Rosa Hasan

Mecanismos do ciclo sono-vigília

Neurochemically distinct systems interact regulating sleep and wakefulness. Wakefulness is promoted by aminergic, acetylcholinergic brainstem and hypothalamic systems. Each of these arousal systems supports wakefulness and coordinated activity is required for alertness and EEG activation. Neurons in the pons and preoptic area control rapid eye movement and non-rapid eye movement sleep. Mutual inhibition between these wake- and sleep-regulating systems generate behavioral states. An up-to-date understanding of these systems should allow clinicians and researchers to better understand the effects of drugs, lesions, and neurologic disease on sleep and wakefulness.Neurochemically distinct systems interact regulating sleep and wakefulness. Wakefulness is promoted by aminergic, acetylcholinergic brainstem and hypothalamic systems. Each of these arousal systems supports wakefulness and coordinated activity is required for alertness and EEG activation. Neurons in the pons and preoptic area control rapid eye movement and non-rapid eye movement sleep. Mutual inhibition between these wake- and sleep-regulating systems generate behavioral states. An up-to-date understanding of these systems should allow clinicians and researchers to better understand the effects of drugs, lesions, and neurologic disease on sleep and wakefulness.

New guidelines for diagnosis and treatment of insomnia

The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.A Associacao Brasileira de Sono reuniu especialistas em medicina do sono com o objetivo de desenvolver novas diretrizes no diagnostico e tratamento das insonias. Nos consideramos quatro niveis de evidencia: padrao, recomendado, opcional e nao recomendado. Os topicos abordados foram: conceito, avaliacao clinica e psicossocial, indicacao da polissonografia, tratamento farmacologico, terapia comportamental cognitiva, comorbidades e insonia na infância. Para o diagnostico da insonia, foi recomendada uma avaliacao psicossocial e a realizacao da polissonografia, enquanto que no que se refere ao tratamento, foi estabelecido como padrao a indicacao da terapia comportamental cognitiva, e, quanto ao tratamento farmacologico, foi indicado o uso do zolpidem como hipnotico padrao, e sendo recomendado o zopiclone, a trazodona e a doxepina.

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.

Lower doses of sublingual Zolpidem are more effective than oral Zolpidem to anticipate sleep onset in healthy volunteers

OBJECTIVE To compare the efficacy of sublingual Zolpidem (5 and 10mg) to conventional oral Zolpidem (10mg). METHODS This was an open, randomized, double-blind, double-dummy, controlled, and single center study. The study took place at the Laboratory of Clinical Neurophysiology and total number of participants was 58 volunteers completed the study whose demographics of age, gender, body mass index (BMI) were similar among everyone. Scores in Epworth, Pittsburgh, Beck and Hamilton Scales did not differ among groups. A model of transient insomnia was determined by the sleep anticipation in 120minute. Subjects were randomly divided in three groups for drug administration (5mSL; 10mgSL and 10mg oral), given in a single dose prior to polysomnography (PSG). Sleep parameters were assessed by PSG and post-sleep questionnaires. RESULTS A significant main treatment effect was evident considering the sleep onset latency (SOL) and persistent sleep latency (PSL). An earlier sleep onset was induced by SL Zolpidem 10mg (SOL=p<0.004; PSL=p<0.006) and SL Zolpidem 5mg (SOL=p<0.025; PSL=p<0.046) compared to oral Zolpidem 10mg. Subjects that received SL Zolpidem 10mg reported an earlier sleep onset (latency to sleep and latency until persistent sleep) when compared to subjects from other groups (p<0.005). CONCLUSIONS Sublingual Zolpidem, both 5 and 10mg, induced faster sleep initiation than 10mg oral Zolpidem. A subjective perception of earlier sleep onset was reported by subjects using SL 10mg.

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.

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.

A IMPORTÂNCIA DA TERAPIA COGNITIVO-COMPORTAMENTAL (TCC) NO TRATAMENTO DA INSÔNIA CRÔNICA: RELATO DE CASO

O Teste das Múltiplas Latências do Sono (TMLS) é o padrão ouro para o diagnóstico da Narcolepsia. No entanto, muitos fatores podem contribuir para o aparecimento de sonolência excessiva diurna, como a síndrome da apneia obstrutiva do sono, bruxismo, convulsão, movimento periódico de membros inferiores, uso de medicações e privação de sono. Este estudo avalia alterações da polissonografia (PSG) em pacientes que realizaram TMLS.