REM sleep behavior disorder: update on diagnosis and management / Transtorno comportamental do sono REM: atualização no diagnóstico e manejo

Abstract REM sleep behavior disorder (RBD) is characterized by a loss of atonia of skeletal muscles during REM sleep, associated with acting out behaviors during dreams. Knowledge of this pathology is important to predict neurodegenerative diseases since there is a strong association of RBD with diseases caused by the deposition of alpha-synuclein in neurons (synucleinopathies), such as Parkinson's disease (PD), multiple system atrophy (MSA), and dementia with Lewy bodies (DLB). Proper diagnosis of this condition will enable the use of future neuroprotective strategies before motor and cognitive symptoms. Diagnostic assessment should begin with a detailed clinical history with the patient and bed partner or roommate and the examination of any recorded home videos. Polysomnography (PSG) is necessary to verify the loss of sleep atonia and, when documented, the behaviors during sleep. Technical recommendations for PSG acquisition and analysis are defined in the AASM Manual for the scoring of sleep and associated events, and the PSG report should describe the percentage of REM sleep epochs that meet the criteria for RWA (REM without atonia) to better distinguish patients with and without RBD. Additionally, PSG helps rule out conditions that may mimic RBD, such as obstructive sleep apnea, non-REM sleep parasomnias, nocturnal epileptic seizures, periodic limb movements, and psychiatric disorders. Treatment of RBD involves guidance on protecting the environment and avoiding injuries to the patient and bed partner/roommate. Use of medications are also reviewed in the article. The development of neuroprotective medications will be crucial for future RBD therapy.

Resumo O transtorno comportamental do sono REM (TCSREM) é caracterizado por uma perda de atonia dos músculos esqueléticos durante o sono REM, associada a comportamentos de atuação durante os sonhos. O conhecimento desse transtorno é importante como preditor de doenças neurodegenerativas, uma vez que existe uma forte associação de TCSREM com doenças causadas pela deposição de alfa-sinucleína nos neurônios, como a doença de Parkinson (DP), atrofia de múltiplos sistemas (MSA) e demência com corpos de Lewy (DLB). O diagnóstico adequado dessa condição permitirá o uso de futuras estratégias neuroprotetoras antes do aparecimento dos sintomas motores e cognitivos. A avaliação diagnóstica deve começar com uma história clínica detalhada com o paciente e acompanhante, além de exame de vídeos. A polissonografia (PSG) é necessária para verificar a perda da atonia do sono e, quando documentados, os comportamentos durante o sono. As recomendações técnicas para aquisição e análise de PSG são definidas no Manual da AASM (Scoring of sleep and associated events) e o relatório de PSG deve descrever a porcentagem de períodos de sono REM que atendem aos critérios para REM sem atonia. Além disso, a PSG ajuda a descartar condições que podem mimetizar o TCSREM, como apneia obstrutiva do sono, parassonias do sono não REM, crises epilépticas noturnas, movimentos periódicos dos membros e transtornos psiquiátricos. O tratamento do TCSREM envolve orientações sobre adaptações do ambiente para evitar lesões ao paciente e ao colega de quarto. Medicamentos utilizados são revistos no artigo, assim como o crucial desenvolvimento de medicamentos neuroprotetores.

Prevalence and Risk Factors of Bruxism in a Selected Population of Iranian Children

ABSTRACT Objective: To investigate the prevalence of bruxism in Iranian children aged 6 to 12 years. Material and Methods: This cross-sectional study was conducted on 600 schoolchildren aged 6-12 years. The questionnaire consisted of two sections: the first section included demographic information, while the second evaluated the occurrence of bruxism. Kruskal-Wallis, Chi-Square, Fisher and Multinomial logistic regression were used. A level of p<0.05 was considered statistically significant. Results: 698 questionnaires were distributed, of which 600 participants were returned. According to Multinomial logistic regression, awake bruxism was associated significantly with the following variables: age, sequence of birth, recurrent headache, gastrointestinal disease, nasal obstruction, neurological disorder, easy child crying, sleep disorders, talking in a dream and snoring and jaw disorder. Sleep bruxism was associated significantly with age, premature birth, allergy, gastrointestinal disease, drooling, mouth breathing, nasal obstruction, oral habit, nail biting, sleep disorder, jaw disorders, and family history. Conclusion: Pre-birth and post-birth factors play an important role in the prevalence of bruxism in society. It is possible to prevent complications of bruxism by informing parents and making a timely diagnosis. Parents should be aware of this occurrence to reduce possible related factors to teeth and the masticatory system.

