Insomnia is one of the most frequently observed sleep disorders, affecting nearly 10% of the general population. It has multiple etiological factors. Recently, it has been reported that EEG abnormalities are associate...Insomnia is one of the most frequently observed sleep disorders, affecting nearly 10% of the general population. It has multiple etiological factors. Recently, it has been reported that EEG abnormalities are associated with insomnia in patients previously diagnosed as idiopathic insomniacs. In addition, transcranial magnetic stimulation (TMS) has shown to be effective in the treatment of disorders characterized by neural hyper-excitability. Method: In the present study, patients with insomnia and EEG abnormalities were submitted to slow repetitive trans-cranial magnetic stimulation, for 15 minutes daily during 10 days. Polysomnographic recordings were performed before and after TMS. Results: The results indicate that the presence of EEG abnormalities significantly decreased after TMS. In addition, most of the sleep parameters showed significant improvement. Conclusions: These data support the notion that TMS is a reliable therapeutic tool for patients affected with abnormalities linked to neuronal hyper-excitability.展开更多
Background: Overweight and obesity are major public-health issues in Mexico. Sleep breathing disorders directly impact the health of affected subjects. The aim of this study was to describe the frequency and severity ...Background: Overweight and obesity are major public-health issues in Mexico. Sleep breathing disorders directly impact the health of affected subjects. The aim of this study was to describe the frequency and severity of obstructive sleep apnea/hypopnea syndrome (OSAHS) in Mexican adolescents grouped by weight status. Secondary objectives were to describe the influence of body mass index (BMI) and neck circumference (NC) as predictive factors of OSAH. Method: Somatometric, demographic data and full-night polysomnography were done. Linear and logistic regression models described the relationship between BMI and NC with OSAHS presence and severity. Receiver-Operating-Characteristics (ROC) curves showed different sensitivity and specificity performances of BMI and NC cutoff-values. Results: OSAHS frequency and severity were significantly greater in obese and extremely-obese adolescents (8% vs 22% vs 67%;p < 0.001). Linear regression showed an AHI increase of 0.940 events/hour for every centimeter-increase in NC and 0.696 events/hour for every1 kg/m2-increase in BMI. Logistic-regression showed extreme-obesity as the main risk factor (OR 9.9) for diagnosis of OSAHS. ROC curves showed an area under the curve (AUC) of 0.83 for BMI defined cutoff-values, and of 0.80 for BMI percentile-for-age cutoff-values. The AUC of NC ROC curve was 0.8043. Conclusion: This is the largest study made on Latin-American population evaluating the frequency and severity of OSAHS with full-night polysomnography. We showed that obese and extremely-obese Mexican-adolescents are at highest risk for OSAHS. Increasing BMI and NC showed positive correlation with AHI. Different BMI cut-off values showed similar diagnostic performance. Extreme-obesity increases 8 times the risk association for OSAHS.展开更多
Abnormal sensory responses have been found in the upper airway of obstructive sleep apnea patients, but no long-term study has been published previously regarding the evolution of obstructive sleep apnea syndrome and ...Abnormal sensory responses have been found in the upper airway of obstructive sleep apnea patients, but no long-term study has been published previously regarding the evolution of obstructive sleep apnea syndrome and persistence of abnormal pharyngeal sensory evaluation in response to continuous positive airway pressure (CPAP) treatment. Over 5 years, we managed healthy, nonobese subjects compliant with nasal CPAP. Only 47 subjects completed this prospective study, due to protocol requirements. They underwent regular clinical evaluation, subjective scales, four polysomnographies without nasal CPAP, recalibration of nasal CPAP with polysomnography, regular downloading of home data, and a palatal two-point discrimination study. None of the subjects presented normal results at any checkpoint when they had been without CPAP for two or three nights. By the completion of the study, all subjects required an increase in nasal CPAP (1- 7cm H2O) and demonstrated abnormal two-point palatal discrimination compared with control subjects. Despite initial control of clinical symptoms with regular usage of nasal CPAP in subjects without weight change, abnormal sensory palatal evaluation was present at the conclusion of the study. Obstructive sleep apnea syndrome involves abnormal upper airway sensory input, which may be responsible for the development of apneas and hypopneas. These neurological lesions are persistent despite nasal CPAP treatment.展开更多
文摘Insomnia is one of the most frequently observed sleep disorders, affecting nearly 10% of the general population. It has multiple etiological factors. Recently, it has been reported that EEG abnormalities are associated with insomnia in patients previously diagnosed as idiopathic insomniacs. In addition, transcranial magnetic stimulation (TMS) has shown to be effective in the treatment of disorders characterized by neural hyper-excitability. Method: In the present study, patients with insomnia and EEG abnormalities were submitted to slow repetitive trans-cranial magnetic stimulation, for 15 minutes daily during 10 days. Polysomnographic recordings were performed before and after TMS. Results: The results indicate that the presence of EEG abnormalities significantly decreased after TMS. In addition, most of the sleep parameters showed significant improvement. Conclusions: These data support the notion that TMS is a reliable therapeutic tool for patients affected with abnormalities linked to neuronal hyper-excitability.
