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

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.

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.

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.

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.

OBJETIVO: Investigar as associações entre atividade física, gravidade das comorbidades, sintomas depressivos e qualidade de vida relacionada à saúde em pacientes com diabetes mellitus tipo 2. SUJEITOS E MÉTODOS: Todos os indivíduos, 200 pacientes e 50 controles, com idades entre 40 e 60 anos, foram analisados por entrevistas, e todas as variáveis foram medidas neste mesmo momento. A atividade física foi avaliada pelo International Physical Activity Questionnaire (IPAQ); a qualidade de vida relacionada à saúde (QVRS), pelo Short-Form Health Survey (SF-36); a gravidade das comorbidades, pelo Índice de Comorbidade de Charlson (CCI); e os sintomas depressivos foram avaliados pelo Inventário de Depressão de Beck (BDI-II > 16). A análise de regressão simples e múltipla avaliou os efeitos das variáveis independentes sobre a atividade física. RESULTADOS: Os pacientes apresentaram mais sintomas depressivos e maior gravidade das comorbidades (p < 0,005). Os pacientes diabéticos apresentaram melhores níveis de atividade (IPAQ) (p < 0,005). A Capacidade Funcional, a Condição Geral de Saúde e a Limitação Física foram as subescalas mais afetadas na avaliação da QVRS no SF-36. Os pacientes diabéticos sedentários apresentaram maior circunferência da cintura, proporção cintura-quadril, mais sintomas depressivos e pior QVRS. A Capacidade Funcional (p = 0,000), seguida pela Condição Geral de Saúde (p = 0,02), foram as subescalas de medida de condição de saúde associadas independentemente com a atividade física. CONCLUSÕES: Os achados sugerem que a independência dos pacientes e o tratamentos dos sintomas depressivos podem pro-mover a atividade física para pacientes com diabetes mellitus tipo 2. Sugere-se que atividades em grupo e o apoio da família/cuidadores podem compensar a dependência do paciente e aumentar a aderência ao programa de exercícios nos pacientes menos ativos.

OBJECTIVE: To investigate associations between physical activity, comorbidity severity, depressive symptoms, and health-related quality of life in type 2 diabetes mellitus. SUBJECTS AND METHODS: All individuals, 200 patients and 50 controls, aged from 40 to 60 years, were investigated by interview, and all variables were measured concurrently. Physical activity was evaluated by the International Physical Activity Questionnaire (IPAQ), Health-Related Quality of Life (HRQL) by the Short-Form Health Survey (SF-36), comorbidity severity by the Charlson Comorbidity Index (CCI), and depressive symptoms by the Beck Depression Inventory (BDI-II > 16). Single and multiple regression analysis evaluated the effects of independent variables on physical activity. RESULTS: The patients had more depressive symptoms and greater comorbidity severity (p < 0.005). Diabetic patients showed better activity levels (IPAQ) (p < 0.005). Functional Capacity, General State of Health, and Physical Limitation were the most affected subscales in the SF-36 evaluation of the HRQL. Sedentary diabetic patients had higher waist circumference, waist-to-hip ratios, more depressive symptoms, and worse HRQL. Functional capacity (p = 0.000), followed by General State of Health (p = 0.02), were the health status measure subscales independently associated with physical activity. Conclusions: The findings suggest that increasing patient independence and treating depressive symptoms can promote physical activity for type 2 diabetes mellitus patients. It is suggested that group activities and caregivers/family support might compensate for the patient dependence, and increase adherence to exercise programs in those that are less active.

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.

O objetivo deste artigo é explicitar o posicionamento das sociedades médicas que, reunidas, estabeleceram consenso sobre os parâmetros clínico-laboratoriais que envolvem os distúrbios respiratórios do sono, em especial o ronco e a síndrome da apneia obstrutiva do sono (SAOS). Os ortodontistas, que vêm ocupando gradativamente seu espaço em equipes multidisciplinares que atuam na área do sono humano, pouco conhecem sobre essa uniformização coordenada pela Associação Brasileira de Sono. Os trabalhos clínicos e as pesquisas científicas oriundos da Odontologia, e em particular da Ortodontia, também devem observar e seguir esses critérios de diagnóstico e tratamento estabelecidos pela comunidade médica brasileira.

