Transtornos do sono: atualização (parte2/2) / Sleep disorders: up to date (2/2)

Este artigo (2/2) compõe uma revisão sobre fundamentos do sono e transtornos do sono (TS), sendo aqui considerados: 1-Incapacidade de dormir na hora desejada-atraso de fase, avanço de fase, ''jet lag'', ritmo sono-vigília irregular, sono/vigília de livre curso, transtornos dos trabalhadores em turnos; 2-Movimentos ou comportamentos anormais durante o sono. Este segundo grupo é aqui subdividido em: A1-Parassonias relacionadas ao sono NREM (Non-rapid eye movement) ­ despertar confusional, sonambulismo, terror noturno, síndrome da cabeça explosiva, alucinações relacionadas ao sono, enurese noturna e parassonias causadas por doenças e medicações; A2-Parassonias relacionadas ao sono REM (rapid eye movement) - transtorno comportamental do sono REM, pesadelos, paralisias recorrentes isoladas do sono, promulgação sono ''dream enactment behavior"; B-Transtornos do movimento relacionados ao sono-bruxismo, síndrome das pernas inquietas, movimentos periódicos das pernas, câimbras do sono, movimentos rítmicos relacionados ao sono, mioclonias proprioespinhais do início do sono, movimentos relacionados à medicação, mioclonias em doenças sistêmicas e mioclonias benignas do sono em bebês.(AU)

This is the second part (2/2) of an article that intends to review major topics regarding sleep fundamentals and sleep disorders (SD), now considering: 1-Circadian rhythm disorders-delayed onset sleep phase disorder, advanced onset sleep phase disorder, jet lag, irregular sleep-wake rhythm, free-running type, shift work type; 2-Abnormal movements or behaviours during sleep. This second category is divided in two groups: A1-NREM (Non-rapid eye movement) parasomnias ­ confusional awakening, sleepwalking, night terrors, explosive head syndrome, sleep-related hallucinations, nocturnal enuresis and parasomnias related to diseases or medications; A2-REM (Rapid eye movement) parasomnias-REM sleep behaviour disorder, nightmares, recurrent isolated sleep paralysis, dream enactment behaviour; B-Sleep related movement disorders-bruxism, restless legs syndrome, periodical limb movement disorders, nocturnal leg cramps, sleep related rhythmic movement disorder, propriospinal myoclonus, movements related to medication use, myoclonus related to systemic diseases and benign myoclonus of sleep.(AU)

La actigrafía como herramienta diagnóstica / ROLE OF ACTIGRAPHY IN THE STUDY OF SLEEP AND CIRCADIAN RHYTHMS : ACCURACY, SENSITIVITY AND SPECIFICITY OF ACTIGRAPHY FOR THE ASSESSMENT OF SLEEP DISORDERS

El diagnóstico y tratamiento de los trastornos de sueño, especialmente los asociados al Ritmo Circadiano, utilizan métodos costosos, invasivos e incómodos tanto para los pacientes como para los médicos, quienes deben realizar un seguimiento de los hábitos de sueño. La actigrafía ha sido aceptada como una herramienta válida para el estudio y diagnóstico de trastornos circadianos. Más de 300 dispositivos se comercializan actualmente para el uso personal, pero pocos de estos han sido probados para un uso diagnóstico. En este estudio comparativo compuesto por 21 sujetos, se informa acerca de los patrones de sueño y actividad registrados por algunos dispositivos, como Micro-Mini Motionlogger Watch, Condor Act Trust, MisFit Flash y Fitbit Flex. No se observan diferencias significativas en el análisis del patrón de actividad de descanso entre dispositivos. Tampoco se observan para el sueño Onset (inicio), el Tiempo Total de Sueño y la Eficiencia del Sueño. Según el tipo de estudio y análisis deseado, éstos dispositivos pueden resultar alternativos para los registros de actividad y sueño.

