Academic literature on the topic 'Sleep disorders Diagnosis Victoria'

Objective: This study (a) compared behavioral sleep problems in children with comorbid ADHD and autism spectrum disorder (ASD) with those with ADHD and (b) examined child/family factors associated with sleep problems. Method: Cross-sectional study comparison of 392 children with a confirmed ADHD diagnosis (ADHD+ASD, n=93, ADHD, n=299) recruited from 21 peadiatric practises in Victoria, Australia. Data were collected from parents. Key measures included the Child Sleep Habits Questionnaire (CSHQ). Results: Children with ADHD + ASD experienced similar levels and types of behavioral sleep problems compared with those with ADHD. In both groups, the presence of co-occurring internalizing and externalizing comorbidities was associated with sleep problems. Sleep problems were also associated with parent age in the ADHD + ASD group and poorer parent mental health in the ADHD group. Conclusion: Findings suggest comorbid ASD is not associated with increased behavioral sleep problems in children with ADHD and that co-occurring internalizing and externalizing comorbidities may flag children in these groups with sleep problems.

Background:Sleep is an essential health aspect that is often impacted in patients with axial spondyloarthritis (axSpA).Objectives:This analysis aims to assess the prevalence and associated factors of sleep disorders in a large sample of European axSpA patients.Methods:Data were analyzed from 2,846 unselected patients with self-reported clinician-given diagnosis of axSpA of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries. Socio-demographic data; BASDAI [0-10] scores; engagement in physical activity; axSpA influence on work choice (assessed with yes/no question “Was your current or past work choice in any way determined by axSpA?”); risk of psychological distress (12-item General Health Questionnaire [GHQ-12; 0-12]); functional limitation [0-54] and self-reported anxiety and depression were evaluated. Presence of sleep disorders was assessed by the question: “Please indicate whether you have been diagnosed with any of the following: sleep disorders”. A Mann-Whitney test was used to compare the means of numerical variables between dichotomous variables, the Chi-Square test was used to compare the distribution between the categorical variables. Simple and multivariable logistic regression models were used to identify associations between sleep disorders and disease characteristics, mental health and work-related variables.Results:Age of respondents was 43.9 years; 61.3% were female; 48.1% had a university degree; 67.9% were married and 71.3% were HLA-B27 positive. The prevalence of sleep disorders was 39.0%. In the bivariate analysis, presence of sleep disorders was associated with female gender (68.3% vs. 31.7%; p<0.001); overweight/obese (56.5% vs. 49.8%; p<0.001); increased BASDAI scores (6.1±1.8 vs. 5.0±2.1; p<0.001); fatigue (7.0±2.0 vs. 5.8±2.4; p<0.001); morning stiffness (5.8±2.4 vs. 4.8±2.4; p<0.001), work impact (56.5% vs. 38.2%; p< 0.001); anxiety (56.8% vs. 12.5%; p<0.001); depression (51.8% vs. 10.1%; p<0.001) and higher GHQ-12 scores (6.4±4.0 vs. 3.9±3.9; p<0.001). However, factors that remained independently associated with sleep disorders in the multivariable analysis were anxiety (OR=3.8 p<0.001) and depression (OR=3.1 p<0.001) and female gender (OR=1.4; p=0.002) [Table 1].Table 1.Regression analysis to predict presence of sleep disorders (N=2191)Simple logistic regressionMultivariable logistic regressionOR95% CIp-valueOR95% CIp-valueGender (female)1.591.36-1.87<0.0011.401.13-1.730.002Marital status (married)1.130.99-1.280.074NANANAOverweight/Obesity1.311.12-1.530.0011.391.14-1.710.001BASDAI (0-10)1.331.27-1.39<0.0011.070.95-1.210.246Fatigue/Tiredness (0-10)*1.281.23-1.33<0.0011.040.97-1.120.271Morning Stiffness intensity (0-10)*1.191.15-1.23<0.0011.050.98-1.130.188Reported Work impact (yes)2.101.78-2.48<0.0011.291.05-1.580.015Anxiety (yes)9.187.58-11.11<0.0013.842.99-4.94<0.001Depression (yes)9.537.78-11.66<0.0013.092.37-4.02<0.001GHQ-12 (0-12)**1.161.14-1.19<0.0011.031.00-1.060.029*As measured by the respective item of the BASDAI scale.**12-item General Health Questionnaire. A value of 3 or above indicates a risk of poor mental health.Conclusion:Sleep disorders were highly prevalent among axSpA European patients and strongly associated with female gender and reporting worse mental health, and spinal stiffness. Patients on permanent and temporary sick leave were more likely to report sleep disorders. The strong association between sleep disorders with both anxiety and depression should encourage rheumatologists to screen their patients with sleep disturbance in case they require additional specialist support.Acknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

IntroductionSleep problems are a characteristic feature of children with autism spectrum disorder (ASD) with 40% to 80% of children experiencing sleep difficulties. Sleep problems have been found to have a pervasive impact on a child’s socio-emotional functioning, as well as on parents’ psychological functioning. The Sleeping Sound ASD project aims to evaluate the efficacy of a brief behavioural sleep intervention in reducing ASD children’s sleep problems in a fully powered randomised controlled trial (RCT). Intervention impact on child and family functioning is also assessed.Methods and analysisThe RCT aims to recruit 234 children with a diagnosis of ASD, aged 5–13 years, who experience moderate to severe sleep problems. Participants are recruited from paediatrician clinics in Victoria, Australia, and via social media. Families interested in the study are screened for eligibility via phone, and then asked to complete a baseline survey online, assessing child sleep problems, and child and family functioning. Participants are then randomised to the intervention group or treatment as usual comparator group. Families in the intervention group attend two face-to-face sessions and a follow-up phone call with a trained clinician, where families are provided with individually tailored behavioural sleep strategies to help manage the child’s sleep problems. Teacher reports of sleep, behavioural and social functioning are collected, and cognitive ability assessed to provide measures blind to treatment group. The primary outcome is children’s sleep problems as measured by the Children’s Sleep Habits Questionnaire at 3 months post-randomisation. Secondary outcomes include parent and child quality of life; child social, emotional, behavioural and cognitive functioning; and parenting stress and parent mental health. Cost-effectiveness of the intervention is also evaluated.Ethics and disseminationFindings from this study will be published in peer-reviewed journals and disseminated at national and international conferences, local networks and online.Trial registration numberISRCTN14077107 (ISRCTN registry dated on 3 March 2017).

