Luciane Bizari Coin de Carvalho

Sleep Disturbance Scale for Children: Translation, cultural adaptation, and validation

INTRODUCTION The Sleep Disturbance Scale for Children (SDSC) is a 26-item instrument for evaluating sleep among children aged 3-18 years. It differentiates among conditions such as disorders of initiating and maintaining sleep, sleep breathing disorders, disorders of arousal, sleep-wake transition disorders, excessive somnolence, and sleep hyperhydrosis. The aim of this study was to translate, culturally adapt, and validate it for Brazilian Portuguese. METHOD The study was carried out in two phases: (1) forward translation, back translation, pretesting, and calculation of sample size; (2) validation: reliability (Chronbachs alpha), convergent analysis (Pearson correlation), and discriminatory validity (comparing the scores of the test with the results of polysomnography). One hundred children, aged 3-18 years, accompanied by their parents and/or guardians participated in the phases. PSG studies have been done to calculate the sample size and validation. RESULTS The scale instructions and items were adapted regarding semantic, experiential, conceptual, and cultural equivalence validation. The scale structure related to visual communication was also adapted to Brazilian population preference and habits, and this resulted in a chart with clear instructions and easy recognition of the statements and possible responses. Reliability analysis showed values greater than 0.55. There has been reasonable convergent validity. Discriminatory validity using the PSG study for positive sleep-disordered breathing (SDB) was 8.9, attesting discriminatory validity only for SDB. The three questions of the scale can screen SDB. CONCLUSION The SDSC was translated, adapted and validated for Brazilian Portuguese, and it presented internal consistency and convergent and discriminatory validity. It can be used in population-based studies in order to screen for sleep-disordered breathing in children.

An E-model implementation for speech quality evaluation in VoIP systems

This article presents a voice quality measurement tool based on the ITU-T E-model. Firstly, the ITU-T and ETSI specifications of E-model are briefly reviewed and some errors found in these documents are pointed. After, a measurement tool based on the corrections is described. VoIP calls through the Brazilian National Education and research network (RNP) backbone were used to verify the tool operation.

Restless legs syndrome during pregnancy in Brazilian women

OBJECTIVE The objective of this study was to identify the prevalence of restless legs syndrome (RLS) among pregnant Brazilian women, with individual diagnostic clinical interviews during the trimesters of pregnancy, and to determine the severity. METHODS It was a cross-sectional study. We interviewed 524 pregnant women (18-45 years old) who came to the prenatal outpatient clinic to consult an obstetrician. We used a RLS clinical-diagnostic interview and the International RLS Study Group rating scale (IRLS). RESULTS The prevalence of RLS during pregnancy was 13.5% in our sample, among which 90.1% of the cases started with their symptoms during pregnancy. More than half of the patients (53.5%) presented severe or very severe symptoms and the largest proportion of them (15.2%) were in their third trimester. We did not observe any demographic differences among the trimesters for RLS prevalence and RLS severity. CONCLUSION RLS during pregnancy is more frequent than in the general population, such that more than half of the pregnant women with RLS present it severely or very severely. It occurs especially in the third trimester.

Translation and validation into the Brazilian Portuguese of the restless legs syndrome rating scale of the International Restless Legs Syndrome Study Group

BACKGROUND Restless legs syndrome (RLS) is a chronic sensory-motor disorder characterized by unpleasant limb sensations and an irresistible urge to move. The International Restless Legs Syndrome Study Group developed the Restless Legs Syndrome Rating Scale (IRLS) to assess the severity of RLS symptoms. The objective of this study was to translate and validate the IRLS into Brazilian Portuguese. METHOD The IRLS was translated into Brazilian Portuguese, analyzed, back translated to English, and compared to the original version. It was applied to 10 patients for cultural verification. The language was adjusted and the final version was administered to 30 patients (13 male, mean age 58.88+/-14.82). RESULTS There was correlation among the IRLS evaluation of three experts. Many linguistic adaptations were required to achieve cultural adequacy and the Cronbachs alpha coefficient showed reliability of 80%. CONCLUSION IRLS was translated, adapted, and validated to Brazilian Portuguese language, showing good reliability and validity.

Cognitive dysfunction in children with sleep-disordered breathing

Two daily school periods are mandatory in Brazil owing to a shortage of academic facilities, which can decrease cognitive performance, especially in children with sleep-disordered breathing. This study aimed to verify the influence of starting time to school on cognition, comparing children with sleep disorders and normal children. Cognition was assessed in 79 children with sleep-disordered breathing, 468 children with nonrespiratory sleep disorders, and 633 normal control children. We analyzed total sleep time, starting time to school (morning or afternoon), and grades. First grade morning students with sleep-disordered breathing had 8.04 higher odds for cognitive dysfunction than normal children. For children with sleep-disordered breathing, second and third grade morning students had higher odds for cognitive dysfunction than those who studied in the afternoon (3.69 and 4.07). Fourth grade morning students had 8.27 higher odds for cognitive dysfunction than first grade children. In conclusion, sleep-disordered breathing, grades, and starting time to school interact to affect cognition in Brazilian children. (J Child Neurol 2005;20:400—404).

