Análisis de movimientos periódicos de piernas durante el sueño, presión arterial de 24 horas y frecuencia cardíaca.

Los Movimientos Periódicos de las Piernas durante el Sueño (PLMS), diagnosticados por polisomnografía, se caracterizan por movimientos estereotipados de las piernas que aparecen de forma repetitiva durante la noche. Cada PLMS se asocia a un microdespertar e incrementos de la frecuencia cardiaca, presión arterial y actividad simpática. Objetivos: Analizar asociación entre el índice patológico de PLMS y la PA de 24 horas, en pacientes normotensos. Evaluar la asociación entre índice patológico de PLMS, con alteraciones en la velocidad de onda de pulso y frecuencia cardíaca. Métodos Estudio observacional de casos y controles. Se estudiaron 19 sujetos normotensos mediante Polisomnografía Nocturna y Monitoreo Ambulatorio de la Presión Arterial. Se determinaron las variables: Edad, sexo, peso, índice de masa corporal. La presión arterial y frecuencia cardíaca de 24 hs, diurna y nocturna se evaluaron con monitoreo ambulatorio de presión arterial de 24 h. Se excluyeron pacientes con índice de apneas/hipopneas ≥ 5 e/h. Se describieron las variables y compararon sujetos con y sin PLMS, considerando significativo una p<0,05, además análisis de correlación.   Resultados Se estudiaron a 11 pacientes con PLMS patológico y 7 controles (Índice PLMS 35,6±15 versus 7,9±5 respectivamente). Los pacientes con PLMS fueron más jóvenes 57 ±14 versus 64±6; p=0,284 años. La presión arterial de 24 h, fue menor en el grupo PLMS que en los controles (sistólica 114,2±11 versus 123±11; p=0,095; y diastólica 65,7±5 versus 74,4±11, p=0,027).   Conclusión Encontramos una relación estadísticamente significativa, inversa, no esperada, al correlacionar los movimientos periódicos de piernas durante el sueño, de grado patológico, con la presión arterial sistólica y media de 24 h, la presión arterial sistólica diurna y nocturna, y la presión arterial media nocturna, como así también hallazgos similares en la presión de pulso de 24 horas y la presión de pulso diurna y nocturna que fueron inferiores al grupo control. No encontramos cambios en la frecuencia cardíaca.

Is Being a Lark Healthier for Patients with Type 1 Diabetes Mellitus?

Background Sleep quality and mood have been evaluated in type 1 diabetic (T1DM) patients, but chronotypes were not studied. Our objectives were to analyze chronotypes, sleep and mood variables and to describe their association with some metabolic variables in this population. Methods An observational, cross-sectional study was performed. Adults with a diagnosis of T1DM were included. We evaluated chronotypes by the Morningness-Eveningness Questionnaires, sleep quality by Pittsburgh Sleep Quality Index (PSQI), excessive daytime sleepiness by Epworth Sleepiness Scale (ESS), symptoms of depression by Patient Health Questionnaire - 9 (PHQ-9) and emotional well-being by Emotional Well Being Index (IWHO-5). A few metabolic variables were included. Results Ninety-five patients participated. The mean age was 38 years old (range 18-70). The average body mass index (BMI) was 24.4 Kg/m 2 (standard deviation [SD]: 4.6). Out of the total sample, 52.6% were males. The Intermediate chronotype was predominant: n = 56 (55%). We found poor quality of sleep in 67.4% of the sample, excessive daytime sleepiness in 14.7%, depressive symptoms in 6.3% by PHQ9 and low perception of well-being by IWHO-5 in 16.8%. Evening chronotype scored worse in sleep quality ( p = 0.05) and had lower well-being ( p = 0.03) compared with the other chronotypes. Higher MEQ values (morningness) correlated with lower height ( p = 0.043), lower values in the PSQI ( p = 0.021); and higher values in emotional well-being ( p = 0.040). Conclusions We found that the predominant chronotype in T1DM was the intermediate. Two-thirds reported poor quality of sleep and 14,7% excessive daytime sleepiness. Possible diagnosis of a depressive disorder in 6.3% and poor self-perception of emotional well-being in 16. 8% were observed. The morning chronotype had significant correlation with better sleep quality and higher scores in emotional well-being.

Analysis of periodic leg movements during sleep, 24-hour blood pressure and heart rate / [Análisis de movimientos periódicos de piernas durante el sueño, presión arterial de 24 horas y frecuencia cardíaca.]

