Impacto econômico da implementação de políticas públicas para distúrbios de sono no Brasil: uma revisão integrativa / Economic impact of the implementation of public policies for sleep disorders in Brazil: an integrative review

Objetivo: Identificar estudos sobre políticas públicas, ações de saúde e análises econômicas relacionados aos distúrbios de sono no Brasil e discutir os seus resultados para o sistema de saúde, gestores de políticas públicas e a sociedade. Métodos: Revisão integrativa da literatura nas bases de dados Lilacs (via BVS), SciELO e PubMed (via Medline), incluindo estudos publicados nos idiomas português, inglês e espanhol, entre os anos de 1960-2023; foram excluídos estudos que não apresentaram a perspectiva brasileira ou aqueles cuja versão integral não estava disponível (seja gratuitamente ou na versão paga). Resultados: A busca retornou 536 resultados, dos quais apenas dois atendiam aos critérios de inclusão e mais cinco trabalhos foram incluídos manualmente, após consulta com especialistas de sono (todos abordaram apneia obstrutiva do sono, sendo: um relato sobre alteração na legislação de trânsito focada em prevenção de acidentes por sonolência excessiva; uma revisão de escopo sobre análises de custo-efetividade do tratamento da doença com uso de CPAP; dois relatos sobre linha de cuidado em um município e outros três em Secretarias Estaduais de Saúde). Conclusões: A revisão integrativa encontrou poucas evidências acerca do tema e aponta para a necessidade de futuros estudos que visem a suprir essa lacuna científica e de que seja necessário o desenvolvimento de futura linha de cuidado que amplie o acesso ao tratamento de doenças do sono no Sistema Único de Saúde.

Objective: To identify studies on public policies, health actions, and economic analyses related to sleep disorders in Brazil and discuss their results for public policy managers and society. Methods: Integrative literature review using Lilacs (via BVS), SciELO, and PubMed (via Medline) databases, including studies published in Portuguese, English, and Spanish languages, between years of 1960-2023; studies that did not present the Brazilian perspective or whose full version was not available were excluded (free or paid version). Results: The search returned 536 results, of which only two met the inclusion criteria, and five more studies were included manually after consulting sleep experts (all addressing obstructive sleep apnea, namely: a report on changes in traffic legislation focused on preventing accidents caused by excessive sleepiness; a scoping review on cost-effectiveness analysis of CPAP for sleep apnea treatment; two reports on care lines in one municipality and another three in State Secretariats). Conclusions: The integrative review found few evidences on the topic and points to the need for future studies aimed at filling this scientific gap and the development of a care line that expands access to sleep disorder treatment in Brazilian Public Health System.

El paciente ortodóncico en dentición mixta y los trastornos del sueño / The orthodontic patient with mixed dentition and sleep disorders

Los desórdenes respiratorios del sueño (DRS) y, principalmente, roncopatías y apneas obstructivas afectan aproximadamente al 7% de los pacientes ortodóncicos. Los DRS no solo son importantes por la cantidad de pacientes afectados, sino por la gravedad de los posibles efectos secundarios a nivel de la salud general del paciente. La obstrucción de las vías aéreas superiores (VAS) provoca alteraciones del crecimiento y deformaciones craneofaciales importantes, por lo que el tratamiento temprano y la prevención de la respiración oral es muy importante.El papel del ortodoncista es muy importante en el diagnóstico y en el tratamiento de los DRS, pero también en su prevención, realizando tratamientos que aumenten la dimensión y la permeabilidad de las VAS. El protocolo de exploración interdisciplinar en niños y adolescentes y la cefalometría de vías aéreas son importantes en el diagnóstico y deben ser tenidos en cuenta en el plan de tratamiento. Pero las pruebas más significativas, el CBCT de vías aéreas y la polisomnografía no son pruebas rutinarias por la dificultad logística y el precio de estas pruebas. En este artículo también se recomiendan los tratamientos de ortodoncia más indicados en estos casos y que tienden al aumento de la dimensión de las VAS (AU)