DEVELOPMENT AND VALIDATION OF YOGA MODULE FOR OBSTRUCTIVE SLEEP APNEA

Background: Sleep is an essential component of human life because it provides for relaxation and recovery from the stresses of everyday living. Reduced sleep quantity or quality leads to sleep deprivation which may offer indirect dangers by affecting cognitive and physical performance and raising the chance of motor vehicle and occupational accidents. Insomnia chronic sleep debt snoring sleep apnea circadian rhythm disturbances (including shift work syndrome) RLS parasomnias and uncommon diseases such as narcolepsy are the most common sleep disorders found in sleep clinics according to experts. Obstructive Sleep apnea is a common disorder in which your breathing stops and starts periodically while you sleep. To determine the design and validation of an Integrated Yoga Module (IYM) for OSA patients. The ?rst phase - IYM for OSA - was created based on a survey of classic books and Materials and Procedures: recently available research studies. The designed IYM was validated by 20 subject matter (yoga) experts in the second phase. Lawshe's formula was used to calculate the content-validity ratio (CVR). Yoga practices were created for the OSA Results: Integrated Yoga Module. The ?nal Integrated Yoga Module featured yoga practises with CVR ?0.5 that were assessed by 20 yoga experts and agreed in faculty group discussion. The yoga practices were designed and validated for IYM for Conclusion: OSA. By applying Lawshe's content validity criteria 20 yoga professionals veri?ed the IYM design.

Dream-Reality confusion: differential psychiatric diagnosis in narcoleptic subjects / Confusão sonho-realidade: diagnóstico psiquiátrico diferencial em narcolépticos

Dream-reality confusion (DRC) is the consequence of hypnagogic content confusion with real events and memories. Narcoleptic subjects eventually have DRC and can be misdiagnosed as schizophrenic or with another disorder with delusional or hallucinatory symptoms. Although dream-related experiences and hallucinatory perception share neurophysiological pathways, they are phenomenologically distinct. The lack of phenomenological intentionality in Dreamrelated perceptions, the different cognitive pathways for delusion generation, and other differences between mental disorders psychopathology, and DRC-related phenomena are here discussed. The lived world and awake experience interpretation, and dream neurobiology in narcoleptic subjects related to DRC, might indicate some hints for the mind-brain gap issue that still exists in neurology and psychiatry.

A confusão entre realidade e sonho (CRS) é a consequência da confusão do conteúdo hipnagógico com eventos e memórias reais. Sujeitos narcolépticos eventualmente têm CRS e podem ser diagnosticados erroneamente como esquizofrênicos ou com outro transtorno com sintomas delirantes ou alucinatórios. Embora as experiências relacionadas ao sonho e à percepção alucinatória compartilhem vias neurofisiológicas, elas são fenomenologicamente distintas. A falta de intencionalidade fenomenológica nas percepções relacionadas ao sonho, as diferentes vias cognitivas para a geração do delírio e outras diferenças entre a psicopatologia dos transtornos mentais e os fenômenos relacionados à CRS são discutidos aqui. A interpretação do mundo vivido e da experiência de vigília, e a neurobiologia dos sonhos em sujeitos narcolépticos relacionados à CRS, podem indicar algumas dicas para a questão do gap mente-cérebro que ainda existe na neurologia e na psiquiatria.

Diagnosis and treatment of narcolepsy and parasomnias / 四川精神卫生

The purpose of this article is to discuss the clinical diagnosis and treatment of narcolepsy and parasomnias. In view of high probability and great harm of missed diagnosis and misdiagnosis of narcolepsy， as well as its close association with parasomnias， this study turns the research perspective to the clinical features of narcolepsy， the effects of rapid eye movement （REM） sleep， the comorbidity of narcolepsy and parasomnia （e.g. sleep paralysis， hypnagogic hallucination， and REM-sleep behavior disorder）， and the treatment of narcolepsy.

Comparison between sleep disorders and polysomnographic records of young adults with and without sleep bruxism: a cross-sectional study / Comparación entre trastornos del sueño y registros polisomnográficos de adultos jóvenes con y sin bruxismo del sueño: un estudio transversal

