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Objectives To investigate the evidence on the association between ankyloglossia and obstructive sleep apnea. Methods An integrative literature review was carried out in the databases. Observational and interventional studies that assessed the lingual frenulum in children with sleep-disordered breathing were included. As exclusion criteria: studies in animals, in vitro, letters to the editor, expert opinions, other reviews. The selected articles were analyzed regarding the study design, sample, characterization of the lingual frenulum and sleep assessment, in addition to the main results and conclusions. Results Ninety-seven articles were identified, but only 4 met the inclusion criteria. Two retrospective studies concluded that the untreated shortened lingual frenulum at birth is associated with obstructive sleep apnea. A prospective study concluded that there was an improvement in speech and deglutition after lingual frenectomy, in addition to improved sleep. A retrospective cohort concluded that lingual frenuloplasty combined with myofunctional therapy is effective in the treatment of snoring and mouth breathing. Conclusion The studies included in this review contribute to corroborate the association between ankyloglossia and obstructive sleep apnea. Resumo Objetivo Investigar as evidências sobre a associação entre a anquiloglossia e a apneia obstrutiva do sono. Método Foi feita revisão de literatura integrativa nas bases de dados. Foram incluídos estudos observacionais e intervencionais em que foi feita a avaliação do frênulo de língua em crianças com distúrbios respiratórios do sono. Como critérios de exclusão: estudo em animais, in vitro, carta ao editor, opinião de expert, outras revisões. Os artigos selecionados foram analisados quanto ao desenho do estudo, casuística, caracterização da avaliação do frênulo lingual e do sono, além dos principais resultados e conclusões. Resultado Foram localizados 97 artigos, porém apenas 4 atenderam aos critérios de inclusão. Dois estudos retrospectivos concluiram que o frênulo lingual curto não tratado ao nascimento está associado à apneia obstrutiva do sono. Um estudo prospectivo concluiu que, após a frenectomia lingual, além da melhoria do sono, houve melhoria na fala e deglutição. Um coorte retrospectivo concluiu que a frenuloplastia lingual associada à terapia miofuncional é eficaz no tratamento do ronco e respiração oral. Conclusão Os estudos incluídos na presente revisão contribuem para corroborar a associação entre anquiloglossia e apneia obstrutiva do sono.

There are no studies comparing tests performed at home with those carried out in the laboratory, using the same device. The only studies that have been performed have compared the device used at home with the standard polygraph used in the laboratory. The purpose of this study was therefore to verify the accuracy of the home diagnosis of obstructive sleep apnea syndrome (OSAS) via unassisted type 2 portable polysomnography, compared with polysomnography using the same equipment in a sleep laboratory. To avoid any possible order effect on the apnea-hypopnea index (AHI), we randomly created two groups of 20—total 40 patients, according to the test sequence. One of the groups had the first test at home and the second test in the laboratory (H-L); the other group had the first test in the laboratory and the second at home (L-H). The second test always took place on the night immediately following the first test. All polysomnographic monitoring was undertaken with the same equipment, an Embletta X100 system (Embla, Natus Inc., Middleton, USA). The Embletta X100 is a portable polygraph that records eleven polygraph signs: (1) electroencephalogram C4/A; (2) electroencephalogram O2/M1; (3) submental EMG; (4) electrooculogram of the right side; (5) nasal cannula (air flow); (6) respiratory effort against a plethysmographic chest strap; (7) respiratory effort against an abdominal plethysmographic belt; (8) heart rate; (9) saturation of oxyhemoglobin; (10) snoring; and (11) body position. There was no difference in sleep efficiency between the group monitored in the laboratory and the group tested at home (p = 0.30). There was no difference in total sleep time (p = 0.11) or sleep latency (p = 0.52), or in the latency in phases N2 and N3 between the monitoring in the laboratory and at home (N2 p = 0.24; N3 p = 0.09). Some differences occurred regarding the PSG that took place at home, with longer duration of wake after sleep onset (WASO) and longer latency for REM sleep, due to failure of the patient to start the monitoring by pressing the “events” button on the device. In the distribution of sleep phases, there was no difference between the group monitored in the laboratory and the group tested at home. Results from home sleep monitoring correlate well with the laboratory “gold standard” and may be an option for diagnosing OSAS in selected patients.

