L.B.F. Prado

Restless legs syndrome: A qualitative analysis of psychosocial suffering and interdisciplinary attention

The aim of this study is to investigate psychosocial factors related to the diagnosis and treatment of patients with restless legs syndrome. Fifteen patients were interviewed at the Neuro-Sono Outpatient Clinic, Universidade Federal de São Paulo. The results were submitted to a qualitative analysis. We identified four content categories: illness description, illness history, illness experience, and relationships. Lack of control over the body and lack of recognition by professionals produce stigma and lead patients to suffering. The research underscores the relevance of psychosocial factors to the diagnosis and treatment of patients with restless legs syndrome and the importance of having interdisciplinary teams when attending patients with restless legs syndrome.

Sleep in Individuals Sharing their Sleep Environment with Dogs: Pilot Study

Introduction: Pets are increasingly sharing a bed with their owners, regardless of social class. Methods: We interviewed 50 Dog owners, at the Neuro-Sono Outpatients Clinic. The semistructured interviews were designed to collect information about the place where it was allowed to sleep (same bed as owner, elsewhere in owner’s bedroom, or elsewhere in the home) and if the owners’ sleep is better or worse sharing the bed with their dogs. Results: Of the 49 participants who made up the final sample, 43% (21 of 49) allowed their dogs to sleep in the bedroom, whereas 57% (28 of 49) had their dogs sleep elsewhere in the home. Of the 21 owners who shared their bedroom with their dogs, 62% (13) allowed their dogs to sleep on the bed, whereas 38% (8) did not. Sixty-six percent of respondents who allowed their dogs to sleep in the bedroom (14 of 21) reported that their sleep was better because of the dog´s presence (95%CI: 0.46-0.85). Conclusion: We conclude that the presence of a dog in the bedroom or bed during nighttime is not associated to poor sleep; to the contrary, the dog owners interviewed in our sample reported that their sleep was better with a dog sleeping in the room.

Psychosocial Features of Brazilian Patients with Paradoxical Insomnia: A Qualitative Study

Psychosocial Features of Brazilian Patients with Paradoxical Insomnia: A Qualitative Study Introduction: According to International Classification of Sleep Disorders (ICSD), Sleep State Misperception (SSM), recently renamed ‘Paradoxical Insomnia’ (PI), is a disorder in which a complaint of severe insomnia occurs without objective evidence of sleep disturbance, and without a significant impairment of daytime function. The present study aims to identify psychosocial features of patients with PI, exploring life history, and sociocultural and familiar environment issues. Methods: We studied PI patients from the Neuro-Sono Sleep Center, Department of Neurology, and Sao Paulo Hospital Sleep Laboratory, Universidade Federal de Sao Paulo, Brazil. In this study, we identified 60 patients (33 females), with confirmed PI diagnosis among 2000 medical files and 1735 PSG studies. Semi structured interviews were conducted with 20 patients, following a script of questions about birthplace, family, childhood, sleep, moves, present life and perceptions. We performed content analysis on the interviews searching interviewees’ feelings, thoughts, and social and familiar insertion.

10. The phone interview for RLS diagnostic

mated prevalence of 6.6–21.5%. The treatment for uremic RLS has been controversial thus a systematic synthesis of evidence is necessary to evaluate the effectiveness and safety of treatment for uremic RLS. Method: Systematic review of randomized or quasi-randomized, double blind trials on treatment for uremic RLS. Outcomes: relief of restless legs symptoms marked on a validated scale, subjective sleep quality, sleep quality measured by night polysomnography and actigraphy, quality of life measured by subjective measures, adverse events associated with the treatments. Results: Six eligible clinical trials were included. The subjective analyses of these studies showed controversial results, although the objective analyses showed in one trial that treatment group had a statistically significant improvement of periodic leg movement during time asleep (PLM). Combined analyses (metanalysis) were not done. The most commonly adverse event seen was gastrointestinal symptoms. Conclusions: Only a few therapeutic trials in uremic patients with RLS have been published, and there is no high level scientific evidence of a specific therapeutic regimen for uremic-associated RLS, and recommendations for practice can be done based on both individual trials results on uremic and non-uremic RLS patients and physician experience yet.

8. Restless legs syndrome during pregnancy

mated prevalence of 6.6–21.5%. The treatment for uremic RLS has been controversial thus a systematic synthesis of evidence is necessary to evaluate the effectiveness and safety of treatment for uremic RLS. Method: Systematic review of randomized or quasi-randomized, double blind trials on treatment for uremic RLS. Outcomes: relief of restless legs symptoms marked on a validated scale, subjective sleep quality, sleep quality measured by night polysomnography and actigraphy, quality of life measured by subjective measures, adverse events associated with the treatments. Results: Six eligible clinical trials were included. The subjective analyses of these studies showed controversial results, although the objective analyses showed in one trial that treatment group had a statistically significant improvement of periodic leg movement during time asleep (PLM). Combined analyses (metanalysis) were not done. The most commonly adverse event seen was gastrointestinal symptoms. Conclusions: Only a few therapeutic trials in uremic patients with RLS have been published, and there is no high level scientific evidence of a specific therapeutic regimen for uremic-associated RLS, and recommendations for practice can be done based on both individual trials results on uremic and non-uremic RLS patients and physician experience yet.

