Fibromialgia é uma síndrome reumática caracterizada por dores musculosqueléticas generalizadas e crônicas, associadas à presença de tender points, fadiga, distúrbios do sono e rigidez matinal com freqüente impacto na capacidade funcional e qualidade de vida. Estudos apontam prevalência em torno de 2% e 3% na população adulta. Este trabalho teve como objetivo avaliar a prevalência de Fibromialgia, sintomas associados e impacto na capacidade funcional e qualidade de vida, na população do município de Embu, SP. A amostra foi selecionada entre os indivíduos cadastrados nas Unidades Básicas de Saúde de Embu no ano de 2003, com idade entre 35 e 60 anos. Dos 2269 sujeitos com telefone, 768 foram entrevistados sobre a presença, localização e tempo de dor. Destes, 304 compareceram para a avaliação pessoalmente que consistia na dolorimetria dos tender points; avaliação da dor pela Escala Analógica Visual (VAS), dos distúrbio do sono pelo Post Sleep Inventory (PSI), da fadiga pela Chalder Fatigue Scale, da capacidade funcional pelo Stanford Health Questionnaire (HAQ) e da qualidade de vida pelo Fibromialgia Impact Questionnaire (FIQ). Para a análise dos dados utilizou-se Análise Descritiva, Estimação Baeysiana, Análise Inferencial (Kruskal- Wallis, Friedmam e ANOVA, com nível de significância de 5%), Tabelas de Contingência e Probabilidade Condicional. Os 768 sujeitos foram classificados em quatro os grupos: Sem Dor (SD) - 185 indivíduos; Dor Regional ou localizada (DR) - 388 indivíduos; Dor Generalizada (DG) segundo o Colégio Américo de Reumatologia (ACR) - 195 indivíduos. Esta classificação nos 304 sujeitos avaliados com exceção dos 106 com DG e crônica dos quais 19 foram classificados como Fibromialgia (FM). A média de idade foi 47,9 (7,2) na amostra total e 49,1 (6,8) na sub-amostra. A prevalência de dor generalizada e crônica foi de 24% com IC95% [21%; 27%] e a de Fibromialgia de 4,4% com IC 95% [2,6%; 6,3%]. Todos os sintomas avaliados são mais intensos no grupo FM, seguido pelo de DG. As maiores probabilidades de coincidências entre a classificação dos grupos e a dos questionários são dadas pelos índices da VAS, HAQ, FIQ e, principalmente, pelo índice geral (média dos demais índices). Esta forma de avaliação tem probabilidade alta (94%) de identificar os sujeitos sem fibromialgia e revelante (67%) para os possíveis fibromiálgicos / Fibromyalgia is a rheumatic syndrome characterized by chronic widespread pain, tender points, fatigue, sleep disorders and morning stiffness. Functional Disability and negative impact in the quality of life are frequent. Studies show a fibromyalgia prevalence around 2% and 3%. The aim of this study was to assess the prevalence of fibromyalgia, associated symptoms, functional disability and quality of life in residents of Embu, SP, Brazil. The sample was selected in individuals of the primary health care, aged by 35 and 60 years old. Of all 2269 subjects with phone number, we interviewed 768 with questions about presence of pain, pain location and time of pain. Of these subjects, 304 were personally evaluated, including tender points examination and assessment of pain by the Visual Analogue Scale (VAS), sleep disorders by the Post Sleep Inventory (PSI), fatigue by the Chalder Fatigue Scale, functional disability by Stanford Health Assessment Questionnaire (HAQ) and quality life by the Fibromyalgia Impact Questionnaire (FIQ). The data were analysed using Descriptive, Baeysian and Interferential Analyses (Kruskal-Wallis, Friedmam, ANOVA, with significance level of 5%), Contingence Tables and Conditional Probabilities. The 768 subjects were distributed in three groups: Without Pain (WP) - 185 individuals, Regional Pain (RP) - 388 individuals and Widespread pain (WpP). In the sub-sample of 304 subjects, the groups of chronic widespread pain were classified in Fibromyalgia (FM), with 19 subjects, and Non-Fibromyalgia, with 87 subjects. The mean age was 47,9 (7,2) years old for 768 sample and 49,1 (6,8) for the 304 sub-sample. The prevalence of chronic widespread pain was 24%, with 95% credibility interval [21%; 27%] and fibromyalgia prevalence was 4,4%, with 95% credibility interval [2,6%; 6,3%]. Pain, sleep disorders, fatigue, functional disability and quality of life were worse in the FM Group, followed by WpP, RP and WP. The major probability coincidence were obtained by VAS, HAQ FIQ and Global indices (mean of all questionnaires). This kind of assessment has high probability (94%) to identify non-fibromyalgia individuals and considerable (67%) to possible fibromyalgia patients

