Flávio Alóe

Portuguese version of Duke Religious Index: DUREL

Endereço para correspondência: Alexander Moreira-Almeida. Rua Cap. Arnaldo de Carvalho, 693/202 – 36036-180 – Juiz de Fora, MG. E-mail: alex.ma@ufjf.edu.br As relações entre religiosidade e saúde têm sido cada vez mais investigadas e as evidências têm apontado para uma relação habitualmente positiva entre indicadores de envolvimento religiosos e de saúde mental (Moreira-Almeida et al., 2006). Como a maioria dos estudos disponíveis na área foi realizada nos Estados Unidos, há uma necessidade de replicação em outras culturas. Tendo como um dos objetivos a ampliação das pesquisas em espiritualidade e saúde em nosso meio, a Revista de Psiquiatria Clínica publicou recentemente um suplemento especial com esse tema (Moreira-Almeida, 2007). No entanto, uma limitação ao desenvolvimento de mais pesquisas em países de língua portuguesa é a carência de escalas de religiosidade que sejam curtas, simples e que forneçam dados relevantes. Com o objetivo de suprir essa carência, apresentamos uma versão em português de uma breve escala de religiosidade que se tem mostrado muito útil em outras pesquisas, a Duke Religious Index (DUREL) (Koenig et al., 1997). A DUREL possui cinco itens que captam três das dimensões de religiosidade que mais se relacionam com desfechos em saúde: organizacional (RO), nãoorganizacional (RNO) e religiosidade intrínseca (RI). Os primeiros dois itens abordam RO e RNO, foram extraídos de grandes estudos epidemiológicos realizados nos Estados Unidos e se mostraram relacionados a indicadores de saúde física, mental e suporte social. Os outros itens se referem à RI e são os três itens da escala de RI de Hoge que melhor se relacionam com a pontuação total nesta escala e com suporte social e desfechos em saúde (Koenig et al., 1997). Na análise dos resultados da DUREL, as pontuações nas três dimensões (RO, RNO e RI) devem ser analisadas separadamente e os escores dessas três dimensões não devem ser somados em um escore total. Para produzir a versão em português, um dos autores (MFP) fez a tradução inicial que foi revisada por dois outros (AMA e FLN). Essa versão revisada foi retrotraduzida para o inglês por FA. Essa versão em inglês foi avaliada e aprovada pelo autor sênior da DUREL (HGK). A versão final em português é apresentada a seguir. Entretanto, é muito importante que sejam feitos estudos de validade e confiabilidade dessa versão na população brasileira. Não se sabe ao certo o quanto estas questões desenvolvidas para a população norte-americana se aplicam aos brasileiros. Entretanto, o fato de ambos os países serem majoritariamente cristãos e de a DUREL apresentar itens mais genéricos, provavelmente aplicáveis à maioria das religiões de nosso meio, sugere que essa versão em português possa ser bem aplicável em nossa realidade.

Epworth Sleepiness Scale outcome in 616 brazilian medical students

The Epworth Sleepiness Scale (ESS) measures daytime sleepiness in adults. This paper reports the following data in 616 medical students: 1-ESS scores, 2-its correlation with the declared night sleep time, 3-comparison with ESS values obtained from Australia, 4-comparison of ESS values in a sub-population of 111 students tested early and late 1995. There were 387 males, 185 females and 4 not specified. Age = 20.16 +/- 2.23 (SD), ESS score = 10.00 +/- 3.69 (SD), declared sleep time = 7.04 +/- 1.03 (SD). ESS scores did not statistically correlate with sleep time. Average ESS score was statistically higher than in the Australian sample. Retesting of the medical students showed an increase in ESS values from March to November 1995. Sleep time difference was non-significant. Higher ESS scores in this sample seem to be related to shorter sleep time, but fatigue effects can not be ruled out.

Apnéia do sono em obesos

Obesity is a disease with high prevalence and obese individuals have a higher risk of cardiovascular diseases, diabetes mellitus, dyslipidemia and Obstructive Sleep Apnea Syndrome (OSAS). OSAS is a chronic, progressive, incapacitating disease with high cardiovascular mortality and morbidity. Clinical symptoms include snoring, respiratory pauses, agitated sleep, nocturia, sudoresis, excessive sleepiness, headache in the morning, neurocognitive deficits, personality and libido changes, depressive symptoms and irritability. Anatomic and functional factors can contribute to the instability of the upper respiratory tract. The confirmations is made by the polisomnography, that also stablish severity criteria. Treatment is based in four points: obesity, behavioral, physical and surgical treatments. In selected patients, some drugs can be useful. Hypothyroidism must be always screened. Intraoral ortesis were developed and patients with normal weight with specific palatopharingeal changes have better chances to success in surgery (uvulopalatopharingoplasty)

