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Correlation analysis of the Marfan syndrome group between palatal morphology and cardiorespiratory monitoring index and echocardiography-derived sizes in the study group.
Source publication
The main cause of mortality in Marfan syndrome (MS) is aortic disease. Obstructive sleep apnea (OSA) is highly prevalent in MS, and it is also associated with cardiovascular risk and maxillary deformities. The aim of this research was to analyze the possible relations between OSA, palatal morphology, and aortic root diameters in growing subjects. A...
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Background
Marfan syndrome (MFS) is a connective tissue disorder characterised by complex aortic pathology and a high prevalence of obstructive sleep apnoea (OSA). OSA produces intrathoracic transmural stresses that may accelerate aortic injury. The current study was designed to examine the associations between OSA risk and markers of aortic enlarg...
Citations
... The interruption of breathing during sleep has many adverse health consequences, including cardiovascular diseases, collagenopathy, metabolic disorders like-insulin resistance and glucose metabolism-other chronic respiratory diseases, epilepsy, Alzheimer, neoplasms, kidney diseases and gastroesophageal reflux. However, the pathogenic mechanisms of OSAS in organs are complex and intertwined and not fully understood [4][5][6][7][8][9]. This disorder is the product of a complex interaction between anatomical factors (i.e., round airways, length and volume of the soft palate, length of the upper airways, pharyngeal fat deposits, adeno-tonsillar hypertrophy, tongue volume, class II skeletal profile and morphological deviations of the cervical spine), sleep-related factors and central nervous system control over ventilation [10]. ...
This study aimed to analyse the effectiveness of four different designs of the Mandibular Advancement Device (MAD) and the morphological changes on upper airway characteristics of Obstructive Sleep Apnea (OSA) patients inducted by each of them, detected by Cone Beam Computer Tomography (CBCT) 3D imaging. Twenty-two patients were recruited after an OSA diagnosis with PSG. Four different customised and titratable MADs were used and an initial CBCT scan was obtained for each patient. Six months after the end of the MAD titration phase, all the subjects performed a second PSG with the MAD in situ; the second PSG showed an Apnoea–Hypopnoea Index (AHI) of <5 or a decrease of 50% in AHI when compared with the initial AHI. Moreover, a second CBCT scan with the MAD in situ was performed. DICOM files were imported into the airway analysis software programme and the pharyngeal area around the oropharynx was highlighted. The area and volume of the oropharynx with and without the device was evaluated. A considerable improvement of the airway was observed (+33.76%), and a significant difference in the enlargement ratio between the posterior soft palate (+32.41%) and the posterior tongue (+36.96%) region was also found. The greatest increase in airway volume was achieved in patients treated with the MAD Forward and TAP (+42.77% and +41.63%, respectively). MAD therapy is effective to treat moderate to severe OSA with an increased upper airway volume. The design of the MAD can influence the effectiveness of the treatment.
... Orthodontists use the term "maxillary constriction" to characterize a maxilla that is narrow in the lateral dimension in comparison to other facial bones, particularly the mandible. Subjects with maxillary constriction are known to have higher nasal resistance and struggle to breathe through their nose [5,6], characteristics that are frequently seen in OSA patients. Low tongue position is also linked to maxillary constriction [7], that may lead to retroglossal airway narrowing, which is another OSA symptom [8,9]. ...
Background:
The aim of this study is to investigate the upper airway analysis at two-time points after the rapid maxillary expansion was performed, using cone-beam computed tomography.
Methods:
Subjects from the Orthodontic Department at the Aristotle University of Thessaloniki with unilateral or bilateral posterior crossbite were screened according to the selection criteria. A sample size calculation was performed, and a total of 14 subjects were recruited. All subjects received a rapid maxillary expansion with a Hyrax-type device as part of their comprehensive treatment. A CBCT was taken before the treatment (T1), immediately after the expansion was completed (T2), and 6 months after (T3). Their upper airway was measured using the CBCT images. Airway volume (V) and minimal cross-sectional area (MCS) were extracted and compared using SPSS to analyze the means.
