Trastorno de hipoventilación central del sueño en pediatría: causas poco frecuentes / Central hypoventilation disorders sleep-related in pediatrics: unusual causes

Congenital central hypoventilation syndrome (CCHS) and rapid-onset obesity syndrome with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) are rare causes of hypoventilation during sleep in the pediatric population. This group of disorders are characterized by the absence or decrease in the automatic control of ventilation, decreased sensitivity of chemoreceptors to CO2, causing hypoventilation during sleep and even in wakefulness, in the most severe cases. For these reasons it is important to diagnose and treat them promptly. The objective of this review is to provide current and complete literature, to be able to identify, treat and refer this group of children early, and thus reduce the complications and/or associated comorbidities in the short and long term, improving their quality of life.

El síndrome de hipoventilación central congénita (CCHS) y síndrome de obesidad de inicio rápido con disfunción hipotalámica, hipoventilación y desregulación autonómica (ROHHAD), son causas poco comunes de hipoventilación durante el sueño en la población pediátrica. Este grupo de trastornos se caracterizan por ausencia o disminución en el control automático de la ventilación, sensibilidad disminuida de los quimioreceptores al CO2, provocando hipoventilación durante el sueño e incluso en vigilia, en los casos más severos. Por estas razones es importante diagnosticarlos y tratarlos oportunamente. El objetivo de esta revisión es proporcionar literatura actual y completa, para poder identificar, tratar y referir a éste grupo de niños tempranamente, y así disminuir las complicaciones y/o comorbilidades asociadas a corto y largo plazo, mejorando su calidad de vida.

Alzheimer's disease and sleep disturbances: a review / Doença de Alzheimer e distúrbios do sono: uma revisão

ABSTRACT The association between Alzheimer's disease (AD) and sleep disturbances has received increasing scientific attention in the last decades. However, little is known about the impact of sleep and its disturbances on the development of preclinical AD stages, such as mild cognitive impairment. This review describes the evolution of knowledge about the potential bidirectional relationships between AD and sleep disturbances exploring recent large prospective studies and meta-analyses and studies of the possible mechanisms through which sleep and the neurodegenerative process could be associated. The review also makes a comprehensive exploration of the sleep characteristics of older people, ranging from cognitively normal individuals, through patients with mild cognitive impairment, up to the those with dementia with AD.

RESUMO A associação entre Doença de Alzheimer (DA) e distúrbios do sono vem recebendo atenção crescente nas últimas décadas. No entanto, pouco se sabe sobre o impacto do sono e suas alterações no desenvolvimento de estágios pré-clínicos da doença, como é o caso do Comprometimento Cognitivo Leve (CCL). Esta revisão descreve a evolução do conhecimento sobre as relações potencialmente bidirecionais entre DA e distúrbios do sono, explorando grandes estudos prospectivos e meta-análises, assim como estudos dos possíveis mecanismos da associação entre o sono e as doenças neurodegenerativas. Também revisamos amplamente as características do sono de pessoas idosas, incluindo indivíduos cognitivamente normais, com CCL e com demência por DA.

Sueño, memoria y aprendizaje / Sleep, memory and learning

Las investigaciones recientes demuestran que mientras estamos tranquilamente durmiendo nuestro cerebro está muy ocupado procesando la información obtenida a lo largo del día. Asimismo, la falta de sueño ocasiona problemas en la consolidación de la memoria. El sueño juega un papel fundamental en el adecuado desarrollo del cerebro en crecimiento y muchos de los fenómenos de plasticidad cerebral ocurren durante el sueño. A nivel celular, los ciclos circadianos coordinan complejos mecanismos de "encender y apagar" genes y estructuras que regulan individualmente y colectivamente las funciones de cada célula del organismo y a su vez de cada órgano, cada sistema fisiológico, para finalmente producir un perfecto equilibrio en el funcionamiento mental, emocional y sistémico del individuo. El sueño influye en los procesos de memoria, aprendizaje, estados de ánimo y comportamiento, en las respuestas inmunológicas, procesos metabólicos, niveles de hormonas, digestión y muchas más funciones fisiológicas. Aquí presentamos una breve revisión de tres aspectos fundamentales relacionados con el sueño, enfocado especialmente en el efecto que tienen en procesos de aprendizaje y memoria: a. actividad eléctrica cerebral durante el sueño y correlación neuroanatómica con los mecanismos fisiológicos de memoria y aprendizaje; b. ciclos circadianos y su importancia en el funcionamiento de diferentes sistemas fisiológicos; c. algunos ejemplos de trastornos clínicos asociados con trastornos del sueño y sus repercusiones en aprendizaje y memoria.

Recent studies have demonstrated that while we are sleeping, our brain is very busy processing all information we have acquired along the day. Lack of sleep has shown to produce deficits in memory consolidation and plays an important role in brain development and brain plasticity in the several developmental stages of the human brain. At the cellular level, circadian cycles coordinate complex mechanism that "turn on and off" genes and cellular structures regulating individual cell functions to impact global organ and systems physiological activities. At the end a perfect and coordinated equilibrium in the mental, emotional and physiological is the goal of this complex process. Sleep impacts memory, learning, mood, behavior, immunological responses, metabolism, hormone levels, digestive process and many more physiological functions. We present a review of three basic aspects related with sleep: a. brain electrical activity during the sleep and neuroanatomic correlation with mechanism related with memory and learning; b. circadian cycles and impact in several physiological systems; c some examples of clinical disorders associated with sleep disorders and impact in learning and memory.