The objective of this article is to clarify the positions of the medical societies that have worked together to establish a consensus regarding the clinical and laboratory parameters involved in sleep-disordered breathing, particularly snoring and obstructive sleep apnea syndrome (OSAS). Orthodontists have gradually come to take part in multidisciplinary teams that act in the area of human sleep, but few know about the uniformity coordinated by the Brazilian Association of Sleep. Clinical and scientific studies from the field of dentistry (particularly orthodontics) also must observe and follow these diagnosis and treatment criteria established by the Brazilian medical community.

INTRODUÇÃO: O uso de ciclofosfamida endovenosa é uma opção terapêutica nas formas graves de lúpus eritematoso sistêmico (LES). No entanto, a toxicidade e o perfil de risco ainda não estão adequadamente definidos. OBJETIVO: Avaliar sobre a ocorrência de alterações do sono em pacientes portadores de LES submetidos à terapia com ciclofosfamida endovenosa. MÉTODOS: Nós estudamos 30 casos consecutivos (27 do sexo feminino) com idade entre 14 e 53 anos (30,5 ± 10), em pulsoterapia com ciclofosfamida (mg) (média 948,27 ± 221,39). Os pacientes foram avaliados quanto à presença de sintomas depressivos, qualidade do sono e sonolência excessiva diurna (SED). A qualidade do sono foi estudada pelo índice de qualidade do sono de Pittsburgh (IQSP), a SED pela escala de sonolência de Epworth e os sintomas depressivos pelo Inventário de Depressão de Beck (21 itens). A gravidade da doença foi avaliada por intermédio do SLEDAI. RESULTADOS: O SLEDAI oscilou entre 2 e 46 (17 ± 11,4). Hipertensão (30%), anemia (23,3%), osteoporose (23,3%) e miocardiopatia (6,6%) foram as comorbidades mais observadas. Um paciente tinha história de convulsões (3,3%). Má qualidade do sono (PSQI e" 6) foi encontrada em 66,7% e SED (ESS > 10), em 30% dos pacientes. Sintomas de depressão (BDI > 19) estavam presentes em 40% dos casos. Os sintomas depressivos associaram-se à presença de má qualidade do sono (p = 0,03). CONCLUSÕES: Nosso estudo mostra que alterações do sono e sintomas depressivos são comuns em pacientes portadores de LES em pulsoterapia com ciclofosfamida. Esses achados são similares a outros estudos previamente relatados e são independentes do tipo de tratamento utilizado.

BACKGROUND: Pulse i.v. cyclophosphamide is a therapeutic option in severe forms of systemic lupus erythematosus (SLE). However, the overall toxicity and risk profile are yet to be adequately defined. OBJECTIVE: To evaluate the occurrence of sleep disturbances in SLE patients subjected to i.v. cyclophosphamide. METHODS: We studied thirty consecutive SLE patients (27 female) age range 14 to 53 years (mean 30.5 ± 10 years) that received i.v. cyclophosphamide (mg) (mean 948.27 ± 221.39). Depressive symptoms, quality of sleep, and the presence of excessive daytime sleepiness were evaluated. Disease severity was assessed by the SLEDAI. Quality of sleep was assessed by the Pittsburgh Sleep Quality Index (PSQI) and excessive daytime sleepiness (EDS) by the Epworth Sleepiness Scale (ESS). Depressive symptoms were evaluated using the 21-item Beck Depression Inventory (BDI). RESULTS: SLEDAI values ranged from 2 to 46 (mean 17 ± 11.4). The most common comorbidities were systemic arterial hypertension (30%), anemia (23.3%), osteoporosis (23.3%), and cardiomyopathy (6.6%). Seizures occurred in one patient (3.3%). Poor quality of sleep (PSQI e" 6) and EDS (ESS >10) were found in 66.7% and 30% of the patients, respectively. Depressive symptoms (BDI >19) were present in 40% of the patients and were associated with poor sleep quality (P = 0.03). CONCLUSIONS: Our findings show an increased prevalence of poor sleep quality and depressive symptoms in SLE patients receiving pulse i.v. cyclophosphamide. These findings were similar to other previously reported series of SLE patients regardless of the therapies used.