Results:
A statistically significant difference was found between all time points regarding both V and MCS (p < 0.001, p = 0.001). There was a statistically significant increase in both V and MCS measurements immediately after RPE expansion (T1-T2) and six months after expansion (T1-T3). Between the end of expansion and 6 months after (T2-T3), there was a decrease in V and no statistical difference in MCS.
Conclusions:
RPE can significantly increase the volume and minimal cross-sectional area of the nasal passage airway.
... The interruption of breathing during sleep has many adverse health consequences including: cardiovascular diseases, collagenopathy, metabolic disorders and diabetes, psoriasis, kidney failure, ophthalmic diseases, chronic obstructive beoncopneumopathy (COPD), epilepsy, neoplasms, dementia [4][5][6][7][8]. This disorder is the product of a manifold interaction between anatomical factors (round airways, length and volume of the soft palate, length of the upper airways, pharyngeal fat deposits, adeno-tonsillar hypertrophy, tongue volume, class II skeletal profile and morphological 2 deviations of the cervical spine), sleep-related factors and central nervous system control over ventilation [9]. ...
... Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 6 July 2023 doi:10.20944/preprints202307.0396.v16 ...
MAD is the gold standard therapy for mild/moderate OSA and is a second-choice treatment in patients with severe OSA not responding to CPAP. The aim of this study was to analyze the upper airway characteristics of OSA patients and the morphological changes in the upper airway, inducted by four different types of mandibular advancement devices, using CBCT 3D imaging. Twenty-two patients were recruited after OSA diagnosis with polysomnography. Four different customized and titratable MAD were used and an initial CBCT scan was obtained for each patient. After 6 months to the end of the MAD titration phase, all the subjects showed an AHI of < 5 or a decrease of 50% in AHI with MAD when compared with initial AHI and a second CBCT scan with MAD in situ was performed. An important improvement of the airway was observed (+33.76%) and a significant difference in the enlargement ratio between the posterior soft palate (+32.41%) and the posterior tongue (+36.96%) region was also found. The greatest increase in airway volume was achieved in patients treated with the MAD Forward and TAP (respectively +42.77% and + 41.63%). MAD therapy is effective to treat mild/severe OSA with increased upper airway volume. The design of the MAD can influence the effectiveness of the treatment.
... The full night PSG showed an AHI = 5.1 events/h. Patients with severe OSA have an increased cardiovascular risk, showing increased prevalence of hypertension, stroke, arrhythmia, and aortic events, although these findings are not always consistent (16)(17)(18). Without CPAP adherence, they must be treated with alternative therapies. ...
Obstructive sleep apnea syndrome (OSAS) is a common disorder which involves upper airway collapse during sleep. Positional Obstructive Sleep Apnoea Syndrome is a sub-type of OSAS characterized by obstructive apneas mainly in the supine sleeping position. Mandibular advancement devices (MAD) are recommended as first-line therapy for mild to moderate OSA or as second-line treatment for severe OSA for patients who do not tolerate or respond to CPAP. A case report of severe positional OSAS (AHI/h 34.7) is presented. The clinical case was studied by CBCT head and neck scan and nocturnal polysomnography and treated with a mandibular advancement device, positional therapy, dietary adjustments and instructions for proper sleep hygiene. After the treatment the patient’s AHI decreased to 5.1 and his general health improved. The MAD appliance represents a valid therapeutic alternative in subjects with severe OSAS who do not tolerate CPAP. A combined approach to the pathology can improve the patient’s overall health and quality of life.
... OSAS has been associated with several systemic disorders, such as hypertension, diabetes, and dyslipidemia. Accordingly, large evidence supports the relation between OSAS and cardiovascular risk [3][4][5]. Several mechanisms linking OSAS to its consequences have been identified, and oxidative stress represents one of the main triggering events leading to the increased cardiovascular risk. Moreover, events in the upper airways caused by snoring, hypoxia, nasal congestion, or muscular stress can concur with the systemic oxidative stress. ...
