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ABSTRACT Objective: This study aims to evaluate the impact of morning-evening preference in pregnancy outcomes in gestational diabetes mellitus (GDM). Materials and methods: This is a prospective cohort study of 2nd-3rd trimester GDM outpatient care in Fortaleza, Brazil (2018-2020). Eveningness was defined by the Horne-Östberg Morningness-Eveningness-Questionnaire (MEQ ≤ 41). Furthermore, we obtained a 7-day actigraphic register. Subjective sleep quality, daytime somnolence, insomnia, fatigue and depressive symptoms were also evaluated. Associations with pregnancy outcomes were investigated. Results: Among 305 patients with GDM, evening preference was found in 21 (6.9%). Patients with evening preference had worse sleep quality (p < 0.01), greater severity of insomnia (p < 0.005), fatigue (p < 0.005) and depressive symptoms (<0.009). Evening chronotype was associated with preeclampsia [p = 0.01; OR = 0.27; CI 0.09-0.79] and a greater need for admission to a neonatal intensive care unit (NICU) [p = 0.02; OR = 0.23; CI .0.06-0.80]. A lower MEQ score confirmed an association with preeclampsia [p = 0.002; OR = 0.94; CI 0.90-0.97] and this was maintained after controlling for age, arterial hypertension, sleep quality, fatigue and depressive symptoms [p < 005; OR = 0.91; CI 0.87-0.95]. Conclusion: In GDM, patients with evening preference had worse sleep quality, more insomnia, fatigue, and depressive symptoms. Furthermore, eveningness was independently associated with preeclampsia. These results indicate the important role of eveningness in adverse pregnancy outcomes. Objective morningevening morning GDM. . (GDM) methods 2nd3rd ndrd 2nd 3rd nd rd Fortaleza 20182020. 20182020 2018 2020 (2018-2020) HorneÖstberg Horne Östberg MorningnessEveningnessQuestionnaire Morningness Questionnaire 41. 41 41) Furthermore 7day day 7 register somnolence evaluated investigated Results 30 2 6.9%. 69 6.9% 6 9 (6.9%) p 0.01, 001 0.01 , 0 01 0.01) 0.005, 0005 0.005 005 <0.009. 0009 <0.009 009 (<0.009) 0.27 027 27 0.090.79 009079 0.09 0.79 09 79 0.09-0.79 NICU (NICU 0.02 002 02 0.23 023 23 .0.060.80. 006080 .0.06 0.80 06 80 .0.06-0.80] 0.002 0002 0.94 094 94 0.900.97 090097 0.90 0.97 90 97 0.90-0.97 age hypertension 0.91 091 91 0.870.95. 087095 0.87 0.95 87 95 0.87-0.95] Conclusion (GDM 2018202 201 202 (2018-2020 4 3 6.9 (6.9% 00 0.0 000 0.00 <0.00 (<0.009 0.2 090 0.090.7 00907 079 0.7 0.09-0.7 060 .0.060.80 00608 006 .0.0 080 0.8 8 .0.06-0.80 0.9 900 0.900.9 09009 097 0.90-0.9 870 0.870.95 08709 087 095 0.87-0.95 201820 20 (2018-202 6. (6.9 0. <0.0 (<0.00 0.090. 0090 07 0.09-0. .0.060.8 0060 .0. 08 .0.06-0.8 0.900. 0900 0.90-0. 0.870.9 0870 0.87-0.9 20182 (2018-20 (6. <0. (<0.0 0.090 0.09-0 .0.060. .0 .0.06-0. 0.900 0.90-0 0.870. 0.87-0. (2018-2 (6 <0 (<0. 0.09- .0.060 .0.06-0 0.90- 0.870 0.87-0 (2018- ( (<0 .0.06- 0.87- (2018 (< (201 (20 (2

https://doi.org/10.20945/2359-3997000000515

Hyperglycemia in pregnancy: sleep alterations, comorbidities and pharmacotherapy
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Façanha, Cristina

; Bruin, Veralice de

; Bruin, Pedro de

; Façanha, Arthur

; Rocha, Hellen Cristina

; Araujo, Mariana

; Forti, Adriana

; Macêdo, Rejane

Revista da Associação Médica Brasileira

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jan 2021, Volume 67 N. 1 Pages 45 - 51

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1806-9282.67.01.20200216 456 downloads

Hyperglycemia in pregnancy: sleep alterations, comorbidities and pharmacotherapy pregnancy alterations
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Façanha, Cristina

