used the aspects of orofacial myology evaluation and quality of sleep in the Berlin Questionnaire and Epworth Sleepiness Scale (ESS). The patient is 61 years old, male, BMI 22.3, with high arterial blood. He swims regularly. He presented at the Clinic of Speech Pathology, Faculty of Dentistry of Bauru – University of São Paulo, with this complaint: ‘‘I wake up scared about six times during the night, and I feel tired during the day.’’ According to diagnosis of an otorhinolaryngologist, the patient had UARS. Results: In the orofacial myology evaluation, his observed neck circumference was 39 cm, Mallampati score IV, hypotonic tongue, increased size, altered mobility and tooth marks, hypotonic soft palate and altered mobility. He presented nasal breathing, lower–middle type, preferential unilateral chewing, contractions atypical of orbicu-
lar and menstrual in swallowing, and normal speech function. In terms of quality of sleep, he scored 13 points on the ESS and three positive categories in the Berlin Questionnaire, meaning high risk for sleep apnea. After 12 therapy sessions a week and exercising at home three times a day, orofacial myology revaluation was done, This was the only mode of treatment during the study period. Observed neck circumference was 37 cm, Mallampati score III, normal tonus, size and mobility of tongue, normal tonus and mobility of soft palate. Functions found nasal breathing, lower–middle type, simultaneous bilateral chewing, adequate swallowing and speech. The questionnaires result a score of 9 on the ESS and one positive category in the Berlin Questionnaire; therefore, a low risk for sleep apnea. Conclusion: Furthermore, the patient reported that he felt a significant improvement in quality of sleep, waking only three times during the night and realizing that he feels rested during the day. This clinical case showed that it is possible for orofacial myology to improve aspects of sleep quality. Acknowledgements: To the patient who engaged during months of therapy and entrusted in Speech-Language Pathologist work. http://dx.doi.org/10.1016/j.sleep.2013.11.220
Electronic tutor about obstructive sleep apnea syndrome: development and evaluation of a health collaborative network C. Corrêa, G. Berretin-Felix, A. Fukushiro, W. Blasca Bauru School of Dentistry, University of São Paulo, Brazil
Introduction: There are studies worldwide about the prevalence of obstructive sleep apnea syndrome (OSAS), including Brazil, where apnea was observed in 32.8% of general population. Although there is a high prevalence of OSAS, there is not always a diagnosis using the same scale because of the lack of information. The World Sleep Day, held on date, helped draw attention to the effects of sleep health; consequently, more people have become aware of the enormous importance of sleep for our health. The Cybertutor has valuable tools to promote sleep health through Interactive Teleducation. Such knowledge makes possible better dynamics, interactive access, and motivation. The aim of the present study was to develop and evaluate content about OSAS and sleep health for a Cybertutor. Materials and methods: We used textual resources, based on scientific publications, selecting, summarizing, and adapting the material language. In addition, we used audiovisual resources to make the educational material motivating and attractive. For evaluation of language, we used the Flesch Reading Facility Index (FRFI) that results in a percentage of a given document’s level of legibility; the higher the level of reading facility in the text, the better. Results: This study has resulted in the creation of three modules on sleep health: ‘‘Obstructive Sleep Apnea Syndrome’’ with nine topics, ‘‘Treatment’’ with nine topics, and ‘‘Prevention’’ with six topics. Related to the contents, the modules contained 19 static images, along with figures and diagrams, 14 videos, and links to two other websites. It was observed that the content of the modules obtained an average of 56% on the FRFI, corresponding to a ‘‘reasonably hard’’ level that requires users to have a minimum level of instruction in high school to ensure language comprehension. Conclusion: Therefore, it is important to carefully consider content development for the Cybertutor or other digital media and do evaluations of the language used to ensure adequate communication of the information and thus construct a health collaborative network. The results of this study were the creation of three modules about OSAS and sleep health, specific for use by a Cybertutor, which received an FRFI rating that indicated a language level corresponding to a minimum of high school instruction.