Waist-to-height ratio and waist circumference as the main measures to evaluate obstructive sleep apnea in the woman's reproductive life stages.

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder. In women, the frequency of OSA increases substantially during and after the menopause, as does the prevalence of obesity in this reproductive life stage. This cross-sectional study uses data from the Sao Paulo Epidemiologic Sleep Study (EPISONO, 2007), and comprises a sample of 500 women aged 20-80 years. Multiple logistic regression analysis was used to assess the factors associated with OSA in premenopausal and postmenopausal women. All participants underwent polysomnography, and obesity was assessed using the waist-to-height ratio (WHtR), body mass index, neck and waist circumference, measured using standard methods. WHtR was the factor most associated with a significant increase in risk of OSA in premenopausal women. Waist circumference was the factor most associated with OSA in postmenopausal women, for all severities of the disease. Anthropometric factors presented a high rate of accuracy in the classification of women with OSA. The study found that different obesity-related anthropometric measures should be considered in the diagnosis of OSA, according to the woman's reproductive stage.

The sleep characteristics in symptomatic patients with Duchenne muscular dystrophy.

BACKGROUND: Duchenne muscular dystrophy (DMD) causes serious health consequences that include impairment of the respiratory system and sleep. The aim of our study is to investigate the sleep architecture and respiratory profile during sleep of symptomatic patients with DMD without ventilatory support. METHODS: We evaluated polysomnography (PSG) of boys with DMD (n = 44) and a control group (n = 79) with sleep complaints that was matched in age but without neuromuscular disease. RESULTS: DMD patients presented sleep impairments when compared with the control group in terms of decreased sleep efficiency (72.4 ± 1.9 vs 80.3 ± 1.4 %, P = 0.002) and increased apnea-hypopnea index (AHI) during nonrapid eye movement (NREM) sleep (1.6 ± 0.3 vs 0.3 ± 0.2/h, P = 0.003). The main changes were observed during rapid eye movement (REM) sleep: an increase in REM sleep latency (202.2 ± 11.8 vs 152.3 ± 8.6 min, P < 0.001), a reduced percentage of REM sleep (13.1 ± 0.9 vs 17.9 ± 0.7 %, P = 0.001), and exacerbation of AHI (8.7 ± 1.5 vs 1.0 ± 1.1 events/h, P = 0.001). There was an increase in the total number of apneas, especially obstructive apneas (6.8 ± 1.9 vs 0.8 ± 1.3, P = 0.013). CONCLUSIONS: The sleep and respiratory profile during sleep of patients with DMD are compromised. The results suggest that these changes reflect the muscle weakness inherent in DMD and are demonstrated mainly during REM sleep. Thus, the use of PSG is important to identify sleep-disordered breathing at an early stage, before deciding when to introduce noninvasive respiratory support for prevention of respiratory complications.

Gender differences in the application of anthropometric measures for evaluation of obstructive sleep apnea.

This study aims to investigate anthropometric measures and their effectiveness as screening method for diagnosing obstructive sleep apnea (OSA) in each gender. We also evaluated which measures were associated with OSA in the adult population of a large metropolitan city, Sao Paulo, Brazil. 552 women and 450 men were submitted to polysomnography (PSG), and the anthropometric measurements as body mass index (BMI), waist-to-height ratio, neck and waist circumference were collected. The measurements were then compared with the OSA classification established by the PSG. In women, waist circumference and waist-to-height ratio were found to be the best predictor, while in men, the factors with great potential for identification varied according to severity of the disease, highlighting waist-to-height ratio, neck circumference and BMI had strongest association. The accuracy of the classification in relation to mild-to-severe OSA based on cut-off values of 92.5cm for waist circumference was greater than 72.9% in men, and 78.9% in women based on cut off values of 95cm. Regarding severe OSA, cut-off values of 116.1cm were greater than 91.3% accurate in the male population, and 95.1% in the female population with a cut-off value of 126.5cm. The study found waist circumference and waist-to-height ratio to be the best measure to assess sleep-disordered breathing in women. Waist-to-height ratio and neck circumferences were the best measures in men with mild OSA, but BMI was more closely associated with severe OSA. The present study identified the anthropometric variables with the highest risk for OSA and their respective cutoff value, according to gender.

