Ricardo Wainberg

Sono e envelhecimento

OBJETIVO: descrever aspectos atualizados sobre as alteracoes e os disturbios do sono no processo de envelhecimento normal e usual. METODOS: procedeu-se a revisao da arquitetura do sono e ritmo circadiano de sono e vigilia para estabelecer o padrao de normalidade e as alteracoes fisiologicas no processo de envelhecimento, descrevendo-se os disturbios de sono mais prevalentes no idoso, sua avaliacao diagnostica e o manejo nao-farmacologico. O texto foi elaborado a partir da consulta as publicacoes cientificas indexadas no Medline, em outras de acesso on line e em livros textos das areas de geriatria, psiquiatria geriatrica e medicina do sono. RESULTADOS E CONCLUSAO: a maioria dos idosos tem queixas relacionadas ao sono decorrentes de mudancas fisiologicas especificas do processo de envelhecimento ou de doencas que podem causar disturbios secundarios de sono. A linha divisoria entre a normalidade e o disturbio pode ser estabelecida por meio de criteriosa avaliacao diagnostica, a qual necessariamente precede e orienta a conduta terapeutica. A maioria dos disturbios de sono sao clinicamente importantes e trataveis com medidas nao-farmacologicas, que incluem a orientacao sobre rotinas e rituais de sono, atividades de vida diaria e condicoes ambientais.AIM: to describe the up-to-date aspects on sleep changes and disturbances in the normal and usual aging process. METHODS: the sleep architecture and the sleep and vigil circadian rhythm were reviewed in order to establish the normalcy pattern and physiological changes in the aging process, describing the most prevalent sleep disturbances of the elderly, their diagnostic evaluation and non-pharmacological management. The text was drawn up based on consulting scientific publications indexed in Medline, in other on-line access publications and in textbooks in the fields of geriatrics, geriatric psychiatry and sleep therapy. RESULTS AND CONCLUSION: Most of the elderly have sleep-related complaints resulting from specific physiological changes that are specific to the aging process or to diseases that may cause secondary sleep disturbances. The borderline between normalcy and disturbance may be established by means of a judicious diagnostic evaluation that necessarily precedes and guides the therapeutic management. Most sleep disturbances are clinically significant and can be treated with non-pharmacological measures, which include guidance concerning sleep routines and rituals, everyday life activities and environmental conditions.

Neurological outcome of newborns with neonatal seizures: a cohort study in a tertiary university hospital

OBJECTIVE To describe the neurological outcome of newborns with seizures. METHOD Cohort study with newborns prospectively followed. Perinatal characteristics and etiological screening were related to outcome in a regression model. RESULTS During the study 3,659 newborns were admitted and 2.7% were diagnosed as having seizures. Hypoxic ischemic encephalopathy (51%) was the etiology more frequently associated to seizures and also to postneonatal epilepsy (53%). In the follow up 25 died during the acute neonatal illness and 9 during the first years of life, 19 were diagnosed as having post neonatal epilepsy, 35 had developmental delay and 11 an association among this two comorbidities. A significant association between abnormal postnatal EEG and neuroimaging to developmental delay (p=0.014, p=0.026) was observed. The group of newborns that had seizures presented an increased risk of developing epilepsy compared to newborns from the same cohort without seizures (19.3/100 vs. 1.8/100, p<0.001). CONCLUSION In this study neonatal seizures predominated in term newborns with perinatal asphyxia an elevated perinatal mortality and post neonatal morbidity was observed. The follow up showed an increased risk for developing postnatal epilepsy and developmental delay.

