Prevalence of chronic insomnia in patients with obstructive sleep apnea.

OBJECTIVES: To investigate the prevalence of and factors associated with chronic insomnia and obstructive sleep apnea (CIOSA) comorbidity in obstructive sleep apnea (OSA) patients. METHODS: Between March 2014 and March 2015, we conducted a prospective, cross-sectional study of 238 adults diagnosed with OSA according to polysomnography and International Classification of Sleep Disorders-Third Edition criteria. RESULTS: The prevalence of CIOSA was 29%. There was a trend towards older age in the CIOSA group. Sex was not associated with CIOSA. Sleep-maintenance and sleep-onset insomnia predominated in the sample. Beck's depression and anxiety inventory scores were higher in the CIOSA group. Both depression and anxiety symptoms were associated with CIOSA. The arousal and apnea-hypopnea indices were lower in the CIOSA group. CIOSA was also associated with age ≥ 60 years and current tobacco use. Severe OSA and alcohol use were negatively associated with CIOSA. CONCLUSIONS: Chronic insomnia is prevalent among OSA patients. Our study highlights the need for detailed evaluation of patients with sleep breathing disorders to diagnose other important sleep and mood disorders (such as depression and anxiety), given their frequent association.

Analysis of leukocytes in medication-overuse headache, chronic migraine, and episodic migraine.

OBJECTIVE: To evaluate the number of immune cells in the peripheral blood of medication-overuse headache (MOH), chronic migraine (CM), and migraine without aura (MWA) patients, as well as from controls. BACKGROUND: Migraine has been linked to immunologic disturbances, but the role of the immune system in chronic forms of headache that evolve from migraine has not been studied. Psychiatric co-morbidity has been related to both headache chronification and immunologic alterations. METHODS: This cross-sectional study comprised 68 subjects divided in 4 groups: MOH, CM, MWA, control. Subjects were gender-matched, had no physical co-morbidity, and were taking only acetaminophen. Clinical and psychological data were recorded in a standardized protocol. Samples of peripheral blood for hematological analysis were obtained in the morning during the ictal (MOH, CM, and MWA groups) and interictal periods (MWA group), as well from control group. RESULTS: A higher lymphocyte count was measured in MOH patients relative to the MWA patients (mean ± standard deviation: 2448.7/mm3 ± 775.8 vs. 1859.7/mm3 ± 564.7; P = .027). The numbers of blood lymphocytes for CM and control subjects were 2086.1/mm3 ± 540.5 and 1961.7/mm3 ± 385.6, respectively. Multiple linear regression analysis demonstrated that only MOH and MWA groups remained associated with lymphocyte count (B = 540.7; CI 95%: 55.2-1026.1; P = .03; R2 = 19.2%). Analysis for linearity of variables in the spectrum control/MWA/CM/MOH resulted positive for body mass index (from 23.5 ± 3.25 in controls to 26.5 ± 4.49 in MOH patients; P = .034), scores on Beck Depression Inventory (from 3.29 ± 3.05 to 14.65 ± 11.21; P < 0.001) and Hamilton Anxiety Scale (from 4.29 ± 3.93 to 23.24 ± 11.01; P < 0.001), hemoglobin (from 13.7 ± 0.79 to 14.6 ± 1.31; P = .022), and lymphocyte count (from 1961.7 ± 385.6 to 2448.7 ± 775.8; P = .01), but negative for CD8+ T lymphocytes (from 34.0 ± 8.82 to 30.0 ± 6.64; P = .046). CONCLUSIONS: A higher lymphocyte count in the MOH group relative to the MWA group may indicate a chronic inflammatory state. Several clinical and laboratorial characteristics have a range along a spectrum extending from healthy subjects to patients suffering from chronic forms of migraine.

Achados neurológicos em crianças com várias apresentaçöes de precocidade sexual / Neurologic finds in children with many sexual precocity presentations

Com a finalidade de investigar os achados neurológicos em várias apresentaçoes de precocidade sexual, foram avaliadas 15 crianças que desenvolveram características sexuais secundárias antes dos 8 anos de idade nas meninas e dos 9 nos meninos. Foram diagnosticados 7 casos de puberdade precoce verdadeira (PPV), sendo 4 de etiologia neurogênica, 2 de telarca precoce (TP), de precocidade sexual transitória (PST) e 5 de pubarca precoce (PP). As crianças foram submetidas ao exame neurológico tradicional (ETN), exame neurológico evolutivo (ENE), tomografia computadorizada de encéfalo (TCE) e eletroencefalograma (EEG). Nas crianças com 4 ou mais anos de idade, o EEG realizado foi quantitativo, com mapeamento cerebral. O ETN mostrou-se alterado em 2 casos de PPV; o ENE em 4 (3 de PPV e um de PP). A TCE demonstrou lesao classicamente relacionada com PPV em 3 casos e, num caso de PP, lesao sem diagnóstico definitivo. O EEG foi alterado em 1O crianças (66,6 por cento): 3 com PPV neurogênica, um com PPV idiopática, um com PST, em todos os casos de PP e nenhum de TP. Os achados sugerem que os distúrbios eletroencefalográficos nas crianças com PPV idiopática e PP possam indicar lesao neurológica nao diagnosticada pelos métodos disponíveis.

Puberdade precoce verdadeira: importancia da tomografia computadorizada de encefalo / True precocious puberty:importance of the computed tomography of the brain

A puberdade precoce verdadeira (PPV) foi diagnosticada em dois pacientes, um do sexo masculino e outro do sexo feminino, com historia previa de meningoencefalite tuberculosa. Num dos casos a tomografia computadorizada de encefalo(TCE) demonstrou dilatacao assimetrica dos ventriculos como sequela do processo infeccioso. No segundo caso, embora a presenca de calcificacao intracraniana tambem sugerisse relacao causal entre a meningoencefalite e a PPV, a TCE evidenciou tumor de terceiro ventriculo com caracteristicas sugestivas de hamartoma. Os achados tomograficos, que podem modificar a conduta terapeutica, enfatizam a necessidade da realizacao da TCE em casos de PPV nos pacientes com historia previa de meningoencefalite tuberculosa. O uso de analogo do hormonio liberador de gonadotrofinas foi indicado no tratamento de ambos os casos