Objectives: To compare sleep disorders and polysomnographic records among a group of young adults with sleep bruxism (SB) and a control group (C). Material and methods: This cross-sectional study considered a consecutive sampling of students from the target population, searching for cases of SB until 20 individuals with and without SB were obtained. Sleep disorders were determined by applying both medical records and physiological records during sleep which were gathered from a polysomnography exam. To establish the difference of the means according to SB, the T-Student or Mann-Whitney U tests were used, depending on the data. A Logistic Regression analysis was also applied. Results: The study found differences (p-value<0.05) in the variables related to the sleep disorder: the possibility of major depressive episode (SB: 30% - C: 5%), degree of nasal airway obstruction (SB: 20% - C: 10%) and in polysomnographic registers: sleep time stage 1 (SB: 9 min - C: 18 min), Rapid Eye Movement (REM) stage (SB: 123 min C: 93 min ), number of periodic movement of the limbs (SB: 84.2 - C: 49.7), bruxism index (SB: 40.2 - C: 10.1) and average of total arousals (SB: 71.9 - C: 57.5). According to the logistic regression model, the Odds Ratio (OR) of SB, in relation to the periodic movement of the limbs and the degree of airway obstruction, it showed a statistically significant relationship (p-value<0.05). Conclusion: There were significant differences recorded in two sleep disorders between the two groups: the degree of airway obstruction and the possibility of having a major depressive episode. Differences were found in sleep and REM time stages, periodic movement of limbs and bruxism events.

Objetivo: Comparar los trastornos del sueño y los registros polisomnográficos entre un grupo de adultos jóvenes con bruxismo del sueño (BS) y un grupo control (C). Material y Métodos: Este estudio transversal consideró una muestra consecutiva de estudiantes de la población objetivo, buscando casos de BS hasta obtener 20 individuos con y sin BS. Los trastornos del sueño se determinaron aplicando registros médicos y fisiológicos durante el sueño que se obtuvieron de un examen de polisomnografía. Para establecer la diferencia de las medias según BS se utilizaron las pruebas t-Student o U de Mann-Whitney, según los datos. También se aplicó un análisis de regresión logística. Resultados: El estudio encontró diferencias (p<0,05) en las variables relacionadas con el trastorno del sueño: posibilidad de episodio depresivo mayor (BS: 30% - C: 5%), grado de obstrucción de la vía aérea nasal (BS: 20% - C: 10%) y en registros polisomnográficos: tiempo de sueño etapa 1 (BS: 9 min - C: 18 min), etapa de Movimiento Ocular Rápido (REM) (SB: 123 min C: 93 min), número de movimientos periódicos del extremidades (BS: 84.2 - C: 49.7), índice de bruxismo (BS: 40.2 - C: 10.1) y promedio de despertares totales (BS: 71.9 - C: 57.5). Según el modelo de regresión logística, el Odds Ratio (OR) del BS, en relación al movimiento periódico de las extremidades y al grado de obstrucción de la vía aérea, mostró una relación estadísticamente significativa (p<0,05). Conclusión: Se registraron diferencias significativas en dos trastornos del sueño entre los dos grupos: el grado de obstrucción de la vía aérea y la posibilidad de tener un episodio depresivo mayor. Se encontraron diferencias en las etapas de sueño y tiempo REM, movimiento periódico de extremidades y eventos de bruxismo.

Unveiling sleep mysteries: neurobiology of dreaming / Revelando mistérios do sono: neurobiologia dos sonhos

Dreaming is the result of the mental activity of rapid eye movement (REM) sleep stage, and less commonly of non-REM sleep. Dreams offer unique insights into the patients' brains, minds, and emotions. Based on neurophysiological and neuroimaging studies, the biological core of dreaming stands on some brain areas activated or inactivated. Dream abnormalities in neurological disorders include a reduction / cessation of dreaming, an increase in dream frequency, changes in dream contents and accompaniments, and the occurrence of dreamlike experiences (hallucinations) mainly during the wake-sleep/sleep-wake transitions. Dream changes can be associated with several neurological conditions, and the unfolding of biological knowledge about dream experiences can also have significance in clinical practice. Regarding the dream importance in clinical neurological management, the aim of this paper encompasses a summary of sleep stages, dreams neurobiology including brain areas involved in the dreams, memory, and dreams, besides Dreams in the aging people and neurodegenerative disorders.

Sonhar é o resultado da atividade mental do estágio do sono de movimento rápido dos olhos (REM) e, menos comumente, do sono não-REM. Os sonhos oferecem informações únicas sobre o cérebro, a mente e as emoções dos pacientes. Com base em estudos neurofisiológicos e de neuroimagem, o núcleo biológico do sonho está em algumas áreas do cérebro ativadas ou inativadas. As anormalidades do sonho nos distúrbios neurológicos incluem uma redução / cessação do sonho, um aumento na frequência do sonho, alterações nos conteúdos e acompanhamentos do sonho e a ocorrência de experiências semelhantes ao sonho (alucinações), principalmente durante as transições de vigília-sono / sono-vigília. As mudanças do sonho podem estar associadas a várias condições neurológicas, e o desenvolvimento do conhecimento biológico sobre as experiências do sonho também pode ter significado na prática clínica. Com relação à importância do sonho no manejo neurológico clínico, o objetivo deste artigo é resumir os estágios do sono, a neurobiologia dos sonhos, incluindo as áreas do cérebro envolvidas nos sonhos, a memória e os sonhos, além dos sonhos nos idosos e nos distúrbios neurodegenerativos.

