Complete denture wear during sleep in elderly sleep apnea patients-a preliminary study
Identifieur interne : 000083 ( PascalFrancis/Checkpoint ); précédent : 000082; suivant : 000084Complete denture wear during sleep in elderly sleep apnea patients-a preliminary study
Auteurs : Fernanda R. Almeida [Canada] ; Ricardo Jun Furuyama [Brésil] ; Danilo Chucralla Chaccur [Brésil] ; Alan A. Lowe [Canada] ; HUI CHEN [Canada] ; Lia Rita Bittencourt [Brésil] ; Maria L. M. A. Frigeiro [Brésil] ; Hiroko Tsuda [Japon]Source :
- Sleep & breathing [ 1520-9512 ] ; 2012.
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- Pascal (Inist)
- Wicri :
- topic : Personne âgée.
English descriptors
Abstract
Objectives There is no consensus in the literature about the impact of complete denture wear on obstructive sleep apnea (OSA). The goal of this randomized clinical study was to assess if complete denture wear during sleep interferes with the quality of sleep. Materials and methods Elderly edentulous OSA patients from a complete denture clinic were enrolled and received new complete dentures. An objective sleep analysis was determined with polysomnography performed at the sleep laboratory for all patients who slept either with or without their dentures. Results Twenty-three patients (74% females) completed the study with a mean age of 69.6 years and a mean body mass index of 26.7 kg/m2. The apnea and hypopnea index (AHI) was significantly higher when patients slept with dentures compared to without (25.9±14.8/h vs. 19.9±10.2/h;p>0.005). In the mild OSA group, the AHI was significantly higher when patients slept with the dentures (16.6±6.9 vs. 8.9±2.4; p<0.05), while in moderate to severe OSA patients, the AHI was not significantly different when sleeping with dentures (.30.8±15.6 vs. 25.7±7.5; p=0.2). The supine AHI in mild patients was related to a higher increase in AHI while wearing dentures (12.7±8.4/h vs. 51.9±28.6/h; p<0.001), A limitation of the study is that the mild OSA patients had a higher BMI when compared to the moderate to severe OSA patients. Ten out of 14 patients who preferred to sleep with their upper and lower dentures showed an increase in their AHI while wearing dentures to sleep. Conclusions Contrary to previous studies, we found that OSA patients may experience more apneic events if they sleep with their dentures in place. Specifically, in mild OSAS patients, the use of dentures substantially increases the AHI especially when in the supine position.
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Almeida</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Oral Health Sciences, University of British Columbia, 2199 Wesbrook Mall</s1><s2>Vancouver, BC V6T 1Z3</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Vancouver, BC V6T 1Z3</wicri:noRegion></affiliation></author><author><name sortKey="Furuyama, Ricardo Jun" sort="Furuyama, Ricardo Jun" uniqKey="Furuyama R" first="Ricardo Jun" last="Furuyama">Ricardo Jun Furuyama</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Prosthodontics, Universidade de São Paulo, Avenida Professor Lineu Prestes, 2227, Cidade Universitaria, 05508-000 São Paulo</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region><settlement type="city">São Paulo</settlement></placeName><orgName type="university">Université de São Paulo</orgName></affiliation></author><author><name sortKey="Chucralla Chaccur, Danilo" sort="Chucralla Chaccur, Danilo" uniqKey="Chucralla Chaccur D" first="Danilo" last="Chucralla Chaccur">Danilo Chucralla Chaccur</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Prosthodontics, Universidade de São Paulo, Avenida Professor Lineu Prestes, 2227, Cidade Universitaria, 05508-000 São Paulo</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region><settlement type="city">São Paulo</settlement></placeName><orgName type="university">Université de São Paulo</orgName></affiliation></author><author><name sortKey="Lowe, Alan A" sort="Lowe, Alan A" uniqKey="Lowe A" first="Alan A." last="Lowe">Alan A. 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M. A." last="Frigeiro">Maria L. M. A. Frigeiro</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Prosthodontics, Universidade de São Paulo, Avenida Professor Lineu Prestes, 2227, Cidade Universitaria, 05508-000 São Paulo</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region><settlement type="city">São Paulo</settlement></placeName><orgName type="university">Université de São Paulo</orgName></affiliation></author><author><name sortKey="Tsuda, Hiroko" sort="Tsuda, Hiroko" uniqKey="Tsuda H" first="Hiroko" last="Tsuda">Hiroko Tsuda</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>General Oral Care, Kyushu University Hospital, 3-1-1 Maidashi Higashiku</s1><s2>Fukuoka</s2><s3>JPN</s3><sZ>8 aut.