Interaction between apolipoprotein E genotypes, excessive daytime sleepiness, and cognitive function in obstructive sleep apnea patients.

BACKGROUND: Some studies show an association between the apolipoprotein E ε4 allele (ApoEε4) and obstructive sleep apnea syndrome (OSAS), and other studies, an association between ApoEε4 and excessive daytime sleepiness (EDS), but there are no data in the literature on the interaction between EDS, cognitive function, and ApoEε4 in patients with OSA. OBJECTIVE: To examine the cognitive function of adults with and without EDS and with and without ApoEε4. METHODS: A total of 21 male and female patients aged between 33 and 79 years, underwent a clinical interview, ApoE genotyping, neuropsychological evaluation, polysomnography, and the application of the Epworth Sleepiness Scale. RESULTS: Excessive daytime sleepiness was associated with lower intelligence quotient (IQ; total performance) and worse immediate visual memory, regardless of the ApoE genotype. Patients carrying the ApoEε3/ε4 genotype had a worse performance in divided attention, constructional praxis, perceptual organization, and cognitive flexibility. A combination of the ε4 allele and EDS potentiates the negative effect on cognition, except for immediate visual memory. In this case, patients had a worse performance in terms of processing speed, selective attention, and visuomotor coordination. CONCLUSIONS: Excessive daytime sleepiness and the ApoEε3/ε4 genotype are associated with worse cognitive performance in OSA patients. The combination of EDS and ε4 allele potentiates cognitive impairment.

ANTECEDENTES: Alguns estudos mostram uma associação entre o alelo ε4 da apolipoproteina E (ApoEε4) e a síndrome da apneia obstrutiva do sono (SAOS), e outros, entre ApoEε4 e a sonolência excessiva diurna (SED), mas não há dados na literatura sobre a interação entre SED, função cognitiva e ApoEε4 em pacientes com SAOS. OBJETIVO: Avaliar a função cognitiva em adultos com SAOS com e sem SED e com e sem ApoEε4. MéTODOS: Ao todo, 21 pacientes, de 33 a 79 anos, homens e mulheres, foram avaliados clinicamente, e submetidos a genotipagem ApoE, avaliação neuropsicológica, polissonografia, e aplicação da Escala de Sonolência de Epworth. RESULTADOS: A SED esteve associada com menor quociente de inteligência (QI; desempenho geral) e pior memória visual imediata, independentemente do genótipo ApoE. Pacientes com genótipo ApoEε3/ε4 apresentaram pior desempenho na atenção dividida, praxe construcional, organização perceptiva e flexibilidade cognitiva. A combinação do alelo ε4 com a SED potencializa esse efeito deletério na cognição, exceto na memória visual imediata. Nesse caso, os pacientes tiveram uma menor velocidade de processamento cognitivo, e piores atenção seletiva e coordenação visiomotora. CONCLUSõES: A SED e o genótipo ApoEε3/ε4 estão associados a um pior desempenho cognitivo em pacientes com SAOS. A combinação de SED e do alelo ε4 potencializa esse efeito.

Interaction between apolipoprotein E genotypes, excessive daytime sleepiness, and cognitive function in obstructive sleep apnea patients / Interação entre genótipos da apolipoproteína E, sonolência excessiva diurna e função cognitiva em pacientes com apneia obstrutiva do sono