Made available in DSpace on 2016-04-04T18:28:16Z (GMT). No. of bitstreams: 1 Micheli Aparecida Gomes dos Santos.pdf: 4751573 bytes, checksum: 7ca8f16261c512805eef4512cc814ae4 (MD5) Previous issue date: 2014-02-18 / Pontif?cia Universidade Cat?lica de Campinas / The aim of this study was to evaluate and compare the level of stress and anxiety in a sample of patients with obstructive sleep apnea syndrome (OSAS) before and after a month of medical or surgical treatment. To collect the data were used the ISSL - Inventory of Stress Symptoms for Adults Lipp, the Beck Anxiety Scale (BAI), answered twice, once before the start of treatment and another, one month after the start of the treatment, and a sociodemographic questionnaire. The sample consisted of 18 patients, 13 men and 5 women, aged between 26 and 74 years (Mean=51,83, SD=13,46). The assessment showed that 77,8% (n=14) of patients had stress on the first evaluation, and such amount was reduced to 16,7% (n=3) in the second evaluation after treatment. Thus, patients showed a significant decrease in mean stress symptoms after treatment (z=-3,53, p<0,000). In relation to anxiety , 44,4% of participants had a minimum degree of anxiety symptoms at the first assessment, although were present mild, moderate and severe degrees. In the second assessment serious cases disappear and there was a significant decrease in moderate cases. Patients showed a significant decrease in mean anxiety symptoms of post-treatment (z=-3,51, p<0,000). Patients with moderate apnea showed a significant decrease in mean stress (z=-2,971, p<0,003) and anxiety symptoms (z=-2,032, p<0,042) of post-treatment. The same occurred in relation to stress (z=-2,023, p<0,043) and anxiety (z=-2,944, p<0,003) in patients with severe apnea. Furthermore, women showed no significant improvement in the symptoms of post-treatment in stress (z=-1,633; p=0,102) and anxiety (z=-1,625; p=0,104) symptoms, while men had reduced the symptoms of stress (z=-3,184; p=0,001) and anxiety (z=-3,062; p=0,001). The research of the type of treatment showed significant improvement in stress (z=- 3,21, p=0,001) and anxiety symptoms (z= -3,17, p=0,001) in patients who were treated with CPAP . Already in the surgical group, no significant differences in any of the constructs assessed were noted. Thus it was possible to see that the patients showed significant improvement in symptoms of stress and anxiety in the second evaluation, in order to be able to say to this group of individuals, that treatment had the desired effect, being effective in improving symptoms of stress and anxiety for the general sample for the two levels (moderate and severe) illness, for males and for patients who were treated with CPAP. / O objetivo deste estudo foi avaliar e comparar o n?vel de stress e de ansiedade em uma amostra de portadores da S?ndrome da Apneia Obstrutiva do Sono (SAOS), antes e ap?s um m?s de tratamento cl?nico ou cir?rgico. Para a coleta dos dados foram utilizados o ISSL -Invent?rio de Sintomas de Stress para Adultos de Lipp, a Escala de Ansiedade de Beck (BAI), respondidos duas vezes, uma antes do in?cio do tratamento e outra, um m?s ap?s o in?cio do mesmo, al?m de um question?rio sociodemogr?fico. A amostra foi composta por 18 pacientes, sendo 13 homens e 5 mulheres, com idade entre 26 e 74 anos (M?dia=51,83; DP=13,46). A avalia??o demonstrou que 77,8% (n=14) dos pacientes apresentavam stress na primeira avalia??o, sendo que tal valor foi reduzido para 16,7% (n=3) na segunda avalia??o, ap?s tratamento. Assim, pacientes apresentaram uma diminui??o significativa na m?dia de sintomas de stress p?s-tratamento (z=-3,53, p<0,000). Em rela??o ? ansiedade, 44,4% dos participantes apresentavam grau m?nimo de sintomas de ansiedade na primeira avalia??o, embora se fizessem presentes graus leve, moderado e grave. Na segunda avalia??o os casos graves desaparecem e houve uma importante diminui??o nos casos moderados. Os pacientes apresentaram uma diminui??o significativa na m?dia de sintomas de ansiedade p?s-tratamento (z=-3,51, p<0,000). Pacientes com SAOS moderada apresentaram uma diminui??o significativa na m?dia de sintomas de stress (z=-2,971, p<0,003) e sintomas de ansiedade (z=-2,032, p<0,042) p?s-tratamento. O mesmo ocorreu em rela??o em rela??o ao stress (z=-2,023, p<0,043) e ansiedade (z=-2,944, p<0,003) dos pacientes com SAOS grave. Por outro lado, mulheres n?o apresentaram melhora significativa nos sintomas de stress p?s-tratamento (z=-1,633; p=0,102) e nem na ansiedade (z=-1,625; p=0,104), ao passo que os homens obtiveram diminui??o dos sintomas de stress (z=-3,184; p=0,001) e ansiedade (z=-3,062; p=0,001). A investiga??o do tipo de tratamento indicou melhora significativa nos sintomas de stress (z=-3,21, p=0,001) e ansiedade (z= -3,17, p=0,001) nos pacientes que fizeram tratamento com CPAP. J? no grupo cir?rgico n?o foram notadas diferen?as significativas em nenhum dos construtos avaliados. Desse modo foi poss?vel visualizar que os pacientes demonstraram melhora significativa nos sintomas de stress e ansiedade na segunda avalia??o, de modo a se poder afirmar, para esse grupo de indiv?duos, que o tratamento teve o efeito desejado, sendo eficaz na melhora dos sintomas de stress e ansiedade para a amostra geral, para os dois n?veis da doen?a (moderada e grave), para o sexo masculino e para os pacientes que fizeram tratamento com CPAP.