Background:Pain is a hallmark of axial spondyloarthritis (axSpA) and can significantly deteriorate patients’ health status.Objectives:This analysis aims to investigate factors associated with pain intensity in a large sample of European axSpA patients.Methods:2,846 unselected patients participated in EMAS, a cross-sectional study (2017-2018) across 13 European countries. Data from 2,636 participants who reported pain were analysed. Pain was measured by the mean of two BASDAI questions (range 0 “no pain” to 10 “most severe pain”): “How would you describe the overall level of AS neck, back or hip pain you have had?” and “How would you describe the overall level of pain/swelling in joints other than neck, back, hips you have had?”. Linear regression analysis was applied to identify associations between pain intensity and sociodemographic factors, patient-reported outcomes [BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), mental health using the 12-item General Health Questionnaire GHQ-12 (0-12)], work life, physical activity and comorbidities, for which 850 patients were included.Results:The mean age of the sample was 44 years, 61.4% were female, 49.4% had a university degree and 67.7% were married. The average reported pain intensity was 5.3 (±2.2); 76.2% reported pain intensity ≥4, with the greatest intensity reported by women (5.5 vs 4.9, p<0.001), those not university educated (5.6 vs 5.0, p<0.001), separated or divorced compared to singles (5.8 vs 5.2, p=0.004), and not physically active (5.7 vs 5.2, p<0.001). In addition, employed patients who experienced work-related issues reported greater pain (5.2 vs 3.9) as did those who experienced/ believed they would face difficulties finding work due to axSpA (5.9 vs 4.3), and those whose employment choice was determined by axSpA (5.7 vs 4.9; all p<0.001). Moreover, associations with anxiety (5.9 vs 5.0), depression (6.1 vs 5.0) and sleep disorders (5.9 vs 4.9; all p<0.001) were also found. The multiple linear regression model showed that those with higher pain intensity reported at least one work-related issue (B=0.65), difficulties finding work due to axSpA (B=0.48), not having attended university (B=0.38), greater spinal stiffness (B= 0.29), being female (B=0.26) and poorer mental health (GHQ-12) (B=0.10) (Table 1).Table 1.Regression analysis of the variables associated with pain intensity (0-10 NRS), n=850UnivariableMultivariableB95% CIB95% CIGender. Female10.6040.432, 0.7750.2600.003, 0.517Educational level. No University20.6710.504, 0.8380.3760.118,0.634Marital Status. Divorced/Separated30.4950.209, 0.780-0.044-0.468, 0.380Body Mass Index. Obese40.362-0.097, 0.821NANAGHQ-12 (0-12)0.1820.163, 0.2010.1000.064, 0.137Functional Limitation (0-54)0.0360.030, 0.0410.009-0.001, 0.018Spinal Stiffness (3-12)0.3570.326, 0.3880.2880.234, 0.342Diagnostic Delay, years0.0200.010, 0.030-0.015-0.032, 0.002Work-Related Issues. Yes1.3381.095, 1.5820.6540.338, 0.970Difficulty finding job due to axSpA. Yes1.5681.362, 1.7740.4760.176, 0.776Work choice determinate by axSpA. Yes0.8080.633, 0.9830.199-0.069, 0.467Physical activity. No0.4940.263, 0.725-0.128-0.497, 0.242Anxiety diagnosis. Yes0.9350.753, 1.117-0.047-0.416, 0.321Depression diagnosis. Yes1.1070.919, 1.2950.115-0.270, 0.500Sleep disorder diagnosis. Yes1.0420.871, 1.213-0.091-0.392, 0.2111Female vs Male; 2No university studies (no schooling, primary and high school) vs University studies; 3Divorced/separated vs single, married and widow; 4Obese vs not obese (underweight, normal and overweight).Conclusion:Pain was most strongly associated with working life impairment, as well as with spinal stiffness. Pain was also associated with suffering from depression, anxiety and sleep disorders. Understanding how pain affects individuals and shared-decision making between rheumatologists and patients are essential for long-term disease management and preserving quality of life of axSpA patients.Acknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the EMAS study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Pedro Plazuelo-Ramos: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

Background:Axial spondyloarthritis (axSpA) is associated with a high burden of disease, which may lead to inability to work and disability.Objectives:This analysis aims to identify factors associated with inability to work and disability among European axSpA patients.Methods:Data from 2,846 unselected patients participating in EMAS, a cross-sectional study (2017-2018) across 13 European countries were analysed. The sample was divided into those on permanent sick leave or with a recognised disability (Group 1) and those with neither permanent sick leave nor a recognized disability (Group 2). Mann-Whitney and Pearson’s χ2 tests were used to analyse possible differences between groups regarding sociodemographic characteristics, patient-reported outcomes [BASDAI (0-10), GHQ-12 (0-12), functional limitation (0-54) and spinal stiffness (3-12)], lifestyle habits, working life, and comorbidities). Univariable and multivariable binary logistic regression were used to analyse variables possibly explaining being on permanent sick leave and disability, for which 1,657 patients were included.Results:Mean age was 43.9 years, 61.3% were female, 48.1% had a university degree, and 67.9% were married. Patients in Group 1 (34.4%; n=978) were more likely to be women (54.3%), married (71.1%), with higher disease activity (BASDAI 5.9 vs. 5.3), functional limitation (25.1 vs. 18.0), spinal stiffness (8.6 vs. 7.3; all p<0.001), and longer diagnostic delay (8.1 vs 7.1 years; p = 0.01) than those in Group 2 (65.6%; n=1,868). In addition, 88.0% of Group 1 (n=728) had difficulties in finding a job due