Síndrome das pernas inquietas (SPI) é um distúrbio do sono com alta prevalência entre pacientes em hemodiálise, nos quais o mecanismo é pouco conhecido. Tem sido postulado que alterações do metabolismo mineral e ósseo relacionadasà doença renal crônica, especialmente o hiperparatireoidismo secundário, possam estar relacionadas à patogênese da SPI. Este trabalho teve como objetivo principal avaliar a SPI antes e após paratireoidectomia (PTX). Além disso, avaliamos dados objetivos do sono por meio de polissonografia, com ênfase em apneia do sono. Estudamos prospectivamente 19 pacientes (6 homens, idade 48 ± 11 anos) com hiperparatireoidismo grave pré e pós-PTX. O diagnóstico e o escore de gravidade da SPI foram avaliados de acordo com o Grupo de Estudo Internacional de SPI. Polissonografia pré e pós-PTX forneceu dados de arquitetura do sono, movimentos periódicos de pernas e apneia do sono, medida por meio do índice de apneia-hipopneia/hora de sono (IAH). SPI foi encontrada em 10 pacientes (53%) e se associou com maiores níveis de fosfato (p=0,005) e maior gravidade da dor (p=0,003). Após a PTX, houve redução dos níveis séricos de paratormônio, fosfato e aumento dos níveis de 25-hidroxivitamina D, calicreína-6 e fetuína-A. A PTX reduziu a SPI para 21% (p=0,044), acompanhada por redução nos escores de gravidade e alívio da dor e do prurido. A análise de regressão logística mostrou que o fosfato pré-PTX permaneceu independentemente associado com SPI (OR=7,28; p=0,035), em modelo ajustado para hemoglobina, idade e sexo. Apneia do sono (IAH > 5) foi encontrada em 11 pacientes pré e 14 pós-PTX (63% vs. 74%, p=0,698). Observamos uma correlação entre o IAH e a relação água corporal extracelular/massa magra (r=0,535, p=0,018), assim como correlação com a circunferência do pescoço pré-PTX (r=0,471, p=0,042). Entretanto, não observamos correlação do IAH com o deslocamento de fluidos da perna direita durante o sono (p=0,09), que aumentou significativamente após PTX (p=0,011). Concluímos que a PTX melhora a SPI, com cura completa ou melhora significativa. Se essa melhora está relacionada à diminuição do paratormônio ou do fósforo necessita de investigação adicional. Além disso, o presente estudo confirma a alta prevalência de apneia do sono entre pacientes em hemodiálise, o que não se modificou com a PTX / Restless legs syndrome (RLS) is a sleep disorder with high prevalence among patients on hemodialysis, which underlying mechanism is still unknown. It has been postulate that bone metabolism disorder, especially secondary hyperparathyroidism may be implicated in the pathogenesis. The present study aimed to evaluate RLS before and after parathyroidectomy (PTX). In addition, we evaluated objective data through polysomnography, focusing on sleep apnea. We prospectively evaluated 19 patients (6 men, aged 48 ± 11 years) with severe hyperparathyroidism pre and post-surgical treatment, parathyroidectomy (PTX). RLS diagnosis and rating scale were accessed based on the International RLS Study Group. Polysomnography pre and post PTX provided data on sleep architecture, periodic leg movements of sleep and apnea-hypopnea index (AHI). RLS was observed in 10 patients (53%), and was associated with higher levels of phosphate (p=0,005) and severe pain (p=0,003). After PTX, there was a reduction of serum parathyroid hormone, serum phosphate, and an increase of 25hydroxyvitamin D, kallicrein-6 and Fetuin-A. PTX improved RLS to 21% (p=0,04), accompanied by a decrease in rating scale, in association with alleviation of pain and pruritus. Logistic regression shows that serum phosphate pre PTX remained independently associated with RLS (HR=7,28; p=0,035), in a model adjusted for hemoglobin, age and gender. Sleep apnea (AHI > 5) was found in 11 patients pre and 14 patients post PTX (63% vs. 74%, p=0,698). There was a correlation between AHI and the relation extracellular water/ lean body mass (r=0,535; p=0,018) as well as a correlation between AHI and neck circumference (r=0,471; p=0,042). However, there was no correlation between AHI and spontaneous rostral fluid shift (p=0,09) that has increased after PTX (p=0,011). We concluded that PTX provided an opportunity to improve RLS. Whether RLS may be improved by reduction of serum phosphorus or parathyroid hormone, merits further investigation. In addition, PTX had no impact on the high prevalence of sleep apnea in this population