INTRODUÇÃO: O transtorno bipolar é caracterizado por episódios alternados e recorrentes de mania ou hipomania com depressão e períodos de eutimia, com prevalência entre 1% e 8% na população geral. Os transtornos mentais influenciam consideravelmente a qualidade de vida, prejudicando as relações familiares, sociais e ocupacionais. O sono que influi diretamente na qualidade de vida, também pode alterar-se no transtorno bipolar. OBJETIVOS: a) Verificar se existe diferença entre a percepção da qualidade de vida e qualidade do sono em portadores de transtorno bipolar quando comparados a um grupo-controle; b) verificar a associação entre qualidade de vida e qualidade do sono em cada grupo; c) avaliar a intensidade de sintomas depressivos e de ansiedade e verificar se essas variáveis são diferentes entre os grupos; d) investigar se existe associação dos sintomas depressivos e de ansiedade na qualidade de vida e na qualidade do sono; e) verificar se a latência, duração e eficiência do sono nos maus dormidores do grupo-estudo são diferentes dos maus dormidores do grupo-controle. MÉTODOS: A pesquisa foi do tipo caso-controle e a amostra foi caracterizada como não probabilística por conveniência. Grupoestudo (n=43) e grupo-controle (n=80). A seleção do grupo-estudo seguiu os seguintes critérios de inclusão: pessoas com transtorno bipolar na fase estabilizada que participavam do grupo de psicoeducação em um Hospital Dia Psiquiátrico, idade entre 25 e 60 anos, diagnóstico de transtorno bipolar tipo I ou II, de acordo com os critérios diagnósticos do Manual Diagnóstico e Estatístico de Transtornos Mentais IV-Revisão, em uso de estabilizador do humor e ausência de co-morbidade psiquiátrica. Foram excluídos os controles com quaisquer diagnósticos psiquiátricos do eixo I, do Manual Diagnóstico e Estatístico de Transtornos Mentais IV-Revisão. O projeto foi aprovado pelo Comitê de Ética do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Os instrumentos utilizados foram: Índice de Qualidade do Sono de Pittsburgh, Inventário de Depressão de Beck, Inventário de Ansiedade de Beck, Questionário de Qualidade de Vida da Organização Mundial da Saúde, Entrevista Clínica Estruturada para o Manual Diagnóstico e Estatístico de Transtornos Mentais IV-Revisão, Escala de Avaliação de Mania Modificada e o Critério de Classificação Econômica Brasil. RESULTADOS: Encontrou-se diferença significativa em relação à qualidade do sono (p=0,045). As diferenças não foram significativas para qualidade de vida (p=0,154), sintomas depressivos (p=0,480) e sintomas de ansiedade (p=0,484). As variáveis qualidade do sono e qualidade de vida apresentaram correlação significativa tanto para o grupo-estudo (p<0,001; r=0,534) quanto para o grupo-controle (p<0,001; r=0,382). Foram encontradas diferenças significativas na latência e duração do sono nos subgrupos de maus dormidores (p=0,026 e p=0,001; respectivamente). CONCLUSÃO: As pessoas com transtorno bipolar apresentaram percepção da qualidade de vida, intensidade de sintomas depressivos e de ansiedade semelhantes às de pessoas não afetadas por este transtorno, porém com pior qualidade do sono. Houve associação diretamente proporcional entre as variáveis: qualidade do sono e qualidade de vida. No subgrupo de maus dormidores do grupo-estudo, a latência e duração do sono estiveram aumentadas comparadas com o subgrupo de maus dormidores do grupo-controle. / INTRODUCTION: The bipolar disorder is characterized by alternating and recurrent episodes of mania and hypomania with depression and periods of euthymia, with prevalence between 1 and 8% in the general population. The mental disorders influence the quality of life considerably, disturbing familiar, social and occupational relations. Sleep is also associated with the quality of life; moreover, it can be modified in bipolar disorder. OBJECTIVES: a) To verify if there is a difference between the perception of the quality of life and the quality of sleep in bipolar disorder when compared with a control-group; b) to verify the association between quality of life and quality of sleep in each group; c) to evaluate the intensity of depressive and anxiety symptoms and verify if these variables are different between the groups; d) to investigate possible association of depressive and anxiety symptoms in quality of life and quality of sleep; e) to