Prevalence of Sleep Bruxism and Association with Oral Health Conditions in Schoolchildren in a Municipality in Southern Brazil

Abstract Objective: To estimate the prevalence of sleep bruxism and its association with oral health conditions in schoolchildren. Material and Methods: Cross-sectional study carried out in public schools of Tubarão, SC, Brazil with students aged 10 to 15 years. The oral examination was performed in classrooms by dental surgeons, using the WHO criteria. Data on malocclusions, caries and dental trauma, fluorosis, bleeding gums and the presence of dental calculus were collected. For the diagnosis of bruxism, the criterion of the American Academy of Sleep Medicine was adopted. The chi-square test was used to assess the association between sleep bruxism and oral health conditions. Prevalence ratios and confidence intervals were estimated by Poisson regression with robust estimator. Results: A total of 389 students were examined. The prevalence of sleep bruxism was 22.0%. Schoolchildren with malocclusion, increased overjet and dental calculus showed a statistically higher and independent prevalence of 9.0% (p=0.003), 6.0% (p=0.006) and 19.0% (p<0.001), respectively. Conclusion: Prevalence of sleep bruxism was 22% in the study population and was associated with malocclusions, particularly increased overjet, and the presence of dental calculus.

Trastornos Paroxísticos No Epilépticos En Pre-Escolares / Non-epileptic paroxysmal disorders in pre-school children

Los trastornos paroxísticos no epilépticos son comunes en la población de niños pre-escolares. Estas condiciones incluyen una variedad de eventos cuyas manifestaciones y fisiopatología son muy distintas. Por esa razón, el diagnóstico puede representar un difícil reto. En algunas ocasiones, estudios como el EEG o la polisomnografía pueden ayudar a clarificar el diagnóstico y descartar un trastorno epiléptico. Sin embargo, la historia clínica y el examen físico suelen ser suficientes para llegar al diagnóstico correcto. En este artículo, presentamos información sobre los trastornos paroxísticos no epilépticos más comunes en la población de niños pre-escolares, incluyendo: tics, discinesias, eventos relacionados al sueño, etc. Además, discutimos estrategias para el diagnóstico y opciones de tratamiento.

Paroxysmal events are commonly encountered in toddlers. These events include a variety of conditions with different manifestations and pathophysiology. For that reason, the diagnosis of these events can be challenging. In some instances, studies such as EEG and polysomnogram may be useful to differentiate between epileptic and non-epileptic events. In the majority of cases, a complete clinical history is enough to make an appropriate diagnosis. In this article, we review some of the most common paroxysmal non-epileptic events affecting toddlers, such as: tics, dyskinesias, sleep related events, etc. We also discuss diagnostic strategies and treatment options.

Alteraciones del sueño y bruxismo / Sleep alterations and bruxism

El sueño es un requerimiento biológico para la vida, sus alteraciones o su ausencia pueden disminuir la calidad de vida, el estado anímico y funcional, afectando seriamente la salud. Un sueño placentero y reparador implica cursar por facetas de profundidad diversa y actividad neuronal compleja. En este artículo se intentan explicar las generalidades del proceso del sueño y algunos de sus trastornos que lo relacionan con aumento de la actividad de los músculos masticatorios (bruxismo). Son presentados aspectos clínicos y neuronales que inducen a un incremento de microdespertares como alteración del sueño, estimulando bruxismo nocturno y bruxismo asociado a apnea nocturna. Son discutidas las posibles relaciones bidireccionales entre bruxismo diurno y nocturno secundarias a modifi caciones en la cantidad y calidad del proceso del sueño. De la misma manera, son sugeridas algunas consideraciones semiológicas y nosológicas para el mejor manejo y control del bruxismo asociado a las alteraciones del sueño, bajo el diagnóstico, atención y supervisión de equipos de atención multi- e interdisciplinarios (AU)