Sleep breathing disorders (SBD) and in the first place, roncopathy and obstructive apnea, affect approximately 7% of orthodontic patients. The SBD are not only important for the number of affected patients, but also for the severity of the possible side effects at the level of general health of a patient. The upper air ways (UAW) obstruction provokes important alterations in growth and craniofacial deformations, and this is why the early treatment and prevention of mouth breathing are very important. The role of an orthodontist in diagnosis and treatment of SBD is very important, but it is also in its prevention, carrying out the treatments which increase the dimension and permeability of UAW. The protocol of interdisciplinary examination.In children and adolescents and the air ways cephalometry analysis have an important role in diagnosis and they should be taken into account in treatment planning. But the most important tests, the air ways CBCT and polysomnography, are not routine tests due to the complicated logistics and their cost. In this article, the orthodontic treatments most indicated in these cases are recommended, because they tend to increase the UAW dimension (AU)

Severidad según índice de apnea hipopnea del sueño en el síndrome de apnea obstructiva del sueño posicional vs no posicional en el Hospital Universitario Clínica San Rafael / Severity according to apnea hypopnea index in the positional and non positional obstructive sleep apnea sindrome in the San Rafael Clinical University Hospital

Introducción: El síndrome de apnea e hipopnea obstructiva del sueño (SAHOS) es un problema de salud pública común, en donde la posición al dormir tiene influencias fisiológicas importantes en el patrón de sueño. Objetivo: Establecer la severidad según índice de apnea hipopnea del sueño en los pacientes con síndrome obstructivo del sueño posicional (supino) y no posicional (no supino) en el Hospital Universitario Clínica San Rafael entre el 1 de enero de 2014 al 31 de diciembre de 2017. Diseño: Estudio observacional descriptivo de corte transversal. Metodología: Se tomaron datos registrados en las historias clínicas de los pacientes que asistieron al Hospital Universitario Clínica San Rafael. El tamaño de la muestra fue de 88 personas de ambos sexos, en edades entre 18 y 90 años. Resultados: La distribución por género fue de 55 hombres (62,5%) y 33 mujeres (37,5%) de los cuales 47(53.4%) fueron SAHOS posicional y 41(46.6%) SAHOS no posicional. El peso promedio de las mujeres es de 71 kg y en hombres de 81 kg, la estatura es 1,58 cm y 1.67 respectivamente presentándose índices de masa corporal altos, en promedio de 28 para los dos géneros. La edad promedio es de 53 años para mujeres y de 46 años para hombres. Se encontró una asociación estadísticamente significativa entre la severidad y SAHOS posicional (Fischer exact p=0.018), en donde el SAHOS severo está asociado con apnea no posicional, mientras que el SAHOS leve tiende a corresponder a la apnea posicional. Conclusiones: En nuestro estudio se evidenció que el SAHOS más severo está asociado a la apnea no posicional, mientras que el SAHOS menos severo tiende a corresponder a la apnea posicional.

Introduction: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is a common public health problem, where the sleeping position has important physiological influences on the sleep pattern. Objective: To establish the severity according to the index of hypopnea sleep apnea in patients with positional (supine) and non-positional (non-supine) sleep obstructive syndrome in the San Rafael Clinical University Hospital from January 1, 2014 to December 31, 2017. Design: Cross-sectional study. Methods: Recorded data of patients that attend the outpatient service of the San Rafael Clinical University Hospital has been taken for the study. The simple size was 88 people of both sexes, with ages between 18 and 90 years. Results: The distribution by gender was 55 men (62.5%) and 33 women (37.5%) of which 47(53.4%) were positional OSAS and 41(46.6%) non-positional OSAS The average weight of women is 71 kg and in men of 81 kg, the height is 1.58 cm and 1.67 cm respectively, with high body mass indexes, on average 28 for both genders. The average age is 53 for women and 46 for men. A statistically significant association was found between severity and positional OSAS (Fischer exact p = 0.018), where severe OSAS is associated with non-positional apnea, while mild OSAS corresponds to positional apnea. Conclusions: In our study it was evidenced that the most severe OSAS is associated to the non-positional apnea, while the less severe OSAS tends to correspond to the positional apnea.