to axSpA throughout life; and more than 30.0% reported a diagnosis of anxiety, depression, or sleep disorders. Moreover, being in Group 1 was associated with higher functional limitation in all daily activities. In the multivariable binary logistic regression, the qualitative variables associated with permanent sick leave or disability were: difficulties finding work (OR= 2.52), belonging to a patient organisation (OR= 1.54) and work choice determined by axSpA (OR= 1.38). The quantitative variables associated with permanent sick leave or disability were: higher spinal stiffness (OR= 1.09), older age (OR= 1.03), longer disease duration (OR= 1.03), shorter diagnostic delay (OR= 0.98), and higher functional limitation (OR= 1.01) (Table 1).Table 1.Regression analysis for variables explaining being on permanent sick leave or disability (n=1,657)Univariable logistic analysisMultivariable logistic analysisQualitative variablesOR95% CI3OR95% CI3Gender11.571.34, 1.831.240.97, 1.57Educational level21.711.46, 2.001.080.86, 1.35Member of a patient organisation. Yes1.961.67, 2.291.541.23, 1.94Smoking. Yes1.281.08, 1.511.220.96, 1.55Difficulty finding job due to axSpA. Yes3.712.89, 4.772.521.83, 3.47Work choice determined by axSpA. Yes1.691.43, 1.991.381.09, 1.75Anxiety diagnosis. Yes1.271.07, 1.510.980.72, 1.34Depression diagnosis. Yes1.581.33, 1.891.250.92, 1.69Sleep disorder diagnosis. Yes1.331.13, 1.560.950.73, 1.23Quantitative variablesOR95% CI3OR95% CI3Age. Years1.041.03, 1.041.031.01, 1.04BASDAI (0-10)1.181.13, 1.241.060.98, 1.13Functional limitation (0-54)1.031.02, 1.031.011.00, 1.02Spinal stiffness (3-12)1.251.20, 1.291.091.03, 1.15Diagnostic delay1.011.01, 1.020.980.96, 0.99Disease duration1.041.03, 1.051.031.01, 1.041Male vs Female; 2No university studies vs university studies. 395% CI for test H0: OR=1Conclusion:One third of patients reported being on permanent sick leave or having a recognised disability. They were more likely to have higher spinal stiffness scores, were older in age, experiencing difficulty finding a job, and belonged to a patient organisation. Increased efforts in relation to early access to effective treatments and the creation of flexible working environments are essential for axSpA patients to continue working and remain active, which benefits their quality of life.Acknowledgements:This study was supported by Novartis Pharma AG.The authors would like to thank all patients who participated in this study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, David Gálvez-Ruiz: None declared, Pedro Plazuelo-Ramos: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

Poremećaji disanja tokom spavanja (Sleep disordered breathing – SDB) obuhvataju spektar bolesti koje nastaju usled povećanog otpora u gornjem disajnom putu i reflektuje se na spavanje. Najveća podgrupa SDB su prekidi disanja tokom spavanja ili sleep apnea sindrom (Sleep Apnea Syndrome – SAS). SDB su prisutni kod 20% opšte populacije, dok je 82% muškaraca i 93% žena koje imaju umerenu i tešku OSA nedijagnostikovano. Kako osnovna dijagnostička metoda, polisomnografija, zahteva stručan kadar i adekvatnu laboratorijsku opermu nameće se potreba za brzom, efikasnom i jeftinom skrining metodom pri dijagnostici SAS. Cilj ove studije jeste da se uradi validacija i prevođenje “STOP BANG“ upitnika sa engleskog na srpski jezik i utvrdi njegova specifičnost i senzitivnost u odnosu na vrednosti AHI indeksa kod odraslih ispitanika pri dijagnostikovanju SAS i da se utvrdi senzitivnost i specifičnost “STOP BANG“ upitnika i Epfortove skale pospanosti zajedno. Istraživanje je u potpunosti sprovedeno u Centru za patofiziologiju disanja sa medicinom sna Instituta za plućne bolesti Vojvodine, Sremska Kamenica. Studijsku grupa se sastojala od 102 ispitanika koji su popunjavali oba upitnika, a potom je svima urađena polisomnografija. Testiranje „STOP BANG“ upitnikom, kao i retest nakon mesec dana uradilo 30 ispitanika. Rezultati istraživanja pokazuju da su u uzorku dominirale osobe muškog pola 69,6%. Prosečna starost je iznosila 50,1±13,8 godina. Najveći broj ispitanika je imao poremećaj disanja tokom spavanja (73,5%). Prema stepenu težine najveći broj ispitanika (30,4%) je bolovao od teškog oblika (apnea/hipopnea indeks- AHI>30), a prema tipu poremećaja dominirali su opstruktivni poremećaji sa 66,7% u ukupnom uzorku. Prekomerna dnevna pospanost, merena Epfortovom skalom pospanosti, bila je prisutna kod 58,8% ispitanika i korelirala je sa stepenom težine poremećaja (r=0,43). Dobijena senzitivnost i specifičnost za „STOP BANG“ upitnik je iznosila 62,7% i 51,9% respektivno. „STOP BANG“ upitnik je preveden na srpski jezik, a zatim je urađen test i retest upitika gde nije bilo razlike u odgovorima. Dobijena je granična vrednost za „STOP BANG“ upitnik koja iznosi 4.5, a senzitivnost i specifičnost testa za različit stepen težine SAS je zadovoljavajuća i iznosila je 70,7%/66,7% za laku, 78,6% /60,9% za umerenu i 87,4%/ 50,7% za tešku sleep apneu. Pri poređenju oba upitnika zajedno dobijena je bolja specifičnost 85,2%, 76,1%, 69,0% ali lošija senzitivnost 53,3%, 58,9% ,71,0% za laku , umerenu i tešku sleep apneu respektivno u grupi ispitanika koji su imali vrednosti oba upitnika iznad graničnih vrednosti. U grupi ispitanika gde je jedan od upitnika imao vrednosti iznad granične vrednosti dobijena je bolja senzitivnost ali lošija specifičnost u odnosu na samo „STOP BANG“ upitnik. Istraživanjem je utvrđen skrining metod -“STOP BANG“ upitnik, koji stratifikuje pacijente na osnovu kliničkih simptoma, fizičkog pregleda i prisustva faktora rizika, na one pacijente sa visokim rizikom kojima treba hitno uraditi polisomnografiju i uputiti ih dalje na lečenje i na one kojima polisomnografija nije potrebna.
