Newton Santos de Faria Júnior

Electromyographic analysis of masseter and anterior temporalis muscle in sleep bruxers after occlusal splint wearing

Bruxism is widely defined as an anxiety response to environmental stress. Occlusal splints are frequently used in sleep bruxism, to protect teeth from damage resulting from the contraction force of mandibular muscles, or to reduce the orofacial pain by relaxing masticatory muscles. Surface electromyography (EMG) of the right and left masseter and temporalis muscles was performed in 15 women presenting sleep bruxism and temporomandibular disorders related to occupational stress, after nocturnal use of the occlusal splint. The EMG signals were recorded twice per patient: After a work shift (pre-splint) and after a night of sleep with the occlusal splint (post-splint) before a new workday. The parametric t-paired test was used to compare differences of the RMS amplitude between pre and post-splint records, for resting and maximal clenching effort. The level of significance for each comparison was set to p < 0.05. The results of the study supports the premise that the use of occlusal splint reduces EMG activity in the masseter and anterior temporalis muscles, in patients who presented with sleep bruxism related to occupational stress.

Sleep study, respiratory mechanics, chemosensitive response and quality of life in morbidly obese patients undergoing bariatric surgery: a prospective, randomized, controlled trial

BackgroundObesity is a major public health problem in both developed and developing countries alike and leads to a series of changes in respiratory physiology. There is a strong correlation between obesity and cardiopulmonary sleep disorders. Weight loss among such patients leads to a reduction in these alterations in respiratory physiology, but clinical treatment is not effective for a long period of time. Thus, bariatric surgery is a viable option.Methods/DesignThe present study involves patients with morbid obesity (BMI of 40 kg/m2 or 35 kg/m2 to 39.9 kg/m2 with comorbidities), candidates for bariatric surgery, screened at the Santa Casa de Misericórdia Hospital in the city of Sao Paulo (Brazil). The inclusion criteria are grade III morbid obesity, an indication for bariatric surgery, agreement to participate in the study and a signed term of informed consent. The exclusion criteria are BMI above 55 kg/m2, clinically significant or unstable mental health concerns, an unrealistic postoperative target weight and/or unrealistic expectations of surgical treatment. Bariatric surgery candidates who meet the inclusion criteria will be referred to Santa Casa de Misericórdia Hospital and will be reviewed again 30, 90 and 360 days following surgery. Data collection will involve patient records, personal data collection, objective assessment of HR, BP, neck circumference, chest and abdomen, collection and analysis of clinical preoperative findings, polysomnography, pulmonary function test and a questionnaire on sleepiness.DiscussionThis paper describes a randomised controlled trial of morbidly obese patients. Polysomnography, respiratory mechanics, chemosensitive response and quality of life will be assessed in patients undergoing or not undergoing bariatric surgery.Trial RegistrationThe protocol for this study is registered with the Brazilian Registry of Clinical Trials - ReBEC (RBR-9k9hhv).

Teste de pressão negativa expiratória: um novo método simples para identificar pacientes com risco para apneia obstrutiva do sono

The objective of this article was to describe a new method for assessing expiratory flow limitation during spontaneous breathing, using the negative expiratory pressure test to identify patients at risk for obstructive sleep apnea. Upper airway collapsibility is evaluated by measuring decreases in flow and in expired volume in the first 0.2 seconds after negative expiratory pressure application at 10 cmH₂O. The negative expiratory pressure test is easily applied and could be adopted for the evaluation of expiratory flow limitation caused by upper airway obstruction in patients with obstructive sleep apnea.

Opto-electronic plethysmography: Noninvasive and accurate measurement of the volume of the chest wall and its different thoraco-abdominal compartments

Source of support: None Summary Background: Opto-electronic plethysmography (OEP) is an innovative, new method to evaluate the ventilation pattern through an external measurement of chest wall surface motion. The OEP system measures changes in the complex shape of the chest wall during breathing by modeling the thoracoabdominal surface with a large number of points belonging to selected anatomical reference sites of the rib cage and abdomen. Material/Methods: The automatic motion analyzer on which it is based uses passive markers composed of a thin film of retro-reflective paper on plastic hemispheres (5–10 mm diameter). The markers are placed on the skin by bi-adhesive hypoallergenic tape. Special video cameras (solid state CCDs) operate up to 140 frames per second synchronized with coaxial infrared flashing LEDs. Dedicated software computes the 3D coordinates of the different markers with high accuracy. No specific calibration is required besides the initial one performed during the installation of the system. The OEP System uses the accurate measurement of the 3-dimensional micro-movement of the points belonging to the chest wall to compute chest wall volumes. Special algorithms compute volume variations of the whole chest wall and of the different compartments. Time courses of these signals can be obtained at different sampling frequencies, up to 140 Hz. Results: Several studies have been conducted under different conditions and have shown that the method provides a very accurate measurement of the volume of the chest wall and its variations during respiration. Conclusions: The OEP System has the great advantage that it can measure breathing patterns in any condition, both in health and disease. It can be used to study respiratory kinematics and, if combined with pressure measurements, it can be used to study statics, dynamics, and energetics.