A travers ce projet de recherche nous avons exploré différents aspects d’une dérégulation du système dopaminergique sur les troubles du repos, en prenant pour exemple deux maladies neurologiques : la maladie de Willis-Ekbom (MWE) et la maladie de Parkinson (MP). La MWE est une maladie neurologique sensorimotrice caractérisée par des douleurs dans les membres inférieurs, s’accompagnant d’un besoin irrépressible de bouger et ce, suivant un profil circadien. Ainsi, le premier volet de ces travaux s’est appliqué à reproduire chez le macaque, les principales altérations du métabolisme du fer et de celui de la dopamine reportées dans la MWE. Tout d’abord, nous avons établit les bases physiologiques des variations circadiennes des concentrations du fer et de ses biomarqueurs au niveau central et périphérique. Puis, nous avons développé un protocole simple, uniquement basé sur des prélèvements sanguins répétés, permettant d’induire efficacement une déplétion en fer sérique et de ses protéines associées. Finalement, ce protocole nous a permis d’explorer les liens entre l’altération de l’homéostasie du fer au niveau du système nerveux central, les perturbations neurochimiques dans différentes structures cérébrales ainsi que les modifications locomotrices qui en résultent. Le second volet de cette thèse a testé l’impact des agonistes des récepteurs dopaminergiques de type D1 (SKF38393) et D2 (quinpirole), sur les troubles du sommeil dans un modèle macaque de la MP, à l’aide d’enregistrements polysomnographiques. Pour cela, nous avons évalué les effets de ces agents pharmacologiques sur l’émergence de la somnolence diurne et sur l’altération du sommeil paradoxal, induits par une intoxication au MPTP. Nos résultats mettent en évidence que le quinpirole est inefficace pour restaurer les niveaux de base de ces deux paramètres. En revanche, le SKF38393 permet une diminution notable de la somnolence diurne ainsi qu’une restauration du sommeil paradoxal. Finalement, les perturbations monoaminergiques liées à la déplétion en fer ouvrent de multiples perspectives de recherche sur la physiopathologie de la MWE. De même, l’amélioration des troubles veille-sommeil par l’agoniste des récepteurs D1, offre de nouvelles pistes thérapeutiques quant à la prise en charge des troubles du repos dans la MP. L’ensemble de nos résultats apporte un niveau de compréhension supplémentaire quant au rôle de la dopamine dans les altérations du repos. / During this thesis project we explored several aspects of the impact of a dopaminergic system dysregulation on the rest alterations, through two neurological diseases: the Willis-Ekbom’s disease (WED) and Parkinson’s diseases (PD). The WED is a neurological sensorimotor disorder mainly characterized by pain in lower limbs. It preferentially appears in the evening and transiently and partially is alleviated by motor activity. Thus, the first part of this work aimed at reproducing the main dysfunctions of the iron and dopaminergic metabolisms observed in WED, in the macaque monkey. We first established the circadian variations of iron-indicator concentrations in serum and cerebrospinal fluid. Then we developed a rapid protocol based on repeated blood withdrawals, allowing to efficiently induce serum iron depletion. Finally, this protocol enabled us to investigate the relationship between iron metabolism dysfunctions, neurochemical alterations and the subsequent locomotor behavioural changes. In the second part, of this research project we examined the impact of selective D1 (SKF38393) and D2 (quinpirole) receptor agonists on the sleep impairments in a macaque model of PD using the polysomnographic recording technique. Thus we investigated the effects of these two pharmacological compounds on the daytime sleepiness and on the paradoxical sleep induced by MPTP intoxication. Our results demonstrated the inefficacy of quinpirole to restore these two altered sleep parameters. By contrast, SKF38393 significantly decreased daytime napping and substantially restored paradoxical sleep. Finally, the monoaminergic dysregulations, induced by iron depletion, may offer multiple perspectives to unravel the WED pathophysiology. In the same line, the beneficial effects exhibited by the D1 receptor agonist bring new therapeutic avenues to treat sleep-wake disorders in PD. Together, the global results bring new insights in the underlying mechanisms of sleep impairment involving dopamine.