verify if latency, duration and efficiency of sleep in the bad sleepers of the study-group are different from those of bad sleepers in the control-group. METHODS: The kind of research was case-control and the sample was characterized as a no-probability for convenience. Study-group (n=43) and control-group (n=80). The selection for the study-group had the following criteria of inclusion: patients with bipolar disorder in the stabilized phase who took part of the group of psychoeducation in a Psychiatric Hospital, age between 25 and 60, diagnostic of bipolar disorder, according to the criteria diagnostics of Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, in use of stabilizer of mood and absence of psychiatric comorbidity. The project has been approved by the Committee of Ethic of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, da Universidade de São Paulo, Brazil. The instruments used in this process were: Pittsburgh Sleep Quality Index, Beck Depression Inventory, Beck Anxiety Inventory, World Health Organization Quality of Life Assessment, Clinical Interview Structuralized for the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Modified Scale of Mania Evaluation and Brazilian Criteria of Economic Classification. RESULTS: a significant difference in the quality of sleep (p=0.045) has been found. The differences werent significant for the variables: quality of life (p=0.154), depressive symptoms (p=0.480) and anxiety symptoms (p=0.154). The variables quality of sleep and quality of life presented a significant correlation to both studygroup (p<0.001; r=0.534) and control-group (p<0.001: r=0.382). Significant differences in latency and duration of sleep in the subgroup of bad sleepers (p=0.026 and p=0.001, respectively) have been found. CONCLUSION: Patients with bipolar disorder presented perception of the quality of life, intensity of depressive and anxiety symptoms similar to those of subjects in the control-group not affected by this disorder. There has been a direct proportional association between the variables quality of sleep and quality of life. In the sub-group of bad sleepers in the study-group, the latency and duration of sleep had been increased compared to those in the sub-group of bad sleepers in the control-group.

Introdução: A apnéia central do sono e a apnéia obstrutiva do sono (ACS e AOS, respectivamente) são comuns em pacientes com insuficiência cardíaca com disfunção sistólica (ICC). No entanto, vários fatores que levam a instabilidade respiratória incluindo baixo débito cardíaco, congestão pulmonar e hipocapnia coexistem nestes pacientes. Pacientes com valvopatias (VAL) com alta pressão de capilar pulmonar (PCP) e com fração de ejeção (FE) de ventrículo esquerdo normal representam um modelo adequado para elucidar a gênese da apnéia do sono. Objetivos: Comparar as características dos distúrbios respiratórios do sono em pacientes com VAL e pacientes com ICC. Métodos: Pacientes com VAL com PCP > 12 mmHg e pacientes com ICC foram avaliados por, gasometria arterial, ecocardiograma e polissonografia. Resultados: Pacientes com VAL (n=17, PCP 24 ± 9 mmHg e FE 61 ± 6 %) e ICC (n=17, FE 31 ± 10 %) eram semelhantes quanto as características demográficas e gases arteriais (idade: 46 ± 10 versus 47 ± 9, sexo feminino: 11 em ambos os grupos, índice de massa corporal: 26 ± 5 vs 26 ± 6 Kg/m2, PaCO2: 34 ± 3 vs 35 ± 4 mmHg, respectivamente). Pacientes com VAL apresentaram índice de apnéia-hipopnéia (IAH) significativamente menor do que pacientes com ICC (10 ± 8 e 26 ± 25 eventos/hora, p=0,0179) e uma menor prevalência de apnéia do sono (IAH > 15 eventos/hora, 29% e 53%, p=0,0009). Dentre os pacientes com apnéia do sono, os pacientes com VAL apresentaram predominantemente AOS (60%) enquanto os pacientes com ICC apresentaram predominantemente ACS (89%, p < 0,0001). Conclusões: Pacientes com VAL e alta PCP e FE normal apresentam apnéia do sono menos grave e com excesso de eventos de origem obstrutiva quando comparados com pacientes com ICC. Congestão pulmonar e hipocapnia não explicam completamente a presença de ACS em pacientes com doenças cardíacas / Introduction: Central and obstructive sleep apnea (CSA and OSA, respectively) are common in patients with systolic congestive heart failure (ICC). However, several factors leading to respiratory instability, including low