Sleep quality is inversely related to body mass index among university students

SUMMARY OBJECTIVE: The purpose of this study was to investigate the prevalence of overweight and obesity and its association with sleep quality in university students from the Anhui province in China. METHODS: A cross-sectional study was conducted in China with 1328 participants. The prevalence of underweight and obesity in university students was estimated according to the reference working group on obesity in China. The sleep quality was evaluated using the standard PSQI (Pittsburgh Sleep Quality Index). RESULTS: This study included 470 male and 858 female students from a university in Anhui; 4.4% of the females and 17.7% of the males were overweight or obese. The prevalence of obesity in males was significantly higher than in females, and the prevalence of obesity in higher years was greater than in other years (p<0.05). In general, the mean score for sleep quality was 4.91±2.67; 36.5% of male and 39.1% of female students had poor sleep quality (PSQI score >5). Among the seven components of sleep quality, sleep duration and the use of sleep medication showed significant differences between male and female students and different years (p<0.05). An obvious correlation was found between sleep quality and body mass index (BMI)(p<0.000) in females who took hypnotic drugs. CONCLUSION: This study suggests that the sleep quality of females is probably associated with their BMI. College students are a special group of young adults whose cause of poor sleeping quality and BMI may be significant to study, so the health status of university students can be improved.

RESUMO OBJETIVO: O objetivo do estudo era investigar a prevalência de sobrepeso e obesidade e sua relação com a qualidade do sono em estudantes universitários da província de Anhui, China. METODOLOGIA: Um estudo transversal foi realizado na China com 1328 participantes. A prevalência de baixo peso e obesidade em estudantes universitários foi estimada com base nas referências do Grupo de Trabalho sobre Obesidade da China. A qualidade do sono foi avaliada utilizando o padrão PSQI (Pittsburgh Sleep Quality Index). RESULTADOS: O estudo incluiu 470 homens e 858 mulheres, todos estudantes universitários de Anhui; 4,4% das mulheres e 17,7% dos homens foram classificados com sobrepeso ou obesidade. A prevalência da obesidade em homens foi significativamente maior do que em mulheres, e a prevalência da obesidade nos últimos anos foi maior do que em outras categorias (P < 0, 05). Em geral, a pontuação média de qualidade do sono foi 4,91 ± 2,67; 36,5% dos homens e 39, 1% das mulheres tiveram uma qualidade de sono ruim (PSQI > 5). Considerando os sete componentes da qualidade do sono, a duração do sono e o uso de medicação para dormir apresentaram diferenças significativas entre estudantes homens e mulheres de anos diferentes (P < 0,05). Uma clara correlação foi encontrada entre a qualidade do sono e o Índice de Massa corporal (IMC) (P < 0.0000) em mulheres que usavam drogas hipnóticas. CONCLUSÃO: Este estudo sugere que a qualidade do sono das mulheres está provavelmente associada com o IMC. Os universitários são um grupo especial de jovens adultos, por isso é importante para estudar a causa da sua má qualidade do sono e sua relação com o IMC, para que seja possível melhorar a saúde dos estudantes universitários.

El sueño del niño con trastornos del neurodesarrollo / The sleep in children with neurodevelopmental disorders

El sueño adecuado es necesario para el desarrollo sináptico y la maduración cerebral, un sueño de mala calidad tiene efectos perjudiciales en las funciones cognitivas, de atención, memoria y conducta de los niños. La preocupación sobre la alta prevalencia de los problemas del sueño es amplia en todo el mundo; las consecuencias de estos problemas son incluso más importantes en los niños portadores de trastornos del neurodesarrollo; estos niños a menudo tienen dificultades de inicio y mantenimiento del sueño y despertares nocturnos frecuentes que afectan a sus problemas de conducta. El propósito de este escrito es revisar el estado del arte de los problemas del sueño en los niños con trastornos del neurodesarrollo. En este punto, es importante tener en cuenta el ritmo circadiano, un reloj que genéticamente dirige los ritmos celulares de transcripción, traslación y metabolismos. Este reloj se combina con el ambiente diurno y nocturno coordinando estos mecanismos durante los ciclos luz/oscuridad, sueño/vigilia, frío/calor, ingesta/ayuno, tanto diariamente como en las diferentes estaciones. En conclusión, los problemas del sueño son un factor condicionante de la evolución y calidad de vida de los niños con trastornos del neurodesarrollo, que debe ser tenido en cuenta en todos los casos y ocupar un lugar preferente tanto en la etapa diagnóstica como en la terapéutica.

