Orientador: Milva Maria Figueiredo De Martino / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T03:28:42Z (GMT). No. of bitstreams: 1 Silva_ClaudiaAparecidaRosada_M.pdf: 5933281 bytes, checksum: abd9b797717c0af73f50c3227041de8e (MD5) Previous issue date: 2005 / Resumo: Este estudo foi conduzido entre 53 enfermeiros, trabalhadores em turnos, com faixa etária de 32 a 40 anos, de um hospital universitário de Campinas - São Paulo. O objetivo foi estudar as características cronobiológicas do ciclo vigília-sono, o estado de sono atual e os estados emocionais presentes. Os questionários utilizados foram: Levantamento de dados da população, Avaliação do ciclo vigília-sono, Caracterização do padrão de sono e Lista de Estados Emocionais Presentes. Os resultados mostraram que o turno matutino é formado por enfermeiros em sua maioria casados, com filhos e que não realizam outra ocupação, o turno vespertino é formado por enfermeiros mais jovens, com menor tempo de formado e de serviço no turno, o turno noturno é formado por enfermeiros com maiores idades e que realizam outra ocupação. As análises dos padrões de sono dos enfermeiros revelaram que os enfermeiros do matutino acordaram mais cedo, porém não anteciparam o horário de dormir, os enfermeiros do turno vespertino apresentaram padrão normal do ciclo vigília-sono, com relação ao sono noturno os enfermeiros do turno noturno apresentaram padrão normal do ciclo vigília-sono, com relação ao sono diurno este é mais curto que o sono noturno e fracionado em até três episódios. Em relação à percepção do estado de sono atual os três turnos classificaram o sono como regular. Os resultados da Lista de Estados Emocionais Presentes, independente do turno de trabalho, mostraram um perfil emocional estável dos enfermeiros, quase ausência de alguns estados emocionais e algumas locuções representaram efeitos específicos do turno com diferenças significativas entre o início e o final do turno / Abstract: This study was conducted among 53 nurses, shift workers, aging between 32 and 40 years old, of a University Hospital in Campinas - São Paulo. The objective was study the chronobiological characteristics of the sleep wake cycle, the current sleeping pattern and present mood states. The questionnaires used were: Survey of population data, Evaluation of sleep-wake cycle, Characterization of sleep standard and Present Mood States List. The results demonstrated that the morning shift is most made up of marriage and with children nurses and that do not carry through another occupation, the afternoon shift is made up of younger nurses, more recently graduated and with less time working at this shift. The night shift is made up of older nurses and that they carry through another occupation. The analysis about the nurses standard sleep showed that the nurses of the morning had waked up more early, however had not anticipated the schedule to sleep, the nurses of the afternoon shift had presented normal standard of the sleep-wake cycle, with relation to night sleep the nurses of the night shift one had presented normal standard of the sleep-wake cycle, with relation to daily sleep this is shorter than night and fragmented in up to three episodes. In relation to the perception of the current sleeping pattern the three shifts had classified sleep as to regulate. The results of the Present Mood States List, independent of the shift work, showed a stable emotional profile of the nurses, almost absence of some emotional states and some locutions had represented specifics effects of the shift, with significant differences between the beginning and end of the shift / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Circadian Rhythms (CR) are driven by a biological clock called as suprachiasmaticnucleus (SCN), located in a brain region called the hypothalamus. These rhythms are very much necessary in maintaining the sleep and wake cycle at appropriate times in a day. As a starting step towards non-invasive investigation of CR, aim is to study changes in the physiological processes of two Regions of Interest (ROI), the hypothalamus and the visual cortex. This was studied using a functional Magnetic Resonance Imaging (fMRI) technique to investigate for any changes or differences in the Blood Oxygen Level Dependent (BOLD)signals extracted from the ROI during a visual stimulation. We acquired and processed fMRI data to extract BOLD signals from ROI and the extracted signals are again further used to study the correlation with the experimental ON-OFF design paradigm. The extracted BOLD signals varied a lot between the two specified brain regions within the same subject and between three types of fMRI data. These variations were found in terms of number of activated voxels and also Signal to Noise ratio(SNR) level present in the signals. The number of activated voxels and SNR werehigh in visual cortex whereas low number of activated voxels and low SNR were found in hypothalamus. The correlation between BOLD responses from primaryvisual cortex were shown as positive with the experimental stimulation whereas BOLD responses extracted from hypothalamus have shown a negative correlation in time with the experimental stimulation. As a start up of the project, these BOLD responses can provide references for a future use in research studies, especially to further study about change in phase of the BOLD signal extracted exactly from the SCN. These phase responses can then be used to study physiological processing in subjects affected by sleep disorders.

