Daniel Ninello Polesel

Waist circumference and postmenopause stages as the main associated factors for sleep apnea in women: a cross-sectional population-based study.

ObjectiveThe current study aimed to investigate stages of reproductive aging as an associated factor for obstructive sleep apnea syndrome (OSAS) among women in a representative sample of Sao Paulo, Brazil. MethodsFour hundred seven women underwent clinical evaluation, polysomnography, and biochemical analysis. Stages of reproductive aging were defined as premenopause, early postmenopause, and late postmenopause. ResultsOSAS was more frequent in the postmenopausal groups, with 68.4% of women affected by severe OSAS belonging to the late postmenopause group. After adjustment for potential confounding factors, associated factors for OSAS, regardless of its severity, were waist circumference, modified Mallampati score IV, and both postmenopause stages. For moderate to severe OSAS and severe OSAS, we found waist circumference and both postmenopause stages to be the main factors. We carried out a receiver operating characteristic curve analysis, which demonstrated that the cutoff value for waist circumference was 87.5 cm, with a maximum of 75.7% accuracy for the classification of women as OSAS or non-OSAS. ConclusionsOSAS is prevalent in postmenopausal women, especially in late postmenopause. This study highlights the association between waist circumference, early postmenopause and late postmenopause, and severity of OSAS. Our findings suggest that postmenopause stages may potentially exacerbate the presence of sleep disturbance and that reducing waist circumference may be an important strategy for managing OSAS in women.

Sleep quality of mother-caregivers of Duchenne muscular dystrophy patients

BackgroundSleep disturbance is a common problem for caregivers. In general, patients with Duchenne muscular dystrophy (DMD) use noninvasive ventilation to maintain quality of life and improve survival.ObjectiveThe aim of this study was to evaluate the sleep quality of caregiver-mothers of sons with DMD and factors that are associated with their sleep quality.MethodsWe evaluated 32 caregiver-mothers of sons with DMD and 32 mothers of sons without any neuromuscular or chronic disease (control—CTRL group). The evaluation of quality of sleep was made using the Pittsburgh Sleep Quality Index (PSQI).ResultsCaregiver-mothers had poor sleep quality, specifically longer sleep latency and reduced sleep efficiency. The impaired sleep quality of the caregiver-mothers was associated with the length of time of noninvasive ventilation used by their sons. ConclusionsOur results suggest that caregiver-mothers of sons with DMD have poor quality of sleep, and the length of use of noninvasive ventilation of their sons is associated with better sleep of caregiver-mothers.

The Relationship Between Sexual Function and Quality of Sleep in Caregiving Mothers of Sons with Duchenne Muscular Dystrophy

Introduction The task of the caregiver, especially a caregiving mother of a son with a chronic and fatal disease, may interfere with their quality of sleep, sexuality, and some hormone levels. Aim The aim of this study was to evaluate the sexual function and the quality of sleep of caregiving mothers of sons with Duchenne muscular dystrophy (DMD). Methods We evaluated 20 caregiving mothers of sons with DMD and 20 caregiving mothers of sons without any neuromuscular or chronic disease. All of them voluntarily responded to the evaluating questionnaires about their sexuality and their quality of sleep, and gave blood samples to evaluate their hormonal levels. Main Outcome Measures All mothers were evaluated using the questionnaire of Female Sexual Function Index (FSFI) and the Pittsburgh questionnaire (PSQI). The blood samples were tested to determine serum levels of testosterone, estradiol, follicle-stimulating hormone, luteinizing hormone, progesterone, adrenocorticotropic hormone, and cortisol. Results Caregiving mothers of sons with DMD had significantly lower scores in the FSFI questionnaire, suggesting a higher risk for sexual dysfunction. The PSQI demonstrated that these caregiving mothers present increased sleep latency, reduced sleep efficiency, daytime dysfunction, and poor sleep quality. Blood tests showed a rise in cortisol levels, which correlated with the compromised sexuality and quality of sleep. Conclusions This study indicates that caregiving mothers of sons with DMD show major risk for sexual dysfunction and a reduction in their quality of sleep mediated in part by the hormonal changes related to stress. Nozoe KT, Hachul H, Hirotsu C, Polesel DN, Moreira GA, Tufik S, and Andersen ML. The relationship between sexual function and quality of sleep in caregiving mothers of sons with Duchenne muscular dystrophy. Sex Med 2014;2:133–140.