Adequate sleep is of critical need for a typical synaptic development and brain maturation, a poor quality sleep can have detrimental effects on children's' cognitive attention, memory, mood regulation, and behavior functions. Great concern has been voiced out regarding the high prevalence of poor sleep in children worldwide, the effects of poor sleep may be even more pronounced in children with neurodevelopmental disorders; these children often have difficulties with falling and staying asleep and with night awakenings, this has a strong association with daytime behavior problems. The purpose of this article is to provide an overview of the state of the science of sleep in children with a neurodevelopmental disorder. In this context, it is important to take the circadian cycle into account, a genetically encoded clock that drives cellular rhythms of transcription, translation and metabolism. The circadian clock interacts with the diurnal and nocturnal environment that also drives transcription and metabolism during light/dark, sleep/wake, hot/cold and feast/fast daily and seasonal cycles In conclusion, the sleep problems are a conditioning factor in the evolution and quality of life of children with neurodevelopmental disorders that must be taken into account in all cases and occupy a preferential place in both the diagnostic and the therapeutic stages.

Quality of sleep, health and well-being in a population-based study / Qualidade do sono, saúde e bem-estar em estudo de base populacional

ABSTRACT OBJECTIVE To estimate the prevalence of poor self-rated sleep and to identify the population subgroups most susceptible to the problem. METHODS This is a cross-sectional, population-based study developed with data from the Health Survey conducted in the city of Campinas (ISACamp 2014/2015). Data from a sample of 1,998 individuals aged 20 years or older were analyzed. The self-rated quality of sleep was analyzed according to socio-demographic characteristics, morbidities, health behaviors and feeling of well-being. The association of sleep quality with different complaints and characteristics of sleep was also analyzed. Adjusted prevalence ratios were estimed using Poisson multiple regression model allowing for the sample weights. RESULTS Prevalence of poor self-rated sleep was 29.1% and showed to be significantly higher in women, in individuals aged from 40 to 50 years, migrants, without occupation, physically inactive in leisure context, with common mental disorder (PR = 1.59), with greater number of health problems (PR = 2.33), poor self-rated health (PR = 1.61), and life dissatisfaction. Poor sleep was strongly associated with reports of difficulty in initiating sleep (PR = 4.17), in maintaining sleep (PR = 4.40) and with never or almost never feeling well when waking up (PR = 4.52). CONCLUSIONS The results identify the population subgroups with poor quality of sleep that deserve greater attention. It also highlight the need to consider, in addition to the presence of comorbidities, mental health and the feeling of well-being in the care of patients with sleep problems and in the interventions planed for promoting healthy sleep.

RESUMO OBJETIVO Estimar a prevalência de sono autoavaliado como ruim e identificar os subgrupos da população mais susceptíveis ao problema. MÉTODOS Trata-se de estudo transversal, de base populacional, desenvolvido com dados de Inquérito de Saúde conduzido no município de Campinas (ISACamp 2014/2015). Foram analisados dados de amostra representativa de 1.998 indivíduos com 20 anos ou mais de idade. A qualidade autoavaliada do sono foi analisada segundo características sóciodemográficas, morbidades, comportamentos de saúde e sentimentos de bem-estar. Analisou-se também a associação da qualidade do sono com diferentes queixas e características do sono. Foram estimadas razões de prevalências e desenvolvido modelo de regressão múltipla de Poisson, considerando-se nas análises os pesos amostrais. RESULTADOS A prevalência de sono autoavaliado como ruim foi 29,1% e mostrou-se significativamente mais elevada nas mulheres, em indivíduos de 40 a 50 anos de idade, migrantes, sem ocupação, fisicamente inativos em contexto de lazer, com transtorno mental comum (RP = 1,59), com maior número de problemas de saúde (RP = 2,33), com saúde autoavaliada como ruim (RP = 1,61) e que manifestavam insatisfação com a vida. Sono ruim esteve fortemente associado com relatos de dificuldade de iniciar o sono (RP = 4,17), de manter o sono (RP = 4,40) e com nunca ou quase nunca se sentir bem-disposto ao acordar (RP = 4,52). CONCLUSÕES Os resultados identificam os segmentos da população com má qualidade do sono que merecem maior atenção e destacam a necessidade de avaliar, além da presença de comorbidades, a saúde mental e a presença de sentimentos de bem-estar no processo de cuidado dos pacientes com problemas de sono e no planejamento de intervenções voltadas à promoção de sono saudável.

Growth and mouth breathers / Crescimento e respiradores orais

Abstract Objective: To assess the relationship between mouth breathing and growth disorders among children and teenagers. Data source: Search on MEDLINE database, over the last 10 years, by using the following terms: "mouth breathing", "adenotonsilar hypertrophy", "allergic rhinitis", "sleep disturbance" AND "growth impairment", "growth hormone", "failure to thrive", "short stature", or "failure to thrive". Data summary: A total of 247 articles were identified and, after reading the headings, this number was reduced to 45 articles, whose abstracts were read and, of these, 20 were deemed important and were included in the review. In addition of these articles, references mentioned in them and specific books on mouth breathing deemed important were included. Hypertrophy of palatine and/or pharyngeal tonsils, whether associated with allergic rhinitis, as well as poorly controlled allergic rhinitis, are the main causes of mouth breathing in children. Respiratory sleep disorders are frequent among these patients. Several studies associate mouth breathing with reduced growth, as well as with reduced growth hormone release, which are reestablished after effective treatment of mouth breathing (clinical and/or surgical). Conclusions: Mouth breathing should be considered as a potential cause of growth retardation in children; pediatricians should assess these patients in a broad manner.

