Navegando por Palavras-chave "sleep disorders"

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    Association of the length polymorphism delayed sleep-phase syndrome: Does in the human Per3 gene with the latitude have an influence upon it?
    (Amer Academy Sleep Medicine, 2005-01-01) Pereira, Danyella Silva [UNIFESP]; Tufik, Sergio [UNIFESP]; Louzada, Fernando Mazzili; Benedito-Silva, Ana Amélia [UNIFESP]; Remesar-Lopez, Alberto Jorge [UNIFESP]; Lemos, Nelson A.; Korczak, Anna Ligia; D'Almeida, Vânia [UNIFESP]; Pedrazzoli, Mario [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Study Objectives: The objective of this study is to analyze the influence of a previously reported hPer3 gene-length polymorphism in the delayed sleep-phase syndrome and in morningness-eveningness tendencies at low latitudes in the southern hemisphere.Design: We have genotyped a length polymorphism in the hPer3 gene characterized by a short repeat allele (4-repeat) and a long repeat allele (5-repeat).Participants: Seventeen patients with delayed sleep-phase syndrome; 156 volunteers chosen according to Horne-Ostberg questionnaire to have morning, intermediate, or evening preference; and 110 volunteers with no Horne-Ostberg score as a sample of the general population.Results: We have found a higher frequency of 5-repeat allele in the delayed sleep-phase syndrome group and an association of this polymorphism with diurnal preference.Conclusion: Our results suggest that latitude has a role in the influence of hPer3 gene polymorphism on delayed sleep-phase syndrome and confirm previous data showing its association with morningness-eveningness tendencies.
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    Casein kinase I epsilon (CKI epsilon) N408 allele is very rare in the Brazilian population and is not involved in susceptibility to circadian rhythm sleep disorders
    (Elsevier B.V., 2008-11-03) Castro, Rosa M. R. P. S. [UNIFESP]; Barbosa, Ana A. [UNIFESP]; Pedrazzoli, Mario [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Circadian rhythms are regulated by clock proteins through post-translational modifications. Indeed, Casein kinase I epsilon (CKI epsilon) promotes reversible phosphorylation of PER proteins, and a deficiency in this phosphorylation has been implicated in human sleep disorders. Here, we investigated the CKI epsilon S408N polymorphism in a Brazilian population sample. the N408 allele was previously described to be much less frequent in individuals with Delayed Sleep-Phase Syndrome (DSPS), than in the general Japanese population, Suggesting a protective function for the allele against the disease. We found that this polymorphism is very rare in the Brazilian population (1.37%), indicating that it has no influence on susceptibility to circadian rhythm sleep disorders. Therefore, it is necessary to account for adaptative influences in genetic background, analyzing different groups with different photoperiods, to validate the effects of this and other polymorphisms on sleep and circadian disorders. (C) 2008 Elsevier B.V. All rights reserved.
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    Clinical profile of menopausal insomniac women referred to sleep laboratory
    (Taylor & Francis As, 2009-01-01) Hachul, Helena [UNIFESP]; Brandao, Leticia de C. [UNIFESP]; Bittencourt, Lia R. A. [UNIFESP]; D'Almeida, Vania [UNIFESP]; Andersen, Monica L. [UNIFESP]; Baracat, Edmund C. [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective. the primary purpose of this study was to assess the overall clinical profile of menopausal women complaining of insomnia who were referred to a sleep laboratory. Methods. A total of 206 menopausal women who had complaints related to insomnia were interviewed. Each participant completed a questionnaire in order to obtain data on general health, menopausal status, medications, and sleep patterns. Results. the mean age of the participants was 55.9 years. Clinical profiles revealed that the most prevalent health problems were systemic arterial hypertension (33.9%) and osteoporosis (19%), though there was no association between insomnia and incidence of chronic disease. Our data demonstrate an overall prevalence of insomnia of 4-5 times a week in 62% of the women, with 68.9% complaining of hot flashes. However, there was no association between hot flashes and frequency of insomnia across the menopausal transition period. Only 7% of women had already undergone polysomnography. Less than 5% of the participants were undergoing treatment for menopause, while 8% were taking benzodiazepines for sleep problems. Conclusions. This study provides evidence that insomnia in postmenopausal women was not associated with incidence of chronic disease. in addition, the majority of the participants were not undergoing treatment for menopause or for sleep disturbance.