Sleep disordered breathing (SDB) includes a spectrum of diseases occurring due to an increased resistance in the upper airway, which affects sleeping. The major SDB subgroup is sleep apnea syndrome (SAS). SDB is present in 20% of the general population, and among the subjects with a moderate or severe SAS, 82% of males and 93% of females remain undiagnosed. Since polysomnography - the basic diagnostic method, requires a well-trained staff and adequate laboratory equipment, the need for a fast, efficient and cheap screening method in the diagnosis of SAS has breen imposed. Objectives of the study are to evaluate and translate the “STOP BANG“ questionnaire from English to Serbian, establish its specificity and sensitivity in relation to the apnea hypopnea index (AHI) values while diagnosing SAS in adults, and to assess the cumulative sensitivity and specificity of the “STOP BANG“ questionnaire and Epworth Sleepiness Scale. The investigation has been entirely carried out in the Lung Function and Sleep Medicine Centre of the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica. The study cohort included 102 subjects who were all, having answered both questionnaires first, submitted to polysomnography. Thirty subjects were tested by the „STOP BANG“ questionnaire, and retested a month later. Results of the investigation show the male sex predominated in the study sample (69.6%). The subjects' mean age was 50.1±13.8 years. Most subjects had SDB (73.5%). The majority of ther subjects (30.4%) had a serious SDB form (AHI>30). Obstuctive disorders prevailed, registered in 66.7% of the study population. Excessive daily sleepiness, measured by the Epworth sleepiness scale, was registered in 58.8% of the examined subjects, correlating well to the disorder severity level (r=0.43). Sensitivity and specificity obtained for the „STOP BANG“ questionnaire amounted to 62.7% and 51.9% respectively. The „STOP BANG“ questionnaire was translated to Serbian first, followed by testing an retesting using the questionairre, providing no differences in the obtained answeres. The obtained cut-off value for the „STOP BANG“ questionnaire was 4.5, and the test sensitivity and apecificity for different SAS severity levels were satisfactory, amounting to 70.7%/66.7% for mild, 78.6% /60,9% for moderate, and 87.4%/50.7% for severe sleep apnea. The cumulative comparation of the two questionnaires has disclosed a better specificity of 85.2%, 76.1%, and 69.0%, but a worse sensitivity of 53.3%, 58.9%, and 71.0% for a mild, moderate and severe sleep apnea respectively in the group of subjects whose values for both questionnaires exceeded the cutoffs. In the group of subjects with one of the questionnaire values exceeding the cutoffs, a better sensitivity but a worse specificity were obtained related to only the „STOP BANG“ questionnaire. The investigation has established the screening method – the “STOP BANG“ questionnaire which (on the basis of the clinical symptoms, physical examination and present risk factors) stratifies the patients into the high risk group requiring urgent polysomnography and referral for further treatment, and to those requiring no polysomnography.

Orientador: Rubens Nelson Amaral de Assis Reimão
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-12T21:24:44Z (GMT). No. of bitstreams: 1 Albertini_FatimaRosana_M.pdf: 2966137 bytes, checksum: 717621ec39fa45a6ee84a55d963bd2a5 (MD5) Previous issue date: 2009
Resumo: : Diagnóstico auxiliar dos Distúrbios Obstrutivos Respiratórios do Sono com telerradiografia em norma lateral em crianças com TDA/H. Os Distúrbios Obstrutivos Respiratórios do Sono (DORS) têm sido associados ao Transtorno de Déficit de Atenção e hiperatividade das crianças com Transtorno de Déficit de Atenção e Hiperatividade (TDAH). O objetivo deste trabalho é utilizar as tele-radiografias norma lateral como auxiliar no diagnóstico das áreas obstruídas das vias aéreas e atresias orofaciais relacionadas aos DORS em manejo interdisciplinar. Métodos: Sujeitos da pesquisa foram diagnosticados pelo Ambulatório de Neuro-Dificuldades de Aprendizagem do Hospital das Clínicas da Universidade Estadual de Campinas. Foram incluídas 23 crianças, 04 (17,39%) meninas e 19 (82,61%) meninos, de 7 à 13 anos (Média 9,65). Foram realizadas duas tomadas radiográficas em cada criança: uma em oclusão dental e outra em Repouso da Mandíbula, para medir menores espaços vazios das vias respiratórias para correlação de Pearson. Em 20 sujeitos, as tonislas faringeas apresentaram porcentagem de 30 à 54%; e nos demais, 3 de 54 à 90%. A correlação de Pearson foi -0,75 para aumento das Tonsilas Faríngeas com o vazio atrésico na nasofaringe alta, isto é, ao aumento das Tonsilas Faríngeas têm se como conseqüência uma diminuição no espaço linear entre a retrofaringe e a parte alta do palato mole, o que dificulta a passagem aérea nasal. (Pearson foi +0,47) com aumento das Tonsilas Faríngeas ocorreu leve aumento do espaço vazio linear entre retrofaringe e o dorso lingual, o qual pode colaborar com a respiração oral. Vinte e uma crianças apresentaram-se com língua de ápice baixo,assim como todo grupo apresentou hipertrofia das Tonsilas Palatinas e atresias dos maxilares, o que colabora com os DORS. Através destes resultados é possível sugerir que a telerradiografia é econômica, não invasiva e facilemtne realizada e é capaz de facilitar o diagnóstico das áreas passíveis de obstrução ligada aos DORS, mediante o manejo interdisciplinar otorrinolaringológico e odontológico quando utilizada em crianças e adolescentes com TDA/H.
Abstract: : Diagnosis of Obstructive Respiratory Sleep Disorders by Standard Lateral Teleradiography in Children with ADHD. Obstructive Respiratory Sleep Disorders (ORSD) have been associated with attention deficit and hyperactivity in children with Attention Deficit Hyperactivity Disorder (ADHD). This purpose of this work is to use standard lateral teleradiography as an auxiliary in the diagnosis of obstructed areas of the airway passages and orofacial atresias related to ORSD. Methods: The subjects of this research were diagnosed by the Neuro-difficulties Outpatient Teaching Clinic at the Clinical Hospital of Campinas State University, and were referred for inclusion and exclusion. Twenty-three 7 to 13 year-olds (mean age: 9.65) were included, 4 girls (17.39%) and 19 boys (82.61%). Two X-rays were taken of each child, one in dental occlusion and the other at mandibular rest, to measure smaller empty spaces of the airway passages for a Pearson correlation. Results: In 20 subjects, the pharyngeal tonsils showed a volume of 30 to 54%, and among the other subjects, 3 showed 54 to 90%. The Pearson correlation was -0.75 for augmented pharyngeal tonsils with the atresic void in the upper nasopharynx, i.e., the augmented pharyngeal tonsil leads to a reduction of the linear space between the retropharynx and the upper part of the soft palate, which impairs the nasal air passage. A Pearson correlation of +0.47 with augmented pharyngeal tonsils indicated a slight increase in the linear empty space between the retropharynx and the dorsal tongue, which may contribute to oral respiration. Twenty-one children presented low tongue apex and the entire group showed palatine tonsil hypertrophy and maxillary atresia, which contribute to ORSDs. These findings suggest that standard lateral teleradiography is inexpensive, noninvasive, easy to carry out, and can facilitate the diagnosis of areas subject to ORSD-related obstruction by means of interdisciplinary odontological and otorhinolaryngological management when applied to children and adolescents with ADHD.