Mecanismos do ciclo sono-vigília

Neurochemically distinct systems interact regulating sleep and wakefulness. Wakefulness is promoted by aminergic, acetylcholinergic brainstem and hypothalamic systems. Each of these arousal systems supports wakefulness and coordinated activity is required for alertness and EEG activation. Neurons in the pons and preoptic area control rapid eye movement and non-rapid eye movement sleep. Mutual inhibition between these wake- and sleep-regulating systems generate behavioral states. An up-to-date understanding of these systems should allow clinicians and researchers to better understand the effects of drugs, lesions, and neurologic disease on sleep and wakefulness.Neurochemically distinct systems interact regulating sleep and wakefulness. Wakefulness is promoted by aminergic, acetylcholinergic brainstem and hypothalamic systems. Each of these arousal systems supports wakefulness and coordinated activity is required for alertness and EEG activation. Neurons in the pons and preoptic area control rapid eye movement and non-rapid eye movement sleep. Mutual inhibition between these wake- and sleep-regulating systems generate behavioral states. An up-to-date understanding of these systems should allow clinicians and researchers to better understand the effects of drugs, lesions, and neurologic disease on sleep and wakefulness.

New guidelines for diagnosis and treatment of insomnia

The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.A Associacao Brasileira de Sono reuniu especialistas em medicina do sono com o objetivo de desenvolver novas diretrizes no diagnostico e tratamento das insonias. Nos consideramos quatro niveis de evidencia: padrao, recomendado, opcional e nao recomendado. Os topicos abordados foram: conceito, avaliacao clinica e psicossocial, indicacao da polissonografia, tratamento farmacologico, terapia comportamental cognitiva, comorbidades e insonia na infância. Para o diagnostico da insonia, foi recomendada uma avaliacao psicossocial e a realizacao da polissonografia, enquanto que no que se refere ao tratamento, foi estabelecido como padrao a indicacao da terapia comportamental cognitiva, e, quanto ao tratamento farmacologico, foi indicado o uso do zolpidem como hipnotico padrao, e sendo recomendado o zopiclone, a trazodona e a doxepina.

Sleep-related laryngospasm

Seven patients (mean age 46.6; range 33-58; 6M,1F) presented with sleep-related choking episodes and were found to have features in common that distinguished them from other known causes of choking episodes during sleep. The characteristic features include: an awakening from sleep with an acute choking sensation, stridor, panic, tachycardia, short duration of episode (less than 60 seconds), infrequent episodes (typically less than 1 per month), and absence of any known etiology. The disorder most commonly occurs in middle-aged males who are otherwise healthy. In one patient an episode of laryngospasm was polysomnographically documented to occur during stage 3. The clinical features and the polysomnographic findings suggest spasm of the vocal cords of unknown etiology.

Jactatio capitis nocturna with persistence in adulthood: case report

Rhythmic movement disorder, also known as jactatio capitis nocturna, is an infancy and childhood sleep-related disorder characterized by repetitive movements occurring immediately prior to sleep onset and sustained into light sleep. We report a 19-year-old man with a history of headbanging and repetitive bodyrocking since infancy, occurring on a daily basis at sleep onset. He was born a premature baby but psychomotor milestones were unremarkable. Physical and neurological diagnostic workups were unremarkable. A hospital-based sleep study showed: total sleep time: 178 min; sleep efficiency index 35.8; sleep latency 65 min; REM latency 189 min. There were no respiratory events and head movements occurred at 4/min during wakefulness, stages 1 and 2 NREM sleep. No tonic or phasic electromyographic abnormalities were recorded during REM sleep. A clinical diagnosis of rhythmic movement disorder was performed on the basis of the clinical and sleep studies data. Clonazepam (0.5 mg/day) and midazolam (15 mg/day) yielded no clinical improvement. Imipramine (10 mg/day) produced good clinical outcome. In summary, we report a RMD case with atypical clinical and therapeutical features.

Diretrizes brasileiras para o tratamento da narcolepsia

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.

Nocturnal eating syndrome: a case report with therapeutic response to dexfenfluramine

A woman with nocturnal eating syndrome responsive to dexfenfluramine (DXF) is reported. Eating consisted of nightly ingestion of large amounts of high-calorie meals and often sloppy meal consumption or preparation. Amnesia for the episodes was total. Anorexigenic medications produced partial control of her daytime carbohydrate craving and no nocturnal eating change. DXF stopped her eating behavior completely. Nocturnal eating herein meets all 4 DSM-III-R diagnostic criteria for binge eating disorder. 5-HT role in neural process controlling sleep-wakefulness (SW) has been widely shown. A 5-HT agonist like DXF could determine changes in the SW processes producing the therapeutic outcome reported herein. However, a specific DXF effect on the behavioral control of carbohydrate ingestion can not be dismissed.

Brazilian guidelines for the diagnosis of narcolepsy

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.