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    Cognitive dysfunction in children with sleep disorders
    (Assoc Arquivos Neuro- Psiquiatria, 2004-06-01) Carvalho, Luciane Bizari Coin de [UNIFESP]; Prado, Lucila Bizari Fernandes do [UNIFESP]; Silva, Luciana [UNIFESP]; Almeida, Marilaine Medeiros de [UNIFESP]; Silva, Tatiana de Almeida e [UNIFESP]; Vieira, Célia Maria Alcântara Machado [UNIFESP]; Atallah, Álvaro Nagib [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Sleep is basic for physical and cognitive development and some studies have suggested that there may be an association between sleep disorders (SD) and cognitive dysfunction (CD) in children. Little is known, however, about SD and cognition in 7-10-year-old children, a fact that motivated the present study. Method: We applied an SD questionnaire in 1180 children, 547 with SD and 633 without SD (CG), to assess cognition with a screening test (Bender Visual Motor Gestalt Test - BT). Results. We observed a similar frequency of CD in the children with SD (39%) and that ot the CG (40%). The 8-year-old children with SID presented a lower prevalence of CD than the CG (SD=6%, n=6; CG=13%, n=16; p=0.04). Conclusion: The frequency of children with CD was equal in the study and control groups when considering the total sample (7- to 10-year-old children). In contrast to our expectations, the SID group of 8-year-old children presented a lower frequency of CD than the control group.
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    Comparison between dopaminergic agents and physical exercise as treatment for periodic limb movements in patients with spinal cord injury
    (Nature Publishing Group, 2004-04-01) Mello, Marco Tulio de [UNIFESP]; Esteves, A. M.; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Study design: Randomized controlled trial of physical exercise and dopaminergic agonist in persons with spinal cord injury and periodic leg movement (PLM).Objective: the objective of the present study was to compare the effectiveness of physical exercise and of a dopaminergic agonist in reducing the frequency of PLM.Setting: Centro de Estudos em Psicobiologia e Exercicio. Universidade Federal de São Paulo, Brazil.Methods: A total of 13 volunteers (mean age: 31.6 +/- 8.3 years) received L-DOPA ( 200 mg) and benserazide ( 50 mg) 1 h before sleeping time for 30 days and were then submitted to a physical exercise program on a manual bicycle ergometer for 45 days ( 3 times a week).Results: Both L-DOPA administration (35.11 - 19.87 PLM/h, P<0.03) and physical exercise (35.11 - 18.53 PLM/h, P<0.012) significantly reduced PLM; however, no significant difference was observed between the two types of treatment.Conclusions: the two types of treatment were found to be effective in the reduction of PLM; however, physical exercise is indicated as the first treatment approach, while dopaminergic agonists or other drugs should only be recommended for patients who do not respond to this type of treatment.
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    Developing ICF core sets for persons with sleep disorders based on the international classification of functioning, disability and health
    (Elsevier B.V., 2008-01-01) Stucki, A.; Cieza, A.; Michel, F.; Stucki, G.; Bentley, A.; Culebras, A.; Tufik, Sergio [UNIFESP]; Kotchabhakdi, N.; Tachibana, N.; Ustun, B.; Partinen, M.; Univ Hosp Bern; Univ Munich; Sci Swiss Parapleg Res; Swiss Parapleg Ctr; Univ Witwatersrand; Upstate Med Univ; Universidade Federal de São Paulo (UNIFESP); Mahidol Univ Salaya; Osaka Med Ctr Hlth Sci & Promot; WHO; Rinnekoti Gdn
    Background: With the International Classification of Functioning, Disability and Health (ICF), we can now rely on a globally agreed-upon framework and system for classifying the typical spectrum of problems in the functioning of persons given the environmental context in which they live. ICF Core Sets are subgroups of ICF items selected to capture those aspects of functioning that are most likely to be affected by sleep disorders.Objective: the objective of this paper is to outline the developmental process for the ICF Core Sets for Sleep.Methods: the ICF Core Sets for Sleep will be defined at an ICF Core Sets Consensus Conference, which will integrate evidence from preliminary studies, namely (a) a systematic literature review regarding the outcomes used in clinical trials and observational studies, (b) focus groups with people in different regions of the world who have sleep disorders, (c) an expert survey with the involvement of international clinical experts, and (d) a cross-sectional study of people with sleep disorders in different regions of the world.Conclusion: the ICF Core Sets for Sleep are being designed with the goal of providing useful standards for research, clinical practice and teaching. It is hypothesized that the ICF Core Sets for Sleep will stimulate research that leads to an improved understanding of functioning, disability, and health in sleep medicine. It is of further hope that such research will lead to interventions and accommodations that improve the restoration and maintenance of functioning and minimize disability among people with sleep disorders throughout the world. (c) 2007 Elsevier B.V. All rights reserved.