Mestrado
Saude da Criança e do Adolescente
Mestre em Saude da Criança e do Adolescente

Sleep is a critical part of the individual's daily performance and survival that is part of the primary sleep-wake circadian rhythm. Any sleep disturbance causes damage to wakefulness (fatigue, drowsiness) and can even lead to various health problems. The alteration of the circadian rhythm affects the quality of sleep, decreases the quality of life (QOL) and can motivate the development of various medical, neurological and mental pathologies such as major depressive disorder (MDD) and substance use disorder (SUD) The relationship between social time and endogenous rhythms is an individual difference called chronotype that classifies individuals into morning type, intermediate or no type, and evening type. There are numerous studies that point to the evening type as a risk factor for developing maladaptive behaviors, sleep disorders, psychiatric symptoms and mental disorders, among which SUD and MDD stand out. Substance use and sleep problems are mutual and feed off each other. Substance use influences sleep with detrimental effects, and the presence of a sleep problem can promote substance use as an attempt at self-medication. Although the available evidence on circadian rhythm, chronotype and SUD in the Iranian population is very limited, existing studies indicate a high prevalence of self-medication with the risk of entering a vicious cycle and developing both SUD and a more serious sleep problem. Substance use can also cause mental illness and vice versa. The presence of a mental disorder comorbid with SUD, which we refer to as dual pathology (DP), implies more clinical (hospitalizations, suicide attempt, relapses) and social problems compared to the presence of a single disorder. However, there is little research in this area and even less in the study of the affectation of circadian rhythmicity and QOL in patients with DP. The general objective of this study was to investigate the clinical characteristics and differences, circadian functioning and QOL in a sample of 238 Iranian male patients (38.14 ± 10.11 years) under treatment with a diagnosis of SUD (N = 81 ), with SUD and comorbid schizophrenia (SUD + SZ; N = 75) and with SUD and comorbid major depressive disorder (SUD + MDD; N = 82). Another objective was to create the Persian version of the Sleep Belief Scale (SBS) and explore its psychometric properties in the sample of patients studied. The history and presence of clinical symptoms were assessed together with circadian functioning, using various standardized instruments [hourly parameters for social jet-lag (SJL), the reduced morning-evening questionnaire (rMEQ), the Pittsburgh sleep quality index (PSQI) and SBS]. For QOL the scale developed by the World Health Organization (WHOQOL-BREF) was used. This study is the first investigation with clinical diagnoses and selected measurements developed in Iran. According to the sociodemographic and clinical variables, the SUD + SZ patients were much younger single people, with a higher number of substance use and an earlier age of onset of SUD compared to the other two groups. In the SUD + MDD group, there was more concomitance of organic pathology, a greater number of antecedents of psychiatric disorders and suicide attempts, as well as more illiterate individuals. SUD patients contributed the highest proportion of opium and crystal users. Both the SUD and SUD + SZ groups had a higher proportion of heroin users and polydrug users. Regarding sleep characteristics, although no differences were observed between the groups in the SJL, the SUD patients tended to go to bed later than the DP groups both during working days and on days off (weekend ) together with a greater presence of IT. In contrast, patients with SUD + MDD were more prone to the morning type and patients with SUD + SZ to the evening type. In the total sample of our study, the evening patients were those who showed the highest rate of polydrug users. The SUD + MDD group had the worst PSQI scores, even after controlling for age and age of onset of SUD, in addition to showing a greater number of drug prescriptions for sleep. In contrast, the SUD + SZ group was the one that showed the worst scores in the sleep disturbance parameter of the three. The age of onset of SUD and the severity of MDD showed a negative and positive relationship, respectively, with the total scores of the PSQI. Furthermore, since we did not find any interaction between the chronotype and the groups with respect to sleep quality, once the mental disorder has developed, it and its severity seem to be the best indicators of sleep disturbances, regardless of the patient's chronotype . The SBS in its original form did not show adequate psychometric properties in the patient sample, with unweighted items in any dimension and an internal reliability of less than 0.700. A reduced version with 13 items was created, which meets the minimum reliability criteria and requires less response time. The analyzes carried out with both the original proposal and our reduced one provided better scores for the SUD and SUD+MDD groups in both cases compared to the SUD + SZ group. This study highlights that a higher number of substance use and the greater severity of SZ or MDD are linked to poorer scores on the SBS, both on the original scale and on the reduced scale. Taking into account the dimensions of SBS (original and reduced), the severity of SZ was negatively related to the scores of Behaviors incompatible with sleep and Thoughts and attitudes towards sleep, while the number of substance use was negatively associated with the scores. Behaviors incompatible with sleep. In addition, in the SUD + MDD group, lower scores in Thoughts and attitudes towards sleep were related to a higher number of substance use, a lower age of onset of SUD and greater severity of MDD. The SUD group provided a better QOL than the DP groups in all dimensions, even after controlling for confounding factors. Except for Environmental Health in the SUD group, all QOL scores in the three groups were lower than the normative data for the healthy population. In the total sample, we found that the number of substance use was negatively related to the overall QOL score. In the SUD + SZ group, more suicide attempts and more SJL were associated with less Physical Health and Social Relationship. On the other hand, in the SUD + MDD group, the higher the SJL and the severity of MDD, the worse physical health was observed and the lower sleep latency was related to more mental health. Our results indicate that DP patients in most clinical and circadian characteristics –with an emphasis on sleep-, as well as QOL suffer more problems compared to patients with SUD. This highlights the importance of caring for these patients in treatment centers for those variables that may be modified during the therapeutic process. Future studies may consider our results for the promotion of knowledge in this area, with the aim of better understanding the associations between variables and overcoming the limitations of the present work with the ultimate aim of designing better and more effective treatments.
