Leonardo Santos Hoff

Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index

INTRODUCTION The Pittsburgh Sleep Quality Index (PSQI) is a questionnaire that assesses sleep quality and disturbances over a 1-month period. It is a valuable tool for research purposes. The aim of this study was to validate a Brazilian Portuguese version of the PSQI. METHODS The Brazilian Portuguese version (PSQI-BR) was developed according to the following steps: (a) translation, (b) back-translation, (c) comparison between translation and back-translation performed by a group of experts, and (d) pretest in bilingual individuals. Between January 2006 and September 2007, the PSQI-BR was applied to a group of consecutive patients who were submitted to overnight polysomnography with clinical suspicion of obstructive sleep apnea syndrome (OSAS) or insomnia. As in the original article, a group of patients with depression and a control group were included. The depression group was composed of patients from the Mood Disorders Unit of the Psychiatry Department of Hospital de Clínicas de Porto Alegre (HCPA), Brazil. The control group was composed of subjects with a history of normal sleep habits, without noticed snoring. RESULTS A total of 83 patients and 21 controls completed the questionnaire and were submitted to overnight polysomnography. The seven-component scores of the PSQI-BR had an overall reliability coefficient (Cronbachs α) of 0.82, indicating a high degree of internal consistency. The groups included 43 patients with OSAS, 21 with insomnia, 19 with depression and 21 controls. The mean (±SD) PSQI-BR score was 8.1±4.0 for patients with OSAS, 12.8±3.7 for insomnia patients, 14.5±3.7 for those with depression and 2.5±2.0 for control subjects. The one-way ANOVA demonstrated significant differences in PSQI-BR scores across the four diagnostic groups (p<0.001). Post hoc tests between paired groups showed that scores for OSAS, depression and insomnia were significantly higher than for controls (p<0.05). PSQI-BR scores for insomnia did not differ from those obtained for depression (p>0.05), but both were higher than for OSAS (p<0.05). CONCLUSIONS The results of the present study demonstrate that the PSQI-BR is a valid and reliable instrument for the assessment of sleep quality and equivalent to its original version when applied to individuals who speak the Brazilian Portuguese language. Despite relevant influences of language and cultural background, no major cultural adaptations were necessary during the validation process. The PSQI-BR can be a tool either for clinical management or research.

Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil

OBJETIVO: Desenvolver uma versao da escala de sonolencia de Epworth (ESE) para o portugues para uso no Brasil. METODOS: A versao no portugues do Brasil (ESE-BR) foi desenvolvida de acordo com as seguintes etapas: traducao; retrotraducao; comparacao entre a traducao e a retrotraducao (por um comite); e aplicacao em individuos bilingues. A ESE-BR foi aplicada a um grupo de pacientes submetidos a polissonografia de noite inteira para identificar sindrome da apneia-hipopneia obstrutiva do sono (SAHOS), insonia e ronco primario. Um grupo controle foi composto de individuos com historia de habitos normais de sono, sem ronco aparente. RESULTADOS: Um total de 114 pacientes e 21 controles foram incluidos. Os 8 itens do ESE-BR tiveram um coeficiente de confiabilidade total de 0,83. O grupo em estudo foi composto por 59 pacientes com SAHOS, 34 pacientes com ronco primario e 21 pacientes com insonia. One-way ANOVA demonstrou diferencas significativas nos escores do ESE-BR entre os quatro grupos diagnosticos (p 0,05). Os escores dos pacientes com SAHOS e nos roncadores primarios foram significativamente maiores que os dos controles (p < 0,05). Alem disso, os escores para pacientes com SAHOS foram significativamente maiores do que os daqueles com ronco primario (p < 0,05). CONCLUSOES: Os resultados do presente estudo demonstraram que a ESE-BR e um instrumento valido e confiavel para a avaliacao da sonolencia diurna e equivalente a sua versao original, quando aplicada em individuos que falam portugues do BrasilOBJECTIVE The aim of this study was to develop a Portuguese-language version of the Epworth sleepiness scale (ESS) for use in Brazil. METHODS The steps involved in creating the ESS in Brazilian Portuguese (ESS-BR) were as follows: translation; back-translation; comparison (by a committee) between the translation and the back-translation; and testing in bilingual individuals. The ESS-BR was applied to a group of patients who were submitted to overnight polysomnography in order to identify obstructive sleep apnea-hypopnea syndrome (OSAHS), insomnia and primary snoring. A control group was composed of subjects with a history of normal sleep habits, without reported snoring. RESULTS A total of 114 patients and 21 controls were included. The 8-item scores of the ESS-BR had an overall reliability coefficient of 0.83. The study group was composed of 59 patients with OSAHS, 34 patients with primary snoring and 21 patients with insomnia. One-way ANOVA demonstrated significant differences in ESS-BR scores among the four diagnostic groups (p < 0.001). Post-hoc tests between groups showed that the ESS-BR scores of the patients with insomnia did not differ from those of the controls (p > 0.05). The ESS-BR scores were significantly higher for OSAHS patients and for primary snorers than for controls (p < 0.05). In addition, the scores for OSAHS patients were significantly higher than were those for primary snorers (p < 0.05). CONCLUSIONS The results of the present study demonstrate that the ESS-BR is a valid and reliable instrument for the assessment of daytime sleepiness, equivalent to its original version when applied to individuals who speak Brazilian Portuguese.

Bola fúngica por Aspergillus fumigatus em cavidade pleural

OBJECTIVE To report the cases of 6 patients with fungus ball caused by Aspergillus fumigatus (aspergilloma) in the pleural cavity. METHODS Between 1980 and 2009, 391 patients were diagnosed with aspergilloma at the Santa Casa Hospital Complex in Porto Alegre, Brazil. The diagnosis of aspergilloma in the pleural cavity was made through imaging tests revealing effusion and pleural thickening with air-fluid level; direct mycological examination revealing septate hyphae, consistent with Aspergillus sp.; and positive culture for A. fumigatus in the surgical specimen from the pleural cavity. RESULTS Of the 391 patients studied, 6 (2%) met the established diagnostic criteria. The mean age of those 6 patients was 48 years (range, 29-66 years), and 5 (83%) were male. The most common complaints were cough, expectoration, and hemoptysis. Four patients (67%) had a history of tuberculosis that had been clinically cured. All of the patients were submitted to surgical removal of the aspergilloma, followed by intrapleural instillation of amphotericin B, in 4; and 2 received systemic antifungal treatment p.o. There was clinical improvement in 5 patients, and 1 died after the surgery. CONCLUSIONS In adult patients with a history of cavitary lung disease or pleural fistula, a careful investigation should be carried out and fungal infection, especially aspergilloma, should be taken into consideration. In such cases, laboratory testing represents the most efficient use of the resources available to elucidate the diagnosis.