Congresso Brasileiro do Sono 2019

Poster a tendency toward disordered sleep. Conclusions: Sleep

habits and disorders correlated directly with quality of
ID: 578 human life.
Palavras-chave: Sleep; Quality Of life; Pantanal; Population.

Basic Research
ID: 581
Sleep patterns and correlation with quality of
life among the pantanal population in Brazil Basic Research
Educational stories to prevent children sleep
Gaudioso, C E V, MAGNA, L A, SOUZA, J C, DA CUNHA, A
L T, BOTELHO, H N, MARTINS, R C D C, JESUS PINTO, E disorders (SD).
NDCD
VALLE, L E L R
UNICAMP - CAMPINAS - Sao Paulo - Brasil
Interclínica Ribeiro do Valle - Poços de Caldas - Minas Gerais - Brasil
Introduction: Sleep habits and quality of life vary among
human populations. Aim: This study evaluated sleep Introduction: Little is known about the educational effects
patterns and sleep disorders, correlating them with the of stories in sleep. In the Preoperative phase (Piaget), the
general quality of life of residents of the Pantanal region child seeks models to construct its concepts and patterns
in Brazil. Methods: The sample, of 789 individuals, was of imitation. Aim: To test stories as strategies for behavior
stratified by age and gender. Data were collected using a modeling of sleep, relating subjective observations of
sociodemographic questionnaire, the Pittsburgh Sleep children between their sleep habits and consequences.
Quality Index (PSQI) instrument, the Berlin Questionnaire Methods: 45 children from the Prepartory period II
(BQ), and the World Health Organization Quality of answered ten questions about sleep: five on Sleep Pratices
Life Scale Brief Version (WHOQOL-BREF). Univariate and the others about complaints verified in bad sleepers
analysis involved comparing proportions using the chi- for comparison related to: a) changes in bedtime; b)
square test and comparing means. Independent variables restless activities before bedtime; c) noise and mess in the
showing significant association with dependent variables room; d) excessive feeding before bedtime; e) annoyances
(PSQI and BQ) on the univariate analysis were entered and fight before bedtime. The obtained preliminar results
into a multiple linear regression analysis model scaled for indicated that “there was no statistically significant
each variable. A significance level of 5% (p < 0.05) was correlation between the fact of changing the bedtime and
adopted throughout.Results: Similarities were detected in the questions about the consequences of sleep (p > 0.05).
age distributions among subjects reporting good and poor There was no correlation between doing restless activities
sleep quality (Mann–Whitney test, p = 0.244), with mean before sleeping and the consequences of sleep (p > 0.05).
ages of 33.1 years (n = 347) for good-quality and 32.1 The responses in relation to the environment show that
years (n = 427) for poor-quality patterns. Student’s t-test the higher the degree of noise and mess in the room,
for heterogeneous variances (Levene’s test, p = 0.003) the greater the degree of distraction (R = 0.428 and P =
was applied to compare WHOQOL domain indices and 0.003); The higher the frequency of food consumption
yielded significantly higher means for subjects with good- before sleep, the higher the frequency of irritability and
quality sleep (72.3%) compared to those with poor-quality somnolence (R = 0.313 and r = 0.432 respectively); The
sleep (65.3%). BQ data revealed a significant increase in more frequent the contrariness to sleep more frequent is
the proportion of sleep disorders with increasing age the delay in sleep and daytime drowsiness (r = 0.371 and
bracket, a finding corroborated by the comparison of age P = 0.012) “. A book on Sleep Hygiene was presented and
distributions (Mann–Whitney test, p < 0.001), with mean the children heard the story “The Treasure of Sleep” and
ages of 30.1 and 36.7 years in the groups reporting sleep they participated in activities of interpretation of story,
disorders (n = 413) or otherwise (n = 261), respectively. relating it to their own sleep experiences. At the end,
The opposite effect was observed for education (p = they were asked: “Why is sleep so important?” Results:
0.005)—i.e., there was a reduction in the proportion of All participating children showed understanding of the
sleep disorders with increasing educational level. Sleep principles of Sleep Hygiene. Analyzing their own sleep
disorders were more frequent among women with high- behavior facilitates the understanding of the importance
school or lower level of education. Other groups did not of sleep. The results of this study are consistent with
differ significantly (p = 0.541) with regard to education. findings from literature on behavior and formation of
For marital status, occupational inactivity (retirement), thought (Vygotsky), suggesting that sleep can be mediated
and alcohol use, p-values (of 0.069, 0.066, and 0.099, by children’s stories. Conclusions: Stories are intervention
respectively) were not statistically significant, but indicated options to aid healthy children sleep. Orientation of sleep

Sleep Sci. 2020;13(Supl.1):1-118

 2

in playful form of stories can be an educational tool to p=0.07, respectively). Conclusions: Poor sleep quality in
support parents in implementation of healthy sleep habits children at 4 and 6 years of age may be influenced by the
and SD`s prevention. Other researches are necessary to adiponectin rs2241766 gene polymorphism. New studies
intervene in sleep from access to children’s imaginary. involving a larger number of children are needed to
Palavras-chave: Keywords: Sleep Disorders; Prevention; Education and Sleep.
better explain the relationship between sleep quality and
adiponectin polymorphism.
ID: 582
Basic Research
ID: 583
Association of LEP-rs7799039 and ADIPOQ-
Basic Research
rs2241766 polymorphisms with sleep quality in
4- and 6-year-old children: The PREDI Study Sleep quality and ergonomic evaluation of
truck drivers’ rest locations
Trombelli, M C M C, Kroll, C, Schultz, L F, Ferreira, R E R,
Mastroeni, S S d B S, Mastroeni, M F Rocha, F P, Moreno, C R C
Departamento de Enfermagem e Programa de Pós-Graduação em Faculdade de Saúde Pública da Universidade de São Paulo - São Paulo
Saúde e Meio Ambiente - Universidade da Região de Joinville - Joinville - Sao Paulo - Brasil
- Santa Catarina - Brasil, Instituto de Psicologia - Universidade de São
Paulo - São Paulo - São Paulo - Brasil Introduction: Inadequate work organization is known
to be associated with sleep disturbances among long haul
Introduction: Sleep disorders in children can be truck drivers. Some studies showed strong evidences
identified through several parameters, including sleep of daytime sleepiness, poor sleep quality, and high
duration and sleep quality. Changes in the circadian cycle prevalence of obstructive sleep apnea syndrome. Other
are an important characteristic associated with children’s health problems such as high cholesterol and triglyceride
sleep disorders. Some studies suggest that alterations in levels, systemic arterial hypertension and high body mass
the secretion of leptin and adiponectin may influence index are some examples noticed in the academic recent
the circadian cycle in children. The LEP-rs7799039 and literature. However, the nature of truck drivers’ work
ADIPOQ-rs2241766 polymorphisms are associated with organization often requires rest to be taken in various
leptin and adiponectin secretion, and thus may influence locations. Aim: To evaluate the drivers’ rest locations
the child’s sleep quality Aim: The aim of this study was and their association with sleep quality. Methods: This
to evaluate the association of the leptin rs7799039 and study was conducted in a large Brazilian transportation
adiponectin rs2241766 gene polymorphisms with sleep company with branches in two different cities. An adapted
quality in 4- and 6-year-old children. Methods: Data version of the Ergonomic Work Analysis (EWA) was
were obtained from the “Predictors of Maternal and used to assess the quality of rest locations, and sleep
Child Excess Body Weight - PREDI Study”, a larger quality was evaluated by the Pittsburgh Sleep Quality
cohort study conducted in Joinville – Brazil (baseline Index (PSQI). This study was approved by the Faculdade
in 2012). The current study is a cross-sectional study, de Saúde Pública ethics commitee, protocol number:
which was carried out in the homes of the participants 2.995.488. Results: 31 rest locations were assessed using
between July 2016 and August 2017 (2nd Follow-up, 4 EWA by the researcher as well as by 60 truck drivers. Rest
years old), and in 2018 (3rd Follow-up, 6 years old). The locations were dorms in truck depots (6.45%) and truck
sleep quality was assessed by the “Sleep Habits Inventory cabin sleeper berths (93.5%). Spearman correlation test
for Preschool Children”, self-reported by the mothers. indicated positive correlations between the researcher
The minimum score on the Sleep Habits Inventory was evaluation and the driver regarding the quality of rest place
considered as a better sleep quality. Genotyping analysis (r=0.6, p=0.0001), illumination (r=0.7, p=0.0001) and
was performed in blood samples by the polymerase chain noise (r=0.5, p=0.0001). Regarding sleep quality, 50.6%
reaction (PCR)-restriction fragment length polymorphism drivers who sleep in dorms and 49.4% who slept in cabin
(RFLP) technique. Results: There was no statistically sleeper berths reported poor quality of sleep. Moreover,
significant association of the ADIPOQ or LEP gene there was a positive correlation between the PSQI score
polymorphism with sleep quality at 4 and 6 years of age. and the average of kilometers travelled (r=0.36, p=0.05),
However, carriers of at least one risk allele (TG+GG) of in which the worse sleep quality the higher average of
the ADIPOQ gene polymorphism were more prevalent kilometers. Conclusions: PSQI mean scores and EWA’s
among children with poor sleep quality when compared to subjective variables indicate, respectively, poor quality of
those carrying the wild-type genotype (TT), in both 4- and sleep and poor evaluations of rest locations, truck depots
6-year-olds (42.3% vs 28.4%, p=0.06; 32.6% vs 19.2%, and truck cabin sleeper berths. Therefore, it is quite

Sleep Sci. 2020;13(Supl.1):1-118

3
relevant to improve the quality of truck depots and truck (CEMSA), Fundo de Amparo à Pesquisa de Minas Gerais
cabin sleeper berths in order to increase their sleep quality. (FAPEMIG), Coordenação de Aperfeiçoamento de
Palavras-chave: sleep, truck drivers, sleep quality, sleeper berths.
Pessoal de Nível Superior (CAPES) and the Conselho
Nacional de Pesquisa (CNPQ).
ID: 584 Palavras-chave: Sleep, injury, athlete, soccer, actigraphy.

Clinical Studies ID: 586

Sleep quality is associated with musculoskeletal Clinical Studies
injuries
Frequency and predictors of obstructive sleep
Silva, A, Narciso, F, Viegas, F, Freitas, L, Soalheiro, I, Lima, A, apnea in patients with chronic kidney disease
Leite, B, Aleixo, H, Duffield, R, De Mello, M T
Patriota, T L G C, Gerônimo, M H A, Oliveira Neto, L A P,
UFMG - Belo Horizonte - Minas Gerais - Brasil
Rodrigues, V K, Mattos, T C L, Magalhães, J A, Silva, M V F P,
Introduction: Sleep quality is an important factor which Patriota, R L S, Dias Filho, E B R, Pedrosa, R P
deserves to be taken into account in evaluations of high- Pronto Socorro Cardiológico de Pernambuco - Recife - Pernambuco
performance athletes. Purpose: An important factor - Brasil
to evaluate high-performance athletes is sleep quality.
The present study proposed to investigate a relationship Introduction: Recent evidence suggests that obstructive
between sleep quality/quantity and muscular injuries sleep apnea (OSA) is common in patients with chronic
in elite soccer players, in addition to comparing those kidney disease (CKD) and may accelerate the loss of
of athletes with good and poor sleep quality. Aim: The renal function. The AOS has been related to increased
present study proposed to investigate a relationship oxidative stress, endothelial dysfunction and inflammatory
between sleep quality/quantity and muscular injuries in states, which are known mechanisms of renal injury.
elite soccer players, in addition to comparing those of Aim: To evaluate the frequency and predictors of OSA
athletes with good and poor sleep quality. Methods: The in patients with non-dialytic CKD. Methods: This is
current investigation was a prospective cohort study of an observational cross-sectional, analytical study. We
elite soccer players competing for two teams at the highest evaluated 79 patients with non-dialytic CKD, glomerular
level of Brazilian competition. Data were collected from filtration rate (GFR) <60mL / min / 1.73m2, age
23 players for 6 months. A specific database for injury between 30 and 64 years. All patients underwent a clinical
recording was assembled and completed in conjunction evaluation, sleep questionnaires (Berlin questionnaire and
with the medical team of each team on the day of the Epworth sleepiness scale) and portable polysomnography
athlete’s injury. Furthermore, the players’s sleep behaviour for diagnosis of OSA (apnea and hypopnea index – AHI
was monitored using self-reporting sleep diaries and a ≥ 5 e / h). Results: Results: OSA was diagnosed in 65
wrist activity monitor for 10 consecutive days. Results: patients (82%, 95% CI: 73-90%). Mild OSA (AHI ≥ 5
Our results indicated a moderate negative correlation e / h) and moderate / severe OSA (AHI ≥ 15 e / h)
between sleep efficiency and injury characteristics of the was present in 26 (33%, 95% CI: 23-43%) and 39 (49%,
23 soccer players (Absence time: r=-0.524, p=0.01; Injury 95% CI: 38-60%) patients, respectively. The Berlin
severity: r=-0.674, p<0.01; Amount of injuries: r=-0.624, questionnaire presented low sensitivity and specificity
p<0.01). The linear regression analysis indicated that the (58% and 47%, respectively) as an AOS predictor (AHI
amount of injuries (number) decreased by 0.06 (R2 = ≥ 5 e / h) in this population and the severity of OSA
0.44) and the absence time after injury (days) decreased was not associated with daytime sleepiness. A logistic
by 1.43 (R2 = 0.23) for each increase in the score for regression for the determination of OSA predictors in this
sleep efficiency. Additionally, the results showed that the population found in the multivariate analysis that age> 50
amount of injuries increased by 0.02 (R2 = 0.30) for each years (OR = 7.8; CI: 1.2 - 50.7; P = 0.03), male sex (OR =
increase in the Wake After Sleep Onset. Conclusions: 4.6; CI: 1.4 – 15,1; P = 0.01), and body mass index (BMI)
Therefore, soccer players with poor sleep quality or non- - (OR = 1,3; CI: 1.1 -1,5 ; P=0.001) were independently
restorative sleep are prone to the risks of musculoskeletal associated with OSA. Conclusions: Conclusion: OSA is
injuries. Acknowledgements: The authors want to thank common in patients with non-dialytic CKD. Advanced
the Universidade Federal de Minas Gerais, the Centro age, male gender and elevated BMI are predictors of
de Estudos em Psicobiologia e Exercício (CEPE), OSA in this population. Sleep questionnaires should be
Centro Multidisciplinar em Sonolência e Acidentes interpreted with caution in these patients.
Palavras-chave Obstructive sleep apnea, Chronic kidney disease, Risk Factors

Sleep Sci. 2020;13(Supl.1):1-118

 4

ID: 591 ID: 592

Clinical Studies Clinical Studies
Hepatic steatosis in preoperative bariatric Sleep and Musculoskeletal Injuries in
surgery patients with obstructive sleep apnea Adolescent Athletes
FRARE, L, MENDES DE SOUZA, A C, PRADO DE GODOY, L, Viegas, F, Ocarino, J M, Freitas, L S N, Pinto, M C, Facundo, L
DOMINGUES DA LUZ, M, JESUS DE MORAIS, L, FERRAZ A, Narciso, F V, Mello, M T, Silva, A
DE PAULA SOARES, C
Universidade Federal de Minas Gerais - Belo Horizonte - Minas Gerais
Centro Universitário da Fundação Assis Gurgacz - Cascavel - Paraná - Brasil
- Brasil
Introduction: Sleep restriction is common in athletes,
Introduction: Obstructive sleep apnea (OSA) is a global especially before competitions, and can impact their
burden disease with increasing incidence associated performance, as well as favoring the appearance of
to obesity incidence, along with its comorbidities, the injuries. Aim: Correlate the quantity of sleep and
main one being metabolic syndrome. Characterized by musculoskeletal injuries in adolescent athletes. Methods:
recurrent upper airway obstruction during sleep results Nineteen athletics athletes (both sex) from the Centro de
in hypoxemia cycles. Obesity is the main risk factor for Treinamento Esportivo in the speed and jump categories,
OSA. Intermittent hypoxemia resulting from OSA may which competed at regional and/or national level, with
lead to increased insulin resistance and a change in lipid an mean age of 16.89 ± 2.74 years and a mean BMI of
metabolism, which may precipitate hepatic steatosis. 21.09 ± 1.42 kg/m2 participated in this study. The sleep
Aim: To evaluate the association of hepatic steatosis in variables were assessed by actigraph, participants were
patients undergoing preoperative evaluation of bariatric instructed to use it for ten days and maintain their usual
surgery diagnosed with OSA. Methods: Retrospective sleep-wake cycle. The monitoring of musculoskeletal
study, with data collected from 1.416 preoperative injuries was performed during the 6-month training period.
bariatric private services, from which ultrasound (US) and Spearman’s correlation coefficient and simple linear
polysomnography (PSG) data were obtained, resulting regression model were estimated for sleep and injuries
in 87 OSA cases. Anthropometric data, grade of hepatic variables. The significance level was α ≤ 5%. Results:
steatosis according to US and PSG data were collected. The mean total sleep time (TST) was 07h13min ± 44min,
Results: The average age was 39.5 (sd ± 11.4); 60% of sleep latency was 20.18 ± 10.47min, sleep efficiency was
sample was women. The body mass index (BMI) was 39.2 82.49 ± 3.68% and the mean wake after sleep onset was
(s.d. ± 4.45); slow wave sleep (SWS) was 12.5 (sd 12.5); 46.02 ± 12.42min. During this period, the incidence of
REM sleep was 16.2 (sd ± 7.1); of the micro-arousals was eight musculoskeletal injuries was observed. The results
39.1 (sd ± 25.4); the apnea and hypoapnea index (AHI) showed significant negative correlation between TST and
was 33.5 (sd ± 38.9); minimum saturation was 73.9 (sd amount of injuries (r = -0.736; p = 0.001). The amount
9.8); saturation below 90% was 23.1 (sd ± 27.2); oxygen of injuries can be significantly explained by the reduction
desaturation index (ODI) was 41.3 (sd ± 34.1), sex (p> of TST (R² = 0.37; β = -0.611; p = 0.05). Conclusions:
0.002). Spliting the AHI by severity where AHI < 15 The quantity of sleep is related and was able to predict the
or AHI >15, we respectively found 36% and 64%. The amount of musculoskeletal injuries in adolescent athletes,
steatosis grade differs by AHI severity (p<0.001) and sex thus emphasizing the importance and impact of sleep on
(p<0.001). Of all women evaluated, 20.7% had no steatosis, the athlete’s health and sports performance.
33.9% grade 1, 37.7% grade 2 and 7.54% grade 3. There
was a difference between the apnea severity groups for age ID: 593
(p = 0.0018), slow wave sleep (SWS; p = 0.027), REM (p =
0.004), micro-arousals (p <0.001), minimum saturation (p Clinical Studies
= 0.005), ODI (<0.001). After adjusting several variables Risk and factors associated with Obstructive
through multiple regression, only the female gender was
a predictor of steatosis grade. Conclusions: This study Sleep Apnea Syndrome in the elderly of
found a high prevalence of steatosis in OSA patients. Primary Health Care
The evaluation between the steatosis grade showed no
difference for BMI and polysomnography data, but rather Grangeiro, A F B, Gomes, L d O, Cunha, C d S, Nóbrega, O d T,
for OSA severity, gender and age, thus being female sex a Neiva, T S, de Castro, J L M, Magalhães, P R d M, de Mello, J L
independent predictor factor to steatoses grade. M, Ferreira, F G, Cintra, T R

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5
Departamento de Gerontologia - Universidade Católica de Brasília, Krakauer, L, Manzi, S B, Frazão, Y, Ieto, V
Centro Universitário de Brasília, Secretaria de Saúde e Instituto do
Faculdade de Odontologia de Bauru - Bauru - São Paulo - Brasil,
Sono - Brasília - DF - Brazil
Núcleo Interdisciplinar de Ciência do Sono - São Paulo - São Paulo
Introduction: The aging process brings significant - Brasil
changes in relation to the numerous sleep disorders, which
Introduction: Obstructive sleep apnea (OSA) may affect
constitute a serious public health problem and 50% of
individuals in several age ranges, yet the incidence increases
the elderly have sleep-related complaints. Insomnia is
with age. CPAP is considered the gold standard in the
the most common sleep disorder in the elderly, followed
rehabilitation of sleep breathing disorders (SBD), yet the
by Obstructive Sleep Apnea Syndrome (OSAS).The
literature presents several case reports in which the adherence
prevalence of OSAS in the elderly varies from 27% to
to the use of CPAP is a therapeutic challenge. The other
75% in the studies, depending on the definition adopted,
treatment options for SBD include the speech-language
and the incidence may vary from 2.9% to 39.5%, in
therapy – Orofacial Myofunctional Therapy (OMT). Aim:
the age group of 60 and 80 years, especially in men.
To describe two cases of male elderly individuals with severe
Aim: To evaluate the risk and factors associated with
OSA, aged 77 and 78 years (patients 1 and 2), both referred by
OSAS in the elderly of primary health care Methods:
the sleep medicine specialist for speech-language treatment
Cross-sectional study conducted with elderly assisted
due to refusal to use the CPAP. Methods: Individuals with
in Primary Health Care, from January to August 2018,
OSA submitted to evaluations - MBGR protocol – Orofacial
selected through medical consultations held in this Unit
Myofunctional Clinical Examination and polysomnography
during 2017. Sociodemographic questionnaires, clinical,
– before and after the OMT program. Based on the initial
anthropometric data, geriatric depression scale, and the
data, the following therapeutic planing was established for
STOP-Bang instrument were used to assess the risk of
4 months: patient 1: 12 weekly sessions; patient 2: 4 weekly,
OSAS. The research was approved by the Research Ethics
two bimonthly and two monthly sessions. For both patients,
Committee under Opinion 1.861.003. Data were processed
the therapy addressed the orofacial functions of breathing,
and analyzed using the SSPS program, version 22.0 for
mastication, swallowing and myotherapeutic exercises,
Windows, duly registered for the research. The statistical
aiming to balance the orofacial muscle dynamics, reduce
treatment to verify the normality of the distribution by
the intensity and frequency of snoring and obstructive
group of quantitative variables was the Shapiro-Wilk test.
breathing episodes during sleep. The patients were instructed
The chi-square test and the non-parametric Kruskal-Wallis
to perform the orofacial exercises 3 times a day, control the
test were applied, with a confidence interval of 95% and
orofacial functions and position during sleep. After 4 months
p≤0.05. Results: 72.9% of the female participants were
of OMT, the patients were submitted to speech-language re-
identified with intermediate risk and high risk of OSAS,
evaluation and returned to the sleep medicine specialist, who
55.7% and 18.6% of the elderly respectively. 54.3%
requested another polysomnography. Results: The following
overweight elderly. There was a statistically significant
results were observed for both patients: reduction of tongue
difference in the variables gender (p = 0.032), Arterial
width and height, greater recruitment of palatal vault muscles
Hypertension (p =0.019), depression (p=0.014) and Body
and adequacy of orofacial functions. The polysomnography
Mass Index (p = 0.005) in relation to the risk for OSAS.
reveled changes in the following parameters: Patient 1: AHI
Conclusions: The elderly had a higher intermediate risk
(before 39.7/h x after 6.9/h) and oxygen saturation (before:
of OSAS and an association of risk factors: Gender,
mean 91% and minimum 77% x after: mean 92% and
Body Mass Index and comorbidities (Systemic Arterial
minimum 88%). Patient 2: AHI (before 36.6/h x after 4.5/h)
Hypertension and Depression). Thus, the investigation of
and time with SpO2 <90%* (before: 2.3% x after: 0%).
OSAS in the elderly is relevant, since the number of health
Conclusions: In the literature, there is no recommendation
professionals that diagnose this syndrome is insufficient,
of OMT for elderly individuals with severe OSA. However, it
being possible the treatment through non-pharmacological
was observed that OMT was effective to reduce the AHI and
therapies, behavioral interventions: weight loss, smoking
enhance the oxygen saturation. Further investigations should
cessation, discontinuation of alcohol use and holistic
be conducted on cases of elderly individuals with severe OSA
sleep positioning guidance.
Palavras-chave: Sleep Medicine Specialty; Sleep Apnea Syndromes; Health of the Elderly; Patient Care Team
who refuse to use the CPAP.
Palavras-chave: aging, obstructive sleep apnea, myofunctional therapy

ID: 594 ID: 595

Case Reports Basic Research
Sleep speech-language therapy: considerations Mental health and sleep in a population in the
on two cases of elderly individuals with severe east of Minas Gerais
obstructive sleep apnea

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 6
ULHOA, M A, Rodrigues, E G, Carli, M d S, Lisboa, A C V, Soares, C F d P, Simões, G C, Satorre, A M K, Zakrzevski, K F
Fonseca, G
Centro Universitário da Fundação Assis Gurgacz - Cascavel - Paraná
UNEC - CARATINGA - Minas Gerais - Brasil, Unileste - IPATINGA - Brasil
- Minas Gerais - Brasil, Univaço - IPATINGA - Minas Gerais - Brasil
Introduction: College years are believed to be those in
Introduction: Mental health problems are causes of which sleep is most neglected, whereas several studies
comorbidities worldwide. It is estimated that 700 million have shown that sleep quality has consequences for
people are affected by this condition, according to WHO. learning. We made a comparative study with students
Minor psychic disorders (MPD) are known to negatively of three different college courses to study this matter.
impact in sleep and MPD are related by symptoms such Aim: This research was developed to compare excessive
as anxiety, fatigue, depression, insomnia, irritability, daytime sleepiness and sleep quality among undergraduate
and memory and concentration deficit. Aim: The aim students of Law, Civil Engineering and Medicine. Also we
of this study was to evaluate the prevalence of MPD performed the correlation between course load, sleepiness
and the impact on sleep in a population in the Eastern and sleep quality. Methods: A cross-sectional study was
Minas Gerais. Methods: This study is characterized as a carried out at a University Center. The students filled out
descriptive, cross-sectional and quantitative research that the Epworth Sleepiness Scale (ESE), Pittsburgh Sleep
was conducted in 2017/18. We used data from interviews Quality Index (PSRI) and a simplified sociodemographic
conducted during a Health Fair, totaling 169 respondents. questionnaire. The analyzes were done in the semesters
Participants were invited to attend the fair to monitoring with the heaviest course load, which was requested to the
health by forming a convenience sample. In the coordination of the course. Descriptive analyzes were
interview, questions were applied for sociodemographic performed (frequencies, means and standard deviations),
characterization and sleep quality. To analyze the the Analysis of Variance (ANOVA) was calculated for
prevalence of common mental disorders we used the Self- sleepiness levels and sleep quality for the three courses,
Reporting Questionnaire (SRQ-20), an instrument with 20 followed by the Test T. Pearson’s Correlation Coefficient,
questions aimed at screening for psychic morbidity. These to compare sleep quality with the compulsory course load.
were collected by medical students, previously trained in Statistically significant values were considered when p
the application of research instruments. A descriptive <0.05. Results: The sample (mean age: 22.27, SD=4.47)
analysis of the data was performed using frequency consisted of 55 Law students, 107 Civil Engineering
tables and calculation of measures of central tendency and 167 medical students. The results showed that the
(mean) and dispersion (standard deviation) using the average daytime sleepiness was 11.58 points (SD=3.77)
SPSS® program. Results: Participaram desta pesquisa for Law, 10.55 (SD=3.42) for Civil Engineering and 11.10
169 voluntários, com idades variando entre 14 e 83 anos (SD=3.33) for Medicine. As for sleep quality, the results
(med=49,9). Em relação ao sexo, 53,8% eram mulheres. A were 8.77 (SD=2.18), 7.17 (SD=2.18) and 8.62 (SD=2.55),
maioria dos voluntários eram casados/as (60,94%) e com respectively. No significant differences were found in
ensino fundamental incompleto (46,74%). A prevalência sleepiness (f=1.13; p>0.05), while in sleep quality there
do DPM foi de 39,05%. Houve maior prevalência no sexo were significant differences (f=8.15; p<0.00). The course
feminino (50,55%), comparado aos homens (25,64%); load and sleep quality were not correlated in Law (r=-0.05;
33% deles eram casados. Cerca de 30% dos entrevistados p>0.05), Civil Engineering (r=-0.09; p>0.05) and Medicine
referiram dormir mal. A duração média de sono foi 7,8 (r=0.17; p>0.05). Conclusions: The study showed no
(± 1,9) horas. Em relação à faixa etária, nota-se maior significant differences in sleepiness among students of
prevalência em idosos acima de 73 anos, uma vez que the 3 courses, however all individuals had high levels
tendem a ser mais vulneráveis às limitações e problemas of daytime sleepiness. In terms of sleep quality, as Civil
de saúde. Conclusions: It is recognized that the presence Engineering students have the best sleep quality, while in
of depressive symptoms negatively affects various aspects Medicine and Law there was no significant difference. The
of an individual’s life, including sleep quality and duration. research also revealed that it is not possible to correlate
Therefore, it is necessary to identify and treat individuals the course load with sleepiness and sleep quality.
with MPD, to maintain the integrity of mental health,
positively interfering with sleep and quality of life. ID: 601
Palavras-chave: Sleep, mental disorder, Health

Clinical Studies
ID: 596
The Comparison of Sleep Quantity in
Basic Research Different Stages of Training in Adolescent
Sleep heterogeneity among the different Track Athletes
students

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7
Freitas, L S N, de Mello, M T, Viegas, F, Pinto, M C, Facundo, be related to musculoskeletal injuries. Adolescents might
L A, Silva, A be more exposed to situations that are detrimental to
Universidade Federal de Minas Gerais - BELO HORIZONTE - Minas sleep quality. Aim: To associate sleep complaints with
Gerais - Brasil musculoskeletal injuries in young track athletes. Methods:
The sample consisted of 30 athletes from Centro de
Introduction: Athlete sleep is an important factor for Treinamento Esportivo, aged between 13 and 22 years and
recovery and maintenance of performance. Athletes mean BMI of 21.21 ± 1.37 kg/m2. Participants answered
may have significant changes in sleep at different stages the Sleep Complaint Questionnaire and retrospective
of training and especially near major competitions. musculoskeletal injuries data were collected from team’s
Aim: Comparison of sleep quantity in different stages physical therapy department (considered last six months).
of training in adolescent track athletes. Methods: Spearman’s correlation coefficient was used to obtain the
The sample consisted of 19 athletics athletes from the association between the variables of the Sleep Complaint
Centro de Treinamento Esportivo aged 12 to 21 years, Questionnaire and injuries. Finally, linear regression
who participated in regional, national and international was performed. The significance level was set at α ≤
track competitions. Quality and quantity of sleep were 5%.Results: The results showed that 23.3% of athletes
assessed by actigraphy at three stages: Preparation Phase, reported poor sleep, 40% reported good sleep and 36.7%
Competitive Phase, and Non-Competitive Phase, with reported very good sleep. The mean of total sleep time
each phase obtaining a two-month interval between was 07h22min±63.55 min (recommended 9 to 10h
actigraphy assessments. The athletes were instructed to sleep for athletes) and the mean severity of injuries was
use on the non-dominant wrist an actigraphy continuously 1.47±1.24 UA (1= no absence and 5 = severe or absence
for 10 days and to maintain their usual sleep-wake style over 28 days). Significant negative correlations were found
during each phase evaluated. Statistical analysis was between the variables sleep complaint and total sleep time
performed using repeated measures ANOVA to compare (r = -0.438; p = 0.016), sleep complaint and sleep quality
sleep in the three phases of training, with a £ 5%, the (r = -0.472; p = 0.009) and significant positive correlation
effect sizes (ES)was evaluated. Results: Total sleep time between somnambulism and injury severity (r= 0.577; p=
showed a significant decrease in the competitive phase 0.006). Linear regression data showed that sleep complaint
(416.41+46.44) when compared to the non-competitive influence 45% on total sleep time (R= 0.456; β= -0.456;
phase (453.10+59.95) (p=0.01; ES=0.71). The number p= 0.011); sleep complaint influence 49% on sleep quality
of awakenings after sleep onset was lower in the non- (R= 0.494; β= -0.494; p= 0.006); and somnambulism is
competitive phase (36.13+15.28) when compared to the influenced 64% by injury severity (R= 0.646; β= 0.646; p
preparation phase (46.02+12.42) (p=0.001; ES=1.49). = 0.002). Conclusions: The presence of sleep complaints
Sleep efficiency (p=0.447) and sleep latency (p = 0.201) has negative implications on sleep duration and quality of
showed no differences between the three phases evaluated. young athletes, as well as implies in the increase of the
Conclusions: We can conclude that the athletes had a severity of injuries.
shorter total sleep time during the competitive phase and a Palavras-chave: Sleep, injury, athlete.

higher number of awakenings during the preparatory phase

compared to the non-competitive phase. Demonstrating
ID: 607
that near and during competitions, sleep was fragmented Basic Research
and worse quality.
Impact of chronotype and sleep quality on
ID: 604
academic performance in medical students:
Clinical Studies which phase of the course is most critical?
Association between sleep complaints and Rodolfo Martins Filho, C L, Silva de Arruda, B E, Cabral da Silva,
musculoskeletal injuries in young track E C, Nagrad de Farias Albuquerque, J E, Silva Normandes, M L,
Souza de Lira, C Z, Leocadio Miguel, M A, Araújo, J F, Negreiros
athletes
Nóbrega, P V
Costa Pinto, M, de Mello, M T, Silva, S, Viegas, F, de Sousa Centro Universitário de João Pessoa - JOAO PESSOA - Paraiba -
Nogueira Freitas, L, Campos Pereira, R H, Silva, A Brasil, Universidade Federal do Rio Grande do Norte - NATAL - Rio
Grande do Norte - Brasil
Introduction: Sleep is a physiologic process that plays
a crucial role in human metabolic functions and it is Introduction: Sleep disorders have a high prevalence in
essential for muscular recovery. Sleep restriction increases college students, especially in medical students, and are
technical errors and affect decision making, which can related to impairments in physical, cognitive and mental

Sleep Sci. 2020;13(Supl.1):1-118

 8

health. Aim: To evaluate the sleep of medical students Introduction: Sleep bruxism (SB) is a masticatory muscle
and to establish their possible correlations with academic activity characterized by repetitive clenching or grinding of
performance parameters across the phases of the medical the teeth and/or by bracing or thrusting of the mandible,
course. Methods: This is a cross-sectional observational usually associated with sleep arousals. Obstructive Sleep
field study which was conducted with 250 medical students Apnea (OSA) is a sleep-related condition and, thus, share a
from a university, located in the city of João Pessoa, Brazil, common physiologic pathway with SB. OSA is a respiratory
from February to April 2019. Participants were divided into disorder characterized by total (apnea) or partial (hypopnea)
three groups according to the phase of the medical course: airway obstruction leading to arousals in response to
basic and clinical cycles and internship. The Pittsburgh respiratory effort. Aim: To elucidate current knowledge
Sleep Quality Index (PSQI) and the Morningness- on the potential association and causality between Sleep
Eveningness Questionnaire (MEQ) were used for the Bruxism (SB) and Obstructive Sleep Apnea (OSA) using full-
evaluation of sleep variables. Specific questionnaires for night polysomnography. Methods: Search strategies were
the evaluation of sociodemographic, general health and developed to PubMed, Web of Science, Cochrane, LILACS,
academic performance variables were also used, including MEDLINE and BBO-ODO and conducted until May 2019.
the Student Revenue Coefficient, an attitudinal evaluation The methodological quality was evaluated using Qu-ATEBS
and the grade regarding a learning check of a discipline tool.Results: Identified 270 articles and after independent
randomly chosen in each semester.Results: The medical screening of abstracts by two authors, 17 articles underwent
students of the present study were characterized by mean full text reading. 10 articles were excluded for not meeting
age of 22,78 (± 4,71) years, intermediate chonotype in inclusion criteria and 7 were included in qualitative synthesis.
MEQ (48,28 ± 10,49 points), poor sleep quality in PSQI Four studies support the association between SB and OSA:
(7,31 ± 3,41 points), sleep latency of 26,22 (± 25,49) (a) a subtype of OSA patients may have SB as a protective
minutes, sleep duration of 6h13min (± 1h09min), mean response to respiratory events (b) most episodes of bruxism
sleep onset time of 23h30min (± 1h10min) and mean occur shortly after the end of apnea / hypopnea (AH) events
wake-up time of 6h15min (± 1h02min). There was no (c) bruxism episodes occur secondary to arousals arising from
statistically significant relationship between the PSQI AH events (d) there is a correlation between the frequency of
total score and the academic performance measures SB and AH events. And three studies do not support: (e) AH
from the total sample and between the course phases. episodes are related to non-specific SB oromotor activities (f)
However, sleep latency, sleep onset and end times, and the SB episodes are not directly associated with the end of AH
MEQ score correlated with academic performance [(r=- events (g) patients with OSA did not experience more SB
0,152; p=0,026) (r=-0,136; p=0,047) (r=-0,15; p=0,036) events than control group. Conclusions: There is no scientific
(r=0,178; p=0,008), respectively]. Similar results were evidence to support a conclusive relationship between SB
found in the basic cycle, except for the time of end of and OSA. Further well-designed and randomized studies
sleep [(r=-0,301; p=0,005) (r=-0,246; p=0,035) (r=0,288; with control groups are need to investigate whether possible
p=0,004), respectively]. Conclusions: It was observed mechanisms common to SB and OSA exist and whether OSA
that medical students have poor sleep quality, so those treatment could improve SB negative oral health outcomes in
students who have a higher sleep latency, sleep later and patients with SB and comorbidity of OSA.
have a lower MEQ score presented a lessened academic Palavras-chave: bruxism, obstructive sleep apnea, sleep bruxism, sleep disordered breathing, systematic review

performance, especially in the basic cycle of the medical

ID: 609
course. Higher attention to medical students should be
offered by educational institutions, aiming at minimizing Clinical Studies
the health problems caused by sleep disorders.
Palavras-chave: Sleep. Sleep wake disorders. Academic performance. Students, medical.
Comparison of the effects of
ID: 608 Adenotonsillectomy and Rapid Maxillary
Expansion on obstructive sleep apnea in
Clinical Studies children - Prospective Randomized Controlled
Is there an association between Sleep Bruxism Trial
and Obstructive Sleep Apnea syndrome? a
Cunha, T C A, Bittencourt, L R A, Cunha, T M, Gomes, L d F G,
systematic review Bacchin, F, Novaes, R M, Almeida, G A, Simamoto - Júnior, P C

Cunha, T C A, Lopes, A J d C, Monteiro, M C M, Serra Negra, J, Faculdade de Medicina - Universidade Federal de São Paulo - São
Simamoto-Junior, P C Paulo - Sao Paulo - Brasil, Faculdade de Medicina - Universidade
Federal de Uberlandia - Uberlandia - Minas Gerais - Brasil, Faculdade
Faculdade de Odontologia - Universidade Federal de Uberlandia -
de Odontologia - Universidade Federal de Uberlandia - Uberlandia -
Uberlandia - Minas Gerais - Brasil
Minas Gerais - Brasil

Sleep Sci. 2020;13(Supl.1):1-118

9
Introduction: Obstructive Sleep Apnea (OSA) affects PREDOLIN, K F B, SOARES, C F D P, SHIMABUKURO, J E,
about 2% of pre-school children and is associated with JUNIOR, J V D S, SHIMABUKURO, S N, Netto, L P, Provensi,
different comorbidities, some of which have implications PT
in adult life. It is an under-diagnosed and under-treated Centro Universitário Fundação Assis Gurgacz - Cascavel - Parana -
disease. Aim: To evaluate the effect of rapid maxillary Brasil, Universidade Estadual do Oeste do Paraná - Cascavel - Parana
expansion (RME) and adenotonsillectomy (ADT) - Brasil
on the subjective and objective parameters of sleep,
echocardiography, spirometry and quality of life of infant Introduction: Vitamin D deficiency is an increasing
with obstructive sleep apnea. Methods: Children with problem in modern society and may be associated with
adenoid and tonsil hypertrophy grade III and IV, with concomitant increase in sleep disorders; and this may
complaints of snoring and respiratory arrest at night be associated with working shifts. Aim: To perform an
and craniofacial alterations that favored the RME were investigation of the association between serum levels of
consecutively selected in the otorhinolaryngology clinic vitamin D and the sleep quality of day and night shift
of the Federal University of Uberlândia.The children were workers. Methods: We selected two groups of female shift
submitted to polysomnography (PSG), those with AHI ≥ workers who did not perform vitamin D supplementation.
2 were selected and randomized by individual lottery in They answered a questionnaire with variables of: age, race,
two groups: ADT (n=13) and RME (n=17). PSG and sleep duration, daily sun exposure and with the Pittsburgh
spirometry examinations were performed by trained Sleep Quality Index. Serum vitamin D levels were
technicians.The echocardiogram was performed by measured at the study site and correlated with the variables.
cardiologists. The questionnaires OSA-18 and SBQ were Statistical analysis using Fisher Exact Test established the
applied by dentists. All reports were made by examining associations between the variables. Results: The average
physicians and blinded for both the pathology being age of participants was 41 years. Most are in the sun <30
investigated and the time of treatment the child was in. minute daily and slept for five to eight hours. Both night-
The exams and questionnaires were applied before and shift workers and day-shift workers had poor sleep quality
after 4 months of the interventions.Results: The sample and vitamin D deficiency. There were no significant
consisted of 30 children, of whom 15 were male, aged 8 associations between vitamin D levels and sleep quality
± 2 years; BMI: 18.5 ± 4.7 kg / m 2. After the therapeutic in shift workers.Results: Some previous studies have
interventions, there was a significant improvement in AHI shown a similar result to the one obtained; whereas others
(p <0.001 / p = 0.003 / p = 0.007), saturation (p = 0.01 / have found a significant association between vitamin D
p = 0.006 / p = 0.03), quality of life (p <0.001 / p <0.001 levels and sleep quality in shift workers. Conclusions:
/ p = 0.04) and sleep behavior (p = 0.01 / p = 0.009 / p Regardless of whether participants worked day or night
= 0.60) for the total sample, ADT and RME respectively. shifts, vitamin D deficiency and poor sleep quality were
However, only 46% of the patients submitted to surgery prevalent in most of the study participants.
and 23% of those submitted to orthodontic treatment had Palavras-chave: Vitamin D, sleep quality, sleep disorders, work shift.

normalization of the AHI after the intervention. When

comparing the two interventions, therapeutic superiority ID: 613
was observed for adenotonsillectomy in the parameters Clinical Studies
of total score (0.01), symptoms during sleep (P = 0.01),
and the informant’s opinion (p = 0.005) of OSA-18, as Sleep quality of medical students and
well as in the total SBQ score (p = 0.009). Conclusions: university performance
Both treatments reduce AHI significantly, but for children
with craniofacial changes and grade III or IV tonsil Koyashiki, M E, Soares, C F D P, Junior, J V D S, Shimabukuro,
hypertrophy, only one of the interventions failed to JE
normalize all polysomnographic parameters. The overlap
of therapies and multiprofessional care is recommended. FAG - Cascavel - Parana - Brasil
Palavras-chave: Tonsillectomy; Maxillary Expansion; Treatment; Obstructive Sleep Apnea; Infant
Introduction: Sleep is a fundamental biological function
ID: 612 and disturbances of this process can cause significant
losses, including cognitive performance, compromising
Clinical Studies the quality of life. However, due to the urban, intense
routine, the sleep time of medical students is reduced,
The relation between serum vitamin d and which has a negative impact on health, compromising
sleep quality on female workers of day and cognitive functions, for which academic performance is a
night shift in a hospital of western paraná priority. Aim: To verify if there is a relationship between
student’s sleep quality and academic performance, based

Sleep Sci. 2020;13(Supl.1):1-118

 10

on test scores, applied to the 4th year Medicine students association between shift work and a higher prevalence of
in 2017. Methods: A prospective, cross-sectional and depressive symptoms and did not show a worst quality of
descriptive study was performed. The sample consisted of sleep in shift workers when compared to daytime workers.
41 students. Data collection was based on the Pittsburgh The questionnaire used and data collection method can
Sleep Quality Index (PSQI), a self-administered partially explain that. Furthermore, the healthy-worker
questionnaire. Regarding the student’s grades, they were effect, described by Anders Knutsson, shows that some
acquired through the subject’s representatives, and the test people tend to adjust to shift work. However, the study
scores were averaged. The SSPS software was used and showed a higher possibility for overweight and obesity
non-parametric analysis was performed.Results: With a for shift workers and higher tendency to indisposition for
sample composed by 28 males and 13 females, average daily activities associated with longer sleeping cycles in off
age of 24 years. The academic performance average was work nights.
71.3 (range 60-82), based on the result of the PSQI, the Palavras-chave: Shift work; Sleep disorders; Circadian Rhythm; Depression; Nursing.

group with good sleep had a grade average of 73.6; the

group with poor sleep 71.5; and those with sleep disorder ID: 616
69,2. No statistically significant difference was observed Clinical Studies
regarding sleep quality and academic performance (p =
0.340). Conclusions: The study showed that students Laryngopharyngeal motor dysfunction and
with higher PSQI scores, meaning those with poor sleep obstructive sleep apnea in Parkinson’s disease
quality and / or disturbance, had a slightly lower average
test scores than students with good quality. Bahia, C M C d S, Lopes, A J, Pereira, J S, Faria, A C
Palavras-chave: Sleep disorders due to excessive drowsiness; Medical education; Medical students; Sleep; Sleep Disorders.

ID: 614 Introduction: Obstructive sleep apnea (OSA) is a

common sleep disorder in Parkinson’s disease (PD), but
Clinical Studies the relationship between these two conditions remains
uncertain. Upper airway (UA) dysfunction in PD is well
How sleep deprivation and disturbance in the documented in some patients and is believed to be a
circadian rhythm affected health in a nursing reflex of the motor involvement of laryngopharyngeal
group muscles. Aim: The aim of this study is to determine
whether UA dysfunction and laryngopharyngeal motor
Batista, R S, Lin, J, Scarlatelli-Lima, A V dysfunction (LMD) are involved in the obstructive
phenomenon of OSA in PD. Methods: Forty-eight
Universidade Sul de Santa Catarina - Tubarão - Santa Catarina - Brasil
PD patients underwent polysomnography for OSA
Introduction: Shift workers don’t have a typical working diagnosis, physical examination, functional evaluation of
schedule in the morning and in the afternoon. Their the UA by spirometry and a clinical protocol for analysis
work rhythm represents a risk factor to health and well- of laryngopharyngeal muscles, where we evaluated de
being because interferes with circadian rhythms and presence of hypophonia, difficulty in protruding at least
sleep wake cycle. The most common consequences of one third of the tongue, difficulty in coughing voluntarily,
this misalignment include decrease in attention, cognitive difficulty in clearing the throat voluntarily, and difficulty
functions, mood, social and in work, besides health. Aim: in elevating the palate during open-mouth inspection and
This research aims to assess sleep quality and the prevalence vocalization of the /ah/ phoneme. Participants with at
of depressive symptoms in shift workers. Methods: It is least one of these symptoms were considered to have
an observational study with cross-sectional design. We LMD.Results: Thirty-one participants (64.6%) fulfilled the
evaluated the nursing staff of a hospital in Santa Catarina criteria for OSA, according to Internacional Classification
with a sociodemographic questionnaire, the Pittsburgh of Sleep Disorders 3rd edition. UA obstruction was
Sleep Quality Index and the Beck Depressive Inventory observed in 25% of participants and LMD in 60.4%.
II during their work shift. We analyzed the results using t Among the clinical indicators of LMD, hypophonia was
Student test and chi square with a 5% level of significance. the most common (58.3%). Participants with LMD had a
Results: Sixty-four nursing staff members were enrolled in threefold greater chance of presenting with OSA than did
the current study, 32 (50%) were in the morning shift and 32 those without LMD (OR = 3.49, 95% CI: 1.01 - 12.1, p =
(50%) in the night shift. Among night shift workers, 59.4% 0.044). Individuals with LMD had more UA dysfunction
is overweight or obese, 68.8% do not engage in physical (37.9 vs 10.5%, p = 0.037), higher scores on UPDRS III
activities, 71.9% do not sleep well or has sleep disturbance (20 vs 15, p = 0.0005) and the Hoehn-Yahr scale (2.5 vs
and only 6.3% shows symptoms for moderate or severe 2.0, p = 0.008), and higher frequencies of postural changes
depression. Conclusions: This study did not show an (51.7 vs 21.1%, p = 0.033) and motor phenomena (65.5 vs

Sleep Sci. 2020;13(Supl.1):1-118

11
31.6%, p = 0.021). Obesity, snoring, neck circumference, best sports performance.
and the Mallampati score did not correlate with OSA in Palavras-chave: Sleep; Sleep disorders; Athletes; Sports performance.

