RESUMO

Introduction: Changes in the autonomic nervous system due to Obstructive Sleep Apnea (OSA) during the life span have been described. Some pediatric studies have shown cardiovascular effects in children who do not fit the criteria for OSA; namely children with mild sleep disordered breathing. Objective: We investigated heart rate variability (HRV) during sleep in children with chronic snoring and flow limitation events during sleep. Methods: Ten children and adolescents with chronic snoring and an apnea hypopnea index < 1, associated to high Respiratory Index, and 10 controls matched for age, gender, and Tanner stage were monitored following one night of habituation in the sleep laboratory. HRV was studied at each sleep stage. The time and frequency domains were calculated for each 5-min period. Results: All patients were chronic heavy snorers. They presented an apnea hypopnea index = 0.8, respiratory disturbance index = 10.2/h with lowest O2 saturation 96.1 ± 2.4%. The total power of HRV was decreased in all stages (p < 0.05). There was also a decrease in NN50 and pNN50 during all sleep stages compared to healthy controls (p = 0.0003 and p = 0.03, respectively). Conclusion: A reduction in parasympathetic tone was found in the patient group. This may represent an autonomic impairment during sleep in children with mild SDB. A reduction in HRV in children with habitual snoring could be associated with possible increases in cardiovascular risk in adulthood. Significance: The study indicates that children with habitual snoring have important parasympathetic tone changes during sleep.

RESUMO

OBJECTIVE: The aim of this study is to complement existing data on the expression and characteristics of cyclic alternating pattern (CAP) in children, specifically in the 12 to 24 month age bracket. METHOD: Descriptive study. SETTINGS: a university pediatric sleep laboratory. PARTICIPANTS: Twelve normal and healthy subjects (6 girls and 6 boys, mean age 18.9 ± 4.72 months; range 12-24 months underwent a standard polysomnography night recording in our pediatric sleep laboratory. Sleep stages and CAP were analyzed according to standard international rules. RESULTS: CAP rate found in children of 12 to 24 months of age was (25.78 ± 10.18%) and it is characterized by a linear increase of 2% per month, from 12% at 12 months reaching 35% at 24 months. With coefficient of determination R² of 0.91. The duration of A phases was 6.93 ± 1.06 seconds, and B phases was found to last 21.44 ± 2.31 seconds. The number of CAP cycles was 173.25 ± 7 3.85 with an average index per hour of 33.55 ± .61. The number of CAP sequences reached 25.25 ± 9.55 per recording. CAP rate for the different type of A phases are (21.83 ± 9.68%), for A1, (2.43 ± 2.30%) for A3 and (1.67 ± 1.11%) for A2. CONCLUSION: Our study provides normative data on CAP in a group of young children (12 to 24 months). The most salient result of this study is the strong correlation of CAP rate of 2% per month in this age group.

Assuntos

RESUMO

OBJECTIVE: The aim of this study is to complement existing data on the expression and characteristics of cyclic alternating pattern (CAP) in children, specifically in the 12 to 24 month age bracket. METHOD: Descriptive study. Settings: a university pediatric sleep laboratory. Participants: Twelve normal and healthy subjects (6 girls and 6 boys, mean age 18.9±4.72 months; range 12-24 months underwent a standard polysomnography night recording in our pediatric sleep laboratory. Sleep stages and CAP were analyzed according to standard international rules. RESULTS: CAP rate found in children of 12 to 24 months of age was (25.78±10.18 percent) and it is characterized by a linear increase of 2 percent per month, from 12 percent at 12 months reaching 35 percent at 24 months. With coefficient of determination R² of 0.91. The duration of A phases was 6.93±1.06 seconds, and B phases was found to last 21.44±2.31 seconds. The number of CAP cycles was 173.25±73.85 with an average index per hour of 33.55±14.61. The number of CAP sequences reached 25.25±9.55 per recording. CAP rate for the different type of A phases are (21.83±9.68 percent), for A1, (2.43±2.30 percent) for A3 and (1.67±1.11 percent) for A2. CONCLUSION: Our study provides normative data on CAP in a group of young children (12 to 24 months). The most salient result of this study is the strong correlation of CAP rate of 2 percent per month in this age group.

