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.

Insomnia: psychological and neurobiological aspects and non-pharmacological treatments.

Insomnia involves difficulty in falling asleep, maintaining sleep or having refreshing sleep. This review gathers the existing informations seeking to explain insomnia, including those that focus on psychological aspects and those considered neurobiological. Insomnia has been defined in psychological (cognitive components, such as worries and rumination, and behavioral aspects, such as classic conditioning) and physiological terms (increased metabolic rate, with increased muscle tone, heart rate and temperature). From the neurobiological point of view, there are two perspectives: one which proposes that insomnia occurs in association with a failure to inhibit wakefulness and another that considers hyperarousal as having an important role in the physiology of sleep. The non-pharmacological interventions developed to face different aspects of insomnia are presented.

Insomnia: psychological and neurobiological aspects and non-pharmacological treatments / Insonia: aspectos psicologicos e neurobiologicos e tratamentos nao farmacologicos

Insomnia involves difficulty in falling asleep, maintaining sleep or having refreshing sleep. This review gathers the existing informations seeking to explain insomnia, including those that focus on psychological aspects and those considered neurobiological. Insomnia has been defined in psychological (cognitive components, such as worries and rumination, and behavioral aspects, such as classic conditioning) and physiological terms (increased metabolic rate, with increased muscle tone, heart rate and temperature). From the neurobiological point of view, there are two perspectives: one which proposes that insomnia occurs in association with a failure to inhibit wakefulness and another that considers hyperarousal as having an important role in the physiology of sleep. The non-pharmacological interventions developed to face different aspects of insomnia are presented.

Insônia é um transtorno que envolve dificuldade em dormir, em manter-se dormindo ou em ter um sono restaurador. Esta revisão reúne informações que buscam explicar a insônia, incluindo aquelas que estudam os aspectos psicológicos e os neurobiológicos. A insônia tem sido definida em termos psicológicos (componentes cognitivos, tais como preocupações e ruminação e aspectos comportamentais, tais como o condicionamento clássico) e em termos fisiológicos (taxa metabólica aumentada, com tônus muscular, frequência cardíaca e temperatura aumentados). Do ponto de vista neurobiológico, há duas perspectivas: uma propondo que a insônia ocorre em associação com uma falha na inibição da vigília e outra que considera o hiperalerta como tendo um papel importante na fisiologia do sono. São apresentadas também as estratégias não farmacológicas desenvolvidas para lidar com os diferentes aspectos da insônia.

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.

Sleep disorders in Machado-Joseph disease: a dopamine transporter imaging study.

OBJECTIVES: Sleep disorders, especially restless legs syndrome (RLS) and rapid eye movement sleep behavior disorder (RBD), are common in spinocerebellar ataxia type 3 or Machado-Joseph disease (MJD), and a possible underlying dopaminergic dysfunction is implicated. This study assessed the relationship between sleep disorders in MJD and dopamine transporter (DAT) densities. PATIENTS AND METHODS: Twenty-two patients with MJD and twenty healthy subjects were enrolled in this study. MJD patients underwent clinical sleep evaluation and polysomnography. SPECT with [(99m)Tc]-TRODAT-1, was performed in all subjects. RESULTS: DAT densities were significantly reduced in MJD group when compared to controls. No significant correlation was found between DAT densities and RLS or RBD in MJD. CONCLUSION: Our study failed to demonstrate a clear correlation between sleep disorders and DAT densities in MJD patients, hence suggesting that extrastriatal and non-presynaptic dopamine pathways could be implicated in MJD-related sleep disorders.

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.

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.

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.

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

CONTEXTO:A síndrome da apnéia obstrutiva do sono (SAOS) é importante e prevalente doença associada à má qualidade de vida em muitos pacientes. Os tratamentos disponíveis incluem cirurgias, CPAP e o aparelho reposicionador mandibular intra-oral (ARMIO). Muitos centros de distúrbios de sono valorizam apenas a redução do número de apnéias no tratamento da SAOS, dando pouca atenção à qualidade de vida como desfecho do tratamento. OBJETIVO: Graduar melhora da qualidade de vida dos pacientes com SAOS usando ARMIO. MÉTODO: O questionário Calgary SAQLI foi aplicado, antes e após, 4 semanas de tratamento com ARMIO, a 11 pacientes masculinos, entre 34 e 63 anos de idade (média de 49 anos), com SAOS leve a moderada. ARMIOs foram manufaturados com polímero acrílico e providos com retentivos para manter a mandíbula em posição anterior durante o sono. RESULTADOS: Observamos grande melhora na qualidade de vida em 5 pacientes (45,5%) e melhora dos sintomas em 10 (90,9%). CONCLUSÃO: O uso do ARMIO associa-se principalmente à melhora dos sintomas, como também à melhora da qualidade de vida global.

Intermittent diazepam and continuous phenobarbital to treat recurrence of febrile seizures: a systematic review with meta-analysis

Convulsions triggered by fever are the most common type of seizures in childhood, and 20 percent to 30 percent of them have recurrence. The prophylactic treatment is still controversial, so we performed a systematic review to find out the effectiveness of continuous phenobarbital and intermittent diazepam compared to placebo for febrile seizure recurrence. METHOD: Only randomized, double-blind, placebo-controlled trials were analyzed. The recurrence of febrile seizure was assessed for each drug. RESULTS: Ten eligible clinical trials were included. Febrile seizure recurrence was smaller in children treated with diazepam or phenobarbital than in placebo group. Prophylaxis with either phenobarbital or diazepam reduces recurrences of febrile seizures. The studies were clinical, methodological, and statistically heterogeneous. CONCLUSION: The effectiveness of phenobarbital and diazepam could not be demonstrated because clinical trials were heterogeneous, and the recommendation for treatment recurrence should rely upon the experience of the assistant physician yet

Personality features ina sample of psychophysiological insomnia patients

The personality is the way people express themselves inside the environment they live. Sleep, quality or quantity, is a way of this physical and psychological expression of well being. Psychological factors, associated with psychophysiological insomnia (PPI) suggest an exaggerated perception of the difficulties to fall asleep. Worries, anxiety and the fear of not sleeping produce a bad sleep quality or sleep misperception. This study aims to identify personality features associated with PPI throughout Rorschach test (RT). METHOD: We studied 32 patients with PPI (22 women), between 29 and 75 years old. We excluded patients with other sleeping or psychiatric disorders. We analysed the data from PPI patients submitted to the RT and we compared our results with the standard data. RESULTS: We noticed a significant increase in global answers and a significant decrease in detailed answers; a trend of a low number of answers; great number of shape and animal answers, especially for women. CONCLUSION: The features of the PPI patient's personality were daily problems insecure and the incapability to avoid or remove them from their thought, making bedtime a time for worries to appear again and motivate insomnia

Histochemical study of the skeletal muscle in children with chronic failure in dialysis treatment

Among the modifications occurring in the uremic organism,in addition to the consequences of dialysis, myophathy and peripheral neuropathy are very significant. Children are particularly affected, as their growth and development are jeopardized. Histochemistry of muscular biopsy was used to study eighteen children with end-stage renal failure under dialysis during a ten-month period. According to our results, the skeletal muscular tissue presented the following types of alterations: atrophy, type grouping, lipidosis, glycogen depletion and mitochondrial proliferation.