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Hansen KK, Hilberg O, Løkke A. High prevalence of undiagnosed and treatment-requiring obstructive sleep apnea and nocturnal desaturation in outpatients with severe chronic obstructive pulmonary disease. Respir Med 2024; 233:107771. [PMID: 39142596 DOI: 10.1016/j.rmed.2024.107771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/10/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Kristina Kock Hansen
- Department of Medicine, University Hospital of Southern Denmark, Lillebaelt Hospital, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Ole Hilberg
- Department of Medicine, University Hospital of Southern Denmark, Lillebaelt Hospital, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Anders Løkke
- Department of Medicine, University Hospital of Southern Denmark, Lillebaelt Hospital, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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Garofalo E, Neri G, Perri LM, Lombardo N, Piazzetta G, Antonelli A, Biamonte E, Bosco V, Battaglia C, Pelaia C, Manti F, Pitino A, Tripepi G, Bruni A, Morelli M, Giudice A, Longhini F. Assessment of cephalometric parameters and correlation with the severity of the obstructive sleep apnea syndrome. J Transl Med 2024; 22:377. [PMID: 38649914 PMCID: PMC11036665 DOI: 10.1186/s12967-024-05194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In individuals diagnosed with obstructive sleep apnea syndrome (OSAS), variations in craniofacial structure have been inconsistently documented, showing differing degrees of alteration between obese and nonobese patients. In addition, sleep disturbance has also been shown to induce disequilibrium in this population of patients. This pilot observational study aimed to assess craniofacial values in obese and nonobese subpopulations of patients with OSAS and their correlation and association with the severity of OSAS. We also assessed whether OSAS patients are characterized by an impaired equilibrium in relation to and associated with the severity of OSAS. METHODS We included all consecutive adult patients with OSAS. Through cephalometry, we assessed the upper (UPa-UPp) and lower (LPa-LPp) pharynx diameters, superior anterior facial height (Sor-ANS), anterior facial height (ANS-Me), anterior vertical dimension (Sor-Me), posterior facial height (S-Go) and craniovertebral angle (CVA). Furthermore, we analyzed postural equilibrium through a stabilometric examination. RESULTS Forty consecutive OSAS patients (45% female with a mean age of 56 ± 8.2 years) were included. The subgroup of nonobese patients had a reduced UPa-UPp (p = 0.02). Cephalometric measurements were correlated with the severity of OSAS in nonobese patients, whereas only Sor-ANS was correlated with the severity of OSAS in the obese subpopulation. In the overall population, altered craniofacial values are associated with severe OSAS. Although there are differences in equilibrium between obese and nonobese OSAS patients, the stabilometric measurements were not correlated or associated with OSAS severity. CONCLUSION Altered craniofacial values and compromised equilibrium in OSAS patients are linked to OSAS severity. Therefore, the management of OSAS should be tailored not only to weight management but also to craniofacial and postural rehabilitation to enhance patient outcomes.
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Affiliation(s)
- Eugenio Garofalo
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Giuseppe Neri
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Lucilla Maria Perri
- Department of Health Sciences, School of Dentistry, Magna Graecia University, Catanzaro, Italy
| | - Nicola Lombardo
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Giovanna Piazzetta
- Department of Otolaryngology, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | - Alessandro Antonelli
- Department of Health Sciences, School of Dentistry, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Biamonte
- Department of Anesthesia and Intensive Care, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | - Vincenzo Bosco
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Caterina Battaglia
- Department of Radiology, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Francesco Manti
- Department of Radiology, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | | | | | - Andrea Bruni
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy.
