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Objective: To evaluate the response to CPAP in patients with chronic insomnia disorder (CID) with OSAS in an unselected patient population including all OSAS severity groups. As a secondary objective, we also wanted to evaluate the differences between patients that improve insomnia symptoms with CPAP and patients that do not improve, specifically evaluating possible gender differences. Methods: Retrospective study of patients with a diagnosis of OSAS treated with CPAP and CID at the first clinical visit, selected from a database of an outpatient sleep clinic of University Hospital. Results: From a database of total of 827 patient, 90 patients were identified with OSAS and CID (53.3% women). Middle / moderate OSAS was diagnosed in 68.9% and severe OSA in 31.1%. Most patients (61.1%) improved insomnia symptoms after CPAP therapy. In the responders group, 58.2% had initial insomnia, 63.6% middle insomnia and 12.7% late insomnia. Responders to CPAP were more frequently women (women 61.8%, men 38.2%, p = 0.035) and there was no other difference between responders and non-responders. On subgroup analysis, this difference was significant only in severe OSAS (women 88.9%, men 31.6%, p = 0.013). Conclusion: In most patients with CID and OSA, there is a consistent reduction of insomnia symptoms with the CPAP use. This factor emphasizes the importance of performing PSG in CID. Insomnia in men with severe OSAS responds less frequently to CPAP suggesting that in these cases the insomnia phenotype is less dependent on the respiratory symptoms.

Excitotoxicity has been related to play a crucial role in Parkinson’s disease (PD) pathogenesis. Pedunculopontine tegmental nucleus (PPT) represents one of the major sources of glutamatergic afferences to nigrostriatal pathway and putative reciprocal connectivity between these structures may exert a potential influence on rapid eye movement (REM) sleep control. Also, PPT could be overactive in PD, it seems that dopaminergic neurons are under abnormally high levels of glutamate and consequently might be more vulnerable to neurodegeneration. We decided to investigate the neuroprotective effect of riluzole administration, a N-methyl-D-aspartate (NMDA) receptor antagonist, in rats submitted simultaneously to nigrostrial rotenone and 24h of REM sleep deprivation (REMSD). Our findings showed that blocking NMDA glutamatergic receptors in the SNpc, after REMSD challenge, protected the dopaminergic neurons from rotenone lesion. Concerning rotenone-induced hypolocomotion, riluzole reversed this impairment in the control groups. Also, REMSD prevented the occurrence of rotenone-induced motor impairment as a result of dopaminergic supersensitivity. In addition, higher Fluoro Jade C (FJC) staining within the SNpc was associated with decreased cognitive performance observed in rotenone groups. Such effect was counteracted by riluzole suggesting the occurrence of an antiapoptotic effect. Moreover, riluzole did not rescue cognitive impairment impinged by rotenone, REMSD or their combination. These data indicated that reductions of excitotoxicity, by riluzole, partially protected dopamine neurons from neuronal death and appeared to be effective in relieve specific rotenone-induce motor disabilities.

Importance: Aesthetic rhinoplasty is the fifth surgical procedure most performed worldwide by plastic surgeons. With the growing demand for rhinoplasty, there is an unmet need for research into the profile of patients who seek aesthetic nasal surgery in an attempt to improve not only cosmetic dissatisfactions, but also the manifestations of other, possibly interrelated disorders, especially sleep disturbances. Objective: To evaluate the sleep quality and the risk of Obstructive Sleep Apnea in patients referred for aesthetic rhinoplasty, as well as the association of these conditions with nasal symptoms. Design: Cross-sectional study performed at the period of June/2016 to August/2017. Setting: Department of Otolaryngology and Head and Neck Surgery - Universidade Federal de São Paulo. Participants: Patients of both sexes, aged 18 to 65 years, who were referred for aesthetic rhinoplasty. We evaluated 46 patients, two of whom were excluded because they were outside the inclusion age criteria. Main Outcome(s) and Measure(s): Anterior rhinoscopy and the following validated surveys were used. Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Nasal Obstruction Symptom Evaluation scale; Berlin Questionnaire. The visual analog scale for snoring was also used. Results: Of the 44 participants, 18 (41%) were males and 26 (59%) were females. 82% had poor sleep quality. 46% presented excessive daytime sleepiness. There was a high risk for Obstructive Sleep Apnea in 27%. Regarding to nasal symptoms, the mean score in the Nasal Obstructive Symptoms Evaluation was 66.25±25.38. When comparing the groups with good and poor sleep quality, we observed a higher risk for Obstructive Sleep Apnea (p=0.05) in patients with poor sleep quality. Patients at high risk for Obstructive Sleep Apnea had higher scores on the Nasal Obstructive Symptoms Evaluation (p=0.001) and on the analogue snoring scale (p

The aim of the current study was to investigate the effect of the blue-light filtering ‘Night Shift’ function on the Apple iPad at night and leptin production, perceived hunger levels and markers of sleep quality and quantity in healthy young adults. In a randomised, crossover design, 13 young adults (6 male/7 female) performed three experimental trials. Two of the interventions included one hour of night-time electronic device use; reading on an iPad ~30 cm from eyes, either with (iPad+NS) or without (iPad) the ‘Night Shift’ blue-light filtering feature turned on. The control trial involved reading a hard-copy book for one hour (CON). Leptin and perceived hunger and tiredness levels were assessed at various time points for the three experimental conditions. Objective sleep indices (actigraphy) and subjective ratings of sleep were recorded. There were no significant interactions for any of the measured variables (p > 0.05). Small to moderate effect sizes were found for perceived sleep quality, with CON (7.3 ± 1.7) having the highest value when compared to iPad+NS (6.6 ± 1.8, d = 0.29) and iPad (5.6 ± 2.3, d = 0.66). Moderate effects were associated with iPad+NS when compared to iPad (d = 0.77) and for iPad compared to CON (d = 0.90) for pre-post change in leptin concentration. Use of electronic devices at night may result in moderate suppression of leptin levels and impaired sleep quality, with negligible differences associated with whether or not the ‘Night Shift’ feature is turned on.