Evaluation of obstructive sleep apnea in non-cystic fibrosis bronchiectasis: A cross-sectional study

The relationship between sleep disorders and bronchiectasis has not been well described. We hypothesize that, due to the irreversible dilatation of the bronchi, the presence of secretions, and airflow obstruction, patients with non-cystic fibrosis bronchiectasis may be predisposed to hypoxemia during sleep, or to symptoms that may lead to arousal. A cross-sectional observational study was performed involving 49 patients with a clinical diagnosis of non-cystic fibrosis bronchiectasis (NCFB). All patients underwent clinical evaluation, spirometry, and polysomnography, and were evaluated for the presence of excessive daytime sleepiness (EDS) and risk of obstructive sleep apnea (OSA). The mean age of the participants was 50.3 ± 13.6 years; 51.1% of patients were male and had a mean body mass index of 23.8 ± 3.4 kg/m2. The mean total sleep time (TST) was 325.15 ± 64.22 min with a slight reduction in sleep efficiency (84.01 ± 29.2%). Regarding sleep stages, stage 1 sleep and REM sleep were abnormal. OSA was present in 40.82% of the patients. The mean arousal index was 5.6 ± 2.9/h and snoring was observed in 71.43% of the patients. The oxygen desaturation index (ODI) was 14.35 ± 15.36/h, mean minimum oxygen saturation (SpO2 nadir) was 83.29 ± 7.99%, and mean TST with an SpO2 less than 90% was 30.21 ± 60.48 min. EDS was exhibited by 53.06% of the patients and 55.1% were at high risk of developing OSA. The patients infected by Pseudomonas aeruginosa had higher apnea-hypopnea indices, ODI, and TST with SpO2 < 90%, and lower values of SpO2 nadir. Adult patients with clinically stable NCFB, especially those infected by Pseudomonas aeruginosa, display EDS and a high prevalence of OSA, associated with considerable oxygen desaturation during sleep.

Observational study of sleep, respiratory mechanics and quality of life in patients with non-cystic fibrosis bronchiectasis: a protocol study.

Introduction Bronchiectasis is a chronic disorder characterised by permanent and irreversible abnormal dilation of the bronchi and bronchioles, primarily caused by repeated cycles of pulmonary infections and inflammation, which lead to reduced mucociliary clearance and to the excessive production of sputum. Patients with non-cystic fibrosis bronchiectasis may be predisposed to hypoxemia during sleep, or to symptoms that may lead to arousals and thereby reduce the quality of life, because of the irreversible dilation of the bronchi and the presence of secretions and airflow obstruction. Methods and analysis For this cross-sectional observational study, patients with a clinical diagnosis of non-cystic fibrosis bronchiectasis will be recruited from the Bronchiectasis Clinic of the Pneumology Department of the Santa Casa de Misericordia Hospital and the Federal University of São Paulo (São Paulo, Brazil). Patients of either sex will be included if high-resolution CT of the thorax and classic sweat test confirms they have non-cystic fibrosis bronchiectasis, are between 18 and 80 years old, use long-acting bronchodilators, are clinically stable for a least 1 month, agree to participate in the study and they sign a statement of informed consent. The first part of the study will involve a clinical evaluation, maximal respiratory pressures, spirometry and the Saint Georges Respiratory Questionnaire. The Sleep Laboratory of the Masters and Doctoral Postgraduate Program in Rehabilitation Sciences of the Nove de Julho University (São Paulo, Brazil) will perform the polysomnographic studies, Berlin Questionnaire, Epworth Sleepiness Scale, waist and neck circumferences, modified Mallampati classification and tonsil index. Ethics and dissemination This protocol has been approved by the Human Research Ethics Committees of Santa Casa de Misericordia Hospital (process number 178/2012) and Human Research Ethics Committee of Nove de Julho University (process number 370474/2010). All participants will sign a statement of informed consent. The study findings will be published in peer-reviewed journals and presented at conferences.

Clinical significance in non-cystic fibrosis bronchiectasis followed in a real practice