| | - Michele Morelli
- Department of Obstetrics and Gynecology, "Annunziata" Hospital, Cosenza, Italy
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, Magna Graecia University, Catanzaro, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
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Alghamdi MA, Alzahrani R, Ali MA, Alharthi Z, Alyahya AM, Alghamdi AH, Alghamdi BN, Alghamdi W. Knowledge, Awareness, and Attitude Regarding Obstructive Sleep Apnea Among Primary Healthcare Physicians in the Al-Baha Region of Saudi Arabia. Cureus 2024; 16:e51435. [PMID: 38298303 PMCID: PMC10828977 DOI: 10.7759/cureus.51435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a clinically significant disorder that requires attention from healthcare professionals. This study aimed to assess the knowledge, awareness, and attitude of primary healthcare physicians regarding OSA in Saudi Arabia. METHODOLOGY A cross-sectional observational study design was employed from January 18, 2023, to August 18, 2023, focusing on primary healthcare physicians practicing in the Al-Baha region of Saudi Arabia. The survey included questions related to knowledge, awareness, and attitudes toward OSA, using the Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) questionnaire for OSA, and demographic information. Descriptive statistics and chi-square tests were used to analyze the data. RESULTS A total sample size of 174 primary health care physicians was collected, where the majority of participants were male (101, 58.0%), and the mean age of the participants was 32.73 years (SD = 9.14). The item with the most correct answers was "The majority of patients with obstructive sleep apnea snore" (150, 86.2%). On the other hand, the item with the lowest number of correct answers was "Laser-assisted uvulopalatoplasty is an appropriate treatment for severe obstructive sleep apnea" (17, 9.8%). The majority of participants agreed that it is essential for physicians to know about OSA as a clinical disorder (161, 92.5%). However, when it came to screening all patients for possible OSA, there was a higher proportion of participants who disagreed or strongly disagreed (111, 63.8%). In general, the majority of participants had a low level of knowledge (109, 62.6%). Gender was significantly associated with both knowledge (p = 0.021) and awareness (p = 0.039), as well as nationality (knowledge (p = 0.012) and awareness (p = 0.039)), and specialty training, which was significantly associated with both knowledge (p = 0.000) and awareness (p = 0.002). CONCLUSION Although all participants acknowledged that OSA is a clinical disease, their perspectives on screening and levels of confidence in utilizing screening techniques varied. While the participants exhibited commendable understanding in the majority of domains, there were some facets of OSA in which they lacked expertise.
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Affiliation(s)
- Mohammed A Alghamdi
- Unit of Otolaryngology, Department of Surgery, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Rajab Alzahrani
- Unit of Otolaryngology, Department of Surgery, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Mujtaba A Ali
- Unit of Otolaryngology, Department of Surgery, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Ziyad Alharthi
- Department of Medicine, Al-Baha University, Al-Baha, SAU
| | | | | | | | - Wejdan Alghamdi
- Family Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
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Berjaoui C, Tesfasilassie Kibrom B, Ghayyad M, Joumaa S, Talal Al Labban N, Nazir A, Kachouh C, Akanmu Moradeyo A, Wojtara M, Uwishema O. Unveiling the sleep-cardiovascular connection: Novel perspectives and interventions-A narrative review. Health Sci Rep 2023; 6:e1773. [PMID: 38107151 PMCID: PMC10723785 DOI: 10.1002/hsr2.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Sleep is an important neurophysiological condition that is intricately linked to general health, laying the basis for both physiological and psychological well-being. A thorough examination of sleep disorders and cardiovascular health demonstrates their deep relationship, emphasizing the numerous diagnostic tools and treatment techniques available. Aim This study aims to examine the impact, mechanisms, diagnostic techniques, treatment strategies, implications, and healthcare interventions of the sleep-cardiovascular connection, to better understand the relationship between sleep disorders and cardiovascular health. Methods The paper reviews key studies conducted from 2015-till date, investigating the impact of sleep disorders on the cardiovascular system. It looked into data relating to cardiovascular outcomes based on the degree of sleep disorders, considered potential confounding factors, and addressed current research constraints. Results The findings highlight a strong link between sleep problems and poor cardiovascular outcomes. Emerging diagnostic tools, such as enhanced sleep-related technology and biomarkers, open up new avenues for determining the impact of sleep disturbances on cardiovascular health. In addition, the research discusses several treatment options, ranging from cognitive behavioral therapy to pharmaceutical therapies, and their potential benefits in addressing sleep-related cardiovascular risks. Conclusion The complex association between sleep disturbances and cardiovascular health emphasizes the need to recognize sleep as a critical component of overall well-being. Thus collaboration among medical disciplines, as well as individualized therapies, are critical to improving patient care. Moreover, Understanding and managing the consequences of sleep problems on cardiovascular health can lead to more effective interventions, better outcomes, and improved public health as research advances.
