Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome.

The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine.

Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome / Consenso Brasileiro para as diretrizes de diagnóstico e tratamento da síndrome das pernas inquietas

The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine.

O Consenso em síndrome das pernas inquietas contou com a participação de neurologistas de vários estados brasileiros, os quais incansavelmente revisaram a literatura dos últimos anos em busca de evidências, tanto no que se refere ao diagnóstico como ao tratamento, de acordo com a Classificação do Centro de Oxford para Medicina Baseada em Evidências.

Polysomnographic sleep aspects in liver cirrhosis: a case control study.

AIM: To study sleep aspects and parameters in cirrhotic patients and assess the role of liver dysfunction severity in polysomnographic results. METHODS: This was a case-control study. Patients with a diagnosis of liver cirrhosis were consecutively enrolled in the study. Clinical examinations and laboratory liver tests were performed in all patients, and disease severity was assessed using the Child-Pugh score. The control group consisted of age- and gender-matched healthy volunteers. All individuals answered a questionnaire about habits, behaviors, and complaints related to sleep and were submitted to polysomnography. Sleep parameters were compared between the two groups, and separate analyses were performed among classes of Child-Pugh classification in the cirrhotic group. RESULTS: Forty-two cirrhotic patients and forty-two controls were enrolled. Compared to the control group, the cirrhotic group exhibited lower sleep efficiency (mean ± SD: 73.89% ± 14.99% vs 84.43% ± 8.55%, P < 0.01), increased latency (151.27 ± 93.24 min vs 90.62 ± 54.74 min, P < 0.01) and a lower percentage of rapid eye movement (REM) sleep (14.04% ± 5.64% vs 20.71% ± 6.77%, P < 0.05) as well as a higher frequency of periodic limb movements (10.56 ± 2.85/h vs 2.79 ± 0.61/h, P < 0.01). The comparison of sleep parameters among Child A, B and C cirrhotic patients revealed a significant reduction of REM sleep stage occurrence in individuals with severe liver disease (Child C patients) compared to Child A/B patients (polysomnography percentage of REM sleep stage of patients Child A: 16.1% ± 1.2%; Child B: 14.9% ± 1.2%; Child C: 8.6% ± 1.6%, P < 0.05). CONCLUSION: Cirrhosis was associated with shorter sleep time, reduced sleep efficiency, increased sleep latency, increased REM latency and reduced REM sleep. Additionally, disease severity influences sleep parameters.

Oxidative stress and quality of life in elderly patients with obstructive sleep apnea syndrome: are there differences after six months of Continuous Positive Airway Pressure treatment?

OBJECTIVES: This study evaluated the effect of Continuous Positive Airway Pressure treatment on oxidative stress parameters and the quality of life of elderly patients with obstructive sleep apnea syndrome. METHODS: In total, 30 obstructive sleep apnea syndrome patients and 27 subjects without obstructive sleep apnea syndrome were included in this study. Both groups underwent quality of life and oxidative stress evaluations at baseline and after six months. Polysomnography was performed in both groups at baseline and a second time in the obstructive sleep apnea syndrome group after six months of Continuous Positive Airway Pressure treatment. All of the variables were compared between the control and obstructive sleep apnea syndrome groups in this prospective case-control study. RESULTS: The baseline concentrations of the antioxidant enzyme catalase were higher in the obstructive sleep apnea syndrome group than the control group. After Continuous Positive Airway Pressure treatment, the obstructive sleep apnea syndrome group exhibited a reduction in the level of oxidative stress, as indicated by a decrease in the level of lipid peroxidation measured by the malondialdehyde (MDA) concentration [pre: 2.7 nmol malondialdehyde/mL (95% 1.6-3.7) vs. post: 1.3 nmol MDA/mL (0.7-1.9), p<0.01]. Additionally, improvements were observed in two domains covered by the SF-36 questionnaire: functional capacity [pre: 77.4 (69.2-85.5) vs. post: 83.4 (76.9-89.9), p = 0.002] and pain [pre: 65.4 (52.8-78.1) vs. post: 77.8 (67.2-88.3), p = 0.004]. CONCLUSION: Our study demonstrated that the use of Continuous Positive Airway Pressure to treat obstructive sleep apnea syndrome in elderly patients reduced oxidative stress and improved the quality of life.

Oxidative stress and quality of life in elderly patients with obstructive sleep apnea syndrome: are there differences after six months of Continuous Positive Airway Pressure treatment?