Los Movimientos Periódicos de las Piernas durante el Sueño (PLMS), diagnosticados por polisomnografía, se caracterizan por movimientos estereotipados de las piernas que aparecen de forma repetitiva durante la noche. Cada PLMS se asocia a un microdespertar e incrementos de la frecuencia cardiaca, presión arterial y actividad simpática. Objetivos: Analizar asociación entre el índice patológico de PLMS y la PA de 24 horas, en pacientes normotensos. Evaluar la asociación entre índice patológico de PLMS, con alteraciones en la velocidad de onda de pulso y frecuencia cardíaca. Métodos: Estudio observacional de casos y controles. Se estudiaron 19 sujetos normotensos mediante Polisomnografía Nocturna y Monitoreo Ambulatorio de la Presión Arterial. Se determinaron las variables: Edad, sexo, peso, índice de masa corporal. La presión arterial y frecuencia cardíaca de 24 hs, diurna y nocturna se evaluaron con monitoreo ambulatorio de presión arterial de 24 h. Se excluyeron pacientes con índice de apneas/hipopneas ≥ 5 e/h. Se describieron las variables y compararon sujetos con y sin PLMS, considerando significativo una p<0,05, además análisis de correlación. Resultados: Se estudiaron a 11 pacientes con PLMS patológico y 7 controles (Índice PLMS 35,6±15 versus 7,9±5 respectivamente). Los pacientes con PLMS fueron más jóvenes 57 ±14 versus 64±6; p=0,284 años. La presión arterial de 24 h, fue menor en el grupo PLMS que en los controles (sistólica 114,2±11 versus 123±11; p=0,095; y diastólica 65,7±5 versus 74,4±11, p=0,027). Conclusión: Encontramos una relación estadísticamente significativa, inversa, no esperada, al correlacionar los movimientos periódicos de piernas durante el sueño, de grado patológico, con la presión arterial sistólica y media de 24 h, la presión arterial sistólica diurna y nocturna, y la presión arterial media nocturna, como así también hallazgos similares en la presión de pulso de 24 horas y la presión de pulso diurna y nocturna que fueron inferiores al grupo control. No encontramos cambios en la frecuencia cardíaca.

Periodic Leg Movements During Sleep (PLMS), diagnosed by polysomnography, is characterized by stereotyped leg movements that appear repetitively at night. Each PLMS is associated with microarousal and increases in heart rate, blood pressure, and sympathetic activity. Objectives: To analyze the association between the pathological index of PLMS and 24-hour BP in normotensive patients.To evaluate the association between the pathological index of PLMS, with alterations in pulse wave velocity and heart rate. Methods: Observational study of cases and controls. 19 normotensive subjects were studied by Nocturnal Polysomnography and Ambulatory Blood Pressure Monitoring. The variables were determined: Age, sex, weight, body mass index. 24-h, diurnal, and nocturnal blood pressure and heart rate were assessed with 24-h ambulatory blood pressure monitoring. Patients with apnea/hypopnea index ≥ 5 e/h were excluded. The variables were described and subjects with and without PLMS were compared, considering significant a p<0.05, in addition to correlation analysis. Results: Eleven patients with pathological PLMS and 7 controls were studied.PLMS Index 35.6±15 versus 7.9±5 respectively. PLMS patients were younger 57±14 versus 64±6; p=0.284. The 24-h blood pressure was lower in the PLMS group than the controls (systolic 114.2±11 versus 123±11; p=0.095; and diastolic 65.7±5 versus 74.4±11, p=0.027). Discussion: We found an unexpected, inverse, statistically significant relationship when correlating pathological-grade periodic leg movements during sleep with 24-hour mean and systolic blood pressure, daytime and nighttime systolic blood pressure, and mean blood pressure. nocturnal, as well as similar findings in the 24-hour pulse pressure and the diurnal and nocturnal pulse pressure that were lower than the control group. We found no changes in heart rate.

[Analysis of causes or reasons that fragment sleep and sleep disorder in pregnant and non-pregnant women] / Análisis de causas o motivos que fragmentan el sueño y los trastornos del sue-ño, en mujeres embarazadas y no embarazadas.

