Simone Chaves Fagondes

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.

Validation of the Bitestrip versus polysomnography in the diagnosis of patients with a clinical history of sleep bruxism

OBJECTIVE This validation study compared an electromyography (EMG) device, Bitestrip, versus polysomnography in the diagnosis of sleep bruxism (SB). STUDY DESIGN Forty-nine consecutive patients (32 women and 17 men, 41.2 ± 12.9 years old) with a clinical history of SB were included in the study from the Orofacial Pain Clinic, Faculty of Dentistry, Pontifical Catholic University of Rio Grande do Sul in Brazil. RESULTS Initially, we compared an SB positive/negative test result for both systems (agreement 87.8%, sensitivity 84.2%, positive predictive value 100%, and crude kappa 0.71). We then compared a 4-scale test (no, light, moderate, or severe bruxism) between the 2 methods (agreement 80.27%, weighted kappa 0.51, and Kendall W coefficient 0.575). CONCLUSIONS The Bitestrip can be considered as a moderate screening method for the diagnosis of SB, because it is more precise in detecting the presence or absence of SB but less precise in detecting its intensity.

Sleep abnormalities in untreated patients with mucopolysaccharidosis type VI.

Mucopolysaccharidosis type VI (MPS VI) is a lysosomal storage disease that affects an enzyme responsible for the degradation of glycosaminoglycans (GAGs). Partially degraded GAGs accumulate in several tissues, such as the upper airways (UA), which leads to the development of obstructive sleep apnea (OSA). Our objective was to determine the prevalence of OSA in a group of untreated patients with MPS VI and the association of OSA with clinical and echocardiographic findings. Patients aged 4 years or older with a biochemical diagnosis of MPS VI were included. Data about clinical history, physical examination, Doppler echocardiogram, and overnight polysomnography (PSG) were collected. Our results showed that of the 28 participants, 14 were boys; mean age was 98.5 months, and mean age at MPS VI diagnosis was 48.4 months. Snoring, witnessed apnea, pectus carinatum, and macroglossia were the main clinical findings. PSG results showed that 23:27 patients (85.1%) had OSA which was mild in 4, moderate in 5, and severe in 14 patients. Echocardiograms showed evidence of pulmonary hypertension (PH) in 14 patients. Lower (P = 0.037) and nadir SpO2 (P = 0.007) were positively associated with PH. Clinical signs suggestive of respiratory abnormalities during sleep were not significantly correlated with the results of PSG. We conclude that the prevalence of OSA in patients with MPS VI was high, and the level of desaturation was positively correlated with PH. Symptoms during sleep were not associated with PSG findings, which suggests that this population should undergo routine PSG as earlier as possible. This study provides baseline data to estimate the potential impact of specific treatments in the sleep abnormalities presented by patients with MPS VI.

Analysis of the effects of a mandibular advancement device on sleep bruxism using polysomnography, the BiteStrip, the sleep assessment questionnaire, and occlusal force.

PURPOSE This before and after study evaluated the effects of a mandibular advancement device (MAD) on sleep bruxism (SB) activity and its associated signs and symptoms. MATERIALS AND METHODS Nineteen young adults (39.9 ± 12.9 years, 58% women) with a clinical history of SB without sleep or neurologic disorders and no spontaneous temporomandibular disorder pain were selected. SB activity was assessed after a habituation period of 2 weeks. The results of a 3-month treatment with a thermoplastic monoblock MAD were compared to baseline using electromyogram polysomnography and the BiteStrip, a portable EMG device. Sleep disorders were assessed and validated against the polysomnography sleep assessment questionnaire (SAQ). Additionally, common signs and symptoms of SB were evaluated with the research diagnostic criteria for temporomandibular disorders. Occlusal force was compared to baseline using a cross-arch force transducer. RESULTS There was a significant improvement in both SB activity and sleep scores (including SB episodes per hour) according to the BiteStrip and the SAQ, respectively. There was also a significant reduction in the signs and symptoms of SB, including grinding and/or clenching, temporomandibular joint (TMJ) sounds, muscle pain, and occlusal force. None of the SB subjects experienced MAD breakage, but in 24% of patients, the MAD treatment had to be interrupted due to TMJ/muscle pain and/or discomfort. CONCLUSION The MAD treatment resulted in the reduction of SB activity, SB signs and symptoms, sleep disorders, and occlusal force.

Nocturnal reflux in children and adolescents with persistent asthma and gastroesophageal reflux.

Background. A higher frequency of nocturnal gastroesophageal reflux (GER) in adult patients with respiratory symptoms has been demonstrated. The aim of this study was to determine the prevalence of nocturnal GER by using prolonged intraesophageal pH monitoring and compare it with spirometry results in children with persistent asthma. Methods. Thirty-eight patients with persistent asthma for at least 2 years were studied. Gastrointestinal symptoms suggestive of GER were considered as regurgitation, heartburn, and abdominal pain. All patients underwent prolonged intraesophageal pH study and spirometry. GER was considered positive when a reflux index (RI) was higher than 5%. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced mid-expiratory flow rate (FEF25 − 75%), and FEV1/FVC ratio were measured. Results. Median age was 10 years of age (range 5 to 15) and 58% were male; GER prevalence was 47.3%. Median (range) of reflux index during supine and upright periods from GER patients were, respectively, 8.7% (3.2 to 23.6) and 10.5% (5.2 to 15.0) (p = 0.913), and only FEF25 − 75% was below the predicted value: 54.5% (39.4 to 96.9). Reflux index was not significantly correlated with FVC, FEV1 and FEF25 − 75%. Conclusions. A high prevalence of GER was found in children and adolescents with persistent asthma, equally distributed in the supine (nocturnal) and upright positions. There was no correlation with pulmonary function test.