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    Distúrbios de sono causam impacto na qualidade de vida de mulheres com lúpus eritematoso sistêmico (les)
    (Universidade Federal de São Paulo (UNIFESP), 2015-08-31) Reis, Lilian Karla Cunha dos [UNIFESP]; Trevisani, Virginia Fernandes Moca Trevisani [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Despite the small number of studies regarding sleep disorders, they are a frequent complaint of patients with SLE (62 to 80%) and are related to fatigue, pain, and decreased quality of life (Qol). Objective: To assess the impact of sleep disorders in Qol, pain, and fatigue in women with SLE. Methods: We used the following questionnaires, scales and indices: actigraphy to assess sleeping habits of women with SLE, the Pittsburgh Sleep Quality lndex (PSQI) questionnaire, Medical Outcomes short form 36 (SF-36), the Fatigue Severity Scale (FSS), the Visual Analogue Scale (VAS), the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and the Systemic Lupus International Collaboration Clinics (SLICC). The software used for data analysis was Minitab version 16.1, with a significance level of 5%. Results: We studied 46 women with SLE, who had subjective complaints of bad sleep (PSQI). When we related the PSQI data with the questionnaires, we observed associations with (FSS) (p=0.048), pain (VAS) (p=0.028), the role-physical (RP) (p = 0.017), the role emotional (RE) (p=0.006), and mental health (MH) scales (SF-36) (p = 0.034). In terms of correlation of the actigraphy variables with the scores of the questionnaires, we observed statistical significance correlation with the SF-36 data in the RE scale, as follows: with sleep latency (SL) (p=0.005), number of wake ups after sleep onset (p=0.038) and sleep efficiency (p=0.046). In the use of drugs: yes or no, the only association that we observed was the use of antimalarial drugs and greater SL (p=0.032). The association of the use of prednisone (PDN) and less total sleep time (TST) almost reached significant value (p=0.056). Conclusion: Our study indicates that patients with SLE and sleep disorders experience a negative impact in terms of fatigue, pain, and some scales of Qol (in the RP, RE and MH scales), particularly role emotional, with increased latency and wake ups after sleep onset, reducing sleep efficiency; in addition to the influence of corticoids and antimalarial drugs over these alterations. We also observed consistency in both evaluation methods (actigraphy and PSQI) in sleep latency. We have no conflict of interest in this study.
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    Efetividade e segurança do treinamento concorrente aeróbio e de força na melhora da qualidade do sono em mulheres com artrite reumatoide: estudo clínico randomizado
    (Universidade Federal de São Paulo (UNIFESP), 2015-09-30) Kayo, Andrea Harumi [UNIFESP]; Trevisani, Virginia Fernandes Moca Trevisani [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    safety of a concurrent strength and endurance training on the subjective and objective sleep quality and to correlate these data with fatigue, pain complaints, disease activity and functional status. METHODS: In this randomized controlled trial, 43 women with ages between 35 and 65 years and RA diagnosis, according to the American College of Rheumatology (1987) and European League Against Rheumatism (2010), and with sleep complaints according to the Pittsburgh Sleep Quality Index (PSQI ? 5 points) were included. They were randomized in one of two groups: Physical Exercise (PE; n = 22) or Control (CO; n = 21). Women in the PE group performed concurrent strength and endurance exercise, twice a week for 16 weeks, and the CO group was evaluated for the same period. Both received counseling about sleep hygiene and were evaluated by polysomnography (PSG) at baseline and final moment, and by PSQI and Epworth Sleepiness Scale (ESS), visual analogue scale for pain and fatigue, Health Assessment Questionnaire (HAQ) and handgrip tests, as well as the Beck Depression Index (BDI) at baseline moment and at 8, 16 and 20 weeks. RESULTS: From the 43 initially recruited patients, 33 completed the study. The group PE did not have improvements in sleep quality as evaluated by PSG, but had significant increase in the subjective evaluation of sleep quality according to the PSQI (p < 0.001). There were no significant differences in pain and fatigue with exercise and the improvement in the BDI score in both groups cannot be attributed to exercise. At eight weeks, there was a significant improvement in HAQ (p = 0.001) in both groups, and disease activity (DAS28) categories changed from moderate to low disease in both groups (p = 0.003), indicating that exercise did not interfere with RA activity. CONCLUSIONS: The PSG exam confirmed that RA patients with sleep complaints have poor quality of sleep. The exercise program was safe, but did not result in sleep quality improvements according to PSG variables; although it has resulted in significant improvements in sleep quality according to PSQI and ESS. Exercising had no effect on pain, fatigue or disease activity, but resulted in improvement in functional ability according to HAQ.