文摘Background: Overweight and obesity are major public-health issues in Mexico. Sleep breathing disorders directly impact the health of affected subjects. The aim of this study was to describe the frequency and severity of obstructive sleep apnea/hypopnea syndrome (OSAHS) in Mexican adolescents grouped by weight status. Secondary objectives were to describe the influence of body mass index (BMI) and neck circumference (NC) as predictive factors of OSAH. Method: Somatometric, demographic data and full-night polysomnography were done. Linear and logistic regression models described the relationship between BMI and NC with OSAHS presence and severity. Receiver-Operating-Characteristics (ROC) curves showed different sensitivity and specificity performances of BMI and NC cutoff-values. Results: OSAHS frequency and severity were significantly greater in obese and extremely-obese adolescents (8% vs 22% vs 67%;p < 0.001). Linear regression showed an AHI increase of 0.940 events/hour for every centimeter-increase in NC and 0.696 events/hour for every1 kg/m2-increase in BMI. Logistic-regression showed extreme-obesity as the main risk factor (OR 9.9) for diagnosis of OSAHS. ROC curves showed an area under the curve (AUC) of 0.83 for BMI defined cutoff-values, and of 0.80 for BMI percentile-for-age cutoff-values. The AUC of NC ROC curve was 0.8043. Conclusion: This is the largest study made on Latin-American population evaluating the frequency and severity of OSAHS with full-night polysomnography. We showed that obese and extremely-obese Mexican-adolescents are at highest risk for OSAHS. Increasing BMI and NC showed positive correlation with AHI. Different BMI cut-off values showed similar diagnostic performance. Extreme-obesity increases 8 times the risk association for OSAHS.
文摘Abnormal sensory responses have been found in the upper airway of obstructive sleep apnea patients, but no long-term study has been published previously regarding the evolution of obstructive sleep apnea syndrome and persistence of abnormal pharyngeal sensory evaluation in response to continuous positive airway pressure (CPAP) treatment. Over 5 years, we managed healthy, nonobese subjects compliant with nasal CPAP. Only 47 subjects completed this prospective study, due to protocol requirements. They underwent regular clinical evaluation, subjective scales, four polysomnographies without nasal CPAP, recalibration of nasal CPAP with polysomnography, regular downloading of home data, and a palatal two-point discrimination study. None of the subjects presented normal results at any checkpoint when they had been without CPAP for two or three nights. By the completion of the study, all subjects required an increase in nasal CPAP (1- 7cm H2O) and demonstrated abnormal two-point palatal discrimination compared with control subjects. Despite initial control of clinical symptoms with regular usage of nasal CPAP in subjects without weight change, abnormal sensory palatal evaluation was present at the conclusion of the study. Obstructive sleep apnea syndrome involves abnormal upper airway sensory input, which may be responsible for the development of apneas and hypopneas. These neurological lesions are persistent despite nasal CPAP treatment.
