Intermittent hypoxia, brain glyoxalase-1 and glutathione reductase-1, and anxiety-like behavior in mice

Objective: Sleep apnea has been associated with anxiety, but the mechanisms of the sleep apnea-anxiety relationship are unresolved. Sleep apnea causes oxidative stress, which might enhance anxiety-like behavior in rodents. To clarify the apnea-anxiety connection, we tested the effect of intermittent hypoxia, a model of sleep apnea, on the anxiety behavior of mice. Methods: The rodents were exposed daily to 480 one-minute cycles of intermittent hypoxia to a nadir of 7±1% inspiratory oxygen fraction or to a sham procedure with room air. After 7 days, the mice from both groups were placed in an elevated plus maze and were video recorded for 10 min to allow analysis of latency, frequency, and duration in open and closed arms. Glyoxalase-1 (Glo1) and glutathione reductase-1 (GR1) were measured in the cerebral cortex, hippocampus, and striatum by Western blotting. Results: Compared to controls, the intermittent hypoxia group displayed less anxiety-like behavior, perceived by a statistically significant increase in the number of entries and total time spent in open arms. A higher expression of GR1 in the cortex was also observed. Conclusion: The lack of a clear anxiety response as an outcome of intermittent hypoxia exposure suggests the existence of additional layers in the anxiety mechanism in sleep apnea, possibly represented by sleepiness and irreversible neuronal damage.

Cognition and behavorial morbidity associated with sleep disordered breathing in children / Alteraciones cognitivas y conductuales en los trastornos respiratorios del sueño (TRS) en niños

Sleeep disorder breathing (SDB) in chilhood includes a broad spectrum of disease ranging from primary snoring to more severe forms of obstructive sleep apnea syndrome. They may be associated with alterations different than those seen in adults, e.g., children present a low percentage of daytime sleepiness. Nevertheless, they present great difficulties in their learning, and failure in memory and attention and reports of behavior of aggressiveness. We analyze in the present review the cognitive and behavioral deficits asscoaited with the RDS and the main tests that are made for its study

Los trastornos respíratorios del sueño (TRS) en la infancia incluyen un amplio espectro que comprende desde el ronquido primario hasta las formas más graves de síndrome de apnea obstructiva del sueño (SAOS). Los niños presentan sintomatología asociada distinta a los adultos, como un bajo porcentaje de sonmolencia diurna. No obstante refieren dificultades en su aprendizaje, fallas en memoria, atención y cambios en su hiperactividad y agresividad. Se analizan los déficit cognitivos y conductuales asociados a los TRSy las principales pruebas neuropsicológicas o test que se realizan para su estudio

Trastornos respiratorios del sueño en niños con síndrome de Down / Sleep disorder breathing in children with Down syndrome

Respiratory sleep disorders in children with Down syndrome (DS) have a high prevalence and are related to anatomical and functional characteristics of this syndrome. In this children we should have a high index of suspicion of sleep breathing disorders, diagnose and treat them in order to achieve their full potential in terms of physical and cogntive health

Los trastornos respiratorios del sueño (TRS) en niños con síndrome de Down (SD) tienen una alta prevalencia y estan relacionados con características estructurales y funcionales propias de la enfermedad. En el SD se debe mantener un alto índice de sospecha de los TRS, diagnosticarlos y tratarlos con el fin que los pacientes puedan alcanzar su pleno potencial en términos de salud física y cognitiva

Death and Disability in Patients with Sleep Apnea - A Meta-analysis / Mortalidade e Incapacidade em Pacientes com Apneia do Sono - Uma Metanálise