Objective: Sleep is of upmost importance for everybody and especially for adolescents who face life and leisure challenges that may impair their sleep. This study aimed to verify if girls are at a higher risk to present sleep problems and if associations of a sleep perception are different between sexes even when accounting for biological maturation. Methods: Data is from the HBSC Portuguese survey 2014, all variables were self-reported. Participants were 3869 adolescents (2057 girls), mean age 14.8 years. Participants’ socio-demographic characteristics included sex, age, school grade, father and mother education; besides participants were inquired about sleep duration and characteristics of their sleep quality. Results: Sleep deprivation was reported by 13.1% of the adolescents (girls 14.3%, boys 11.7%, p

Study objectives: Night-to-night variability in the apnea-hypopnea index (AHI) may affect the accuracy of the diagnosis of obstructive sleep apnea (OSA) and treatment selection. This study was conducted to assess the utility of the standard error of measurement (SEM) in predicting the night-to-night variability in the OSA. Methods: Ninety nine patients underwent a 3-consecutive nights of sleep monitoring with a validated home portable monitoring devise (BTI-APNiA, BTI Biotechnology Institute, Vitoria, Spain). The night-to-night variability in apnea- and hypopnea-related measures and blood desaturation were assessed. The agreement between the three nights was also assessed. The SEM and the AHI of the first night were used to calculate a range for the severity of the OSA. This range was then challenged to predict the most frequent OSA severity, the OSA severity in nights 2 and 3, and the OSA severity in the three nights. Results: Ninety nine patients (mean age: 56±14 years) participated in the study. The mean body mass index was 25.4±4.0 Kg/m2 and the mean score of Epworth questionnaire was 8±5. The AHI of the first, second and third nights were 13.96±13.46, 13.76±12.76 and 13.52±12.91 events/h, respectively. The night-to-night variability in the AHI and the sleep time in supine position over the three nights were not statistically significant. However, the differences in the severity of the OSA was statistically significant (range of agreement in the diagnosis: 41.7%- 83.3%). The standard error of measurement (SEM) considering the AHI was 4.64 events/h.. The SEM was efficient in predicting the most frequent OSA severity (among the three nights) in more than 96% of the cases. Conclusions: The night-to-night variability in the AHI might affect the diagnosis of OSA. The use of standard error of measurement and the AHI of one single night would be of interest to predict the night-to-night variability in the severity of OSA.

Background and aim: Given the ever-increasing of the older adults population and in order to achieve healthy and active ageing goals and improvement in the cognitive function and sleep quality in older adult, this study aimed to evaluate the effect of cognitive training program on improving cognitive function and ageing-related sleep quality in community-dwelling elderly in Iran, in 2018. Methods: This was an experimental study. The sample comprised 420 older adults who were a member of the comprehensive health center in one of the southern cities of Iran. 164 had a cognitive problem and sleep disorder, of whom 108 were selected by the available method and based on inclusion criteria. Participants were randomly allocated to an experimental group (n=54) and a control group (n=54). Experimental group samples were undergoing the intervention for two months. Data were collected using MMSE questionnaire, Pittsburgh sleep quality, insomnia severity index and Clinical Dementia Rating Scale (CDR). Data were collected one month before-andafter the intervention. Data were analyzed using SPSS software. Results: There was no significant difference between the mean score of cognitive function and sleep quality in both the intervention group and the control group before the intervention (p>0.05). At the post-test, the mean (SD) of elderly adults’ cognitive function in the intervention and control groups were 2.7 (1.3) and 3.44 (1.7), respectively (p=0.017). Moreover, the mean (SD) of sleep quality in older adults in the intervention and the control group was 6.76 (2.3) and 9.25 (2.36), respectively (p

Objectives: Sleep is one of the basic elements which affects the growth and development and mental health of the child. The aim of this study was to determine the relationship between sleep habits and mental health in elementary school children in Nahavand/Iran. Methods: In this correlation study, 240 children aged 6-11 years old were selected by cluster random sampling from schools of Nahavand city in Iran, 2017. Data were collected through questionnaires included demographic information, children’s sleep habits (CSHQ) and children sickness indications (CSI-4). Questionnaires were completed by one of parents as self-report. The data were analyzed using Pearson’s correlation and regression analysis. Results: Based on results, Trouble in sleeping was reported by 36% and mental health disorders by 24.5% of elementary schools children. The regression analysis showed sleep habits had significant associations with the mental health score. In other words, improper sleep habits were associated with higher scores of illness symptoms of mental health that are indicative of poor mental health. Discussion: Sleep disorder is one of the problems of elementary schools children, which related to their mental health. Sleep health training for parents and trainers in schools can help to improve the mental health of children by reforming proper sleep habits.

Two-piece mandibular advancement devices (MAD) are considered more comfortable than monoblock devices, and they are commonly used for the treatment of obstructive sleep apnea (OSA). However, they are not without limitations, especially in patients with nasal obstruction/malocclusion. Here, we discuss the case of a 37-year-old woman with mandibular regression and severe OSA, for whom a standard twopiece MAD was not adequetely effective. However, her sleep apnea improved with concurrent treatment with lip-muscle training (orofacial myofunctional therapy, OMFT) and a two-piece oral appliance (OA) supplemented with an elastic retention band (ERB). The OMFT improved lip muscle strength. In particular, the ERB restricted mouth opening. The application of OMFT together with an OA and ERB was a good option for this patient. Future clinical trials should include a three-arm study involving the OMFT (with measurement of lip-closure force, reflecting the degree of mouth opening), the two-piece OA with an ERB, and combined treatment.

Objective: The focus of this study was to evaluate the associations between subjective sleep quality and duration and weight gain during pregnancy. Methods: A prospective and longitudinal study was conducted with 63 pregnant women. Pregnant women were evaluated at the first, second and third trimester for subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and anthropometric variables for body mass index [BMI] calculation. The sleep quality was grouped per cluster, identifying those individuals who maintained, improved or worsened their sleep quality, based on the PSQI classifications. Generalized estimating equations (GEE) were used to examine the association between sleep and BMI over the pregnancy period. Results: An effect of the interaction between time of pregnancy and clusters of sleep quality was observed on the BMI (p

Objective: To estimate the prevalence and association of work organization associated with poor sleep quality among airline pilots. Methods: 1234 airline pilots filled out an online questionnaire. Independent variables included demographic data, work organization aspects, health, and sleep information. A question derived from the Karolinska Sleep Questionnaire was used to obtain subjective sleep quality. Poisson regression with robust variance was performed. Results: The prevalence of poor sleep quality was 48.2%. Poor sleep quality was associated with high frequency of technical delays, ≥ 5 consecutive night shifts, moderate and great need for recovery after work, difficulty commuting to work, being insufficiently physically active and sleeping 6-8 hours and < 6 hours on days off. Conclusion: Pilots’ daily work schedules, consisting of frequent delays, long working hours and perceived high work demands preventing adequate recovery were associated with poor sleep quality.

Objective: Polygraphy (PG) is an attractive alternative for diagnosing obstructive sleep apnea (OSA) in patients with high pre-test probability. However, several patients may not present typical symptoms. In this scenario, it is unclear the performance of PG for diagnosing OSA in nonreferred populations to sleep laboratories. Methods: Data from participants of the ELSA-Brasil cohort were used for this analysis. We performed an overnight home PG (Embletta GoldTM) synchronized with a wrist actigraphy (Actiwatch model 2TM). The validation strategy comprised three scorings from each participant: 1) Original scoring (PG): Routine scoring using data from the exclamation button mark to define “analysis start” and “analysis stop”; 2) Scoring using actigraphy data (PG+actigraphy): total sleep time defined by the actigraphy data; 3) Scoring using diaries (PG+diary): “analysis start” and “analysis stop” based on the diaries. Bland-Altman plots were generated to assess the agreements (Kappa) between each scoring strategy. Results: A total of 300 participants were included in the final analysis (45% males, mean age: 48±8 years). The frequency of OSA using the PG score was 27.3%. Despite small differences in the OSA severity index, we obtained a high concordance of AHI comparing the PG vs. PG+actigraphy (Kappa: 0.95) as well as PG+diary vs. PG+actigraphy (Kappa: 0.96). No significant changes in the OSA classification (mild, moderate and severe) were observed in the 3 protocols. Conclusion: Using a pragmatic approach to address OSA at home, our results suggest that PG is a useful tool for OSA diagnosis even in subjects not referred to sleep studies.