Resumo Objetivo: Avaliar a relação entre respiração oral e distúrbios do crescimento entre crianças e adolescentes. Fonte de dados: Busca na base de dados do MEDLINE, nos últimos 10 anos, com o emprego dos seguintes termos: "mouth breathing" ou "adenotonsilar hypertrophy", ou "allergic rhinitis" ou sleep disturbance" AND "growth impairment" ou "growth hormone" ou "failure to thrive" ou "short stature" ou "failure to thrive". Síntese dos dados: Foram identificados 247 artigos, que após a leitura dos títulos foram reduzidos a 45, cujos resumos foram lidos e desses 20 foram considerados de importância e integraram a revisão. Além desses, referências por eles citadas e livros-texto específicos sobre respiração oral considerados importantes foram incluídos. A hipertrofia de tonsilas palatinas e/ou faríngeas, associada ou não à rinite alérgica, assim como a rinite alérgica mal controlada, é a principal causa de respiração oral na criança. Distúrbios respiratórios do sono são frequentes entre esses pacientes. Vários estudos associam a respiração oral à redução do crescimento, bem como à redução de liberação de hormônio do crescimento, que são restabelecidos após o tratamento efetivo da respiração oral (clínico e/ou cirúrgico). Conclusões: A respiração oral deve ser cogitada como possível causa de retardo de crescimento em crianças e cabe ao pediatra a tarefa de investigar esses pacientes de forma mais abrangente.

El índice de masa corporal como fenotipo en el perfil clínico y funcional en mujeres con osteoartritis de rodilla / Association between the functional impact of osteoarthritis and body mass index in women

Background: Obesity is associated with pain, reduction of function and quality of life in patients with osteoarthritis (OA). Aim: To describe the clinical profile of women with knee OA according to their body mass index (BMI). Material and Methods: Observational study in 308 women with knee OA. According to their BMI, they were classified as normal-weight, overweight and obese. The primary outcome measure was functionality evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI) and quality of life assessed with the European Quality of Life Five Dimension (EuroQol-5D). Results: WOMAC, PSQI and EuroQol-5D scores were significantly higher in obese women. Conclusions: Overweight and obese women with OA have more sleep disorders, reduction on functionality and quality of life compared to their normal weight counterparts.

Twenty-five years since the identification of the first SCA gene: history, clinical features and perspectives for SCA1 / Vinte e cinco anos desde a identificação do primeiro gene das SCAs: história, aspectos clínicos e perspectivas para a SCA1

ABSTRACT Spinocerebellar ataxias (SCA) are a clinically and genetically heterogeneous group of monogenic diseases that share ataxia and autosomal dominant inheritance as the core features. An important proportion of SCAs are caused by CAG trinucleotide repeat expansions in the coding region of different genes. In addition to genetic heterogeneity, clinical features transcend motor symptoms, including cognitive, electrophysiological and imaging aspects. Despite all the progress in the past 25 years, the mechanisms that determine how neuronal death is mediated by these unstable expansions are still unclear. The aim of this article is to review, from an historical point of view, the first CAG-related ataxia to be genetically described: SCA 1.

RESUMO As ataxias espinocerebelares (SCA) são um grupo clínico e geneticamente heterogêneo de doenças monogênicas que compartilham ataxia e herança autossômica dominante como características principais. Uma proporção importante de SCAs é causada por expansões de repetição de trinucleotídeos CAG na região de codificação de diferentes genes. Além da heterogeneidade genética, os aspectos clínicos transcendem os sintomas motores, incluindo aspectos cognitivos, eletrofisiológicos e de imagem. Apesar de todo o progresso feito nos últimos 25 anos, os mecanismos que determinam como se dá a morte neuronal mediada por essas expansões instáveis ainda não estão claros. O objetivo deste artigo é revisar, de um ponto de vista histórico, a primeira ataxia geneticamente relacionada com o CAG descrita: SCA 1.

Sleep disorders in children with moderate to severe persistent allergic rhinitis / Distúrbios do sono em crianças com rinite alérgica persistente moderada-grave

