Marlit Veldi

Myotonometry demonstrates changes of lingual musculature in obstructive sleep apnoea

Upper airway dilator muscles are important in the pathogenesis of obstructive sleep apnoea (OSA). Previously, soft palate and tongue muscles of patients with OSA have been studied from a histological point of view. Electromyographic studies revealed increased activity of upper airway dilator muscles. We used computerized endopharyngeal myotonometry (CEM) to measure the biomechanical properties of lingual musculature, mainly the genioglossal muscle, to characterize changes of tongue muscles in patients with OSAS. The method records and analyzes the response of the tongue sublingually after a brief mechanical impact. It enabled us to evaluate the most important parameters of tissue tone – stiffness, which is expressed as a frequency, and elasticity, as a logarithmic decrement of the damped oscillation. The results of CEM indicated that patients with OSAS show an increased stiffness (14.1 ± 0.7 Hz) of the tongue in comparison with non-snoring subjects (11.5 ± 0.2 Hz). The elasticity of the tongue is decreased, which is numerically expressed as an increased decrement (4.0 ± 0.2) in patients with OSA in comparison with non-snorers (2.2 ± 0.2). Changes in the biomechanical characteristics of lingual musculature during wakefulness could result from pathophysiological processes caused by obstructive sleep apnoea.

A survey of parentally reported sleep health disorders in estonian 8–9 year old children

BackgroundPediatric sleep research is rather new in Estonia. There has not been a comprehensive study of age specific sleep disorders in Estonian children. The aim of this study was to investigate sleep disorders in a sample of Estonian second grade children.We hypothesized that:• Children with low BMI are as susceptible to SDB as are children with high BMI.• Under weight children are susceptible to residual SDB after adenotonsillectomy.• Parasomnias present with SDB in children.• Excessive day time sleepiness is a significant symptom which leads parents to suspect sleep disorders in their child.MethodsA retrospective questionnaire based survey was used to analyze factors influencing sleep, parasomnias, daytime sleepiness, and sleep disordered breathing (SDB). 1065 Pediatric Sleep Questionnaire (PSQ) packets were distributed by post to randomly selected parents of second grade students; 703 (66%) subjects were included in the study group; each parent/guardian participant had one second grade child. Descriptive statistics were used to compare characteristics of SDB symptomatic and healthy children. We used logistic regression to analyze factors influencing sleep and parasomnias in relation to SDB severity. Odds ratios (OR) and 95% CI were used to estimate relative risk.ResultsParents of children with SDB complaints seem to pay attention to sleep disorders especially when a child is suffering from excessive day time sleepiness. Parasomnias are present simultaneously with SDB and tend to worsen in relation to more severe SDB complaints. Many underweight children have SDB symptoms after adenotonsillectomy.ConclusionSDB symptoms are found in both overweight and underweight children. Both groups should be observed, especially in terms of the current focus on overweight children. Careful follow up after SDB treatment is necessary in case of under and overweight children. Parental suspicions regarding SDB are noticeably higher in cases of excessive daytime sleepiness in their children.

Obstructive sleep apnea syndrome (OSAS): Pathophysiology in Estonians

The aim of the study was to clarify the roles of age, obesity, smoking, alcohol, pathoanatomy and -physiology in Estonians OSAS. For this 164 randomly chosen such patients were selected in different regions of Estonia. They underwent naso-oropharyngeal examination, physical examination of craniofacial abnormalities, and polysomnography. They also completed a self-reported questionnaire about smoking, alcohol use, excessive daytime sleepiness, hypertension, cardiac disorders, headaches, concentration disorders, and recurrent upper-airway diseases. The patients (129 men; 35 women) aged between 19 and 75 years (mean 47+/-12), BMI between 21 and 49 (mean 30.5+/-5.15), AHI between 5 and 105 (33+/-22). The results showed that there was a high percentage of naso-oropharyngeal disorders, such as: recurrent upper-airway diseases (54.2%), nasal breathing disorders (63.5%), and hypertrophy of tonsils (57%). There was also a high percentage of general characteristics, such as alcohol use (64%), excessive daytime sleepiness (85.5%), overweight (63%), and hypertension (51.2%). The regression summary for the dependent variable AHI if p-level=0.0042 (R=0.63347013) included age, BMI, hypertension, cardiac disorders, headaches, nasal obstruction, hypertrophy of pharyngeal muscles, tongue level, submental fat and slow-wave sleep (S3+S4%). In conclusion recurrent upper-airway diseases, nasal obstruction, and hypertrophy of tonsils in combination with smoking and alcohol caused the changes in the pharyngeal and lingual muscles. The latter gives rise to such sleep apnea-related problems as heart complaints, hypertension, headache and shortage of slow-wave sleep (SWS).

Obstruktiivse uneapnoe sündroomi riskitegurid võivad pärineda lapse- ja noorukieast. Haigusjuhu kirjeldus

Uneapnoe nahtude – luhiaegsete hingamispauside voi aeglase hingamise episoodide – kordumine une ajal kutsub esile une struktuuri haireid ja sellest tulenevalt paevast vasimust, mitut laadi psuuhilisi ja somaatilisi haireid. Uneapnoest tingitud kliiniliste ilmingute esinemise korral diagnoositakse uneapnoe sundroomi. Sagedasem uneapnoe esinemise vorm on obstruktiivne uneapnoe (OUS), mille puhul kujunevad une ajal ulemiste hingamisteede sulguse episoodid. OUSi kujunemist soodustavad ulemiste hingamisteede ahenemist pohjustavad anatoomilised isearasused ja neelu pehmete kudede hupertroofia, samuti ulekaalulisus. Need isearasused esinevad juba lapseeas ja nende tahelepanuta voi ravita jatmine on OUSi riskitegur hilisemas elus. Artiklis on kirjeldatud 24 a mehe haigusjuhtu, kellel oli valja kujunenud raske OUS, esines ulekaalulisus lapseeast alates ning suuneelu ahenemine tingituna kombineeritud pohjustest. Haigele rakendati CPAP-ravi, mille tulemusena seisund paranes. Hiljem teostati uvulopalatoplastika ning haige suunati ka ortodontilisele ravile. Eesti Arst 2010; 89(11):746−750