Intimate Partner Violence is a global health issue with higher prevalence worldwide, mostly in women, higher social and economic costs and devastating physical and mental health consequences for the victims. Sleep disturbances has been associated with other mental health issues, being an important symptom when diagnosing post-traumatic stress disorder, depression or anxiety. It can also constitute an important sign to help health professionals to identify potential victims of intimate partner violence. This review paper main objectives are to address the connection between intimate partner violence and sleep disruption, the role and barriers of health professionals in screening this type of violence when sleep problems are present, and to describe good practices in order to identify these victims and to provide support. It has been found that intimate partner victims commonly experience significant sleep disturbances that include truncated sleep, nightmares and less restful sleep. Health professionals are first-line professionals with a pivot role to screen and identify women victims. However, a set of personal (e.g., lack of knowledge and inadequate perceptions about violence, cultural issues) and organizational barriers (e.g., time constraints, lack of training, absence of institutional protocols) may limit the accurate reading of those symptoms. Accordingly, health professionals must be alert not only to physical health conditions associated with violence (acute physical injuries, chronic physical injuries, obstetric and genital injuries), but also psychological problems, like depression, anxiety, post-traumatic stress disorder, alcohol or drug misuse, sleep disturbances, insomnia and nightmares. In the presence of alert symptoms related to violence, health professionals become able to screen, identify and provide ongoing care for women, promoting a trusting relationship and assuming an attentive non-judgmental listening., (undefined)

The cone beam computed tomography (CBCT) image provides clear differentiation of soft tissues from empty spaces. This paper presents a literature review to evaluate the effects of orthopedic and surgical treatment on the pharyngeal dimension by CBCT. It was concluded that treatments involving dentofacial orthopedics and orthognathic surgery have been related with an increase in the upper airway volume. Standardized capturing of tomographic images and more controlled and randomized studies are necessary.

The diagnosis of a nightmare disorder is based on clinically significant distress caused by the nightmares, e.g., sleep or mood disturbances. In order to understand nightmare etiology better empirical research should focus on studying factors that affect nightmare distress in addition to nightmare frequency. Overall, 2492 persons (1437 woman, 1055 men) completed the online survey. Nightmare frequency, global nightmare distress, and personality traits were measured. The findings indicate that in addition to nightmare frequency heightened emotional reactivity measured as neuroticism contribute to global nightmare distress and, thus, supporting the neurocognitive model of Levin and Nielsen (2007). Moreover, the recurring nightmares that relate to a waking-life event were associated with higher nightmare distress. From a clinical viewpoint, it would be desirable to carry out similar surveys using diagnostic interviews in order to determine the presence of a nightmare disorder and study the variables that are related to that diagnosis.

Introduction: Sleep bruxism (SB) is a frequent condition in children. Its pathophysiology involves certain neurotransmitters (serotonin, dopamine, noradrenalin, histamine), but the environment seems to influence its occurrence. Objective: The objective of this study was to investigate the prevalence of SB in children and their biological mothers, relating it to stress through a case control study. Methods and Material: The group of cases (SG) was composed of 48 subjects, including 24 children with SB and their mothers, and the control group (CG), formed by 36 children without SB and their mothers. The chi-Square test was used and the probability was computed with 95% confidence intervals (p

Objective: This study aimed to investigate subjective sleep quality and its association with demographics, psychological health, and sleep hygiene related behaviors in pre-clinical medical students. Methods: In this cross-sectional study, a self-administered questionnaire consisting of demographics, sleep hygiene behaviors, Pittsburgh Sleep Quality Index (PSQI), and Depression, Anxiety and Stress Scale-21 (DASS21) was handed out to all medical students of Tehran University of Medical Sciences at pre-clinical stage. Results: The questionnaire was filled out by 553 (89.7%) of 616 students approached. About 60% of our sample had a global PSQI score of more than 5 (cut off of poor sleep quality) with mean global PSQI score of 6.32 (SD=2.72). The prevalence of moderate to extremely severe depression, anxiety and stress scores were 26.1%, 29.61%, and 14.5% respectively. Poor sleep quality was associated with later year in the school, psychological distress and several lifestyle behaviors. Constructing a multivariate logistic model, depression, anxiety and some sleep hygiene behaviors were significantly associated with higher PSQI score. Discussion: Our findings suggest that poor sleep quality is a common problem among pre-clinical medical students and is associated with some psychological symptoms and sleep hygiene behaviors. This issue demonstrates necessity of interventions to improve the sleep quality in this population group.

Objective: The role of sleep architecture in consolidation of memory has not been extensively investigated. In this study, the association of continuous positive airway pressure (CPAP) and sleep architecture and quality, and sleep disordered breathing on changes in memory are explored during the course of a 6 month clinical trial of CPAP or sham CPAP (APPLES). Methods: 848 participants had polysomnographic and memory assessments (Buschke Selective Reminding Test [Buschke] and Digit Symbol Substitution Test [DSST]) at baseline, CPAP/Sham CPAP titration, and the 2 and 6 month time points. Half were assigned to the CPAP and Sham CPAP groups respectively. Changes in performance on the Buschke and the DSST were analyzed over the course of the study between CPAP and Sham CPAP as well as in relationship to changes in sleep architecture, sleep quality and sleep disordered breathing (SDB). Results: Sleep architecture, sleep quality and SDB improved in the CPAP group at 6 months; performance on the Buschke and DSST improved equally in both CPAP and Sham CPAP groups. There also were no significant correlations between changes in the amount or percentage of sleep stages between baseline and the 6 months, and corresponding changes in either the Buschke or the DSST. However, when stratified by the upper quartile and lower 3 quartiles, greater changes in the Buschke occurred over 6 months in the top quartile of total sleep time (5.7±7.3 vs. 4.0±6.8, p≤0.01) and amount of N3 sleep (55.9±7.7 vs. 53.6±8.9 min, p≤0.01). Those with more %N3 at 6 months scored better on the Buschke as well (55.9±7.8 vs. 53.6±8.9, p≤0.01). Borderline improvement in the DSST over 6 months was observed in the top quartiles of amount of N3 and %N3. Those in the top quartile of the amount of REM and %REM also showed greater improvement in the Buschke after 6 months. No differences were observed for the AHI, but those in the top quartile of oxygen desaturation had worse scores on the Buschke at 6 months. CPAP/Sham CPAP adherence did not impact 6 month Buschke or DSST performance. Conclusions: CPAP improved long-term sleep duration, quality and architecture, but did not memory. However, large changes in REM and N3 sleep as well as moderate amounts of nocturnal hypoxemia are associated with changes in assessments of memory.