; Bruin, Veralice de

; Bruin, Pedro de

; Façanha, Arthur

; Rocha, Hellen Cristina

; Araujo, Mariana

; Forti, Adriana

; Macêdo, Rejane

Revista da Associação Médica Brasileira

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2021, N. ahead

Abstract: En | Text: En | PDF: En

SUMMARY OBJECTIVE: To investigate sleep alterations and associated factors in pregnant diabetic women (n=141). METHODS: Sleep profile, sociodemographics and clinical information were collected. Poor sleep quality (Pittsburgh Sleep Quality Index >5) and excessive daytime sleepiness (Epworth Sleepiness Scale ≥10), sleep duration (h), sleep latency (min), frequent sleep interruption and short sleep (≤6 h) were assessed in type 1 diabetes mellitus (16.3%), type 2 diabetes mellitus (25.5%) and gestational diabetes mellitus (58.2%). RESULTS: Poor sleep quality was found in 58.8% of patients and daytime sleepiness in 25.7%, regardless of hyperglycemia etiology. No correlation existed between daytime sleepiness and poor sleep quality (Pearson correlation r=0.02, p=0.84). Short sleep duration occurred in 1/3 of patients (31.2%). Sleep interruptions due to frequent urination affected 72% of all and sleep interruptions due to any cause 71.2%. Metformin was used by 65.7% of type 2 diabetes mellitus and 28.7% of gestational diabetes mellitus. In gestational diabetes mellitus, parity number was independently associated with poor sleep quality (p=0.02; OR=1.90; 95%CI 1.07-3.36) and metformin use was also independently associated with poor sleep quality (p=0.03; OR=2.36; 95%CI 1.05-5.29). CONCLUSIONS: Our study originally shows that poor sleep quality and excessive daytime sleepiness are frequent in diabetic pregnancy due to different etiologies. Interestingly, only in gestational diabetes mellitus, metformin therapy and higher parity were associated with poor sleep quality. OBJECTIVE n=141. n141 n n=141 . 141 (n=141) METHODS profile collected Pittsburgh >5 5 Epworth ≥10, 10 ≥10 , ≥10) h, h (h) min, min (min) ≤6 6 (≤ 16.3%, 163 16.3% 16 3 (16.3%) 25.5% 255 25 (25.5% 58.2%. 582 58.2% 58 (58.2%) RESULTS 588 8 58.8 257 7 25.7% etiology Pearson r002 r 0 02 r=0.02 p=0.84. p084 p p=0.84 84 p=0.84) 13 1/ 31.2%. 312 31.2% 31 (31.2%) 72 712 71 71.2% 657 65 65.7 287 28 28.7 p=0.02 p002 (p=0.02 OR=1.90 OR190 OR 90 95CI CI 95 1.073.36 107336 1.07 3.36 07 36 1.07-3.36 p=0.03 p003 03 (p=0.03 OR=2.36 OR236 1.055.29. 105529 1.05 5.29 05 29 1.05-5.29) CONCLUSIONS etiologies Interestingly n14 n=14 14 (n=141 > ≥1 (h (min ≤ ( 16.3 (16.3% 25.5 (25.5 58.2 (58.2% 58. 25.7 r00 r=0.0 p08 p=0.8 31.2 (31.2% 71.2 65. 28. p=0.0 p00 (p=0.0 OR=1.9 OR19 9 073 1.073.3 10733 107 1.0 336 3.3 1.07-3.3 OR=2.3 OR23 055 1.055.29 10552 105 529 5.2 1.05-5.29 n1 n=1 (n=14 ≥ 16. (16.3 25. (25. (58.2 r0 r=0. p0 p=0. 31. (31.2 71. (p=0. OR=1. OR1 1.073. 1073 1. 33 3. 1.07-3. OR=2. OR2 1.055.2 1055 52 5. 1.05-5.2 n= (n=1 (16. (25 (58. r=0 p=0 (31. (p=0 OR=1 1.073 1.07-3 OR=2 1.055. 1.05-5. (n= (16 (2 (58 r= p= (31 (p= OR= 1.07- 1.055 1.05-5 (n (1 (5 (3 (p 1.05-

https://doi.org/10.1590/1806-9282.67.01.20200216

Depressive symptoms are associated with impaired sleep, fatigue, and disease activity in women with rheumatoid arthritis
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Lopes, Fernando Henrique Azevedo

; Freitas, Max Victor Carioca

; Bruin, Veralice Meireles Sales de

; Bruin, Pedro Felipe Carvalhedo de

Advances in Rheumatology

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2021, Volume 61 elocation 18

Abstract: En | Text: En | PDF: En

Abstract Objectives: To investigate the associations between sleep quality, fatigue, disease activity and depressive symptoms in women with rheumatoid arthritis (RA). Methods: Female patients with previous diagnosis of RA from a Rheumatology Outpatient Clinic at a tertiary referral centre, in Fortaleza, Brazil, were consecutively recruited into the study. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI); fatigue by the Fatigue Severity Scale (FSS); daytime sleepiness by the Epworth Sleepiness Scale (ESS); and depressive symptoms by the Beck Depression Inventory II (BDI-II). RA activity was measured by the disease activity score (DAS28). Results: One hundred ten women (mean age ± SD = 51.1 ± 13.0 y) were included in the study. On average, patients with depressive symptoms (BDI-II > 13), as compared to those without, showed poorer sleep quality (PSQI: 10.09 ± 4.1 vs 7.33 ± 3.55; p = 0.001 respectively), more fatigue (FSS: 4.69 ± 1.89 vs 3.34 ± 1.8; p = 0.001) and higher disease activity level (DAS28: 4.36 ± 1.53 vs 3.7 ± 1.39; p = 0,047). The logistic regression analysis showed that sleep quality is an independent predictor of depressive symptom severity. Conclusion: Depressive symptoms, impaired sleep and fatigue are common in women with RA. Poor sleep is associated with greater frequency and severity of depressive symptoms in these patients, suggesting that screening for sleep and mood problems may be relevant both in clinical research and routine patient care. Future studies investigating the impact of measures to promote healthy sleep on depressive symptom control in this patient population are warranted.

https://doi.org/10.1186/s42358-021-00176-6 150 downloads

Chronotype in bipolar disorder: an 18-month prospective study
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Melo, Matias C.