</sZ></inist:fA14><country>Japon</country><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">12-0374360</idno><date when="2012">2012</date><idno type="stanalyst">PASCAL 12-0374360 INIST</idno><idno type="RBID">Pascal:12-0374360</idno><idno type="wicri:Area/PascalFrancis/Corpus">000051</idno><idno type="wicri:Area/PascalFrancis/Curation">000647</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000083</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000083</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Complete denture wear during sleep in elderly sleep apnea patients-a preliminary study</title><author><name sortKey="Almeida, Fernanda R" sort="Almeida, Fernanda R" uniqKey="Almeida F" first="Fernanda R." last="Almeida">Fernanda R. Almeida</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Oral Health Sciences, University of British Columbia, 2199 Wesbrook Mall</s1><s2>Vancouver, BC V6T 1Z3</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Vancouver, BC V6T 1Z3</wicri:noRegion></affiliation></author><author><name sortKey="Furuyama, Ricardo Jun" sort="Furuyama, Ricardo Jun" uniqKey="Furuyama R" first="Ricardo Jun" last="Furuyama">Ricardo Jun Furuyama</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Prosthodontics, Universidade de São Paulo, Avenida Professor Lineu Prestes, 2227, Cidade Universitaria, 05508-000 São Paulo</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region><settlement type="city">São Paulo</settlement></placeName><orgName type="university">Université de São Paulo</orgName></affiliation></author><author><name sortKey="Chucralla Chaccur, Danilo" sort="Chucralla Chaccur, Danilo" uniqKey="Chucralla Chaccur D" first="Danilo" last="Chucralla Chaccur">Danilo Chucralla Chaccur</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Prosthodontics, Universidade de São Paulo, Avenida Professor Lineu Prestes, 2227, Cidade Universitaria, 05508-000 São Paulo</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region><settlement type="city">São Paulo</settlement></placeName><orgName type="university">Université de São Paulo</orgName></affiliation></author><author><name sortKey="Lowe, Alan A" sort="Lowe, Alan A" uniqKey="Lowe A" first="Alan A." last="Lowe">Alan A. Lowe</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Oral Health Sciences, University of British Columbia, 2199 Wesbrook Mall</s1><s2>Vancouver, BC V6T 1Z3</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Vancouver, BC V6T 1Z3</wicri:noRegion></affiliation></author><author><name sortKey="Hui Chen" sort="Hui Chen" uniqKey="Hui Chen" last="Hui Chen">HUI CHEN</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Oral Health Sciences, University of British Columbia, 2199 Wesbrook Mall</s1><s2>Vancouver, BC V6T 1Z3</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Vancouver, BC V6T 1Z3</wicri:noRegion></affiliation></author><author><name sortKey="Rita Bittencourt, Lia" sort="Rita Bittencourt, Lia" uniqKey="Rita Bittencourt L" first="Lia" last="Rita Bittencourt">Lia Rita Bittencourt</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Psicobiologia, Universidade Federal de São Paulo, Rua Botucatu, 862-1° andar 04023-062, São Paulo</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>6 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Frigeiro, Maria L M A" sort="Frigeiro, Maria L M A" uniqKey="Frigeiro M" first="Maria L. M. A." last="Frigeiro">Maria L. M. A. Frigeiro</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Prosthodontics, Universidade de São Paulo, Avenida Professor Lineu Prestes, 2227, Cidade Universitaria, 05508-000 São Paulo</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region><settlement type="city">São Paulo</settlement></placeName><orgName type="university">Université de São Paulo</orgName></affiliation></author><author><name sortKey="Tsuda, Hiroko" sort="Tsuda, Hiroko" uniqKey="Tsuda H" first="Hiroko" last="Tsuda">Hiroko Tsuda</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>General Oral Care, Kyushu University Hospital, 3-1-1 Maidashi Higashiku</s1><s2>Fukuoka</s2><s3>JPN</s3><sZ>8 aut.</sZ></inist:fA14><country>Japon</country><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Sleep & breathing</title><title level="j" type="abbreviated">Sleep breath.</title><idno type="ISSN">1520-9512</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Sleep & breathing</title><title level="j" type="abbreviated">Sleep breath.