Orthostatic hypotension and REM sleep behaviour disorder: impact on clinical outcomes in α-synucleinopathies.

OBJECTIVE: Review the effect of orthostatic hypotension (OH) and rapid-eye-movement sleep behavioural disorder (RBD) on survival, cognitive impairment and postural stability, and discuss pathogenic mechanisms involved in the association of these two common non-motor features with relevant clinical outcomes in α-synucleinopathies. METHODS: We searched PubMed (January 2007-February 2019) for human studies of OH and RBD evaluating cognitive impairment, postural instability, and survival in Parkinson's disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA) and pure autonomic failure (PAF). Included studies were analysed for design, key results and limitations as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: OH and RBD showed a positive association with cognitive impairment in PD and DLB, conflicting association in PAF, and no association in MSA. OH was correlated with incident falls and postural instability in PD and DLB but not in MSA. The association between RBD and postural instability was inconclusive; positive in five studies, negative in seven. OH, but not RBD, correlated with reduced survival in PD, DLB and MSA. The combination of OH and RBD was associated with cognitive impairment and more rapid progression of postural instability. CONCLUSIONS: OH and RBD yielded individual and combined negative effects on disability in α-synucleinopathies, reflecting a 'malignant' phenotype of PD with early cognitive impairment and postural instability. Underlying mechanisms may include involvement of selected brainstem cholinergic and noradrenergic nuclei.

Quality of life in upper airway resistance syndrome.

STUDY OBJECTIVES: To evaluate the health-related quality of life (HRQoL) in patients with upper airway respiratory syndrome (UARS) and obstructive sleep apnea (OSA) compared to the general population (GP) in Lima, Peru, and to explore the variables associated with differences in HRQoL in patients with UARS. METHODS: This was a retrospective study of medical and polysomnography records from 2009-2014 in a referral sleep medicine center for patients aged 18-64 years. UARS was defined by polysomnography as follows: apnea-hypopnea index < 5 events/h, oxygen saturation ≥ 92%, respiratory effort-related arousal index ≥ 5. HRQoL was assessed using the 36-Item Short Form Survey (version 1) questionnaire validated in Peru. The GP HRQoL was obtained from a population-based survey. Linear and logistic regression analyses were conducted. RESULTS: We reviewed 1,329 polysomnograms and selected 888. UARS and OSA were diagnosed in 93 and 795 participants, respectively. The GP cohort consisted of 641 participants. Total HRQoL mean scores (95% confidence interval) in patients with UARS, patients with OSA, and the GP were 67.4 (63.7-71.1), 66.9 (65.4-68.4), and 82.9 (81.6-84.3), respectively. Patients with UARS and patients with OSA had a 5.5 times (95% confidence interval, 3.3-9.2) and 6.2 times (95% confidence interval, 4.6-8.4) greater probability of having a low total HRQoL score compared to patients in the GP, respectively. In patients with UARS, muscle pain, use of psychotropic medication, obesity, and depression were negatively correlated with the total HRQoL score. CONCLUSIONS: The impact of OSA and UARS on HRQoL is similar between disease groups and markedly worse when compared to the impact in the GP. In patients with UARS, the presence of muscle pain, obesity, female sex, depression, and use of psychotropic medication negatively impacted HRQoL. CITATION: Vizcarra-Escobar D, Duque KR, Barbagelata-Agüero F, Vizcarra JA. Quality of life in upper airway resistance syndrome. J Clin Sleep Med. 2022;18(5):1263-1270.

Sleep societies and sleep training programs in Latin America.

STUDY OBJECTIVES: To describe and compare current information about sleep societies, training programs, and requirements for certification in sleep medicine across Latin America. METHODS: Online research was conducted from July-September 2019. Search terms and logic were established, including every region or territory in Latin America. Members of sleep societies were contacted to complete missing information. RESULTS: There are 11 sleep societies in Latin America included in the Federation of Latin American Sleep Societies. They have varied levels of available online information. Regarding training programs, Brazil offers a sleep medicine residency and Mexico includes sleep training in the neurophysiology specialty; both countries offer sleep medicine certification. Sleep societies of Colombia and Argentina have developed their own certification processes. CONCLUSIONS: There are remarkable differences in sleep society consolidation, training programs, available certification, terminology, regulatory entities, and requirements in Latin America, which may increase difficulties and obstacles for a multinational certification project.

A case of positional central sleep apnea due to compression of the left vertebral artery on brainstem.