; Garcia, Raquel F.

; Araújo, Carolina F. de

; Luz, José H.

; Bruin, Pedro F. de

; Bruin, Veralice M. de

Brazilian Journal of Psychiatry

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feb 2020, Volume 42 N. 1 Pages 68 - 71

Abstract: En | Text: En | PDF: En

Objective: Circadian dysregulation plays an important role in the etiology of mood disorders. Evening chronotype is frequent in these patients. However, prospective studies about the influence of chronotype on mood symptoms have reached unclear conclusions in patients with bipolar disorder (BD). The objective of this study was to investigate relationship between chronotype and prognostic factors for BD. Methods: At the baseline, 80 euthymic BD patients answered a demographic questionnaire and clinical scales to evaluate anxiety, functioning and chronotype. Circadian preference was measured using the Morningness-Eveningness Questionnaire, in which lower scores indicate eveningness. Mood episodes and hospitalizations were evaluated monthly for 18 months. Results: Among the BD patients, 14 (17.5%) were definitely morning type, 35 (43.8%), moderately morning, 27 (33.7%) intermediate (neither) and 4 (5%) moderately evening. Eveningness was associated with obesity or overweight (p = 0.03), greater anxiety (p = 0.002) and better functioning (p = 0.01), as well as with mood episodes (p = 0.04), but not with psychiatric hospitalizations (p = 0.82). This group tended toward depressive episodes (p = 0.06), but not (hypo)mania (p = 0.56). Conclusion: This study indicated that evening chronotype predicts a poor prognostic for BD. It reinforces the relevance of treating rhythm disruptions even during euthymia to improve patient quality of life and prevent mood episodes.

https://doi.org/10.1590/1516-4446-2019-0489 587 downloads

Adiponectin levels and sleep deprivation in patients with endocrine metabolic disorders
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Oliveira, Roseane Feitosa de

; Daniele, Thiago Medeiros da Costa

; Façanha, Cristina Figueiredo Sampaio

; Forti, Adriana Costa e

; Bruin, Pedro Felipe Carvalhedo de

; Bruin, Veralice Meireles Sales de

Revista da Associação Médica Brasileira

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dec 2018, Volume 64 N. 12 Pages 1122 - 1128

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO INTRODUÇÃO: Problemas de sono são frequentes em pacientes com distúrbios endócrino-metabólicos (DEM), como hipertensão arterial, diabetes e obesidade. A adiponectina é um peptídeo segregado por adipócitos e apresenta diversas propriedades, como por exemplo, anti-inflamatória, antioxidante, antiaterogênica, pró-angiogênica e vasoprotetora. A adiponectina relaciona-se inversamente com o peso corporal. OBJETIVO: Examinar os fatores que influenciam os níveis de adiponectina em uma população com DEM. MÉTODOS: Trata-se de uma avaliação transversal com 332 pacientes (18 a 80 anos) apresentando hipertensão arterial, pré-diabetes, diabetes e/ou obesidade. A investigação incluiu avaliação clínica de comorbidades, exames de sangue e medidas de adiponectina (Elisa). A restrição crônica do sono foi determinada com o sono habitual <6 horas >4 dias/semana. RESULTADOS: Doenças como hipertensão arterial (78,5%), diabetes tipo 2 (82,3%) e sobrepeso (45,0%)/obesidade (38,8%) foram frequentes. Pacientes com diabetes tipo 2 apresentaram uma tendência na restrição crônica do sono (p=0,05). Os níveis de adiponectina aumentaram com a idade e foram inversamente correlacionados com o diâmetro abdominal sagital (p=0,04) e com a insulina em jejum (p=0,001). A restrição crônica do sono foi associada à maior concentração de adiponectina [OR=1,34; CI=1,13-1,58; p<0,005] e isso foi mantido após ajuste por gênero, idade, índice de massa corporal, menopausa, hipertensão arterial, classificação dos níveis da American Diabetes Association e exercício físico [OR=1,38; CI=1,14-1,66: p=0,001]. CONCLUSÕES: Em pacientes com DEM, a adiponectina é influenciada não apenas pela obesidade, mas também pela idade e pela restrição de sono. O último achado pode ser explicado por um efeito compensatório ou por um regulamento contrário para minimizar os efeitos nocivos da restrição do sono.

