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Effects of Acute Sleep Deprivation on the Sequential Rate of Torque Development throughout the Force-Time Curve. 急性睡眠不足对整个力-时间曲线上扭矩发展顺序率的影响。
IF 1.6 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-22 eCollection Date: 2023-12-01 DOI: 10.1055/s-0043-1776869
André Dias Gonçalves, Pedro Pezarat-Correia, Carolina Vila-Chã, Gonçalo Vilhena Mendonça

Objective  The impact of sleep deprivation on the physiological determinants of explosive torque production remains poorly understood. We aimed at determining the acute effects of 24 hours of sleep deprivation on the sequential rate of torque development (RTD) obtained during plantar flexion through maximum voluntary isometric contraction (MVIC). Materials and Methods  The study included 14 healthy-young adults (8 men and 6 women). The participants visited the laboratory on 2 different occasions: without and with 24 hours of sleep deprivation. In each session, the subjects were tested for RTD of the plantar flexors with concomitant recordings of the electromyographic (EMG) amplitude of the soleus over the following time intervals: 0 to 30, 30 to 50, 50 to 100, and 100 to 150 ms. Results  Sleep deprivation did not affect peak RTD (without sleep deprivation: 283.3 ± 111.6 N.m.s -1 versus with sleep deprivation: 294.9 ± 99.2 N.m.s -1 ; p  > 0.05) of plantar flexion. The sequential values of RTD, as well as the normalized amplitude of the soleus EMG, remained similar between both conditions (p > 0.05). Discussion  In conclusion, we found that 24 hours of sleep deprivation do not affect muscle activation, nor explosive torque production throughout the torque-time curve. Thus, exercise performance and daily functionality in tasks involving rapid torque development might remain well preserved after 24 hours of acute sleep deprivation.

目的 睡眠不足对爆发性扭矩产生的生理决定因素的影响仍然知之甚少。我们的目的是确定 24 小时睡眠不足对通过最大自主等长收缩(MVIC)在跖屈过程中获得的扭矩顺序发展率(RTD)的急性影响。材料和方法 研究对象包括 14 名健康的年轻人(8 男 6 女)。受试者在两个不同的场合访问了实验室:没有睡眠和睡眠不足 24 小时。在每次测试中,受试者都接受了跖屈肌 RTD 测试,同时记录了比目鱼肌在以下时间间隔内的肌电图(EMG)振幅:0 至 30、30 至 50、50 至 100 和 100 至 150 毫秒。结果 睡眠剥夺不影响跖屈的峰值 RTD(未剥夺睡眠:283.3 ± 111.6 N.m.s -1 与剥夺睡眠:294.9 ± 99.2 N.m.s -1 ;P > 0.05)。两种情况下,RTD 的连续值和比目鱼肌肌电图的归一化振幅保持相似(p > 0.05)。讨论 总之,我们发现 24 小时睡眠不足不会影响肌肉活化,也不会影响整个扭矩-时间曲线上的爆发性扭矩产生。因此,在涉及快速扭矩发展的任务中,运动表现和日常功能在急性睡眠剥夺 24 小时后仍可保持良好。
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引用次数: 0
A Retrospective Pilot Study of Imagery Rehearsal Therapy Enhanced with Narrative Therapy Principles for the Treatment of Nightmares in US Military Veterans. 用叙事疗法原理加强想象排练疗法治疗美国退伍军人噩梦的回顾性试点研究。
IF 1.6 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-22 eCollection Date: 2023-12-01 DOI: 10.1055/s-0043-1776796
Ann Marie Wagner, Anne Richards, Christine Chiros, Paul Thuras, Elizabeth C Parsons, Angela D Oien, Carlos H Schenck, Muna Irfan

