EVALUATING THE USE OF CEPHALOMETRIC MEASUREMENTS, PRESENCE OF A POSTERIOR CROSSBITE, THE BERLIN SLEEP QUESTIONNAIRE SCORE, AND RESULTS OF THE NOX-T3 SLEEP MONITOR FOR PREDICTING OBSTRUCTIVE SLEEP APNEA IN THE ORTHODONTIC POPULATION: PART 1
AdvisorGodel, Jeffrey H.
Committee memberSciote, James J.
Tellez Merchán, Marisol
Berlin Sleep Questionnaire
Nox-t3 Sleep Monitor
Obstructive Sleep Apnea
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/3354
MetadataShow full item record
AbstractIntroduction: Untreated obstructive sleep apnea (OSA) has deleterious effects on one's overall health. Recent literature suggests that craniofacial abnormalities, as noted on a lateral cephalometric radiograph (ceph) or clinically by the presence of a posterior crossbite, may be associated with OSA. Literature also suggests that if abnormal ceph measurements are noted or if a patient presents with a posterior crossbite, then further questioning about that patients sleep habits and snoring should be addressed. The primary purpose of this study is to explore any possible associations between ceph measurements, and/or presence of a posterior crossbite with OSA, as determined by the Berlin sleep questionnaire, in the orthodontic population. The second purpose of this research is to outline a part 2 follow-up study through administration of an at home sleep test, the Nox-T3 sleep monitor, to further validate presence of OSA. The overall goal is to see if the combined data from the Berlin score, the clinical presence or absence of a posterior crossbite, and standard orthodontic ceph measurements can increase the predictive value of patients in the orthodontic office who might be suffering from obstructive sleep apnea. Methods: A total of 85 consecutive subjects who were already undergoing records in 5 private practice orthodontic offices around the greater Philadelphia area were recruited for voluntary participation in the study. A Berlin questionnaire, lateral ceph, and any noted presence of a posterior crossbite were collected on all subjects. 12 ceph measurements (SNA, SNB, ANB, Co-A, Co-Gn, A-Na perp, Pg-Na perp, SN-MP, FH-MP, Ba-SN, Wits, and MP-Hyoid) were traced by a second year orthodontic resident. 5 subjects were then selected using a random numbers table and given the Nox-T3 sleep monitor for self-administration to record their sleep for one night. Statistical analyses were run using SAS version 9.2 to evaluate any associations. Results: A total of 76 subjects completed data collection, whereas 9 subjects either failed to report their height, and/or weight, and/or failed to complete the Berlin questionnaire in its entirety thus excluding them from the study. A total of 11, or 14% of subjects scored high on the Berlin, meaning a high risk of suffering from OSA. Of all ceph measurements, the only one that showed a statistically significant association with the high Berlin score was MP-Hyoid (p=0.0033). BMI alone was not found to be associated with the Berlin score (p=0.3712). Presence of a posterior crossbite also did not show any correlation with the Berlin score (p= 0.1000). Conclusions: 1) BMI was not found to be associated with the Berlin score among the orthodontic subject population. 2) MP-hyoid was found to be associated with the Berlin score, at a high level of statistical significance. 3) All other cephalometric measurements, including SNA, SNB, ANB, Co-A, Co-Gn, A-Na perp, Pg-Na perp, SN-MP, FH-MP, Ba-SN, and Wits, failed to show any statistically significant correlation to the Berlin score. 4) Posterior crossbite was not found to be associated with the Berlin Score among the orthodontic subject population. Key words: Obstructive sleep apnea, Berlin sleep questionnaire, cephalometric, posterior crossbite, Nox-T3 sleep monitor, orthodontic population
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Sleep duration and weight loss among overweight/obese women enrolled in a behavioral weight loss programO'Brien, EM; Fava, J; Subak, LL; Stone, K; Hart, CN; Demos, K; Wing, R (2012-09-01)OBJECTIVE: The purpose of this study was to examine whether baseline sleep duration predicts weight loss outcomes in a randomized controlled trial examining a behavioral weight loss (BWL) intervention among overweight and obese (OW/OB) women with urinary incontinence; and whether participation in the BWL intervention is associated with changes in sleep duration. DESIGN: Longitudinal, clinical intervention study of a 6-month BWL program. SUBJECTS: Three hundred sixteen OW/OB women, with urinary incontinence (age: 30-81 years, body mass index (BMI; 25-50 kgm-2) enrolled from July 2004-April 2006. MEASUREMENTS: Measured height and weight, self-report measures of demographics, sleep and physical activity. RESULTS: Neither self-reported total sleep time (TST) nor time in bed (TIB) at baseline significantly predicted weight loss outcomes among OW/OB women in a BWL treatment. BWL treatment was successful regardless of how much subjects reported sleeping at baseline, with an average weight loss of 8.19 kg for OW/OB women receiving BWL treatment, versus a weight loss of 1.44 kg in the control condition. Similarly, changes in weight, BMI and incontinence episodes did not significantly predict changes in sleep duration or TIB across the treatment period. CONCLUSION: Although epidemiological and cross-sectional studies support a relationship between short sleep and increased BMI, the present study found no significant relationship between TST or TIB and weight loss for OW/OB women participating in a BWL treatment. © 2012 Macmillan Publishers Limited. All rights reserved.