Aims: The overall aim was to determine how lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) affect sleep, health related quality of life and disease specific quality of life, and how the men’s urinary symptoms affect their partners. Subjects and methods: In papers I–II, a descriptive design with a pre-test and post-test was used and in papers III-IV the design was descriptive and comparative. The method was self-administered questionnaires. In papers I- II: The questionnaires were translated in the ethnographic mode. In paper I the reliability of the questionnaire was tested in 122 patients with LUTS/ BPO. The disease specific quality of life was studied before and after intervention in 572 consecutive patients with BPO, aged 45-94 yrs. In paper II, the partner specific quality of life was studied in partners to men with BPO before and after TURP. The reliability and the responsiveness of the questionnaire were tested in two groups with 51 partners each. Papers III-IV: A study of 239 men with LUTS, aged 45-80 yrs, and their partners (n=126) who were compared to randomly selected men from the population (n=213) and their partners (n=131). The men had an extra control group, men with inguinal hernia (n=200). Sleep and health related quality of life was studied in both men and their partners. The partners’ specific quality of life was also studied and the men with LUTS answered questions about urinary symptoms and disease specific quality of life. Results: Papers I-II: All the tested questionnaires showed an acceptable reliability and responsiveness. I: Before and after intervention the prevalence of urinary incontinence was 46 % and 16 % respectively. II: Partners were affected by the patients’ BPO symptoms before and improved after the patients TURPs. III: Most sleep variables were significantly impaired in men with LUTS compared to one or both of the control groups. The men with LUTS had a significantly higher prevalence of insomnia (40 %) than both control groups and significantly lower sleep efficiency (49 %) than men with hernia. The men with LUTS were significantly impaired in most domains of the health related quality of life compared to men in the population. IV: There were no significant differences between the two partner groups regarding the quantity and quality of sleep or the health related quality of life. Conclusions: All tested questionnaires showed an acceptable reliability and responsiveness. The prevalence of urinary incontinence before and after intervention was higher than earlier reported. Men with LUTS had significantly poorer sleep quality, reduced sleep efficiency and a higher prevalence of insomnia than men in the population and men with inguinal hernia. The HRQOL is impaired in men with LUTS compared to men in the population and men with inguinal hernia. Partners are affected by the patients’ symptoms, and it is emotional rather than practical aspects that affect them most. Partners of men with LUTS did not differ significantly from partners in the population with regard to sleep and health related quality of life.

No description available.

Made available in DSpace on 2016-12-06T17:07:01Z (GMT). No. of bitstreams: 1 Joana Carniel - Dissertacao.pdf: 1480883 bytes, checksum: 0e7aa3c6da93e8b4a83835b3d8e72d16 (MD5) Previous issue date: 2014-06-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / During the teenage years, there are significant alterations in the expression of the Sleep-Wake Cycle with great consequences for health. The two main objectives of this study were to validate the Pediatric Daytime Sleepiness Scale (PDSS) for the Brazilian Portuguese and analyze the associations between the matters of health with the variables related to the Sleep-Wake Cycle of teenagers. In order to answer the first objective the sample was formed by 90 teenagers of both sexes, age ranging form 11 to 18 years old, enrolled in two private schools, one in Florianopolis-SC and the other in Curitiba-PR. To answer the second objective, a sample was formed considering a population of teenagers in a private school in Florianopolis-SC (N=198). To validate, the typical process of analysis like translation, back translation and the