Introduction  Chronic nightmares are a common and disabling feature of posttraumatic stress disorder (PTSD) for which broadly effective treatments are still lacking. While imagery rehearsal therapy (IRT) demonstrates benefits for patients with idiopathic nightmares and some patients with PTSD-related nightmares, research indicates it may be less beneficial for veterans. Narrative therapy (NT) is a form of psychotherapy which is client-centered and value-focused and has demonstrated benefits for PTSD patients. The application of NT principles to IRT may provide a valuable therapeutic approach for treatment in veterans. Objective  To perform a retrospective chart review of veteran clients participating in a novel, brief intervention developed by the first author consisting of IRT enhanced with NT principles (N-IRT) for the treatment of nightmares. The primary outcomes were nightmare frequency and intensity, and the secondary outcome was the impact of the intervention on nightmare distress and coping, subjective sleep quality, and overall PTSD symptoms. Materials and Methods  We conducted retrospective chart reviews for eight veterans referred to the first author for the treatment of nightmares, who completed N-IRT, including baseline and end-of-treatment measures. The protocol involved a single 60-minute NT-enhanced rescripting session and assigned homework to rehearse the revised dream script, and a follow-up evaluation 4 weeks later. The subjects completed a sleep and nightmare interview developed by the first author and the PTSD Checklist at baseline and after the intervention at the follow-up evaluation. Paired t -tests were conducted to test for pre-to-post differences. Results  In the statistical analysis, we observed a statistically significant and clinically meaningful reduction in the frequency ( p  = 0.04) and intensity of nightmares ( p  = 0.001) from pretreatment to the 1-month follow-up. Measures of nightmare-associated emotional distress, the ability to cope with nightmares, sleep duration and sleep efficiency, as well as overall PTSD symptoms also demonstrated significant improvements. Conclusion  These pilot data provide compelling preliminary evidence that a single-session IRT intervention modified with NT (N-IRT) is effective in reducing nightmare frequency and intensity, reducing nightmare distress, improving the act of coping with nightmares, and improving sleep quality and overall PTSD symptoms in veterans. Further investigation of this method with gold-standard clinical trial designs and larger sample sizes is indicated to confirm effectiveness and to better understand the possible mechanisms of treatment effect.

导言:慢性恶梦是创伤后应激障碍(PTSD)的一种常见致残特征,目前仍缺乏广泛有效的治疗方法。虽然意象排演疗法(IRT)对特发性噩梦患者和一些与创伤后应激障碍相关的噩梦患者有一定疗效,但研究表明该疗法对退伍军人的疗效可能较差。叙事疗法(NT)是一种以客户为中心、以价值为重点的心理疗法,已证明对创伤后应激障碍患者有益。将叙事疗法的原则应用于 IRT 可能会为退伍军人的治疗提供一种有价值的治疗方法。目标 对参与第一作者开发的新型简短干预的退伍军人客户进行回顾性病历审查,该干预由采用 NT 原则的 IRT(N-IRT)强化而成,用于治疗噩梦。主要结果是噩梦的频率和强度,次要结果是干预对噩梦困扰和应对、主观睡眠质量以及整体创伤后应激障碍症状的影响。材料与方法 我们对第一作者转诊的八名完成了 N-IRT 治疗的退伍军人进行了回顾性病历审查,包括基线和治疗结束时的测量。治疗方案包括一次60分钟的NT增强型梦境脚本重写疗程和指定的家庭作业以排练修改后的梦境脚本,以及4周后的随访评估。受试者在基线期和干预后的随访评估中分别完成了由第一作者开发的睡眠和噩梦访谈以及创伤后应激障碍核对表。我们进行了配对 t 检验,以检验前后的差异。结果 在统计分析中,我们观察到从治疗前到 1 个月的随访期间,噩梦的频率(p = 0.04)和强度(p = 0.001)均有显著的减少,且具有临床意义。与噩梦相关的情绪困扰、应对噩梦的能力、睡眠时间和睡眠效率以及创伤后应激障碍的总体症状也有了明显改善。结论 这些试验数据提供了令人信服的初步证据,证明用NT(N-IRT)改良的单次IRT干预能有效降低退伍军人的噩梦频率和强度、减少噩梦困扰、改善应对噩梦的行为、改善睡眠质量和整体创伤后应激障碍症状。为了证实该方法的有效性,并更好地了解治疗效果的可能机制,需要采用黄金标准临床试验设计和更大的样本量对该方法进行进一步研究。
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引用次数: 0
Clinical Application of the Multicomponent Grading System for Sleep Apnea Classification and Incident Cardiovascular Mortality. 睡眠呼吸暂停多组分分级系统的临床应用与心血管死亡率事件。
IF 1.6 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-22 eCollection Date: 2023-12-01 DOI: 10.1055/s-0043-1776770
