Nocturnal sleep pattern in Native Brazilian Terena adults.

Social-economic factors influence sleep habits. This research analyzes characteristics of nocturnal sleep in Brazilian Native Terena adults. Sixty-four adults (31 M; 33 F) from 18 to 75 years, with a mean age of 37.0, from the Indian Reservation village of Córrego do Meio, in the central region of Mato Grosso do Sul, an agriculturally oriented group were evaluated. Nocturnal sleep characteristics were evaluated by means of a standard questionnaire applied to each individual. It was observed that reported nocturnal sleep was longer, sleep onset was earlier and wake up time was also earlier than usually described in urban populations. The mean total time in bed was 8.5 h or more, in every age bracket. The seven-day prevalence rate of insomnia was 4.6%, while the seven-day prevalence rate of hypnotic use was 1.5%, both remarkably less than described in urban populations. These findings stress the need to consider ethnic influences on sleep patterns and disorders.

Chronic insomnia in workers poisoned by inorganic mercury: psychological and adaptive aspects.

Insomnia is one of the symptoms of inorganic mercury poisoning (IMP). The objective of this study is to analyze the chief psychological aspects in the adjustment of workers with chronic insomnia associated with IMP. For this purpose the Preventive Clinical Interview and the Ryad Simon Operational Adaptive Diagnostic Scale (Escala Diagnóstica Adaptativa Operacionalizada-EDAO) were utilized. Fifteen subjects with mean age of 40 years (10 males and 5 females) were studied. Nine were diagnosed with High Adaptive Inefficacy, five with Moderate Inefficient Adaptation and only one with Mild Inefficient Adaptation. Impairment occurred in four adaptive sectors: affective relationship, social-cultural, productivity and organic. Adaptive efficiency indicated that in all the 15 subjects studied the adaptive solutions were frustrating and led to psychic suffering and/or environmental conflict confirming the severity of the involvement in chronic IMP.

Siestas among Brazilian Native Terena adults : a study of daytime napping.

Regular daytime napping behavior, also known as siesta culture, is influenced by circadian, cultural and environmental factors. This research analyzes characteristics of regular daytime napping in Brazilian Native Terenas. We evaluated 65 adults ( 32 M; 33 F ) from 18 to 75 years, with a mean age of 37.2, from the Indian Reservation village Córrego do Meio, in the central region of Mato Grosso do Sul. Daytime napping characteristics were evaluated by means of a standard questionnaire applied to each individual. It was observed that weekly daytime napping (at least once a week) was present in 72. 3% of the population. There was a tendency to occur in males. The effects of weekends was mild. Mean onset time of daytime sleep was 12.2 h, remarkably earlier than usually described in urban populations. This data stresses the need to consider ethnic influences in order to understand sleep habits.

Sleep habits in Native Brazilian Bororo children.

Sleep behavior patterns in childhood are influenced by familial, cultural and environmental factors. In understanding sleep in Native Brazilian Bororo children, one should consider the influence of their culture on the child's sleep. This research analyzes sleep habits of Native Bororo children from the Meruri village, located in an Indian Reservation in the state of Mato Grosso. Fourty four children (24 M; 20 F) were evaluated; ages ranged from one month to 10 years, with a mean age of 4.9 years. Sleep characteristics were assessed by means of a standard questionnaire applied to the mothers. Cosleeping--sleeping together with family members--was a remarkable finding, in every child 0-2 year old and in 81.5% in the 2-10 years group. The second characteristic was sleeping with many people in the same room. There was an average of 5.1 people per room in the younger group and 3.9 people in the older group.

Sleep characteristics in children in the isolated rural African-Brazilian descendant community of Furnas do Dionísio, State of Mato Grosso do Sul, Brazil.

Developmental and cultural factors affect sleep habits in childhood. The objective of this research was to determine sleep habits of children in the isolated rural African-Brazilian community of Furnas do Dionísio. Mato Grosso do Sul, Brazil. The members of this community are closely related descendants of the ex-slave Dionísio, and remained in relative geographical isolation for about a century. Sleep characteristics of 55 children (35 M; 20 F), 2 to 10 year olds, were evaluated in interviews with their mothers. The results showed that cosleeping, in the same bed with family members, was present in 80.0% of the 2-3 year olds; decreasing to 25.0% of the 8-10 year olds. Only 5.4% of the children slept alone in their own bedroom. Mean number of persons per bedroom was 2.8. Only 7.0% of the bedrooms had TV; 98.1% slept in silence. The data obtained support the need to weigh cultural factors influence on sleep.

