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Nicolau ABF, Figueiredo DB, Stefanini R, de Aguiar Vidigal T, Bittencourt LRA, Andersen ML, Tufik S, Haddad FLM. The role of upper airway and facial skeleton anatomy in the evolution of obstructive sleep apnea: an 8-year follow-up. Sleep Breath 2024; 28:401-409. [PMID: 37682494 DOI: 10.1007/s11325-023-02907-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE To evaluate the role of anatomic alterations of the upper airway and facial skeleton in the evolution of obstructive sleep apnea (OSA) in a prospective population-based study with an 8-year follow-up. METHODS This was a population-based, longitudinal, prospective study, which took place from 2007 to 2015 at the Instituto do Sono, Sao Paulo, Brazil. In 2007, type I polysomnography (PSG), otorhinolaryngological examination, and collection of anthropometric measurements of all volunteers were performed. Volunteers were classified according to their anatomical features of the upper airway and facial skeleton. After 8 years, volunteers were invited for reevaluation. The relationship between anatomical characteristics and polysomnographic evolution was evaluated. RESULTS The study included 554 patients. After 8 years of follow-up, there was an increase in neck circumference and body mass index of the participants. There was a worsening in all polysomnographic parameters analyzed, with an increase in the apnea-hypopnea index, a decrease in minimum saturation values, and an increase in the percentage of sleep time with peripheral oxyhemoglobin saturation <90%. There was no statistical relationship between the anatomical findings considered unfavorable and the worsening of polysomnographic parameters. CONCLUSIONS In a sample of the general population, after 8 years, we did not find any relationship between upper airway and facial skeleton characteristics and the progression of OSA.
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Affiliation(s)
- Aline Bruno Figueiredo Nicolau
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Débora Bruno Figueiredo
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato Stefanini
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tatiana de Aguiar Vidigal
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
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Martins RB, Bittencourt LRA, Botelho AB, Resende ACL, Gomes PS, Tufik S, Matias SLK, Soares MR, Pereira CADC. Sleep parameters in patients with chronic hypersensitivity pneumonitis: a case-control study. J Bras Pneumol 2023; 49:e20230036. [PMID: 37909550 PMCID: PMC10759982 DOI: 10.36416/1806-3756/e20230036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/11/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To compare patients with chronic hypersensitivity pneumonitis (cHP) and controls with normal spirometry in terms of their sleep characteristics, as well as to establish the prevalence of obstructive sleep apnea (OSA) and nocturnal hypoxemia. Secondary objectives were to identify factors associated with OSA and nocturnal hypoxemia; to correlate nocturnal hypoxemia with the apnea-hypopnea index (AHI) and lung function, as well as with resting SpO2, awake SpO2, and SpO2 during exercise; and to evaluate the discriminatory power of sleep questionnaires to predict OSA. METHODS A total of 40 patients with cHP (cases) were matched for sex, age, and BMI with 80 controls, the ratio of controls to cases therefore being = 2:1. The STOP-Bang questionnaire, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index, the Berlin questionnaire and the Neck circumference, obesity, Snoring, Age, and Sex (NoSAS) score were applied to all cases, and both groups underwent full-night polysomnography. RESULTS The patients with cHP had longer sleep latency, lower sleep efficiency, a lower AHI, a lower respiratory disturbance index, fewer central apneas, fewer mixed apneas, and fewer hypopneas than did the controls. The patients with cHP had significantly lower nocturnal SpO2 values, the percentage of total sleep time spent below an SpO2 of 90% being higher than in controls (median = 4.2; IQR, 0.4-32.1 vs. median = 1.0; IQR, 0.1-5.8; p = 0.01). There were no significant differences between cases with and without OSA regarding the STOP-Bang questionnaire, NoSAS, and ESS scores. CONCLUSIONS The prevalence of OSA in cHP patients (cases) was high, although not higher than that in controls with normal spirometry. In addition, cases had more hypoxemia during sleep than did controls. Our results suggest that sleep questionnaires do not have sufficient discriminatory power to identify OSA in cHP patients.
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Affiliation(s)
- Rafaela Boaventura Martins
- . Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | | | - André Bezerra Botelho
- . Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - Ana Carolina Lima Resende
- . Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - Paula Silva Gomes
- . Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - Sergio Tufik
- . Departamento de Psicobiologia, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - Simone Lobo Krupok Matias
- . Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - Maria Raquel Soares
- . Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
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Seva DC, Mônico-Neto M, Antunes HKM, Pino JMV, Bittencourt LRA, Galvão TD, Dâmaso AR, Oyama LM, Shivappa N, Hébert JR, Tufik S, da Silveira Campos RM. Beneficial Short-Term Effects of Bariatric Surgery on Nutritional Inflammatory Profile and Metabolic Biomarkers. Obes Surg 2023; 33:2789-2798. [PMID: 37540480 DOI: 10.1007/s11695-023-06743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Bariatric surgery (BS) has several potential metabolic benefits. However, little is known about its impact on changes in the inflammatory potential of diet and its effect on inflammatory and metabolic markers. This study aimed to assess the short-term beneficial effects of BS on dietary inflammatory potential and inflammatory and metabolic markers. MATERIALS AND METHODS Participants (n = 20) were evaluated 3 months before and after BS. Body mass, body mass index, anthropometric measurements, fat mass, fat-free mass, visceral fat, skeletal muscle mass, basal metabolic rate, serum lipids, HOMA-IR, QUICKI and inflammatory markers, including leptin, adiponectin, adiponectin/leptin ratio and plasminogen activator inhibitor-1 (PAI-1), were evaluated. Diet data were collected using a 3-day diet record and the dietary inflammatory index (DII®) and energy-adjusted dietary inflammatory index (E-DIITM) scores were computed. RESULTS There was a reduction in DII® (2.56 vs 2.13) and E-DIITM (2.18 vs 0.45) indicating an improvement in inflammatory nutritional profile. Moreover, there were increases in the adiponectin/leptin ratio (0.08 vs 0.21) and QUICKI scores (0.31 vs 0.37), and reductions in leptin (36.66 vs 11.41 ng/ml) and HOMA-IR scores (3.93 vs 1.50). There were also improvements in body composition and anthropometric parameters. CONCLUSIONS BS promotes changes in metabolic profile, inflammatory state and food intake and these modifications appeared to be associated with improvements in diet-related inflammation, an increase in the adiponectin/leptin ratio and a reduction in leptin. These results contribute to knowledge on the contribution bariatric surgery can make to the treatment of obesity and the reduction of related comorbidities.
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Affiliation(s)
- Danielle Cristina Seva
- Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo, Campus Baixada Santista, Rua Silva Jardim, 136 - Térreo, Vila Matias, Santos, 11015020, Brazil
| | - Marcos Mônico-Neto
- Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo, Campus Baixada Santista, Rua Silva Jardim, 136 - Térreo, Vila Matias, Santos, 11015020, Brazil.
- Post Graduate Program in Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
- BariMais - Medicina Integrada, São Paulo, Brazil.
| | - Hanna Karen Moreira Antunes
- Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo, Campus Baixada Santista, Rua Silva Jardim, 136 - Térreo, Vila Matias, Santos, 11015020, Brazil
- Post Graduate Program in Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Biosciences, Universidade Federal de São Paulo, Santos, Brazil
| | | | - Lia Rita Azeredo Bittencourt
- Post Graduate Program in Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Ana R Dâmaso
- Post Graduate Program of Nutrition, Paulista Medicine School, Universidade Federal de São Paulo (UNIFESP-EPMP), São Paulo, Brazil
| | - Lila Missae Oyama
- Post Graduate Program of Nutrition, Paulista Medicine School, Universidade Federal de São Paulo (UNIFESP-EPMP), São Paulo, Brazil
- Department of Physiology Paulista Medicine School, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Nutrition, Connecting Health Innovations LLC (CHI), Columbia, SC, USA
| | - James R Hébert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Nutrition, Connecting Health Innovations LLC (CHI), Columbia, SC, USA
| | - Sergio Tufik
- Post Graduate Program in Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Raquel Munhoz da Silveira Campos
- Post Graduate Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo, Campus Baixada Santista, Rua Silva Jardim, 136 - Térreo, Vila Matias, Santos, 11015020, Brazil
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Stefanini R, Campanholo MDAT, Prescinotto R, Caparroz FDA, Bittencourt LRA, Tufik S, Haddad FLM. Immediate and Medium-Term Follow-Up of Patients with Obstructive Sleep Apnea Undergoing Pharyngeal and Nasal Surgery: A Pilot Study. Sleep Sci 2023; 16:7-13. [PMID: 37151764 PMCID: PMC10157821 DOI: 10.1055/s-0043-1767747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/25/2022] [Indexed: 05/09/2023] Open
Abstract
Objectives To evaluate the evolution of obstructive sleep apnea (OSA), comparing data from preoperative, immediate postoperative and late postoperative, in patients undergoing pharyngeal surgery associated with nasal surgery, and to compare the findings of arterial tonometry and type 1 polysomnography in the late postoperative period. Methods Seventeen adults with moderate or severe OSA were included in the study. They underwent clinical evaluation, surgical intervention, and sleep study preoperatively, on the 1 st night after surgery, and after a minimum period of 3 months. The data for the three moments were compared. Results The mean age was 38.1 ± 12.5 years old (22 to 59 years old), and 82.3% were male. Body mass index (BMI) ranged from 25.6 to 45.1 kg/m2 (mean = 33.1 ± 5.8 kg/m 2 ). Fifteen patients (88.2%) were diagnosed with severe OSA. There was a progressive improvement, with a decrease in the indexes (AHI and RDI) and in the percentage of time with peripheral oxyhemoglobin saturation below 90% (tSpO < 90%), and an increase in nadir of SpO2. In the comparison between the 2 methods used in the late postoperative period - arterial tonometry and polysomnography - there was no difference in the indexes and in the tSpO < 90%. Discussion There was a progressive and favorable impact of pharyngeal surgery on the improvement of polysomnographic and clinical respiratory parameters; however, many patients maintained residual OSA, suggesting the need for a new sleep study in the postoperative period. The arterial tonometry showed similar findings to polysomnography, which can be considered as an option in postoperative follow-up of patients.