analysis of internal consistency were used. To evaluate the issues related to the Sleep-Wake Cycle, it was analyzed: time to go to sleep and wake up (day with no classes), the duration of the sleep, the excessive daily somnolence, the chronotype and the quality of the sleep. In the health variables, issues like the perception of health and stress, the consumption of nutrients during school snack, physical activities, time used in media for recreation, BMI and weight status were investigated. Analysis of association, differences between averages and internal consistency were made considering a significance level of 5%. It was checked that the PDSS presented suitable indicators of contents validity and clarity of language in Brazilian Portuguese. The analysis of the internal consistency identified Cronbach`s alpha of 0,784. The PDSS showed suitable reproducibility in test-retest (p=0,725). The scores of the PDSS presented negative and significant interconnection with the duration of the sleep (r= -0,214; p=0,011). In the second objective, it was observed that teenagers who sleep less, show more somnolence (p=0,028), spend more time in front of the screen of electronic devices exercising sedentary behavior (p=0,011) and spend more time commuting to school (p=0,023). Other than that, the results show that the tendency to eveningness is associated to a bigger consumption of carbohydrates in the school snack (p=0,032), with more leisure time in front of the screen of electronic devices (p=0,005) and a bigger BMI (p=0.017). It can be pointed out that health and sleep issues in teenagers have important relations and that the accompaniment of these matters in the school environment is necessary. / Na adolescência, ocorrem significativas alterações na expressão do ciclo vigília/sono com importantes consequências para a saúde. Os dois objetivos principais deste estudo foram, validar a Pediatric Daytime Sleepiness Scale (PDSS) para o português brasileiro e analisar as associações entre as questões de saúde com as variáveis relacionadas ao ciclo vigília/sono de adolescentes. Para responder ao primeiro objetivo a amostra foi formada por 90 adolescentes, de ambos os sexos, com idades de 11 a 18 anos matriculadas em duas escolas particulares, sendo uma em Florianópolis SC e outra em Curitiba PR. Para responder ao segundo objetivo formou-se uma amostra considerando a população de adolescentes de uma escola particular de Florianópolis SC. Para validação utilizou-se o processo típico de análise como, tradução, retrotradução e análise da consistência interna. Para avaliar as questões relacionadas ao ciclo vigília/sono foram analisados: os horários de dormir e acordar (nos dias com e sem aulas), a duração do sono, a sonolência diurna excessiva, o cronotipo e a qualidade do sono. Nas variáveis de saúde foram investigadas questões como a percepção de saúde e estresse, consumo de nutrientes no lanche escolar, atividade física, tempo de utilização de mídias no lazer, IMC e status de peso. Realizaram-se análises de associação, diferenças entre médias e de consistência interna considerando um nível de significância de 5%. Verificou-se que a PDSS apresentou adequados indicadores de validade de conteúdo e clareza de linguagem em português do Brasil. A análise da consistência interna identificou alfa de Cronbach de 0,784. A PDSS apresentou adequada reprodutibilidade em teste-reteste (p=0,725). Os escores da PDSS apresentaram correlação negativa e significativa com a duração do sono (r= -0,214; p=0,023). No segundo objetivou observou-se que os adolescentes que dormem menos tempo apresentam maior sonolência (p=0,028), passam mais tempo em frente às telas de mídias eletrônicas exercendo comportamento sedentário (p=0,011) e possuem maior tempo de deslocamento para a escola (p=0,023). Além disso, os resultados mostram que a tendência a vespertinidade se associou com maior consumo de carboidrato no lanche escolar (p=0,032), com mais tempo do lazer em frente às telas de mídias eletrônicas (p=0,005) e com maior IMC (p=0,017). Destaca-se que as questões de saúde e sono dos adolescentes possuem importantes relações e que o acompanhamento destas questões no ambiente escolar faz-se necessário.