Sleep and aging

OBJETIVO: descrever aspectos atualizados sobre as alteracoes e os disturbios do sono no processo de envelhecimento normal e usual. METODOS: procedeu-se a revisao da arquitetura do sono e ritmo circadiano de sono e vigilia para estabelecer o padrao de normalidade e as alteracoes fisiologicas no processo de envelhecimento, descrevendo-se os disturbios de sono mais prevalentes no idoso, sua avaliacao diagnostica e o manejo nao-farmacologico. O texto foi elaborado a partir da consulta as publicacoes cientificas indexadas no Medline, em outras de acesso on line e em livros textos das areas de geriatria, psiquiatria geriatrica e medicina do sono. RESULTADOS E CONCLUSAO: a maioria dos idosos tem queixas relacionadas ao sono decorrentes de mudancas fisiologicas especificas do processo de envelhecimento ou de doencas que podem causar disturbios secundarios de sono. A linha divisoria entre a normalidade e o disturbio pode ser estabelecida por meio de criteriosa avaliacao diagnostica, a qual necessariamente precede e orienta a conduta terapeutica. A maioria dos disturbios de sono sao clinicamente importantes e trataveis com medidas nao-farmacologicas, que incluem a orientacao sobre rotinas e rituais de sono, atividades de vida diaria e condicoes ambientais.AIM: to describe the up-to-date aspects on sleep changes and disturbances in the normal and usual aging process. METHODS: the sleep architecture and the sleep and vigil circadian rhythm were reviewed in order to establish the normalcy pattern and physiological changes in the aging process, describing the most prevalent sleep disturbances of the elderly, their diagnostic evaluation and non-pharmacological management. The text was drawn up based on consulting scientific publications indexed in Medline, in other on-line access publications and in textbooks in the fields of geriatrics, geriatric psychiatry and sleep therapy. RESULTS AND CONCLUSION: Most of the elderly have sleep-related complaints resulting from specific physiological changes that are specific to the aging process or to diseases that may cause secondary sleep disturbances. The borderline between normalcy and disturbance may be established by means of a judicious diagnostic evaluation that necessarily precedes and guides the therapeutic management. Most sleep disturbances are clinically significant and can be treated with non-pharmacological measures, which include guidance concerning sleep routines and rituals, everyday life activities and environmental conditions.

Sueño y envejecimiento

OBJETIVO: descrever aspectos atualizados sobre as alteracoes e os disturbios do sono no processo de envelhecimento normal e usual. METODOS: procedeu-se a revisao da arquitetura do sono e ritmo circadiano de sono e vigilia para estabelecer o padrao de normalidade e as alteracoes fisiologicas no processo de envelhecimento, descrevendo-se os disturbios de sono mais prevalentes no idoso, sua avaliacao diagnostica e o manejo nao-farmacologico. O texto foi elaborado a partir da consulta as publicacoes cientificas indexadas no Medline, em outras de acesso on line e em livros textos das areas de geriatria, psiquiatria geriatrica e medicina do sono. RESULTADOS E CONCLUSAO: a maioria dos idosos tem queixas relacionadas ao sono decorrentes de mudancas fisiologicas especificas do processo de envelhecimento ou de doencas que podem causar disturbios secundarios de sono. A linha divisoria entre a normalidade e o disturbio pode ser estabelecida por meio de criteriosa avaliacao diagnostica, a qual necessariamente precede e orienta a conduta terapeutica. A maioria dos disturbios de sono sao clinicamente importantes e trataveis com medidas nao-farmacologicas, que incluem a orientacao sobre rotinas e rituais de sono, atividades de vida diaria e condicoes ambientais.AIM: to describe the up-to-date aspects on sleep changes and disturbances in the normal and usual aging process. METHODS: the sleep architecture and the sleep and vigil circadian rhythm were reviewed in order to establish the normalcy pattern and physiological changes in the aging process, describing the most prevalent sleep disturbances of the elderly, their diagnostic evaluation and non-pharmacological management. The text was drawn up based on consulting scientific publications indexed in Medline, in other on-line access publications and in textbooks in the fields of geriatrics, geriatric psychiatry and sleep therapy. RESULTS AND CONCLUSION: Most of the elderly have sleep-related complaints resulting from specific physiological changes that are specific to the aging process or to diseases that may cause secondary sleep disturbances. The borderline between normalcy and disturbance may be established by means of a judicious diagnostic evaluation that necessarily precedes and guides the therapeutic management. Most sleep disturbances are clinically significant and can be treated with non-pharmacological measures, which include guidance concerning sleep routines and rituals, everyday life activities and environmental conditions.