Background: Several studies have been attempting to ascertain the risks of Sleep Apnea Syndrome (SAS) and its morbidity and mortality. Objective: The main objective was to verify whether SAS increases the risk of death; the secondary objective was to evaluate its morbidity in relation to cardiovascular disease and the number of days hospitalized. Methods: A systematic review and a meta-analysis were performed of the published literature. The research focused on studies comparing the number of deaths in patients with untreated SAS and in patients with non-SAS. Results: The meta-analysis was based on 13 articles, corresponding to a total of 13394 participants divided into two groups (non-SAS = 6631; SAS = 6763). The meta-analysis revealed a clear association of SAS with the occurrence of fatal events, where the presence of SAS corresponded to a 61% higher risk of total mortality (OR=1.61; CI: 1.43 - 1.81; p < 0.00001), while the risk of death from cardiac causes was 2.52 times higher in these patients (OR = 2.52; IC: 1.80 - 3.52; p < 0.00001). Similar results were obtained for mortality from other causes (OR = 1.68; CI: 1.08 - 2.61; p = 0.02). Resembling results were obtained in the remaining outcomes: non-fatal cardiovascular events were higher in the SAS group (OR = 2.46; IC: 1.80 - 3.36; p < 0.00001), the average number of days hospitalized was also higher in the SAS group (IV = 18.09; IC: 13.34 - 22.84; p < 0.00001). Conclusion: The results show that untreated SAS significantly increases the risk of death, cardiovascular events and the average number of days hospitalized. .

Introdução: Vários estudos têm avaliado os riscos, morbidade e mortalidade associados à síndrome da apneia do sono (SAS). Objetivo: O objetivo principal foi verificar se a SAS aumenta o risco de morte e o objetivo secundário foi avaliar a sua morbidade, no que diz respeito às doenças cardiovasculares e ao número de hospitalizações. Método: Realizou-se uma revisão sistemática e metanálise da literatura publicada. A pesquisa incluiu estudos que compararam o número de mortes em doentes com SAS não tratada e sem SAS. Resultados: A metanálise se baseou em 13 estudos, o que correspondeu a um total de 13.394 participantes (sem SAS: n = 6.631; com SAS: n = 6.763). A metanálise revelou uma clara associação da SAS com a ocorrência de eventos fatais nos vários modelos analíticos utilizados, correspondendo a presença de SAS a um risco de morte 61% superior para a mortalidade total (odds ratio [OR] : 1,61; intervalo de confiança de 95% [IC] = 1,43 - 1,81; p < 0,00001), tendo sido o risco de morte por causas cardíacas 2,52 vezes maior nestes doentes (OR = 2,52; IC: 1,80 - 3,52; p < 0,00001). Resultado semelhante foi obtido para a mortalidade por outras causas (OR = 1,68; IC = 1,08 - 2,61; p = 0,02). Para os demais desfechos, os eventos cardiovasculares não fatais foram superiores no grupo com SAS (OR = 2,46; IC = 1,80 - 3,36; p < 0,00001); o tempo médio de hospitalização foi também superior nos doentes com SAS (IV = 18,09 dias; IC = 13,34 - 22,84 dias; p < 0,00001). Resultados: A presença de SAS não tratada aumenta significativamente o risco de morte, o risco de eventos cardiovasculares e a duração média de internamentos. .

Apneia do sono é causa secundária de hipertensão arterial? / Is Sleep apnea a secondary cause of arterial hypertension?

Apneia obstrutiva do sono (AOS) e hipertensão arterial sistêmica (HAS) são condições que coexistem em muitos pacientes. O mecanismo primário subjacente para a hipertensão arterial em indivíduos com apneia do sono é a ativação simpática desencadeada pelosepisódios apneicos. A classificação da apneia do sono como causa secundária de hipertensão parece ser inadequada. Meta-análise recente mostrou que aterapia para AOS com CPAP por longo prazo não esteve associada com diminuição dos níveis de pressãoarterial e nem promoveu redução da necessidade da medicação para controle da pressão arterial elevada.

Obstructive sleep apnea (OSA) and arterial hypertension are conditions that coexist in many patients. The main underlying mechanism of arterialhypertension for people with sleep apnea is sympathetic activation triggered by apneic episodes. The classification of sleep apnea as a secondary cause of hypertension appears to be inadequate. A recentmeta-analysis showed that long-term treatment for OSA with CPAP was not associated with reductions in blood pressure levels and did not lessen the need for high blood pressure medications.