OBJECTIVES: This study evaluated the effect of Continuous Positive Airway Pressure treatment on oxidative stress parameters and the quality of life of elderly patients with obstructive sleep apnea syndrome. METHODS: In total, 30 obstructive sleep apnea syndrome patients and 27 subjects without obstructive sleep apnea syndrome were included in this study. Both groups underwent quality of life and oxidative stress evaluations at baseline and after six months. Polysomnography was performed in both groups at baseline and a second time in the obstructive sleep apnea syndrome group after six months of Continuous Positive Airway Pressure treatment. All of the variables were compared between the control and obstructive sleep apnea syndrome groups in this prospective case-control study. RESULTS: The baseline concentrations of the antioxidant enzyme catalase were higher in the obstructive sleep apnea syndrome group than the control group. After Continuous Positive Airway Pressure treatment, the obstructive sleep apnea syndrome group exhibited a reduction in the level of oxidative stress, as indicated by a decrease in the level of lipid peroxidation measured by the malondialdehyde (MDA) concentration [pre: 2.7 nmol malondialdehyde/mL (95% 1.6-3.7) vs. post: 1.3 nmol MDA/mL (0.7-1.9), p<0.01]. Additionally, improvements were observed in two domains covered by the SF-36 questionnaire: functional capacity [pre: 77.4 (69.2-85.5) vs. post: 83.4 (76.9-89.9), p = 0.002] and pain [pre: 65.4 (52.8-78.1) vs. post: 77.8 (67.2-88.3), p = 0.004]. CONCLUSION: Our study demonstrated that the use of Continuous Positive Airway Pressure to treat obstructive sleep apnea syndrome in elderly patients reduced oxidative stress and improved the quality of life.

Nocturnal awakening with headache and its relationship with sleep disorders in a population-based sample of adult inhabitants of Sao Paulo City, Brazil.

Our aim was to estimate the prevalence of nocturnal awakening with headache (NAH) in the population of São Paulo City according to gender, age (20-80 years old) and socioeconomic classes and its relationship to sleep disorders, sleep parameters, anxiety, depression, fatigue, life quality and obesity. We used a population-based survey with a representative three-stage cluster sample. Questionnaires and scales were applied face-to-face, and polysomnography was performed in 1101 volunteers, aged 42 ± 14 years, 55% women. The complaint of NAH occurring at least once a week had a prevalence of 8.4%, mostly in women, obese subjects and those aged 50-59 years-old. We observed associations of NAH with insomnia, restless leg syndrome (RLS), nightmares and bruxism, but not obstructive sleep apnea syndrome. In a logistics regression model, risk factors for NAH were female gender, odds ratio (OR) (95% confidence interval [CI]) 4.5 (2.8-7.3); obesity, OR 1.9 (1.1-3.3); age between 50 and 59 years, OR 2.4 (1.2-4.7); severe anxiety, OR 8.1 (3.6-18.1); RLS, 2.7 (1.2-5.6); and nightmares, 2.2 (1.3-3.7). Our study shows that NAH was highly prevalent in the population of São Paulo and suggests that this phenomenon has specific characteristics with specific risk factors: obesity, RLS and nightmares.

[Minimal hepatic encephalopathy detection by neuropsychological and neurophysiological methods and the role of ammonia for its diagnosis]. / Detecção de encefalopatia hepática mínima através de testes neuropsicológicos e neurofisiológicos e o papel da amônia no seu diagnóstico.

CONTEXT: Minimal hepatic encephalopathy has been systematically investigated in cirrhotic patients. Although, there are controversies regarding the best methods as well as the role of ammonia for its diagnosis. OBJECTIVE: To evaluate the frequency of minimal hepatic encephalopathy diagnosed by neuropsychological and neurophysiological methods in cirrhotic patients, as well as possible associated risk factors for this condition, including the role of arterial ammonia concentrations for its diagnosis. METHODS: Cirrhotic patients were evaluated by the number connection test parts A and B (NCT-A and NCT-B), and auditory evoked-related potentials (P300). Minimal hepatic encephalopathy was diagnosed by the presence of abnormal P300 and in unless one of the performed neuropsychologic tests. Arterial ammonia concentration, scholarity and cirrhosis severity accessed by Child-Pugh classification were evaluated in all. RESULTS: Forty-eight cirrhotic patients were evaluated, with median age 50 +/- 8 years old, 79% male. The main etiologies were alcoholic and viral. The P300 was abnormal in 75% of cases, while NCT-A and NCT-B were abnormal in 58% and 65%, respectively. The NCT-B results were influenced by scholarity. The minimal hepatic encephalopathy frequency was 50%. Arterial ammonia concentration was not significantly increased in minimal hepatic encephalopathy diagnosed patients (195 +/- 152 mmol/L versus 148 +/- 146 mmol/L; P>0,05). There was no difference between groups with or without minimal hepatic encephalopathy in the other studied variables. CONCLUSION: Minimal hepatic encephalopathy is a frequent condition in cirrhotic patients. The arterial ammonia concentration does not play a major role in its diagnosis.