Background:
Obstructive sleep apnea syndrome (OSAS) may be associated with and activates the stress response system, and variation in the physiological antioxidant capacity of body fluids. Our aim was to evaluate the variation of pH and antioxidant capacity on the saliva of obstructive sleep apnea subjects (OG) compared to a control group (CG).
Method:
Fifty subjects with moderate/severe OSAS were recruited in Tor Vergata Hospital and compared with 20 healthy subjects CG. The buffer and the antioxidant capacity of the samples were quantified measuring the pH and the percentage of total salivary antioxidant capacity (%TAC), which refers to the reduced glutathione salivary concentration (GSH). Moreover, the protein concentration and the gelatinolytic activity of metalloproteinases were quantified.
Results:
The data showed that the pH value is slightly more alkaline in OSAS subjects; however, it is not directly related to the severity of OSAS. The %TAC was found to be significantly reduced by 86.2% in the OG. Proteins of saliva from the OG were found 1.5 times more concentrated than in the healthy sample. The gelatinolytic activity of metalloproteinases of healthy and OSA did not show statistically significant changes.
Conclusions:
The salivary samples from OSAS compared to CG show an alteration of the oxidative state, the pH buffering power, and protein concentrations, inducing conditions that can easily evolve chronic gingivitis. Further investigations are necessary to evaluate the feasibility of using salivary fluid for the early diagnosis of oral or systemic problems in OSAS subjects.
... In the paper [25] Oxygen saturation (SpO2) (91:3 ± 2:0) % The oxygen saturation for sleep apnea patients is in this range In the paper [6] Heart rate (70:9 ± 2:2) bpm The study detected sleep apnea in this range of heart rate. In the paper [26] Polysomonography 91.8% to 96.5% accuracy on adaptive apnea index In the paper [27] Snoring sound intensity 45 dB to 58 dB and mean value is approximately 52 dB In the paper [11] 3D camera A novel approach has been proposed to measure respiratory movement using a 3D camera to detect apnea. ...
Sleep is an essential and vital element of a person’s life and health that helps to refresh and recharge the mind and body of a person. The quality of sleep is very important in every person’s lifestyle, removing various diseases. Bad sleep is a big problem for a lot of people for a very long time. People suffering from various diseases are dealing with various sleeping disorders, commonly known as sleep apnea. A lot of people die during sleep because of uneven body changes in the body during sleep. On that note, a system to monitor sleep is very important. Most of the previous systems to monitor sleeping problems cannot deal with the real time sleeping problem, generating data after a certain period of sleep. Real-time monitoring of sleep is the key to detecting sleep apnea. To solve this problem, an Internet of Things- (IoT-) based real-time sleep apnea monitoring system has been developed. It will allow the user to measure different indexes of sleep and will notify them through a mobile application when anything odd occurs. The system contains various sensors to measure the electrocardiogram (ECG), heart rate, pulse rate, skin response, and SpO2 of any person during the entire sleeping period. This research is very useful as it can measure the indexes of sleep without disturbing the person and can also show it in the mobile application simultaneously with the help of a Bluetooth module. The system has been developed in such a way that it can be used by every kind of person. Multiple analog sensors are used with the Arduino UNO to measure different parameters of the sleep factor. The system was examined and tested on different people’s bodies. To analyze and detect sleep apnea in real-time, the system monitors several people during the sleeping period. The results are displayed on the monitor of the Arduino boards and in the mobile application. The analysis of the achieved data can detect sleep apnea in some of the people that the system monitored, and it can also display the reason why sleep apnea happens. This research also analyzes the people who are not in the danger of sleeping problems by the achieved data. This paper will help everyone learn about sleep apnea and will help people detect it and take the necessary steps to prevent it.
... Despite all of these, the etiology of OSAS remains controversial. It is now considered a multifactorial disease caused by various factors such as adenotonsillar hypertrophy, allergic rhinitis, obesity, craniofacial anomalies, genetic and/or congenital neuromuscular diseases, cleft palate, a contracted upper jaw or changes in lingual posture [4,6,7]. ...
