Sleep quality and polysomnographic changes in patients with chronic pain with and without central sensitization signs.

BACKGROUND: Insufficient sleep is common nowadays and it can be associated with chronic pain. OBJECTIVE: To describe the main polysomnographic findings in patients with chronic musculoskeletal pain and to estimate the association between sleep quality, polysomnography variables and chronic musculoskeletal pain. METHODS: This cross-sectional research analyzed a database from polysomnography type 1 exams results and then collected data via an electronic form from these patients. The form collected sociodemographic data and presented clinical questionnaires for measuring sleep quality, sleepiness, pain intensity and central sensitization signs. Pearson's correlation coefficient and odds ratio were used to estimate the associations. RESULTS: The mean age of the respondents was 55.1 (SD 13.4) years. The mean score of the Central Sensitization Inventory showed signs of central sensitization (50.1; SD 13.4) in the participants. Most patients (86%) had 1 or more nocturnal awakenings, 90% had one or more episodes of sleep apnea, 47% had Rapid Eye Movement sleep phase latency greater than 70-120 min and the mean sleep efficiency among all participants was 81.6%. The Pittsburgh Sleep Quality Index score was correlated with the CSI score (r = 0.55; 95% CI: 0.45, 0.61). People with central sensitization signs have 2.6 times more chance to present sleep episodes of blood oxygen saturation below 90% (OR = 2.62; 95% CI:1.23, 6.47). CONCLUSION: Most people with central sensitization signs had poor sleep quality, night waking episodes and specific disturbances in sleep phases. The findings showed association between central sensitization, sleep quality, nocturnal awakening, and changes in blood oxygen saturation during sleep.

Metástase tumoral de pulmão com invasão cardíaca: relato de um caso e revisão da literatura / Metastatic lung tumor invading the heart: report of one case and review of the literature

Os autores descrevem a evolução clínica de um rapaz de 16 anos com osteossarcoma, primário na perna direita e secundário do pulmão direito com protrusão do tumor para o átrio esquerdo através da veia pulmonar superior direita. O diagnóstico foi realizado durante ecocardiografia como protocolo para detecção de cardiotoxicidade às drogas antineoplásicas. Neste estágio, já havia uma grande metástase pulmonar à direita, irressecável e que foi controlada apenas pela quimioterapia. O paciente desenvolveu sinais clínicos de obstrução do átrio esquerdo e hipertensão arterial pulmonar, sendo submetido a ressecção da protrusão tumoral por cirurgia cardíaca aberta. No entanto, mesmo com prognóstico ruim, sobreviveu por quatro meses mais. A despeito do prognóstico pobre esperado, este tipo de cirurgia não impõe dificuldades técnicas e deveria ser feita sempre que possível tendo em vista a melhora da qualidade de vida que poderá trazer