Abstract Introduction Allergic rhinitis is associated with several complications, including sleep disorders. The Children's Sleep Habits Questionnaire has been recently translated and validated in Portuguese for the evaluation of sleep disorders in children. Objective To assess sleep disorders in children with moderate to severe persistent allergic rhinitis and to correlate the findings with disease severity markers. Methods We evaluated 167 children (4-10 years), 112 with allergic rhinitis and 55 controls. Parents/guardians of the children answered the Children's Sleep Habits Questionnaire, consisting of 33 questions divided into eight subscales, which refers to the previous week. Patients with rhinitis were also evaluated regarding the score of nasal and extra-nasal symptoms related to the previous week and the peak nasal inspiratory flow. Results There were no significant differences between groups of different age. All patients with rhinitis were being treated with nasal topical corticosteroids. The total Children's Sleep Habits Questionnaire score was significantly higher among children with rhinitis than in controls (median 48 vs. 43, p < 0.001). Significantly higher values were also observed for the parasomnia (9 vs. 8), respiratory disorders (4 vs. 3) and daytime sleepiness (14 vs. 12) subscales. Among the patients with rhinitis, no significant correlation was observed between the total Children's Sleep Habits Questionnaire score and disease activity variables, but moderate correlations were observed for the respiratory distress subscale vs. nasal symptom score (r = 0.32) and vs. extra-nasal symptom score (r = 0.32). Conclusion Children with moderate to severe persistent allergic rhinitis, even when submitted to regular treatment, have a higher frequency of sleep disorders than controls, particularly concerning nocturnal breathing disorders, daytime sleepiness, and parasomnias. The intensity of sleep disorders found in some subscales was correlated with objective markers of allergic rhinitis severity.

Resumo Introdução A rinite alérgica está associada a diversas complicações, como, por exemplo, os distúrbios do sono. O Children's Sleep Habits Questionnaire é um questionário para avaliação dos distúrbios do sono em crianças, recentemente traduzido e validado para o português. Objetivos Avaliar distúrbios do sono em crianças com rinite alérgica persistente moderada/grave e correlacionar os achados com marcadores de gravidade da doença. Método Foram avaliadas 167 crianças (4-10 anos), 112 com rinite alérgica e 55 controles. Todos os responsáveis pelas crianças responderam o questionário, composto por 33 questões dividas em oito subescalas e referentes à última semana. Os pacientes com rinite foram avaliados também pelo escore de sintomas nasais e extranasais referentes à última semana e pelo pico de fluxo inspiratório nasal. Resultados Não houve diferenças significantes entre os grupos com relação à idade. Todos os pacientes com rinite eram tratados com corticosteroide tópico nasal. O escore total do questionário foi significantemente maior entre os com rinite do que entre os controles (mediana 48 vs. 43; p < 0,001). Valores significantemente maiores também foram observados para as subescalas de parassonias (9 vs. 8), distúrbios respiratórios (4 vs. 3) e sonolência diurna (14 vs. 12). Entre os pacientes com rinite não foi observada correlação significante entre o escore total do questionário e as variáveis de atividade da doença, porém correlações moderadas foram observadas para a subescala de distúrbios respiratórios vs. escore de sintomas nasais (r = 0,32) e vs. escore de sintomas extranasais (r = 0,32). Conclusões Crianças com rinite alérgica persistente moderada-grave, mesmo em tratamento regular, apresentam maior frequência de distúrbios do sono do que controles, particularmente em relação aos distúrbios respiratórios noturnos, à sonolência diurna e às parassonias. A intensidade das alterações do sono encontradas em algumas subescalas se correlacionou com marcadores objetivos de gravidade da rinite alérgica.

Problemas de sono em idosos estão associados a sexo feminino, dor e incontinência urinária / Sleep disturbances in older adults are associated to female sex, pain and urinary incontinence

RESUMO: Objetivos: A prevalência de problemas de sono em idosos, como insônia, é uma questão relevante em nossa sociedade. A má qualidade do sono, por exemplo, é vista por muitos como um resultado inevitável do envelhecimento. Neste contexto, este estudo teve como objetivo estimar a prevalência e os fatores associados a distúrbios do sono em homens e mulheres idosos (60 anos ou mais). Métodos: O presente trabalho é parte do estudo de coorte Saúde, Bem-Estar e Envelhecimento (SABE), realizado em São Paulo, Brasil. A amostra deste estudo transversal constituiu-se de 1.334 idosos com 60 anos ou mais. Os distúrbios foram avaliados com base nas respostas dos participantes, levando em conta se eles tinham experimentado qualquer perturbação do sono no mês anterior. Resultados: Dentre os avaliados, 44,9% indicaram distúrbios do sono em geral, sendo esses mais frequentes em mulheres (51,5%) e na faixa etária de 75 a 79 anos (48,2%). De acordo com a análise de regressão, gênero, doenças articulares, noctúria e incontinência urinária foram associados aos distúrbios, sobre os quais também foi verificado que seu aumento não é linearmente dependente da idade. Conclusões: Sexo, dor, incontinência urinária e noctúria são fatores associados a distúrbios do sono em idosos. Assim, concluímos que a sua ausência está associada ao gênero e ao estado de saúde.

ABSTRACT: Objectives: The prevalence of sleep problems in elderly, such as insomnia, is a relevant issue in our society. Poor sleep quality is viewed by many as an inevitable result of aging. In this context, this study aimed to estimate the prevalence and associated factors of sleeping disturbances in elderly men and women (60 years and older). Methods: The present study is part of SABE Study (Health, Well-being and Aging), a cohort conducted in São Paulo, Brazil. The sample included in the present cross-sectional study comprised 1,334 elderly people aged 60 years or older. Sleep disturbances were assessed based on responses of study participants on whether they had experienced any sleep disturbance in the past month. Results: Among the elderly assessed, 44.9% had overall sleep disturbances, which were more frequent in women (51.5%) and in 75 to 79 years old (48.2%). According to the regression analysis, the variables gender, joint diseases, as well as nocturia and urinary incontinence, were associated with sleep disorders. Increase in sleep disturbances was found not to be linearly age-dependent. Conclusions: Gender, pain, urinary and nocturia incontinence were factors associated with sleep disorders. Thus, we might conclude that the absence of sleep disturbances in older adults depends on gender and health status.