Made available in DSpace on 2014-12-17T14:13:51Z (GMT). No. of bitstreams: 1 SarahLC.pdf: 479103 bytes, checksum: 18505e514106184b131f32d9fea8ec78 (MD5) Previous issue date: 2006-07-19 / To evaluate sleep disorder complaints in outpatients with depressive disorder from a general hospital. Methods: An observational, cross-sectional study was carried out with a study sample composed of 70 patients (44 women and 26 men) with diagnosis of depressive disorder, according to the DSM-IV criteria. The patients were interviewed and evaluated by the Identification Questionnaire, the Sleep Habits Questionnaire and the Beck Depression Inventory (BDI). Results: In this study, 50 (71.3%) patients had recurrence of sleep disorder complaints. Mean BDI score was 35.83+8.85, with significant differences between patients with (38.50+8.70) and without (29.60+7.80) recurrence (p<0.05) and among patients with 1, 2, 3 and >3 episodes (p<0.05). In this study, 49 (70%) patients had insomnia and 21 (30%) had subjective excessive sleepiness. Significant differences were observed between the mean duration in months of the sleep disorders (7.16+2.10) and the depressive disorder (6.12+1.90) (p<0.05). Discussion: In the study sample, recurrence of sleep disorder complaints was high and significantly associated with severe depression. Insomnia was prevalent and the mean duration of sleep disorders was higher in relation to depressive disorder / Identificar e avaliar os transtornos do sono presentes em pacientes ambulatoriais com transtorno depressivo do Hospital Universit?rio Onofre Lopes, Natal, RN. M?todos: Foi realizado um estudo transversal com uma amostra n?o-probabil?stica de 70 pacientes, sendo 26 homens e 44 mulheres, com m?dia de idade de 40,48 + 12,54. A sele??o dos pacientes foi realizada segundo os seguintes crit?rios de inclus?o: idade entre 18 e 65 anos e diagn?stico de transtorno depressivo dado atrav?s de entrevista cl?nica segundo os crit?rios da DSM-IV. Os pacientes foram entrevistados e avaliados atrav?s dos seguintes instrumentos: Ficha de identifica??o e de avalia??o m?dica; Prontu?rios m?dicos; Question?rio de H?bitos do Sono; ?ndice de Qualidade do Sono de Pittsburgh; Escala de Sonol?ncia de Epworth; Invent?rio de Depress?o de Beck; Escala de Idea??o Suicida de Beck. Resultados: Neste estudo, 50 (71,3%) pacientes apresentaram recorr?ncia das queixas de transtornos do sono, que foi associada significativamente ? gravidade do epis?dio depressivo. Um total de 49 (70%) pacientes apresentou ins?nia e 21 (30%) sonol?ncia excessiva. A dura??o m?dia dos transtornos do sono foi maior em rela??o ? do transtorno depressivo. Na amostra, os pacientes apresentaram qualidade subjetiva do sono ruim, principalmente em pacientes com ins?nia. Houve uma associa??o entre a ins?nia e a sonol?ncia excessiva com a idea??o suicida. A sonol?ncia diurna excessiva foi freq?ente nos pacientes com transtorno depressivo e associado significativamente ? gravidade do quadro depressivo e ? idea??o suicida. A preval?ncia de pesadelos nos pacientes foi elevada e relacionada ? gravidade do quadro depressivo. Paralelamente, o Question?rio de H?bitos do Sono, utilizado neste estudo para acessar as queixas de transtornos do sono, foi confi?vel e v?lido para o uso na avalia??o da ins?nia e da sonol?ncia excessiva em pacientes depressivos ambulat?rias. Conclus?es: Houve uma marcante associa??o entre os transtornos do sono, como ins?nia, sonol?ncia excessiva e pesadelos, com o transtorno depressivo, sugerindo que a investiga??o criteriosa dos transtornos do sono ? necess?ria na avalia??o da gravidade do quadro depressivo