Impact of corticotherapy, nutrition, and sleep disorder on quality of life of patients with Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is the second most common hereditary genetic disease in humans and has elevated mortality. DMD is an X-linked, life-limiting progressive muscle-wasting disease found predominantly in boys and young men. One of the main treatments for patients with DMD is corticosteroids. However, long-term use may cause major side effects such as obesity, a reduction in vitamin D, and osteoporosis. Sleep-disordered breathing is a common condition among patients with DMD, especially obstructive sleep apnea (OSA). In children, OSA is associated with obesity and a reduction of vitamin D concentration. In this article we aim to explore the interrelationship that exists between corticosteroids, obesity, OSA, and the risk of osteoporosis. Our main hypothesis is that factors such as nutrition and sleep are related to obesity and OSA, respectively. In addition, the chronic use of corticosteroids, obesity, and OSA are factors that can reduce serum levels of vitamin D, triggering osteoporosis. Thus, these factors play a key role in affecting the quality of life for patients with DMD and intervention based on these aspects may improve survival.

Can Ayahuasca and sleep loss change sexual performance in male rats

The ingestion of the beverage Ayahuasca usually occurs in religious ceremonies that are performed during the night leading to sleep deprivation. The purpose of the present study was to characterize the acute effects of Ayahuasca upon the sexual response of sleep deprived male rats. One group of sexually experienced male Wistar rats were submitted to a paradoxical sleep deprivation (PSD) protocol for 96h, while another group spent the same amount of time in the home cage (CTRL). After this period, either saline or Ayahuasca drink (250, 500 and 1000μgmL(-1)) was administered by gavage and sexual behavior and hormonal concentrations were measured. Ayahuasca alone significantly decreased sexual performance at all doses. However, in sleep deprived rats, the lower dose increased sexual performance while the intermediate dose produced a detrimental effect on sexual response compared to the CTRL rats at the same dose. Regarding the hormonal analyses, a lower testosterone concentration was observed in sleep-deprived saline rats in relation to the CTRL group. Progesterone was significantly lower only in PSD rats at the dose 500μgmL(-1) compared with CTRL-500μgmL(-1) group. Corticosterone was unchanged among the groups evaluated. Our results suggest that Ayahuasca intake markedly impaired sexual performance alone, but, when combined with sleep deprivation, had significant, but heterogeneous, effects on male sexual response.

Obstructive sleep apnea as a potential confounding factor in atherosclerosis in the Asian population

Recently, Cao and colleagues presented an interesting article titled “Association of heme oxygenase-1 gene rs2071746 polymorphism with vascular outcomes in patients with atherosclerotic stroke” [1] that demonstrated that a larger neck circumferencewas considered an independent variable associated with a higher risk of early stage atherosclerosis in a sample of Chinese adults. We would like to congratulate the authors for carrying out such a complex study and for the detailedmethodology used in this atherosclerosis investigation. We would also like to highlight the efforts of these authors on the accomplishment of this research and suggest additional considerations for future researches. According to official data, in China, about 230 million people have cardiovascular diseases. In 2010, 154.8 per 100,000 deaths per year are estimated to be associated with cardiovascular diseases in urban areas [2]. One in five adults in the China has a cardiovascular disease, resulting in the cost of 12,566 RMB (approximately US

Obesity, Dyslipidemia, and Sleep Disorders : Complexity Requires Complementary Analysis