Kleine-Levin syndrome. Clinical course, polysomnography and multiple sleep latency test. Case report.

A case of Kleine-Levin syndrome, with chronic severe periodic hypersomnia is described in a 17-year-old female. The first episode started when she was 15 years old. The episodes were characterized by periodic hypersomnia accompanied by hyperphagia, lasting 5 days, and repeating at 28 to 60 day intervals. The severity of hypersomnia prevented her from attending school activities. Outside the hypersomnia periods, she was asymptomatic. EEG, brain computerized tomography and brain nuclear magnetic resonance were normal; all-night polysomnography, Multiple Sleep Latency Test (MSLT) and Epworth Sleepiness Scale (ESS) were within normal limits. During the period of hypersomnolence, polysomnography showed short sleep latency and short REM latency. MSLT mean sleep latency was 1.8 min; and REM period was present in one subtest; the ESS was markedly elevated.

Sleep habits in native Brazilian Terena children in the state of Mato Grosso do Sul, Brazil.

Sleep habits in childhood vary in function of physiological factors. Cultural traits also influence sleep habits. This research evaluates sleep habits of Native Brazilian Terena children. The Terena group here studied live in the central region of Mato Grosso do Sul, Brazil, on the plains; they are peaceful and dedicated mainly to agriculture. Two villages were studied, Tereré and Córrego do Meio, both in Reservations. Sleep characteristics of 67 children (40M;27F), 2 to 10 year olds, were evaluated in interviews with their mothers. The results evidenced that cosleeping, in the same bed with family members is the standard Terena pattern present in every evaluated child. The presence of two or more beds and a mean of five or more people in each bedroom was the typical finding. The authors propose that cosleeping and the presence of numerous family members reflect the high values attributed to family links in the Terena culture.

Narcolepsy and depression.

Narcolepsy main symptoms include excessive daytime sleepiness and cataplexy. Its chronic course is accompanied by psychosocial impairment added to the difficulties and side effects of stimulants and tricyclics long term use. Depressive complaints are occasionally reported. The aim of this paper was to evaluate objectively the possibility of depression in a sample of 12 narcoleptics (7F; 5M), with mean age of 53 years (12 years SD), using the Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (HAM-D). The results showed absence of depressive disorder in 75.0% of the cases according to BDI (or 58.3% according to HAM-D). The remaining patients had mild depression (only one patient presented major depression). The findings showed no correlation between narcolepsy and major depression.

Pierre Robin sequence and obstructive sleep apnea.

The case of a 12-year-old female patient with Pierre Robin sequence is reported, in which reduction of the pharyngeal airway leads to obstructive sleep apnea syndrome (OSAS) and excessive daytime sleepiness. Radiological evaluation, computerized tomography and magnetic resonance image showed bilateral temporomandibular ankylosis. Cephalometric data evidenced marked reduction of the posterior airway space. Three all-night polysomnographic evaluations detected severe OSAS with decrease in oxygen saturation. The Multiple Sleep Latency Test (MSLT) performed on two separate days objectively quantified the excessive daytime sleepiness with short sleep latencies; stage REM was not present. Polysomnography, MSLT and thorough radiologic studies, in this case, made it possible to determine the severity of OSAS, the site of obstruction, and the associated malformations.

Obstructive sleep apnea treatment with dental appliance.

The case of a 40-year-old male patient with obstructive sleep apnea syndrome (OSAS) is reported, with emphasis on treatment with a dental appliance. This therapeutic approach, which has been focused on recent research, has as its objective, the posturing of the mandibule and, consequently, the tongue more anteriorly, thus in turn leading to an increase in the posterior oropharyngeal airway space (PAS). Cephalometry contributed determining in this case whereby enlargement limits were observed in the PAS with mandibular displacement. Clinical and polysomnographic controls showed subjective reduction of the excessive daytime sleepiness and objective decrease in apneas intensity to normal limits. Eight months follow-up evidenced the steady improvement.

Haemochromatosis as a window into the study of the immunological system: a novel correlation between CD8+ lymphocytes and iron overload.

