Sleep and restless legs syndrome in female adolescents with idiopathic musculoskeletal pain / Sono e síndrome das pernas inquietas em adolescentes do sexo feminino com dor musculoesquelética idiopática

Abstract Objectives: To assess the presence of restless legs syndrome, periodic leg movement, and sleep disorders in female adolescents with idiopathic musculoskeletal pain through a sleep scale and polysomnography, and to compare these data in adolescents without pain history. Method: Twenty-six adolescents diagnosed with idiopathic musculoskeletal pain followed in a pain outpatient clinic and 25 healthy controls matched by age and education were recruited. The restless legs syndrome criteria were evaluated according to the International Restless Legs Syndrome Study Group, the Sleep Disturbance Scale for Children was completed, nocturnal polysomnography was performed, and anxiety symptoms were recorded. Results: The mean age of idiopathic musculoskeletal pain adolescents was 13.9 ± 1.6 years; in controls, it was 14.4 ± 1.4 years. One adolescent in the control group (4 %) and nine patients with idiopathic musculoskeletal pain (34.6 %) fulfilled the restless legs syndrome criteria (p = 0.011). The authors did not observe significant differences in Sleep Disturbance Scale for Children scores between the groups in all components: disorders of initiating and maintaining sleep (p = 0.290), sleep breathing disorders (p = 0.576), disorders of arousal (p = 0.162), sleep-wake transition disorders (p = 0.258), disorder of excessive daytime somnolence (p = 0.594), and sleep hyperhidrosis (p = 0.797). The neurophysiological, respiratory, and periodic leg movement parameters were similar in both groups. Having anxiety was not associated with restless legs syndrome (p = 0.11). Three patients with idiopathic musculoskeletal pain (11.5 %) presented restless legs syndrome and periodic leg movement simultaneously, which was absent in the control group. Conclusion: Female adolescents with idiopathic musculoskeletal pain present criteria for RLS more frequently than healthy adolescents. However, this study did not observe relevant changes in objective and subject sleep variables.

Resumo Objetivos: Avaliar a presença de síndrome das pernas inquietas, movimento periódico das pernas e distúrbios do sono em adolescentes do sexo feminino com dor musculoesquelética idiopática por meio da escala do sono e da polissonografia e comparar esses dados em adolescentes sem histórico de dor. Método: Foram recrutados 26 adolescentes diagnosticados com dor musculoesquelética idiopática acompanhados em um ambulatório de dor e 25 controles saudáveis pareados por idade e escolaridade. Avaliamos os critérios da síndrome das pernas inquietas de acordo com o Grupo Internacional de Estudos de Síndrome das Pernas Inquietas, a Escala de Distúrbios do Sono em Crianças, a polissonografia noturna e os sintomas de ansiedade. Resultados: A idade média dos adolescentes com dor musculoesquelética idiopática foi 13,9 ± 1,6 anos e dos controles foi 14,4 ± 1,4 anos. Um adolescente no grupo de controle (4%) e nove pacientes com dor musculoesquelética idiopática (34,6%) atenderam aos critérios da síndrome das pernas inquietas (p = 0,011). Não observamos diferenças significativas nos escores da Escala de Distúrbios do Sono em Crianças entre os grupos em todos os componentes: distúrbios do início e da manutenção do sono (p = 0,290), distúrbios respiratórios do sono (p = 0,576), distúrbios do despertar (p = 0,162), distúrbios da transição sono-vigília (p = 0,258), sonolência diurna excessiva (p = 0,594) e hiperidrose do sono (p = 0,797). Os parâmetros neurofisiológicos, respiratórios e o movimento periódico das pernas foram semelhantes nos dois grupos. Ansiedade não foi associada à síndrome das pernas inquietas (p = 0,11). Três pacientes com dor musculoesquelética idiopática (11,5%) apresentaram síndrome das pernas inquietas e movimento periódico das pernas simultaneamente, situação ausente no grupo de controle. Conclusão: As adolescentes do sexo feminino com dor musculoesquelética idiopática apresentaram critérios para síndrome das pernas inquietas com mais frequência do que as adolescentes saudáveis. Contudo, não observamos mudanças relevantes nas variáveis do sono objetivas e subjetivas.

Sleep and restless legs syndrome in female adolescents with idiopathic musculoskeletal pain.

OBJECTIVES: To assess the presence of restless legs syndrome, periodic leg movement, and sleep disorders in female adolescents with idiopathic musculoskeletal pain through a sleep scale and polysomnography, and to compare these data in adolescents without pain history. METHOD: Twenty-six adolescents diagnosed with idiopathic musculoskeletal pain followed in a pain outpatient clinic and 25 healthy controls matched by age and education were recruited. The restless legs syndrome criteria were evaluated according to the International Restless Legs Syndrome Study Group, the Sleep Disturbance Scale for Children was completed, nocturnal polysomnography was performed, and anxiety symptoms were recorded. RESULTS: The mean age of idiopathic musculoskeletal pain adolescents was 13.9±1.6 years; in controls, it was 14.4±1.4 years. One adolescent in the control group (4 %) and nine patients with idiopathic musculoskeletal pain (34.6 %) fulfilled the restless legs syndrome criteria (p=0.011). The authors did not observe significant differences in Sleep Disturbance Scale for Children scores between the groups in all components: disorders of initiating and maintaining sleep (p=0.290), sleep breathing disorders (p=0.576), disorders of arousal (p=0.162), sleep-wake transition disorders (p=0.258), disorder of excessive daytime somnolence (p=0.594), and sleep hyperhidrosis (p=0.797). The neurophysiological, respiratory, and periodic leg movement parameters were similar in both groups. Having anxiety was not associated with restless legs syndrome (p=0.11). Three patients with idiopathic musculoskeletal pain (11.5 %) presented restless legs syndrome and periodic leg movement simultaneously, which was absent in the control group. CONCLUSION: Female adolescents with idiopathic musculoskeletal pain present criteria for RLS more frequently than healthy adolescents. However, this study did not observe relevant changes in objective and subject sleep variables.