PD. Conclusions: The results of this study indicate that

LMD may be a factor involved in the occurrence of UA ID: 618
obstructive phenomena inOSA in patients with PD. LMD Clinical Studies
can help identify which PD patients should be monitored
in regard to the development of OSA as most of the Prevalence of edentulism and sleep
characteristics commonly associated with OSA in the disturbances following stroke
general population do not apply to parkinsonians.
Palavras-chave: Parkinson`s Disease, Laryngopharyngeal Motor Dysfunction, Upper Airway, Obstructive Sleep Apnea, Spirometry, Mallampati
Vago, E L, Frange, C, Oliveira, G P, Juliano, M L, Machado, M
Score

A C, Coelho, F M
ID: 617
Unifesp - Sao Paulo - Sao Paulo - Brasil
Clinical Studies
Introduction: Many authors have demonstrated the
Subjective sleep quality, sleep complaints and association between edentulism and various clinical,
sleepiness in elite athletes neurological (e.g. stroke) and sleep disorders such as
obstructive sleep apnea (OSA). Edentulism may influence the
Facundo, L A, de Mello, M T, Viegas, F, Freitas, L S N, prevalence of sleep disturbances, including OSA, as well as
Albuquerque, M, Silva, A poor sleep quality, excessive diurnal somnolence and restless
Universidade Federal de Minas Gerais - Belo Horizonte - Minas Gerais
leg syndrome in participants following stroke, and thus
- Brasil
having consequent higher disabilities and negative outcomes.
Aim: To investigate the prevalence of edentulism, sleep
Introduction: Sleep with adequate duration and quality is quality, risk of obstructive sleep apnea and excessive daytime
vital for high performance athletes, because it acts in the sleepiness, the type of stroke, and the potential association
process of physical and cognitive recovery, which ensures between edentulism and these sleep related factors in stroke
improved sports performance. In this way, it is essential patients attending the Neurovascular Outpatient Clinic at our
to monitor the sleep of athletes to propose interventions University. Methods: This study assessed the prevalence of
that seek to improve it. Aim: To describe the subjective different types of stroke in 130 patients, and the influence of
quality of sleep, sleep complaints and sleepiness of elite sleep disturbances using questionnaires on sleep quality, risk
athletes and to analyze the impact of complaints on of obstructive sleep apnea, and excessive daytime sleepiness
sleep quality. Methods: The sample consisted of 107 complaints. We also investigated the number of teeth and the
elite athletes (with or without disabilities), with an mean nocturnal use of dental prostheses.Results: The prevalence
age of 29 ± 9 years. Data were collected online using of ischemic stroke was 94.6%, with minor stroke severity
the following questionnaires: Pittsburgh Sleep Quality and no significant disability or slight disability. Regarding the
Index (PSQI), Epworth Sleepiness Scale (ESS) and Sleep evaluation of sleep, our sample had poor sleep quality, higher
Complaint Questionnaire (SCQ). However, 107 athletes risk of obstructive sleep apnea, but presented no excessive
answered to the SCQ, 62 athletes answered to the PSQI daytime sleepiness. We also found a high prevalence of
and 75 athletes answered to the ESS. Data were presented missing teeth, or edentulism, as the majority used full
as mean and standard deviation, as well as absolute and removable dental prostheses and half of the sample slept with
relative frequency. In addition, simple linear regression them. Conclusions: Despite the complex and sometimes
was performed to analyze the impact of sleep complaints bi-directional relationships between edentulism, obstructive
on sleep quality (PSQI).Results: It can be observed that sleep apnea, sleep and stroke, we found a higher prevalence
106 (99%) athletes had at least one sleep complaint, 26 of poor sleep quality and a higher risk of obstructive sleep
(35%) had excessive sleepiness and 51 (82%) had poor apnea in edentulous patients following stroke with a minor
sleep quality. The complaints with higher incidence were severity. This indicates the need for further studies on treating
insufficient sleep (71; 66%), wake up during the night (69; and preventing sleep disturbances and edentulism in stroke
65%) awakenings at night (64; 60%), moving a lot during patients.
sleep (61; 57%). In the simple linear regression model, Palavras-chave: Stroke, apnea and edentulism.

we observed R² = 0.367 (β = 3.881; p = 0.001), thereby,

ID: 619
sleep complaints impact 37% on the athletes’ sleep quality.
Conclusions: Elite athletes have poor sleep quality and Basic Research
possible sleep disorders due to the presence of complaints
that they reported. From this, it is essential to monitor Relationship between iron, sleep, physical
athletes’ sleep to identify complaints, as they impact 37% exercise in an animal model of sleep-related
on the sleep quality of this population and thus ensure the
movement disorders

Sleep Sci. 2020;13(Supl.1):1-118

 12
Franco, B, Mota, D S, Nosé, P D R d S, Rodrigues, N A, Simino, ID: 623
L A P, de Fante, T, Bezerra, R M N, Machado Gobatto, F B,
Torsoni, A S, Esteves, A M Basic Research
Faculdade de Ciências Aplicadas - UNICAMP - Limeira - Sao Paulo - Sleep disorders and the risk of
Brasil, Faculdade de Educação Física - UNICAMP - Campinas - Sao
temporomandibular disorders: systematic
Paulo - Brasil
review and meta-analysis
Introduction: One of the risk factors for the increased
incidence of Restless Legs Syndrome (RLS) in pregnant da Silva, C A G, Roithmann, C C, Grossi, M L, Patussi, M P
women is anemia, since iron deficiency during pregnancy School of Health Sciences - Postgraduate Program in Dentistry
can have serious consequences for the mother and her (Prosthodontics) - Pontifical Catholic University of Rio Grande do
baby, such as cognitive deficits and behavioral changes. Sul - Porto Alegre - Rio Grande do Sul - Brazil, Program in Collective
On the other hand, there is evidence in the literature that Health - University of Bells River Valley (Unisinos) - São Leopoldo -
the practice of physical activity presents neuroprotective Rio Grande do Sul - Brazil
properties, modulating different brain functions. Aim:
The objective of the present study was to observe Introduction: According to the American Academy
in the offspring of rats, treated with diet presenting of Orofacial Pain, temporomandibular disorders
different concentrations of iron (control, restriction and (TMD) are defined as a “group of disorders involving
supplementation), alterations caused in sleep, locomotor the masticatory muscles, the temporomandibular joint
activity and in the receptor and dopaminergic transporter. (TMJ) and associated structures”. Efforts have been
In addition, the impact of a physical exercise protocol on made in order to identify related disorders concerning
these variables analyzed in the offspring was evaluated. TMD’s multifactorial etiology, with the purpose of
Methods: For this, pregnant Wistar rats were distributed providing the best healthcare for the patients in need.
in groups that received control diets, supplementation Among those conditions, sleep disorders stand out. Aim:
and iron restriction. After weaning, the offspring of each The study aims to evaluate the relation between sleep
group were divided into two groups: 1)Physical exercise disorders and TMD based on the available literature, as
and2) Sedentary. Sleep assessments (Polysomnography), well as to verify the distribution of sleep disorders in
behavior (Open Field), gene expression (PCR) and protein the different diagnostic groups presented by the DC/
content (WB) of dopamine receptor (D2) and dopamine TMD questionnaire. Methods: The research protocol
transporter (DAT) were performed after 8 weeks of was registered in PROSPERO (CRD42018109382). A
physical exercise (swimming).Results: In the Open Field systematic review was performed in the PubMed, Embase,
test the exercised offspring of supplementary mothers Lilacs, Web of Science, Scielo, Cinahl and Cochrane
showed a significant increase in the freezing parameter Central databases. Manual search and gray literature search
when compared to all other groups at most times (Repeated were also performed. Only observational studies that
measures ANOVA p≤0.05). Through polysomnography were published since 1992 were included. Two reviewers
it was verified that the sleep pattern of the offspring of participated independently. Quality analysis on the
the restriction group (sedentary and Physical Exercise) included papers was conducted according to the Ottawa-
presented an increase in the number of awakenings and Newcastle Scale. The extracted data were submitted to
paw movements during 24h of registration in relation heterogeneity calculation, publication bias analysis and
to the supplementation group (Repeated measures meta-analysis. Results: 1071 articles were found after the
ANOVA p≤0,05). In the analysis of gene expression online search. 3 papers were added manually. Duplicate
between sedentary groups and exercise according to diet, exclusion was carried out. According to the eligibility
the exercise restriction group increased D2 compared criteria, 131 articles were selected for full-text reading. 30
to sedentary (Test T p≤0.05). No difference was found were included in the final work. Meta-analysis indicates a
in protein content of D2 and DAT between sedentary positive relationship between sleep disorders and TMD in
groups (one-way ANOVA p≤0.05). Conclusions: In this all DC/TMD diagnostic groups, except for axis 1 group
context, we can suggest that the iron diet during pregnancy II (disc displacements). The calculated Odds Ratio was
and the physical exercise performed by the offspring in 3.48. Conclusions: Based on the obtained results, there is
adulthood may present some changes in the behavior and a positive relationship between sleep disorders and TMD
sleep pattern in this offspring evaluated. However, the (except for the diagnosis of disc displacements). There is
results suggest that the presence of iron deficiency during a 3.48 times increased risk of TMD for individuals who
pregnancy is not a predisposing factor for offspring to suffer from sleep disorders compared to those without
have movement disorders in adulthood. this diagnosis.
Palavras-chave: exercise, sleep, animal model Palavras-chave: temporomandibular disorders; TMD; sleep disorders; systematic review; meta-analysis

Sleep Sci. 2020;13(Supl.1):1-118

13
ID: 624 ID: 626
Clinical Studies Clinical Studies
Respiratory therapists keeping up with new Does sleep deprivation alter muscle, core and
technologies in sleep field. thermographic temperature?
Telles, S C L Narciso, F V, Silva, A, Costa, C M A, Carvalho, A N S, Brant, V
M, Agrello, M T N, Borba, D A, Cruz, A A S, Wanner, S P, de
Consultório Particular - São Paulo - São Paulo - Brazil
Mello, M T
Introduction: Technology has been changing the way we Universidade Federal de Minas Gerais - Belo Horizonte - Minas Gerais
deal with CPAP adhesion. Respiratory therapists involved - Brasil
in sleep field have to keep up with new developments
such as devices and masks. Aim: Establish the profile Introduction: Body temperature is a robust physiological
of age and related comorbidities in sleep apnea patients; of sleep-wake cycle marker and of thermal homeostasis
quantification of different positive pressure devices with under different environmental conditions. Aim: The
different programming; quantification of different masks objective of this study was to verify the muscle, core and
models that patients adapted. Methods: Retrospective thermographic temperatures of the adults before and
analysis of first evaluation data including age and after nocturnal sleep deprivation. Methods: Fourteen
comorbidities and quantitative analysis of CPAP devices male adults (mean age of 24.36±3.67 years; mean BMI
and masks models applied from years 2014 to 2019 in of 25.12± 2.14 kg/m²) were participated in the study. The
patients of private sleep clinic in first evaluation.Results: body temperatures measurements were performed over
50 patients were analyzed, 37 were male, average age: 58,2 two days (D1 and D2). An actigraph was used to verify
(±12,45891206), minimum age 25 and maximum age 87. the time awake and the absence of naps during the sleep
Regarding comorbidities 24% had hypertension, 18% were deprivation protocol. The muscle, core and thermographic
obese, 12% had diabetes, 8% had psychiatric disorders, temperatures were recordings in ten moments (8:00,
6% had had brain stroke or sinusitis or Alzheimer or heart 11:00, 14:00, 17:00, 20:00 on D1 and D2) during the
disease, 2% had cancer or fibromyalgia or leg thrombosis protocol. The muscle temperature (mT) were measured by
or insomnia or hypothyroidism. 12% of the patients had Insulation Disk Method (IDisk) on the Braquial Triceps
no other health problems. For CPAP devices 64% were S9 (mTBT), Trapezius (mTTR), and Vastus lateralis thigh
Resmed®,10% S10 Resmed®, 8% System One Philips (mTVL). The core temperature (CT) and skin temperature
Respironics® or S8 Resmed®, 6% Remstarpro Philips (Tt) were measured by rectal probe (10-12cm into the anus)
Respironics®, 2% Dreamstation Philips Respironics® or and by thermographic camera (Thermovisor) respectively.
Cpap Transcend®. The mask types that best adapted were The General Linear Model (GLM) was used to compare
16% Prong Nuance Pro Philips Respironics®, 12% Nasal the three body temperatures before and after nocturnal
Swift FX Resmed®, 10% Nasal Mirage FX Resmed® sleep deprivation. The α-level for all analysis was set at
or Full Face Mirage Quattro Resmed®, 8% Full Face 0.05. Results: We found there was a significant effect of
Quattro Fx Resmed®, 6% Nasal Eson Fisher&Paykel® or time to the Tt (F=5.91, p<0.01, PES=0.18; OP=0.95),
Nasal Mirage Activa Resmed®, 4% Full Face AmaraView mTBT (F=7.49; p<0.01, PES=0.22, OP=0.98), mTTR
Philips Respironics® or Nasal Eson 2 Fisher&Paykel® (F=4.63, p=0.01, PES=0.15, OP=0.81), and mTVL
or Nasal Mirage Micro Resmed® or Nasal Pico Philips (F=15.62, p<0.01, PES=0.37, OP=1.00) respectively.
Respironics® or Nasal Swift FX Nano Resmed® or Nasal However, no significant differences were observed in
Wisp Philips Respironics®, 2% Nasal DreamWear Philips the CT after the sleep deprivation (F=2.54, p=0.09,
Respironics® or Full Face Airfit Resmed® or Full Face PES=0.09, OP=0.48). Therefore, there was an increase
Mirage Activa Resmed® or% Nasal Softgel Resmed®. of muscle and thermographic temperatures after sleep
Conclusions: The profile of comorbidities and age fits deprivation (p<0.05). Conclusions: The muscle and
other studies of sleep apnea patients. Eight different thermographic temperatures increased after nocturnal
positive pressure devices were used along with seventeen sleep deprivation. However, the core temperature was not
different masks from years 2014 to 2019. The respiratory influenced by sleep deprivation. In general, sleep-deprived
therapist must keep up with new devices and masks to people are tired and have increase the physical effort to
adapt the sleep apnea patient using the best technology stay awake and not falling asleep. As a physical effort result
available in Brazil. there is an increase skin vasodilatation and peripheral
Palavras-chave: Keywords: Sleep Apnea Syndromes, Continuous Positive Airway Pressure, Trends, Instrumentation.
temperatures. Additionally, an elevated skin temperature
while core temperature does not decrease should be an

Sleep Sci. 2020;13(Supl.1):1-118

 14

alarm to inform thermoregulatory systems about the at M2 (F=77.45; p<0,01; PES=0.84; OP=0.99) and M3
desynchronization of thermoregulatory mechanisms. (F=77.45; p<0.01; PES=0.84; OP=0.99) compared
Acknowledgment: FAPEMIG, CEPE, CEMSA, AFIP, to M1. Conclusions: Our findings suggest that 50%
CAPES, CNPq, UFMG. sleep restriction decreased psychomotor performance
Palavras-chave: Body temperature, Sleep deprivation, Circadian Rhythm.
and alertness of night shift students, which may impair
occupational activities, specialty classroom performance
ID: 627 and daily life activities, as well as increased risk of lapses
Clinical Studies and accidents. Acknowledgment: CEPE, CEMSA, AFIP,
CAPES, FAPEMIG, CNPq.
Partial sleep restriction impairs alertness and Palavras-chave: Sleep, Performance, Students.

psychomotor performance of students ID: 628

Carvalho, A N S, Narciso, F V, Barela, J A, Silva, A, Queiroz, S S, Basic Research
Ruiz, F S, Tufik, S, de Mello, M T
Sleep quality and excessive daytime sleepiness
Universidade Federal de Minas Gerais - Belo Horizonte - Minas Gerais
- Brasil
in women with urinary incontinence
Introduction: The students, athletes, shift workers as Bezerra, P C, Silva, G M, Barbosa, L, Lemos, A, Ferreira, S T B P,
well as general populations has been sleep restricted in Chaves, S Í D, De Siqueira, P P S, Lima, A M J
favor of social, economic, professional and personal Federal Rural University of Pernambuco e Federal University of
commitmentsAim: The aim of this study was to verify Pernambuco - Recife - Pernambuco - Brazil
the sleep restriction effects on alertness and psychomotor
performance of the studentsMethods: Sixteen male Introduction: Urinary incontinence is defined as any
students (mean age of 25.0 ± 6.3 years) participated in complaint of involuntary loss of urine. One of the
the study. Participants studied at night (07:00am-10:30 main symptoms in women with urinary incontinence is
pm) and worked at the day (8:00 am to 5:00 pm). The nocturia, characterized by the need to awake one or more
sleep-wake cycle was measured by actigraph for 10 days times per night to void. Repeated nocturnal voiding can
(before protocol) and mean Total Sleep Time (TST) leads to chronically disturbed sleep, which negatively
was analyzed (mean TST = 8.02 hours). Participants affects the sleep quality (SQ). The sleep fragmentation
were requested to sleep for at least 7 hours on the night causes excessive daytime sleepiness (EDS), a difficulty
before protocol (mean TST= 7.12 hours). At the first day to maintain wakefulness or alertness at appropriate
of protocol was calculated 50% sleep restriction by the situations during the day. The gold standard to measure
individual mean TST (10 days of actigraph).In addition, sleep objectively is polysomnography, however, wrist
psychomotor performance and sleepiness were measured actigraphy supports large-scale, is cheaper, and can be
using the Psychomotor Vigilance Task (PVT) and useful to investigate sleep/wake patterns for prolonged
Karolinska Sleepiness Scale (KSS) at the three moments observations in non-laboratory environments. Aim:
(M1, M2, M3) for 24 hours: basal moment (M1 - 8:00 Therefore, the aim of the present study was to evaluate
am), before the sleep restriction (M2 – 8:00 pm) and after sleep quality and excessive daytime sleepiness in women
the sleep restriction (M3: 8:00 am). At the second day the with urinary incontinence. Methods: We evaluated 66
participants slept in the lab at 2:00 am until 6:00 am in a women with urinary incontinence. They used the Fitbit
controlled and comfortable thermoneutral environment. Charge 3, an activity tracker, for 7 days to objectively
In order to avoid sleep inertia, M3 evaluations started evaluate the SQ and Epworth sleepiness scale to assess
at 8:00 am (2 hours after awakening). Paired-Samples EDS. Results: The patients were aged: 57.7 ± 11.2 years,
ANOVA was used to compare the PVT and KSS variables body mass index (BMI): 29.1± 4.2kg/m2, 59% had
at the moments (M1, M2, M3). The significance level mixed urinary incontinence (n = 39), 28% stress urinary
considered was 5% (p<0.05).Results: After the sleep incontinence (n = 19) and 12% (n = 08) urge urinary
restriction, the mean time reaction (mTR) increased in M3 incontinence. According to actigraphy data: total sleep
compared to M1 (F= 14.51; p<0.01; PES=0.49; OP=0.99) time (TTS): 6.10±0.95 hours; Total time in bed (TTB):
and M2 (F=14.51; p=0.01; PES=0.49; OP=0.99), as well 7.0±1.0 hours; Awakening episode per night (WE):
as there was an increased lapses of attention (LA) in M3 19.1±6.7 events; Awakenings after sleep onset (WASO):
compared to M2 (F=5.46; p=0.04; PES=0.27; OP=0.68). 0.88±0.16 hours and sleep efficiency (SE): 87.4±2.3%.
However, there was no significant difference on False The total score for the Epworth sleepiness scale was 11.1
Starts (FS) between M3 and M1 and M2 (F=1.68, p=0.13; ± 6.2, characterizing the presence of EDS. Conclusions:
F = 1.68, p = 0.88) respectively. The sleepiness increased According to the results, despite the presence of EDS and

Sleep Sci. 2020;13(Supl.1):1-118

15
shortened sleep time, it was showed that the women with respectively. N3= 19.25± 6.0 REM sleep=9.1±4.2, arousal
urinary incontinence had good sleep efficiency. Future index = 35.1±17.5, desaturation index (ODI)= 36.9±3.0,
research is suggested to correlate sleep data obtained SaO2mean =92.0±4.0 and SaO2nadir=75.0±12.3. Mean
with actigraphy with those obtained by polysomnography sleep latency showed normal values (25±3.8), but mean
in women with urinary incontinence, since there are REM latency was increased (203.0±78.0), with a reduced
evidences indicating overestimation of sleep efficiency by sleep efficiency (79.1±14.0). AIH was not correlated to
the actigraphy. BMI, neck circumference and age. All patients presented
Palavras-chave: Urinary Incontinence, Excessive Daytime Sleepiness, Sleep Quality, Actigraphy.
snoring. Only 2 (8.7%) did not present sleep bruxism (SB).
The prevalence of OSA and SB was 100% (mild=21.7%,
ID: 631 moderate=47.0%, severe=31.3%) and 91.3%, respectively.
Clinical Studies Conclusions: Adults with DS often presents coexistent
sleep disorders. Due to the high prevalence of OSA in
Polysomnographic features and OSA this population, added to a high ODI and marked sleep
prevalence in adult with Down Syndrome fragmentation, adults with Down syndrome should be
screened for OSA with polysomnography routinely.
Palavras-chave: down syndrome; obstructive sleep apnea; polysomnography; sleep disorders
Giannasi, L C, Dutra, M T S, Nacif, S R, Oliveira, E F, Nazario,
L d M, Silvestre, P R, Oliveira, L V F, Salgado, M A C, Amorim, ID: 632
J B O, Gomes, M F

Centro Univresitário de Anápolis Uni-Evangélica - Anápolis - Goias Clinical Studies

- Brasil, Hospital do Servidor Público Estadual de São Paulo-IAMSPE-
Short-term CPAP or moderate aerobic
HSPE - Sao Paulo - Sao Paulo - Brasil, ICT-UNESP/SJC - Sao Jose dos
Campos - Sao Paulo - Brasil
exercise do not improve oxidative stress and
inflammatory biomarkers in obstructive sleep
Introduction: Oropharyngeal hypotonia, is common in
apnea
individuals with Down syndrome (DS), resulting in several
impairments including the total or partial obstruction ARAÚJO, M T M, BORGES, Y G, CIPRIANO, L H C, AIRES,
of the airways during sleep, leading to snoring and to R, ZOVICO, P V C, CAMPOS, F V, GOUVEA, S A
obstructive sleep apnea (OSA). It is associated with a high
risk of morbidity and mortality in individuals with DS. Physiological Sciences Department - Federal University of Espírito
Several works investigated the sleep disorders in children Santo - Vitória - Espírito Santo - Brazil
with Down syndrome, but few studies are available in this
Introduction: Previous studies have shown that the
adult population. Aim: This study aimed to assess the
levels of oxidative stress, inflammatory and cell-free
polysomnographic features and the prevalence of OSA
DNA (cfDNA) markers are increased in individuals
in adult with Down syndrome. Methods: Medical and
suffering from obstructive sleep apnea (OSA). The effects
dental anamnesis were performed in order to investigate
of medium to long-term CPAP therapy and physical
the overall health, to address anthropometric data, dental
activity in decreasing these levels have been somewhat
status and parafunctional habits. Patients underwent
explored, unlike short-term interventions. Aim: Evaluate
the polysomnography(PSG) type II (Embla Embletta
oxidative stress marker, pro-inflammatory cytokines, anti-
MPR+PG ST+Proxy, Natus, California-USA). The
inflammatory cytokines, and cfDNA levels before and after
inclusion criteria included the presence of symptoms
8-week CPAP treatment or moderate-intensity aerobic
of OSA, preserved cognitive function to respond to
training in moderate to severe OSA. Methods: Thirty-nine
verbal commands and informed and written consent.
patients diagnosed with OSA were randomly divided into
The exclusion criteria included body mass index (BMI)
CPAP (n=18) – with and without humidifier – and exercise
> 35 Kg/m2, and have been exposed to physiotherapy
(n=21) groups. They were all submitted to the Epworth
treatment at least 6 months prior to the study.Results:
Sleepiness Scale and the Pittsburgh questionnaire. Blood
The entire group consisted of 23 patients (14 men and
samples were taken for the quantification of lipid oxidation
9 women), with a mean age of 22.7±6.5 years, mean
(TBARS), protein oxidation (AOPP) and antioxidant
body mass index (BMI) of 28.5±6.8 kg/m2 and mean
(SOD) biomarkers, as well as pro-inflammatory (TNF-α,
neck circumference of 39±4.0. Moderate to severe tooth
IL-1β, IL-6, IL-8, IL-17A) anti-inflammatory cytokines
wear was present in all patients. All patients presented
(IL-4, IL-10) and cfDNA, before and after 8 weeks of
Mallampati IV and, 73% and 27% tonsil grade II and III,
either CPAP therapy or moderate-intensity aerobic
respectively. The polysomnography showed a mean apnea/
exercise. Comparisons between averages were made
hypopnea index (AIH)=42.0±3.0, with a mean duration
with the Student’s t test for dependent samples when the
of apnea and hypopnea events of 15.1±6.3 and 18.6±7.0,
Shapiro test indicated parametric and, if not, the Wilcoxon

Sleep Sci. 2020;13(Supl.1):1-118

 16

test. A 95% confidence interval and a significance level verbal commands necessary to perform this study, such as
of 5% were considered.Results: After 8 weeks of either “open the mouth”, “close the mouth”, “ bite”, “relax”),
CPAP therapy or exercise no significant differences were agreed to participate by free will and written consent
observed in the levels of cfDNA, oxidative stress and signed by patient or patient’s responsible. The sEMG was
inflammation markers, except for an increase in AOPP performed at rest, at maximum voluntary clenching effort
(6.6±3.9 / 10.5±6.8, p=0.02) and IL-17A (21(8.4) / (MVC) and at maximum habitual intercuspation effort
29(6.7), p<0.001) levels in individuals who went through (MHI). The EMG signal was analyzed using the root
CPAP, which were higher when the CPAP device was used mean square amplitude (RMS), mean frequency (MNF),
without the humidifier (AOPP: 6,13±2,74 / 10,67±7,06, median frequency (MDF) and approximate entropy
p<0.05 and IL-17A: 21,4±7,42 / 33,7±14,82, p<0.05). (apEn). Values near 0 indicate the presence of illness or
The 8-week CPAP therapy promoted a significant decrease dysfunction and values near 2 indicate the absence of
in the Pittsburgh scores, while ESS scores remained illness or dysfunction. Results: The intraclass correlation
unaffected. No significant changes were observed in these (ICCs) for the three trials recorded in MHI in two session
parameters after the exercise treatment. Conclusions: (test and retest) revealed excellent within-and-inter session
Short-term treatment for OSA, be it CPAP therapy or reliability (range: 0.76 to 0.97) for all EMG parameters
moderate-intensity aerobic exercise, was not sufficient to and muscles recorded in MHI. At rest position it was
alter either the oxidative stress and inflammatory profiles seen an excellent reliability for RMS and ApEn (range:
or the cell-free DNA levels of moderate to severe OSA 0.75 to 1.00); good and excellent reliability MDF e MNF
patients. However, short-term CPAP did improve self- (range: 0.64 to 0.93). Conclusions: Test-retest showed
reported sleep quality. the reliability and the reproducibility of the nonlinear
Palavras-chave: OSA; CPAP; Aerobic exercise; Oxidative stress; Inflammation.
sEMG variables of the masticatory muscles in adults with
DS. These measures will give confidence to professionals
ID: 633 perform studies on masticatory muscles behavior (e.g.
Clinical Studies sleep and awake bruxism), as well as evaluate the results
of treatment, with high confidence, in this population. In
Test-retest of measurements of the addition, it will be useful to choose the best therapeutic
electromyographic signal on masseter and approach in DS individuals.
Palavras-chave: Down syndrome; test-retest; Electromyography; reliability; masticatory muscles

temporal muscles in patients with Down

syndrome ID: 637

Giannasi, L C, Politti, F, Dutra, M T S, Tenguan, V L S, Silva, G Clinical Studies

R C, Mancilha, G P, Oliveira, L V F, Bacigalupo, E F, Amorim, J Obstructive Sleep Apnea is Associated with
B O, Gomes, M F
Higher Left Ventricle Hypertrophy Frequency
Centro Universitário de Anápolis-Uni-Evangélica - Anápolis - Goias -
in Patients with Resistant Hypertension
Brasil, ICT-UNESP/SJC - Sao Paulo - Sao Paulo - Brasil, Universidade
9 de Julho-UNINOVE - Sao Paulo - Sao Paulo - Brasil Cabrini, M L, Macedo, T A, de Barros, S, Azam, I F B, Pio-Abreu,
A, Silva, G V, Bortolotto, L A, Lorenzi-Filho, G, Drager, L F
Introduction: To our knowledge, no studies have
accessed the reliability or the reproducibility of the Hospital das Clínicas de São Paulo - São Paulo - Sao Paulo - Brasil,
nonlinear surface electromyography (sEMG) variables Instituto do Coração de São Paulo - São Paulo - Sao Paulo - Brasil,
of the masseter and temporalis muscles in adults with Laboratório do Sono do Incor - São Paulo - Sao Paulo - Brasil
DS. Therefore, it is important to determine the variation
in EMG signals measurements (intra-day and inter- Introduction: Obstructive Sleep Apnea (OSA) is
day reliability) prior to suggest the use of EMG as a common in patients with hypertension, especially in those
tool for evaluating the efficacy of therapies applied to with Resistant Hypertension (RH). However, it is unclear
the investigation and improvement of the masticatory whether OSA can contribute to target-organ damage
muscles function in this population. Aim: The aim of (TOD) in patients with non-resistant hypertension (NRH)
the present study was to evaluate intra-day (test) and and in patients with RH. Aim: To compare the presence
inter-day (re-test) reliability of surface electromyography of left ventricular hypertrophy (LVH), one of the major
(sEMG) signals of the masseter and temporal muscles in TOD, in patients with NRH and RH according to the
individuals with Down syndrome (DS). Methods: The presence of OSA. Methods: We recruited consecutive
reliability of the EMG variables was verified in twenty- cases of adult patients with NRH and RH (as defined by
three individuals with DS. The inclusion criteria were standardized criteria) from our Hypertension outpatient
adult individuals aged between 18-35 years-old, preserved unit. To avoid potential confounders, we excluded
cognitive function (ability to understand and respond to patients with diabetes, smokers or significant chronic

Sleep Sci. 2020;13(Supl.1):1-118

17
kidney disease (estimated glomerular filtration rate <45 To scrutinize the reliability properties of the Brazilian
mL/min). All patients underwent sleep monitoring version of the QSQ ― specific health-related quality
with portable sleep monitor (Embletta Gold®) for of life instrument for OSA. Methods: This is a cross-
the diagnosis of OSA. We defined OSA by an apnea- sectional study that included 125 OSA patients (AHI ≥
hypopnea index (AHI) ≥15 events / hour. The patients 5) in whom QOL was measured by using the Brazilian
also performed other procedures including office blood version of the QSQ. Reliability was assessed by item-
pressure (BP), ambulatory BP monitoring (ABPM) and to-total correlation (the correlation of the item to the
transthoracic echocardiography. After performing the domain summated score) and by internal consistency with
proposed procedures, the patients were divided into four Cronbach’s alpha. Finally, a sub-sample (n=26) was used
groups: patients with NRH without OSA (NRH-OSA); for the analysis of test-retest stability.Results: The item-
patients with NRH with OSA (NRH+OSA); patients with to-total analysis demonstrated good correlation between
RH without OSA (RH-OSA) and patients with RH with all the items and the scores of their related domains. Item
OSA (RH+OSA). All analyses were performed without 25 “loud snoring” and the domain “nocturnal symptoms”
previous access to OSA and RH status. We compared the demonstrated the lowest correlation (Pearson’s r 0.53; p
BP and echocardiograph data using analysis of variance < 0.001) whilst “daily symptoms” domain and the item
(ANOVA).Results: We initially screened 248 patients. So 17 “feeling decreased energy” presented the highest
far, 50 subjects (mean age: 54±8 years old, 60% female, correlation (Pearson’s r = 0.89; p < 0.001). Global internal
body mass index: 29.8±4.0 kg/m²) were included in the consistency was excellent (Cronbach’s alpha 0.95) and
analysis. As expected, patients with RH took more anti- internal consistency within each domain ranged from 0.67
hypertensive medications than NRH but no significant for “social interaction” to 0.93 from “diurnal symptoms”.
differences were observed in patients with and without Test-retest intraclass correlation coefficients for each
OSA. In patients with RH (n=24), the presence of OSA domain were: daytime sleepiness, ICC = 0.86; diurnal
(58%) was associated with a strong tendency towards a symptoms, ICC= 0.86; nocturnal symptoms, ICC=0.81;
higher frequency of LVH (RH+OSA: 92% vs. RH-OSA: social interactions, ICC=0.74; and emotions, ICC=0.55.
50%, p=0.05). This finding was not observed in patients Conclusions: The research provided evidence for the
with NRH (NRH+OSA: 31% vs. NRH-OSA: 33%, reliability of the Brazilian Version of the QSQ. Additional
p=1.00). Data from office BP measurements and ABPM studies will be needed in order to assess the validity of the
did not show significant differences in patients with and instrument.
without OSA regardless of RH status. Conclusions: Our Palavras-chave: Obstructive sleep apnea, quality of life, questionnaires.

preliminary data suggest that the presence of OSA may

contribute to higher cardiac remodeling in patients with ID: 641
RH. Clinical Studies
Palavras-chave: Obstructive Sleep Apnea, Hypertension, Target Organ Damage, Left Ventricular Hypertrophy, Blood Pressure.

ID: 638
Clinical profile of a type 1 narcoleptic
population from a Brazilian tertiary outpatient
Clinical Studies clinic
Quebec Sleep Questionnaire: Reliability of Huebra, L, Frange, C, Coelho, F M S
the Brazilian Version of a Specific Quality-of-
Universidade Federal de São Paulo - São Paulo - Sao Paulo - Brasil
life Instrument for Obstructive Sleep Apnea
Introduction: Narcolepsy type 1 is a rare pleomorphic
MELO JR, J T, MAURICI, R, PIZZICHINI, M M M, disease with generally difficult and late diagnosis, especially
PIZZICHINI, E in emerging countries. We present a clinical profile of
Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas (Nupaiva), a sample of type 1 narcoleptic patients from a large
Universidade Federal de Santa Catarina - Florianópolis - Santa Catarina Brazilian center and its peculiarities. Aim: Our purposes
- Brazil were to identify general clinical aspects of our Brazilian
narcolepsy patients and to evaluate the sleep quality of our
Introduction: Obstructive Sleep Apnea (OSA) is a highly narcoleptic patients, in addition to determine the severity
prevalent disease and is associated with significant impact of the narcoleptic symptoms. Secondarily we aimed to
on patient’s quality of life (QOL). As such, reliable and characterize the treatment in use (anticatapletics and
valid instruments for the assessment of QOL in OSA stimulants). Methods: Physical examination and evaluation
are necessary. The Quebec Sleep Questionnaire ― QSQ of the medical records of 51 patients with a stablished
― is the only instrument adapted to Brazilian Portuguese diagnosis of type 1 narcolepsy. Also we applied clinical
for the measurement of QOL in OSA patients. Aim: sleep scales: Epworth Sleepiness Scale (ESS), Pittsburgh

Sleep Sci. 2020;13(Supl.1):1-118

 18

Sleep Quality Index (PSQI) and Narcolepsy Severity Scale Kyoto); 2) Control - CTRL (SHR); 3) SHR PE; 4) SHR
(NSS). Results: The majority (58,8%) of the patients PE + PPX; 5) SHR PPX. The tratament of control group
was female. The mean age at the time of the evaluation and PE group consisted of saline vehicle. PE + PPX and
was 36.74 ± 12.48, and the mean age at the beginning of PPX groups received a dose of 0.125 mg / kg. The PE was
follow-up in our service was 32.87 ± 12.45. Mean ESS was performed on a treadmill, with 5 sessions per week lasting
15.7 + 5.4, PSQI 11.76 + 4.17 and NSS 33.92 + 11.32. 1h (moderate intensity). The intervention lasted 4 weeks.
Despite an unfavorable treatment profile, with only 31.4% Gene expression analyzes were performed on the striatum
using both stimulant and anti-catapletic antidepressant, by qPCR. Data were analyzed by Statistica software. The
the severity of the patients was not directly corelated with effect size was calculated using the Hedges g formula.
the use of medications or not. We observed high index Results: The results of the PTPRD gene characterization,
of overweight 27.3% and obesity 56.8%, with the mean although not significant, showed that SHR CTRL animals
body mass index (BMI) of 32.87 + 12.34 and abdominal demonstrated to express lower levels of transcript of this
circumference 98.3 + 18.89. There was a correlation of gene compared to Wistar-Kyoto group. Regarding the
BMI with the PSQI (Pearson 0.384), but there was no comparison of the other genes between the SHR CTRL and
correlation with ESS (Pearson 0.008) and NSS (Pearson Wistar-Kyoto groups, it was observed that the SHR CTRL
0.056). Of our patients, 56.9% experienced bad dreams animals showed a significantly lower reduction (p = 0.05) in
or nightmares more than once a week. Conclusions: Our the DAT gene expression. In addition, it was observed that
observed narcolepsy population presents clinical severity the SHR PE + PPX group showed a tendency (p = 0.07;
higher than that found in the literature, but not directly g = 0.75) of higher TH gene expression compared to the
related to the therapeutic regimen in use. We observed a SHR PPX group. Although not statistically significant, the
high rate of overweight and obesity corelated with general SHR PE + PPX (g = 0.25) and SHR PPX (g = 0.25) groups
bad sleep quality. Oniric symptoms were more frequent in showed increased PTPRD gene expression, while the SHR
narcolepitc patients than general population in our study. PPX (g = 0.5) group showed increased levels of DAT gene
Palavras-chave: Narcolepsy type 1, clinical profile, severity
expression. Conclusions: It is suggested that reduced
levels of PTPRD gene transcripts in SHR animals may be
ID: 642 associated with RLS. In addition, PE in combination with
Basic Research PPX, as well as PPX alone, suggest to increase levels of
SPI-related protein gene expression.
Effect of exercise and pramipexol on gene Palavras-chave: Dopamine; PTPRD; Non-pharmacological treatment; Pharmacological treatment.

expression of proteins associated with restless ID: 643

legs syndrome in shr rats
Case Reports
Morais, M A, Franco, B S, Holanda, A S S, Freitas, S M, Torsoni,
A S, Esteves, A M
Sleep extension, performance and heart
autonomic modulation: brazilian paralympic
Faculdade de Ciências Aplicadas/UNICAMP - LIMEIRA - Sao Paulo
- Brasil
athlete, world record holder
Introduction: Restless Leg Syndrome (RLS) is a Pancotto, H P, Barboza, C d A, Ministro, G, Silva, S B, de Mello,
sleep-related movement disorder characterized by an M T, Silva, A, Narciso, F, Rodrigues, B, Misuta, M S, Esteves, A M
uncontrollable desire to move the body (legs) to relieve Universidade Estadual de Campinas - Campinas - Sao Paulo - Brasil
uncomfortable sensations. Changes in dopaminergic
transmission, as well as variations in PTPRD (Protein Introduction: In high performance sports, frequent
Tyrosine Phosphatase Receptor Type Delta) gene exposure to high intensity training programs and
expression may be associated with RLS. Its treatment competitions increases the need for recovery and
may be pharmacological or non-pharmacological. Aim: therefore may increase the overall sleep demand and affect
This study aims to characterize PTPRD gene expression physiological adaptations. Aim: Considering the growing
in SHR (Spontaneously Hypertensive Rats) animals; to body of evidence suggesting that sleep extension may aid
compare PTPRD, dopamine transporter (DAT), tyrosine improvements in reaction time and overall assessments of
hydroxylase enzyme (TH) and dopaminergic receptor (DA- physical and mental well-being, the aim of the study was
2) gene expression between Wistar-Kyoto and SHR rats to analyze the effect of sleep extension (25% of total bed
(control), and to verify the influence of pramipexole (PPX) time). On performance parameters and cardiac autonomic
and physical exercise (PE) treatment on gene expression modulation of the Brazilian swimmer, visually impaired
of these proteins in SHR animals. Methods: The rats (S13), world record holder and medalist at Parapan-
were distributed in 5 groups: 1) Standard control (Wistar- Americans of Lima, in 2019. Methods: Data collection

Sleep Sci. 2020;13(Supl.1):1-118

19
was performed at the Brazilian Paralympic Center. Tha actigraphy. This work is a pilot study that aims to adequate
actigraphy (10 days baseline and 7 days extension), was instruments and procedures used in the full study. Aim:
used for sleep analysis, considering total sleep time, latency, to execute a pilot study, through actigraphy, in order to
efficiency and awake period after sleep onset (WASO). The optimize the collection and registering of data. Methods:
sleepiness questionnaires (Epworth and Karolinska) and The study was submitted and approved by the Commitee
the sleep quality questionnaire (Pittsburgh-PSQI) were of Ethics and Research. From the list of students enrolled
applied. Autonomic modulation analysis was performed from the 1st to the 12th semesters, 50 students were
from the beat-to-beat photoplestimography record and randomly drawn and invited, by e-mail, to take part in the
the performance analysis (50 meters at maximum speed) research and were communicated about the procedures to
considering the total time at 50m and the reaction time. schedule a visit to wear the actigraph. In the scheduled
Results: The results indicated that the athlete had a date, the participants received the necessary instructions
positive PSQI score (7) and had a sleep extension of 28% and were notified to take notes of complications or of the
of total bed time. In addition, at sleep extension there was need to remove the device before the scheduled hour. The
a reduction in sleep latency (12%), WASO (30%) and an actigraph was to be worn for 7 days.Results: No replies
increase in sleep efficiency (7.4%). Regarding sleepiness, were obtained from the invitations sent by e-mail, so it
the scores were lower during the period of sleep extension was necessary to invite presentially with nominal listing of
(Epworth: basal (8); extension (7) and Karolinska: basal interested subjects. The main difficulty was the absence
(2); extension (1). Considering performance results and of recorded data. From the total sample (50), we did not
modulation variables, in the sleep extension period, obtain data from 14 participants (28%). Norms of use by
there was an increase in RR pulse interval (5.4%), as well the manufacturer were followed. This impass engendered
as a reduction in sympathetic modulation (LF - 54.4%) an adaptation in the aforementioned norms for this study,
and sympathovagal balance (LF / HF). 86.85%). No namely the sequential deactivation and reactivation of
changes in blood pressure variability and total reaction the software in subsequent placements. Conclusions:
time were identified. Conclusions: In this context, the we realized that an additional phase is necessary, based
results suggest that sleep extension had positive aspects in on the frequency in which the actigraph was used in this
sleep and autonomic modulation variables, not indicating pilot study involving multiple volunteers in a sequentially.
changes in time of total reaction. This additional phase is not necessary when the evaluation
Palavras-chave: Sleep Extension. Heart Rate Variability. Athletes. Visual Impairment. Performance.
is done less frequently. The adaptations made will be
useful in the definitive data collection (in the full study).
ID: 646 Considering that Medical school is highly demanding, the
Clinical Studies sleep evaluation done in the full study will be able to guide
and aid these future health professionals.
Adaptation of the use of actigraphy for the Palavras-chave: actigraphy, medical students

study of the sleep-wake cycle in undergraduate ID: 647

medicine students: a pilot study
Clinical Studies
Vicentini, S C, Tailor, L F B, Costa, O D G, Aguiar, F C, Gomes,
P H d C, Dias, A F C F R, Oliveira, L M P, Garcia, A S, Santos,
Sleep-wake cycle in newborns monitored with
F, Rocha, E D amplitude integrated electroencephalography
Universidade Federal do Estado do Rio de Janeiro - RIO DE JANEIRO Rodrigues, D P, Avelar, A F M, Variane, G F T, Pietrobom, R F R,
- Rio de Janeiro - Brasil Netto, A, Tafner, L, Magalhães, M
Introduction: Actigraphy is a diagnostic method to Division of Neonatology, Department of Pediatrics, Irmandade da
evaluate disturbances in the sleep-wake cycle. It provides Santa Casa de Misericórdia de São Paulo - São Paulo - Sao Paulo -
data about sleep in the natural environment of an Brasil, Division of Neonatology, Grupo Santa Joana - São Paulo - Sao
individual through the parameters: subjective latency of Paulo - Brasil, Neonatal Unit, Sociedade Beneficente Israelita Brasileira
night sleep, time of onset and ending, WASO (Wake After Hospital Albert Einstein - São Paulo - Sao Paulo - Brasil, Nutrition
Sleep Onset), number of night awakenings, total time Department, Centro de Pesquisas Clínicas – CPClin - São Paulo -
in bed in minutes, total time of night sleep in minutes Sao Paulo - Brasil, Pediatric Nursing Department, Escola Paulista de
and sleep efficiency. It’s done through an accelerometer Enfermagem, Universidade Federal de São Paulo - São Paulo - Sao
called actigraph. Sleep-wake cycle alterations common Paulo - Brasil, Protecting Brains and Saving Futures Organization - São
in individuals who are exposed to stressful situations, Paulo - Sao Paulo - Brasil
such as medical students, a group subject to physical
and/or mental disturbances, may be measured through Introduction: The incidence of impaired outcomes in

Sleep Sci. 2020;13(Supl.1):1-118

 20

neonates at high risk for brain injury is high and represents Morelhão, P K, Andersen, M L, Gobbi, C, Grande, G D, Damato,
a challenge in neonatal care. Amplitude-integrated T M, Sanches, C S, Aoyagi, G A, Tufik, S, Franco, M R, Pinto,
electroencephalography (aEEG) consists in a non- RZ
invasive, bedside and simplified method of continuous Centro Universitário - Belo Horizonte - Minas Gerais - Brasil,
brain monitoring, which is used to access brain function in Universidade do Oeste Paulista - Presidente Prudente - Sao Paulo
NICU. Sleep-wake cycle (SWC) is a marker for neurological - Brasil, Universidade Estadual Paulista Júlio de Mesquita Filho
development and the onset helps to determine a prognostic - Presidente Prudente - Sao Paulo - Brasil, Universidade Federal de
factor in newborn. Precise evaluation and early diagnosis Minas Gerais - Belo Horizonte - Minas Gerais - Brasil, Universidade
of brain injury plays is important to prevent neurological Federal de São Paulo - São Paulo - Sao Paulo - Brasil
impairment, and the brain monitoring with aEEG can
give information about neurological status and prognosis. Introduction: For healthy aging, the regular practice of
Data from SWC in wide groups of infants is still scarce. physical activity has been indicated as it generates further
Aim: To describe the indication of brain monitoring using health benefits. However, it is unknown in a single cohort
aEEG and to identify SWC in newborns at high risk for if physical activity domains can predict improvement in
brain injury. Methods: We analyzed the database from a sleep quality and clinical outcomes in the elderly with low
private company that works with remote and centralized back pain. Aim: To verify the predictive ability of physical
brain monitoring using aEEG in 20 hospitals in Brazil. activity domains on sleep quality in older adults with low
Monitored infants from July 2017 up to June 2019 were back pain. Methods: Older adults with low back pain
included in this study. We identified SWC and classified were recruited and assessed through a home interview at
it into present or absent. The indications for brain baseline and after 6 months. This was a longitudinal study
monitoring with aEEG were identified and SWC was with a 6-month follow-up. Multivariate linear regression
analyzed in each group of indication. Statistical analysis was analyses were performed to verify whether the levels of
descriptive, and data was presented according to absolute physical activity in leisure time, sports and household tasks,
and relative frequency.Results: A total of 1639 patients measured by the Baecke Physical Activity Questionnaire
were analyzed, 59% were male and 67% were caesarean Modified for the Elderly, predict an improvement on sleep
section. According to the indication for brain monitoring, quality at 6 months follow-up. The analysis was adjusted
was found 335 (20%) of suspected seizure, 274(17%) of by the following covariates: age, gender, body mass index
asphyxia + therapeutic hypothermia(TH), 166(10%) of (BMI), mental state, depression, comorbidities, and
previous seizure, 142(9%) of neonatal anoxia, 127(8%) somnolence.Results: A total sample of 231 older adults
extreme prematurity, 115(7%) asphyxia >35weeks, 91(6%) with low back pain were included, between March 2017
congenital heart disease(CHD), and 389(24%) of other 28 and December 2018, consisting of 177 (76.6%) women,
different indications. The SWC was present in 774(47,2%) mean age of 71 years. Final regression models showed no
of the total of newborns, being 160(47,8%) of newborns evidence of association between the domains of baseline
with suspected seizure, 129(47,1%) asphyxia + TH, physical activity with sleep quality at 6 months follow-up,
69(41,6%) previous seizure, 90(63,4%) neonatal anoxia, domestic, sports, and leisure. Conclusions: Our findings
36(28,3%) extreme prematurity, 67(58,3%) asphyxia suggest that the different domains of physical activity do
>35weeks, 16(17,6%) CHD, and 207(53,2%) other not influence the sleep quality in older adults with low
indications. Conclusions: Absence of SWC was common back pain at 6 months follow-up.
in the population, as we found presence of SWC in less Palavras-chave: physical activity, sleep, older adults

than 50% of newborns, and this varied according to the

clinical condition. The group of extreme prematurity ID: 650
and CHD showed the major absence of SWC. Brain
monitoring allows real time access to the brain function Clinical Studies
and SWC, which may be related with neurodevelopmental
outcomes. Newborns undergoing therapeutic hypother-
Palavras-chave: Neonates, amplitude-integrated electroencephalography, sleep-wake cycle
mia: a relationship between sleep-wake cycle,
ID: 649 amplitude-integrated electroencephalography
background activity and seizures
Clinical Studies
Rodrigues, D P, Avelar, A F M, Variane, G F T, Pietrobom, R F R,
The domains of physical activity are not able Netto, A, Tafner, L, Magalhães, M
to predict sleep quality in older adults with
Division of Neonatology, Department of Pediatrics, Irmandade da
low back pain: A longitudinal study Santa Casa de Misericórdia de São Paulo - São Paulo - Sao Paulo -
Brasil, Division of Neonatology, Grupo Santa Joana, - São Paulo - Sao

Sleep Sci. 2020;13(Supl.1):1-118

21
Paulo - Brasil, Neonatal Unit, Sociedade Beneficente Israelita Brasileira ID: 652
Hospital Albert Einstein - São Paulo - Sao Paulo - Brasil, Nutrition
Department, Centro de Pesquisas Clínicas – CPClin - São Paulo - Clinical Studies
Sao Paulo - Brasil, Pediatric Nursing Department, Escola Paulista de
Enfermagem, Universidade Federal de São Paulo - São Paulo - Sao Can sleep quality be associated with falls in
Paulo - Brasil, Protecting Brains and Saving Futures Organization, - older adults? A cross-sectional study
São Paulo - Sao Paulo - Brasil
Kakazu, V A, Anderesn, M L, Gobbi, C, Tufik, S, Pinto, R Z,
Introduction: Hypoxic-ischemic encephalopathy (HIE) Franco, M R, Medoruma, A M, Aoyagi, G, Matos, Y, Morelhão,
affects 3 to 20/1000 live births and is an important PK
cause of neonatal mortality and morbidity. Therapeutic
Universidade Estadual Paulista Julio de Mesquita Filho - Presidente
hypothermia (TH) is a standard therapy for newborns
Prudente - Sao Paulo - Brasil, Universidade Federal de Minas Gerais
with HIE, showing reduction of mortality and major
- Belo Horizonte - Minas Gerais - Brasil, Universidade Federal de São
neurodevelopmental disability. Amplitude integrated
Paulo - São Paulo - Sao Paulo - Brasil
electroencephalography (aEEG) provides continuous
observation of brain activity and allows the assessment Introduction: Falls in older people is a public health
of brain injury and adverse outcomes. Sleep-wake cycle problem that impacts the functionality of this population.
(SWC) is considered a marker for neurological wellbeing It is still not clear in the literature whether poor sleep
and the onset on aEEG is important to determine a quality constitutes as a risk factor for falls in older adults.
prognosis. Aim: To identify the SWC and to describe the Aim: To investigate whether sleep quality is a risk factor
association with aEEG background activity and presence for falls in the elderly. Methods: The participants were
of seizures in newborns undergoing TH. Methods: interviewed at home. Only individuals over 60 years
We analyzed the database from a private company that old and who had good cognition were included. The
works with brain monitoring of newborns with aEEG sleep quality was assessed by the Pittsburg Sleep Quality
at 20 hospitals in Brazil. Newborns undergoing TH Index Questionnaires and the Center for Epidemiologic
from July 2017 up to June 2019 were included in this Studies Depression scale (CSES-D) was applied to assess
study. SWC was categorized as present or absent, aEEG depression. Participants reported the presence or absence
background activity was categorized as pathological and of falls in the past year. Anthropometric and demographic
non-pathological, and seizure activity was categorized as variables were also obtained.Results: The final sample
present or absent. We observed the association between the of this study included 513 participants. Among them,
SWC and aEEG background activity, and the association 324 (63%) reported falls after 60 years and 183 (35.6%)
between the SWC and seizures. Data will be presented fell in the last year. According to the logistic regression
according to absolute and relative frequency.Results: 274 analysis, older people who have poorer sleep quality are
patients were included in this study, 164(59,8%) were male 8% more likely to have a fall in the last year. Age also
and 138(50,4%) were born by caesarean section. SWC was contributed to falls. Every 1 year of age, the chance of a
present in 129(47%) of monitored infants. Pathological fall increased by 3%. Conclusions: Poor sleep quality was
aEEG background activity was shown in 110(40,1%), and a risk factor for falls in the elderly, even after controlling
95(34,7%) had the presence of seizures. The majority (76; for covariates. Therefore, health professionals need to be
80%) of seizures were subclinical, 15(15,8%) were clinical aware of the sleep quality of their patients over 60 years.
and 4(4,1%) were clinical + subclinical. In newborns with Sleep assessment should be included in their conducts,
SWC absent, pathological aEEG background activity as sleep impairment can negatively impact, not only the
was identified in 90(62%). In contrast, when the SWC quality of life, but also contribute to falls, generating even
was present, pathological aEEG background activity more spending for the public health system.
was shown in only 20(16%) of newborns. Seizures were Palavras-chave: Falls, Sleep, Older adults

present in 57(39%) when SWC was absent, but seizures

were present in 38(29%) when the SWC was present. ID: 653
Conclusions: More than half of newborns at high risk
for brain injury had SWC absent. The importance of Case Reports
brain monitoring was demonstrated since most diagnosed Anti-IgLON5 subclass IgG1 disease: case
seizures were subclinical and detected only because of
aEEG monitoring. Absence of SWC was more common report
in newborns with pathological aEEG background activity
Huebra, L, Oliveira, M B, Ventura, L M G B, Torretta, P H B,
or seizures. Newborns with abnormal aEEG and seizures
Simabukuro, M M
have alteration in the SWC.
Palavras-chave: Newborns, therapeutic hypothermia, amplitude-integrated electroencephalography, sleep-wake cycle, seizures
Universidade de São Paulo - São Paulo - Sao Paulo - Brasil, Universidade
Federal de São Paulo - São Paulo - Sao Paulo - Brasil

