Cauby Maia Chaves Junior

Neck circumference, a bedside clinical feature related to mortality of acute ischemic stroke

OBJECTIVE The aim of this study was to evaluate clinical/demographic factors, sleep alterations and one year mortality in acute ischemic stroke. METHODS This was a prospective study of 89 consecutive patients (mean age 64.39 ± 8.51 years) with acute ischemic stroke. High risk of obstructive sleep apnea (OSA) was evaluated by the Berlin questionnaire, daytime somnolence by the Epworth Sleepiness Scale (> 10) and subjective sleep quality by the Pittsburgh Sleep Quality Index (> 5). Clinical and anthropometric data including body mass index, hip-waist ratio, neck circumference (NC) were obtained. Increased NC was defined if > 43 cm in men and > 38 cm in women. Stroke severity was estimated by the Barthel Index and the modified Rankin Scale. The end-point was death after 12 months follow-up. RESULT One-year mortality was 8.9%. Non-survivors were older (p = 0.006) and had larger NC (p = 0.02). Among all cases, large NC was related to high risk of OSA, diabetes and hypertension (Fishers exact test). Compared to men, women showed relatively larger NC. Overall, family history of stroke (74.2 %), diabetes (33.7%) and hypertension (78.6%) were frequent; obesity (11.2%) was uncommon. Daytime sleepiness (34.8 %), poor sleep quality (65.2%) and risk of OSA (58.42%) were frequently found. CONCLUSION Poor sleep quality, excessive daytime sleepiness and high risk of OSA are frequent in this sample with acute ischemic stroke. One-year mortality was related to older age and large NC. As obesity is uncommon in acute stroke patients, a large NC should be taken as a significant clinical sign related to mortality.

Avaliação clínica e polissonográfica do aparelho BRD no tratamento da Síndrome da Apneia Obstrutiva do Sono

OBJETIVOS: este trabalho de pesquisa teve o intuito de realizar uma avaliacao clinica e polissonografica do efeito de um aparelho intraoral (AIO) para tratamento da Sindrome da Apneia Obstrutiva do Sono (SAOS), desenvolvido e testado por duas universidades federais brasileiras. METODOS: a amostra constou de 50 pacientes (idades entre 18 e 65 anos, sendo 33 homens e 17 mulheres) com diagnostico polissonografico inicial de SAOS de grau leve e moderado. Todos os pacientes submeteram-se a uma nova avaliacao polissonografica de noite inteira (em uso do AIO) aproximadamente 6 meses apos a primeira avaliacao. Baseado na diminuicao dos eventos respiratorios obstrutivos, obtida com o uso do AIO, os pacientes foram entao divididos em bons respondedores (reducao de 50% ou mais no indice de apneia e hipopneia (IAH), permanecendo abaixo de 10 eventos/hora) e maus respondedores (IAH permanecendo maior ou igual a 10 eventos/hora). RESULTADOS E CONCLUSOES: em 54% da amostra o IAH diminuiu para menos de cinco eventos/hora com o uso do AIO; em 38% a reducao do IAH foi maior do que 50%, mas permaneceu acima de cinco eventos/hora; e em 6% da amostra o IAH reduziu menos que 50%. Os bons respondedores corresponderam a 86% da amostra estudada, enquanto os maus respondedores a 14%. Houve melhora significativa na escala de sonolencia, no IAH, nos microdespertares e na saturacao minima de oxihemoglobina com a terapia utilizada. O Indice de Massa Corporea elevado parece interferir desfavoravelmente no desempenho do aparelho em estudo.

Consenso brasileiro de ronco e apneia do sono: aspectos de interesse aos ortodontistas

The objective of this article is to clarify the positions of the medical societies that have worked together to establish a consensus regarding the clinical and laboratory parameters involved in sleep-disordered breathing, particularly snoring and obstructive sleep apnea syndrome (OSAS). Orthodontists have gradually come to take part in multidisciplinary teams that act in the area of human sleep, but few know about the uniformity coordinated by the Brazilian Association of Sleep. Clinical and scientific studies from the field of dentistry (particularly orthodontics) also must observe and follow these diagnosis and treatment criteria established by the Brazilian medical community.

Severe obstructive sleep apnea treatment with mandibular advancement device: A case report

Mandibular advancement device (MAD) has been described as an alternative treatment to the severe obstructive sleep apnea (OSA), once it is not as effective as the continuous positive airway pressure therapy (CPAP) in reducing the apnea and hypopnea index (AHI). The objective of this study is to report a case using a MAD in a CPAP-intolerant patient suffering from severe OSA. Polysomnography exams were performed before and after treatment. Five months after fitting and titrating the MAD, the AHI was reduced from 80.5 events/hour to 14.6 events/hour and the minimum oxyhemoglobin saturation (SpO2) increased from 46% to 83%. A two-year assessment of therapy revealed an AHI of 8 events/hour and SpO2 of 85%.

Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review

ABSTRACT Introduction: Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. Objective: This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. Methods: An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. Results: A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. Conclusion: The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.