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    Effect of continuous positive airway pressure therapy on hypothalamic-pituitary-adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome
    (Amer Physiological Soc, 2008-08-01) Carneiro, Glaucia [UNIFESP]; Togeiro, Sonia Maria [UNIFESP]; Hayashi, Lilian F. [UNIFESP]; Ribeiro-Filho, Fernando Flexa [UNIFESP]; Ribeiro, Artur Beltrame; Tufik, Sergio [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp Rim & Hipertensao
    Obstructive sleep apnea syndrome (OSAS) increases the risk of cardiovascular events. Sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis activation may be the mechanism of this relationship. the aim of this study was to evaluate HPA axis and ambulatory blood pressure monitoring in obese men with and without OSAS and to determine whether nasal continuous positive airway pressure therapy (nCPAP) influenced responses. Twenty-four-hour ambulatory blood pressure monitoring and overnight cortisol suppression test with 0.25 mg of dexamethasone were performed in 16 obese men with OSAS and 13 obese men controls. Nine men with severe apnea were reevaluated 3 mo after nCPAP therapy. Body mass index and blood pressure of OSAS patients and obese controls were similar. in OSAS patients, the percentage of fall in systolic blood pressure at night (P = 0.027) and salivary cortisol suppression postdexamethasone (P = 0.038) were lower, whereas heart rate (P = 0.022) was higher compared with obese controls. After nCPAP therapy, patients showed a reduction in heart rate (P = 0.036) and a greater cortisol suppression after dexamethasone (P = 0.001). No difference in arterial blood pressure (P = 0.183) was observed after 3 mo of nCPAP therapy. Improvement in cortisol suppression was positively correlated with an improvement in apnea-hypopnea index during nCPAP therapy (r = 0.799, P = 0.010). in conclusion, men with OSAS present increased postdexamethasone cortisol levels and heart rate, which were recovered by nCPAP.
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    Evaluation of periodic limb movements in a putative animal model of restless leg syndrome
    (Wiley-Blackwell, 2012-03-01) Lopes, Cleide [UNIFESP]; Esteves, Andrea M. [UNIFESP]; Frussa-Filho, Roberto [UNIFESP]; Tufik, Sergio [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Restless leg syndrome (RLS) is a major healthcare burden with increasing prevalence. It has been demonstrated that periodic limb movements (PLM) can occur as an isolated phenomenon, but they are often associated with this syndrome and are the only symptom of this disorder that can be measured electrophysiologically. the aim of this study was to examine the sleep-wake behavior and the presence of limb movement in a rat model of RLS induced by lesioning the A11 dopaminergic nuclei with the neurotoxin 6-hydroxydopamine (6-OHDA). Rats were implanted with electrodes for electrocorticography and electromyography. Sleep recordings were monitored during light/dark periods lasting 12 hours each and were evaluated on days 7, 15, and 28 after injection of the drug or phosphate-buffered saline (PBS). A control group that did not receive any injection was also included. Wakefulness percentages were generated for 4-hour segments of the dark period, yielding the following 3 bins: 7 PM to 11 PM, 11 PM to 3 AM, and 3 PM to 7 PM. Additionally, slow wave sleep, paradoxical sleep, wakefulness, and limb movements were evaluated over the entire 12 hours of the light/dark cycle. All A11-lesioned rats exhibited an increased percentage of wakefulness during the last block of the dark period, as would be expected for an animal model of this syndrome. in addition, at all time points after lesioning, these animals presented increased frequencies of limb movement during both the light and the dark periods. These alterations were reversed by the acute administration of the dopaminergic agonist pramipexole. This animal model strengthens the notion that 6-OHDAinduced A11 lesions can be a valid animal model for RLS and PLM. (c) 2011 Movement Disorder Society
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    Gastroesophageal Reflux Causing Sleep Interruptions in Infants