This randomized, double-blind and controlled clinical trial investigates how a diode laser lingual frenectomy can improve obstructive sleep apnea syndrome (OSAS) in pediatric patients.
Background:
Several authors have shown that a short lingual frenulum causes a reduction in incoming air flow and the relationship between OSAS and a short lingual frenulum.
Methods:
Thirty-two pediatric patients were equally randomly divided into a Study Group (SG) and a Control Group (CG). On each SG patient a polysomnography 1 (PSG1) and a lingual frenectomy were performed using a diode laser via Doctor Smile Wiser technology, power 7 W. After three months, a new polysomnography (PSG2) was performed to evaluate the lingual frenectomy efficacy in pediatric patients. The pain was assessed by a numerical rating scale (NRS) before and after surgery. The CG followed the same protocol without a lingual frenectomy but myofunctional and speech therapy were conducted to qualitatively and quantitatively improve the lingual functionality. In the SG, eight subjects (50%) had severe OSAS and eight had moderate (50%) while in the CG, three subjects had severe OSAS (18.8%) and thirteen had moderate (81.2%).
Results:
In the SG, 93.8% were classified as mild OSAS and 6.2% as moderate. In contrast, in the CG, 18.75% were classified as mild OSAS, 62.5% as moderate and 18.75% as severe.
Conclusion:
The study demonstrates how a lingual laser frenectomy can improve OSAS in pediatric patients.
Sleep is an essential and vital element of a person life and health that helps to refresh and recharge the mind and body of a person. The quality of sleep is very important in every person lifestyle, removing various diseases. Bad sleep is a big problem for a lot of people for a very long time. People suffering from various diseases are dealing with various sleeping disorders, commonly known as sleep apnea. Real-time monitoring of sleep is the key to detecting sleep apnea. To solve this problem, an IoT based real-time sleep apnea monitoring system has been developed. It will allow the user to measure different indexes of sleep and will notify them through a mobile application when anything odd occurs. The system contains various sensors to measure the ECG, Heart Rate, Pulse rate, Skin response, and SpO2 of any person during the entire sleeping period. To analyze and detect sleep apnea in real time, the system monitors several people during the sleeping period. The results are displayed on the monitor of the Arduino boards and in the mobile application. The analysis of the achieved data can detect sleep apnea in some of the people that the system monitored, and it can also display the reason why sleep apnea happens. This paper will help everyone learn about sleep apnea and will help people detect it and take the necessary steps to prevent it.
Background:
Despite extensive knowledge about the quality of life of people suffering from rare diseases, data on patients with Marfan syndrome (MFS) are scarce and inconsistent. Hence, the problem of assessing the quality of life (QOL) and its relationship with the assessment of which ailments are the most burdensome for these patients is still open.
Aim:
Comparison of the quality of life of patients with MFS and determination as to which of the reported complaints in patients with MFS are related to the QOL of patients.
Methods:
The study included 35 patients with MFS and 35 healthy controls, matched for gender and age. In the study, the questionnaire of quality of life assessment SF-36 was used to assess the level of health-related quality of life, as well as an interview of the most severe symptoms reported by patients with MFS.
Results:
The level of the physical dimension of the QOL (p < 0.001) and limiting of roles due to physical health (p = 0.002), as well as the level of general index of the QOL (p < 0.001), were statistically significantly lower in MFS patients when compared to controls. People from both studied groups do not vary in the scope of pain, vitality, social functioning, limiting the roles due to emotional problems, and state of mind but also in the mental dimension of the health-related quality of life (HRQL). Additionally, there has been a correlation between HRQL and the subjective assessment of the effects of orthopedic, ophthalmic, and cardiological problems in life, as well as lower exercise tolerance in the evaluation of people with MFS and QOL in most areas.
Conclusions:
Patients with MFS present a reduced QOL in the areas of physical functioning, limiting roles due to physical health, general feeling of general health, the physical dimension of the HRQL, and the general index of the QOL; in these areas, they require careful evaluation, as well as medical and psychosocial assistance.