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Affiliation(s)
- Christin Berjaoui
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Bethlehem Tesfasilassie Kibrom
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Mohammad Ghayyad
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Safaa Joumaa
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine, Faculty of Medical ScienceLebanese UniversityBeirutLebanon
| | - Nihal Talal Al Labban
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Abubakar Nazir
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | - Charbel Kachouh
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of MedicineSaint‐Joseph UniversityBeirutLebanon
| | - Abdulrahmon Akanmu Moradeyo
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine and SurgeryLadoke Akintola University of TechnologyOgbomoshoNigeria
| | - Magda Wojtara
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
| | - Olivier Uwishema
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of MedicineClinton Global Initiative UniversityNew YorkNew YorkUSA
- Department of MedicineKaradeniz Technical UniversityTrabzonTurkey
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Katasani T, Holt G, Al-Khyatt W, Idris I. Peri- and Postoperative Outcomes for Obstructive Sleep Apnoea Patients after Bariatric Surgery-a Systematic Review and Meta-analysis. Obes Surg 2023; 33:2016-2024. [PMID: 37140722 PMCID: PMC10289925 DOI: 10.1007/s11695-023-06557-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is prevalent among patients undergoing bariatric surgery. Previous studies have reported a higher risk of complications, ICU admission and longer length of stay in patients with OSA following surgery. However, clinical outcomes following bariatric surgery are unclear. The hypothesis is that patients with OSA will have an increased risk of these outcome measures after bariatric surgery. METHODS A systematic review and meta-analysis were performed to answer the research question. Searches for bariatric surgery and obstructive sleep apnoea were performed using PubMed and Ovid Medline. Studies which compared OSA and non-OSA patients undergoing bariatric surgery and used outcome measures that included length of stay, risk of complications, 30-day readmission and need for ICU admission were selected for the systematic review. Comparable datasets from these studies were used for the meta-analysis. RESULTS Patients with OSA are at greater risk of complications after bariatric surgery (RR = 1.23 [CI: 1.01, 1.5], P = 0.04), driven mostly by an increased risk of cardiac complications (RR = 2.44 [CI: 1.26, 4.76], P = 0.009). There were no significant differences between the OSA and non-OSA cohorts in the other outcome variables (respiratory complications, length of stay, 30-day readmission and need for ICU admission). CONCLUSION Following bariatric surgery, patients with OSA must be managed carefully due to the increased risk of cardiac complications. However, patients with OSA are not more likely to require a longer length of stay or readmission.
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Affiliation(s)
- Tarun Katasani
- Medical School, University of Nottingham, Nottingham, UK
| | - Guy Holt
- Royal Derby Hospital, East Midlands Bariatric & Metabolic Institute, Derby, DE22 3NE, UK
| | - Waleed Al-Khyatt
- Royal Derby Hospital, East Midlands Bariatric & Metabolic Institute, Derby, DE22 3NE, UK
| | - Iskandar Idris
- Royal Derby Hospital, East Midlands Bariatric & Metabolic Institute, Derby, DE22 3NE, UK.
- Clinical, Metabolic and Molecular Physiology Research Group, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK.
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Abu-Awwad SA, Craina M, Gluhovschi A, Boscu L, Bernad E, Iurciuc M, Abu-Awwad A, Iurciuc S, Tudoran C, Bernad R, Maghiari AL. Comparative Analysis of Neonatal Effects in Pregnant Women with Cardiovascular Risk versus Low-Risk Pregnant Women. J Clin Med 2023; 12:4082. [PMID: 37373775 DOI: 10.3390/jcm12124082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are a leading cause of mortality and morbidity worldwide. Pregnancy imposes unique physiological changes on a woman's cardiovascular system. MATERIALS AND METHODS A cohort of 68 participants, comprising 30 pregnant women with cardiovascular risk and 38 without cardiovascular risk, was recruited for this study. These participants were prospectively followed during their pregnancies from 2020 to 2022 at the Obstetrics and Gynecology Department of the "Pius Brînzeu" Emergency County Clinical Hospital in Timişoara, Romania. All women included in this study underwent cesarean section deliveries at the same medical facility. Data regarding the gestational weeks at delivery, birth weight, and Apgar scores assessed by neonatologists were collected for each participant. Statistical analyses were performed to compare the neonatal effects between the two groups. RESULTS The results of this study revealed significant differences between the groups in terms of Apgar scores (p = 0.0055), gestational weeks (p = 0.0471), and baby birth weight (p = 0.0392). CONCLUSION The findings underscore the importance of considering maternal cardiovascular health as a potential determinant of neonatal outcomes. Further research is needed to elucidate the underlying mechanisms and develop strategies for optimizing neonatal outcomes in high-risk pregnancies.