Introduction: During pregnancy, sleep undergoes important changes. The objective was to assess the causes or reasons that fragment sleep and sleep disorders in different women and trimesters of pregnancy, comparing them with those of non-pregnant women (NPW). Methods: Cross-sectional study. Anonymous surveys were used to evaluate reasons that fragment sleep and specific questionnaires to evaluate sleep disorders. Results: Pregnant Women (PW)= 320. 1st Trimester of pregnancy (T): n = 106, 2nd. T: n = 104, 3rd T: n = 110. MNE: n = 304. Most frequent reasons that fragmented sleep, statistically significant in PW and were: need to urinate, uncomfortable position, not being able to rotate in bed. As sleep disorders we find: nightmares 44 vs 4.9%; snoring with pauses: 31 vs 3%. Conclusion: We found that in the PW studied, most of the causes or reasons analyzed fragmented sleep; they had more sleep disorders such as nightmares, respiratory disorders and periodic leg movements, in that order, compared to the NPW who in turn, presented insomnia, excessive sleepiness and bruxism.

Introducción: Durante la gestación, el sueño sufre cambios importantes. El objetivo fue evaluar causas o motivos que fragmentan el sueño y los trastornos del sueño en diversas mujeres y trimestres de embarazo, comparándolos con los de las mujeres no embarazadas (MNE). Métodos: Estudio de corte transversal. Se utilizó encuestas anónimas, para evaluar motivos que fragmentan el sueño y cuestionarios específicos para evaluar trastornos del sueño. Resultados: Mujeres Embarazadas (ME)= 320. 1er Trimestre de embarazo (T): n = 106, 2do. T: n = 104, 3er T: n = 110. MNE: n = 304. Motivos más frecuentes que fragmentan el sueño, se presentó en ME y fueron: necesidad de orinar, posición incómoda, no poder rotar en la cama. Como trastornos del sueño encontramos: pesadillas 44 vs 4.9%; ronquidos con pausas: 31 vs 3%. Conclusión: En las mujeres embarazadas estudiadas, la mayoría de las causas o motivos analizados fragmentaron el sueño; tuvieron más desórdenes del sueño como pesadillas, trastornos respiratorios y movimientos periódicos de piernas, comparados con las no embarazadas; quienes a su vez, presentaron insomnio, somnolencia excesiva y bruxismo.

[Pre-pandemic melatonin treatment for sleep disorders and COVID-19 infection. A retrospective cross-sectional study]. / Tratamiento con melatonina pre-pandemia por trastornos del sueño e infección por COVID-19. Estudio de corte transversal, retrospectivo.

INTRODUCTION: Melatonin is a safe medication with multiple uses in sleep medicine for the treatment of circadian rhythm disorders, insomnia, and REM sleep behavior disorder. In view that melatonin has been recommended as an adjuvant treatment in COVID-19 pandemic mainly due to its anti-inflammatory properties, the objective of the present study was to evaluate the history of COVID-19 infection and the requirement of hospitalization in a group of adult patients previously treated with melatonin for various sleep disorders. MATERIAL AND METHODS: This is a retrospective cross-sectional study of data from a closed population of 110 adult patients at a University Hospital treated with melatonin for various sleep disorders, analyzed until the onset of COVID-19 pandemic. Demographic and melatonin-related variables (dose, treatment time) were analyzed and were reevaluated during the pandemic period, by scheduled tele-consultation regarding diagnosis, hospitalization requirements, variables related to COVID-19 infection prior to specific vaccination. Categorical variables were described as relative and absolute frequencies. RESULTS: N = 110 patients. Age range = 40- 96 years (mean = 71 years ± 9.9), older adults > 65 years: N =87 (79,1%). COVID-19 infection was recorded in 15 patients (13.5%) requiring hospitalization in 5 of those infected, only one of them with severe pneumonia. There were no deaths due to COVID-19. There were no differences between infected vs. uninfected in age (p = 0.74), body mass index (p = 0.65) or melatonin dose (p = 0.10).The melatonin dose range was 3-150 mg / day (mean = 46.33 ± 34.1), older adults receiving a mean dose of 50,3 ± 35,6.The 75.5% of the patients were treated for at least 12 months with melatonin. CONCLUSION: We found that 13.5% of patients previously treated with melatonin for various sleep disorders were infected by COVID-19, requiring hospitalization with subsequent medical discharge one third of them. According to national records the lethality rate in older adults in August 2020 was 10.5%. No patient treated with melatonin died for this cause in this sample. We did not find statistically significant differences in terms of indicated melatonin dose, age or body mass index, when comparing those infected with those not infected. The patients in general were mostly older adults, treated with a mean dose greater than 40 mg / day of melatonin for various sleep disorders, mainly for complaints of insomnia, for more than 12 months. The results are consistent with a possible preventive effect of melatonin in the COVID-19 pandemic.