Abstract Background Some studies show an association between the apolipoprotein E ε4 allele (ApoEε4) and obstructive sleep apnea syndrome (OSAS), and other studies, an association between ApoEε4 and excessive daytime sleepiness (EDS), but there are no data in the literature on the interaction between EDS, cognitive function, and ApoEε4 in patients with OSA. Objective To examine the cognitive function of adults with and without EDS and with and without ApoEε4. Methods A total of 21 male and female patients aged between 33 and 79 years, underwent a clinical interview, ApoE genotyping, neuropsychological evaluation, polysomnography, and the application of the Epworth Sleepiness Scale. Results Excessive daytime sleepiness was associated with lower intelligence quotient (IQ; total performance) and worse immediate visual memory, regardless of the ApoE genotype. Patients carrying the ApoEε3/ε4 genotype had a worse performance in divided attention, constructional praxis, perceptual organization, and cognitive flexibility. A combination of the ε4 allele and EDS potentiates the negative effect on cognition, except for immediate visual memory. In this case, patients had a worse performance in terms of processing speed, selective attention, and visuomotor coordination. Conclusions Excessive daytime sleepiness and the ApoEε3/ε4 genotype are associated with worse cognitive performance in OSA patients. The combination of EDS and ε4 allele potentiates cognitive impairment.

Resumo Antecedentes Alguns estudos mostram uma associação entre o alelo ε4 da apolipoproteina E (ApoEε4) e a síndrome da apneia obstrutiva do sono (SAOS), e outros, entre ApoEε4 e a sonolência excessiva diurna (SED), mas não há dados na literatura sobre a interação entre SED, função cognitiva e ApoEε4 em pacientes com SAOS. Objetivo Avaliar a função cognitiva em adultos com SAOS com e sem SED e com e sem ApoEε4. Métodos Ao todo, 21 pacientes, de 33 a 79 anos, homens e mulheres, foram avaliados clinicamente, e submetidos a genotipagem ApoE, avaliação neuropsicológica, polissonografia, e aplicação da Escala de Sonolência de Epworth. Resultados A SED esteve associada com menor quociente de inteligência (QI; desempenho geral) e pior memória visual imediata, independentemente do genótipo ApoE. Pacientes com genótipo ApoEε3/ε4 apresentaram pior desempenho na atenção dividida, praxe construcional, organização perceptiva e flexibilidade cognitiva. A combinação do alelo ε4 com a SED potencializa esse efeito deletério na cognição, exceto na memória visual imediata. Nesse caso, os pacientes tiveram uma menor velocidade de processamento cognitivo, e piores atenção seletiva e coordenação visiomotora. Conclusões A SED e o genótipo ApoEε3/ε4 estão associados a um pior desempenho cognitivo em pacientes com SAOS. A combinação de SED e do alelo ε4 potencializa esse efeito.

Translation and adaptation of the sleep apnea quality of life index (SAQLI) to Brazilian Portuguese.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is characterized by episodes of upper airway obstruction during sleep, with a risk of cardiovascular and cerebrovascular diseases. There is no tool in Brazil to measure the impact of treatment on patients with OSAS. OBJECTIVE: To translate and culturally adapt the Sleep Apnea Quality of Life Index (SAQLI) into Brazilian Portuguese. METHODS: The translation and cultural adaptation were carried out in five steps: translation, synthesis of the translations, back translation, review committee and pretesting. RESULTS: A version of a culturally compatible SAQLI was constructed after lexical changes, along with changes to the sentence structures, visual format, instructions and cards. The essence of the questionnaire and its social, emotional, and disease impact in treatment measures was maintained, with 80% understanding. CONCLUSIONS: The questionnaire was translated and adapted culturally to Brazilian Portuguese, and presented good comprehension in the study population.

Translation and adaptation of the sleep apnea quality of life index (SAQLI) to Brazilian Portuguese / Tradução e adaptação cultural do questionário de qualidade de vida (SAQLI) para o português brasileiro

ABSTRACT Background Obstructive sleep apnea syndrome (OSAS) is characterized by episodes of upper airway obstruction during sleep, with a risk of cardiovascular and cerebrovascular diseases. There is no tool in Brazil to measure the impact of treatment on patients with OSAS. Objective To translate and culturally adapt the Sleep Apnea Quality of Life Index (SAQLI) into Brazilian Portuguese. Methods The translation and cultural adaptation were carried out in five steps: translation, synthesis of the translations, back translation, review committee and pretesting. Results A version of a culturally compatible SAQLI was constructed after lexical changes, along with changes to the sentence structures, visual format, instructions and cards. The essence of the questionnaire and its social, emotional, and disease impact in treatment measures was maintained, with 80% understanding. Conclusions The questionnaire was translated and adapted culturally to Brazilian Portuguese, and presented good comprehension in the study population.