Studies evaluating the association between Central Sleep Apnea (CSA) and positional sleep apnea are not commonly described and are barely understood. We report a case of a 51-year-old-male with moderate Obstructive Sleep Apnea (OSA) and severe CSA probably secondary to brainstem compression, which responded to the adoption of strict lateral body posture. The addition of Continuous Positive Airway Pressure (CPAP) optimally resolved the remaining obstructive respiratory events. We suggest including Magnetic Resonance Imaging (MRI) in the work-up plan of patients with positional CSA.

Cyclic Alternating Pattern Associated with Catathrenia and Bruxism in a 10-Year-Old Patient.

ABSTRACT: Cyclic alternating pattern (CAP) is widely recognized as an expression of sleep instability in electroencephalogram activity during non-rapid eye movement sleep. We report a case with sequences of CAP followed by bruxism and catathrenia in a 10-y-old male patient with a diagnosis of attention deficit hyperactivity disorder in treatment with methylphenidate. We found CAP in 83.1% of all episodes of catathrenia, and the CAP rate was 12.8%. We propose to consider catathrenia as one of the sleep disorders that may be accompanied by CAP.

[Mental health in older adults: major neurocognitive, affective, and sleep disorders]. / Salud mental en el adulto mayor: trastornos neurocognitivos mayores, afectivos y del sueño.

Numerous biological, psychological, and social factors influence the mental health of elderly individuals to varying degrees. Apart from components related to the normal aging process and the co-occurrence of various medical conditions, events such as the death of a loved one, retirement, or disability significantly contribute to a variety of mental and emotional problems in this stage of the life cycle. The most frequent problems affect the neurocognitive, emotional, and oneiric spheres. Major neurocognitive disorders reduce one's overall performance and, thus, increase their need for close care. Affective disorders may be exacerbated by the lack of family support and decreased social interactions, which may lead to significant isolation result in suicidal behavior. The increased frequency of sleep disorders such as insomnia and daytime sleepiness and specific disorders such as obstructive apnea significantly alter the quality of life of this population.

Is restless legs syndrome associated with chronic mountain sickness?

BACKGROUND: Restless legs syndrome (RLS) and chronic mountain sickness (CMS) share physiological traits. Our objective was to explore a possible association between RLS and CMS. METHODS: We carried a cross-sectional study with male subjects living between 4100 and 4300 m above sea level. Participants underwent a clinical interview, physical examination, electrocardiographic (EKG) recording, and spirometry. We classified subjects into CMS, Limbo, and healthy high-altitude dwellers (hHAD), according to their Quinghai score and hematocrit levels. We applied the "Paradigm of questions for epidemiological studies of RLS," The International Restless Leg Syndrome Study Group Scale, and the Pittsburgh Sleep Quality Index. Logistic regression analysis was used to determine the association between variables. RESULTS: Seventy-eight male subjects were included. Forty subjects were hHAD, 23 were CMS patients, and 15 participants were considered as Limbo. CMS and Limbo subjects had a higher frequency of RLS (p <0.05). Limbo subjects had the highest severity score for RLS. There were no differences in age, body mass index (BMI), or tobacco use between RLS patients and non-sufferers. In the multivariate analysis, CMS was not associated with RLS diagnosis. Oxygen saturation (p = 0.019), poor sleep quality (p <0.01), and Quinghai score of ≥6 (p = 0.026) were independently associated with RLS diagnosis. CONCLUSIONS: Our results did not show a direct association between RLS and CMS; however, RLS was associated with reduced oxygen saturation. Hence, RLS could represent an early clinical manifestation of hypoxia, or, in CMS natural history, an early sign of maladaptation to high altitude.

Biological and nonbiological complex drugs for multiple sclerosis in Latin America: regulations and risk management.

Biological drugs and nonbiological complex drugs with expired patents are followed by biosimilars and follow-on drugs that are supposedly similar and comparable with the reference product in terms of quality, safety and efficacy. Unlike simple molecules that can be copied and reproduced, biosimilars and follow-on complex drugs are heterogeneous and need specific regulations from health and pharmacovigilance agencies. A panel of 14 Latin American experts on multiple sclerosis from nine different countries met to discuss the recommendations regarding biosimilars and follow-on complex drugs for treating multiple sclerosis. Specific measures relating to manufacturing, therapeutic equivalence assessment and pharmacovigilance reports need to be implemented before commercialization. Physical, chemical, biological and immunogenic characterizations of the new product need to be available before clinical trials start. The new product must maintain the same immunogenicity as the original. Automatic substitution of biological and complex drugs poses unacceptable risks to the patient.

Multiple sclerosis in South America: month of birth in different latitudes does not seem to interfere with the prevalence or progression of the disease.