Jorge Jorquera, Jorge Dreyse, Constanza Salas, Francisca Letelier, Bunio Weissglas, Javiera Del-Río, Mario Henríquez-Beltrán, Gonzalo Labarca, Jorge Jorquera-Díaz

Objective  To evaluate the clinical utility of the Baveno classification in predicting incident cardiovascular mortality after five years of follow-up in a clinic-based cohort of patients with obstructive sleep apnea (OSA). Materials and Methods  We evaluated the reproducibility of the Baveno classification using data from the Santiago Obstructive Sleep Apnea (SantOSA) study. The groups were labeled Baveno A (minor symptoms and comorbidities), B (severe symptoms and minor comorbidities), C (minor symptoms and severe comorbidities), and D (severe symptoms and comorbidities). Within-group comparisons were performed using analysis of variance (ANOVA) and post hoc tests. The associations between groups and incident cardiovascular mortality were determined through the Mantel-Cox and Cox proportional hazard ratios (HRs) adjusted by covariables. Results  A total of 1,300 OSA patients were included (Baveno A: 27.7%; B: 28%; C: 16.8%; and D: 27.5%). The follow-up was of 5.4 years. Compared to Baveno A, the fully-adjusted risk of cardiovascular mortality with Baveno B presented an HR of 1.38 (95% confidence interval [95%CI]: 0.14-13.5; p  = 0.78); with Baveno C, it was of 1.71 (95%CI: 0.18-16.2; p  = 0.63); and, with Baveno D, of 1.04 (95%CI: 0.12-9.2; p  = 0.98). We found no interactions involving Baveno group, sex and OSA severity. Discussion  Among OSA patients, the Baveno classification can describe different subgroups. However, its utility in identifying incident cardiovascular mortality is unclear. Long-term follow-up studies and the inclusion of demographic variables in the classification could improve its ability to detect a high-risk phenotype associated with cardiovascular mortality. Conclusion  The Baveno classification serves as a valuable method for categorizing varying groups of patients afflicted with OSA. Nevertheless, its precision in identifying occurrence of cardiovascular mortality is still unclear.

目的 评估阻塞性睡眠呼吸暂停(OSA)患者临床队列随访五年后,巴韦诺分类法在预测心血管疾病死亡率方面的临床实用性。材料与方法 我们利用圣地亚哥阻塞性睡眠呼吸暂停(SantOSA)研究的数据评估了巴韦诺分类法的可重复性。各组分别标记为巴韦诺 A 组(轻微症状和合并症)、B 组(严重症状和轻微合并症)、C 组(轻微症状和严重合并症)和 D 组(严重症状和合并症)。组内比较采用方差分析(ANOVA)和事后检验。各组与心血管疾病死亡率之间的关系通过经协变量调整的 Mantel-Cox 和 Cox 比例危险比 (HRs) 来确定。结果 共纳入 1300 名 OSA 患者(Baveno A:27.7%;B:28%;C:16.8%;D:27.5%)。随访时间为 5.4 年。与贝文诺 A 相比,贝文诺 B 的完全调整后心血管死亡风险 HR 为 1.38(95% 置信区间 [95%CI]:0.14-13.5;p = 0.78);贝文诺 C 为 1.71(95%CI:0.18-16.2;p = 0.63);贝文诺 D 为 1.04(95%CI:0.12-9.2;p = 0.98)。我们没有发现贝文诺组别、性别和 OSA 严重程度之间存在相互作用。讨论 在 OSA 患者中,巴韦诺分类可以描述不同的亚组。然而,其在确定心血管疾病死亡率方面的作用尚不明确。长期随访研究以及在分类中加入人口统计学变量可提高其检测与心血管死亡相关的高风险表型的能力。结论 巴韦诺分类法是对不同OSA患者群体进行分类的重要方法。然而,它在识别心血管死亡发生方面的准确性仍不明确。
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引用次数: 0
Detecting Lucid Dreams by Electroencephalography and Eyebrow Movements. 通过脑电图和眉毛运动检测迷梦
IF 1.6 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-22 eCollection Date: 2023-12-01 DOI: 10.1055/s-0043-1776749
Michael Raduga, Andrey Shashkov

