Heidi Haueisen Sander

A comparison of the Fujita classification of awake and drug-induced sleep endoscopy patients

UNLABELLEDnOnly a few studies have compared the outcomes of patients kept awake during endoscopic examination and subjects submitted to drug-induced sleep endoscopy.nnnOBJECTIVEnThis study aimed to compare the endoscopic findings of patients submitted to outpatient endoscopy and endoscopic examination with sedation by propofol based on the Fujita Classification.nnnMETHODnThis cross-sectional cohort study enrolled 34 patients. The subjects underwent ENT examination, nasal endoscopy with Müllers maneuver, and drug-induced sleep endoscopy with propofol. The Fujita Classification was used to compare the two modes of endoscopic examination. The examinations were correlated to patient clinical data such as BMI, age, and OSAS severity.nnnRESULTSnThere was no agreement between the two modes of endoscopic examination, whether for the group in general or for the analyzed subgroups.nnnCONCLUSIONnThere was no agreement between the endoscopic findings of endoscopic examinations done with the patient awake or in drug-induced sleep.

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.

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.

Central apnea after adenotonsillectomy in childhood: case report

Obstructive sleep apnea syndrome (OSAS) during childhood has a prevalence of 2–4%, and its main underlying cause is hypertrophy of the upper airway lymphoid tissues [1–3]. In children, central apnea (CA) may be part of OSAS or may occur as a physiological event of wake–sleep transition or REM sleep. However, although CA is considered to be common in healthy children, several authors have detected CA indices generally <1/h even when different criteria are used for the definition of the events [4–7]. The preponderance of CA in the context of OSAS should suggest secondary causes. CA presenting as a periodic breathing pattern is observed at a certain frequency only in premature babies or among children at high altitude. In older children, unless it occurs as a brief phenomenon at the beginning of sleep, a more expressive periodic breathing pattern may be associated with anomalies of the central nervous system [8]. Children with OSAS appear to have a higher central apnea index (CAI) than healthy children. A proposed underlying mechanism is a possible inhibitory action of mechanoceptors of the upper airways on the respiratory center causing CA in the presence of a pharyngeal collapse and obstruction [9]. Another possible mechanism regarding post-movement CA is that these events could be favored by a larger number of arousals induced by obstructive respiratory events [10]. More recently, a new entity called complex apnea syndrome (CAS) was described in adult patients with OSAS after treatment with a positive airway pressure (PAP) device, as the resolution of obstructive apneas is followed by the emergence of central ones [11–17]. CAS can represent a polysomnographic pattern that occurs due to different underlying mechanisms. These mechanisms are believed to involve PAP-dependent aspects like the lung stretch reflex and reduction of the anatomical dead space. Also, PAPindependent mechanisms, such as a possible increment of ventilation due to increased chemosensitivity that could develop over time of recurrent exposure to apnea and hypoxia, might also take part in these events. With increased ventilatory gain, small oscillations of CO2 could generate an over-compensatory response, leading to CA events. Sleep may uncover a high latent chemosensitivity as ventilation becomes more dependent on gas variations and is less modulated by the wakefulness ventilatory drive. Microarousals, while leading to a decreased CO2 tension, could be a trigger for CA. Although this mechanism is present under physiological conditions, only non-repetitive CA events are considered normal. A large number of CA can occur during L. A. de Almeida :A. L. Eckeli :H. H. Sander : R. M. F. Fernandes Department of Neuroscience and Behavioral Sciences— Neurology Division, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, SP, Brazil

Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome

The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine.

Prevalence and quality of life and sleep in children and adolescents with restless legs syndrome/Willis-Ekbom disease

OBJECTIVEnTo estimate the prevalence of restless legs syndrome/Willis-Ekbom disease (RLS/WED) and its impact on sleep and quality of life in children and adolescents.nnnMETHODSnThis was a cross-sectional study conducted in the Municipality of Cássia dos Coqueiros, Brazil. Participants included 383 children and adolescents 5-17 years of age. A comparison group was randomly matched by gender and age with the RLS/WED-affected individuals, pairing one by one.nnnRESULTSnInterviews were conducted for 383 individuals by a neurologist experienced in sleep medicine. RLS/WED was diagnosed using the essential clinical criteria for definitive RLS/WED in children recommended by the International Restless Legs Syndrome Study Group. Sleep and quality of life were evaluated using the Sleep Behavior Questionnaire (SBQ) and the Health-related Quality of Life Questionnaire─Pediatric Quality of Life Inventory (PedsQL). Comparisons were established with a group of randomly selected individuals without RLS/WED, matched by age and gender (control group). The prevalence of RLS/WED symptoms that manifested at least twice a week was 1.9%. The average age of children with RLS/WED was higher compared to the general population (11.5xa0±xa02.3 vs 9.9xa0±xa02.5, pxa0<xa00.005). A family history of RLS/WED was detected in 90.9% of the patients. The scores obtained by SBQ were higher (53.9xa0±xa09.4 vs 47.6xa0±xa010.9, pxa0<xa00.047), whereas the scores achieved by PedsQL were lower (69.8xa0±xa014.8 vs 81.9xa0±xa010.4, pxa0<xa00.003) in children with RLS/WED compared to controls.nnnCONCLUSIONnThe prevalence of RLS/WED symptoms manifested at least twice in the preceding week was 1.9% in children and adolescents. Worsened sleep and quality of life were observed in the study.