La utilidad del monitoreo holter con saturación de oxígeno en la valoración de pacientes con sospecha de apnea del sueño / The utility of holter monitoring with oxygen saturation in the evaluation of patients with suspected sleep apnea

Justificación: los trastornos respiratorios asociados con el sueño son frecuentes. Entre ellos la apnea del sueño ocupaun lugar importante como problema de salud, pues está asociada con la aparición de arritmias, trastornos metabólicos,hipertensión arterial y cardiopatía isquémica. La detección tiene cierto grado de dificultad, puesto que métodos comola polisomnografía pueden ser complejos y costosos. El objetivo de este trabajo es presentar la experiencia con el usodel monitoreo ambulatorio de la saturación de oxígeno de 24 horas (OxyholterR), como método de detección inicial depacientes con este síndrome.Metodología: estudio descriptivo de los principales hallazgos en los registros de OxyholterR realizados en el Centro CardiológicoIntegral entre el año 2005 y 2013, en pacientes con sospecha clínica de apnea del sueño. Por lo tanto se analizóla presencia de las alteraciones en la saturación de oxígeno nocturno según edad y sexo. Y se clasificó dichas alteracionescon base en la duración e intensidad. Se analizó la presencia de arritmias durante los periodos de sueño.Resultados: en 494 estudios, la edad promedio general fue de 65 años, la distribución por género fue: 279 (56 %) hombresy 215 (43 %) mujeres. Un 10 % (51 casos) de los estudios fueron normales, un 90 % (443 casos) mostró alteración significativaen la saturación y en estos, el tiempo con saturación de O2 baja fue menor de 30 minutos en 43 % de los pacientes ymayor de 30 minutos en 57 % de los pacientes. En un 33 % la disminución en la saturación fue leve (Saturación O2 80-88%),en un 39 % moderada (Saturación O2 70-79 %) y en un 28 % severa (Saturación O2<69 %). De los casos con saturaciónnocturna baja, en 88 (20 %) se documentaron arritmias de predominio nocturno...

Justification and Objective: The respiratory abnormalities that may occur during the sleep period are frequent. Sleepapnea has an important place as a health problem, because of the association with arrhythmias, metabolic abnormalities,hypertension and ischemic hearth. To diagnosis this condition is not easy because of the complexity and cost of themethods, like the polisomnography. The objective of this paper is to present the experience with the Ambulatory HolterMonitoring with 24 hours Oxygen Saturation (OxyholtherR), as an initial diagnosis method for this condition.Methodology: descriptive study of the main findings in the OxiholtherR in the ¨Centro Cardiológico Integral¨ betweenthe year of 2005 and 2013. The study analyzed the presence of oxygen saturation abnormalities during the night periodaccording to the age, gender, and weight. This abnormalities were classify base on the severity and the time in which thedesaturation lasted.Results: we analyzed 494 studies, the age in general average was 65 years, 279 (56 %) were mans and 215 (43 %) women.A 10 % (51 cases) had a normal oxygen saturation level. Of the 443 (90 %) studies that show a significant decrease insaturation, 43 % had this decrement for a period of time less than 30 minutes and 57 % extended for more than 30minutes until 10 hours. In 33 % of the group with abnormalities show mild decrease in saturation levels (saturation 80 to88 %), 39% had moderate decrease (saturation 70-79 %) and 28 % show saturation level below 69 % (severe). In the 443cases with nocturnal low oxygen saturation, 88 patients (20 %) had arrhythmias in the same nocturnal period...

Apnea obstructiva del sueño y trastornos psiquiátricos / Obstructive sleep apnea and psychiatric disorders

Introduction: Obstructive sleep apnea is one of the most common sleep disorders, and is characterized by recurrent collapse of the upper airway during sleep caused suddenly, with a subsequent decrease in blood oxygen's saturation and has repercussions in the patient's general condition. Aim: To describe the characteristics of this association according to the available medical evidence. Report: The mechanisms of association of sleep apnea with psychiatric disorders are not well defined. However the coexistence of depressive symptoms with this condition has been documented and refractoriness in the treatment of psychiatric disorders when there is comorbidity. Although there is more evidence linking psychiatric disorders with obstructive sleep apnea, there is some evidence linking depressive disorders and anxiety symptoms, comorbid sleep apnea, which alerts the active search for both conditions in patients one of the diagnoses. Conclusions: Physicians should suspect obstructive sleep apnea in patients with refractory depression mainly chronic snoring, short and wide neck, a high body mass index and excessive daytime sleepiness.