El sueño es una parte fundamental del desempeño diario y la supervivencia del individuo que forma parte del ritmo circadiano principal de sueño-vigilia. Cualquier alteración del sueño provoca un perjuicio para la vigilia (fatiga, somnolencia) e incluso puede derivar en diversos problemas de salud. La alteración del ritmo circadiano afecta la calidad del sueño, disminuye la calidad de vida (CV) y puede motivar el desarrollo de diversas patologías médicas, neurológicas y mentales como el trastorno depresivo mayor (TDM) y el trastorno por uso de sustancias (TUS). La relación entre el tiempo social y los ritmos endógenos es una diferencia individual denominada cronotipo que clasifica a los individuos en tipo matutino, intermedio o ningún tipo y tipo vespertino. Existen numerosos estudios que apuntan al tipo vespertino como factor de riesgo para desarrollar conductas inadaptadas, trastornos del sueño, síntomas psiquiátricos y trastornos mentales, entre los que destacan el TUS y el TDM. El uso de sustancias y los problemas de sueño son mutuos y se retroalimentan. El uso de sustancias influye en el sueño con efectos perjudiciales y la presencia de un problema de sueño puede promover el consumo de sustancias como un intento de automedicación. Aunque la evidencia disponible sobre ritmo circadiano, cronotipo y TUS en la población iraní es muy limitada, los estudios existentes indican una alta prevalencia de automedicación con el riesgo de entrar en un círculo vicioso y desarrollar tanto TUS como un problema de sueño más graves. El uso de sustancias también puede causar enfermedades mentales y viceversa. La presencia de un trastorno mental comórbido con TUS, al que nos referimos como patología dual (PD), implica más problemas clínicos (hospitalizaciones, intento de suicidio, recaídas) y sociales en comparación con la presencia de un solo trastorno. Sin embargo, hay poca investigación en esta área y menos todavía en el estudio de la afectación de la ritmicidad circadiana y la CV de los pacientes con PD. El objetivo general de este estudio fue el de investigar las características y diferencias clínicas, el funcionamiento circadiano y la CV en una muestra de 238 pacientes varones iraníes (38,14 ± 10,11 años) en tratamiento con diagnóstico de TUS (N = 81), con TUS y esquizofrenia comórbida (TUS+SZ; N = 75) y con TUS y trastorno depresivo mayor comórbido (TUS+TDM; N = 82). Otro objetivo fue crear la versión persa de la Sleep Belief Scale (SBS) y explorar sus propiedades psicométricas en la muestra de pacientes estudiados. El historial y la presencia de síntomas clínicos se evaluaron junto con el funcionamiento circadiano, mediante diversos instrumentos estandarizados [parámetros horarios para el jet-lag social (JLS), el cuestionario reducido de matutinidad-vespertinidad (rMEQ), el índice de calidad del sueño de Pittsburgh (PSQI) y la SBS]. Para la CV se utilizó la escala desarrollada por la Organización Mundial de la Salud (WHOQOL- BREF). Este estudio es la primera investigación con los diagnósticos clínicos y mediciones seleccionadas desarrollado en Irán. Según las variables sociodemográficas y clínicas, los pacientes TUS+SZ eran personas solteras mucho más jóvenes, con un mayor número de consumo de sustancias y una edad más temprana de inicio del TUS en comparación a los otros dos grupos. En el grupo SUD+TDM se observó más concomitancia de patología orgánica, una mayor cantidad de antecedentes de trastornos psiquiátricos e intentos de suicidio, así como más individuos analfabetos. Los pacientes TUS aportaron la mayor proporción de consumidores de opio y cristal, mientras que los SUD+SZ mostraron la tasa más alta de número de sustancias consumidas. Tanto el grupo SUD como el SUD+SZ tenían una mayor proporción de consumidores de heroína y de policonsumidores. En cuanto a las características del sueño, si bien no se observaron diferencias entre los grupos en el JLS, los pacientes TUS tendían a una hora más tardía de acostarse que los grupos PD tanto durante los días laborales como en los días libres (fin de semana) junto a una mayor presencia del TI. En cambio, los pacientes con TUS+TDM eran más propensos al tipo matutino y los pacientes con TUS+SZ al tipo vespertino. En la muestra total de nuestro estudio, los pacientes vespertinos fueron los que mostraron la tasa más alta de policonsumidores. El grupo TUS+TDM aportó las peores puntuaciones del PSQI, incluso después de controlar la edad y la edad de inicio del TUS, además de mostrar una mayor cantidad de prescripciones farmacológicas para dormir. En cambio, el grupo SUD+SZ fue de los tres el que mostró las peores puntuaciones en el parámetro de alteración del sueño. La edad de inicio del TUS y la gravedad del TDM mostraron una relación negativa y positiva, respectivamente, con las puntuaciones totales del PSQI. Además, dado que no encontramos ninguna interacción entre la cronotipo y los grupos con respecto a la calidad del sueño, una vez desarrollado el trastorno mental éste y su severidad parecen ser los mejores indicadores de las alteraciones del sueño, con independencia de la cronotipo del paciente. La SBS en su forma original no mostró unas propiedades psicométricas adecuadas en la muestra de pacientes, con ítems sin ponderar en ninguna dimensión y una fiabilidad interna inferior a 0,700. Se creó una versión reducida con 13 ítems, que cumple con el mínimo criterio de fiabilidad y requiere menor tiempo de respuesta. Los análisis realizados tanto con la propuesta original como con la nuestra reducida aportaron en ambos casos mejores puntuaciones de los grupos TUS y TUS+TDM en comparación con el grupo TUS+SZ. Este estudio destaca que un mayor número de uso de sustancias y la mayor gravedad de SZ o MDD se vinculan a peores puntuaciones en la SBS, tanto en la escala original como en la reducida. Teniendo en cuenta las dimensiones de SBS (original y reducida), la gravedad de SZ se relacionó negativamente con las puntuaciones de Comportamientos incompatibles con el sueño y Pensamientos y actitudes hacia el sueño, mientras que el número de consumo de sustancias se asoció negativamente con los Comportamientos incompatibles con el sueño. Además, en el grupo TUS+TDM las puntuaciones más bajas en Pensamientos y actitudes hacia el sueño se relacionaron con un mayor número de consumo de sustancias, menor edad de inicio del TUS y mayor gravedad del TDM. El grupo SUD aportó una mejor CV que los grupos con PD en todas las dimensiones, incluso tras controlar los factores de confusión. A excepción de la Salud ambiental en el grupo TUS, todas las puntuaciones de CV en los tres grupos fueron inferiores a los datos normativos de la población sana. En la muestra total, encontramos que el número de consumo de sustancias se relacionó negativamente con la puntuación general de CV. En el grupo TUS+SZ, más intentos de suicidio y más SJL se asociaron a una menos Salud física y Relación social. En cambio, en el grupo TUS+TDM, a mayor JLS y gravedad del TDM se observó peor Salud física y la menor latencia del sueño se relacionaba con más Salud psíquica. Nuestros resultados indican que los pacientes con PD en la mayoría de las características clínicas y circadianas –con énfasis en el sueño-, así como la CV sufren más problemas en comparación con los pacientes con TUS. Ello resalta la importancia de la atención a estos pacientes en los centros de tratamiento de aquellas variables que puedan ser modificadas durante el proceso terapéutico. Los estudios futuros pueden considerar nuestros resultados para la promoción del conocimiento en este ámbito, con el objetivo de comprender mejor las asociaciones entre variables y superar las limitaciones del presente trabajo con la finalidad última de diseñar tratamientos mejores y más efectivos.

