Childhood obstructive sleep apnea (OSA) may be associated with several clinical consequences such as gastroesophageal reflux.
OBJECTIVES: In a prospective study, we evaluated the effects of adenotonsillectomy on quality of life, polysomnographic measures and gastroesophageal reflux disease in children with OSA.
METHODS: Twelve children aged 6 to 12 (8.14 ± 1.75) with adenotonsillar hypertrophy and clinical indication for surgical treatment, were submitted to adenotonsillectomy. Quality of life was evaluated by OSA-18. Sleep measures, full night polysomnography and 24 hour esophageal pH monitoring were performed simultaneously.
RESULTS: Increased weight and height were observed 3 months post adenotonsillectomy. Baseline scores of the OSA-18 scale were significantly improved after surgery (p = 0.001). Polysomnography showed significant reduction of arousals, increased amount of REM sleep and reduction of the apnea-hypopnea index. Adenotonsillectomy reduced the percent time distal esophageal pH below was 4 (supine period: 11.6 ± 3.4% vs 3.9 ± 1.7%, p = 0.005; total period: 7.5 ± 1.6% vs 3.7 ± 1.2%, p = 0.007). Adenotonsillectomy also reduced the duration of the longest gastroesophageal reflux episode during the supine position (p = 0.02).
CONCLUSION: Adenotonsillectomy significantly improved weight and height measures, gastroesophageal reflux disease, quality of life, sleep architecture and respiratory abnormalities.
Keywords: adenoidectomy, gastroesophageal reflux, polysomnography, sleep apnea syndromes, tonsillectomy.
Hypocretin system has been described as one of the most important neurotransmission systems involved in the waking process. The system's lack of function, caused by mutation or neuron death, leads to sharp sleepiness in mammals. It has been proposed that a hyperactive hypocretin system can result in hyperarousal episodes and insomnia. Hypocretins 1 and 2 are bind to two known receptors that are widely distributed in the brain. The current study sought to analyze if either polymorphism in hypocretin receptor 1 or in hypocretin receptor 2 are associated to insomnia. We enrolled 83 insomnia patients, confirmed their clinical insomnia symptoms by means of polysomnographic recordings, comparing single nucleotide polymorphism frequencies in both hypocretin receptors and to those from healthy control patients who had no sleep disorders as confirmed by two nights of sleeping records. Our results show no association to either receptor polymorphism or insomnia.
Keywords: polymorphism genetic, polymorphism single nucleotide, receptors insomnia, sleep.
OBJECTIVES: To determine the prevalence of sleep-disordered breathing in Peruvian truck drivers working at high altitudes and to validate the automatic versus manual scoring system of a respiratory polygraph test.
METHODS: A cross-sectional and probabilistic study was conducted on truck drivers working the day shift at 2,020 meters above sea level. The collected information included anthropometric variables, the Epworth Sleepiness Scale (ESS), and the Lake Louise Acute Mountain Sickness (AMS) Questionnaire. A simplified type III screening instrument was used, and each recording was scored both automatically and manually.
RESULTS: In a total population of 70 drivers, 63 respiratory polygraph tests were conducted and four recordings were excluded. Out of the final sample of 59 (84%) drivers, 46 (78%) were normal, seven (12%) had altitude-induced central sleep apnea, and six (10%) showed obstructive sleep apnea-hypopnea syndrome. The results from the ESS and the Lake Louise AMS Questionnaire were normal for all three groups. Six out of seven drivers with central sleep apnea were intermittently exposed to altitude. No demographic variable was able to predict the abnormal test results. The automatic and manual methods for scoring respiratory events were similar according to the Pearson correlation and the Bland-Altman analysis; r = 0.992 for the apnea-hypopnea index (p < 0.001) and r = 0.945 for the central sleep apnea index (p < 0.001).
CONCLUSION: A high prevalence of sleep-disordered breathing was observed, and no predictive variables for an abnormal study were identified. The use of simplified instruments is recommended to identify sleep-disordered breathing in drivers working at high altitudes who are far away from specialized sleep laboratories.