This is a comparative analysis of actigraphy performance in comparison with different sleep Parameters. Actigraphy is a non-invasive and valid method of monitoring human rest activity cycles. The report describes the role of actigraphy to assess the study of sleep-wake patterns and circadian rhythms, evaluating its development as a diagnostic tool, with a comparative analysis of actigraphy performance in comparison with different sleep parameters. The diagnosis and treatment of sleep disorders, especially those associated with the cicardian rhythm, employ very expensive costs, invasives or unconfortable for the patients the same as for physicians, who must perform a demand of the sleeping habits. The International Classification of Sleep Disorders has identified more than 80 sleep disorders, all of them have associated treatments. Actinography has been accepted as a valid tool for the study and diagnosis of circadian disorders. All these aspects are discussed in the article

Transtornos do sono: atualização (1/2) / Sleep disorders: up to date (1/2)

Esta é uma primeira parte (1/2) da abordagem de fundamentos do sono e transtornos do sono (TS) sobre aspectos: neurobiológicos (neuroanatômicos, neuroquímicos e fisiológicos); clínicos (anamnese e exame físico; exames subjetivos - questionários e escalas; exames objetivos - polissonografia, teste de latências múltiplas e actigrafia). É valorizada a terceira Classificação Internacional dos Transtornos do Sono (ICSD-3) para abordar aspectos clínicos, diagnósticos e terapêuticos, segundo as quatro queixas principais referentes dos TS: Insônia, Sonolência excessiva diurna, Movimentos e comportamentos anormais durante o sono e Incapacidade de dormir na hora desejada. Neste artigo abordamos apenas: 1-Insônia - dificuldade em adormecer ou manter-ser dormindo, acordar cedo, ou um distúrbio na qualidade do sono que faz com que o sono pareça inadequado ou não restaurador; duração: aguda ou crônica; 2- Sonolência excessiva diurna; consequente a distúrbios do sono, privação do sono; distúrbios centrais da hipersonia; distúrbios médicos ou psiquiátricos. (AU)

This is the first part (1/2) on this paper about sleep fundamentals and sleep disorders (TS) questions: neurobiological (neuroanatomical, neurochemical and physiological); clinical (anamnesis and physical examination; subjective exams - questionnaires and scales; objective examinations - polysomnography, multiple latency tests and actigraphy). The third International Classification of Sleep Disorders (ICSD-3) is valued to address clinical, diagnostic and therapeutic aspects, according to the four main complaints regarding TS: Insomnia, Excessive daytime drowsiness, Abnormal movements and behaviors during sleep, and Inability to sleep at the desired time. In this paper, it is discussed the only first two: 1-Insomnia: difficulty falling as-leep, staying asleep, early morning waking, non- restorative sleep, quality of sleep, and amount of sleep; duration: acute or chronic. (AU)

Características polisomnográficas nocturnas y otras variables relacionadas, en pacientes adultos mayores / Nocturnal polysomnbnographic characteristics and other related variables in elderly patients

Se cree que los ancianos necesitan dormir menos. Sin embargo, no es la necesidad de sueño sino la capacidad de dormir lo que disminuye con la edad, en paralelo a la mayor prevalencia de enfermedades cardiovasculares o metabólicas, o de depresión. Poco se ha descripto sobre los hallazgos polisomnográficos de esta población. En el presente estudio analizamos los hallazgos polisomnográficos en pacientes mayores de 65 años. Se realizó un estudio descriptivo a partir del análisis de una base de datos de 551 pacientes mayores de 65 años evaluados entre junio de 2013 y diciembre de 2014. Todos los sujetos se realizaron una polisomnografía (PSG) nocturna de 6 horas de duración. Las variables analizadas fueron: latencia de sueño (LS), eficacia de sueño (ES), latencia de fase REM (Lat R), % de R, índice de apneas hipopneas (IHA) y movimientos periódicos de piernas durante el sueño (PLMS). Se dividió la población en 3 grupos: G1: de 65 a 70 años; G2: 71 a 75; G3: mayor de 75 años. Se analizaron los datos de la serie general y las diferencias intergrupos. El IHA se incrementó con la edad y resultó más severo en los pacientes mayores de 75 años en relación con el grupo de menor edad. El incremento del IAH no se asoció a un incremento del índice de masa corporal ni a mayor somnolencia diurna. (AU)