Psychological characteristics of caregivers of pediatric patients with chronic rheumatic disease in relation to treatment adherence.

BACKGROUND: Adherence to treatment for chronic diseases is lower in children than in adults, less extensively studied in children and is associated with multiple related factors. The aim of this study is to perform a descriptive analysis of psycho-cognitive aspects of primary caregivers of pediatric patients with chronic rheumatic diseases, as well as socioeconomic and clinical factors, family functioning and treatment satisfaction. METHODS: Primary caregivers of 90 patients were included. Pairs (caregiver plus patient) were grouped as presenting good adherence (n = 50) or poor adherence (n = 40) according to the Morisky Adherence Test. Psycho-cognitive aspects were evaluated by Adult Self-Report and Wechsler Adult Intelligence Scale tests. For statistical comparisons, quantitative variables with normal distribution were analyzed by Student's t test, and those with non-Gaussian distribution with the Mann Whitney test. Categorical variables were analyzed by Chi square test. A multivariate logistic regression analysis was performed to estimate the contribution of the independent variables to adherence. RESULTS: Compared to caregivers in the good adherence group, caregivers in the poor adherence group were more likely to be classified as clinical on the scales for attention problems and externalizing problems, which include impulsiveness and aggressiveness. They also scored higher on the depressive problem scale. In addition, the average number of children per caregiver and the mean age of caregivers and patients were significantly higher in the poor adherence group, while the proportion of caregivers with higher education was lower. The poor adherence group also included a higher incidence of pediatric patients assuming sole responsibility for managing medications. Economic status, clinical factors, treatment satisfaction, family functioning and caregiver cognitive profile were not related to adherence, except for working memory index. CONCLUSION: Older patients, patients as the one solely responsible for medication management, and caregivers with externalizing problems, were observed to be the most strongly associated to poor adherence. Interventions aimed at adolescent patients are needed. Also, psychological programs and interventional studies to better determine caregivers' behavioral/emotional status, and parent-child relationships are recommended.

Perceptual-motor maturity in adolescence and the Tanner Stages: a study with Bender-Gradual Scoring System

Visual-motor skill forms an important psycho diagnostic component and is associated with psycho-neurological aspects. The Bender Visual-Motor Gestalt Test, widely used for the evaluation of this area, is meant for children up to 11 years. In adolescence, the changes associated with puberty generate nonlinear anthropometric development resulting in mild and temporary incoordination. This study investigated the relation between visual-motor development measured by the Bender test and pubertal changes according to the Tanner scale. In all 134 adolescents of both sexes, aged from 10 to 15, who kept routine medical appointments, participated. We used the Bender Visual-Motor Gestalt Test, Raven's Progressive Matrices Test, and medical chart data. The techniques were applied individually. Pubertal changes were associated with the Bender test results showing higher scores at the G3 stage, the period corresponding to a growth spurt, compared to the G5 stage (p = .007, ES = .187), the post-growth spurt period in boys. Age and gender did not influence the Bender test scores. According to the Raven test, the g intelligence factor, interfered significantly in the visual-motor performance (r = -57%, p < .001). Schooling, repetition of a school year, and developmental problems (p = .002, ES = .156; p = .002, ES = .623; p < .001, ES = .880, respectively) obtained similar results. The Bender Test was sensitive to schooling and maturational problems during adolescence. There was an association between visual-motor development and sexual maturity in male adolescents. Our results indicate the usefulness of the Bender Test at older ages than those used in the test standardization

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Bender Visual-Motor Gestalt Test in adolescents: relationship between visual-motor development and the Tanner Stages.

Visual-motor skill is fundamental to human development and is an important component of psychological evaluations. The goal of the present study was to determine whether there is a correlation between visual-motor development, as measured by the Bender Visual-Motor Gestalt Test (Bender test), and sexual maturity in adolescents, based on the Tanner Stages in Adolescents. 134 adolescents from 10 to 15 years of age participated in the study. The Bender test and the Raven's Progressive Matrices Test were employed. The measures were administered individually and information on sexual maturity and the presence of developmental disorders was collected from medical charts. The results of the Bender test were not affected by gender, age, schooling, or changes stemming from puberty, but were significantly affected by having repeated a school year and by developmental disorders. An association was found with Raven's scores. The Bender test proved sensitive to developmental disorders in adolescence. No association was found between visual-motor development and sexual maturity in adolescents.