Objective  When metacognition arises during rapid eye movement (REM) sleep, people experience lucid dreaming (LD). Studies on this phenomenon face different obstacles. For example, its standard verification protocol requires at least three types of sensors. We hypothesized that preagreed frontalis movements (PAFMs), as a sign of lucidity, could be seen on electroencephalography (EEG) during REM sleep. In this case, only one EEG sensor would be needed to verify LD. Method  Under laboratory observation, five volunteers were instructed to induce LD, during which they needed to use the standard verification protocol with pre-agreed eye movements (PAEMs) and then immediately raise their eyebrows three times as a PAFM. Results  All participants were able to send signals from a total of eight LDs using one or both methods. Preagreed frontalis movements and PAEMs were equally distinctive on most EEGs, but PAFM quality was strongly dependent on the accuracy of the method. Preagreed frontalis movements exhibited two types of EEG patterns and led to immediate awakening when LD was not stable. Discussion  Though the outcomes show that PAFMs can be used to verify LD, this method was less consistent and apparent than PAEMs. Furthermore, accurate instructions are needed before using PAFMs. When polysomnography is unavailable, PAFMs can be applied, as it requires only one EEG sensor to detect REM sleep and consciousness simultaneously.

目的 当人们在快速眼动(REM)睡眠中产生元认知时,就会经历清醒梦(LD)。对这一现象的研究面临着不同的障碍。例如,其标准验证协议需要至少三种传感器。我们假设,在快速眼动睡眠期间,脑电图(EEG)上可以看到预先约定的额叶运动(PAFMs),这是清醒的标志。在这种情况下,只需要一个脑电图传感器就能验证 LD。方法 在实验室观察下,指导五名志愿者诱发 LD,在此期间,他们需要使用预先商定的眼球运动(PAEMs)标准验证方案,然后立即抬起眉毛三次作为 PAFM。结果 所有参与者都能使用一种或两种方法发出共八次 LD 信号。在大多数脑电图上,预先约定的额肌运动和 PAEM 同样明显,但 PAFM 的质量在很大程度上取决于方法的准确性。预设额肌运动表现出两种类型的脑电图模式,并在 LD 不稳定时导致立即唤醒。讨论 虽然研究结果表明 PAFM 可用来验证 LD,但这种方法的一致性和明显性不如 PAEM。此外,在使用 PAFMs 之前需要准确的指导。在没有多导睡眠图的情况下,可以使用 PAFMs,因为它只需要一个脑电图传感器就能同时检测快速动眼期睡眠和意识。
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引用次数: 0
Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review. 下颌前突矫治器治疗小儿阻塞性睡眠呼吸暂停:综述。
IF 1.6 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-22 eCollection Date: 2023-12-01 DOI: 10.1055/s-0043-1776747
Carolina Cozzi-Machado, Fátima Rosana Albertini, Silvana Silveira, Almiro José Machado-Júnior

Introduction  Obstructive sleep apnea (OSA) is defined as intermittent partial or complete collapse of the upper airway during sleep. It is a common condition in childhood, with an incidence ranging from 1.2% to 5.7%, and it can harm several aspects of children's life, such as cognitive, metabolic and cardiovascular functions, among others. There are treatment options, such as adenotonsillectomy, myofunctional therapy, mandibular advancement appliances (MAAs), rapid maxillary expansion, and positive airway pressure devices, but there is still doubt about which method is more suitable for the treatment of OSA in children. Objective  To analyze the effectiveness of MAAs in the treatment of pediatric OSA. Materials and Methods  The search was conducted in August 2021 in different electronic databases, such as PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS, Ovid, SciELO, Web of Science, EMBASE BIREME, BBO BIREME, and the Cochrane Library. Results  Only three systematic reviews and two meta-analyses were included in the present study. All studies showed improvement in the score on the apnea-hypopnea index after using MAAs in the treatment of pediatric OSA. Conclusion  Although more randomized studies are needed, based on the present umbrella review, MAAs must be considered part of the multidisciplinary treatment for pediatric OSA.

