RESUMO
The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.
Assuntos
Terapia Cognitivo-Comportamental , Hipnóticos e Sedativos/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia , Doença Aguda , Antidepressivos/uso terapêutico , Brasil , Doença Crônica , Humanos , Sociedades MédicasRESUMO
The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.
A Associação Brasileira de Sono reuniu especialistas em medicina do sono com o objetivo de desenvolver novas diretrizes no diagnóstico e tratamento das insônias. Nós consideramos quatro níveis de evidência: padrão, recomendado, opcional e não recomendado. Os tópicos abordados foram: conceito, avaliação clínica e psicossocial, indicação da polissonografia, tratamento farmacológico, terapia comportamental cognitiva, comorbidades e insônia na infância. Para o diagnóstico da insônia, foi recomendada uma avaliação psicossocial e a realização da polissonografia, enquanto que no que se refere ao tratamento, foi estabelecido como padrão a indicação da terapia comportamental cognitiva, e, quanto ao tratamento farmacológico, foi indicado o uso do zolpidem como hipnótico padrão, e sendo recomendado o zopiclone, a trazodona e a doxepina.
Assuntos
Humanos , Terapia Cognitivo-Comportamental , Hipnóticos e Sedativos/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia , Doença Aguda , Antidepressivos/uso terapêutico , Brasil , Doença Crônica , Sociedades MédicasRESUMO
A 52 year-old male patient, had complaint of "restless sleep". His wife informed that for the past ten years the patient had presented intense and aggressive body movements, and sometimes, violent dreams. The patient also complained of excessive daytime sleepiness. His relevant previous medical history included a traumatic brain injury at the age of 28 which left him in coma for two months. A video-polysomnography showed periodic leg movements and, during REM sleep, aggressive and agitated behaviour. The multiple sleep latency test revealed extremely short latencies. Initially, he was treated with levodopa-benzerazide, 100/25 mg, 2 hours before bedtime. After 10 weeks his overnight behaviour pattern improved and leg movements diminished. This case supports the hypothesis of an association between cranial trauma and alterations in the dopaminergic pathways represented by periodic leg movements during sleep and a sleep behaviour disorder and proposes the possibility of hypothalamic hypocretin involvement in its pathophysiology.
Assuntos
Traumatismos Craniocerebrais/complicações , Distúrbios do Sono por Sonolência Excessiva/etiologia , Síndrome das Pernas Inquietas/etiologia , Antiparkinsonianos/uso terapêutico , Distúrbios do Sono por Sonolência Excessiva/tratamento farmacológico , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Periodicidade , Polissonografia , Distúrbios do Início e da Manutenção do Sono/complicações , Fases do Sono/fisiologiaRESUMO
Um homem de 52 anos, procurou o Hospital. Universitário de Brasília com queixa de sono agitado. Sua esposa relatava, desde há cerca de 10 anos, intensa movimentaçäo de membros e agressividade em meio a sonhos violentos. Desde entäo apresentava sonolência diurna excessiva. Havia relato de traumatismo de crânio há 34 anos e coma de 2 meses de duraçäo. A vídeo-polissonografia revelou comportamento agressivo e agitado durante o sono REM, e movimentos periódicos de pernas. Havia importante sonolência diurna no teste de latências de sono. Foi instituído tratamento com levodopa-benzerazida 100/25 mg à noite. Após 10 semanas de evoluçäo, houve melhora da movimentaçäo noturna global, e desaparecimento dos episódios ligados a sonhos de conteúdo violento. Este caso nos permite analisar a associaçäo entre trauma craniano e alteraçöes nas vias dopaminérgicas (movimentos periódicos das pernas e distúrbio de comportamento do sono REM) e revisar a importância dos distúrbios na produçäo de hipocretina hipotalâmica na fisiopatologia desse quadro clínico
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Craniocerebrais , Distúrbios do Sono por Sonolência Excessiva , Síndrome das Pernas Inquietas/etiologia , Antiparkinsonianos , Distúrbios do Sono por Sonolência Excessiva , Levodopa , Periodicidade , Polissonografia , Distúrbios do Início e da Manutenção do Sono , Fases do SonoRESUMO
This report presents an analysis of the complaints of increasing daytime sleepiness as well as a study on their possible effects on the academic performance of medical students at the University of Brasilia. The Epworth Sleepiness Scale was applied to 172 medical students, at the beginning of August 1997 and at the end of November 1997. Academic performance was measured by analyzing the number of SS grades (from 9.0 to 10 over ten) and MM grades (from 5.0 to 6.9) attained in exams at the end of that school period. The results showed that at the beginning of the semester, 68 (39.53%) of these 172 students already presented with excessive daytime sleepiness, and that of the 104 remaining students, 38 (22%) developed daytime sleepiness by the end of the semester. Furthermore, it was observed that the sleepier students did not achieve as well as the others on their final examinations.
Assuntos
Ritmo Circadiano/fisiologia , Fases do Sono/fisiologia , Estudantes de Medicina/psicologia , Nível de Alerta , Estudos Transversais , Humanos , Inquéritos e Questionários , Fatores de TempoRESUMO
This report presents an analysis of the complaints of increasing daytime sleepiness as well as a study on their possible effects on the academic performance of medical students at the University of Brasilia. The Epworth Sleepiness Scale was applied to 172 medical students, at the beginning of August 1997 and at the end of November 1997. Academic performance was measured by analyzing the number of SS grades (from 9.0 to 10 over ten) and MM grades (from 5.0 to 6.9) attained in exams at the end of that school period. The results showed that at the beginning of the semester, 68 (39.53 percent) of these 172 students already presented with excessive daytime sleepiness, and that of the 104 remaining students, 38 (22 percent) developed daytime sleepiness by the end of the semester. Furthermore, it was observed that the sleepier students did not achieve as well as the others on their final examinations