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Affiliation(s)
- Renato Stefanini
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
- Address for correspondence Renato Stefanini
| | | | - Renato Prescinotto
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Fábio de Azevedo Caparroz
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Lia Rita Azeredo Bittencourt
- Universidade Federal de São Paulo, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Sergio Tufik
- Universidade Federal de São Paulo, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Fernanda Louise Martinho Haddad
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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Lopes TR, Pereira HM, Bittencourt LRA, Silva BM. How Much Does Sleep Deprivation Impair Endurance Performance? A Systematic Review and Meta-analysis. Eur J Sport Sci 2022:1-14. [DOI: 10.1080/17461391.2022.2155583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Thiago Ribeiro Lopes
- Laboratory of Exercise Physiology at Olympic Center of Training and Research, Department of Physiology, Federal University of São Paulo, São Paulo, SP, Brazil
- São Paulo Association for Medicine Development, São Paulo, SP, Brazil
| | - Hugo Maxwell Pereira
- Department of Health and Exercise Science, The University of Oklahoma, Norman, OK, USA
| | | | - Bruno Moreira Silva
- Laboratory of Exercise Physiology at Olympic Center of Training and Research, Department of Physiology, Federal University of São Paulo, São Paulo, SP, Brazil
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Nakayama LF, Tempaku PF, Bergamo VC, Polizelli MU, Santos da Cruz NF, Bittencourt LRA, Regatieri CVS. Obstructive sleep apnea and the retina: a review. J Clin Sleep Med 2021; 17:1947-1952. [PMID: 34165073 DOI: 10.5664/jcsm.9312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CITATION This review's objective was to synthesize the literature on the repercussions of obstructive sleep apnea (OSA) in the retinal vascular system. Two independent investigators conducted a search using the MEDLINE/PubMed database using the following terms: sleep apnea syndrome, obstructive sleep apnea, retina, vascular tortuosity, central serous chorioretinopathy, diabetes mellitus, and subfoveal choroidal thickness. Patients with OSA present increased vascular tortuosity compared with patients without OSA, decreased parafoveal and peripapillary vessel density, and increased retinal vein occlusion incidence. In central serous chorioretinopathy patients and patients who are poor responders to intravitreal anti-VEGF (-vascular endothelial growth factor) treatment for macular edema, OSA is more frequent. Macular choroidal thickness alterations are controversial, and OSA may worsen diabetic maculopathy, thus being a risk factor for diabetic retinopathy, proliferative diabetic retinopathy, and macular edema. OSA is a prevalent syndrome with many systemic vascular changes. The retina and choroid are the most affected ocular structures, with primarily vascular changes. New noninvasive technologies such as optical coherence tomography and optical coherence tomography angiography could help to better understand retinal structures and help clarify the ophthalmological repercussions of OSA. CITATION Nakayama LF, Tempaku PF, Bergamo VC, et al. Obstructive sleep apnea and the retina: a review. J Clin Sleep Med. 2021;17(9):1947-1952.
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Affiliation(s)
- Luis Filipe Nakayama
- Department of Ophthalmology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | - Priscila Farias Tempaku
- Departamento de Psicobiologia, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | - Vinicius Campos Bergamo
- Department of Ophthalmology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | - Murilo Ubukata Polizelli
- Department of Ophthalmology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
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Pedrazzoli M, Mazzotti DR, Ribeiro AO, Mendes JV, Bittencourt LRA, Tufik S. A single nucleotide polymorphism in the HOMER1 gene is associated with sleep latency and theta power in sleep electroencephalogram. PLoS One 2020; 15:e0223632. [PMID: 32645048 PMCID: PMC7347117 DOI: 10.1371/journal.pone.0223632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/16/2020] [Indexed: 12/14/2022] Open
Abstract
Glutamate is the most excitatory neurotransmitter in the central nervous system and it is involved in the initiation and maintaining of waking and rapid-eye-movement (REM) sleep. Homer proteins act in the trafficking and/or clustering of metabotropic glutamate receptors, and polymorphisms in the HOMER1 gene have been associated with phenotypes related to glutamate signaling dysregulation. In this study, we report the association of a single nucleotide polymorphism (SNP) in the HOMER1 gene (rs3822568) with specific aspects of sleep in a sample of the Brazilian population. To accomplish this, 1,042 individuals were subjected to a full-night polysomnography, and a subset of 983 subjects had rs3822568 genotyping data available. When compared with the A allele carriers, GG genotyped individuals showed higher sleep latency, lower sleep efficiency, reduced number of arousals per hour, lower apnea-hypopnea index (AHI) and lower theta spectral power. In summary, the present findings suggest that the rs3822568 polymorphism in the HOMER1 gene is associated with sleep EEG profiles and might have an impact on sleep quality and sleep structure, with potential to explain inter-individual variation in sleep homeostasis.
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Affiliation(s)
- Mario Pedrazzoli
- School of Arts, Sciences and Humanities, University of São Paulo (USP), São Paulo, Brazil
- * E-mail:
| | - Diego Robles Mazzotti
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | - Juliana Viana Mendes
- School of Arts, Sciences and Humanities, University of São Paulo (USP), São Paulo, Brazil
| | | | - Sergio Tufik
- Department of Psychobiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Mônico-Neto M, Moreira Antunes HK, dos Santos RVT, D'Almeida V, Alves Lino de Souza A, Azeredo Bittencourt LR, Tufik S. Physical activity as a moderator for obstructive sleep apnoea and cardiometabolic risk in the EPISONO study. Eur Respir J 2018; 52:13993003.01972-2017. [DOI: 10.1183/13993003.01972-2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 07/28/2018] [Indexed: 11/05/2022]
Abstract
Obstructive sleep apnoea (OSA) is positively associated with cardiometabolic diseases; however, high levels of physical activity could decrease the incidence of OSA and associated comorbidities.In this study we aimed to examine the incidence of OSA in relation to physical activity, and its role as a protective factor in individuals with OSA on the incidence of cardiometabolic diseases, in an 8–9-year follow-up study. We analysed data of 658 volunteers from the São Paulo Epidemiologic Sleep Study (EPISONO), a cohort study of individuals aged 20–80 years, collected through polysomnography, the International Physical Activity Questionnaire and an assessment of cardiometabolic profile.Active subjects had a lower risk of developing OSA compared with nonactive subjects (relative risk 0.877, 95% CI 0.296–0.855) and there was a reduced risk of developing type 2 diabetes mellitus in active/apnoeic subjects (relative risk 0.493, 95% CI 0.252–0.961) compared with nonactive subjects. Metabolic equivalent was negatively associated to cardiometabolic markers, such as C-reactive protein (exp(B)=0.720; p=0.001), interleukin-6 (exp(B)=0.991; p=0.03), insulin (exp(B)=0.982; p=0.03), triglycerides (exp(B)=0.997; p<0.001), homeostasis model assessment for insulin resistance (exp(B)≤0.946; p<0.024), quantitative insulin sensitivity check index (exp(B)=992.4; p<0.001) and mean arterial pressure (exp(B)=0.987; p=0.001).Physical activity was a protective factor against type 2 diabetes mellitus in apnoeic individuals; moreover, being active reduced the risk of developing OSA and was associated with a better cardiometabolic profile.
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Mônico-Neto M, Antunes HKM, Santos RVTD, D’Almeida V, Bittencourt LRA, Tufik S. Association Between Cardiovascular Markers And Physical Activity In Patients With Obstructive Sleep Apnea. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536677.85109.3a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Botelho RV, Balieiro Abgussen CM, Pereira Machado GCF, Reis Elias AJ, Benedito-Silva AA, Azeredo Bittencourt LR, França Fontoura EA. Epidemiologia do trauma raquimedular cervical na zona norte da cidade de São Paulo. Arq Bras Neurocir 2018. [DOI: 10.1055/s-0038-1623470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Resumo
Objetivos: Estudar a epidemiologia do paciente vítima de trauma raquimedular cervical na zona norte da cidade de São Paulo, na área definida como DIR IV e na região de Franco da Rocha, entre 1996 e 2000.
Métodos: Estudo parte retrospectivo, parte prospectivo, baseado em dados de protocolo padronizado para trauma raquimedular, consultas médicas e estudo de prontuários.
Casuística: 95 pacientes consecutivos foram estudados entre abril de 1996 e dezembro de 2000.