导言 阻塞性睡眠呼吸暂停(OSA)是指睡眠时上气道间歇性部分或完全塌陷。它是儿童时期的一种常见病,发病率从1.2%到5.7%不等,可损害儿童生活的多个方面,如认知、新陈代谢和心血管功能等。目前有多种治疗方法,如腺扁桃体切除术、肌功能疗法、下颌前突矫治器(MAAs)、上颌快速扩张术和气道正压装置,但哪种方法更适合治疗儿童 OSA 仍存在疑问。目的 分析上下颌前突矫治器治疗儿童 OSA 的效果。材料与方法 2021 年 8 月在不同的电子数据库中进行了检索,如 PubMed、EBSCO(Dentistry & Oral Sciences Source)、LILACS、Ovid、SciELO、Web of Science、EMBASE BIREME、BBO BIREME 和 Cochrane Library。结果 本研究只纳入了三篇系统综述和两篇荟萃分析。所有研究均显示,使用 MAAs 治疗小儿 OSA 后,呼吸暂停-低通气指数得分有所改善。结论 虽然还需要更多的随机研究,但根据本综述,必须将 MAAs 视为小儿 OSA 多学科治疗的一部分。
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引用次数: 0
Performance of the NOSE Questionnaire in Mask Selection for Home CPAP Titration. NOSE 问卷在家用 CPAP 滴定法面罩选择中的表现。
IF 1.6 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-22 eCollection Date: 2023-12-01 DOI: 10.1055/s-0043-1776769
Magalí Blanco, Glenda Ernst, Alberto Rabino, Alejandro Salvado, Eduardo Enrique Borsini

Introduction  Many patients abandon CPAP treatment because they find the mask uncomfortable. Therefore, specialists may benefit from the predictive value of airway assessment tools. Objective  To identify nasal ventilation failure through the Nasal Obstruction Symptom Evaluation (NOSE) scale in patients with obstructive sleep apnea (OSA) who undergo home-based auto-adjusting CPAP titration and to determine whether there is a correlation between NOSE score and the type of mask selected. Materials and Methods  In this prospective correlational study, the NOSE scale was used in terms of mask selection and titration indicators. Patients were classified based on their NOSE score: > or < 50. Results  We included 303 patients; 226 men (74.5%), BMI: 33.2 ± 6.1 kg/m 2 , neck circumference (cm): 42.8 ± 3.6 and Epworth (ESS) score: 9.2 ± 5.6, mild OSA: 12 (3.9%), moderate OSA: 127 (41.9%), and severe OSA: 164 (54.1%). The mean NOSE score was 24.3 ± 22.8 and 42 patients (13.8%) had NOSE scores > 50. Indicators for both groups were: compliance (5.9 ± 1.3 vs. 5.8 ± 1.4 hours) p: 0.41, therapeutic pressure (9.1 ± 2.0 vs. 8.8 ± 1.6 cm of H 2 O) p: 0.23, residual AHI (2.3 ± 1.8 vs. 2.8 ± 2.6 events/hour) p: 0.25, and leaks (20.5 ± 10.6 vs. 21.3 ± 10.7 liters/minute) p: 0.64. According to adjusted multiple regression, a NOSE of > 50 was not a predictor of mask selection. Conclusions  A > 50 NOSE score was not a predictor of mask selection, and it was not correlated to titration performance.

