Systematic head and neck physical examination as a predictor of obstructive sleep apnea in class III obese patients

Martinho, Fernanda Louise; Tangerina, Rodrigo P.; Moura, S.; Gregório, Luiz Carlos; Tufik, Sérgio; Bittencourt, Lia

doi:10.1590/s0100-879x2008001200008

Cited by 38 publications

(42 citation statements)

References 24 publications

(37 reference statements)

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“…Moreover, overjet/overbite values were normal, thereby denoting good incisor dental occlusion and good skeletal relationship between the jaws. These data are in agreement with studies that found that no abnormalities in the facial skeleton were associated with OSAHS in patients with severe obesity (14).…”

Section: Further Discussionsupporting

confidence: 93%

“…The dentofacial characteristics of patients with OSAHS (whether obese or non‐obese) must be evaluated before the appropriate treatment is offered. This investigation includes a guided patient history, systematic physical examination of the head and neck, nasal evaluation and some kind of imaging evaluation of the airway and dentofacial morphology, with the investigation of hard and soft tissues (3,14,15).…”

Section: Introductionmentioning

confidence: 99%

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Dentofacial characteristics as indicator of obstructive sleep apnoea‐hypopnoea syndrome in patients with severe obesity

et al. 2011

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Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is a complex disease with a multifactor aetiology. OSAHS is strongly associated with obesity, but there are many other clinical risk factors, such as the dentofacial characteristics of hard and soft tissues, hyoid bone position, neck circumference, upper airway spaces and nasal respiration. A descriptive cross-sectional study was carried out involving 13 patients (one man and 12 women) with severe obesity in order to evaluate specific physical dentofacial characteristics through a cephalometric examination. Cephalometry was analysed using 29 measurements of the hard and soft tissues of the craniofacial structures and dimensions of the upper airways. The demographic data revealed a mean body mass index of 48 ± 6.26 kg m(-2) and cervical circumference of 43 ± 3.69 cm. No patient exhibited important facial asymmetry and facial types 1 (normal) and 3 (mandible forward) were the most prevalent. Septal deviation was observed in 46% of patients. The most prevalent modified Mallampati index score was between 3 and 4, while grade 1 was the most prevalent tonsillar hypertrophy index score (46%). Cephalometry revealed angular and linear measurements with normally acceptable values for the hard tissues. Obese patients seem to have a normal craniofacial structure and the risk of developing OSAHS is especially related to obesity.

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Section: Further Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Dentofacial characteristics as indicator of obstructive sleep apnoea‐hypopnoea syndrome in patients with severe obesity

et al. 2011

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“…Literatürde OUAS'li olanlar ile olmayanların karşılaştırıldığı çalışmalarda 30,31 septal deviasyon ve konka hipertrofisine OUAS'lilerde daha sık rastlanıldı [bir çalış-mada 30 bu değerler sırasıyla OUAS'li olmayanlarda %10 ve %30; OUAS'lilerde %23 ve %65,7 olarak bildirilmiştir] ancak bu çalışmalarda OUAS'liler pozisyonel olup olmadıklarına göre gruplandırılmamıştır.…”

Section: Discussionunclassified

“…2,33,34 Bizim çalışmamızda hem pozisyonel hem pozisyonel olmayan hasta gruplarında 3.-4. derece Mallampati skoru sık bulunmuştur. Sayısal olarak POH grubumuzda daha yüksek olsa da gruplar arasında anlamlı bir fark saptanmamıştır; Martinho 30 ve arkadaşlarının çalışması ile uyumlu bir şekilde, AHİ ile bu skor arasında bir ilişki tespit edilmemiştir.…”

Section: Discussionunclassified

Clinical and Polysomnographic Properties of Patients with Positional Obstructive Sleep Apnea Syndrome