OBJETIVO: O objetivo deste estudo é complementar os dados normativos sobre a expressão e as características do padrão alternante cíclico (CAP) em crianças, especificamente na faixa etária de 12 para 24 meses. MÉTODO: Estudo descritivo. Participantes: Doze indivíduos normais e saudáveis (6 meninas e 6 meninos, entre 12-24 meses de idade (média de 18,9±4,72 meses), foram submetidos a uma noite de gravação de polissonografia em nosso laboratório de sono pediátrico. As fases do sono e CAP foram analisados de acordo com padrão e normas internacionais. RESULTADOS: A taxa máxima encontrada em crianças de 12 a 24 meses de idade foi de (25,78 por cento±10,18) e é caracterizada por um aumento linear de 2 por cento ao mês, a partir de 12 por cento em 12 meses atingindo 35 por cento em 24 meses de idade. A duração da fase A foi de 6,93±1,06 segundos, e nas fases B foi encontrado a média de 21,44±2,31 segundos. O número de ciclos CAP foi 173,25±73,85, com um índice médio por hora de 33,55±14,61. O número de sequências CAP chegou a 25,25±9,55 por registro.Os índices dos subtipos de fases A foram (21,83 por cento±9,68), para a A1, (2,43 por cento±2,30) para a A3 e (1,67 por cento±1,11) para A2. CONCLUSÃO: Nosso estudo fornece dados normativos sobre CAP em um grupo de crianças (12 a 24 meses de idade). O resultado mais saliente deste estudo é a forte correlação entre taxa do CAP e idade, mostrando que a cada mês ocorreu o aumento de 2 por cento.

Assuntos

RESUMO

The classification of short duration events in the EEG during sleep, as the A stage of the cyclic alternating pattern (CAP) is a tedious and error prone task. The number of events under normal conditions is large (several hundreds), and it is necessary to mark the limits of the events with precision, otherwise the time sensitive classification of the CAP phases (A and B) and specially the scoring of different types of A phases will be compromised. The objective of this study is to verify the feasibility of visual CAP scoring with only one channel of EEG, the evaluation of the inter-scorer agreement in a variety of recordings, and the comparison of the visual scorings with a known automatic scoring system. Sixteen hours of one channel (C4-A1 or C3-A2) of NREM sleep were extracted from eight whole night recordings in European Data Format and presented to the different scorers. The average inter-scorer agreement for all scorers is above 70%, the pair wise inter-scorer agreement found was between 69% up to 77.5%. These values are similar to what has been reported in different type studies. The automatic scoring system has similar performance of the visual scorings. The study also has shown that it is possible to classify the CAP using only one channel of EEG.

Assuntos

RESUMO

The classification of short duration events in the EEG during sleep, as the A stage of the cyclic alternating pattern (CAP) is a tedious and error prone task. The number of events under normal conditions is large (several hundreds), and it is necessary to mark the limits of the events with precision, otherwise the time sensitive classification of the CAP phases (A and B) and specially the scoring of different types of A phases will be compromised. The objective of this study is to verify the feasibility of visual CAP scoring with only one channel of EEG, the evaluation of the inter-scorer agreement in a variety of recordings, and the comparison of the visual scorings with a known automatic scoring system. Sixteen hours of one channel (C4-A1 or C3-A2) of NREM sleep were extracted from eight whole night recordings in European Data Format and presented to the different scorers. The average inter-scorer agreement for all scorers is above 70 percent, the pair wise inter-scorer agreement found was between 69 percent up to 77.5 percent. These values are similar to what has been reported in different type studies. The automatic scoring system has similar performance of the visual scorings. The study also has shown that it is possible to classify the CAP using only one channel of EEG.