导言:许多患者因为觉得面罩不舒服而放弃 CPAP 治疗。因此,专家可能会从气道评估工具的预测价值中获益。目的 通过鼻阻塞症状评估量表(NOSE)确定接受家庭自动调节 CPAP 滴定的阻塞性睡眠呼吸暂停(OSA)患者的鼻通气失败情况,并确定 NOSE 评分与所选面罩类型之间是否存在相关性。材料和方法 在这项前瞻性相关研究中,NOSE 量表被用于面罩选择和滴定指标。根据 NOSE 评分对患者进行分类:> 结果 我们纳入了 303 名患者;其中 226 名男性(74.5%),体重指数(BMI):33.2 ± 6.1 kg/m 2,颈围(厘米):42.8 ± 3.6,瞳孔:1.5 ± 1.5 厘米:轻度 OSA:12 人(3.9%),中度 OSA:127 人(41.9%),重度 OSA:164 人(54.1%)。平均 NOSE 分数为 24.3 ± 22.8,42 名患者(13.8%)的 NOSE 分数大于 50。两组患者的指标分别为:依从性(5.9 ± 1.3 对 5.8 ± 1.4 小时)P:0.41;治疗压力(9.1 ± 2.0 对 8.8 ± 1.6 厘米 H 2 O)P:0.23;残余 AHI(2.3 ± 1.8 对 2.8 ± 2.6 次/小时)P:0.25;渗漏(20.5 ± 10.6 对 21.3 ± 10.7 升/分钟)P:0.64。根据调整后的多元回归,NOSE > 50 不能预测喉罩的选择。结论 NOSE > 50 分并不能预测面罩选择,而且与滴定性能无关。
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引用次数: 0
Association between Sleep Quality and Cardiac Autonomic Modulation in Adolescents: A Cross Sectional Study. 青少年睡眠质量与心脏自主神经调节之间的关系:一项横断面研究
IF 1.6 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-22 eCollection Date: 2023-12-01 DOI: 10.1055/s-0043-1776750
Ozeas de Lima Lins-Filho, Aluisio Andrade-Lima, Auguste Daniel Torres, Luciano Machado Oliveira, Wagner Luiz do-Prado, Raphael Ritti-Dias, Diego Giulliano Destro Christofaro, Breno Quintella Farah

Objective  To analyze the impact of sleep quality/duration on cardiac autonomic modulation on physically active adolescents with obesity. Materials and Methods  The present cross-sectional study included 1,150 boys with a mean age of 16.6 ± 1.2 years. The assessment of cardiac functions included the frequency domain of heart rate variability (HRV; low frequency - LF; high frequency - HF; and the ratio between these bands -LF/HF -, defined as the sympathovagal balance), and each parameter was categorized as low / high . Physical activity levels and sleep quality/duration were obtained by questionnaires. Abdominal obesity was assessed and defined as waist circumference > 80 th percentile. Results  Poor sleep quality resulted in lower HF (odds ratio [OR]: 1.8; 95% confidence interval [95%CI]: 1.01-3.21]) regardless of physical activity and abdominal obesity. Moreover, the study found no association between sleep duration and HRV parameters in adolescents. Conclusion  Sleep quality, not sleep duration, reduces parasympathetic cardiac modulation apart from other factors such as physical activity and abdominal obesity in adolescents.

目的 分析睡眠质量/持续时间对体力活动量大的肥胖青少年心脏自主神经调节的影响。材料与方法 本次横断面研究共纳入 1150 名男孩,平均年龄为 16.6 ± 1.2 岁。对心脏功能的评估包括心率变异的频域(HRV;低频-LF;高频-HF;以及这些频段之间的比值-LF/HF-,定义为交感摇摆平衡),每个参数被分为低/高两类。体力活动水平和睡眠质量/持续时间通过问卷调查获得。腹部肥胖是指腰围大于 80th 百分位数。结果 无论体力活动和腹部肥胖与否,睡眠质量差都会降低高频率(几率比 [OR]:1.8;95% 置信区间 [95%CI]:1.01-3.21])。此外,研究还发现青少年的睡眠时间与心率变异参数之间没有关联。结论 除体力活动和腹部肥胖等其他因素外,睡眠质量(而非睡眠时间)会降低青少年副交感神经对心脏的调节作用。
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引用次数: 0
2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults – Brazilian Sleep Association 2023 年成人失眠症诊断和治疗指南 - 巴西睡眠协会
IF 1.6 Q4 CLINICAL NEUROLOGY Pub Date : 2023-10-01 DOI: 10.1055/s-0043-1776281
L. F. Drager, Maria Assis, Andrea Frota Rego Bacelar, D. Poyares, Silvia Gonçalves Conway, G. Pires, Alexandre Pinto de Azevedo, Alicia Carissimi, A. Eckeli, Álvaro Pentagna, Carlos Maurício Oliveira Almeida, C. Franco, E. Sobreira, F. Stelzer, Giuliana Macedo Mendes, G. Minhoto, Ila Marques Porto Linares, Ksdy Maiara Moura Sousa, L. Gitaí, Lucia Sukys-Claudino, M. Sobreira-Neto, Marcio Andrei Zanini, Regina Margis, Sandra Cristina Gonçalves Martinez
Abstract Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P – Patient, problem, or population; I – Intervention; C – Comparison, control, or comparator; O – Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.