</title><idno type="ISSN">1520-9512</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Elderly</term><term>Nervous system diseases</term><term>Sleep</term><term>Sleep apnea syndrome</term><term>Sleep disorder</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Syndrome d'apnée du sommeil</term><term>Pathologie du système nerveux</term><term>Trouble du sommeil</term><term>Personne âgée</term><term>Sommeil</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Personne âgée</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives There is no consensus in the literature about the impact of complete denture wear on obstructive sleep apnea (OSA). The goal of this randomized clinical study was to assess if complete denture wear during sleep interferes with the quality of sleep. Materials and methods Elderly edentulous OSA patients from a complete denture clinic were enrolled and received new complete dentures. An objective sleep analysis was determined with polysomnography performed at the sleep laboratory for all patients who slept either with or without their dentures. Results Twenty-three patients (74% females) completed the study with a mean age of 69.6 years and a mean body mass index of 26.7 kg/m<sup>2</sup>. The apnea and hypopnea index (AHI) was significantly higher when patients slept with dentures compared to without (25.9±14.8/h vs. 19.9±10.2/h;p>0.005). In the mild OSA group, the AHI was significantly higher when patients slept with the dentures (16.6±6.9 vs. 8.9±2.4; p<0.05), while in moderate to severe OSA patients, the AHI was not significantly different when sleeping with dentures (.30.8±15.6 vs. 25.7±7.5; p=0.2). The supine AHI in mild patients was related to a higher increase in AHI while wearing dentures (12.7±8.4/h vs. 51.9±28.6/h; p<0.001), A limitation of the study is that the mild OSA patients had a higher BMI when compared to the moderate to severe OSA patients. Ten out of 14 patients who preferred to sleep with their upper and lower dentures showed an increase in their AHI while wearing dentures to sleep. Conclusions Contrary to previous studies, we found that OSA patients may experience more apneic events if they sleep with their dentures in place. Specifically, in mild OSAS patients, the use of dentures substantially increases the AHI especially when in the supine position.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>1520-9512</s0></fA01><fA03 i2="1"><s0>Sleep breath.</s0></fA03><fA05><s2>16</s2></fA05><fA06><s2>3</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Complete denture wear during sleep in elderly sleep apnea patients-a preliminary study</s1></fA08><fA11 i1="01" i2="1"><s1>ALMEIDA (Fernanda R.)</s1></fA11><fA11 i1="02" i2="1"><s1>FURUYAMA (Ricardo Jun)</s1></fA11><fA11 i1="03" i2="1"><s1>CHUCRALLA CHACCUR (Danilo)</s1></fA11><fA11 i1="04" i2="1"><s1>LOWE (Alan A.)</s1></fA11><fA11 i1="05" i2="1"><s1>HUI CHEN</s1></fA11><fA11 i1="06" i2="1"><s1>RITA BITTENCOURT (Lia)</s1></fA11><fA11 i1="07" i2="1"><s1>FRIGEIRO (Maria L. M. A.)</s1></fA11><fA11 i1="08" i2="1"><s1>TSUDA (Hiroko)</s1></fA11><fA14 i1="01"><s1>Department of Oral Health Sciences, University of British Columbia, 2199 Wesbrook Mall</s1><s2>Vancouver, BC V6T 1Z3</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></fA14><fA14 i1="02"><s1>Department of Prosthodontics, Universidade de São Paulo, Avenida Professor Lineu Prestes, 2227, Cidade Universitaria, 05508-000 São Paulo</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>7 aut.</sZ></fA14><fA14 i1="03"><s1>Department of Psicobiologia, Universidade Federal de São Paulo, Rua Botucatu, 862-1° andar 04023-062, São Paulo</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>6 aut.</sZ></fA14><fA14 i1="04"><s1>General Oral Care, Kyushu University Hospital, 3-1-1 Maidashi Higashiku</s1><s2>Fukuoka</s2><s3>JPN</s3><sZ>8 aut.</sZ></fA14><fA20><s1>855-863</s1></fA20><fA21><s1>2012</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>27172</s2><s5>354000505300300380</s5></fA43><fA44><s0>0000</s0><s1>© 2012 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>42 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>12-0374360</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Sleep & breathing</s0></fA64><fA66 i1="01"><s0>DEU</s0></fA66><fC01 i1="01" l="ENG"><s0>Objectives There is no consensus in the literature about the impact of complete denture wear on obstructive sleep apnea (OSA). The goal of this randomized clinical study was to assess if complete denture wear during sleep interferes with the quality of sleep. Materials and methods Elderly edentulous OSA patients from a complete denture clinic were enrolled and received new complete dentures. An objective sleep analysis was determined with polysomnography performed at the sleep laboratory for all patients who slept either with or without their dentures. Results Twenty-three patients (74% females) completed the study with a mean age of 69.6 years and a mean body mass index of 26.7 kg/m<sup>2</sup>. The apnea and hypopnea index (AHI) was significantly higher when patients slept with dentures compared to without (25.9±14.8/h vs. 19.9±10.2/h;p>0.005). In the mild OSA group, the AHI was significantly higher when patients slept with the dentures (16.6±6.9 vs. 8.9±2.4; p<0.05), while in moderate to severe OSA patients, the AHI was not significantly different when sleeping with dentures (.30.8±15.6 vs. 25.7±7.5; p=0.2). The supine AHI in mild patients was related to a higher increase in AHI while wearing dentures (12.7±8.4/h vs. 51.9±28.6/h; p<0.001), A limitation of the study is that the mild OSA patients had a higher BMI when compared to the moderate to severe OSA patients. Ten out of 14 patients who preferred to sleep with their upper and lower dentures showed an increase in their AHI while wearing dentures to sleep. Conclusions Contrary to previous studies, we found that OSA patients may experience more apneic events if they sleep with their dentures in place. Specifically, in mild OSAS patients, the use of dentures substantially increases the AHI especially when in the supine position.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17A02</s0></fC02><fC02 i1="02" i2="X"><s0>002A25K</s0></fC02><fC02 i1="03" i2="X"><s0>002B17F</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Syndrome d'apnée du sommeil</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Sleep apnea syndrome</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Apnea sueno síndrome</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Pathologie du système nerveux</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Trouble du sommeil</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Sleep disorder</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Trastorno sueño</s0><s5>03</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Personne âgée</s0><s5>09</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Elderly</s0><s5>09</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Anciano</s0><s5>09</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Sommeil</s0><s5>11</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Sleep</s0><s5>11</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Sueño</s0><s5>11</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Homme</s0></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Human</s0></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Hombre</s0></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Pathologie de l'appareil respiratoire</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Respiratory disease</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Aparato respiratorio patología</s0><s5>37</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Cycle veille sommeil</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Sleep wake cycle</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Ciclo sueño vigilia</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Trouble neurologique</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Neurological disorder</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Trastorno neurológico</s0><s5>40</s5></fC07><fN21><s1>289</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist><affiliations><list><country><li>Brésil</li><li>Canada</li><li>Japon</li></country><region><li>État de São Paulo</li></region><settlement><li>São Paulo</li></settlement><orgName><li>Université de São Paulo</li></orgName></list><tree><country name="Canada"><noRegion><name sortKey="Almeida, Fernanda R" sort="Almeida, Fernanda R" uniqKey="Almeida F" first="Fernanda R." last="Almeida">Fernanda R. Almeida</name></noRegion><name sortKey="Hui Chen" sort="Hui Chen" uniqKey="Hui Chen" last="Hui Chen">HUI CHEN</name><name sortKey="Lowe, Alan A" sort="Lowe, Alan A" uniqKey="Lowe A" first="Alan A." last="Lowe">Alan A. Lowe</name></country><country name="Brésil"><region name="État de São Paulo"><name sortKey="Furuyama, Ricardo Jun" sort="Furuyama, Ricardo Jun" uniqKey="Furuyama R" first="Ricardo Jun" last="Furuyama">Ricardo Jun Furuyama</name></region><name sortKey="Chucralla Chaccur, Danilo" sort="Chucralla Chaccur, Danilo" uniqKey="Chucralla Chaccur D" first="Danilo" last="Chucralla Chaccur">Danilo Chucralla Chaccur</name><name sortKey="Frigeiro, Maria L M A" sort="Frigeiro, Maria L M A" uniqKey="Frigeiro M" first="Maria L. M. A." last="Frigeiro">Maria L. M. A. Frigeiro</name><name sortKey="Rita Bittencourt, Lia" sort="Rita Bittencourt, Lia" uniqKey="Rita Bittencourt L" first="Lia" last="Rita Bittencourt">Lia Rita Bittencourt</name></country><country name="Japon"><noRegion><name sortKey="Tsuda, Hiroko" sort="Tsuda, Hiroko" uniqKey="Tsuda H" first="Hiroko" last="Tsuda">Hiroko Tsuda</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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