Introdução:A sequência de Robin (SR) é uma anomalia congênita definida pela ocorrência de retromicrognatia e glossoptose, com ou sem fissura de palato. Caracteriza-se clinicamente por obstrução das vias aéreas superiores e dificuldades alimentares. As modalidades de tratamento para alívio da obstrução respiratóriana SR incluem: posição prona, intubação nasofaríngea (INF), glossopexia, traqueostomia e distração osteogênica mandibular. O Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP) desenvolveu larga experiência com utilização da INF para o tratamento de crianças com SR, conseguindo importante redução dos procedimentos cirúrgicos na infância precoce. Indivíduos com SR têm risco aumentado para apresentar apneia obstrutiva do sono (AOS) e o exame padrão ouro para confirmar este diagnóstico é a polissonografia.O diagnóstico preciso da AOS é fundamental, para orientar o tratamento adequado e prevenir possíveis complicações. Objetivos: Estudar a dificuldade respiratória de recém-nascidos e lactentes com sequência de Robin isolada e a prevalência e gravidade da apneia obstrutiva do sono antes e após intervenção terapêutica com INF. Métodos: foram avaliados lactentes com SRI, menores de três meses, com obstrução respiratória tipo 1 ou 2 e sintomas respiratórios moderados ou graves, tratados com INF. Os indivíduos foram avaliados clinicamente e através de estudo polissonográfico. A polissonografia foi realizada 48 horas após a INF, sendo partedo exame realizado com INF e partesem INF e repetida no momento da decanulação, sem a INF. A gravidade da obstrução respiratória foi definida pelo índice de apneia-hipopneia (IAH): apneia leve se IAH maior ou igual a 1 e menor ou igual a 5 eventos/hora; moderada se IAH maior que 5 e menor ouigual a 10 eventos/hora e grave quando IAH foi maior que 10 eventos/hora.Resultados: foram avaliados 17 indivíduos com SRI, 9 (53%) do gênero feminino e 8 (47%) do gênero masculino, com idade média de 36 dias na primeira avaliação. Todos apresentavam sintomas respiratórios moderados e graves e foram tratados com INF. O tempo médio de uso da INF foi de 51 dias (variando de 23 a 172 dias). Todos apresentaram melhora clínica dos sintomas respiratórios com a INF, que passaram de graves e moderados para leves ou ausentes. Embora todos os indivíduos apresentassem dificuldades alimentares, 16 (94%) puderam se alimentar oralmente e apenas 1 (6%) foi submetido a gastrostomia. Os exames polissonográficos diagnosticaram apneia obstrutiva do sono (AOS) grave (IAH médio >10) em todas asavaliações. O IAH médio foi de 41,5 (variando de 0 a 104) no primeiro exame sem INF, 29,5 (variando de 5 a 80) no primeiro exame com a INF e de 29 (variando de 5 a 78) no segundo exame. Conclusão: A melhora clínica dos sintomas respiratórios dos indivíduos com SR, tratados com INF, não correspondeu à melhora da apneia obstrutiva do sono, diagnosticada por polissonografia, que identificou alta prevalência de AOS grave, antes e após intervenção terapêutica com INF / Introduction:Robin sequence (RS) is a congenital anomaly characterized by retromicrognatia and glossoptosis, with or without cleft palate. The main clinical problems in RS infants are upper airway obstruction and feeding difficulties. The airway interventions for patients with RS include: prone position, nasopharyngeal intubation (NPI), glossopexy, tracheostomy and mandibular distraction osteogenesis. The Hospital de Reabilitação de AnomaliasCraniofaciais, Universidade de São Paulo (HRAC-USP) has gained a large experience with NPI for management of airway obstruction in RS,which has proven to be an effective method for improving breathing and preventing surgical procedures in early infancy. Individuals with RS have an increased risk for obstructive sleep apnea (OSA).The criterion standard for diagnosis is the polysomnography (PSG) which is an accurate diagnostic procedure, required not only to ensure proper treatment but also to prevent possible complications. Objectives: to study respiratory difficulty in neonates and infants with isolated Robin sequence; to evaluate the prevalence and severity of obstructive sleep apnea before and after therapeutic intervention with NPI, to assess the efficacy of NPI. Methods: Infants younger than 3 months of age with isolated Robin sequence, with type 1 ortype 2 respiratory obstruction,moderate or severe respiratory symptomsandmanaged with NPI were evaluated. The individuals were evaluated clinically and by a polysomnographic study. Polysomnography was performed 48 hours after NPI, part of it withNPI and part without NPI and performed again after definite removal of NPI. Standardresearch definitions for OSA severity were used based on the apnea-hipopnea index (AHI): mild OSA defined as 1 to <5 events per hour; moderate as 5 to<10 events per hour and severe apnea when AHI10 events per hour. Results:A total of 17 individuals with IRS were evaluated, 9 (53%) girls and 8 (47%) boys. The mean age at the first evaluation was 36 days. All of them presented moderate and severe respiratory symptoms and were treated with NPI. The mean duration of NPI use was 51 days (ranging from 23 to 172 days). Allinfants presented clinical improvement forrespiratory symptoms with NPI, going from severe and moderate to mild or to no symptoms. Although all individuals presented feeding difficulties, only one (6%) underwent gastrostomy and 16(94%) could be fed orally. Polysomnography diagnosed severe obstructive sleep apnea in all evaluations. The mean obstructive apnea-hipopnea index (AHI) was 41.5 (ranging from 0 to 104) in the first test without NPI, 29.5 (ranging from 5 to 80) in the first test with NPI and 29 (ranging from 5to 78) in the second test. Conclusion: the clinical improvement of respiratory symptoms of individuals with RS, treated with NPI, did not correspond to the improvement of obstructive apnea sleep diagnosed by polysomnography, which identified a high prevalence of severe AOS, before and after therapeutic intervention of NPI

Orientador: Silke Anna Theresa Weber / Resumo: Introdução: Síndrome da apneia obstrutiva do sono (SAOS) acomete 1 a 4% da população infantil, o tratamento padrão ouro é a adenotonsilectomia (AT). Sabe-se que 10 a 35% dos pacientes submetidos a AT permanecem com SAOS residual. A endoscopia do sono induzido por droga (DISE) pode auxiliar no diagnóstico dos níveis de colabamento da via aérea superior (VAS), podendo melhorar esta estatísticas. Objetivos: avaliar a viabilidade da realização da endoscopia do sono induzido por droga (DISE) em crianças com síndrome da apneia obstrutiva do sono (SAOS) e correlacionar os achados da mesma com a gravidade de SAOS pelo índice de apneia e hipopneia (IAH). Métodos: estudo prospectivo que avaliou crianças com SAOS confirmada pela polissonografia, com indicação de adenotonsilectomia (AT). As mesmas foram submetidas à DISE no momento imediatamente anterior a cirurgia e os resultados de gravidade de SAOS e níveis de obstrução foram comparados. Resultados: dos 45 indivíduos, 32 (20 masculinos) finalizaram todas as etapas do projeto, sendo que a média de idade foi de 7,5 anos (3,25 - 9,92) com média do índice de massa corporal pelo score-Z de 1,24 (-2,06 - 10,42) e gravidade de SAOS com IAH médio de 19,47 (2,9-54,8). A DISE mostrou que 15 (46,88%) pacientes apresentavam obstrução completa a nível de velofaringe e 23 (71,88%) a nível de orofaringe. Vinte e sete (84,32%) apresentavam algum grau de obstrução em velo e orofaringe associados. Nove (28,13%) apresentaram obstrução total em base de l... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Objetivos: Verificar 1) a presença de associação entre bruxismo do sono (BS) e dor miofascial (DMF); 2) se há correlação entre atividade rítmica dos músculos mastigatórios (ARMM) e os valores de limiar de dor à pressão matinais (LDP-pósPSG); 3) se maiores níveis de dor ou sensibilidade à palpação correlacionam-se com menores índices de ARMM em bruxômanos e não bruxômanos com e sem DMF e 4) avaliar a confiabilidade do exame clínico de bruxismo (ECB) Material e Métodos: Realizaram-se exame PSG (2 noites consecutivas) e ECB em 30 pacientes com DMF e 30 indivíduos assintomáticos, correspondentes em sexo e em idade. Previamente à PSG (2a noite) verificou-se o LDP (pré- PSG) da origem, corpo, inserção e porção profunda do masseter e porções anterior, média e posterior do temporal. Na manhã seguinte, verificou-se o LDP pós-PSG nos mesmos sítios musculares. Resultados: Todos os pacientes com DMF apresentaram queixa de dor nos músculos mastigatórios (temporal e/ou masseter), 90% relataram dor leve ou moderada, com duração média de 34,67 ± 36,96 meses (2 a 120). Não houve diferenças entre os grupos quanto à macroestrutura do sono. Houve associação significativa entre BS e DMF [(Quiquadrado, p = 0,039); OR 3,45 (IC 95% 1,066 - 11,194); RR:1,83 e LR+: 1,9. Apenas entre os pacientes de DMF houve correlações negativas entre ARMM e LDP pós-PSG. As correlações foram mais fortes entre os pacientes não-bruxômanos do que nos pacientes bruxômanos. Apenas entre os bruxômanos assintomáticos houve correlações positivas entre LDP pré-PSG e ARMM. Conclusões: 1) O BS associou-se com DMF; 2) a DMF parece ser fator predisponente à maior sensibilidade matinal à palpação; 3) não bruxômanos com DMF parecem responder com maior sensibilidade matinal à palpação a aumentos na intensidade da ARMM do que bruxômanos com DMF; 4) apenas entre os bruxômanos assintomáticos encontrou-se suporte à ocorrência do mecanismo de adaptação à dor e 5) o ECB apresentou valores distintos de confiabilidade para a população com DMF e assintomática, apresentando valores mais altos na população com DMF, embora não tenha atingido os níveis adequados de sensibilidade (75%) e especificidade (90%). / Objectives: To test 1) the association between sleep bruxism (SB) and miofascial pain (MFP); 2) the correlation between rhythmic masticatory muscle activity (RMMA) and pressure pain threshold (PPT) at morning, 3) the influence of previous tenderness over RMMA in bruxers and non-bruxers with/without MFP, and 4) the validity of a clinical diagnostic criteria of sleep bruxism (DCSB). Materials and Methods: Polysomnographic recording (PSG) (two consecutive nights) were performed in 30 MFP patients, selected according to RDC/TMD and 30 asymptomatic controls age and gender-matched. Pre and post-PSG PPT values were verified for masseter (origin, body, insertion, and deep portion), as well as for temporal (anterior, medium, posterior) muscles. Results: All MFP patients reported pain complaints on masseter and/or temporal muscles. Most of MFP patients reported mild or moderate pain (46.67%, and 43.33%, respectively), and only 3 (10%) reported severe pain. Pain duration ranged from 2 to 120 months (mean of 34.67 ± 36.96 months). No differences in sleep architecture were observed in both groups. A significant association was observed between SB and MFP [Chi-Square=0.039, Odds Ratio=3.45 [CI 95% 1.066-11.194)]. Only in MFP patients negative correlations were seen between ARRM and morning-PPT ? indicating a dose-response gradient between ARRM and tenderness to palpation on morning. This gradient seemed more evident among MFP non-bruxers than on bruxers. There were positive correlations between pre-PSG PPT and RMMA only among asymptomatic bruxers. Conclusions: These findings indicate that: 1) Sleep bruxism is significantly associated with MFP; 2) MFP seems to be a predisposing factor that increases bruxism-related muscle sensitivity; 3) MFP non-bruxers seem to show more tenderness on palpation due to more intense RMMA than do MFP bruxers. 4) Only among asymptomatic bruxers was found some evidence of pain-adaptation model; and 5) The DCSB showed different confiability values for MFP and asymptomatic patients, presenting higher values for MFP patients, although not reaching adequate sensitivity (75%) and specificity (90%) levels.