SUMMARY BACKGROUND: Sleep abnormalities are frequent in patients with endocrine metabolic disorders (EMD) such as arterial hypertension, diabetes and obesity. Adiponectin is a peptide largely secreted by adipocytes and has various properties e.g. anti-inflammatory, antioxidant, antiatherogenic, pro-angiogenic, vasoprotective and insulin-sensitizing. Adiponectin inversely relates to body weight and when its concentration decreases, the resistin concentration increases resulting in greater insulin resistance. OBJECTIVE: The objective of this study is to examine factors influencing adiponectin levels in a population with EMD. METHODS: This was a cross-sectional evaluation of 332 patients (18 to 80y) presenting arterial hypertension, pre-diabetes, diabetes, and/or obesity. Investigation included clinical evaluation of comorbidities, general blood tests and adiponectin measures (ELISA). Chronic sleep deprivation was determined if habitual sleep was <6 hours >4 days/week. RESULTS: Arterial hypertension (78.5%), type-2 diabetes (82.3%), and overweight (45.0%)/obesity (38.8%) were frequent. Patients with type-2 diabetes tended to have more chronic sleep deprivation (p=0.05). Adiponectin levels increased with age and were inversely correlated with sagittal abdominal diameter (p=0.04) and fasting insulin (p=0.001). Chronic sleep deprivation was associated with higher adiponectin concentration [OR=1.34; CI=1.13-1.58; p<0.005] and this was maintained after adjustment for gender, age, body mass index, menopause, arterial hypertension, American Diabetes Association classification and physical exercise levels [OR=1.38; 0=1.14-1.66: p=0.001]. CONCLUSION: In patients with EMD, adiponectin is influenced not only by obesity but also by age and sleep deprivation. The latter finding may be explained by a compensatory effect or a counter regulation to minimize the harmful effects of sleep deprivation.

https://doi.org/10.1590/1806-9282.64.12.1122 1889 downloads

1º Posicionamento Brasileiro sobre o Impacto dos Distúrbios de Sono nas Doenças Cardiovasculares da Sociedade Brasileira de Cardiologia
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Drager, Luciano F.

; Lorenzi-Filho, Geraldo

; Cintra, Fatima Dumas

; Pedrosa, Rodrigo P.

; Bittencourt, Lia R. A.

; Poyares, Dalva

; Carvalho, Carolina Gonzaga

; Moura, Sonia Maria Guimarães Pereira Togeiro

; Santos-Silva, Rogerio

; Bruin, Pedro F. C. de

; Geovanini, Glaucylara R.

; Albuquerque, Felipe N.

; Oliveira, Wercules Antonio Alves de

; Moreira, Gustavo A.

; Ueno, Linda Massako

; Nerbass, Flávia Baggio

; Rondon, Maria Urbana Pinto Brandão

; Barbosa, Eline Rozária Ferreira

; Bertolami, Adriana

; Paola, Angelo Amato Vincenzo de

; Marques, Betânia Braga Silva

; Rizzi, Camila Futado

; Negrão, Carlos Eduardo

; Uchôa, Carlos Henrique Gomes

; Maki-Nunes, Cristiane

; Martinez, Denis

; Fernández, Edmundo Arteaga

; Maroja, Fabrizio U.

; Almeida, Fernanda R.

; Trombetta, Ivani C.

; Storti, Luciana J.

; Bortolotto, Luiz Aparecido

; Mello, Marco Túlio de

; Borges, Melania Aparecida

; Andersen, Monica Levy

; Portilho, Natanael de Paula

; Macedo, Paula

; Alves, Rosana

; Tufik, Sergio

; Fagondes, Simone C.

; Risso, Thaís Telles

Arquivos Brasileiros de Cardiologia

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aug 2018, Volume 111 N. 2 Pages 290 - 340

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.5935/abc.20180154 8719 downloads

Assessment of fatigue using the Identity-Consequence Fatigue Scale in patients with lung cancer
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Nogueira, Ingrid Correia

; Araújo, Amanda Souza

; Morano, Maria Tereza

; Cavalcante, Antonio George

; Bruin, Pedro Felipe de

; Paddison, Johana Susan

; Silva, Guilherme Pinheiro da

; Pereira, Eanes Delgado

Jornal Brasileiro de Pneumologia

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jun 2017, Volume 43 N. 3 Pages 169 - 175

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar as propriedades da Escala de Identificação e Consequências da Fadiga (EICF) em pacientes com câncer de pulmão (CP), analisando a intensidade da fadiga e fatores associados. Métodos: Estudo transversal com pacientes com CP, atendidos em um hospital-escola no Brasil, que preencheram a EICF. Pacientes com doenças cardíacas crônicas (DCC) e controles saudáveis, pareados por idade e sexo, também preencheram a escala. Inicialmente, uma versão brasileira da escala foi aplicada a 50 pacientes com CP por dois entrevistadores independentes; para testar a reprodutibilidade, ela foi reaplicada aos mesmos pacientes. No momento basal, os pacientes com CP realizaram espirometria e teste de caminhada de seis minutos, bem como preencheram a Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e Fatigue Severity Scale (FSS). O estado inflamatório foi avaliado pelos níveis de proteína C reativa (PCR) no sangue. Para validar a EICF, avaliamos as correlações entre as pontuações na mesma e essas variáveis. Resultados: A amostra foi composta por 50 pacientes em cada grupo (CP, DCC e controle). No grupo CP, os coeficientes de correlação intraclasse para confiabilidade intra e interobservador para as variáveis resumidas da EICF variaram de 0,94 a 0,76 e de 0,94 a 0,79, respectivamente. A EICF apresentou excelente consistência interna, e as disposições gráficas de Bland-Altman demonstraram boa confiabilidade teste-reteste. A EICF apresentou correlações significativas com as pontuações na FSS, HADS e SF-36, bem como com os níveis de PCR. As médias das pontuações na EICF do grupo CP diferiram significativamente das dos grupos DCC e controle. Conclusões: A EICF é um instrumento válido e confiável para a avaliação de pacientes com CP, nos quais depressão, qualidade de vida e níveis de PCR parecem estar significativamente associados à fadiga.