Conclusões: A incidência de casos de trauma raquimedular geral estimada foi de 22,63 milhão/ano e de trauma cervical foi de 8,6 milhão/ano. A média mensal foi 84% maior no ano de 1999 em comparação a 1996. Predominaram as quedas ao solo como causa. A média de idade foi de 35 anos. Quarenta e cinco por cento da amostra apresentava-se com menos de 30 anos. Quarenta e dois por cento dos pacientes apresentaram complicações potencialmente graves. A média de internação foi de 25,86 dias.As lesões O-C1-C2 causaram dano neurológico menos freqüentemente que as C3-C7 (11,6%/ 61,04%). As lesões que produziram deficit completo acima de C3 foram fatais. Mais de 60% dos pacientes com traumatismo C3-C7 apresentaram deficits neurológicos e 41,5% apresentam paralisia, com nenhuma força evidente ao exame, com ou sem preservação sensitiva; 44% destes morreram. Um paciente teve piora neurológica antes da cirurgia e outro teve seu quadro neurológico piorado pela cirurgia.O estado neurológico e o nível da lesão foram os fatores prognósticos mais importantes.Os 95 pacientes utilizaram 77 sistemas de fixação e/ou halo-coletes.
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Martinelli EO, Haddad FLM, Stefanini R, Moreira GA, Rapoport PB, Gregório LC, Tufik S, Bittencourt LRA. Clinicals and upper airway characteristics in obese children with obstructive sleep apnea. Sleep Sci 2017. [DOI: 10.1016/j.slsci.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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de Souza Vilela T, Bittencourt LRA, Tufik S, Moreira GA. Factors influencing excessive daytime sleepiness in adolescents. J Pediatr (Rio J) 2016; 92:149-55. [PMID: 26688555 DOI: 10.1016/j.jped.2015.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/22/2015] [Accepted: 05/27/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Sleep deprivation in adolescents has lately become a health issue that tends to increase with higher stress prevalence, extenuating routines, and new technological devices that impair adolescents' bedtime. Therefore, this study aimed to assess the excessive sleepiness frequency and the factors that might be associated to it in this population. METHODS The cross-sectional study analyzed 531 adolescents aged 10-18 years old from two private schools and one public school. Five questionnaires were applied: the Cleveland Adolescent Sleepiness Questionnaire; the Sleep Disturbance Scale for Children; the Brazilian Economic Classification Criteria; the General Health and Sexual Maturation Questionnaire; and the Physical Activity Questionnaire. The statistical analyses were based on comparisons between schools and sleepiness and non-sleepiness groups, using linear correlation and logistic regression. RESULTS Sleep deprivation was present in 39% of the adolescents; sleep deficit was higher in private school adolescents (p<0.001), and there was a positive correlation between age and sleep deficit (p<0.001; r=0.337). Logistic regression showed that older age (p=0.002; PR: 1.21 [CI: 1.07-1.36]) and higher score level for sleep hyperhidrosis in the sleep disturbance scale (p=0.02; PR: 1.16 [CI: 1.02-1.32]) were risk factors for worse degree of sleepiness. CONCLUSIONS Sleep deficit appears to be a reality among adolescents; the results suggest a higher prevalence in students from private schools. Sleep deprivation is associated with older age in adolescents and possible presence of sleep disorders, such as sleep hyperhidrosis.
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Affiliation(s)
| | | | - Sergio Tufik
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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de Souza Vilela T, Bittencourt LRA, Tufik S, Moreira GA. Factors influencing excessive daytime sleepiness in adolescents. Jornal de Pediatria (Versão em Português) 2016. [DOI: 10.1016/j.jpedp.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
OBJECTIVE To determine the therapeutic effects of two selective GABA-A agonists, zopiclone and eszopiclone, in the treatment of insomnia. METHODS This study comprised a phase III, single-center, randomized, double-blind, double-dummy, parallel-group, non-inferiority trial. Patients were randomized to receive zopiclone 7.5 mg or eszopiclone 3 mg, both orally, for four weeks. In total, 199 patients were evaluated during two visits and then followed for at least six weeks. The primary endpoint was the Insomnia Severity Index after four weeks of treatment. Secondary endpoints were obtained through polysomnography data, including total sleep time, sleep latency and sleep efficiency. The frequency of adverse events was also analyzed. ClinicalTrials.gov: NCT01100164. RESULTS The primary efficacy analysis demonstrated the non-inferiority of eszopiclone over zopiclone. Analysis of objective parameters assessed by polysomnography showed that eszopiclone increased total sleep time and also improved sleep efficiency. The safety profile of both study treatments was similar and the most common events reported in both groups were dysgeusia, headache, dizziness, irritability and nausea. Adverse events were observed in 223 patients, 109 (85.2%) in the eszopiclone group and 114 (87.7%) in the zopiclone group. CONCLUSION Based on the Insomnia Severity Index at the end of four weeks of treatment, eszopiclone demonstrated efficacy comparable to that of zopiclone in the treatment of insomnia, increasing total sleep time as well as sleep efficiency according to polysomnography.
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Guerra de Araújo Freitas I, Bittencourt LRA, Sales de Bruin VM, Carvalhedo de Bruin PF, Pinto TF, Coutinho da Silva FG. EFEITO DO TRATAMENTO DA APNEIA OBSTRUTIVA DO SONO SOBRE A FUNÇÃO CARDIOVASCULAR EM PACIENTES COM HIPERTENSÃO ARTERIAL SISTÊMICA RESISTENTE. Sleep Sci 2015. [DOI: 10.1016/j.slsci.2016.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Martins Junior GDN, de Assis Pereira G, Pimentel Filho LH, Azeredo Bittencourt LR. NARCOLEPSIA E SÍNDROME DA APNEIA OBSTRUTIVA DO SONO: ASSOCIAÇÃO DE DISTÚRBIOS DO SONO COMO CAUSA DE SONOLÊNCIA EXCESSIVA. Sleep Sci 2015. [DOI: 10.1016/j.slsci.2016.02.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Prescinotto R, Haddad FLM, Fukuchi I, Gregório LC, Cunali PA, Tufik S, Bittencourt LRA. Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome. Braz J Otorhinolaryngol 2015; 81:663-70. [PMID: 26387988 PMCID: PMC9442756 DOI: 10.1016/j.bjorl.2015.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 01/06/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS). Objective To assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS. Methods Prospective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared. Results 28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p = 0.02), smaller cervical circumference (p = 0.05), and lower AHI at baseline (p = 0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p = 0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence. Conclusion MAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities.
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Affiliation(s)
- Renato Prescinotto
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Otorhinolaryngology, Faculdade de Medicina do ABC, Santo André, SP, Brazil.
| | | | - Ilana Fukuchi
- Department of Otorhinolaryngology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Luiz Carlos Gregório
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Paulo Afonso Cunali
- Dentistry Course, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil; Department of Medicine and Sleep Biology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sérgio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Lia Rita Azeredo Bittencourt
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Medicine and Sleep Biology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Vidigal TA, Haddad FLM, Cabral RFP, Oliveira MCS, Cavalcante RR, Bittencourt LRA, Tufik S, Gregório LC. New clinical staging for pharyngeal surgery in obstructive sleep apnea patients. Braz J Otorhinolaryngol 2014; 80:490-6. [PMID: 25457068 PMCID: PMC9442696 DOI: 10.1016/j.bjorl.2014.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/01/2014] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients. OBJECTIVE To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome. METHODS A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m(2) with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4. RESULTS The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I-V. CONCLUSION The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III).
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Affiliation(s)
- Tatiana Aguiar Vidigal
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fernanda Louise Martinho Haddad
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | | | | | | | - Lia Rita Azeredo Bittencourt
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sergio Tufik
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Luis Carlos Gregório
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Hachul H, Oliveira DS, Bittencourt LRA, Andersen ML, Tufik S. The beneficial effects of massage therapy for insomnia in postmenopausal women. ACTA ACUST UNITED AC 2014; 7:114-6. [PMID: 26483913 PMCID: PMC4521661 DOI: 10.1016/j.slsci.2014.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/14/2014] [Indexed: 11/17/2022]
Abstract
With increases life expectancy, the incidence of undesirable manifestations of menopause has increased as well. The effects of lost ovarian function include progressive decrease in estradiol secretion, trophic changes in the breast, vasomotor symptoms, anxiety, depression, and sleep disorders. Insomnia, which has physiological consequences and can result in a loss of quality of life, is prevalent in women after menopause. Hormone therapy has been widely used to reduce menopausal symptoms, but its use in recent years has been questioned because of the reported risks of cardiovascular events and increased incidence of tumors. This controversy has generated significant interest in non-hormonal treatments among both physicians and patients. Our previous research has shown a positive effect of massage therapy on menopausal symptoms. We explored the hypothesis that massage therapy would produce beneficial effects in postmenopausal women through inflammatory and immunological changes. Recent results from self-report questionnaires have shown improvements in sleep pattern and quality of life following massage therapy. These findings demonstrate the effectiveness of massage therapy for the treatment of postmenopausal symptoms, particularly insomnia, and indicate that it is a promising line of research.