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Affiliation(s)
- Simona-Alina Abu-Awwad
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Marius Craina
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adrian Gluhovschi
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Lioara Boscu
- Senate Office, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Elena Bernad
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mircea Iurciuc
- Senate Office, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Departament VI-Discipline of Outpatient Internal Medicine, Cardiovascular Prevention and Recovery, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Ahmed Abu-Awwad
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Department XV-Discipline of Orthopedics-Traumatology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Center University Professor Doctor Teodor Șora, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Stela Iurciuc
- Senate Office, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Departament VI-Discipline of Outpatient Internal Medicine, Cardiovascular Prevention and Recovery, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Cristina Tudoran
- Discipline of Cardiology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- "Pius Brinzeu" Emergency County Clinical Hospital, Blvd Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Robert Bernad
- Department of Automatic Control and Applied Informatics, Politehnica University of Timisoara, 300223 Timisoara, Romania
| | - Anca Laura Maghiari
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Department I-Discipline of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
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Caldarelli V, Porcaro F, Filippo PD, Attanasi M, Fainardi V, Gallucci M, Mazza A, Ullmann N, La Grutta S. Long-Term Ventilation in Children with Medical Complexity: A Challenging Issue. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1700. [PMID: 36360427 PMCID: PMC9688784 DOI: 10.3390/children9111700] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/11/2022] [Accepted: 10/28/2022] [Indexed: 12/09/2023]
Abstract
Children with medical complexity (CMCs) represent a subgroup of children who may have congenital or acquired multisystemic disease. CMCs are frequently predisposed to respiratory problems and often require long-term mechanical ventilation (LTMV). The indications for LTMV in CMCs are increasing, but gathering evidence about indications, titration, and monitoring is currently the most difficult challenge due to the absence of validated data. The aim of this review was to examine the clinical indications and ethical considerations for the initiation, continuation, or withdrawal of LTMV among CMCs. The decision to initiate long-term ventilation should always be based on clinical and ethical considerations and should be shared with the parents.
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Affiliation(s)
- Valeria Caldarelli
- Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Paola Di Filippo
- Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy
| | - Marina Attanasi
- Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy
| | - Valentina Fainardi
- Cystic Fibrosis Unit, Department of Paediatrics, Parma University Hospital, 43126 Parma, Italy
| | - Marcella Gallucci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, 40126 Bologna, Italy
| | - Angelo Mazza
- Department of Pediatrics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Stefania La Grutta
- Institute of Traslational Pharmacology IFT, National Research Council, 90146 Palermo, Italy
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Ye Min Soe KT, Ishiyama H, Nishiyama A, Shimada M, Maeda S. Effect of Different Maxillary Oral Appliance Designs on Respiratory Variables during Sleep. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6714. [PMID: 35682298 PMCID: PMC9180795 DOI: 10.3390/ijerph19116714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022]
Abstract
This study aimed to analyze the efficacy of maxillary oral appliance (MOA) designs on respiratory variables during sleep. At baseline, 23 participants underwent a sleep test with a portable device for two nights and were categorized as participants with mild obstructive sleep apnea (mild-OSA) (n = 13) and without OSA (w/o-OSA) (n = 10). Three types of MOAs, standard-OA (S-OA), palatal covering-OA (PC-OA), and vertically increasing-OA (VI-OA), were each worn for three nights, and sleep tests with each MOA were performed with a portable device for two nights. Based on the average of the respiratory event index (REI) values for the two nights for each MOA, w/o-OSA participants with an REI ≥ 5.0 were defined as the exacerbation group and those with an REI < 5.0 as the non-exacerbation group. In mild-OSA participants, an REI ≥ 15.0 or REI ≥ baseline REI × 1.5 were defined as the exacerbation group and those with an REI < 15.0 and REI < baseline REI × 1.5 were defined as the non-exacerbation group. The percentage of the exacerbation and non-exacerbation groups with MOA was evaluated in the w/o-OSA and mild-OSA participants. The maxillary and mandibular dental-arch dimension was compared by dentition model analysis. The exacerbation group in w/o-OSA participants (n = 10) comprised 10.0% participants (n = 1) with S-OA, 40.0% (n = 4) with PC-OA, and 30.0% (n = 3) with VI-OA. The exacerbation group in the mild-OSA participants (n = 13) comprised 15.4% subjects (n = 2) with S-OA, 23.1% (n = 3) with PC-OA, and 23.1% (n = 3) in VI-OA. In the model analysis for w/o-OSA, the posterior dental arch width was significantly greater in the exacerbation group than in the non-exacerbation group wearing S-OA (p < 0.05). In addition, the ratio of the maxillary to mandibular dental arch width (anterior dental arch width) was significantly greater in the exacerbation group than in the non-exacerbation group for both PC-OA and VI-OA (p < 0.05). In mild-OSA, the maxillary and mandibular dental arch lengths and the ratio of maxillary to mandibular dental arch width (posterior dental arch width) were significantly smaller in the exacerbation group than in the non-exacerbation group for S-OA (p < 0.05). This study confirmed that wearing an MOA by w/o-OSA and mild-OSA participants may increase the REI during sleep and that PC-OA and VI-OA may increase the REI more than S-OA. The maxillary and mandibular dental-arch dimensions may affect the REI when using an MOA.