ABSTRACT Objective: To evaluate the properties of the Identity-Consequence Fatigue Scale (ICFS) in patients with lung cancer (LC), assessing the intensity of fatigue and associated factors. Methods: This was a cross-sectional study involving LC patients, treated at a teaching hospital in Brazil, who completed the ICFS. Patients with chronic heart disease (CHD) and healthy controls, matched for age and gender, also completed the scale. Initially, a Brazilian Portuguese-language version of the ICFS was administered to 50 LC patients by two independent interviewers; to test for reproducibility, it was readministered to those same patients. At baseline, the LC patients were submitted to spirometry and the six-minute walk test, as well as completing the Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), and Fatigue Severity Scale (FSS). Inflammatory status was assessed by blood C-reactive protein (CRP) levels. To validate the ICFS, we assessed the correlations of its scores with those variables. Results: The sample comprised 50 patients in each group (LC, CHD, and control). In the LC group, the intraclass correlation coefficients for intra-rater and inter-rater reliability regarding ICFS summary variables ranged from 0.94 to 0.76 and from 0.94 to 0.79, respectively. The ICFS presented excellent internal consistency, and Bland-Altman plots showed good test-retest reliability. The ICFS correlated significantly with FSS, HADS, and SF-36 scores, as well as with CRP levels. Mean ICFS scores in the LC group differed significantly from those in the CHD and control groups. Conclusions: The ICFS is a valid, reliable instrument for evaluating LC patients, in whom depression, quality of life, and CRP levels seem to be significantly associated with fatigue.

https://doi.org/10.1590/s1806-37562016000000033 5030 downloads

10.

Wake-up stroke: Clinical characteristics, sedentary lifestyle, and daytime sleepiness
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Diniz, Deborath Lucia de Oliveira

; Barreto, Pedro Rodrigues

; Bruin, Pedro Felipe Carvalhedo de

; Bruin, Veralice Meireles Sales de

Revista da Associação Médica Brasileira

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oct 2016, Volume 62 N. 7 Pages 628 - 634

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: wake-up stroke (WUS) define o acidente vascular cerebral (AVC) que ocorre sem horário preciso de início, pois os sintomas manifestam-se ao despertar. Alterações do sono associam-se a maior risco de AVC e doenças cardíacas. Este estudo avalia as características dos pacientes com e sem WUS, a presença de sonolência diurna e os fatores de risco associados. Método: pacientes com AVC isquêmico foram identificados quanto à presença de WUS. Foram avaliadas as características clínico-demográficas, a gravidade do AVC pela National Institutes of Health Stroke Scale (NIHSS) e pela Modified Rankin Scale (MRS) e o grau de sonolência pela Epworth Sleepiness Scale (ESS). Resultados: setenta pacientes (57,1% homens) com idade entre 32 e 80 anos (58,5±13,3) foram estudados. Wake-up stroke foi observado em 24,3% dos casos. Hipertensão arterial sistêmica (67,1%), diabetes (27,1%) e distúrbio do metabolismo lipídico (22,8%) foram frequentes. Diabetes e hábitos sedentários foram mais comuns nos casos com WUS (p<0,05). Na amostra total, 62,3% dos casos apresentavam AVC leve, moderado ou com poucos sintomas (NIHSS<5). Sonolência excessiva diurna (SED) (ESS>10) foi identificada em 20% dos pacientes. Não houve diferença entre os grupos com e sem WUS quanto à gravidade do AVC e o grau de sonolência. Pacientes com SED eram mais jovens e mais sedentários (p<0,05). Os indivíduos com etilismo tinham maior grau de sonolência (p=0,03). Conclusão: wake-up stroke manifesta-se em 25% dos casos de AVC isquêmico. Neste estudo, os pacientes com WUS apresentaram mais diabetes e sedentarismo. Sonolência diurna é frequente e associa-se a hábitos sedentários e etilismo.

Summary Objective: Wake-up stroke (WUS) is defined when the exact time of the beginning of the symptoms cannot be determined, for the deficits are perceived upon awakening. Sleep alterations are important risk factors for stroke and cardiovascular diseases. This study evaluates the characteristics of patients with and without WUS, the presence of daytime sleepiness, and associated risk factors. Method: Patients with ischemic stroke were investigated about the presence of WUS. Clinical and demographic characteristics were evaluated. Stroke severity was studied by the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (MRS), and daytime sleepiness severity was studied by the Epworth Sleepiness Scale (ESS). Results: Seventy patients (57.1% men) aged from 32 to 80 years (58.5±13.3) were studied. WUS was observed in 24.3%. Arterial hypertension (67.1%), type 2 diabetes (27.1%), and hyperlipidemia (22.8%) were frequent. Type 2 diabetes and sedentary lifestyle were more common in patients with WUS (p<0.05). Overall, mild, moderate or very few symptoms of stroke (NIHSS<5) were predominant (62.3%). Among all cases, 20% had excessive daytime sleepiness (ESS>10). No differences were found between patients with and without WUS as regards stroke severity or excessive daytime sleepiness. Patients with excessive daytime sleepiness were younger and had more sedentary lifestyle (p<0.05). Individuals with previous history of heavy drinking had more daytime sleepiness (p=0.03). Conclusion: Wake-up stroke occurs in approximately 25% of stroke cases. In this study, patients with WUS had more diabetes and sedentary lifestyle. Daytime sleepiness is frequent and is associated with sedentary lifestyle and heavy drinking.

https://doi.org/10.1590/1806-9282.62.07.628 6153 downloads

11.