15. Levodopa for idiopathic restless legs syndrome: Systematic review

Background: Restless Legs Syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. The prevalence of RLS is estimated at 2.7–5% of adults and it is more common in women. The treatment of RLS with levodopa has been reported thus a systematic synthesis of evidence is necessary to evaluate the effectiveness and safety of levodopa for RLS. Method: It was a systematic review of randomized or quasi-randomized, double blind trials on levodopa. Relief of restless legs symptoms marked on a validated scale, subjective sleep quality, sleep quality measured by night polysomnography and actigraphy, quality of life measured by subjective measures, adverse events associated with the treatments. Results: Nine eligible clinical trials were included. The subjective analyses of these studies showed controversial results, although the objective analyses showed that treatment group had a statistically significant improvement of periodic leg movement (PLM) index, favoring the treatment group. The most commonly adverse event seen was gastrointestinal symptoms. Conclusions: The short-term treatment with levodopa was demonstrated effective and safety for PLM, but there was only few trials assessing long-term treatment and the augmentation phenomenon in RLS. Further long-term randomized controlled trials using standard follow-up measurements as the International RLS Study Group Rating Scale are necessary.

13. Speech disorders in obstructive sleep apnea syndrome: Systematic review

Background: Obstructive sleep apnea (OSA) is a common disorder, and estimates of prevalence may affect 5–7% in general population. The treatment of OSA is based on Continuous Positive Airway Pressure (CPAP) appliance and Mandibular Advancement Oral Appliances. Phonoaudiologic approach for treatment of patients with Obstructive Sleep Apnoea has been controversial, and the aim of this review was to evaluate the effectiveness of these phonoaudiologic interventions. Method: It was a review of randomized or quasi-randomized, double blind trials on OSA. Outcomes: decrease of apnea/hypopnea index (AHI), daytime somnolence, and snoring measured by a validated scale. Results: Two eligible trials were potentially analyzed, but none of them could provide good scientific evidence favoring the intervention. The objective analysis of these studies showed improvement of OSA, and an improvement of snoring by subjective analysis. However the poor methodological quality and the heterogeneity of the results limited us to pool the results. Conclusions: There is no accepted scientific evidence on phonoaudiologic approach for treatment of OSA. Well designed RCTs are needed to assess the efficacy of these interventions. Supported by FAPESP 02/02145-1, 99/08189-6 (L.B.C. Carvalho and G.F. Prado).

14. Second line treatment for idiopathic restless legs syndrome: Systematic review

Background: Obstructive sleep apnea (OSA) is a common disorder, and estimates of prevalence may affect 5–7% in general population. The treatment of OSA is based on Continuous Positive Airway Pressure (CPAP) appliance and Mandibular Advancement Oral Appliances. Phonoaudiologic approach for treatment of patients with Obstructive Sleep Apnoea has been controversial, and the aim of this review was to evaluate the effectiveness of these phonoaudiologic interventions. Method: It was a review of randomized or quasi-randomized, double blind trials on OSA. Outcomes: decrease of apnea/hypopnea index (AHI), daytime somnolence, and snoring measured by a validated scale. Results: Two eligible trials were potentially analyzed, but none of them could provide good scientific evidence favoring the intervention. The objective analysis of these studies showed improvement of OSA, and an improvement of snoring by subjective analysis. However the poor methodological quality and the heterogeneity of the results limited us to pool the results. Conclusions: There is no accepted scientific evidence on phonoaudiologic approach for treatment of OSA. Well designed RCTs are needed to assess the efficacy of these interventions. Supported by FAPESP 02/02145-1, 99/08189-6 (L.B.C. Carvalho and G.F. Prado).

11. Phonoaudiologic approach for treatment of patients with obstructive sleep apnea syndrome: Systematic review

Background: Obstructive sleep apnea (OSA) is a common disorder, and estimates of prevalence may affect 5–7% in general population. The treatment of OSA is based on Continuous Positive Airway Pressure (CPAP) appliance and Mandibular Advancement Oral Appliances. Phonoaudiologic approach for treatment of patients with Obstructive Sleep Apnoea has been controversial, and the aim of this review was to evaluate the effectiveness of these phonoaudiologic interventions. Method: It was a review of randomized or quasi-randomized, double blind trials on OSA. Outcomes: decrease of apnea/hypopnea index (AHI), daytime somnolence, and snoring measured by a validated scale. Results: Two eligible trials were potentially analyzed, but none of them could provide good scientific evidence favoring the intervention. The objective analysis of these studies showed improvement of OSA, and an improvement of snoring by subjective analysis. However the poor methodological quality and the heterogeneity of the results limited us to pool the results. Conclusions: There is no accepted scientific evidence on phonoaudiologic approach for treatment of OSA. Well designed RCTs are needed to assess the efficacy of these interventions. Supported by FAPESP 02/02145-1, 99/08189-6 (L.B.C. Carvalho and G.F. Prado).