Publications by authors named "Fernando Morgadinho Santos Coelho"

43 Publications

Development and validation of the sleep assessment instrument for older adults with pain.

Arq Neuropsiquiatr 2021 10;79(10):904-911

Universidade Federal de São Paulo, Departamento de Geriatria e Gerontologia, Serviço de Doenças Musculoesquelentas, São Paulo SP, Brazil.

Background: The co-occurrence of chronic pain and sleep disturbance contribute to a significant functional and social impact in older adults. However, there are no validated instruments to measure sleep disturbance and pain in this population that could be used to screen or diagnose individuals or monitor treatment effectiveness.

Objective: Our aim was to develop and validate a brief, practical, and comprehensive tool to assess the impact of co-occurring pain and sleep disturbance in older adults.

Methods: Development and validation of a measurement tool for assessing pain and sleep in older adults consisting of seven items.

Results: We applied the "Sleep Assessment Instrument for Pain in older adults" (SAIOAP) in a sample of 100 older individuals. A Cronbach's alpha of 0.602 indicated a moderate level of reliability, and item-total correlations of ≥0.4 for all items indicated good homogeneity. There were statistically significant correlations between the SAIOAP and sleep quality (PSQI, r=61.5), pain intensity (VNS, r=30.5), the multidimensional impacts of pain (GPM, r=40.5), depression (GEAP, r=45.5), comorbidity (r=27.9), and medication use (r=30.4). A ROC curve indicated a sensitivity of 73.2% and a specificity of 79.1% in relation to the prediction of sleep disturbances associated with pain in older adults.

Conclusions: The SAIOAP presented adequate metric properties and was demonstrated to be a simple and practical tool for the assessment of the impact of pain on sleep in older adults.
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http://dx.doi.org/10.1590/0004-282X-ANP-2020-0433DOI Listing
October 2021

Decreased concentration of klotho and increased concentration of FGF23 in the cerebrospinal fluid of patients with narcolepsy.

Sleep Med 2021 02 15;78:57-62. Epub 2020 Dec 15.

Disciplina de Neurologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil; Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Electronic address:

Objective: to explore the status of concentration of klotho and fibroblast growth factor 23 (FGF23) in cerebrospinal fluid (CSF) of patients with narcolepsy.

Patients/methods: 59 patients with narcolepsy and 17 control individuals were enrolled. We used radioimmunoassay, human klotho enzyme-linked immunosorbent assay (ELISA), human intact FGF23 ELISA and spectrophotometry to measure hypocretin-1, klotho, FGF-23 and phosphorus, respectively. T-Student Test was used to compare klotho and phosphate concentrations, Mann-Whitney U Test were used to compare FGF-23 levels between groups. ANOVA Test was used to compare klotho and phosphate CSF concentrations among narcolepsy patients with CSF hypocretin-1 <110 pg/ml (HCRT-) and narcolepsy patients with CSF hypocretin-1 >110 pg/ml (HCRT+) versus control subjects.

Results: Klotho and phosphorus CSF levels were lower in narcoleptic patients than in control (908.18 ± 405.51 versus 1265.78 ± 523.26 pg/ml; p = 0.004 and 1.34 ± 0.25 versus 1.58 ± 0.23 mg/dl; p = 0.001, respectively). We found higher FGF-23 levels in narcoleptic patients (5.51 versus 4.00 pg/mL; p = 0.001). Klotho and phosphorus CSF levels were lower in both HCRT- and HCRT+ than controls. Moreover, there were higher FGF-23 levels in both HCRT-/HCRT+ groups versus controls. However, we did not find differences comparing HCRT- and HCRT+ groups, analyzing CSF klotho, FGF-23 or phosphorus levels.

Conclusions: Patients with narcolepsy have decreased CSF concentration of klotho and increased CSF levels of FGF-23. These findings may play a role in understanding the pathogenesis of narcolepsy.
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http://dx.doi.org/10.1016/j.sleep.2020.11.037DOI Listing
February 2021

Validation of the Brazilian Portuguese version of the narcolepsy severity scale.