An Analysis of Sleep and Ergometer Performance in Collegiate Male RowersRosney, Daniel M; Hart, Chantelle Nobile; Lauer, Richard T. (Temple University. Libraries, 2020)Introduction: Research has increasingly looked at the effects of sleep on athletic performance. Although there is currently a plethora of data expressing the detrimental effects of sleep deprivation on athletic performance, fewer studies have assessed the effects of sleep extension. Of those studies that have been done, all have been with field or team sport athletes and all have been conducted with athletes who traditionally have practice times later in the day. Rowing is a sport with traditionally early practice times and represents an under examined population. Heart rate variability (HRV) biofeedback has been an increasingly utilized tool in monitoring athletes through training programs and allowing coaches a better picture of the effects of an athlete’s training regimen. Members of the Temple Men’s Rowing Team participated in an eight-week sleep extension study to observe any performance benefits gained from the increased amount of sleep. Methods: Nineteen members of the Temple University’s men’s rowing team were asked to increase their sleep to nine to ten hours a night for four weeks, following a two-week baseline period. A two-week post-intervention phase followed the sleep extension period. Three sport specific assessments (Open rate 1-minute, Rate-capped 1-minute, and Interval tests) and daily HRV recordings were captured each week. Results: Subjects were unable to obtain the amount of sleep for sleep extension, averaging 392.07 ± 53.69 and 374.11 ± 41.53 minutes of total sleep time during baseline and the intervention respectively (p = .137). Significant variation was found in the Interval test and OR1-Min test in a week to week comparison. Conclusion: Athletes failed to increase their time asleep, limiting our ability to assess the impact of sleep on performance. Performance did suffer over the course of the study, suggesting participants were below he minimal amount of sleep necessary to maintain performance. Better athlete education by coaches might prove beneficial for athletes to develop the habits necessary for sufficient sleep and improved performance.
Sleep problems and school competence: Transactional relations across middle childhood and the effects on children's adjustmentWeinraub, Marsha; Daly, Brian P.; Drabick, Deborah A.; DuCette, Joseph P.; Thurman, S. Kenneth (Temple University. Libraries, 2012)Despite evidence suggesting considerable overlap between the neurobiology underlying sleep regulation and the neurobehavioral systems regulating attention control and emotional arousal, sleep remains an understudied domain in the quest to improve children's regulation of behavior, emotions, and cognition in support of school competence during middle childhood. Using a large, normative sample (n = 1,057) from the National Institutes of Child Health and Human Development's Study of Early Childcare and Youth (NICHD-SECCYD), I tested a conceptual model of sleep, school competence, and children's adjustment to address important gaps in our understanding of the direction of effects and interrelations among sleep problems, attention problems, and academic and social competence across middle childhood. I examined the domains for their combined effects and pathways of influence on children's adjustment (e.g., depressive symptoms and feelings about school) at the end of middle childhood--a period just prior to the impending biological and contextual changes associated with adolescence. Using structural equation modeling and repeated measurement at 54 months-of-age, Grade 1, Grade 3, and Grade 5, findings indicated that maternal-reported sleep problems in preschool directly predicted teacher-reported attention problems when children were in third and fifth grade. Findings lend support for models of sleep and neural development that posit adverse early effects of sleep problems on prefrontal cortex (PFC) maturation that aids in the development of attention control. Maternal-reported sleep problems did not predict standardized assessments of reading and math at any time across the assessment period. In contrast, sleep problems predicted teacher reports of children's ability to effectively cooperate and execute positive response strategies with peers. Effective language and cognitive skills are important and necessary for positive peer interactions and problem solving, and sleep problems have been associated with slower growth in language development and memory processes. Both maternal-reported sleep problems and teacher-reported peer relations uniquely predicted children's self-reported depressive symptoms, perceived competence, and motivation and social support in school at the end of middle childhood. Findings lend support for an emotion information processing model of sleep and competency-based models of depression. Academic achievement and attention problems and attention problems and peer relations were reciprocally related at all assessment periods. In support of the academic underachievement hypothesis, academic achievement consistently exerted stronger effects on attention problems compared to inverse relations. Attention problems and academic achievement had no direct effects on children's depressive symptoms or motivation for school, but exerted indirect effects through their effects on peer relations. Despite expected relations, no domain in the present study predicted children's sleep problems. Even though results are somewhat surprising given theoretical perspectives and limited empirical work investigating associations between sleep problems, attention problems, and academic and social competence, this study was novel in its design for simultaneously evaluating effects of these domains together across time. Findings from the present study may fail to align with prior research because multiple domains were allowed to compete with one another in a single model, and shared rater variance as well as prior and concurrent levels of each domain were controlled across the study period. Alternatively, variables not measured in the present study but associated with children's sleep problems, such as child temperament or parenting practices, may be stronger predictors of children's sleep. In sum, results point to the unique associations between children's sleep problems, attention problems, and academic and social competence across middle childhood, and the importance of considering their combined influence on children's feelings of adjustment as they enter the challenging period of adolescence.