Sleep Sci. 2020;13(Supl.1):1-118

 22

Introduction: A number of autoantibodies are recently management of Obstructive Sleep Apnea (OSA) is shown
being associated with sleep disorders. In the last 5 years, to present better efficacy in mild to moderate patients.
cases of a novel tauopathy associated with IgLON5 The last clinical practice guidelines recommend that
antibodies are being recognized in patients with obstructive sleep physicians prescribe OA for adult patients who are
sleep apnea, stridor, REM sleep disorders, bulbar intolerant of CPAP therapy or prefer alternate therapy.
symptoms and dysautonomia. Anti-IgLON5 subclass OA treatment can present some dental side effects, mainly
IgG1 and IgG4 are related to the disease, but its phenotype through prolonged use. Since it is a long-term treatment, it
differences are not known yet. Aim: To report a case of is mandatory to follow-up patients in terms of treatment
Anti-IgLON5 disease with the less common subclass efficacy and side effects. Aim: Report a case of severe
IgG1 antibody. Methods: Several clinical evaluations OSA patient successfully treated with OA, and the long-
and follow-up of the patient.Results: A 75-year-old man term follow-up on dental side effects. Methods: MFS,
reported insomnia since 40 years old, followed later by 46 y. O., male, with complaints of snoring and excessive
snoring, and sleep fragmentation, being diagnosed at daytime sleepiness (EDS) was indicated for OA treatment.
age of 68 with moderate obstructive sleep apnea (OSA). Results: On baseline polysomnography (PSG), AHI
He presented severe symptomatic bradycardia, so it was 56.7 events/hour and total sleep time (TTS) with
was implanted a permanent pacemaker. By 70 years, the oxyhemoglobin below 90% was 3.6%. PSG with CPAP
patient evolved with progressive dysphagia, dysarthria (8cm H2O) shown efficacy (AHI=4.7 events/hour) and
and nocturnal laryngeal stridor. Otorhinolaryngological 0.7% of the TST with oxyhemoglobin below 90%, but he
evaluation showed vocal cord paralysis. After recurrent did not adapt to CPAP. He presented atresic hard palate,
pneumonia, he was submitted to tracheostomy that dental crowding and gyroversions, midline deviation,
occurred with laryngeal stenosis, treated with serial dental Class II, skeletal Class II, grade IV Mallampati,
dilations without improvement and later laryngectomy. grade I tonsils and absence of septal deviations. Patient
He also refers symptoms of restless legs syndrome, was submitted to an orthodontic radiographic and
REM sleep behavioral disorder (RBD), sleep talking, photographic documentation. From a total mandibular
and nocturnal myoclonus. No cognitive impairment or range of 14 mm, the OA was started with 4 mm and
extrapyramidal symptoms. From the diagnostic suspicion, titrated until 9 mm, with the improvement of snoring
we investigated and demonstrated HLA-DRB1* and and EDS. A PSG performed with OA shown AHI of
HLA-DQB1* in homozygosis and CSF analysis with 0.5 events/hour and no desaturation and no more snore
anti-IgLON5 subclass IgG1. Head CT without significant complaints. After one year of OA, the patient was keeping
abnormalities, polysomnography with low sleep efficiency, the successful results, but he presented the first side effects:
poor structured NREM sleep, severe OSA, PLMS, and an increase in mesialization of lower premolars. After
REM sleep without atonia. CPAP was titrated and initiated three years of use, he presented posterior bite opening,
to OSA control and clonazepam 0.5mg for RBD with good and four years later, more evident vestibularization of the
response. Submitted to 3 immunoglobulin cycles without lower incisors and lingualization of the upper incisors.
clinical improvement. Evolved with ophthalmoplegia. We Despite dento-occlusal alterations, the patient did not
prescribed rituximab and the patient responded with good present functional and/or aesthetic complaints and was
tolerance and had mild improvement of visual symptoms. satisfied with the treatment results. Conclusions: OA is
Conclusions: Anti-IgLON5 disease is a rare sleep an alternative treatment to severe OSA in patients who did
condition, which may develop sleep disordered breath, not accept CPAP. Despite the dental side effects observed,
bulbar symptoms, dysautonomia and gaze palsy. It is not the success of the treatment prevailed in the decision of
known yet whether subclass IgG1 and IgG4 antibodies continuity by the patient.
lead to clinical different diseases. Palavras-chave: Obstructive Sleep Apnea, Oral Appliance, side effects

Palavras-chave: IgLON5, autoimmunity, tauopathy

ID: 655
ID: 654
Clinical Studies
Case Reports
Rhythmic masticatory muscle activity
Oral Appliance Dental Side Effects in Severe (RMMA) index does not decrease with age,
Obstructive Sleep Apnea – A Case report conversely to self reports of sleep bruxism:
Sguillar, A G S, Oliveira, S M, Balsalobre, R, Sguillar, D A, Dal-
data from sleep laboratories of 3 continents
Fabbro, C
Dal Fabbro, C, Rompré, P, Kato, T, Maluly Filho, M, Haraki, S,
Instituto do Sono - São Paulo - Sao Paulo - Brasil Toyota, R, Shiraishi, Y, Andersen, M L, Tufik, S, Lavigne, G

Introduction: Oral Appliance (OA) as a clinical CIUSSS Nord Ile Montreal, CEAMS - Canadá, Instituto do Sono - São

Sleep Sci. 2020;13(Supl.1):1-118

23
Paulo - Sao Paulo - Brasil, Osaka University - Japão, UNIFESP - São Case Reports
Paulo - Sergipe - Brasil, Université de Montréal - Canadá
Speech Therapy Performance in OSAS Patients
Introduction: Prevalence of Sleep bruxism (SB) self- and the Contribution to CPAP Beginners Use
report decrease with age. There are no studies assessing
prevalence of rhythmic masticatory muscle activity Blank, J P
index (RMMA)/hr, one of the SB biomarker scored
on PSG. We hypothesize the RMMA index will follow Hearing Center Audfono Company - Araraquara - São Paulo - Brasil
the same trajectory as self-reports. Aim: Describe the
Introduction: A person with OSAS obstructive
RMMA prevalence according to age in clinical and
Sleep Apnea Syndrome usually comes to the office
epidemiological populations of three sleep laboratories.
complaining of snoring, choking and frequent waking
Methods: Retrospective analyses of PSG-RMMA sleep
up with breathlessness and excessive tiredness during the
laboratory data were collected in 3 centers (Montreal,
day. And we know that most patients who are referred
Canada; Osaka, Japan; Sao Paulo, Brazil). SB subjects (18-
for CPAP ContinuousPositiveAirwayPressure use have
70 y. O.) were recruited: for experimental-physiological
poor performance and adherence. Speech therapy is
studies (Montreal, Osaka (M&O sample)), and from a
necessary to adapt the breathing posture training for the
general representative population sample (Sao Paulo-
physiological and functional strengthening of organs of
EPISONO study (SP sample)). The n was 428 subjects:
the oro pharyngeal region and speech therapy intervention
159 SB and 169 controls. PSG data from second night in
in mouth breathing syndrome and temporomandibular
M&O sample and first night in SP sample were analyzed.
disorders which influence the use of CPAP. The speech
RMMA episodes were scored based on AASM criteria.
therapy work was essential to the success of the treatment.
Distribution of RMMA/h, below/over 40 yo. were
Aim: The adequate therapeutic effect on OSAS and
analyzed with linear regression according to cut off index
adherence to CPAP use,was the objective in this case
(< and => 2/hr) for control and SB subjects. Analyses were
study. Methods: 60 year old patient; BMI:23,2; Women.
done: with clinical diagnosis (+ tooth grinding history &
Complaint:Frequent headaches; strong snores; daytime
PSG) and only with PSG cut off RMMA index.Results:
tiredness. Speech Therapy exercises for the adaptation
Data from M&O sample revealed decrease in RMMA
of aero-dynamic forces; myofunctional exercises; nasal
index prevailing in subjects below 40 yo. with the Pearson
breathing training using nasal mask and CPAP therapy
analysis for SB subjects (R2=0.048, p=0.015; explaining
to adjust pressure level in 7-10cmH2O was defined on
4.8% of variability) and with a decrease Spearman for both
titration polysomnography and is the pressure needed
controls and SB subjects (Rho=-0.249, p=0.009; Rho=-
to supply sleep apnea. Monitoring the results of CPAP
0.193, p=0.03). The overall age analysis did not reveal any
use for 30 days; 3 months and 6 months.The patient was
global decrease in RMMA index for either control and SB
instructed to maintain the same spontaneous breathing
subjects with Pearson analysis, although a significant but
rhythm avoiding trying to follow the CPAP rhythm.
marginal decrease with Spearman for controls only was
Relaxation and the use of habitual breathing reassures the
seen (Rho=-0.287, p< 0.001). Taking in consideration the
patient and avoids discomfort and shortness of breath.
PSG RMMA index cut-off alone, < 2 or =>2: - In the
Results: Already after the 10 sessions of speech therapy,
M&O sample, a mild drop in RMMA index for all ages
she was able to use CPAP. Comparing the exam rates
for the < 2 group was significant (R2=0.085, p< 0.001;
we have: Polysomnography1:AHI:58,5 events per hour;
Rho: -0.34, p< 0.001), which explains 8.5% of variability
Polysomnography2 with CPAP: AHI: 16,2 events per
in RMMA index drop (0.8 to 0.3 RMMA/h from 20 to 60
hour; Treatment Compliance Report 90 days:AHI:1,1
yo.). This effect was again positioned in the group below
events per hour.Guidelines on sleep hygiene + CPAP use
40 yo. (Rho=-0.264, p=0.01). With the RMMA/hr =>
was important to get positive results to snoring. During the
2, a nonsignificant rise (4.5 to 6.0 RMMA/h) was noted
treatment the patient showed satisfaction with the results.
between 20 and 60 yo. without age effect. - In the SP
Conclusions: Comparing the polysomnography exams it
sample, the RMMA index < 2 also did not reach significant
can be seen that the apnea and hypopnea index using CPAP
value; with the RMMA episode/hr =>2, a nonsignificant
decreases but still maintains a moderate level change in
35% rise (+1.7 RMMA/h) between 20 and 70 yo. was
AHI16,2 events per hour. Concluding that through speech
noted. Conclusions: Contrary to the decrease of SB
therapy sleep monitoring we achieved treatment sucess as
self-reports with aging, the PSG-RMMA index remained
found in the treatment compliance report demonstrating
relatively stable over ages. It remains to be investigated if
an AHI 1,1 events per hour. Effective treatment and
presence of critical sleep conditions, e.g., insomnia and
adherence to CPAP requires myofunctional therapy
apnea, influence or bias how patient respond to SB self-
follow-up and monitoring. The adaptation to CPAP and
report surveys.
Palavras-chave: Sleep Bruxism, Prevalence, rhythmic masticatory muscle activity index (RMMA), Polysomnography
the fall in apnea and hipopnea events return the patient to
health and disposition daily.
ID: 656 Palavras-chave: apnea; snoring; cpap therapy; sleep therapy

Sleep Sci. 2020;13(Supl.1):1-118

 24

ID: 658 ID: 659

Clinical Studies Clinical Studies
Effect of a high-protein meal during a night Obstructive sleep apnea syndrome prior to
shift on food perceptions and dietary intake stroke: a risk stratification study
the following day according to chronotype: a
da Silva, P V, Lin, J, Scarlatelli-Lima, A V
randomized crossover study
Universidade do Sul de Santa Catarina - Florianópolis - Santa Catarina
Teixeira, G P, Silva, C M, Cunha, N B, Mota, M C, Teixeira, K R, - Brazil
Crispim, C A
Introduction: The prevalence of obstructive sleep apnea
Universidade Federal de Uberlândia - Uberlândia - Minas Gerais - syndrome (OSAS) in the general population is 3-7%, while the
Brasil prevalence of OSAS in patients who have had stroke is 30 to
70%. Since stroke affects 16.9 million people each year and
Introduction: Nutritional strategies are needed to promote
is the second leading cause of death worldwide, prevention
healthy food choices and thus avoid weight gain in night
of its risk factors such as systemic arterial hypertension is
workers. These strategies should consider chronotype - a
important. Since OSAS is an under diagnosed risk factor for
variable associated with food choices of different populations.
stroke and an independent risk factor for hypertension, which
However, this subject is little explored among shift workers.
increases the risk for stroke by 3 to 4 times, the aim of this
Aim: The aim of this study was to compare the acute effect
study was to apply validated scales in the literature for OSAS
of a high-protein (HP) versus normal protein (NP) meal
screening. Aim: To evaluate the presence of OSAS through
served at night on the food perceptions and consumption
the STOP-BANG and SOS score questionnaires in patients
the following day in shift workers with different chronotype.
with ischemic stroke. Methods: Cross-sectional study. The
Methods: The study was conducted with 14 male nurses. After
study population consisted of individuals over 18 years of age,
being followed-up for 7 days before each night intervention
after acute stroke in the Hospital Nossa Senhora da Conceição,
in relation to eating and sleeping habits, participants
from September 2018 to February 2019 in the city of Tubarão
underwent two different isocaloric dietary conditions at 1:00
- SC. Data were obtained through the application of STOP
h of the night shift, with a 6-day washout period between
–Bang and SOS score scales, and a questionnaire on socio-
them: high-protein meal containing 45% carbohydrate, 35%
demographic profile prepared by the researchers was also
protein and 20% fat; and normal protein meal containing
applied. In addition, the area affected by stroke was evaluated
65% carbohydrate, 15% protein and 20% fat. Participants
through the first imaging exam performed after the patient’s
consumed a standardized breakfast with high carbohydrate
admission to the hospital.Results: 50 patients participated in
content. After that, they answered a food register including
this study and what could be observed was that the prevalence
food perception data of all food consumed at the moment
of OSAS risk by SOS score was 80%. According to the STOP-
and the following day of each condition. Chronotype was
Bang scale, 70% of the patients were classified as high risk and
calculated using the time of midsleep time adjusted for sleep
24% as intermediate risk. The percentage of men who were at
debt. Generalized estimating equations analyses were used
high risk for OSAS by the SOS score was 17.8% and women
to examine the effect of each meal test on food perception
22.7%. On the STOP-Bang scale, 85.7% for males and 50%
and consumption of energy and macronutrients. Results:
for females for OSAS risk. The relationship between systemic
Evening types enjoyed NP meal more than HP meal (9.37
arterial hypertension (HAS) and risk of sleep apnea was high
versus 7.75, respectively; p=0.025), and more than morning
on both scales. Conclusions: It was concluded that the studied
chronotype (9.37 versus 6.77, respectively; p=0.004). For
population had a high risk of OSAS assessed by STOP-Bang
evening types, satiety was better after NP meal compared
and SOS score and the association between OSAS and HAS
to HP meal (8.50 versus 6.75, respectively; p=0.032). For
was frequent, showing a high prevalence of hypertension in
standardized breakfast, evening types enjoyed more the meal
the studied population.
served after HP meal compared NP meal intervention (8.25 Palavras-chave: Systemic Arterial Hypertension, Stroke, Obstructive sleep apnea, STOP-Bang, SOS score.

versus 7.25, respectively; p=0.009). Evening types presented

a higher percentage of fat consumption after HP meal than ID: 660
after NP meal (32.4% versus 18.5%, respectively; p<0.001).
Conclusions: Different meal composition consumed at Basic Research
night influences the food consumption and perception the
following day in shift workers of different chronotypes. This Health perception, musculoskeletal pain and
study was supported by FAPEMIG and CNPq. insomnia in motorcycle taxi drivers from Rio
Palavras-chave: Food perceptions, chronotype, shift work, food intake.
Branco, Acre

Sleep Sci. 2020;13(Supl.1):1-118

25
dos Santos, E d S G, de Araújo, N C, de Souza, O F Avelar, A F M, Rodrigues, D P, Pietrobom, R F R, Netto, A,
Tafner, L, Magalhães, M, Variane, G F T
Instituto Federal de Educação, Ciência e Tecnologia do Acre e
Universidade Federal do Acre - Rio Branco - Acre - Brasil Division of Neonatology, Department of Pediatrics, Irmandade da
Santa Casa de Misericórdia de São Paulo - São Paulo - Sao Paulo -
Introduction: Background: Research has found evidence Brasil, Neonatal Unit, Sociedade Beneficente Israelita Albert Einstein,
of association between pain and insomnia. Motorcycle Hospital Albert Einstein - São Paulo - Sao Paulo - Brasil, Nutrition
taxi drivers are workers susceptible to musculoskeletal Department, Centro de Pesquisas Clínicas - CPClin - São Paulo -
pain and commonly report sleep impairment, difficulty Sao Paulo - Brasil, Pediatric Nursing Department, Escola Paulista de
sleeping or insomnia. Aim: Objective: To evaluate the Enfermagem, Universidade Federal de São Paulo - São Paulo - Sao
association between health perception, musculoskeletal Paulo - Brasil, Protecting Brains and Saving Futures Organization - São
pain and insomnia in motorcycle taxi drivers from Rio Paulo - Sao Paulo - Brasil
Branco, Acre. Methods: Methods: Cross-sectional study
with 296 male motorcycle taxi drivers from Rio Branco, Introduction: The incidence of impaired outcomes
Acre. The variables were obtained by applying structured in newborns at high risk for brain injury is high.
questionnaires. The insomnia report was investigated by Amplitude-integrated electroencephalography (aEEG) is
the question “Do you often have insomnia or difficulty a non-invasive, bedside and simplified method for brain
sleeping?”, from health perception “How do you rate monitoring to access brain function, presence of seizures
your health?”. The Nordic Musculoskeletal Questionnaire and sleep-wake cycle (SWC). The presence of SWC is
was used to survey musculoskeletal pain for the last 7 associated with a better prognosis for babies, this involves
days. Prevalence and prevalence ratios were calculated at a endogenous brain activity and has impact on cognitive,
significance level of 5%.Results: Results: The motorcycle psychomotor and behavioral development. Aim: To
taxi drivers had mean age of 39.4 years (SD 8.2, mim.19, describe SWC with aEEG background activity and presence
max.60), working average of 63.2 hours per week, 60% of seizures in newborns. Methods: Retrospective and
and 30% working 6 and 7 days a week, respectively. Among descriptive analysis of the database of a private company
the sample, 9.5% were smokers, 23.3% consumed alcohol, that works with brain monitoring of newborns with
37.5% were sedentary and 83.8% were overweight or obese. aEEG at 20 hospitals in Brazil. All monitored newborns
Still, 48% reported poor perception of health, 42.5% from July 2017 up to June 2019 were included in this
reported presence of musculoskeletal pain in the last 7 days study. SWC was categorized as present or absent, aEEG
and 22% reported having insomnia or difficulty sleeping. background activity was classified as pathological and non-
Among motorcycle taxi drivers with insomnia, 29.0% pathological, and the seizure was categorized as present
were unsatisfied with their health and 28.6% reported or absent. We described the concomitant occurrence of
musculoskeletal pain. Unsatisfied motorcycle taxi drivers SWC and aEEG background activity, and concomitant
were 1.9 times (p = 0.013) more likely to report insomnia occurrence of SWC and seizures. The data was presented
when compared to those who reported health satisfaction. according to absolute and relative frequency.Results:
Similarly, those who reported musculoskeletal pain were In this study were included 1,639 newborns. SWC was
1.67 times (p = 0.039) more likely to report insomnia when present in 774(47.2%) newborns. The pathological aEEG
compared to those who did not report pain. In assessing background activity was shown in 442(27%), and 376(23%)
the association of musculoskeletal pain by body region, had the presence of seizures. Almost the totality (276;
motorcycle taxi drivers with wrist / hand pain were more 73.4%) of seizures were subclinical, 74(19.7%) clinical
likely to have insomnia (RP = 1.94, p = 0.044). Conclusions: and 29(7.7%) clinical + subclinical. In newborns with
Conclusion: The perception of health satisfaction and SWC absent (865; 52.8%) aEEG pathological background
the presence of musculoskeletal pain was associated with activity was shown in 378(43.7%). However, in the
insomnia in motorcycle taxi drivers in Rio Branco, Acre. pathological aEEG background activity was shown only
Health promotion actions should be applied to this group in 64(8.3%) when the SWC was present. At the absence
of workers in order to improve sleep quality by reducing of SWC, 244(28.2%) of the newborns had the presence
insomnia. of seizures, but when the SWC was present, 641(82.8%)
Palavras-chave: Insomnia. Pain. Health perception. Motorcycle taxi drivers.
did not have seizures. There was a difference of the aEEG
background activity between newborns with and without
ID: 661 SWC. Seizures were more common when SWC was
Clinical Studies absent. Newborns with brain dysfunction had alteration in
SWC. Conclusions: More than half of newborns at high
The relation of the sleep-wake cycle with risk for brain injury had absence of SWC. The importance
amplitude-integrated electroencephalography of brain monitoring was pointed when more than 70%
of diagnosed seizures were subclinical and detected only
background activity and seizures in newborns because of aEEG monitoring, this helped to guide the

Sleep Sci. 2020;13(Supl.1):1-118

 26

treatment and, possibly, improved the prognosis. Brain Costa, C C, Athayde, R A B, Leite, I C P R, Santos, C R B,
monitoring detects brain dysfunction, to screen for seizures Fernandes, G S, Barreto, R T S, Carvalho, T H F
and to assess the presence of SWC. Centro Universitário Pessoense - João Pessoa - Paraiba - Brasil
Palavras-chave: Newborns, sleep-wake cycle, amplitude-integrated electroencephalography, seizures

Introduction: Obesity Hypoventilation Syndrome (OHS)

ID: 665 is defined as the presence of obesity (BMI ≥ 30 kg/m²)
Case Reports and daytime arterial hypercapnia (PaCO2 ≥ 45 mmHg), in
the absence of other causes of hypoventilation. One third
Obstructive sleep apnea as a manifestation of of obese patients admitted to internal medicine services
relapsing polychondritis: case report may have OHS. OHS is often neglected or misdiagnosed
as other causes of hypoventilation, especially COPD. The
Fernandes, M D, Passini, V V, Lacerda, C B, Cano, T, Vasconcelos, importance of recognizing OHS is a high morbidity and
B S, Yanagimori, M, Uneda, C B, Genta, P R, Lorenzi Filho, G mortality, if not treated. Aim: We report a case of OHS in
which, despite previous treatment improvement, the lack of
Introduction: Relapsing polychondritis (RP) is a rare syndrome’s diagnosis led to further worsening. Methods:
connective tissue disease in which recurrent bouts of Case report. Results: Woman, 47 years-old, admitted in the
inflammation involve the cartilage of the ears, nose, larynx, ER due to dyspnea and cough with sputum. Her husband
tracheobronchial tree and cardiovascular system. The cause referred a history of snoring, nocturnal gasping and daytime
of RP is still unknown. It is considered an immune-mediated sleepiness. She had hypertension, was non-smoker, without
disease with an annual incidence around of 3.5 cases per previous respiratory symptoms or risk exposures. About 30
million. Aim: We report a 22 year-old woman complaining days before, presented an episode of progressive dyspnea,
of snoring and nocturnal stridor associated with occasional evolving to acute respiratory failure (ARF). In that moment,
awakenings and daytime sleepiness in the last 05 months. it was performed an early tracheostomy, with significant
Methods: The patient had a tracheal t-tube due to tracheal improvement and quick discharge from ICU. Nearly 9 days
stenosis. Stridor and snoring started after her t-tube was before, the tracheostoma was closed. She had respiratory
changed to a shorter cannula. Oropharyngeal inspection did distress and BMI = 50 kg/m² at the physical examination.
not show any findings suggesting the reason for her OSA: A case of pneumonia was diagnosed in the ward, and
Friedman stage 2, with tonsil size grade 1 and Mallampati antibiotics were initiated, with laboratorial improvement but
grade 1. Her body mass index was 18.5 kg/m², and her clinical worsening. As it evolved to ARF, the patient then was
awake oximetry was 98%.Results: Polysomnography showed transferred to the ICU. Previous arterial blood gas analysis
an of AHI: 103.1 events per hour, associated with reduced presented PCO2 = 52,4mmHg and Bicarbonate=29,7
sleep efficiency (44.3%) and a large wake after sleep onset mmol/L. There was a clinical and respiratory improvement
(WASO) time: 230.5 min. A Drug Induced Sleep Endoscopy just after intubation and mechanical ventilation, with PCO2
(DISE) was performed to identify the site of the obstruction. = 42,5mmHg. A tracheostomy was redone and was the
Respiratory flow was simultaneously recorded using a nasal treatment option due to social and healthcare limitations,
mask attached to a pneumotachograph (see video acessing being stable during the follow-up at the outpatient clinic.
QRcode). The patient underwent a spirometry that revealed Conclusions: We report an OHS case that underwent
a fixed inspiratory and expiratory obstruction. A thoracic CT tracheostomy due to ARF. After discharge, the tracheostomy
scan showed narrowing of the bronchial tree. During DISE, was reversed without any additional measures, which led to
obstruction at the level of the glottis was observed. The further worsening. The importance of identifying OHS is
velopharynx, oropharynx, tongue and epiglottis had a normal due to the high mortality in untreated patients. Treatment
appearance. A fibrotic aspect of lower airway distal to the aims to normalize ventilation during sleep. In 90% of
t-tube was observed. Conclusions: Due to the impossibility the cases, it is associated with Obstructive Sleep Apnea
of t-tube opening during sleep, CPAP was titrated to 8cmH2O. (OSA). Tracheostomy, the first treatment reported, is now
Obstructive events were abolished (residual AHI = 4.7 events considered a last option. The treatment of choice is the
per hour). After 30 days, the patient referred important quality use of continuous positive airway pressure (CPAP) as it
of sleep improvement and resolution of daytime sleepiness. mitigates obstructive events.
Palavras-chave: Obesity-Hypoventilation Syndrome, Tracheostomy; Diagnosis
Palavras-chave: Sleep obstructive apnea, relapsing polychondritis, CPAP

ID: 668 ID: 668

Case Reports Case Reports

Even when the treatment works, unknowledge Even when the treatment works, unknowledge
is a big problem: an obesity-hypoventilation is a big problem: an obesity-hypoventilation
syndrome case report syndrome case report

Sleep Sci. 2020;13(Supl.1):1-118

27
Costa, C C, Athayde, R A B, Leite, I C P R, Santos, C R B, patients with chronic obstructive pulmonary
Fernandes, G S, Barreto, R T S, Carvalho, T H F
disease
Centro Universitário Pessoense - João Pessoa - Paraiba - Brasil
de França Pereira Silva, M V, Lustosa Mattos, T C, Silva Clímaco,
Introduction: Obesity Hypoventilation Syndrome (OHS) D C, G Couto Silva Patriota, T L, Lins-Filho, O L, Rodrigues,
is defined as the presence of obesity (BMI ≥ 30 kg/m²) V K, Pereira de Oliveira Neto, L D a, Magalhães, J A, Pinho
and daytime arterial hypercapnia (PaCO2 ≥ 45 mmHg), in Queiroga Júnior, F J, Pedrosa, R P
the absence of other causes of hypoventilation. One third
of obese patients admitted to internal medicine services PROCAPE - Recife - Pernambuco - Brasil
may have OHS. OHS is often neglected or misdiagnosed Introduction: Portable polysomnography (PSG) has
as other causes of hypoventilation, especially COPD. The been used to diagnose obstructive sleep apnea (OSA)
importance of recognizing OHS is a high morbidity and in several populations. However, its use has not been
mortality, if not treated. Aim: We report a case of OHS in validated in patients with chronic obstructive pulmonary
which, despite previous treatment improvement, the lack of disease (COPD) and OSA. The objective of the study was
syndrome’s diagnosis led to further worsening. Methods: to validate portable PSG (ApneaLink plus ™, ResMed,
Case report. Results: Woman, 47 years-old, admitted San Diego, CA, USA) for the diagnosis of OSA in patients
in the ER due to dyspnea and cough with sputum. Her with COPD. Aim: Validate portable PSG (ApneaLink
husband referred a history of snoring, nocturnal gasping plus ™, ResMed, San Diego, CA, USA) for OSA diagnosis
and daytime sleepiness. She had hypertension, was non- in COPD patients. Methods: This is a cross-sectional
smoker, without previous respiratory symptoms or risk validation study. Patients with COPD recruited at three
exposures. About 30 days before, presented an episode reference centers were simultaneously submitted to
of progressive dyspnea, evolving to acute respiratory PSG and portable PSG for the diagnosis of OSA. The
failure (ARF). In that moment, it was performed an early high risk for OSA was verified by the Berlin, NoSAS
tracheostomy, with significant improvement and quick and Stop-Bang questionnaires. Sensitivity, specificity,
discharge from ICU. Nearly 9 days before, the tracheostoma positive predictive value and negative predictive value
was closed. She had respiratory distress and BMI = 50 were calculated for the portable PSG for the 5, 15 and
kg/m² at the physical examination. A case of pneumonia 30 events / hour apnea hypopnea index cut-offs (AHI),
was diagnosed in the ward, and antibiotics were initiated, as well as for the questionnaires used. The Bland-Altman
with laboratorial improvement but clinical worsening. As plot and correlation analysis between the PSG AHI and
it evolved to ARF, the patient then was transferred to the the portable PSG were also performed.Results: A total
ICU. Previous arterial blood gas analysis presented PCO2 of 62 patients (67.5 ± 12.5 years, 55% men) participated
= 52,4mmHg and Bicarbonate=29,7 mmol/L. There was in the study. The Stop-Bang questionnaire presented the
a clinical and respiratory improvement just after intubation highest sensitivity [94.4 (72.7 - 99.9%)] for the diagnosis
and mechanical ventilation, with PCO2 = 42,5mmHg. A of OSA among the questionnaires. The sensitivity of
tracheostomy was redone and was the treatment option portable PSG decreased and specificity increased as the
due to social and healthcare limitations, being stable during AHI cut-off increased from 5, 15 and 30 events/hour
the follow-up at the outpatient clinic. Conclusions: We (87.0%, 66.7% and 44.4% and 40.0%, 78.6% and 100.0%
report an OHS case that underwent tracheostomy due respectively). The Bland-Altman analysis indicated good
to ARF. After discharge, the tracheostomy was reversed acceptance limits (AHI = 5.5 ± 11.7 events / hour). The
without any additional measures, which led to further AHI of the portable PSG showed a strong and positive
worsening. The importance of identifying OHS is due correlation with the PSG AHI (p <0.0001, r = 0.70).
to the high mortality in untreated patients. Treatment Conclusions: This study demonstrated that portable
aims to normalize ventilation during sleep. In 90% of PSG may be a useful equipment for the diagnosis of OSA
the cases, it is associated with Obstructive Sleep Apnea in patients with COPD due to its ease of use and accuracy
(OSA). Tracheostomy, the first treatment reported, is now in diagnosis.
considered a last option. The treatment of choice is the Palavras-chave: Chronic obstructive pulmonary disease, Obstructive sleep apnea, Validation studies.

use of continuous positive airway pressure (CPAP) as it

mitigates obstructive events. ID: 672
Palavras-chave: Obesity-Hypoventilation Syndrome, Tracheostomy; Diagnosis

Clinical Studies
ID: 669
Quantitative evolution of compulsory
Clinical Studies notification infectious diseases that may have
Validation of a portable monitoring system for sleepiness as a sign or symptom in brazil
the diagnosis of obstructive sleep apneia in SOUZA, L F X, MACIEL, R A M

Sleep Sci. 2020;13(Supl.1):1-118

 28
Universidade Federal do Rio Grande do Norte e Instituto Federal de Sleep Medicine
Educação, Ciência e Tecnologia do RN - Natal - Rio Grande do Norte
- Brasil NAVARRO, C A, GAMA, M R, BIANCHINI, E M G

Introduction: According to the Virtual Health Library, CETMA - ITATIBA - Sao Paulo - Brasil, UNIAUP - PIRACICABA -
linked to the Brazilian Ministry of Health, sleepiness Sao Paulo - Brasil
is one of the main signs of infectious and parasitic
diseases. Thus, there may be a misperception of sleep Introduction: Currently, we observe an increase in the
disorder when there is a decrease in cognition, perception, participation of speech-language pathologists in the sleep
emotional state, and behavior that also frequently occur area. Aim: the objective of this study was to contribute to
in infectious diseases. Such altered perception may information about the professional profile of the speech
interfere in the characterization of chronobiological therapist, regarding their area of expertise, specialty, as well
aspects. Thus, careful observation of epidemiological as their interest with the positive airway pressure equipment
aspects of the participants of sleep-related researches (CPAP/PAP). Methods: This study was conducted through
is essential. Aim: Perform a comparative analysis of an online questionnaire survey sent to the main groups of
data on the quantitative development of compulsory studies in sleep speech therapy in Brazil.Results: A number
notification infectious diseases in Brazil that may manifest of 44 speech therapists related to different specialties
sleepiness as a sign or symptom. Methods: From the answered it: 73% orofacial myofunctional therapy, 22%
National List of Compulsory Notification - present in neurofunctional, 16% language, 11% audiology, 5% voice,
Brazilian Ministry of Health Ordinance No. 204 of 2016 and 16% other specialties. The practice in the therapeutic
- we selected infectious diseases, based on International area had the highest performance index and the lowest one in
Statistical Classification of Diseases and Related Health the hearing area. More than 80% of them operate in the São
Problems – ICD, that are quantitatively monitored by Paulo state and the others are distributed among other states.
the Disease Notification Information System. Then, the Most of the participants (91%) consider it important for
number of confirmed cases reported from 2007 to date the speech therapist to have knowledge about how to adjust
was compared in order to follow the evolution of these the PAP and 96% suggest myotherapy exercises in order to
diseases in the national territory.Results: In this context, help the PAP acceptance process. Speech therapists working
we present the number of reported cases of infectious with snoring and apnea need knowledge of how to adjust
diseases from 2007 to date. Finally, we reached a total PAP and 27% work directly with PAP equipment. They
of 11,038,416 confirmed cases reported in Brazil of have all completed either a specific training course to assist
infectious diseases that may show drowsiness as a sign with PAP adaptation, including counseling, supervision
or symptom. Very significant number that shows the of other health professionals (12), trainings at companies
relevance of considering the variable infectious disease providing PAP (7), Congresses (7), other speech therapists
in sleep research in the brazilian territory. Conclusions: (6), internet courses (2), and others (2). 50% of all said they
From this research, it is intended to highlight the need did not take any courses although they feel the need for
for a broader view related to infectious conditions that acquiring knowledge about the subject. Among the activities
may influence the characterization of chronobiological performed in their care, in addition to myotherapy follow-
aspects in research on chronotypes and social jet-leg. In up (24), it is performed the sleep hygiene (23), guidance on
addition to providing a better understanding of the role cleaning and use (10), chip reading and its reporting issue (9),
of sleep in these pathological conditions, such integrated (5) adjusting and marketing (4). As for treatment requests,
knowledge has the potential to assist in the development it is the otorhinolaryngologists (23) who refer patients
of more effective sleep-related researches strategies. more often, followed by neurologists (12),cardiologists (9),
Thus, it is expected to contribute to the optimization orthodontists (2), and other professionals (14). Conclusions:
of the format of sleep questionnaires and diaries and it was observed that in addition to the performance already
to increase scientific knowledge about chronobiological recognized of the speech therapist in the snoring and apnea
characteristics and their relation with infectious diseases. myotherapy area, this has also been helping in the fiting
In line with health promotion actions proposed by the processes of PAP, indicating a new tendency for speech
World Sleep Society and the Brazilian Sleep Association. therapy within sleep medicine.
Palavras-chave: Speech-Language Pathologists, continuous positive airway pressure ; Obstrutive sleep apnea
Palavras-chave: infectious diseases, sleepiness, chronobiology

ID: 673 ID: 675

Clinical Studies Case Reports

Contributions to the Professional Profile of Childhood narcolepsy mimicking epileptic

Speech-Language Pathologists in the area of seizures: case report

Sleep Sci. 2020;13(Supl.1):1-118

29
Vasconcellos, B S, Fernandes, M D, Lacerda, C B, Linares, I M P, Instituto Biomédico, Programa de Pós-graduação em Enfermagem e
Yanagimori, M, Toscanini, A C, Borges, D G S, Bueno, C, Soster, Biociências e Escola de Medicina e Cirurgia- Universidade Federal do
LSA Estado do Rio de Janeiro - Rio de Janeiro - Rio de Janeiro - Brazil

Instituto da Criança do HCFMUSP - São Paulo - Sao Paulo - Brasil Introduction: Insufficient sleep is considered a risk factor
for obesity. Sleep deprivation modifies the hormones that
Introduction: Narcolepsy type 1 is a chronic neurologic disorder
regulate the appetite and raises the calories intake, affecting
defined by excessive daytime sleepiness, cataplexy, sleep paralysis,
both sides of energy balance. The influence obesity and sleep
hallucinations and disrupted nocturnal sleep, typically with
deprivation have on the post graduation student´s physical
onset during childhood/adolescence. The peculiar presentation
and mental health cannot be ignored. Multiple environmental
of symptoms in narcoleptic children could in part explain
factors, such as changes on waking up and going to bed
the misdiagnosis. Hypotonia and the complex hyperkinetic
time, the increase of study time and the decrease of extra
movements that characterize cataplexy close to the onset could
curricular activities time make such students potentially
be misdiagnosed as a movement disorder or as other neurologic
at risk of circadian rhythm rupture. Aim: To investigate
conditions, as epileptic seizures with consequent therapeutic delay.
the relationship between sleep quality and obesity in post
In healthy children without history of epileptic seizures, incidence
graduation students. Methods: Observational research
of abnormalities in EEG was 2–4%. Aim: To report a case of
with quantitative approach, made with stricto sensu post
a 8-years-old narcoleptic patient misdiagnosed with epilepsy.
graduation students from a federal university located in Rio
Methods: The following report was made through retrospective
de Janeiro. The study was sent though Zip Code under the
analysis of the patient’s medical records and interviews with the
approval number 2.022.926. The variables used were: Sleep
patient and her mother. Review of the literature about the subject
quality: bad (PSQI ≤5) and good (PSQI >5), defined by the
was conducted.Results: The patient is a female who, at 8 years-old,
Pittsburgh Sleep Quality Index (PSQI); Total Time of Night
began having excessive daytime sleepiness, with recent increase of
Sleep in Minutes (TTNSM) measured by the actigraph for
total sleep time from 9 hours to 14 hours a day, due to increase of
24 hours; Body Mass Index (BMI) – height²/ weight; and
daytime sleep, mantaining the same patern of sleep at night. She
Body Mass Index Classification: appropriate weight (BMI<
also started presenting sudden episodes of loss of strength in the
25) and overweight (IMC ≥ 25). The statistical analysis
whole body without losing conciousness, and episodes of ptosis
was made with the program Rcommander. The correlation
and mumbled speech, which lasted seconds to a few minutes
between TTNSM and BMI was assessed by the Spearman
with no identifiable triggering factors at the time. Patient reported
correlational test. In order to compare the TTNSM with
weight gain, impairment in the social and school performance
the BMI classifications, Wilcoxon test was used. The chi-
due to the symptoms. Few months later she was diagnosed with
squared test was used to check the relationship between BMI
anemia, without response to its clinical treatment. About a year
categories and sleep quality. It was considered statistically
later, she kept hypersomnia symptoms and was submited to an
relevant when p < 0,05.Results: The sample was made of
eletroencephalogram, which evidenced epileptform discharge. At
32 post graduation students, from which 69 % presented
the time, it was introduced Carbamazepine, titled up to 600mg/
poor quality sleep and 69% were considered overweight.
day with no improvement of the symptoms. She was then refered
However, the relationship between these variables was not
to a sleep practioner, perfomed a polysomnograhy with a latency
relevant (chi-square = 0.86, p = 0.34). The average and
time to NREM sleep of 2,8min. No MLST was conducted at
medium TTNSM of the overweight sample was 391.9 and
the time because of the patient’s age. Catapletic symptoms
412 minutes respectively and with appropriate weight 358
became clearer and she was diagnosed with type-1 Narcolepsy
and 360 minutes. Despite the overweight post graduation
due the clinical symptoms.It was introduced Sertraline 50mg a
students sleep less, no significant difference was found
day and methylphenidate with improvement of the symptoms.
(Wilcoxon – p = 0.14). The correlation between TTNSM
Conclusions: In this case report, cataplexy was mistaken as
and BMI was negative, but not significant (Rho = - 0.22, p =
epileptic seizure, which was reinforced by the exam finding in one
0.2)Conclusions: Although it was a small sample, the results
EEG, which might have no significant repercussion. In children,
show the necessity of a more comprehensive approach
cataplexy is more difficult to identify due to its particularities.
Palavras-chave: type-1 narcolepsy, epilepsy
regarding the monitoring of post graduation students’
sleep. The situation demands an intensified formation of
ID: 676 professionals who have a concern about their lifestyles
Palavras-chave: Obesity; Sleep; Post Graduation Programs

Clinical Studies
ID: 677
The relationship between insufficient sleep and
obesity in a stricto sensu post graduation course Clinical Studies
Effects of a sleep educational program on sleep
GARCIA, A D S, SANTOS, F D, VICENTINI, S C, BARBOSA, M
T S, DA SILVA, C R L
knowledge, habits and pattern in high school
students
Sleep Sci. 2020;13(Supl.1):1-118
 30
FERREIRA, L G D F, CARVALHO, D A F D, BRUIN, P F C D Introduction: There is a need that is increasingly
UFC - Fortaleza - Ceara - Brasil discussed in the scientific environment to shift the
focus of attention from the disease to the person. The
Introduction: One of the ways to promote better sleep humanization of care and health care led to the triad
quality in adolescents is the implementation of sleep disease / patient / caregiver. This caregiver can be both
education programs with information dissemination, a professional and one who stays at home taking care
encouraging health preservation, changing habits and of your loved ones, often compromising your own
values related to sleep. Thus, adolescents can consciously health. Aim: This study aimed to evaluate through
choose the behavior to be adopted. Aim: To evaluate the questionnaires the quality of life, quality of sleep, and
effects of an intervention, through a health education symptoms of depression, anxiety and stress in caregivers
program on sleep, on the knowledge, habits and sleep of individuals with Down Syndrome. Methods: Nineteen
pattern in high school students. Methods: This is a caregivers (19) of individuals with Down Syndrome (DS)
longitudinal and intervention design, with evaluation participated in this study. Inclusion criteria were fluency
before and after a sleep-wake sleep education program, in the Portuguese language to answer the following
conducted with adolescents from 01 public school in validated questionnaires: Quality of Life Questionnaire
Teresina, Piauí, Brazil. Students were divided into control (SF-36), Sleep Quality Index of Pittsburgh (PSQI) and
group (CG) and intervention group (GI). The study Depression, Anxiety and Stress Scale (EADS-21). In
took place in three stages: Stage I (evaluation), in which addition to the questionnaires, the participants answered
participants answered questionnaires to collect sleep the following questions: age, marital status, gender,
variables such as habits, knowledge, chronotype, pattern kinship and period devoted to caring for the relative with
and quality of sleep; Stage II consisted of a Sleep Health DS, working time, presence of the following factors that
Education Program (PESS) with 04 meetings of 50 could influence sleep quality: caffeine drink consumption
min; and Stage III (reevaluation) occurred after 1 month after 18h, tobacco use, physical exercise after 20h and use
after the end of the PESS, and the instruments of Stage of medications. This research is linked to a main project
I, an intervention evaluation form, were reapplied. The that received FAPES research assistance and approval by
research protocol was approved by the Research Ethics CEPH ICT - UNESP (CAAE: 64173616.4.0000.0077).
Committee. Results: 163 students participated, 91 in Results: The caregivers had a mean age of 54.57±10.43,
GI and 72 in CG, 54.6% female, mean age 16.6 ± 0.7 with a minimum of 27 and a maximum of 75 years. The
years. In the reassessment, there was an increase of right sample consists mainly of married individuals (63.15%),
answers in 7 (41.2%) questions in GI and none in CG. As female (78.94%), who are fully dedicated to the care of
for sleep-related habits, it revealed a significant change in relatives with DS (47.36%). The SF-36 showed that the
the “not being able to sleep thinking about things to do” domains vitality, general health and pain were the ones
behavior with the absence of habit going from 24.4% to with the lowest averages, 46.78±22.50; 51.36±19.12 and
45.1% in GI. There was also an increase in the percentage 52.42±33.03, respectively. The PSQI showed that 62.15%
of 12.1% of students with good sleep quality in GI in of caregivers have poor sleep quality and 31.37% some
Stage III. Conclusions: It is concluded that educational sleep disorder. In the EADS-21 the average stress, anxiety
interventions may change students’ knowledge, but they and depression scales were 7.26±6.20; 4.8±5.24 and
are not enough for behavioral change. Finally, educational 4.52±5.32, respectively. Conclusions: The evaluations
measures must be combined with other aspects, such as made evident some important aspects about the physical
changing hours and parental involvement, to maximize and emotional health of caregivers of individuals with
benefits. Down Syndrome, making their health care essential. The
Palavras-chave: Adolescents, health education, sleep.
data obtained in this research will allow us to establish the
diagnosis of the pathologies studied and the indication of
ID: 679 individualized therapies, envisaging new studies.
Clinical Studies
Palavras-chave: Quality of life, Sleep quality, Down Syndrome.

ID: 680
Evaluation of quality of life, sleep and
psychosocial factors in caregivers of Clinical Studies
individuals with Down Syndrome. Sleep and awake bruxism in adult with Down
Rezende, T G G P, Dutra, M T, Giannasi, L C, Gomes, M F, syndrome
Oliveira, W, Oliveira, T A, Rode, S M
Giannasi, L C, Dutra, M S T, Rezende, T G G P, Nacif, S R,
Universidade Estadual Paulista - São José dos Campos - São Paulo - Oliveira, E F, Oliveira, L V F, Oliveira, W, Pereira, B D, Gomes,
Brasil MF

Sleep Sci. 2020;13(Supl.1):1-118

31
Centro Universitário de Anápolis Uni-Evangélica - Anápolis - Ceara ID: 686
- Brasil, Hospital do Servidor Público Estadual de São Paulo-IAMSPE-
HSPE - Sao Paulo - Para - Brasil, ICT-UNESP/SJC - Sao Jose dos Clinical Studies
Campos - Sao Paulo - Brasil
Relationship between headaches and sleep: a
Introduction: To our knowledge, no studies have accessed longitudinal study
awake bruxism (AB) and stage by stage sleep bruxism (SB)
in adults with Down syndrome (DS). The gold standard for Lucchesi, L M, Tempaku, P F, Smith, A K A, Togeiro, S, Hachul, H,
SB diagnosis is polysomnography type I, but recent works Andersen, M L, Tufik, S, Poyares, D
have shown that the accuracy of portable PSG systems
for SB is considered good even in absence of audio-video Introduction: Introduction: Evidence in the literature showed
recording. Aim: To evaluate the prevalence of awake an association between headache and sleep disturbances,
and stage-by-stage sleep bruxism in adult with Down especially when headaches occur during the night or early
syndrome through questionnaire answered by caregivers morning. Our group has demonstrated that waking up during
and PSG type II. Methods: Twenty-three adults with the night with headache was prevalent (8.4%) in the Sao Paulo
DS were enrolled in this study. Clinic examination, dental general population Aim: Objective: We aimed to assess the
anamnesis and RDC-TMD were performed in order to incidence and associate sleep variables of “Nocturnal awakening
address anthropometric data, dental status, parafunctional with headache (NAH)“ in a prospective 8-year follow-up study.
habits and temporomandibular symptoms. The history of Methods: Methods: From 1,042 volunteers enrolled in the
SB/AB was answered by caregivers. A portable PSG type baseline study, 712 agreed to participate to the follow-up study.
II system (Embla Embletta MPR+PG ST+Proxy, Natus, Questionnaires and scales were applied and polysomnography
California-USA) was used to perform a full-sleep study at (PSG) and actigraphy were performed. Sleep disorders were
patients’ home. Sleep data were visually scored according determined through sleep questionnaires, and also DSM-IV was
to the AAMS criteria and SB was scored according to used to characterize insomnia. Frequent NAH was defined by
the published rules. RMMA activity was defined as low symptoms of at least once a week, occasional NAH was defined
(>1 and <2 episodes/h of sleep), moderate (>2 and <4 by symptoms frequency of less than once a month or 1 to 3
episodes/h of sleep), or high (>4 episodes/h of sleep). times a month and absence of NAH was defined by a negative
Subjects received the PSG diagnosis of SB if RMMA response.Results: Results: From the 712 participants, 702
index was >2 episodes/h of sleep.Results: The sample completed their NAH questionnaire. In the follow-up setting,
was composed by 23 adults with DS (mean age 21.7±4.3; 84.5% referred no NAH, 8.4% had occasional headache and
9 females, 14 males). All patients presented moderate to 7.1% had frequent headache. There was a significant association
severe tooth wear and identations on tongue. Muscular between baseline frequent NAH with occasional NAH, as
and temporomandibular joint(TMJ) palpation presented 17.7% of frequent NAH changed to occasional NAH. In the
8.7% and 0% for local myalgia and TMJ pain, respectively. follow-up, frequent NAH was associated with female gender,
According to caregivers reporting, all patients presented higher body mass index (BMI), insomnia DSM-IV, lower self-
AB and only 13.1% SB. PSG data showed a SB prevalence reported sleep duration, higher insomnia severity index (ISI),
of 91.3%, with a mean RMMA index 40.0±30.0/h. objective longer sleep latency and higher mean wake time at
When the RMMA index was separated by frequency, it actigraphy. After adjustment for sex and BMI, self-reported
was found 17.4% low RMMA, 21.7% moderate RMMA sleep duration, DSM-IV insomnia, ISI score, and objective
and 43.5% high RMMA. Only 2 showed RMMA index sleep onset latency remained significantly associated with
of 0.0/h. SB episodes/h were 30.4%, 8.7%, 21.7% and frequent NAH. Conclusions: Conclusions: Our study shows
26.1% in N1, N2, N3 and REM sleep stage, respectively. that NAH was highly prevalent in the São Paulo population in
Clinical data showed probable AB. In addition, all patients both the baseline and follow-up studies with some sleep-related
presented obstructive sleep apnea 32.8±28.6 and snoring risk factors, mainly insomnia.
per hour was 26.2±15.0. Despite the raised RMMA index, Palavras-chave:
Paulo Research Keywords:
Foundationnocturnal
(FAPESP,awakening, headache,
#2018/00955-4 sleep disorders. Financial support: Associação Fundo de Incentivo à Pesquisa (AFIP) and São
to PFT)

the majority of patients did not present TMD symptoms.