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Affiliation(s)
- Kay Thwe Ye Min Soe
- Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Hiroyuki Ishiyama
- Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Akira Nishiyama
- Department of General Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Masahiko Shimada
- Dental Anesthesiology and Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Shigeru Maeda
- Dental Anesthesiology and Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
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Assessment of the Effectiveness of Obstructive Sleep Apnea Treatment Using Optical Coherence Tomography to Evaluate Retinal Findings. J Clin Med 2022; 11:jcm11030815. [PMID: 35160269 PMCID: PMC8837143 DOI: 10.3390/jcm11030815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
Retinal findings may change in patients with obstructive sleep apnea syndrome (OSAS). The present study aims to evaluate several retinal findings, such as macula layer thickness, the peripapillary retinal nerve fiber layer, and the optic nerve head in patients with OSAS, using optical coherence tomography (OCT); it also aims to monitor the result of several types of treatment of OSAS with OCT. A prospective comparative study was designed. Patients were recruited at a Sleep Unit of a University Hospital and underwent comprehensive ophthalmological examinations. Following exclusion criteria, fifty-two patients with OSAS were finally included. Patients were examined by OCT twice: once before treatment, and again after six months of treatment. In mild–moderate patients, where retinal swelling had been demonstrated, retinal thicknesses decreased [fovea (p = 0.026), as did inner ring macula (p = 0.007), outer ring macula (p = 0.015), and macular volume (p = 0.015)]. In severe patients, where retinal atrophy had been observed, retinal thickness increased [fovea (p < 0.001)]. No statistically significant differences in efficacy between treatments were demonstrated. In conclusion, OCT can evaluate the retina in patients with OSAS and help to monitor results after treatment. In severe OSAS, retinal thickness increased six months after treatment.
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10
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Tenney-Soeiro R, Sieplinga K. Teaching about children with medical complexity: A blueprint for curriculum design. Curr Probl Pediatr Adolesc Health Care 2021; 51:101129. [PMID: 35086780 DOI: 10.1016/j.cppeds.2021.101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Children with medical complexity make up a small portion of the pediatric population but utilize a large percentage of health care time and spending. The medical needs of children with medical complexity are highly variable and the education of healthcare providers in the care of these children has taken on more significance. Designing curricula and educational innovations related to the care of children with medical complexity can be challenging. Familiarity with the sociocultural theory, the zone of proximal development, Kolb's experiential learning model, and the educational resources that already exist allow for more ease in developing a curriculum that fits the needs of learners who may have a wide range of exposure to children with medical complexity. Flipped classroom models, simulations, asynchronous modules, and home and community experiences are all useful learning modalities to provide a varied and important curriculum. Taking advantage of the knowledge and skills of the many different members of the multi-disciplinary team caring for children with medical complexity is an important educational strategy that provides benefits to the learners and can enhance interprofessional education.
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Affiliation(s)
- Rebecca Tenney-Soeiro
- Associate Professor of Pediatrics, Perelman School of Medicine at University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Kira Sieplinga
- Assistant Professor Pediatrics, Program Director Pediatric Residency Spectrum Health, Helen DeVos Children's Hospital, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
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11
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Mc Carthy CE. Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person. Med Sci (Basel) 2021; 9:medsci9020031. [PMID: 34063838 PMCID: PMC8162526 DOI: 10.3390/medsci9020031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/14/2023] Open
Abstract
Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, and may have an impact on quality of life, mortality, falls and disease risk. Sleep assessment should form part of the comprehensive geriatric assessment. If sleep disturbance is brought to light, consideration of sleep disorders, co-morbidity and medication management should form part of a multifaceted approach. Appreciation of the bi-directional relationship and complex interplay between co-morbidity and sleep in older patients is an important element of patient care. This article provides a brief overview of sleep disturbance and sleep disorders in older patients, in addition to their association with specific co-morbidities including depression, heart failure, respiratory disorders, gastro-oesophageal reflux disease, nocturia, pain, Parkinson's disease, dementia, polypharmacy and falls. A potential systematic multidomain approach to assessment and management is outlined, with an emphasis on non-pharmacological treatment where possible.