Evaluation of quality of sleep in women with stress urinary incontinence before and after surgical correction / Avaliação da qualidade do sono em mulheres com incontinência urinária antes e depois da correção cirúrgica

ABSTRACT Objective: To evaluate the quality of sleep in women with urinary incontinence before and after sling surgery. Methods: A prospective study of case series of women with urodynamic diagnosis of stress urinary incontinence. To evaluate the subjective quality of sleep, two specific questionnaires were used and validated for the Portuguese Language: Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. The questionnaires were applied before and 6 months after surgical repair. Results: When analyzing the Epworth Sleepiness Scale, there was an improvement in sleep quality (p=0.0401). For the Pittsburgh Sleep Quality Index, only for sleep disorder there was improvement in quality of sleep after surgery (p=0.0127). Conclusion: Women with urinary incontinence, submitted to surgery with sling, showed improvement in both quality of sleep and sleep disorder.

RESUMO Objetivo: Avaliar a qualidade do sono em mulheres com incontinência urinária antes e após correção cirúrgica do tipo sling. Métodos: Estudo prospectivo do tipo série de casos de mulheres com diagnóstico urodinâmico de incontinência urinária de esforço. Para avaliar a qualidade subjetiva do sono, utilizaram-se dois questionários específicos e validados para a língua portuguesa: Escala de Sonolência de Epworth e Índice de Qualidade do Sono de Pittsburgh. Os questionários foram aplicados antes e 6 meses após a correção cirúrgica. Resultados: Ao analisar a Escala de Sonolência de Epworth, houve melhora da qualidade do sono (p=0,0401). Para o Índice de Qualidade do Sono de Pittsburgh, apenas para o transtorno do sono, houve melhora da qualidade do sono após a cirurgia (p=0,0127). Conclusão: Mulheres com incontinência urinária, submetidas à correção cirúrgica por meio de sling, apresentaram melhora tanto na qualidade do sono como no transtorno do sono.

Clinical Characteristics of Primary Insomniacs with Sleep-State Misperception

BACKGROUND AND PURPOSE: The aims of this study were to determine the prevalence of sleep-state misperception and to identify any differences in the clinical characteristics of primary insomniacs with and without misperception. METHODS: In total, 250 adult primary insomniacs were enrolled whose objective total sleep time (TST) was more than 120 min, as assessed by full-night polysomnography. Sleep state misperception was defined objectively as a TST of at least 6.5 h and an objective sleep efficiency (SE) of at least 85%. RESULTS: The prevalence of sleep-state misperception in primary insomniacs was 26.4%. The (low) quality of sleep and psychiatric parameters were similar in the two groups, although the objective sleep architecture was relatively normal for the misperception group. Multivariate analysis revealed that both SE and sleep quality were significant factors associated with subjective TST in the misperception group, while only SE was significant in those without misperception. Subjective TST was a significant effect factor with respect to sleep quality in the misperception group, while the Beck Depression Inventory-2 score and age were significant factors in those without misperception. CONCLUSIONS: The clinical characteristics of patients with sleep-state misperception differed from those without this condition. This suggests that these two groups should be separated and the treatment goals tailored specifically to each.

Positive Sleep State Misperception Mimicking Hypersomnia

A condition of underestimation of sleep is classified as paradoxical insomnia or sleep state misperception. However, overestimation of sleep, so called positive sleep state misperception has not been clearly described. Here we report a middle-aged woman with positive sleep state misperception who presented excessive sleepiness mimicking hypersomnia.

Prevalencia y riesgos asociados con pacientes adultos con asma de 40 años o más de la Ciudad de México: estudio de base poblacional / Adult asthma in Mexico City: a population-based study

OBJETIVOS: Determinar la prevalencia de asma y la asociación entre características sociodemográficas, espirométricas, síntomas respiratorios, calidad de vida y sueño en adultos >40 años. MATERIAL Y MÉTODOS: Este informe es parte del estudio PLATINO (Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar), llevado a cabo en la Ciudad de México y área metropolitana en 2003. Se utilizaron modelos de regresión logística ajustados por el diseño del estudio, donde asma fue la variable dependiente y las independientes síntomas respiratorios y características sociodemográficas y clínicas, entre otras. RESULTADOS: La prevalencia de asma diagnosticada por médico fue de 3.3% en hombres y 6.2% en mujeres. La función pulmonar disminuyó en asmáticos. En el análisis multivariado, después de ajustar por confusores potenciales, los asmáticos mostraron un mayor riesgo de ronquido más somnolencia excesiva diurna [RM=3.2 (IC95%1.4-7.4), p=0.008], y mayor frecuencia de inasistencias laborales por problemas respiratorios [RM=5.1 (IC95% 2.5-10.4), p<0.0001]. CONCLUSIONES: La prevalencia de asma fue de 5%. Los asmáticos mostraron menor calidad de vida y función pulmonar.