[Adaptation to Spanish and cross-cultural interpretation of the scale of lucidity and awareness in the subjects (Lucidity and Consciousness in Dreams scale)] / Adaptación al español e interpretación transcultural de la escala de lucidez y consciencia en los sueños (Lucidity and Consciousness in Dreams scale)

Introduction: It is called lucid dreaming, when the dreamer is aware that he is dreaming and can control the dream content. We lack Spanish-speaking tools that assess the presence of lucid dreams, so our objectives were to carry out the adaptation to Spanish and cross-cultural interpretation of the Lucidity and Consciousness in Dreams Scale (LuCID) and to evaluate the presence of lucid dreamers. Material and methods: Cross-sectional study, carried out by means of translation and retro-translation of the LuCID scale. The ethics committee approved it with number 3359. Results: 220 surveys, N = 216 were chosen. Age of subjects who completed: 18-76 (mean: 47) years. Women: n = 146 women. Countries: Argentina and Mexico were the ones that mostly participated. The mean and standard deviation of the analyzed subscales were: control: 2.82 / 1.1; introspection: 2.79 / 1.1; positive emotion: 2.66 / 1.3; dissociation: 2.62 / 1.3; memory: 2.51 / 1.1; thoughts: 2.44 / 1.3; realism: 2.34 / 1.2; negative emotion: 2.22 / 1.3. Of those surveyed, 56 individuals (24.5%) presented higher scores on the subscales for lucid dream diagnosis. Conclusion: The transcultural adaptation and interpretation of the lucidity and consciousness in dreams scale (LuCID) was carried out, which allowed us to detect almost a third of lucid dreamers. This scale should be validated in a select population of lucid dreamers for use.

Introducción: Se denomina sueños lúcidos, cuando el soñador es consciente de que esta soñando y puede controlar el contenido onírico. Carecemos de herramientas en habla hispana, que valoren la presencia de sueños lúcidos, por lo que nuestros objetivos fueron realizar la adaptación al español e interpretación transcultural de la escala Lucidity and Consciousness in Dreams Scale (LuCID) y evaluar la presencia de soñadores lúcidos en una población afines a las neurociencias. Material y métodos: Estudio de corte transversal, realizado mediante traducción y retro-traducción de la escala LuCID. El comité de ética, lo aprobó con el número 3359. Resultados: 220 encuestas, se eligieron N=216. Edad de sujetos que completaron: 18-76 (media:47) años. Mujeres: n=146 mujeres. Países: Argentina y México fueron los que mayoritariamente participaron. La media y desvío estándar de las subescalas analizadas fueron: control: 2.82/1.1; introspección: 2.79/1.1; emoción positiva: 2.66/1.3; disociación: 2.62/1.3; memoria: 2.51/1.1; pensamientos: 2.44/1.3; realismo: 2.34/1.2; emoción negativa: 2.22/1.3. De los encuetados, 56 individuos (24.5%), presentaron mayores puntajes en las subescalas para diagnóstico de sueño lúcidos. Conclusión: se realizó la adaptación e interpretación transcultural de la escala de lucidez y consciencia en los sueños (LuCID), que nos permitió detectar casi un tercio de soñadores lúcidos. Esta escala, deberá ser validada en población selecta de soñadores lúcidos para su uso.

Early impact on sleep and mental health during the mandatory social isolation of COVID-19 outbreak: an obser vational cross-sectional study carried out in Argentina.

Introduction: The mandatory social isolation (MSI) due to the pandemic caused by COVID-19 in the world produced many changes in sleep and different areas of mental health. Objectives: To evaluate the early effects of MSI on sleep, anxiety, and depression in Argentina. Material and Methods: An anonymous observational cross-sectional web-based study was distributed throughout the country and was completed by 2,594 respondents to analyze demographic information, quality of sleep, REM sleep-related events, depressive, and anxiety symptoms. Results: The study revealed that 53, 21, 22, 23, and 16% of people surveyed were poor sleepers, had dream-related behaviors, nightmares, depression, and anxiety symptoms, respectively. Multivariate logistic regression showed a positive correlation between anxiety, being a poor sleeper, and having nightmares. Conclusion: We identified the early effects of MSI on sleep quality, dreaming activity, anxiety, and depression in Argentina during the COVID-19 outbreak. Our findings can be used to formulate sleep and psychological interventions to improve mental health during the pandemic and post-pandemic times.

[Sleep Disorders and depression in Parkinson's Disease]. / Trastornos del sueno y Depresión en la enfermedad de Parkinson.