OBJECTIVE: To assess whether the month of birth in different latitudes of South America might influence the presence or severity of multiple sclerosis (MS) later in life. METHODS: Neurologists in four South American countries working at MS units collected data on their patients' month of birth, gender, age, and disease progression. RESULTS: Analysis of data from 1207 MS patients and 1207 control subjects did not show any significant variation in the month of birth regarding the prevalence of MS in four latitude bands (0-10; 11-20; 21-30; and 31-40 degrees). There was no relationship between the month of birth and the severity of disease in each latitude band. CONCLUSION: The results from this study show that MS patients born to mothers who were pregnant at different Southern latitudes do not follow the seasonal pattern observed at high Northern latitudes.

Salud mental en el adulto mayor: trastornos neurocognitivos mayores, afectivos y del sueño / Mental health in older adults: major neurocognitive, affective, and sleep disorders

RESUMEN Existen numerosos factores biológicos, psicológicos y sociales con impacto más o menos prominente en la salud mental de las personas adultas mayores. Aparte de componentes derivados de los procesos normales de envejecimiento o de la coocurrencia de enfermedades médicas diversas, eventos como la muerte de un ser querido, la jubilación o la discapacidad, contribuyen significativamente a una variedad de problemas mentales o emocionales en esta fase del ciclo vital. Los problemas más frecuentes afectan las esferas neurocognitiva, afectiva y onírica. Los trastornos neurocognitivos mayores reducen el rendimiento general del paciente y generan con ello exigentes necesidades de dependencia y cuidado cercano. Los trastornos afectivos pueden acentuarse por falta de apoyo familiar y disminución marcada de interacciones sociales que pueden dar lugar a un significativo aislamiento con conducta suicida resultante. La mayor frecuencia de trastornos del sueño como insomnio, somnolencia diurna y trastornos específicos como apnea obstructiva alteran significativamente la calidad de vida de esta población.

ABSTRACT Numerous biological, psychological, and social factors influence the mental health of elderly individuals to varying degrees. Apart from components related to the normal aging process and the co-occurrence of various medical conditions, events such as the death of a loved one, retirement, or disability significantly contribute to a variety of mental and emotional problems in this stage of the life cycle. The most frequent problems affect the neurocognitive, emotional, and oneiric spheres. Major neurocognitive disorders reduce one's overall performance and, thus, increase their need for close care. Affective disorders may be exacerbated by the lack of family support and decreased social interactions, which may lead to significant isolation result in suicidal behavior. The increased frequency of sleep disorders such as insomnia and daytime sleepiness and specific disorders such as obstructive apnea significantly alter the quality of life of this population.

Optimizing outcomes in multiple sclerosis: consensus guidelines for the diagnosis and treatment of multiple sclerosis in Latin America.

OBJECTIVE: The prevalence of multiple sclerosis (MS) in Latin America varies across different studies but an intermediate risk and increased frequency of the disease have been reported in recent years. The circumstances of Latin American countries are different from those of Europe and North America, both in terms of differential diagnoses and disease management. METHODS: An online survey on MS was sent to 855 neurologists in nine Latin American countries. A panel of nine experts in MS analyzed the results. RESULTS: Diagnostic and therapeutic recommendations were outlined with special emphasis on the specific needs and circumstances of Latin America. The experts proposed guidelines for MS diagnosis, treatment, and follow up, highlighting the importance of considering endemic infectious diseases in the differential diagnoses of MS, the identification of patients at high risk of developing MS in order to maximize therapeutic opportunities, early treatment initiation, and cost-effective control of treatment efficacy, as well as global assessment of disability. CONCLUSIONS: The experts recommended that healthcare systems allocate a longer consultation time for patients with MS, which must be conducted by neurologists trained in the management of the disease. All drugs currently approved must be available in all Latin American countries and must be covered by healthcare plans. The expert panel supported the creation of a permanent forum to discuss future clinical and therapeutic recommendations that may be useful in Latin American countries.

Ansiedad, síndrome de piernas inquietas y onicofagia en estudiantes de medicina / Anxiety, restless legs syndrome and onychophagia in medical students