The public opinion is ever more interested and worried about possible effects of exposure to VGs (video games) on human life and well-being. Scientific literature shows several evidences highlighting negative outcomes on behavioural, emotive, cognitive and physical health spheres. All these aspects are intrinsically linked to sleep quality and quantity and to date very few studies directly investigated the effects of videogame (VG) exposure on sleep and post-sleep cognitive status. The aim of the present systematic review is to examine the impact that the exposure to VGs can produce on sleep pattern and the consequent post-sleep cognitive abilities. To this extent, only studies directly investigating the effects of VGs on sleep features and post-sleep cognitive abilities have been selected and discussed. Data currently present in literature show the alteration of sleep pattern after exposure to VGs. The analysis indicated a reduction of Total Sleep Time (TST) and an increase of Sleep Onset Latency (SOL), modifications of the REM sleep and Slow Wave Sleep (SWS), and increased sleepiness and self-perceived fatigue. Moreover, post-sleep sustained attention and verbal memory also appear to be impaired. It can be concluded that playing VGs for long periods, particularly in the evening, is a significant, common and probable cause of sleep problems: evening exposure to VGs, in fact, can bring to insufficient and low quality sleep, with possible effects on cognition in the subsequent waking days. Potential methodological flaws and limitations of these studies have also been described and discussed. Because of the very limited number of available study on this topic further research is strongly needed.

The purpose of this study was to analyze the rest-activity rhythm of type 2 diabetics mellitus (T2DM) and compare it to healthy controls using the nonparametric analytic approach. Twentyone diabetics and 21 healthy subjects matched for gender and age were recruited to participate in the study. Data were analyzed using the Independent t-test, Mann-Whitney U test, and Spearmans correlation. T2DM subjects demonstrate lower interdaily stability (IS) (p=.03), higher intradaily variability (p=.046) and lower rhythm amplitude (p=.02) when compared to healthy controls. Also, there was a positive correlation between IS and most active 10 hr (M10) in the average of 24 hours pattern (r =.44; p=.046) in the diabetes group and a negative correlation between IV and M10 in the healthy group (r =-.57; p=.007). These data together suggest that T2DM exhibits a dysfunction in the rest-activity rhythm due to alterations in the circadian function as well as in the homeostatic capacity to maintain sleep; mainly characterized by less consistency across days of the daily circadian signal, higher rhythm fragmentation and lower rhythm amplitude. Future approaches may be developed considering the influence of circadian glucose variations throughout the day on the coupling of the rest-activity rhythm to zeitgeber and rhythm fragmentation.

Objective To evaluate the safety and efficacy of a 5 mg sublingual dose of zolpidem, compared to a 10 mg oral dose, at bedtime and "as needed" following middle-of-the-night awakenings. Methods Participants were randomized into an oral group (oral zolpidem 10 mg and sublingual placebo at bedtime and "as-needed") and a sublingual group (oral placebo and sublingual zolpidem 5 mg at bedtime and "as-needed"). Participants underwent medical evaluation, polysomnography, the psychomotor vigilance test, and completed questionnaires. Results Of 85 patients, 67 met the criteria for insomnia (48±10 years; 79% women) and were randomized. Of these, 46 completed 92±5 days of treatment. Mild-to-moderate adverse events were reported by 25% of the participants, including headache, sleepiness, and dizziness. Both treatments decreased middle-of-the-night awakenings by an average of -3.1±2.3 days/week and increased total sleep time by 1.5 hours. Changes in sleep quality and insomnia severity scores were also favorable and comparable between groups: variation depended on continuation of treatment. Regarding PSG findings, sleep latency decreased more in the sublingual group than the oral group (-14±42 vs. 10±29 min; p = 0.03). The psychomotor vigilance test showed minor residual effects 30 minutes after awakening, which reversed after 2 hours. Conclusions The safety and efficacy of both zolpidem formulations are comparable. The sublingual 5 mg dose induced sleep more rapidly. Clinical trial registration NCT01896336.

Objectives: To describe the frequency of sleep-disordered breathing (SDB) in pediatric cystic fibrosis (CF) and to study associations between polysomnographic respiratory parameters and available clinical information. Methods: This was a retrospective, cross-sectional study. The sample data were obtained from information recorded on patient charts in 2015 and 2016. The study included all individuals with CF aged from 2 to 20 years for whom records were available for polysomnography performed within the previous two years. Results: Sixteen individuals with CF (mean age 11 ± 5.6 years old) were included. Polysomnographic respiratory parameter abnormalities were defined as an apnea-hypopnea index (AHI) exceeding one event per hour of sleep or an oxyhemoglobin saturation (SpO2) nadir below 90%; observed in 10 subjects (62.5%). Forced expiratory volume in first second (FEV1) was correlated (r=0.602, p=0.023) with mean sleep SpO2. FEV1 was also negatively correlated with sleep peak end-tidal carbon dioxide (EtpCO2) (r=-0.645, p=0.024). Additionally, chronic airway colonization by Pseudomonas aeruginosa was associated with mean EtpCO2 in non-REM sleep (p=0.024). Discussion: SDB was frequently observed in this sample of children with CF. There was an association between CF respiratory disease progression markers and sleep breathing parameters in children. Sleep studies appear to be an important tool for assessment of the respiratory status of these individuals with CF, although further studies are needed, especially with carbon dioxide sleep analysis.

Obstructive Sleep Apnea is a common respiratory disorder characterized by recurrent nocturnal episodes of normal breathing interruption due to upper airway total or partial collapse. Obstructive sleep apnea and cardiovascular diseases has similar risk factors, but the first is also a predisposing factor for cardiovascular pathologies independently of individuals demographic characteristics or risk markers. Heart rate variability is a non-invasive method to evaluate the regulation of autonomic nervous system and its a promising marker for health and disease, such as cardiovascular and respiratory diseases. The aim was to review whether heart rate variability is altered in patients with obstructive sleep apnea. We searched in five databases, including BIREME, Cochrane, Scholar Google, MEDLINE/PubMed and Periodics CAPES, and reference lists were also searched. Only cross-sectional studies comparing the heart rate variability of obstructive sleep patients with controls were included. Two authors independently extracted data and assessed trial quality. Twelve studies (513 participants with obstructive sleep apnea and 340 controls) met the inclusion criteria. This review evidence that adults with obstructive sleep apnea may demonstrate diminished vagal tone and higher sympathetic responsiveness.