    (Lippincott Williams & Wilkins, 2013-04-01) Machado, Rodrigo [UNIFESP]; Woodley, Frederick W.; Skaggs, Beth; Di Lorenzo, Carlo; Splaingard, Mark; Mousa, Hayat; Universidade Federal de São Paulo (UNIFESP); Nationwide Childrens Hosp
    Background and Aim: Little is known about the relation between gastroesophageal reflux (GER) episodes and sleep interruptions in infants. the aim of the study was to evaluate the relationship between GER and the incidence of sleep interruptions in infants.Methods: Study patients included 24 infants (younger than 1 year) referred for multichannel intraluminal impedance and esophageal pH monitoring with simultaneous polysomnography. Exclusion criteria were a previous fundoplication and studies lasting <20 hours. Tests were clinically indicated to investigate suspicion of GER-related apnea (17, 70.8%), stridor (6, 25%), noisy breathing (2, 8.3%), and cyanotic spells (1, 4.2%). Most patients presented with significant comorbidities (19, 79.2%).Results: the number of nonacid GER (NAGER) per hour was greater during sleep time than during daytime and awakening following sleep onset (median 0.27 vs 1.85 and 1.45, P < 0.01). A total of 1204 (range 7-86 per infant) arousals in 24 infants was detected, 165 (13.7%) that followed GER episodes, and 43 (3.6%) that preceded GER episodes. Seven patients presented with a positive symptom association probability for arousals; 5 were exclusively because of NAGER. A positive symptom association probability for awakenings was detected in 9 patients; 4 were because of NAGER, 4 were because of AGER, and 1 was because of both NAGER and GER. Patients with awakenings related to GER presented longer mean clearance time of AGER during sleep (165.5 vs 92.8 seconds, P = 0.03).Conclusions: GER was a frequent cause of interrupting sleep among our infant patients, and NAGER proved to be equally important as AGER for causing arousals and awakenings in infants.
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    Histological analysis of palatopharyngeal muscle from children with snoring and obstructive sleep apnea syndrome
    (Elsevier B.V., 2007-02-01) De Vuono, Isabela Mattos; Zanoteli, Edmar; Butte de Oliveira, Acary Souza; Fujita, Reginaldo Raimundo; Nagata Pignatari, Shirley Shizue; Pizarro, Gilberto Ulson; Cassia Pradelle-Hallinan, Mrcia Lurdes de; Moreira, Gustavo Antonio; Universidade Federal de São Paulo (UNIFESP)
    Obstructive sleep apnea syndrome (OSAS) is an upper airway obstruction that occurs during the sleep. One of the suggested mechanisms involved in this process is a neuromuscular abnormality of the palatal muscles. Whether children with OSAS develop into OSAS adults, or children and adult OSAS are two distinct disorders occurring at different ages are questions to be answered. Here, we made the histological analysis of palatophryngeat muscle in 34 oral-breathing children of both genders, aged 5-12 years old, with hypertrophic tonsils and adenoids. According to the polysomnographic study the participants were divided into children without sleeping disorders (group I) and children with primary snoring (group II) or apnea (group III). the main histological findings were fiber size variability in 70% cases from groups II and III and in 71% from group I; perimysial connective tissue infiltration in 48% children from groups II and III and in 71% from group I; intracytoplasmatic mitochondrial proliferation in 63% cases from groups II and III and in 57% cases from group I. Muscle necrosis was only observed in one case, in association with subglandular inflammation. Others findings observed in all groups included fibers with internal architecture alteration, such as moth-eaten and lobulated fibers, type 2 fiber predominance, and small areas of fiber type grouping. the presence of similar histological findings in the palatopharyngeal muscle in children with primary snoring or apnea but also in children without sleeping disorders indicate that such changes could be a normal histological feature of this muscle rather than a neurogenic or myopathic pathology. (C) 2006 Elsevier Ireland Ltd. All rights reserved.