It is believed that the elderly need less sleep. However, it is not the need for sleep but the ability to sleep that decreases with age, in parallel to the increasing prevalence of cardiovascular or metabolic disease, or depression. Little has been described about the polysomnographic findings of this population, hypothesizing that there are several alterations that prematurely corrected could improve the quality of life as the years go by. We analyzed the polysomnographic findings in patients over 65 years of age. A descriptive study was carried out based on the analyses of a database of 551 patients over 65 years of age evaluated between June 2013 to December 2014. All subjects underwent nocturnal PSG of 6 hours duration. The polysomnographic variables analyzed were: sleep latency (LS), sleep efficiency (ES), latency R phase (Lat R), % R, Apneas Hypoapneas Index (AHI) and Periodic Limb Movements of Sleep (PLMS). The population was divided into 3 groups: G1: from 65 to 70 years G2: 71 to 75, G3 greater than 75. AHI increased with age, being more severe in patients over 75 years of age in relation to the younger age group. The increase in AHI was not associated with an increase in Body Mass Index (BMI) or greater daytime sleepiness. (AU)

Sleep, ageing and night work

Studies have shown that the frequency or worsening of sleep disorders tends to increase with age and that the ability to perform circadian adjustments tends to decrease in individuals who work the night shift. This condition can cause consequences such as excessive sleepiness, which are often a factor in accidents that occur at work. The present study investigated the effects of age on the daytime and nighttime sleep patterns using polysomnography (PSG) of long-haul bus drivers working fixed night or day shifts. A total of 124 drivers, free of sleep disorders and grouped according to age (<45 years, N = 85, and ≥45 years, N = 39) and PSG timing (daytime (D) PSG, N = 60; nighttime (N) PSG, N = 64) participated in the study. We observed a significant effect of bedtime (D vs N) and found that the length of daytime sleep was shorter [D: <45 years (336.10 ± 73.75 min) vs N: <45 years (398 ± 78.79 min) and D: ≥45 years (346.57 ± 43.17 min) vs N: ≥45 years (386.44 ± 52.92 min); P ≤ 0.05]. Daytime sleep was less efficient compared to nighttime sleep [D: <45 years (78.86 ± 13.30 percent) vs N: <45 years (86.45 ± 9.77 percent) and D: ≥45 years (79.89 ± 9.45 percent) and N: ≥45 years (83.13 ± 9.13 percent); P ≤ 0.05]. An effect of age was observed for rapid eye movement sleep [D: <45 years (18.05 ± 6.12 percent) vs D: ≥45 years (15.48 ± 7.11 percent) and N: <45 years (23.88 ± 6.75 percent) vs N: ≥45 years (20.77 ± 5.64 percent); P ≤ 0.05], which was greater in younger drivers. These findings are inconsistent with the notion that older night workers are more adversely affected than younger night workers by the challenge of attempting to rest during the day.

Delta sleep instability in children with chronic arthritis

The objective of the present study was to evaluate the expression of a cyclic alternating pattern (CAP) in slow wave sleep (SWS) in children with the well-defined chronic syndrome juvenile idiopathic arthritis (JIA). Twelve patients (9-17 years of age), 7 girls, with JIA were compared to matched controls by age, pubertal stage and gender. After one night of habituation in the sleep laboratory, sleep measurements were obtained by standard polysomnography with conventional sleep scoring and additional CAP analyses. The sleep parameters of the JIA and control groups were similar for sleep efficiency (91.1 ± 6.7 vs 95.8 ± 4.0), sleep stage in minutes: stage 1 (16.8 ± 8.5 vs 17.8 ± 4.0), stage 2 (251.9 ± 41 vs 262.8 ± 38.1), stage 3 (17.0 ± 6.0 vs 15.1 ± 5.7), stage 4 (61.0 ± 21.7 vs 77.1 ± 20.4), and rapid eye movement sleep (82.0 ± 27.6 vs 99.0 ± 23.9), respectively. JIA patients presented nocturnal disrupted sleep, with an increase in short awakenings, but CAP analyses showed that sleep disruption was present even during SWS, showing an increase in the overall CAP rate (P < 0.01). Overall CAP rate during non-rapid eye movement sleep was significantly higher in pediatric patients who were in chronic pain. This is the first study of CAP in pediatric patients with chronic arthritis showing that CAP analyses can be a powerful tool for the investigation of disturbance of SWS in children, based on sleep EEG visual analysis.