This study investigated the relationship among anxiety, depression, and sleep disturbances and the treatment of these three disorders through neurotherapy. Research suggests that these conditions commonly co-occur in the general population and that central nervous system (CNS) arousal may play a primary role in the development and maintenance of these disorders. Several recent studies suggested that neurotherapy, a biofeedback-based treatment for CNS dysregulation, might be an effective treatment for comorbid conditions, particularly the ones of interest here, depression, anxiety, and sleep disturbances. This investigation used a clinical case-series design to assess pre/post neurotherapy changes on objective measures of anxiety, depression, and sleep and to determine whether changes in anxiety and depression then predict improvements in sleep quality. Data for 23 participants (10 males) were obtained from files of adults (Mage = 40.22 years, SD = 16.20) who received at least 15 neurotherapy sessions (M = 47.83 sessions, SD = 22.23) the University of North Texas Neurotherapy Lab. Matched pair t-tests revealed that symptoms of sleep disturbance, depression, and anxiety showed significant improvements following neurotherapy. Neurotherapy treatment effect sizes generally ranged from moderate to large (d = .414 - .849). Multiple regression analysis found that changes in self-reported anxiety symptoms, but not depressive symptoms, predicted observed improvements in sleep quality (adjusted R2 = .26). Last, the implications and limitations were discussed in relation to neurotherapy practice and the associated research.

Introduction: Restless Legs Syndrome (RLS) is more prevalent in chronic kidney disease patients in comparison to the general population, but its diagnosis is still delayed and predictors are unknown. Objectives: The goals of this study are to diagnose, determine the prevalence and severity of RLS and to identify independent variables associated with this disease among chronic dialysis patients. Methods: 326 chronic dialysis patients were launched in this observational and transversal study. International Study Group of Restless Legs Syndrome criterion was used to diagnosis RLS and International Scale of Degrees of Restless Legs Syndrome was used to determine its severity. Patients with and without RLS were compared using demographic and clinical characteristics, including dialysis modality. Statistical analysis was performed using Student t test and chi-square test (significance level p<0.05). Results: The median age was 50 years, 59% were men, 77% had time on dialysis >1 year and hypertension was the most common etiology (26%). RLS was diagnosed in 19.3% of patients and in 52.4% of them it was in severe forms. Patients with and without RLS were not different according to demographic, clinical and modalities characteristics. Conclusions: RLS is frequent in chronic dialysis patients and it happen in severe forms. Dialysis modality and other clinical characteristics analyzed in this sample may not have a significant effect on the diagnosis. Further studies are necessary to identify potentially predictors of RLS in this specific population. / Introdução: A Síndrome das Pernas Inquietas (SPI) possui maior prevalência em pacientes renais crônicos quando comparados à população geral, porém seu diagnóstico é tardio e seus preditores desconhecidos. Objetivos: Diagnosticar, determinar a frequência e avaliar a gravidade da SPI em renais crônicos em diálise, comparar prevalência e gravidade da SPI entre as modalidades dialíticas e identificar seus possíveis fatores preditores nesta população. Métodos: Estudo observacional e transversal com 326 pacientes em diálise, utilizando os critérios estabelecidos pelo Grupo Internacional de Estudo da SPI para o diagnóstico e a Escala de Graduação da SPI para determinação da sua gravidade. Compararam-se pacientes com e sem SPI no tocante a características clínico-demográficas e à modalidade dialítica. Realizou-se a análise estatística através dos testes t de Student e Qui-Quadrado, considerando p<0,05 para rejeição da hipótese nula. Resultados: Na amostra predominaram homens (59%), com média de idade de 50 anos, há mais de um ano em diálise (77%), tendo a nefrosclerose hipertensiva como principal etiologia (26,1%). Diagnosticou-se SPI em 19,3% dos pacientes e esta ocorreu em 52,4% deles nas formas grave ou muito grave. Pacientes com e sem SPI não diferiram no tocante às características clínico-demográficas e modalidade dialítica. Conclusões: A SPI é frequente em pacientes dialíticos e ocorre predominantemente nas suas formas mais graves, devendo ser pesquisada rotineiramente neles. Modalidade dialítica parece não exercer influência na sua ocorrência. Estudos adicionais são necessários na tentativa de identificar possíveis fatores preditores, já que as características analisadas nesta série não se associaram ao diagnóstico.