RESUMO Antecedentes A síndrome da apneia obstrutiva do sono (SAOS) é caracterizada por episódios de obstrução da via aérea superior durante o sono, com risco para doenças cardiovasculares e cerebrovasculares. Não há ferramenta no Brasil para medir o impacto do tratamento em pacientes com SAOS. Objetivo Traduzir e adaptar culturalmente o Índice de Qualidade de Vida em Apneia do Sono (SAQLI) para o português brasileiro. Métodos A tradução e adaptação cultural foram realizadas em cinco etapas: tradução, síntese das traduções, retrotradução, comitê de revisão e pré-teste. Resultados Uma versão de SAQLI culturalmente compatível foi construída após mudanças lexicais, bem como mudanças nas estruturas das frases, formato visual, instruções e cartões, mantendo a essência do questionário e seu impacto social, emocional e da doença nas medidas de tratamento, com 80% de compreensão. Conclusões O questionário foi traduzido e adaptado culturalmente para o português brasileiro apresentando bom índice de compreensão na população estudada.

Obstructive sleep apnea prevents the expected difference in craniofacial growth of boys and girls.

OBJECTIVES: It was to compare cephalometric measures of mouth-breather boys and girls and with the cephalometric pattern observed in obstructive sleep apnea syndrome (OSAS) patients. METHODS: Craniofacial measurements of lateral cephalometric radiographs obtained from 144 children aged 7-14 years were compared between boys and girls, and both were compared to cephalometric pattern of OSAS patients. RESULTS: Mouth-breather boys and girls had no gender differences regarding to craniofacial morphology while nose-breather boys and girls showed those expected differences. Nose-breather boys presented a more retruded mandible and proinclined upper incisor when compared to nose-breather girls, but mouth-breather boys and girls had no differences. The measure NS.GoGn was the only variable with an interaction with gender and breathing. CONCLUSIONS: There were no cephalometric difference in mouth breather-boys and girls related to normal growth, suggesting that oral breathing make the same craniofacial morphology and both have craniofacial morphology close to that of OSAS patients.

Obstructive sleep apnea prevents the expected difference in craniofacial growth of boys and girls / A apneia obstrutiva do sono impede a esperada diferença de crescimento cranofacial de meninos e meninas

OBJECTIVES: It was to compare cephalometric measures of mouth-breather boys and girls and with the cephalometric pattern observed in obstructive sleep apnea syndrome (OSAS) patients. METHODS: Craniofacial measurements of lateral cephalometric radiographs obtained from 144 children aged 7-14 years were compared between boys and girls, and both were compared to cephalometric pattern of OSAS patients. RESULTS: Mouth-breather boys and girls had no gender differences regarding to craniofacial morphology while nose-breather boys and girls showed those expected differences. Nose-breather boys presented a more retruded mandible and proinclined upper incisor when compared to nose-breather girls, but mouth-breather boys and girls had no differences. The measure NS.GoGn was the only variable with an interaction with gender and breathing. CONCLUSIONS: There were no cephalometric difference in mouth breather-boys and girls related to normal growth, suggesting that oral breathing make the same craniofacial morphology and both have craniofacial morphology close to that of OSAS patients.