In this thesis sleep, psychological symptoms and quality of life (Qol) in patients undergoing coronary artery bypass grafting (CABG) at the University Hospital in Linköping were evaluated. Interviews and 24-hour polysomnography were performed prior to surgery, immediately after surgery and again at one month, with a six-month-follow-up mailed questionnaire. Habitual sleep was evaluated using the Uppsala Sleep Inventory questionnaire and a diary the recorded mornings. The Spielberger State of Anxiety Scale and the Zung's Self-rating Depression Scale were used to measure anxiety and depression, respectively. Physical functional capacity was assessed according to the New York Heart Association's (NYHA) classes and Qol, with the Nottingham Health Profile instrument (NHP). A retrospective evaluation of nurse's documentation about sleep was also performed. In addition, the quality and quantity of sleep were assessed before surgery and in the immediate postoperative period in a pilot study, with a one-month follow-up interview. The results indicated disturbed sleep, and changes in behaviour and mental state after surgery due to fragmented sleep, pain and anxiety. Forty-four patients were examined prior to surgery. The results showed that almost two-fifths experienced too little sleep habitually and 50 % had a combination of at least two sleep problems. Poorer health, higher level of anxiety and increased difficulties maintaining sleep (DMS) were consistent with significantly longer sleep latency, increased fragmented sleep, and reduced stages 3 and 4 and RIM sleep measured by polysomnography. The level of Qol on the NBP was significantly associated with objectively measured sleep. In the immediate period following CABG there is a changed distribution of sleep, with a reduction of nocturnal sleep duration and an increase in daytime sleep, which had almost returned to preoperative values one month after surgery. Qol was significantly improved six months after surgery compared to before surgery. It was noted that patients with a more anxiety prone reactivity during six months following CABG had significantly more sleep disturbances, reduced energy and functional physical capacity, and lower quality of life, compared to those without such reactivity. Significantly more sleep disturbances, reduced energy and lower quality of life were more prominent among those with sadness/depression or cognitive/behavioural fatigue as reactions to sleep loss. A higher degree of cognitive/behavioural fatigue and dysphoria reactions were associated with a higher NYHA class. In conclusion, patients with coronary artery disease have poor quantity and quality of sleep. Increased psychological symptoms in patients with CAD prior to surgery were associated with greater symptoms six months after surgery. Physical functional capacity and quality of life were significantly improved six months after surgery. / 1999

BACKGROUND: Sleep problems affect people of all ages, race, gender, and socioeconomic classifications. Undiagnosed sleep disorders significantly and adversely impact a person’s level of academic achievement, job performance, and subsequently, socioeconomic status. Undiagnosed sleep disorders also negatively impact both direct and indirect costs for employers, the national government, and the general public. Sleepiness has significant implications on quality of life by impacting occupational performance, driving ability, cognition, memory, and overall health. The purpose of this study is to describe the prevalence of daytime sleepiness, as well as other quantitative predictors of sleep continuity and quality. METHODS: Population data from the CDC program in fatigue surveillance were used for this secondary analysis seeking to characterize sleep quality and continuity variables. Each participant underwent a standard nocturnal polysomnography and a standard multiple sleep latency test (MSLT) on the subsequent day. Frequency and chi-square tests were used to describe the sample. One-Way Analysis of Variance (ANOVA) was used to compare sleep related variables of groups with sleep latencies of <5 >minutes, 5-10 minutes, and >10 minutes. Bivariate and multivariate logistic regression was used to examine the association of the sleep variables with sleep latency time. RESULTS: The mean (SD) sleep latency of the sample was 8.8 (4.9) minutes. Twenty-four individuals had ≥1 SOREM, and approximately 50% of participants (n = 100) met clinical criteria for a sleep disorder. Individuals with shorter sleep latencies, compared to those with longer latencies reported higher levels of subjective sleepiness, had higher sleep efficiency percentages, and longer sleep times. The Epworth Sleepiness Scale, sleep efficiency percentage, total sleep time, the presence of a sleep disorder, and limb movement index were positively associated with a mean sleep latency of <5 >minutes. CONCLUSIONS: The presence of a significant percentage of sleep disorders within our study sample validate prior suggestions that such disorders remain unrecognized, undiagnosed, and untreated. In addition, our findings confirm questionnaire-based surveys that suggest a significant number of the population is excessively sleepy, or hypersomnolent. Therefore, the high prevalence of sleep disorders and the negative public health effects of daytime sleepiness demand attention. Further studies are now required to better quantify levels daytime sleepiness, within a population based sample, to better understand their impact upon morbidity and mortality. This will not only expand on our current understanding of daytime sleepiness, but it will also raise awareness surrounding its significance and relation to public health.

