OBJECTIVES: The loss of vertical dimension of occlusion (VDO) is a problem that affects stomatognathic system performance, mainly in edentulous patients. Thus, diseases related to musculature failure such as obstructive sleep apnea syndrome (OSAS) are common in these patients. Consequently, efficient and low-cost therapeutic strategies such as intraoral devices (IOD) used to expand the upper airway (UA) are needed to improve the quality of sleep in these patients. The aim of this study was to assess both the subjective and objective effect of VDO increase on the quality of sleep in 19 elderly patients using bimaxillary total prostheses (TPs) before and after placement of new TPs and therapy with intraoral devices (IOD) especially designed to increase VDO without causing mandibular advancement.
METHODS: For this purpose, questionnaires surveying quality of sleep (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and sleep anamnestic questionnaire) and polysomnography tests (PSG) were performed at three different phases: baseline without TPs, with TPs and with IODs.
CONCLUSIONS: It was concluded that the tested IODs may contribute to improvements in the quality of sleep for patients and their sleeping partners because they led to significant decreases in snoring. Most patients also expressed a preference for IOD use while sleeping. However, the use of IOD did not significantly improve polysomnography parameters compared to the baseline and thus cannot be indicated for the treatment of OSAS.
Keywords: aging, equipment and supplies, obstructive, sleep apnea, vertical dimension.
OBJECTIVES: The Night Eating questionnaire (NEQ) is regarded as an important tool for the assessment of the severity of the Night Eating Syndrome. The objective of this study was to validate a new Brazilian Portuguese version of the NEQ that could be easily applied to patients from the public health system.
METHODS: In order to develop the Brazilian Portuguese version of the NEQ, we adopted the following steps: (a) translation, (b) back-translation, (c) comparison between translation and back-translation and (d) pretest. Subsequently, intra and inter-observer reproducibility were assessed in 37 patients from the Endocrinolgy Outpatient Clinic at the University Hospital of the Federal University of Ceará, Brazil. The reliability of the questionnaire was evaluated in 90 individuals from the same Institution. The construct validity of the NEQ was assessed by correlations with clinical variables.
RESULTS: This new translated and culturally adapted version showed excellent internal consistency (alfa coefficient =0.87) and reproducibility both intra-observer and inter-observer (individual item coefficients ranging from 0.95 to 1.0 and 0.92 - 1.0, respectively).
CONCLUSIONS: These results indicate that this Brazilian Portuguese version of the NEQ is a valid and reliable instrument for the assessment of patients with nocturnal eating problems and is equivalent to its original version. No major cultural adaptations were introduced to the questionnaire during the validation process, despite significant linguistic and cultural differences.
Keywords: adaptation, circadian rhythm, eating disorders, obesity, questionnaires, sleep.
OBJECTIVES: Obstructive sleep apnea (OSA) is associated with a variable spectrum of sleep abnormalities and has been connected with memory impairment. The aim of this study was to evaluate the associations between OSA, memory alterations and sleep structure abnormalities.
METHODS: Polysomnography was performed in 20 consecutive patients (12 male, 57.9±5.8 years) with moderate/severe OSA (AHI 35.8±16.7). Daytime somnolence (Epworth Sleepiness Scale, ESS), state of alertness (Karolinska Sleepiness Scale), subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI) and depressive symptoms (Beck Depression Inventory, BDI) were evaluated. Patients were tested before all night polysomnography and a retrieval test was performed in the following morning. Declarative memory was assessed by Verbal Paired Associates from the Wechsler Memory Scale, emotional memory by the exposure to emotional and non-emotional images and procedural memory by the maze test.
RESULTS: Excessive daytime sleepiness (ESS>10, 55%) and impaired sleep (PSQI>5, 40%) were found. Patients with OSA presented greater neck circumference (p<0.005). Procedural memory, as evaluated by the maze test, showed worse retrieval in OSA patients and this was maintained after controlling for age, body mass index and BDI. In subjects with moderate/severe OSA, stage 3 sleep was correlated to the performance in the procedural memory test.
CONCLUSION: We show that procedural memory is altered in OSA patients as compared to controls and this alteration is related to stage 3 of non-rapid eye movement sleep. We confirm that recall memory tests after one night sleep are efficacious to examine memory abnormalities in OSA patients.
Keywords: memory, polysomnography, sleep, sleep apnea syndromes.
OBJECTIVE: Paradoxical sleep deprivation increases grooming behaviors in rats. Discordant data on the change promoted by such deprivation on the experimentally defined anxiety levels have made difficult to assess if the deprivation induced grooming may be used as an experimental model of repetitive behaviors, observed in different psychiatric disorders, due increased anxiety levels. In such context, the present study aims to report data gathering grooming and anxiety in rats.
METHODS: The degrees of tidiness displayed by female (n=26) and male (n=27) rats were evaluated after a period of maintenance in home-cages provided with wood shavings that have the property to dye animal's fur. In the second study, the tidiness degrees were evaluated after 96 h of sleep deprivation in anxious male rats (n=6) and compared to non-anxious controls (n=6).
RESULTS: Females, that are believed to be more anxious than males, displayed higher tidiness (0% colored females x 96% colored males) in the first study. All anxious male rats (100%) that displayed wild running in response to intense acoustic stimulation showed better tidiness than their controls at the end of 96 h sleep deprivation.
CONCLUSIONS: Our data suggest that self-grooming in rats is tightly related to anxiety and allows the interpretation that its increased occurrence in sleep deprivation results from its anxiolytic or tranquilizing property.
Keywords: animal, anxiety, compulsive behavior, grooming, models, rats, sleep deprivation.
There is a clear association between primary headaches and sleep disorders, especially when these headaches occur at night or upon waking. The primary headaches most commonly related to sleep are: migraine, cluster headache, tension type, hypnic headache and chronic paroxysmal hemicrania. The objective of this review was to describe the relationship between these types of headaches and sleep and to address sleep apnea headaches. There are various types of demonstrated associations between sleep and headache disorders, and the mechanisms underlying these associations are complex, multi-factorial and poorly understood. Moreover, all sleep disorders may be related to headaches to some degree; therefore, the evaluation of patients with headaches should include a brief investigation on sleep patterns and related complaints. Patients with headache at night or upon waking who are resistent to the indicated treatment require formal polysomnographic evaluation to exclude a treatable sleep disorder.
Keywords: headaches, migraine disorders, obstructive, pain, sleep apnea, sleep disorders.
There are emerging links between disturbed sleep and mental illness. These associations may have particular relevance for military populations which are often faced with extremely stressful situations and profound sleep deprivation. Indeed, disturbed sleep has been predictive of mental illness following exposure to trauma, and, conversely, treatment of sleep problems has helped alleviate mental illness. There is a need for further investigation of sleep and mental health of soldiers participating in basic combat training (BCT), which is clearly also associated with sleep loss and stress.
Keywords: depression, health status disparities, post-traumatic stress disorders, sleep.
Obstructive sleep apnea(OSA) has multiple underlying mechanisms which vary across patients. In afflicted patients, the degree of abnormality in pharyngeal anatomy, dilator muscle function, ventilatory control instability etc is highly variable. In patients with anatomical compromise at the velopharynx, robust responses to palatal surgery would be predicted, whereas other patients may have no major improvement if the primary abnormality were elsewhere. Similarly, measures to influence ventilatory control such as oxygen or acetazolamide may yield major improvements, but only for patients with unstable ventilatory control. Further research into treatment of OSA based on underlying mechanism is required.
Keywords: apnea, future, lung, respiration, sleep, therapy.