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Affiliation(s)
- Christine E. Mc Carthy
- Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland;
- HRB-Clinical Research Facility, National University of Ireland, Galway, Co., Galway, Ireland
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12
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Dale N. CO 2 sensing by connexin26 and its role in the control of breathing. Interface Focus 2021; 11:20200029. [PMID: 33633831 PMCID: PMC7898151 DOI: 10.1098/rsfs.2020.0029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/14/2022] Open
Abstract
Breathing is essential to provide the O2 required for metabolism and to remove its inevitable CO2 by-product. The rate and depth of breathing is controlled to regulate the excretion of CO2 to maintain the pH of arterial blood at physiological values. A widespread consensus is that chemosensory cells in the carotid body and brainstem measure blood and tissue pH and adjust the rate of breathing to ensure its homeostatic regulation. In this review, I shall consider the evidence that underlies this consensus and highlight historical data indicating that direct sensing of CO2 also plays a significant role in the regulation of breathing. I shall then review work from my laboratory that provides a molecular mechanism for the direct detection of CO2 via the gap junction protein connexin26 (Cx26) and demonstrates the contribution of this mechanism to the chemosensory regulation of breathing. As there are many pathological mutations of Cx26 in humans, I shall discuss which of these alter the CO2 sensitivity of Cx26 and the extent to which these mutations could affect human breathing. I finish by discussing the evolution of the CO2 sensitivity of Cx26 and its link to the evolution of amniotes.
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Affiliation(s)
- Nicholas Dale
- School of Life Sciences, University of Warwick, Coventry CV4 7AL, UK
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13
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Jagpal SK, Jobanputra AM, Ahmed OH, Santiago TV, Ramagopal M. Sleep-disordered breathing in cystic fibrosis. Pediatr Pulmonol 2021; 56 Suppl 1:S23-S31. [PMID: 33263201 DOI: 10.1002/ppul.25028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/06/2020] [Accepted: 08/08/2020] [Indexed: 11/10/2022]
Abstract
Sleep-disordered breathing (SBD) is an under recognized comorbidity in the cystic fibrosis (CF) population across the lifespan. Nocturnal hypoxemia, obstructive sleep apnea, and nocturnal hypoventilation are respiratory abnormalities that occur commonly during sleep in patients with lung disease, and have deleterious consequences to the quality of life in people with CF. Effective screening for these abnormalities is needed to allow for timely initiation of treatment, which has been reported to be efficacious. Lack of treatment leads to worsened pulmonary, cardiovascular, and metabolic outcomes in patients. In this review, we give an overview of SBD for the CF clinician, including prevalence, treatment, and suggestions for future research. We strongly encourage the CF community to incorporate evaluation for SBD in CF clinical care so that outcomes for the subset of the CF patients with comorbid SBD improve.
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Affiliation(s)
- Sugeet K Jagpal
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Aesha M Jobanputra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Omar H Ahmed
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Teodoro V Santiago
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Maya Ramagopal
- Division of Pediatric Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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14
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Park JW, Mehta S, Fastlicht S, Lowe AA, Almeida FR. Changes in headache characteristics with oral appliance treatment for obstructive sleep apnea. Sci Rep 2021; 11:2568. [PMID: 33510288 PMCID: PMC7843638 DOI: 10.1038/s41598-021-82041-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/22/2020] [Indexed: 01/03/2023] Open
Abstract
Changes in headache characteristics in obstructive sleep apnea (OSA) patients following oral appliance treatment was investigated for the first time. Thirteen OSA patients with headaches treated with a mandibular advancement device were investigated. Level I polysomnography and Migraine Disability Assessment Questionnaire were completed before and after treatment. Various headache characteristics and concomitant conditions were analyzed. The patient was considered a headache responder when ≥ 30% reduction in headache frequency following treatment. Differences in headache and polysomnographic parameters were compared between headache responder groups. Eight patients (62%) were headache responders. Eleven patients (85%) before and 7 (54%) after treatment reported morning headaches. Significantly more patients had bilateral headache in the responder group before treatment (P = 0.035). The severest headache intensity (P = 0.018) at baseline showed a significant decrease in the headache responder group after treatment. The time spent in N2 (r = - 0.663, P = 0.014), REM sleep (r = 0.704, P = 0.007) and mean oxygen saturation (r = 0.566, P = 0.044) showed a significant correlation with post-treatment average headache intensity. Pre-treatment lower PLM index (r = - 0.632, P = 0.027) and higher mean oxygen saturation levels (r = 0.592, P = 0.043) were significantly correlated with higher post-treatment severest headache intensity. Treatment with an oral appliance is beneficial for many OSA patients with headaches. It should be considered as an alternative treatment in headache patients with mild to moderate OSA.
