Evaluation of quality of sleep in women with stress urinary incontinence before and after surgical correction.

OBJECTIVE: To evaluate the quality of sleep in women with urinary incontinence before and after sling surgery. METHODS: A prospective study of case series of women with urodynamic diagnosis of stress urinary incontinence. To evaluate the subjective quality of sleep, two specific questionnaires were used and validated for the Portuguese Language: Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. The questionnaires were applied before and 6 months after surgical repair. RESULTS: When analyzing the Epworth Sleepiness Scale, there was an improvement in sleep quality (p=0.0401). For the Pittsburgh Sleep Quality Index, only for sleep disorder there was improvement in quality of sleep after surgery (p=0.0127). CONCLUSION: Women with urinary incontinence, submitted to surgery with sling, showed improvement in both quality of sleep and sleep disorder.

Evaluation of quality of sleep in women with stress urinary incontinence before and after surgical correction / Avaliação da qualidade do sono em mulheres com incontinência urinária antes e depois da correção cirúrgica

ABSTRACT Objective: To evaluate the quality of sleep in women with urinary incontinence before and after sling surgery. Methods: A prospective study of case series of women with urodynamic diagnosis of stress urinary incontinence. To evaluate the subjective quality of sleep, two specific questionnaires were used and validated for the Portuguese Language: Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. The questionnaires were applied before and 6 months after surgical repair. Results: When analyzing the Epworth Sleepiness Scale, there was an improvement in sleep quality (p=0.0401). For the Pittsburgh Sleep Quality Index, only for sleep disorder there was improvement in quality of sleep after surgery (p=0.0127). Conclusion: Women with urinary incontinence, submitted to surgery with sling, showed improvement in both quality of sleep and sleep disorder.

RESUMO Objetivo: Avaliar a qualidade do sono em mulheres com incontinência urinária antes e após correção cirúrgica do tipo sling. Métodos: Estudo prospectivo do tipo série de casos de mulheres com diagnóstico urodinâmico de incontinência urinária de esforço. Para avaliar a qualidade subjetiva do sono, utilizaram-se dois questionários específicos e validados para a língua portuguesa: Escala de Sonolência de Epworth e Índice de Qualidade do Sono de Pittsburgh. Os questionários foram aplicados antes e 6 meses após a correção cirúrgica. Resultados: Ao analisar a Escala de Sonolência de Epworth, houve melhora da qualidade do sono (p=0,0401). Para o Índice de Qualidade do Sono de Pittsburgh, apenas para o transtorno do sono, houve melhora da qualidade do sono após a cirurgia (p=0,0127). Conclusão: Mulheres com incontinência urinária, submetidas à correção cirúrgica por meio de sling, apresentaram melhora tanto na qualidade do sono como no transtorno do sono.

Sleep disruption in chronic rhinosinusitis.

INTRODUCTION: Chronic rhinosinusitis (CRS) is a common disease of the upper airways and paranasal sinuses with a marked decline in quality of life (QOL). CRS patients suffer from sleep disruption at a significantly higher proportion (60 to 75%) than in the general population (8-18 %). Sleep disruption in CRS causes decreased QOL and is linked to poor functional outcomes such as impaired cognitive function and depression. Areas covered: A systematic PubMed/Medline search was done to assess the results of studies that have investigated sleep and sleep disturbances in CRS. Expert commentary: These studies reported sleep disruption in most CRS patients. The main risk factors for sleep disruption in CRS include allergic rhinitis, smoking, and high SNOT-22 total scores. The literature is inconsistent with regard to the prevalence of sleep-related disordered breathing (e.g. obstructive sleep apnea) in CRS patients. Although nasal obstruction is linked to sleep disruption, the extent of sleep disruption in CRS seems to expand beyond that expected from physical blockage of the upper airways alone. Despite the high prevalence of sleep disruption in CRS, and its detrimental effects on QOL, the literature contains a paucity of studies that have investigated the mechanisms underlying this major problem in CRS.

