OBJECTIVE: Rapid Eye Movement Sleep Deprivation (RSD) increases aggressiveness and is manifested in male rats as fighting episodes. The determination of the role played by such fights should constitute an important contribution toward assessing the adaptive function of this type of sleep. Nevertheless, female rats do not exhibit such behavior. Recent data indicate that RSD-induced fighting and wild running flights are panic manifestations, thus advancing the hypothesis that female rats do not fight because their prevalent response in panic situations is flight.
METHODS: Therefore, 10 male and 12 female rats were acoustically kindled at 14 days of age, and their susceptibility to display wild running was evaluated at 30, 60 and 90 days of age.
RESULTS: 6 males and 10 females produced respective totals of 12 and 30 wild running episodes (chi-square test, p=0.0003), with mean (± standard error) of 0.60±0.21 and 1.41±0.24 episodes/rat. (ANOVA/MANOVA, p=0.0169).
CONCLUSIONS: The results validate the hypothesis and are concordant with the higher frequency of panic attacks observed in women as compared to men.
Keywords: Sleep, REM; Sleep deprivation/physiopathology; Aggression/physiology; Panic/physiology; Rats
OBJECTIVE: To compare clinical and polysomnographic profiles of patients with obstructive respiratory sleep disorder according to the type of recommended treatment.
METHODS: A retrospective study of 131 patients treated at the Sleep Disorders Outpatient Clinic of Faculdade de Medicina do ABC, between August 2003 and July 2008. The indication of treatment considered both clinical and polysomnographic criteria. The patients were divided into clinical and surgical treatment groups.
RESULTS: Of the 131 patients, 59.5% were male and 40.5% were female with an average age of 48.9 ± 13.2 years. Clinical treatment was recommended for approximately 71.8% of the patients, and surgical treatment was recommended for approximately 28.2% with a prevalence of continuous positive airway pressure (CPAP) (60.6%). In both groups, there was male prevalence, and the average age was between forty and fifty years with no statistical significant differences between the groups. In the group receiving clinical treatment, the majority of the patients had moderate and severe obstructive sleep apneas (OSA). No statistical differences were found between the two groups in terms of clinical and polysomnographic variables.
CONCLUSIONS: The majority of the patients were clinically treated with CPAP prevalence. However, almost one-third of the patients needed surgical intervention, with a high prevalence of anatomical abnormalities in this group. The type of recommended treatment was not influenced by clinical or polysomnographic parameters, which suggests that the presence of anatomical abnormalities in the upper respiratory tract or craniofacial region may be the main criterion for recommending surgical treatment.
Keywords: Sleep apnea, obstructive/surgery; Polysomnography; Positive-pressure respiration; Pharynx/surgery; Continuous positive airway pressure
OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) has gained increased attention in recent years, mainly due to the increased number of diagnosed cases and OSAS's relationship with other diseases. About 90% of the patients with OSAS snore. The objective of this paper was to investigate the relationship between the Stanford classification and the apnea-hypopnea index in patients with OSAS.
METHODS: Two hundred and six patients were included in a longitudinal cohort study. The patients were evaluated and classified according to the Mallampati score, Stanford classification and the severity of their OSAS, as measured by the apnea-hypopnea index (AHI) using polysomnography.
RESULTS: A total of 168 patients who underwent polysomnography in the sleep laboratory were included in the final study. In a cross-tabulation of the Stanford classification for snoring and the AHI, the relative risk (RR) was 3.06 (95%CI: 1.47 - 6.33). Therefore, we can infer that a patient with loud and intense snoring has a greater chance of developing moderate to severe OSAS.
CONCLUSIONS: We concluded that there is a positive correlation between the intensity of snoring and OSAS severity.
Keywords: Snoring/classification; Sleep apnea syndromes/complications; Polysomnography/methods
OBJECTIVE: Few studies about sleep have been conducted in healthy older adults. The objective of this study was to describe behavioral and environmental factors that can provide a good quality of sleep in Brazilian healthy older adults.
METHODS: Healthy older adults without evidence of disease, not taking any medication and who were able to perform instrumental activities of the daily life were included in the study. They were submitted to full geriatric assessment and to The Pittsburgh Sleep Quality Index questionnaire. Forty patients (87%) had good sleep quality (PSQI < 5) and were selected to be studied. The following variables were collected: age, sex, education level, family income, employment status; subjective temperature sensation and ventilation conditions in the room; bed conditions; self-analysis of health status; number of awakenings during the night; daytime napping; television set in the sleep environment and types of nighttimes TV programming watched; subjective latency and sleep duration; regularity of sleep onset/waking times; nocturia and sexual frequency.
RESULTS: Half of the sample presented overweight or were obese. Sixty per cent (n=24) had a good family income. Self-analysis of health status showed that all patients ranked their health as good, very good or excellent. No subjects referred bad or very bad health conditions. Over 90% of the subjects reported good bed and room conditions. Three-quarters of the sample had at least one episode of waking during the night and 70% reported daytime napping few days per week or daily.
CONCLUSIONS: In conclusion, we found that adequate sleeping habits, as well as the absence of health disorders, apparently contribute to the results observed. Nocturia, naps and overweight did not affect sleep quality in healthy aged people.
Keywords: Sleep disorders/physiopathology; Sleep disorders/epidemiology; Aging/physiology; Attitude to health; Circadian rhythm; Sleep stages; Predictive value of tests; Questionnaires; Geriatric assessment; Middle aged; Brazil
The aim of this study was to show the efficacy of mandibular repositioning appliance (MRA) to treat severe obstructive sleep apnea (OSA) on a marked retrognathic patient that refused continuous positive airway pressure (CPAP) therapy. The apnea/hypopnea index (AHI) reduced from 38.5 to 12.0, despite marked retrognathia represented for the variable pog/N-perp = -15.0 mm. After six months and after three years of MRA usage, another polysomnogram (PSG) was carried out. The results showed an AHI=12.0 and 13.0, respectively, besides improvements in other physiologic variables. We concluded that MRA was effective in the treatment of severe OSA with a marked retrognathia. Sleep physicians should consider this therapy option when patients refuse CPAP and surgery approaches.
Keywords: Sleep apnea, obstructive/therapy; Orthodontic appliance design; Orthodontic appliances, functional; Mandibular advancement/instrumentation; Retrognathism