cardiac output, pulmonary congestion and hypocapnia co-exist in these patients. Patients with valvular heart disease (VAL) with high pulmonary capillary wedge pressure (PCWP) but normal resting left ventricular ejection fraction (LVEF) may provide insights into the genesis of sleep apnea. Objectives: Compare sleep disordered breathing characteristics in patients with VAL and patients with ICC. Methods: Patients with VAL and PCWP > 12 mmHg and ICC were evaluated by awake arterial blood gas analysis, echocardiogram and overnight polysomnography. Results: Patients with VAL (n=17, PCP=24 ± 9 mmHg and LVEF=61 ± 6 %) and ICC (n=17, LVEF=31 ± 10 %) were similar for demographics and blood gases (age: 46 ± 10 vs 47 ± 9, females: 11 in both groups, body mass index: 26 ± 5 Kg/m2 vs 26 ± 6, PaCO2: 34 ± 3 vs 35 ± 4 mmHg, respectively). Patients with VAL as compared to patients with ICC presented significantly lower apnea hypopnea index (10 ± 8 vs 26 ± 25 events/hour, p=0.0179), a lower prevalence of sleep apnea (apnea-hypopnea index > 15 events/hour) 29% vs 53%, p=0.0009, and among patients with sleep apnea the nature was predominantly OSA (60%) while patients with ICC had predominantly CSA (89%, p < 0.0001). Conclusion: Patients with VAL and high PCWP had a less severe sleep apnea and an excess of obstructive events when compared to patients ICC. Pulmonary congestion and hypocapnia do not completely explain CSA in patients with heart diseases

Les troubles du comportement en sommeil paradoxal (TCSP) ont été individualisés comme un type de parasomnie par Carlos Schenck en 1986. Il s’agit d’une parasomnie caractérisée par l’absence d’atonie musculaire pendant le sommeil paradoxal associée à l’apparition de mouvements anormaux allant de simples secousses à des comportements élaborés souvent violents. Ces comportements dépendent de l’activité onirique et sont décrits comme une « mise en acte des rêves ». Les TCSP sont fréquents dans la maladie de Parkinson. Les patients parkinsoniens ayant des TCSP ont des troubles cognitifs plus importants et ont un risque de démence plus important que les autres patients. Les TCSP peuvent également se présenter de manière isolée, sans aucune cause pathologique apparente. Ils sont alors considérés comme « idiopathiques » (TCSPi). Ce terme « idiopathique » a néanmoins été remis en cause du fait de la présence de nombreux signes évocateurs d’une synucléinopathie chez ces patients (affaiblissement des performances cognitives, anomalies cérébrales structurales et fonctionnelles). De nombreux patients ayant des TCSP initialement considérés comme idiopathiques, vont développer un syndrome parkinsonien et/ou une démence après plusieurs années d’évolution. Une étude récente rapporte que cela concerne 81 % des patients après 16 ans de suivi. Ces données ont conduit à l’hypothèse selon laquelle les TCSP seraient un symptôme révélant les stades précoces « non-moteurs » de la MP. Les agrégats pathologiques d’alpha-synucléine touchant les structures du tronc cérébral seraient à l’origine de l’apparition de TCSP avant même le syndrome parkinsonien. Cette chronologie dans les stades d’évolution de la MP (pré-clinique, pré-moteur, moteur, démence) ne semble néanmoins pas être retrouvée chez tous les patients parkinsoniens. Elle révèlerait plutôt un certain sous-type de MP, caractérisée par de nombreux symptômes non-moteurs précédant le syndrome parkinsonien et par un risque accru de démence précoce. Parmi ces symptômes non moteurs, les troubles cognitifs seraient importants et toucheraient notamment le fonctionnement visuo-perceptif. Ce travail a eu pour objectif d’étudier le lien entre les TCSP, les troubles visuo-perceptifs et la maladie de Parkinson. Dans une première étude, des évaluations spécifiques des fonctions visuo-spatiales ont permis de mettre en évidence des troubles visuo-perceptifs chez les patients ayant des TCSPi. Les patients parkinsoniens ayant des TCSP avaient des troubles visuo-perceptifs plus marqués que ceux n’ayant pas de TCSP. Les résultats ont également permis d’identifier la nature des troubles visuo-perceptifs. Les processus intermédiaires de traitement de l’information visuelle semblent spécifiquement touchés dans ces groupes de patients.La deuxième partie de notre travail a été consacrée à l’exploration des corrélats neurophysiologiques de cette atteinte