Keywords: altitude, automobile driving, sleep-disordered breathing.
HIOMT is a gene that encodes hydroxyindole-O-methyltransferase, the final enzyme in the melatonin synthesis pathway. As the timing of melatonin synthesis is different for morning and evening people, it is possible that polymorphisms in genes coding for the enzymes which participate in melatonin synthesis can influence this hormone synthesis and release patterns that may result in different circadian outputs. The aim of this study was to search for polymorphisms in the HIOMT gene and to verify possible associations between genetic variations in this gene and circadian phenotypes in a Brazilian population sample. Among the 44 extreme morning and the 48 extreme evening people, ten polymorphisms were found, being two of them not described so far. Haploview analyses showed linkage disequilibrium between pairs of polymorphisms in the promoter B region. Also, the haplotype AG (rs4446909, rs5989681) is associated with evening preference. The analysis of these data indicates that polymorphisms in the HIOMT gene exhibit a possible trend to influence circadian phenotypes in this Brazilian population sample, possibly affecting the rate and/or level of melatonin synthesis.
Keywords: circadian rhythm, genetics behavorial, melatonin, polymorphism genetic.
OBJECTIVES: Over the last century, studies have shown that sleep provides numerous benefits and improves quality of life. However, modern life often subjects inhabitants of large cities to chronic lack of sleep due to either social or financial reasons. Simultaneously, sleep loss is frequently associated with the use of illicit drugs to obtain stimulant and pleasurable effects. This review presents a general overview of global production of preclinical studies on drugs of abuse and sleep.
METHODS: To carry out this survey, specific keywords were searched in the Web of Science database. The drugs selected for this review were based on the most abused drugs described by the United Nations Office on Drugs and Crime (UNODC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
RESULTS: The results show an increase in studies examining these drugs and sleep. Gamma-hydroxybutyrate (GHB) had the highest percentage of preclinical sleep studies than the other drugs due to its sleep-inducing properties. On the other hand, no preclinical sleep studies were found for other drugs such as ayahuasca, psilocybin, desomorphine, and benzodifuranyls.
CONCLUSION: The results indicate a growing number of publications examining sleep-inducing drugs in preclinical sleep research and also revealed a great expansion in the study with drugs of abuse.
Keywords: clinical research, drugs of abuse, sleep.
OBJECTIVES: The behavioral phenotype observed during lactation is peculiar, mainly due to the rise of two specific behaviors: maternal aggressive behavior and maternal care. Current data reported are inconsistent regarding the relationship between these behaviors. Some studies propose a direct association, while others point to an inverse correlation. Additionally, sleep disturbances and other sources of stress may affect the maternal behavior phenotype during lactation. Thus, the present study evaluated the correlation between maternal behavior and maternal aggression, in both control and sleep-restricted female rats.
METHODS: Eighteen 90-days old female Wistar rats were distributed into two groups: 1) Control (n = 9) - not submitted to any manipulation during pregnancy, and 2) Sleep restriction (n = 9) - submitted to sleep restriction during the entire pregnancy. At the fifth day postpartum both maternal and aggression behavior were assayed by the resident intruder paradigm. Both behaviors were correlated by means of Pearson correlation matrices, independently for control and sleep-restricted groups. A statistically significant positive correlation was observed between latency to lateral attack and frequency of maternal behavior and between latency to lateral attack and duration of maternal behavior, but only in the control group.
RESULTS: The present data indicate that maternal and aggressive behavior during lactation (represented by shorter latencies to attack) oppose each other, and that maternal care levels are proportional to the time taken until the first attack by the female.
CONCLUSION: Sleep restriction prevented the correlations observed for the control group, probably due to an increase in maternal aggression accompanied by decreased or sustained maternal care.
Keywords: aggression, maternal behavior, postpartum period, pregnancy, sleep, sleep deprivation.