Sleep Med 2020 12 17;76:134-139. Epub 2020 Oct 17.

Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil; Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil. Electronic address:

Introduction: Narcolepsy type 1 is a sleep disorder and the most common cause of hypersonia of central origin. It is characterized by sleep attacks, cataplexy, sleep-related hallucinations, sleep paralysis and sleep fragmentation in a pleomorphic presentation. The Narcolepsy Severity Scale (NSS), questionnaire which assesses the frequency and impact of the main symptoms of narcolepsy was developed in order to determine its clinical severity, needing translation, cultural adaptation and validation in many languages. The objective is to validate the Brazilian Portuguese version of the NSS.

Methods: The Brazilian version of the NSS was translated to Brazilian Portuguese and applied to patients with a diagnosis of narcolepsy type 1 at the Daytime Excessive Sleepiness Service, at Psychobiology Department of the Universidade Federal de São Paulo (UNIFESP) between February 2018 and July 2019.

Results: A total of 52 patients completed the questionnaire. Cultural adaptations were made to better comprehension of patients. The Brazilian version of the NSS showed high internal consistency, demonstrated by the Cronbach's alpha coefficient of 0.82. It showed good reproducibility capacity, verified through the test-retest, whose intraclass correlation was 0.98. The average severity of Brazilian patients was 33.94 (±11.24), higher than the values found in other population, which also underwent validation of this scale. There was a correlation between sleep latency in diagnostic polysomnography and the NSS.

Conclusions: The Brazilian Portuguese version of NSS showed to be valid and reproducible tool for assessing the severity of patients with type 1 narcolepsy and have potential impact on clinical practice.
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http://dx.doi.org/10.1016/j.sleep.2020.10.016DOI Listing
December 2020

The effects of the COVID-19 pandemic on patients with narcolepsy.

J Clin Sleep Med 2021 Apr;17(4):621-627

Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.

Study Objectives: To the best of our knowledge, there has not as yet been any study on the effects of the COVID-19 pandemic on patients with narcolepsy, in particular, in relation to its impact on sleep schedules, symptoms, the need for medication, work, income, and quality of life. This study therefore aimed to explore these factors and their possible influence on sleep, circadian timing, and narcolepsy symptoms during the pandemic.

Methods: Patients with narcolepsy who had been in quarantine for at least 3 months completed a 36-question online survey. Questions targeted the conditions of the quarantine, sleep-related behaviors, and factors known to affect sleep and circadian rhythms (work status, income, appetite, narcolepsy symptoms, and medication), as well as the quality of life during the quarantine period.

Results: The routines of the participants had been altered by quarantine, with changes in their place of work, and an increase in narcolepsy symptoms, such as cataplexy, sleep paralysis, hallucinations, nocturnal awakenings, and sleepiness. Sleep and wake times changed, resulting in altered sleep patterns in most of the sample. No association between changes in the place of work and narcolepsy symptoms was found. Regarding medication, the participants used fewer antidepressant pills but took more stimulants. Appetite was increased and self-reported quality of life decreased during the period.

Conclusions: During the quarantine, the patients with narcolepsy reported changes in their bedtime and waking-up schedules, suggesting a tendency to circadian misalignment. In Brazil, the effects of the COVID-19 outbreak have gone beyond the direct action of the virus because of the collateral damage it has caused in respect to unemployment, financial hardship, and a reduction in quality of life. These impacts have been amplified in Brazil because of the level of social inequality found in the country, and they have particularly affected vulnerable patients with rare diseases, such as the narcolepsy population.
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http://dx.doi.org/10.5664/jcsm.8952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020708PMC
April 2021

Narcolepsy and bone metabolism: is there any association?

Sleep Med 2020 10 5;74:297. Epub 2020 Aug 5.