Describir la frecuencia de ansiedad, onicofagia y síndrome de piernas inquietas (SPI) en estudiantes de medicina y explorar la relación entre los mismos. Materiales y métodos: Participaron 315 estudiantes del primer al quinto año de medicina de una universidad privada de Lima. Se administraron la Escala de Ansiedad de Beck (BAI), una escala Likert para onicofagia, el Inventario de Estudios Epidemiológicos de SPI (García - Borreguero) y el Inventario de SPI (Grupo Internacional de SPI). Resultados: Se halló la frecuencia de ansiedad (61,3%), onicofagia (52,63%) y SPI (9,29%). Ser hombre es un factor protector para ansiedad (razón de prevalencia (RP) = 0,74; p = 0,001; IC 95% = 0,63 û 0,89). Existe asociación entre sintomatología ansiosa y SPI (RP =2,52; p = 0,036; IC 95% = 1,06 û 6); y entre sintomatología ansiosa y onicofagia (RP = 1,47; p = 0,002; IC 95% = 1,15 û 1,87). La presencia de onicofagia y SPI tenía asociación con sintomatología ansiosa (RP = 5,37; p = 0,023; IC 95% = 1,26 û 22,82). No se encontró asociación significativa entre SPI y onicofagia. Conclusiones: Existe una asociación entre ansiedad y SPI; y entre ansiedad y onicofagia; pero no entre SPI y onicofagia...

Objectives: The present work describes the frequency of anxiety, onychophagy and restless legs syndrome (RLS) in medical students and explore the relation among these conditions. Materials and methods: 315 medical students from the first to the fifth year from a private university where selected to participate. The instruments used for the study where: The Beck Anxiety Inventory, a Likert scale for onychophagy (nail biting), the Inventory of Epidemiological Studies for RLS (García - Borreguero) and the RLS Inventory (International RLS Group). Results: A frequency of anxiety (61.3%), onychophagy (52.63%) and RLS (9.29%) were found. Being male was a protective factor for anxiety (prevalence ratio (PR) = 0.74; p = 0.001, 95% CI = 0.63 to 0.89). There was an association between anxiety symptoms and RLS (PR = 2.52; p = 0.036, 95% CI = 1.06 - 6.00); and between anxious and onychophagy symptoms (PR = 1.47; p = 0.002, 95% CI = 1.15 - 1.87). Coexistence of onychophagy and RLS were associated with anxiety symptoms (PR = 5.37; p = 0.023, 95% CI = 1.26 - 22.82). There was no significant association between RLS and onychophagy. Conclusions: There is an association between anxiety and RLS, and between anxiety and onychophagy; but not between RLS and onychophagy...

Multiple sclerosis in South America: month of birth in different latitudes does not seem to interfere with the prevalence or progression of the disease / Esclerose multipla na America do Sul: mes de nascimento em diferentes latitudes nao parece interferir com a prevalencia ou progressao da doenca

Objective To assess whether the month of birth in different latitudes of South America might influence the presence or severity of multiple sclerosis (MS) later in life. Methods Neurologists in four South American countries working at MS units collected data on their patients' month of birth, gender, age, and disease progression. Results Analysis of data from 1207 MS patients and 1207 control subjects did not show any significant variation in the month of birth regarding the prevalence of MS in four latitude bands (0–10; 11–20; 21–30; and 31–40 degrees). There was no relationship between the month of birth and the severity of disease in each latitude band. Conclusion The results from this study show that MS patients born to mothers who were pregnant at different Southern latitudes do not follow the seasonal pattern observed at high Northern latitudes. .

Objetivo Avaliar se o mês de nascimento em diferentes latitudes da América do Sul pode influenciar a presença ou gravidade da esclerose múltipla (EM) na vida. Método Neurologistas de quatro países da América do Sul trabalhando em unidades de EM coletaram os dados de seus pacientes com referência ao mês de nascimento, gênero, idade e progressão da doença. Resultados A análise dos dados mostrou que, para 1207 pacientes com EM e 1207 controles, não havia diferença significativa no mês de nascimento com relação à prevalência de EM em quatro zonas de latitude (0–10; 11–20; 21–30; e 31–40 graus). Não houve relação entre o mês de nascimento e a gravidade da doença em nenhuma destas zonas. Conclusão Os resultados deste estudo mostram que pacientes com EM nascidos de mães grávidas em diferentes latitudes sul não seguem o padrão dos resultados sazonais encontrados nas latitudes norte. .

Prevalencia de Esclerosis Múltiple en Lima - Perú / Prevalence of Multiple Sclerosis in Lima - Perú

La Esclerosis Múltiple (EM) es la principal enfermedad desmielinizante a nivel mundial. La epidemiología señala una mayor prevalencia de esta entidad en áreas alejadas de la línea ecuatorial. Existen algunos estudios de prevalencia en Latinoamérica, ninguno publicado en el Perú. Objetivo: Determinar la prevalencia de Esclerosis Múltiple en Lima, Perú. Material y métodos: Se utilizó el método captura recaptura para estimar la prevalencia de EM en Lima en 4 centros de pacientes con Esclerosis Múltiple de la ciudad: Hypnos Instituto del Sueño en la Clínica San Felipe, elHospital Nacional Cayetano Heredia, la Clínica El Golf y la Asociación ôEsclerosis Múltiple Perúõ (ESMUP). Resultados: Se calculó la prevalencia de EM en 7,69 x 100 000 habitantes (intervalo de confianza al 95 por ciento 7,09 a 8,30). Conclusiones: La prevalencia estimada de EM, para la ciudad de Lima, se encuentra en rango medio bajo.