Sleep pattern and spectral analysis of caregiver-mothers of sons with Duchenne muscular dystrophy, and an examination of differences between carriers and non-carriers.

OBJECTIVES: Sleep is essential for physical and mental well-being. However, poor sleep is a common complaint among caregivers. The aim of the present study was to determine sleep patterns of caregiver-mothers (CM group) of sons with Duchenne muscular dystrophy (DMD) and also to examine the differences between non-carriers and carriers of the gene related to DMD within the CM group. METHODS: Observational case-control study. PARTICIPANTS: The CM and control (CTRL) groups were matched for age, body mass index and social class. Polysomnography was conducted in a sleep laboratory for one night. The discrete fast Fourier transformation method was used to calculate the electroencephalogram (EEG) power spectrum for the entire night and sleep stages. RESULTS: The CM group presented higher sleep latency and N3 sleep stage compared with the CTRL. When carrier and non-carrier CM subgroups were analyzed, increased sleep latency and time awake, as well as reduced sleep efficiency and N2, were observed in the carrier group. Regarding respiratory parameters, carriers demonstrated higher hypopnea index values compared with non-carriers. Spectral analysis showed that carriers compared with non-carrier DMD caregiver-mothers presented lower spectral power in fast waves, mainly beta, during REM sleep in some EEG derivations. CONCLUSIONS: There was an impairment of sleep pattern in the CM group compared with CTRL mothers; this was possibly associated with difficulty in initiating sleep. Being a DMD gene carrying caregiver further compromised some aspects of sleep microstructure during REM sleep. The data demonstrated the importance of sleep evaluation in caregiver-mothers, and the relationship between sleep and being a carrier of the gene associated with DMD, which was demonstrated as possibly impacting sleep quality.

Restless leg syndrome exacerbated by amytriptiline in a patient with Duchenne Muscular Dystrophy.

We report an unusual case of a Duchenne Muscular Dystrophy(DMD) patient who initiated a restless leg syndrome after the use of amytriptiline. The prescription and use of this medication for patients with persistent neuropathic pain is relatively common, especially for patients with DMD. Normally, this medication is well tolerated, however, we now report the occurrence of an induction or intensification of a restless leg syndrome case in a young patient with DMD, treated with amytriptiline for his chronic pain.

The role of sleep in Juvenile idiopathic arthritis patients and their caregivers.

Juvenile idiopathic arthritis is a chronic disease that may lead to various consequences for patients and caregivers, especially in relation to sleep quality. Sleep is an essential process for homeostasis of the organism. In general, caregivers of children with JIA are more susceptible to these sleep disorders and a lower quality of life. This impairment in sleep can potentially affect the health of caregiver. For this reason, it is very important to continue to evaluate the quality of sleep in caregivers and how to support these JIA children's caregivers more effectively.

Anxiety-like effects of meta-chlorophenylpiperazine in paradoxically sleep-deprived mice.

Chlorophenylpiperazines (CPP) are psychotropic drugs used in nightclub parties and are frequently used in a state of sleep deprivation, a condition which can potentiate the effects of psychoactive drugs. This study aimed to investigate the effects of sleep deprivation and sleep rebound (RB) on anxiety-like measures in mCPP-treated mice using the open field test. We first optimized our procedure by performing dose-effect curves and examining different pretreatment times in naïve male Swiss mice. Subsequently, a separate cohort of mice underwent paradoxical sleep deprivation (PSD) for 24 or 48h. In the last experiment, immediately after the 24h-PSD period, mice received an injection of saline or mCPP, but their general activity was quantified in the open field only after the RB period (24 or 48h). The dose of 5mgmL(-1) of mCPP was the most effective at decreasing rearing behavior, with peak effects 15min after injection. PSD decreased locomotion and rearing behaviors, thereby inhibiting a further impairment induced by mCPP. Plasma concentrations of mCPP were significantly higher in PSD 48h animals compared to the non-PSD control group. Twenty-four hours of RB combined with mCPP administration produced a slight reduction in locomotion. Our results show that mCPP was able to significantly change the behavior of naïve, PSD, and RB mice. When combined with sleep deprivation, there was a higher availability of drug in plasma levels. Taken together, our results suggest that sleep loss can enhance the behavioral effects of the potent psychoactive drug, mCPP, even after a period of rebound sleep.