perceptive chez les patients ayant des TCSPi. Cette étude était basée sur l’analyse d’un potentiel évoqué cognitif : la Ncl (negativity associated with closure) décrite comme un marqueur de notre capacité à reconnaître des objets partiellement occultés ; autrement dit, une composante générée par la mise en jeu des processus intermédiaires de traitement de l’information visuelle. L’absence de Ncl observée chez les patients ayant des TCSPi est compatible avec l’hypothèse d’un dysfonctionnement des régions du Lateral occipital complex (LOC) situées sur la voie ventrale de traitement de l’information visuelle. [...] / Rapid eye movement sleep behavior disorder (RBD) has been recognized formally as a parasomnia in 1986 by Carlos Schenck. RBD is characterized by loss of normal muscle atonia during rapid eye movement sleep, associated with motor activity from simple jerks to elaborate, often violent, behaviors. This motor activity occurs while dreaming, and has been described as “acting out dreams”. RBD are frequent in Parkinson’s disease (PD). PD patients with RBD show more severe cognitive disorders and have a higher risk of developing dementia than patients without RBD. When isolated and with no identified pathological etiology, RBD are considered as “idiopathic” (iRBD). This “idiopathic” form has been questioned due to the presence of markers of neurodegeneration (cognitive disorders, structural and functional cerebral abnormalities) in iRBD patients. A quite large number of iRBD patients will eventually develop parkinsonism and/or dementia after several years. A recent study reports a delayed emergence of parkinsonism/dementia in 81 % of iRBD patients with a mean interval of 14 years from onset of RBD. These data has leaded to consider RBD as a symptom of the PD “pre-motor” stage. This classic progression of PD staging (pre-clinic, pre-motor, motor, dementia) is not found in every PD patient. It would rather reveal a specific PD sub-type characterized by many non-motor symptoms preceding parkinsonism and with a higher risk of early dementia. Cognitive disorders would be one of these non-motor symptoms, especially affecting visual perception. The goal of this doctoral dissertation was to study the relationship between RBD, visual perception disorders and PD. The first study aimed at identifying the nature of visual perception disorders in iRBD patients, based on specific assessments of visuo-spatial functions. The results showed a deficit of the intermediate stage of visual perception in iRBD patients. PD patients had a similar deficit which was more severe when associated with RBD. The second study focused on the analysis of the possible cerebral dysfunction underlying this visual perception deficit in iRBD patients. This study was based on the recording of the Ncl (negativity associated with closure), a cognitive event-related potential indexing the ability to recognize an object even partially occulted, mainly based on the intermediate stage of object processing. The results showed no Ncl component in iRBD patients. This is in line with a cerebral dysfunction located in the lateral occipital complex (LOC), a region belonging to the ventral visual pathway. The third study examined the cognitive profile of treatment-naïve PD patients, first at the time of diagnosis and then one year later. Previous published data demonstrated that the presence of RBD is associated with more severe cognitive disorders in treated PD patients. Based on the first assessments of our group of treatment-naïve patients, we examined whether these differences already exist at the time of diagnosis. The objective of the second evaluation session was to determine whether PD patients with RBD had a higher risk of early severe cognitive impairments than non-RBD patients. At the first session, 17 of the 57 patients (30%) met the criteria for RBD. At that time, RBD was not found to be associated with cognitive decline. We did not find clinical differences related to PD or others sleep disorders between RBD and non-RBD PD patients. Some yet isolated results might reflect a trend towards a potential decline in RBD patients. At the second session, only RBD patients but not non-RBD patients showed a cognitive slowing. RBD patients may also have a trend toward apathy. A longer follow-up study is needed to confirm this trend. [...]