2000) for each hospitalization associated with a heart attack (myocardial infarction) [2]. Thebestway to reduce this highmortality rate is by addressing the prevention of these diseases and by focusing on their risk factors, such as obesity, diabetes and hypertension. We would like to emphasize another relevant risk factor for atherosclerosis: obstructive sleep apnea (OSA). The authors did not consider the effect of variables, obesity-related and possible influence of OSA on atherosclerosis.Wewould like to highlight the relationship between OSA and obesity in the sample (Chinese subjects) studied by the authors. The pathogenesis of OSA ismultifactorial. Obesity and craniofacial alterations are amongst the main predisposing factors of OSA. The anatomical features of individuals from different ethnic origins are one of the factors that can contribute to the development of OSA. The risk factors for OSA include obesity, excess regional adipose tissue, enlarged soft tissues of the upper airway, and craniofacial abnormalities [3]. Craniofacial structure depends on both bone and soft tissue components. Because the soft palate is one of these soft tissue components, its length may be strongly influenced by obesity. The relationship between the limiting size of the craniofacial skeletal enclosure and the amount of soft tissue can play a key role in the evaluation of Asian patients with suspected OSA. In comparison with Caucasian subjects, Asians appear to show greater restriction of skeletal measurements, including a smaller maxilla, retropositioned mandible and a shorter anterior cranial base [4]. It is noteworthy that in the Asian population, patients with OSA are majorly diagnosed as being overweight, but are not always considered obese [5]. The events of obstruction are naturally

Sleep pattern and spectral analysis of caregiver-mothers of sons with Duchenne muscular dystrophy, and an examination of differences between carriers and non-carriers

Financial/nonfi nancial disclosures: The authors have reported to CHEST that no potential confl icts of interest exist with any companies/organizations whose products or services may be discussed in this article . Funding/Support: This study was supported by the Science Foundation of Guangxi Returned Oversea Scholars [No. 0991004 ]. Correspondence to: Rui-Xing Yin, MD, PhD, Department of Cardiology, Institute of Cardiovascular Diseases, The First Affi liated Hospital, Guangxi Medical University, 22 Shuangyong Rd, Nanning 530021, Guangxi, China; e-mail: yinruixing@yahoo.com.cn

Phenotypic contrasts of Duchenne Muscular Dystrophy in women: Two case reports.

OBJECTIVES Sleep is essential for physical and mental well-being. However, poor sleep is a common complaint among caregivers. The aim of the present study was to determine sleep patterns of caregiver-mothers (CM group) of sons with Duchenne muscular dystrophy (DMD) and also to examine the differences between non-carriers and carriers of the gene related to DMD within the CM group. METHODS Observational case-control study. PARTICIPANTS The CM and control (CTRL) groups were matched for age, body mass index and social class. Polysomnography was conducted in a sleep laboratory for one night. The discrete fast Fourier transformation method was used to calculate the electroencephalogram (EEG) power spectrum for the entire night and sleep stages. RESULTS The CM group presented higher sleep latency and N3 sleep stage compared with the CTRL. When carrier and non-carrier CM subgroups were analyzed, increased sleep latency and time awake, as well as reduced sleep efficiency and N2, were observed in the carrier group. Regarding respiratory parameters, carriers demonstrated higher hypopnea index values compared with non-carriers. Spectral analysis showed that carriers compared with non-carrier DMD caregiver-mothers presented lower spectral power in fast waves, mainly beta, during REM sleep in some EEG derivations. CONCLUSIONS There was an impairment of sleep pattern in the CM group compared with CTRL mothers; this was possibly associated with difficulty in initiating sleep. Being a DMD gene carrying caregiver further compromised some aspects of sleep microstructure during REM sleep. The data demonstrated the importance of sleep evaluation in caregiver-mothers, and the relationship between sleep and being a carrier of the gene associated with DMD, which was demonstrated as possibly impacting sleep quality.

Influence of sleep disorders on television viewing time, diabetes and obesity.

We discussed two cases of symptomatic female carriers to Duchenne Muscular Dystrophy. The first case is a 20 year-old girl with classical phenotypic manifestation of the disease, similar to the condition in boys. The case 2 is a 62 year-old woman with progressive muscular weakness. The disease is much less common in woman than men so both cases described here are considered rare forms of the disease, with several clinical implications. In both cases, a progressive muscle weakness, impairment in walking and sleeping was observed, in addition to obstructive sleep apnea syndrome and alveolar hypoventilation, that required noninvasive ventilatory support.