Introduction: Obstructive breathing disorders are highly prevalent in the pediatric population, several guidelines proposing management of obstructive sleep apnea (OSA) diagnosis and multi-professional treatment. However, Brazil is a low-resource country with heterogenous access to complex diagnosis strategies, with the needs of adjusted strategies. Aims: to elaborate a multi-professional consensus for the diagnosis and management of OSA in children adapted for the Brazilian reality. Methods: A multi-professional group (otolaryngologists, dentists, speech-language therapists, physiotherapists and psychologists) of 2 universities at Sao Paulo State, Brazil, elaborated a protocol of domains and questions to be submitted to a major group of specialists for consensus analysis, based on the Delphi Method. Results: A multi-professional group of 28 specialists were invited to discuss the questions elaborated by the consensus group. Six domains for consensus elaboration were defined: anamnesis, physical examination, complementary exams of the upper airway, polysomnography or similar, multi-level treatment. For each domain, 4 to 5 questions were elaborated with answers based on best clinical evidence and on real-life feasibility. Conclusion: Delphi method attended the necessity for question elaboration and judgement. Multi-professional discussion showed to be important for defining best clinical practice for the Brazilian reality. Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical Practice Guideline: Tonsillectomy in Children (Update)-Executive Summary. Otolaryngol Head Neck Surg 160 (2019) 187-205 doi:10.1177/0194599818807917.

Background: The current limited evidence may be suggestive that mandibular advancement appliance (MAAs) result in improvements in AHI scores, but it is not possible to conclude that MAAs are effective to treat paediatric OSA. There are significant weaknesses in the existing evidence due primarily to absence of control groups, small sample sizes, lack of randomization and short-term results. Aim: the objective of the present study was to evaluate MAAs in children with OSA. Material and Methods: Children presenting an apnea-hypopnea index (AHI) greater than or equal to one event per hour were considered to be apneic. This group of children with AHI greater than or equal to one was randomly divided through a draw into two subgroups: half of them in an experimental subgroup and half of them in a control subgroup. In the experimental subgroup, molds of each of these children’s maxillary and mandibular arches were taken using standard molds and molding material. The control group did not use any intraoral device and did not undergo any type of treatment for OSAS. The MAAs used in this study had the aim of achieving mandibular advancement, thereby correcting the mandibular position and dental occlusion, and perhaps increasing the airway and treating OSAS. After 12 consecutive months of use of the mandibular advancement devices, polysomnography examinations using the same parameters as in the initial examinations were requested for both the experimental and the control subgroup. Results: There was a decrease in AHI in the experimental group and an increase in the control group, with statistical significance. These data were used to calculate the sample size, which was 28 children in total in the groups. Conclusions: There was a decrease in AHI one year after implementing use of mandibular advancement devices, in comparison with the group that did not use these devices.

Objective to produce the Brazilian version of the Berlin Questionnaire (BQ) with evidence of reliability and validity. Method The cultural adaptation was carried out in the following stages: translation, synthesis of translations, back-translation, evaluation by an expert committee and pre-test with 30 participants. Next, the psychometric properties were evaluated with 104 participants who answered the Brazilian version of the BQ and underwent polysomnography (PSG). They also completed a sociodemographic and clinical characterization instrument and the Epworth Sleepiness Scale. Reliability was assessed concerning homogeneity of the items (internal consistency), and criterion validity was tested by comparing the Brazilian version of the BQ with the apnea and hypopnea index (AHI) obtained through PSG. Results The Brazilian version of the BQ presented evidence of semantic-idiomatic, conceptual and cultural equivalence, with good acceptability and feasibility. The findings demonstrated the reliability of the measure (Cronbach's alpha 0.74). The instrument presented a sensitivity of 81.3%, 86.2%, and 93.8%, and specificity of 82.5%, 54.7% and 50.0% for the risk stratification of obstructive sleep apnea according to the AHI ≥5, ≥15 and ≥ 30 events per hour, respectively. It should be emphasized that the BQ is a screening instrument for obstructive sleep apnea (OSA) and should be combined with a clinical evaluation and later confirmed with PSG. Conclusion The Brazilian version of the Berlin Questionnaire was reliable and valid in the study population.