Les troubles du sommeil, tels que la somnolence diurne excessive et les attaques narcoleptiques, sont fréquemment observés chez les patients Parkinsoniens. Malgré de nombreux efforts cliniques à l’échelle mondiale, il reste à déterminer si ces troubles sont causés par les lésions neuronales dopaminergiques (DAergiques) ou non DAergiques, par les troubles moteurs ou par les effets délétères des médicaments anti-parkinsoniens. Par une approche pluridisciplinaire (analyse EEG; mesure de l’activité locomotrice; tests pharmacologiques; immunohistochimie) chez le félin traité au MPTP, nous avons étudié la corrélation possible entre perte DAergique et troubles du cycle veille-sommeil (V/S). Le MPTP (5mg/kg/jour x5, i.p.) induit en période aiguë, une hypersomnie en sommeil lent (SL), une suppression du sommeil paradoxal (SP), ainsi qu’une diminution de la locomotion et une difficulté à l’initiation des mouvements. Les agonistes DAergiques (L-dopa; ropinirole) empêchent l’hypersomnie en SL de façon transitoire. Durant la période chronique, les taux d’éveil et de SL reviennent à la normale. Le SP augmente transitoirement et s’associe à des épisodes narcoleptiques. Les analyses ex-vivo révèlent une diminution du marquage TH (corps cellulaire de la substance noire ; fibres du striatum). Le marquage des neurones cholinergiques (cerveau antérieur basal et tegmentum mésopontique) semblent inchangée. Nos résultats montrent donc que le MPTP induit chez le félin des symptômes moteurs et des troubles du sommeil proches de ceux observés chez les patients parkinsoniens. Cette étude suggère également une corrélation possible entre les troubles du cycle V/S et la perte des cellules DAergiques / Motors disorders are not the only symptoms of Parkinson disease (PD), and sleep disorders such as somnolence and narcolepsy are frequently reported in PD patients. Despite much investigation worldwide, it remains unknown whether these disorders are caused by dopaminergic (DArgic), non-DArgic neural lesions, nocturnal motor disability or deleterious effect of anti-PD drugs. Using multiple experimental approaches (EEG and sleep-wake recordings/pharmacological dosing / immunohistochemistry) in cats treated with MPTP, which causes DArgic neuronal loss, we have studied the possible correlation between the induced effects on the sleep-wake (S/W) cycle and those on DArgic neurons. MPTP (5mg/kg/day x 5, i.p.) caused, during the acute period, a slow wave sleep hypersomnia (SWS, up to 80% of recorded time) and a suppression of paradoxical sleep (PS), accompanied with pronounced behavioural somnolence, marked decrease in locomotion and difficulty to initiate movements. DArgic agonists L-dopa and ropinirole transiently prevented hypersomnia in SWS. During the chronic period, whereas the amount of W and SWS returned to control, PS transiently increased, associated with narcolepsy-like episodes. Ex-vivo analyses revealed marked decrease in TH labelling (cell bodies in the substantia nigra and terminal-like dots in the striatum) whereas cholinergic neurons in the basal forebrain and mesopontine-tegmentum seemed unchanged. Thus, MPTP treated cats showed major signs of motor and S/W disorders similar to those seen in PD patients and so could serve as useful animal model. Our results also suggest a possible correlation/causality between the MPTP-induced S/W disorders and DArgic cell loss.

<p>The aim of this thesis was to explore the prevalence of parentally experienced infant sleep problems, with special interest in severe problems, in a total community sample of 2 518 infants aged between 6 and 18 months. Factors associated with severe sleep problems were sought. Parents reported 16 % of the infants to have difficulties in falling asleep at night, and 30 % to have frequent night waking. Severe sleep problems were associated with frequent night meals, psychosocial problems in the family, exhaustion and depression in the mother, and parental stress. An association with infant difficultness, high activity and problematic behaviour was also found. </p><p>In a five-year prospective study a group of children fulfilling specific criteria for severe sleep problems in infancy (N=27) was followed after an interventional sleep programme and compared with a control group regarding sleep characteristics, behaviour and development. One month after an interdisciplinary treatment programme, combining behavioural technique with family work, the average number of times the case babies woke up had diminished from 6.0 to 1.8 times per night. A 92 % rate of improvement was reported.</p><p>The changes were stable over time. Comparisons with the controls during five years revealed no significant group difference in sleep characteristics. Concerning behaviour and development, however, there were significant differences. At the age of 5.5 years, seven of the children in the former sleep problem group met the criteria for the diagnosis of attention-deficit/hyperactivity disorder. No control child qualified for the diagnosis.</p>

The aim of this thesis was to explore the prevalence of parentally experienced infant sleep problems, with special interest in severe problems, in a total community sample of 2 518 infants aged between 6 and 18 months. Factors associated with severe sleep problems were sought. Parents reported 16 % of the infants to have difficulties in falling asleep at night, and 30 % to have frequent night waking. Severe sleep problems were associated with frequent night meals, psychosocial problems in the family, exhaustion and depression in the mother, and parental stress. An association with infant difficultness, high activity and problematic behaviour was also found. In a five-year prospective study a group of children fulfilling specific criteria for severe sleep problems in infancy (N=27) was followed after an interventional sleep programme and compared with a control group regarding sleep characteristics, behaviour and development. One month after an interdisciplinary treatment programme, combining behavioural technique with family work, the average number of times the case babies woke up had diminished from 6.0 to 1.8 times per night. A 92 % rate of improvement was reported. The changes were stable over time. Comparisons with the controls during five years revealed no significant group difference in sleep characteristics. Concerning behaviour and development, however, there were significant differences. At the age of 5.5 years, seven of the children in the former sleep problem group met the criteria for the diagnosis of attention-deficit/hyperactivity disorder. No control child qualified for the diagnosis.