Disciplina de Neurologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil; Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.sleep.2020.07.036DOI Listing
October 2020

Exercise for "Sleep Rehabilitation" in Parkinson's Disease.

Mov Disord 2020 07;35(7):1285

Neurology and Neurosurgery Department, Universidade Federal de São Paulo, São Paulo, Brazil.

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http://dx.doi.org/10.1002/mds.28136DOI Listing
July 2020

Narcolepsy Severity Scale: experience of a Brazilian Sleep Center.

Sleep 2020 09;43(9)

Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.

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http://dx.doi.org/10.1093/sleep/zsaa113DOI Listing
September 2020

The influence of sleep quality and circadian preferences on upper extremity rehabilitation in stroke patients after constraint-induced movement therapy.

Int J Rehabil Res 2020 Mar;43(1):20-27

Departamento de Psicobiologia, Universidade Federal de São Paulo.

Our aim was to explore the influence of sleep and circadian preference on upper extremity (UE) rehabilitation in stroke patients after constraint-induced movement therapy (CIMT) in a cross-sectional retrospective observational study. Forty-three patients were selected to complete questionnaires on circadian preference, sleep quality, excessive daytime sleepiness, and risk of obstructive sleep apnea. They had undergone a 10-day standard CIMT program without medical complications and with normal to minimal cognitive dysfunction. All pre- and postrehabilitation scores (patient perception of the quantity and quality of use of the affected UE and self-quantification of motor ability) were analyzed retrospectively. All patients had improved perception of the quantity and quality of use of the affected UE and self-quantified motor ability. Patients with an evening-type chronotype demonstrated less improvement than those with morning and intermediate types. In addition, patients with poor sleep quality showed less improvement in functional ability than those with good sleep quality. Circadian preferences and sleep quality impacted the improvements in motor performance of patients with stroke after CIMT rehabilitation. This is the first study to suggest that rehabilitation sessions must respect the circadian preferences of patients and that sleep quality can affect outcomes. Future studies should investigate the relationship and mechanisms between circadian preference and poor sleep quality and rehabilitation outcomes on a larger scale.
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http://dx.doi.org/10.1097/MRR.0000000000000379DOI Listing
March 2020

Narcolepsy, Precocious Puberty and Obesity in the Pediatric Population: a Literature Review.

Pediatr Endocrinol Rev 2018 Dec;16(2):266-274

Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil, E-mail:

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic and hypnopompic hallucinations. The onset of the symptoms usually occurs in childhood, and previous studies have reported an association between narcolepsy and other endocrine diseases in the pediatric population, such as obesity and precocious puberty. The incidence of overweight or obesity ranges from 25% to 74% in patients with narcolepsy type I, while precocious puberty is present in 17% of children with narcolepsy with cataplexy. However, the mechanisms involved in the association of narcolepsy with obesity and precocious puberty have not been fully elucidated yet. In this review, we aimed to discuss narcolepsy in pediatric populations, highlighting the diagnostic difficulties and the complexity of the possible mechanisms that can relate narcolepsy to precocious puberty and obesity. We also emphasized the fact that endocrine diseases must be taken into consideration in children diagnosed with narcolepsy.
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http://dx.doi.org/10.17458/per.vol16.2018.NarcolepsypubertyobesityDOI Listing
December 2018

A rare differential diagnosis of excessive daytime sleepiness - Artery of Percheron territory infarct.

Sleep Sci 2018 Jan-Feb;11(1):25-27

Universidade Federal de São Paulo, Department of Neurology e Neurosurgery - São Paulo, SP, - Brazil.