Effect of biliopancreatic diversion on sleep quality and daytime sleepiness in patients with obesity and type 2 diabetes

ABSTRACT Objective: The poor quality of sleep and the deprivation thereof have been associated with disruption of metabolic homeostasis, favoring the development of obesity and type 2 diabetes (T2DM). We aimed to evaluate the influence of biliopancreatic diversion (BPD) surgery on sleep quality and excessive daytime sleepiness of obese patients with T2DM, comparing them with two control groups consisting of obese and normal weight individuals, both normal glucose tolerant. Subjects and methods: Forty-two women were divided into three groups: LeanControl (n = 11), ObeseControl (n = 13), and ObeseT2DM (n = 18). The LeanC and ObeseC groups underwent all tests and evaluations once. The ObeseT2DM underwent BPD and were reassessed after 12 months. Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were applied before and 12 months after BPD. Results: Before surgery, there was less daytime sleepiness in LeanC group (p = 0.013) compared with ObeseC and T2DMObese groups. The two obese groups did not differ regarding daytime sleepiness, demonstrating that the presence of T2DM had no influence on daytime sleepiness. After surgery, the daytime sleepiness (p = 0.002) and the sleep quality (p = 0.033) improved. The score for daytime sleepiness of operated T2DMObese group became similar to LeanC and lower than ObeseC (p = 0.047). Conclusion: BPD surgery has positively influenced daytime sleepiness and sleep quality of obese patients with T2DM, leading to normalization of daytime sleepiness 12 months after surgery. These results reinforce previously identified associations between sleep, obesity and T2DM in view of the importance of sleep in metabolic homeostasis, quality of life and health.

Calidad de sueño y rendimiento académico en alumnos de educación secundaria / Quality of sleep and academic performance in high school students

Background: Sleeping and studying are the day-to-day activities of a teenager attending school. Aim: To determine the quality of sleep and its relationship to the academic performance among students attending morning and afternoon shifts in a public high school. Material and Methods: Students of the first and second year of high school answered an interview about socio-demographic background, academic performance, student activities and subjective sleep quality; they were evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results: The interview was answered by 322 first year students aged 15 ± 5 years attending the morning shift and 364 second year students, aged 16 ± 0.5 years, attending the afternoon shift. The components: sleep latency, habitual sleep efficiency, sleep disturbance, drug use and daytime dysfunction were similar and classified as good in both school shifts. The components subjective sleep quality and duration of sleep had higher scores among students of the morning shift. The mean grades during the first semester of the students attending morning and afternoon shifts were 5.9 and 5.8, respectively (of a scale from 1 to 7). Among students of both shifts, the PSQI scale was associated inversely and significantly with academic performance. Conclusions: A bad sleep quality influences academic performance in these students.

Night eating syndrome: How to treat it? / Síndrome do comer noturno: como tratar?

Summary Night eating syndrome (NES) is characterized by caloric intake ≥ 25% of total daily after dinner and/or by two or more weekly nocturnal awakenings accompanied by food ingestion. Causes of NES are not entirely clear and seem to involve a desynchronization between the circadian rhythms of food ingestion and sleep, resulting in a delayed pattern of food intake. Estimates of the prevalence of NES in the general population are around 1.5%, and although much higher frequencies have been described in obese individuals, a causal relationship between NES and obesity is not clearly established. Since the first NES reports, several treatment modalities have been proposed, although, in many cases, the evidence is still insufficient and there is no consensus on the ideal approach. In order to conduct a critical review of proposed treatments for NES since its original description, a systematic search of articles published in journals indexed in Medline/Pubmed database in the period 1955-2015 was performed. Seventeen articles addressing non-pharmacological and pharmacological therapies met the selection criteria. Based on the articles analyzed, we conclude that serotonergic agents and psychological interventions, particularly cognitive behavioral therapy, have been shown to be effective for the treatment of NES. A combination of non-pharmacological and pharmacological therapies must be considered in future studies on the treatment of these patients.