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Affiliation(s)
- Ji Woon Park
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sujay Mehta
- Vancouver Orofacial Pain, 1160 Burrard Street #701, Vancouver, BC, V6Z 2E8, Canada
| | - Sandra Fastlicht
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Alan A Lowe
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Fernanda R Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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15
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Plotogea OM, Ilie M, Bungau S, Chiotoroiu AL, Stanescu AMA, Diaconu CC. Comprehensive Overview of Sleep Disorders in Patients with Chronic Liver Disease. Brain Sci 2021; 11:brainsci11020142. [PMID: 33499194 PMCID: PMC7911845 DOI: 10.3390/brainsci11020142] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
The impact of sleep disorders (SDs) on patients with chronic liver diseases (CLD) is tremendous. SDs are frequently encountered among these patients and interfere with their quality of life. This review aims to present the data available so far about the prevalence, phenotypes, and proposed pathophysiological mechanisms of SDs in CLD. Moreover, we proposed to search the literature regarding the most reliable methods to assess SDs and the possible therapeutic options in patients with CLD. The main results of this review show that when it comes to prevalence, the percentages reported vary widely between studies performed among populations from the USA or Europe and those coming from Asian countries. Furthermore, it has been proven that SDs may also be present in the absence of neurocognitive disorders attributable to hepatic encephalopathy (HE), which contradicts traditional suppositions where SDs were considered part of the clinical scenario of HE. Currently, there are no specific recommendations or protocols to assess SDs in CLD patients and data about the therapeutic management are limited. Taking into consideration their impact, a protocol for diagnosing and managing SDs should be developed and included in the daily practice of hepatologists.
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Affiliation(s)
- Oana-Mihaela Plotogea
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
- Correspondence: (O.-M.P.); (C.C.D.)
| | - Madalina Ilie
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | | | | | - Camelia Cristina Diaconu
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
- Correspondence: (O.-M.P.); (C.C.D.)
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16
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Herrero Babiloni A, Beetz G, Dal Fabbro C, Martel MO, Huynh N, Masse JF, Sessle B, Lavigne GJ. Dental sleep medicine: Time to incorporate sleep apnoea education in the dental curriculum. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:605-610. [PMID: 32320121 DOI: 10.1111/eje.12533] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/10/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
Dental sleep medicine is a discipline that includes conditions such as sleep breathing disorders (eg snoring and sleep apnoea), sleep bruxism, orofacial pain and sleep-related complaints, and to some extent gastro-oesophageal reflux disorder and/or insomnia. Obstructive sleep apnoea (OSA) is a life-threatening condition that dentists need to identify and manage when indicated in order to increase patient well-being and to be taken in consideration in the dental curriculum. The main objective of this paper is to highlight the relevance of dental sleep medicine in the context of dental education, and to discuss potential educational content for integration in the dental curriculum with a focus on OSA, a condition that is not yet integrated in many dental training curricula around the world.