Introducción: La apnea obstructiva del sueño es una de las alteraciones más comunes del dormir, se caracteriza por colapsos recurrentes de la vía aérea superior causados repentinamente durante el sueño, con posterior disminución de la saturación de oxígeno en sangre y repercusiones en el paciente en su estado general. Objetivo: Describir las características de esta asociación conforme a la evidencia médica disponible. Desarrollo: Los mecanismos de asociación de la apnea del sueño con trastornos psiquiátricos no están bien definidos. Sin embargo, se ha documentado la coexistencia de síntomas depresivos con esta patología, y la refractariedad en el tratamiento de los trastornos psiquiátricos cuando existe esta comorbilidad. Aunque no se encuentra mayor evidencia que relacione los trastornos psiquiátricos con la apnea obstructiva del sueño, existen algunos datos que relacionan los trastornos depresivos y síntomas ansiosos, con comorbilidad de apnea del sueño, lo que alerta sobre la búsqueda activa de ambas condiciones en los pacientes con uno de los diagnósticos. Conclusiones: El médico debe sospechar apnea obstructiva del sueño en pacientes con depresión refractaria principalmente, ronquido crónico, cuello corto y ancho, un elevado índice de masa corporal y somnolencia diurna excesiva.

Sleep-related breathing disorders in patients with Schistosomal cor-pulmonale

Schistosmiasis has long been an endemic disease in Egypt and an important cause of pulmonary hypertension. We aimed to investigate the clinical and polysomnographic features of sleep-related breathing disorders [SRBD] in patients with schistosomal cor-pulmonale and to evaluate their effects on pulmonary hemodynamics. We studied 10 stable patients diagnosed with schistosomal pulmonary hypertension [7 males and 3 females their mean age was 43.7 +/- 8.04] and 10 healthy volunteers matched for age, sex and BMI. Patients' exclusion criteria were: smoking, morbid obesity, other secondary causes of pulmonary hypertension, systemic hypertension, ischemic or rheumatic heart disease or left heart failure. All patients underwent overnight polysomnography or ambulatory cardiorespiratory sleep studies, spirometry, ECG and echocardiography. Daytime sleepiness was also assessed using the Epworth sleepiness scale [ESS]. The mean AHI in patients group was 20.0 +/- 11.34/h while in the control group it was 2.3 +/- 1.16/h. 80% of the patients were found to have an AHI > 10/h and 60% had moderate to severe sleep apnea [AHI >/= 15/h]. In addition, the majority of the patients [80%] spent > 30% of the night with an arterial oxygen saturation <90%. SRBD were not correlated with anthropometric measures, spirometry nor with the typical symptoms of SA such as excessive sleepiness as assessed by ESS. More importantly, SRBD were significantly associated with measures of pulmonary hypertension severity, and patients with moderate to severe SA had more impaired cardiovascular function as indicated by more severe right ventricular dilatation [p = 0.036] than patients with mild sleep apnea. SRBD are highly prevalent in patients with schistosomal pulmonary hypertension [PH]. Also, the SA severity was correlated with more advanced PH and more severe cardiovascular impairment. Therefore in the evaluation of patients with schistosomal PH, polysomnography or an ambulatory cardiorespiratory sleep study seems justified to identify potentially treatable SRBD that may additionally challenge the already compromised cardiovascular system in these patients

Consecuencias neurocognitivas de los trastornos respiratorios del sueño / Neurocognitive consequences of sleep breathing disorder

Sleep disordered breathing affect almost 10 percent of the pediatric population. There is consistent evidence that supports an association between sleep disordered breathing and neurocognitive consequences like hyperactivity, poor school performance, aggressiveness, and somnolence. There is also a dose-effect and molecular relationship between this variables that may lead to irreversible damage of the developing nervous system. Not only obstructive sleep apnea may have neurocognitive consequences, primary snorers may also show this adverse development. Early detection and treatment may stop the progression of long-term neurocognitive consequences.