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Affiliation(s)
- H Hachul
- Departamento de Ginecologia e Psicobiologia, Universidade Federalde São Paulo (UNIFESP), Rua Napoleão de Barros, 925, São Paulo, Brazil ; Casa de Saúde Santa Marcelina, Rua Santa Marcelina, 177, São Paulo, Brazil
| | - D S Oliveira
- Departamento de Ginecologia, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 925, São Paulo, Brazil
| | - L R A Bittencourt
- Departamento de Ginecologia, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 925, São Paulo, Brazil
| | - M L Andersen
- Departamento de Ginecologia, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 925, São Paulo, Brazil
| | - S Tufik
- Departamento de Ginecologia, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 925, São Paulo, Brazil
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Gama RL, Bruin VMSD, Bruin PFCD, Távora DGF, Lopes EMS, Jorge IF, Bittencourt LRA, Tufik S. Risk factors for visual hallucinations in patients with Parkinson’s disease. Neurol Res 2014; 37:112-6. [DOI: 10.1179/1743132814y.0000000418] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Correa KM, Bittencourt LRA, Tufik S, Hachul H. [Frequency of sleep disturbances in overweight/obese postmenopausal women]. Rev Bras Ginecol Obstet 2014; 36:90-96. [PMID: 24676018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/28/2014] [Indexed: 06/03/2023] Open
Abstract
PURPOSE To evaluate the frequency of sleep disorders, such as obstructive sleep apnea, restless leg syndrome and insomnia in overweight/obese postmenopausal women seen in a climacteric sleep disorders clinic. METHODS Thirty-four postmenopausal women were selected using the following inclusion criteria: age between 50 and 70 years; at least 12 months of amenorrhea; body mass index (BMI) greater than or equal to 25 kg/m2; and sleep-related complaints with at least one previous polysomnography. Patients provided responses to 6 questionnaires related to sleep characteristics and menopausal symptoms. Weight and height were measured using standardized scales, and abdomen and hip circumferences were also measured. The statistical analyses were performed using the χ² test for qualitative variables and using Student's t-test for quantitative variables. RESULTS Patients' characteristics were as follows: mean age of 60.35 years; mean BMI of 31.62; an average of 11.61 postmenopausal years and an average Kupperman Index of 19. A total of 85.2% of the patients had a waist/hip ratio of less than 0.8. The Epworth Scale score was greater than or equal to 9 in 50% of patients; 68% had sleep disturbances according to the Pittsburgh Index, and 68% were classified as high-risk for sleep apnea by the Berlin Questionnaire. On polysomnography, 70.58% of the patients had a sleep efficiency lower than 85%; 79.41% had a sleep latency of less than 30 min; 58.82% had a REM sleep latency of less than 90 min, and 44.11% had mild apnea. When the groups were compared, a linear association was identified between BMI and the AHI average, and a relationship between high BMI and use of drugs for thyroid treatment was found. CONCLUSION There was a high prevalence of sleep-disordered breathing, initial insomnia, fragmented sleep, and thyroid disorders in the group with higher BMI.
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Affiliation(s)
| | | | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brasil
| | - Helena Hachul
- Departamento de Ginecologia e Ambulatorio de Disturbios do Sono no Climaterio, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brasil
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Mazzotti DR, Guindalini C, de Souza AAL, Sato JR, Santos-Silva R, Bittencourt LRA, Tufik S. Adenosine deaminase polymorphism affects sleep EEG spectral power in a large epidemiological sample. PLoS One 2012; 7:e44154. [PMID: 22952909 PMCID: PMC3430663 DOI: 10.1371/journal.pone.0044154] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 07/30/2012] [Indexed: 11/18/2022] Open
Abstract
Slow wave oscillations in the electroencephalogram (EEG) during sleep may reflect both sleep need and intensity, which are implied in homeostatic regulation. Adenosine is strongly implicated in sleep homeostasis, and a single nucleotide polymorphism in the adenosine deaminase gene (ADA G22A) has been associated with deeper and more efficient sleep. The present study verified the association between the ADA G22A polymorphism and changes in sleep EEG spectral power (from C3-A2, C4-A1, O1-A2, and O2-A1 derivations) in the Epidemiologic Sleep Study (EPISONO) sample from São Paulo, Brazil. Eight-hundred individuals were subjected to full-night polysomnography and ADA G22A genotyping. Spectral analysis of the EEG was carried out in all individuals using fast Fourier transformation of the signals from each EEG electrode. The genotype groups were compared in the whole sample and in a subsample of 120 individuals matched according to ADA genotype for age, gender, body mass index, caffeine intake status, presence of sleep disturbance, and sleep-disturbing medication. When compared with homozygous GG genotype carriers, A allele carriers showed higher delta spectral power in Stage 1 and Stages 3+4 of sleep, and increased theta spectral power in Stages 1, 2 and REM sleep. These changes were seen both in the whole sample and in the matched subset. The higher EEG spectral power indicates that the sleep of individuals carrying the A allele may be more intense. Therefore, this polymorphism may be an important source of variation in sleep homeostasis in humans, through modulation of specific components of the sleep EEG.
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Affiliation(s)
- Diego Robles Mazzotti
- Departamento de Psicobiologia – Universidade Federal de São Paulo - São Paulo, Brazil
| | - Camila Guindalini
- Departamento de Psicobiologia – Universidade Federal de São Paulo - São Paulo, Brazil
- Laboratório de Neurociências Clínicas (LiNC) – Departamento de Psiquiatria - Universidade Federal de São Paulo - São Paulo, Brazil
| | | | - João Ricardo Sato
- Centro de Matemática, Computação e Cognição – Universidade Federal do ABC – Santo André, Brazil
| | - Rogério Santos-Silva
- Departamento de Psicobiologia – Universidade Federal de São Paulo - São Paulo, Brazil
| | | | - Sergio Tufik
- Departamento de Psicobiologia – Universidade Federal de São Paulo - São Paulo, Brazil
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Santos LG, Pires GN, Azeredo Bittencourt LR, Tufik S, Andersen ML. Chronobiology: Relevance for tuberculosis. Tuberculosis (Edinb) 2012; 92:293-300. [DOI: 10.1016/j.tube.2012.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/16/2012] [Accepted: 03/20/2012] [Indexed: 11/24/2022]
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Santos EAS, Santos Filho WJ, Possatti LL, Bittencourt LRA, Fontoura EAF, Botelho RV. Clinical complications in patients with severe cervical spinal trauma: a ten-year prospective study. Arq Neuro-Psiquiatr 2012; 70:524-8. [DOI: 10.1590/s0004-282x2012000700010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/21/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To determine the complications due to severe acrescentar sigla após o nome (CST). METHODS: Between 1997 and 2006, 217 patients (191 men and 26 women) were prospectively evaluated. The mean age was 36.75±1.06 years. RESULTS: Forty-five percent of the patients had medical complications. The most important risk factor was alcoholic beverage use. The most important associated injury was head trauma (HT). Patients with American Spine Injury Association (ASIA) A or B had a 2.3-fold greater relative risk of developing complications. Thirty-three patients (15.2%) died. Patients with neurological deficit had a 16.9-fold higher risk of death. There was no influence of age and time between trauma and surgery on the presence of complications. CONCLUSIONS: Of the patients, 45% had clinical complications and 7.5% had associated injuries; pneumonia was the most important complication; patient age and time between trauma and surgery did not influence the development of medical complications; neurological status was the most important factor in determining morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | - Ricardo Vieira Botelho
- Conjunto Hospitalar do Mandaqui, Brazil; Instituto de Assistência Médica ao Servidor Público Estadual, Brazil
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Alves EDS, Ackel-D'Elia C, Luz GP, Cunha TCA, Carneiro G, Tufik S, Bittencourt LRA, de Mello MT. Does physical exercise reduce excessive daytime sleepiness by improving inflammatory profiles in obstructive sleep apnea patients? Sleep Breath 2012; 17:505-10. [PMID: 22760814 DOI: 10.1007/s11325-012-0729-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is associated with a variety of long-term consequences such as high rates of morbidity and mortality, due to excessive diurnal somnolence as well as cardiovascular and metabolic diseases. Obesity, recurrent episodes of upper airway obstruction, progressive hypoxemia, and sleep fragmentation during sleep cause neural, cardiovascular, and metabolic changes. These changes include activation of peripheral sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, insulin sensitivity, and inflammatory cytokines alterations, which predispose an individual to vascular damage. DISCUSSION Previous studies proposed that OSAS modulated the expression and secretion of inflammatory cytokines from fat and other tissues. Independent of obesity, patients with OSAS exhibited elevated levels of C-reactive protein, tumor necrosis factor-α and interleukin-6, which are associated with sleepiness, fatigue, and the development of a variety of metabolic and cardiovascular diseases. OSAS and obesity are strongly associated with each other and share many common pathways that induce chronic inflammation. Previous studies suggested that the protective effect of exercise may be partially attributed to the anti-inflammatory effect of regular exercise, and this effect was observed in obese patients. Although some studies assessed the effects of physical exercise on objective and subjective sleep parameters, the quality of life, and mood in patients with OSAS, no study has evaluated the effects of this treatment on inflammatory profiles. In this review, we cited some studies that directed our opinion to believe that since OSAS causes increased inflammation and has excessive daytime sleepiness as a symptom and being that physical exercise improves inflammatory profiles and possibly OSAS symptoms, it must be that physical exercise improves excessive daytime sleepiness due to its improvement in inflammatory profiles.