Anatomical, physiological, psychological and hormonal alterations affect sleep during pregnancy. Sleep appears tobe commonly impaired only after the first trimester. Albeit objective data regarding the reduction of sleep durationand efficiency are not univocal, poor sleep is reported by over half of pregnant women. The reasons underlyingthese complaints are multiple, including lower back pain, gastroesophageal reflux disorder (GERD), increasedmicturition and repositioning difficulties at night. Specific primary sleep disorders whose prevalence drasticallyincreases during pregnancy include obstructive sleep apnea (OSA) and restless legs syndrome (RLS), both relatedto gestational hypertension and gestational diabetes mellitus (GDM). Pre-eclampsia and labor complicationsleading to an increased number of cesarean sections and preterm births correlate with insomnia and OSA inparticular. Post-partum depression (PPD) and impairment of the mother-infant relationship may also be consideredas secondary effects deriving from poor sleep during pregnancy. Recognition and treatment of sleep disordersshould be encouraged in order to protect maternal and fetal health and prevent dire consequences at birth.

Objective: There is limited evidence about the effect of socio-economic status (SES) on the severity of obstructive sleep apnea (OSA). We aimed to investigate this relationship in a referral population in Greece, with regards to other established risk factors. Methods: We used a retrospective cross-sectional design to assess socio-economic status based on occupational activity in a sample of 282 OSA patients diagnosed in a public hospital sleep laboratory during one-year period. Demographic, anthropometric and social characteristics, as well as the Epworth sleepiness scale (ESS) scores and apnea-hypopnea indexes (AHI) of subjects in each socio-economic class were recorded and statistically significant differences were explored in univariate and multiple regression analysis. Results: 99 (35.1%) of the subjects were categorized in the upper, 70 (24.8%) in the intermediate and 113 (40.1%) in the working class. Subjects of the intermediate class had significantly larger neck circumference than those of the upper class (p=0.022). Neither class differed significantly in terms of ESS score and intermediate class had a trend for higher AHI than upper class (p=0.075 in univariate and p=0.082 in multivariate analysis). Age (p=0.020) and occasional alcohol consumption (p=0.022) were independent negative and neck circumference (p

BackgroundRapid Eye Movement sleep deprivation (REMSD) of rats causes inflammation of the liver and apoptotic cell death of neurons and hepatocytes. Studies also suggest that REMSD are involved with muscle injury, cardiac injury and neurodegerative diseases.Objective and methodsThe aim of this research was to determine whether REMSD of rats would generate reactive oxygen species (ROS) and create oxidative stress in the hepatocytes. We selectively deprived the rats from REM sleep using the standard flower pot method.ResultsWe observed that when rats were subjected to REMSD, the levels of ROS in the hepatocytes increased with the increase in the number of days of REMSD by ∼265%, but it returned towards normal levels after recovery sleep for 5 days (∼36%) compared to controls. Nitric oxide synthase (iNOS) gene and protein was found elevated in hepatocytes in response to REM sleep loss as confirmed by real time PCR and western blot analysis compared to controls. The level of nitric oxide (NO) also increased by ∼ 675% in the hepatocytes of REMSD rats as compared to that of control group of animals.DiscussionWe have analyzed the oxidative stress generated and potentiation of hepatocytes against oxidative stress in response to REMSD. Since, REM sleep is known to play an important role for survival of most animals and has important role in maintenance of body physiology. Hence, our findings that loss of REM sleep in hepatocytes of rats can affect the ROS levels and induce iNOS & NO circulation, while making them more susceptible to oxidative stress assumes significance.Highlights of the studyWe observed elevated levels of ROS in the hepatocytes of REM sleep deprived rats.The hepatocytes of REMSD group of rats were found more susceptible to oxidative stress than that of control groups.We found increased expression of iNOS gene and nitric oxide synthase protein in the hepatocytes of REMSD rats.We observed that nitric oxide levels in the hepatocytes of REM sleep deprived rats increased positively with days of REMSD, but returned to its normal levels after 5 days of recovery sleep.

Objective: To establish the prevalence of positional (PP) OSA patients using self-administered home-based respiratory polygraphy (RP). Materials and Methods: 52 month retrospective study based on RP records. Results: 200 PR records: 70.5% men 29.5% women. 76% were diagnosed with OSA and 54.6% with PP OSA. There were no significant differences in Epworth Sleepiness Scale, apnea hypopnea index and oxygen desaturation index. PP OSA patients were younger, had a lower BMI (30.3±0.9 vs. 35.3±1.2) (p

Objective: to determine the value of dopamine transporter (DAT) neuroimaging radiotracer in a group of idiopathic rapid eye movement sleep behavior disorder (iRBD) patients regarding the development of a synucleinopathy. Methods: 6 retrospectively selected patients with clinical and polysomnographic diagnosis of iRBD, on treatment or not, were submitted to a single-photon emission computerized tomography (SPECT) with TRODAT. Results: Five from six patients have an abnormal test showing reduction in DAT density measured by the linkage potential on SPECT. Conclusions: TRODAT crosses the blood brain barrier, has a high affinity for DAT and is capture by SPECT. The decreased uptake of DAT tracers means a reduction in dopaminergic activity which suggest the possibility of Parkinson Disease. We have tried to reinforce iRBD as a marker of neurodegenerative disease and suggest SPECT with TRODAT as an easy method in our country to follow longitudinally these patients.

Objectives: To: 1) evaluate the quality of an ambulatory monitoring technique for diagnosing Obstructive Sleep Apnea Syndrome (OSAS) while patients move through the city; and 2) identify factors that lead to data loss. Methods: Clinical histories were reviewed and ambulatory portable monitorings of adults with high pretest probability for OSAS were included, the signals monitored were pulse oximetry, heart rate, nasal pressure, snoring, chest band and body position. The equipment was connected from 14:00-20:00 h and then patients moved through the city turning it off and on at home. Results were analyzed visually to record all the minutes lost. A good-quality study was defined as recording time 240 min and signal loss

Objectives: This study aimed to evaluate if a partial morning or evening sleep restriction protocol could affect executive functioning in healthy young adults. Methods: Participants were assigned to one of three groups: control (n=18), in which participants maintained their habitual sleep/ wake cycle; morning restriction (n=17), in which volunteers terminated sleep approximately three hours earlier than the usual on the experimental night, and evening restriction (n=13), in which volunteers initiated sleep approximately three hours later than the usual on the experimental night. On the day of the experiment, they performed the Stroop Test, the Go-NoGo Test and the Iowa Gambling Task (IGT). Results: When compared to the control group, neither morning nor evening sleep-restricted individuals displayed any significant deficits in: a) selective attention as assessed by the interference index (H=3.38; p=0.18) and time to performed the interference card (H=2.61; p=0.27) on the Stroop test; b) motor response inhibition as assessed by number of false alarms (H=0.8; p=0.67) on the Go-NoGo Test; and c) in decision-making as assessed by total won (H=2.64; p=0.26) and number of selected advantageous cards (H=4.43; p=0.11) on the IGT. Conclusion: These findings suggest that the ability to pay attention, inhibit a motor response and make decisions is preserved following approximately 3 hours of sleep restriction, regardless of its timing (in the morning or in the evening).