Sleep disorders in pregnancy

CONTEXT The precise function of sleep in animals and human beings is still unknown, and any sort of physical, social or psychological variation may change the normal sleep-wake cycle. PURPOSE This research aims is to determine the sleep disorders (SD) for each of the three trimesters of the pregnancy comparing them to the pre-pregnancy state (PG). METHOD SD were investigated in three hundred pregnant women 11- to 40-years-old through with a brief clinical interview based on directed questions. One hundred pregnant women were considered for each trimester. RESULTS The rate of pregnant women with insomnia increased by 23% in the 2nd trimester (p< 0.005); the rate for excessive daytime sleepiness (EDS) by 15% in the 1st trimester (p<0.003), 55% in the 2nd trimester (p<0.001) and by 14% in the 3rd trimester (p<0.002); the rate for mild sleepiness increased by 33% in the 2nd trimester (p<0.002) and by 48% in the 3rd trimester (p<0.001); the rate for specific awakenings increased by 63% in the 1st trimester, by 80% in the 2nd trimester and by 84% in the 3rd trimester (p<0.001). CONCLUSION SD were more frequent during pregnancy comparatively to PG state, mostly at the expenses of EDS and specific awakenings.

Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome

OBJECTIVE To determine whether mouth breathing children present the same cephalometric patterns as patients with obstructive sleep apnea syndrome (OSAS). METHOD Cephalometric variables were traced and measured on vertical lateral cephalometric radiographs. The cephalometric measurements of 52 mouth and 90 nose breathing children were compared with apneic patients. The children had not undergone adenoidectomy or tonsillectomy and had not had or were not receiving orthodontic or orthopedic treatment. RESULTS Mouth breathing children showed same cephalometric pattern observed in patients with OSAS: a tendency to have a retruded mandible (p=0.05), along with greater inclination of the mandibular and occlusal planes (p<0.01) and a tendency to have greater inclination of the upper incisors (p=0.08). The nasopharyngeal and posterior airway spaces were greatly reduced in mouth breathing children, as observed in patients with apnea (p<0.01). CONCLUSION Mouth breathing children present abnormal cephalometric parameters and their craniofacial morphology resembles that of patients with OSAS.

Levodopa for idiopathic restless legs syndrome: evidence-based review

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 to 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. 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. Nine eligible clinical trials were included. The subjective analyses of these studies showed contradictory 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. 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.

Electrical Stimulation of the Posterior Tibialis Nerve Improves Symptoms of Poststroke Neurogenic Overactive Bladder in Men: A Randomized Controlled Trial

OBJECTIVE To evaluate the effectiveness of electrical stimulation of the posterior tibialis nerve in men with neurogenic overactive bladder secondary to ischemic stroke at 45 days and 12 months after treatment. MATERIALS AND METHODS We studied 24 patients older than 18 years, with ischemic stroke that occurred between 6 months and 3 years previously and with no prior urinary symptoms. These patients were randomly allocated to receive electrical stimulation of the posterior tibialis nerve twice weekly for 6 weeks (treatment group, n = 12) or general advice and stretching sessions 1 to 3 times monthly for 6 weeks (control group, n = 12). Each session lasted 30 minutes in both groups. The primary outcomes were reduction in urinary frequency, reduction in urinary urgency, and overall improvement in voiding diary variables. RESULTS Patients in the electrical stimulation group, in relation to baseline and to control group, experienced improvement in urinary symptoms, reducing urinary urgency and frequency, and reported subjective improvement after treatment. This effect persisted after 12 months of follow-up. The patients with lesion in right hemisphere, advanced age, and with higher body mass index presented more chance to develop urinary symptoms. CONCLUSION Electrical stimulation of the posterior tibialis nerve is a safe and effective option for the treatment of poststroke neurogenic overactive bladder in men, reducing urinary frequency and urgency.

ANTICONVULSANTS TO TREAT 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. Many treatments have been used to minimize the discomfort of the disease, among them the anticonvulsant therapy. AIM This review aims to evaluate the efficacy and safety of anticonvulsant treatment for idiopathic RLS. METHOD Systematic review of randomized or quasi-randomized, double blind trials on anticonvulsant treatment for RLS. OUTCOMES relief of RLS symptoms, subjective and objective sleep quality, quality of life, and adverse events associated with the treatments. RESULTS A total of 231 patients were randomized in three cross over studies and one parallel study. Three studies with carbamazepine, one with sodium valproate, and one with gabapentin, and they were very heterogeneous so we could not perform a meta-analysis. CONCLUSIONS There is no scientific evidence on RLS treatment with anticonvulsants for clinical practice.