OBJECTIVES: Sleep disorders are common in Parkinson's disease (PD). To diagnose sleep disturbances analyzing the sleep macrostructure and other variables in PD. METHOD: The cross-sectional, retrospective study in PD patients. Sociodemographic, clinical/pharmacological variables, Epworth sleepiness scale (ESS), Beck depression index (BDI) and polysomnography of patients with Parkinson's disease. Frequency, mean, standard deviation analysis were obtained. The variables were compared using t test student, univariate ANOVA and chi-square. A p<0.05 was considered significant. SPSS (Chicago SPSS Inc.) 18 was used. The n were 44 patients, 33 men, mean age 71 (range 52-90), ESS 7.7±6 (normal), BDI 13±8 points (pathological). CONCLUSIONS: At older age, the time awake after sleep began (p=0.03) was greater and lower sleep efficiency (p=0.02).The average percentage of stage of N3 sleep was 37.2% in women vs 24.7% in men (p=0.02). Hypopnea apnea index was pathological grade at 79.5% (n=35).We diagnose apnea hypopnea syndrome in the majority, insomnia and REM parasomnias. The increase in the percentage of stage N3 was rarely reported in the literature. At older age were more changes in the macroestructure and more sleep disturbances.

Respiratory disorders during sleep in patients with acute ischemic stroke. / [Trastornos respiratorios durante el sueño en pacientes con accidente cerebrovascular isquémico.]

Introduction: Sleep breathing disorders (SBD) especially obstructive hypopnea apnea syndrome (OSA) in patients with stroke are common and can complicate their evolution. The objective was analyzing the different sleep breathing disorders in patients with stroke. Methods: Descriptive, cross-sectional and retrospective study of acute ischemic stroke patients, using nightly polysomnography with oximetry (PSG). Results: It was a descriptive, cross-sectional, retrospective study during 19 months; 53 patients with stroke were included, with a men age of 67 ±12 years and 62% were men. SBD was evaluated by nocturnal polysomnography with oximetry within 10 days of installing the stroke. The Apnea hypopnea index (AHI) was 24.5±20, of mild grade in 21%, moderate in 31%, severe grade in 34%. The average oxygen saturation time less than 90% was 38 ±51 minutes. The minimum oxygen saturation was marked in infratentorial lesions. Conclusion: We found a high percentage of OSA, which was associated with older patients and a higher body mass index. There was a marked decrease in the minimum oxygen saturation and greater tendency to present central apneas in infratentorial lesion. Early diagnosis and treatment could minimize neuronal damage and improve prognosis.

Introducción: Los trastornos respiratorios durante el sueño (TRDS), sobre todo el síndrome de apneas hipopneas obstructivas (SAHOS) en pacientes con accidente cerebrovascular o ACV, son frecuentes y pueden complicar su evolución. El objetivo fue analizar diversos TRDS en pacientes con ACV. Métodos: Estudio descriptivo, de corte transversal y retrospectivo de 19 meses, en pacientes con ACV, mediante polisomnografía nocturna con oximetría (PSG). Resultados: Se incluyó a 53 pacientes, con edad media de 67 ± 12 años, y 62% pertenecían al sexo masculino. Se evaluó los TRDS mediante polisomnografía nocturna con oximetría dentro de los 10 días de instalado el ACV. Se detectó un índice de apneas hipopneas durante el sueño (IAH) de grado leve en 21%, grado moderado en 31% y severo en 34%. La media de tiempo de saturación de oxígeno < a 90% fue de 38 ±51 minutos. La saturación mínima de oxígeno fue marcada en lesiones infratentoriales. Conclusión: Nosotros hemos encontrado en nuestro estudio, un alto porcentaje de SAHOS, que se asoció a pacientes de mayor edad y mayor índice de masa corporal. Se constató descenso marcado de la saturación mínima y mayor tendencia a presentar apneas centrales en lesiones infratentoriales. El diagnóstico y tratamiento precoz podría minimizar el daño neuronal y mejorar el pronóstico.

Importancia del buen dormir en nuestros pacientes / Importance of good sleep in our patients

El sueño es una necesidad biológica. Regula las funciones inmunitarias. Las funciones inmunológicas dependen de los ritmos circadianos y del sueño regular. Según estudios previos a la pandemia, la corta duración del sueño o privación de sueño, en la semana cercana a la vacunación, se asocia con respuestas más bajas de anticuerpos. La privación de sueño da como resultado una función inmunológica más deficiente (es decir, actividad reducida de las células natural killer, producción de IL-2 suprimida) así como un aumento de los niveles circulantes de marcadores inflamatorios (IL-6, TNF-α [factor de necrosis tumoral] y proteína C reactiva). Los médicos deben ser conscientes de que muchas enfermedades que mencionamos en esta resumida actualización son comórbidas con alteraciones del sueño, y es importante, por ello, enseñar a los pacientes a mejorar su comportamiento con respecto al sueño y fomentar la educación sobre higiene del sueño. Destacamos que, en el interrogatorio de cualquier especialidad médica, deben incorporarse preguntas sobre el "dormir", dado que el sueño de buena calidad es fundamental en la prevención y el tratamiento de diversas enfermedades. (AU)