Depression is commonly associated with abnormal sleep architecture. This thesis undertook to assess sleep architecture as a biological correlate of self and observer-rated depressive state, and consists of three studies. The first used a categorical approach to examine the association of sleep architecture with subjective mood in a community sample of 74 preoperative patients, and found no association between high depression scores and hypothesized sleep markers. The second followed 16 patients with Major Depression who were treated with the antidepressant mirtazapine in an 8 week longitudinal study during which they underwent polysomnography on 6 occasions. It was found that classes of sleep markers (REM latency or REM, arousal index, and slow wave sleep) tend to predict response when analyzed concurrently. The third study was methodological in nature, and found that commercially available software for automating eye movement counts did not show strong correspondence with visually scored polysomnographic data.

Depression is commonly associated with abnormal sleep architecture. This thesis undertook to assess sleep architecture as a biological correlate of self and observer-rated depressive state, and consists of three studies. The first used a categorical approach to examine the association of sleep architecture with subjective mood in a community sample of 74 preoperative patients, and found no association between high depression scores and hypothesized sleep markers. The second followed 16 patients with Major Depression who were treated with the antidepressant mirtazapine in an 8 week longitudinal study during which they underwent polysomnography on 6 occasions. It was found that classes of sleep markers (REM latency or REM, arousal index, and slow wave sleep) tend to predict response when analyzed concurrently. The third study was methodological in nature, and found that commercially available software for automating eye movement counts did not show strong correspondence with visually scored polysomnographic data.

No description available.

Psychotic-like experiences (PLEs) are prevalent occurrences deemed comparable with the symptoms of psychosis, but not sufficiently severe to warrant a diagnosis upon clinical presentation. Their presence is associated with several adverse clinical outcomes: the onset of various common mental health disorders (e.g. anxiety, mood, substance abuse), poorer functioning, non-remission and relapse. Sleep and circadian rhythm disruption (SCRD) is observed in 30-80% of patients with psychosis. The omnipotence of SCRD across all phases of the disorder (including the prodromal, acute, chronic and residual phases) raises the question as to whether SCRD may directly contribute to the development of psychosis. Assuming that PLEs are along the same continuum to developing psychosis, a logical next step to further disentangle the sleep-psychosis relationship is to examine whether SCRD relates to the experience of PLEs and whether this relationship is bi-directional. This thesis begins by examining the core predictions made by a continuum model of understanding psychosis and how specific parameters of sleep may influence PLEs. A smaller high-definition cross-sectional study follows, examining biological underpinnings (electroencephalography (EEG), electrocardiography (ECG), endogenous melatonin rhythms and actigraphy) of a complaint of poor sleep and their relation to the occurrence of PLEs. We then refocus on which parameters of sleep are most integral to the sleep-PLE relationship and close with an investigation of how Hypothalamic Pituitary Adrenal (HPA) axis activity may further our knowledge of this relationship. The findings of this thesis demonstrate specificity in the parameters of sleep shown to impact certain PLEs. The importance of objective sleep and biologically driven measures in this line of research are underscored, with group differences in EEG, ECG and melatonin. This thesis also highlights dissociative symptomatology as a candidate mediator for the sleep-psychosis relationship, and emphasises the ties between paranoia and negative affect. Finally, this thesis also illuminates the challenges of examining the relationship between sleep and PLEs in isolation, and suggests that they must be considered within the broader framework of co-existing mental health problems.