OBJETIVOS: Foi comparar medidas cefalométricas entre meninos e meninas respiradores bucais com o padrão cefalométrico de pacientes com síndrome da apneia obstrutiva do sono (SAOS). MÉTODOS: Medidas craniofaciais de radiografias cefalométricas laterais de 144 crianças com idade entre 7 e 14 anos foram comparadas entre meninos e meninas, e estas comparadas com o padrão cefalométrico de pacientes com SAOS. RESULTADOS: Meninos e meninas respiradores bucais não apresentaram diferenças em relação à morfologia craniofacial, enquanto meninos e meninas respiradores nasais mostraram as diferenças fisiologicamente esperadas. Meninos respiradores nasais apresentaram mandíbula mais retraída e incisivos superiores inclinados para frente quando comparados com meninas respiradoras nasais, mas os respiradores bucais não apresentaram diferenças. A medida NS.GoGn foi a única variável com interação entre gênero e tipo de respiração. CONCLUSÕES: Não houve diferença cefalométrica entre os respiradores bucais em relação ao crescimento craniofacial, sugerindo que a respiração bucal determina a mesma morfologia, e ambos os gêneros têm morfologia craniofacial semelhante àquela dos pacientes com SAOS.

Insônia / Insomnia

Insônia é um sintoma comum. Cerca de 33% a 50% da população sofre de insônia em alguma parte de sua vida. Pode ser primária ou secundária a problemas emocionais, dor física ou uso de algumas medicações. A causa deve ser determinada pela avaliação do sono, uso de drogas, grau de estresse e nível de atividade física. O tratamento depende da causa primária. Para insônia devida a alterações emocionais, que não a depressão e casos refratários, uma droga hipnótica pode ser temporariamente utilizada, especialmente se ela melhora a qualidade de vida e bem-estar.

Restless legs syndrome during pregnancy in Brazilian women.

OBJECTIVE: The objective of this study was to identify the prevalence of restless legs syndrome (RLS) among pregnant Brazilian women, with individual diagnostic clinical interviews during the trimesters of pregnancy, and to determine the severity. METHODS: It was a cross-sectional study. We interviewed 524 pregnant women (18-45 years old) who came to the prenatal outpatient clinic to consult an obstetrician. We used a RLS clinical-diagnostic interview and the International RLS Study Group rating scale (IRLS). RESULTS: The prevalence of RLS during pregnancy was 13.5% in our sample, among which 90.1% of the cases started with their symptoms during pregnancy. More than half of the patients (53.5%) presented severe or very severe symptoms and the largest proportion of them (15.2%) were in their third trimester. We did not observe any demographic differences among the trimesters for RLS prevalence and RLS severity. CONCLUSION: RLS during pregnancy is more frequent than in the general population, such that more than half of the pregnant women with RLS present it severely or very severely. It occurs especially in the third trimester.

Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome.

OBJECTIVE: To determine whether mouth breathing children present the same cephalometric patterns as patients with obstructive sleep apnea syndrome (OSAS). METHOD: Cephalometric variables were traced and measured on vertical lateral cephalometric radiographs. The cephalometric measurements of 52 mouth and 90 nose breathing children were compared with apneic patients. The children had not undergone adenoidectomy or tonsillectomy and had not had or were not receiving orthodontic or orthopedic treatment. RESULTS: Mouth breathing children showed same cephalometric pattern observed in patients with OSAS: a tendency to have a retruded mandible (p=0.05), along with greater inclination of the mandibular and occlusal planes (p<0.01) and a tendency to have greater inclination of the upper incisors (p=0.08). The nasopharyngeal and posterior airway spaces were greatly reduced in mouth breathing children, as observed in patients with apnea (p<0.01). CONCLUSION: Mouth breathing children present abnormal cephalometric parameters and their craniofacial morphology resembles that of patients with OSAS.

Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome / Crianças respiradoras bucais apresentam padrão cefalométrico semelhante àquele observado em pacientes adultos com síndrome da apnéia obstrutiva do sono

OBJECTIVE: To determine whether mouth breathing children present the same cephalometric patterns as patients with obstructive sleep apnea syndrome (OSAS). METHOD: Cephalometric variables were traced and measured on vertical lateral cephalometric radiographs. The cephalometric measurements of 52 mouth and 90 nose breathing children were compared with apneic patients. The children had not undergone adenoidectomy or tonsillectomy and had not had or were not receiving orthodontic or orthopedic treatment. RESULTS: Mouth breathing children showed same cephalometric pattern observed in patients with OSAS: a tendency to have a retruded mandible (p=0.05), along with greater inclination of the mandibular and occlusal planes (p<0.01) and a tendency to have greater inclination of the upper incisors (p=0.08). The nasopharyngeal and posterior airway spaces were greatly reduced in mouth breathing children, as observed in patients with apnea (p<0.01). CONCLUSION: Mouth breathing children present abnormal cephalometric parameters and their craniofacial morphology resembles that of patients with OSAS.

OBJETIVO: Determinar se crianças respiradoras bucais apresentam o mesmo padrão cefalométrico que os pacientes que tem síndrome da apnéia obstrutiva do sono (SAOS). MÉTODO: Foram traçadas radiografias laterais verticais da cabeça para a mensuração das variáveis cefalométricas. As medidas cefalométricas de 52 crianças respiradoras bucais e de 90 crianças respiradoras nasais foram comparadas à de pacientes com apnéia. Foram excluídas as crianças que haviam sido submetidas à cirurgia de remoção de amídalas ou adenóides, ou que haviam recebido tratamento ortodôntico prévio ou em andamento. RESULTADOS: As crianças respiradoras bucais apresentaram o mesmo padrão cefalométrico observado em pacientes com SAOS: tendência a ter retrusão de mandíbula (p=0,05), assim como uma maior inclinação dos planos mandibular e oclusal (p<0,01) e tendência a ter maior inclinação dos incisivos superiores (p=0,08). O espaço da nasofaringe e o espaço aéreo posterior se apresentaram muito diminuídos nas crianças respiradoras bucais, como é observado em pacientes com SAOS (p<0,01). CONCLUSÃO: Crianças respiradoras bucais apresentam padrão cefalométrico alterado e sua morfologia craniofacial é semelhante àquela observada em pacientes com SAOS.

Methods to increase muscle tonus of upper airway to treat snoring: systematic review.

BACKGROUND: Snoring is the noise caused by vibration during the in-breath; and which structure actually vibrates depends on many factors. OBJECTIVE: The treatment of snoring with methods to increase muscle tonus of upper airway has been controversial, and poorly reported, thus a review of evidence is necessary to evaluate the effectiveness of these methods. METHOD: A review of randomized or quasi-randomized, double blind trials on snoring treatment that have employed any method to increase muscle tonus of upper airway like phonotherapy or physical therapy among others. OUTCOMES: decrease or completely stop of snoring, sleep quality, quality of life, and adverse events. RESULTS: Three eligible trials were potentially analyzed, but none of them could provide good scientific evidence favoring the intervention. The objective analyses of one study showed improvement of snoring, although the objective sub-analyses and subjective analyses showed controversial results. The adverse events were not reported. CONCLUSION: There is no enough evidence to support the recommendation of methods to increase muscle tonus of upper airways in treatment of snoring. Well designed randomized clinical trials are needed to asses the efficacy of such methods, and a standard and worldwide accepted method for snoring assessment would be useful for future researches.

Methods to increase muscle tonus of upper airway to treat snoring: systematic review / Métodos para aumentar o tônus muscular da via aérea superior no tratamento do ronco: revisão sistemática

