EXPOSIÇÕES AMBIENTAIS NOS PRIMEIROS MIL DIAS DE VIDA E ALTERAÇÕES FUNCIONAIS LIGADAS ÀS MÁS OCLUSÕES AOS 12 ANOS: COORTE BRISA, SÃO LUÍS

Abstract

The first thousand days of a human being's life comprise the period between pregnancy and the first two years of age (270 days of pregnancy plus 365 days of the first year of life and 365 days of the second year of life) and are considered the most sensitive period of human development. Environmental exposures during the first 1000 days of life appear to have a strong influence on epigenetic regulation, due to their power to influence the course of life, as well as serving as a window of opportunity for the prevention of future chronic diseases. This is because the health patterns established in the first years of life are capable of generating effects throughout an individual's life cycle. Therefore, the ideal time to intervene in these patterns is as early as possible, during pregnancy, in order to implement healthy habits and prevent the transmission of unhealthy habits from mother to child. In this context, that was hypothesized that environmental exposures from birth to two years of age have repercussions on functional alterations and malocclusion at 12 years of age. Chapter I of this thesis was the original article: “Having asthma traits in the 2nd year of life explained the dimensions of snoring, sleep, behavior and malocclusion at 12 years of age: BRISA São Luís cohort”, which aimed to investigate the association between asthma traits in the 2nd year of life and their effect on snoring, malocclusion, sleep and behavior at 12 years of age. This is a prospective study involving data from the Brisa - São Luís cohort in three follow-ups: prenatal (2010), 2nd year of the child (2011-2012) and at 12 years of age (2022-2023) (n=591). The theoretical model considered the latent variables: Prenatal Socioeconomic Status as the distal determinant; Asthma Traits in the 2nd year (wheezing, emergency, rhinitis and asthma diagnosis) as the main exposure; and, as the outcomes of interest: the three Dimensions of the Pediatric Sleep Questionnaire - QPS (Snoring, Sleep and Behavior) and Malocclusion at 12 years, being analyzed by Structural Equation Modeling. Having Asthma Traits in 2nd grade explained all three dimensions of the QPS: Snoring, Sleep, and indirectly Behavior, via snoring-sleep. Having asthma traits also indirectly explained malocclusion via snoring. Snoring was associated with Malocclusion and Sleep. Sleep strongly explained Behavior. As a conclusion it was observed that changes in respiratory function typical of asthma in the first two years of life are reflected in all the Snoring, Sleep and Behavior dimensions, as well as in Malocclusion in early adolescence. Chapter II of this thesis was the original article: “Confirmatory factor analysis of the Pediatric Sleeping Questionnaire at 12 years of age: BRISA Cohort, Brazil.” The aim of this study was to evaluate the psychometric properties of the Pediatric Sleep Questionnaire (PSQ) in population-based studies. This study used data from the BRISA cohort in the city of São Luís, at 12-year follow-up (n= 2,404). The interviews were carried out between May 2022 and July 2023. The Pediatric Sleep Questionnaire (PSQ) is a 22-item instrument that assesses three dimensions: Snoring, Sleep and Behavior. The confirmatory factor analysis explored a multidimensional construct that encompasses these three dimensions. The model fit indices indicated a good fit for all the proposed models (RMSEA < 0.05, 90% CI < 0.08, CFI > 0.95, TLI > 0.95). The latent dimensions of Snoring, Sleep and Behavior were analyzed based on their observed variables, following the structure of the PSQ. These three dimensions were then combined to form the overall PSQ construct. The variable “Growth stopped at some point” had a factor loading of less than 0.2 and was excluded from further analysis. Similarly, “Bedwetting” and “Overweight” were removed due to factor loadings of less than 0.3. The variable “Mouth breathing” was incorporated into the Snoring dimension using modification indices. In the final model, all latent factor loadings for Snoring, Sleep, Behavior and the overall PSQ construct were greater than 0.5 and statistically significant (all with p < 0.001). Sleep Disordered Breathing (SDB) was a multidimensional construct that encompassed the dimensions of Snoring, Sleep and Behavior. The PSQ demonstrated strong psychometric properties and proved reliable for assessing SRD in epidemiological studies. Chapter III of this thesis consists of an Instructional Resource in E-book format, entitled: “Obstructive Sleep Apnea Handbook: a simplified guide for dentists”, with the aim of highlighting the role of the dentist in the prevention of Sleep Disordered Breathing (SDB), especially Obstructive Sleep Apnea (OSA), based on knowledge of the essential aspects of OSA, including its manifestations, diagnosis and therapeutic options, as well as emphasizing the importance of the participation of caregivers and multidisciplinary cooperation between health professionals.