Los trastornos respiratorios del sueño (TRS) afectan aproximadamente al 10 por ciento de la población pediátrica. Existe evidencia considerable que sustenta una asociación causal entre los TRS y efectos neurocognitivos en niños como hiperactividad, mal rendimiento escolar, agresividad y somnolencia. Existe asociación de tipo dosis-efecto y molecular que demostraría un posible daño irreparable a zonas susceptibles del cerebro en desarrollo; no tan sólo el síndrome de apnea obstructiva del sueño, sino también los roncadores primarios pueden tener consecuencias neurocognitivos. Una detección precoz y tratamiento oportuno de los TRS pudiera detener la progresión de las consecuencias neurocognitivas a largo plazo.

Computerized analysis of snoring in sleep apnea syndrome / Análise computadorizada do ronco na síndrome da apneia do sono

The International Classification of Sleep Disorders lists 90 disorders. Manifestations, such as snoring, are important signs in the diagnosis of the Obstructive Sleep Apnea Syndrome; they are also socially undesirable. OBJECTIVE: The aim of this paper was to present and evaluate a computerized tool that automatically identifies snoring and highlights the importance of establishing the duration of each snoring event in OSA patients. MATERIAL AND METHODS: The low-sampling (200 Hz) electrical signal that indicates snoring was measured during polysomnography. The snoring sound of 31 patients was automatically classified by the software. The Kappa approach was applied to measure agreement between the automatic detection software and a trained observer. Student's T test was applied to evaluate differences in the duration of snoring episodes among simple snorers and OSA snorers. RESULTS: Of a total 43,976 snoring episodes, the software sensitivity was 99. 26 percent, the specificity was 97. 35 percent, and Kappa was 0. 96. We found a statistically significant difference (p <0. 0001) in the duration of snoring episodes (simple snoring x OSA snorers). CONCLUSIONS: This computer software makes it easier to generate quantitative reports of snoring, thereby reducing manual labor.

A classificação internacional de distúrbios do sono enumera aproximadamente 90 distúrbios. Manifestações, como o ronco, são um sinal no diagnóstico da Síndrome da Apneia Obstrutiva, além de ser um incômodo social. OBJETIVO: O objetivo deste artigo é apresentar e avaliar a ferramenta computacional que identifica o ronco automaticamente e destacar a importância da quantificação da duração de cada evento do ronco em pacientes com SAHOS. MATERIAL E MÉTODOS: O sinal elétrico que representa o ronco de baixa amostragem (200 hz) foi captado enquanto os pacientes eram submetidos à polissonografia. O sinal do ronco dos 31 pacientes foi classificado pelo programa computacional automaticamente. Utilizamos o valor de Kappa para avaliar a concordância entre o programa de detecção automática e o observador treinado (teste t-student). Avaliamos a diferença da duração dos episódios de ronco entre simples roncadores e roncadores com SAOS. RESULTADOS: De um total de 43,976 roncos, o programa computacional obteve uma sensibilidade de 99,26 por cento, especificidade de 97,35 por cento e Kappa de 0,96. Foi observada diferença estatística significante (p<0,0001) na duração de episódios de ronco (simples roncadores x roncadores com SAOS). CONCLUSÃO: Este programa computacional facilita a criação de relatórios quantitativos do ronco, oferecendo redução do trabalho manual.

Consequências do ronco não-tratado / Consequences of untreated snoring

Em alguns estudos, o ronco tem sido associado com um risco aumentado de hipertensão, doença cardíaca isquêmica e acidente vascular encefálico. Os mecanismos são desconhecidos, mas provavelmente mediados pela apneia obstrutiva do sono. Contudo, a maioria dos roncadores não tem apneia do sono. Se o ronco, por si só, aumenta o risco de doença cardiovascular, isso ainda permanece controverso.

In some studies, snoring has been associated with an increased risk of hypertension, ischemic heart disease and stroke. Although the mechanisms involved in these associations are unknown, they are probably mediated by obstructive sleep apnea. Nevertheless, most snorers do not have sleep apnea. Whether snoring itself increases the risk of cardiovascular disease remains controversial.

Sleep disordered breathing in women of childbearing age & during pregnancy.