Comparing caregivers reports with PSG data, they seem ID: 688
not be aware of the presence of SB. Conclusions: The
high prevalence of definitive SB and probable AB, added Clinical Studies
to the high prevalence of obstructive sleep apnea and Interventional psychodiagnosis in preschool
snoring, point to the recommendation for the PSG in
adult with Down syndrome, routinely. Parents seem not to insomnia
be aware about the presence of SB.
Palavras-chave: Down syndrome; sleep bruxism; awake bruxism
ALCÂNTARA, C S, Ribeiro do Valle, L E

Instituto de Neurociências e Tecnologia Dr Marcio Ribeiro do Valle - Poços

de Caldas - Minas Gerais - Brazil

Sleep Sci. 2020;13(Supl.1):1-118

 32

Introduction: Complains of insomnia in preschool Introduction: Studies show that some patients have
children is very common in pediatric offices. When difficulty on Continuos positive airway pressure (CPAP)
their causes are not organic, we should evaluate their adherence in the treatment of Obstructive sleep apnea
possible psychological causes,in view of this stage of syndrome (OSAS). Aim: To present a case report of OSAS
development. These include external factors such as: which the myofunctional therapy improved adherence to
birth of a sibling, entry into school, separation or tension CPAP. Methods: Patient, female, 73 years old, diagnosed
between parents, maternal depression or loss of a loved with sleep apnea syndrome and heart arrhytmia,
one or pet. Among the intra-psychic factors, which may presenting difficulty using CPAP. She was referred by the
or may not relate to external events, we find the typical sleep physician to speech therapy. Iniatially, she reported
childhood fantasies of this phase as: ambivalence between that she was having trouble to sleep, developing panic in
good and evil; love and hatred; voracity, omnipotence and the sleep time, described as breathing discomfort, fear
persecutory anguish arising from an incipient and cruel and accerelated heartbeat. Her husband reported the
superego, symbolized by fairy tales. Aim: To evaluate presence of intense snoring on the nigths that she could
the effectiveness of interventional psychodiagnosis in sleep. During daytime, she was very tired and sleepy. In
children with complaints of insomnia in this age group. her first polysomnography (2012), the AHI was 26,5/
Methods: Thirty-six preschool children, between two and hour, classified as moderate sleep apnea, and minimum
six years old, between 2015 and 2017, ( 19 girls and 17 oxygen saturation of 86%. She tried CPAP therapy,
boys), with initial and intermediate insomnia complaints but she could not addapt and ended up abandoning
were evaluated. The method used was interventional treatment. When she returned to the sleep physician, a
psychodiagnosis, which is characterized by seeking new polysomnography (split night) was requested (2015),
diagnostic understanding in the psychodynamic aspect which indicated a therapeutic pressure of 10,5cm H2O.
and at the same time, briefly intervening in a model of She was referred to CPAP therapy again, although this
therapeutic consultations. Two to three interviews with time with combined speech therapy. In the myofunctional
parents were conducted, and two to four consultations therapy, breathing exercises were used with and without
with children (with or without parental presence). The the mask in the seated position until reaching the lay down
instruments used were: semi-directed interviews with position. Information about sleep hygiene, sleep schedule
parents, with specific interventions. Playful observations and rhythm were also given during therapy sessions.
and other projective techniques, such as story drawings, Daily exercises were suggested, 3 times a day, involving
with timely interventions focused on sleep quality. intraoral sensitization of the tongue; and isometric and
Feedback interviews are included in this process.Results: isotonic exercises associated with oropharyngeal muscle
Of the 36 children, we obtained positive responses and strengthening and mobility, and facial as: snapping and
improved insomnia in 90% of the subjects, according to tongue pressure on the palate, elevation and rotation of
their parents’ feedbacks, after two months of psychological tongue in the oral vestibule, /B/prolonged, fry laryngeal;
intervention. Conclusions: The onset of insomnia in this Crackling, protrusion and retraction of lips, and blowing
age group is very common, however, even if transient, it and sucking with different resistances. The sessions
is a symptom that generates great family stress and if not started weekly and, as time went by, semiannuallyResults:
well managed, can condition a poor quality sleep for a long Nowadays, she uses CPAP all night, 5,27h/night on
time. Interventional psychodiagnosis proves to be a quick average, with significant reduction of symptoms, besides
and effective instrument for listening and welcoming the the control of the arrhythmia, leading the cardiologist to
anxieties and parental conflicts and the child himself. It gradually decrease the dose of amiodarone from 200mg,
allows the understanding of each family dynamics and the to 100mg and, currently, to suspend it. The patient has
child’s own, and because it is interventional, punctuates, been using CPAP for 3 years, with good adeherence and
discriminates and guides the impeding aspects of a AHI 1/hour. Conclusions: The myofunctional therapy
peaceful sleep for the child and their parents. assisted in the adherence to CPAP treatment and the
Palavras-chave: infant insomnia; preschool sleep; interventional psychodiagnosis; sleep psychology
improvement of patient’s quality of life.
Palavras-chave: Myofunctional therapy, positive airway pressure, apnea, arrhythmia

ID: 691
ID: 692
Case Reports
Case Reports
The influence of speech therapy in the adherence
of continuous positive airway pressure devices Myofunctional therapy as an Oral Appliance
in sleep apnea syndrome: case report Therapy adjunct in moderate OSA patient
with Sleep Apnea Digital Monitoring home
NAVARRO, C A, MACHADO, C C test follow-up
UNIAUP - PIRACICABA - Sao Paulo - Brasil

Sleep Sci. 2020;13(Supl.1):1-118

33
Barbosa, D F, Sousa, V M, Berzin, F Gallina, L F, Arend, V A E, Soares, C F d P, Rauber, R, Peron, C S

FOP - UNICAMP - Piracicaba - Sao Paulo - Brasil Centro Universitário da Fundação Assis Gurgacz - Cascavel - Paraná
- Brasil
Introduction: Obstructive Sleep Apnea Syndrome (OSAS)
is a highly prevalent condition affecting people with an Introduction: Alzheimer’s disease is the most common
increasing public health burden. Oral Appliance Therapy form of dementia present in the elderly population above
(OAT) is recommended in clinical practices in OSAS non- 65 years old. Losses in sleep architecture, already present
adherent patients or who refused CPAP therapy. In OSAS in elderly, are often found together with the disruptive
patients, the hypoglossal nerve structure and genioglossus behavioral symptoms of Alzheimer’s dementia, sleep
muscles function are always abnormal. In addition, the impairments can have a substantial impact on cognitive
tongue does not always move simultaneously with the activity. Interference in the sleep-wake cycle, given by the
mandible when an Oral Appliance (OA) is being used. fragmentation of sleep with nocturnal awakenings and
Sometimes, the genetic and environmental influences consequent daytime sleepiness, suggest a deficit of cognitive
can interfere in clinical endpoint, as malocclusion and functions and possible demential progression. Aim:
oropharyngeal muscles hypotonia. Thus, some patients Evaluate presence of sleep impairments in Alzheimer’s
with OSAS, malocclusion and stomatognathic dysfunction dementia. Methods: This is a retrospective analytical study
may benefit from myofunctional therapy (MFT) as an to with a quantitative and qualitative descriptive approach. It
OAT adjunct for treatment efficacy. Furthermore, the was conducted by applying a specific questionnaire based
polysomnography (PSG) is a gold standard study for on the Neuropsychiatric Inventory, The Pittsburgh Sleep
diagnosis and monitoring of OSAS patients; however, the Quality Index (PSQI), Epworth Sleepiness Scale, Stanford
test is expensive, time-consuming and difficult to access. Sleepiness Scale and selected articles covering questions
Therefore, other methods have been proposed such as about sleep pattern in patients with the diagnosis of
Sleep Apnea Digital Monitoring (SADM), which is a home- Alzheimer’s disease retrospectively.Results: The study
styled oximetry diagnosis to detect severe OSA that uses analysis include 17 participants. The age range varies from
the Oxygen Desaturation Index (ODI). Aim: We show an 60 to 92 years, with mean of 79.88 years. Most patients had
OSAS patient who refused CPAP therapy, and was treated an average daily sleep time of 6 to 8 hours. 38.4% of those
with OAT and MFT, his monitoring and following-up with interviewed had symptoms of nocturnal psychomotor
SADM before final PSG sleep study. Methods: Caucasian agitation, with frequent interruptions at night. Research
63-year-old man with class III dental occlusion and 24 data show the high prevalence of sleep-deprivation-related
BMI, with moderate AHI and intense snoring who refused disorders, which affect approximately 41% of patients. As
CPAP therapy. Patient with clinical history of diabetes II, for the quality of sleep, only 35.2% of patients reported
hypercholesterolemia, hypertension who was submitted to not having a peaceful and deep sleep all night. Of these,
septal deviation surgery. At first OAT was prescribed and approximately 23.5% reported difficulties in initiating
after that, MFT. The OA used induced lip sealing, mandible sleep, and around 29.4% of respondents reported having
and tongue protrusion. MFT induced neuromuscular and difficulty maintaining sleep for a satisfactory period of
functional balance for stomatognathic system. Clinical time. Of those who had sleep disorders, only 29.4% of this
evaluation, Epworth Sleepiness Scale, polysomnography and appeared in the past and 41%, appeared after the diagnosis
SADM were evaluated in 12 months of follow-up.Results: of Alzheimer’s dementia. Regarding the relationship of
An improvement in objective and subjective parameters disorders with Alzheimer’s progression, 47% of patients
were shown as: BMI(24.5 to 23.9), SaO2 min(79 to 86%), had shown a worsening of sleep deprivation disorders
SaO2 max(93 to 96%), Arousal Index(29,7 to 7.1/h), after diagnosis. Conclusions: This study evidences a
IDO=10 to 8, ESE (13 to 7) and Snore ( intense to mild). probable involvement between sleep impairment, mainly
Conclusions: Patient demonstrated as being compliant sleep disruption, and the Alzheimer’s dementia.
with OAT and MFT as an adjunct therapy. An improvement Palavras-chave: Alzheimer. Dementia. Sleep disturbance. Sleep impairment.

in respiratory parameters and daytime sleepiness were

achieved. In this case report the SADM demonstrated to be ID: 695
a good tool for OAT and MFT monitoring and follow-up
before final PSG sleep study. Basic Research
Prevalence of insomnia in shift workers: a
Palavras-chave: sleep apnea syndrome, snoring, oral appliance, myofunctional therapy, oximetry, follow-up.

ID: 693 systematic review

Clinical Studies Brito, R S, Dias, C, Salles, C, Filho, A A

The relevance of sleep impairment in Escola Bahiana de Medicina e Saúde Pública - Salvador - Bahia - Brasil,
Clinos: Clínica de Neurologia e Otorrinolaringologia - Santo Antônio
alzheimer’s dementia

Sleep Sci. 2020;13(Supl.1):1-118

 34
de Jesus - Bahia - Brasil Introduction: Sleep paralysis (SP) involves a period of
inability to perform voluntary movements at the onze
Introduction: Insomnia is a sleep disorder of high of sele o no awakening. Aim: To describe a clinical case
prevalence with somatic and psychic repercussions. Aim: about the correlation between sleep paralysis and frontal
The present study aimed to describe the prevalence lobe tumor, as well as to perform a brief literature review.
of insomnia in shift workers, as well as the following Methods: Qualitative and individualized analysis of a
associated variables: sex, age, marital status, profession and rare clinical case on brain neoplasia-related sleep disorder,
shift work schedule. Methods: A systematic review was following the patient’s evolution from diagnosis, therapy
performed using the descriptors “insomnia” AND “shift and prognosis.Results: A 24-year-old male patient
work”, in the databases PubMed, Scielo and LILACS. The complains of an early feeling of suffocation on sleep, with
inclusion criteria were: studies addressing the frequency difficulty waking up in these episodes since two months
of insomnia in shift workers; studies published from ago. He reported that at sleep he felt paralysis of the body
01/01/2008 onwards, with the intention of contemplating and the sensation of trying to move, scream and fail.
the most updated studies; studies in English or Portuguese Initially it was indicative of apnea, reflux or sleep paralysis.
languages; studies with participants aged 18 years or older; Polysomnography detected moderate apnea. Upper
studies conducted only with human beings. The exclusion digestive endoscopy found erosive reflux esophagitis.
criteria were: review articles; studies whose participants After treatment, on return patient reported worsening
presented other comorbidities that justified the presence sleep paralysis and was prescribed benzodiazepine without
of insomnia; studies whose participants were undergoing improvement after 30 days. Thus, a magnetic resonance
treatment for sleep disorders; studies with pregnant imaging of the brain was requested, which showed
women and articles without abstracts.Results: From 402 expansive lesion with infiltrative characteristics of the
studies identified, 4 were included in the analysis, with a right frontal lobe. He was referred for neurosurgery and
total sample of 9,410 participants, of which 3,674 shift tumor resection was performed. Pathological examination
workers. The prevalence of insomnia in shift workers revealed morphological pattern compatible with grade
ranged from 12.8% to 76.4%, higher than that estimated 2 diffuse astrocytoma. After tumor removal the patient
for the general population. In addition, there was a higher did not have sleep paralysis again.The etiology of sleep
prevalence among women and single people, and there was paralysis tends to be multifactorial: hereditary factors,
no significant variation with age and occupation. On the physical health problems, stress and trauma may develop.
other hand, the relation between the shift work schedule And it also appears to be associated with posttraumatic
and the onset of insomnia still seems controversial. stress disorder (PTSD), narcolepsy and panic attacks.
Conclusions: The present systematic review identified a The pathophysiology of sleep paralysis is due to faulty
high prevalence of insomnia in shift workers compared to brainstem structures. This paralysis is a result of skeletal
the general population. Moreover, a higher prevalence was muscle tone suppression by the pons and ventromedial
observed among women and single people and there was cord, exerted by the γ-aminobutyric acid and glycine
no significant variation with age and occupation. On the neurotransmitters, which inhibit the motor neurons of the
other hand, the relationship between shift work schedule spinal cord. Brain lobes are interconnected, so any damage
and the emergence of insomnia still seems controversial. to their structure can lead to changes in behavior. The
This review therefore suggests an important association frontal lobe is responsible for social behavior and motor
between insomnia and shift work, with the following planning. Therefore, an injury to the frontal cortex can
consequences: a decrease in professional and social lead to paresis. Conclusions: It is relevant to highlight the
performance and repercussions on physical and mental scarcity in the literature of the correlation between sleep
health, which reinforces the need for early identification paralysis and frontal lobe tumor, as well as the rarity of
and intervention on the potential damage to the health of identifying similar clinical cases.
these workers. Palavras-chave: apnea, sleep paralysis, frontal lobe tumor.
Palavras-chave: Keywords: Insomnia. Shift work. Prevalence. Worker.

ID: 697
ID: 696
Clinical Studies
Case Reports
Comparing the OSA severity and symptoms
Correlation between sleep paralysis and
among patients from the private and public
frontal lobe tumor
health systems
Martins, L M N, Resende, L O, Santos, I M, Prado, V L S, Reis, L
O, Tavares, F C S, Trevisan, D D, Camargos, P A M Fernandes, M D, Passini, V V, Lacerda, C B, Vasconcellos, B S,
Cano, T, Yanagimori, M, Lorenzi-Filho, G, Genta, P R
Universidade Federal de São João Del-Rey - Divinópolis - Minas Gerais
- Brasil

Sleep Sci. 2020;13(Supl.1):1-118

35
INCOR - SP - Sao Paulo - Brasil Introduction: Sleep disorders have been the subject of
research in the world, however, when we relate visually
Introduction: Obstructive sleep apnea (OSA) is a common impaired and actigraphy, we find little research. Aim: We
disorder among adults. Despite of a high prevalence, OSA evaluated the sleep/wake cycle of a paratleta (ICD 10-
remains underdiagnosed and undertreated, especially H54.2; F12), 38 years, complaining of poor quality of sleep
in underdeveloped countries. In Brazil, very few public (seem CEP 3.383.966). Methods: For 30 days we used
services offer OSA diagnosis and treatment. Our laboratory ActTrust-Actimeter/Condor® associated with sleep diary
is one of a few in our state that performs polysomnography and sociocultural questionnaires, chronotype and PSQI.
(PSG) for the public health system. Our hypothesis was that The audiograph data were evaluated in the ActStudio
patients referred from the public health system would have software.Results: She began her professional career at the
more severe OSA than patients coming from the private age of 22, in the modalities of weight throwing, darts and
sector due the differences in access to polysomnography disc. It has daily training routine in the afternoon. Before
between these populations. Aim: The aim of this study was sleeping makes use of the mobile phone for about 1:30.
to compare anthropometric characteristics, sleepiness, and She never used application or calendar to control the
OSA severity among public and private patients referred reproductive cycle, subjectively calculating the probable
for PSG with a suspicion of OSA. Methods: We analyzed date of next menstruation. When in PMS, reported
data from 1381 patients that underwent PSG at our Sleep headache, difficulty sleeping, agitated sleep, increases in
Laboratory from January 2017 to December 2018. Studies chocolate intake and aggressiveness, the latter, according
with inconsistent data (n = 69), portable devices (n = 47), to her, positive when it coincides with tournament and/
research protocols (n = 386), titration studies or split night or competition. Regarding the circadian profile, she was
studies (n = 153) were excluded. Anthropometric, clinic and indifferent, preferring to perform her training in the
polysomnographic data were collected. Statistical analysis afternoon. Research indicates that profiles with a tendency
was performed in GraphPad Prism software version to indifference have preference for the afternoon period.
7.Results: A total of 726 patients were included in this PSQI scored 8, featuring poor quality sleep. Periodogram
study, of which 410 were from the public health system with circadian rhythm and sleep efficiency of 89.37%,
(Group 1) and 316 from the private health system (Group with an average of six awakenings per night. Bed time at
2). The proportion of men was higher among private health night was, on average, 06h30m and, sleeping, 05h48m.
system patients(59.1% men) as compared to public health Presence of irregularities in bedtime and waking up on
system patients (45.4% men) (P=0.0003). Age was similar weekends and various daytime rest periods throughout the
in both groups (56.8±13.7 years and 57.0±15.4 years, week. Comparing sleep diary, socio-cultural questionnaire
Group 1 and 2, respectively; P=0.7345). Body-mass index and actogram, we see low perception in relation to time
(BMI) was higher in Group 1 (32.8±7.4 vs. 29.6±5.6 kg/m² between bedtime and sleep, delay in relation to the
in Group 2; P<0.0001). OSA severity was higher in Group probable date of next menstruation, mood changes and
1 (36.4±29.4 versus 30.3±25.9 events per hour; P=0.0123). greater agitation during sleep, the latter, possibly related to
Epworth Sleepiness Scale was higher among public sector PMS. Conclusions: The actigraphy, when combined with
patients as compared to private sector patients (11.4±6.2 other methodologies, can contribute to the clarification
and 9.6±5.0, respectively; P=0.0002). Conclusions: in relation to self perception of sleep, in addition to
Patients from the public health system are sleepier and have directing actions of measures of hygiene of sleep, to
higher OSA severity as compared to private health system. improve sleep efficiency, with gains in quality of personal
These findings may reflect a greater difficulty for public and professional life.
health system patients to access specialized sleep diagnostic Palavras-chave: Sleep; Visual disability; Self-knowledge

centers when compared to patients from private health

assistance. ID: 699
Palavras-chave: Sleep Apnea, Obstructive; Polysomnography; Health Systems.

Clinical Studies
ID: 698
Impact of multiprofessional residence on
Basic Research sleep quality and mental health
Is it possible to verify relationships between low
FERREIRA, L G D F, SILVA, I A, BRAZIL, C M D M,
vision and sleep patterns through actigraphy? CARVALHO, D A F D

de Castro Rocha, M Y, de Mello, S T HU-UFPI - TERESINA - Piaui - Brasil

Departamento de Biologia - Universidade Estadual de Maringá - Introduction: Residence is a period marked by several
Maringá - Paraná - Brasil, Departamento de Ciências Morfológicas - changes in lifestyle, leading to impairment in physical
Universidade Estadual de Maringá - Maringá - Paraná - Brasil

Sleep Sci. 2020;13(Supl.1):1-118

 36

and mental health, impacting on quality of life. Aim: To at our sleep clinic reporting abnormal movements and
investigate the impact of multiprofessional residency on confusional awakenings during sleep. Symptoms had
sleep quality and mental health in multiprofessional health started 15 years before and were characterized by muscle
residents. Methods: This is a cross-sectional study with contractions and occasional urinary incontinence. The
quantitative data. The target audience was multiprofessional patient also mentioned that sometimes she woke up in
health residents (R1 and R2) of a university hospital in other rooms of the house, with faucets turned on or home
the state of Piauí, Brazil. Pittsburgh Sleep Quality Index appliances plugged in and running. Since the beginning
(PSQI), Epworth Sleepiness Scale (ESS) and Preliminary of the condition phenobarbital and clonazepam were
Burnout Identification Questionnaires were used. This prescribed without improvement of symptoms. Results:
study was approved by the Research Ethics Committee. A polysomnography showed two epileptic seizures during
Results: The sample consisted of 28 residents, 82.1% slow wave sleep. These episodes lasts approximately four
female, mean age 25.5 + 0.69 years. It observed an average minutes and presented an electroencephalographic pattern
sleep duration of 5.9 ± 0.6 with significant difference of epileptiform activity in all channels. Subsequently, she
between first and second year residents (p = 0.03). As performed a long-term video-electroencephalography,
for sleep quality, a mean PSQI score of 8.18 ± 3.0 (> 5 which evidenced epileptiform discharges like sharp waves
= poor sleep quality) will decrease with 67.9% of poor over the right temporal region. We diagnosed NTLE
sleep quality. The Epworth Sleepiness Scale showed and the patient was treated with carbamazepine 200mg
a mean score of 10.4 ± 4.3 (> 10 = excessive daytime twice daily, with significant improvement of her clinical
sleepiness - EDS) with 46.4% showing more sleepy EDS condition. Seizure during sleep is not a classical feature
for R2. Regarding Burnout Syndrome, an average score of NTLE, in these cases, usually there are infrequent
of 57.3 was observed, and 61.4% of R2 reported “onset and non clustered seizures, with rare familial history of
of installation” or “executable phase” of the syndrome epilepsy. NTLE usually presents during adolescence with
that occurs in this case of difference between groups seizures nearly exclusively at nighttime sleep. In most
R1 and R2 (p <0.01). There is no significant correlation cases, seizures are characterized by sudden awakening
between sleep and burnout variables. Conclusions: It is from sleep with a sensory aura, which progresses to a focal
concluded that residents are affected by sleep deprivation seizure with impaired awareness. It is often associated with
and burnout symptoms, and it is highlighted that residents amnestic automatisms, mimicking a confusional arousal
R1 are similar to R2. and are responsible for late diagnosis in several cases.
Palavras-chave: Sleep, Mental Health, Exhaustion; Hospital Residence.
Conclusions: Distinguishing nocturnal epileptic seizures
from complex movement disorders and parasomnia can
ID: 700 be challenging. Knowing the differential diagnosis and the
Case Reports diagnostic criteria are essential to properly conduct this
case.
Differential diagnosis between nocturnal Palavras-chave: Sleep; Seizures; Parasomnia

temporal lobe epilepsy (NTLE) and ID: 704

parasomnia: case report and literature review
Basic Research
Passini, V V, Lacerda, C B, Fernandes, M D, Toscanini, A C,
Borges, D G S, de Azevedo, A P, Hasan, R
Correlation of the masticatory biomechanics,
adiposity and sleep disorders in patients with
IPQ - HCFMUSP - São Paulo - Sao Paulo - Brasil
Down syndrome
Introduction: Nocturnal epilepsy may be a difficult
condition to diagnose. It can often be mistaken as Serafim, I M, Mancilha, G P, Giannasi, L C, Silva, G R C, Fillietaz-
sleep disturbance and has a high mortality rate related Bacigalupo, E, Rode, S M, Salgado, M A C, Gomes, M F
to sudden unexpected death in epilepsy (SUDEP). Instituto de Ciência e Tecnologia de São José dos Campos da
Nocturnal complex partial seizures of temporal lobe Universidade Estadual Paulista - São José dos Campos - São Paulo -
are sometimes responsible for phenomena resembling Brasil
sleep terror or somnambulism and may be associated
with violence. We report a case of a patient with a Introduction: Down Syndrome (DS) is a genetic disorder
typical history of NREM parasomnia that was diagnosed characterized by an extra copy of chromosome 21 (Hsa21).
as nocturnal temporal lobe epilepsy after clinical The muscle hypotonia is one of the main phenotypical
evaluation and polysomnography. Aim: The purpose features of this syndrome which can be a deleterious
of this report is to show the importance of evaluating condition for total or partial obstruction of the airways
differential diagnoses facing complex movement during during sleep, causing Obstructive Apnea of Sleep (OSA).
sleep. Methods: A 39-year-old woman was evaluated Aim: This study assessed the masticatory biomechanics

Sleep Sci. 2020;13(Supl.1):1-118

37
by means of electromyographic records of the masseter that its need is increased in this age group. Thus, few aspects
and temporal muscles at rest and in function, as well as of child health have as significant an impact on well-being
the maximum bite force (MBF) and the maximum mouth as sleep disorders, especially considering the characteristics
opening (MMO). These findings were correlated with of modern life and its effect on the family environment.
body fat distribution and risk of sleep disorders in patients Aim: Objective: To monitor the development of the sleep-
with DS. Methods: Twenty-four patients with DS were wake cycle of infants (from birth to twelve months) and to
enrolled in this study to evaluate the electrical activities of correlate the results for two groups of mother-baby dyads: a
the masseter and temporal muscles, bilaterally, at rest and in study group, composed of emotionally fragile mothers, due to
maximum voluntary clench (MVC). The MMO and MBF prenatal diagnosis of a structural alteration in their childs; and a
were also measured. The overcomes were compared with control group of dyads with no diagnosed changes. Methods:
non-syndromic healthy individuals which were described in Methods: We followed 50 mother-baby dyads at six different
the literature. Furthermore, the body fat distribution (body stages of their lives: first as a newborn and then at two, four,
mass index, BMI; neck and abdomen circumferences, NC six, nine and twelve months old. The mothers completed both
and AC; and waist to hip ratio, WHR) and the subjective the Infant Behavior Questionnaire - Revised and the Sleep
diagnosis for sleep disorders (Epworth Sleepiness Scale, Habit Questionnaire for Babies Under 12 Months - CSHQ-I
STOP-BANG and Fletcher & Luckett questionnaires) were when their infants were nine months of age. The former
investigated.Results: The electromyographic records and questionnaire allows the assessment of a variety of domains
the MBF, in function, showed lower values in our patients (such as Feeding and Sleeping) by checking how often certain
with SD than in non-syndromic healthy individuals. The behaviors tend to manifest.Results: Results: The infants kept
MMO was slightly high in the DS group, probably, due to the inclusion criteria with typical development according to
the relaxation and the stretch of the studied muscles. The the screening and evaluation protocols used. In addition, there
body fat levels were high in BMI, NC, AC, and WHR in was a significant difference between some statistical variables,
both the genders; however, the NC was only superior in but these did not include variables that verified the quality of
men. The results showed that our patients were overweight the Sleep construct. Finally, there was no significant difference
or obese (obesity grade I), indicating risks for developing regarding the analysis of the grouped variables of all domains.
obesity-related diseases. The excessive daytime sleepiness, Conclusions: Conclusion: The presence of structural
high risk of OSA, and impaired sleep quality were alteration in the baby had no negative effect on sleep-wake
evidenced in women (42,8%, 42,8% and 14,3%) and men cycle development. Some babies had difficulties such as
(35,3%, 64,7%, and 11,76%). Conclusions: We concluded frequent nighttime awakenings, sleeping resistance, infant
that the hypofunction of the temporalis and masseter dependence to fall asleep alone, and excess electronic devices,
muscles was found in our patients with DS, configuring a but these characteristics did not reach statistical significance
masticatory muscle hypotonia in these individuals. High between the groups. Therefore, the development of the
MMO amplitude was also evidenced, probably, due to the sleep-wake cycle in the first year of life deserves especially
extensibility of the studied muscles. The masticatory muscle individualized attention and care, considering its immense
hypotonia, associated with excess body fat, influenced the importance in the child’s future development.
high risk of OSA, especially in men. Palavras-chave: Key words: sleep-wake cycle, sleep in infants, mother-baby dyad.

Palavras-chave: Down Syndrome, Muscles hypotonia; Adiposity; Sleep Wake Disorders.

ID: 707
ID: 705
Case Reports
Basic Research
Sleep disorders in amyotrophic lateral
Mother-baby dyad interaction and sleep-wake sclerosis: by the way of a case
cycle development: a longitudinal study of the
newborn during the first year of life Franco, C M R, Gemir, T L, Xavier, H, Correia, C C

Souza, V C A, Vilhena, T d, Silva, V B O, Vilhena, P H d, Introduction: Sleep disorders are a common and
Machado, A M C, Machado, A M C, Achieta, L M, Achieta, L M, can be an early manifestation of amyotrophic lateral
Parlato-Oliveira, E M, Parlato-Oliveira, E M sclerosis (ALS), but can be undetected until the later
stages of disease. Abnormal breathing during sleep
Universidade Federal de Minas Gerais - BELO HORIZONTE - Minas
is frequently present and may occur even in patients
Gerais - Brasil
with normal respiratory function and no signs of
Introduction: Introduction: Sleep is an active state, responsible diaphragmatic denervation. Various studies have reported
in the early years of life for the Central Nervous System obstructive and central apneas as well as non-obstructive
maturation processes. Sleep is so important in young infants hypoventilation in patients with ALS. Aim: Describe

Sleep Sci. 2020;13(Supl.1):1-118

 38

sleep disorders caught on polysomnography in a patient the Research Diagnostic Criteria for TMD, were invited
with amyotrophic lateral sclerosis and a literature review to fullfill the Morningness-Eveningness Questionnaire
about sleep disorders in ALS. Methods: The study was (MEQ-SA). It is composed by 19 multiple-choice
conducted from the examination analysis of a patient who questions regarding sleep characteristics and preference.
underwent polysomnography in the sleep laboratory of a Subjects are defined as late rising, moderately late rising,
school hospitalResults: RFL, 76 years old, three months intermediate, moderately early rising and early rising. We
after diagnosis of ALS, presented alterations of the sleep- also avaliate duration and intensity of pain.Results: The
wake cycle. Polysomnography findings were: extremely participants mean age was 41 years old and the visual
short total sleep time, normal sleep latency and slightly analogic scale media was 6.2 . They had an average of
decreased for REM sleep. Alteration of sleep architecture pain duration from six months to 12 years. Regarding
was also found at the expense of increased N1 and N2 the MEQ-AS, the result show: one (2.5%) late rising, 3
phase content, decreased REM sleep and absence of N3 (7.5%) moderately late rising, 23 (57,5%) intermediate,
phase. There was also an increase in the rate of respiratory 12 (30.0%) moderately early rising and one (2.5%) early
disorders, all of obstructive pattern, being exacerbated rising. Conclusions: Although several studies show the
during REM sleep. Conclusions: Amyotrophic lateral association of late types with more pain, our study could
sclerosis represents a multi-faceted disorder of multiple not show the relationship between TMD individuals with
genetic preponderance, with disturbance of respiratory pain and late types. In contrary, it could be observed that
function and sleep a key component and early indicator the most prevalent chronotype in individuals with TMD is
of respiratory compromise. Not only is REM sleep the intermediate, followed by moderate early rising.
period of greatest vulnerability for developing nocturnal Palavras-chave: Chronotype, Temporomandibular disorders, Myofascial pain, Chronic pain

hypoventilation, a marked reduction of REM sleep

duration has been shown to be associated with reduced ID: 713
survival in ALS. Case Reports
Palavras-chave: amyotrophic lateral sclerosis, sleep disorders, REM sleep

ID: 712
Obstructive sleep apnea preceding acromegaly
diagnosis
Clinical Studies
Yanagimori, M, Cano, T, Passini, V V, Fernandes, M D, Lacerda,
Chronotypes of individuals with C B, Vasconcellos, B S, Uneda, C B, Filho, G L, Genta, P R
temporomandibular disorders FMUSP - São Paulo - Sao Paulo - Brasil

Lalue Sanches, M S Introduction: Obstructive sleep apnea may be

Universidade Metodista de São Paulo - UMESP - São Bernardo do caused by endocrine disorders such as acromegaly and
Campo - Sao Paulo - Brasil, Universidade Santa Cecília - UNISANTA hypothyroidism. Acromegaly is a benign and rare disease
- Santos - Sao Paulo - Brasil characterized by excessive secretion of growth hormone
(GH) and insulin-like growth factor (IGF1). Acromegaly is
Introduction: Temporomandibular disorders (TMD) associated with increased mortality due to cardiovascular
are the second most prevalent musculoskeletal condition, and respiratory complications. Obstructive sleep apnea
affecting the temporomandibular joint, its associated (OSA) is the most typical respiratory comorbidity. OSA
muscles and all the related structures that are inervated diagnosis can can precede acromegaly diagnosis. Aim:
by the trigeminal complex. As it is know, the sleep can be This case report an OSA patient with typical symptoms
influenced, in an unfavorable way, by many conditions that of acromegaly yet undiagnosed. Methods: A 48 year-old
cause pain. Chronotype refers preferences for activities male patient was referred to the outpatient sleep medicine
during certain times of the day and is a behavioral clinic due to loud snoring, nocturnal respiratory pauses
manifestation underlying circadian rhythms. Several and daytime excessive sleepiness (Epworth 18/24). When
studies had shown that the chronotype can influenced asked, he mentioned that his voice became low-pitched
the interpretation of pain. Studies with Chronic pain, in the last few years and that he had to cut his wedding
fibromyalgia, depression and some musculoskeletal ring twice due to increase in the diameter of his ring
disorders, that are comorbidities commonly encountered finger. He brought old photos which revealed that his face
in individuals with TMD, encountered that evening enlarged, his jaw protruded, his nose wings enlarged and
chronotype are more sensitive to pain. Aim: The aim of his lip thickened. A polysomnography and serum IGF1
this study was to identify the chronotype of individuals were requested .Results: The polysomnography showed
with TMD in order to find other ways to minimize the severe obstructive apnea (89. 2 events/h), IGF1=843ng/
pain. Methods: This is a descriptive study where forty ml(normal range 53-215 ng/ml). The patient was referred
individuals with TMD of muscular origin, according to the neuroendocrinology service for treatment. CPAP

Sleep Sci. 2020;13(Supl.1):1-118

39
and and weight loss were recommended. Two months patients. days of use and patient B with a fixed pressure
after the OSA diagnosis, the patient was using CPAP of 7 cmH20, AHI of 5 and 77% adherence at 89 days
regularly (use=28/30 days; CPAP level=7cmH20 and of use. Both had a reduction in blood pressure values
residual AHI=0.2 events/h) . The patient reported documented by an attending physician. Conclusions:
improvement in both sleep quality and excessive daytime Self-titration accompanied by professional, educational
sleepiness (Epworth 14/24). Conclusions: One must pay guidelines were able to ensure treatment and adherence of
attention on clinical signs and symptoms of acromegaly the association of hypertension and OSAS.
among patients with OSA. Palavras-chave: Hypertension, Sleep Apnea, Adherence, Treatment, Continuous Positive Pressure

Palavras-chave: obstructive sleep apnea, acromegaly

ID: 715
ID: 714
Clinical Studies
Case Reports
Diagnosis and treatment of sleep apnea
Impact of continuous positive pressure patients in the public health system
(CPAP) treatment in patients with systemic
HUNHOFF, B, BELLON, M, STELZER, F G, GARCIA, E,
arterial hypertension (SAH) and obstructive
SCHORR, F
sleep apnea syndrome (OSAS): case report
Santa Casa de Misericórdia de Porto Alegre - Porto Alegre - Rio Grande
PAIVA, V S do Sul - Brasil

FACTUM - Porto Alegre - Rio Grande do Sul - Brasil Introduction: The Obstructive Sleep Apneia (OSA) is a
common disease among adult population. However, the
Introduction: The association between hypertension maiority of patients remain undiagnosed and untreated.
and OSAS it is considered worrying because they involve Polysomnography is the gold-standard for OSA diagnosis,
conditions that lead to serious cardiovascular problems but inaccessible and very expensive for our population.
with consequent increase in deaths, if not properly treated. The Home Sleep Apneia Test (HSAT) evaluates respiratory
It has been reported that in hypertensive patients the variables and can be used when there is a high risk of
prevalence of OSAS is 35%, so it is relevant to consider OSA. The effective treatment to moderate and severe
the appropriate therapy for this association. The treatment OSA is the Continuous Positive Airway Pressure (CPAP).
of isolated hypertension is known to involve the selection However, this device is so expensive for population of
of medications and an increase in lifestyle change. Public Health System of Brazil (SUS). Aim: Describe a
However, in OSAS, CPAP predilection is considered the model available for management of sleep apnea patients
ideal standard; however, there is no consensus on the exact from public health system in Southern Brazil. Methods:
CPAP values to lower systolic and diastolic pressures. Aim: One hundred and thirty patients were referred to sleep
To demonstrate the management of CPAP treatment in clinic of Santa Casa de Misericórdia de Porto Alegre/RS.
two patients with refractory hypertension and severe and All patients underwent a clinical evaluation and those with
moderate OSAS. Methods: study of two cases, a 53-year- high probability of OSA performed to HSAT (Stardust
old man (A) and another 68-year-old woman (B) from II©) from March 2018 to March 2019. The severity of
medical services and referred after polysomnography OSA was classified according to the apnea/hypopnea
examination to a specialized sleep physiotherapy service index (AHI) as mild (5 to 14,9), moderate (15 to 29,9)
in the metropolitan region of Porto Alegre/RS. Patient and severe (≥ 30 events/h). Patients with severe OSA
A’s hypopnea apnea index (AHI) was 113 events with and moderate OSA with cardiovascular comorbidities
a minimum SatO2 of 85%, and patient B had AHI of or excessive daytime sleepiness were referred to CPAP
23 events and a minimum SatO2 of 81%. Both had treatment. Oral appliance (OA) and maxillomandibular
symptoms of excessive sleepiness, complaints of memory advancement surgery (MMA) were other forms to OSA
loss and poor occupational and home-based performance. treatment in select cases. Weight loss was indicated for
Self-titration exam (automatic equipment) was performed all overweight and obese patients.Results: Were studied
for 6 nights accompanied by physiotherapist. Satisfactory 106 patients, 61% female (n=65), mean age 58 years and
when considered to be 4 hours per night / use, without mean body index 32±6,5kg/m2. Most patients (63%) had
significant leakage,> 24 liters per minute for, ≥ 30% of excessive daytime sleepiness (ESS 12 [2-24]). HSAT was
use time and a residual AHI (measured by the device) ≤ performed 285 days after clinical evaluation and confirmed
5 events / hour. Results: After titration, follow-up and the OSA diagnosis in 87 patients (82%). Mean AHI was 21
educational guidance (explanation about the disease, events/h and most of the sample was moderate to severe
equipment, treatment and adherence factors), patient OSA (n=51). Only 8,5% of the sample (n=9) needed
A evolved with 13 cm H2O fixed pressure equipment to repeat the HSAT and oximetry loss represented the
and 3.5 events AHI, maintaining 80% adherence in 49

Sleep Sci. 2020;13(Supl.1):1-118

 40

mainly reason for the repetition (n=6). Among 51 patients than the saline and luzindole. There was a reduction in
with moderate to severe OSA, 42 had indication for CPAP the activity of CAT enzymes in the luzindole and LPS
treatment, but few patients were using the device (n=12) when compared to saline. The luzindole group showed
due to financial constraints. Four patients were referred an increase in GSHConclusions: The acute blockade of
to OA and one to MMA. Conclusions: The HSAT is an endogenous MLT with luzindole, a MT1 and MT2 receptor
accessible model for OSA diagnosis among patients with inhibitor, induces precocious and prominent inflammatory
high probability of OSA. However, the waiting time to and pro-oxidant effects with altered intestinal morphology.
perform the HSTA is still long in the public health system. As compared, LPS induced mucosa pathological changes.
Similarly, after OSA diagnosis, few patients have access It is proposed that high concentrations of endogenous
to treatment, especially those with indication for CPAP MLT in the intestine have a primordial function blocking
treatment. inflammation and oxidative stress. This research was
Palavras-chave: Obstructive sleep apnea; continuous positive airway pressure; home sleep test
supported by Conselho Nacional de Desenvolvimento
Científico e Tecnológico (CNPq), Brazilian Research
ID: 717
Council
Basic Research
Palavras-chave: Luzindole; Melatonin; LPS; Inflammation; Oxidative stress; Intestine

Inhibition of endogenous melatonin ID: 719

by luzindole induces small intestinal Case Reports
inflammation and morphology alterations in
Polysomnography Findings in Patients with
mice
Restless Legs Syndrome: by the way of a case
Matos, R S , Bruin, V M S, Bruin, P F C, Pinto, D V, Viana, A F
Gemir, T L, Franco, C M R, Xavier, H, Pinheiro, S N
S C, Nunes Filho, J C C, Daniele, T M C, Santos, F A, Duarte, A
S G, Oriá, R B Hospital Universitário Oswaldo Cruz - Recife - Pernambuco - Brasil
Sleep and Biological Rhythms Laboratory - School of Medicine - Introduction: Sleep disturbances and their sequelae are
Federal University of Ceará - Ceará - Fortaleza - Brazil, Department of the most common complaints of patients with restless legs
Physiology and Pharmacology - Natural Products Laboratory - Faculty syndrome (RLS). The consequences of chronic sleep loss
of Medicine - Federal University of Ceará - Ceará - Fortaleza - Brazil, have been investigated intensively in recent years. Aim:
Laboratory of Tissue Healing, Ontogeny and Nutrition - Department Describe sleep disorders caught on polysomnography in
of Morphology - School of Medicine- Federal University of Ceará - a patient with restless leg syndromes and do a literature
Ceará - Fortaleza - Brazil. review about restless legs syndrome. Methods: The study
was conducted from the examination analysis of a patient
Introduction: Acute blocking of the endogenous
who underwent polysomnography in the sleep laboratory
melatonin (MLT) receptors by luzindole without MLT
of a school hospital.Results: SDS, 72 years old, presents
supplementation have not been explored. Aim: To
alterations of the sleep-wake cycle. Evaluation in the pre-
investigate the effects of luzindole administration, a high
sleep questionnaire, the patient answered positively to the
affinity MLT receptor antagonist (MT1 and MT2) in mice
4 diagnostic criteria defined by the International Restless
small intestine, where MLT concentration is substantially
Leg Syndrome Study Group. Polysomnography result
higher. The intestinal aggressor lipopolysaccharide (LPS)
was consistent with increased sleep latency for non-REM
was administered for comparison. Methods: Swiss
and REM. Presented fragmented sleep and importante
mice (24) were treated with either saline (0.35mg/kg,
increased wakefulness after sleep onset and consequent
i.p), luzindole (0.35mg/kg, i.p.) or LPS (1.25mg/kg, i.p).
reduction in sleep efficiency. It also presented a slight
After 90-min, jejunum samples were evaluated regarding
change in sleep architecture at the expense of increased
intestinal morphometry, i.e. histopathological crypt
N2 phase content, and reduced REM sleep content. The
scoring and PAS-positive villus goblet cell counting; plus
alteration of REM sleep, with reduction of REM sleep
inflammatory (Iba-1, IL-1β, TNF-α, NFkB, and MPO) and
duration and increase of REM sleep latency, is a novel
oxidative stress (NP-SHs, CAT, GSH, MDA, and nitrate/
finding. It might have occurred as a consequence of sleep
nitrite) markers.Results: Animals treated with luzindole
interruptions which were in turn due to the nocturnal
or LPS showed shortening of villus height compared to
occurrence of RLS symptoms. The consequences of
saline. The LPS group had worse histopathological score
chronic sleep loss have been investigated intensively in
of the crypts. Luzindole treatment and LPS reduced the
recent years. Chronic sleep deprivation, as in untreated
amount of goblet cells immunolabelled with PAS and
RLS, may lead to increased risk of insulin resistance and
increased Iba-1-immunolabelled cells as compared to
type 2 diabetes or to impairment of sleep-dependent
saline. Immunoblotting for IL-1β, TNF-α, and NFκB was
memory consolidation. Prefrontal cognitive deficits
more intense in the luzindole group. Mice treated with
LPS showed higher tissue alterations, and MPO activity
Sleep Sci. 2020;13(Supl.1):1-118
41
similar to those reported for loss of one night of sleep ID: 721
were shown recently in patients with RLS. Conclusions:
The findings show markedly fragmented sleep with Clinical Studies
deterioration of both NREM and REM sleep in RLS.
The long-term consequences of sleep loss in this patient
Can sleep quality or daytime sleepiness be
population should be investigated further. associated with physical disability in older
Palavras-chave: restless leg syndrome, sleep disorders, REM sleep
adults? A cross-sectional study
ID: 720 de Oliveira, S D, Pinto, R Z, Kakazu, V A, Matos, Y L, Franco, M,
de Negrão, R F, Gobbi, C, Tufik, S, Andersen, M L, Morelhão, P K
Clinical Studies
Departamento de Fisioterapia - Universidade Estadual Paulista -
Does sleep quality predict different physical Presidente Prudente - São Paulo, Brasil, Departamento de Fisioterapia -
activity levels? Cross-sectional study in older Universidade Federal de Minas Gerais - Belo Horizonte - Minas Gerais
adults with low back pain - Brasil, Departamento de Fisioterapia - Centro Universitário - Belo
Horizonte - Minas Gerais - Brasil, Departamento de Psicobiologia -
Luciano, Y M, Pinto, R Z, Franco, M R, Bortolotti, L M, Gobbi, Universidade Federal de São Paulo - São Paulo - Brasil
C, Lorenconi, R M, Tufik, S, Andersen, M L, Kakazu, V A,
Morelhão, P K
Introduction: : Low back pain is a major cause of disability
worldwide. Reports in the literature show that 60% of
Departamento de Fisioterapia - Universidade Estadual Paulista - patients with low back pain have sleep complaints. At the
Presidente Prudente - São Paulo, Brasil, Departamento de Fisioterapia - moment, the relationship between sleep and disability in
Universidade Federal de Minas Gerais - Belo Horizonte - Minas Gerais older adults remains unclear. Aim: To investigate whether
- Brasil, Departamento de Fisioterapia - Centro Universitário - Belo sleep quality is associated with disability in older adults
Horizonte - Minas Gerais - Brasil, Departamento de Psicobiologia - with low back pain. Methods: The study was designed
Universidade Federal de São Paulo - São Paulo - Brasil as cross-sectional. Inclusion criteria for participation were
age over 60 years, low back pain in the last 12 weeks or at
Introduction: Sleep quality changes due to the aging
the moment of the interview, and absence of cognitive
process. It is not yet clear in the literature whether poor sleep
impairment. The questionnaires applied were Epworth
quality can influence the intensity of physical activity in the
Sleepiness Scale, Pittsburgh Sleep Quality Index, and the
elderly with low back pain. Aim: To investigate whether
Roland Morris Questionnaire. To perform the statistical
sleep quality can predict different levels of physical activity
analysis, the multivariate regression model was applied and
in older people with low back pain. Methods: This study
adjusted for covariates.Results: The sample consisted of
was designed as a cross-sectional. Participants aged 60 and
225 older adults with low back pain. The average (standard
over were recruited. A face-to-face interview was performed
deviation) of sleep quality was 10.33 (3.24) points in the
at their homes and data were collected using the Modified
Pittsburg Sleep Quality Index questionnaire, the average
Baecke Elderly Questionnaire, the Pittsburgh Sleep Quality
daytime sleepiness scale of 5.01 (3.37), and the mean
Index, the Daytime Sleepiness Scale, and participants were
disability questionnaire in this population was 10.92 (6.6).
asked about the presence of low back pain at moment of
After the covariate-controlled multivariate linear regression
the interview and/or in the last three months.Results: The
analysis, the final model showed that the daytime sleepiness
final sample of this study included 225 elderly with low
scale was associated with disability in patients with low back
back pain. Among the participants, 77% were women. The
pain β=0.20 (0.001 to 0.40) and p=0.04, meaning that, at
mean age (standard deviation) was 71.07 years and the Body
each point on the sleepiness scale, patients increased 0.20
Mass Index averaged 28.27 (5.09) kg/m². The mean low
points on the disability questionnaire. Conclusions: Our
back pain intensity of those participants was 4.52 (3.18),
results suggest that daytime sleepiness was associated with
the average sleep quality was 10.92 (6.86), and the average
an increase in physical disability in older people with low
total physical activity was 4.82 (4.03). The linear regression
back pain. Future studies should investigate if there is a
analysis demonstrated that sleep quality is not associated
relationship of causality.
with physical activity of older adults with low back pain Palavras-chave: Older adults, disability, sleep, low back pain

(β=-0.01 CI=-1.67 to 0.15 and p=0.95). Conclusions:

The results from this study showed sleep quality was not ID: 723
able to predict the levels of physical activity of the older
population. This result may be due to the fact that our Basic Research
participants present a previous heath condition, such as low
back pain. Future studies should investigate the domains of Effects of hydroxychloroquine on blood
the sleep questionnaire related to physical activity levels. pressure control in sleep apnea
Palavras-chave: Sleep quality, Physical activity, Low back pain, Older adults

Sleep Sci. 2020;13(Supl.1):1-118

 42
Piccin, C F, Guaresi, S, do Nascimento, N, Pearson, M E, Azeredo, Clinical Studies
M A, Chiarello, P T, de Cezaro, J C, Costa, L S, Campagnol, D,
Martinez, D Frequency and Predictors of Sleep Duration
Faculdade de Desenvolvimento do Rio Grande do Sul - Porto Alegre Misperceptions: Data from 2,036 participants
- Rio Grande do Sul - Brasil, Hospital de Clínicas de Porto Alegre - from the ELSA-Brasil Study
Porto Alegre - Rio Grande do Sul - Brasil, Universidade Federal do Rio
Grande do Sul - Porto Alegre - Rio Grande do Sul - Brasil SANTOS, R B, AIELO, A N, GIATTI, S, SILVA, W A, PARISE, B
K, SOUZA, S P, DA CUNHA, L F, LOTUFO, P A, BENSENOR,
Introduction: Obstructive sleep apnea (OSA) is I M, DRAGER, L F
recognized as independently associated with high
INCOR FMUSP - SÃO PAULO - Sao Paulo - Brasil
blood pressure. Protocols of chronic intermittent
hypoxia (CIH) increase blood pressure (BP) in animal Introduction: Accumulating evidence links short and/
models. Hypertension has been linked to inflammation. or long sleep duration (SD) with several metabolic and
Hydroxychloroquine (HCQ) has been proven to exert cardiovascular diseases. However, the majority of the
anti-inflammatory effects through down-regulation of previous studies used self-reported SD. It is unclear,
pro-inflammatory cytokines. Aim: We hypothesized however, the magnitude and the factors associated with
that CIH simulating sleep apnea causes hypertension via SD misperceptions that may potentially limited the utility
inflammation-mediated mechanisms and that hypertension of using subjective SD. Aim: To evaluate the frequency
could be inhibited by the anti-inflammatory action of and predictors of Sleep Duration (SD) misperceptions
HCQ. Methods: Seventeen male 12-week-old Wistar rats in a large cohort of participants not referred to sleep
were submitted to telemetry sensor implantation surgery laboratories. Methods: Participants from the ELSA-Brasil
(DSI®, USA) for continuous BP verification. After study underwent clinical and sleep evaluation (including
surgical recovery, they underwent 14-day CIH protocol mean subjective SD and wrist actigraphy for 7 days). We
with either injection of 35mg/kg/day of HCQ diluted considered a significant SD underestimation (underSD)
in saline (Sigma-Aldrich, USA) (CIH+HCQ group, n=5) and overestimation (overSD) when the differences
or saline vehicle (CIH group, n=6) or sham hypoxia with between subjective and objective SD reached at least -1
saline vehicle injection (sham group, n=6). The hypoxia hour/+1-hour, respectively. The Bland‑Altman method
protocol was performed by introducing nitrogen into the and Pearson correlation coefficients (r) were assessed for
cages reducing the oxygen fraction from 21% to 7±1%. exploring potential bias and agreement between the self-
The rats underwent CIH daily during 8 hours, simulating reported and actigraphy data. We used logistic regression
an apnea/hypopnea index of 51/h. The BP recordings analyses for identifying characteristics associated with SD
were performed in the morning and in the afternoon. misperceptions.Results: Data from 2,036 participants
Averages of individual BP values were calculated for were used in the final analysis (42.7% males; mean age:
each day. For the present analysis, only mean arterial 49±8 years). Subjective SD revealed poor correlations and
pressure (MAP) data were used. P values were obtained low agreement with objective SD. The overall frequency
from generalized estimating equations with Bonferroni’s of significant SD misperceptions was 39.1% (underSD:
correction for multiple comparisons.Results: No baseline 19.4%; overSD: 19.7%). The predictors of underSD
MAP difference was seen (day-1: Sham, 123±2mmHg; included: black race (OR: 1.88; 95% CI: 1.35, 2.64), mixed
CIH, 114±6mmHg; CIH+HCQ, 117±4mmHg), but race (OR: 1.57; 95% CI: 1.18-2.09); excessive daytime
at 14-day follow-up (day-14: Sham, 105±5mmHg; CIH, sleepiness (OR: 1.46; 95% CI: 1.12-1.91); longer wake
121±3mmHg; CIH+HCQ, 115±2mmHg) a significant time after sleep onset time, WASO (OR: 2.38; 95% CI:
difference existed between sham and CIH groups (p=0.01). 1.34-4.26), and longer objective SD (OR: 2.98; 95% CI:
The HCQ group effect on delta MAP from day-1 to 2.52-3.52). Longer WASO (OR: 2.24; 95% CI: 1.33-
day-14 exposure against CIH and sham groups showed 3.79), and higher number of awakenings (OR: 1.02;
statically significant time × group interaction (p<0.001). 95% CI: 1.00-1.03) were independently associated with
Conclusions: The CIH model is capable of increasing overSD. Interestingly, married status, high education
significantly MAP, confirming previous reports of the levels and higher sleep efficiency were associated
OSA role on the pathogenesis of high blood pressure. with good SD perceptions. Conclusions: Subjective
Our data suggests a potential inflammatory pathway in the has poor correlations and agreement with objective
OSA-hypertension relationship, which is mitigated by the measurements of SD contributing to a significant rate of
use of HCQ. Studies in humans are needed to assess the SD misperceptions. While underSD was more associated
effect of HCQ as adjunctive therapy in OSA. with black/mixed race, daytime sleepiness, longer SD and
Palavras-chave: intermittent hypoxia, sleep apnea, hydroxychloroquine