In the present study we report a serial investigation of the numbers of the peripheral blood cells--erythrocytes, polymorphonuclear neutrophils, total lymphocytes, T-lymphocyte subpopulations (CD2, CD4, CD8), B lymphocytes and monocytes--in a group of 21 patients with haemochromatosis during the time of intensive phlebotomy treatment, i.e., from iron overload until the onset of iron deficiency. A remarkable individual stability of all blood cell populations studied was found in all patients. Patients differed in their relative proportions of CD4+ and CD8+. Each individual's CD4/CD8 ratio, as well as the absolute numbers, remained unaffected with time, confirming the existence of a strict homeostatic regulation of the relative numbers of the two major peripheral T lymphocytes. A significant positive correlation between CD4/CD8 ratios and the amount of iron mobilised by phlebotomy was found during this study. A novel correlation between the relative proportions of CD4+ and CD8+ cells and iron overload is confirmed by the follow-up of iron re-entry in the serum transferrin pool in the treated patients.

Síndrome do risco de morte súbita infantil / Near sudden infant death syndrome. A case report

A síndrome da morte súbita infantil, ou morte durante o sono, se dá em uma criança normal, após adormecer bem, sem causa aparente. É considerada, como a causa isolada, a mais frequente de morte no primeiro ano de vida, em estatísticas do exterior. Acredita-se ocorrer a morte por um distúrbio funcional dos centros respiratórios levando à apnéia. Em crianças encontradas flácidas em apnéia reversível após estimulaçäo ou ao despertar, denomina-se em "risco" da morte súbita infantil. Apresentamos um caso desta síndrome, com crises de cianose e apnéia durante o sono a partir do oitavo dia de vida. O paciente foi internado, feita a monitorizaçäo respiratória, submetido a registro polissonográfico de 24 horas. Näo foram detectadas causas justificando as apnéias. Foi medicado com aminofilina e constatou-se o desaparecimento das crises de apnéias no segundo mês de vida. Este trabalho permite evidenciar um caso de entidade pouco diagnosticada em nosso meio

Iron overload in beta 2-microglobulin-deficient mice.

The present paper describes the results of a comparative histological and quantitative analysis of iron distribution in tissues of beta 2m-/- and beta 2m+/- mice of different ages. Progressive hepatic iron overload, indistinguishable from that observed in human hemochromatosis, was found only in mice homozygous for the mutated beta 2m gene. Total iron measurements done by flame atomic absorption showed statistically significant differences between liver samples from 5 beta 2m+/- heterozygotes (468 +/- 174 micrograms/g of dry weight) and 9 mice homozygous for the mutated beta 2m gene with average total hepatic iron levels of 1583 +/- 423 micrograms/g of dry weight.

Midazolam daytime residual effect evaluated by the Multiple Sleep Latency Test.

Daytime sleepiness after ingestion of midazolam as a hypnotic was quantitatively studied employing the Multiple Sleep Latency Test (MSLT). We evaluated 20 healthy volunteers, 10 of which received a single oral dose of midazolam (15 mg, one tablet) and 10 of which received placebo, in a double-blind design. Tablets were administered at 2200 h, bedtime. On the following day, all subjects were submitted to a clinical evaluation, a subjective checklist and the MSLT. The mean age was 34.7 +/- 8.9 years in the midazolam and 38.0 +/- 10.6 years in the placebo groups (n.s.). Sex and weight distributions were similar in both groups (n.s.). Clinical evaluation and subjective symptom checklist did not make evident significant differences between midazolam and placebo groups (n.s.). The MSLT was performed at 0900, 1100, 1300, 1500 and 1700 h. Mean sleep latencies were 12.0, 12.7, 8.0, 13.5, 17.0 min in the midazolam group; mean sleep latencies were 13.8, 9.0, 6.9, 9.5, 13.6 min in the placebo group (n.s.). In the single dose, double-blind design here evaluated, midazolam did not show differences in relation to placebo on the following day, detectable by the MSLT.

Primary sleep enuresis in childhood. Polysomnographic evidences of sleep stage and time modulation.