Sleep is a biological requirement for life, its alterations or privation thereof may reduce a person's quality of life, his or her state of mind and physical functions, which signifi cantly aff ects their health. Pleasant and repairing sleep implies going through variable deepness sleep stages, and a complex neuronal activity. This article intends to explain the generalities of the sleep process and certain disorders, particularly those in connection with the activity of the mastication muscles (bruxism). Clinical and neuronal aspects are presented inducing an increase in micro-awakenings such as sleep alterations stimulating nocturnal and bruxism associated with sleep apnea. Bidirectional connections between diurnal and nocturnal bruxism are argued as secondary to changes in the amount and quality of the sleep process. In the same manner, certain considerations associated to semiology and nosology of the diverse bruxism manifestations are considered for the better handling and control of the bruxism associated with sleep alterations under the diagnosis attention and supervision of multi- and interdisciplinary teams (AU)

Transtornos do sono: atualização (parte2/2) / Sleep disorders: up to date (2/2)

Este artigo (2/2) compõe uma revisão sobre fundamentos do sono e transtornos do sono (TS), sendo aqui considerados: 1-Incapacidade de dormir na hora desejada-atraso de fase, avanço de fase, ''jet lag'', ritmo sono-vigília irregular, sono/vigília de livre curso, transtornos dos trabalhadores em turnos; 2-Movimentos ou comportamentos anormais durante o sono. Este segundo grupo é aqui subdividido em: A1-Parassonias relacionadas ao sono NREM (Non-rapid eye movement) ­ despertar confusional, sonambulismo, terror noturno, síndrome da cabeça explosiva, alucinações relacionadas ao sono, enurese noturna e parassonias causadas por doenças e medicações; A2-Parassonias relacionadas ao sono REM (rapid eye movement) - transtorno comportamental do sono REM, pesadelos, paralisias recorrentes isoladas do sono, promulgação sono ''dream enactment behavior"; B-Transtornos do movimento relacionados ao sono-bruxismo, síndrome das pernas inquietas, movimentos periódicos das pernas, câimbras do sono, movimentos rítmicos relacionados ao sono, mioclonias proprioespinhais do início do sono, movimentos relacionados à medicação, mioclonias em doenças sistêmicas e mioclonias benignas do sono em bebês.(AU)

This is the second part (2/2) of an article that intends to review major topics regarding sleep fundamentals and sleep disorders (SD), now considering: 1-Circadian rhythm disorders-delayed onset sleep phase disorder, advanced onset sleep phase disorder, jet lag, irregular sleep-wake rhythm, free-running type, shift work type; 2-Abnormal movements or behaviours during sleep. This second category is divided in two groups: A1-NREM (Non-rapid eye movement) parasomnias ­ confusional awakening, sleepwalking, night terrors, explosive head syndrome, sleep-related hallucinations, nocturnal enuresis and parasomnias related to diseases or medications; A2-REM (Rapid eye movement) parasomnias-REM sleep behaviour disorder, nightmares, recurrent isolated sleep paralysis, dream enactment behaviour; B-Sleep related movement disorders-bruxism, restless legs syndrome, periodical limb movement disorders, nocturnal leg cramps, sleep related rhythmic movement disorder, propriospinal myoclonus, movements related to medication use, myoclonus related to systemic diseases and benign myoclonus of sleep.(AU)

Trastornos del sueño: ¿qué son y cuáles son sus consecuencias? / Sleep disorders: what are they and what are their consequences?

Resumen Desde hace décadas, el ritmo de la vida moderna ha generado múltiples cambios en nuestra conducta y hábitos. Especialmente, los hábitos alimenticios y de ejercicio se han modificado de manera importante, pero uno de los cambios más evidentes ha ocurrido en el sueño. En la actualidad, el tiempo dedicado a este ha disminuido drásticamente, pero no solo se trata de la cantidad, sino también de la calidad del sueño que se ha visto afectada de forma relevante en todos los grupos de edad, en especial en la población joven. Desde hace algunos años se sabe que el sueño juega un papel muy importante para el óptimo funcionamiento físico y mental del ser humano, pero solo recientemente hemos comenzado a conocer y entender las consecuencias que una mala calidad del sueño puede tener sobre la salud a mediano y largo plazo. En esta revisión se incluyen los trastornos del sueño más comunes o representativos, los estudios que se utilizan para su diagnóstico y, finalmente, se da un panorama general sobre las consecuencias de estos trastornos en la salud a largo plazo.

Abstract For decades, the rhythm of modern life has generated multiple changes in our behavior and habits. Especially, the way we eat and our exercise habits have changed significantly but one of the most evident effects is regarding sleep behavior. Nowadays, sleep has decreased dramatically, but not only in quantity. The quality of sleep has been affected in a significant way on all age groups, especially in the young population. For several years, we've known that sleep plays an essential role for an optimal physical and mental performance in the human being. Only recently we've begun to discover and understand the consequences that sleep disturbances can have on health in the long term. In the present article we include a general review of the most common or representative sleep disorders, the studies used for their diagnosis and finally we made an overview of the consequences of these disorders on health.

