Anderson Soares Silva

A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis.

The purpose of this study was to conduct a systematic review of the available evidence on sleep disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD). [Subjects and Methods] Two independent reviewers performed a computer-assisted search of the MEDLINE, SciELO, LILACS, and BIREME Virtual Health Library medical databases from their inception to November 2015. [Results] One thousand one hundred twenty-six articles were found that met the inclusion criteria. Articles were excluded if they were not in English, the patients did not undergo HD, or the studies were not cross-sectional or clinical trials. After reading the full text, a further 300 studies were excluded because they did not use polysomnography. The remaining 18 studies with ESRD patients undergoing HD comprised 8 clinical trials and 10 cross-sectional studies. This systematic review followed the criteria outlined by the PRISMA declaration. [Conclusion] In this systematic review, a high prevalence of sleep disorders was observed in ESRD, including sleep-disordered breathing. This knowledge may enable health professionals to devise new strategies for the diagnosis and treatment of these patients, in order to reduce morbidity and mortality and improve their quality of life.

Sleep, lung function, and quality of life in patients with myasthenia gravis: A cross-sectional study.

The purpose of this study was to investigate the physiological variables of lung function, respiratory muscle strength, and sleep in clinically stable patients with myasthenia gravis. This was a prospective cross-sectional study conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Patients adhering to the eligibility criteria were consecutively recruited from the Research Department of Neuromuscular Diseases at the Federal University of Sao Paulo and the Department of Neurology at Santa Casa de Misericordia of Sao Paulo and were referred to the Nove de Julho University Sleep Laboratory (Sao Paulo, Brazil). The study included 25 patients (21 female) with a mean age of 45.28 ± 12.33 years. Only one patient exhibited a restrictive ventilatory pattern. The maximum ventilatory pressures observed were considerably reduced in most patients as compared to reference values. In sleep studies, the patients exhibited significantly reduced oxygen saturation, reduced rapid eye movement sleep time, increased non-rapid eye movement stage 3 sleep, and considerable apnoea/hypopnoea indexes. Clinically stable patients with myasthenia gravis exhibit a high prevalence of sleep-disordered breathing, significant reductions in maximum ventilatory pressures, and impairment of health-related quality of life.

PHYSICAL ACTIVITY LEVEL, FUNCTIONAL MOBILITY AND FALL RISK IN THE ELDERLY

Introduction: Low levels of physical activity and functional mobility lead to greater difficulty in performing activities of daily living and are directly proportional to mortality in the elderly. Thus, there are the need to create mechanisms linked to the maintenance of the functional capacity, which assure the elderly autonomy and self-confidence. Objective: To verify the level of physical activity and functional mobility in the elderly and if this functional mobility suffers interference of the age group and physical activity. Methods: The study involved the elderly aged 60 and over, living in Senhor do Bonfim (BA), in the northeastern region of Brazil, from February to July 2015. The evaluation of the subjects occurred in a single session, with physical and general clinical evaluation, as well as the collection of sociodemographic, anthropometric and self-reported morbidities through the application of questionnaires. It was also carried out the Timed Up and Go test (TUG) to verify the levels of functional mobility and level of physical activity with application of the International Questionnaire of Physical Activity (IPAQ) adapted for the elderly. Results: In this study, 127 patients were studied, predominantly female (87%) and mean age of 68 ± 7 years, and the majority of the elderly corresponded to the age group of 60 to 69 years. The elderly belonging to the group considered inactive (IPAQ up to 150 min/weekly) presented the execution time of TUG higher than the elderly in the group considered active (IPAQ > 150 min/weekly), with averaging time for carrying out the test of 10.5±2 minutes and 8.9±2 minutes respectively, with a statistically significant difference of p<0.01. And the execution time of TUG increased proportionally to the increase of the age group. Conclusion: Elderly with lower level of physical activity and belonging to the higher age groups present a higher risk of falls. Strategies should be developed to stimulate increased physical activity level and functional mobility of this population, especially among the older ones, reducing the incidence of falls and providing greater autonomy.

Prevalence of Overlap Syndrome. Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease. A study protocol.

Introduction: Chronic obstructive pulmonary disease (COPD) and Obstructive sleep apnea (OSA) cause an inflammatory response and hypoxia. Patients who have both conditions have increased morbidity and mortality. Overlap syndrome between OSA and COPD is important but under-recognised. Objectives: We aimed to determine the prevalence and severity of overlap syndrome in patients with COPD through the overnight standard polysomnography. Methods/Design: A consecutive single-center cross-sectional study will be performed. The design, conduct and report of this study followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. The sample will be of convenience, recruited consecutively with respiratory complaints that seek care in a private clinic specializing in pulmonology in the city of Cascavel, in the state of Parana, from September 2016 to July 2017. All subjects will be submitted to the same evaluation protocol described subsequently. Initially will be collected data on baseline demographic, anthropometric and clinical aspects, including body mass index, neck, hip and waist circumferences, respiratory and cardiac rates, peripheral blood pressure, and BODE index. After this phase of the study, patients will perform lung function tests through petismography, sleep studies using the standard overnight PSG, and respond to the Berlin and Pittsburgh questionnaires, and Epworth Sleepiness Scale.

Nocturnal oxyhemoglobin desaturation during sleep in congestive heart failure patients

Introducao: Os disturbios respiratorios do sono ocorrem em 45% dos pacientes com insuficiencia cardiaca, com 36%-50% manifestando respiracao Cheyne-Stokes com apneia do sono central e 12% exibindo apneia obstrutiva do sono. Varios estudos tem demonstrado que a fisiopatologia do sono pode afetar negativamente o sistema cardiovascular e que a disfuncao cardiaca altera o sono e a respiracao. Objetivo: Examinar a dessaturacao da oxihemoglobina durante o sono em pacientes com insuficiencia cardiaca congestiva (ICC), utilizando a oximetria de pulso durante a noite. Metodos: A oximetria de pulso noturna foi realizada nas casas dos pacientes com oximetros de pulso acoplados ao redor dos dedos indicadores de 15 pacientes com ICC e fracao de ejecao menor que 50%, sendo classificados pelo New York Heart Association como classes funcionais II e III. Resultados: Os pacientes foram divididos em dois grupos. O primeiro grupo era composto por sete pacientes com indices de dessaturacao da oxihemoglobina (IDO) maior que 5 eventos/h e o segundo grupo continha oito pacientes com IDO igual ou menos que 5 eventos/h. Testes t de Student nao apresentou diferencas significativas entre os grupos. Os indices de massa corporal dos pacientes foram positivamente correlacionados com o total de episodios de dessaturacao e tempo de dessaturacao inferior a 90% e negativamente com a saturacao de oxigenio arterial. Conclusao: O monitoramento da oximetria de pulso durante o sono pode ser usado para detectar disturbios respiratorios do sono em pacientes estaveis com ICC.