Stroke is an example of neurological diseases that can commonly drives Excessive Daytime Sleepiness (EDS). Extensive strokes with brain edema can leave a brain herniation and coma. Other causes of EDS after stroke are strategic lesions at Thalamus and brainstein. A 56-year-old man, right handed, with hypertension and hypercholesterolemia was admitted at Emergency Room due to 5 days onset of EDS, memory impairment, and left-sided weakness. A brain magnetic resonance imaging showed paramedian thalamic hyperintensity with rostral midbrain hyperintensity extending along the pial surface of the interpeduncular fossa. The artery of Percheron (AP) is an unusual anatomical variation that originates from the posterior cerebral artery and irrigates the paramedian regions of the thalamus and part of the midbrain. It is important the clinical suspicions with detailed drowsy patients history. Awareness of the clinical and neuroimaging features of this stroke syndrome is essential for timely diagnosis and appropriate management.
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http://dx.doi.org/10.5935/1984-0063.20180006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5916572PMC
May 2018

The critical influence of nocturnal breathing complaints on the quality of sleep after stroke: the Pittsburgh Sleep Quality Index and STOP-BANG.

Arq Neuropsiquiatr 2017 Nov;75(11):785-788

Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil.

In stroke patients particularly, many factors, such as sleep-related respiratory disturbances, can impair sleep. Cheap and easy-to-use tools have been created to identify sleep quality and sleep disturbances in patients after stroke. This study described the scores of the sleep apnea screening questionnaire - STOP-BANG - in patients after a stroke, and correlated the findings with sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). The scores of the STOP-BANG and PSQI were 4.3 ± 1.8 and 76 ± 3.9, respectively. The STOP-BANG scores were higher in poor sleepers (4.5 ± 1.6 versus 3.5 ± 1.9; p = 0.032). Logistic regression analysis was used to identify predictors of subjective sleep quality (PSQI) and the STOP-BANG as a predictor of poor quality sleep, with a relative risk of 1.6, controlled for age and sex. This study indicated that sleep quality was largely influenced by sleep breathing problems, which were well identified by the STOP-BANG, especially in younger stroke patients.
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http://dx.doi.org/10.1590/0004-282X20170137DOI Listing
November 2017

Challenges in congenital central hypoventilation syndrome (Ondine's curse) on pregnancy: a case report.

J Obstet Gynaecol 2017 Jan 21;37(1):107-108. Epub 2016 Nov 21.

b Department of Psychobiology , Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil.

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http://dx.doi.org/10.1080/01443615.2016.1233944DOI Listing
January 2017

Parathyroidectomy Improves Restless Leg Syndrome in Patients on Hemodialysis.

PLoS One 2016 19;11(5):e0155835. Epub 2016 May 19.

Department of Medicine, Division of Nephrology, Universidade de São Paulo, Brazil.

Background: Restless leg syndrome (RLS) is a sleep disorder with high prevalence among patients on hemodialysis. It has been postulated that high phosphate and high parathyroid hormone may be implicated in its pathogenesis. Standard international criteria and face-to-face interview are not always applied.

Methods: this was an interventional prospective study in which 19 patients (6 men, aged 48±11 years) with severe hyperparathyroidism were evaluated. RLS diagnosis and rating scale were accessed based on the International RLS Study Group pre- and post-parathyroidectomy. Patients also underwent standard polysomnography.

Results: At baseline, RLS was present in 10 patients (52.6%), and pain was the most reported symptom associated with the diagnosis. Patients with RLS had higher serum phosphate (p = 0.008) that remained independently associated with RLS in a logistic regression model, adjusted for hemoglobin, age and gender (HR = 7.28;CI = 1.14-46.3, p = 0.035). After parathyroidectomy, there was a reduction of serum parathyroid hormone, phosphate, calcium and alkaline phosphatase, and an increase of 25(OH)-vitamin D, and Fetuin-A. Parathyroidectomy alleviated RLS (from 52% to 21%; p = 0.04), which was accompanied by a decrease in severity scale, in association with relief of pain and pruritus. Polysomnography in these patients showed an improvement of sleep parameters as measured by sleep efficiency, sleep latency and percentage of REM sleep.