摘要 慢性失眠症(本文中简化为失眠症)是社会上越来越常见的一种临床病症,也是不同医疗领域(尤其是医学和心理学)的常见病。在这种情况下,治疗方法也随之发生了重大变化,同时,以适当的方式对待患者也面临着挑战。本临床指南由巴西睡眠协会和巴西睡眠医学协会协调制定,得到了该领域多位专家的积极参与,其中包括成人失眠症诊断和治疗的最新进展。为此,该指南采用了结构化方法。与诊断有关的主题是根据理论框架、文献证据和专业经验编写的。至于与失眠症治疗相关的主题,则根据 PICO 首字母缩写词(P - 患者、问题或人群;I - 干预;C - 对比、对照或比较者;O - 结果)制定了一系列问题。工作组在每个参数中定义了符合条件的选项。关于药物干预,只有目前在巴西上市或未来几年可能上市的药物才被认为符合条件。为帮助编写文本和确定每种干预措施的证据水平,还进行了系统性回顾。最终形成了一份客观实用的文件,为参与失眠症治疗的专业人员提供了具有最佳科学依据的建议。
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引用次数: 0
Brazilian Consensus on Sleep-Focused Speech-Language-Hearing Sciences - 2023 Brazilian Sleep Association 巴西睡眠集中语言听力科学共识- 2023巴西睡眠协会
Q4 CLINICAL NEUROLOGY Pub Date : 2023-10-01 DOI: 10.1055/s-0043-1776109
Luciana Moraes Studart-Pereira, Esther Mandelbaum Gonçalves Bianchini, Márcia Assis, Marieli Timpani Bussi, Camila de Castro Corrêa, Thays Crosara Abrahão Cunha, Luciano Ferreira Drager, Vanessa Ieto, Geraldo Lorenzi-Filho, Gabriele Ramos de Luccas, Evelyn Lucien Brasil, Silmara Regina Pavani Sovinski, Edilson Zancanella, Gabriel Natan Pires
Abstract Introduction This consensus aimed to develop a structured document presenting the role of sleep-focused Speech-Language-Hearing (SPH) Sciences (SPHS). The recommendations were based on the expertise of specialists and on evidence in the literature, aiming to guide the coverage of this area and the consequent improvement in the quality of the professionals' approach. Methods A Delphi method was conducted with 49 SLH pathologists (SLHP), four sleep physicians, one dentist, one physical therapist, and one methodologist. Four Delphi panel rounds were conducted in Google Forms. The items were analyzed based on the panelists' percentage of agreement; consensuses were reached when ⅔ (66.6%) of valid responses were on a same on a same answer (either “agree” or “disagree”). Results Participants voted on 102 items. The mean consensus rate was 89.9% ± 10.9%. The essential topics were the importance of professional training, the SLH diagnosis, and the SLH treatment of sleep disorders. It was verified that all fields of the SLHS are related to the area of sleep; that sleep-focused SLH pathologists (SLHP) are the responsible for assessing, indicating, and conducting specific orofacial myofunctional therapy for sleep-disordered breathing alone or in combination with other treatments; that SLHP are included in interdisciplinary teams in the area of sleep in public and private services. Discussion The Brazilian consensus on sleep-focused SLHS is a landmark in this area. This consensus described the scope of action of sleep-focused SLHP and systematized recommendations being useful as a reference for the professional practice in the area of sleep.