Multiple Sclerosis (ME) is the main demyelinating disease over the world. The epidemiology shows a higher prevalence of this entity in areas away from the equatorial line. There are some prevalence studies published in Latinamerica, but no previous information reported in Peru. Objective: To determine the prevalence of ME in Lima, Peru. Material and Methods: Capture-recapture method was used to estimate the prevalence of ME in Lima, four centres of patients with ME in the city were evaluated: Hypnos Sleep Institute in ôSan Felipeõ Clinic, Hospital Nacional Cayetano Heredia, ôEl Golfõ Clinic and ôEsclerosis Múltiple del Perúõ Society (ESMUP). Results: The calculated prevalence of ME was 7.69 x 100 000 habitants (Confidence Interval at 95 per cent: 7.09 to 8.30). Conclusions: The estimated prevalence of ME, for Lima, is about the medium low range.

Frecuencia de síntomas del Síndrome Apnea hipopnea del sueño e insomnio en médicos de una clínica privada peruana / Frequency of symptoms of the syndrome apnea hipopnea of the dream and insomnia in doctors of a private Peruvian clinic

Objetivo: El estudio tuvo la finalidad de determinar las frecuencias de síntomas relacionados al SAHS e insomnio en 99 médicos. Material y métodos: Se empleó una encuesta anónima y autoadministrada. Respondieron 42 encuestados con edad promedio 48ñ5.3 [35-78] años, 39 fueron hombres. Cuatro aceptaron realizarse una polisomnografía. Resultados: Las frecuencias de los síntomas registrados por medio de la encuesta fueron: ronquido 22 (51 por ciento), hipersomnia 9 (22 por ciento) y pausas respiratorias durante el sueño 5 (11 por ciento). Ronquido + pausas 5 (11 por ciento), ronquido + pausas + IMC mayor igual 27 2 (5 por ciento) y ronquido + pausas + hipersomnia 1 (3 por ciento). Diecicinueve (45 por ciento) presentaron insomnios. Las cuatro polisomnografías documentaron SAHS. Conclusión: El estudio permite concluir que los síntomas de SAHS e insomnio en la población evaluada fueron frecuentes y que el SAHS fue documentado en al menos 4 de 39 médicos hombres encuestados.

Identificación de síntomas relacionados al Síndrome de Apnea Obstructiva del sueño en historias clínicas de pacientes con eventos vasculares agudos / Identification of obstructive sleep apnea syndrome related symptoms in clinical charts of patients with an acute vascular event

El síndrome de apnea obstructiva del sueño (SAOS) se caracteriza por ronquidos, pausas en la respiración y somnolencia diurna excesiva entre los síntomas más relevantes. Se ha demostrado una asociación con incremento de riesgo vascular en pacientes con SAOS. Objetivo: Evaluar si el personal médico busca síntomas relacionados al SAOS en pacientes con un cuadro cerebrovascular o síndrome coronario agudo, en los servicios de Medicina del Hospital Nacional Cayetano Heredia en Lima, Perú, desde Setiembre del 2003 hasta Setiembre del 2004. Materiales y métodos: Se planteó un estudio observacional restrospectivo. Se revisaron historias clínicas de 291 pacientes con diagnóstico al ingreso de accidente cerebrovascular, ataque isquémico transitorio o síndrome coronario agudo, buscando información sobre síntomas relacionados al SAOS, incluyendo evaluación por especialidades y epicrisis, detallando los evaluadores que recogieron los datos. Resultados: En la evaluación de 291 pacientes participaron 1122 evaluadores, 0.98 por ciento de ellos consignó descartar el SAOS, que correspondió a 9 pacientes. En sólo 1 paciente se sugirió realizar un estudio de poliosomnografía para corroborar el diagnóstico, sin ofrecerse ninguna opción terapéutica. Del total de pacientes, en el 6.87 por ciento se indagó por ronquidos durante el sueño, 28,52 por ciento por somnolencia y 0,68 por ciento por episodios de apneas durante el sueño. Conclusiones: No se realiza una adecuada búsqueda del SAOS en pacientes con un evento cardiovascular o cerebrovascular agudo. En los pocos pacientes en los que se sospecha esta patología no existe seguimiento clínico ni tampoco se ofrece opción diagnóstica ni terapéutica alguna.