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Affiliation(s)
- Eduardo da Silva Alves
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo-UNIFESP, São Paulo, CEP: 04020-050, Brazil
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Cintra F, Bittencourt LRA, Santos-Silva R, Andersen M, de Paola A, Poyares D, Tufik S. The association between the Framingham risk score and sleep: a São Paulo epidemiological sleep study. Sleep Med 2012; 13:577-82. [PMID: 22516609 DOI: 10.1016/j.sleep.2011.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 12/06/2011] [Accepted: 12/09/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sleep is an important factor in the maintenance of cardiovascular integrity. It seems that cardiovascular injury and sleep impairment is another chicken or egg puzzle and we hypothesized that the higher the cardiovascular risk factors the higher the sleep impairment. Therefore, the goal of this study is to analyze the sleep profile of a general population based on cardiovascular risk stratification. METHODS This population-based survey used a probabilistic three-stage cluster sample of Sao Paulo inhabitants to represent the population. A sample size of 1056 volunteers was defined in order to allow for prevalence estimates with 3% precision. From the 1101 selected and interviewed participants, a complete full-night polysomnogram (PSG) was performed in 1042 participants as well as clinical evaluation and blood samples analyses to assess Framingham risk score. RESULTS Nine hundred four subjects were classified according the Framingham score and were included in the analyses. A total of 91.7% were classified as a low risk, 5.8% in the intermediate, and 2.4% in the high risk groups according to Framingham score. All polisomnographic parameters were different between groups, except those related to REM sleep parameters. AHI were greater in the high risk compared to the intermediate and low risk groups (23.9 ± 2.8; 17.7 ± 1.8; 7.2 ± 0.5, respectively, p<0.001), as well as a lower total sleep time in minutes (295.3 ± 16.2; 338.4 ± 10.2; 347.4 ± 2.6, respectively, p=0.01). Sleep efficiency in percentage also exhibits a reduction between groups (67.6 ± 2.5; 78.4 ± 1.6; 82.9 ± 0.4, respectively, p<0.001). After adjustment for confounder factors age (p<0.001) and sleep efficiency (p=0.06) remained strongly associated with high risk population. CONCLUSION High Framingham risk score was associated with poor sleep efficiency and aging.
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Affiliation(s)
- Fatima Cintra
- Department of Psychobiology of Universidade Federal de São Paulo, São Paulo, Brazil.
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Coelho FM, Pradella-Hallinan M, Palombini L, Tufik S, Bittencourt LRA. The STOP-BANG questionnaire was a useful tool to identify OSA during epidemiological study in São Paulo (Brazil). Sleep Med 2012; 13:450-1. [DOI: 10.1016/j.sleep.2012.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/16/2012] [Indexed: 11/16/2022]
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de Aguiar Vidigal T, Martinho Haddad FL, Gregório LC, Poyares D, Tufik S, Azeredo Bittencourt LR. Subjective, anatomical, and functional nasal evaluation of patients with obstructive sleep apnea syndrome. Sleep Breath 2012; 17:427-33. [PMID: 22382652 DOI: 10.1007/s11325-012-0667-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 01/11/2012] [Accepted: 02/06/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies have shown a high occurrence of nasal alterations in patients with obstructive sleep apnea syndrome (OSAS), but no studies have used different methods to evaluate the nose of patients with OSAS. The objective of this study was to evaluate the nose of patients with OSAS, compare them to controls, and correlate the different methods used to evaluate the nose. METHODS Forty-seven patients with moderate/severe OSAS and 20 controls who were matched for gender, age, and body mass index were included. Questionnaires regarding sleep and nasal symptoms, physical examination, rhinoscopy, nasofibroscopy, nasal inspiratory peak flow (NIPF), and acoustic rhinometry (AR) measurements were performed. RESULTS In the OSAS group, 33 (70.2%) were male, with a mean age of 53.2 ± 9.1 years. In the control group, 13 (65%) were male, with a mean age of 53.7 ± 9.7 years. The OSAS group had a higher score on the nasal symptoms scale (p < 0.01) and a higher frequency of nasal alterations [presence of septal deviation, clinical complaints (p = 0.01) and hypertrophy of the inferior nasal turbinate (p < 0.01)]. The NIPF and AR parameters could not differentiate between the OSAS and control groups. There were no significant correlations among the different methods used to evaluate the nose. Lower NIPF values were capable of predicting higher apnea-hypopnea index scores (p = 0.007). CONCLUSION Clinical complaints and nasal alterations as measured by rhinoscopy and nasofibroscopy were associated with the presence of OSAS, which was not the case for the NIPF and AR parameters. The results of different evaluation methods were not correlated with each other.
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Affiliation(s)
- Tatiana de Aguiar Vidigal
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil.
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Santos-Silva R, Castro LS, Taddei JA, Tufik S, Bittencourt LRA. Sleep disorders and demand for medical services: evidence from a population-based longitudinal study. PLoS One 2012; 7:e30085. [PMID: 22312420 PMCID: PMC3270015 DOI: 10.1371/journal.pone.0030085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 12/13/2011] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to investigate whether insomnia and obstructive sleep apnea (OSA) were predictors of hospitalizations or emergency department visits during two years following the Sao Paulo Epidemiologic Sleep Study (EPISONO) sample. Methods and Findings All participants (n = 1,101) who underwent a baseline evaluation between July and December 2007 were contacted in December 2009 and asked to fill out a questionnaire about body weight changes, number of hospitalizations and visits to the emergency department. Participants lost during the follow-up period represented 3.2% (n = 35) and 7 subjects had died. Hospitalizations were reported by 116 volunteers (10.5%) and emergency department visits were reported by 136 participants (12.4%). The average body mass index (BMI) did not vary significantly between the first and the second assessment [26.7(95%CI:26.3–27.1) vs. 26.9(26.5–27.4) kg/m2]. After adjusting for confounders, a multiple logistic regression model revealed that female gender [1.4(1.0–1.9)], age ≥40 years, insomnia diagnosed according to the DSM-IV criteria [1.6(1.0–2.6)], and apnea-hypopnea index ≥15 [1.5(1.0–2.2)] were predictors of hospitalizations and/or demand for emergency services. Conclusion Our study of a probabilistic sample of the Sao Paulo inhabitants shows that over a period of two years, insomnia and OSA were both associated with health impairment. Considering the high prevalence and public health burden of sleep disorders, the consequences of untreated disease for both the individual and society are undeniable and should be addressed.
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Affiliation(s)
- Rogerio Santos-Silva
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo – UNIFESP, São Paulo, Brazil
| | - Laura Siqueira Castro
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo – UNIFESP, São Paulo, Brazil
| | - Jose Augusto Taddei
- Disciplina de Nutrição e Metabolismo, Departamento de Pediatria, Universidade Federal de São Paulo – UNIFESP, São Paulo, Brazil
| | - Sergio Tufik
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo – UNIFESP, São Paulo, Brazil
| | - Lia Rita Azeredo Bittencourt
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo – UNIFESP, São Paulo, Brazil
- * E-mail:
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Stefanini R, Tufik S, Soares MCM, Haddad FLM, Bittencourt LRA, Santos-Silva R, Gregorio LC. Systematic evaluation of the upper airway in the adult population of São Paulo, Brazil. Otolaryngol Head Neck Surg 2012; 146:757-63. [PMID: 22298684 DOI: 10.1177/0194599811434256] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To study the prevalence of otorhinolaryngologic symptoms and findings of physical examination of the upper airway (UA) of a representative sample of the adult population of São Paulo, Brazil, and the association between these findings. STUDY DESIGN Cross-sectional survey. SETTING Population sample. METHODS A total of 1101 randomly selected volunteers representing the adult population of São Paulo according to sex, age, and socioeconomic class were included in this study. Otorhinolaryngological evaluation included investigation of nasal complaints, physical examination of the UA, and a facial inspection. RESULTS A total of 993 volunteers (53.9% women), with a mean age of 41.8 ± 0.89 years, underwent otorhinolaryngologic examination. The most prevalent symptoms were the following: symptoms suggestive of rhinitis (44.9%), snoring (42.8%), mouth breathing (39.3%), and nasal obstruction (33.3%). In physical examination, the most common findings were a web palate (redundant posterior pillar; 62.9%), septum deviation (56.9%), and inferior turbinate hypertrophy (37.7%). Significant associations were found between nasal obstruction and septum deviations, inferior turbinate hypertrophy, high-arched palate, and class II dental occlusion; between symptoms of rhinitis and inferior turbinate hypertrophy; and between snoring and obstructive deviated septum, modified Mallampatti grades III and IV, increased neck circumference, and age greater than or equal to 50 years. CONCLUSIONS The prevalence of otorhinolaryngologic symptoms and alterations in physical examination of the UA were high in the adult population of São Paulo, Brazil. The snoring and nasal symptoms were significantly associated with findings from UA physical examination and inspection of the facial skeleton.
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Affiliation(s)
- Renato Stefanini
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.
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Bruin VMS, Bittencourt LRA, Tufik S. Sleep-Wake Disturbances in Parkinsons Disease: Current Evidence regarding Diagnostic and Therapeutic Decisions. Eur Neurol 2012; 67:257-67. [DOI: 10.1159/000335078] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 11/14/2011] [Indexed: 11/19/2022]
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Yagihara F, Lucchesi LM, D'Almeida V, Mello MTD, Tufik S, Bittencourt LRA. Oxidative stress and quality of life in elderly patients with obstructive sleep apnea syndrome: are there differences after six months of Continuous Positive Airway Pressure treatment? Clinics (Sao Paulo) 2012; 67:565-72. [PMID: 22760893 PMCID: PMC3370306 DOI: 10.6061/clinics/2012(06)04] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 02/13/2012] [Accepted: 02/16/2012] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES This study evaluated the effect of Continuous Positive Airway Pressure treatment on oxidative stress parameters and the quality of life of elderly patients with obstructive sleep apnea syndrome. METHODS In total, 30 obstructive sleep apnea syndrome patients and 27 subjects without obstructive sleep apnea syndrome were included in this study. Both groups underwent quality of life and oxidative stress evaluations at baseline and after six months. Polysomnography was performed in both groups at baseline and a second time in the obstructive sleep apnea syndrome group after six months of Continuous Positive Airway Pressure treatment. All of the variables were compared between the control and obstructive sleep apnea syndrome groups in this prospective case-control study. RESULTS The baseline concentrations of the antioxidant enzyme catalase were higher in the obstructive sleep apnea syndrome group than the control group. After Continuous Positive Airway Pressure treatment, the obstructive sleep apnea syndrome group exhibited a reduction in the level of oxidative stress, as indicated by a decrease in the level of lipid peroxidation measured by the malondialdehyde (MDA) concentration [pre: 2.7 nmol malondialdehyde/mL (95% 1.6-3.7) vs. post: 1.3 nmol MDA/mL (0.7-1.9), p<0.01]. Additionally, improvements were observed in two domains covered by the SF-36 questionnaire: functional capacity [pre: 77.4 (69.2-85.5) vs. post: 83.4 (76.9-89.9), p = 0.002] and pain [pre: 65.4 (52.8-78.1) vs. post: 77.8 (67.2-88.3), p = 0.004]. CONCLUSION Our study demonstrated that the use of Continuous Positive Airway Pressure to treat obstructive sleep apnea syndrome in elderly patients reduced oxidative stress and improved the quality of life.