Obstructive sleep apnoea (OSA) affects 11 per cent of pre-menopausal women though it often remains undetected. Women may present differently than men, and the classic findings of snoring, witnessed apnoeas and sleepiness may not be observed. Factors which predispose to OSA include polycystic ovarian syndrome, obesity, retromicrognathia, and hypothyroidism. OSA may contribute to neurocognitive dysfunction, depression, hypertension and metabolic syndrome. Emerging evidence indicates that snoring and OSA increase during pregnancy. For normal women with normotensive, low-risk pregnancies the prevalence of OSA is very low. Among normotensive pregnant women with high risk pregnancies, the prevalence of OSA is high and is even higher among those with gestational hypertension/preeclampsia during pregnancy. Incident snoring, which is a marker for OSA, is associated with an increased risk of developing gestational hypertension. Recent studies indicate that OSA per se is an independent risk factor for gestational hypertension/pre-eclampsia and may contribute to other poor obstetrical outcomes. The diagnostic test of choice for OSA is a polysomnography with electroencephalogram. Milder degree of disease than what is usually considered clinically significant among men or non-pregnant women appears to be relevant for foetomaternal outcomes. There seems to be benefit for blood pressure control to treating even milder degrees of OSA with CPAP, both acutely and over the 9 months of pregnancy. Chronic hypertensive women should be strongly considered for diagnosis and treatment of OSA prior to or beginning as early as possible in pregnancy to help maintain blood pressure control. Increasing awareness of OSA among maternal health care providers is important given the potential benefits for pregnancy and other health-related outcomes associated with identification and treatment of OSA.

Sleep disordered breathing in patients with chronic kidney disease.

The prevalence of sleep-disordered breathing (SDB) in the advanced chronic kidney disease (CKD) patient population has been estimated to be more than 50 per cent. SDB is associated with episodic upper airway obstruction or cessation of breathing during sleep leading to repetitive episodes of hypoxaemia, hypercapnia, and sleep fragmentation, activation of the sympathetic nervous system, endothelial dysfunction, oxidative stress, and inflammation. Clinical consequences of this disorder may include excessive daytime sleepiness, depressed mood, cognitive impairment, hypertension, as well as increased risk for cardiovascular disease and metabolic dysregulation. SDB may also contribute substantially to the daytime sleepiness, poor quality of life, and high rate of cardiovascular disease in CKD patients. Although the causal links between CKD and SDB remain speculative, there are multiple factors related to fluid overload and azotaemia that may contribute to the increased propensity to SDB. Renal transplantation, nocturnal automated peritoneal dialysis and nocturnal haemodialysis have been found to be associated with a reduction in the severity of SDB when compared to conventional forms of dialysis. Nocturnal dialysis modalities may facilitate further understanding of the pathophysiology of SDB as well as provide therapeutic alternatives for patients with both kidney failure and SDB. SDB is an important but often overlooked public health problem in the CKD patient population. Early diagnosis and treatment of SDB may provide better quality of life and attenuate the cardiovascular risk of morbidity and mortality in these patients.

A propósito de un caso de apnea del sueño (SAOS): una entidad omitida en los baremos / Case report sleep apnea: a clinical situation omitted in our legislation

La patología en el acto de respirar durante el sueño es rica y variada, centrándose en los síndromes de apnea del sueño. El síndrome de apnea obstructiva del sueño incluye nombres alternativos como son: apnea del sueño, apnea obstructiva del sueño, síndrome de apnea del sueño, apnea mixta, síndrome de hipopnea obstructiva y síndrome de resistencia de la vía respiratoria alta. Es una patología causal de un gran número de accidentes y ausentismo laboral. Llamativamente, ningún baremo de uso oficial o no al momento presta consideración a esta patología clínicamente relevante, por lo cual corresponde su atención medicolegal para la determinación de incapacidad resultante ante su presencia. Ante su ausencia, se hace necesario recurrir a lo mecanismos fisiopatológicos intervinientes a fin de lograr un adecuado encuadramiento en los baremos de uso, en base al principio de un punto de vista de la analogía jurídica.