Introduktion: Sömnbrist kan orsaka måttligt ökad risk för sjukdom och förkortad livslängd. Det kan bland annat leda till infektionssjukdomar eftersom immunsystemet försvagas, samt är en riskfaktor för kardiovaskulär sjuklighet och diabetes typ 2. Sämre sömnkvalitet hos högskolestudenter är förknippade med symtom som exempelvis antisociala personlighetsstörningar och ångestproblematik. I Sverige har 20 procent av alla högskolestudenter barn under 18 år. Vid sömnstörningar hos barn kan i sin tur föräldrarnas sömn påverkas och vid långvariga problem kan det bland annat leda till nedstämdhet. Syfte: Syftet med studien är att undersöka om det är någon skillnad i självskattade sömnbesvär hos högskolestudenter med barn och högskolestudenter utan barn som studerar på en högskola i sydvästra Sverige. Metod: En kvantitativ tvärsnittsstudie genomfördes som mätte självskattade sömnbesvär med den validerade enkäten Karolinska Sleep Qustionnaire. Studiepopulationen valdes via ett bekvämlighetsurval och datan analyserades med deskriptiv statistik. Resultat: Studiepopulationen inbegrep 41 högskolestudenter. Av dessa hade 22 studenter barn och 19 studenter hade inga barn. Studien visade att endast uppvaknandebesvär hos studenter utan barn var värda att utreda vidare. Varken studenter med eller utan barn hade problem med snarkbesvär. Studien indikerade dock att studenter utan barn haft mer besvär med sömnkvalitet än studenter med barn. Slutligen hade studenter med barn mer besvär med sömnighet/trötthet än studenter utan barn. Slutsats: Fler studier behövs inom området sömnbesvär och hur det skiljer sig mellan studenter med och utan barn. Det kan då ligga till grund för hur universitet och högskolor framgent kan arbeta för att hjälpa olika studentgrupper färdigställa sin utbildning. / Introduction: Sleep deprivation can cause a moderately increased risk of illness and shortened life expectancy. It can, among others, lead to infectious diseases since the immune system weakens. It is also a risk factor for cardiovascular diseases and diabetes type 2. Sleep disorders can lead to infectious diseases as the immune system weakens. Poorer sleep quality in university students is associated with symptoms such as antisocial personality disorders and anxiety problems. In Sweden, 20 percent of all university students have children under the age of 18 years. If children have sleep disorders that can also affect the parental sleep which could, if long term, lead to depression. Aim: The aim of the study is to investigate whether there is a difference in self-rated sleep disorders in university students with children and university students without children studying at a university in southwestern Sweden. Methods: A quantitative cross-sectional study was conducted that measured self-rated sleep disorders with the validated Karolinska Sleep Qustionnaire survey. The study population was selected via a sample of convenience and the data was analyzed using descriptive statistics. Results: The study population included 41 university students. Of these, 22 students had children and 19 students had no children. The study showed that only awakening problems in students without children were worth investigating further. Neither students with nor without children had problems with snoring problems. However, the study indicated that students without children had more trouble with sleep quality than students with children. Finally, students with children had more trouble with sleepiness/fatigue than students without children. Conclusion: More studies are needed in the field of sleep disorders and how it differs between students with and without children. This can then form the basis for how universities and colleges can work in the future to help different student groups complete their education.