BACKGROUND: Snoring is the noise caused by vibration during the in-breath; and which structure actually vibrates depends on many factors. OBJECTIVE: The treatment of snoring with methods to increase muscle tonus of upper airway has been controversial, and poorly reported, thus a review of evidence is necessary to evaluate the effectiveness of these methods. METHOD: A review of randomized or quasi-randomized, double blind trials on snoring treatment that have employed any method to increase muscle tonus of upper airway like phonotherapy or physical therapy among others. Outcomes: decrease or completely stop of snoring, sleep quality, quality of life, and adverse events. RESULTS: Three eligible trials were potentially analyzed, but none of them could provide good scientific evidence favoring the intervention. The objective analyses of one study showed improvement of snoring, although the objective sub-analyses and subjective analyses showed controversial results. The adverse events were not reported. CONCLUSION: There is no enough evidence to support the recommendation of methods to increase muscle tonus of upper airways in treatment of snoring. Well designed randomized clinical trials are needed to asses the efficacy of such methods, and a standard and worldwide accepted method for snoring assessment would be useful for future researches.

CONTEXTO: O ronco é o ruído causado pela vibração durante a inspiração, cujas estruturas vibratórias, dependem atualmente de vários fatores. OBJETIVO: O tratamento do ronco com métodos para aumentar o tônus muscular da via aérea superior tem sido controverso e pouco relatado, portanto uma revisão de evidências é necessária para avaliar a efetividade destes métodos. MÉTODO: Revisão sistemática de ensaios clínicos randomizados ou quasi-randomizados, duplo-cegos para o tratamento do ronco, com métodos visando o aumento do tônus da via aérea superior, tais como fonoterapia e fisioterapia. Desfechos: diminuição ou cura do ronco, qualidade do sono, qualidade de vida e efeitos adversos. RESULTADOS: Três estudos elegíveis foram potencialmente analisados, porém nenhum deles demonstrou evidência científica de qualidade favorecendo a intervenção. As análises subjetivas em um estudo mostrou melhora do ronco, entretanto as sub-análises objetivas demonstraram resultados controversos. Os efeitos adversos não foram relatados. CONCLUSÃO: Não existe evidência científica suficiente para sustentar a recomendação de métodos para aumentar o tônus muscular da via aérea superior no tratamento do ronco. Ensaios clínicos randomizados bem elaborados são necessários para avaliarmos a eficácia de tais métodos e uma padronização de métodos para intervir no ronco mundialmente aceitos se tornariam úteis em pesquisas futuras.

Anticonvulsants to treat idiopathic restless legs syndrome: systematic review.

BACKGROUND: Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. Many treatments have been used to minimize the discomfort of the disease, among them the anticonvulsant therapy. AIM: This review aims to evaluate the efficacy and safety of anticonvulsant treatment for idiopathic RLS. METHOD: Systematic review of randomized or quasi-randomized, double blind trials on anticonvulsant treatment for RLS. OUTCOMES: relief of RLS symptoms, subjective and objective sleep quality, quality of life, and adverse events associated with the treatments. RESULTS: A total of 231 patients were randomized in three cross over studies and one parallel study. Three studies with carbamazepine, one with sodium valproate, and one with gabapentin, and they were very heterogeneous so we could not perform a meta-analysis. CONCLUSIONS: There is no scientific evidence on RLS treatment with anticonvulsants for clinical practice.

Anticonvulsants to treat idiopathic restless legs syndrome: systematic review / Anticonvulsivantes para a síndrome das pernas inquietas idiopática: revisão sistemática

BACKGROUND: Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. Many treatments have been used to minimize the discomfort of the disease, among them the anticonvulsant therapy. AIM: This review aims to evaluate the efficacy and safety of anticonvulsant treatment for idiopathic RLS. METHOD: Systematic review of randomized or quasi-randomized, double blind trials on anticonvulsant treatment for RLS. Outcomes: relief of RLS symptoms, subjective and objective sleep quality, quality of life, and adverse events associated with the treatments. RESULTS: A total of 231 patients were randomized in three cross over studies and one parallel study. Three studies with carbamazepine, one with sodium valproate, and one with gabapentin, and they were very heterogeneous so we could not perform a metanalyses. CONCLUSIONS: There is no scientific evidence on RLS treatment with anticonvulsants for clinical practice.