Night eating syndrome: How to treat it?
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Pinto, Thisciane Ferreira

; Silva, Francisco Girleudo Coutinho da

; Bruin, Veralice Meireles Sales de

; Bruin, Pedro Felipe Carvalhedo de

Revista da Associação Médica Brasileira

Journal Metrics
- Sobre o periódico
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oct 2016, Volume 62 N. 7 Pages 701 - 707

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo A síndrome do comer noturno (SCN) caracteriza-se por ingestão calórica ≥ 25% do total diário após o jantar e/ou por dois ou mais despertares noturnos semanais acompanhados de alimentação. As causas da SCN não estão totalmente esclarecidas e parecem envolver uma dessincronização entre os ritmos circadianos de alimentação e sono, resultando em um atraso do padrão alimentar. Estimativas da prevalência de SCN na população geral estão em torno de 1,5% e, embora frequências bem mais elevadas tenham sido descritas em obesos, uma relação de causalidade entre SCN e obesidade não está claramente estabelecida. Desde os primeiros relatos da SCN, várias modalidades de tratamento têm sido propostas, embora, em muitos casos, a evidência ainda seja insuficiente e não exista um consenso sobre a abordagem ideal. Com o objetivo de realizar uma revisão crítica dos tratamentos propostos para a SCN, desde sua descrição original, foi realizada uma busca sistemática de artigos publicados nos periódicos indexados na base de dados MedLine / Pubmed entre 1955 e 2015. Dezessete artigos, abordando terapias não farmacológicas ou farmacológicas, preencheram os critérios de seleção. Com base nos artigos analisados, conclui-se que os agentes serotonérgicos e intervenções psicológicas, particularmente, a terapia cognitivo-comportamental, têm mostrado eficácia no tratamento da SCN. Uma combinação de terapias não farmacológicas e farmacológicas precisa ser considerada em estudos futuros sobre o tratamento desses pacientes.

Summary Night eating syndrome (NES) is characterized by caloric intake ≥ 25% of total daily after dinner and/or by two or more weekly nocturnal awakenings accompanied by food ingestion. Causes of NES are not entirely clear and seem to involve a desynchronization between the circadian rhythms of food ingestion and sleep, resulting in a delayed pattern of food intake. Estimates of the prevalence of NES in the general population are around 1.5%, and although much higher frequencies have been described in obese individuals, a causal relationship between NES and obesity is not clearly established. Since the first NES reports, several treatment modalities have been proposed, although, in many cases, the evidence is still insufficient and there is no consensus on the ideal approach. In order to conduct a critical review of proposed treatments for NES since its original description, a systematic search of articles published in journals indexed in Medline/Pubmed database in the period 1955-2015 was performed. Seventeen articles addressing non-pharmacological and pharmacological therapies met the selection criteria. Based on the articles analyzed, we conclude that serotonergic agents and psychological interventions, particularly cognitive behavioral therapy, have been shown to be effective for the treatment of NES. A combination of non-pharmacological and pharmacological therapies must be considered in future studies on the treatment of these patients.

https://doi.org/10.1590/1806-9282.62.07.701 11002 downloads

12.

Excessive daytime sleepiness in type 2 diabetes
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Medeiros, Camila

; Bruin, Veralice

; Férrer, Débora

; Paiva, Ticiana

; Montenegro Júnior, Renan

; Forti, Adriana

; Bruin, Pedro

Arquivos Brasileiros de Endocrinologia & Metabologia

Journal Metrics
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aug 2013, Volume 57 N. 6 Pages 425 - 430

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Em pacientes com diabetes tipo 2, avaliar a sonolência excessiva diurna (SED). SUJEITOS E MÉTODOS: Pacientes (N = 110) foram investigados com relação a Escala de Sonolência de Epworth (SED), qualidade do sono (Índice de Qualidade de Sono Pittsburgh), sintomas depressivos (Inventário de Depressão de Beck), Síndrome das Pernas Inquietas (SPI), risco de apneia obstrutiva do sono (AOS) (Questionário de Berlim) e comorbidades (Índice de Comorbidade de Charlson), e foram comparados com indivíduos com hipertensão arterial sem diabetes. RESULTADOS: Pacientes diabéticos apresentavam mais SED, sintomas depressivos e comorbidades que os hipertensos (p < 0,005). Em pacientes diabéticos, má qualidade do sono (53,3%), risco de AOS (40,9%) e SPI (14,5%) foram encontrados. SED (55,5%) associou-se com os sintomas depressivos em 44,5% (OR = 1,08; 95% IC 1,01-1,15) e permaneceu após controle para idade, sexo, índice de massa corporal e hemoglobina glicosilada (OR = 2,27 95% IC 1,03-5,03). CONCLUSÕES: Anormalidades do sono são frequentes. SED afeta a maioria dos pacientes e associa-se de forma independente com os sintomas depressivos. Terapia antidepressiva pode melhorar a SED.