[Depressive phenomenology at the outset of neuropaediatric diseases]. / Fenomenología depresiva al inicio de enfermedades neuropediátricas.

INTRODUCTION: Depressive phenomenology, in its diverse nosological forms, affects 8-10% of children and adolescents of general population. Most frequently mood disorders have a primary origin, following poligenic multifactorial model. Moreover there is a non negligible proportion of cases in which depressive symptoms accompany neurological illnesses or they even constitute a part of predominant manifestations at the clinical start of neurologic disease, or mark a point of inflexion in its course. The aim of the present article is to review relevant literature dealing with this topic. DEVELOPMENT: A significative higher frequency of depressive phenomenology, not explainable by hazard, can be an early manifestation in children and adolescents with: epileptic syndromes, sleep disorders, chronic recurrent cephalalgias, several neurometabolic diseases, and intracranial tumors. Points of coincidence have been shown in dysequilibrium of brain neurotransmitters (serotonine, noradrenaline, hyperglutamatergic states) which could not be hypothesized as maintaining both neurological and mood conditions. CONCLUSIONS: The suspiction of a neurological disease should be adopted in cases of mood disorder not easily explainable by familial antecedents or clear biographical stressors. The search for a brain disorder by means of a meticulous anamnesis and neurological clinical and ancillary exams makes possible to discover the brain disorder at a very early stage and ameliorate the chances of accurately manage both the neurological and mood disorders. The simultaneous treatment of both dimension of the illness helps to improve the patients' quality of life.

TITLE: Fenomenologia depresiva al inicio de enfermedades neuropediatricas.Introduccion. La depresion, en sus diversas formas, afecta al 8-10% de niños y adolescentes y en la mayor parte de casos su origen es primario, siguiendo el modelo genetico multifactorial. Pero hay una proporcion de pacientes, no bien cuantificada todavia, en la que la depresion acompaña precozmente una enfermedad neurologica o marca un punto de inflexion en el curso de esta. El objetivo es revisar la bibliografia al respecto. Desarrollo. Se observa fenomenologia depresiva, con una frecuencia significativamente mayor que por azar, en niños y adolescentes afectos de epilepsia, trastornos del sueño, cefaleas primarias cronicas recurrentes, enfermedades neurometabolicas y tumores intracraneales. En varias de estas patologias neuropediatricas se hipotetizan puntos de coincidencia fisiopatologica con la depresion a traves de un deficit de disponibilidad cerebral de serotonina y noradrenalina. No se considera aqui la depresion disadaptativa a una neurodiscapacidad cronica. Conclusiones. En niños y adolescentes, los trastornos del animo sintomaticos de enfermedad neurologica deben sospecharse en ausencia de antecedentes familiares o de experiencias vitales que los expliquen. La busqueda sistematica de anomalias neurologicas y los examenes complementarios permitirian en estos casos abordar precozmente el tratamiento de la enfermedad cerebral causante del cuadro depresivo. A su vez, como ocurre en casos de epilepsia, cefaleas o trastorno del sueño, la terapia farmacologica y psicologica del cuadro depresivo contribuye a mejorar la calidad de vida de los afectados.

Cognition in perimenopause: the effect of transition stage.