My dissertation focuses on investigating the associations of neighborhood environments—namely, built and social environments—with health among community-dwelling older Americans. The first paper examines groupwide variations in social participation patterns among older adults before and during the COVID-19 pandemic, and if community social cohesion and health during the pandemic were significantly associated with social participation patterns. Using Rounds 9 and 10 longitudinal data from the National Health and Aging Trend Study, I employed latent class analysis to identify the presence of groupwide variations in social participation, before and during the pandemic. I used logistic and linear regressions to examine the associations between social participation patterns, community social cohesion, and health during the pandemic. Results suggested two participation patterns, active and selective participants. Compared to active participants, older adults who were selective in their social participation were more likely to live in less socially cohesive communities and report substantial depressive and anxiety symptoms. In the second paper, I examined cross-sectional and longitudinal relationships between neighborhood physical disorder, low social cohesion, and sleep problems among older Americans. Mediators of health behaviors (i.e., lack of physical activity and social participation) and mental health (i.e., depressive and anxiety symptoms) were also tested in these relationships. Data were derived from three rounds of panel data (Rounds 7-9) from the National Health and Aging Trends Study, involving a sample of 4,029 Americans aged 65 or older. I found statistically significant cross-sectional and longitudinal associations between physical disorder and low social cohesion, and late-life sleep problems. Only cross-sectional mediation effects of health behaviors and mental health were found in the relationship of physical disorder and sleep problems, whereas both cross-sectional and longitudinal associations between low social cohesion and sleep problems were significantly mediated by health behaviors and mental health. In the third paper, I used annual data from the 2015-16 Poverty Tracker study to examine the roles of distance to grocery stores, neighborhood disadvantage, and social cohesion in explaining food insecurity among older adults in New York City. Multiple logistic regressions were conducted to assess these relationships. Results showed that greater distance to grocery stores (0.26–0.75 miles vs. 0.00–0.25 miles) and living in more disadvantaged neighborhoods increased the odds of food insecurity. Community social cohesion was a marginally significant protective factor against food insecurity. The findings of these papers highlighted the associations between the neighborhood environment, social health, sleep quality, and food security status among older adults. These papers also emphasized the potential for environmental policy and social work program interventions to improve the well-being and quality of life among community-dwelling older adults.

Le premier objectif de cette étude était d’évaluer la relation entre l’alexithymie et différents troubles du sommeil chez des patients diagnostiqués (N= 580) selon la polysomnographie et la classification de l’American Academy of Sleep Medicine (AASM) et chez des sujets contrôle (N= 145) en utilisant l’Échelle d’Alexithymie de Toronto à 20 items (TAS-20). Le deuxième objectif était d’estimer le lien entre l’alexithymie et des caractéristiques de rêves suivant un Questionnaire sur les Rêves de 14 items. Les résultats confirment un lien entre l’alexithymie et les troubles du sommeil. Sa prévalence était supérieure dans le groupe clinique comparativement au groupe contrôle, et était différente selon les troubles. Les hommes cotaient plus haut que les femmes à l’Échelle d’Alexithymie de Toronto à 20 items (TAS-20) et sur ses sous-échelles DDF (difficulty describing feeling) et EOT (externally oriented thinking). L’EOT pourrait être impliquée dans les troubles de sommeil en étant l’unique sous-échelle, où un effet principal des diagnostics était significatif dans le groupe clinique. Pour les rêves, le score du TAS-20 corrélait positivement avec le facteur « détresse des cauchemars »; et négativement avec « rappel de rêves » et « signification des rêves ». Les sous-échelles du TAS-20 avaient des corrélations différentes: positive entre DIF et « détresse des cauchemars », négative entre DDF et « rappel de rêves » et EOT avec « signification des rêves ». À part quelques exceptions, ces modèles sont obtenus pour les groupes cliniques et non-cliniques, et pour les hommes et les femmes dans ces deux groupes. Ces résultats suggèrent un modèle consistant, et reproductible, de relations entre l’alexithymie et les composantes des rêves. / Using a large clinical group of patients suffering from sleep disorders (N= 580) and non-clinical comparison subjects (N= 145), the first aim of this study was to evaluate the relationship between alexithymia and several different sleep disorders diagnosed from polysomnography following the American Academy of Sleep Medicine classification system and using a Canadian French translation of the 20-item Toronto Alexithymia scale (TAS-20). The second objective was to evaluate the link between alexithymia and dream characteristics using a 14-item Dreaming Questionnaire. Results confirm a relationship between alexithymia and sleep disorders. Its prevalence was higher in the clinical than the non-clinical group and differed according to sleep disorder diagnoses. Men scored higher than women on the TAS-20 total score and on the DDF (difficulty describing feeling) and EOT (externally oriented thinking) subscales. EOT could be implicated in sleep disorders pathology as it was the only subscale for which the sleep diagnosis effect was significant in the clinical group. Concerning the second objective, TAS-20 total score correlated positively with nightmare distress and negatively with dream recall; and correlated negatively with dream meaning. TAS-20 subscales were differentially correlated with the 3 dream factors of the Dreaming Questionnaire: DIF with increased nightmare distress, DDF with decreased dream recall and EOT with decreased dream meaning. With some exceptions, these patterns were obtained for clinical and non-clinical groups and for men and women. These results suggest a consistent and replicable pattern of relationships between alexithymia and dreaming components.

Made available in DSpace on 2016-01-26T12:51:39Z (GMT). No. of bitstreams: 1 elianeapdemellotroncoso_dissert.pdf: 1571246 bytes, checksum: 253b6968386f08855127a125add32375 (MD5) Previous issue date: 2012-04-23 / Introduction: Sleep disorders are not only a problem in Brazil, has become a worldwide public health condition, affecting people physically and emotionally, and even putting them in danger of life. Objectives: To identify, analyze and compare habits and sleep disturbances (SD) in a sample of students from municipal schools in a midsize city in the state of Sao Paulo. Method: A study descriptive, qualitative-quantitative, with data collection conducted between November and December 2009, 188 children between six and 11 years of municipal schools in the city of Sao Jose do Rio Preto, SP, from screenplay data demographic questions about sleep habits and the Sleep Disorders Scale for Children (EDSC), completed by the parents / caregivers. The same was conducted within the standards required by the Helsinki Declaration, Resolution 196/96 of the National Health Council (NHC) and approved by the ethics committee of the Faculty of Medicine of São José do Rio Preto (Number 316/269). Results: Overall, the results indicate that the prevalence of SD in the sample school Sao Jose do Rio Preto, hit rate higher than that reported in literature with greater frequency among those who studied in the morning, consistent with research area, and whose parents / caregivers are considered mulatto. Students belonging to families with more members showed a greater tendency to Sleep Disordered Breathing (SDB), those taking medication for SED, and those who complained of pain or discomfort, for all SD. Boys were more SD, poor sleep habits healthy and more probability to Sleep Hyperhidrosis (HS) and enuresis, compared to girls in the study, was found increased occurrence and association between HS and SDB. Students with behavioral problems, expulsion and insufficient grade school tended to some SD specific, indicating a relationship between the variables. With regard to the habits that influence the quality of sleep, significant amount of students