Sleep is a biological necessity. Regulates immune functions. Immune functions depend on circadian rhythms and regular sleep. According to studies prior to the pandemic, short duration of sleep or sleep deprivation, in the week leading up to vaccination, is associated with lower antibody responses to vaccination. Sleep deprivation results in poorer immune function (i.e., reduced natural killer cell activity, suppressed IL-2 production) as well as increased circulating levels of inflammatory markers (IL-6, factor of tumor necrosis, C-reactive protein). Clinicians should be aware that many illnesses, which we mention in this brief update, are comorbid with sleep disturbances and it is therefore important to teach patients to improve their sleep behavior and should encourage sleep hygiene education . We emphasize that in the questioning of any medical specialty, questions about "sleep" should be incorporated, given that good quality sleep is essential in the prevention and treatment of various diseases. (AU)

[Sleep quality, depressive symptoms and other menopause things]. / Calidad de sueño, síntomas depresivos y las otras cosas de la menopausia.

Sleep disorders (insomnia, hypersomnia, parasomnias and breathing disturbances), hormonal changes and vasomotor symptoms are highly prevalent in peri and postmenopausal women. The aim of our study was to assess sleep quality, some sleep disturbances, depression and suffocation during postmenopausal. Data come from a cross-sectional study of 195 women, which was conducted at a University Hospital. Data related to sleep were assessed with the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Oviedo Sleep Questionnaire (OSQ) and Beck´s Inventory of Depression (BDIII). The hospital Ethical Committee granted their approval of this study. The mean PSQI score was 6.90½ 4.43. Up to 46.7% of participants had a PSQI > 5 (poor sleep quality). Snoring was reported by 13% of the patients (PSQI # 10 A). COS score was 17.57± 7. According to COS #1 all the subjects (100%) reported some degree of sleep dissatisfaction. Media of BDIII´s inventory of depression was 9.8 (½7.14), 41% of women reported depression. Correlation BDIII and PSQI was 0.00. We found that the level of dissatisfaction was elevated. One out of two women referred poor quality of sleep, requiring medical assistance. Poor sleep quality was associated with depression.

[COMPARISON OF DREAMS IN PREGNANT WOMEN AND NON-PREGNANT WOMEN]. / Comparación de las características de los sueños en mujeres embarazadas y en mujeres no gestantes.

Sleep disturbances are prevalent among, pregnant women, among them sleep is more fragmented during the third trimester, and could be associated with increased ability to remember dream's content. The aim of this study were to compare recall, and the contents of dreams during the three trimesters of pregnancy according to Gruen's Scale (Scale Subjective assessment scale of sleep and dreams), and to compare this with a non-pregnant women. An observational cross-sectional study was conducted during 50 months. After oral informed consent, a demographic survey and the Scale of dreams were offered and self-administered by parti-cipants. Assesses frequency of recall and other dreams characteristics. A total of 621 questionnaires were available for analysis, 320 pregnant and 301 non pregnant women. Pregnant women showed statistically significant decreased of recall, stirring, pleasant, erotic, strange, and vivid dreams compared with non pregnant women. Conclusions: non pregnant women have mayor recall of dreams and other characteristic in comparison with pregnant women. We did not find differences between the various trimesters.

Sleep quality and related factors in postmenopausal women.