OBJECTIVE: The aims of this cross-sectional study were to determine if cognitive function differs across stages of reproductive aging and to evaluate whether hormones or menopausal symptoms predict cognition in perimenopause. We hypothesized that women in late menopausal transition and early postmenopause would perform more poorly than those in the late reproductive stage on attention and verbal memory tasks, and that estradiol, depressive symptoms, anxiety symptoms, hot flashes, and sleep disturbance would predict cognitive performance on those tasks. METHODS: One hundred seventeen middle-aged women enrolled in the Rochester Investigation of Cognition Across Menopause were categorized into late reproductive stage (n = 34), early menopausal transition stage (n = 28), late menopausal transition stage (n = 41), or early postmenopause stage (n = 14) according to criteria from the Stages of Reproductive Aging Workshop +10. We administered a neuropsychological battery assessing six domains of cognition, assessed menopausal symptoms, and measured serum levels of estradiol and follicle-stimulating hormone. Multivariate regressions were conducted to determine the impact of menopausal stage and symptoms on cognition. RESULTS: Women in the first year of postmenopause performed significantly worse than women in the late reproductive and late menopausal transition stages on measures of verbal learning, verbal memory, and motor function. They also performed significantly worse than women in the late menopausal transition stage on attention/working memory tasks. CONCLUSIONS: Cognitive function does not change linearly across perimenopause. Decreases in attention/working memory, verbal learning, verbal memory, and fine motor speed may be most evident in the first year after the final menstrual period.

Preliminary identification of key clinical domains for outcome evaluation in fibromyalgia using the Delphi method: the Italian experience.

OBJECTIVE: Fibromyalgia (FM) is a complex syndrome that, in Italy, affects at least 2% of the adult population. It is characterized by chronic widespread musculoskeletal pain often accompanied by multiple other symptoms. The aim of this study was to identify a set of clinical domains for FM considered relevant by both clinicians and patients using a consensus process. METHODS: Consensus was achieved using the Delphi method based on questionnaires and systematic, controlled opinion feedback. The Delphi exercise involved a panel of 252 rheumatologists and 86 patients with FM as defined by the American College of Rheumatology criteria. All of the patients and clinicians were asked to rank the relative different domains of FM in order of priority. The content validity index (CVI) was used to establish the percentage agreement. The importance of each item was ranked on a 0-3 Likert scale. The frequency, mean relevance scores, and frequency importance product were also calculated. RESULTS: The Delphi exercise showed that the domains ranked highest by patients were similar to those of the clinicians, with the exception of tender point intensity (considered relevant by the clinicians but not by the patients) and environmental sensitivity (considered important by the patients but not by the clinicians). A final 8-item model was developed which was considered to demonstrate adequate validity. CONCLUSIONS: The Delphi exercises identified and ranked relevant key clinical domains that need to be assessed in FM research. On the basis of these results, a new patient-reported composite outcome index can be developed and used in clinical trials.

Parasomnias and movement disorders in children and adolescents.

Childhood parasomnias and movement disorders arise from a variety of etiologic factors. For some children, psychopathology plays a causal role in sleep disorders; in other cases, recurrent parasomnia episodes induce psychopathology. Current research reveals complex interconnections between sleep and mental health. As such, it is important that clinicians consider the impact psychiatric disorders have on childhood parasomnias. This article describes common parasomnias and movement disorders in children and adolescents, with emphasis on psychologic and behavioral comorbidities.

Disruption of cognitive function in fibromyalgia syndrome.

Accumulating evidence points to significant cognitive disruption in individuals with Fibromyalgia Syndrome (FMS). This study was carried out in order to examine specific cognitive mechanisms involved in this disruption. Standardized experimental paradigms were used to examine attentional function and working memory capacity in 30 women with FMS and 30 matched controls. Cognitive function was examined using performance on these tests and between group results were analysed in the context of important psychological and behavioural measures. Performance of standardized everyday attentional tasks was impaired in the FMS group compared to controls. Working memory was also found to be impaired in this group. Stimulus interference was found to be significantly worse in the FMS group as the demands of the tasks increased. These effects were found to exist independent of the measures of mood and sleep disruption. However, when pain levels were accounted for statistically, no differences existed between groups on cognitive measures. These findings point to disrupted working memory as a specific mechanism that is disrupted in this population. The results of this study suggest that pain in FMS may play an important role in cognitive disruption. It is likely that many factors, including disrupted cognition, play a role in the reduced quality of life reported by individuals with FMS.