OBJECTIVE: To examine excessive daytime sleepiness (EDS) in type 2 diabetes. SUBJECTS AND METHODS: Patients (N = 110) were evaluated regarding Epworth Sleepiness Scale (EDS), sleep quality (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventory), Restless Legs Syndrome (RLS), risk of obstructive sleep apnea (OSA) (Berlin questionnaire), and comorbidity severity (Charlson Comorbidity Index). Patients were compared with indivi-duals with arterial hypertension and without diabetes. RESULTS: Diabetic patients had more EDS, depressive symptoms, and higher comorbidity severity than hypertensive patients (p < 0.005). In diabetic patients, poor quality sleep (53.3%), and high risk of OSA (40.9%) and RLS (14.5%) were found; EDS (55.5%) was associated with depressive symptoms present in 44.5% indivi-duals (OR = 1.08; 95% CI: 1.01-1.15), and remained so after data were controlled for age, gender, body mass index, and glycated hemoglobin (OR = 2.27; 95% CI 1.03-5.03). CONCLUSIONS: Sleep abnormalities are frequent. EDS affects most of the patients and is independently associated with depressive symptoms. Adequate antidepressant therapy should be tested for the effects on EDS.

6859 downloads

13.

Neck circumference, a bedside clinical feature related to mortality of acute ischemic stroke
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Medeiros, Camila Andrade Mendes

; Bruin, Veralice Meireles Sales de

; Castro-Silva, Claudia de

; Araújo, Sonia Maria Holanda Almeida

; Chaves Junior, Cauby Maia

; Bruin, Pedro Felipe Carvalhedo de

Revista da Associação Médica Brasileira

Journal Metrics
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oct 2011, Volume 57 N. 5 Pages 559 - 564

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: O objetivo do estudo é avaliar em pacientes com acidente vascular cerebral (AVC) isquêmico, os fatores clínico/demográficos, alterações do sono e a mortalidade após um ano. MÉTODOS: Trata-se de estudo prospectivo envolvendo 89 pacientes consecutivos (64,39 ± 8,51 anos) com AVC isquêmico agudo. Foram avaliados o risco elevado de apneia obstrutiva do sono (AOS) (questionário de Berlin), a sonolência diurna (Escala de Sonolência Epworth > 10) e a qualidade subjetiva do sono (Índice de Qualidade de Sono Pittsburgh > 5). O índice de massa corpórea, a relação cintura-quadril e o perímetro cervical (PC) foram estudados: PC aumentado foi definido se > 43 cm (homens) e > 38 cm (mulheres). Estimou-se a gravidade da doença pelo Índice de Barthel e pela Escala de Rankin modificada. O desfecho final foi o óbito após 12 meses. RESULTADOS: A mortalidade após um ano foi de 8,9%. Os pacientes que foram a óbito eram mais idosos (p = 0,006) e apresentavam PC aumentado (p = 0,02). O PC aumentado relacionou-se com a presença de diabetes, hipertensão arterial e risco elevado de AOS (teste exato de Fisher). As mulheres apresentavam, relativamente, maior PC. Entre todos, história familiar de doença cerebrovascular (74,2%), diabetes (33,7%) e hipertensão (78,6%) foram frequentes; obesidade (11,2%) foi incomum. Sonolência diurna (34,8%), má qualidade do sono (65,2%) e risco de AOS (58,42%) foram frequentes. CONCLUSÃO: Alterações do sono são frequentes no AVC isquêmico agudo. Mortalidade foi mais comum em pacientes mais idosos e com maior PC. No AVC isquêmico, o PC aumentado relaciona-se com a mortalidade e provavelmente constitui-se uma medida clínica importante a ser considerada.

OBJECTIVE: The aim of this study was to evaluate clinical/demographic factors, sleep alterations and one year mortality in acute ischemic stroke. METHODS: This was a prospective study of 89 consecutive patients (mean age 64.39 ± 8.51 years) with acute ischemic stroke. High risk of obstructive sleep apnea (OSA) was evaluated by the Berlin questionnaire, daytime somnolence by the Epworth Sleepiness Scale (> 10) and subjective sleep quality by the Pittsburgh Sleep Quality Index (> 5). Clinical and anthropometric data including body mass index, hip-waist ratio, neck circumference (NC) were obtained. Increased NC was defined if > 43 cm in men and > 38 cm in women. Stroke severity was estimated by the Barthel Index and the modified Rankin Scale. The end-point was death after 12 months follow-up. RESULT: One-year mortality was 8.9%. Non-survivors were older (p = 0.006) and had larger NC (p = 0.02). Among all cases, large NC was related to high risk of OSA, diabetes and hypertension (Fisher's exact test). Compared to men, women showed relatively larger NC. Overall, family history of stroke (74.2 %), diabetes (33.7%) and hypertension (78.6%) were frequent; obesity (11.2%) was uncommon. Daytime sleepiness (34.8 %), poor sleep quality (65.2%) and risk of OSA (58.42%) were frequently found. CONCLUSION: Poor sleep quality, excessive daytime sleepiness and high risk of OSA are frequent in this sample with acute ischemic stroke. One-year mortality was related to older age and large NC. As obesity is uncommon in acute stroke patients, a large NC should be taken as a significant clinical sign related to mortality.