摘要:本共识旨在发展一份结构化的文件,展示睡眠聚焦语音语言听力科学(SPH)的作用。这些建议以专家的专门知识和文献中的证据为基础,旨在指导这一领域的覆盖范围,并由此提高专业人员方法的质量。方法采用德尔菲法对49名睡眠障碍病理学家、4名睡眠内科医生、1名牙科医生、1名物理治疗师和1名方法学家进行调查。在谷歌表格中进行了四轮德尔菲小组讨论。这些项目是根据小组成员的同意百分比进行分析的;当三分之二(66.6%)的有效回复在同一答案上相同(“同意”或“不同意”)时,达成共识。参与者对102个项目进行了投票。平均共识率为89.9%±10.9%。主要的主题是专业培训的重要性,SLH的诊断,以及SLH治疗睡眠障碍。结果表明,SLHS的所有脑区都与睡眠区有关;以睡眠为重点的SLH病理学家(SLHP)负责评估、指示和实施针对睡眠呼吸障碍的特定口面肌功能治疗,单独或与其他治疗相结合;在公共和私营服务机构的睡眠领域,将特殊睡眠人员纳入跨学科小组。巴西人对以睡眠为重点的SLHS的共识是这一领域的一个里程碑。这一共识描述了以睡眠为中心的SLHP的作用范围和系统化的建议,可作为睡眠领域专业实践的参考。
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引用次数: 0
Positive Pressure Ventilation Treatment Based on Daytime and Night-time Titration in Patients with Obesity Hypoventilation Syndrome: A Randomized Controlled Trial 基于昼夜滴定的正压通气治疗肥胖低通气综合征患者:一项随机对照试验
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-01 DOI: 10.1055/s-0043-1773790
Babak Amra, Marzieh Ghasemi, Forogh Soltaninejad, Mehrzad Salmasi
Abstract Objectives The aim of the present study was to investigate the improvements of gas exchange and excessive daytime sleepiness in patients with obesity hypoventilation syndrome (OHS) in daytime and night-time split polysomnography (DSPSG and NSPSG). Materials and Methods In the present randomized controlled trial, patients with OHS were enrolled in two DSPSG (51 patients) and NSPSG (50 patients) groups in the Bamdad respiratory and sleep research center in Isfahan, Iran. In both groups, the diagnostic polysomnography (PSG) and titration were conducted in one session according to the guidelines of NSPSG. SpO2, PaCO2, and the Epworth Sleepiness Scale (ESS), were measured initially and 12 weeks after treatment. Furthermore, the PSG parameters and the type of treatments for the two groups were recorded and analyzed. Results A total of 101 OHS patients (age: 62.02 ± 12.4 year old; 61 females [60.4%]) were evaluated. There were no significant differences regarding BMI, gender, and AHI between groups (p > 0.05). Primary SpO2, PaCO2, and ESS were not significantly different between the two groups. After 12 weeks of treatment by continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP), there were significant improvement of SpO2, PaCO2, and ESS score (p < 0.001). The amount of change of these variables was not different between groups. Among all variables, only the lower SpO2 and higher PaCO2 were associated with response to BiPAP. Discussion There were no significant differences in the number of changes of SpO2, PaCO2, and ESS by treatment in the DSPSG and NSPSG groups. Therefore, DSPSG may be considered as a valuable alternative method for the diagnosis and titration in OHS patients. Clinical Trials IRCT20170512033930N2
摘要目的探讨肥胖低通气综合征(OHS)患者在白天和夜间分割多导睡眠图(DSPSG和NSPSG)下气体交换和日间过度嗜睡的改善情况。材料与方法在本随机对照试验中,OHS患者被纳入伊朗伊斯法罕Bamdad呼吸与睡眠研究中心的DSPSG组(51例)和NSPSG组(50例)。两组均按照NSPSG指南进行诊断性多导睡眠图(PSG)和滴定术。治疗前和治疗后12周分别测量SpO2、PaCO2和Epworth嗜睡量表(ESS)。记录并分析两组患者PSG参数及治疗方式。结果101例OHS患者(年龄:62.02±12.4岁;61名女性(60.4%)被评估。两组间BMI、性别和AHI无显著差异(p >0.05)。两组间原发性SpO2、PaCO2、ESS差异无统计学意义。持续气道正压(CPAP)或双水平气道正压(BiPAP)治疗12周后,SpO2、PaCO2、ESS评分均有显著改善(p <0.001)。这些变量的变化量在组间没有差异。在所有变量中,只有较低的SpO2和较高的PaCO2与BiPAP的反应相关。DSPSG组与NSPSG组治疗前后SpO2、PaCO2、ESS变化数无显著差异。因此,DSPSG可能被认为是OHS患者诊断和滴定的有价值的替代方法。临床试验IRCT20170512033930N2
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引用次数: 0
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