took plenty of fluids, including milk, close to bedtime, some children from school B responded in the affirmative to play strong, and the school A to the games video game or computer. After lying down, was the high amount of which were sporadic use of television and slept without turning it off, irregularities in the time and place to sleep were also identified in both institutions, as well as the permanence of parents / caregivers in the room until the child fall asleep. Conclusions: The SH, SD poorly addressed by the scientific literature was identified with high frequency in the population studied, and the SDB. Participants who showed sleep habits that were unfavorable constitute a significant portion of the sample, that may be influencing both the quantity and quality of sleep, increasing the risks related to diseases, as well as interfering with the development of intellectual abilities and school behavior. More detailed studies on SH as well as surveys are suggested, and specialty specific assistance programs should be developed and deployed for this community. / Introdução: Distúrbios do sono (DS) constituem um problema não só no Brasil, já se tornou condição de saúde pública mundial, prejudicando as pessoas, física e emocionalmente, e até colocando-as em perigo de vida. Objetivos: Identificar, analisar e comparar hábitos e distúrbios do sono em uma amostra de alunos da rede municipal de ensino de uma cidade de médio porte do interior do estado de São Paulo. Método: Pesquisa descritiva, qualiquantitativa, com coleta de dados realizada entre novembro e dezembro de 2009, em 188 crianças entre seis e 11 anos, de escolas municipais da cidade de São José do Rio Preto, São Paulo, a partir de um Roteiro de dados demográficos, Questões sobre hábitos do sono e Escala de Distúrbios do Sono para Crianças (EDSC), preenchidos pelos pais/responsáveis. A mesma foi conduzida dentro dos padrões exigidos pela Declaração de Helsinque, Resolução 196/96 do Conselho Nacional de Saúde e aprovada pela comissão de ética da Faculdade de Medicina de São José do Rio Preto - Parecer n° 316/269. Resultados: No geral, a prevalência de DS da amostra em escolares de São José do Rio Preto, SP, atingiu índice superior ao relatado pela literatura, com maior frequência entre os que estudavam no período matutino, e os cujos pais/responsáveis se consideraram pardos. Escolares pertencentes a famílias com maior número de integrantes demonstraram maior tendência para Distúrbio Respiratório do Sono (DRS), os que tomavam remédio, para Sonolência Excessiva Diurna (SED), e aqueles que apresentavam queixa de dor ou incômodo, para todos os DS. Os meninos apresentaram mais DS, hábitos desfavoráveis ao sono saudável e maior tendência para Hiperhidrose do Sono (HS) e enurese, quando comparados às meninas do estudo; foi verificada maior ocorrência e associações entre HS e DRS. Escolares com problemas de comportamento, notas insuficientes e expulsão, demonstraram tendência para alguns DS específicos, indicando uma estreita relação entre as variáveis. Com relação aos hábitos que influenciam a qualidade do sono, quantidade significativa de escolares tomava muito líquido, incluindo o leite, próximo da hora de dormir, algumas crianças da escola B responderam de forma afirmativa às brincadeiras vigorosas, e os da escola A aos jogos de vídeo game ou computador. Após deitar, foi alta a quantidade dos que faziam uso esporádico da televisão e que dormiam sem desligá-la, irregularidades quanto ao horário e local para dormir também foram identificadas em ambas as instituições, bem como a permanência de pais/responsáveis no quarto até a criança adormecer. Conclusões: A HS, DS pouco abordado pela literatura científica, foi identificada com alta frequência na população estudada, bem como o DRS. Participantes que mostraram hábitos considerados desfavoráveis ao sono constituem parcela significativa da amostra, que podem estar influenciando tanto a quantidade quanto a qualidade do sono, aumentando os riscos relacionados às doenças, bem como interferindo no desenvolvimento das capacidades intelectuais e do comportamento escolar. Estudos mais detalhados sobre HS, bem como inquéritos populacionais são sugeridos, e programas específicos de intervenções especializadas devem ser elaborados e implantados para este público.

No description available.