Chronic kidney disease (CKD) patients have compromised health related quality of life (HRQOL) by several reasons. This study aimed to evaluate HRQOL on hemodialysis (HD) and peritoneal dialysis (PD) patients and to identify HRQOL associated factors. Methods: We conducted a transversal study with 215 patients on HD and 58 on PD between July and September 2013, in Sergipe, Brazil. HRQOL was assessed using the Kidney Disease Quality of Life Short Form Instrument- 1.3 (KDQOL-SF), consisting of two cores: specific (KDCS) and generic (RAND-36). Additionally demographic and clinical variables directly related to CKD, factors such as mood, sleep disorders and sexual dysfunction were evaluated through specific instruments. Results: Patients had a mean age of 51 years (SD ± 15.4), mostly men (62%), with low educational (72%) and economic (95%) levels. There was no difference related to HRQOL among dialysis modalities, only PD patients felt more stimulated by caring staff than that on HD (p<0.01). The prevalence of depressive (29%) and anxiety (30%) symptoms, poor quality of sleep (56%), excessive daytime sleepiness (43%) and male (48%) and female (76%) sexual dysfunction were high. Multiple linear regression showed that depressive (R= -0.39 p<0.01, R= -0.48 p<0.01) and anxiety (R = -0.41 p <0.01, R = -0.27 p <0.01) symptoms were independently associated with KDCS and RAND-36. Confirmatory factorial analysis models confirmed the association of mood disorders with low HRQOL. High prevalence of anxiety (30%) and depressive symptoms (29%) were revealed. Conclusion: Patients on HD and PD showed no differences in HRQOL. Mood disorders are independently associated with low HRQOL, with high prevalence of anxiety and depressive symptoms in dialysis patients. / Portadores de doença renal crônica (DRC) possuem comprometimento da qualidade de vida relacionada à saúde (QVRS) por diversas razões. Este estudo objetivou avaliar QVRS de pacientes em hemodiálise (HD) e diálise peritoneal (DP) e identificar fatores a ela associados. Casuística e Método: Estudo transversal realizado entre julho e setembro de 2013 com 215 pacientes em HD e 58 em DP, em Sergipe, Brasil. Avaliou-se a QVRS através do questionário Kidney Disease Quality of Life Instrument- Short Form 1.3 (KDQOL-SF), composto por dois núcleos: específico (KDCS) e genérico (RAND-36). Além de variáveis demográficas e clínicas diretamente relacionadas a DRC, foram avaliados fatores como distúrbios de humor, sono e disfunções sexuais através de instrumentos específicos. Resultados: Os pacientes possuíam em média 51 anos (desvio-padrão±15,4), eram na maioria homens (62%), com níveis educacional (72%) e econômico (95%) baixos. Não se evidenciaram diferenças relacionadas à QVRS entre as modalidades dialíticas, apenas pacientes em DP se sentiram mais estimulados pela equipe cuidadora que os em HD (p<0,01). As prevalências de sintomas depressivos (29%), sintomas ansiosos (30%), baixa qualidade de sono (56%), sonolência diurna excessiva (43%) e disfunções sexuais masculina (48%) e feminina (76%) foram altas. Análise por regressão linear múltipla mostrou que sintomas depressivos (R= -0,39 p<0,01; R= -0,48 p<0,01) e ansiosos (R= -0,41 p<0,01; R= -0,27 p<0,01) foram fatores independentemente associados aos núcleos KDCS e RAND-36. Modelos de análise fatorial corroboraram a associação dos distúrbios de humor com baixa QVRS. Evidenciou-se alta prevalência de sintomas ansiosos (30%) e depressivos (29%). Conclusão: Pacientes em HD e DP não apresentaram diferenças na percepção de QVRS. Os distúrbios de humor foram fatores independentemente associados à baixa QVRS, com alta prevalência de sintomas ansiosos e depressivos em pacientes em diálise.