INTRODUCAO: Bronquiectasia e uma doenca cronica caracterizada pela dilatacao permanente dos bronquios e bronquiolos acompanhada por alteracoes inflamatorias nas paredes dessas estruturas e parenquima pulmonar adjacente. OBJETIVO: O objetivo do presente estudo e realizar uma caracterizacao clinica e funcional de pacientes adultos com bronquiectasias e fibrose nao cistica. Metodos: Um estudo clinico descritivo e retrospectivo foi realizado com pacientes com bronquiectasias e fibrose nao cistica atendidos em um ambulatorio de pulmao entre 2004 e 2012. RESULTADOS: A amostra foi composta por 232 pacientes (134 mulheres, idade media: 52,9 anos ± 17,7, indice de massa corporal: 23,5 ± 4,4 kg/m2). Os sintomas predominantes foram tosse (91,4%), expectoracao (85,8%) e dispneia (76,3%). A maioria dos casos foi de etiologia nao tuberculosa (64,7%). Em relacao a funcao pulmonar, o padrao de respiracao obstrutiva foi predominante (43,5%). As comorbidades mais comuns foram de origem cardiovascular (51,0%). CONCLUSOES: pacientes adultos com bronquiectasias de fibrose nao cistica (principalmente pos-infeccao ou pos-tuberculose de origem) sao caracterizados por um baixo nivel de escolaridade, tosse excessiva, expectoracao, dispneia, fadiga muscular, um padrao de respiracao obstrutiva com hipoxemia frequente e multiplas comorbidades, essencialmente de origem cardiovascular. No entanto, nossos pacientes tem um baixo indice de exacerbacoes e hospitalizacoes que podem ser atribuidos a um protocolo clinico para o acompanhamento.

Hypertonic saline solutions do not influence the solubility of sputum from secretor and non-secretor cystic fibrosis patients

Introduction Functional alterations of the cystic fibrosis transmembrane conductance regulator gene (CFTR) increase the viscoelasticity of pulmonary secretions of cystic fibrosis (CF) patients and require the use of therapeutic aerosols. The biochemical properties of exocrine secretions are influenced by the expression of the FUT2 gene which determine the secretor and non-secretor phenotypes of the ABH glycoconjugates. The aim of this study was to determine the influence of secretor and non-secretor phenotypes by means of photoacoustic analysis, both the typical interaction time (t 0) and the solubilization interval (Δt) of the sputum of secretor and non-secretor CF patients nebulized by hypertonic saline solutions at different concentrations. Material and methods Sputum samples were obtained by spontaneous expectoration from 6 secretor and 4 non-secretor patients with CF. Each sample was nebulized with 3%, 6%, and 7% hypertonic saline solutions in a photoacoustic cell. The values of t 0 and Δt were determined using the Origin 7.5® computer program (Microcal Software Inc.). The t-test was employed using the GraphPad Instat 3.0® computer program to calculate the mean and standard deviation for each parameter. Results For all hypertonic saline solutions tested, the mean values of t 0 and Δt do not show statistically significant differences between secretor and non-secretor patients. Conclusions The secretor and non-secretor phenotypes do not influence the in vitro solubilization of the sputum nebulized by hypertonic saline solutions at different concentrations when analysed by photoacoustic technique.

Cross-sectional observational study of the influence of regular physical exercise on sleep quality and presence of sleep disorders in patients assisted in the basic health units of divinopolis, brazil - a protocol study

Submit Manuscript | http://medcraveonline.com Abbreviations: BHU: Basic Health Unit; BMI: Body Mass Index; EDS: Excessive Daytime Sleepiness; ESS: Epworth Sleepiness Scale; ICSD-3: International Classification of Sleep Disorders -3a edition; NRPE: Non-Regular Physical Exercise; PSQI: Pittsburgh Sleep Quality Index; RPE: Regular physical Exercise; SCF: Statement of Consent Form; SF-36: Medical Outcomes Study 36-Item Short-Form Health Survey; STROBE: Strengthening the Reporting of Observational Studies in Epidemiology Statement; OSA: Obstructive sleep apnea; UEMG: University of the State of Minas Gerais

Evaluation of the best environment for the six-minute walk test

Introduction The purpose of the six-minute walk test (6MWT) is to evaluate cardiopulmonary capacity using a low-cost test that is easy to administer, generally well tolerated by different populations and reflects one’s performance on activities of daily living. However, few studies have been conducted to determine the difference between performing the 6MWT indoors and outdoors.Objective The aim of the present study was to compare the distance covered on the 6MWT performed indoors and outdoors and evaluate the following physiological variables: heart rate, blood pressure and the subjective sensation of shortness of breath, using the Borg perceived exertion scale.Materials and methods A prospective, randomized, clinical trial was conducted involving eight healthy females not engaged in regular physical activity, with mean age 23.75 ± 1.67 years. Each subject performed the 6MWT indoors and outdoors with a 30-minute interval between tests. The order of the tests was determined randomly.Results The mean distance traveled was 578 ± 50.07 m on the outdoor trial and 579.95 ± 45.35 m on the indoor trial (p = 0.932). The mean physiological variables were 82.25 ± 11.02 bpm (indoors) versus 84.38 ± 9.42 bpm (outdoors) for heart rate, 121.88 ± 10.28 mmHg (indoors)versus 118.75 ± 19.40 mmHg (outdoors) for systolic blood pressure, 81.88 ± 9.74 mmHg (indoors) versus 80.50 ± 7.89 mmHg (outdoors) for diastolic blood pressure and a mean score of 12 on the perceived exertion score in both environments.Conclusions The present data demonstrate no differences in the distance walked on the 6MWT or the physiologic variables of participants between the indoor and outdoor trials.