Conclusion: RLS is associated with high levels of phosphate in patients with severe secondary hyperparathyroidism on hemodialysis. Pain is most reported complain in these patients. Parathyroidectomy provided an opportunity to relief RLS. Whether the reduction of serum phosphorus or parathyroid hormone contributed to this improvement merits further investigation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0155835PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873141PMC
July 2017

Infancy narcolepsy: Streptococcus infection as a causal factor.

Sleep Sci 2015 Jan-Mar;8(1):49-52. Epub 2015 Feb 18.

Ambulatory of Excessive Daytime Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil.

Streptococcal infections are suggested as a risk factor for narcolepsy. This hypothesis is supported by the presence of anti-streptolysin antibodies in 65% of patients with narcolepsy. These infections are associated with the activation of general immunity and concomitant increased permeability of blood-brain barrier after T cell activation during inflammation and fever. It has also been shown a significant association between birth order and narcolepsy in genetically susceptible patients, with positivity for HLA-DQB1⁎0602 allele. Watson and colleagues showed a significant association between birth order and narcolepsy in genetically susceptible patients, with positivity for HLA-DQB1⁎0602 allele. In that study, the disease was predominant in young children cases compared to controls. We report here the case of a child diagnosed with narcolepsy with cataplexy, positivity for the HLA-DQB1⁎0602 and previous history of streptococcal infection.
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http://dx.doi.org/10.1016/j.slsci.2015.02.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608894PMC
October 2015

Circadian rest-activity rhythm in individuals at risk for psychosis and bipolar disorder.

Schizophr Res 2015 Oct 26;168(1-2):50-5. Epub 2015 Jul 26.

Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.

Background: At-risk mental states (ARMS) are clinical syndromes that are associated with higher risk, compared with the general population, for developing psychosis and bipolar disorder. Circadian rhythm misalignments have been proposed to be part of this early phase of the clinical course.

Objective: To compare circadian rhythm of activity and rest changes between ARMS individuals and a healthy control group.

Methods: Forty volunteers of both genders, aged between 13 and 27years old, participated in this study (n=20 ARMS group, and n=20 healthy controls). The ARMS individuals were classified as ultra-high risk for psychosis according to the CAARMS (Comprehensive Assessment of At-risk Mental State) or at high risk for bipolar disorder according to criteria proposed by Bechdolf and colleagues. Participants used an actigraph for fifteen days, kept a sleep diary, and completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, and a Morningness-Eveningness Questionnaire.

Results: Compared with healthy volunteers, the ARMS group presented worse sleep quality (P=0.010); longer nap durations (P=0.038), shorter wake times (P=0.001), higher total sleep times (P=0.011), and shorter activity duration (P=0.021), sleep rhythms were more fragmented, the circadian rest-activity rhythms were less synchronized with the dark-light cycle and had lower amplitudes of motor activity.

Conclusion: The results suggest alterations in the circadian rest-activity rhythms (and likely in sleep-wake cycle patterns) in ARMS individuals compared with healthy controls. It is possible that circadian rhythms of activity and rest changes are one of the prodromal clinical and behavioral expressions of the brain changes that underlie ARMS individuals.
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http://dx.doi.org/10.1016/j.schres.2015.07.024DOI Listing
October 2015

Continuous positive airway pressure treatment associated with face injury during rapid eye movement behavior disorder.

Sleep Med 2015 Jun 5;16(6):805-6. Epub 2015 Mar 5.

Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.

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http://dx.doi.org/10.1016/j.sleep.2014.11.021DOI Listing
June 2015

Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome.

Arq Neuropsiquiatr 2015 Mar;73(3):260-80

Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brazil.

The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine.
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http://dx.doi.org/10.1590/0004-282X20140239DOI Listing
March 2015

Influenza A (H1N1) pandemic vaccination - an underlying risk factor for many CNS complications in Brazil.

Arq Neuropsiquiatr 2015 Jan 1;73(1):72. Epub 2015 Jan 1.

Departamento de Psicobiologia, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.

