Sleeping and dreaming in Greek mythology.

This article aims to emphasize the major influence of Ancient Greek Mythology on modern sleep medicine. An analysis of Greek texts and medical literature using the MeSH terms Greek mythology, sleep, Greek Gods, and myths was conducted to identify mythological references related to sleep medicine. The findings are discussed concerning etymology, the early conceptualization of some disorders, and the developing characterization of sleep disorders in Greek mythology. The search found several observations in clinical sleep medicine concealed in ancient myths. Beyond the etymology of terms and reflective imaginations, these myths and their characters influence concepts that still tantalize our medical practice in modern days.

Circadian preference and stroke characteristics: A descriptive study.

There is evidence that circadian misalignment is linked with an increased risk of stroke and that circadian preference is linked with rehabilitation outcomes after stroke. Circadian preferences refer to preferences based on individuals' characteristics in respect of the timing of physiological functions that are typically assessed by self-report questionnaires. This study set out to explore this relationship by examining whether there was an association between circadian preference and stroke characteristics in a sample of stroke outpatients, considering the time of stroke onset, the topography of the stroke and the resulting disability. We also examined whether sleep complaints (snoring, insomnia, sleep apnea) were associated with circadian preferences (i.e., morning-, evening-, and intermediate-types). We also compared circadian preferences and comorbidities in this sample, matched by age and sex, with those of healthy controls who took part in an epidemiological study (EPISONO) comprising a representative sample of the population of the city of São Paulo, Brazil. Most of our sample in both groups were morning-type, and in the stroke group, ischemic stroke was the most common type. There was an increased risk for sleep apnea among evening-types, and a higher prevalence of diabetes in the evening- and intermediate-types. We found no association between circadian preference and the time of stroke onset, or with wake-up stroke. We found a low prevalence of evening-type participants in our sample of controls (2.9%) and in the stroke group (1.7%). This investigation showed a similar circadian preference (morning-types) in stroke outpatients and the general population.

The effects of the COVID-19 pandemic on patients with narcolepsy.

STUDY OBJECTIVES: To the best of our knowledge, there has not as yet been any study on the effects of the COVID-19 pandemic on patients with narcolepsy, in particular, in relation to its impact on sleep schedules, symptoms, the need for medication, work, income, and quality of life. This study therefore aimed to explore these factors and their possible influence on sleep, circadian timing, and narcolepsy symptoms during the pandemic. METHODS: Patients with narcolepsy who had been in quarantine for at least 3 months completed a 36-question online survey. Questions targeted the conditions of the quarantine, sleep-related behaviors, and factors known to affect sleep and circadian rhythms (work status, income, appetite, narcolepsy symptoms, and medication), as well as the quality of life during the quarantine period. RESULTS: The routines of the participants had been altered by quarantine, with changes in their place of work, and an increase in narcolepsy symptoms, such as cataplexy, sleep paralysis, hallucinations, nocturnal awakenings, and sleepiness. Sleep and wake times changed, resulting in altered sleep patterns in most of the sample. No association between changes in the place of work and narcolepsy symptoms was found. Regarding medication, the participants used fewer antidepressant pills but took more stimulants. Appetite was increased and self-reported quality of life decreased during the period. CONCLUSIONS: During the quarantine, the patients with narcolepsy reported changes in their bedtime and waking-up schedules, suggesting a tendency to circadian misalignment. In Brazil, the effects of the COVID-19 outbreak have gone beyond the direct action of the virus because of the collateral damage it has caused in respect to unemployment, financial hardship, and a reduction in quality of life. These impacts have been amplified in Brazil because of the level of social inequality found in the country, and they have particularly affected vulnerable patients with rare diseases, such as the narcolepsy population.

Narcolepsy, Precocious Puberty and Obesity in the Pediatric Population: a Literature Review.

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic and hypnopompic hallucinations. The onset of the symptoms usually occurs in childhood, and previous studies have reported an association between narcolepsy and other endocrine diseases in the pediatric population, such as obesity and precocious puberty. The incidence of overweight or obesity ranges from 25% to 74% in patients with narcolepsy type I, while precocious puberty is present in 17% of children with narcolepsy with cataplexy. However, the mechanisms involved in the association of narcolepsy with obesity and precocious puberty have not been fully elucidated yet. In this review, we aimed to discuss narcolepsy in pediatric populations, highlighting the diagnostic difficulties and the complexity of the possible mechanisms that can relate narcolepsy to precocious puberty and obesity. We also emphasized the fact that endocrine diseases must be taken into consideration in children diagnosed with narcolepsy.