CONTEXTO: A síndrome das pernas inquietas (SPI ) é uma desordem caracterizada por um impulso de mover as pernas e as vezes outras partes do corpo acompanhado geralmente por desconforto ou da dor nas pernas ou em outra parte afetada. Muitos tratamentos tem sido utilizados para aliviar o desconforto causado pela doença entre eles os anticonvulsivantes. OBJETIVO: Este estudo objetivou avaliar a eficácia e segurança do tratamento da SPI com as drogas anticonvulsivantes. MÉTODO: Revisão sistemática de ensaios clínicos randomizados ou quasi-randomizados, duplo-cegos para o tratamento com anticonvulsivantes para SPI. Desfechos: alívio dos sintomas da SPI, qualidade subjetiva e objetiva do sono, qualidade de vida e efeitos adversos relacionados ao tratamento. RESULTADOS: Um total de 231 pacientes foram randomizados em três estudos cross-over e um estudo paralelo. Três estudos avaliaram a carbamazepina, um estudo avaliou o ácido valpróico e o outro a gabapentina, eles eram muito heterogêneos, o que impossibilitou a metanálise dos resultados. CONCLUSÃO: Não existe evidência científica, que o tratamento da SPI com anticonvulsivantes é eficaz e seguro, para a prática clínica.

Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: randomized clinical trial.

OBJECTIVE: To compare hydrotherapy (HT) and conventional physiotherapy (CP) in the treatment of fibromyalgia (FM), regarding quality of life (QOL), total sleep time (TST), and total nap time (TNT). METHODS: Fifty outpatients, all female, 30-60 years old, diagnosed with FM, were randomly assigned to two groups to carry out 3 weeks of treatment with HT or CP. In the beginning and in the end of treatment, patients were evaluated with the SF-36 questionnaire to measure QOL and the sleep diary for TST and TNT. Data analyses were blind. RESULTS: All 24 HT patients increased 1h in TST compared to 19 CP patients. TNT decreased in the HT group. QOL improved for the two groups in all domains when pre- and post-intervention were compared, but there was no difference between groups. CONCLUSION: HT is more effective than CP to improve TST and to decrease TNT in FM patients.

Cognitive dysfunction in children with sleep disorders.

UNLABELLED: Sleep is basic for physical and cognitive development and some studies have suggested that there may be an association between sleep disorders (SD) and cognitive dysfunction (CD) in children. Little is known, however, about SD and cognition in 7-10-year-old children, a fact that motivated the present study. METHOD: We applied an SD questionnaire in 1180 children, 547 with SD and 633 without SD (CG), to assess cognition with a screening test (Bender Visual Motor Gestalt Test - BT). RESULTS: We observed a similar frequency of CD in the children with SD (39%) and that ot the CG (40%). The 8-year-old children with SD presented a lower prevalence of CD than the CG (SD=6%, n=6; CG=13%, n=16; p=0.04). CONCLUSION: The frequency of children with CD was equal in the study and control groups when considering the total sample (7- to 10-year-old children). In contrast to our expectations, the SD group of 8-year-old children presented a lower frequency of CD than the control group.

Sleep disorders in pregnancy.

CONTEXT: The precise function of sleep in animals and human beings is still unknown, and any sort of physical, social or psychological variation may change the normal sleep-wake cycle. PURPOSE: This research aims is to determine the sleep disorders (SD) for each of the three trimesters of the pregnancy comparing them to the pre-pregnancy state (PG). METHOD: SD were investigated in three hundred pregnant women 11- to 40-years-old through with a brief clinical interview based on directed questions. One hundred pregnant women were considered for each trimester. RESULTS: The rate of pregnant women with insomnia increased by 23% in the 2nd trimester (p< 0.005); the rate for excessive daytime sleepiness (EDS) by 15% in the 1st trimester (p<0.003), 55% in the 2nd trimester (p<0.001) and by 14% in the 3rd trimester (p<0.002); the rate for mild sleepiness increased by 33% in the 2nd trimester (p<0.002) and by 48% in the 3rd trimester (p<0.001); the rate for specific awakenings increased by 63% in the 1st trimester, by 80% in the 2nd trimester and by 84% in the 3rd trimester (p<0.001). CONCLUSION: SD were more frequent during pregnancy comparatively to PG state, mostly at the expenses of EDS and specific awakenings.