Parasomnia as an Initial Presentation of Narcolepsy

Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. Only a few studies have focused on non-rapid eye movement (NREM) and REM parasomnias in narcolepsy. We report a narcolepsy without cataplexy patient presenting parasomnia as an initial symptom. A 18-year-old boy was admitted to hospital for abnormal behavior of sitting up during sleep over 2 years. He had a symptom of lethargy without cataplexy and subjective excessive daytime sleepiness, but his family found him often asleep during daytime. He underwent 3 times of polysomnography (PSG) including 1 multiple sleep latency test (MSLT) after the last PSG. The last PSG showed 1 episode of abrupt sitting. Three sleep REM onset period was observed in MSLT which was not detect in PSG. Parasomnia as an initial symptom of narcolepsy is a rare clinical entity. The MSLT may be useful in the evaluation of patients with parasomnia and unexplained hypersomnia.

Research status of sleep disorders in children / 中华实用儿科临床杂志

Good sleep plays a key role in children's physical growth,mental development and personality matu-rity.Sleep disorders are common and most easily neglected problems in children.Early sleep problems of children can sustain from childhood to adulthood,not only have relevance to the children's physical,cognitive and behavioral development,but also to be the high risk factors of the adult obesity,hypertension,depression,anxiety and other chronic diseases.A deep study of sleep disorders in children is very important for the protection of children's physical and men-tal health.This article reviews the etiology,classification,diagnosis and treatment of sleep disorders in children.

Parasomnias en Pediatría: Una visión clínica / Parasomnia in Pediatrics: A clinical view

Resumen Un motivo frecuente de consulta, en la práctica pediátrica, son los trastornos del sueño que pueden afectar hasta al 30% de la población infantil, con repercusiones negativas tanto en el aspecto cognitivo como conductual y físico (Meijer et al. 2000). Dentro de estas manifestaciones se encuadran las denominadas parasomnias que son fenómenos o manifestaciones anormales, molestas o displacenteras, que se presentan durante las etapas del sueño y se pueden acompañar de cambios siológicos cardiovasculares y/o motores. Constituyen un tercio de todos los trastornos del sueño con causas relacionadas al neurodesarrollo o a patrones familiares y desencadenantes similares (medicamentos, ebre, trastornos respiratorios y stress). Particularmente cuando coexisten con trastornos neurológicos o del neurodesarrollo, pudiendo confundirse con otras patologías tal como la epilepsia, lo que conlleva un desafío diagnóstico para el Neuropediatra. Corresponden a la tercera causa de alteraciones de sueño en la infancia con origen tanto en factores genéticos con patrones ligados a la herencia y otras se asociadas al neurodesarrollo del SNC. Se las clasifica, según en qué etapa del sueño se presentan en: Trastornos del Alertamiento, Trastornos de la Transición sueño/vigilia, Trastornos asociados al sueño REM y otras parasomnias. Existen cada vez más evidencias acerca de los efectos de la inadecuada higiene se sueño y problemas del neurodesarrollo que nos obligan a echar más luz sobre esta problemática para corregir y evitar problemas futuros asociadas a ello, siendo el propósito de este trabajo el realizar una revisión sobre los conocimientos actuales sobre el tema en cuestión.

Abstract A frequent chief complaint in pediatric practice are sleep disorders, which may affect up to 30% of the pediatric population. These may have harmful e ects on cognition, behavior and physical development (Meijer et al. 2000). These sleep disorders include parasomnias, unpleasant abnormal phenomena that occur during sleep and may be accompanied by cardiovascular and/or motor manifestations. These make up one third of all sleep disorders caused by disturbances of neural development or family patterns, with similar triggering factors, such as medication, fever, respiratory disorders and stress. When they coincide with neurological or neural development disorders they may be confused with other disease conditions, such as epilepsy, and be a diagnostic challenge for the pediatric neurologist. Parasomnias are the third cause of sleep disorders of childhood, originating in both hereditary genetic factors and others pertaining to neural development of the CNS. They are classified according to the stage of sleep they affect: disorders of waking, disorders of the sleep/waking transition, REM sleep associated disorders and other parasomnias. A growing body of evidence points to the effects of inadequate sleep hygiene and disorders of neural development, requiring, therefore, further research. This paper reviews current knowledge on the subject.