Sleep disorders, resulting from hormonal changes and vasomotor symptoms, are common in both peri- and postmenopausal women. Poor sleep quality is associated with increased metabolic and cardiovascular risk, depression and a global impairment in health status. OBJECTIVES: Our study aimed to assess sleep quality in a sample of postmenopausal women and to identify the factors associated with poor sleep quality. It also considered the negative impact of sleep disorders such as insomnia, hypersomnia and breathing disturbances. SUBJECTS & METHODS: Data came from a cross-sectional study of 195 postmenopausal women conducted at the Italian Hospital of Buenos Aires, Argentina. Their sociodemographic, gynecological and clinical characteristics were recorded and sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Oviedo Sleep Questionnaire (Cuestionario Oviedo de Sueño, COS). RESULTS: The mean PSQI score was 6.90 ± 4.43. Sleep problems were common, with 46.7% of participants scoring over 5 on the PSQI. Snoring was reported by 13% of the patients (PSQI item 10 A). While 10% of the poor sleepers reported episodes of apnea during rest (PSQI item 10B), 7.1% reported leg spasm (PSQ I item 10C). The mean total COS score was 17.57 ± 7. According to COS item 1, all the subjects reported some dissatisfaction with the quality of their sleep. According to the COS, the prevalence of insomnia was 3.6% using ICD-10 criteria and 15.4% using DSM-IV criteria. The mean ESS score was 6.12 ± 4.09. CONCLUSION: Postmenopausal women are likely to complain of disturbed sleep. Almost half of the women in this survey said their sleep quality was impaired, and most of that group would benefit from medical attention.

Características polisomnográficas nocturnas y otras variables relacionadas, en pacientes adultos mayores / Nocturnal polysomnbnographic characteristics and other related variables in elderly patients

Se cree que los ancianos necesitan dormir menos. Sin embargo, no es la necesidad de sueño sino la capacidad de dormir lo que disminuye con la edad, en paralelo a la mayor prevalencia de enfermedades cardiovasculares o metabólicas, o de depresión. Poco se ha descripto sobre los hallazgos polisomnográficos de esta población. En el presente estudio analizamos los hallazgos polisomnográficos en pacientes mayores de 65 años. Se realizó un estudio descriptivo a partir del análisis de una base de datos de 551 pacientes mayores de 65 años evaluados entre junio de 2013 y diciembre de 2014. Todos los sujetos se realizaron una polisomnografía (PSG) nocturna de 6 horas de duración. Las variables analizadas fueron: latencia de sueño (LS), eficacia de sueño (ES), latencia de fase REM (Lat R), % de R, índice de apneas hipopneas (IHA) y movimientos periódicos de piernas durante el sueño (PLMS). Se dividió la población en 3 grupos: G1: de 65 a 70 años; G2: 71 a 75; G3: mayor de 75 años. Se analizaron los datos de la serie general y las diferencias intergrupos. El IHA se incrementó con la edad y resultó más severo en los pacientes mayores de 75 años en relación con el grupo de menor edad. El incremento del IAH no se asoció a un incremento del índice de masa corporal ni a mayor somnolencia diurna. (AU)

It is believed that the elderly need less sleep. However, it is not the need for sleep but the ability to sleep that decreases with age, in parallel to the increasing prevalence of cardiovascular or metabolic disease, or depression. Little has been described about the polysomnographic findings of this population, hypothesizing that there are several alterations that prematurely corrected could improve the quality of life as the years go by. We analyzed the polysomnographic findings in patients over 65 years of age. A descriptive study was carried out based on the analyses of a database of 551 patients over 65 years of age evaluated between June 2013 to December 2014. All subjects underwent nocturnal PSG of 6 hours duration. The polysomnographic variables analyzed were: sleep latency (LS), sleep efficiency (ES), latency R phase (Lat R), % R, Apneas Hypoapneas Index (AHI) and Periodic Limb Movements of Sleep (PLMS). The population was divided into 3 groups: G1: from 65 to 70 years G2: 71 to 75, G3 greater than 75. AHI increased with age, being more severe in patients over 75 years of age in relation to the younger age group. The increase in AHI was not associated with an increase in Body Mass Index (BMI) or greater daytime sleepiness. (AU)

[Sleep related eating disorders as a side effect of zolpidem]. / Síndrome de ingesta nocturna como efecto colateral del zolpidem.

Zolpidem is a hypnotic drug used in sleep disorders. It binds selectively to alpha 1 subunit of the GABA A benzodiazepine receptor. Zolpidem reduces sleep latency, number of arousals and increases the total time of sleep. However, it is considered that it may increase phase 3 of non rapid eye movement sleep, where somnambulism can take place. Our aim is to report 8 cases of sleep related eating disorders associated with the use of this drug. We have evaluated the medical history of 8 patients who had received zolpidem for sleeping disorders and who have presented sleep related eating disorders. Eight patients (6 women, 2 men) aged between 32 to 72 years old, which received 10 mg of zolpidem/night except 1 that received 12.5 mg, were presented. They have referred strange eating behavior compatible to sleep related eating disorder. Symptoms appeared at a mean of 39.8 days after starting the medication. The numbers of nocturnal episodes recorded by the family or by the patient were 1 to 8 episodes of nocturnal eating per night. The morning after, patients found leftovers from the night before which they did not recall to have eaten. The remission was complete after discontinuing zolpidem. Zolpidem may induce sleep related eating disorder in about 1% of patients, although we consider there may be a subdiagnosis of this phenomenon. It will be important to bear in mind and look for this side effect because all the episodes could easily be controlled by withdrawing the drug.