ID: 724

Sleep Sci. 2020;13(Supl.1):1-118

43
WASO, overSD was specifically associated with markers of ID: 728
sleep fragmentation. Considering the available technology,
these results underscore the need for stopping the use of Clinical Studies
subjective data for SD definitions.
Palavras-chave: sleep duration, actigraphy; measurement error.
Interactions between Obstructive Sleep
Apnea and Sleep Duration with Subclinical
ID: 726
Atherosclerosis Evaluated by Coronary
Clinical Studies Calcium Score: Cross-sectional Data from
Cheeks asymmetry is not associated with ELSA-Brasil study
sleep apnea severity Souza, S P, BIttencourt, M S, Santos, R B, Parise, B K, Giatti, S,
Aielo, A N, Silva, W A, Bensenor, I M, Lotufo, P A, Drager, L F
Prikladnicki, A, Sousa, L C C R, Cotes, L C R, de Cezaro, J C,
Ramos, J U, Sezerá, L, Piccin, C F, Gomes, E, Martinez, D
Introduction: Recent data suggest that sleep disorders
Universidade Federal do Rio Grande do Sul - Porto Alegre - Rio like Obstructive Sleep Apnea (OSA) and extremes of
Grande do Sul - Brasil Sleep Duration (SD) are associated with coronary artery
disease. However, the interaction of OSA and SD with
Introduction: Obstructive sleep apnea (OSA) is a prevalent subclinical markers of the coronary atherosclerosis
health condition among adults and one of the most remains to be determined. Aim: To Test the association
underdiagnosed diseases worldwide. Polysomnography is of OSA, SD and their interactions on subclinical
the golden standard assessment to precisely diagnose sleep- atherosclerosis evaluated by cornary artery calcium (
related disorders. Craniofacial anatomical phenotypes are CAC) score. Methods: We consecutively evaluated
established risk factors for OSA in children and adult participants from ELSA-Brasil, a cohort study of adult
populations. Abnormalities such as mandibular deficiency, civil servants. All participants were submitted to a single
maxillary hypoplasia, inferior position of the hyoid bone, night portable sleep monitoring (Embletta GoldTM) to
a narrowed posterior air space in adults are risk factors determine OSA status and wrist actigraphy during one
for OSA. Therefore, investigating the facial symmetry week (Actiwatch 2TM) for the objective ascertainment of
may be of clinical interest in OSA adult population. the SD. An apnea-hypopnea index (AHI) <5 events per
Aim: Verify whether cheeks appearance asymmetry is hour was considered normal; AHI 5-14.9 and IAH ≥15
a predictor of OSA risk. Methods: Adult patients with events/hour were classified as mild OSA and moderate-
sleep complaint were assessed in a sleep clinic between severe OSA, respectively. Computed tomography using a
October of 2018 and March of 2019. They underwent Philips Brilliance 64-detectot scanner (Philips Healthcare,
overnight polysomnography and face photography was Andover, MA) was performed to assess the calcium score
taken by one of the evaluators while assessing them in by a standard protocol adjusted for each participant’s
loco. Two other blinded and independents evaluators biotype. Subclinical atherosclerosis was defined as a
assessed all the patients based on photographic data. The CAC >100 score. Analysis of adjustment for potential
cheeks appearance evaluation was based on the volume confounding factors was performed, including age, sex,
and the tone of the structures, assessing the right and the and cardiovascular risk factors and drug use.Results:
left cheek separately. Results: A total of 248 subjects We studied 2,169 participants (age: 49±8 years; 56.6%
were included (mean age, 46 years; 147 [59 %] male; 114 female). The frequency for OSA was 32%. We observed
[46 %] obese). 29% were non-OSA cases, 26% had mild a progressive increase in the frequency of CAC >100
OSA, 23% had moderate OSA and 22% had severe OSA. in parallel to the severity of OSA: No OSA: 4%, mild
33 (13.3%) of the subjects had cheeks asymmetry based OSA: 8% and moderate-severe OSA: 12% (p trend:
on the protocol used. The results show no statistical <0.001). Interestingly, participants with long SD (>8
difference in AHI when comparing the symmetric hours) presented higher frequency of CAC >100 (15%)
(19±23/h) to the asymmetric cheeks groups (18±15; as compared to subject with SD 6-8 hours (7%) and SD
p=0.15) when associating to apnea-hypopnea index (IAH). <6 hours (9%; p trend: 0.01). In the logistic regression,
The binary logistic regression analysis including cheeks moderate-severe OSA (OR 1.18; IC 95%: 0,85 1,64) or
asymmetry as dependent variable and adjusting for BMI, SD >8 hours (OR 1.39; IC 95%: 0,88 2,21) were not
age and gender remained non-significant. Conclusions: associated with CAC >100. However, the interaction of
Cheeks appearance asymmetry is not related to OSA OSA with SD >8 hours was independently associated
severity and does not seem to imply in a higher risk for with CAC >100 (OR 2.78; p=0.01) when compared to the
OSA, suggesting that soft tissue asymmetry is irrelevant reference group (no OSA, SD <8 hours). Conclusions:
as OSA predictor. We observed an interesting interaction of OSA with long
Palavras-chave: diagnostic accuracy; speech, language and hearing sciences; obstructive sleep apnea (OSA); polysomnography (PSG)

Sleep Sci. 2020;13(Supl.1):1-118

 44

SD (>8 hours) with almost three-fold chance to present Palavras-chave: cardiovascular system; obstructive sleep apnea (OSA); diabetes mellitus; arterial pressure.

relevant subclinical atherosclerosis (defined by a CAC ID: 730

>100).
Palavras-chave: Obstructive Sleep Apnea, Sleep Duration, coronary artery disease, coronary atherosclerosis.
Basic Research
ID: 729 Association between children’s sleep habits
Clinical Studies and blood pressure at six years of age
Obstructive sleep apnea and heart rate Schultz, L F, Kroll, C, Torres, C H, Trombelli, M C, Santos, D d,
variability assessed by ambulatory blood Mastroeni, M F

pressure monitoring in seniors with diabetes. Universidade da Região de Joinville -UNIVILLE - Joinville - Santa
A propensity score matched case-control Catarina - Brasil

study Introduction: Sleep habits play an important role on

health maintenance and prevention of non-communicable
Reimann, L M T S, do Nascimento, N, Rossi, B J C, Prikladnicki, chronic diseases in childhood and adulthood. Aim: To
A, de Cezaro, J C, Cotes, L C R, Sezerá, L, Piccin, C F, Martinez, D evaluate the effect of sleep habits on blood pressure of
Universidade Federal do Rio Grande do Sul - Porto Alegre - Rio six-year-old children. Methods: This research is a part
Grande do Sul - Brasil of a bigger study denominated Predictors of Maternal
and Infant Excess Body Weight – PREDI Study that was
Introduction: Impaired heart rate variability (HRV) in performed in Joinville-SC, Brazil. Data were collected at
continuous ECG recordings is an index of cardiovascular the homes of mothers and children that participated in
risk. Increased HRV during sleep, estimated from the third follow-up of the PREDI Study in 2018. Sleep
ambulatory blood pressure monitoring (ABPM-HRV), habits of the children were obtained by self-reports of
has been described as a predictor of cardiovascular events the mothers by using the “Inventory of Sleep Habits for
in type 2 diabetes mellitus (T2DM). Obstructive sleep Preschool Children”. Children’s Systolic Blood Pressure
apnea (OSA) is common in T2DM and could explain (SBP) and Diastolic Blood Pressure (DBP) were measured
the increased nighttime ABPM-HRV in T2DM. Aim: by a health professional through the auscultatory method
Identify whether the HRV is higher in diabetic seniors in and according to the “2017 Clinical Practice Guideline
comparison with non-diabetic seniors controls. Methods: for Screening and Management of High Blood Pressure
Community-dwelling and physically independent persons in Children and Adolescents”. Instructional therapeutic
aged 65 years and older of both sexes were recruited play was used as a strategy to avoid embarrassment to the
from an ongoing cohort study that performs respiratory children and to facilitate blood pressure assessment by
polygraphy and ambulatory blood pressure monitoring the health professional. Results: Of the 178 children that
at 15-minute intervals during the day and 20-  minute participated in the study, 21 (11.8%) presented elevated
intervals during the night. ABPM-HRV was estimated SBP (≥P90). Among these children, there was a greater
from the standard deviation (SD) and coefficient of prevalence poor sleep quality (57.1%). Additionally,
variation (CV) of heart rate. Non-diabetic controls were children classified as having inadequate sleep habits
matched by age, sex and body mass index using the showed significantly greater mean of SBP in comparison
propensity score Diabetic vs. non-diabetic and OSA vs. to children with adequate sleep habits, 61.5mmHg e
non-OSA comparisons were performed to assess their 52.8mmHg respectively. The logistic regression analysis
associations with daytime and nighttime ABPM-HRV. revealed that children with inadequate sleep habits had
Results: Among the 429 subjects in the cohort, we greater odds of having SBP≥P90 when compared to
found 90 T2DM cases and were able to match 90 non- children with adequate sleep habits even after adjustment
diabetic controls. In univariate analysis, participants for nutritional status and years of education (OR=5.3,
with T2DM showed a 24-hour ABPM-HRV CV lower 95%CI=2.0-13.9, p=0.001). Conclusions: Children with
than the controls: 11.7 ± 4.2 vs. 13.4 ± 4, respectively; inadequate sleep habits have greater odds of developing
P=0.006. Adjusting for AHI and usual confounders the high blood pressure at six years of age. Taking care of
difference is still significant (P=0.017). Conclusions: sleep quality in preschool age is essential to avoid the
Reduced HRV was independently associated with T2DM. development of chronic-degenerative diseases that can
This may contradict a previously reported hypothesis that last until adulthood.
OSA could participate in increasing nighttime ABPM- Palavras-chave: Sleep habits; systolic blood pressure; preschool age; children.

HRV in T2DM. The present results in seniors warrant

further research on the mechanisms of the OSA-HRV
relationship.

Sleep Sci. 2020;13(Supl.1):1-118

45
ID: 731 Conclusions: Anxiety and mood results indicate adequate
psychological preparation for competition. Athletes had
Basic Research bad sleep quality, which could have been influenced by the
competition environment. It is emphasized the need for
Anxiety, Mood and Sleep Quality of Basketball awareness to improve competitive Brazilian athletes’ sleep
Elite Athletes in a Competition conditions.
Palavras-chave: Sleep, anxiety, competition, athletes.

Daniel, N V S, Zimberg, I Z, Padovani, R d C, Estadella, D,

Juzwiak, C R ID: 732
Pós-Graduação Interdisciplinar em Ciências da Saúde, Departamento Case Reports
de Saúde, Educação e Sociedade, Departamento de Biociências e
Departamento de Ciências do Movimento Humano - Universidade Treatment of zolpidem abuse and dependence
Federal de São Paulo - Santos - São Paulo - Brasil, School of Public in an insomniac patient
Health and Preventive Medicine - Monash University - Melbourne -
Victoria - Australia. Yanagimori, M, Cano, T, Hasan, R, Borges, D S, Toscanini, A C,
de Azevedo, A P
Introduction: It is known that anxiety and sleep quality
can influence athletes’ performance, so these are important FMUSP - São Paulo - Sao Paulo - Brasil
factors in a competition. Aim: To evaluate athletes’ sleep
Introduction: Zolpidem is a gamma-aminobutyric
quality, anxiety and mood in a competition day. Methods:
acid agonist that binds on the benzodiazepine site of
This cross-sectional study assessed nine basketball male
its pentameric receptor. It has a hypnotic action with
athletes in a state competition, using actigraphy, sleep
only minor anxiolytic, myorelaxant and anticonvulsant
diary, Brunel Mood Scale (BRUMS), short-form version
properties. Although zolpidem has a low dependency risk,
of Competitive State Anxiety Inventory-2 and State-
there is current evidence in literature that at higher than
Trait Anxiety Inventory (STAI). Anxiety and mood
recommended doses, its pharmacology resembles that of
questionnaires were applied in the morning after the
benzodiazepines and consequently potential for abuse.
studied night. Pittsburgh Sleep Quality Index (PSQI) and
Aim: The purpose of this report is to show a case of
Morningness-eveningness questionnaire were used to
zolpidem dependence in which high doses of zolpidem
classify usual sleep quality and chronotype, respectively.
were used not only to improve insomnia but also to induce
Results: Athletes had 18.4±0.7 years old. During
anxiolytic effects. Methods: A 50-year-old woman with
competition they slept on mattresses disposed on the floor
chronic insomnia complaint for 15 years (initiated after
of a classroom school. The team complained about the
a period of alcohol and cocaine abuse) was seen in our
poor quality of the mattress and environmental noise as
Sleep Center. At that moment, for insomnia treatment, she
causes for awakenings. They had poor sleep quality, with a
received a prescription of zolpidem 10mg at night with
mean PSQI score of 5.5±3.2. Regarding the chronotype,
improvement of the initial symptoms. The patient started
six (67%) athletes were intermediate, two (22%) morning
to use zolpidem without medical prescription in adverse
and one (11%) evening type. The total sleep time was
life situations, like when her mother passed away. Two years
359.5±56.7 minutes, with efficiency of 91.1±6.1%. Sleep
before the patient was evaluated at our Sleep center, she
latency (46.0±46.8 minutes) and wake after sleep onset
sought medical help for insomnia and started to use low
(34.0±27.3 minutes) indicate a poor sleep quality. Subjective
doses of quetiapine and clonazepam, but also maintained
sleep quality (SSQ) was 5.2±1.4, with 43% of athletes
the use of zolpidem. During the last year, while she was
evaluating their night as “bad”. In subsequent morning, six
feeling sad, she was taking at least 150mg/day of zolpidem
athletes (67%) reported waking up at least once during the
trying to get the anxiolytic effect of the drug.Results:
night. BRUMS indicated that the positive psychological
When she started the treatment under our medical care,
state (vigor) was apparently superior (7.0±3.0) to the fatigue
she was given an outpatient treatment with valproic acid
(4.0±3.0), tension (4.0±1.2), confusion (0.0±1.9), angry
500mg/day, quetiapine 100mg/day and initial doses of
(0.0±1.3) and depression (0.0±0.7). There was a positive
clonazepam 3mg/day, at which time she was able to stop
correlation between SSQ and vigor (p=0.02). Regarding
using zolpidem. As a side effect, it was seen an important
competitive anxiety, self-confidence (2.8±0.5) was higher
weight gain and valproic acid was replaced by topiramato
than cognitive anxiety (2.0±0.7) and somatic anxiety
50mg/day. Her anxiety symptoms are now stable and she
(1.3±0.4). Somatic anxiety was positively correlated with
maintains a good sleep pattern. Conclusions: It is now
sleep latency (p=0.03) and negatively with total sleep time
known that zolpidem can be misused by some insomniac
(p=0.02). Self-confidence was positively correlated with
patients to induce an anxiolytic effect. At high doses,
SSQ (p=0.05). STAI indicated that anxiety trait (15.0±1.4)
zolpidem may lose its selectivity for hypnotic effects, and
was apparently superior to state anxiety (13.0±1.8).

Sleep Sci. 2020;13(Supl.1):1-118

 46

show all the other effects of common benzodiazepines. ID: 736

Patients with a past history of any substance abuse may be
at risk for zolpidem abuse. Clinical Studies
Palavras-chave: insomnia, zolpidem, abuse

Age-related sleep fragmentation

ID: 735
Koga, C M T, Louzada, F M, Borgio, J G F
Basic Research
Instituto Paranaense de Otorrinolaringologia - Curitiba - Parana -
Inflammatory mechanisms in the healing Brasil, Universidade Federal do Paraná - Curitiba - Parana - Brasil
process influenced by sleep deprivation Introduction: Obstructive sleep apnea (OSA) is
associated with sleep fragmentation. The ventilatory
Holanda, A S S, Rodrigues, H G, Esteves, A M
disruption ultimately causes physiological changes that
Universidade Estadual de Campinas - Limeira - Sao Paulo - Brasil affect arousal control in central nervous system (CNS).
Arousals are, in fact, a diagnostic criterion for marking
Introduction: The inadequate sleep pattern can be associated hypopneas in the polysomnography (PSG). Age is also
to a series of consequences related to sleep disorders, such related to sleep maintenance. Current evidence suggests
as autoimmune diseases, increased risk of cardiovascular, that arousal index increases with age. However, to date, it
metabolic diseases and inflammation. Inflammation is is not known any study with a large group of individuals
a natural and essential defense mechanism of the body, evaluating the arousal index (AI) in the PSG in relation
responsible for combating antigens, restoring homeostasis to age, controlling to other causes of sleep disruption.
and repairing tissue damage, such as wound healing. The Aim: This study aimed to evaluate the correlation of AI
wound healing process is complex and involves soluble with age, controlling for apnea and hypopnea index (AHI)
mediators, blood cells, extracellular matrix and parenchymal and periodic leg movement index (PLMI). Methods: A
cells. It is understood that the interactions between the retrospective analysis of all 30159 PSG studies performed
biological mechanisms of sleep and inflammation reinforce between 2008 and 2016 in patients of a large sleep center
a path for the development of treatments that modulate was conducted. Exclusion criteria were repeated PSG of
healing. Aim: To investigate inflammatory mechanisms the same patient, split-night or CPAP PSG studies, age
of paradoxical sleep deprivation under the inflammatory below 18 years and use of sleep-inducing drugs in the
aspect in the skin healing process in an animal mode, as well night of the PSG. Thus, 21961 eligible PSG reports were
as the sleep pattern. Methods: The study will be conducted analyzed. A multiple regression analysis was conducted,
on male C57B16 mice. Animals will be randomly assigned with AI as dependent variable and age, AHI, and PLMI
to the control group, wound group or paradoxical wound as independent variables. Results: There were positive
sleep deprivation group, and their respective control groups. correlations between increased AI and AHI (beta=0.68,
With regard to skin wound induction, the animals will be p<0,001), PLMI (beta=0.10, p<0,001), and age
anesthetized with xylazine and ketamine and an area on the (beta=0.01, p=0.01). Conclusions: As expected, the main
skin of the dorsal region will be scraped and removed by predictor factor of arousal index was AHI, and the second
surgery. The evaluation of skin wound closure will be by was PLMI. Even controlling for those two main causes
daily photographs from day 0 to 14. Electrode implantation of sleep fragmentation, age continued to be significantly
will be performed by stereotactic procedure, to assess sleep related to the arousal index. This result gives new insights
pattern through electrocorticogram and electromyogram about CNS resilience to arousing stimuli changing with
signals. In addition, paradoxical sleep deprivation will be aging.
performed by the multiple platform method for mice. Palavras-chave: Sleep fragmentation, ageing, polysomnography, arousal index

Finally, the animals will be euthanized and consequently the

tissues will be collected for proper histological analysis and ID: 737
determination of cytokine concentrations by Elisa.Results:
No results. Conclusions: Paradoxical sleep deprivation Clinical Studies
is expected to further increase the levels of inflammatory Effects of hypnotic drugs on macroarchitecture
cytokines in animals with skin lesions. And consequently,
the transition from the wound inflammation stage to the of sleep
proliferation stage is more effective due to the induction
Raposo, B K, Louzada, F M, Borgio, J G F
of anti-inflammatory mediators and growth factors.
Considering that, the literature points out that the lack of Instituto Paranaense de Otorrinolaringologia - Curitiba - Parana -
sleep affects the skin only when associated with the age Brasil, Universidade Federal do Paraná - Curitiba - Parana - Brasil
factor.
Palavras-chave: Sleep. Sleep deprivation. Wound healing.

Sleep Sci. 2020;13(Supl.1):1-118

47
Introduction: Insomnia has a high prevalence in precipitate episodes of bipolar disorder. Bipolar patients
adulthood and has great impact on social and cognitive often complain of longer time in bed, fragmented sleep,
performance. The pharmacological treatment might unstable and irregular sleep-wake cycles. The exact
involve benzodiazepines, non-benzodiazepines hypnotics mechanism of interaction between affect and sleep is still
(Z-drugs), sedative antidepressants and other drugs; unknown, but it has been hypothesized that interventions
each of them may present different effects on sleep toward good sleep habits might prevent relapse. Aim:
macroarchitecture. Long term use of benzodiazepines The objective of this research is to detect relations of
is associated with an increase of stage 1 non-REM sleep alterations in sleep-wake cycle and affective symptoms and
(N1), reduction of stage 3 non-REM sleep (N3) and REM functionality in patients with bipolar disorder. Methods:
sleep, and increase of sleep latency (SL) and REM sleep Outpatients attending a psychiatric service specialized
latency (REML). Z-drugs show little or no alterations in bipolar disorder (DSM-5 criteria) were recruited to
on the macroarchitecture of sleep, and trazodone (a participate in a larger study that is investigating response
largely used sedative antidepressant) increases REM sleep predictors to the disease. As part of the screening, in the
compared to benzodiazepines. Aim: The objective of this initial interviews, individuals completed the Hamilton
study was to compare the effect of different sleep-inducing Depression Scale (HAM-D), Young Mania Rating Scale
drugs on the macroarchitecture of sleep. Methods: The (YMRS), Biological Rhythms Interview of Assessment in
macroarchitecture of sleep (N1, N2, N3, REM, SL, Neuropsychiatry (BRIAN), and Functional Assessment
SREM, and sleep efficiency - SE) was analyzed in 30159 Staging (FAST). Response of the scales had a maximum
polysomnographic reports (PSG), grouped according to time-lapse of 30 days, and interviews were held between
the medication used or not by the patient in the night of March 2017 and January 2018. Ethics Committee approved
the exam. Exclusion criteria were repeated PSG of the the study.Results: After excluding those individuals
same patient, split-night or CPAP PSG reports, age below with unstable clinical status and current substance use,
18 years, apnea-hypopnea index > 5/hour and periodic 32 patients (17 women) were recruited, with mean age
limb movement index > 15/hour. The resulting sample of 44.7 years (27 - 62). Spearman´s correlations were
had 7360 patients, aged 18 to 86, divided in no-drug significant for BRIAN and HAM-D (rs=0.40, p=0.04) and
(n=6893), benzodiazepines (n=209), z-drugs (n=77), for BRIAN and FAST (rs=0.56, p=0.002). HAM-D was
trazodone (n=62), other drug (n=72) and multiple drugs related to YMRS (rs=0.41, p=0.02) and to FAST (rs=0.42,
(n=47) in order to run ANOVA with Games-Howell post- p=0.03). After controlling for the other variables, only
hoc tests.Results: Benzodiazepines showed, compared to BRIAN and FAST remained significant (r=0.53, p=0.02).
no-drug, increase of SL (4 min), REML (32 min), and N2 Conclusions: Circadian alterations related to depressive
(7 percentage points - pp), and reduction of N3 (5 pp) symptoms and not to manic symptoms. After controlling
and REM sleep (2 pp). The use of trazodone resulted in for other variables, only the alterations in biological
significant increase of N3 compared to benzodiazepines rhythms predicted the functionality of bipolar patients.
(10 pp) and no-drug (5 pp), and was the only group However, the neuropsychological profiles of the patients
that did not lowered REM sleep, compared to no-drug. were not evaluated. Regularity and rhythmicity in behavior
Conclusions: The results suggest that trazodone have a in bipolar patients are important in maintaining their
more benefic profile than benzodiazepines in preserving functionality.
normal sleep macroarchitecture. These alterations caused Palavras-chave: Bipolar disorder, sleep-wake cycle, BRIAN, functionality

by benzodiazepines might affect sleep functions, such

as memory consolidation, restoration of individual ID: 739
performance, among others. Clinical Studies
Palavras-chave: Insomnia, Benzodiazepines, Z-drugs, Trazodone, Sleep macroarchitecture

ID: 738
Sleep quality in bipolar disorder
Braga, A H, Iqueuti, F T M, Higa, M L, Alvim, P H P, Schwind,
Clinical Studies
M R, Guilherme, E A, Zorzetto Filho, D, Borgio, J G F
Circadian alterations in bipolar disorder Universidade Federal do Paraná - Curitiba - Parana - Brasil

Iqueuti, F T M, Higa, M L, Braga, A H, Alvim, P H P, Schwind, Introduction: Sleep and mood are intimately related.
M R, Guilherme, E A, Zorzetto Filho, D, Borgio, J G F Alterations in sleep timing or duration are observed in
Universidade Federal do Paraná - Curitiba - Parana - Brasil depressed and manic patients and may precipitate episodes
of bipolar disorder. Bipolar patients often complain about
Introduction: The sleep-wake cycle is important for the quality of their sleep, delay in start sleeping, fragmented
affect regulation. Alterations in sleep timing or duration sleep, difficulty to maintain enthusiasm, and using sleep-
are observed in depressed and manic patients and may inducing medications. The mechanisms of interaction

Sleep Sci. 2020;13(Supl.1):1-118

 48

between affect and sleep, though, are still unknown. Aim: clobazan and lamotrigine. After stimulator implantation,
The objective of this study is to evaluate relations between the patient observed better control of the number of
sleep quality and both depressive and manic symptoms and seizures but noticed intermittent hoarseness. Six months
functionality in patients with bipolar disorder. Methods: A after cervical electrode implantation the number of
cross-sectional evaluation of bipolar outpatients (DSM-5 seizures had increased again. The patient noticed daytime
criteria) were conducted between March 2017 and January sleepiness and snoring. Polysomnography was requested
2018, as part of a larger study, which is investigating to investigate possible obstructive sleep apnea. Results:
response predictors to the disease. Individuals completed Polysomnography revealed obstructive respiratory events
the Hamilton Depression Scale (HAM-D), Young Mania at regular intervals and with a similar duration in all events.
Rating Scale (YMRS), Functional Assessment Scale An electrocardiogram artifact was also noticed during
(FAST), and The Pittsburgh Sleep Quality index (PSQI) respiratory events. AHI was 27,0 hour . A few cases of
in the initial interviews, and those questionnaires will be vagus nerve stimulation inducing OSA have been reported.
repeated regularly throughout 94 weeks. Response of Obstructive events are caused by vagus nerve stimulation
the scales had a maximum time-lapse of 30 days. Only of upper airway muscles. Reduction of stimulus intensity,
responses from the first wave have been included so far. switching the device off or CPAP may be necessary to
Ethics Committee approved the study.Results: Thirty- control obstructive respiratory events. Conclusions:
two patients met inclusion and exclusion criteria (unstable Obstructive sleep apnea may be a side effect of vagus
clinical status, current substance use). The mean age was nerve stimulation that may affect seizure control.
44.7 years (27 - 62) and 53% (n=17) were women. Data Palavras-chave: seizures, sleep apnea, VNS, vagus nerve stimulation

were not normally distributed, so the non-parametric

Spearman´s correlation was conducted between numeric ID: 742
variables. The only significant correlation was between Case Reports
PSQI and FAST (rs=0.44, p=0.03). Conclusions: Sleep
quality is an important component of quality of life and, in Use of Intraoral Appliance in Light-to-
this study, related significantly with functionality. However, Moderate Obstructive Sleep Apnea - Case
it did not relate to depressive or manic symptoms. This
result stresses the importance of maintaining good sleep Series Report
habits in bipolar patients.
Palavras-chave: Sleep quality, PSQI, Bipolar disorder
HAGGSTRAM, F M, Knoll, L E

PNEUMOSONO - Centro de Distúbios do Sono - Porto Alegre - Rio

ID: 741 Grande do Sul - Brasil

Case Reports Introduction: Obstructive sleep apnea is a prevalent

disease associated with cognitive damage and increased
Vagus nerve stimulation may induce
risk to cardiovascular disease. The use of intraoral
obstructive sleep apnea : a case report aplliances is a treatment option for patients with light-
to-moderate obstructive sleep apnea. Aim: To evaluate
Cano, T, Yanagimori, M, Passini, V V, Fernandes, M D,
the effectiveness of the use of the intraoral appliances
Vasconcellos, B S, Lacerda, C B, Uneda, C B, Filho, G L, Genta, P R
in the treatment of patients with obstructive sleep apnea.
FMUSP - Sao Paulo - Sao Paulo - Brasil Methods: Case series report. All patients were evaluated
by a sleep medicine doctor and submitted to a sleep
Introduction: Frontal lobe epilepsy is relatively common evaluation with full night polysonography. Patients with
and often presents with nocturnal seizures. Vagus nerve light to moderate obstructive sleep apnea (AHI between
stimulation can be an alternative treatment for refractory 5 to 29.9 events per sleep hour), without indication of
patients. The left vagus nerve is stimulated using an surgery, were reffered to a dental assessment for the uso
implanted device at the level of the neck. Obstructive of a mandibular advanced intraoral aplliance. All intraoral
sleep apnea may impair seizure control. Aim: Report a aplliances were made by Odonto Knoll (R). After 30 to
case of obstructive sleep apnea secondary to vagus nerve 60 days of intraoral aplliance use, patients were submitted
stimulation for epilepsy treatment. Methods: We report a to another polysonography using the intraoral device.
29-year old male patient with a diagnosis of frontal lobe Results of polisonographies were compared.Results: 100
epilepsy under treatment with vagus nerve stimulation Patients were assessed. 8 patients did not made de device.
that was referred to the sleep medicine outpatient clinic N = 92. Avarege age:52 YEARS. 56% were men. Total
due to snoring and daytime sleepiness. His epilepsy sleep time (mean, SD): 374.4 (190-475) Minutes; Number
started during childhood. Vagus nerve stimulation was of respiratory events(mean, SDE): 78 (34-162) events;
indicated due to inadequate control of seizures with AHI (mean, SD): 12.3 (4.3 - 23.9) events/h; Nadir varied

Sleep Sci. 2020;13(Supl.1):1-118

49
between 61-93%. Avarege mandibular advance was 3.3 mg/dL) (p<0.05). Serum triglycerides were reduced
mm (varing from 2.5 to 4.5 mm); The use of intraoral in mice with SD (72.18 ± 3.96 mg/dL) and in EX+SD
aplliance reduced significantly the number of respiratory mice (p<0.05) (81.90 ± 3.93 mg/dL) as compared to the
events and AHI, but there was no modification of total control group (137.4 ± 8.62 mg/dL). Serum cholesterol
sleep time, as follow: Total sleep time (mean, SD): 374.8 was uniform in all groups. Glycogen was elevated in the
(288-453) minutes, (P> 0.05); Number of respiratory liver of EX (4.77 ± 0.35 mg/100mg) mice as well as in
events (mean, SD): 53 (3-165) events, (P <0.05); AHI muscle (0.6474 ± 0.0067 mg/100mg), although the latter
(mean, SD): 7.16 (0.5-22.1) events/h, (P <0.05); Nadir had only a moderate increase. A degree of homogeneity
varied between 74-91%. Conclusions: Intraoral was found among the other groups. Hepatic triglycerides
appliance significantly reduced the number of respiratory were reduced in SD (8.32 ± 0.95 mg/100mg) and high in
events and, therefore, AHI in these patients with light- EX + SD mice (20.72 ± 2.67 mg/100mg). Furthermore,
to-moderate obstructive sleep apnea. These findings hepatic cholesterol was elevated in EX + SD (3.84 ± 0.48
show the importance of intraoral appliance in the roll of mg/100mg) mice,Conclusions: Sleep deprivation and
obstructive sleep apnea treatment and the importance of association with exercise modify serum glucose, lactate,
a multidiciplinary evaluation. and triglyceride levels, as well as liver and muscle glycogen
Palavras-chave: Apnea Obstructive Sleep Intraoral Appliance Mandibular
stores. Muscle levels were maintained under direct control,
as expected. Previous exercise increased cholesterol and
ID: 745 trygliceride levels in the liver of SD mice. Our findings
Clinical Studies suggest that exercise provide a biologic advantage in
adverse condition such as extreme sleep deprivation.
Exercise as a modifier of glycidic and lipid Palavras-chave: Sleep deprivation. Exercise. Metabolism. Glycogen. Cholesterol.

metabolism in sleep-deprived mice

ID: 746
Silva, B R D, Bruin, v M S, Nunes, P I G, Matos, R S, Bruin, P F
C, Santos, F A, Daniele, T M d C
Basic Research
Sleep and Biological Rhythms Laboratory - School of Medicine - Untargeted-metabolomics of mice cortex
Federal University of Ceará - Fortaleza - Ceará - Brazil, Department of subjected to sleep deprivation – the modifying
Physiology and Pharmacology - Natural Products Laboratory - Faculty effects of exercise
of Medicine - Federal University of Ceará - Fortaleza - Ceará - Brazil.

Introduction: Repeated deprivation of a fundamental Silva, B R D, Nunes, P I G, Silva, L M A, Alves-Filho, E G, Brito,

need, such as sleep, results in physiological adaptations E S, Bruin, P F C, Bruin, V M S
and phenotypic changes. Sleep deprivation (SD) is known “Sleep and Biological Rhythms Laboratory - School of Medicine -
to be associated with adverse consequences for individual Federal University of Ceará - Fortaleza - Ceará - Brazil, Department
health and well-being. Weight management and glycemic of Physiology and Pharmacology - Natural Products Laboratory -
control are negatively affected by SD. To date, in vivo Faculty of Medicine - Federal University of Ceará - Fortaleza - Ceará -
systemic and local metabolic shift patterns associated with Brazil, Food Technology - Chemical Engineering department - Federal
SD and the modifying factors need more clarification. University of Ceará - Fortaleza - Ceará - Brazil, EMBRAPA and
Aim: To evaluate metabolic alterations associated with Brazilian Agricultural Research Corporation
SD in mice and to further investigate the influence of
associated exerciseMethods: Three-month-old swiss Introduction: Sleep deprivation/restriction (SD) occur
mice were divided into four groups: control, SD, exercise in association with sleep disorders such as insomnia and
(EX) and previous exercise followed by SD (EX+SD). sleep apnea. Cognitive impairment and dementia are also
Exercised animals were submitted to motorized treadmill associated with these sleep disturbances. Exercise has
(9m / s) for 8 weeks. Sleep deprived mice were submitted been found to have a positive influence on sleep and on
to the modified multiple platform model (72h). The cognitive impairment and dementia. It has recently been
metabolite profiles of mice cortex, in all groups, were shown that several metabolites are altered in the brain in
analyzed using liquid chromatography/mass spectrometry. association with sleep fragmentationAim: The aim of this
Data were expressed as Mean ± Standard Error of Mean study was to evaluate the effects of chronic aerobic exercise
(E.P. M.). ANOVA, followed by Newman-Keuls test was on metabolomics of the cortex of mice subjected to sleep
performed and significance was considered at p <0.05 deprivation. Methods: Three-month-old swiss mice were
. Statistical analysis was performed using GraphPad divided into four groups: control, SD, exercise (EX) and
Prism® 5.01 software.Results: EX mice showed high previous exercise followed by SD (EX+SD). Exercised
levels of serum glucose (144.40 ± 8.27 mg/dL), lactate animals were submitted to motorized treadmill (9m / s)
(98.50 ± 4.56 mg/dL) and triglycerides (227.10 ± 28.03 for 8 weeks. Sleep deprived mice were submitted to the

Sleep Sci. 2020;13(Supl.1):1-118

 50

modified multiple platform model (72h). The metabolite slept during daytime activities and had learning disabilities
profiles of mice cortex, in all groups, were analyzed using due to DS. Regarding previous history, he was born with
liquid chromatography/mass spectrometry. Results: A congenital heart disease that was surgically corrected
deep chemometrics analysis revealed distinctive metabolic and underwent adenotonsillectomy, but had persistent
profiles between the SD, EX+SD, EX and Control symptoms even after surgery. Has hypothyroidism, in
groups. Aerobic exercises induced the production of treatment with Puran (levothyroxine), and hypertension,
lactate, n-acetylaspartic acid, creatine, taurine while a in use of Captopril.Results: Polysomnography showed
decrement of the content of ethanol, alanine, gamma- a moderately elevated index of breathing disorders,
aminobutyric acid, myo-inositol, choline, and acetate was high index of arousals and normal oxyhemoglobin
observed. Sleep deprivation induces acetate production desaturation, snoring, sleep efficiency, with proportionate
while decreasing the content of ethanol, lactate, alanine, sleep stages. The patient was diagnosed with OSA and
gamma-aminobutyric acid (GABA), n-acetyl aspartic acid, treated with CPAP. Returned with improved sleep quality
creatine, choline, taurine and myo-inositol in the cortex. and daytime sleepiness. Conclusions: The child with DS
Importantly, the cortex from EX+SD mice and control had a classic OSA condition but, at first, was diagnosed
samples presented a similar composition. Conclusions: with hypothyroidism. Thus, the case becomes relevant
This untargeted metabolomics study shows that previous once identifies an OSA through polysomnography and
exercise reestablished scores of SD mice cortex to similar discards the differential diagnosis, which has a very similar
values as in control. These findings provide further clinic that makes the early diagnosis harder. Therefore, it
mechanistic explanation for the beneficial effects of is important to know the differential diagnoses of patients
exercise in conditions of sleep deprivation/restriction that with OSA to obtain their early, effective recognition and
commonly occurs in many sleep disorders to optimize results with time to avoid complications and
Palavras-chave: Metabolomics. Cortex. Sleep deprivation. Exercise. Mice. Brain
increase the life expectancy of these children.
Palavras-chave: Down’s syndrome; Obstructive Sleep Apnea; Polysomnography.

ID: 751
ID: 755
Case Reports
Case Reports
Hypothyroidism as differential diagnosis
in children with down’s syndrome and Clinical management of patients with sleep
obstructive sleep apnea – case report breathing disorder: obstructive sleep apnea
and central sleep apnea with Cheyne Stokes
HATA, M M, VOIGT, A D, DE QUADROS, A C, RODRIGUES, breathing
A J S, FAVARÃO, A M, SANTOS, C V W, BAZZANELLA, F,
VICINI, K M, TURMINA, L, MATSUMOTO, A P I Monteiro, P.S
Centro Universitário Fundação Assis Gurgacz - Cascavel - Paraná - Hospital Universitário Gaffrée Guinle - UNIRIO, Rio de Janeiro, Rio
Brasil de Janeiro, Brazil
Introduction: Obstructive sleep apnea (OSA) is Introduction: Central apnea is defined as > 90% reduction
common in children with Down’s syndrome (DS) due in oronasal flow for at least 10 seconds associated with
to anatomic abnormalities that results in an airway loss of respiratory effort, while in obstructive apnea effort
collapse during sleep time. Hypothyroidism in children is observed even during the absence of flow. When a
mimetizes the clinical situation of a patient with OSA. central apnea is associated with Cheyne Stokes breathing,
Thus, the Polysomnography exam, recommended in all it has risk factors for CHF, stroke, and renal failure. The
children with DS from 4 years old, is essential to allow the treatment is with positive pressure devices. Aim: To analyze
differential diagnoses and, therefore, to treat the primary or therapeutic management with positive pressure devices
cause of symptoms by improving the quality of life of in patients with obstructive sleep apnea and central sleep
these patients. Aim: To highlight the differential diagnosis apnea with Cheyne Stokes breathing. Methods: Male, 70
of hypothyroidism in children with Down’s syndrome years old, insomnia and snoring for 1 year, in addition
and Obstructive Sleep Apnea through a case report and to excessive daytime sleepiness, breathing interruptions,
literature reviews. Methods: J.I.S, male, Down’s syndrome, frequent awakenings. Has hypertension, heart failure.
four years old, accompanied by his father, complaining of STOP - BANG of 7; Epworth scale of 13. Submitted to
agitated sleep. The father reported that his son often had polysomnography type 1 that shows an apnea and hypopnea
night sweats and restless sleep. Routinely woke up at night index of 110.92/h with predominance of central apnea
and showed episodes of soliloquy and nocturnal enuresis. and crescendo-decrescendo breathing pattern.Results:
Occasionally he felt tired when he woke up, snored lightly, A new polysomnography was performed for CPAP

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51
titration, where an optimal pressure of 10cmH2O with Methods: Methods: Fifteen subjects with VPI, aged 6 to
event resolution was determined. Epworth is reapplied 17 years (10 years, on average) were included in the study so
after 1 month of treatment, scoring 8. The CPAP device far. None of them had enlarged tonsils. All were assessed
is an initial option for central apnea because upper airway before and after surgery (13 months, on average). Snoring
obstruction is important in the pathophysiology of and excessive daytime sleepiness (ES) were investigated
hypercapnic and non-hypercapnic central apnea. Positive using standardized questionnaires (Sleep Disturbance
bilevel ventilation exacerbates central apnea and periodic Scale for Children-SDSC and Epworth Sleepiness Scale).
breathing. Adaptive servo-ventilation (ASV) devices Nasopharyngeal area and speech nasalance (the acoustic
compatible with expiratory, inspiratory support, and correlate of nasality) were assessed by rhinomanometry
responses that consider variation in ventilation or flow and nasometry, respectively. Informed consent was
may be used and are primarily designed for patients with obtained (institutional ERB No.1,905,404).Results:
non - hypercapnic central apnea. Treatment with ASV is Results: Before surgery, snoring was reported by 5(33%)
more tolerated than CPAP and is effective in suppressing of the parents and ES by 4(27%). After surgery, the
central apnea, improving oxygenation in the presence number increased to 7(47%) and 6(40%). The differences
of heart failure. Regarding sleep quality, sleepiness and were not significant (p>0.05). No surgery complications
quality of life there is not much difference between the such as bleeding, airway obstruction, dehiscence and
adaptive servo-ventilation and CPAP. Conclusions: In fistula were observed. Confirming clinical observations,
patients with central apnea, appropriate pressure therapy subnormal nasopharyngeal area and hyponasality,
is essential to prevent worsening of sleep disordered suggesting decrease in pharyngeal patency, were not
breathing. observed on the instrumental methods. Conclusions:
Palavras-chave:
ventilation, obstructive
bilevel sleep pressure.
positive airway apnea; central sleep apnea; cheyne stokes breathing; continuous positive airway pressure; adaptive servo-
Conclusion: Preliminary data suggest that the Sommerlad
palate re-repair has less impact on sleep breathing than
ID: 756 the one reported for PF surgery. Identifying a lower effect
of Sommerlad’s surgery on sleep quality will be a relevant
Clinical Studies
contribution for the treatment of cleft-related VPI.
Sleep disordered breathing (SDB) after Palavras-chave: Sleep Apnea, Snoring, Sleepiness, Cleft Palate, Velopharyngeal Insufficiency.

palate re-repair in children with cleft palate: ID: 757

preliminary findings
Clinical Studies
SILVA, A S C, Araújo, B M A M, Bertier, C E, Brosco, T V S,
Fukushiro, A P, Yamashita, R P, Trindade, S H K, TRINDADE,
Effects of chronotype on sleep duration and
IEK psychomotor performance throughout a
Bauru School of Dentistry-FOB-USP - Sao Paulo - Brasil, Hospital for
complete shift rotation schedule: a prospective
Rehabilitation of Craniofacial Anomalies, HRAC-USP - Bauru - Sao study in a real-life condition
Paulo - Brasil
Rosa, D E, Crispim, C A, Marot, L P, de Mello, M T, Narciso, F
Introduction: Introduction: Individuals with cleft palate V, Marqueze, E
are at risk for sleep-disordered breathing (SDB) due to
Universidade Federal de Uberlândia - Uberlândia - Minas Gerais - Brasil
facial abnormalities, maxillomandibular deformities, nasal
airway impairment and palatal defects. The treatment Introduction: Recent evidence demonstrates that shift
involves several steps, including primary surgical closure work is associated to negative effects on psychomotor
of the palate and secondary correction of residual performance, which include cognitive impairments such
velopharyngeal insufficiency (VPI). The most commonly as attention drop. One of the main triggers for such
surgery used for VPI treatment has been the pharyngeal impairments seems to be deterioration of the sleep
flap (PF) technique which promotes partial mechanical pattern. Individual worker characteristics - such as the
obstruction between the oro- and nasopharynx favoring chronotype – could also be associated with psychomotor
VP closure. However, studies from our laboratory have performanceAim: To evaluate the effect of chronotype
shown that the PF is an additional risk factor for SDB on the sleep duration and psychomotor performance in
in this population. In contrast, the Sommerlad palate re- industrial workers throughout a complete shift rotation
repair, characterized by dissection and retroposition of schedule. Methods: Thirty shift workers participated in this
velar muscles, seems to be less obstructive than the PF. observational and prospective study. Sociodemographic
Aim: Objective: To investigate the frequency of SDB characteristics, health behaviors and Munich Chronotype
symptoms in nonsyndromic children with repaired cleft Questionnaire –(MCTQ) were collected. Individuals
palate±lip who underwent the Sommerlad palate re-repair were followed for all seven consecutive days carried out
and correlate findings with pharyngeal patency indicators. as follow: two days (D1 and D2) working during the day

Sleep Sci. 2020;13(Supl.1):1-118

 52

(08:00- 16:00); two days (D3 and D4) working during the general population for SB, ii) if these variables can help to
evening (16:00 – 00:00); two days (D6 and D7) working better predict presence of SB/RMMA on PSG. Methods:
during the night (00:00 – 08:00). Evaluations regarding Individuals from a general population participated 2 times
the work performance by Psychomotor Vigilance Test in the EPISONO Sao Paulo, Brazil, sleep study (20 to 80
(PVT) and sleep by actigraphy were assessed over the y. O; time 1, 2007: n= 1042 and time 2, 2015: n=712. SB
seven days. The Generalized Linear Models (GLM) were and insomnia symptoms were self-reported and insomnia
used to analyze the effect of chronotype, shift rotation was further scored with DSM-IV criteria, for both time 1
and its interaction on sleep duration and psychomotor and 2. From a one night of PSG scoring used 2 RMMA/
performance variables.Results: Intermediate (I-type) and hr and over and AHI of 5/hr criteria. Tests used were:
late types (L-type) – but not evening types (E-type) - had a logistic regression, identification of predictor variable
longer sleep duration in day work than night work (I-type: with CHAID decision tree mathematical analysis. The
08:17:16 ± 0:20:45 and 05:29:38 ± 0:37:36, respectively; validation of predictor assessment was done with time 2
L-Type: 08:10:52 ± 0:21:06 and 4:30:49 ± 0:35:17, follow up data. Cluster were identified by correspondence
respectively; p <0.001 for all). We found that L-type had analysis.Results: With questionnaires data there is an
a higher number of lapses of attention during day work higher risk of being a SB subject (n=127) if a subject is
(06.18 ± 2.68) than E-type and I-type (1.0 ± 0.63 and a male (Prevalence ratio 1.5), overweight & obese (PR 3.3
1.67 ± 0.59, respectively; p<0.001). During evening work, & 2.7, respectively), reporting insomnia corresponding to
the I-type had a lower number of lapses of attention DSM IV (PR 2.7) and presenting AHI over 30 (PR 2.8).
(0.87 ± 0.22) than E-type and L-type (3.44 ± 0.73, 6.31 With PSG data (n=56) overweight and DSM IV had a
± 1.98, respectively; p <0.001). For the night work, the PR of 3 regardless age or gender. Using the CHAID tree
L-type had a higher number of lapses of attention (4.06 analysis decision, SB complaints correctly classifies non-
± 1.18) than I-type (1.50 ± 1.98, p <0.001). Conclusions: SB subjects/+SB in 87.7% of cases with questionnaires
Late chronotype workers presented a greater mean of data (p= 0.001). SB subjects present higher frequency
lapses of attention in all shifts of the schedule, while the of DSM-IV insomnia (21.3%/10.7% for good sleepers).
E-type group increased the number of lapses of attention Using PSG data RMMA/h of 2 and over correctly
from morning to evening and night shift. Intermediate classifies non-SB subjects/+SB at 91% (p= 0.008). SB
chronotypes oscillated less in the number of attention subjects again present higher frequency of DSM-IV
lapses insomnia (17.7%/7.8% for good sleepers). The follow-up
Palavras-chave: Chronotype. Sleep duration. Psychomotor performance. Shift rotation schedule
revealed that the prediction values is still acceptable since
it correctly discriminate non SB, based on 2 RMMA/hr,
ID: 758 at 70.1 % with a male gender dominance for SB subjects.
Clinical Studies The correspondence analysis revealed 3 age sub-groups
of SB subjects. Conclusions: Concomitant insomnia is
Prediction of sleep bruxism diagnosis with a predictive variable for SB diagnosis. In mid-age female
concomitant insomnia complaints: a mid-age subjects’ insomnia is comorbid to SB as is OSA in older
obese man.
sub-group in general population Palavras-chave: Sleep Bruxism, Insomnia, Polysomnography

Maluly, M, Dal-Fabbro, C, Lavigne, G, Andersen, M, Tufik, S ID: 759

Departamento de Psicobiologia - Universidade Federal de São Paulo
Basic Research
- São Paulo - São Paulo - Brazil, Instituto do Sono - São Paulo - São
Paulo - Brazil, Center for Advanced Research in Sleep Medicine, Sleep assessment in medical students at a
CIUSSS NIM & Faculty of Dental Medicine - Université de Montréal
university in southern Brazil
- Montréal - Canada
ARGONDIZZO, L C, MOTA, D M, DI GIANNI, A, DE
Introduction: Sleep bruxism (SB) is characterized by
OLIVEIRA, G S P, DIETRICH, M V F, FRIZZO, R A
rhythmic masticatory muscle activity (RMMA) during sleep
with occasional tooth grinding. It is reported by 8-12% of Universidade Federal de Pelotas - Pelotas - Rio Grande do Sul - Brasil
the population. Screening of SB in clinic include reports
of tooth grinding sounds, tooth wear, jaw muscle fatigue Introduction: Sleep is a physiological condition which
or pain. SB risk factors and concomitant sleep complaints relates to various functions of the body. Therefore, its
or disorders include age, gender, body mass index (BMI), disturbances can worsen the lives of individuals. Among
sleep quality, insomnia and obstructive sleep apnea (OSA). sleep disorders, excessive daytime sleepiness is relevant
Aim: The aims of the present study are to: i) assess if among due to its association with changes in physical and
the above variables which are the predominant ones in a psychosocial health. Studies revealed that college students