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Affiliation(s)
- Fabiana Yagihara
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Bittencourt LRA, Pedrazzoli M, Yagihara F, Luz GP, Garbuio S, Moreira GA, Perfeito JAJ, Tufik S. Late-onset, insidious course and invasive treatment of congenital central hypoventilation syndrome in a case with the Phox2B mutation: case report. Sleep Breath 2011; 16:951-5. [PMID: 22102181 DOI: 10.1007/s11325-011-0614-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 09/05/2011] [Accepted: 11/02/2011] [Indexed: 10/15/2022]
Affiliation(s)
- Lia Rita Azeredo Bittencourt
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002, São Paulo, São Paulo, Brazil.
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Coelho FMS, Pradella-Hallinan M, Pedrazzoli M, Soares CAS, Fernandes GBP, Murray BJ, Tufik S, Bittencourt LRA. Low CD40L levels and relative lymphopenia in narcoleptic patients. Hum Immunol 2011; 72:817-20. [PMID: 21669245 DOI: 10.1016/j.humimm.2011.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 05/15/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Abstract
Narcolepsy has been studied as a possible autoimmune disease for many years, and recent findings lend more credence to this belief. Although recent and important advances have been done, no study has analyzed the role of the CD40L in patients with narcolepsy. The purpose of this study was to assess CD40L levels, CD3, TCD4, TCD8, CD19, and CD56 lymphocytes, as well as levels of tumor necrosis factor-α and interleukin-6 in narcoleptic patients. We quantified the levels of CD40L, different types of lymphocytes, and levels of tumor necrosis factor-α and interleukin-6 in narcoleptic patients and control subjects. Narcoleptic patients had lower levels of CD40L. Total lymphocytes; CD3, and TCD4 were lower than in the control group. Our findings highlight the important role of CD40L in narcolepsy.
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Polese JF, Santos-Silva R, Kobayashi RF, Pinto INDP, Tufik S, Bittencourt LRA. Portable monitoring devices in the diagnosis of obstructive sleep apnea: current status, advantages, and limitations. J Bras Pneumol 2011; 36:498-505. [PMID: 20835599 DOI: 10.1590/s1806-37132010000400017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 03/01/2010] [Indexed: 01/11/2023] Open
Abstract
Recent years have seen a growing interest in the use of portable monitoring devices for the diagnosis of obstructive sleep apnea syndrome. These have the potential to be used in lieu of the more complicated and uncomfortable alternative, polysomnography, which has long been considered to be the gold standard for the diagnosis of this relatively prevalent condition. Following their approval in 2008 by the Center of Medicare and Medicaid Services, the federal agency which administers Medicare and Medicaid in the United States, there has been extensive discussion about the utility and validity of these devices for use in the diagnosis of obstructive sleep apnea syndrome. Although there are various models of portable monitoring devices, the literature contains little information regarding how each device should be used in specific age groups, patients presenting comorbidities, and asymptomatic patients. Additionally, studies about the cost-effectiveness of this diagnostic method are scarce and conflicting. Therefore, this objective of this study was to review what has been learned about portable monitoring devices over time, as well as to examine the recent progress, advantages, limitations, and applications of these devices in the diagnosis of obstructive sleep apnea syndrome in different groups of patients.
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Affiliation(s)
- Jéssica Fábia Polese
- Sleep Medicine and Biology Division, Psychobiology Department, Universidade Federal de São Paulo, São Paulo, Brasil
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Coelho FMS, Pradella-Hallinan M, Pedrazzoli M, Soares CAS, Fernandes GBP, Gonçalves AL, Tufik S, Bittencourt LRA. Traditional biomarkers in narcolepsy: experience of a Brazilian sleep centre. Arq Neuropsiquiatr 2011; 68:712-5. [PMID: 21049180 DOI: 10.1590/s0004-282x2010000500007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 03/24/2010] [Indexed: 11/21/2022]
Abstract
UNLABELLED This study was thought to characterized clinical and laboratory findings of a narcoleptic patients in an out patients unit at São Paulo, Brazil. METHOD 28 patients underwent polysomnographic recordings (PSG) and Multiple Sleep Latency Test (MSLT) were analyzed according to standard criteria. The analysis of HLADQB1*0602 allele was performed by PCR. The Hypocretin-1 in cerebral spinal fluid (CSF) was measured using radioimmunoassay. Patients were divided in two groups according Hypocretin-1 level: Normal (N) - Hypocretin-1 higher than 110 pg/ml and Lower (L) Hypocretin-1 lower than 110 pg/ml. RESULTS Only 4 patients of the N group had cataplexy when compared with 14 members of the L group (p = 0.0002). DISCUSSION This results were comparable with other authors, confirming the utility of using specific biomarkers (HLA-DQB1*0602 allele and Hypocretin-1 CSF level) in narcolepsy with cataplexy. However, the HLADQB1*0602 allele and Hypocretin-1 level are insufficient to diagnose of narcolepsy without cataplexy.
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Mazzotti DR, Guindalini C, Pellegrino R, Barrueco KF, Santos-Silva R, Bittencourt LRA, Tufik S. Effects of the adenosine deaminase polymorphism and caffeine intake on sleep parameters in a large population sample. Sleep 2011; 34:399-402. [PMID: 21359089 PMCID: PMC3041717 DOI: 10.1093/sleep/34.3.399] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the association between the adenosine deaminase polymorphism, sleep architecture, and caffeine consumption. DESIGNS Genetic association study. SETTING NA. PATIENTS OR PARTICIPANTS 958 participants who underwent polysomnography and genotyping. INTERVENTIONS NA. MEASUREMENTS AND RESULTS Individuals carrying the A allele who consumed caffeine in the day prior to polysomnography demonstrated higher sleep efficiency and REM sleep percentage, after adjustment for potential confounders. No effect was observed in the absence of caffeine. CONCLUSIONS Our data support the role of the ADA G22A polymorphism in sleep, and demonstrate for the first time that caffeine may act as a modulator of its functional effects. CLINICAL TRIAL INFORMATION Name: Epidemiology of sleep disturbances among adult population of the Sao Paulo City. URL: http://www.clinicaltrials.gov/ct2/show/NCT00596713?term=NCT00596713&rank=1. Number: NCT00596713
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Affiliation(s)
| | - Camila Guindalini
- Departmento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Laboratório de Neurociências Clínicas (LiNC), Departmento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renata Pellegrino
- Departmento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Rogério Santos-Silva
- Departmento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Sergio Tufik
- Departmento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
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Chaves Junior CM, Dal-Fabbro C, Bruin VMSD, Tufik S, Bittencourt LRA. Consenso brasileiro de ronco e apneia do sono: aspectos de interesse aos ortodontistas. Dental Press J Orthod 2011. [DOI: 10.1590/s2176-94512011000100007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste artigo é explicitar o posicionamento das sociedades médicas que, reunidas, estabeleceram consenso sobre os parâmetros clínico-laboratoriais que envolvem os distúrbios respiratórios do sono, em especial o ronco e a síndrome da apneia obstrutiva do sono (SAOS). Os ortodontistas, que vêm ocupando gradativamente seu espaço em equipes multidisciplinares que atuam na área do sono humano, pouco conhecem sobre essa uniformização coordenada pela Associação Brasileira de Sono. Os trabalhos clínicos e as pesquisas científicas oriundos da Odontologia, e em particular da Ortodontia, também devem observar e seguir esses critérios de diagnóstico e tratamento estabelecidos pela comunidade médica brasileira.