Síndrome de ingesta nocturna como efecto colateral del zolpidem / Sleep related eating disorders as a side effect of zolpidem

El zolpidem es una droga hipnótica utilizada para el tratamiento del insomnio. Disminuye la latencia del sueño, el número total de despertares y aumenta el tiempo total del sueño respetando en general su arquitectura. Se cree que aumenta la fase 3 del sueño lento profundo. Nuestro objetivo es comunicar 8 casos de síndrome de ingesta nocturna relacionado al sueño y conductas automáticas complejas asociadas a sonambulismo como efecto colateral del zolpidem. Se analizaron las historias clínicas de 8 pacientes tratados con zolpidem que referían ingesta nocturna de alimentos con amnesia total o parcial del episodio. Se presentan 6 mujeres y 2 hombres, entre 32 y 72 años (media: 58 años), 7 tratados con zolpidem 10 mg/noche y 1 con zolpidem 12.5 mg/noche de liberación prolongada. El tiempo de exposición previo al desarrollo de eventos fue de 1 a 180 días (media de 39.8). El número de episodios relatados era de 1 a 8/noche (media 2.5) asociado con amnesia. Los episodios desaparecieron por completo en el 100% de los casos al suspender la medicación. El síndrome de ingesta nocturna relacionado al sueño es una parasomnia de sueño lento profundo que consiste en episodios de ingesta de alimento o bebida durante la noche, con amnesia parcial o completa del episodio. El zolpidem podría inducir el síndrome de ingesta nocturna relacionado al sueño en aproximadamente el 1% de pacientes, aunque creemos que es un efecto adverso que está subdiagnosticado. Se resuelve simplemente suspendiendo la medicación.

Zolpidem is a hypnotic drug used in sleep disorders. It binds selectively to alpha 1 subunit of the GABA A benzodiazepine receptor. Zolpidem reduces sleep latency, number of arousals and increases the total time of sleep. However, it is considered that it may increase phase 3 of non rapid eye movement sleep, where somnambulism can take place. Our aim is to report 8 cases of sleep related eating disorders associated with the use of this drug. We have evaluated the medical history of 8 patients who had received zolpidem for sleeping disorders and who have presented sleep related eating disorders. Eight patients (6 women, 2 men) aged between 32 to 72 years old, which received 10 mg of zolpidem/night except 1 that received 12.5 mg, were presented. They have referred strange eating behavior compatible to sleep related eating disorder. Symptoms appeared at a mean of 39.8 days after starting the medication. The numbers of nocturnal episodes recorded by the family or by the patient were 1 to 8 episodes of nocturnal eating per night. The morning after, patients found leftovers from the night before which they did not recall to have eaten. The remission was complete after discontinuing zolpidem. Zolpidem may induce sleep related eating disorder in about 1% of patients, although we consider there may be a subdiagnosis of this phenomenon. It will be important to bear in mind and look for this side effect because all the episodes could easily be controlled by withdrawing the drug.

Interview accuracy in partial epilepsy.

The statistical concept of accuracy has never been applied to verify the history data collected on seizure disorders by open format interview. We compared patients'/witnesses' descriptions of epileptic seizures with videotaped seizure characteristics and analyzed the accuracy (ACC), sensitivity (SN), specificity (SP), false-positive rate (FPR), and false-negative rate (FNR) of various components of the semiology in patients with partial epilepsy. Language disturbances, complex automatisms, and autonomic signs have high ACC and intermediate FNRs. This means that these manifestations are most obvious to the witness/patient and, therefore, are memorized easily. Dystonic posturing and upper limb automatisms have the highest FNRs, leading to low ACC. These are very subtle signs, not vigorous enough to be paid attention to, but their predictive value in partial epilepsy syndromes is relatively high. We believe these signs need to be directly sought in the interview, because often the patient/witness pays limited attention to them.

Determinación de anti-HC en familiares de portadores, como pesquisa de nuevos casos / Determination of anti-HC in relatives of carriers as a way of detecting new cases

A matter of interest is still knowing the disease in carriers of HVC among relatives. We studied 270 relatives of carriers of HVC. In only 3 cases the serology was (+). We did not found differences between our results and what was published. This could mean that the differences were not due only too transfusional transmission and could exist others possibilities.