Síndrome das pernas inquietas (SPI) é um distúrbio do sono com alta prevalência entre pacientes em hemodiálise, nos quais o mecanismo é pouco conhecido. Tem sido postulado que alterações do metabolismo mineral e ósseo relacionadasà doença renal crônica, especialmente o hiperparatireoidismo secundário, possam estar relacionadas à patogênese da SPI. Este trabalho teve como objetivo principal avaliar a SPI antes e após paratireoidectomia (PTX). Além disso, avaliamos dados objetivos do sono por meio de polissonografia, com ênfase em apneia do sono. Estudamos prospectivamente 19 pacientes (6 homens, idade 48 ± 11 anos) com hiperparatireoidismo grave pré e pós-PTX. O diagnóstico e o escore de gravidade da SPI foram avaliados de acordo com o Grupo de Estudo Internacional de SPI. Polissonografia pré e pós-PTX forneceu dados de arquitetura do sono, movimentos periódicos de pernas e apneia do sono, medida por meio do índice de apneia-hipopneia/hora de sono (IAH). SPI foi encontrada em 10 pacientes (53%) e se associou com maiores níveis de fosfato (p=0,005) e maior gravidade da dor (p=0,003). Após a PTX, houve redução dos níveis séricos de paratormônio, fosfato e aumento dos níveis de 25-hidroxivitamina D, calicreína-6 e fetuína-A. A PTX reduziu a SPI para 21% (p=0,044), acompanhada por redução nos escores de gravidade e alívio da dor e do prurido. A análise de regressão logística mostrou que o fosfato pré-PTX permaneceu independentemente associado com SPI (OR=7,28; p=0,035), em modelo ajustado para hemoglobina, idade e sexo. Apneia do sono (IAH > 5) foi encontrada em 11 pacientes pré e 14 pós-PTX (63% vs. 74%, p=0,698). Observamos uma correlação entre o IAH e a relação água corporal extracelular/massa magra (r=0,535, p=0,018), assim como correlação com a circunferência do pescoço pré-PTX (r=0,471, p=0,042). Entretanto, não observamos correlação do IAH com o deslocamento de fluidos da perna direita durante o sono (p=0,09), que aumentou significativamente após PTX (p=0,011). Concluímos que a PTX melhora a SPI, com cura completa ou melhora significativa. Se essa melhora está relacionada à diminuição do paratormônio ou do fósforo necessita de investigação adicional. Além disso, o presente estudo confirma a alta prevalência de apneia do sono entre pacientes em hemodiálise, o que não se modificou com a PTX / Restless legs syndrome (RLS) is a sleep disorder with high prevalence among patients on hemodialysis, which underlying mechanism is still unknown. It has been postulate that bone metabolism disorder, especially secondary hyperparathyroidism may be implicated in the pathogenesis. The present study aimed to evaluate RLS before and after parathyroidectomy (PTX). In addition, we evaluated objective data through polysomnography, focusing on sleep apnea. We prospectively evaluated 19 patients (6 men, aged 48 ± 11 years) with severe hyperparathyroidism pre and post-surgical treatment, parathyroidectomy (PTX). RLS diagnosis and rating scale were accessed based on the International RLS Study Group. Polysomnography pre and post PTX provided data on sleep architecture, periodic leg movements of sleep and apnea-hypopnea index (AHI). RLS was observed in 10 patients (53%), and was associated with higher levels of phosphate (p=0,005) and severe pain (p=0,003). After PTX, there was a reduction of serum parathyroid hormone, serum phosphate, and an increase of 25hydroxyvitamin D, kallicrein-6 and Fetuin-A. PTX improved RLS to 21% (p=0,04), accompanied by a decrease in rating scale, in association with alleviation of pain and pruritus. Logistic regression shows that serum phosphate pre PTX remained independently associated with RLS (HR=7,28; p=0,035), in a model adjusted for hemoglobin, age and gender. Sleep apnea (AHI > 5) was found in 11 patients pre and 14 patients post PTX (63% vs. 74%, p=0,698). There was a correlation between AHI and the relation extracellular water/ lean body mass (r=0,535; p=0,018) as well as a correlation between AHI and neck circumference (r=0,471; p=0,042). However, there was no correlation between AHI and spontaneous rostral fluid shift (p=0,09) that has increased after PTX (p=0,011). We concluded that PTX provided an opportunity to improve RLS. Whether RLS may be improved by reduction of serum phosphorus or parathyroid hormone, merits further investigation. In addition, PTX had no impact on the high prevalence of sleep apnea in this population

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.