The pathology of the act to breathe during the dream rich and is varied, concentrating in the syndromes of apnea of the dream. The syndrome of obstructive apnea of the dream includes alternative names e.g.: apnea of the dream, obstructive apnea of the dream, syndrome of apnea of the dream, mixed apnea, syndrome of obstructive hypopnea and syndrome of resistance of high the respiratory tract. It is a causal pathology of a great number of accidents and labor absenteeism. Showy, no scale of official use or no, at the quick moment consideration to this clinically relevant pathology, thus deserve its legal medical attention, for the determination of resulting incapacity before its presence. Before his absence, one becomes necessary to resort to the intervening physiopathological mechanisms, in order to obtain a suitable frame in the used scales, on the basis of the principle of a point of view of the legal analogy.

Dimensions of sleepiness and their correlations with sleep-disordered breathing in mild sleep apnea / Dimensões da sonolência e suas correlações com os transtornos respiratórios do sono na apneia do sono leve

OBJECTIVE: There are many ways of assessing sleepiness, which has many dimensions. In patients presenting a borderline apnea-hypopnea index (AHI, expressed as events/hour of sleep), the mechanisms of excessive daytime sleepiness (EDS) remain only partially understood. In the initial stages of sleep-disordered breathing, the AHI might be related to as-yet-unexplored EDS dimensions. METHODS: We reviewed the polysomnography results of 331 patients (52 percent males). The mean age was 40 ± 13 years, and the mean AHI was 4 ± 2 (range, 0-9). We assessed ten potential dimensions of sleepiness based on polysomnography results and medical histories. RESULTS: The AHI in non-rapid eye movement (NREM) stage 1 sleep (AHI-N1), in NREM stage 2 sleep (AHI-N2), and in REM sleep (AHI-REM) were, respectively, 6 ± 7, 3 ± 3 and 10 ± 4. The AHI-N2 correlated significantly with the greatest number of EDS dimensions (5/10), including the Epworth sleepiness scale score (r = 0.216, p < 0.001). Factor analysis, using Cronbach's alpha, reduced the variables to three relevant factors: QUESTIONNAIRE (α = 0.7); POLYSOMNOGRAPHY (α = 0.68); and COMPLAINTS (α = 0.55). We used these factors as dependent variables in a stepwise multiple regression analysis, adjusting for age, gender, and body mass index. The AHI-N1 correlated significantly with POLYSOMNOGRAPHY (β = -0.173, p = 0.003), and the AHI-N2 correlated significantly with COMPLAINTS (β = -0.152, p = 0.017). The AHI-REM did not correlate with any factor. CONCLUSIONS: Our results underscore the multidimensionality of EDS in mild sleep apnea.

OBJETIVO: Há muitas formas de avaliação da sonolência, a qual possui diversas dimensões. Em pacientes com um índice de apneia-hipopneia (IAH, expresso em eventos/hora de sono) limítrofe, os mecanismos da sonolência excessiva diurna (SED) permanecem apenas parcialmente esclarecidos. Nos estágios iniciais do transtorno respiratório do sono, o IAH pode estar relacionado a outras dimensões da SED ainda não exploradas. MÉTODOS: Revisamos os resultados de polissonografia de 331 pacientes (52 por cento do sexo masculino). A idade média foi de 40 ± 13 anos e o IAH médio de 4 ± 2 (variação, 0-9). Avaliamos dez dimensões potenciais de sonolência com base nos resultados da polissonografia e da história médica. RESULTADOS: O IAH em sono non-rapid eye movement (NREM) estágio 1 (IAH-N1), em sono NREM estágio 2 (IAH-N2), e em sono REM (IAH-REM) foram, respectivamente, 6 ± 7, 3 ± 3 e 10 ± 4. O IAH-N2 se correlacionou significantemente com o maior número de dimensões de SED (5/10), incluindo o escore da escala de sonolência de Epworth (r = 0,216, p < 0,001). Análise de fatores, utilizando-se o alfa de Cronbach, reduziu as variáveis a três fatores relevantes: QUESTIONÁRIO (α = 0,7); POLISSONOGRAFIA (α = 0,68); e QUEIXAS (α = 0,55). Usando esses fatores como variáveis dependentes na regressão múltipla, ajustando para idade, gênero e índice de massa corporal, o IAH-N1 se correlacionou significantemente com POLISSONOGRAFIA (β = -0,173, p = 0,003) e o IAH-N2, com QUEIXAS (β = -0,152, p = 0,017). O IAH-REM não se correlacionou com nenhum fator. CONCLUSÕES: Nossos resultados confirmam a multidimensionalidade da SED na apneia do sono leve.