Moebius syndrome and narcolepsy: A case dissertation.

Moebius syndrome (MS) is a congenital syndrome characterized by unilateral or bilateral aplasia of the VI and VII cranial nerves, with consequent convergent strabismus and bilateral peripheral facial paralysis. This syndrome might be associated with diurnal excessive sleepiness and muscular hypotony, mimetizing in this manner, narcolepsy. The diagnostic criteria for narcolepsy depend on the presence of REM sleep during the day. As with patients with MS we do not have ocular movements due to the VI nerve paralysis, the absence of horizontal ocular movements might make it difficult to confirm narcolepsy in these patients. The common clinical characteristics of these patients are due to a possible impairment of the same structures that are affected in the central nervous system. However, the mechanism by which it occurs remains to be fully understood. Further electrophysiological researches are necessary to better clarify the association of these two diseases. The objective of this dissertation is to describe and discuss a case of Moebius syndrome with diurnal excessive sleepiness as a differential diagnosis for narcolepsy.

Experience with the use of modafinil in the treatment of narcolepsy in a outpatient facility specialized in diurnal excessive sleepiness in São Paulo.

Narcolepsy is a chronic neurological disease characterized by diurnal excessive sleepiness and catapleaxy. It affects 1 in every 2000 to 4000 individuals with personal, social and familiar significant repercussions. The treatment of narcolepsy is mainly based on the use of stimulants for the control of the diurnal excessive sleepiness, in conjunction with behavioral measures and sleep hygiene. Among the stimulants, modafinil has presently been the drug of choice for the treatment of the diurnal excessive sleepiness in patients with narcolepsy. In the worldwide experience, its use is better tolerated and the majority of its side effects is considered light or moderate. However, the clinical use in Brazil was initiated at the end of 2008, with little experience on the narcolepsy population of this country. In this context, the objective of this study was the evaluation of the use of modafinil, verifying the indication of use, causes for discontinuation, daily dosage, efficiency of the treatment in a patient sample of narcoleptics consulted in a specialized center in Brazil. In this study, modafinil was effective for the control of the symptoms related do narcolepsy in 66% of the studied patients. The side effects such as headache, parestesias and diarrhea were the main reasons for the discontinuation of treatment with modafinil. It is important to clinically follow up the patients for a long period to evaluate symptomatology, control of use, tolerability and re-evaluation of the more effective therapeutic dosage able to control narcolepsy. Due to its high cost and clinical benefits, this drug should be on the government׳s list of free drugs for the treatment of these patients.

Prevalence of periodical leg movements in patients with narcolepsy in an outpatient facility in São Paulo.

Studies have pointed out that approximately 50-60% of narcolepsy patients may demonstrate higher prevalence of periodical leg movements. However, we highlight that the prevalence studies and the effects of periodical leg movements in patients with narcolepsy are limited and with conflicting results. The objective of this study was that of describing and discussing the prevalence of periodical leg movements in patients with narcolepsy in the outpatient facility of diurnal excessive sleepiness of the Federal University of São Paulo, Brazil. We revised 59 files of patients with the clinical and electrophysiological diagnosis of narcolepsy according to the American Academy of Sleep Medicine. Of these 59 cases of patients with narcolepsy, 12 (20.3%) demonstrated periodical leg movements. Thirty five patients (59.3%) had history of cataplexy and 38 patients (64.4%) had the presence of the allele HLA-DQB1⁎0602. There was a higher prevalence of periodical leg movements in patients with cataplexy (p<0.0001) and in patients with the presence of the allele HLA-DQB1⁎0602 (p<0.0001). Our study characterized the higher prevalence of periodical leg movement in patients with narcolepsy, mainly in patients with cataplexy and with the presence of the allele HLA-DQB1⁎0602.

Clock gene polymorphisms and narcolepsy in positive and negative HLA-DQB1*0602 patients.

Narcolepsy is a chronic sleep disorder. It is linked to the HLA-DQB1*0602 allele. A recent report established a genetic linkage between narcolepsy and the chromosomal region 4p13-q21 that contains the Clock gene. We studied two SNPs in the Clock gene aiming to find any association with narcolepsy. We did not find differences in genetic frequencies in the patients group. We concluded that these two SNPs are not associated with narcolepsy.