INTRODUCTION: Obstructive sleep apnoea (OSA) is common in obesity and is associated with cardiovascular and metabolic complications. Continuous positive airway pressure (CPAP) in OSA may lead to physiological changes reflected in the urinary proteome. The aim of this study was to characterise the urinary proteome in severely obese adult subjects with OSA who were receiving CPAP compared with severely obese subjects without OSA.
METHODS: Severely obese subjects with and without OSA were recruited. Subjects with OSA were receiving CPAP. Body composition and blood pressure measurements were recorded. Urinary samples were analysed by Capillary Electrophoresis-Mass Spectrometry (CE-MS).
RESULTS: Twenty-seven subjects with OSA-on-CPAP (age 49±7years, BMI 43±7kg/m2) and 25 controls without OSA (age 52±9years, BMI 39±4kg/m2) were studied. Age and BMI were not significantly different between groups. Mean CPAP use for OSA patients was 14.5±1.0 months. Metabolic syndrome was present in 14(52%) of those with OSA compared with 6(24%) of controls (p=0.039). A urinary proteome comprising 15 peptides was identified showing differential expression between the groups (p<0.01). Although correction for multiple testing did not reach significance, sequences were determined for 8 peptides demonstrating origins from collagens, fibrinogen beta chain and T-cadherin that may be associated with underlying cardiovascular disease mechanisms in OSA.
CONCLUSIONS: The urinary proteome is compared in OSA with CPAP and without OSA in severe obesity. The effects of CPAP on OSA may lead to changes in the urinary peptides but further research work is needed to investigate the potential role for urinary proteomics in characterising urinary peptide profiles in OSA.
Keywords: Obstructive sleep apnoea, Severe obesity, Urinary proteomics, CPAP
Sleep reduction impairs the performance of many tasks, so it may affect a basic cognitive process, such as working memory, crucial for the execution of a broad range of activities. Working memory has two storage components: a phonological and a visuospatial component. The objective of this study was to analyze the effects of sleep reduction for 5 days on the storage components of working memory. Thirteen undergraduate students (18.77±2.20 years of age), 5 men and 8 women, responded two N-Back tasks (auditory and visual), with three sections each (0-Back, 1-Back, and 2-Back). These tasks were performed at 13:00 h under the following conditions: before sleep reduction (control; C); on the first (SR1), fourth (SR4), and fifth (SR5) days of sleep reduction (4h of sleep per night); and one day after they slept freely (recovery, R). Sleep reduction produced a decrement in accuracy on the auditory 2-Back section the fifth day of sleep reduction (C=87.86±13.35%; SR5=74.76±16.37%; F=14.57, p<0.01). In the visual 2-Back section accuracy decreased (C=88.10±9.95%; SR1=82.45±11.57%; SR5=77.76±14.14%; F=10.80, p<0.05), and reaction time increased (C=810.02±173.96 ms; SR1=913.51±172.25 ms; SR5=874.78±172.27 ms; F=10.80, p<0.05) on the first and fifth day of sleep reduction. In conclusion, five days of sleep reduction produces a decrease in the phonological and visuospatial storage components of working memory, which may interfere with processing verbal information and solving problems that require spatial analysis.
Keywords: Sleep reduction, Working memory, Phonological storage, Visuospatial storage
BACKGROUND AND AIMS: Aging is a multifactorial process that elicits changes in the duration and quality of sleep. Polysomnography is considered to be the standard examination for the analysis of sleep and consists of the simultaneous recording of selected physiological variables during sleep.
OBJECTIVE: The objective of this study was to use polysomnography to compare sleep reported by senior citizens.
METHODS: We selected 40 patients, both male and female, with ages ranging from 64 to 89 years from the Center for the Study of Aging at the Federal University of São Paulo. Patients answered questions about sleep on the Comprehensive Geriatric Assessment and underwent polysomnography.
RESULTS: The results were compared, and agreement between perceived sleep and polysomnography was found in several areas. There was an association between difficulty sleeping and sleep onset latency (p=0.015), waking up at night with sleep onset latency (p=0.005), total sleep time with daytime sleepiness (0.005) and snoring (0.027), sleep efficiency with sleepiness (0.004), snoring (0.033) and pause in breathing (p=0.024), awakenings with snoring (p=0.012) and sleep apnea with pauses in breathing (p=0.001).
CONCLUSION: These results suggest that the older adult population have a good perception of their sleep. The questionnaires aimed at this population should be used as an alternative to polysomnography.
Keywords: Aging, Sleep, Polysomnography
Schizophrenia is characterized by major sleep/wake disturbances including increased vigilance and arousal, decreased slow wave sleep, and increased REM sleep drive. Other arousal-related symptoms include sensory gating deficits as exemplified by decreased habituation of the blink reflex. There is also dysregulation of gamma band activity, suggestive of disturbances in a host of arousal-related mechanisms. This review examines the role of the reticular activating system, especially the pedunculopontine nucleus, in the symptoms of the disease. Recent discoveries on the physiology of the pedunculopontine nucleus help explain many of these disorders of arousal in, and point to novel therapeutic avenues for, schizophrenia.
Keywords: Calcium channels, Gamma band activity, Neuronal calcium sensor protein, P50 potential
We consider insomnia a disorder of waking rather than a disorder of sleep. This review examines the role of the reticular activating system, especially the pedunculopontine nucleus, in the symptoms of insomnia, mainly representing an overactive waking drive. We determined that high frequency activity during waking and REM sleep is controlled by two different intracellular pathways and channel types in PPN cells. We found three different PPN cell types that have one or both channels and may be active during waking only, REM sleep only, or both. These discoveries point to a specific mechanism and novel therapeutic avenues for insomnia.
Keywords: Calcium channels, Gamma band activity, Neuronal calcium sensor protein, N-type calcium channel, P/Q-type calcium channel
INTRODUCTION: Recurrent hypersomnia (RH) is a rare disorder without established treatment. Methods: We report 2 RH medication-responsive cases with typical characteristics of Kleine-Levin syndrome (KLS).
CASE-REPORTS: A 10 y.o. girl and a 14 y.o. boy presented with sudden sleepiness for 3-9 days (every 2-3 weeks). Physical examination, brain images and blood tests were normal. Polysomnographic findings were heterogenous, including disrupted sleep architecture. MSLTs revealed 2-3 SOREMPs and short sleep latency. Carbamazepine rendered girl's sleep normalization, while risperidone normalized boy's sleep cycles.
CONCLUSIONS: Facing the absence of clinical trials in RH, reports of responsive cases are the available therapeutic evidence.
Keywords: Recurrent hypersomnia, Kleine-Levin syndrome, Treatment, Carbamazepine, Risperidone
Treatment with a mandibular advancement device (MAD) is recommended for mild obstructive sleep apnea (OSA), primary snoring and as a secondary option for Continuous Positive Airway Pressure, because it has better adherence and acceptance. However, edentulous patients do not have supports to hold the MAD. This study aimed to present a possible to OSA treatment with MAD in over complete upper and partial lower dentures. The patient, a 38-year-old female with mild OSA, was treated with a MAD. The respiratory parameter, such as apnea-hypopnea index, arousal index and oxyhemoglobin saturation was improved after treatment.
Keywords: Mandibular advancement device, Prothesis