Due to the changes that took place since the 1970s, women have achieved important socioeconomic positions. Many tasks, including domestic and familiar ones, continue to be under women’s responsibility, which leads to an overload work. Additionally, the female organism has its peculiarities due to hormonal changes. Adding all these factors up, women seem to be more vulnerable to stressing factors and consequently, might be prone to present several health problems. Within this scenario, one can point out insomnia as a highly prevalent disease among women, directly affecting performance and quality of life. Progesterone has an important effect over sleep, acting both as a hypnogenic and as a respiratory stimulant. Hormonal contraceptives are largely recognized among the modern society women; however, little is known about the effects of these drugs on sleep. This proposal hypothesizes that the use of hormonal contraceptives, mainly those based on progestagens could be a new therapeutic element for the treatment of insomnia and one more tool to be used to improve women´s sleep pattern and quality of life.

Objectives: To evaluate patient`s satisfaction, efficacy and adherence to CPAP with a hybrid nasal mask (DW) we tested patients with OSA in unattended setting under real-life conditions. Material and Methods: Prospective, comparative study using DW mask 7 days against habitual mask in patients adapted to CPAP therapy. Results: We analyzed 52 patients: 35 men (67%) with IAH mean; 24.3±12.3 events/hour. At baseline mean compliance of 5.42±1.83 hours/night. After using DW mask, patients reported fewer marks, more comfort, greater partners acceptance, easier to use and was ranked higher to preventing leaks; p0.0042). Differences were not found in pressure 90th-95th percentile (9.6±9.2 cm of H2O, p

Introduction: Existing sleep questionnaires to assess sleep behaviors may not be sensitive in determining the unique sleep challenges faced by elite athletes. The purpose of the current study was to develop and validate the Athlete Sleep Behavior Questionnaire (ASBQ) to be used as a practical tool for support staff working with elite athletes. Methods: 564 participants (242 athletes, 322 non-athletes) completed the 18-item ASBQ and three previously validated questionnaires; the Sleep Hygiene Index (SHI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). A cohort of the studied population performed the ASBQ twice in one week to assess test-retest reliability, and also performed sleep monitoring via wrist-actigraphy. Results: Comparison of the ASBQ with existing sleep questionnaires resulted in moderate to large correlations (r=0.32 - 0.69). There was a significant difference between athletes and non-athletes for the ASBQ global score (44±6 vs. 41±6, respectively, p

Background: Nowadays, sleep-related problems are a prevalent occurrence among university students. Poor sleep quality is one of the most studied aspects of sleep complaints, affecting from 10% to 50% of this population. Poor sleep quality consequences are many and have a profound impact in the student’s psychobiological health. University students live through a period of psychological challenge and adaptation, since the transition from high school to professional life. Abrupt autonomy challenges students to deal with many choices, from their academic and social life to their intimate habits. Frequently, sleep hygiene is neglected, or they are unable to use proper coping mechanisms, resulting in disturbing consequences that could impact their lives as adults. Research has found a significant association between sleep quality and depression or depressive symptoms, but this relationship is still somewhat difficult to interpret. Objective: The objective of this review is to appraise the current knowledge around the relationship of sleep with depression in this group of young adults. Data Source: Articles included in Medline database. Methods: After a careful search, the articles selected aimed mainly college students. The studies had sleep quality and depression objectively assessed, focused in the relationship between both, and addressed possible influencing factors. Results: The current literature still supports a bidirectional relationship between sleep and depression, however, the importance of sleep quality is becoming a very relevant variable. Conclusion: Education and the application of policies regarding sleep hygiene may prevent, in some cases, the development of depression and improve the quality of sleep in other cases. Future research should clarify the relationship between sleep problems and depression in a way they could be prevented or, at least, minimalized with effective and achievable interventions.

Sleep-related breathing disturbances are exacerbated at altitude in patients with Obstructive Sleep Apnea (OSA). The objective of this case report was to determine if a portable auto-CPAP device effectively treated sleep apnea across different altitudes. We report the severity of sleep apnea from 60 to 12,000 feet high in a man with severe OSA (Apnea Hypopnea Index at diagnosis = 60 events/hour) during the 2017 Dakar rally over the Andes mountains. The man was equipped with a lightweight portable auto-CPAP device with a narrow window [6-8 cmH2O]. Pressures delivered and corresponding residual events were assessed at different altitudes. The 95th percentile pressure reached the maximal set pressure at the highest altitudes, and residual AHI increased from 5 events/hour to 45 events/hour at the highest altitudes. Potential mechanisms behind the development of central apnea, and optimal clinical management at altitude are discussed in the light of the findings.

Introduction: Mountaineers exposed to hypobaric hypoxia (HH) show high-altitude periodic breathing (PB) and its characteristics may vary during the ascent. Purpose: To analyze high-altitude PB during the ascent of Mount Aconcagua (Argentina). Materials and Methods: Descriptive study in healthy volunteers using respiratory polygraphy (RP) at different altitudes between 746 meters above sea level (m.a.s.l) and 5.380 m.a.s.l. Results: 43 RP were conducted in 4 women and 4 men, mean age: 36 years old (25-51), with a baseline body mass index (BMI) of 23.6 kg/m2(20.9-28.7) and 22.77 kg/m2(20.9-27.7) upon return, p RP without PB showed a lower Oxygen Desaturation Index (ODI) 5.43 (0 – 20) versus 45.95 (2-122) p PB was not observed at 746 m.a.s.l. All mountaineers, however, showed high-altitude PB above 4.900 m.a.s.l. with mean altitude of 4.130 (2,581–5,380 m.a.s.l.), cycles of 24.2 seconds, and Duty Cycle of 0.417 (0.37-0.49) without variations at different altitudes. Conclusion: High-altitude PB is frequent above 2,581m.a.s.l. healthy volunteers and is characterized by short cycles and a stable Duty Cycle during the ascent.

Purpose Athletes involved in team sports may be subject to varying degrees of sleep deprivation either before or after training and competition. Despite the belief among athletes and coaches of the importance of adequate sleep for ensuing performance, the effect of sleep loss on team-sport anaerobic performance remains unclear. There is conflicting evidence in the scientific literature as to the impact of acute sleep deprivation and caffeine supplementation on anaerobic performance indices. The purpose of this study is to investigate the effect of 24 hours of acute sleep deprivation on anaerobic performance and the effect of caffeine supplementation on anaerobic performance in the sleep deprived state. Methods 11 club level games players (n=11, 25±4 yr, 178±7.5 cm, 80.2±10.4 kg, 15.1±5.6% body fat) participated in a repeated measures double-blinded placebo control trial. Following familiarisation, each participant returned for testing on three separate occasions. One of the testing sessions took place following a night of normal sleep and the other two sessions took place following 24 hours of sleep deprivation with supplementation of either placebo or 6 mg.kg- 1 of caffeine. During each testing session participants performed the vertical jump height, 20-m straight sprint, Illinois speed agility test and 5-m shuttle run. Results No significant differences were detected comparing non sleep deprived and sleep deprived interventions in any of the assessed outcome measures. There were also no significant differences observed in any of the outcome measures when comparing caffeine and placebo data in the sleep deprived state. Conclusion In this cohort of athletes, a 24-h period of acute sleep deprivation did not have any significant impact on anaerobic performance. Caffeine also did not have any effect of on anaerobic performance in the sleep-deprived state.