INTRODUCTION: Obstructive sleep apnea syndrome has a high prevalence among adults. Cephalometric variables can be a valuable method for evaluating patients with this syndrome. OBJECTIVE: To correlate cephalometric data with the apnea-hypopnea sleep index. METHODS: We performed a retrospective and cross-sectional study that analyzed the cephalometric data of patients followed in the Sleep Disorders Outpatient Clinic of the Discipline of Otorhinolaryngology of a university hospital, from June 2007 to May 2012. RESULTS: Ninety-six patients were included, 45 men, and 51 women, with a mean age of 50.3 years. A total of 11 patients had snoring, 20 had mild apnea, 26 had moderate apnea, and 39 had severe apnea. The distance from the hyoid bone to the mandibular plane was the only variable that showed a statistically significant correlation with the apnea-hypopnea index. CONCLUSION: Cephalometric variables are useful tools for the understanding of obstructive sleep apnea syndrome. The distance from the hyoid bone to the mandibular plane showed a statistically significant correlation with the apnea-hypopnea index. INTRODUÇÃO: A síndrome da apneia do sono apresenta grande prevalência na população adulta. A cefalometria com análise das variáveis morfológicas pode ser um método valioso na avaliação de pacientes com essa síndrome. OBJETIVO: Correlacionar dados cefalométricos com o índice de apneia-hipopneia do sono, com a finalidade de detectar fatores preditores para a gravidade da síndrome da apneia obstrutiva do sono. MÉTODOS: Trata-se de um estudo retrospectivo, em que foram analisadas cefalometrias de pacientes em acompanhamento no ambulatório de distúrbios do sono da disciplina de Otorrinolaringologia, de um hospital universitário terciário, no período de junho de 2007 a maio de 2012. RESULTADOS: Foram avaliados 96 pacientes, sendo 45 homens e 51 mulheres. Onze pacientes eram portadores de roncopatia, 20 de apneia leve, 26 de apneia moderada e 39 de apneia grave. A única variável cefalométrica que apresentou correlação estatisticamente significante com o índice de apneia e hipoapneia foi a distância linear perpendicular do osso hioide ao plano mandibular. CONCLUSÃO: As variáveis cefalométricas podem ser úteis no entendimento da síndrome da apneia obstrutiva do sono e uma atenção deve ser dada à variável que mede a distância do hioide perpendicularmente ao plano mandibular.

Background: OSAS during childhood leads to significant physical and neuropsychomotor impairment. Thus, it needs to be recognized and treated early in order to avoid or attenuate the chronic problems associated with OSAS, which are deleterious to a child’s development. Adenotonsillectomy and, in select cases, continuous positive airwaypressure (CPAP) have been the preferred treatments for OSAS in children, and yet they are ineffective at fully ameliorating the disease. Minimally invasive treatments have recently been proposed, comprising intra-oral and extra-oral devices as well as speech therapy. Objetive: to conduct a meta-analysis on studies from around the world that used rapid maxillary expansion (RME) to treat OSAS in children. Material and Methods: We performed a meta-analysis of studies using RME for OSA treatment in children. A literature survey was conductedusing PubMed and Medline for English articles published up to December 2014 with the following descriptors: Sleep Apnea, Obstructive, Children, Treatment, Orthodontic, Othopaedic, Maxillaryexpansion. Studies were included in the meta-analysisif they were case-controlled studies, randomized, and involved non-syndromic children aged 0 to 12years old diagnosed with OSA by the polysomnography apneahypopnea index (AHI) before and after the intervention, submitted RME only. Results: In all, 10 articles conformed to the inclusion criteria and were included in this meta-analysis. The total sample size across all these articles was 215 children, having a mean age of 6.7 years,of whom58.6%were male. The mean AHI during the follow-up was -6.86 (p