Made available in DSpace on 2015-12-06T23:00:44Z (GMT). No. of bitstreams: 0 Previous issue date: 1999 / A medida da atividade motora, atraves de monitores denominados actigrafos, permite inferir estados de sono e vigilia, o que tem sido assunto de crescente interesse tanto na pesquisa quanto na clinica. Geralmente compara-se essa nova metodologia a polissonografia, considerada o padrao-ouro no estudo do sono. A concordancia entre os dois metodos e realizada tipicamente atraves da concordancia epoca-a-epoca, e dos calculos de coeficientes de correlacao entre os parametros obtidos pelos dois metodos. Portanto, o nosso trabalho teve como objetivo validar a actigrafia no estudo do sono. Para tanto, apos uma noite de adaptacao, foram realizados registros simultaneos polissonograficos e actigraficos ao longo de uma noite de 21 voluntarios sadios. A analise actigrafica foi realizada de acordo com os algoritmos propostos por COLE et al(l992) e por SADEH et al (l994). Os registros polissonograficos foram analisados de acordo com os criterios de RECHTSCHAFEN & KALES (l968). Os seguintes parametros de sono foram obtidos: Latencia para Inicio do Sono (LS), Periodo Total de Sono (PTS), Tempo Total de Sono (TTS), Despertares Intermitentes (DI) e EfiCiência do Sono. A concordancia entre os metodos foi avaliada atraves: 1) dos calculos de sensibilidade (S), especificidade (E) e acuidade (A); 2) dos indices de correlacao de Pearson; 2) da tecnica de concordancia proposta por BLANDALTMAN (l986). O algoritmo de Cole apresentou os seguintes valores: S = 99 por cento, E = 34 por cento e A = 91 por cento. Valores semelhantes foram observados para o algoritmo de Sadeh: S = 97 por cento, E = 44 por cento e A = 91 por cento. Os coeficientes de correlacao obtidos entre as medidas fornecidas pelos algoritmos de Cole e Sadeh e derivadas da PSG foram: PTS: r = O,99 para ambos os algoritmos; TTS: r = O,89 para ambos os algoritmos; LS: r = O,69 e O,64, respectivamente; ES: r = O,39 e O,41, respectivamente; DI: r = O,36 e O.37, respectivamente. A concordancia, segundo a tecnica de Bland-Altman, entre o algoritmo de Cole e a PSG mostrou os seguintes resultados: 1) A media da diferenca (MD) da LS foi de 1,3 min com os limites do intervalo de concordancia (LIC) de 95 por cento de -5,9 e 8,5 min; PTS: MD de -O,5 min e LIC de -lO,9 e 9,9 min; TTS: MD de 18,5 min, e LIC de -22,9 e 59,9 min; DI: MD de -l 8,6 min e LIC de -57 e 20 min; ES: MD de 4,1 por cento e LIC de -4,1 e 12,3 por cento. A concordancia entre o algoritmo de Sadeh e a PSG mostrou que a MD da LS foi de ...(au) / BV UNIFESP: Teses e dissertações