Yosunkaya¹,

Öztürk²

2012

Solunum

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ÖZETAmaç: Obstrüktif uyku apne sendromlu (OUAS) hastalardan, sırt üstü yatış pozisyonunda, yan yatış pozisyonuna göre, apne hipopne indeksi (AHİ) en az iki kat artan veya yan yatış pozisyonunda normalleşen (AHİ<5) hastalar yani "pozisyonel hasta"lar ile sırt üstü yatış pozisyonlarında AHİ'de iki kattan daha az bir artış olan "pozisyonel olmayan" OUAS'li hastaların klinik bulgularının, fizik muayene bulgularının ve polisomnografik özelliklerinin karşılaştırılması. Sonuç: Bu çalışmayla, iki yıllık bir süreyi kapsayan hasta kayıtları-mızdan pozisyonel OUAS tanısı alanların temel özelliklerini, hastalığın pozisyonel olup olmamasına göre gruplandırarak belgelemiş olduk. Pozisyonel hastaların bazı klinik, fizik muayene ve polisomnografik bulgularında POH'ye göre farklılıklar tespit edildi. Anah tar kelimeler:Uyku apnesi, apne, tıkayıcı uyku apne sendromu ABST RACTAim: "Positional patients" (PP) were patients with obstructive sleep apnea (OSA) whose apnea hypopnea index (AHI) becomes at least twice as high in the supine position as in the lateral position and an AHI that normalizes (AHI<5) in the non-supine position. Non-positional patients (NPP) were characterised by an AHI in the supine position less than twice as high as in the lateral position. In this study we aimed to compare clinical, polysomnographic and physical characteristics of patients with non-positional and positional sleep apnea. Materials and Methods:Medical records of 500 patients diagnosed with OSA syndrome (OSAS) by polysomnography (PSG) in our clinic, between 2006-2008, were retrospectively reviewed, and 230 of these were included in the study. Patients were separated into two groups according to polisomnographic results as PP and NPP. The clinical, polysomnographic and physical characteristics of the two groups were compared.Results: 112 of the 230 patients (48.6%) were classified as PP. These were younger, with lower body mass index and neck circumflex and a milder OSAS as compared to the NPP. AHI in 31% of the PP fell below 5 in the lateral recumbent position. Excessive daytime sleepiness (EDS), as assessed by the Epworth Sleepiness Scale, was lighter in the PP group. Also, frequency of complaint from year-long nasal blockage and frequency of finding turbinate hypertrophy were more common in the PP as compared to the NPP. Conclusion:In this study, basic features of patients diagnosed as positional OSAS over a two-year period were documented by grouping as PP and NPP. Some differences were identified at the physical examination, clinical and polysomnographic features of the positional and non-positional cases.Keywords: Sleep apnea, apnea, obstructive sleep apnea syndrome Solunum Dergisi'ne www.solunum.org.tr adresinden ulaşabilirsiniz.

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“…These processes were conducted using an Embla N7000 system (Medcare-Embla®, Reykjavik, Iceland) using Somnologica version 3.3.1 (Medcare-Embla®, Reykjavik, Iceland). This system and software are used in many sleep studies 25-28…”

Section: Methodsmentioning

confidence: 99%

The Effect of Aging and Severity of Sleep Apnea on Heart Rate Variability Indices in Obstructive Sleep Apnea Syndrome

Song

Ryu

et al. 2012

Psychiatry Investig

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ObjectiveThis study aims to analyze how much heart rate variability (HRV) indices discriminatively respond to age and severity of sleep apnea in the obstructive sleep apnea syndrome (OSAS).Methods176 male OSAS patients were classified into four groups according to their age and apnea-hypopnea index (AHI). The HRV indices were compared via analysis of covariance (ANCOVA). In particular, the partial correlation method was performed to identify the most statistically significant HRV indices in the time and frequency domains. Stepwise multiple linear regressions were further executed to examine the effects of age, AHI, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and sleep parameters on the significant HRV indices.ResultsThe partial correlation analysis yielded the NN50 count (defined as the number of adjacent R-wave to R-wave intervals differing by more than 50 ms) and low frequency/high frequency (LF/HF) ratio to be two most statistically significant HRV indices in both time and frequency domains. The two indices showed significant differences between the groups. The NN50 count was affected by age (p<0.001) and DBP (p=0.039), while the LF/HF ratio was affected by AHI (p<0.001), the amount of Stage 2 sleep (p=0.005), and age (p=0.021) in the order named in the regression analysis.ConclusionThe NN50 count more sensitively responded to age than to AHI, suggesting that the index is mainly associated with an age-related parasympathetic system. On the contrary, the LF/HF ratio responded to AHI more sensitively than to age, suggesting that it is mainly associated with a sympathetic tone likely reflecting the severity of sleep apnea.

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Systematic head and neck physical examination as a predictor of obstructive sleep apnea in class III obese patients

Cited by 38 publications

References 24 publications

Dentofacial characteristics as indicator of obstructive sleep apnoea‐hypopnoea syndrome in patients with severe obesity

Dentofacial characteristics as indicator of obstructive sleep apnoea‐hypopnoea syndrome in patients with severe obesity

Clinical and Polysomnographic Properties of Patients with Positional Obstructive Sleep Apnea Syndrome

The Effect of Aging and Severity of Sleep Apnea on Heart Rate Variability Indices in Obstructive Sleep Apnea Syndrome

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