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Alóe F, Alves RC, Araújo JF, Azevedo A, Bacelar A, Bezerra M, Bittencourt LRA, Bustamante G, Cardoso TAMDO, Eckeli AL, Fernandes RMF, Goulart L, Pradella-Hallinan M, Hasan R, Sander HH, Pinto LR, Cecília Lopes M, Minhoto GR, Moraes W, Moreira GA, Pachito D, Pedrazolli M, Poyares D, Prado L, Rizzo G, Nonato Rodrigues R, Roitman I, Ademir Baptista S, Tavares SMA. [Brazilian guidelines for the treatment of narcolepsy]. Braz J Psychiatry 2010; 32:305-314. [PMID: 20945021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 04/09/2010] [Indexed: 05/30/2023]
Abstract
This manuscript contains the conclusion of the consensus meeting of the Brazilian Sleep Association with Brazilian sleep specialists on the treatment of narcolepsy based on the review of medical literature from 1980 to 2010. The manuscript objectives were to reinforce the use of agents evaluated in randomized placebo-controlled trials and to issue consensus opinions on the use of other available medications as well as to inform about safety and adverse effects of these medications. Management of narcolepsy relies on several classes of drugs, namely, stimulants for excessive sleepiness, antidepressants for cataplexy and hypnotics for disturbed nocturnal sleep. Behavioral measures are likewise valuable and universally recommended. All therapeutic trials were analyzed according to their class of evidence. Recommendations concerning the treatment of each single symptom of narcolepsy as well as general recommendations were made. Modafinil is the first-line pharmacological treatment of excessive sleepiness. Second-line choices for the treatment of excessive sleepiness are slow-release metylphenidate followed by mazindol. The first-line treatments of cataplexy are the antidepressants, reboxetine, clomipramine, venlafaxine, desvenlafaxine or high doses of selective serotonin reuptake inibitors antidepressants. As for disturbed nocturnal sleep the best option is still hypnotics. Antidepressants and hypnotics are used to treat hypnagogic hallucinations and sleep paralysis.
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Affiliation(s)
- Flávio Alóe
- Hospital das Clínicas, Universidade de São Paulo, SP, Brasil.
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Haddad F, Gregorio LC, Bittencourt LRA, Tufik S. Comparison of Measures of Nasal Airway in Obstructive Apnea. Otolaryngol Head Neck Surg 2010. [DOI: 10.1016/j.otohns.2010.06.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alóe F, Alves RC, Araújo JF, Azevedo A, Bacelar A, Bezerra M, Bittencourt LRA, Bustamante G, Cardoso TAMDO, Eckeli AL, Fernandes RMF, Goulart L, Pradella-Hallinan M, Hasan R, Sander HH, Pinto LR, Lopes MC, Minhoto GR, Moraes W, Moreira GA, Pachito D, Pedrazolli M, Poyares D, Prado L, Rizzo G, Rodrigues RN, Roitman I, Silva AB, Tavares SMA. [Brazilian guidelines for the diagnosis of narcolepsy]. ACTA ACUST UNITED AC 2010; 32:294-304. [PMID: 20585744 DOI: 10.1590/s1516-44462010005000014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 04/09/2010] [Indexed: 11/21/2022]
Abstract
This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy based on the review of Medline publications between 1980-2010. Narcolepsy is a chronic disorder with age at onset between the first and second decade of life. Essential narcolepsy symptoms are cataplexy and excessive sleepiness. Cataplexy is defined as sudden, recurrent and reversible attacks of muscle weakness triggered by emotions. Accessory narcolepsy symptoms are hypnagogic hallucinations, sleep paralysis and nocturnal fragmented sleep. The clinical diagnosis according to the International Classification of Sleep Disorders is the presence of excessive sleepiness and cataplexy. A full in-lab polysomnography followed by a multiple sleep latency test is recommended for the confirmation of the diagnosis and co-morbidities. The presence of two sleep-onset REM period naps in the multiple sleep latency test is diagnostic for cataplexy-free narcolepsy. A positive HLA-DQB1*0602 with lower than 110pg/mL level of hypocretin-1 in the cerebrospinal fluid is required for the final diagnosis of cataplexy- and sleep-onset REM period -free narcolepsy.
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Affiliation(s)
- Flávio Alóe
- Hospital das Clínicas, Universidade de São Paulo, SP, Brasil.
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Abstract
Neste capítulo são apresentadas as principais abordagens para o diagnóstico e tratamento dos pacientes com SAOS. O diagnóstico deve ser realizado através de uma minuciosa história clínica e exame físico. Para a confirmação diagnóstica, é necessária a realização da polissonografia completa de noite inteira sob supervisão, sendo que em pacientes cuja suspeita clínica é alta, registros simplificados domiciliares podem ser uma alternativa. O tratamento da SAOS requer medidas gerais e o uso de aparelhos de pressão positiva. Em casos moderados e graves, CPAP é o mais indicado, enquanto aparelhos intraorais são indicados em casos leves. Os procedimentos cirúrgicos são indicados quando alterações anatômicas são evidentes ou como auxílio aos demais tratamentos.
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Santos-Silva R, Bittencourt LRA, Pires MLN, de Mello MT, Taddei JA, Benedito-Silva AA, Pompeia C, Tufik S. Increasing trends of sleep complaints in the city of Sao Paulo, Brazil. Sleep Med 2010; 11:520-4. [PMID: 20494615 DOI: 10.1016/j.sleep.2009.12.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 12/08/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to compare the prevalence of sleep habits and complaints and to estimate the secular trends through three population-based surveys carried out in 1987, 1995, and 2007 in the general adult population of the city of Sao Paulo, Brazil. METHODS Surveys were performed using the same three-stage cluster-sampling technique in three consecutive decades to obtain representative samples of the inhabitants of Sao Paulo with respect to gender, age (20-80 years), and socio-economic status. Sample sizes were 1000 volunteers in 1987 and 1995 surveys and 1101 in a 2007 survey. In each survey, the UNIFESP Sleep Questionnaire was administered face-to-face in each household selected. RESULTS For 1987, 1995, and 2007, respectively, difficulty initiating sleep (weighted frequency %; 95% CI) [(13.9; 11.9-16.2), (19.15; 16.8-21.6), and (25.0; 22.5-27.8)], difficulty maintaining sleep [(15.8; 13.7-18.2), (27.6; 24.9-30.4), and (36.5; 33.5-39.5)], and early morning awakening [(10.6; 8.8-12.7), (14.2; 12.2-16.5), and (26.7; 24-29.6)] increased in the general population over time, mostly in women. Habitual snoring was the most commonly reported complaint across decades and was more prevalent in men. There was no statistically significant difference in snoring complaints between 1987 (21.5; 19.1-24.2) and 1995 (19.0; 16.7-21.6), but a significant increase was noted in 2007 (41.7; 38.6-44.8). Nightmares, bruxism, leg cramps, and somnambulism complaints were significantly higher in 2007 compared to 1987 and 1995. All were more frequent in women. CONCLUSIONS This is the first study comparing sleep complaints in probabilistic population-based samples from the same metropolitan area, using the same methodology across three consecutive decades. Clear trends of increasing sleep complaints were observed, which increased faster between 1995 and 2007 than from 1987 to 1995. These secular trends should be considered a relevant public health issue and support the need for development of health care and educational strategies to supply the population's increased need for information on sleep disorders and their consequences.
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Affiliation(s)
- Rogerio Santos-Silva
- Division of Medicine and Biology of Sleep, Department of Psychobiology, Universidade Federal de Sao Paulo - UNIFESP, Sao Paulo, SP, Brazil
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Lucchesi LM, Speciali JG, Santos-Silva R, Taddei JA, Tufik S, Bittencourt LRA. Nocturnal awakening with headache and its relationship with sleep disorders in a population-based sample of adult inhabitants of Sao Paulo City, Brazil. Cephalalgia 2010; 30:1477-85. [PMID: 20974608 DOI: 10.1177/0333102410368440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Our aim was to estimate the prevalence of nocturnal awakening with headache (NAH) in the population of São Paulo City according to gender, age (20-80 years old) and socioeconomic classes and its relationship to sleep disorders, sleep parameters, anxiety, depression, fatigue, life quality and obesity. We used a population-based survey with a representative three-stage cluster sample. Questionnaires and scales were applied face-to-face, and polysomnography was performed in 1101 volunteers, aged 42 ± 14 years, 55% women. The complaint of NAH occurring at least once a week had a prevalence of 8.4%, mostly in women, obese subjects and those aged 50-59 years-old. We observed associations of NAH with insomnia, restless leg syndrome (RLS), nightmares and bruxism, but not obstructive sleep apnea syndrome. In a logistics regression model, risk factors for NAH were female gender, odds ratio (OR) (95% confidence interval [CI]) 4.5 (2.8-7.3); obesity, OR 1.9 (1.1-3.3); age between 50 and 59 years, OR 2.4 (1.2-4.7); severe anxiety, OR 8.1 (3.6-18.1); RLS, 2.7 (1.2-5.6); and nightmares, 2.2 (1.3-3.7). Our study shows that NAH was highly prevalent in the population of São Paulo and suggests that this phenomenon has specific characteristics with specific risk factors: obesity, RLS and nightmares.
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Botelho RV, Bittencourt LRA, Rotta JM, Tufik S. The effects of posterior fossa decompressive surgery in adult patients with Chiari malformation and sleep apnea. J Neurosurg 2010; 112:800-7. [DOI: 10.3171/2009.7.jns09174] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
One of the feared consequences of craniovertebral junction diseases is apnea. Although several cases of patients with central apnea have been described, obstructive sleep apnea has been identified as the most frequent manifestation of sleep respiratory disorder. Neuronal involvement may be responsible for both central and obstructive apneas. The objective of this work was to study the effect of posterior fossa decompressive surgery on respiratory parameters during sleep in patients with craniovertebral junction malformations and breathing-related sleep disorders.
Methods
In this study, prospectively enrolled consecutive symptomatic adult patients were monitored with full-night polysomnography before and after surgical decompression of the cranial posterior fossa.