INTRODUÇÃO: A literatura confirma a relação existente entre os Distúrbios Respiratórios do Sono (DRS) e os sintomas do Transtorno do Déficit de Atenção/Hiperatividade (TDAH). Há estudos que mostram o efeito dos tratamentos para DRS no comportamento, observando-se, após adenotonsilectomia, melhora nos índices dos testes de comportamento, assim como no desempenho escolar das crianças com TDAH. Considerando-se a relação existente entre a Respiração Oral (RO) e os DRS e entre estes e o TDAH, pretende-se avaliar se ocorrem interferências sintomáticas entre a RO e o TDAH, quando se obtém a reversão da RO em respiração nasal fisiológica, através da utilização do tratamento ortopédico funcional (utilização de placas ortopédicas, orientação para o fechamento labial, ginástica respiratória) e terapia fonoaudiológica. MÉTODOS: Neste estudo longitudinal, realizado entre janeiro de 2004 e janeiro de 2007, acompanhando pacientes com TDAH e RO, de 7 a 13 anos de idade, por 18 meses, no ambulatório de TDAH do Hospital das Clínicas/ FMUSP, comparamos os escores de testes comportamentais para TDAH (Conners e SNAP IV) em dois grupos de pacientes que estavam sendo tratados com metilfenidato, um dos quais recebeu tratamento ortopédico funcional e fonoaudiológico para a RO. RESULTADOS: 1) Não houve diferenças entre o grupo tratado e não tratado para a RO com respeito à idade; 2) Os escores dos questionários no grupo tratado para RO foram significantemente diminuindo (indicando melhora) em todas as variáveis (exceto Conners Pais -conduta anti-social), ao longo do tempo; 3) Os escores dos questionários no grupo tratado para RO foram significantemente menores (indicando melhora) do que os escores do grupo não tratado, para todas as variáveis estudadas, quando se comparam os dois grupos; 4) Esta melhora dos sintomas ocorreu após 12 meses de tratamento para RO e persistiu aos 18 meses; 5) dois dos oito pacientes do grupo tratado puderam interromper o metilfenidato, sendo que todos os pacientes do grupo não tratado ainda utilizam o medicamento. CONCLUSÕES: O Tratamento Ortopédico Funcional para RO, em conjunto com a terapia fonoaudiológica, foi efetivo para a melhora dos sintomas de TDAH em pacientes em tratamento com metilfenidato; a RO e os DRS devem ser investigados e tratados em pacientes com diagnóstico ou suspeita de TDAH, pois podem contribuir para a piora dos sintomas. / INTRODUCTION: A number of studies demonstrate the relationship between Sleep Respiratory Disorders (SRD) and symptoms of the Attention Deficit Hyperactivity Disorder (ADHD). Some of them assess the effect of the treatments for SRD on the behavior; for example, an improvement of the scores in the behavior tests, as well as in the school performance of children with TDAH is observed after adenotonsillectomy Considering the relation between mouth breathing (MB) and SRD and between these and the ADHD, we aimed to evaluate symptomatic interferences between MB and ADHD, through the reversion of MB in physiological nasal breath, by means of functional orthopedics treatment (use of orthopedics plates, orientation for labial closing, respiratory gymnastics) and speech therapy. METHODS: In this longitudinal study, performed between January of 2004 and January of 2007, 16 patients with ADHD and MB, aged 7 to 13 years, and who were being treated with methylphenidate, were followed-up for 18 months, in the outpatient clinic for ADHD at the Hospital das Clínicas da FMUSP. We compared the scores in ADHD tests (Conners and SNAP IV) of two groups of eight patients, one of which received functional orthopedics treatment and speech therapy for MB and the other did not. RESULTS: 1) The two groups were statistically equivalent by age; 2) The scores of the questionnaires in the group of patients treated for MB were significantly lowering (indicating improvement) regarding all the variables (except Conners Parents - antisocial behavior), along the follow-up period; 3) The scores of the questionnaires in the treated group were significantly lower (indicating improvement) of the scores in no treated group, for all the studied variables, when the two groups are compared; 4) This improvement of the symptoms occurred 12 months after the beginning of the treatment for MB and persisted at 18 months; 5) two of the eight patients from the treated group were indicated for interrupting the methylphenidate; however, all patients of the group not treated were still utilizing the medication. CONCLUSIONS: Functional the Orthopedics Treatment for MB, associated with speech therapy, was effective for the improvement of the symptoms of ADHD in patients who were being treated with methylphenidate; MB and SRD must be investigated and treated in patients with diagnosis or suspicion of ADHD, as they can contribute for the worsening of the symptoms.