Detecção de encefalopatia hepática mínima através de testes neuropsicológicos e neurofisiológicos e o papel da amônia no seu diagnóstico / Minimal hepatic encephalopathy detection by neuropsychological and neurophysiological methods and the role of ammonia for its diagnosis

CONTEXTO: A encefalopatia hepática mínima vem sendo sistematicamente investigada em pacientes com cirrose hepática. Entretanto, existem controvérsias quanto aos melhores métodos, bem como o papel da amônia para seu diagnóstico. OBJETIVO: Avaliar a frequência de encefalopatia hepática mínima diagnosticada através de testes neuropsicológicos e neurofisiológicos em cirróticos, bem como os possíveis fatores de risco para esta condição, incluindo o papel da concentração arterial de amônia em seu diagnóstico. MÉTODOS: Indivíduos com cirrose hepática foram avaliados através do teste de conexão numérica partes A e B (TCN-A e TCN-B) e potencial evocado relacionado a eventos (P300). O diagnóstico de encefalopatia hepática mínima foi feito quando da presença de anormalidade no P300 e em, pelo menos, um dos testes neuropsicológicos. As concentrações arteriais de amônia, a escolaridade e a gravidade da cirrose hepática também foram avaliadas em todos. RESULTADOS: Foram avaliados 48 pacientes cirróticos, com média de idade 50 ± 8 anos, sendo 79 por cento do sexo masculino. As principais causas foram a alcoólica e a viral. O P300 foi anormal em 75 por cento dos casos e o TCN-A e TCN-B anormais em 58 por cento e 65 por cento dos casos, respectivamente. Os resultados do TCN-B foram influenciados pela escolaridade. A frequência de encefalopatia hepática mínima foi de 50 por cento. A concentração arterial de amônia não foi significantemente maior em pacientes com diagnóstico de encefalopatia hepática mínima (195 ± 152 mmol/L versus 148 ± 146 mmol/L; P>0,05). Não houve diferença significante entre os grupos com e sem encefalopatia hepática mínima quanto às demais variáveis estudadas. CONCLUSÃO:A encefalopatia hepática mínima é condição frequente em pacientes com cirrose hepática. A concentração arterial de amônia não parece ter papel importante no seu diagnóstico.

CONTEXT: Minimal hepatic encephalopathy has been systematically investigated in cirrhotic patients. Although, there are controversies regarding the best methods as well as the role of ammonia for its diagnosis. OBJECTIVE: To evaluate the frequency of minimal hepatic encephalopathy diagnosed by neuropsychological and neurophysiological methods in cirrhotic patients, as well as possible associated risk factors for this condition, including the role of arterial ammonia concentrations for its diagnosis. METHODS: Cirrhotic patients were evaluated by the number connection test parts A and B (NCT-A and NCT-B), and auditory evoked-related potentials (P300). Minimal hepatic encephalopathy was diagnosed by the presence of abnormal P300 and in unless one of the performed neuropsychologic tests. Arterial ammonia concentration, scholarity and cirrhosis severity accessed by Child-Pugh classification were evaluated in all. RESULTS: Forty-eight cirrhotic patients were evaluated, with median age 50 ± 8 years old, 79 percent male. The main etiologies were alcoholic and viral. The P300 was abnormal in 75 percent of cases, while NCT-A and NCT-B were abnormal in 58 percent and 65 percent, respectively. The NCT-B results were influenced by scholarity. The minimal hepatic encephalopathy frequency was 50 percent. Arterial ammonia concentration was not significantly increased in minimal hepatic encephalopathy diagnosed patients (195 ± 152 mmol/L versus 148 ± 146 mmol/L; P>0,05). There was no difference between groups with or without minimal hepatic encephalopathy in the other studied variables. CONCLUSION: Minimal hepatic encephalopathy is a frequent condition in cirrhotic patients. The arterial ammonia concentration does not play a major role in its diagnosis.

[Sleep in psychiatric disorders]. / O sono em transtornos psiquiátricos.

Altered sleep patterns are prominent in the majority of psychiatric disorders. This article examines the psychiatric disorders that are most often associated to sleep dysfunction as it is related in clinical practice and describes the polysomnographic findings. Patient's main complaints are related to difficulty in initiating and maintaining sleep (initial or middle insomnia, respectively) and poor quality of sleep. Early awakening or terminal insomnia is most described in the depressive conditions. Hypersomnia may be the main symptom in some depressive disorders, as seasonal depression, depression with atypical features or depressive episodes in bipolar disorder. Polysomnographic evaluation shows, in general, a significative reduction in the efficiency and total time of sleep, in detriment to the amount of slow wave sleep. The reduction of rapid eye movement (REM) sleep latency is mainly described for the depression, but has also been reported in other psychiatric disorders.