Diagnóstico dos transtornos do sono relacionados ao ritmo circadiano / Diagnosis of circadian rhythm sleep disorders

Queixas de insônia e sonolência excessiva são comuns na investigação dos distúrbios respiratórios do sono; os transtornos do sono relacionados ao ritmo circadiano talvez sejam as causas mais freqüentemente esquecidas no diagnóstico diferencial destes sintomas. Estes transtornos se manifestam por desalinhamento entre o período do sono e o ambiente físico e social de 24 h. Os dois transtornos do sono relacionados ao ritmo circadiano mais prevalentes são o de fase atrasada (comum em adolescentes) e avançada do sono (comum em idosos), situações nas quais o período de sono se desloca para mais tarde e mais cedo, respectivamente. As possíveis confusões com insônia e sonolência excessiva tornam importante ter sempre em mente estes transtornos. Entretanto, há nove possíveis diagnósticos, e todos são de interesse clínico. Como a luz é o principal sinal para sincronizar os relógios biológicos, pessoas cegas e trabalhadores em turnos e noturno são os mais propensos a desenvolver transtornos do sono relacionados ao ritmo circadiano. Neste artigo, revisa-se a nova classificação internacional dos transtornos do sono relacionados ao ritmo circadiano.

Insomnia and excessive sleepiness are common in the investigation of sleep-disordered breathing. Circadian rhythm sleep disorders are perhaps the most often overlooked conditions in the differential diagnosis of these symptoms. Circadian rhythm sleep disorders manifest as misalignment between the sleep period and the physical/social 24-h environmental cycle. The two most prevalent circadian rhythm sleep disorders are delayed sleep phase (common in adolescents) and advanced sleep phase (common in the elderly), situations in which the sleep period is displaced to a later or earlier time, respectively. It is important to keep these two disorders in mind, since they can be confused with insomnia and excessive sleepiness. However, there are nine possible diagnoses, and all nine are of clinical interest. Since light is the principal cue used in synchronizing the biological clock, blind individuals and night-shift/swing-shift workers are more prone to develop circadian rhythm sleep disorders. In this article, the new international classification of circadian rhythm sleep disorders is reviewed.

Enfermedades del sueño y su impacto laboral / Sleep disorders and its impacts on work

El desarrollo progresivo de la medicina del sueño, y su papel en la calidad de vida y en el riesgo de padecer enfermedades cardio- y cerebrovasculares, ha incentivado la investigación en otras importantes áreas, como la medicina del trabajo. La asociación de accidentes automovilísticos con la hipersomnia diurna es bien conocida; a pesar de eso, hay un gran desconocimiento tanto en los médicos como la población en general sobre estos temas. por esta razón se efectúa un análisis del impacto de los problemas del sueño en la actividad laboral.

Introducción a la medicina del sueño / Introduction to sleep medicine

Psiquiatras, neurofisiólogos y una gran diversidad de especialistas han tenido interés por el estudio del sueño. El interés probablemente se deba al poco conocimiento de la fisiología del sueño. En la mayoría de los mamíferos el sueño tiene dos tipos de estadios: el sueño de ondas lentas (SWS) y el sueño de movimientos oculares rápidos (REM). El SWS o sueño no REM tiene cuatro etapas I, II, III/IV. El sueño no es un fenómeno continuo, sino tiene un ritmo diario circadiano y nocturno ultradiano. Existen muchos problemas del sueño como el insomnio, la hipersomnia y las parasomnias, éstas producen problemas neuropsicológicos además de dificultades sociales y de personalidad.

Controversias sobre sueño y trabajo / Controversies on sleep and work

Aún cuando existe abundante literatura sobre los efectos del trabajo nocturno en la fisiología humana y su repercusión en el mundo laboral, hay muchos aspectos que no están suficientemente entendidos. Este artículo presenta algunos de los ámbitos más controvertidos y entrega algunas recomendaciones sobre cómo enfrentar de mejor manera este tipo de trabajo y cómo sospechar la presencia de trastornos del sueño.