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    Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: Randomized clinical trial
    (Elsevier B.V., 2006-04-01) Vitorino, Debora Fernandes de Melo; Carvalho, Luciane Bizari Coin de [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); UNILAVRAS
    Objective: To compare hydrotherapy (HT) and conventional physiotherapy (CP) in the treatment of fibromyalgia (FM), regarding quality of life QOL), total sleep time (TST), and total nap time (TNT).Methods: Fifty outpatients, all female, 30-60 years old, diagnosed with FM, were randomly assigned to two groups to carry out 3 weeks of treatment with HT or CP. in the beginning and in the end of treatment, patients were evaluated with the SF-36 questionnaire to measure QOL and the sleep diary for TST and TNT. Data analyses were blind.Results: All 24 HT patients increased I h in TST compared to 19 CP patients. TNT decreased in the HT group. QOL improved for the two groups in all domains when pre- and post-intervention were compared, but there was no difference between groups.Conclusion: HT is more effective than CP to improve TST and to decrease TNT in FM patients. (C) 2005 Elsevier B.V. All rights reserved.
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    Is the population properly informed about sleep disorders?
    (Academia Brasileira de Neurologia - ABNEURO, 2013-02-01) Camargo, Eleida Pereira [UNIFESP]; Carvalho, Luciane Bizari Coin de [UNIFESP]; Prado, Lucila Bizari Fernandes do [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To measure the prior knowledge about sleep disorders and patient's ability to report their problems adequately to health professionals. METHODS: We analyzed 208 patient's records and extracted the following information: date of birth, gender, medical diagnostic hypotheses, patient's primary complaint in their words, considering the most appropriated semantic approximation to the perceptual phenomena, either by their own or by reasoning information from the partner. We compared the agreement (Kappa's test) between patient's complaint and medical diagnosis. The 95% confidence interval was used to analyze proportions. RESULTS: We found strong correlations for bruxism; moderate for snoring, insomnia, nightmares, somniloquy, and restless legs syndrome; fair for excessive movement during sleep (EMDS) and obstructive sleep apnea syndrome (OSA). CONCLUSIONS: The observed correlations were heterogeneous, but important diseases such as OSA and EMDS in children showed fair and weak correlations. This suggests an unsatisfactory knowledge level among the population about these disorders, despite their high prevalence and impact on patient's overall health.
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    Juvenile fibromyalgia: Clinical and polysomnographic aspects
    (J Rheumatol Publ Co, 1997-03-01) Roizenblatt, S.; Tufik, Sergio [UNIFESP]; Goldenberg, J.; Pinto, L. R.; Hilario, MOE; Feldman, D.; Universidade Federal de São Paulo (UNIFESP)
    Objective, To identify the child-mother diagnostic correlation in fibromyalgia (FM), to study sleep disturbance in juvenile FM, and to compare clinical aspects and sleep disorders between these groups.Methods, We studied 34 children with confirmed FM aged 11 +/- 1 years, 10 children with diffuse pain, and 17 age and sex matched asymptomatic controls. The respective 61 mothers were included: 34 asymptomatic and 27 with FM. All participants were subjected to clinical evaluation, a sleep questionnaire, and nocturnal polysomnography, preceded by a night of adaptation. Sleep scoring was done visually and a computerized analysis was performed for alpha, theta, and delta waves in slow wave sleep (SWS).Results. A significant predominance of mothers with FM was observed in the group of children with FM (71%) compared to children with diffuse pain (30%) and asymptomatic children (0%). According to the sleep questionnaire, the complaints of superficial sleep and nonrestorative sleep were more prominent in mothers with FM than in children with FM, whereas motor agitation during sleep was more frequent in the children with FM. Polysomnographic anomalies were also more prominent in mothers with FM than in children with FM in terms of decrease in sleep efficiency, increase of number of arousals during sleep, and alpha intrusion in SWS. Both FM groups presented an increased alpha + theta time/delta time index during SWS compared to respective controls, and mothers with FM also showed an increase in alpha time/delta time index during SWS, compared to asymptomatic mothers. A correlation was found between alpha + theta time/delta time index during SWS and intensity of clinical manifestations of pain and sleep anomalies in children and their mothers.Conclusion, Significant concordance was observed regarding FM diagnosis in children and their mothers. Sleep complaints and polysomnography findings were less prominent in affected children compared to mothers with FM. In addition, we observed a significant correlation between polysomnographic indexes, sleep anomalies, and pain manifestations in children and their mothers.