O sono em transtornos psiquiátricos / Sleep in psychiatric disorders

O achado de padrões alterados de sono é notável na maioria dos transtornos psiquiátricos. Neste artigo são abordados os transtornos psiquiátricos que mais freqüentemente apresentam alterações de sono na prática clínica e a descrição dos achados polissonográficos. As queixas mais freqüentes dos pacientes são relacionadas à dificuldade para iniciar e manter o sono (insônia inicial e de manutenção, respectivamente) e sono não reparador, observadas na maioria dos transtornos. A insônia terminal ou despertar precoce é mais relacionada a quadros depressivos. A hipersonia pode aparecer em alguns quadros de depressão como sazonal, atípica ou em transtornos bipolares. Em relação aos achados polissonográficos, temos, em geral, redução significativa da eficiência e do tempo total do sono à custa da redução do sono de ondas lentas. A redução da latência para o sono de movimentos oculares rápidos (REM) é descrita principalmente para os quadros depressivos, mas pode aparecer em outras patologias.

Efeitos neurofisiológicos e comportamentais do zolpidem em voluntários normais / Neurophysiological and behavioral effects of zolpidem in normal female volunteers

0 zolpidem (Z), derivado imidazopiridínico, é um hipnótico bioquimicamente distinto dos benzodiazepínicos (BDZs) e que, a princípio, se liga com maior especificidade ao receptor BDZ do tipo BDZ1, ou w1. 0 presente estudo teve como objetivo investigar os efeitos agudos de doses orais clínicas de Z em voluntárias normais jovens nos potenciais evocados ligados a eventos (ERP), eletrencefalograma (EEG) e medidas comportamentais. 0 estudo foi duplo-cego em grupos independentes de tratamento. As participantes foram alocados aleatoriamente em três grupos: Z (5 e 10 mg) e placebo (P) e foram testadas antes e após o tratamento. As latências e amplitudes do ERP foram medidas em Fz, Cz e Pz, utilizando o paradigma "oddball" auditivo. As medidas comportamentais incluíram evocaçao imediata e tardia de uma estória, o DSST, um teste de cancelamento, e escalas de avaliaçoes de sensaçoes subjetivas (do experimentador e do sujeito). Foram descritos aumentos de latência dos ERPs (N200 e P300); reduçao da amplitude interpico N200-P300 e aumento das amplitudes N100-P200 e P200-N200; aumento da potência da banda beta no EEG; prejuízo no desempenho psicomotor e na recordaçao da estória e efeitos subjetivos compatíveis com drogas depressoras. Os resultados obtidos foram semelhantes aos já descritos com BDZs (exceto aumento de algumas amplitudes de ERPs), o que sugere que a ligaçao preferencial ao receptor BDZ1 nao caracterizaria esta droga como tendo um perfil diferencial e que todos os cuidados relacionados ao comprometimento da cogniçao que cercam a prescriçao do BDZs deveriam ser tomados também com o zolpidem

Achados eletrencefalográficos em alcoólicos que apresentam convulsöes / Electroencephalographic findings in alcoholics presenting convulsions

Pela vivência em interpretaçäo de exames eletrencefalográficos de pacientes alcoólicos em tratamento no Serviço de Psiquiatria e Psicologia Médica do Hospital do Servidor Público Estadual "Francisco Morato Oliveira" - Säo paulo - e pela revisäo de literatura disponível sobre o assunto, verificamos que a maioria dos alcoólicos com história de convulsöes apresentam achados EEG dentro dos limites normais de variabilidade. Se excluirmos os portadores de epilepsia pós-traumatica ou idiopática a proporçäo de achados anormais reduz-se consideravelmente. Por essa razäo, achamos que o clínico deve ser alertado para o fato de que se em um alcoólico que apresente convulsöes o EEG for persistentemente anormal deve ser sempre pesquisada uma causa associada ou superposta ao alcoolismo. Por exemplo, a possibilidade de convulsöes devido a hematoma subdural crônico deve ser considerada

Achados eletrencefalográficos em alcoólicos que apresentam convulsöes / Electroencephalographic findings in alcoholics with convulsions

Pela vivência em interpretaçäo de exames eletrencefalográficos de pacientes alcoólicos em tratamento no Serviço de Psiquiatria e Psicologia Médica do Hospital do Servidor Público Estadual "F.M.O." - Säo Paulo - e pela revisäo de literatura disponível sobre o assunto, verificou-se que a maioria dos alcoólicos com história de convulsöes apresentam achados EEG dentro dos limites normais de variabilidade. Se excluirem-se os portadores de epilepsia pós-traumática ou idiopática a proporçäo de achados anormais reduz-se consideravelmente. Por essa razäo, achamos que o clínico deve ser alertado para o fato de que se um alcoólico que apresente convulsöes, o EEG for persistentemente anormal, deve ser sempre pesquisada uma causa associada ou superposta ao alcoolismo. Por exemplo, a possibilidade de convulsöes devido a hematoma sub-dural crônico deve ser considerada