5111 downloads

14.

Morphometry MRI in the differential diagnosis of parkinsonian syndromes
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Gama, Rômulo L

; Távora, Daniel F.G

; Bomfim, Rodrigo C

; Silva, Cruiff E

; Bruin, Veralice M. de

; Bruin, Pedro F. de

Arquivos de Neuro-Psiquiatria

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jun 2010, Volume 68 N. 3 Pages 333 - 338

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Morfometria pela ressonância magnética (RM) no diagnóstico diferencial entre doença de Parkinson (DP), paralisia supranuclear progressiva (PSP) e atrofia de múltiplos sistemas (AMS). Este estudo avaliou a RM no diagnóstico diferencial de 21 casos com DP, 11 AMS-c, 8 AMS-p e 20 com PSP. A área sagital do mesencéfalo (Ams), área sagital da ponte (Apn), largura do pedúnculo cerebelar médio (PCM) e pedúnculo cerebelar superior (PCS) foram medidas pela RM e realizadas comparações entre destes pacientes. A Ams <105 mm² e a largura média do PCS <3 mm foram preditivas para PSP (sensibilidade de 95,0 e 80,0%, respectivamente). Nos casos de AMS-c a área pontina <315 mm² apresentou boa especificidade e valor preditivo positivo para o diagnóstico (93,8% e 72,7%). Em conclusão, as dimensões e valores de cortes obtidos a partir da RM podem diferenciar PD, PSP e AMS-c, com sensibilidade, especificidade e precisão.

This study evaluates the diagnostic value of morphometric magnetic resonance imaging (MRI) in the differential diagnosis among Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). We studied 21 PD cases, 11 MSA-c, 8 MSA-p and 20 PSP cases. Midbrain area (Ams), pons area (Apn), middle cerebellar peduncle (MCP) and superior cerebellar peduncle (SCP) were measured using MRI. Comparisons were made between PD, MSA-p, MSA-c and PSP. Apn, MCP and SCP morphometry dimensions presented differences among groups. Ams below 105 mm² and SCP smaller than 3 mmwere the most predictive measures of PSP (sensitivity 95.0 and 80.0%, respectively). For the group of MSA-c patients, Apn area below 315 mm² showed good specificity and positive predictive value (93.8% and 72.7%, respectively). In conclusion, dimensions and cut off values obtained from routine MRI can differentiate between PD, PSP and MSA-c with good sensitivity, specificity and accuracy.

6032 downloads

15.

Alterações cognitivas na SAOS
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Bruin, Pedro Felipe Carvalhedo de

; Bagnato, Mauricio da Cunha

Jornal Brasileiro de Pneumologia

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jun 2010, Volume 36 Suppl. 2 Pages 32 - 37

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Alterações da cognição e do desempenho estão bem estabelecidas em pacientes com SAOS, causando um impacto significativo sobre a qualidade de vida e o risco de acidentes nesses indivíduos. Tais alterações são mais profundas nos quadros mais graves de SAOS, o que explica a aparente discrepância na frequência e gravidade desse prejuízo entre estudos com pacientes de clínicas de sono e estudos de base populacional. Vários aspectos podem estar comprometidos, incluindo o processamento cognitivo, a atenção sustentada, as funções executivas e a memória. Entretanto, os mecanismos causais desses déficits não estão inteiramente elucidados, e existem controvérsias, particularmente em relação à contribuição relativa da hipóxia intermitente e da interrupção do sono presentes na SAOS. O impacto da sonolência diurna sobre o desempenho desses pacientes nos diversos testes cognitivos também ainda deve ser determinado, assim como o possível efeito de comorbidades frequentes, incluindo o diabete melito, a hipertensão arterial sistêmica, a doença cardiovascular e a obesidade. Existem evidências convincentes de que o tratamento com CPAP produz uma significativa melhora do desempenho e da cognição, sobretudo nos portadores de SAOS moderada e grave, embora sejam necessários mais estudos acerca do seu impacto a longo prazo.

Cognitive and performance impairment is well established in patients with obstructive sleep apnea syndrome (OSAS), having a significant impact on the quality of life and the risk of accidents in these individuals. The severity of the impairment correlates with that of the OSAS, which explains the apparent discrepancy between studies using patients from sleep clinics and population-based studies in terms of the reported frequency and severity of such impairment. Cognitive processing, sustained attention, executive functioning, and memory have all been reported to be impaired in OSAS. However, the causal mechanisms of these deficits have not been entirely clarified, and the relative contribution of intermittent hypoxia and sleep disruption in OSAS is particularly controversial. The potential effect of daytime sleepiness on the performance of these patients on various cognitive tests has yet to be determined, as does that of common comorbidities, such as diabetes, systemic arterial hypertension, cardiovascular disease, and obesity. There is compelling evidence that CPAP treatment can improve performance and cognition, particularly in mild to moderate cases, although further studies on the long-term impact of this type of treatment are still needed.

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