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    Melhora da dor, do cansaço e da qualidade subjetiva do sono por meio de orientações de higiene do sono em pacientes com fibromialgia
    (Sociedade Brasileira de Reumatologia, 2012-10-01) Orlandi, Aline Cristina [UNIFESP]; Ventura, Camila; Gallinaro, Andrea Lopes [UNIFESP]; Costa, Renata Alqualo [UNIFESP]; Lage, Laís Verderame; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); King's College of London Division of Neuroscience Department of Physiology
    OBJECTIVE: To evaluate the effectiveness of sleep hygiene instructions for women with fibromyalgia. MATERIALS AND METHODS: Seventy women with fibromyalgia completed the study. The assessment comprised the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), and a general questionnaire with personal data and lifestyle information. All patients received information about the disease and a sleep diary, but only the experimental group received the sleep hygiene instructions. Patients were asked to practice sleep hygiene, and, after three months, they were reevaluated by use of the same questionnaires. RESULTS: The mean age in the control group was 55.2 ±7.12 years, and, in the experimental group, 53.5 ±8.89 years (P = 0.392). The experimental group showed: a decrease in the pain Visual Analogue Scale values (P = 0.028), in fatigue (P = 0.021), and in the PSQI component 1 (P = 0.030); and a significant reduction in the difficulty falling asleep after waking up in the middle of the night (P = 0.031). The experimental group also showed an increase in the reporting percentage of silent environment (ranging from 42.9% to 68.6%), a decrease in the reporting percentage of fairly quiet environment (ranging from 40% to 22.9%), and a decrease in the reporting percentage of noisy environment (ranging from 17.1% to 8.6%). These changes facilitated falling asleep after waking up in the middle of the night. CONCLUSION: The sleep hygiene instructions allowed changing the patients' behavior, which resulted in pain and fatigue improvement, increased subjective quality of sleep, in addition to facilitating falling asleep after waking up in the middle of the night.
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    Methods to increase muscle tonus of upper airway to treat snoring: systematic review
    (Academia Brasileira de Neurologia - ABNEURO, 2008-01-01) Valbuza, Juliana Spelta [UNIFESP]; Oliveira, Márcio Moysés de [UNIFESP]; Conti, Cristiane Fiquene [UNIFESP]; Prado, Lucila Bizari Fernandes do [UNIFESP]; Carvalho, Luciane Bizari Coin de [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: Snoring is the noise caused by vibration during the in-breath; and which structure actually vibrates depends on many factors. OBJECTIVE: The treatment of snoring with methods to increase muscle tonus of upper airway has been controversial, and poorly reported, thus a review of evidence is necessary to evaluate the effectiveness of these methods. METHOD: A review of randomized or quasi-randomized, double blind trials on snoring treatment that have employed any method to increase muscle tonus of upper airway like phonotherapy or physical therapy among others. Outcomes: decrease or completely stop of snoring, sleep quality, quality of life, and adverse events. RESULTS: Three eligible trials were potentially analyzed, but none of them could provide good scientific evidence favoring the intervention. The objective analyses of one study showed improvement of snoring, although the objective sub-analyses and subjective analyses showed controversial results. The adverse events were not reported. CONCLUSION: There is no enough evidence to support the recommendation of methods to increase muscle tonus of upper airways in treatment of snoring. Well designed randomized clinical trials are needed to asses the efficacy of such methods, and a standard and worldwide accepted method for snoring assessment would be useful for future researches.
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    Mioclonia fragmentária excessiva na doença de machado-joseph
    (Universidade Federal de São Paulo (UNIFESP), 2014-02-26) Santos, Diogo Fernandes dos [UNIFESP]; Prado, Gilmar Fernandes Do Prado [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Machado-Joseph disease (MJD) is a neurodegenerative disease which usually presents several clinical findings including cerebellar ataxia and other extracerebellar features, such as parkinsonism, dystonia, peripheral neuropathy, and lower motor neuron disease. Some data have demonstrated a high frequency of sleep disorders in these patients, including excessive daytime sleepiness (EDS), insomnia, obstructive sleep apnea (OSA), rapid eye movement (REM) sleep behavior disorder (RBD), and restless legs syndrome (RLS). Objective: This study aims to describe the high frequency of excessive fragmentary myoclonus (EFM) in MJD. Methods: We recruited 44 patients with MJD and 44 controls, matched for sex and age, without MJD. All participants underwent an all-night polysomnography (PSG). EFM was evaluated and defined in accordance to the criteria of the American Academy of Sleep Medicine (AASM). Results: Half of the MJD patients (n=22) had EFM diagnosed through PSG, jthough no healthy control participant presented this finding (P< 0.0001). In the MJD group, older participants and men had a higher frequency of EFM. There was no correlation between EFM and the following data: body mass index (BMI), apnea-hypopnea index (AHI), EDS, loss of atonia during REM sleep, periodic limb movements during sleep (PLMS), RLS, RBD, ataxia severity, the number of cytosine-adenine-guanine trinucleotide (CAG) repeats, disease duration, sleep efficiency, sleep fragmentation, and sleep stage percentages between patients with or without EFM. Conclusion: EFM is highly prevalent in patients with MJD. This study demonstrates that EFM must be included in the clinical spectrum of sleep disorders in MJD patients.