Indicadores da prática de atividade física e da qualidade do sono em escolares adolescentes / Physical activity level and sleep patterns among scholar adolescents / Indicadores de la práctica de la actividad física y de la calidad del sueño de los adolescentes escolares

Resumo O estudo objetivou investigar indicadores da prática regular de atividade física (AF) e da qualidade do sono em escolares adolescentes em Pelotas (RS). A amostra de conveniência foi constituída de 85 alunos de ambos os sexos, entre 14 e 18 anos, que cursavam o ensino médio. Foi usado um questionário para medir nível de AF, horários de acordar e dormir, qualidade e tempo de sono e presença de parassônias. Os resultados indicaram que os rapazes foram mais ativos e que o tempo médio de sono dos adolescentes variou por volta de 7h30 m de segunda a quinta-feira, de 5h30 m às sextas-feiras e mais de 10 h nos fins de semana e feriados, independentemente do nível de AF. Concluiu-se que os hábitos de sono dos adolescentes foram desregrados e fora do padrão.

Abstract To investigate indicators of sleep quality and regular physical activity (PA) practice in adolescents from Pelotas/RS. The sample consisted of 85 students among 14 to 18-years-old attending high school. A questionnaire was used to measure PA levels, times of waking and sleep, quality and sleep time and presence of parasomnias. Results indicated that boys were more active and that the average sleep duration of adolescents was around 7,5 h Monday through Thursday, from 5,5 h on Fridays and more than 10 hours to weekends and holidays, regardless of the level of PA. It was concluded that the sleep habits of teenagers were unruly and nonstandard.

Resumen Este estudio tuvo como objetivo relacionar los indicadores de la calidad del sueño y la práctica regular de la actividad física (AF) en adolescentes escolares de la ciudad de Pelotas/RS. El muestreo de conveniencia consistió en 85 estudiantes de ambos sexos, entre 14 y 18 años, que asisten a la escuela secundaria. Se utilizó un cuestionario para medir los niveles de AF, las horas de vigilia y del sueño, la calidad y el tiempo de sueño, y la presencia de parasomnias. Los resultados indicaron que los niños eran más activos y que la duración media de sueño de los adolescentes fue de unas 7 horas y media de lunes a jueves, de unas 5 horas y media el viernes, y de más de 10 horas los fines de semana y días festivos, independientemente del nivel de AF. Se concluyó que los hábitos de sueño de los adolescentes no seguían ninguna disciplina y no eran de tipo estándar.

Intake of stimulant foods is associated with development of parasomnias in children / Ingestão de alimentos estimulantes está associada ao desenvolvimento de parassonias em crianças

ABSTRACT Objective To verify if nighttime feeding habits can influence parasomnia in children. Method Seven private and four public Elementary Schools took part in the study. A total of 595 Sleep Disturbance Scale for Children were distributed to the parents of children aged from 7 to 8 years. Data of dietary recall, starting time to school, physical activity, and nutritional status were studied. Results Of the 226 questionnaires completed, 92 (41%) reported parasomnia. Girls had 2.3 times more the chance to parasomnia than boys. Children who consumed stimulant foods had 2.6 times more chance to have parasomnia than those of children who consumed non-stimulant foods. There were no difference between parasomnia and no-parasomnia groups in food type (p = 0.78) or timing of last meal before bedtime (p = 0.50). Conclusion Our findings suggest that intake of stimulant foods is associated with development of parasomnia in children.

RESUMO Objetivo Verificar se hábitos de alimentação noturna influenciam parassonias em crianças. Método Sete escolas privadas e quatro públicas, de Ensino Fundamental, fizeram parte do estudo. Um total de 595 Escalas de Distúrbio do Sono para Crianças foram distribuídas para os pais de crianças entre 7 e 8 anos. Dados de recordatório alimentar, período escolar, atividade física e estado nutricional foram estudados. Resultados Dos 226 questionários preenchidos, 92 (41%) relataram presença de parassonias. Meninas tiveram 2,3 vezes mais chance de parassonias e crianças que consumiram alimentos estimulantes tiveram 2,6 vezes mais chance de parassonias em relação àquelas que consumiram alimentos não estimulantes. Não houve diferença entre os grupos em relação ao tipo de alimento (p = 0,78) ou horário da última refeição antes de ir para a cama (p = 0,50). Conclusão Nossos achados sugerem que a ingestão de alimentos estimulantes está associada com o desenvolvimento de parassonias em crianças.