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Affiliation(s)
- Alberto Herrero Babiloni
- Sacré-Coeur Hospital, University of Montreal, Montreal, QC, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, QC, Canada
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Gabrielle Beetz
- Sacré-Coeur Hospital, University of Montreal, Montreal, QC, Canada
| | | | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada
- Faculty of Dentistry & Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Nelly Huynh
- Faculty of Dental Medicine, University of Montreal, Montreal, QC, Canada
| | | | - Barry Sessle
- Faculty of Medicine, Faculty of Dentistry and Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Gilles J Lavigne
- Sacré-Coeur Hospital, University of Montreal, Montreal, QC, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, QC, Canada
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada
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17
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Association between sleep-disordered breathing and lower extremity artery disease: a meta-analysis. Sleep Breath 2020; 25:227-236. [DOI: 10.1007/s11325-020-02096-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
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18
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Wei Y, Zheng B, Fan J, Lv J, Guo Y, Bian Z, Du H, Yang L, Chen Y, Chen J, Zhong X, Chen J, Chen Z, Yu C, Li L. Habitual snoring, adiposity measures and risk of type 2 diabetes in 0.5 million Chinese adults: a 10-year cohort. BMJ Open Diabetes Res Care 2020; 8:8/1/e001015. [PMID: 32111718 PMCID: PMC7050323 DOI: 10.1136/bmjdrc-2019-001015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/31/2019] [Accepted: 01/14/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The present study aimed to examine whether habitual snoring was independently associated with risk of type 2 diabetes among Chinese adults, and to assess the role that adiposity measures play in the snoring-diabetes association, as well as to evaluate the joint influence of snoring and adiposity measures on diabetes. RESEARCH DESIGN AND METHODS The China Kadoorie Biobank study recruited 512 715 adults aged 30-79 years from 10 regions in China during 2004 and 2008. Data from 482 413 participants without baseline diabetes were analyzed in the present study. Autoregressive cross-lagged panel analysis was used to assess the longitudinal relationship between adiposity measures and habitual snoring. Cox proportional hazards models were used to examine the association between habitual snoring and diabetes risk. RESULTS Both higher body mass index and waist circumference were associated with higher risks of subsequent habitual snoring, whereas no reverse association was detected. A total of 16 479 type 2 diabetes cases were observed during a 10-year follow-up. Habitual snoring was independently associated with 12% (95% CI 6% to 18%) and 14% (95% CI 9% to 19%) higher risks of diabetes among men and women, respectively. Habitual snorers who had general obesity or central obesity were about twice as likely to develop diabetes as non-snorers at the lowest levels of adiposity measures. CONCLUSION Habitual snoring was independently associated with a higher risk of type 2 diabetes among Chinese adults. It is important to maintain both a healthy weight and a normal waist circumference to prevent or alleviate habitual snoring and ultimately prevent diabetes among Chinese adults.
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Affiliation(s)
- Yuxia Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Bang Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Junning Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
- Peking University Institute of Environmental Medicine, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Huaidong Du
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jianxin Chen
- Public Health Department, Pengzhou People's Hospital, Pengzhou, China
| | - Xunfu Zhong
- NCDs Prevention and Control Department, Pengzhou CDC, Pengzhou, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Lavigne G, Herrero Babiloni A, Beetz G, Dal Fabbro C, Sutherland K, Huynh N, Cistulli P. Critical Issues in Dental and Medical Management of Obstructive Sleep Apnea. J Dent Res 2019; 99:26-35. [DOI: 10.1177/0022034519885644] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This critical review focuses on obstructive sleep apnea (OSA) and its management from a dental medicine perspective. OSA is characterized by ≥10-s cessation of breathing (apnea) or reduction in airflow (hypopnea) ≥5 times per hour with a drop in oxygen and/or rise in carbon dioxide. It can be associated with sleepiness and fatigue, impaired mood and cognition, cardiometabolic complications, and risk for transportation and work accidents. Although sleep apnea is diagnosed by a sleep physician, its management is interdisciplinary. The dentist’s role includes 1) screening patients for OSA risk factors (e.g., retrognathia, high arched palate, enlarged tonsils or tongue, enlarged tori, high Mallampati score, poor sleep, supine sleep position, obesity, hypertension, morning headache or orofacial pain, bruxism); 2) referring to an appropriate health professional as indicated; and 3) providing oral appliance therapy followed by regular dental and sleep medical follow-up. In addition to the device features and provider expertise, anatomic, behavioral, demographic, and neurophysiologic characteristics can influence oral appliance effectiveness in managing OSA. Therefore, OSA treatment should be tailored to each patient individually. This review highlights some of the putative action mechanisms related to oral appliance effectiveness and proposes future research directions.
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Affiliation(s)
- G.J. Lavigne
- Faculté de médicine dentaire, Université de Montréal, Montréal, Canada
- Research Center, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, Canada
- Division of Experimental Medicine, McGill University, Montréal, Canada
| | - A. Herrero Babiloni
- Faculté de médicine dentaire, Université de Montréal, Montréal, Canada
- Research Center, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, Canada
- Division of Experimental Medicine, McGill University, Montréal, Canada
| | - G. Beetz
- Research Center, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, Canada
| | | | - K. Sutherland
- Charles Perkins Centre and Sydney Medical School, University of Sydney, and Royal North Shore Hospital, Sydney, Australia
| | - N. Huynh
- Faculté de médicine dentaire, Université de Montréal, Montréal, Canada
| | - P.A. Cistulli
- Charles Perkins Centre and Sydney Medical School, University of Sydney, and Royal North Shore Hospital, Sydney, Australia
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