Sleep Sci. 2020;13(Supl.1):1-118

53
have more sleep disorders than the general population. As shift workers with sleep disorders. Methods: A cross-
other college students, medical students may have changes sectional study was performed in 118 male shift workers
in sleep quality and excessive daytime sleepiness due to from an iron ore extraction company, who presented
the full-time workload, extracurricular activities, pressure, with at least one overall risk factor for cardiovascular
stress and the pursuit of high academic performance. This disease. Anthropometric data were collected, and
study aims to demonstrate the importance of education polysomnography (PSG) was performed. Results: The
and the maintenance of healthy sleep habits. In addition frequency of OSA in the sample was 84.7%. The adiposity
to this, it may show the need for curriculum changes that indicators used to predict OSA (≥ 5 events/hour) with
enable adequate sleep for the full cognitive and behavioral a sensitivity of more than 70% were the body mass index
development of medical students. Aim: Analyze and (BMI), waist circumference (WC), waist-to-height ratio
describe the quality of sleep and the presence of excessive (WHtR), and total body fat (TBF). Visceral fat (VF), neck
daytime sleepiness in medical students at a university in circumference (NC), and neck-to-height ratio (NHtR)
south Brazil. Methods: Observational cross-sectional showed specificity values of more than 70% and thus were
design. Sample: 328 students from the 1st to the 8th the most effective in correctly identifying workers without
semesters of the School of Medicine in southern Brazil OSA. The areas under the receiver operating characteristic
from September to December 2018. Instruments: self- (ROC) curves for WC and NHtR were greater than 0.7,
administered questionnaires containing sociodemographic which indicated the effectiveness of the test for the
questions, Epworth Sleepiness Scale (for assessment discrimination of individuals with OSA. Conclusions:
of excessive daytime sleepiness) and Pittsburgh Sleep The use of abdomen and neck adiposity indicators as a
Quality Index. Statistics: The EPi info 7.0 and STATA screening method for PSG is effective since alterations
12 statistical packages were used. Univariate analysis in these indicators demonstrate a significant relationship
was performed to obtain frequencies of all variables for with the presence of OSA. WC and NHtR are considered
sample characterization, bivariate analysis using Pearson good tools for OSA prediction.
chi-square test. A significance level of 5% was adopted. Palavras-chave: SHIFT WORKERS, POLYSOMNOGRAPHY, ADIPOSITY INDICATORS

Results: The prevalence of excessive daytime sleepiness

(EDS) was 62,8% being 18% severe EDS. Pitsburg Sleep ID: 762
Quality Scale, showed a prevalence of 80.8% of bad
sleepers. ). In the evaluation of sub-items of this scale 52% Clinical Studies
of students think their sleep is bad or very bad, 70% of
them have less than expected total sleep time, 91.5% show Relationship between Stress and Sleep in the
some degree of sleep deprivation and about 25% have a Behavior of Children and Adolescents
poor sleep efficiency. About sleeping medications, 22.57%
used it in the last month and 11.5% use it at least once Valle, L E L R, Alcântara, C S, Valle, E L R
/ week. Conclusions: Our academics are experiencing Instituto de Neurociências e Tecnologia Dr Marcio Ribeiro do Valle -
lower than expected quality of sleep, excessive daytime Poços de Caldas - Minas Gerais - Brazil
sleepiness and sleep deprivation. . These data point to a
real and urgent need to reassess curriculum changes and Introduction: Sleep is a complex and highly organized
implement actions aiming to improve sleep hygiene and process that interferes with the behavior of children and
quality of life for our student population. adolescents. The stress of daily life strikes young people
Palavras-chave: sleep, excessive daytime sleep, sleep quality and it worries parents and teachers, so it needs to be better
understood. Aim: The aim of this study was to describe the
ID: 760 quality of sleep and the presence of stress in adolescents
to evaluate if there is a relationship between sleep quality
Clinical Studies
and the presence of stress behavior. Methods: Descriptive
Adiposity indicators as criteria for exploratory research with a population of 118 young
polysomnography in shift workers people, mostly female (61% ), with an average age of 13
years (SD = 2.4 years). The instruments used were the
NASCIMENTO, R M Pittsburgh Sleep Quality Inventory (PSQI) and the Lipp
Stress Inventory for Adolescents (SAI). The presence of
Universidade Federal de Ouro Preto - Ouro Preto - Minas Gerais - stress and stress phase were described according to quality
Brasil of sleep using chi-square or likelihood tests (Kirkwood
Introduction: To verify the discriminatory power of and Sterne, 2006) and SPSS analyzes, with a significance
adiposity indicators in the prediction of obstructive sleep level of 5%. Results: More than half of adolescents had
apnoea (OSA) in shift workers. Aim: The main objective poor sleep quality or presence of sleep disorders (61.9%).
of the study is to correlate the body composition of It was found that 25.4% of adolescents presented

Sleep Sci. 2020;13(Supl.1):1-118

 54

stress, with the psychological domain being the most Excessive Daytime Sleepiness, and 18,91% reported causes
predominant (11.1%) and the most frequent was phase of of sleep problems such as unregulated sleep, anxiety,
resistance (8.7%). The presence of stress (psychological, insomnia, concern about school and studies; 21,62% rated
cognitive, physiological and interpersonal) is statistically the quality of their sleep as poor or very poor, and 34,46%
associated with poor sleep quality or the presence of sleep report difficulty staying awake while doing activities
disorders (p = 0.002). Virtually all adolescents with some during the day. Moreover, 13,51% of students feel tired
type of stress had poor sleep quality or sleep disorders (p all the time, 23,65% feel tired most of the time, 22,29%
<0.001); only 2 adolescents with good sleep quality had feel tired currently, and only 3,37% never feel tired. Still,
stress in the interpersonal field. The results show that the 52,7% feel very nervous during “most of the time” and
presence of total stress was statistically associated with “all the time”, and 30,4% feel discouraged and downcast
worse subjective sleep quality, higher number of sleep during “most of the time” and “all the time”. All students
disturbances, higher latency and lower habitual sleep stay in school from 7:20 am to 1:00 pm, and it’s seen that
efficiency and higher frequency of daytime sleepiness (p 98,65% of them go to bed after 22 pm, what suggests
<0, 05). Short sleep duration was statistically significantly that adolescents sleeping habits and morning classes are
associated only with total stress (p = 0.004). Conclusions: related. Conclusions: It is observed that the physiological
The results of the tests show the influence between stress alteration of circadian rhythm of adolescents and school
and sleep of young people, recognizing that cognitive hours anticipate students wake-up time, and have a big
issues affected their behavior. Further studies would be impact on their learning process, behavior and life quality.
needed to attend this demand. Therefore, it’s important to discuss about school hours
Palavras-chave: SLEEP AND STRESS; SLEEP, CHILDREN AND TEENAGERS; YOUNG BEHAVIOR.
and advise students’ sleeping habits, in order to encourage
sleep hygiene and prevent future consequences on their
ID: 763 mental and physical health.
Basic Research
Palavras-chave: sleep, memory, learning, adolescents

ID: 764
Analysis of sleep, learning and quality of life
of high school students from São Caetano do Clinical Studies
Sul Sleep characteristics of blind volunteers
Fonseca, B B O, Fernandes, K N d S M V
Ramos, L C N, Correia, F d J, Barreto, D M, Silva, M H C,
Universidade Municipal de São Caetano do Sul - São Caetano do Sul - Pithon, K R
Sao Paulo - Brasil
Universidade Estadual do Sudoeste da Bahia - Jequié - Bahia - Brasil
Introduction: Sleep is very important in daily life,
Introduction: Many aspects of human physiology and
since it has great impact in physical and psychological
behavior vary with circadian phase, including sleep, which
development of young people, and influences the behavior
has a sleep/wake circadian rhythm that is anatomically
and learning (Valle, 2009). Considering that, the Brazilian
determined by the suprachiasmatic nucleus. Its function
Sleep Association states that teenagers “have more
depends, among other factors, on the environmental
difficulty anticipating sleep and waking hours to adapt
information of light captured in the eye retina and
to morning school class, especially those starting before
conducted through the optic nerve. Thus, it is believed that
eight o’clock”.They also point out that sleep restriction
people with visual impairment have changes in their sleep
is associated with health problems, and affects academic
due to little or no perception of light. Aim: The aim of
performance “by increasing sleepiness, reducing attention
the study was to characterize the sleep of blind volunteers.
and learning readiness, which also compromises memory
Methods: It was a cross-sectional and descriptive study,
consolidation”(ABS, 2017). Aim: Understand sleep and
conducted in a blind association center, between June and
its relationship with school hours, and the impact on
August 2019. The inclusion criteria were: visually impaired
learning and quality of life of high school students of
individuals, over 18 years. Written informed consent was
São Caetano do Sul. Methods: The study was conducted
obtained from all the study participants. The instruments
from April 2018 to August 2019. After literature review,
used were a sociodemographic and sleep questionnaire
148 students from the first to the third year of high school
and the Pittsburgh Sleep Quality Index (PSQI). Data were
from a private school in São Caetano do Sul, were analyzed
presented in mean ± standard deviation, it was analyzed
through the Pittsburgh Scale, Epworth Sleepiness Scale,
using descriptive statistics with Epi Info version 7.2
and the SF-36 Quality of Life Questionnaire, as well as
software.Results: Seventeen volunteers participated in
other informations such as their age and gender. Results
the research, 58.8% male, with a mean age of 50.5 ± 16.4
were tabulated and statistically analyzed.Results: The
years, 41.2% of them studied until elementary school and
results analysis showed that 51,35% of the students have

Sleep Sci. 2020;13(Supl.1):1-118

55
83.4% received one Brazilian basic salary. All participants Results: After surgical procedure, patient was submitted to
use at least one assistive device, the most frequent being a new whole-night polyssonography in wich was observed
the cane (94.1%). Although most of them were classified an 1,53 AHI, a significant decrease in arousal, snoring and
as blind, 11.8% of participants could be able to see daytime sleepiness. Conclusions: In patients with Prader-
with some degree of vision in one eye, 64.5% reported Willi syndrome we should always observe the possible
light perception. They sleep, a mean of 5.5 ± 2.4 hours, association with OSAHS. Identifying the presence of
with a mean latency time of 29.8 ± 30.1 minutes, 23.5% apnea or hypopnea through the study, as well as asking for
reported snoring at night. The mean PSQI was 9.7 ± 5.3, symptoms such as excessive daytime sleepiness, is essential
and 70.6% of the participants had a score greater than for the proper treatment of the patient. In patients with
5. Conclusions: Most of individuals had complete visual Prader-Willi syndrome we should always observe the
impairment, poor sleep quality, insufficient sleep time per possible association with OSAHS. It is essential for proper
night and sleep latency around 30 minutes. patient management that this respiratory disturb and its
Palavras-chave: blind, sleep, sleep quality
symptoms be identified.
Palavras-chave: Prader-Willi Syndrome, Obstructive Sleep Apnea-Hypopnea Syndrome, Apneia, genetic, child

ID: 765
ID: 766
Case Reports
Clinical Studies
Young patient with Prader-Willi Syndrome
and Obstructive Sleep Apnea-Hypopnea Frequency of sleep disorders in patients with
Syndrome - case report insomnia

Silva, D.V. Lopes, Y C, Garrido, J G S, Seixas, L R, Santos, A M F, Galtieri,

R M S, Salles, C
Hospital Universitário Gaffrée e Guinle - UNIRIO - Rio de Janeiro -
Rio de Janeiro - Brazil Escola Bahiana de Medicina e Saúde Pública - Salvador - Bahia - Brasil,
Associação Brasileira do Sono - Regional Bahia - Salvador - Bahia -
Introduction: The Prader-Willi syndrome is a genetic Brasil
disorder caused by loss of function of some genes. As a
consequence, patients can present craniofacial alterations, Introduction: Insomnia is a global healthcare problem and
hypotonia, hyperphagia and mental retardation. The is defined by a subjective feeling of inability to start sleeping
first three are directly related to the development of or the sensation of disturbed sleep or to maintain sleep.
respiratory disorders as hypoventilation and Obstructive It affects both physical and mental spheres, thus reducing
Sleep Apnea-Hypopnea Syndrome (OSAHS). The the life quality and sometimes even the lifespan. Aim: To
OSAHS is less seen in children, but patients with Prader- identify the insomnia frequency in patients at a sleep clinic.
Willi syndrome shows a high prevalence of this disorder, Methods: This is a cross-sectional study. Study sample:
demanding closer follow up to initiate treatment as soon Individuals who sought a sleep laboratory in Salvador (Ba)
as possible, reducing daytime symptoms and preventing were evaluated. Project approved by the research ethics
future cardiovascular and other complications. Aim: committee. Inclusion criteria: Patients complaining of
To get attention on the importance of knowing the insomnia who answered questionnaires with information
correlation between Prader-Willi syndrome and OSAHS about the characteristics of sleep which were applied
in childhood, as well as the possible approaches (surgical between 2014 and October/2018 in individuals of any age,
or not) for better assist infant patients. Methods: gender, who sought a sleep laboratory in Salvador (Ba).
A male 10 years-old patient, carrier of Prader-Willi Exclusion criteria: Medical records with incomplete data.
syndrome, morbid obesity, hepatic steatosis and arterial Results: This sample consisted of 362 patients, mean age
hypertension, was referred to the otorrorinolaringology = 47 (32-60) years, female frequency = 55.8%, median BMI
service due to snoring and apnea witnessed by the = 25.9 (22.3-31.7) kg/m², median Epworth Scale = 9 (5-
mother. During the first attendance at this service, was 13), mean of bedtime = 22:51±1:40 h, mean of wake-up
observed STOP-BANG= 4 scale, Epworth= 19/21, time = 6:14±1:38 h, mean of total sleep time = 7:13±1:44
cervical circumference= 38, II-degree septal deviation h. The most frequent sleep disorders in individuals who
in Cottle’s IV area, adenoid hypertrophy with 40% of reported difficulty in initiating or maintaining sleep were:
cavun obstruction and III-degree tonsils. It was indicated snoring (83.4%), tiredness when waking up (66.6%) and
whole-night polysomnography (Type 1), which showed memory impairment (59.7%). Women presented a higher
an apnea and hypopnea index (AHI) of 7/hour and sleep frequency of headaches on waking up when compared
fragmentation. Given the OSAHS polysomnographic to men (40.1% vs. 25.6%; p=0.004), as well as in relation
diagnosis, it was decided to perform septoplasty and to body pain (69.8% vs. 43.8%; p<0.001), respectively.
adenotonsillectomy, followed by a new polysomnography. On the other hand, men presented a higher frequency of

Sleep Sci. 2020;13(Supl.1):1-118

 56

assisted sleep apnea in relation to women (42.5% vs. 28.7%; the device for each individual. Each patient used the
p=0.006); men also presented a higher frequency of snoring MAD, after the presence of OSAS was conformed by
when compared to women (88.1% vs. 79.7%; p=0.032). polysomnographic examination, and than personalized
Conclusions: In the present study it was possible to by a dentist with extensive clinical experience. After
observe that insomnia was more frequent in women and it adaptation to the device, they remained for a period of
was associated with snoring, tiredness when waking up and 8 to 12 weeks. Results: Male sample (n = 5) with an
memory impairment. Women with insomnia have a higher average age of 46.20 ± 11.32 years old and body mass
frequency of headache on waking up and body pain when index of 32.41 ± 2.42 Kg/m2. There was a significant
compared to men, while men have a higher frequency of reduction in sleepiness (Pre: 10.80 ± 6.30 ® Post: 7.60 ±
assisted apnea and snoring when compared to women. 4.77) (p = 0.030), as well as the AHI (Pre: 36.88 ev/h ±
Palavras-chave: Insomnia, sleep complaints, sleep disorders, sleep deprivation.
15.62 ev/h ® Post: 12, 26 ev/h ± 9.12 ev/h) (p = 0.006).
Conclusions: In the evaluated sample, it was observed
ID: 768 that drivers of intercity bus drivers with obstructive sleep
Clinical Studies apnea syndrome who used the mandibular advancement
device obtained a reduction in daytime sleepiness and an
Effects of the mandibular advancement device improvement in polysomnographic profile.
on daily sleepeness and polysomnographical
Palavras-chave: Obstructive sleep apnea syndrome, sleep, sleepiness, polysomnography.

profile in intercity bus drivers with obstructive ID: 769

sleep apnea syndrome: a pilot study Clinical Studies
Rocha, A, Wagner, L E, Abentroth, L, Caram, J M, Trindade, M, Frequency of sleep disorders in patients aged
Paiva, D N
65 years or older
Programa de Pós-Graduação em Promoção da Saúde - Santa Cruz
do Sul - Rio Grande do Sul - Brazil, Universidade Federal de Minas Santos, A M F, Garrido, J G S, Seixas, L R, Lopes, Y C, Galtieri,
Gerais - Belo Horizonte - Minas Geras - Brazil, Universidade Federal R M S, Salles, C
de Pernambuco - Recife - Pernambuco - Brazil,
Escola Bahiana de Medicina e Saúde Pública - Salvador - Bahia - Brasil,
Introduction: Mandibular advancement devices (MAD) Associação Brasileira do Sono - Regional Bahia - Salvador - Bahia -
are indicated for the treatment of Obstructive Sleep Apnea Brasil
Syndrome (OSAS), since they reduce the collapse of the
Introduction: The elderly may present changes in sleep,
upper airways and keep the jaw and tongue in a protruded
such as decreased total sleep time to less than 6 to 7.5
position. Aim: To evaluate the effects of MAD on the
hours, more superficial sleep, and may predispose to the
polysomnographic profile and daytime sleepiness of
emergence of nocturnal awakenings, sleep fragmentation
intercity bus drivers with OSAS. Methods: This is a quasi-
and afternoon nap. Aim: To evaluate the frequency of sleep
experimental pilot study that evaluated male intercity bus
disorders in patients aged 65 years or older. Methods: This
drivers from a municipality in the interior of Rio Grande
is a cross-sectional study. Study sample: Individuals who
do Sul-RS. The sample was accessed non-probabilistically
sought a sleep laboratory in Salvador (Ba) were evaluated.
and for convenience. After selection, anthropometric and
Project approved by the research ethics committee.
labor data were collected, and the Epworth Sleepiness
Inclusion criteria: Patients who answered questionnaires
Scale was applied and the diagnosis of OSAS was made by
with information about the characteristics of sleep which
type III polysomnography (ApneaLinkAir®, RESMED,
were applied between 2014 and October/2018 in individuals
Sidney, Australia). The Epworth Sleepiness Scale was
aged 65 years or older who sought a sleep laboratory in
evaluated before and after treatment with MAD, where
Salvador (Ba). Exclusion criteria: Medical records with
it consists of 8 questions that demonstrate the presence
incomplete data.Results: This sample consisted of 115
of sleepiness (0 - 3 points). The score ranges from 0 to
patients, mean age = 72.5±6.3 years, female = 53%, BMI
24 points and when a score ≥ 10 indicates an increased
= 27.7±6.9 kg/m², Epworth Scale = 8.5 (6-15), bedtime
daytime sleepiness. Type III polysomnography was
= 22:15±1:43 h, wake-up time = 5:51±1:31 h, total sleep
performed before and after treatment, which was applyed
time = 7:30±1:48 h. The most frequent sleep disorders
during his sleep night at the individual’s home. The
were: snoring (89.6%), insomnia (47.8%), leg movements
severity of OSAS was defined by the Apnea-Hypopnea
during sleep (46.1%) and assisted apnea (44.3%). Women
Index (AHI), where 5 - 15 classifies it as mild, 15 - 29,
presented greater difficulty to sleep when compared to men
moderate and ≥ 30, severe. The treatment was performed
(62.3% vs. 31.5%; p<0.001), as it occurred in relation to
through the prefabricated MAD (BluePro®, BLUESOM,
Orvault, França), which allows the individualization of

Sleep Sci. 2020;13(Supl.1):1-118

57
body pain (67.2% vs. 40.7%; p=0.004), respectively. Men Conclusions: Through the present study it was observed
presented a higher frequency of excessive daytime sleepiness that the sleep disorders with higher prevalence were snoring
than women (46.3% vs. 16.4%; p<0.001), respectively, (86.6%), insomnia (72.1%) and leg movements (52.6%).
and a higher frequency of sleep talking (24.1% vs. 6.6%; Palavras-chave: Sleep disorders, prevalence, insomnia, snoring

p<0.016). Conclusions: When evaluating patients aged 65

years or older, at least 89.6% had some sleep disorder. ID: 771
Clinical Studies
Palavras-chave: Sleep disorders; aged; epidemiology.

ID: 770
Sleep quality and sleepiness in visually
Clinical Studies impaired volunteers
Prevalence of major sleep disorders Ramos, L C N, Correia, F d J, Barreto, D M, Silva, M H C,
Pithon, K R
Garrido, J G S, Lopes, Y C, Santos, A M F, Seixas, L R, Galtieri,
R, Salles, C Universidade Estadual do Sudoeste da Bahia - Jequié - Bahia - Brasil

Escola Bahiana de Medicina e Saúde Pública - Salvador - Bahia - Brasil, Introduction: The biological rhythm of the sleep-wake
Associação Brasileira do Sono - Regional Bahia - Salvador - Bahia - cycle is determined by some factors, specially, the light’s
Brasil sensory stimulation through vision. Thus, it is believed
that the absence of light perception can negatively
Introduction: Sleep disorders are changes in the patterns influence the visually impaired volunteers sleep. Aim:
of sleep that can negatively affect the health quality of an The aim of the study was to evaluate sleep quality
individual. Thus, the high level of prevalence in the modern and sleepiness in volunteers with visual impairment.
society is a major health problem that usually does not receive Methods: It was a cross-sectional study, conducted in a
the equivalent attention by the medical community. Aim: To blind association center, between June and August 2019.
evaluate the frequency of sleep disorders in patients seeking The inclusion criteria were: visually impaired individuals,
a sleep laboratory. Methods: This is a cross-sectional study. over 18 years. Written informed consent was obtained
Study sample: Individuals who sought a sleep laboratory from all participants. The instruments were a structured
in Salvador (Ba) were evaluated. Inclusion criteria: Patients questionnaire for sociodemographic investigation, the
who answered questionnaires with information about the Pittsburgh Sleep Quality Index (PSQI) and the Epworth
characteristics of sleep which were applied between 2014 Sleepiness Scale (ESSE). Data were presented in mean ±
and October/2018 in individuals of any age, gender, who standard deviation, the Student’s t-test was used to assess
sought a sleep laboratory in Salvador (Ba). Exclusion the association between sleep quality and excessive daytime
criteria: Medical records with incomplete data. Project sleepiness variables with sociodemographic variables,
approved by the research ethics committee. Results: This considering p <0.05. Epi Info version 7.2 software was
sample consisted of 871 patients with mean age = 45 ± (31 used. Results: Seventeen volunteers participated, 58.8%
– 59) years, male percentage = 52.7%, median BMI = 26.46 male, with a mean age of 50.5 ± 16.4 years. Among
(22.4 - 31.2) kg/m², median of the Epworth Scale = 10 (6 them, 64.5% reported being able to distinguish a bright
- 14.3), mean of bedtime = 22:39 ± 1:32 h, mean of wake- environment from a dark one. Nevertheless, 11.8% have
up time = 6:15 ± 1:26 h, mean of total sleep time = 7:31 ± some degree of vision in the left eye and no participant
1:37 h. The most frequent disorders were snoring (86.6%), has degree of vision in the right eye. The average PSQI
followed by insomnia (72.1%) and leg movements (52.6%). was 9.7 ± 5.3; 70.6% of the participants had a score
Women wake up more during the night (76.9% vs 67.8%; p greater than 5. The ESE mean was 7.8 ± 4.7. Statistical
= 0.003), they have more difficulty sleeping (49% vs 34.9%; association was observed between PSQI scores and the
p < 0.001), they also report more tiredness when waking up presence of some degree of light perception in the left eye
(63.8% vs 54%; p = 0.003), besides presenting more daytime (p = 0.0156). Conclusions: Visually impaired participants
sleepiness (62.4% vs 55.6%; p = 0.041) when compared to had poor sleep quality, which could be influenced by the
men. Women reported more body pain (62.4%% vs 39.7%; degree of vision, but it could not be observed sleepiness.
p < 0.001), they also reported more irritation (49.3% vs 39%; Palavras-chave: blind, sleep quality, sleep.

p = 0.002), as well as a weaker memory (58.3% vs 46.8%;

p = 0.001), and finally they reported more headache when ID: 774
waking up (34.5% vs 22%; p < 0.001). Men have a higher
frequency of daytime sleepiness (24% vs 14.6%; p < 0.001), Clinical Studies
they snore more (90.2% vs 82.5%, p = 0.001) and bother Nasal and Oronasal Mask: literature x clinical
more third parties when they snore (61.1% vs 54.1%; p =
0.002), they also have a higher frequency of assisted apnea practice
(44.4% vs 30.8%; p < 0.001) when compared to women.

Sleep Sci. 2020;13(Supl.1):1-118

 58
Seixinho, A C, Mesquita, D, Sant’Anna, P, Taddei, A C, Unsatisfactory sleep habits, especially in the weeks in which
Assumpção Oliveira, L F, Zanussi, G they undergo evaluative tests. Studies with undergraduates
Sleep Care - São Paulo - São Paulo - Brasil around the world indicate that approximately more than
half of them are poor sleepers. Aim: To evaluate the
Introduction: CPAP is considered the gold standard of quality of sleep and the degree of daytime sleepiness
treatment for OSA. The effectiveness of the treatment is among medical students from an Amazonian institution.
associated with the proper use of the device and directly Methods: Cross-sectional study with three questionnaires:
related to the type of mask used. Recent studies show Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness
that the nasal mask is the most suitable for providing Scale (ESE) and sociodemographic questionnaire. G
greater comfort and effectiveness, but in clinical practice and Chi-square tests Adherence to univariate tables
we still face the need for adaptation of the oronasal and Independence to bivariate comparisons. Results:
mask. Aim: To compare medium-term adherence, AHI, 192 medical students from the 1st to the 4th year of
leakage and therapeutic pressure of OSA patients who graduation were interviewed. There was a significant
use oronasal and nasal mask in a CPAP clinic. Methods: incidence of participants consuming caffeine-containing
Retrospective design study, where patients with AHI substances. Regarding other substances, such as alcohol,
≥30 events/hour were selected, classified as severe anxiolytics, antidepressants and brain stimulants, there
on polysomnography examination, and subsequently was no important difference in the proportion of people
titrated by polysomnography with CPAP. They should who consume them. As assessed by the PSQI, there was
be in CPAP treatment for 90 to 360 days, using nasal or a predominance of students with poor sleep quality, with
oronasal mask, aged 45 to 80 years, both genders. Patients 29.7% classified as having sleep disorders, and over the
who changed their mask during treatment were excluded. years, the proportion of students with bad sleep increases.
Good adherence was considered the percentage of use The ESS indicated absence of drowsiness among most
≥70% and the average hours of use ≥4 hr. For excessive students, with an increase in the proportion of absence
leakage, it was considered above 24 l/min using AirView- of drowsiness over the years. It is pointed out that this
Resmed monitoring. Results: 220 patients were located, discrepancy may be related to increased consumption of
201 wearing nasal masks and 19 oronasal. When matched stimulant substances. There was no significance regarding
for age, gender and severity, each group remained with 9 gender and marital status differences. The results agree
patients. The adherence of patients with nasal mask was with those in the literature regarding the high frequency
81.5% compared to 68.2% with oronasal mask (p <0.05). of altered aspects of sleep quality, which is not interpreted
The difference in AHI was 4.7 events/hour (p <0.05). as a problem or disorder, which may cause harmful health
When comparing treatment pressure and mask leak we repercussions. Conclusions: It is noted that health
noticed that in the oronasal mask the leak is clinically promotion actions are essential among the group of higher
higher, but without statistical difference. Conclusions: In education students, such as proposals for the conversion
clinical practice we still face the need to adapt the oronasal of adopted health behaviors and the dissemination of
mask, but even in this scenario we have worse adherence sleep hygiene techniques associated with the suppression
and increased residual AHI. of bad habits, improving sleep quality. of this population.
Palavras-chave: CPAP, OSA, nasal and oronasal mask. Palavras-chave: Sleep Wake Disorders; Medicine; Education Medical.

ID: 776 ID: 778

Basic Research Basic Research
Sleep quality and daily sleepeness in medical Sleep duration in hours of children and their
schools of a amazon institution nutritional status at 4 and 6 years of age
Oliveira, M C S, Silva, R A, Gonçalves, F A, Tavares, L F, Schultz, L F, Kroll, C, Torres, C H A, Trombelli, M C, Mastroeni,
Assunção, D F S, Paes, F A S S S, Mastroeni, M F

Centro Universitário Metropolitano da Amazônia (UNIFAMAZ) -

Belém - Para - Brasil Introduction: The maintenance of adequate sleep
duration in preschool children is essential for childhood
Introduction: College students are exposed to major growth and development. Biological, cultural, behavioral
psychological stress due to extensive workload, social and socioeconomic factors can alter the sleep pattern
demands and competitiveness of the labor market, thus of children and consequently influence their nutritional
may not consider sleep as a priority, reducing sleep time status. Aim: To evaluate if there is an association between
in favor of overtime dedicated to studies and developing children’s sleep duration in hours and their nutritional

Sleep Sci. 2020;13(Supl.1):1-118

59
status at 4 and 6 year of age. Methods: This research is a education institution located in the northern region of
part of a bigger study denominated Predictors of Maternal Brazil. Methods: Observational, descriptive and analytical
and Infant Excess Body Weight – PREDI Study, a cohort study, where individuals from the eight initial periods of
study started in 2012 in Joinville-SC, Brazil. 221 mother- medical school of a private educational institution in Belém
child pairs participated in this study when the children / PA were surveyed. The self-answering WHOQOL-bref
were four (2013-2014) and six (2016-2017) years of age. questionnaire was used, which presents four research
Data were collected during scheduled appointments at domains: physical, psychological, social relationship
the families’ homes. Sleep habits of the children were and environment, as well as a general domain related to
obtained from reports filled by mothers in which the quality of life and health. The research focused on the
“Inventory of Sleep Habits for Preschool Children” was physical domain, specifically the analysis of students’
used. Total sleep duration was informed by the mothers sleep and rest quality. Results: The study included 398
and classified according to the recommendations of medical students attending the first to eighth semester of
the National Sleep Foundation. Ethical aspects: The the course, 236 (65.8%) female and 136 (34.2%) male. In
development of this study was approved by the Ethical a broad context, the physical domain for both sexes had
Committee of Research of the University of Joinville lower quality scores in the 3rd and 7th semesters, while
Region – UNIVILLE (number 107/2011). Results: The in the 1st and 6th they were higher on average. Summing
prevalence of excess body weight (risk of overweight and the general values ​​of physical domain, students have an
obesity) was 41.9%, 22.6% and 21.1% for children with average of 2.05 (median quality). As for the quality of
sleep deprivation (<9 hours), 9-12 hours and ≥12 hours of sleep and rest, the students obtained an overall average of
daily sleep, respectively. There was no significant difference 3.1, considering higher values ​​in the 1st semester (value
(p=0.075) between the categories. In addition, time of = 3.4) and 8th semester (value = 3.5) generating the
sleep was associated to nutritional status of children at highest possible value of 70%. of satisfaction with sleep.
four years of age. Conclusions: Sleep duration in hours The worst rates correspond to the 7th and 3rd semester,
is not associated to the nutritional status of children at with values ​​of 2.7 and 2.8 respectively, generating a value
four and six years of age. However, more studies with a of 55% of satisfaction. Conclusions: Therefore, this
greater number of subjects must be conducted to better research was fundamental to recognize that the student
understand the effects of sleep in childhood nutritional loses quality of sleep during the first 8 periods of medical
status. school, recognizing that the 7th and 3rd period of curing
Palavras-chave: Sleep habits; nutritional status; overweight; childhood obesity; preschool age
are the moments that have lower quality of sleep and rest
when compared to too much.
ID: 781 Palavras-chave: Sleep Wake Disorders; Medicine; Education Medical

Basic Research ID: 783

Sleep quality in medical graduation: academic Case Reports
perception from a north Brazil institution
Sleep apnea in picnodisostosis: case report
Silva, R A, Oliveira, M C S, Barbosa, B B, Diniz, I G, Portella,
MB da Costa, M O, Monteiro, P, e Silva, D V, da Rocha, M, Joffily, L

Centro Universitário Metropolitano da Amazônia (UNIFAMAZ) - Hospital Universitário Gaffrée Guinle - UNIRIO, Rio de Janeiro, Rio
Belém - Para - Brasil de Janeiro, Brazil

Introduction: The change in the student scenario from Introduction: Pycnodysostosis is a rare autosomic
high school to higher education, experienced by several recessive skeletal dysplasia due to a defect in the
medical freshmen, is permeated by countless doubts. cathepsin K enzyme gene. Both sexes are affected and it’s
It is considered the most critical period of adaptation characterized by short stature, osteosclerosis, mandibular
and change, as teaching in medical schools requires the hypoplasia, delayed fontanel closure, separated cranial
student’s full-time effort and dedication to compromise sutures, abnormal dental development, clavicle dysplasia,
their physical and psychosocial well-being. In this sense, and terminal phalanx aplasia. Obstructive sleep apnea,
the difficulty in facing stress and anguish situations, as well characterized by prolonged and intermittent upper airway
as the lack of a well-prepared family and institutional basis obstruction, is severe in children with pycnodysostosis due
are factors that can directly affect the quality of life and to the craniofacial skeleton pattern they present, which may
sleep of these medical students and even predispose them lead to cardiorespiratory disorders. Several anatomical and
to physical, mental illness. or social. Aim: To evaluate the functional mechanisms may contribute to upper airway
sleep quality of medical students from a private higher obstruction in pycnodysostosis. In particular, the arched
shape of the palate, the maxillary hypoplasia and obtuse

Sleep Sci. 2020;13(Supl.1):1-118

 60

mandibular angle may cause retroposition of the base Hospital in São Paulo-Brazil. Postpartum women aged of
of the tongue and reduction of airway diameter. Aim: 18 years or over, whose child was born at term, healthy
Report a case of Pycnodysostosis and its repercussion on and breastfeeding, had a postpartum period greater than
obstructive sleep apnea. Methods: RSL, female, 13 yo, or equal to 12 hours, single pregnancy, no history of
diagnosed with picnodisostosis, complains about nocturnal psychiatric, thyroid and/or sleep disorders, who did not
stop breathing, snoring and excessive diurnal somnolence. use illicit drugs during pregnancy, and have not worked
Tonsillectomized. STOP BANG 3; Epworth scale 13. at night for the past three years were included. Blind
Clinical examination highlighting, prognathism, left septal women, taking beta-blockers, diuretics, corticosteroids
deviation, ogival palate and class III bite, thick uvula. and/or central nervous system depressant medication
Nasolaryngofibroscopy: estimated adenoid hypertrophy were excluded. Eligible postpartum women were allocated
of 70% of rhinopharynx, epiglottis in omega, reduction of randomly in the rooms with different light. The control
pharyngeal anteroposterior diameter. Polysomnography group was characterized by mothers who were exposed
type 1 was performed, with serious AOS diagnosis with to white light (Osram®), commonly used by the service.
apnea-hypopnea index of 55 events/hour.diagnosed. In the experimental group, the puerperal women were
Results: The clinical and nasofibroscopical evaluation assigned to the room with long wavelength emission light
of the patient allowed the detection of two different (Align PM®). Data were obtained between 2018 and 2019
sites of obstruction: nasopharyngeal area, due to the after approval of ethical merit. The total resting time
presence of adenoid vegetation and hypopharyngeal area and 6-sulfatoxymelatonin level were measured during 24
with reduction of posterior anterior diameter. Therefore, hours, respectively, by ActTrust® actimeter and ELISA
the surgical treatment proposed was the adenoidectomy method. Fisher, Shapiro-Wilks, Levene, Mann-Whitney
to improve the nasopharyngeal space, and posterior and t-tests were used, with significance level of 5% and
orthodontic evaluation to perform maxillary disjunction power of 80%. Results: Twenty-one postpartum women,
and advancement to improve the hypopharingeal space. 11 in the control group and 10 in the experimental group
While the patient is on surgical preparation, she was were analyzed. The average night rest time was similar (p
followed by an important improvement of the respiratory = 0.89) between the experimental (6.8 hours) and control
pattern and complaints with positive continuous (6.9 hours) groups. The mean diurnal and nocturnal
pressure device. Conclusions: The patient’s obstruction percentage of the total 6-sulfatoxymelatonin load excreted
degree was very marked. The obstructive apnea has a was similar in the control groups (47.4 and 52.5 µg/period)
multifactorial etiology and the treatment usually consists and experimental (47.6 and 52.4 µg/period), respectively
in a “multilevel” surgery. (p>0.05). Conclusions: The type of artificial lighting did
Palavras-chave: Sleep disorders; apnea; picnodisostosis
not affect the rest time and 6-sulfatoxymelatonin level of
hospitalized postpartum women.
ID: 784 Palavras-chave: Circadian Rhythm; Melatonin; Lighting; Postpartum Period, Nursing

Clinical Studies ID: 785

Influence of light type exposure at nighttime Clinical Studies
on resting time and 6-sulfatoxymelatonin level
of postpartum women in the rooming-in unit Sleepiness-insomnia phenotype and
obstructive sleep apnea severity–is there an
Pinheiro, E M, Volcov, C F, Amaral, F G, Tsunemi, M H, Avelar, association?
A F M, Gonçalves, B S B, Coca, K P
MARTINS, EF, JUR, L C R C, L T S R, Martins, L M d S, Cortes,
Departamento de Enfermagem Pediátrica e Departamento de
A L, R S M, D M
Enfermagem em Saúde da Mulher - Universidade Federal de São Paulo
- São Paulo - São Paulo - Brasil, Departamento de Bioestatística do UFRGS - PORTO ALEGRE - Rio Grande do Sul - Brasil
Instituto de Biociências, Universidade Estadual Paulista, Botucatu, São
Paulo, Brasil Introduction: The complaint of sleepiness in insomnia
patients represents an apparent clinical paradox. Amidst
Introduction: The Postpartum woman’s sleep and wake the symptoms that aggregate with insomnia, sleepiness
cycle changes to attend the demands of the newborn. is especially defying since conditions as diverse as
Thus, constant exposure to artificial light can compromise depression, circadian rhythm sleep-wake disorders, and
total sleep time and synthesis of 6-sulfatoxymelatonin, narcolepsy cause sleepiness and insomnia. Both sleepiness
a hormone that synchronizes biological rhythmicity. and insomnia have been associated with obstructive sleep
Aim: To evaluate the influence of artificial light types at apnea since its first reports. Comorbid obstructive sleep
night on rest time and the 6-sulfatoxymelatonin level of apnea (OSA) is usually suspected in such cases. Aim:
hospitalized postpartum women. Methods: Clinical trial We investigated clinical and polysomnographic data
performed with puerperal women admitted to a University regarding the sleepiness-insomnia phenotype of patients
Sleep Sci. 2020;13(Supl.1):1-118
61
from a sleep clinic. Methods: A database of consecutive OSA is associated with cognitive impairment in seniors.
patients referred to a university-affiliated sleep laboratory Methods: Independent adults aged 65 years or older
was analyzed. Besides polysomnography to assess previously screened for OSA performed a home sleep
sleep architecture, OSA, and periodic limb movement apnea testing. OSA was defined by an Apnea-Hypopnea
disorder (PLMD), usual insomnia criteria and validated Index (AHI) ≥5. Seniors included had their anthropometric
instruments, including the Epworth sleepiness scale information collected and their global cognitive function
(ESS) and the Symptom Check List-90-R were employed. measured by the Mini-Mental State Examination (MMSE).
Results: Among 3808 adults included, 1437 had insomnia A MMSE score≤26 indicated seniors with cognitive
criteria (38%) and 2131 (56%) had an ESS score>10. decline. Subjects with score>10 points in the Excessive
Among the 2371 non-insomnia cases, 1383 (58%) had Sleepiness Scale (ESS) were considered sleepy. Results:
an ESS score>10. Among the 1437 individuals classified In the study were included 296 seniors. The mean age was
as insomnia cases, 748 (52%; P<0.001) had an ESS 71±5 years, 45% were men, mean BMI was 28.5±4.7 kg/
score>10, i.e., sleepiness-insomnia phenotype. This group m2, 34% scored>10 in the ESS, and 85% had OSA. Using
had depression and anxiety scores that were significantly MMSE were identified 106 seniors with cognitive decline.
higher than in all other patients. Sleepiness-insomnia They had fewer years of schooling than those with
phenotype, categorized in three levels of ESS-based MMSE >26. Among the seniors with OSA, 36% showed
sleepiness (mild, moderate, severe), adjusted in multinomial cognitive decline. The percentages of AHI<5 and AHI≥5
model for confounders as sex, age, use of psychotropic were similar in seniors with cognitive decline. Percentages
drugs, OSA or PLMD severity, showed the following of hypertension, diabetes, and psychiatric disorders were
significant associations: 1) insomnia plus mild sleepiness significantly greater in seniors with MMSE score≤26 than
and insomnia plus moderate sleepiness phenotypes were in seniors with MMSE >26. To predict MMSE score≤26,
associated with both anxiety and depression upper-quartile a multivariate binary logistic model was built adjusting for
scores; 2) insomnia plus severe sleepiness phenotype was confounders from the following variables: female gender,
associated with upper-quartile scores of depression and age, BMI, AHI≥5, ESS>10, hypertension, diabetes,
anxiety, and with obesity. Conclusions: Among insomnia neurological disorder, and psychiatric disorder. The model
patients, ESS>10 is only slightly less frequent than with a Nagelkerke R square=0.19 showed the following
among sleep laboratory patients and unrelated to OSA. significant associations: female gender (OR 2.37, CI 1.14-
The sleepiness-insomnia phenotype was associated with 4.93), diabetes (OR 3.52, CI 1.39-8.92), and psychiatric
depression, anxiety, and obesity, three conditions in which disorder (OR 2.84, CI 1.18-6.81). The variable AHI≥5
inflammation may be involved. Further research targeting was not associated with cognitive decline. Conclusions:
inflammatory mechanisms involved in the sleepiness- In the present study, OSA in seniors does not seem to
insomnia relationship is warranted. be significantly associated with cognitive impairment
Palavras-chave: sleepiness, insomnia, obstructive sleep apnea
measured by MMSE. The data demonstrated that diabetes
is the strongest predictor of cognitive impairment,
ID: 787 followed by psychiatric disorders and female gender.
Clinical Studies
Palavras-chave: obstructive sleep apnea, cognitive decline, seniors

ID: 788
Is obstructive sleep apnea associated with
cognitive decline in seniors? Clinical Studies
L M M d S,, A P,, J C d C,, L S,, C P F,, N d N,, L C C R S,, E F Blood pressure levels and sleep characteristics:
M,, R S M,, D M preliminary results of ambulatory blood
Universidade Federal do Rio Grande do Sul - Porto Alegre - Rio pressure monitoring in a subsample of ELSA-
Grande do Sul - Brasil. Brasil
Introduction: The prevalence of obstructive sleep ALMEIDA, I A, PAULA, D P, JUVANHOL, L L, MILL, J G,
apnea (OSA) increases with age. Previous studies have MELO, E C P, FONSECA, M D J M D, SILVA-COSTA, A,
shown an association between OSA and a higher risk of GRIEP, R H
cognitive impairment in middle-aged adults. The OSA-
related mechanisms involved in cognitive impairment may Escola Nacional de Saúde Pública - FIOCRUZ - Manguinhos - Rio
include sleep fragmentation, daytime sleepiness, oxidative de Janeiro - Brazil, Escola Nacional de Ciências Estatísticas - Rio de
stress, and metabolic dysfunction. Nonetheless, the role Janeiro - Rio de Janeiro - Brazil, Departamento de Nutrição e Saúde
of the OSA on the pathogenesis of age-linked cognitive - Universidade Federal de Viçosa - Viçosa - Minas Gerais - Brazil,
impairment remains unclear. Aim: To determine whether Universidade Federal do Espírito Santo - Vitória - Espírito Santo -

Sleep Sci. 2020;13(Supl.1):1-118

 62
Brazil, Departamento de Saúde Coletiva - Universidade Federal do Sartorelli, W, Weber, V M R, Costa, J C d, Bueno, M R d O,
Triângulo Mineiro - Uberaba - Minas Gerais - Brazil, Instituto Oswaldo Borges, P H, Silva, L F R, Romanzini, M, Ronque, E R V
Cruz - FIOCRUZ - Manguinhos - Rio de Janeiro - Brazil
Universidade Estadual de Londrina - Londrina - Paraná - Brasil
Introduction: Daily blood pressure (BP) regulation
Introduction: The sleep pattern has gained prominence
is associated with pathophysiological alterations that
in sports training, as it can directly influence the athlete’s
occur during the sleep-wake cycle, suggesting that BP
performance (cognitive and muscular function). Since
is particularly sensitive to sleep changes. However, the
the last decades, a reduction of sleep time in 2 hours/
influence of sleep alterations on blood pressure levels,
day has been visualized. In the specific case of young
such as nocturnal dipping, BP variability, and morning
athletes, the reduction in sleep time is linked by several
surge, which are important predictors of cardiovascular
behavioral and biological changes caused by the biological
risk, is unclear. Aim: To describe nocturnal dipping
maturation process. Thus, associating the training load,
patterns (dipping, reduced/reverse dipping, extreme
psychological load, and trips to championships, which can
dipping) according to sleep duration and insomnia
influence the difference between the sleep of mid-week
symptoms, BP levels (variability and morning surge),
sleep and weekend called social jetlag. However, there is
and sociodemographic factors in a sample of public
little scientific evidence to clarify the possible influence
servants. Methods: A descriptive study including 850
of social jetlag on the sports performance of young
participants from the second wave of ELSA-Brasil whose
soccer players. Aim: Compare muscle fatigue index (FI)
BP was monitored for 24 hours using a Spacelabs 90207
according to social jetlag classification in young soccer
device, programmed to perform measurements every 20
players. Methods: The sample consisted of 73 young
minutes during awake time and every 30 minutes during
soccer players aged 12 to 15 years (14.5 ± 1.9 years; 58.7
sleep. Nocturnal dipping was calculated by the difference
± 13.9 kg; 172.4 ± 11.7 cm), belonging to two academy
between mean waking and sleeping BP. Variability was
soccer teams from Londrina/Paraná. Were collect
evaluated from the standard deviation of the mean and
measurements of Body size (body mass, height), duration
morning surge by means of the sleep-through morning
and quality of sleep and social jet lag (Actigraph GT3X+),
surge classification. Self-reported sleep duration, insomnia
bone age (hand and wrist radiography). Social jetlag was
symptoms, as well as sociodemographic data and lifestyle
categorized as recommended ≤2hs and not recommended
habits were also evaluated. R software, version 3.5.2 was
≥2hs. To compare the FI between social jetlag groups, the
used for the analysis. Results: The mean age was 52±9.1
Mann-Whitney U test was used. Statistical analysis was
years, with 50% men. The group classified with reduced/
performed using SPSS 25.0 software and the adopted
reverse dipping (32%) had a higher frequency of men
significance was 5%. Results: Difference was noted only
(57%), black/brown color/ethnicity (48%), overweight
for chronological age (P=0.02), which the group classified
and obesity (71%), and greater nocturnal BP variability
as Not recommended has higher values. However, no
compared to the groups dipping and extreme dipping. The
significant difference was observed for FI (P=0.55).
prevalence of hypertension was higher among reduced/
Conclusions: It was concluded that FI didn’t show any
reverse dippers (48%) compared to dipping (39%) and
significant difference between social jetlag groups in
extreme dipping patterns (36%). Morning surge was lower
young soccer players. Longitudinal studies are suggested
among reduced/reverse dippers, however, the elevation
to verify the causality between this phenomenon.
measures varied more in this group. Among individuals Palavras-chave: Sleep, youth sports, adolescent, circadian rhythm.

with reduced/reverse dipping, 54% reported short sleep

duration and 23% reported insomnia symptoms, similar ID: 792
to those with pattern dipping. Conclusions: Participants
classified with reduced/reverse nocturnal dipping Clinical Studies
presented a higher prevalence of hypertension and higher
blood pressure variability than those with dipping or
Are sleep quality and body mass index
extreme dipping pattern. However, no differences were associated? A cross-sectional study in older
observed regarding alterations in sleep. Further analysis adults with low back pain
will contribute to our understanding of which sleep
factors are associated with nocturnal dipping. Findings Kakazu, V A, Pinto, R Z, Matos, Y, Franco, M, de Oliveira, S D,
may support important public health policies. Dias, T A, Filho, R N, Tufik, S, Andersen, M L, Morelhão, P K
Palavras-chave: sleep, blood pressure, ambulatory blood pressure monitoring
Departamento de Fisioterapia - Universidade Estadual Paulista -
ID: 789 Presidente Prudente - São Paulo, Brasil, Departamento de Fisioterapia -
Universidade Federal de Minas Gerais - Belo Horizonte - Minas Gerais
Clinical Studies - Brasil, Departamento de Fisioterapia - Centro Universitário - Belo

Comparison of muscular fatigue according to

social jetlag in young soccer players
Sleep Sci. 2020;13(Supl.1):1-118
63
Horizonte - Minas Gerais - Brasil, Departamento de Psicobiologia - the participants were instructed to maintain their usual
Universidade Federal de São Paulo - São Paulo - Brasil lifestyle and was instructed to use the actigraph in the
non-dominant wrist (ActTrust®) during four days and
Introduction: High body mass index (BMI) elevated can three consecutive nights. Sleep variables were obtained
negatively impact the health in older adults. Poor sleep by actigraphic analysis and from subjective sleep diary.
and low back pain are common comorbidities in this The variables were: latency period, wake after sleep onset
population. The literature has shown that BMI can be (WASO), number of awakenings, distal skin temperature
influenced in pain and sleep in adults. It is unclear in the (DST), mean value of 5 continuous hours of lowest
literature the relationship between sleep and BMI in older activity (L5) and mean value of 10 continuous hours of
people with low back pain. The sedentary lifestyle may highest activity (M10). Descriptive analysis was performed
be linked with a consequence of these changes. Aim: To consisting of frequencies, arithmetic means and standard
assess whether sleep quality can be associated with BMI deviations. Results: The results of sleep performance by
in older people with low back pain. Methods: This is a actigraphy showed that the latency period was 100±0.17’
cross-section study. The inclusion criteria were aged 60 in the overweight and obesity groups, and 52±0.10’ in
years and over and had low back pain at the moment in normal weight group, indicating difficulty in initiating
interviewed or last 3 months and excluded those who did sleep in all groups. Higher WASO values were observed
not agree to sign or informed consent and who did not in the obesity group (99±0.40’) and low in the overweight
have cognitive ability to answer questionnaires. Data on and normal group 47±0.24’ and 42±0.28’, respectively. A
age, sex, education, smoking habits, alcohol consumption, higher number of awakenings was observed in the obesity
income, mental status, depression, daytime sleepiness group (15±8), compared to the overweight (9±5) and
and number of comorbidities were collected through control groups (9±7). DST values ranged from 33°-34°C
questionnaires. Results: A total of 212 participants in the period from 02:20 to 04:30 for all groups, indicating
were collected according to the inclusion and exclusion the degree of skin vasodilation. Low M10 values indicated
requirements. The mean (standard deviation) age was 70 low activity during wakefulness observed in the obese
(7.5). Most of the women sample was representing 77.4%. group (16:59±01:24h), when compared to the normal
The average of BMI was 28.17 (5.0) and the mean sleep weight group (17:02±07:43h). Low L5 values indicated low
quality was 10.3 (3.19). Results from univariate regression awakening sleep and less fragmented sleep in the normal
analysis showed sleep quality was associated BMI. After weight group (01:01±00:20h). The increase in the value
adjusting of the covariables for age, gender, mental state, of L5 indicated the presence of awakenings during sleep,
depression, and comorbidity, the sleep quality was not suggesting fragmented and short sleep, as observed in the
able to predict BM. Conclusions: Our findings showed overweight (02:39±00:20h) and obesity (03:01±00:31h)
that sleep quality was not associated with BMI in the older groups. Conclusions: Given the results obtained, it can
adults with low back pain. Future studies should evaluate be concluded that, the obesity group showed low physical
the sleep quality objectively to control bias of memory. activity, higher number of awakenings and fragmented
Palavras-chave: Low back pain, older adults, sleep

sleep, when compared to the normal weight group, which

ID: 793 presented acceptable activity, fewer arousals and less
fragmented sleep.
Clinical Studies Palavras-chave: Sleep, obesity, actigraphy

The use of the actigraphy in the assessment ID: 794

of the sleep-wake cycle according to body Clinical Studies
mass index: preliminar results.
Sleep deprivation and human performance: a
Díaz, D Z R, Gaviao, M B D comparison between single and dual tasks
Universidade Estadual de Campinas - Piracicaba - Sao Paulo - Brasil
Andrade, H A, Narciso, F V, Brant, V M, Magno, C A, Silva, A,
Introduction: The actigraphy records events during the de Mello, M T
sleep-wake cycle. Aim: To describe the characteristics of
Federal University of Minas Gerais - BELO HORIZONTE - Minas
the sleep-wake cycles by actigraphy in the participants
Gerais - Brasil
with different body mass indexes (BMI). --Methods: This
is a cross-sectional and descriptive study. A convenience Introduction: Sleep deprivation leads to physical and
sample of 15 participants was selected, nine females and cognitive impairments. In addition, we commonly
six males, age range from 25-34 years (28.5±2.6). BMI perform concurrent activities, which can generate even
was obtained and the participants were classified: normal more psychomotor damage. Aim: To measure the effect
weight (n=5), overweight (n=5) and obese (n=5). After,

Sleep Sci. 2020;13(Supl.1):1-118

 64

of 36 hours of sleep deprivation on the psychomotor Exclusion criteria were: previous treatment for apnea,
performance of adults in single and dual task conditions. predominantly central apnea, renal, cardiac, pulmonary
Methods: The following group participated in the study: or peripheral vascular insufficiency; use of diuretics
14 male subjects with mean age 24,36±3,67 years and or substances acting on the central nervous system.
BMI 25,01±2,54 kg/m². The participants performed Anthropometric assessment and 24 hour urine collection
the Psychomotor Vigilance Task (PVT) every 12 hours were performed to assess sodium and aldosterone levels.
during the protocol of sleep deprivation of 36 hours. The Salt intake was calculated from 24 hour urinary sodium.
variables analized were: Mean of Reaction Time and the The study was approved by ClinicalTrials.gov number:
number of Attentional Lapses in a Single Task Condition NCT01945801, and Research Ethics Committee of
(STC) and in a Dual Task Condition (DTC). In the STC, Hospital de Clínicas of Porto Alegre number: 13-0272.
the participants performed the PVT seated and holding Results: Were included 54 men with a mean (± SD) aged
the instrument in their hands. In the DTC, the participants of 45±8.8 years, body mass index (BMI) 30±2.9 kg/
performed the PVT standing on a Force Platform and were m², blood pressure 125±8.9/85±8.6 mmHg. In 24-hour
oriented to maintain the body as static as possible during urine, 204±78mEq/24h of sodium (equivalent to 12±4.6
the entire test. The GLM (General Linear Model) test was grams of sodium/day) and 11±5.2 µg/24h of aldosterone
used to compare the psychomotor performance of the were detected. AHI averaged 49±19 events/hour and the
participants in the STC and in the DTC on the 4 moments minimum arterial blood oxygen saturation 77±8.8%. AHI
of application. The level of significance adopted was correlated significantly with urinary sodium excretion
p<0.05. Results: There was no statistical difference in the (r=0.29; p=0.031). In the linear regression model to
variables Mean of Reaction Time (F<0,01; p=0,96) and predict the AHI, urinary sodium was the only variable the
Lapses (F=0,10 p=0,92) of the psychomotor performance remained significant (beta=0.41; p=0.02), controlling for
between STC and DTC. However, there was time-effect BMI, age and level of urinary aldosterone. The coefficient
between the 4 moments in the variables Mean Reaction of determination R² of the regression model shows that
Time (F=9,88; p<0,01) and Attentional Lapses (F=12,43 adjusted explain 21% of the AHI variability (p =0.027).
p<0,01), showing that the psychomotor performance Conclusions: The severity of obstructive sleep apnea
were negatively impacted by sleep deprivation in both correlated with sodium intake. This association increase
conditions. Conclusions: The sleep deprivation of 36 evidence that fluid displacement to the cervical region
hours reduced the participants psychomotor performance during sleep participates in the pathogenesis of OSA.
in the STC and in the DTC. Furthermore, we observed that Interventions reducing fluid retention could be play role
a psychomotor task performed in a single task condition in sleep apnea therapy.
can identify the psychomotor performance of individuals Palavras-chave: Obstructive sleep apnea; fluid shift; sodium chloride

who realize concurrent activities.