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http://dx.doi.org/10.1590/0004-282X20140175DOI Listing
January 2015

Prevalence of bruxism in children with episodic migraine--a case-control study with polysomnography.

BMC Res Notes 2014 May 14;7:298. Epub 2014 May 14.

Disciplina de Neurologia, Departamento de Neurologia e Neurocirurgia e da Universidade Federal de São Paulo, São Paulo, Brazil.

Background: Parents of children with migraine have described a higher prevalence of sleep bruxism and other sleep disturbances in their children. The objective of this study was to use polysomnography to investigate the prevalence of bruxism during sleep in children with episodic migraine relative to controls.

Findings: Controls and patients were matched by sex, age, years of formal education, presence of snoring, arousals per hour, and respiratory events per hour.A total of 20 controls, between 6 and 12 years old, with no history of headache, recruited from public schools in Sao Paulo between 2009 and 2012, and 20 patients with episodic migraine recruited from the Headache Clinic at the Federal University of Sao Paulo between 2009 and 2012 underwent polysomnography.No intervention was performed before sleep studies.Among migraine patients, 27.5% experienced aura prior to migraine onset. The sleep efficiency, sleep latency, REM sleep latency, arousals per hour, percentage of sleep stages, and breathing events per hour were similar between groups. Five children (25%) with episodic migraine exhibited bruxism during the sleep study while this finding was not observed in any control (p = 0.045).

Conclusions: Our data demonstrate that bruxism during sleep is more prevalent in children with episodic migraine. Further prospective studies will help elucidate the underlying shared pathogenesis between bruxism and episodic migraine in children.
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http://dx.doi.org/10.1186/1756-0500-7-298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4026587PMC
May 2014

Kleine-Levin Syndrome: A case report.

Sleep Sci 2014 Jun 9;7(2):122-5. Epub 2014 Sep 9.

Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil ; Department of Neurology and Neurosurgery, Federal University of São Paulo, Brazil.

The Kleine-Levin Syndrome is a differential diagnosis for patients with diurnal excessive sleepiness and a suspicion of narcolepsy. It is characterized by paroxysmal attacks of diurnal excessive sleepiness, associated with one or more symptoms of hyperphagia, hypersexuality, coprolalia and copropraxia. During crisis intervals, there are no symptoms. This pathology predominantly manifests itself in teenagers, being more frequent among males. The course of this disease is unpredictable, with variable duration and frequency. The most accepted physiopathology is that of a hypothalamic dysfunction, although and recently, there has appeared a hypothesis of a post-infectious autoimmune disorder. These patients show an elevated body mass index, which can predispose to association with comorbidities such as the sleep obstructive apnea syndrome. Treatment involves medications with different effects, but there is no specific and effective therapy. Our article shows a classic case of Kleine-Levin Syndrome associated with sleep obstructive apnea syndrome, a rare association in the literature.
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http://dx.doi.org/10.1016/j.slsci.2014.09.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521662PMC
June 2014

Short sleepers or sleep deprivation: finding the real risk factor for ischemic stroke.

Sleep Med 2014 Apr 8;15(4):480. Epub 2014 Feb 8.

Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.

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http://dx.doi.org/10.1016/j.sleep.2014.01.007DOI Listing
April 2014

Prevalence of periodical leg movements in patients with narcolepsy in an outpatient facility in São Paulo.

Sleep Sci 2014 Mar 19;7(1):69-71. Epub 2014 Aug 19.

Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil ; Department of Neurology and Neurosurgery, Federal University of São Paulo, Brazil.

