A systematic review and meta-analysis of the cyclic alternating pattern across the lifespan.

BACKGROUND: Cyclic alternating pattern (CAP) is the electroencephalogram (EEG) pattern described as a marker of sleep instability and assessed by NREM transient episodes in sleep EEG. It has been associated with brain maturation. The aim of this review was to evaluate the normative data of CAP parameters according to the aging process in healthy subjects through a systematic review and meta-analysis. METHODS: Two authors independently searched databases using PRISMA guidelines. Discrepancies were reconciled by a third reviewer. Subgroup analysis and tests for heterogeneity were conducted. RESULTS: Of 286 studies, 10 submitted a total of 168 healthy individuals to CAP analysis. Scoring of CAP can begin at 3 months of life, when K-complexes, delta bursts, or spindles can be recognized. Rate of CAP increased with age, mainly during the first 2 years of life, then decreased in adolescence, and increased in the elderly. The A1 CAP subtype and CAP rate were high in school-aged children during slow-wave sleep (SWS). A1 CAP subtypes were significantly more numerous in adolescents compared with other groups, while the elderly showed the highest amounts of A2 and A3 CAP subtypes. Our meta-analysis registered the lowest CAP rate in infants younger than 2 years old and the highest in the elderly. CONCLUSIONS: This review summarized the normative data of CAP in NREM sleep during the aging process. The CAP rate increased with age and sleep depth, especially during SWS. Parameters of CAP may reflect gender hormonal effects and neuroplasticity. More reports on CAP subtypes are needed for their reference values establishment.

Obstructive sleep apnea in patients with chronic rhinosinusitis with nasal polyps: a cross-sectional study.

INTRODUCTION: Adults with chronic rhinosinusitis with nasal polyps (CRSwNP) often suffer from sleep disruption and sleep apnea. As the apneic profile of CRSwNP may differ from obstructive sleep apnea (OSA) classic patients without nasal polyps (NP), it may prove useful to define a new profile for OSA screening in these patients. The aim of the current study was to compare baseline characteristics and apneic profile of OSA patients with CRSwNP to OSA patients without NP. MATERIALS AND METHODS: Thirty-one apneic patients with CRSwNP and 62 apneic cases without NP were included in our study. Both groups underwent nasal endoscopy, Epworth Sleepiness Scale (ESS) evaluation, and overnight polysomnography (PSG). We additionally accessed anthropometric characteristics such as snoring, tiredness, observed apnea, high blood pressure, body mass index (BMI), age, neck circumference, male gender, and OSA risk via the STOP-Bang questionnaire. RESULTS: Although the patients were matched according to age and gender, the median BMI and STOP-Bang score were significantly higher in patients with OSA than in those with OSA and CRSwNP. Notably, the median ESS showed low somnolence and a low median apnea-hypopnea index in patients with CRSwNP, despite the fact that the lowest median oxygen saturation was not significantly different between groups. CONCLUSIONS: Anthropometric characteristics in individuals with apnea caused by CRSwNP were significantly different from those in individuals with typical. This finding will improve screening and treatment of apneic patients CRSwNP.

Vocal quality of patients treated for laryngeal tuberculosis, before and after speech therapy.

OBJECTIVES: To evaluate dysphonia in patients treated for laryngeal tuberculosis, and to assess the effect of speech therapy on patients' vocal quality. MATERIALS AND METHODS: Seven of 23 patients with a confirmed diagnosis of laryngeal tuberculosis, treated at the Evandro Chagas Institute of Clinical Research, Oswaldo Cruz Foundation, underwent speech therapy for six months. These seven patients were evaluated by videolaryngoscopy and vocal acoustic analysis, before, during and after a course of speech therapy. RESULTS: The 23 patients with laryngeal tuberculosis comprised five women and 18 men, with ages ranging from 25 to 83 years (mean 41.3 years). Dysphonia was present in 91.3 per cent of these laryngeal tuberculosis patients, being present as the first symptom in 82.6 per cent. In laryngeal tuberculosis patients with dysphonia, laryngeal tuberculosis treatment resulted in dysphonia resolution in only 15.8 per cent. After speech therapy, dysphonia patients had better vocal quality, as demonstrated by statistical analysis of jitter, shimmer, fundamental frequency variability, maximum phonation time, and the ratio between maximum phonation time for voiceless and voiced fricative sounds. CONCLUSIONS: Following treatment of laryngeal tuberculosis, the incidence of dysphonia was very high. Speech therapy improved patients' vocal quality.

Risk factors associated with dizziness during treatment of mucosal leishmaniasis with meglumine antimoniate: 16-year retrospective study of cases from Rio de Janeiro, Brazil.

OBJECTIVE: To evaluate dizziness in patients receiving meglumine antimoniate for the treatment of mucosal leishmaniasis. MATERIALS AND METHODS: We retrospectively studied 127 patients treated at the Laboratory of Leishmaniasis Surveillance, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, between 1 January 1989 and 31 December 2004. RESULTS: A low dose of meglumine antimoniate (5 mg/kg/day) was used in 86.6 per cent of patients; a dose of 10 mg/kg/day or higher was used in 13.4 per cent of patients. Dizziness was reported by 4.7 per cent of patients. The adjusted odds ratios were 7.37 for dizziness in female patients, 4.9 for dizziness in patients aged 60 years or older, and 7.77 for dizziness in the presence of elevated serum lipase. CONCLUSION: We suggest that dizziness may be a side effect of meglumine antimoniate, particularly in elderly individuals, in females and in patients with elevated serum lipase.