Thesis (M.S.)--University of South Florida, 2007. / Title from PDF of title page. Document formatted into pages; contains 40 pages. Includes bibliographical references.

Made available in DSpace on 2014-06-11T19:25:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-12-02Bitstream added on 2014-06-13T18:47:49Z : No. of bitstreams: 1 santos_vjb_me_botfm.pdf: 165407 bytes, checksum: 75e1e4eb834684addce37aa949b6f2b8 (MD5) / A síndrome da apnéia obstrutiva do sono (SAOS) está relacionada à lesão cardiovascular, causada por hipóxia intermitente e elevação de catecolaminas circulantes. A relação entre SAOS e doenças cardiovasculares não é completamente compreendida. Poucos estudos têm sido realizados em crianças. Uma série de relatos de casos de complicações cardiovasculares secundárias a distúrbios respiratórios obstrutivos graves relacionados ao sono têm sido descritos em pacientes pediátricos, como hipertensão pulmonar e cor pulmonale. Há divergências entre os estudos quanto à recuperação dos níveis de pressão arterial normal e descenso fisiológico noturno após a correção obstrutiva distúrbio respiratório. O objetivo deste estudo é studar as alterações da pressão arterial em crianças com distúrbios respiratórios obstrutivos, antes e após a correção dos distúrbios respiratórios através de adenotonsilectomia. Selecionamos crianças, de ambos os sexos, com idades entre 8-12 anos, com sintomas de distúrbios respiratórios do sono, com indicação de adenotonsilectomia. Submetidas à polissonografia basal, foram alocadas em dois grupos de acordo com diagnóstico de SAOS ou Ronco Primário. Realizou-se a monitorização de 24 horas da pressão arterial, repetido seis meses após a adenotonsilectomia. Um total de 26 crianças foram incluídas, dezoito eram do sexo masculino, idade média era de 11 anos. Crianças do grupo SAOS apresentaram níveis elevados de pressão arterial média e diastólica, quando comparadas a crianças do grupo Ronco Primário. A perda do descenso noturno fisiológico foi 6,66 vezes maior entre as crianças do grupo SAOS. Após adenotonsilectomia os grupos se mostraram homogêneos quanto aos níveis tensionais, sendo que a chance de perda do descenso noturno passou a ser insignificante... / Obstructive Sleep Apnea is related to cardiovascular injury, caused by intermittent hypoxia and elevation of circulating catecholamine. The mechanisms underlying the link between OSA and cardiovascular diseases are not completely understood. Only few studies have been performed in children. A number of case reports described cardiovascular complications of severe obstructive sleep-disordered breathing in pediatric patients, such as pulmonary hypertension and cor pulmonale. There are differences between studies regarding the recovery of normal blood pressure levels and nocturnal physiological decline after correcting obstructive respiratory disorder. The aim of this study is to study the 24 hours monitoring of blood pressure in children with OSA, before and after respiratory disorders correction through adenotonsillectomy. We selected children of both genders, aged 8-12 years with symptoms of sleep-disordered breathing, with indication of adenotonsillectomy. Underwent overnight polysomnography, were allocated into two groups according to diagnosis of OSA or primary snoring. We calculated the 24-hour monitoring of blood pressure, repeated six months after adenotonsillectomy. A total of 26 children were included, eighteen were male, median age was 11 years. Children of the OSA group showed elevated levels of diastolic and mean arterial pressure when compared to children in the Primary Snoring. The loss of physiological nocturnal dip was 6.66 times higher among children in the OSA. After adenotonsillectomy groups were homogeneous with regard to blood pressure levels, and the chance of loss of nocturnal became statistically insignificant. Our results clearly indicate that OSA children have an increased blood pressure 24 hours compared with those with primary snoring... (Complete abstract click electronic access below)