Resumo A síndrome do comer noturno (SCN) caracteriza-se por ingestão calórica ≥ 25% do total diário após o jantar e/ou por dois ou mais despertares noturnos semanais acompanhados de alimentação. As causas da SCN não estão totalmente esclarecidas e parecem envolver uma dessincronização entre os ritmos circadianos de alimentação e sono, resultando em um atraso do padrão alimentar. Estimativas da prevalência de SCN na população geral estão em torno de 1,5% e, embora frequências bem mais elevadas tenham sido descritas em obesos, uma relação de causalidade entre SCN e obesidade não está claramente estabelecida. Desde os primeiros relatos da SCN, várias modalidades de tratamento têm sido propostas, embora, em muitos casos, a evidência ainda seja insuficiente e não exista um consenso sobre a abordagem ideal. Com o objetivo de realizar uma revisão crítica dos tratamentos propostos para a SCN, desde sua descrição original, foi realizada uma busca sistemática de artigos publicados nos periódicos indexados na base de dados MedLine / Pubmed entre 1955 e 2015. Dezessete artigos, abordando terapias não farmacológicas ou farmacológicas, preencheram os critérios de seleção. Com base nos artigos analisados, conclui-se que os agentes serotonérgicos e intervenções psicológicas, particularmente, a terapia cognitivo-comportamental, têm mostrado eficácia no tratamento da SCN. Uma combinação de terapias não farmacológicas e farmacológicas precisa ser considerada em estudos futuros sobre o tratamento desses pacientes.

Sleep disorder investigation might be considered to be mandatory in attention deficit/hyperactivity disorder guideline / Investigação de distúrbio do sono deve ser considerada obrigatória e incluída no manejo de distúrbios do déficit de atenção/hiperatividade

ABSTRACT Objective To determine the prevalence of obstructive sleep apnea (OSA) in children with attention deficit/hyperactive disorder (ADHD) and compare amplitude and latency of the P300 potential among children with and without OSA. Method Sixty-one children with ADHD underwent oddball auditory attention tests for detection of P300 (ERPs) followed by an all-night polysomnography. The children were divided in two groups, those with and without OSA. Results Significant decreased amplitude of the P300 potential was observed in children with OSA when compared with children without OSA. Conclusion The study showed that sleep fragmentation as a result of OSA can exacerbate the attention disorder that characterizes ADHD, and highlights the importance of assessing the presence of OSA in the differential diagnosis of children with attention deficits.

RESUMO Objetivo determinar a prevalência de apneia obstrutiva do sono (AOS) em crianças com déficit de atenção / hiperatividade (TDAH) e comparar amplitude e latência do potencial P300 entre as crianças com e sem AOS. Método Sessenta e uma crianças com TDAH foram submetidos a testes de atenção auditiva com o paradigma oddball para a detecção de potenciais relacionados a eventos (PREs) do tipo P300, seguidos por polissonografia de noite inteira. As crianças foram divididas em dois grupos, crianças com e sem AOS. Resultados Foi observada redução significativa da amplitude do potencial P300 em crianças com AOS quando comparadas com crianças sem AOS. Conclusão O estudo mostrou que a fragmentação do sono, consequente a AOS, pode exacerbar o déficit de atenção, que caracteriza o TDAH, e destacou a importância de avaliar a presença de AOS no diagnóstico diferencial de crianças com déficit de atenção.

Is polysomnographic examination necessary for subjects with diaphragm pathologies?

OBJECTIVES: While respiratory distress is accepted as the only indication for diaphragmatic plication surgery, sleep disorders have been underestimated. In this study, we aimed to detect the sleep disorders that accompany diaphragm pathologies. Specifically, the association of obstructive sleep apnea syndrome with diaphragm eventration and diaphragm paralysis was evaluated. METHODS: This study was performed in Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital between 2014-2016. All patients had symptoms of obstructive sleep apnea (snoring and/or cessation of breath during sleep and/or daytime sleepiness) and underwent diaphragmatic plication via video-assisted mini-thoracotomy. Additionally, all patients underwent pre- and postoperative full-night polysomnography. Pre- and postoperative clinical findings, polysomnography results, Epworth sleepiness scale scores and pulmonary function test results were compared. RESULTS: Twelve patients (7 males) with a mean age of 48 (range, 27-60) years and a mean body mass index of 25 (range, 20-30) kg/m2 were included in the study. Preoperative polysomnography showed obstructive sleep apnea syndrome in 9 of the 12 patients (75%), while 3 of the patients (25%) were regarded as normal. Postoperatively, patient complaints, apnea hypopnea indices, Epworth sleepiness scale scores and pulmonary function test results all demonstrated remarkable improvement. CONCLUSION: All patients suffering from diaphragm pathologies with symptoms should undergo polysomnography, and patients diagnosed with obstructive sleep apnea syndrome should be operated on. In this way, long-term comorbidities of sleep disorders may be prevented.

Currents issues in cardiorespiratory care of patients with post-polio syndrome / Tópicos atuais no tratamento cardiorrespiratório de pacientes com síndrome pós-poliomielite

ABSTRACT Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.

RESUMO Síndrome pós-polio (SPP) é uma condição que afeta sobreviventes da poliomielite aguda (PAA), anos após a recuperação de um ataque agudo inicial do vírus. Na maioria das vezes, os sobreviventes da polio começam a apresentar nova paresia gradual nos músculos que foram previamente afetados pela infecção. A incidência real de doenças cardiovasculares (DCV) em indivíduos que sofrem de SPP não é conhecida. Entretanto, há indícios para suspeitar de que sujeitos com SPP podem estar em maior risco. Método Realizou-se uma busca de artigos nas bases de dados: Bireme, Scielo e Pubmed, utilizando as seguintes palavras-chave: síndrome pós-poliomielite, função cardiorrespiratória e reabilitação, nos idiomas Inglês, Francês e Espanhol. Embora tenhamos selecionado um número expressivo de artigos, somente foram considerados os duplo-cegos, randomizados-controlados, além de consensos. Resultados e Discussão Certas características da SPP, tais como fadiga muscular, paresia, dor muscular e/ou articulares podem resultar em descondicionamento por inatividade física, além de obesidade e dislipidemia. Dificuldades respiratórias são comuns e podem resultar em hipoxemia. Conclusão Somente quando avaliados e tratados em tempo hábil, alguns pacientes são capazes de obter os benefícios do uso dos músculos respiratórios auxiliares em termos de qualidade de vida.