Results
Of the 25 patients who were evaluated, 68% received a diagnosis of sleep apnea. After surgery, the mean number of respiratory events decreased from 180.70 to 69.29 (p = 0.005); the mean number of obstructive events decreased from 107.37 to 60.58 (p = 0.01); and the mean number of central events decreased from 38.45 to 8.05 (p = 0.01). The mean preoperative apnea/hypopnea index decreased from 26.68 to 12.98 (p = 0.06), and the mean central apnea index decreased from 13.81 to 1.68 (p = 0.01).
Conclusions
Decompressive surgery in patients with craniovertebral junction malformations resulted in decreased respiratory events during sleep, lowered sleep fragmentation, and enhanced the sleep apnea index in a significant number of patients. The effect was more pronounced in patients with central apnea.
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Affiliation(s)
- Ricardo Vieira Botelho
- 1Neurosurgical Service, Hospital do Servidor publico do Estado de São Paulo; and
- 2Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Lia Rita Azeredo Bittencourt
- 2Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - José Marcus Rotta
- 1Neurosurgical Service, Hospital do Servidor publico do Estado de São Paulo; and
| | - Sérgio Tufik
- 2Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
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Dal-Fabbro C, Chaves Junior CM, Bittencourt LRA, Tufik S. Avaliação clínica e polissonográfica do aparelho BRD no tratamento da Síndrome da Apneia Obstrutiva do Sono. Dental Press J Orthod 2010. [DOI: 10.1590/s2176-94512010000100013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVOS: este trabalho de pesquisa teve o intuito de realizar uma avaliação clínica e polissonográfica do efeito de um aparelho intraoral (AIO) para tratamento da Síndrome da Apneia Obstrutiva do Sono (SAOS), desenvolvido e testado por duas universidades federais brasileiras. MÉTODOS: a amostra constou de 50 pacientes (idades entre 18 e 65 anos, sendo 33 homens e 17 mulheres) com diagnóstico polissonográfico inicial de SAOS de grau leve e moderado. Todos os pacientes submeteram-se a uma nova avaliação polissonográfica de noite inteira (em uso do AIO) aproximadamente 6 meses após a primeira avaliação. Baseado na diminuição dos eventos respiratórios obstrutivos, obtida com o uso do AIO, os pacientes foram então divididos em bons respondedores (redução de 50% ou mais no índice de apneia e hipopneia (IAH), permanecendo abaixo de 10 eventos/hora) e maus respondedores (IAH permanecendo maior ou igual a 10 eventos/hora). RESULTADOS E CONCLUSÕES: em 54% da amostra o IAH diminuiu para menos de cinco eventos/hora com o uso do AIO; em 38% a redução do IAH foi maior do que 50%, mas permaneceu acima de cinco eventos/hora; e em 6% da amostra o IAH reduziu menos que 50%. Os bons respondedores corresponderam a 86% da amostra estudada, enquanto os maus respondedores a 14%. Houve melhora significativa na escala de sonolência, no IAH, nos microdespertares e na saturação mínima de oxihemoglobina com a terapia utilizada. O Índice de Massa Corpórea elevado parece interferir desfavoravelmente no desempenho do aparelho em estudo.
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Coelho FMS, Pradella-Hallinan M, Predazzoli Neto M, Bittencourt LRA, Tufik S. Prevalence of the HLA-DQB1*0602 allele in narcolepsy and idiopathic hypersomnia patients seen at a sleep disorders outpatient unit in São Paulo. Braz J Psychiatry 2009; 31:10-4. [PMID: 19506770 DOI: 10.1590/s1516-44462009000100004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 11/28/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Narcolepsy (with and without cataplexy) and idiopathic hypersomnia, are disorders with common features but with different HLA-DQB1*0602 allele prevalence. The present study describes the prevalence of HLA-DQB1*0602 allele in narcoleptics with and without cataplexy and in patients with idiopathic hypersomnia. METHOD Subjects comprised 68 patients who were diagnosed for narcolepsy or idiopathic hypersomnia and 23 healthy controls according to the International Classification of Sleep Disorders-2. Subjects comprised 43 patients with narcolepsy and cataplexy, 11 patients with narcolepsy but without cataplexy, 14 patients with idiopathic hypersomnia and 23 healthy controls. Genotyping of HLA-DQB1*0602 allele was performed for all subjects. RESULTS The prevalence of the HLA-DQB1*0602 allele was increased in idiopathic hypersomnia and in narcoleptic patients with and without cataplexy when compared to healthy subjects (p = 0.04; p = 0.03 and p < 0.0001, respectively). CONCLUSIONS This finding is in accordance with those of previous studies. The gold standard exam of narcolepsy with cataplexy is Hypocretin-1 dosage, but in patients without cataplexy and idiopathic hypersomnia, there are no specific diagnostic lab findings. The presence of the HLA-DQB1* 0602 allele may be important for the differential diagnosis of situations that resemble those sleep disorders such as secondary changes in sleep structure due to drugs' consumption.
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Abstract
Disrupted sleep and nocturnal hypoxia are common in cystic fibrosis (CF). However, the predictors of nocturnal hypoxia in CF are still controversial. In order to identify the risk factors for nocturnal desaturation and sleep disturbances, we carried out a clinical and polysomnographic investigation of CF patients. We studied 30 clinically stable CF cases with clinical lung disease (mean age = 12.8; mean FEV1 = 65.2), 10 CF cases without significant lung disease (mean age = 13.3; mean FEV1 = 99.8), and 20 controls (mean age = 15.5). Patients were evaluated by spirometry, 6-min walk test, the Shwachman-Kulczycki (S-K) score, and full overnight polysomnography. Cases with clinical lung disease had lower body mass index, forced vital capacity, and S-K scores. During sleep, five CF cases with clinical lung disease (15%) had SaO(2) <90% during more than 30% of total sleep time and 11 cases (36.6%) had a nadir SaO(2) below 85%. FEV1 values for CF cases with clinical lung disease were related to nadir SaO(2) (P < 0.03) and to mean SaO(2) (P = 0.02). A receiver operating characteristic (ROC) analysis determined FEV1 at 64% to be predictive of nocturnal desaturation as defined by minimum SaO(2) <85% (sensitivity = 92.3%; specificity = 77.3%) or SaO(2) <90% for 30% of sleep time (sensitivity = 81.8%; specificity = 85.2%). Frequency of impaired sleep was not different in CF cases with (N = 2) and without significant lung disease (N = 5, P = 0.53). Sleep architecture was not significantly different between the two groups. Sleep apnea was present in three CF cases with clinical lung disease and in one case without significant lung disease. In summary, desaturation during sleep can be predicted by FEV1 <64% with good sensitivity and specificity. There are no significant differences in sleep architecture between clinically stable CF cases with and without significant lung disease.
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Santos EAS, Filho WJS, Possatti LL, Bittencourt LRA, Fontoura EAF, Botelho RV. Epidemiology of severe cervical spinal trauma in the north area of São Paulo City: a 10-year prospective study. J Neurosurg Spine 2009; 11:34-41. [DOI: 10.3171/2009.3.spine08325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The main objective was to study the epidemiological data obtained in patients with cervical spinal trauma (CST) in the north area of São Paulo City between 1997 and 2006.
Methods
All patients with severe CST in the north area of São Paulo City were studied. The data analyzed were age, sex, incidence, causes of trauma, level of trauma, morbidity, deaths, and complications. Analytical tests were performed to study risks of trauma and complications. The chi-square and analysis of variance tests were used for analytical data (significance level p < 0.05).
Results
The study population consisted of 217 patients who were hospitalized for CST. The average incidence rate was 21.6 cases annually or 1.8 cases monthly. The mean patient age was 36.75 years. The 20–40-year-old age bracket was found to be most highly represented, corresponding to 52.6% of total patients. Patients were predominantly male; 191 patients (88.01%) were male compared with only 26 female patients (11.99%). The ratio of men to women was 7.35:1. Injuries in the craniocervical region corresponded to 43 (19.8%) of the cases; injuries in the cervical subaxial region corresponded to 174 (80.2%) of the cases and were associated with worse neurological lesions. Additionally, 40.6% of patients presented with complications in other organs and systems; several patients presented with multiple complications, and 33 patients (15.02%) died. During the hospitalization period, 4 patients presenting as Grade A on the American Spinal Injury Association (ASIA) Scale evolved to Grade C, 1 patient presenting as ASIA Grade A evolved to Grade B, and 2 patients evolved to Grade E. Two patients who had been admitted without neurological lesions evolved to ASIA Grade C (1 patient postsurgery and 1 patient post-traction). Two patients presenting initially as ASIA Grade E evolved to Grade D, and another to central cord syndrome. On average, patients with incomplete lesions improved 1 grade in ASIA classification during hospitalization.
Conclusions
Data from severe CST observed in the current study suggest many differences in the characteristics described in the majority of published epidemiological studies and those found in patients in the north area of São Paulo City. It is likely that these differences reflect the urban and cultural habits and behaviors of the population specific to this area.
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Affiliation(s)
| | | | | | | | | | - Ricardo Vieira Botelho
- 1Conjunto Hospitalar do Mandaqui, Neurosurgery Service
- 3Hospital do Servidor Público Estadual de São Paulo, Neurosurgery Service, São Paulo, Brazil
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Hachul H, Bittencourt LRA, Soares JM, Tufik S, Baracat EC. Sleep in post-menopausal women: Differences between early and late post-menopause. Eur J Obstet Gynecol Reprod Biol 2009; 145:81-4. [DOI: 10.1016/j.ejogrb.2009.03.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 03/02/2009] [Accepted: 03/30/2009] [Indexed: 11/26/2022]
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