Patients with obstructive sleep apnea (OSA) may have subclinical swallowing abnormalities due to progressive mechanical trauma of the pharyngeal tissues caused by snoring. There are few trials on swallowing among OSA patients, and most of them used videoradiography. The aim of this trial was to show swallowing function in OSA patients by nasal fibroscopy. Eleven patients with OSA diagnosed by polysomnography, with a mean age of 48 ± 14 years, without spontaneous complaints of swallowing, and 14 non-snoring volunteers, with a mean age of 47 ± 12 years, without spontaneous complaints of swallowing, participated in the study. The participants were evaluated using nasal fibroscopy. Each participant was offered diet boluses (5 and 10 ml) such as thin liquids, puree, and solids, and their swallowing function was determined according to the following criteria: (1) premature oral leakage to the pharynx; (2) laryngeal penetration; (3) tracheal aspiration; and (4) pharyngeal stasis. Sixty-four percent of the OSA patients presented premature oral leakage, 55% presented pharyngeal stasis of the bolus after swallowing, and we did not observe laryngeal penetration or tracheal aspiration. There were no subclinical manifestations in the control group. OSA patients presented subclinical manifestations of abnormal swallowing, when analyzed using nasal fibroscopy, possibly associated with neuromuscular injury caused by snoring.

A Síndrome da Apneia e Hipopneia Obstrutiva do Sono (SAOS) é caracterizada por colapsos recorrentes da região faríngea durante o sono, resultando em redução substancial do fluxo aéreo; os eventos respiratórios desencadeiam desordens intermitentes dos gases sanguíneos e podem levar a um a ativação do sistema simpático. Desta forma, a SAOS pode ser encontrada em mais de um terço dos pacientes portadores de hipertensão arterial sistêmica (HAS). O Programa “Cuide-se” corre os institutos e unidades da Universidade identificando pacientes para a prevenção e tratamento de Doenças Crônicas não Transmissíveis, dentre elas a HAS. No grupo de pacientes hipertensos foram aplicados os questionários Escala de Berlim para triagem dos sujeitos com Ronco e SAOS e a escala de sonolência de Epworth. Neles são coletados dados antropométricos como peso, altura, Índice de Massa Corpórea, circunferência cervical e abdominal, avaliação do tipo de palato, Classificação de Mallampatti modificado, tonsilas, Classificação de Angle, avaliação de Perfil facial e gênero. Pacientes selecionados são encaminhados para exame Otorrinolaringológico, solicitação do exame de polissonografia e seleção de tratamento: aparelhos intra-orais de avanço mandibular, Aparelho de Pressão Positiva de Ar , terapia cirúrgica e/ou combinação de mais de um tipo de terapia. Após um ano de adesão dos pacientes às terapias, estes serão reavaliados e comparados com os dados iniciais. Observou-se boa aceitação da investigação da SAOS no grupo de pacientes com HAS, fato inédito nos grupos até o momento. Nos pacientes selecionados, a Polissonografia confirmou a presença de SAOS, e a todos foi oferecido tratamento adequado.

Introduction Obstructive Sleep Apnea (OSA) in childhood leads to physical impairment and psychomotor important. Thus, it must be recognized and treated early, in an attempt to prevent or mitigate the consequences, as they may be harmful to the proper development of the child. The adenotonsillectomy, and in selected cases, the Continuous Positive Airway Pressure (CPAP) have been the treatments of choice for OSAS in children, without having absolute success in treating this syndrome. Minimally invasive treatments have been proposed more recently, intra-oral devices, extra-oral and speech therapy. Objective: To perform a meta-analysis of maxillary expansion in OSA in children. Materials and methods Citations to potentially relevant published trials were located by searching PubMed, Embase, Scopus and Medline. Inclusion criteria were (1) randomized controlled trials, case-control trials, or cohort studies with controls; (2) studies in nonsyndromic children 0 to 12 years of age (3) polysomnography with apnea- hypopnea index (AHI) before and after treatment; and (4) maxillary expansion treatment. The quality of the studies selected was evaluated by assessing their methodologies. Treatment effects were combined by meta-analysis with the random-effects method. Results The total sample of these articles was 116 children with a mean age of 6.7 years. Of the six items assessed four underwent two periods of follow-up. Mean AHI in the first follow-up was −4.958 ( p p Conclusion Meta-analysis of six international papers, we concluded that maxillary expansion in children with OSA is an effective method in the treatment of this syndrome being supplementary maintained in the medium term. Further studies are needed to assess whether this effectiveness remains in adulthood. Acknowledgement FAPESP process 2012/00092–0.