Palavras-chave: sleep deprivation, dual task, psychomotor performance, sustained attention, reaction time.
ID: 796

ID: 795 Basic Research

Clinical Studies Sleep fragmentation related to moon phases

Sodium intake in men with severe obstructive Nakamura, V H, Louzada, F M, Borgio, J G F
sleep apnea Universidade Federal do Paraná - Curitiba - Parana - Brasil

de Cezaro, J C, Sezerá, L, Cotes, L C R, Piccin, C F, Prikladnicki, Introduction: There are ancient folk beliefs regarding
A, do Nascimento, N, Kaminski, R S, Moraes, R S, Martinez, D, the influence of moon phases on human behavior and
Fiori, C Z physiology. Current literature data show conflicting
results about the association between moon phases and
Introduction: Water retention through high sodium intake sleep architecture. Most studies found less total sleep
is associated with hypertension and risk of developing time (TST), lower sleep efficiency (SE), higher sleep
obstructive sleep apnea (OSA). The displacement of fluid latency (SL) and higher REM sleep latency (REML) in full
accumulated in the lower limbs to the periphery during moon, comparing to new moon. Aim: The objective of
the supine position increase pharyngeal collapsibility and this study was to compare sleep architecture with moon
OSA severity. Aim: To evaluate the association of sodium phase. Methods: A retrospective analysis of all 30,159
intake with the severity of obstructive sleep apnea in men. polysomnography reports (PSG) performed between 2008
Methods: Men aged 18 and 60 years previously diagnosed and 2016 in a large sleep center was conducted. Parameters
with severe obstructive sleep apnea defined by apnea- were age, sex, TST, SE, SL, REML, arousal index (AI), and
hypopnea index (AHI) ≥30 events per hour of sleep.

Sleep Sci. 2020;13(Supl.1):1-118

65
percent time of sleep stages (N1, N2, N3 and REM). The breathing. Methods: This is a cross-sectional study. Study
moon phase was defined by setting the new moon day as sample: Individuals who sought a sleep laboratory in
zero and full moon either as 14 or 15 (depending on the Salvador (BA) were evaluated. Project approved by the
month). Then phases were divided as New Moon (days research ethics committee. Inclusion criteria: Patients
0 to 4), Intermediary Moon (days 5 to 9) and Full Moon with complaints related to sleep-disordered breathing
(days 10 to 14 or 15). Exclusion criteria were repeated PSG who answered questionnaires with information about
of the same patient, split-night or CPAP PSG studies, age sleep characteristics which were applied between 2014
below 18 years, use of sleep-inducing drugs in the night and October/2018 in individuals of any age, gender, who
of the PSG, apnea-hypopnea index (AHI) > 15/hour, and sought a sleep laboratory in Salvador (BA). Exclusion
periodic limb movement index (PLMI) > 15/hour. Thus, criteria: Medical records with incomplete data. Results:
13,131 eligible PSG studies were analyzed. First, three-way This sample consisted of 754 patients complaining of
ANOVA with Tukey post-hoc tests were conducted, with snoring, with a mean age of 46 (31.8-59) years, median
moon phase, sex, and age-range (18–35, 36–60, and >60) BMI: 27 (23-31.6) kg/m2, mean of bedtime: 22:39 ± 1:33
as group variables. After that, multiple regression analyses hours, mean of wake-up time: 6:14 ± 1:27 hours, mean of
were conducted, with moon phase, sex, age, AHI, and total sleep time: 7:30 ± 1:38 hours. The main characteristics
PLMI as independent variables. The dependent variables of these individuals were: sleep fragmentation (71.4%),
in each test were TST, SE, SL, REML, N3, REM, and AI. snoring that bothers (67.5%), excessive daytime sleepiness
Results: ANOVA results showed greater AI in the elder (58.4%), and fatigue when waking up (57.3%). Women
group comparing to the other two groups (+2.6/hour) had greater difficulty in initiating and maintaining sleep
and greater AI between middle-age group and the younger when compared to men (47.5% vs. 34.1%; p<0.001). Men
group (+1/hour). However, moon phase did not showed presented higher frequency of assisted apnea (47.1% vs.
difference. The multiple regression analyses showed that 35.6%; p = 0.001) and excessive daytime sleepiness (24.2%
PLMI (beta=0.14), AHI (beta=0.13), and age (beta=0.10) vs. 13.8%; p < 0.001). Conclusions: The present study
were significant in predicting AI; age (beta=-0.27), AHI showed that individuals with sleep- disorder breathing
(beta=0.06), and PLMI (beta=-0.05) in SE; PLMI (beta=- had sleep fragmentation, excessive daytime sleepiness
0.04), age (beta=-0.03), and AHI (beta=0.03) in N3; and fatigue on waking. Women had greater difficulty in
and AHI (beta=0.07) and PLMI (beta=-0.03) in REM. initiating and maintaining sleep when compared to men,
In none of the analyses the moon phase had significant while men had greater frequency of assisted apnea and
effects. Conclusions: This is the only clinical-based, large excessive daytime sleepiness.
study evaluating the moon influence in sleep architecture Palavras-chave: Sleep apnea; frequency; sleep disorders.

parameters. In contrast to the existing literature, moon

phases had not a significant effect. ID: 799
Basic Research
Palavras-chave: Sleep-wake cycle, moon phase, polysomnography

ID: 797
Evaluation of Sleep Architecture in extended
Clinical Studies families in a Brazilian population: The
Factors associated with sleep-disordered Baependi Heart Study
breathing Taporoski, T P, Beijamini, F, Ruiz, F S, Horimoto, A R V R,
Gómez, L M G, von Schantz, M, Pereira, A C, Knutson, K L
Seixas, L R, Santos, A M F, Garrido, J G S, Lopes, Y C, Galtieri,
R M S, Salles, C Feinberg School of Medicine - Northwestern University - Chicago -
IL - USA, Federal University of Fronteira Sul - Realeza - PR - Brazil,
Escola Bahiana de Medicina e Saúde Pública - Salvador - Bahia - Brasil, Department of Psychiatry - University of São Paulo School of Medicine
Associação Brasileira do Sono - Regional Bahia - Salvador - Bahia - - Sao Paulo - SP - Brazil, Faculty of Health and Medical Sciences -
Brasil University of Surrey - Guildford - Surrey - UK, Division of Medical
Genetics - Department of Medicine - University of Washington -
Introduction: Obstructive Sleep Apnea and Hypopnea
Seattle - Washington, USA, Incor - University of Sao Paulo School of
Syndrome (OSAHS) is characterized as a disorder caused
Medicine - Sao Paulo - SP Brazil
by repetitive and intermittent closure of the upper airways
during sleep, due to total collapse of the pharyngeal Introduction: Sleep traits are gaining increasing
walls and it is associated with several symptoms and recognition as indicators of health, and impaired sleep
comorbidities. It is believed that about 33% of men of is associated with increased risk of cardiovascular and
productive age are affected by the syndrome. Aim: To metabolic disease. Therefore, we have initiated a project
evaluate the factors associated with sleep-disordered which adds polysomnography (PSG) to an existing cohort

Sleep Sci. 2020;13(Supl.1):1-118

 66

study, the Baependi Heart Study. The aims of this project generate disturbances in quality of life. Some external
are to examine associations between sleep architecture, factors may cause restrictions and sleep fragmentation.
particularly slow-wave sleep, and cardiometabolic disease Studies correlate sleep disorders to diabetes mellitus,
risk. Aim: In this project, we will collect data on 2,000 arterial hypertension and obesity, as well as to their
participants of a family-based study in semi-rural Brazilian worsening. Stressful factors tend to decrease the amount
population. We are conducting unattended, in-home PSG of sleep and to desyncronize the sleep-wake cycle,
recordings, and assessing cardiovascular and metabolic resulting in decreased quality of sleep and, sometimes,
risk. Sex and age differences in these measures will also in excessive daytime sleepiness (EDS). In regards to
be investigated. Here, we present preliminary PSG results. medical students, anxiety due to the aproval and access
Methods: All current participants in the Baependi Heart to medical school and later due to scenarios in which
Study will be invited to participate in our ancillary sleep they deal with matters related to sickness, suffering and
study. PSG is recorded using a type 1 ambulatory device death, besides the prospects of entering the job market,
(Track-It, Nihon Kohden). PSG was staged using standard make them vulnerable to sleep disorders. Considering the
criteria. Sleep traits were analyzed for the full sample and aforementioned aspects, this work intends to demonstrate
stratified by sex and by age (<50 vs >=50 years) excluding how medical students may be affected in their routines
those with sleep<4 hours. Results: Preliminary results during their professional qualification. Aim: To analyse
comprised PSG data from 98 participants (64 women), with if anthropometric and cardiovascular parameters differ
an average age of 44 (±15) years (42%>=50). For the full between different degrees of excessive daytime sleepiness.
sample, mean (SD) of total recording and sleep time were Methods: Observational, descriptive and analytical study
8.4 (±1.3) hours and 6.3 (±0.9) hours, respectively. Means submitted to the Commitee of Ethics and Research
(SD) for sleep stage percentages were: wake=22.6 (±12.8) (N.3.168.630). The sample totalized 77 undergraduate
%; N2=51.1 (±8.4) %; N3=15.4 (±5.9) %; REM=23.2 medical students from the first and last two years of the
(±7.5) %. Women slept on average 6.4 (±0.9) hours, whilst course. Socio-demographic and anthropometric data
men averaged 6.1 (±0.9) (p=.13). Sleep stage percentages was gathered (height and weight for BMI calculation,
for men|women were the following: wake=22.4|22.7; neck circumference, abdominal circumference, arterial
N2=50.5|51.4; N3=13.9|16.2; REM=22.7|23.4. The pressure and heart rate and the Epworth Sleepiness Scale
younger group slept an average of 6.5 (±1.0) hours, while (ESS) was used to evaluate excessive daytime sleepiness.
the older group slept 6.1 (±0.9) hours on average (p=.045). The analyses and statistic tests were done in the program
Sleep stage percentages for young|old: wake=19.5|26.9; R Commander (Rx64 3.6.0). Values of p<0.05 were
N2=50.3|52.1; N3=16.0|14.7; REM=24.6|21.1). These considered significant. Results: Answer variables: EDS
measures did not differ significantly between sexes, but with arrive at home/min (Kruskal-Wallis P<0.03).
wake and REM percentages were significantly different GENDER with physical activity (qui- sq p<0.06)/CP.cm
between age groups (p<.05). Conclusions: We have (Wilcoxon P<0.001)/ CA.cm (Test t Student p<0.001)/
demonstrated that in-home unattended PSG is a feasible PAS (Wilcoxon p<0.01)/ PAD (Test t Student p<0.01).
method of sleep measurement in Baependi, Brazil. AGE with arrive at home/min (Kruskal-Wallis p<0.06)/
Palavras-chave: Sleep architecture, slow wave sleep, epidemiology, gender, aging
IMC (ANOVA p<0.02)/ Interval between the beginning
and end of graduation (Fisher p<0.001). Conclusions:
ID: 800 Considering that these students may present risk factors
Clinical Studies for the development of an irregular sleep-wake cycle, it
is necessary to intensify studies about excessive daytime
Association of Excessive Daytime Sleepiness sleepiness in order to prevent sleep disorders.
with Anthropometric and Cardiovascular
Palavras-chave: Excessive daytime sleepiness, medical student, anthropometry

parameters ID: 801

Vicentini, S C, Rocha, E D, Dias, A F C F R, Costa, O D G, Basic Research
Gomes, P H C, Tailor, L F B, Oliveira, L M P, Aguiar, F C,
Barbosa, M T S, Silva, C R L
Chronotype, morning light exposure, sleep
quality, daytime sleepiness and attention in
Instituto Biomédico, Programa de Pós-graduação em Enfermagem e
Biociências e Escola de Medicina e Cirurgia- Universidade Federal do
adolescents
Estado do Rio de Janeiro - Rio de Janeiro - Rio de Janeiro - Brazil
Galina, S D, Souza, J C, Valdez, P R, Azevedo, C V M
Introduction: Sleep is defined as a state of temporary Universidad Autónoma de Nuevo León - México, Universidade Federal
loss of consciousness from which an individual may be do Rio Grande do Norte - Natal - Rio Grande do Norte - Brasil
awakened naturally or through endogenous mechanisms
which regulate the cyrcadian rhythm. Sleep disorders may

Sleep Sci. 2020;13(Supl.1):1-118

67
Introduction: The sleep-wake cycle (SWC) and attention in a sample of elderly patients. Methods: Retrospective
are modulated by the light-dark cycle. Studies suggest study, whose information was obtained from the Sleep
that nighttime light exposure may influence chronotype Laboratory database of the Gaffrée and Guinle University
expression, sleep quality and daytime sleepiness in Hospital, from June 2017 to June 2019. Individuals
adolescents. Aim: The aim of this study was to evaluate aged 60 years old or older were selected. The following
the relationship between chronotype, morning light variables were analyzed and compared to the PSG report,
exposure, sleep quality, daytime sleepiness and attention which determined the diagnosis of OSAS: gender, age,
in adolescents. Methods: 73 adolescents of both sexes family income, education, weight, body mass index (BMI),
participated (48 girls), mean age was 15±0.7 years, in cervical circumference (CC), abdominal circumference
the morning shift and early years of high school from (AC), pelvic circumference (PC), ESS, SBQ, BQ, and
Rio Grande do Norte-RN. Actiwatches were used previous diseases. T test or Wilcoxon was used to compare
for 10 days to collect information on SWC and light quantitative variables and Chi-square or Fisher’s exact
intensity (exposure from wake-up until classroom entry); test for qualitative variables. All variables were applied
Pittsburgh Sleep Quality Index and Pediatric Daytime in a univariate model. Odds ratio (OR) was verified for
Sleepiness Scale were answered; Attention was assessed by each variable that had a significant association in the
a Continuous Performance Task, measuring sustained and model. It was considered significance of 5%. Results: 74
selective attention, tonic alertness and phasic alertness, patients were found in our database, 57 of them had all
and the overall stability of task execution. Results: the informations that have been investigated. From those,
Chronotype correlated with daytime sleepiness (r=-0.68), 39 were diagnosed with OSAS by PSG. The prevalence
sleep quality (r=-0.33), percentage of hits of sustained of the syndrome in the sample was 68.42%. The average
attention (r=0.20) and selective attention (r=0.18), TA age for those with OSAS was 74 ± 8.30 ys and without
(r=0.21); and overall stability of task execution (r=-0.32). 74 ± 8.10 ys. Females were predominant, representing
The intensity of light from wake-up until the classroom 82.1% of the OSAS group and 88.9% without OSAS.
entry tended to correlate with irregularity for bedtime In exploratory analysis, AC (0.012) and BQ (0.047) were
(r=0.23) and with irregularity of sleep duration (r=-0.23). associated with OSAS. When applied in the univariate
Conclusions: This result indicates relationships among model, the variables with association were AC (0,019) and
morning light exposure and bedtimes and sleep duration; CC (0,037), both proved to be a risk factor for OSAS with
however, a larger sample is needed to evaluate the role OR of 1.07 (1.01-1.14) and 1.24 (1.01-1.52), respectively.
of light exposure in sleep-wake cycle and attention in Conclusions: In this sample of elderly patients with a
adolescents. predominance of females, a high prevalence of OSAS was
Palavras-chave: chronotype; light exposure; sleep pattern; attention; adolescents.
found, in which abdominal and cervical circumference
measures seem to be good predictors. These results need
ID: 802 to be expanded to larger samples and investigated in other
Clinical Studies age groups, aiming to be considered as possible criteria for
the suspicion of OSAS in the clinical context.
Prevalence and predictors of obstructive sleep Palavras-chave: obstructive sleep apnea syndrome, elderly, prevalence

apnea syndrome in a elderly sample ID: 803

Godoy, P H, Nucera, A P C d S, Colcher, A d P, Andrade, J E d, Clinical Studies
Padilla, M P, Gomes, G S, de Sousa, L S, Andrade, A B d S N,
Alves, D d S B Impact of prolonged use of continuous
Universidade Federal do Estado do Rio de Janeiro - Rio de Janeiro - Rio
positive pressure in high airways on pressoric
de Janeiro - Brasil levels of patients with resistant arterial
hypertension and obstructive sleep apnea
Introduction: Obstructive sleep apnea syndrome (OSAS)
is a great cause of morbidity. Polysomnography (PSG) is still Moliterno MBM, Fernandes ACV, Cavalcanti AH, Silaid E
expensive and poorly available in health systems especially
in low- and middle-income countries. Thus, investigating Programa de Hipertensão Arterial ProHArt, Hospital Universitário
OSAS using clinical tools, whose associations enable its Clementino Fraga Filho, e Laboratório do Sono Lab Sono - Universidade
prediction, are relevant and deserve study in different Federal do Rio de Janeiro - Rio de Janeiro - Rio de Janeiro - Brazil
age groups. Aim: Estimate the prevalence of OSAS and
Introduction: Obstructive sleep apnea (OSA) is
verify its association with the Epworth Sleepiness Scale
independently associated with poor blood pressure (BP)
(ESS), Stop-Bang (SBQ), Berlin questionnaire (BQ),
control, worsening nocturnal descent and target organ
anthropometric measurements, and previous diseases
damage, and a high prevalence of resistant hypertension
(RH). It is not yet clear whether the use of CPAP

Sleep Sci. 2020;13(Supl.1):1-118

 68

(continuous positive pressure in high airways)promotes are prevalent. Aim: Evaluate and classify respiratory
significant BP reduction. Most studies have evaluated events and the presence of immaturity of the respiratory
short-term therapeutic response, perhaps insufficient to patterns using polysomnographic daytime studies.
reduce sympathetic activity and endothelial dysfunction. Methods: Between January 2010 and March 2013 we
Aim: To prospectively evaluate changes in ambulatory undertook Polysomnographic daytime studies (of infants
blood pressure monitoring (ABPM) after prolonged use up to one year old) at the Instituto do Sono in São Paulo
of CPAP, compared with a control group with moderate City. Results: The sample derived from sleep evaluations
to severe OSA and RH. Methods: 115 patients (38.3% of 60 infants, 36 males, with 4.3 ± 2.9 months age (16
male, mean age 62 [8] years) diagnosed with moderate and days to 11 months). Corrected gestational age was 58.3
severe OSA were divided into 2 groups for use (CPAP ± 14 weeks (36 to 87 weeks). Total sleep time was 103
group) and non-use of CPAP (Control group). During ± 32 minutes. Obstructive apnea index was 11.1 ± 16.1
follow-up, antihypertensive drugs were adjusted by 24- (0 to 62 events). Central apnea index was 13 ± 18 (0 to
hour ABPM at baseline and at the end of the study. The 92 events). Twenty-three (23) infants had predominantly
median follow-up was 49 months (range 11 to 77 months). central events, 32 obstructive events and 5 presented no
The intergroup comparison of BP changes was calculated abnormal index of respiratory events. Periodic breathing
by the linear model with group allocation as a fixed occurred during 3.1 ± 7.2 % of the total sleep time. We
factor and adjusted by the respective basic BP values. A noticed that 8 infants spend more than 5% of the total
subanalysis was also performed only in patients with good sleep time with periodic breathing and between these, 5
CPAP adherence and another with those who started had a corrected conception age greater than 42 weeks.
the study with uncontrolled ABPM. Results: 67 (58.3%) Conclusions: Polysomnographic daytime studies are a
patients were included in the CPAP group and 48 (41.7%) robust method to identify sleep respiratory disturbances
in the control group, 71 (61.7%) diagnosed with severe and breathing immaturity in infants.
OSA - both groups (CPAP and Control). Demographic, Palavras-chave: Pre-pubertal, children, sleep, central, obstructives, apneas

anthropometric, clinical and laboratory characteristics,

with similar mean ABPM values. After 49 months, there ID: 806
were no significant changes in ABPM comparing the two Basic Research
groups. Control in ABPM increased from 37.5% to 41.7%
in the control group and decreased from 37.3% to 31.3% Does academic demand, use of electronic
in the CPAP group (p = 0.12), with no significant changes device and domestic chores related to sleep/
in medication. In the subanalysis only with patients with
good CPAP adherence (n = 58), changes in BP were wake cycle of university students?
also similar in both groups. Analyzing those who had
ARAÚJO, M F S, Lopes, X F M, FERNANDES, L C B, SILVA,
uncontrolled ABPM at the time of inclusion in the study,
M A P, ARAÚJO, S M, ARAÚJO, Y D, DANTAS, D S, SOUZA,
the control group (n = 30) showed a linear reduction
JC
(p = 0.06) in nocturnal diastolic BP compared with the
CPAP group (n = 42). Conclusions: The use of CPAP in Universidade Federal do Rio Grande do Norte - Santa Cruz - Rio
resistant hypertensive patients with moderate and severe Grande do Norte - Brasil
OSA had no benefit in blood pressure control.
Palavras-chave:
Positive PressureResistant Hypertyension
in High Airways (CPAP) (RH) Obstructive Sleep Apnea (OSA) ambulatory blood pressure monitoring (ABPM) Continuous
Introduction: Admission to the university is considered
a milestone in the lives of many young people. However,
ID: 805 it can be a stressful experience and may contribute to the
emergence of unhealthy habits which may interfere with
Case Reports the sleep/wake cycle. Aim: To evaluate the sleep/wake
cycle of university students according to academic demand,
To what extent do infants present central or electronic use and household chores during the week and
obstructives apneas events during sleep? weekend. Methods: This study was conducted with 297
university students of both sexes (♂=26,3%; ♀=73,7%)
Ott, V L L, Pradella-Hallinan, M, Moreira, G A, Tufik, S from Nursing, Nutrition, Physiotherapy and Psychology
Department of Psychobiology - Universidade Federal de São Paulo - undergraduate courses. Pittsburgh Sleep Quality
São Paulo - São Paulo - Brazil Index, Epworth Sleepiness Scale, Munich Chronotype
Questionnaire and “A Saúde e o Sono questionnaire” were
Introduction: Obstructive apneas are the most frequent used. The latter evaluates the sleep/wake cycle (SWC) at
respiratory disturbance in prE-pubertal children during week and weekend, and the reasons reported by students
sleep. In infants, it is thought that, because of the for sleep and wake up times (academic demand, use of
immaturity of the central respiratory center, central apneas electronics devices and household chores). The students

Sleep Sci. 2020;13(Supl.1):1-118

69
were divided into two groups (presence or absence of sleep, grouped into categories by cluster analysis.
report) and were compared by the Mann Whitney test. Depressive symptoms were assessed using the Geriatric
It was considered a significance level of 5%. Results: Depression Scale (GDS-15) and stressful life events using
The average age of the students was 21.2 ± 4.0 years. the Elders Life Stress Inventory (ELSI). Mann-Whitney,
Regarding the reasons given for bedtime in the week, those Kruskal-Wallis and chi-square tests were used, considering
who reported having academic demand showed higher a significance level of 5%. Results: Results: Three
daytime sleepiness (p = 0.003), and those who reported categories were obtained from cluster analysis: Good
using electronics devices showed worse sleep quality (p = Sleep; Bad Sleep; Early Awakening. When compared to
0.001), slept 27 minutes later (p = 0.001) and 31 minutes older adults in the Good Sleep category, the older adults
longer than those who do not use electronic device. Over in the Bad Sleep and Early Awakening categories showed
the weekend, students who reported academic demand (p higher GDS-15 scores (p<0.0001), as well as reporting the
= 0.028) and use of electronics devices (p = 0.009) went occurrence of stressful events with greater intensity in the
to bed later and showed longer duration when compared Finitude (p=0.007) and Well-being (p<0.0001) domains.
to those who did not report. Regarding the reasons given There was a higher prevalence of stressful life events
for wake-up time in the week, only academic demand in the Well-being domain (p=0.0002) for the Bad Sleep
was related to greater irregularity in the SWC (p = 0.022). category, and a lower prevalence of stressful life events in
However, over the weekend, students who reported wake- the Descendence domain (p=0.017) for the Good Sleep
up due to academic demand or household chores showed category. Conclusions: Conclusion: The approach to
less irregularity in the SWC, and they presented earlier hypertension in health care should include an assessment
bedtime and wake-up time; and longer duration compared of the older adults in their entirety, considering other
to those who do not reported these reasons. Conclusions: common complaints at this age, such as sleep complaints
The results indicated that the use of electronics devices and other psychosocial factors that imply detriment
and academic demand influence the sleep and wake and failures during their treatment, such as depressive
pattern of the undergraduate’s students. symptoms. This grouping of symptoms may affect the
Palavras-chave: Diurnal sleepiness; Sleep quality; Student Health
management of the treatment of their underlying chronic
disease and the investigation of them should be expanded.
ID: 808 Palavras-chave: Descriptors: Hypertension; Depression; Sleep Initiation and Maintenance Disorders

Clinical Studies ID: 809

Is it important to evaluate symptoms of Basic Research
insomnia in older adults with hypertension?
Neurodegenerative diseases: what are the
Andrechuk, C R S, Rosas, C, Oliveira, H C, Oliveira, C d S, impacts of the exercise? A systematic review
Inazumi, C K, Neri, A L, Ceolim, M F and meta-analysis of experimental models
Introduction: Introduction: The increase in chronic Daniele, T M C, Matos, R S, Bruin, P F C, Bruin, G S , Nunes, C
diseases such as hypertension and their association V, Nunes Filho, J C C, Bruin, V M S
with cardiovascular mortality in the elderly represents a
Sleep and Biological Rhythms Laboratory - School of Medicine -
public health priority. Persistent insomnia is associated
Federal University of Ceará - Ceará - Fortaleza - Brazil, Department
with increased risk of hypertension and people with
of Neurology - Washington University - St Louis - Missouri - USA,
hypertension and symptoms of insomnia have a worse
Department of Medicine - School of Medicine - Federal University of
prognosis for the disease. In addition, older adults are
Ceará - Ceará - Fortaleza - Brazil.
more vulnerable to stressful life events and depressive
symptoms, which have also been related to hypertension. Introduction: The neurophysiological effects of exercise
Aim: Objective: To verify the relation of insomnia on brain and behavior and its mechanistic basis deserve
symptoms with depressive symptoms and stressful events clarification. Aim: This review and metanalysis examines
in older adults with hypertension. Methods: Method: the strength of scientific evidence on how exercise modifies
cross-sectional study conducted with 438 older adults brain and behavior in healthy mice, in Alzheimer’s disease
(mean age 72.1 years, 71.5% female) with hypertension, (AD) and Parkinson disease (PD) models Methods:
participants of the Brazilian Older Adult Frailty Study Search (PubMed) included the words: “mice”, “treadmill”,
(FIBRA-Campinas). Insomnia symptoms were the “exercise”, “physical exercise”, “cognition”, “brain”,
dependent variable, assessed by four questions in the “depression”, “anxiety”, “memory”, “learning” or
Nottingham Health Profile: disorders of initiating and “behavior” Results: In most studies, animals (N=1,172;
mantaining sleep, early awakening and non-restorative 96 articles) exercised 4-8 weeks, 60 min/day and 10/12m/

Sleep Sci. 2020;13(Supl.1):1-118

 70

min. Hippocampus followed by cerebral cortex, striatum activity, and chronic diseases (hypertension and diabetes).
and whole brain were more frequently investigated. Data were analyzed using the SPSS® 20 software, with
Exercise improved learning and memory. Meta-analysis descriptive and inferential statistics (Mann-Whitney and
showed that exercise increased: cerebral BDNF, TrkB Kruskal-Wallis tests, 5% significance level). The study
levels and neurogenesis. Exercise augmented amyloid was approved by the Research Ethics Committee of the
clearance and reduced amyloid plaques in AD models. institution. Results: Results: Among the participants,
In PD models, dopaminergic neurons were increased. 52.9% were male and 50.7% were 60 years of age or over.
Evidence regarding inflammation, oxidative stress and Mean TIB of 474.2 minutes (SD=74.7), TST of 392.7
energy metabolism were scarce. Studies on acute versus minutes (SD=70.5), SOL of 11.8 minutes (SD=9.1), SE
chronic exercise, extreme training and the durability of of 82.9% (SD=6.2%), WASO of 58.6 minutes (SD=25.1)
exercise benefit were rare. Conclusions: In conclusion, and mean number of awakenings 24.5 (SD=7.6) were
meta-analysis showed that exercise had positive effects observed. The SE was higher in the Control Group
on brain and behavior, directly and indirectly related to (p=0.003) and WASO was higher for the Cases (p=0.046).
neurogenesis in healthy and dementia models. Exercise There was a significant difference between genders, with
reduced toxicity and inhibited amyloid pathology in AD higher TST (p=0.013), lower SOL (p=0.043), higher SE
model. Few studies on PD models were reported. Vascular (p<0.001), lower WASO (p=0.001) and lower number
or glucose metabolism changes were rarely reported. The of awakenings (p<0.001) for the women. Higher SOL
underpinning mechanism explaining exercise benefits on (p=0.013), lower SE (p=0.001) and higher WASO
brain tissue needs clarification. (p=0.003) were found among the participants that
Palavras-chave: Treadmill exercise; Brain; Cognition; Neurogenesis; Neurological disorders.
reported napping. Conclusions: Conclusion: Actigraphy
showed to be useful in the evaluation of sleep of the
ID: 810 population and may become an important and convenient
Clinical Studies measure for helping the adoption of practices that favor
sleep quality.
Sleep patterns measured by actigraphy Palavras-chave: Descriptors: Actigraphy, Sleep, Sleep Wake Disorders

in adults of a city in southeastern Brazil: ID: 811

ISACAMP-sono study
Basic Research
Andrechuk, C R S, Oliveira, C d S, Ceolim, M F, Rosas, C,
Inazumi, C K, Zancanella, E, Lima, M G, Barros, M B d A,
Sleep quality in adolescents studying in the
Oliveira, T A M d morning shift at a public school at Cascavel
(PR), Brazil.
Introduction: Introduction: Quality of sleep and its
relation to health habits constitute an important aspect of Picole, A P, de Andrade, F P, da Silva, A C M
study in the current scenario of society and, therefore, the Universidade Estadual do Oeste do Paraná (Unioeste) - Cascavel -
use of objective parameters for evaluation of sleep patterns Parana - Brasil
is an essential tool for assessing sleep of the population.
Aim: Objective: To describe sleep characteristics of adults Introduction: In adolescence, a period characterized by
from a city located in Southeastern Brazil, according to profound changes, the sleep-wake cycle also changes: a
actigraphic records. Methods: Method: An observational, sleep phase delay occurs. Despite this, the final grades of
cross-sectional study with 270 individuals who constituted elementary school and high school are offered standardly
a sub-sample drawn from the Campinas Municipal Health in the morning (beginning between 7am and 7:30 am).
Survey (Inquérito de Saúde do Município de Campinas - Among adolescents there is a high use of electronic devices
ISACamp) 2014/2015. Two groups were formed: Cases before they sleep may contribute to sleep difficulties, as
(people with sleep complaints, n=215) and Controls it alters the modulation of the light-dark cycle of WSC.
(people without sleep complaints, n=55). Participants Aim: Evaluate quality of sleep and the use of electronic
used an Actiwach 2® actigraph (Phillips Respironics, Inc.) devices in adolescents studying in the morning shift in
for seven consecutive days, with 1-minute epoch lengths. a public school in Cascavel (PR), Brazil. Methods: The
The following sleep variables were estimated using the research was designed as cross-sectional study, quantitative
Actiware 6.0.8 software algorithm (Phillips Respironics, and descriptive, based on application of Pittsburgh Sleep
Inc.): time in bed (TIB), total sleep time (TST), sleep Quality Index (PSQI), added a question, along the lines
onset latency (SOL), sleep efficiency (SE), wakefulness of the questionnaire, on the use of electronic devices (like
after sleep onset (WASO) and number of awakenings. The cell phone, tablet and notebook) before bed. Students
following variables were also selected: gender, age, physical from a ninth grade elementary school and first, second

Sleep Sci. 2020;13(Supl.1):1-118

71
and third year vocational of high school (information answered the question using a Likert scale from 0
technology) from a State College were evaluated. This to 10, where 0 means “very bad” and 10 “very good”.
study was approved by the Committee of Ethics in Sleep quality on weekdays and weekends were evaluated.
Human Beings (n. 3.451.752) and signed hose responsible Data were collected through an electronic inquiry and
for adolescents. We evaluated 73 students of both sexes subsequently exported to statistical treatment software
(48 male and 25 female) aged 15.37±1.23. Statistical (Mann-Whitney and Wilcoxon tests). The research was
analysis was made using the program IBM-SPSS. Results: approved by the institution’s Research Ethics Committee
91.8% of students used electronic devices at bedtime; (CAAE10653019.4.0000.5568). Results: We analyzed 74
72% of them three or more times a week. Total score of employees (20 teachers and 54 administrative technicians
PSQI=5.75±3.02. 52.1% had PSQI> 5, indicating poor in education - ATE) with a mean age of 55 ±6 years, 44
sleep quality, with 10.9% reaching score ≥ 10. The PSQI (59%) males, 31 (42%) whites, average of 18 years of
components were reached these scores: 01 (subjective study and withn the majority (74%) housed on Campus
sleep quality: 0.86±0.75); 02 (sleep latency: 0.88±0.87); 03 in the capital. As regards sleep quality, the servants had
(sleep duration: 0.86±0.97); 04 (habitual sleep efficiency: 7.1 ±2.32 points for sleep quality on weekdays and 7.6
0.62±0.89); 05 (sleep disorders: 1.15±0.62), 06 (use of ±2.35 points on weekends, the latter being significantly
sleeping medications: 0.1±0.51) and component 07 better (p<0.001). In a stratified analysis by housing (capital
(daytime dysfunction: 1.33±0.87). The PSQI components and interland), significant differences in sleep quality
that scored higher were component 05 (sleep disorder) were found during weekdays 7.2 ±2.2 and weekends
and 07 (daytime dysfunction); with occurrences one or 7.6 ±2.1 only for the servants of the capital (p=0.001).
more times per week of 89.1% and 84.9%, respectively. The strtatified comparisons by category (teacher and
Conclusions: Students presented high use of electronic ATE) and gender did not show significant differences.
devices at bedtime and most of them had poor sleep Conclusions: The datapoint to a better quality of sleep
quality. Studies like this are needed to disseminate on weekends compred to weekdays, more specifically of
prophylactic sleep hygiene measures that contribute to servants housed in the capital. This may occur due to
improve sleep quality as well as contribute to a scientific the daily life of capitals and metropolitan regions. Future
effort to demonstrate that the morning school shift should studies with larger samples and multivariate analyzes may
start later, allowing adolescents to develop healthier. provide more evidence.
Palavras-chave: sleep; school; adolescents. Palavras-chave: Sleep. Aging. Occupational Health

ID: 812 ID: 815

Basic Research Basic Research
Sleep quality assessment in middle-aged and Sleep quality and its association with metabolic
older servants of an university in Northeastern variables in medical students of an institution
Brazil in the Amazon
MACEDO, H T D S, DE SOUZA, D E, LIMA, F R D R T, DE Oliveira, M C S, Brito, G P, Ramos, M S N, Ribeiro, S S, Cardoso,
SOUZA, J C, DA SILVA, M A P S, SILVA, F E D N, ROCHA, D Y M, Lima, K O, Silva, R A, Cunha, F S, Pantoja, P M M
F, DE ARAÚJO, J A R, GUEDES, D T
Centro Universitário Metropolitano da Amazônia (UNIFAMAZ) -
Instituto Brasileiro de Geografia e Estatística - Natal - Rio Grande do Belém - Para - Brasil
Norte - Brasil, Universidade Federal do Rio Grande do Norte - Santa
Cruz - Rio Grande do Norte - Brasil Introduction: A medical student’s study routine is intense,
with full-time classes plus nighttime activities. Taking up
Introduction: The current world of work has presented most of the student’s time, overwork can end up interfering
triggers of illness and loss of quality of life, among which with the sleep quality of these individuals and can be a
sleep disorders. Coupled with the fact that with aging risk factor for the development of metabolic disorders
people sleep less, have shorter deep sleep and can wake due to the lack of control of their biological cycles. Aim:
up more easily, this condition may have an impact on The present study aimed to correlate sleep habits and
their ability to work. Aim: To evaluate the quality of sleep metabolic variables in medical students at an educational
of middle-aged and older servants of an university in institution in the Amazon. Methods: This was an
Northeastern Brazil. Methods: Cross-sectional study of observational cross-sectional study of analytical character
servants (≥45 years) from June to August 2019. Visits were aimed at collecting information on habits and clinical
made in workplace to collect information. To assess the aspects related to sleep quality in medical students from
quality of sleep, the following guiding question was used: the 1st to the 8th period of the course. The study had two
“How is the quality of your sleep at night?” Participants data collection instruments: an Epworth sleepiness scale

Sleep Sci. 2020;13(Supl.1):1-118

 72

questionnaire, a questionnaire prepared by the researchers, (Epworth Sleepiness Scale-ESS), Depression symptoms
containing 15 items (questions), which took as reference (Edinburgh Postnatal Depression Scale – EPDS, used
the students’ day and night habits. An anthropometric during pregnancy), insomnia (Insomnia Severity Index
measurement collection was also used, which included: -ISI) and fatigue (Fatigue Severity Scale-FSS). Circadian
weight, height, measurement of cervical, waist and hip preference was measured using the Horne-Östberg
circumferences and measurement of systolic (SBP) and Morningness-Eveningness Questionnaire (MEQ);
diastolic (DBP) blood pressure, body mass index (BMI) Everningness was defined by a MEC score ≤ 40. The study
and waist-to-hip ratio. Results: A total of 117 students was approved by Federal University of Ceará ethic board,
who regularly attended medical school with a mean age of approval number 1.801.860 Results: During the second
22 years were evaluated. Of these, 59% had pathological half of pregnancy, 242 women with GD, with age from 19
sleepiness, most had poor sleep quality, 56% of the sample to 46 (33.2), mean BMI of 32,3 and mean gestational age
had fragmented sleep and 46% non-repairing. Nocturia (p of 28 weeks were evaluated. Hypertension was diagnosed
= 0.02) and use of stimulants (p = 0.007) were the only in 21,4% and overweight or obesity in 78%. Among all, 19
sleep variables with statistical significance, and frequency were identified with evening preference (8.1%), and among
and use (respectively) were higher in the 2nd, 3rd and them, the prevalence of hypertension was similar to rest
4th years. of course. In metabolic variables, the only one of the group. MEQ lower scores (eveningness trend) were
with significance was sedentary lifestyle (p = 0.03), which associated with higher PSQI index (r=-.016 p=.01) and
increased in the 2nd, 3rd and 4th years. With the research, EDPS (r=.45 p<0.005). Moreover, lower MEQ scores
there was no correlation between metabolic variables and were correlated with increased levels of fatigue (r= -.30
sleep quality. Conclusions: Most medical students, from p<0.005) and insomnia (r=.53 p<0.005). Conclusions:
the first to the fourth year of the course, have a poor Women with GD and evening preference reported more
quality of sleep, which is fragmenting most of the sample, frequent sleep and mood disturbances, including poor
on average less than 6 hours a night, non-repairing and sleep quality, insomnia, depressive symptoms and fatigue.
during the day students have excessive drowsiness, and These results show that eveningness, in women with GD,
some use stimulants to stay awake and study. is associated with more sleep complications. Given this
Palavras-chave: Medicine; Education Medical; Sleep Wake Disorders.
evidence, and the known risk of poor pregnancy outcomes
associated with GD, Sleep disorders and depression,
ID: 816 studies evaluating the effects of light exposure in these
Clinical Studies patients are warranted
Palavras-chave: Gestational Diabetes, Circadian Rhythm, everningness, sleep disturbancies, pregnancy

Evening preference in gestational diabetes is ID: 817

associated with poor sleep quality, depressive
symptoms, insomnia and fatigue Basic Research

Facanha, C F S, Alencar, V S, Ballalai, M S, da Rocha, L N,

Sleep and self-perception of stress and
Machado, P S, Facó, T L, Bruin, P F C, Sales, P L P, Bruin, V M S happiness in the post-graduation professors
Centro universitário Unichristus - FORTALEZA - Ceara - Brasil Teixeira, V H S, Moreno, C R C
Introduction: Sleep problems are common in pregnancy Universidade de São Paulo - São Paulo - Sao Paulo - Brasil
and women with gestational diabetes (GD) are at
increased risk of associated clinical complications and Introduction: The postgraduate programs professors
adverse maternal outcomes. Preliminary reports indicate have atypical conditions in their work routine due to the
that mother circadian preference may influence sleep high institutional demands and the diversity of functions
problems in pregnancy and in early childhood. This and activities. Hence, their quality of life is impaired by
study assessed circadian preference in women with GD. many factors, including working during days-off. Aim:
Aim: To investigate circadian preferences in woman with This study aimed to analyze the association between sleep
gestational Diabetes and correlate with other sleep and duration and self-perception of stress and happiness
mood disorder. Methods: This cross-sectional study in a sample of professors of postgraduate programs
consecutively evaluated women with GD attending a from a public university in State of São Paulo, Brazil.
public health care unity in the northwest of Brazil. DMG Methods: The sample was composed for 66 professors
was defined according to WHO 2013 criteria. An in- (n = 66) that completed 2 instruments for 10 consecutive
person interview was performed to collect clinical and days: Daily Activity Protocols (PAD) that records an
demographic data as well as assesses patient’s Sleep quality amount of spent time on various activities, such as sleep
(Pittsburgh Sleep Quality Index-PSQI), daytime sleepiness duration, working time, leisure time, transportation time
and feeding time; and, Visual Analog Scales (VAS) to

Sleep Sci. 2020;13(Supl.1):1-118

73
measure their happiness self-perception. For the sample underwent a type 1 polysomnography examination at the
characterization, a Sociodemographic, Labor and Health Sleep Studies Unit (Laboratory of Physiology HRAC-
Questionnaires (QSLS) was also collected. Results: USP) using an EMBLA N7000 system. Results: The main
Among the 66 professors who completed the survey polysomnographic results were: number of arousals=12,
instruments, 17 (25.8%) worked an average of 18h41min arousal index=5,3, numbers of apnea/hypopnea=629,
more (SD = 15h40min; median = 17h; maximum value = apnea/hypopnea index=77,5 (severe OSA), mean
49h30min; 64.7% women; 58.8% work in capital campus) duration of apneas=47,4s, mean SatO2=86,9%, lowest
than those who slept more than they worked (sleep SatO2=58% (22% below 80%). 3D tomographic analysis
duration = 64h51min; SD = 12.22; median = 66h45min; (Dolhpin Imaging) of the airways was also performed
minimum value = 39h30min) for 10 consecutive days (6 and the pharyngeal volume and minimal cross-sectional
working days and 4 days off). On a scale from 0 to 10, these areas corresponded to 12cm3 (ref. values = 20±5cm3)
professors’ self-perception mean of stress and happiness and 40,7mm2 (ref. values = 108±40mm2), respectively.
were 4.9 and 6.2, qualitatively worse than the mean of Conclusions: Micrognathia, as a result of TCS, and
professors who sleep more than they worked (3.3 and 7.2 obesity were determinant factors for the occurrence
). Conclusions: A quarter of postgraduate professors of a severe OSA condition in this patient. This case
has overload work, and therefore, choose to work when evidences the importance of multiprofessional follow-up
they should be asleep. This influences your quality of life for individuals with TCS and enforces the importance of
decreasing your sleep duration and self-perception of pharyngeal dimensions in the genesis of OSA, probably
happiness while increasing their self-perception of daily due to the combination of two important risk factors,
stress. In this study, being a woman and working on São obesity and the craniofacial malformation itself.
Paulo’s campus were factors for a self-perception of stress Palavras-chave: Dysostosis,
Mandibulofacial Sleep Apnea, Obstructive, Mandibulofacial
Polysomnography, Tomography. Dysostosis, Polysomnography, Tomography Sleep Apnea, Obstructive,

and lack of happiness.