Introduction: The purpose of this paper was to evaluate and compare the questionnaires regarding sleep quality among children aged up to 12 years old, used in the Portuguese language in Brazil. Material and methods: A search at the literature databases of Lilacs, Scielo and Pubmed was performed using keywords “sleep quality” and “children”. Selected Articles were analysed for age of the studied population, the number of questions and the issues addressed thereby, who realized the application, the analysis of the results, and content. Results: Out of 9377 titles, 11 studies were included, performing 7 different questionnaires: Questionnaire to measure quality of life among children with enlarged palatine and pharyngeal tonsils (translation of OSD-6) (1); Inventory of Sleep Habits for Preschool Children (2); the Questionnaire on Obstructive Sleep Apnoea-18 (OSA-18) (3), Sleep Questionnaire by Reimão and Lefévre - QRL (4); the Questionnaire on Sleep Behaviour Patterns (5) and the translation of the Sleep Disturbance Scale for Children (6); Brief Infant Sleep Questionnaire - BISQ (7) . Six of the questionnaires have covered the following issues: snoring and daytime sleepiness. Conclusions: A total of 7 protocols were found to be available in Brazil, the most commonly mentioned being OSA-18 and OSD-6. The use of protocols as a guided interview helps to define diagnosis and treatment among the paediatric population, but its large variability makes it difficult to compare a standardised monitoring process.

Introduction: Parents' report is the most used method for the study of sleep bruxism (SB) in children, especially in research with large samples. However, there is no consensus about the questions used to assess SB, what may difficult the comparisons between studies. Objective: The aim of this research was to evaluate the agreement between two different approaches to assess possible sleep bruxism (PSB) in children using parents' report. Methods: This cross-sectional study was conducted with 201 parents/caregivers. Prior to the questionnaire completion, all participants received a standard explanation of SB concept. Subsequently, the parents/caregivers answered a general question (GQ) and a frequency-time question (FTQ) about SB, and the answers were compared. Results: The majority of the participants were the children's mothers (73%) and the childrens mean age was 7.5 years (SD: 2.25). PSB frequency in children did not differ statistically through the two questions [GQ: 30.7% (CI95%: 24.2 - 37.1) and FTQ: 26.6% (CI95%: 20.4 - 32.8)], and an almost perfect agreement was observed between the answers (kp=0.812). Nevertheless, the FTQ showed a more coherent relation with the factors already recognized as associated with childhood bruxism than GQ. Conclusions: Different approaches result in similar PSB frequency, however, they show different ability to identify PSB associated factors and suggest the need of questions including frequency and time in further studies.

Obstructive Sleep Apnea Syndrome (OSA) is a multifactorial disease that highly alters a persons quality of life. It is characterized by the repeated interruption of breathing during sleep, due to an obstruction or the collapse of the upper airways. Since it is a multifactorial etiological disorder, it requires a thorough diagnosis and treatment with an interdisciplinary team, which comprises several professionals such as a surgical dentist, phonoaudiologist, otorhinolaryngologist, sleep doctor, neurologist and physiotherapist. The diagnosis and the degree of severity of the syndrome is determined through a polysomnography examination. After that, the best form of treatment is devised depending on the gravity of the case. In cases of moderate to severe apnea, invasive treatment through surgical procedures such as maxillomandibular advancement remains the preferred option as it increases the posterior air space, reducing and/or eliminating the obstruction. Thus, improving the patients respiratory function and, consequently, his quality of life as it is shown in the clinical case at hand. In which the male patient, facial pattern type I, 41 years of age, diagnosed with moderate OSA (Apnea-Hypopnea Index - AHI of 23.19), decided to have a surgical treatment instead of a conservative one, resulting in the cure of apnea (AHI of 0.3).

Sleep disturbances are common in older people. This study was conducted to examine the effects of a hot pack, which was used to warm the lower limbs, on the sleep of elderly people living in a nursing home. This is a prospective cohort involving seven elderly women. Subjects aged 74-93 years old were treated by warming the lower limbs for 40 minutes using hot packs every night over 8 weeks. A hot pack made of a dense polymer and warmed in a microwave oven was used as a warming device. In the first and last week, the subjects were required to wear an activity monitor to determine their sleep-awake status. During the second to ninth week, they received limb-warming treatment by a hot pack heated to 42ºC for 40 min every night. Surface skin temperature data were collected by thermographic measurement. As a result, lower-limb warming by a hot pack significantly improved the quality of sleep in the subjects. During warming, the surface temperature of the hands and face rose by approximately 0.5-1.5ºC. This study showed that lower-limb warming with a hot pack reduced sleep latency and wake episodes after sleep onset; thus, improving the quality of sleep in elderly people living in a nursing home.

The pineal hormone Melatonin plays an important role in the regulation of the circadian sleep/wake cycle, mood, and perhaps immune functions, carcinogensis and reproduction. The human circadian rhythm of melatonin release from the pineal gland is tightly synchronized with the habitual hours of sleep. Peri- and postmenopausal women often complain of difficulties initiating and/or maintaining sleep, with frequent nocturnal and early morning awakenings. In this review we discuss the pathophysiology of melatonin function as it relates to sleep disorders in menopausal women, highlighting the potential use of exogenous melatonin during the menopausal transition and beyond.

Objectif: Dans un appareil base sur l'analyse des mouvements de la mâchoire medio-sagittale, nous avons evalue un sommeil-eveil detecteur automatique comme methode objective pour mesurer le sommeil chez des adultes en bonne sante par actigraphie du poignet contre la polysomnographie (PSG). Methodes: inlab simultane et synchronise PSG, actigraphie du poignet et mouvements de la mâchoire ont ete effectues chez 38 participants en bonne sante. Epoque par analyse d'epoque a ete realisee pour evaluer la capacite de distinction sommeil-eveil. Parametres de sommeil comme mesures par les trois appareils ont ete compares. Cela comprenait trois parametres regulierement signales: temps total de sommeil, latence de sommeil et reveil apres le sommeil. De plus, deux parametres supplementaires, reveil pendant la periode de sommeil et le temps de latence, ont ete ajoutes pour mesurer l'etat de veille tranquille. Resultats: Les mouvements de la mâchoire ont montre un niveau de sensibilite egal a l'actigraphie de 96% et un niveau de specificite plus eleve (64% et 48% respectivement). Le niveau d'accord entre les deux appareils etait eleve (87%). le l'analyse de leur desaccord par une resolution de divergence analyse a utilise PSG comme resolveur a revele que la mâchoire les mouvements etaient justes (58,9%) plus souvent que l'actigraphie (41%). Dans la comparaison des parametres de sommeil, la correlation de coefficient des mouvements de mâchoire etait plus elevee que l'actigraphie dans tous les parametres. En outre, sa capacite a distinguer l'etat veille-sommeil a permis une estimation plus efficace des parametres mesure l'etat de veille tranquille. Conclusions: l'analyse des mouvements de la mâchoire medio-sagittale est un methode pour mesurer le sommeil. Chez l'adulte en bonne sante, ce dispositif s'est revele superieur a l'actigraphie en termes d'estimation de tous les parametres du sommeil et distinction du statut veille-sommeil.