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    Nocturnal awakening with headache and its relationship with sleep disorders in a population-based sample of adult inhabitants of São Paulo City, Brazil
    (Sage Publications Ltd, 2010-12-01) Lucchesi, Ligia Mendonca [UNIFESP]; Speciali, Jose Geraldo; Santos-Silva, Rogerio [UNIFESP]; Taddei, Jose Augusto [UNIFESP]; Tufik, Sergio [UNIFESP]; Azeredo Bittencourt, Lia Rita [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Our aim was to estimate the prevalence of nocturnal awakening with headache (NAH) in the population of São Paulo City according to gender, age (20-80 years old) and socioeconomic classes and its relationship to sleep disorders, sleep parameters, anxiety, depression, fatigue, life quality and obesity. We used a population-based survey with a representative three-stage cluster sample. Questionnaires and scales were applied face-to-face, and polysomnography was performed in 1101 volunteers, aged 42 +/- 14 years, 55% women. the complaint of NAH occurring at least once a week had a prevalence of 8.4%, mostly in women, obese subjects and those aged 50-59 years-old. We observed associations of NAH with insomnia, restless leg syndrome (RLS), nightmares and bruxism, but not obstructive sleep apnea syndrome. in a logistics regression model, risk factors for NAH were female gender, odds ratio (OR) (95% confidence interval [CI]) 4.5 (2.8-7.3); obesity, OR 1.9 (1.1-3.3); age between 50 and 59 years, OR 2.4 (1.2-4.7); severe anxiety, OR 8.1 (3.6-18.1); RLS, 2.7 (1.2-5.6); and nightmares, 2.2 (1.3-3.7). Our study shows that NAH was highly prevalent in the population of São Paulo and suggests that this phenomenon has specific characteristics with specific risk factors: obesity, RLS and nightmares.
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    NREM-related parasomnias in Machado-Joseph disease: clinical and polysomnographic evaluation
    (Wiley-Blackwell, 2016) Fontes Silva, Giselle Melo [UNIFESP]; Pedroso, Jose Luiz [UNIFESP]; Dos Santos, Diogo Fernandes [UNIFESP]; Braga-Neto, Pedro [UNIFESP]; Prado, Lucila Bizari Fernandes Do [UNIFESP]; Carvalho, Luciane Bizari Coin De [UNIFESP]; Barsottini, Orlando G. P. [UNIFESP]; Do Prado, Gilmar Fernandes [UNIFESP]
    Spinocerebellar ataxias (SCA) are autosomal dominant neurodegenerative disorders that affect the cerebellum and its connections, and have a marked clinical and genetic variability. Machado-Joseph disease (MJD) or spinocerebellar ataxia type 3 (SCA3)MJD/SCA3is the most common SCA worldwide. MJD/SCA3 is characterized classically by progressive ataxia and variable other motor and non-motor symptoms. Sleep disorders are common, and include rapid eye movement (REM) sleep behaviour disorder (RBD), restless legs syndrome (RLS), insomnia, excessive daytime sleepiness, excessive fragmentary myoclonus and sleep apnea. This study aims to focus upon determining the presence or not of non-REM (NREM)-related parasomnias in MJD/SCA 3, using data from polysomnography (PSG) and clinical evaluation. Forty-seven patients with clinical and genetic diagnosis of MJD/SCA3 and 47 control subjects were evaluated clinically and by polysomnography. MJD/SCA3 patients had a higher frequency of arousals from slow wave sleep (P<0.001), parasomnia complaints (confusional arousal/sleep terrors, P=0.001; RBD, P<0.001; and nightmares, P<0.001), REM sleep without atonia (P<0.001), periodic limb movements of sleep index (PLMSi) (P<0.001), percentage of N3 sleep (P<0.001) and percentage of N1 sleep (P<0.001). These data show that NREM-related parasomnias must be included in the spectrum of sleep disorders in MJD/SCA3 patients.