Positive correlation between functional disability, excessive daytime sleepiness, and fatigue in relapsing-remitting multiple sclerosis / Correlação positiva entre incapacidade funcional, sonolência excessiva diurna e fadiga na forma recorrente-remitente da esclerose múltipla

ABSTRACT Sleep disorders in patients with multiple sclerosis have various causes and interfere with daytime wakefulness. This study assessed the correlation between fatigue, excessive daytime sleepiness and level of disability. Method Retrospective review of medical records from patients with multiple sclerosis to collect data on severity of fatigue, disability, daytime sleepiness, and depression. From 912 medical records reviewed, 122 reported daytime sleepiness: 67% had relapsing remitting, 12% had primary progressive, and 21% had secondary progressive. Results In 95% of the patients with relapsing remitting who complained of daytime sleepiness and fatigue, association was found between these symptoms and neurological disability. Patients with relapsing remitting who complained of daytime sleepiness and fatigue also experienced depression (p = 0.001). No association between fatigue, excessive daytime sleepiness, depression, and disability was found in patients with progressive disease. Conclusion In relapsing remitting, there is correlation between functional disability, excessive daytime sleepiness and fatigue, a finding not confirmed in primary progressive and secondary progressive form.

RESUMO Os distúrbios do sono em pacientes com esclerose múltipla são multifatoriais e interferem no alerta diurno. O objetivo deste estudo foi verificar a correlação entre a fadiga, sonolência excessiva diurna e nível de incapacidade. Método Estudo retrospectivo de prontuários de pacientes com esclerose múltipla, onde foram coletados dados sobre gravidade da fadiga, nível de incapacidade, sonolência diurna e depressão. Dos 912 prontuários analisados, 122 apresentaram queixa de sonolência excessiva, divididos 67% forma recorrente-remitente; 12% forma primariamente progressiva; 21% forma secundariamente progressiva. Resultados 95% dos pacientes recorrente remitente apresentaram sonolência excessiva diurna e fadiga, foi observada associação entre estes sintomas e incapacidade neurológica. Nos pacientes recorrentes remitentes observamos sonolência excessiva diurna, fadiga e depressão (p = 0,001). Nas formas progressivas não foi possível observar associação entre fadiga, sonolência excessiva diurna, depressão e incapacidade. Conclusão Na forma remitente recorrente existe uma relação entre incapacidade funcional, sonolência excessiva diurna e fadiga, entretanto, não notamos esta associação nas formas secundariamente progressiva e primariamente progressiva.

Sleep disorder or simple sleep ontogeny? Tendency for morningness is associated with worse sleep quality in the elderly

The objective of this study was to evaluate the alterations in sleep and circadian parameters during the aging process. The study sample comprises volunteers older than 18 up to 90 years of age that answered the Pittsburgh Sleep Quality Index (PSQI) and the Horne and Östberg circadian preference questionnaire. We observed that the shift to morningness with increasing age is associated with a significant worsening in sleep quality. We discuss that this sleep profile characterized by morningness and worse sleep quality observed in elderly, when compared to younger people, reflects not necessarily a pathological state, but an expected profile for this age group.

Poor sleep in middle-aged women is not associated with menopause per se

Whether sleep problems of menopausal women are associated with vasomotor symptoms and/or changes in estrogen levels associated with menopause or age-related changes in sleep architecture is unclear. This study aimed to determine if poor sleep in middle-aged women is correlated with menopause. This study recruited women seeking care for the first time at the menopause outpatient department of our hospital. Inclusion criteria were an age ≥40 years, not taking any medications for menopausal symptoms, and no sleeping problems or depression. Patients were assessed with the Pittsburgh Sleep Quality Index (PSQI), modified Kupperman Index (KI), and Menopause Rating Scale (MRS). A PSQI score of <7 indicated no sleep disorder and ≥7 indicated a sleep disorder. Blood specimens were analyzed for follicle-stimulating hormone and estradiol levels. A total of 244 women were included in the study; 103 (42.2%) were identified as having a sleep disorder and 141 as not having one. In addition, 156 (64%) women were postmenopausal and 88 (36%) were not menopausal. Follicle-stimulating hormone and estradiol levels were similar between the groups. Patients with a sleep disorder had a significantly higher total modified KI score and total MRS score (both, P<0.001) compared with those without a sleep disorder. Correlations of the PSQI total score with the KI and MRS were similar in menopausal and non-menopausal women. These results do not support that menopause per se specifically contributes to sleep problems.