The objective of this study was to evaluate enuretic events and its relations to sleep stages, sleep cycles and time durations in a selected group of children with primary essential sleep enuresis. We evaluated 18 patients with mean age of 8.2 years old (ranging from 5 to 12 years); 10 were males and 8 females (n.s.). They were referred to the Sleep Disorders Center with the specific complaint of enuresis since the first years of life (primary). Pediatric, urologic and neurologic workup did not show objective abnormalities (essential). The standard all-night polysomnography including an enuresis sensor attached to the shorts in the crotch area was performed. Only enuretic events nights were included. All were drug free patients for two weeks prior to polysomnography. In this report, only one polysomnography per patient was considered. The enuretic events were phase related, occurring predominantly in non-REM (NREM) sleep (p < 0.05). There was no predominance of enuretic events among the NREM stages (n.s.). A tendency of these events to occur in the first two sleep cycles was detected but may be due to the longer duration of these cycles. The events were time modulated, adjusted to a normal distribution with a mean of 213.4 min of recording time.

Midazolam daytime residual effect evaluated by the Multiple Sleep Latency Test

Daytime sleepiness after ingestion of midazolam as a hypnotic was quantitatively studied employing the Multiple Sleep Latency Test (MSLT). We evaluated 20 healthy volunteers, 10 of which received a single oral dose of midazolam (15 mg, one tablet) and 10 of which received placebo, in a double-blind design. Tablets were administered at 2200 h, bedtime. On the following day, all subjects were submitted to a clinical evaluation, a subjective checklist and the MSLT. The mean age was 34.7 +/- 8.9 years in the midazolam and 38.0 +/- 10.6 years in the placebo groups (n.s.). Sex and weight distributions were similar in both groups (n.s.). Clinical evaluation and subjective symptom checklist did not make evident significant differences between midazolam and placebo groups (n.s.). The MSLT was performed at 0900, 1100, 1300, 1500 and 1700 h. Mean sleep latencies were 12.0, 12.7, 8.0, 13.5, 17.0 min in the midazolam group; mean sleep latencies were 13.8, 9.0, 6.9, 9.5, 13.6 min in the placebo group (n.s.). In the single dose, double-blind design here evaluated, midazolam did not show differences in relation to placebo on the following day, detectable by the MSLT.

Narcolepsy in childhood and adolescence.

The objective of this study was to evaluate clinical, polysomnographic and the multiple sleep latency test (MSLT) features in young narcoleptics. We evaluated 14 patients with mean age of 13.6 years old (ranging from 6 to 18 years); 11 were males and 3 females. Daytime sleepiness was the main complaint in all cases and started at the ages of 6 to 17 years. Cataplexy was described in 10 cases and it was considered mild to moderate in all but one case. Sleep paralysis was present in 6 cases and hypnagogic hallucinations in 7 cases. The main polysomnographic characteristics were the short sleep latency in 9 cases and the sudden onset of REM periods in 7 cases. The MSLT showed short or borderline sleep latencies in 13 cases, with a mean of 4.9 min; 2 or more REM periods were present in 13 cases. Clinical, polysomnographic and MSLT characteristics in the age bracket focused were remarkably similar to those of adult narcoleptics suggesting the stability of these physiopathological markers.

Night sleep electroencephalogram power spectral analysis in excessive daytime sleepiness disorders.

A group of 53 patients (40 males, 13 females) with mean age of 49 years, ranging from 30 to 70 years, was evaluated in the following excessive daytime sleepiness (EDS) disorders: obstructive sleep apnea syndrome (B4a), periodic movements in sleep (B5a), affective disorder (B2a), functional psychiatric non affective disorder (B2b). We considered all adult patients referred to the Center sequentially with no other distinctions but these three criteria: (a) EDS was the main complaint; (b) right handed; (c) not using psychotropic drugs for two weeks prior to the all-night polysomnography. EEG (C3/A1, C4/A2) samples from 2 to 10 minutes of each stage of the first REM cycle were chosen. The data was recorded simultaneously in magnetic tape and then fed into a computer for power spectral analysis. The percentage of power (PP) in each band calculated in relation to the total EEG power was determined of subsequent sections of 20.4 s for the following frequency bands: delta, theta, alpha and beta. The PP in all EDS patients sample had a tendency to decrease progressively from the slowest to the fastest frequency bands, in every sleep stage. PP distribution in the delta range increased progressively from stage 1 to stage 4; stage REM levels were close to stage 2 levels. In an EDS patients interhemispheric coherence was high in every band and sleep stage. B4a patients sample PP had a tendency to decrease progressively from the slowest to the fastest frequency bands, in every sleep stage; PP distribution in the delta range increased progressively from stage 1 to stage 4; stage REM levels were between stage 1 and stage 2 levels.(ABSTRACT TRUNCATED AT 250 WORDS)