Sleep in the intensive care unit

ABSTRACT Poor sleep quality is a consistently reported by patients in the ICU. In such a potentially hostile environment, sleep is extremely fragmented and sleep architecture is unconventional, with a predominance of superficial sleep stages and a limited amount of time spent in the restorative stages. Among the causes of sleep disruption in the ICU are factors intrinsic to the patients and the acute nature of their condition, as well as factors related to the ICU environment and the treatments administered, such as mechanical ventilation and drug therapy. Although the consequences of poor sleep quality for the recovery of ICU patients remain unknown, it seems to influence the immune, metabolic, cardiovascular, respiratory, and neurological systems. There is evidence that multifaceted interventions focused on minimizing nocturnal sleep disruptions improve sleep quality in ICU patients. In this article, we review the literature regarding normal sleep and sleep in the ICU. We also analyze sleep assessment methods; the causes of poor sleep quality and its potential implications for the recovery process of critically ill patients; and strategies for sleep promotion.

Apneia obstrutiva do sono em crianças

Childhood obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. The disease encompasses a continuum from primary snoring (a benign condition without physiological alterations or associated complications) to increased upper airway resistance, obstructive hypoventilation and OSAS. The prevalence of snoring is high, ranging from 1.5% to 15%, depending on how it is defined. Based on parent-reported questionnaires and complementary tests, the prevalence of OSAS is 1-4%. This syndrome is more common in boys, overweight children, of African ancestry, with a history of atopy and prematurity. The most common symptoms are snoring that is frequent and loud; family-reported apnea; and restless sleep. The physical examination should assess growth status, signs of chronic upper airway obstruction, and craniofacial malformations. Overnight polysomnography is the gold standard test for the diagnosis and for the determination of the appropriate positive pressure level, as well as for postsurgical treatment evaluation. Intermittent hypoxia and multiple arousals resulting from obstructive events contribute to the well-described cardiovascular, neurocognitive, and behavioral consequences in pediatric patients with OSAS. Although the main treatment for OSAS in children is adenotonsillectomy, treatment with CPAP or Bilevel is becoming more widely used in the pediatric population.

The role of flexible fiberoptic laryngoscopy in Robin Sequence: A systematic review.

OBJECTIVE Systematically search literature for flexible fiberoptic laryngoscopy (FFL) use in Robin Sequence (RS) patients, in diverse clinical scenarios. DATA SOURCES Pubmed, LILACS and SCIELO. REVIEW METHODS Systematic review using a sensitive search strategy focused on RS patients and FFL. RESULTS There were 48 full text articles included in this systematic review. No summary meta-analytic measurement could be calculated due to heterogeneity of interventions and outcomes. FFL approaches were grouped in five topics, as follows: Endoscopic classification: no evidence on superiority of awake over light sedation and correlation of grading scales with symptom severity. Airway abnormalities: high incidence of concomitant lesions besides glossoptosis. Swallowing evaluation: no validation against fluoroscopy (gold standard) yet. Intubation aid for mechanical ventilation: ultra-thin bronchoscopes improve success rates of intubation. Treatment outcome monitoring: no consensus on ideal parameters to be checked. CONCLUSION Some applications have their roles already well established in the management of RS patients, like the evaluation of glossoptosis and associated lesions and as an intubation assistance tool, while others need to be the subject of further research, like the exact method of evaluation, its association with clinical manifestations, its role in swallowing investigation and as a postoperative success predictor.

Sono na unidade de terapia intensiva

RESUMO O sono de ma qualidade e uma situacao persistentemente descrita em UTIs. O sono nesse ambiente potencialmente hostil e caracterizado pela sua extrema fragmentacao e arquitetura nao convencional, com predominio de fases leves e limitada quantidade de tempo nos estagios reparadores. Entre as causas da privacao do sono na UTI estao fatores intrinsecos aos pacientes e a condicao aguda de sua doenca, assim como fatores relacionados ao ambiente da UTI e ao tratamento em curso, como o suporte ventilatorio e a terapia medicamentosa. Embora as consequencias da ma qualidade do sono no processo de recuperacao desses pacientes ainda sejam desconhecidas, ela parece influenciar os sistemas imune, metabolico, cardiovascular, respiratorio e neurologico. Evidencias sugerem que intervencoes multifacetadas, focadas na minimizacao das perturbacoes do sono noturno, promovem melhora na qualidade do sono nesses pacientes. Este artigo revisa a literatura acerca do sono normal e do sono na UTI. Tambem analisa seus metodos de avaliacao, as causas da ma qualidade do sono, suas potenciais implicacoes no processo de recuperacao de pacientes criticos e estrategias para sua promocao. Descritores: Sono; Privacao do sono; Unidades de terapia intensiva.