Palavras-chave: sleep; happiness; quality of life; time management; occupational health. ID: 819

ID: 818 Case Reports

Case Reports Obstructive sleep apnea in an adult individual

with Robin Sequence: case report
Micrognathia and obesity as determinant
factors for severe obstructive apnea in a MENDES SILVA, M, FIDELIS DA SILVA, L V, TRINDADE, S
treacher collins syndrome individual. H K, TONELLO, C, TRINDADE-SUEDAM, I K

Hospital de Reabilitação de Anomalias Craniofaciais - USP - Bauru -

Fidélis da Silva, L V, Ribeiro, A A, Mendes Silva, M, Trindade, S BAURU - Sao Paulo - Brasil
H K, Tonello, C, Trindade-Suedam, I K
Introduction: Robin Sequence (RS) is a rare craniofacial
Hospital de Reabilitação Anomalias Craniofaciais - HRAC - USP -
anomaly (between 1: 8,500 and 1: 30,000 live births)
Bauru - Sao Paulo - Brasil
related to mutations in the SOX9, COL, TCOF1,
Introduction: Treacher Collins syndrome (TCS) is a rare PLOR1C and POLR1D genes. Clinically, it presents as
congenital malformation which includes zygomatic arch a triad characterized by micrognathia, glossoptosis and
and mandibular hypoplasia, choanal atresia, cleft palate and airway obstruction, associated or not with cleft palate.
airway narrowing. Aim: This study aimed at evaluating, Severe micro- and retrognathia, observed in neonates,
by means of polysomnography, the sleep of an individual remain in adulthood in a considerable number of cases,
diagnosed with TCS. Methods: Female patient, 18y, with resulting in an extremely convex facial pattern. When
Treacher Collins Syndrome, regularly registered at HRAC associated with the occurrence of tonic dysfunctions of
/ USP. High-intensity snoring, breathing pauses during the peripharyngeal muscles and glossoptosis, retrognathia
sleep, excessive daytime somnolence, lip cyanosis and may lead to obstructive sleep apnea (OSA) Aim: To report
mouth breathing during sleep were symptoms referred. the case of an adult patient with Robin Sequence (RS)
Berlin questionnaire indicated high risk for obstructive seen at the Sleep Studies Unit (Laboratory of Physiology
sleep apnea (OSA). Anthropometric assessment reveled a HRAC-USP) Methods: 17-year-old male patient with
grade III obesity: BMI=42, cervical circumference=41cm a repaired isolated cleft palate, with complaints of loud
(ref. value<36cm) and abdominal circumference=113cm snoring and excessive daytime sleepiness. Physical
(ref. value<80cm). Common craniofacial features of TCS examination revealed a BMI of 21,5 (eutrophy), cervical
were observed such as zygomatic hypoplasia, micro- and circumference = 32cm (reference value <40cm) and
retrognathia, represented by the cephalometric angles abdominal circumference = 66cm (reference value <94cm)
SNB=70° (ref. value = 80°±2°) and ANB=-13° (ref. Results: The main polysomnographic results, using
value = 2°±2°) denoting a class II skeletal pattern. She EMBLA N7000 system, were: number of arousals = 21,

Sleep Sci. 2020;13(Supl.1):1-118

 74

arousal index = 1,2, numbers of apnea/hypopnea = 50, (44.5±13.5 to 9.0±4.3, p≤0.001), ODI (46.8±11.6 to
apnea/hypopnea index = 10.1 (mild OSA), mean duration 12.1±9.1(p<0.05)), REM (18.4± 4.8 to 21.5± 2.9 (p<0.05))
of apneas = 21s, mean SatO2 = 94,6%, lowest SatO2 and SaO2nadir (75.7± 9.4 to 87.0±3.6, p<0.001), as well
= 88%, reduced sleep efficiency (59%), increased REM as ESS (p<0.005). Comorbidities were present in entire
sleep latency (328min), and REM sleep reduction (15min– group, 9 with hypertension and with hypertension and
3%) Conclusions: Although this young individual does diabetes II. Ten patients reported that the arterial pressure
not present anthropometric characteristics that predispose values reduced for systolic and diastolic parameters and
to OSA, a (mild) apnea condition was detected, probably among them, 3 patients reduced the hypertensive drug
due to the presence of craniofacial conditions imposed by dose. Conclusions: The findings of the present study
the anomaly and which justify the respiratory complaints demonstrated that OAm is a safe and viable treatment
frequently observed in this population. option to severe OSA, when patients cannot tolerate or
Palavras-chave: Pierre Robin Syndrome, Glossoptosis, Sleep Apnea, Obstructive, Polysomnography
refuse CPAP therapy. Further studies should include
thermosensitie microsensor to objectively measure the
ID: 820 effectiveness of a long-term OAm therapy.
Palavras-chave: mandibular advancement oral appliance; obstructive sleep apnea; polysomnography; hypertension; Continuous Positive Airway

Clinical Studies
Pressure

Patients who refused CPAP have a safe option ID: 822

to treat severe obstructive sleep apnea: pilot Case Reports
study
Monitoring for 8 years of serious case of
Giannasi, L C, Gomes, M F, Araújo, D O, Oliveira, L V F controlled sleep apnea syndrome through
Centro Universitário de Anápolis Uni-Evangélica - Anápolis - Goias lingual technique: case report
- Brasil, ICT-UNESP/SJC - Sao Jose dos Campos - Sao Paulo - Brasil
Rocha, A, Wagner, L E, Abentroth, L, Caran, J M, Trindade, M,
Introduction: Obstructive sleep apnea (OSA) is Paiva, D N
characterized by episodes of complete and/or partial Programa de Pós-Graduação em Promoção da Saúde - Santa Cruz
pharyngeal collapse resulting in poor sleep quality. A non- do Sul - Rio Grande do Sul - Brazil, Universidade Federal de Minas
reparative sleep can trigger systemic alterations related to Gerais - Belo Horizonte - Minas Geras - Brazil, Universidade Federal
a several co-morbidities including, hypertension, stroke, de Pernambuco - Recife - Pernambuco - Brazil,
diabetes II, insulin resistance, depression/anxiety, obesity,
neurocognitive deficits and others pathologies. OSA Introduction: Obstructive sleep apnea syndrome (OSAS)
is progressive, life-threatening and multifactor disease, is a sleep disorder caused by upper airway occlusion. It
which demands a multiprofessional approach. The most has a high prevalence, mortality and morbidity, with
common worldwide treatments are Continuous Positive consequent reduction or absence of respiratory airflow
Airway Pressure (CPAP) and mandibular advancement causing nocturnal awakenings and oxyhemoglobin
oral appliance (OAm). Aim: The aim of this study was desaturation. Patients with OSAS have a reduced
evaluating the effects OAm on severe OSA, in patients pharyngeal muscle contractile capacity and higher upper
who refused CPAP, comparing polysomnographic and airway blockade pressure than those without OSAS.
Epworth Sleepiness Scale (ESS) data obtained prior to and Intermittent hypoxia in the pharynx muscles and central
during OAm treatment, after 6 month-period. Methods: nervous system represents a disease progression factor
A prospective study was carried out involving severe OSA by altering the structure of the dilator muscles. The
patients, who did not accepted CPAP (continuous positive most efficient noninvasive treatment for OSAS control
airway pressure) and were referred to treatment with an is the use of Continuous Positive Airway Pressure
OAm. Subjects with complaints of snoring, gasping/ (CPAP) devices. However, the discomfort caused by the
choking during sleep, fatigue and daily sleepiness were ventilatory mechanism causes many patients to opt for
evaluated by a sleep medicine specialist and the diagnosis the use of oral appliances (OA). Aim: To demonstrate the
of severe OSA with a basal polysomnography (PSG). performance of an oral device, based on the concepts of
The appliance chosen was PMPositioner®. After 6 Lingual Technique, that uses a different mode of action.
months a new PSG was performed o evaluate the efficacy The mechanism, called ‘Lingual Orthosis’, is proposed as
of OAm therapy. Subjective daytime sleepiness was an alternative method of treatment for resistant CPAP
evaluated by ESS questionnaire prior to treatment and patients. Methods: A patient with severe OSAS - 36.4
at 6 months follow up. Results: Seventeen patients met ev/h - and resistant to CPAP was submited to a treatment
the inclusion criteria and 13 finished the protocol. The with AIO Lingual Orthosis and was followed up for eight
following parameters improved significantly OSA severity years. At the end of this period a second lingual orthosis

Sleep Sci. 2020;13(Supl.1):1-118

75
was made. This device, one of the components of the group comparing to z-drugs (+18.2/h), benzodiazepines
lingual arsenal techniques, acts controlling directly and (+14.2/h), and others (+14.6/h); there was no difference
actively with the purpose of containing the retroposition between drug groups. CAI was greater in no-medication
and consequent occlusion of the oropharyngeal canal. group comparing to benzodiazepines (+3.2/h) and multiple
To attest the results, three polysomnographic (Icelera, drugs (+3.2/h); no other difference was significant. Those
São Paulo, Brasil) examinations were performed, one effects remained even after controlling for BMI, age and
baseline and the other two with their respective devices sex. Conclusions: As opposed to what was expected in
installed. Results: Polysomnographs demonstrate that the literature, sleep-inducing drugs had a protective effect
both devices were effective in controlling OSAS. The in both obstructive and central apneas. One limitation of
first device reduced the initial apneia hipopneia index the study was that the information about the reason of
(AHI) from 36.4 to 3.3 ev/h. The second device, eight the PSG was lacking. As people who used sleep-inducing
years later, also reduced the AHI, scoring it down to 0.6 drugs had the same epidemiological profile of insomniacs,
ev/h. Conclusions: The results of the polysomnographs one may infer that that was the reason for performing
demonstrated the effectiveness of the active and direct PSG in such group. Even though, drug classes did not
action proposed by Lingual Technique, represented differ in their effects on both types of apnea.
here by the Lingual Orthosis device. The primary action Palavras-chave: Sleep apnea, benzodiazepines, z-drugs

of restraining the posterior sliding of the tongue was

successful, thus ensuring AHI reduction. ID: 824
Clinical Studies
Palavras-chave: obstructive sleep apnea syndrome; polysomnography; sleep.

ID: 823
Actigraphic assessment of patients with
Clinical Studies gestational diabetes shows severe compromise
Effect of sleep-inducing drugs on central and of sleep measures
obstructive apnea Ballalai, M S, Façanha, C F S, Alencar, V S, Jacinto, V N, Furtado,
F L B, Bruin, P F C, Macêdo, R B L, Bruin, V M S
Marroni, G A, Louzada, F M, Borgio, J G F
Centro Integrado de Diabetes e Hipertensão (CIDH- CE) - Fortaleza
Universidade Federal do Paraná - Curitiba - Parana - Brasil - Ceara - Brasil, Centro Universitário Christus, Faculdade de Medicina
- Fortaleza - Ceara - Brasil, Universidade Federal Do Ceará- UFC,
Introduction: Sleep apnea is a condition associated with
Faculdade de Medicina - Fortaleza - Ceara - Brasil
repeated breathing pauses during sleep. It may be result of
upper airway occlusion (obstructive sleep apnea) or altered Introduction: Sleep pattern assessed by actigraphy has
automatic breathing control (central sleep apnea). Several been seldom reported in gestational diabetes mellitus
medications have an effect on sleep respiratory physiology, (GDM). Importantly, studies have shown that short
including sleep-inducing drugs. Benzodiazepines, for sleep duration and later sleep midpoint have been linked
instance, may cause muscle relaxation, leading to weakness to hypertension and GDM latter in pregnancy. These
of pharyngeal muscle tonus and obstructive respiratory issues are vital because Hypertension, GDM and Sleep
events. Aim: The objective of this study was to evaluate disturbances are frequent during pregnancy and can
the effects of sleep-inducing drugs on central and lead to adverse outcomes. Aim: To evaluate sleep/wake
obstructive apnea. Methods: An cross-sectional study activity, with objective and subjective measures, using daily
of polysomnography reports (PSG) performed between wrist actigraphy and behavior questionnaires. Methods:
2008 and 2016 was conducted, totaling 30159 reports. A cross-sectional study evaluated 53 GDM patients in
Exclusion criteria were repeated PSG of the same patient, the last trimester of pregnancy, attending a public health
split-night or CPAP PSG reports, and age below 18 care unity in Brazil. Valid actigraphy recordings (5 to 7
years. Of the resulting 23,178 cases, 21,961 had taken no days) were obtained from 41 patients. GDM was defined
medication, 568 used benzodiazepines, 217 used z-drugs, according to WHO 2013 criteria. Sleep onset latency,
312 used other drugs, and 120 used multiple sleep-inducing sleep duration, sleep efficiency and wake after onset of
drugs. Two one-way ANOVA with Games-Howell post- sleep (WASO) were analyzed. Patients were interviewed to
hoc tests were conducted, with medication as group factor complete the Pittsburgh Sleep Quality Index (PSQI,)
and apnea-hypopnea index (AHI) and central apnea index Epworth Sleepiness Scale, Fatigue Severity Scale, Insomnia
(CAI) as dependent variables. Results: Patients who used Severity Index and Edinburgh Postnatal Depression Scale
medication before PSG were thinner (-5.9 BMI points, (EPDS). Short sleep duration was defined if sleep duration
p<0.001), younger (-20.3 years, p<0.001), and women was < 7 hours; prolonged sleep latency if >30 minutes
(67% X 41%, p<0.001). AHI was greater in no-medication and reduced sleep efficiency if <85%. Pregestational

Sleep Sci. 2020;13(Supl.1):1-118

 76

diabetes patients were excluded. The study was approved the software ActStudio©. Sleep habits were registered
by Federal University of Ceára ethic board, approval by children and their parents in a sleep diary. Results:
number 1.801.860. Results: Forty-one GDM patients We analysed the sleep habits of 12 children, 6 boys and
aged 27 - 46 y (35.2±4.8), BMI 24.3 to 41.1(31.5±4.4) with 6 girls, that were 7.58(±1.09) years old in average. The
a mean gestational age of 27 weeks were studied, showing mean of total resting time among the children was 479.89
normal sleep latency (0.50 to 29.3 min; 8.5±8.0), reduced (±21.03) minutes, the bedtime was 10:56pm and the
sleep duration (148-455min; 262.9±75.1), reduced sleep arousal time was 7:49 am. According to the sleep habits,
efficiency (63.7-98.4%; 84.5±8,5) and increased WASO 50% of children have a TV set in the room, 16.7% used
(3.8-150.4min; 58.3±34.8). Delayed midpoint sleep was to keep some kind of light on during sleep, 33.3% used
detected only in three patients. Sleep efficiency correlated to eat stimulating food at night, and all children practice
with fatigue (FSS r=-.42 p=.02), depressive symptoms physical activity during the day. The average time use of
(EDP r=-.51 p=.007), sleep quality (PSQI r=-.39 p=.04) electronic equipments by children was 2.8(±1.86) hours a
and there was a trend with insomnia (ISI r=-.34 p=.07). day. Conclusions: School-aged children are sleeping later
WASO was correlated with fatigue (FSS r=.41 p=.03), and fewer than recommended in the literature, making
depressive symptoms (EDP r=.55 p=.003), sleep quality extensive use of electronics equipments and eating
(PSQI r=-.39 p=.04), and insomnia (ISI r=.39 p=.04). stimulating foods just before bedtime. These habits can
Conclusions: Actigraphic evaluation of GDM patients in be changed to improve the quality and quantity of sleep.
the last trimester of pregnancy show severe compromise Palavras-chave: Nursing, sleep, education, child, pediatric nursing

of sleep efficiency, short sleep duration and increased

WASO. Actigraphic measures were associated with ID: 826
depressive symptoms; a less powerful association was Clinical Studies
found with behavioral questionnaires evaluating fatigue,
insomnia and sleep quality. Sleep quality of high-risk pregnant women in
a Public Hospital Maternity
Palavras-chave: Actigraphy; Sleep Disturbances; Gestational Diabetes

ID: 825
Costa, J A G, Viana, A R, Alves, M D S, Moreira, W S, Lima, A C
Clinical Studies G, Ykeda, D S

Universidade Estadual do Piauí - Floriano - Piauí - Brasil

Sleep Habits and Total Resting Time of
School-Aged Children Introduction: Sleep is essential in life, a very well
organized and structured activity that depends on both
Avelar, A F M, Llaguno, N S, Tsunemi, M H, Pinheiro, E M personal and environmental factors, different and specific
Escola Paulista de Enfermagem - Universidade Federal de São Paulo - to each phase of human life. Insufficient or poor sleep
São Paulo - Sao Paulo - Brasil quality during pregnancy may lead to several casualties as
a higher risk of complications during pregnancy. A high-
Introduction: Sleep is important for the mental and risk pregnancy is characterized by disorders that threaten
physical health of children. Insufficient time and the health of both mother and fetus and often leads
sleep fragmentation are associated, for example, with women to hospital admission. Usually, people who have
obesity, poor performance at school, and behavioral and been admitted to a hospital have two hours less sleep than
emotional problems. Good sleep habits are acquired in the at home and poorer sleep since they are often disturbed
family environment from birth, however, a decrease on at night. Aim: To evaluate the quality of sleep of high-
the total sleep time has been noted, related to the habits risk pregnant women in a public hospital maternity ward.
of modern families regarding food, physical activity, and Methods: This is a cross-sectional and observational study
use of electronic equipment, as well as misuse of lighting that evaluated the quality of sleep of 67 high-risk pregnant
at night. Aim: This study aimed to identify the sleep women hospitalized in a public hospital maternity ward.
habits and total resting time of school-aged children. Data to assess the quality of sleep of pregnant women
Methods: This is a cross-sectional and descriptive study were collected from the Brazilian version of the Pittsburgh
and all the procedures were approved by the Ethics Sleep Quality Index (PSQI-BR). Results: It was obtained
Committee (nº370/2018) of the Federal University of an average of 31 ± 35 minutes to fall asleep, and 5.3 ± 1.8
São Paulo. Children from the 1st to the 4th grades of a hours of sleep a night. It was also possible to analyze that
private elementary school in São Paulo - Brazil had their these pregnant women go to bed at approximately 9 p.
activity-rest cycle monitored for 15 consecutive days by M. and wake up at 5:30 a. M. The total sum of PSQI-BR
an actimeter (ActTrust®) that was positioned on the non- showed poor sleep quality (total scores > 5) in 59 of the
dominant upper limb. Data analysis was performed using 67 participants, 88.0% of the total, and sleep disturbance

Sleep Sci. 2020;13(Supl.1):1-118

77
(scores > 10) in 33 pregnant women, 49,3% of the total the climacteric had mild to moderate insomnia. There was
surveyed. The average PSQI score was 10 ± 3.8. The a significant difference between sleep quality (p = 0.001)
hospital factors that negatively interfered with sleep and insomnia severity (p = 0.014) comparing both groups.
quality as reported by pregnant women were: number of Conclusions: Climacteric women have worse sleep quality
people sharing the ward; each ward had 6 beds, the arrival and mild to moderate insomnia compared to women who
of professionals late at night and the fact that they usually regularly menstruate.
leave the lights on after performing the procedures were Palavras-chave: Sleep. Menstrual cycle. Climacteric. Insomnia.

also causes of sleep disturbance, as well as uncomfortable

beds, noise at night and homesickness. Conclusions: The ID: 829
majority of hospitalized pregnant women assessed by the Clinical Studies
study have poor sleep quality or sleep disorders.
Palavras-chave: Sleep. Pregnant woman. Hospitalization.
Sleep habits assessment of children in child
ID: 827 maltreatment situations in the city of Canoas,
RS
Clinical Studies
BERTOLETTI, L, PETKOWICZ, R D O, DA COSTA, M O,
Comparative study of sleep quality and SCARPA, F C, DE MARCO, R M, KRUPP, P S, MARIN, L G
insomnia among climacteric women with
Hospital Universitário de Canoas - Canoas - Rio Grande do Sul - Brasl
regular menstrual cycle
Introduction: Sleep disorders (SD), present in children
Silva, C S, Oliveira, B C, Souza, S M O, Ykeda, D S victims of violence, are associated with alterations in
Universidade Estadual do Piauí - Floriano - Piauí - Brasil emotional, learning and social functions and may be a
risk factor for the neurodevelopment of mental disorders.
Introduction: One of the most common complaints Aim: Recognize sleep alterations observed in children
of mid-life women is poor sleep. Poor sleep is more who experienced child maltreatment (CM) situations
prevalent in women, with gender differences emerging identified through a multidisciplinary assessment
around menarche and further increasing in mid-life. Peri- (medical, social assistance and psychology). The objective
menopause encompasses the menopausal transition and is to establish the main SD and to correlate the variables
the first year after the final menstrual period. The term with each other – type of violence, age, gender and SD.
“climacteric” may also be used to describe peri-menopause Methods: The study analyzed the sleep pattern of 123
and the part of the post-menopausal period in which children (age range: from 2 to 10 years old), during the
climacteric symptoms occur. The passage between the period of 11 months, who received care at an assistance
reproductive and non-reproductive period of women, when center specialized in child maltreatment in the city of
they typically experience hot flashes and sweating, causing Canoas, RS. The analysis was based on the Children’s Sleep
changes in their quality of life, which may interfere with Habits Questionnaire (CSHQ) through the perception
sleep, with the most common complaint being nighttime of parents and caregivers. Results: Among the 123
awakenings and routine activities. Aim: To evaluate the children evaluated, 66,7% had SDs. The sample profile
sleep quality and insomnia level of climacteric women and was predominantly female (59,3%) and aged between
compare it with women of the regular menstrual cycle. 4 and 7 years old (48,8%). Physical violence was found
Methods: Personal data such as the last day of LMP and in 40,7% of the children, sexual (35,8%), psychological
anthropometric data were collected. Three questionnaires (24,4%), negligence (14,6%) and other types of violence
were used: Brazilian version of the Pittsburgh Sleep - exposure to home violence - (4,5%). SD is significantly
Quality Index (PSQI-BR). And Insomnia Severity Index associated with sexual, psychological and other types of
in both groups and the Kupperman Menopausal Index violence (p = 0,016). Regarding the CSHQ subscales,
(IMK), applied only to the group of women who were there was a significant difference between the age groups
in the climacteric. The frequencies of both groups were in the bed resistance factor score (RS) (p = 0,033). The RS
compared using the Chi-Square test. Results: The sample characteristic typifies sexual (11,6 points), psychological
consisted of 53 women, 30 of them with the regular and other types of violence (11,0 points each). Sleep
menstrual cycle and 23 during climacteric. The average anxiety (SA) typifies more psychological (7,9 points),
age was 45 ± 9 years, weight 70 ± 7 kg and height 158 ± 4 sexual (7,5 points) and other types of violence (7,3 points).
cm. Regarding the severity of climacteric symptoms, 61% Night awakening (NA) typifies psychological (4,4 points),
of women had moderate symptoms and had poor sleep sexual and physical (4,3 points each) violence. According
quality, only women in the climacteric were identified to the data by type of violence, significant differences
having a sleep disorder and 67% of women who were in in SA (p = 0,039), NA (p = 0,026) and RS (p = 0,004)

Sleep Sci. 2020;13(Supl.1):1-118

 78

were found in the analysis. Conclusions: The outcomes intervals were obtained with a reliability of 95%. Results:
highlight the association between SD and CM. The impact Most assessments corresponded to grade 4 (percentages
of the results contribute to the elaboration of appropriate ranging from 61.8% to 68.1%). The percentages of Grade
therapeutic interventions in order to prevent violence and 1 ranged from 4.2% to 10.4%, grade 2 ranged from 6.9%
rehabilitate children regarding SD, aiming to avoid the to 15.3% and grade 3 from 11.1% to 20.8%. The weighted
development of future mental and physical disorders. kappa value was higher among examiners 1 and 2 (0.92)
Palavras-chave: Child abuse; Sleep Disorders; Violence against children, Child Maltreatment
indicating excellent concordance and 0.69 to 0.72 in the
other two pairs (good concordance). The kappa value for
ID: 830 the three pairs of examiners was 0.78 (good concordance).
Clinical Studies Conclusions: There was good concordance in the
evaluation of Mallampati among speech therapists,
Degree of concordance of the mallampati anesthesiologists and otorhinolaryngologists.
classification among specialists from different
Palavras-chave: oropharynx; diagnosis; oral; sleep apnea syndromes

areas ID: 834

Santos, E R d, Duarte, N M d C, Sousa, D F M d, Silva, J H C d, Clinical Studies
Studart-Pereira, L M
Factors associated with unintentional napping
Universidade Federal de Pernambuco - Recife - Pernambuco - Brasil,
in adolescents: population based study
Clínica MEDDICINE Especialidades Médicas Integradas - Recife -
Pernambuco - Brasil Inazumi, C K, Andrechuck, C R S, Ceolim, M F, Oliveira, C d S,
Ordoñez, C d L A, Zancanella, E, Lima, M G, Barros, M B d A,
Introduction: Although it is controversial, the Mallampati
Oliveira, T A M d
classification is routinely adopted as an evaluation tool used
to predict the presence and severity of Obstructive Sleep Faculty of Nursing - Campinas State University - Campinas - São
Apnea. The Oropharyngoscopy is a simple, minimally Paulo - Brazil, Department of Otorhinolaryngology and Department
invasive examination, but it requires specific knowledge, of Collective Health - School of Medical Science - Campinas State
and training. Given the growth of sleep medicine and the University - Campinas - São Paulo - Brazil
insertion of non-medical professionals in multidisciplinary
teams, it is necessary to guarantee a consistency in its Introduction: Introduction: Adolescents present changes
assessments. Aim: To verify the concordance of the in sleep patterns, such as difficulty in sleeping and
Mallampati evaluation among professionals of different getting up early, which is frequently imposed on them
specialties. Methods: Analytical, observational and cross- by school and social commitments. This may result in
sectional study with the participation of 144 individuals, sleep deprivation and poor sleep quality. Naps can be a
of both sexes with a mean age 33.79 years. Approved N compensatory response to sleep deprivation, especially
2,891,458. The photograph was taken by a student of when unintentional, and may be associated with factors
speech therapy and another of dentistry. Two records that are detrimental to adolescent health. Aim: Objective:
were taken for each patient as they and were told to To analyze factors associated with unintentional napping
open their mouths and swallow, relaxing the tongue. in adolescents. Methods: Methods: population-based
To select the images that were analysed, luminosity and cross-sectional study conducted with data from the
better tongue relaxation position were considered. The Campinas Municipal Health Survey (Inquérito de Saúde
images were sent separately to three evaluators, (a speech do Município de Campinas - ISACamp)-2014/2015, with
therapist certified in Sleep Medicine, an anaesthetist and participants from 10 to 19 years of age (n=1022), approved
an otorhinolaryngologist) along with a spreadsheet of by the institution’s Research Ethics Committee. Dependent
answers. Professionals observed the relationship between variable was the intentionality of naps and independent
the tongue and the oral cavity and classified it according variables were: sociodemographic characteristics, feelings
to the Modified Mallampati score in grade I, II, III or of loneliness, life and health habits and sleep habits.
IV. After analysis and completion, the spreadsheet was Descriptive analysis, Rao-Scott chi-square test and
returned by e-mail and blindly forwarded for statistical Student’s t-test were performed, considering a significance
analysis. To verify the degree of coincidence between the level of 5%. The Stata 14.0 software was used in survey
pairs of examiners, the weighted Kappa coincidence scores mode for analysis. Results: Results: 50.9% were male
and confidence intervals were obtained for the parameter and 84.0% were students; mean age was 14.6 (SD=2.7)
cited. The values for the three pairs of examiners and their years. Prevalence of unintentional napping was 8.2%, and
confidence intervals were also obtained. The statistical was significantly lower in white adolescents (p=0.003), in
program MEDCALC version 14.8.1 was used. The those who often or always felt isolated (p=0.001) and that

Sleep Sci. 2020;13(Supl.1):1-118

 79

never felt well disposed after awakening (p<0.0001). There studying in the afternoon, 7.79 ± 1.09 and 7.17 ± 1.27
was no significant difference in habits such as physical (p <0.0001) respectively. The average weekend sleep
activity and alcohol consumption. Duration of sleep on duration of the morning shift adolescents was higher
weekdays was 437 (SD=191) minutes and on weekends, than the average of the afternoon shift, 9.33 ± 1.63 (p =
541 (SD=117) minutes, with no significant difference 0.016), especially among boys (p = 0.007), inferring the
from those who napped intentionally. Adolescents that attempt to compensate sleep deficit during school days.
napped unintentionally estimated that they needed a mean Boys’ sleep duration (8.00 ± 1.06) was shorter than girls’
of 530 (SD=204) minutes of sleep to feel well disposed sleep duration (7.52 ± 1.06). The average sleep duration
after awakening. Conclusions: Conclusions: Adolescents decreased markedly when considering only school days,
that napped unintentionally verbalized the need to sleep 6.83 ± 1.23 and 7.45 ± 1.23, for boys and girls, respectively.
for longer periods, suggesting that they are sleep-deprived. Conclusions: Conclusion: Morning shift adolescents had
They expressed unwillingness to wake up and feelings shorter sleep duration than afternoon shift adolescents
of isolation. Identifying the reasons related to napping during school days. However, over the weekend this group
can contribute to promote better sleep quality in this of teenagers try to compensate for their sleep deficit by
age group, as well as generate actions to improve health sleeping more hours of sleep. Studying sleep duration
and even public policies, involving healthcare providers, and its consequences among adolescent students from
educators and family members, in order to avoid damage different shifts can contribute to health promotion and
to physical and psychological health of the adolescent. better student performance.
Palavras-chave: Descriptors: Sleep, Adolescent, Disorders of Excessive Somnolence Palavras-chave: Keywords: Sleep Duration. Study Shift. Adolescents.

Palavras-chave: Sleep Quality, Middle Childhood, Leptin, Adiponectin, Polymorphisms, ADIPOQ-rs2241766, LEP-rs7799039.

ID: 836
ID: 838
Basic Research
Clinical Studies
Analysis of sleep duration per study shift in
adolescents from Rio Branco, Acre Heart rate reactivity to acute mental stress
is blunted in individuals who sleep less than
dos Santos, E d S G, de Souza, O F seven hours.
Instituto Federal de Educação, Ciência e Tecnologia do Acre e
Monteiro, C P C, Gomes, J B, Mendonça, V R, Ohara, D, Ribeiro,
Universidade Federal do Acre - Rio Branco - Acre - Brasil
L F P, Edwards, K, Alvim, R O, Mill, J G, de Mello, M T, Alves,
Introduction: Background: Sleep duration plays an ES
important role in adolescent health. During adolescence Universidade Estadual de Santa Cruz - Ilhéus - Bahia - Brasil,
there are biological and behavioral changes that lead Universidade Federal de Minas Gerais - Belo Horizonte - Minas Gerais
to a phase delay in the sleep-wake cycle, which added - Brasil, University of Sidney - Sidney - New South Wales - Australia
to the social and school contexts, reflects a decrease in
sleep hours. Studies show that adolescent students from Introduction: Inadequate sleep and stress both have
different shifts experience different sleep durations, negative impact on health, increasing the risk for negative
causing health impacts. Aim: Objective: To analyze sleep outcomes such as cardiovascular disease, diabetes and
duration per study shift in adolescents from Rio Branco, depression. Moreover, the effects of a decrease in sleep
Acre. Methods: Methods: Cross-sectional study with time on physiological responses to acute stress still
1,733 adolescents aged 12 to 17 years, students of the unclear. Aim: To evaluate heart rate reactivity (HRR)
morning or afternoon shifts in the capital Rio Branco, after an acute mental stress in individuals who sleep less
Acre, participants of the Study of Cardiovascular Risks or more than seven hours. Methods: All procedures
in Adolescents - ERICA. The variable sleep duration was in this study were approved by the Research Ethics
collected through a questionnaire. Mean sleep duration Committee – UESC (CAAE: 94666418.0.0000.5526).
for school days (Monday to Friday), weekend (Saturday A total of 28 undergraduate students (N=10 female)
and Sunday), and weekly sleep duration (weighted average) visited the Laboratory of Exercise Psychophysiology
were calculated. Absolute and relative frequencies were (LAPFISIO – UESC) between 08:00am and 11:00am.
calculated. Comparison of proportions was performed Volunteers completed seated rest for 15 minutes to
by Pearson’s chi-square test, the means by Student’s measure baseline heart rate (HRBASE) (Polar RS800CX).
t-test, with significance level of 5% between study Then, acute mental stress was induced by serial arithmetic
shift groups. Results: Results: The average weekly and addition test, where, after a period, the speed of numerical
class days sleep duration of adolescents studying in the presentation increased. The numbers were presented on
morning shift were lower than the averages of adolescents an audio recording and the volunteer responded verbally.

Sleep Sci. 2020;13(Supl.1):1-118

 80

Heart rate was measured again immediately after the “insomnia” (15% vs. 10%; p=0.23), “somnolence” (2.0%
acute mental stress (HRSTRESS). HRR was defined as vs. 1.3%; p = 0.64). In cases with 60 years old, woman and
HRSTRESS minus HRBASE. Volunteers then received men had similar snoring and insomnia complaints. Among
a self-reported sleep diary to fill and return after seven elderly over 80 years old and controls, the prevalence of
days. Finally, the volunteers were divided in two groups: sleep efficiency <85% were 71.7% vs. 48.7%, respectively
Group ≥ 7 = Individuals who slept more than 7 hours (n with adjusted residual analysis (p<0.001). The sleep apnea
= 16, 20.7 ± 1.8 years, 65.2 ± 9.4 kg and 169 ± 7 cm) and diagnosed with AHI>5 was similar between cases and
Group < 7 = Individuals who slept less than seven hours controls (88% vs. 87%; p=0.85). There was no association
(n = 12, 23 ± 4.4 years, 68.1 ± 15.1 kg and 170.5 ± 7 cm). between apnea severity among cases and controls:
Results: Independent t-test showed a statistical significant AHI> 15 (73% vs. 62%; p=0.80), AHI>30 (49% vs.
difference (P < 0.001) in total sleep time in Group ≥ 7 (8.1 40%; p=0.20), respectively. Conclusions: There was no
± 0.8 hours) compared with Group < 7 (6.17 ± 0.7 hours). difference between complaints of sleep disorders among
In addition, the t-test showed a significant difference (P = the studied groups, except for complaints about snoring,
0.02) in HRR in Group ≥ 7 (9.8 ± 6.6 bpm) compared which was more prevalent in the 60 years old patients.
with Group < 7 (1.3 ± 6.1 bpm). Lastly, a significant Polysomnographic data showed that older people, over 80
negative correlation (P = 0.01) was found between the years old, had higher insomnia criteria than 60 years old
HRR and total sleep time (r = - 0.72) only in the Group subjects. This is the first study to analyze the relationship
< 7. Conclusions: We conclude that a reduction in total of sleep disorder complaints with polysomnography test
sleep time is associated with a decrease in HRR after acute in elderly over 80 years old.
mental stress in sleep-restricted individuals. Furthermore, Palavras-chave: elderly; insomnia; obstructive sleep apnea

it could increase cardiovascular risk due to changes in

sympathetic nervous system activity. ID: 840
Case Reports
Palavras-chave: Sleep, stress and hear rate reactivity

ID: 839
Efficacy of the stabilizer plate through
Clinical Studies electrognatography in bruxism with disc
Polysomnographic variables and complaints displacement and reduction: case report
of sleep disorders in elderly Rocha, A, Trindade, M, Lira, V, Wagner, L E, Abentroth, L,
Caram, J M, Paiva, D N
Sezera, L, de Cezaro, J C, Redondo, L C, Prikladnicki, A, Facco,
C P, Martins, E F, Moraes, R S, Martinez, D Programa de Pós-Graduação em Promoção da Saúde - Santa Cruz
do Sul - Rio Grande do Sul - Brazil, Universidade Federal de Minas
Gerais - Belo Horizonte - Minas Geras - Brazil, Universidade Federal
Introduction: Difficulty in initiating or maintaining sleep
de Pernambuco - Recife - Pernambuco - Brazil,
could indicate insomnia and/or obstructive sleep apnea
(OSA). Complaints of sleep disorders in adults are already Introduction: The stabilizing occlusal plates act to
established, but the relationship in elderly over 80 years old reduce proprioceptive information that originates in the
is still poorly investigated. Aim: To evaluate complaints periodontium and temporomandibular joint, breaking the
related to sleep disorders and polysomnographic variables vicious cycle of sustained muscle contraction. Pain relief
in elderly over 80 years old. Methods: Subjects with is obtained as the stabilizing plate promotes the condyle
suspect of sleep disorders were retrospectively gathered clearance from the articular cavity and the increase of its
where they performed a full night polysomnography. biological space, and its indication is due to the fact that
Demographic data and clinical symptoms were self- such technique is configured in a less invasive and reversible
described by the participants. Sleep efficiency of <85% method. Aim: To evaluate the efficacy of occlusal stabilizer
was the standard to define insomnia and an apnea- plaque as the main therapy in the treatment of bruxism
hypopnea index (AHI) >5 events per hour was the one to with reduced articular disc deviation. Methods: A 17-year-
diagnose OSA. Results: Were included 100 participants old female TTL patient with leucoderma sought the
older than 80 years old and 156 control subjects with Dentistry Clinic of the Federal University of Pernambuco
60 exact years. As regards the total number of the (UFPE), Recife - PE, complaining of orofacial pain
participants, 58% (n=147) had a sleep efficiency <85% and wear on the internal cusps of the posterior teeth
and 87% (n=222) AHI>5 on polysomnography. The main support cusps. upper limbs with unilateral click in the
complaints among older and 60 years old, respectively right hemiface and impairment of mandibular opening
(chi-square test adjusted residual analysis): “snoring” (27% and closing movements. Electrognathography (EGN)
vs. 56%; p<0.001), “sleep apnea” (15% vs. 11%; p=0.33), was performed by affixing a small magnet to the labial

Sleep Sci. 2020;13(Supl.1):1-118

 81

surface of the lower incisors at the midline level, and the Kg/m². They underwent the six-minute step test (6MST)
movements were immediately visualized through software and the following variables were assessed: HR, SBP and
(BioPAKSistem®, SQUIB, Brazil). The patient underwent DBP at rest and one minute after the cessation of 6MST.
the use of a thermopolymerizable stabilizing occlusal Data between groups were compared using unpaired t-test
plate for the purpose of protecting the teeth, relaxing the or Mann Whitney test. Results are expressed as mean ±
muscles and stabilizing the stomatognathic system. Pain standard deviation and confidence interval. Results: The
was measured by Visual Analogue Scale (VAS), which is groups were similar in age, weight, height, BMI, waist and
a one-dimensional instrument for pain scale assessment. neck circumference, excessive daytime sleepiness, apnea/
Results: It was observed that after the use of the occlusal hypopnea index, FEV¹ and FVC. Sleep quality was worst
stabilizer plate there was a decrease in the maximum mouth in nCPAP compared to CPAP group (PSQI score: nCPAP
opening amplitude, a reduction in the lateral deviation to 6,19 ± 3,38 vs. CPAP 4,89 ± 3,37 (p = 0,048) and FEV¹/
the right, a reduction in the maximum oblique opening of FVC ratio was higher in nCPAP compared to CPAP
the mouth, an increase in symmetry between opening and group (nCPAP 84,85 ± 6,68%predicted vs. CPAP 77,93
closing in the mouth. sagittal plane, increased protrusion ± 9,26%predicted; p = 0,001). Regarding the difference
and retrusion of the mandible, increased velocity during in the resting and first minute after 6MST blood pressure
opening and reduction during mandibular closure. Pain values, as well the SBP (nCPAP 24.2 ± 12,04% vs. CPAP
reduction from grade 8 to 3 was evidenced. Conclusions: 4.6 ± 7,31%; p = 0.000; CI 14.97 to 24.27), as the DBP
The case report demonstrates the effectiveness of the (nCPAP = 5.5% ± 0,78% vs. CPAP 0.2% ± 4,33%; p =
occlusal stabilizer plate in reducing muscle and joint pain 0.000; CI 3.22 to 7.48) were higher in nCPAP compared
and promoting improvement in mandibular movement. to CPAP group. However, the difference in the resting
Palavras-chave: Bruxism; Temporomandibular joint; Stomatognathic system.
and first minute after 6MST HR values were the same in
the two groups (nCPAP 18.6 ± 15,34% vs. CPAP 15.08 ±
ID: 841 10,59%; p = 0.260; CI -2.65 to 9.68). Conclusions: The
Basic Research results suggest that OSA individuals treated with CPAP
have an attenuated hemodynamic response to submaximal
Does cpap mitigate cardiovascular responses effort and a faster recovery compared to non-treated OSA
to submaximal effort in subjects with subjects.
Palavras-chave: obstructive sleep apnea. continuous positive airway pressure. cardiovascular responses. submaximal effort.

obstructive sleep apnea? a cross-sectional

study ID: 846

DAHER, S, MAGALHÃES, M G S, RIBEIRO, A S V, FERREIRA, Basic Research

S T B P, de SIQUEIRA, P P S, CARREIRO, P B P, de LIMA, A Circadian measurements of visual contrast
MJ
sensitivity of young adults
UNIVERSIDADE FEDERAL DE PERNAMBUCO (UFPE) -
RECIFE - Pernambuco - Brasil Figueiredo, B G D, Rezende, M T C, Bonifácio, T A S, Fernandes,
T P, Gonçalves, L M, Lima, E S H, Sales, H F S, Santos, N A,
Introduction: Obstructive sleep apnea (OSA) is a Andrade, M J O
clinical condition characterized by repetitive upper airway
obstructions during sleep. These transient episodes of Universidade Federal da Paraiba - João pessoa - Paraiba - Brasil
hypoxemia-reoxygenation lead to increased oxidative
Introduction: Circadian rhythms have characteristics
stress, contributing to the development of cardiovascular
that are important to analyze; one initial proposal is their
diseases and reduced exercise tolerance. In this context,
relationship with the mechanisms of visual functions. Aim:
continuous positive airway pressure (CPAP), the gold
Thus, this study used the staircase psychophysical method
standard treatment for moderate and severe OSA, reduces
to investigate luminance contrast variation associated with
apnea/hypopnea events and restores the homeostasis
the course of the daytime circadian clock. Methods: This
of the cardiovascular system. Aim: The aim of this
study evaluated visual sensitivity to luminance contrast
study was to compare cardiovascular responses in OSA
during a daily period. Twenty-eight young male adults (M
subjects with and without CPAP treatment. Methods:
= 24.85; SD = 2.4) with normal color vision and 20/20
It was conducted a cross-sectional study in 73 subjects
visual acuity participated in this study. The circadian
diagnosed with moderate or severe OSA, who showed
pattern was assessed using the Karolinska Sleepiness
good adherence (at least 2 months, at least 4 h/night) to
Scale (KSS), the Pittsburgh Sleep Quality Index (PSQI),
CPAP treatment (CPAP group: n = 36) and never used
and a sleep diary. To measure the luminance contrast, we
the device (nCPAP group: n= 37). All patients were aged
used version 11.0 of the Metropsis software with sine-
between 30 and 70 years old and BMI between 18 and 45

Sleep Sci. 2020;13(Supl.1):1-118

 82

element frequency stimuli for spatial frequencies of 0.2, in a sleep laboratory. Methods: Studies that compared
0.6, 1, 3.1, 6.1, 8.8, 13.2, and 15.6 cycles per degree of healthy individuals and those with apnea, were based on
visual angle (cpd). The stimuli were presented on a 19- polysomnographic results, and without restriction on age,
inch color cathode ray tube (CRT) video monitor with a language or year of publication were eligible for inclusion.
resolution of 1024 × 786 pixels, an update rate of 100 This review was registered in PROSPERO under the
Hz, and a photopic luminance of 39.6 cd/m2. Results: number: CRD42016037278, adhered to the PRISMA
There was a significant difference in KSS on the weekdays check list and used QUADAS as a tool to evaluate
[χ2(2) = 20.27; p = .001] and in the luminance contrast methodological quality and calculate the risk of bias.
for frequencies of 13.2 cpd [χ2(2) = 8.27; p = .001] and We consulted: PubMed, Embase, MEDLINE, LILACS,
15.6 cpd [χ2(2) = 13.72; p = .041]. Participants had a good BBO-ODO, Cochrane and Google scholar. Results: We
sleep quality index (M = 5.09 ± 2.6). The Wilcoxon test of found 232 studies, 15 of which were included for detailed
related measures showed significant differences at bedtime analysis and extraction of salivary biomarker diagnostic
(Z = 2.37; p = .018), indicating that the participants went predictors for OSA. However, 13 were excluded because
to sleep later on the non-working days of the week (01: they did not report sensitivity and specificity. This review
35 min ± 72 min) when compared to the weekdays (00: suggests that α-amylase and the alpha-2-HS- glycoprotein
55 min ± 71 min). There was a significant difference in protein are potential salivary biomarkers. Conclusions:
KSS on the weekdays [χ2(2) = 20.27; p = .001] and in the Although more studies are needed to confirm the observed
luminance contrast for frequencies of 13.2 cpd [χ2(2) = results, we can say that salivary biomarkers associated with
8.27; p = .001] and 15.6 cpd [χ2(2) = 13.72; p = .041]. the phenotypic pattern of OSA are a potential simple,
The Spearman’s rho correlation test showed a correlation low-cost alternative diagnostic method.
in the following variables: spatial frequency of 6.1 cpd Palavras-chave: Saliva; Polysomnography; sleep-disordered breathing; Sleep Apnea, Obstructive; salivary biomarkers

at 5:00 pm with the waking time on weekdays (σ = 0.44;

p = .039); spatial frequency of 8.8 cpd also at 5:00 pm ID: 848
with the variables of bedtime on weekdays (σ = 0.46; p = Basic Research
.029) and waking time on weekdays (σ = 0.42; p = .049)
and non-working days (σ = 0.44; p = .032). Conclusions: Correlates of daily habits, quality of sleep and
This article discusses the perceptual processes of excessive sleepiness of morning and evening
circadian visual sensitivity. this study discusses nonlinear
characteristics of circadian associated with the role of the students
visual timing system.
Palavras-chave: Circadian rhythms; contrast sensitivity; psychophysica
Silva, N P, Bonifácio, T A S, Rezende, M T C, Figueiredo, B G
D, Santos, N A, Andrade, M J O
ID: 847 Universidade Federal da Paraíba - João pessoa - Paraiba - Brasil

Basic Research Introduction: The circadian rhythm is the expression

of different genes that keep in sync with environmental
Salivary Diagnostic Biomarkers For
cycles. Circadian individual characteristics of behavioral
Obstructive Sleep Apnea - A Systematic styles correlate with activity and rest preference over
Review a 24-hour period. Aim: Considering that students
have excessive curricular and extracurricular academic
CUNHA, T C A, MAGALHÃES, M C M, BACCHIN, F, CUNHA, demands associated with irregular behavioral patterns, this
T M, FERNANDES-NETO, A J, SILVA, R S, SIMAMOTO- study aimed to evaluate the circadian typology (CT) of
JUNIOR, P C academics according to their daily rhythms, sleep quality
Faculdade de Odontologia - Universidade Federal de Uberlandia - and excessive sleepiness. Methods: Fifty-six students
Uberlandia - Minas Gerais - Brasil aged 17 to 34 years participated in this study (M = 20.89;
SD = 2.9). Of these, 27 students were studying between
Introduction: Obstructive sleep apnea (OSA) is a highly the 1st and 3rd period and 29 students were studying
prevalent disease, affecting individuals of all ages, and is between the 7th and 9th period. The instruments used
a risk factor for cognitive disorders, metabolic disorders were the Pittsburgh Sleep Quality Index (PSQI), the
and cardiovascular diseases. Despite its impact on general Morning and Evening Questionnaire and the Brief Social
health and quality of life, it remains underdiagnosed due Pace Scale. After evaluating the PSQI, all participants
to the high costs, and limited access to polysomnography. answered the instruments for a period of 14 consecutive
Aim: The aim of this systematic review was to evaluate days. Results: MANOVA showed significant difference
the diagnostic value of salivary biomarkers in OSA for daily sleepiness during working days [λ = 0.81; F (4.47)
compared to full-night polysomnography performed = 451.53; p <0.05], specifically for the 9 pm time [F (2, 5) =

Sleep Sci. 2020;13(Supl.1):1-118

 83

3.03; p <0.05]. In addition, ANOVA showed a significant Polysomnographic examination: basal oxyhemoglobin
difference between sleep quality and CT [F (2,30) = 4.61; saturation remained greater than 90% in all; average sleep
p <0.05] (Figure 2). Tukey HSD post hoc test showed that efficiency 89.6% and average HR 64.5 bpm. Conclusions:
intermediate students (M = 8.08; SD = 2.9) had worse The data indicate a prevalence of mild OSAS (41.6%), and
sleep quality compared to afternoon subjects (M = 5.62; the most frequent cardiac pathology arrhythmia (50%)
SD = 1.7). Conclusions: It is concluded that students followed by AMI (25%) in this group of patients. The
have poor sleep quality and generally try to compensate for most severe stages correspond to lower values of basal
the lack of nights of sleep during the week on weekends. oxyhemoglobin saturation (90%) and presented as cardiac
The differences between circadian typologies must be complications stroke and severe hypertension, using 4 or
understood from a broad perspective, leading us to assert more medications (combined antihypertensive drugs and
that they are associated with different lifestyles. statins). However, less severe patients had considerable
Palavras-chave: circadian typology; daily rhythms; students
desaturation and heart problems such as arrhythmias, AMI
and CHF. The data corroborate current studies relating
ID: 849 OSAS as a multifactorial cardiovascular risk factor.
Palavras-chave: Cardiovascular Diseases; Sleep Apneia Syndromes; Heart Failure

Clinical Studies ID: 850

Profile of sleep apnea patients and severa
Clinical Studies
cardiopathy in the extreme south of Bahia
Epidemiological profile of patients submitted
Silva, L R C, Fonseca, T F, Pessôa, V S, De Lima, C M F to polysonography in the south of Bahia
Universidade Federal do Sul da Bahia - Teixeira de Freitas - Bahia -
Brasil. Pessôa, V S, Fonseca, T F, Silva, L R C, De Lima, C M F

Universidade Federal do Sul da Bahia - Teixeira de Freitas - Bahia -

Introduction: OSAS is a disease characterized by
Brasil.
pharyngeal suppressions, causing hypoxia during sleep.
Evidence points to the relationship between sleep Introduction: OSAS is a disease described in 3 to 7% of
disorders and diseases such as arterial hypertension the world population that affects the upper airways and is
(SAH), congestive heart failure (CHF) and arrhythmias. characterized by pharyngeal region suppression, causing
In addition, the number of deaths from cardiovascular interruption of respiratory flow during sleep. These
events in OSAS patients has increased in recent years. interruptions in respiratory flow lead to arrest or reduction
Aim: To determine the profile of heart disease patients of respiratory flow (apnea or hypopnea). Examples of
diagnosed with OSAS in the far south of Bahia. symptoms are snoring, breathing pauses during sleep,
Methods: Quali-quantitative, descriptive, retrospective daytime sleepiness, irritability, etc. It is associated with
cross-sectional study. Data collection was performed at several comorbidities such as type 2 DM, hypertension,
a clinic in the extreme south of Bahia, through medical COPD exacerbation, reduced quality of life, significant
records of 12 patients diagnosed with OSAS and increase in the risk of occupational and traffic accidents, and
severe heart disease. Data collected: age, gender, BMI, is considered an independent risk factor for cardiovascular
comorbidities, basal oxyhemoglobin saturation, HR, sleep disease. Aim: To evaluate the epidemiological profile
efficiency and degree of apnea. Data were tabulated in a of patients with obstructive sleep apnea and hypopnea,
spreadsheet of Microsoft Excel Software and analyzed living in the far south of Bahia. Methods: Qualitative and
as descriptive statistics, calculating the distribution of quantitative descriptive study (case study) with retrospective
frequencies and averages. Results: Within the sample, cross-sectional development. Data collection was
the severity of OSAS ranged from 41.6% mild, 33.3% performed in a clinic located in the extreme south of Bahia,
moderate, 25% severe. Of the total, 11 were men with through patient records. The variables analyzed were age,
an average age of 62 years. An average BMI of 29.7 kg / gender, weight, height, reason for the exam, comorbidities
m². It was found that 50% of patients have arrhythmia, research and medication use. Results: A total of 620
16.6% have severe hypertension and 16.6% have CHF; medical records were analyzed, 60% (371) are men and 40%
25% refer 1 AMI event, 16.6% refer 1 stroke event. (249) are women. The mean age was 45.1 years (standard
Cardiovascular risk factors include dyslipidemia in 8.3% deviation 13.5), mean BMI 29.3 (standard deviation 5.9).
of patients, DM in 8.2%, obesity in 66.6%, hypertension The main reason for the exam was “snoring” (36%). In
in 66.6% and renal failure in 8.3% of cases. Life habits: comorbidities stand out 37.3% of obesity; 27.4% have
smoking in 75% of cases and alcoholism in 50%. Daily hypertension; 10.6% have gastritis and 5% have some heart
medications: 83% of patients take 4 or more medications, disease. Among those who snore, 37.1% are associated
8.3% use antiarrhythmic drugs, and 50% use statins. with hypertension, 35.4% obesity, 9.7% diabetes and 6.6%

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heart disease. Among those who reported having OSAS, Rachid, R M, Almeida, J M J
40.4% had SAH and 48.1% were obese. Of the total, 58.4% Amazon FisioCare - BELEM - Para - Brasil
use medicines, of which 15.7% use statin/fibrate; 12.1%
use hypoglycemic drugs, and 65.7% use antihypertensive Introduction: Obstructive Sleep Apnea is considered the
drugs, of which 45.7% use ARB; 23.5% use thiazides; most prevalent Sleep Respiratory Disorder, affecting 1/3 of
30.6% use other classes. Conclusions: Given the analyzed, the world’s population to some degree. Considered the “Gold
the most prevalent comorbidities were hypertension and Standard”, CPAP therapy is effective in controlling moderate
obesity; Among the people who underwent the test for and severe OSAS. However, studies have shown that some
snoring, 37.1% have hypertension and 35.4% are obese. CPAP users doesn’t maintain satisfactory medium and
Among those already diagnosed with OSAS, 40.4% have long-term therapeutic adherence. Therefore, it is necessary
hypertension and 48.1% are obese. These findings reinforce to establish strategies that improve this adherence. Aim:
the strong indication of the relationship between OSAS, To analyze CPAP therapeutic adherence after two years of
SAH and obesity, according to the literature. adaptation; to suggest therapeutic strategies for the CPAP
Palavras-chave: Sleep Apneia Syndrome; Morbidity and Mortality; Hypertensio; