Desenvolvimento de aplicativo para higiene do sono em adultos / Development of an application for sleep hygiene in adults / Desarrollo de una aplicación para la higiene del sueño en adultos

Introdução: Diferentes condições clínicas podem afetar a quantidade e a qualidade do sono. As medidas de higiene do sono interferem diretamente na qualidade deste. Elas podem ser propagadas à população por meio de aplicativos. Objetivo: Desenvolver, avaliar e disponibilizar um aplicativo que contemple as medidas de higiene do sono e que seja capaz de gerar mudança e verificar a ocorrência de sonolência diurna excessiva. Metodologia: O aplicativo "Somnum" foi desenvolvido e 26 fonoaudiólogos certificados em Sono pela Associação Brasileira do Sono foram convidados a avaliar usando o questionário Emory e outro questionário elaborado pelas autoras. Após, 38 estudantes usaram o aplicativo e responderam antes e depois do uso o Índice de Qualidade do Sono de Pittsburgh e a Escala de Epworth. Resultados: Após seu desenvolvimento, o aplicativo foi avaliado por 4 fonoaudiólogas que contribuíram com suas sugestões e 38 universitários participaram respondendo os questionários, sendo que 6 deles participaram antes e após o uso do aplicativo. Sobre o Índice de qualidade de sono de Pittsburgh, foi observado na análise estatística, comparando o antes e após o uso do aplicativo, melhora da qualidade de sono (p=0,04). No que se refere ao questionário Epworth, foi verificado na situação após o uso do aplicativo "Somnum", que não houve diferença significativa. Conclusão: Após o uso do aplicativo, verificou-se possível melhora na qualidade de sono. Houve ocorrência de sonolência diurna excessiva. (AU)

Introduction: Different clinical conditions can affect the quantity and quality of sleep. Sleep hygiene measures directly affect the quality of sleep. They can be disseminated to the population by means of applications. Objective: To develop, evaluate and make available an application that approach sleep hygiene and that is able to generate changes and verify the occurrence of excessive daytime sleepiness. Methodology: The application "Somnum" was developed and 26 speech therapists certified in sleep by the Brazilian Sleep Association were invited to evaluate it using the Emory questionnaire and another questionnaire developed by the authors. Afterwards, 38 students used the application and answered before and after the use the Pittsburgh Sleep Quality Index and the Epworth Scale. Results: After its development, the app was evaluated by 4 speech therapists who contributed with their suggestions, and 38 university students participated by answering the questionnaires, 6 of them before and after the use of the application. In the Pittsburgh Sleep Quality Index, it was observed in the statistical analysis, comparing before and after using the application, improvement in sleep quality (p=0.04). In the Epworth questionnaire, it was verified in the situation after using the "Somnum" application, that there was not significant difference. Conclusion: After using the application, there was a possible improvement in sleep quality. There was occurrence of excessive daytime sleepiness. (AU)

Introducción: Diferentes condiciones clínicas pueden afectar a la cantidad y calidad del sueño. Las medidas de higiene del sueño afectan directamente a la calidad del mismo. Pueden propagarse a la población mediante aplicaciones. Objetivo: Desarrollar, evaluar y poner a disposición una aplicación que incluya medidas de higiene del sueño y que sea capaz de generar cambios y verificar la aparición de somnolencia diurna excesiva. Metodología: Se desarrolló la aplicación "Somnum" y se invitó a 26 fonoaudiólogos certificados en soeño por la Asociación Brasileña del Sonido a evaluarla utilizando el cuestionario Emory y otro cuestionario elaborado por los autores. Posteriormente, 38 estudiantes utilizaron la aplicación y respondieron antes y después del uso de la misma al Índice de Calidad del Sueño de Pittsburgh y a la Escala de Epworth. Resultados: Tras su desarrollo, la aplicación fue evaluada por 4 fonoaudiólogos que aportaron sus sugerencias y 38 estudiantes universitarios participaron respondiendo a los cuestionarios, 6 de ellos antes y después del uso de la aplicación. Sobre el Índice de Calidad del Sueño de Pittsburgh, se observó en el análisis estadístico, comparando antes y después del uso de la aplicación, mejoría en la calidad del sueño (p=0,04). Con respecto al cuestionario de Epworth, se verificó en la situación posterior al uso de la aplicación "Somnum", que no hubo diferencia significativa. Conclusión:Después de usar la aplicación, hubo uma posible mejora em la calidad del sueño. Hubo ocurrencia de somnolencia diurna excesiva. (AU)

The past, present and future of sleep medicine in China / 北京大学学报(医学版)

Sleep is a highly conserved phenomenon in endotherms, and has a universal physiological function across all species. In mammals, sleep can be divided into two stages: rapid eye movement (REM) sleep and non-REM (NREM) sleep, which alternate in a cyclic manner. Humans spend about one-third of their lives asleep. Sufficient sleep is necessary for humans to sustain everyday functioning. Sleep plays an important role in regulating energy metabolism, immune defense, endocrine function, and the consolidation of memory process. With the development of social economy and the change of life style, sleep duration of the residents has gradually decreased and the incidence of sleep disturbances has increased. Sleep disturbances can lead to severe mental disorders, such as depression, anxiety disorders, dementia, and other mental diseases, and may increase the risk of physical diseases, such as chronic inflammation, heart disease, diabetes, hypertension, atherosclerosis and others. Maintaining good sleep is of great significance for developing social productive forces, promoting sustainable development of economic society, and is a necessary condition for carrying out the "Healthy China Strategy". The sleep research in China started in 1950s. After decades of development, researchers have made great progress in the molecular mechanisms of sleep and wakefulness, the pathogenesis of sleep disorders and the development of new therapies. With the advancement of science and technology and the public's attention to sleep, the level of clinical diagnosis and therapy of sleep disorders in China is gradually brought in line with international standards. The publication of diagnosis and treatment guidelines in the field of sleep medicine will promote the standardization of the construction. In the future, it is still necessary to promote the development of sleep medicine in the following aspects: Strengthening the professional training and discipline construction, improving the cooperation of sleep research, promoting the intelligent diagnosis and treatment of sleep disorders, and developing the new intervention strategies. Therefore, this review will comprehensively summarize the origin, current situation, and future expectations of sleep medicine in China, including discipline construction of sleep medicine, the number of sleep project grants, research findings, the status and progress of diagnosis and treatment of sleep disorders, and the development direction of sleep medicine.

Somnolencia diurna excesiva identificada con la escala de Epworth en gestantes que acuden a consulta prenatal ambulatoria / Excessive daytime sleepiness identified with the Epworth scale in pregnant women attending an outpatient prenatal consultation

INTRODUCCIÓN: Durante el embarazo se reportan a menudo trastornos del sueño, pero son poco explorados en el control prenatal. El objetivo fue estimar la frecuencia e identificar los factores asociados a somnolencia diurna excesiva (SDE) en gestantes de bajo riesgo obstétrico que acudieron a consulta prenatal. MÉTODO: Estudio transversal dentro del proyecto «Salud biopsicosocial en gestantes», aprobado por el comité de ética de la Clínica Santa Cruz de Bocagrande, Cartagena, Colombia. Se estudiaron mujeres con 12 o más semanas de gestación. Se aplicó un formulario que incluía las escalas de somnolencia diurna de Epworth (ESE), de estrés percibido de 10 ítems (EPP-10) y revisada de depresión del Centro de Estudios Epidemiológicos (CESD-R10). Se realizó regresión logística ajustada y no ajustada de SDE con las otras escalas y variables cualitativas. Se buscó correlación entre variables cuantitativas y la escala de Epworth. Se consideró significativo p < 0,05. RESULTADOS: Se estudiaron 683 mujeres de 28,3 ± 6,3 años y 31,5 ± 6,9 semanas de gestación. Puntuación en la escala de Epworth: 3,82 ± 3,45. En el 4,9% se identificó SDE: 50% leve, 32,2% moderada y 17,6% importante. No se observó en el primer trimestre de gestación y la frecuencia fue similar en los otros; la SDE importante solo se observó en el tercer trimestre. Depresión: odds ratio [OR]: 3,69, intervalo de confianza del 95% [IC95%]:1,83-7,43. Anemia: OR 3,10, IC95%:1,50-6,38. Fatiga: OR 3,22, IC95%:1,23-8,44. Nerviosismo: OR 2,49, IC95%:1,22-5,12. Estrés: OR: 2,38, IC95%:1,12-5,05. Gran paridad: OR: 2,64, IC95%: 1,01-6,89. Trabajar fuera de casa: OR: 2,33, IC95%: 1,05-5,15. Todas estas variables se asociaron con SDE. En el modelo ajustado, la anemia (OR: 3,05, IC95%: 1,44-6,45) y la depresión (OR: 2,72, IC95%: 1,26-5,85) conservaron la asociación. Se observó correlación positiva, despreciable y estadísticamente significativa, de la ESE con la CESD-R10 y con la EPP-10; y ausencia de correlación con la edad materna, la edad gestacional, el número de abortos y el número de cesáreas. CONCLUSIONES: En una de cada 20 gestantes de bajo riesgo obstétrico se identificó SDE, y varias situaciones biopsicosociales se asociaron con mayor presencia.

INTRODUCTION: Sleep disturbances are constantly reported during pregnancy, although they are not often taken care of in prenatal care. The aim was to estimate the regularity and identify factors associated with excessive daytime sleepiness (EDS) in pregnant women at low obstetric risk who attended prenatal consultation. METHOD: Cross-sectional study belonging to the project “Biopsychosocial health in pregnant women”, approved by the ethics committee of the Santa Cruz de Bocagrande Clinic, Cartagena, Colombia. Pregnant women with 12 or more weeks of gestation were studied. A form including: Epworth Daytime Sleepiness Scale, 10-item Perceived Stress and the Revised Depression Scale of the Centre for Epidemiological Studies was applied. Adjusted and unadjusted logistic regression was performed between EDS with the other scales and qualitative variables. In addition, correlation between quantitative variables and the Epworth scale. P<0.05 was significant. RESULTS: 683 pregnant women were studied, maternal age 28.3 ± 6.3 years and gestational age 31.5±6.9 weeks. Epworth Scale score: 3.82 ± 3.45. EDS was identified in 4.9%, 50% mild, 32.2% moderate and 17.6% severe. It was not observed in the first gestational trimester and the frequency was similar in the others, severe EDS only in the third trimester. Depression OR: 3.69 [95% CI: 1.83-7.43], anemia OR: 3.10 [95% CI: 1.50-6.38], fatigue OR: 3.22 [95% CI: 1.23-8.44], nervousness OR: 2.49 [95% CI: 1.22-5.12, stress OR: 2.38 [95% CI: 1.12-5.05], high parity OR: 2.64 [95% CI: 1.01-6.89] and working outside the home OR: 2.33 [95% CI: 1.05-5.15, were associated with EDS. In the adjusted model, anemia OR: 3.05 [95% CI: 1.44-6.45] and depression OR: 2.72 [95% CI: 1.26-5.85] retained the association. CONCLUSIONS: In one out of every twenty low obstetric risk pregnant women EDS was identified and several biopsychosocial situations were associated with more presence.

Recommendations from the Asociación Colombiana de Medicina del Sueño for the practice of sleep medicine in Colombia during the COVID-19 pandemic / Recomendaciones de la Asociación Colombiana de Medicina del Sueño para el ejercicio de la medicina del sueño en Colombia durante la pandemia por COVID-19

Abstract Measures such as frequent handwashing, mandatory use of face masks by the general population in public spaces, social and physical distancing, and mandatory confinement of most people at their homes have contributed to slowing down the spread of the new coronavirus (SARS-CoV-2), which is the source of the current COVID-19 pandemic. However, adopting some of these measures has caused delays in the diagnosis and treatment of various diseases, including sleep disorders. Therefore, it is urgent for sleep specialists and sleep centers to gradually resume activities, as long as strict biosecurity protocols aimed at reducing the risk of contagion are implemented. In this scenario, and in order to help somnologists reopen sleep centers and resume the procedures performed there, the Asociación Colombiana de Medicina del Sueño (Colombian Association of Sleep Medicine) proposes through this reflection paper several recommendations that should be considered during the reactivation process. These recommendations are based on the COVID-19 spread mitigation strategies established by the Colombian health authorities, the guidelines issued by the American Academy of Sleep Medicine, and relevant literature on this subject, which was reviewed after performing a search in the PubMed, SciELO, and Google Scholar databases using the search terms "sleep" "sleep medicine" and "COVID19".

Resumen El lavado de manos frecuente, el uso obligatorio de mascarilla por parte de la población general en sitios públicos, el distanciamiento físico y social, y el confinamiento obligatorio de la mayoría de la población en sus casas son las medidas que hasta el momento han ayudado a frenar la propagación del nuevo coronavirus (SARS-CoV-2), causante de la actual pandemia por COVID-19. Sin embargo, la adopción de algunas de estas medidas ha generado retraso en el diagnóstico y tratamiento de diferentes enfermedades, incluyendo los trastornos del sueño, por lo que es urgente que los especialistas en medicina del sueño y los centros de sueño retomen sus actividades gradualmente, siempre que se implementen estrictos protocolos de bioseguridad que mitiguen el riesgo de contagio. En este contexto, y con el fin de ayudar a los somnólogos a reabrir los centros de sueño y reanudar los procedimientos allí realizados, la Asociación Colombiana de Medicina del Sueño propone en la presente reflexión una serie de recomendaciones para tener en cuenta durante el proceso de reactivación. Estas recomendaciones se basan en las estrategias de mitigación establecidas por las autoridades sanitarias del país, las directrices de la American Academy of Sleep Medicine y la literatura disponible sobre el tema, la cual fue revisada luego de realizar una búsqueda en las bases de datos PubMed, SciELO y Google Scholar usando los términos "sleep" "sleep medicine" y "COVID19".

Interpretation of American Academy of Sleep Medicine(AASM) clinical practice guideline for treatment of adult obstructive sleep apnea with positive airway pressure / 中国实用内科杂志

Recently, the publication of the new guideline for positive airway pressure(PAP) treatment of obstructive sleep apnea(OSA) in adults by the American Academy of Sleep Medicine(AASM) has caused a great response. Based on the quality of evidence, the balance of clinically significant benefits and harms, patient evaluation and preferences and use of resources, the new guidelines are divided into three types, which were good practice statements, strong recommendations and conditional recommendations. This guideline establishes clinical practice recommendations on OSA diagnosis, patients selection, initiation of PAP treatment, PAP ventilation mode,health education, behavior intervention, as well as follow-up. Unlike drug therapy, the medical insurance policy and management of PAP ventilator in China are different from those of European countries and America, therefore, the implementation of the guidelines should be in line with Chinese national conditions. This paper introduced and interpreted the changes in the new guidelines.

Future Sleep Medicine: Mobile Health and Big Data

Sleep is well known to be important to health and well-being, creativity, memory consolidation, and cognitive functions. However, sleep disorder patients sometimes had some limitation to get proper diagnosis and treatments. Now we live in an era of big change, so called the Fourth Industrial Revolution, which is characterized by mobile internet connectivity and artificial intelligence. Sleep medicine also started to change to patients-centered medicine with technical enhancement. To date, lots of smartphone applications and wearable device for monitoring sleep have appeared but not been validated enough against polysomnography. As another topic, big data receives lots of attention among sleep specialists. It is believed that big data would provide the basis of personalized healthcare. Here, we will discuss about new trend of sleep medicine involving mobile health such as telemedicine, smartphone, wearable device, and big data.

Evaluation of the relationship between sleep bruxism and pulpal calcifications in young women: A clinico-radiological study

PURPOSE: This study was performed to investigate the relationship between sleep bruxism (SB) and pulpal calcifications in young women. MATERIALS AND METHODS: A total of 100 female participants between 20 and 31 years of age who were referred to our radiology clinic for a dental check-up, including 59 SB and 41 non-SB patients, were sampled for the analysis. SB was diagnosed based on the American Academy of Sleep Medicine criteria. All teeth were evaluated on digital panoramic radiographs to detect pulpal calcifications, except third molars, teeth with root canal treatment, and teeth with root resorption. Binary logistic regression analysis was used to determine the risk factors for pulpal calcifications. The Spearman correlation coefficient was applied and the Pearson chi-square test was used for categorical variables. To test intra-examiner reproducibility, Cohen kappa analysis was applied. P values 0.05). In SB patients, the total number of pulpal calcifications was 129, while in non-SB patients, it was 84. Binary logistic analysis showed that SB was not a risk factor for the presence of pulpal calcifications (odds ratio, 1.19; 95% CI, 0.52–2.69, P>.05). CONCLUSION: No relationship was found between SB and pulpal calcifications.

Application of electrocardiogram-based cardiopulmonary coupling technique in sleep-related diseases / 上海交通大学学报（医学版）

Sleep problems have become a common health problem nowadays, and researches on sleep disorders have become a hot topic. Polysomnography (PSG) is the most commonly used method of sleep monitoring in sleep research, but its operation process is cumbersome and complicated, which is likely to cause "first night effect", affecting the compliance of the subjects and the reliability of the monitoring results. In 2005, the cardiopulmonary coupling (CPC) technique based on electrocardiogram signals was used for sleep assessment for the first time, and now it has been widely used in sleep monitoring and analysis of patients with sleep apnea syndrome, sleep disorders, insomnia, depression or other sleep-related diseases and the healthy people, to some extent making up for the lack of traditional PSG technology. It has the advantages of simplifying the operation and improving the sensitivity of the information effectively. However, CPC technique also has the limitations in target crowd, function and use, which can be improved by the developments of CPC algorithm and the cross-system integration of nerve in the future.

Application of electrocardiogram-based cardiopulmonary coupling technique in sleep-related diseases / 上海交通大学学报（医学版）

Sleep problems have become a common health problem nowadays,and researches on sleep disorders have become a hot topic.Polysomnography (PSG) is the most commonly used method of sleep monitoring in sleep research,but its operation process is cumbersome and complicated,which is likely to cause "first night effect",affecting the compliance of the subjects and the reliability of the monitoring results.In 2005,the cardiopulmonary coupling (CPC) technique based on electrocardiogram signals was used for sleep assessment for the first time,and now it has been widely used in sleep monitoring and analysis of patients with sleep apnea syndrome,sleep disorders,insomnia,depression or other sleep-related diseases and the healthy people,to some extent making up for the lack of traditional PSG technology.It has the advantages of simplifying the operation and improving the sensitivity of the information effectively.However,CPC technique also has the limitations in target crowd,function and use,which can be improved by the developments of CPC algorithm and the cross-system integration of nerve in the future.

Drug-induced sleep endoscopy in the identification of obstruction sites in patients with obstructive sleep apnea: a systematic review / Endoscopia do sono induzido por droga na identificação do(s) sítio(s) de obstrução em pacientes com apneia obstrutiva do sono: revisão sistemática

INTRODUCTION: Obstructive sleep apnea syndrome has multifactorial causes. Although indications for surgery are evaluated by well-known diagnostic tests in the awake state, these do not always correlate with satisfactory surgical results.OBJECTIVE: To undertake a systematic review on endoscopy during sleep, as one element of the diagnosis routine, aiming to identify upper airway obstruction sites in adult patients with OSAS.METHODS: By means of electronic databases, a systematic review was performed of studies using drug-induced sleep endoscopy to identify obstruction sites in patients with OSAS.RESULTS: Ten articles were selected that demonstrated the importance of identifying multilevel obstruction, especially in relation to retrolingual and laryngeal collapse in OSAS.CONCLUSION: DISE is an additional method to reveal obstruction sites that have not been detected in awake patients.

INTRODUÇÃO: A síndrome de apneia obstrutiva do sono (SAOS) apresenta causas multifatoriais com indicação cirúrgica avaliada por meio dos exames diagnósticos consagrados em vigília, que podem, porém, não assegurar resultados cirúrgicos satisfatórios.OBJETIVO: Realizar uma revisão sistemática sobre a endoscopia do sono, como parte da rotina diagnóstica, em pacientes adultos com SAOS a fim de identificar os sítios de obstrução da via aérea superior.MÉTODO: Revisão sistemática da literatura (RSL), a partir de bases de dados eletrônicas, dos estudos que identificaram os sítios de obstrução em pacientes com SAOS a partir da endoscopia do sono induzido por droga (DISE).RESULTADOS: Foram selecionados dez artigos que demonstraram relevância na identificação dos multiníveis de obstrução, principalmente em relação ao colapso retro-lingual e laríngeo na SAOS.CONCLUSÃO: DISE é um método adicional na identificação de sítios de obstrução não detectáveis no paciente em vigília.

Guía para la certificación de servicios diagnósticos de trastornos del sueño en Colombia (Incluye estándares para Servicios Pediátricos) / Guidelines for the voluntary certification of services studying sleep disorders in Colombia (including standards for paediatric services)

Antecedentes. La Asociación Colombiana de Sociedades Científicas (ACSC) convocó al Grupo de Investigación Transdisciplinario en Trastornos del Sueño (GITTS) -conformado por la Asociación Colombiana de Medicina del Sueño (ACMES), la Asociación Colombiana de Medicina Interna (ACMI®-Médicos para adultos), la Asociación Colombiana de Neumología y Cirugía de Tórax (Asoneumocito), la Asociación Colombiana de Neurología (ACN), la Asociación Colombiana de Otorrinolaringología y Cirugía Plástica Facial (ACORL) y la Asociación Colombiana de Psiquiatría (ACP)- para que elaboraran un documento con el cual se estableciera una normatividad para la certificación voluntaria de los servicios que estudian los trastornos del sueño en Colombia. Se busca que este proceso fomente la excelencia en el diagnóstico de los trastornos del sueño. Objetivos. El proceso busca definir los estándares mínimos para los servicios diagnósticos de medicina del sueño en Colombia. Aunque riguroso, el proceso ha de ser "amigable para el usuario". Se propone a la ACMES como ente evaluador. Materiales y métodos. El proceso evalúa la organización y administración de los servicios, los empleados y la dirección, las políticas y los procedimientos, la educación y el desarrollo del personal, las instalaciones y los equipos, así como el aseguramiento de la calidad. El enfoque general estuvo influenciado por programas establecidos y adoptados en otros países. Se espera que la consistencia con las guías internacionales disminuya la cantidad de trabajo necesaria para preparar la aplicación para los servicios que ya estén involucrados en los procedimientos de certificación -por ejemplo, certificación de hospitales- y que esto ayude a preparar el camino para la certificación en sueño. Resultados. La primera fase del proceso incluye contestar un cuestionario detallado designado para evaluar qué tan preparado está el servicio para ser certificado. La autoevaluación es una característica clave de esta fase. La habilidad para responder satisfactoriamente el cuestionario, guiado por los Estándares de Certificación detallados más adelante, deberá indicar al servicio solicitante su capacidad para cumplir con los requisitos de certificación. Si las respuestas son satisfactorias, el servicio enviará una solicitud completa. Si el Comité Evaluador (ACMES) establece que la solicitud llena los estándares, se realizará una visita a las instalaciones. Los servicios que evalúan niños menores de 12 años, deben cumplir con los requisitos específicos para esta población. Los mayores de 12 años sin condiciones médicas complejas se pueden estudiar en servicios certificados para adultos, siempre y cuando, disponga de los equipos de reanimación y de personal entrenado.

Background. The Colombian Association of Scientific Societies (known as ACSC in Spanish) requested the Transdisciplinary Research Group on Sleep Disorders (GITTS) to prepare a document establishing regulations for the voluntary certification of services studying sleep disorders in Colombia. The GITTS was formed by the Colombian Association of Sleep Medicine (ACMES), the Colombian Association of Internal Medicine (ACMI), the Colombian Association of Pneumology and Thoracic Surgery (Asoneumocito), the Colombian Association of Neurology (ACN), the Colombian Association of Otorhinolaryngology and Facial Plastic Surgery (ACORL) and the Colombian Association of Psychiatry (ACP). It was intended that this exercise would promote excellence in diagnosing sleep disorders. Objectives. Defining minimum standards for assessing/evaluating sleep disorder diagnosis services in Colombia; although rigorous, they had to be user-friendly. ACMES was proposed to play the role of guidelines controller. Materials and methods. The exercise evaluated service organisation and management, employees and management, policy and procedures, education and staff development, facilities and equipment and quality assurance. The overall approach was influenced by programmes already established and adopted by other countries. It was expected that uniformity regarding international guidelines would decrease the amount of work needed for preparing documentation for services which are already involved in certification procedures, for example, hospital certification, and that this would help pave the way for sleep medicine certification. Results. The first step involved a self-questionnaire designed to assess whether a particular service was ready to be certified, self-assessment being a key feature of this phase. Successfully responding to the questionnaire (guided by the certification standards) indicated whether a particular sleep disorder service met certification requirements. If the answers were satisfactory, then such service would send in a complete application. A site visit would then be made if the evaluation committee (ACMES) stated that the full standards had been satisfactorily met. Services assessing children under 12 years-old had to meet specific requirements for such population. Children over 12 years-old who did not have a complex medical condition could be studied by certified adult services, as long as resuscitation equipment and trained personnel were available.

Adesão de pacientes com síndrome da apneia obstrutiva do sono à pressão positiva contínua em via aérea em um serviço público / Adherence of obstructive sleep apnea syndrome patients to continuous positive airway pressure in a public service

Introdução: A terapia padrão para tratamento da síndrome da apneia obstrutiva do sono (SAOS) é o aparelho de pressão positiva contínua em via aérea (CPAP); todavia, seu uso correto e frequente é determinante para o controle da doença. Objetivo: Analisar a adesão ao CPAP entre pacientes com SAOS tratados em um ambulatório multidisciplinar em um hospital público. Métodos: Estudo retrospectivo avaliando 156 pacientes com SAOS que foram submetidos à polissonografia para titulação de CPAP de 2008 a 2011. Os pacientes foram divididos em dois grupos: os com boa e os com má adesão. Os grupos foram comparados entre si em relação aos seus dados: sexo, idade, IMC, doenças associadas, IAH à polissonografia diagnóstica e pressão em (cmH20) sugerida à polissonografia de titulação. Resultados: Foram analisados 125 pacientes, demonstrando que 82 dels (65%) tinham boa adesão, enquanto 43 (35%) eram maus usuários. A comparação entre os grupos mostrou que os pacientes com maior índice de apneia e hipopneias (IAH) eram os com melhor adesão ao tratamento com CPAP. Conclusões: A taxa de adesão ao CPAP entre os pacientes com SAOS monitorizados regularmente em um serviço público foi de 65%. Os pacientes com pior IAH foram os mais aderentes ao tratamento com CPAP. .

Introduction: The standard therapy for obstructive sleep apnea syndrome (OSAS) is continuous positive airway pressure (CPAP), but its correct and frequent use is essential to control the disease. Purpose: To analyze adherence to CPAP among patients with OSAS treated in a multidisciplinary outpatient clinic of a public tertiary hospital. Methods: This was a retrospective study evaluating 156 patients with OSAS who underwent polysomnography for CPAP titration from 2008 to 2011. The patients were divided into two groups, those with good adherence to CPAP (a mean use of four or more hours per night) and those with poor adherence. The groups were compared regarding the following data: gender, age, body mass index, associated diseases, AHI at diagnostic polysomnography, and pressure (cmH2O) suggested by titration polysomnography. Results: 125 patients were analyzed, and it was observed that 82 of the patients (65%) had good adherence, whereas 43 (35%) showed poor adherence. Comparison between groups revealed that patients with a higher apnea-hypopnea index (AHI) were those who better adhered to treatment with CPAP. Conclusions: the rate of adherence to CPAP among OSAS patients undergoing clinical monitoring at a public service was 65%. Patients with a higher AHI were those who adhered better to treatment with CPAP. .

Sleep Forensics: a critical review of the literature and brief comments on the Brazilian legal situation / Medicina do sono Forense: uma revisao critica da literatura e breves comentarios sobre a situacao brasileira

Sleep medicine is a relatively new field among Medical Sciences. Its legal aspects are still obscure, either for lack of knowledge of the biological mechanisms underlying violent behaviour during sleep or the virtual absence of clear legal and uniformly accepted guidelines as to whether to punish or treat those disorders. An updated review of the pertinent literature was performed to determine the most prevalent pathological conditions involving violence and sleep and to identify their most common precipitating factors, attempting to provide some technical support to aid Brazilian medical-experts or assistants in preparing substantial and scientific-based reports in a legal environment.

A medicina do sono é um campo relativamente novo dentro das Ciências Médicas. Seus aspectos legais encontram-se ainda na obscuridade, seja por falta de conhecimento dos mecanismos biológicos do desenvolvimento dos transtornos de comportamento e da violência praticada em estados alterados de sono, seja por virtual ausência de previsão legal do binômio tratamento/punição. Realizamos revisão atualizada da literatura para determinar as condições patológicas mais prevalentes envolvendo violência e sono, identificar seus fatores precipitantes mais comuns e os critérios médico-legais que podem auxiliar eventuais médicos-peritos ou assistentes na elaboração de pareceres abalizados em âmbito legal.

Professor Elio Lugaresi's contributions to neurology and sleep disorders / As contribuicoes do Professor Elio Lugaresi para a neurologia e os disturbios do sono

The authors present a brief historical review of the most important contributions by Professor Elio Lugaresi, of the University of Bologna, Italy, to neurology and sleep disorders.

Os autores apresentam uma breve revisão histórica sobre as mais importantes contribuições do Professor Elio Lugaresi, da Universidade de Bolonha, Itália, para a Neurologia e para os distúrbios do sono.