OBJETIVOS: Alterações do sono têm sido relatadas em até 80% dos pacientes com Insuficiência renal crônica dialítica (IRCD). Insônia, síndrome da apnéia do sono, síndrome das pernas inquietas (SPI), movimentos periódicos de extremidades e sonolência excessiva diurna (SED) têm sido descritos. A influência que o turno da diálise exerce sobre as alterações do sono e sobre a morbidade e mortalidade ainda é desconhecida. O objetivo deste estudo foi avaliar a influência do turno da diálise sobre as anormalidades do sono em pacientes com IRCD. MÉTODOS: Estudamos 100 pacientes consecutivos provenientes de um centro de diálise. A qualidade do sono foi avaliada através do Índice de Qualidade do Sono de Pittsburgh (IQSP) e a SED através da Escala de sonolência de Epworth (ESE). A SPI foi avaliada utilizando os quatro critérios mínimos definidos internacionalmente pela International Restless Legs Syndrome Study Group. Os parâmetros clínicos e laboratoriais foram obtidos através de entrevistas e revisão de prontuários. A qualidade da diálise foi avaliada pelo índice Kt/V. RESULTADOS: Má qualidade do sono (IQSP>6), encontrada em 75% dos casos, associou-se à SPI (P= 0.004) e à presença de ronco (P= 0.016). Pacientes com SED (ESE>10) (1.33±0.29) apresentaram valores do índice Kt/v menores (P=0.01) do que aqueles sem SED (1.52±0.32). Observou-se a presença de SPI em 48% dos pacientes. Má qualidade do sono, SED e SPI não diferiram entre os pacientes agrupados quanto ao turno de diálise. CONCLUSÃO: Má qualidade do sono, SED e SPI são freqüentes e não se relacionam com o turno da diálise.

OBJECTIVES: Subjective sleep complaints have been reported in up to 80% of patients with end stage renal disease (ESRD). In these patients, sleep disturbances manifesting as insomnia, sleep apnea syndrome, restless leg syndrome (RLS), periodic limb movement disorder and excessive daytime sleepiness (EDS) have been frequently reported. Moreover, studies about the role of dialysis shift on sleep abnormalities, morbidity and mortality are still scarce. The aim of this study was to investigate the influence of dialysis shift on the quality of sleep and sleep abnormalities in patients with ESRD. MÉTHODS: We studied one hundred consecutive patients from a dialysis center. Quality of sleep was assessed by the Pittsburgh Sleep Quality Index and subjective EDS by the Epworth Sleepiness Scale. Restless leg syndrome was diagnosed using the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Clinical and laboratory parameters were obtained by interview and chart review. Adequacy of dialysis was evaluated by the Kt/V index. RESULTS: Poor quality sleep (PSQI>6) was found in 75% of cases and was associated with RLS (p=0.004) and with snoring (p=0.016). EDS (ESS>10) was present in 28% of cases. Patients with EDS (1.33±0.29) had lower values of the Kt/v index (P=0.01) than those without EDS (1.52±0.32). RLS was present in 48% of cases. Irrespective of dialysis shift, poor quality sleep, EDS and RLS were not different among patients. CONCLUSION: Poor quality sleep, EDS and RLS were common and not related to dialysis shift.

How to handle Western blot (WB) seroindeterminate individuals for Human T-lymphotropic Virus 1/2 (HTLV-1/2) constitutes a challenge for blood banks and fam ilies. We made a cross-sectional study of 191 enzyme linked immunoassay (EIA) reactive individuals from the hematological center (HEMOCE) of Fortaleza (Brazil), examining their serological (WB) and molecular (PCR) diagnosis, and demographic profiles, as well as a possible association of their condition with other infectious pathologies and risk factors. Ethical institutional approval and personal consent were obtained. Out of 191 EIA reactive individuals, 118 were WB seroindeterminate and 73 were seropositive for HTLV-1/2. In the PCR analysis of 41 WB seroindeterminate individuals, 9 (22%) were positive and 32 (78%) were negative for HTLV-1/2. The demographic analysis indicated a trend towards a predominance of males among the seroindeterminate individuals and females in the seropositive ones. The seroindeterminate individuals were younger than the seropositive ones. We did not find any association of these conditions with syphilis, Chagas disease or HIV or hepatitis, and with risk factors such as breast-feeding, blood transfusion, STD (syphilis) and IDU.