Studies have pointed out that approximately 50-60% of narcolepsy patients may demonstrate higher prevalence of periodical leg movements. However, we highlight that the prevalence studies and the effects of periodical leg movements in patients with narcolepsy are limited and with conflicting results. The objective of this study was that of describing and discussing the prevalence of periodical leg movements in patients with narcolepsy in the outpatient facility of diurnal excessive sleepiness of the Federal University of São Paulo, Brazil. We revised 59 files of patients with the clinical and electrophysiological diagnosis of narcolepsy according to the American Academy of Sleep Medicine. Of these 59 cases of patients with narcolepsy, 12 (20.3%) demonstrated periodical leg movements. Thirty five patients (59.3%) had history of cataplexy and 38 patients (64.4%) had the presence of the allele HLA-DQB1⁎0602. There was a higher prevalence of periodical leg movements in patients with cataplexy (p<0.0001) and in patients with the presence of the allele HLA-DQB1⁎0602 (p<0.0001). Our study characterized the higher prevalence of periodical leg movement in patients with narcolepsy, mainly in patients with cataplexy and with the presence of the allele HLA-DQB1⁎0602.
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http://dx.doi.org/10.1016/j.slsci.2014.07.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521645PMC
March 2014

Experience with the use of modafinil in the treatment of narcolepsy in a outpatient facility specialized in diurnal excessive sleepiness in São Paulo.

Sleep Sci 2014 Mar 20;7(1):65-8. Epub 2014 Aug 20.

Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil ; Department of Neurology and Neurosurgery, Federal University of São Paulo, Brazil.

Narcolepsy is a chronic neurological disease characterized by diurnal excessive sleepiness and catapleaxy. It affects 1 in every 2000 to 4000 individuals with personal, social and familiar significant repercussions. The treatment of narcolepsy is mainly based on the use of stimulants for the control of the diurnal excessive sleepiness, in conjunction with behavioral measures and sleep hygiene. Among the stimulants, modafinil has presently been the drug of choice for the treatment of the diurnal excessive sleepiness in patients with narcolepsy. In the worldwide experience, its use is better tolerated and the majority of its side effects is considered light or moderate. However, the clinical use in Brazil was initiated at the end of 2008, with little experience on the narcolepsy population of this country. In this context, the objective of this study was the evaluation of the use of modafinil, verifying the indication of use, causes for discontinuation, daily dosage, efficiency of the treatment in a patient sample of narcoleptics consulted in a specialized center in Brazil. In this study, modafinil was effective for the control of the symptoms related do narcolepsy in 66% of the studied patients. The side effects such as headache, parestesias and diarrhea were the main reasons for the discontinuation of treatment with modafinil. It is important to clinically follow up the patients for a long period to evaluate symptomatology, control of use, tolerability and re-evaluation of the more effective therapeutic dosage able to control narcolepsy. Due to its high cost and clinical benefits, this drug should be on the government׳s list of free drugs for the treatment of these patients.
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http://dx.doi.org/10.1016/j.slsci.2014.07.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521685PMC
March 2014

The use of citalopram for the treatment of cataplexy.

Sleep Sci 2014 Mar 4;7(1):50-2. Epub 2014 Sep 4.

Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil ; Department of Neurology and Neurosurgery, Federal University of São Paulo, Brazil.

This is a series of cases describing the use of citalopram for the treatment of cataplexy in patients with narcolepsy. Cataplexy is the most specific symptom of narcolepsy, being characterized by a sudden and temporary loss of muscle tonus, triggered by episodes of emotion during vigil. Some antidepressants, besides gamma-hydroxybutyrate, are used for the control of cataplexy. As gamma-hydroxybutyrate is not available in Brazil, local treatment is usually done by the use of antidepressants. Citalopram is a selective inhibitor of serotonin reuptake, with reasonable price and with fewer side effects when compared with other drugs of the same type. In this study, we report a series of cases with patients with narcolepsy and cataplexy, treated with citalopram for the control of cataplexy.
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http://dx.doi.org/10.1016/j.slsci.2014.07.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521659PMC
March 2014

Cataplexy as a side effect of modafinil in a patient without narcolepsy.

Sleep Sci 2014 Mar 19;7(1):47-9. Epub 2014 Aug 19.

Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil ; Department of Neurology and Neurosurgery, Federal University of São Paulo, Brazil.

Narcolepsy is a disease in which there is diurnal excessive sleepiness with sleep attacks and a prevalence in the general population of 1/4000 individuals. Classically, it is characterized by cataplexy, sleep paralysis, hypnagogic hallucinations and fragmented sleep. The use of modafinil in the treatment of narcolepsy is the first option of treatment for diurnal excessive sleepiness. Although considered a safe drug for use in patients with narcolepsy, being utilized for more than 20 years, modafinil possesses a series of side effects, some of them still not fully researched or described. Side effects such as headache, nausea, anxiety, insomnia, lumbago, diarrhea, dyspepsia, rhinitis and vertigo are the most frequent. However, the clinical follow-up of patients under treatment with modafinil must be intensive and the side effects ought to be noted and evaluated. The under-response to treatment or the unexpected side effects must always be directed to differential diagnostics. The objective of this article is to describe an unexpected side effect of the use of modafinil in a patient with incorrect diagnosis of narcolepsy.
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http://dx.doi.org/10.1016/j.slsci.2014.07.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521649PMC
March 2014

Moebius syndrome and narcolepsy: A case dissertation.

Sleep Sci 2014 Mar 19;7(1):43-6. Epub 2014 Aug 19.

Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil ; Department of Neurology and Neurosurgery, Federal University of São Paulo, Brazil.

Moebius syndrome (MS) is a congenital syndrome characterized by unilateral or bilateral aplasia of the VI and VII cranial nerves, with consequent convergent strabismus and bilateral peripheral facial paralysis. This syndrome might be associated with diurnal excessive sleepiness and muscular hypotony, mimetizing in this manner, narcolepsy. The diagnostic criteria for narcolepsy depend on the presence of REM sleep during the day. As with patients with MS we do not have ocular movements due to the VI nerve paralysis, the absence of horizontal ocular movements might make it difficult to confirm narcolepsy in these patients. The common clinical characteristics of these patients are due to a possible impairment of the same structures that are affected in the central nervous system. However, the mechanism by which it occurs remains to be fully understood. Further electrophysiological researches are necessary to better clarify the association of these two diseases. The objective of this dissertation is to describe and discuss a case of Moebius syndrome with diurnal excessive sleepiness as a differential diagnosis for narcolepsy.
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http://dx.doi.org/10.1016/j.slsci.2014.07.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521652PMC
March 2014

Mortality associated with periodic limb movements during sleep in amyotrophic lateral sclerosis patients.

Einstein (Sao Paulo) 2012 Oct-Dec;10(4):428-32

University of Toronto, Toronto, Canada.

Objective: To describe the prevalence and severity of periodic limb movements during sleep in amyotrophic lateral sclerosis patients and to explore this fact as a predictor of severity of the condition with respect to mortality.

Methods: In this case-control study, questionnaire and polysomnographic data were analyzed from 35 amyotrophic lateral sclerosis patients. Controls were matched by age, genre, and body mass index. A Kaplan-Meier curve was used to compare the survival time of patients with periodic limb movements of sleep index below or above 5.

Results: The number of amyotrophic lateral sclerosis patients with an index greater than five was higher than controls (19 (53%) versus 4 (11%); p < 0.0001), and the mean index was higher (23.55 ± 40.07 versus 3.28 ± 8.96; p = 0.0009). Earlier mortality was more common in patients with more than five periodic limb movements per hour of sleep than patients with less than five periodic limb movements per hour of sleep (7/19 (37%) versus 1/16 (6%); p = 0.04) in this group of patients that had a mean survival of 33 months.

Conclusions: There were more periodic limb movements of sleep in amyotrophic lateral sclerosis patients than in the control population. The higher number of these movements in amyotrophic lateral sclerosis patients correlates with disease severity and may suggest poor survival.
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http://dx.doi.org/10.1590/s1679-45082012000400006DOI Listing
December 2013
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