Stella Tavares

Epworth Sleepiness Scale outcome in 616 brazilian medical students

The Epworth Sleepiness Scale (ESS) measures daytime sleepiness in adults. This paper reports the following data in 616 medical students: 1-ESS scores, 2-its correlation with the declared night sleep time, 3-comparison with ESS values obtained from Australia, 4-comparison of ESS values in a sub-population of 111 students tested early and late 1995. There were 387 males, 185 females and 4 not specified. Age = 20.16 +/- 2.23 (SD), ESS score = 10.00 +/- 3.69 (SD), declared sleep time = 7.04 +/- 1.03 (SD). ESS scores did not statistically correlate with sleep time. Average ESS score was statistically higher than in the Australian sample. Retesting of the medical students showed an increase in ESS values from March to November 1995. Sleep time difference was non-significant. Higher ESS scores in this sample seem to be related to shorter sleep time, but fatigue effects can not be ruled out.

Apnéia do sono em obesos

Obesity is a disease with high prevalence and obese individuals have a higher risk of cardiovascular diseases, diabetes mellitus, dyslipidemia and Obstructive Sleep Apnea Syndrome (OSAS). OSAS is a chronic, progressive, incapacitating disease with high cardiovascular mortality and morbidity. Clinical symptoms include snoring, respiratory pauses, agitated sleep, nocturia, sudoresis, excessive sleepiness, headache in the morning, neurocognitive deficits, personality and libido changes, depressive symptoms and irritability. Anatomic and functional factors can contribute to the instability of the upper respiratory tract. The confirmations is made by the polisomnography, that also stablish severity criteria. Treatment is based in four points: obesity, behavioral, physical and surgical treatments. In selected patients, some drugs can be useful. Hypothyroidism must be always screened. Intraoral ortesis were developed and patients with normal weight with specific palatopharingeal changes have better chances to success in surgery (uvulopalatopharingoplasty)

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.

Jactatio capitis nocturna with persistence in adulthood: case report

Rhythmic movement disorder, also known as jactatio capitis nocturna, is an infancy and childhood sleep-related disorder characterized by repetitive movements occurring immediately prior to sleep onset and sustained into light sleep. We report a 19-year-old man with a history of headbanging and repetitive bodyrocking since infancy, occurring on a daily basis at sleep onset. He was born a premature baby but psychomotor milestones were unremarkable. Physical and neurological diagnostic workups were unremarkable. A hospital-based sleep study showed: total sleep time: 178 min; sleep efficiency index 35.8; sleep latency 65 min; REM latency 189 min. There were no respiratory events and head movements occurred at 4/min during wakefulness, stages 1 and 2 NREM sleep. No tonic or phasic electromyographic abnormalities were recorded during REM sleep. A clinical diagnosis of rhythmic movement disorder was performed on the basis of the clinical and sleep studies data. Clonazepam (0.5 mg/day) and midazolam (15 mg/day) yielded no clinical improvement. Imipramine (10 mg/day) produced good clinical outcome. In summary, we report a RMD case with atypical clinical and therapeutical features.

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.

Mandibular-Lingual Repositioning Device - MLRD: preliminary results of 8 patients with Obstructive Sleep Apnea Syndrome - OSAS

Dental devices have been employed in the treatment of snoring and obstructive sleep apnea syndrome (OSAS) of mild to moderate degrees. The authors disclose the preliminary results in 8 patients with clinically diagnosed obstructive sleep apnea polisomnographically confirmed and treated with a dental device (Mandibular-Lingual Repositioning Device--MLRD) developed by one of the authors (RCB). Cephalometrics was performed before usage of MLRD, Epworth Sleepiness Scale (ESS) tests were conducted before and after the MLRD and a questionnaire that subjectively qualified the Overall Subjective Improvement of the patient (OSI) was filled out. The tests were repeated 4 weeks after the application of the MLRD. The average subjective overall improvement was 73.75% and the Epworth Sleepiness Scale was 13.88 (pre-MLRD) and 6.63 (post-MLRD) representing a significant statistical variation (p = 0.05). The authors discuss probable factors involved in the improvement of the subjective measurements of excessive sleepiness.

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.

Insomnia: can it be treated?

ippocrates, the father of Medicine, spoke of the importance of sleep through this wonderful aphorism. However, it can be said that it was only in 1929 that the modern era of sleep investigation began, with the description of the electrical ac-tivity of the human brain by the German psychiatrist Hans Berger, who created the term “electroencephalography”. In Chicago in the 1930s, Loomis, Harvey and Hobart