Sleepwalking Triggered by Hypoglycemia

Sleepwalking is a rare parasomnia in the elderly. We report two cases of the patients who presented complex motor behaviors during sleep triggered by hypoglycemia. A 76-year-old male patient with diabetes mellitus presented to the sleep clinic for recurrent sleepwalking with amnesia. Night polysomnogram showed REM sleep without atonia with sleep talking and distal arm movements. While taking clonazepam, he had a few more episodes of sleepwalking. The last episode finally revealed severe hypoglycemia when he was found very far from his house. The second patient, a 67-year-old male showed four episodes of nocturnal confusion and sleepwalking lasting 20 minutes during sleep. His blood glucose and HbA1c were low. After decrease of the dose of oral hypoglycemic agent, no more recurrent sleepwalking occurred. Our cases showed hypoglycemia can induce sleepwalking in the older adults, rather than decreased mentality. Metabolic workup should perform for evaluation of sleepwalking, especially in the elderly.

Effect of rapid eye movement sleep deprivation on expression of neuropeptide s in dorsomedial nucleus of rat hypothalamus / 第二军医大学学报

Objective To observe the changes of the neuropeptide S (NPS) expression in dorsomedial nucleus of rat hypothalamus after rapid eye movement (REM) sleep deprivation. Methods Totally 24 adult male rats were evenly randomized into 3 groups: normal control group (CC), tank control group (TC) and REM sleep deprivation group (SD). Modified multiple platform method (MMPM) was used to establish REM sleep deprivation model in rats. Immunohistochemistry and hybridization in situ were applied to examine the expression of NPS protein and mRNA in the rat hypothalamus. Results There was no significant differences in the expression of NPS protein or mRNA in rats hypothalamus between CC group and TC group. After REM sleep deprivation, NPS protein and mRNA positive cells in rats hypothalamus in SD group were (27. 86 ± 2. 47) and (25. 75±2. 12), respectively, which were significantly more than those in CC group and TC group (16. 75 ± 2. 12 and 19. 63 ± 1. 85 in CC group, 18. 60±1.60 and 18. 50±1.69 in TC group; P

Wilson?s disease presenting as rapid eye movement sleep behavior disorder: a possible window to early treatment / Doença de Wilson apresentando-se com transtorno comportamental do sono REM: uma janela possível para instituição de tratamento precoce

Objective To describe characteristics of REM sleep behavior disorder in Wilson’s disease. Method Questionnaire-based interviews (patients and relatives), neurological examinations, two-week prospective dream-diary, video-polysomnography, transcranial sonography, MRI. Results Four Wilson’s disease cases with REM sleep behavior disorder were described; three had REM sleep behavior disorder as initial symptom. All showed mesencephalic tegmental/tectal sonographic hyperechogenicities and two presented ponto-mesencephalic tegmental MRI hyperintensities. Conclusion This first description of REM sleep behavior disorder in Wilson’s disease in literature documents REM sleep behavior disorder as a possible presenting symptom of Wilson’s disease and adds further evidence to the parallelism of Parkinson’s disease and Wilson’s disease in phenotype and brainstem topography, which ought to be further studied. REM sleep behavior disorder has prognostic relevance for neurodegeneration in α-synucleinopathies. In Wilson’s disease, usefulness of early diagnosis and treatment are already well established. REM sleep behavior disorder in Wilson’s disease offers a possible theoretical model for potential early treatment in this extrapyramidal and brainstem paradigm syndrome, previewing the possibility of neuroprotective treatment for REM sleep behavior disorder in “pre-clinical” Parkinson’s disease. .

Objetivo Descrever características do transtorno comportamental do sono REM (TCSR) na doença de Wilson (DW). Método Aplicação de entrevistas, vídeo-polissonografia, sonografia transcraniana (STC), ressonância magnética (RM), diário de sonhos. Resultados Descrevemos quatro casos de DW com TCSR. Três apresentaram o TCSR como primeira manifestação. Todos mostraram hiperecogenicidades mesencefálicas na STC, dois apresentaram hiperintensidades ponto-mesencefálicas na RM. Conclusão Esta é a primeira descrição do TCSR na DW. Relatamos o TCSR como um sintoma inicial da DW. Acrescentamos prova para o paralelismo entre a doença de Parkinson e DW, com relação aos fenótipos e localização das lesões cerebrais. Nas alfa-sinucleinopatias, o TCSR tem relevância prognóstica quanto à neurodegeneração. Na DW, já conhecemos a importância de diagnóstico e tratamento precoces. O TCSR na DW oferece um modelo para antecipar o tratamento desta síndrome de acometimento dos núcleos basais e tronco, vislumbrando a possibilidade de tratamento neuroprotetor para a fase “pré-clínica” da DP. .