Sleep disorder: a possible cause of attention deficit in children and adolescents with Chiari malformation type II / Distúrbios do sono: possível causa de déficit de atenção em crianças e adolescentes com malformação de Chiari tipo II

BACKGROUND: Attention deficit may be related to sleep disorders in Chiari malformation type II (CMII). Our aim is identify sleep disorders and their specific contribution in attention deficit. METHOD: We selected 24 patients with CM II and 24 without CM II. DSM-IV criteria and a neuropsychological analysis were applied in all. All patients underwent full night polysomnography. RESULTS: 14 CM II patients presented sleep apnea syndrome, REM sleep behavior disorder and periodic limb movement in sleep; six patients without CM II presented sleep apnea syndrome. Among these patients, 12 (six with CM II and six without CM II) presented attention deficit related to the sleep disorders. CONCLUSION: Sleep disorders may impair cognitive functions, as attention, and contribute to poor quality of learning also in patients with CM II.

INTRODUÇÃO: Déficits de atenção podem estar relacionados a distúrbios do sono em indivíduos com malformação de Chiari tipo II (CM II). Nosso objetivo é identificar distúrbios do sono e sua contribuição para a ocorrência de déficit de atenção. MÉTODO: Foram selecionados 24 pacientes com CM II e 24 sem CM II. Todos foram submetidos à avaliação neuropsicológica, aos critérios do DSM-IV e a polissonografia. RESULTADOS: 14 pacientes com CM II apresentaram síndrome da apnéia do sono, distúrbio do comportamento da fase do sono REM e movimentos periódicos dos membros em sono; seis pacientes sem CM II apresentaram síndrome da apnéia do sono. Entre estes pacientes, 12 (seis com CM II e seis sem CM II) apresentaram déficit de atenção relacionado a distúrbios do sono. CONCLUSÃO: Distúrbios do sono podem prejudicar funções cognitivas, como a atenção, contribuindo para a piora da qualidade de aprendizado também em pacientes com CM II.

Impacto de los trastornos del sueño en la salud de las personas: insomnio y síndrome de apnea del sueño / Impact of sleep disorders in the people's health: insomnia and sleep apnea syndrome

El sueño constituye un estado dinámico que busca ofrecemos descanso y reparación. El insomnio y las apneas del sueño, perturban el sueño generando importantes consecuencias. El insomnio conduce no sólo a disminución del alerta, la productividad laboral e incremento del riesgo de enfermar, sino también se relaciona con comorbilidades como depresión. El costo económico del ausentismo laboral, mayor tasa de enfermedades, menor rendimiento y accidentes es de billones de dólares al año en los Estados Unidos. En el caso de apneas del sueño, hay un mayor riesgo de enfermedad coronaria, insuficiencia cardiaca congestiva y accidente cerebrovascular. Los mecanismos intermediarios incluyen la, activación simpática. El tratamiento con CPAP reduce la presión arterial y mejora la función ventricular, lo que apoya la relación apnea y enfermedad cardiovascular. Son necesarios estudios sistemáticos para explicar otras relaciones complejas entre apnea del sueño y enfermedad vascular, las que pueden verse agravadas por el síndrome metabólico.

Sleep is a dynamic state aimed at offering rest and repair. insomnia and sleep apneas disrupt sleep generating significant consequences. Insomnia leads not only to decreased alertness, labor productivity, and increased risk of becoming ill, but is also related to comorbidities such as depression. The economic cost of absenteeism, ín addition to higher illness rate, accidents and reduced performance amaunts to billions of dallars a year in the United States. Individuals with severe sleep apnea are at increased risk far coronary disease, congestive heart failure, and stroke. Several intermediar y mechanisms might be in volved including sympathetic activation. Linkage between obstructive apnea and cardiovascular disease is corroborated by evidence that treatment with CPAP reduces systolic blood pressure and improves left ventricular systalic function. Several systematic studies are necessary to explicate complex assaciations between sleep apnea and vascular disease, which may be compounded by the metabolic syndrome.