Objective: To identify the prevalence and associated factors of overweight and obesity in Brazilian commercial airline pilots. Methods An observational, cross-sectional study involving 1198 Brazilian commercial airline pilots with a sampling power >80% (ß=20%) and confidence level of 95% (α=5%) was carried out. The pilots completed an on-line questionnaire collecting data on sociodemographics, work, health, lifestyle and sleep. Poisson regression, with robust variance (stepwise forward technique), was employed to analyze the factors associated with excess weight (overweight and obesity). The models were adjusted for the variables age, marital status and education. The data were analyzed using the STATA 12.0 program. Results: The prevalence of overweight among the pilots was 53.7% and of obesity was 14.6%. The probability of being overweight was highest among pilots working night shifts for 6–10 years and that had difficulty relaxing after work, where perceived morningness was a protective factor. Risk factors for obesity included working night-shifts for 6–10 years, having difficulty relaxing after work, sleeping

To identify the scales to assess sleep disorders applied to women with climacteric stage. Bibliographical research without intervention, the available information in scientific databases. Performed in PubMed, ScienceDirect, Scopus, Ebscohos OvidSP and Health Library. The words used in this article: insomnia, adjustment sleep disorder, questionnaires, studies and menopause. Publications of all types were included. Seven scales were identified: Insomnia Severity Index, Athens Insomnia Scale, Pittsburgh Quality of sleep Index, Epworth Sleepiness Scale, Jenkins Sleep Scale, Basic Nordic Sleep Questionnaire and The St Mary's Hospital Sleep Questionnaire. There are validated scales in multiple languages and considered appropriate for studying sleep disorders.

Stroke is an example of neurological diseases that can commonly drives Excessive Daytime Sleepiness (EDS). Extensive strokes with brain edema can leave a brain herniation and coma. Other causes of EDS after stroke are strategic lesions at Thalamus and brainstein. A 56-year-old man, right handed, with hypertension and hypercholesterolemia was admitted at Emergency Room due to 5 days onset of EDS, memory impairment, and left-sided weakness. A brain magnetic resonance imaging showed paramedian thalamic hyperintensity with rostral midbrain hyperintensity extending along the pial surface of the interpeduncular fossa. The artery of Percheron (AP) is an unusual anatomical variation that originates from the posterior cerebral artery and irrigates the paramedian regions of the thalamus and part of the midbrain. It is important the clinical suspicions with detailed drowsy patients history. Awareness of the clinical and neuroimaging features of this stroke syndrome is essential for timely diagnosis and appropriate management.

Objective: To examine the semantics of chronic pain in narcolepsy and to compare with the poem Inferno, from Dante Alighieri. Methods: A cross-sectional study, in which type 1 (n=33) and type 2 (n=33) patients (hypocretin-1 quantification in cerebrospinal fluid), were studied at Departamento de Psicobiologia - Universidade Federal de São Paulo (Brazil). We assessed pain descriptors in the Present Rating Index (PRI) from McGill Pain Questionnaire. Results: There was no significant difference in PRI between narcolepsy groups. In both groups, the most frequent words had a sensory dimension: throbbing, jumping, and tugging. Multiple correspondence analysis revealed the predominance of sensory descriptors and the deficiency of affective descriptors in these groups. Discussion: A study that interpreted the poem Inferno, from Dante Alighieri, as McGill Pain Questionnaires descriptors suggested a contribution of the sensory dimension in pain of possibly narcolepsy patients, similar as in our results.

Objective: Poor sleep patterns are common in undergraduates and may turn them prone to mood disorders, substance abuse and impaired academic performance. The aim of this study was to assess sleep disturbances among medical students, and whether associations with academic performance, depressive symptoms or substance use were present. Methods: Cross-sectional study in which 544 medical students of the Pontificia Universidad Javeriana in Bogota, Colombia were included. Using a computer-based survey, self-reported variables were assessed, including demographics, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Berlin Questionnaire, Diagnostic and Statistical Manual of Mental Disorders (DSM) - IV depression criteria, Grade Point Average (GPA), and substance use. Associations between these variables were obtained. Results: Fifty-four percent of students were women. Poor sleep quality (PSQI>5) and daytime sleepiness (ESS>10) were found in 65% of the population. A higher GPA was more frequent in students with good sleep quality (OR= 2.6 [1.5-4.5]), lack of daytime sleepiness (OR= 2 [1.3-3.1]) and low risk of Obstructive Sleep Apnea Syndrome (OSAS) (OR= 3.1 [1.6-5.9]). DSM-IV depression criteria were fulfilled by 26% of the students and were associated with poor sleep patterns. Energy drinks use was associated with poor sleep quality. Discussion: Poor sleep quality, daytime sleepiness and depressive symptoms are frequent among medical students and are associated with lower academic performance. The identification of students at risk and the implementation of targeted interventions are warranted. Fostering adequate sleep habits and training on sleep medicine may partly counteract these issues.

Parasomnias are a group of sleep disorders that are characterized by the presence of undesirable behavioral, experiential, or autonomic nervous system events during sleep initiation, within sleep, or during arousals from any stage of non-rapid eye movement (NREM) or rapid eye movement (REM) sleep. During wakefulness and NREM sleep, the hypothalamus plays a central role in thermoregulation. REM sleep has a very distinct thermoregulatory response that is characterized by an inhibition of hypothalamic control over body temperature, with resulting poikilothermia. The role of the thermoregulatory features of REM sleep is currently unknown. Drawing conclusions from other parasomnias one can assume that a disorder could exist in which the thermoregulatory features of REM sleep are impaired. The existence of this condition may have eluded current research because most of the research on thermoregulation has been completed using animal models or healthy volunteers. If this disorder were to exist, it could be associated with metabolic disorders, or with neurodegenerative conditions, and perhaps it could be an early biomarker for alpha-synucleinopathies in idiopathic REM sleep behavior disorder. New and evolving wearable technologies offer the promise of facilitating the monitoring of core body temperature and the testing of this hypothesized thermoregulatory autonomic disorder and its clinical correlates.