Quality of life of patients with obstructive sleep apnea syndrome treated with an intraoral mandibular repositioner.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a very important and prevalent disease, which is associated with a poor quality of life in many patients. Treatments for OSAS include surgery, Continuous Positive Air way Pressure, and an intraoral mandibular repositioner (IOMR), but the tendency of sleep centers is to emphasize the apnea index, neglecting quality of life as treatment outcome. OBJECTIVE: To verify to what extent treatment with an IOMR improves the OSAS patient's quality of life. METHOD: Eleven male patients aged 34 to 63 years (mean=49) with mild to moderate OSAS were evaluated using the Calgary SAQLI questionnaire applied before and four weeks after treatment with an IOMR. The mandibular repositioners were manufactured individually for each patient with acrylic polymer and equipped with a retentive device to maintain the mandible in a forward position during sleep. RESULTS: Excellent improvement in the quality of life was observed in five patients (45.5%) and excellent improvement in symptoms in 10 (90.9%). CONCLUSION: The systematic use of the IOMR indicates a clear improvement in the global quality of life as well as in the symptoms of patients with OSAS.

Cognitive dysfunction in children with sleep disorders

O sono é fundamental no desenvolvimento físico e cognitivo, vários estudos na literatura sugerem haver associação entre distúrbio do sono (DS) e disfunões cognitivas (DC) em crianças. Pouco se sabe, no entanto, sobre DS e cognição na faixa etária de 7 a 10 anos, motivo porque empreendemos este estudo. MÉTODO: Aplicamos um questionário de DS em 1180 crianças: 547 com DS e 633 sem DS (GC), avaliandose cognição pelo Teste Gestáltico de Bender (TB). RESULTADOS: Observamos proporção semelhante de DC nas crianças com DS (39%) e nas do GC (40%). As crianças de 8 anos do DS apresentaram menor prevalência de DC do que as do GC (DS=6%, n=6; GC=13%, n=16; p=0,04). CONCLUSÃO: A proporção de crianças com DC foi igual nos grupos estudo e controle quando consideramos a amostra total (crianças de 7 a 10 anos). Contrariando nossas expectativas, o grupo DS de 8 anos apresentou menos DC que o grupo controle.

Sleep disorders in pregnancy

INTRODUÇÃO: A função exata do sono em animais e seres humanos ainda é desconhecida e qualquer variação física, social ou psíquica pode alterar o ciclo normal de sono e vigília. OBJETIVO: O objetivo desta pesquisa é detectar os principais distúrbios do sono (DS) nos três trimestres da gravidez comparando-os ao estado pré-gestacional (PG). MÉTODO: Os DS foram investigados em 300 gestantes com idades variando de 11 a 40 anos, através de breve entrevista com questões dirigidas. Foram incluídas 100 gestantes para cada trimestre. RESULTADOS: A proporção de grávidas com insônia aumentou 23% no 2º trimestre (p<0,005); a de sonolência intensa 15% no 1º trimestre (p<0,003), 55% no 2º (p<0,001) e 14% no 3º (p<0,002); a de sonolência leve 33% no 2º trimestre (p<0,002) e 48% no 3º (p<0,001); a de despertares específicos 63% no 1º trimestre, 80% no 2º e 84% no 3º (p<0,001). CONCLUSÃO: DS foram mais freqüentes durante a gravidez comparativamente ao PG, principalmente às custas de sonolência intensa e despertares específicos.