Abstract Depression, anxiety and sleep disorders have been reported to be associated with low level of inflammation, i.e., low-grade inflammation, but mainly in males. The evidence has mainly been based on laboratory or clinical studies with small sample sizes or epidemiological studies with elderly subpopulations. In this study the association of low-grade inflammation with depression, anxiety, and sleep disturbances was investigated using the Northern Finland 1966 Birth Cohort (NFBC 1966). In women, the effect of hormonal factors, menopause and the use of oral contraceptives/hormone replacement therapy on the association between low-grade inflammation and depression was also studied by using the Pieksämäki Study data. In 31-year follow-up of NFBC 1966 (N=6007), the depressive and anxiety symptoms were assessed by Hopkins Symptom Checklist-25 (HSCL-25) and sleep disorders by 15-D questionnaires, while the marker of low-grade inflammation, plasma concentration of high sensitivity C-reactive protein (hs-CRP), was measured. In the Pieksämäki study a representative sample of inhabitants in the town of Pieksämäki were invited to clinical examination. Depressive symptoms were obtained by Beck’s Depression Inventory-21, and hs-CRP was measured (512 women). The results of this study revealed that at epidemiological level, elevated hs CRP levels of &#8805;1.0 mg/L increased the probability of current depressive symptoms of single depressive episode in the two highest subgroups (i.e., HSCL-25 mean scores &#8805;1.75 and &#8805;2.01) 1.4- and 1.7- fold in males, respectively. In addition, anxiety symptoms (HSCL-25 anxiety scale mean score &#8805;1.75) increased independently the probability of elevated hs-CRP levels (&#62;3.0 mg/L) in males over 2-fold. Risk ratio of 1.3 was found for males with moderate to severe sleep disturbances and elevated hs-CRP levels (&#8805;1.0 mg/L). Regarding females, a positive correlation between elevated hs-CRP levels and depressive symptoms was found only among peri- and postmenopausal women not using exogenous hormones. The results suggest that low-grade inflammation is associated not only with depression but also with anxiety and sleep disturbances in young adult men. In women, hormonal factors may have an effect on the association between low-grade inflammation and depression. Further investigations are called for to confirm these findings and furthermore, to determine the possible role of low-grade inflammation in the pathophysiology of these disorders. / Tiivistelmä Depressio, ahdistuneisuushäiriöt ja unihäiriöt on yhdistetty elimistön matala-asteiseen tulehdustilaan, joskin pääasiallisesti vain miehillä. Tulosten yleistettävyyttä ovat rajoittaneet tutkimusten pienet otoskoot tai painottuminen iäkkäisiin väestöaineistoihin. Tässä tutkimuksessa selvitettiin matala-asteisen tulehduksen yhteyttä depressioon, ahdistuneisuuteen ja unihäiriöihin Pohjois-Suomen syntymäkohortti 1966 -aineistossa. Lisäksi Pieksämäki-tutkimuksen aineistossa selvitettiin naisilla menopaussin ja ehkäisyvalmisteiden/vaihdevuosihormonikorvaushoidon vaikutusta depression ja matala-asteisen tulehduksen väliseen yhteyteen. Pohjois-Suomen syntymäkohortti 1966 -tutkimuksen 31-vuotisseurannassa kartoitettiin 6007 henkilöltä masennus- ja ahdistuneisuusoireita Hopkins Symptom Checklist-25 -arviointiasteikolla (HSCL-25) ja unihäiriöitä 15-D-kyselyllä. Lisäksi mitattiin matala-asteisen tulehduksen mittarina käytetyn herkän C-reaktiivisen proteiinin (CRP) pitoisuus. Pieksämäki-tutkimuksessa edustava otos Pieksämäen asukkaista kutsuttiin kliiniseen tutkimukseen ja depressiivisiä oireita kartoitettiin Beckin 21-osioisella arviointiasteikolla ja mitattiin herkkä CRP (512 naista). Nuorilla aikuisilla miehillä, joiden herkkä CRP oli kohonnut (&#8805;1.0 mg/l), todettiin 1.7-kertainen masennusoireiden riski, kun katkaisupisteenä käytettiin HSCL-25-kyselyn masennuskeskiarvopistettä &#8805;2.01. Ahdistuneisuusoireet (HSCL-25-kyselyn ahdistuneisuuskeskiarvopisteet &#8805;1.75) lisäsivät kohonneen herkän CRP:n riskiä (&#62;3.0 mg/l) yli kaksinkertaiseksi miehillä. Keskivaikeasta tai vaikeasta unihäiriöstä kärsivillä todettiin 1.3-kertainen kohonneen herkän CRP:n (&#8805;1.0 mg/l) riski. Naisilla positiivinen yhteys masennuksen ja kohonneen herkän CRP:n välillä todettiin vain peri- ja postmenopausaalisilla naisilla, jotka eivät käyttäneet hormonikorvaushoitoa tai suun kautta otettavia ehkäisyvalmisteita. Tutkimustulokset viittaavat matala-asteisen tulehduksen liittyvän depressioon, ahdistukseen ja unihäiriöön nuorilla aikuisilla miehillä. Naisilla hormonaaliset seikat mahdollisesti vaikuttavat depression ja matala-asteisen tulehduksen väliseen yhteyteen. Tulevaisuuden tutkimushaasteena on selvittää matala-asteisen inflammaation mahdollinen merkitys depression, ahdistuneisuuden ja unihäiriöiden patofysiologiassa.