Uzroci gubitka svesti su različiti i teško ih je diferencirati. Razlikovanja epileptičkih od neepileptičkih gubitaka svesti je od krucijalnog značaja za ispitivanje, lečenja i prognoze ovih poremećaja. Elektroencefalografija (EEG) je standardna, neinvazivna metoda koja se koristi u ispitivanju nakon gubitka svesti. Inicijalni EEG nalaz nakon prvog gubitka svesti može biti normalan, specifičan ili nespecifičan. Procenat patološkog EEG nalaza je veći kod rano urađenog EEG pregleda. Kod dece rani EEG pregled u roku od 48h ne pokazuje statistički značajne abnormalnosti. Spontanim spavanjem ili EEG pregledom nakon deprivacije spavanja se beleži značajno veća prisutnost epileptiformnih promena kod dece starije od 3 godine, čak i kada je prvi EEG u budnom stanju normalan. Kombinacijama pregleda u budnom stanju i spavanju povećava prisutnost patoloških promena u EEG zapisu. Materijal metode: Istraživanje je obuhvatilo 198 dece uzrasta od 3-12 godine života nakon prvog gubitka svesti. Ispitanici su klasifikovani u dve grupe na osnovu otpusne dijagnoze: na grupu dece kod kojih dijagnoza epilepsije nije postavljena i na grupu dece kod kojih je dijagnoza epilepsije potvrđena. Korelirani su nalazi EEG-a u budnom stanju i spavanju (spontanom ili nakon deprivacije spavanja) sa anamnestičkim i kliničkim podacima o gubitku svesti, podacima o dužini trajanja gubitka svesti i vremena oporavka, vremenom kada je urađen prvi EEG u odnosu na gubitak svesti kao i sa podacima o ličnoj i porodičnoj anamnezi, a koji su navedeni u protokolu istraživanja. Ispitanici su potom podeljeni prema uzrastu u pet grupa u intervalima od 2 godine (3-4; 5-6; 7-8; 9-10; 11-12). Rezultati: Nakon prvog gubitka svesti specifičan (epileptiformni) nalaz EEG u budnom stanju imalo je 41,97% ispitanika, a 58,03% je imalo nespecifičan ili uredan EEG nalaz u budnom stanju, dok je specifičan nalaz EEG u spavanju imalo je 73,57% ispitanika, a 26,43% je imalo nespecifičan ili uredan EEG nalaz u spavanju. Ispitanici koji su imali specifičan EEG nalaz u budnom stanju imali su i specifičan nalaz u spavanju, a 45,07%, nakon deprivacije sna. Ispitanici koji su u budnom stanju imali nespecifičan ili uredan EEG nalaz u budnom stanju su u 35,92% nakon deprvacije spavanja imali specifičan EEG nalaz u spavanju, za razliku od 1,41% dece koji su imali specifičan EEG nalaz u spontanom spavanju. Sumarno gledano bolesnici koji su “aktivirani” odnosno oni kod kojih je deprivacija spavanja uticala na dobijanje specifičnog nalaza (epileptiformnih pormena) u spavanju čine 37.32% od svih ispitanika sa specifičnim (epileptiformnim) promenama u EEG-u u spavanju Zaključak: Kod većine pacijenata nakon prvog gubitka svesti EEG nalaz u budnom stanju je bio nespecifičan ili uredan. Procenat specifičnih EEG nalaza (epileptiformnih promena) se značajno povećao prilikom snimanja EEG u spavanju. Naročito velika korist od deprivacije spavanja kao metode aktivacije potvrđena kod onih pacijenata koji su imali inicijalni EEG u budnom stanju uredan ili nespecifičan. Dobijeni rezultati nesumljivo ukazuju na efikasnost deprivacije spavanja kao provokacione metode i povećanja procenta interiktalnihepileptiformnih EEG promena. Neprovociranih prvi gubitci svesti su se češće javljali u grupi dece kod kojih je dijagnoza epilepsije potvrđena, dok su se provocirani gubitci svesti javljali češće u grupi dece kod kojih dijagnoza epilepsije nije postavljena. Uzrast dece nije uticao na postavljanje dijagnoze epilepsije kao ni na inicijalne nalaze EEGa u budnom stanju i spavanju ali se registrovalo povećanje specifičnih nalaza (epileptiformnih promena) EEG-a, nakon deprivacije spavanja , sa porastom godina života.