OBJECTIVES: To determine the prevalence of asthma and the association between sociodemographic characteristics, spirometry, respiratory symptoms, quality of life and sleep in adults > 40 years. MATERIALS AND METHODS: This report is part of our study (Latin American Research Project Obstructive Pulmonary), held in Mexico City and the metropolitan area in 2003. We used logistic regression models adjusted for study design, where asthma was the dependent and independent variable respiratory symptoms, sociodemographic and clinical characteristics among others. RESULTS: The prevalence of physician-diagnosed asthma was: 3.3% in men and 6.2% in women. Decreased lung function in asthmatics was observed. In multivariate analysis, after adjusting for potential confounders, asthmatics had a higher risk of excessive daytime sleepiness more snoring [OR = 3.2 (95% CI 1.4-7.4), p= 0.008], and more frequent work absences due to respiratory problems [OR = 5.1 (95% CI 2.5-10.4), p<0.0001]. CONCLUSIONS: The prevalence of asthma was 5%. Asthmatics showed lower quality of life and lung function.

Transtornos do sono / Sleeping disorders

Os autores ressaltam a importância do clínico em conhecer e diagnosticar os principais transtornos do sono, bem como seu tratamento. É abordado, em linhas gerais, o diagnóstico e tratamento da insônia, das principais parassônias, da apneia obstrutiva do sono, da síndrome das pernas inquietas e da narcolepsia.

Síndrome de Kleine-Levin: caso clínico y revisión del tema / Kleine-Levin Syndrome: clinical case and revision

Episodic hypersomnia, compulsive excessive eating and erotic behaviour, with schizophreniclike mental symptoms are the hallmarks of the rare Kleine–Levin syndrome. Many patients may not necessarily fulfill minimum criteria described for diagnosis. We report a 19 years young man with incomplete presentation the Kleine–Levin syndrome and briefly reviewed the most relevantaspects of this disorder, its epidemiology, clinical symptoms and complementary diagnostic examinations. Known therapeutic options and prognosis are also discussed.

Congenital central hypoventilation with renal tubular acidosis

CCHS presents as hypoventilation, mainly in depth rather than rate of breathing, manifest mainly in quiet sleep; however in severe cases, even in awake period. Hirschprung disease is high in the list of associated anomaly as high as 30% in one report and neuroblastoma as 20%. Although, eye anomalies, developmental delay, seizures, hearing defects, GIT motility disorders have been linked as other associated findings, renal tubular defect seems to be unusual and should be looked for also. Management of CCHS is difficult and challenging with guarded prognosis although some families would not continue the treatment for ever

Transtornos do sono e suas relaçöes com as funçöes cognitivas / Sleep disorders and cognitive dysfunctions

É feita uma revisäo sobre o sono, sua arquitetura normal e as relaçöes existentes entre esta atividade, a memória e as funçöes cognitivas. As hipóteses que vinculam a memória ao sono REM e ao sono näo-REM säo avaliadas quanto à possível funçäo "consolidadora" desta atividade sobre a memória recente e aprendizado. Condiçöes de transtorno de sono ou situaçöes de supressäo de sono REM ou näo-REM que podem alterar as funçöes cognitivas säo criticamente analisadas. O papel desempenhado pela hipoxemia cerebral em condiçöes como a apnéia de sono é revisto quanto às disfunçöes cognitivas e seu retorno à normalidade uma vez que seja instituído tratamento eficaz. As correlaçöes entre narcolepsia, memória e cogniçäo säo também analisadas. As disfunçöes mnêmicas e cognitivas causadas por hipnoindutores, benzodiazepínicos e antidepressores säo revistas e discutidas