A classificação dos eventos de curta duração no EEG durante o sono, como a fase A do padrão alternante cíclico (CAP) é tarefa tediosa e propensa ao erro. O número de eventos é geralmente grande (centenas ao milhar), e é necessário marcar os limites dos eventos com precisão, caso contrário tanto a classificação das duas fases do CAP como a distinção dos diferentes tipos de fases A podem ser comprometidas. O objetivo deste estudo é a avaliação da concordância inter-estagiadores no CAP tanto visual quanto automático usando um único canal de EEG, a avaliação do acordo inter-estagiadores em uma variedade das gravações, e a comparação das classificações visuais com um sistema classificador automático. Dezesseis horas de um canal (C4-A1 ou C3-A2) do sono de NREM foram extraídas de oito gravações inteiras da noite no Formato de dados Europeus e apresentadas a diferentes classificadores, o acordo médio inter-estagiadores para todas as classificações está acima de 70 por cento, o acordo inter-estagiadores do par encontrado entre 69 por cento até 77,5 por cento. Estes valores são similares ao que foi relatado nos diferentes tipos de estudos. O sistema marcador automático tem o desempenho similar aos dos classificadores visuais. O estudo também mostrou que é possível classificar o CAP usando somente um canal de EEG.

Assuntos

RESUMO

STUDY OBJECTIVES: The aim of this study is to complement the data on the expression and characteristics of cyclic alternating pattern (CAP) events in children, specifically in the peripubertal age group of 8 to 12 years and to analyze the association of CAP events with arousals. The study of CAP and arousal is a useful tool for assessing sleep instability and fragmentation in children. DESIGN: Descriptive study. PARTICIPANTS: Ten sex-matched healthy children, aged 8 to 12 years, underwent standard polysomnography after 1 adaptation night in the sleep laboratory. Sleep stages, CAP, and arousals were analyzed according to standard international rules. RESULTS: The mean CAP rate was 62.1% +/- 10.8% and the mean CAP cycle duration, 24.6 +/- 2.1 minutes. CAP A1 phase was the most numerous (85.5% +/- 3.9%), whereas the A2 phase was 9.1% +/- 4.7%, and the A3 phase as 5% +/- 2.3%, (P < .01). Differences between boys and girls were detected by analysis of variance, namely increases of phase A2 and A3 subtypes in girls (P < .001). Stronger phase A1 subtype expression in slow-wave sleep was verified in both sexes. Positive correlation between electroencephalogram arousals and the sum of phase A2 and A3 subtypes was also present. The overall CAP rate is higher in this age group than the rate previously reported in children aged 6 to 10 years (62.1% +/- 10.8% vs 33.4% +/- 5.3%). CONCLUSIONS: Our study provides normative data on CAP in children aged 8 to 12 years and indicates that age and Tanner stages must both be considered when investigating peripubertal children.

Assuntos

RESUMO

Cases of violent behavior during sleep have been reported in the literature. However, the incidence of violent behavior during sleep is not known. One epidemiological study showed that approximately 2% of the general population, predominantly males, presented violent behavior while asleep. In the present study, the authors describe clinical and medico-legal aspects involved in violent behavior investigation. Violent behavior refers to self-injury or injury to another during sleep. It happens most frequently following partial awakening in the context of arousal disorders (parasomnias). The most frequently diagnosed sleep disorders are REM behavior disorder and somnambulism. Violent behavior might be precipitated by stress, use of alcohol or drugs, sleep deprivation or fever.

Assuntos

RESUMO

Casos de comportamento violento (CV) durante o sono são relatados na literatura. A incidência de comportamento violento durante o sono não é muito conhecida. Um estudo epidemiológico mostra que cerca de 2 por cento da população geral apresentava comportamento violento dormindo e eram predominantemente homens. Neste artigo, os autores descrevem aspectos clínicos e médico-legais envolvidos na investigação do comportamento violento. O comportamento violento se refere a ferimentos auto-infligidos ou infligidos a um terceiro durante o sono. Ocorre, muito freqüentemente, seguindo um despertar parcial no contexto de um transtorno de despertar (parassonias). Os transtornos do sono predominantes diagnosticados são: transtorno de comportamento REM e sonambulismo. O comportamento violento poderia ser precipitado pelo estresse, uso de álcool e drogas, privação do sono ou febre.

Assuntos