The reasons for the loss of consciousness are various and difficult to be differentiated. It is of utmost importance to differentiate between epileptic and non-epileptic losses of consciousness for the purpose of testing, treating and giving prognosis related to this disorder. Electroencephalography (EEG) is a standard, non-invasive method used in testing after the loss of consciousness. The initial EEG after the first loss of consciousness can be normal, specific and non-specific. The percentage of pathological EEG findings is higher in EEG exams performed at an earlier stage. In children, an early EEG exam within 48 hours does not reveal any statistically relevant abnormalities. Spontaneous sleeping or an EEG examination after sleep deprivation leads to a significantly higher number of epileptiform changes in children above the age of 3, even in cases when the first EEG in the awake state was normal. Combinations of examinations in the awake state and during sleep lead to an increased presence of pathological changes in the EEG recording. Material and methods: The research included 198 children aged 3-12 who have experienced their first loss of consciousness. The subjects were classified into two groups, based on their discharge diagnosis: children who have not been diagnosed with epilepsy and children who have had epilepsy confirmed. A correlation was established between EEG findings in the awake state and sleep (spontaneous or following sleep deprivation) and medical history and clinical data related to the loss of consciousness, the information about the length of the loss of consciousness and recovery time, the time when the first EEG examination was performed in relation to the loss of consciousness, as well as the data from the personal and family history. The subjects were further divided into five groups, depending on their age, with each group covering a 2-year period (3-4; 5-6; 7-8; 9-10; 11-12). Results: Following the first loss of consciousness, specific (epileptiform) EEG findings were noticed in 41.97% subjects, while 58.03% of them had non-specific, i.e. regular findings in the awake state. When it comes to the findings during sleep, 73,57% were specific, while 26,43% were non-specific, i.e. regular. The subjects who had specific EEG findings in the awake state also had specific findings during sleep, while that percentage was 45,07% after sleep deprivation. The subjects who had non-specific, i.e. regular EEG findings in the awake state had specific EEG findings during sleep in 35.92% of the cases following sleep deprivation, while 1.41% of the children had specific EEG findings during spontaneous sleep. In total, the patients who were “activated”, i.e. those whose sleep deprivation contributed to specific findings (epileptiform changes) during sleep comprise 37.32% of all subjects with specific (epileptiform) changes in the EEG findings during sleep. Conclusion: In most patients suffering from the first loss of consciousness the EEG findings were non-specific, i.e. regular. The percentage of specific EEG findings (epileptiform changes) was significantly increased when the EEG examination was performed during sleep. Sleep deprivation, as an activation method, was particularly useful in patients whose initial EEG findings in the awake state were regular, i.e. non-specific. The results obtained undoubtedly confirm the efficiency of sleep deprivation as a provoking method and the increase of the percentage of interictal epileptiform EEG changes. Unprovoked first losses of consciousness were more common in the group of children who have had the diagnosis of epilepsy confirmed, while provoked losses of consciousness were more common in the group of children who have not been diagnosed with epilepsy. The age of children did not affect the process of establishing a diagnosis of epilepsy, nor did it affect the initial EEG findings in the awake state or during sleep, but it was observed that the number of specific EEG findings (epileptiform changes) following sleep deprivation increased with the increase of the age of the patients.

Introduction: Parkinson’s disease is a progressive neurodegenerative disease that affects millions of people worldwide. Although Parkinson’s disease has traditionally been described as a disorder of the motor system, it is now recognized as a complex disease with several clinical features that include neuropsychiatric and non-motor manifestations. Studies show that 97% of patients with Parkinson’s disease report non-motor symptoms, in addition to motor symptoms, and some non-motor characteristics may appear before classic motor signs. Objectives: To list the main non-motor clinical manifestations of Parkinson’s disease and analyze its importance in establishing an accurate and early clinical diagnosis. Methods: This is an integrative review, carried out based on the search of scientific publications indexed in the datebase MEDLINE via PubMed, Lilacs and SciELO. At the end of the searches, 66 publications met the eligibility criteria and were selected to compose the study. Results: Within the non-motor clinical manifestations, there may be present: cognitive dysfunction and dementia, psychosis and hallucinations, mood disorders, sleep disorders, fatigue, autonomic dysfunction, olfactory dysfunction, gastrointestinal dysfunction, pain, sensory disorders and dermatological manifestations. Of these, olfactory dysfunction, constipation, depression and sleep disorders stand out because they often precede the motor symptoms of Parkinson’s disease. Conclusion: In this perspective, it is up to the general practitioner and the neurologist or geriatrician to carry out, whenever possible, screening tests to identify early changes that may precede Parkinson’s disease, guaranteeing patients an early multiprofessional treatment and consequently a better prognosis in the course of the disease.

This talk is aimed at presenting novel solutions developed recently by the author’s group for many neurological disorders including Parkinson’s disease, Alzheimer’s disease, depression, anxiety, sleep apnea and sleep disorders using the fundamental research and developments in nanotechnologies and wireless sensor network. Point-of-care (POC) diagnostics promises to bring diagnostic testing out of the laboratory directly to patients and the general public wherever they may be. The key to POC diagnostics is capable of bringing immediate answers so that health care professionals can make rapid and accurate diagnosis of disease so as to ensure the effectiveness of therapy and early detection for preventive therapy. Selected movies illustrating the applications of both invasive and non-invasive wireless nanosensor systems to patients and surgical procedures will be shown at the talk.

Introduction: Renal failure is characterized by functional loss of the kidney and hemodialysis is the therapeutic option. The renal patient may have sleep disorders, including restless legs syndrome (RLS), which occurs in 30% of renal patients and in 10% of the general population. It is a motor neurological disorder, whose etiopathogenesis is not understood. Clinical diagnosis is the gold standard. RLS has been associated with cardiovascular morbities and increased mortality, however, it is underdiagnosed. The present study aimed to assess the prevalence and factors associated with RLS symptoms in patients with dialysis renal failure in a private clinic for chronic renal patients. Methods: Cross-sectional study, including 140 patients seen at the Tubarão Renal Diseases Clinic, from August to November 2016. Results: The average age of the interviewed population was 60.82 years, the majority being men (63.6%). Most respondents reported having restful sleep (78.6%). Despite this, snoring / sleep apnea prevalence was found in more than half of the patients (57.1%) and SPI in 19.3% (the most severe form being found in 8.6% of the patients). Other comorbidities found were: SAH, insomnia, diabetes mellitus and cardiac disorders. Statistically, dialysis time was longer among patients with RLS (P = 0.03). The female gender was shown to be a risk factor (P = 0.006) and cardiac alterations also had a significant association (P = 0.044-Fisher), as well as insomnia (p = 0.00011). Conclusions: Sleep disorders are prevalent and should be part of the assessment of all dialysis patients.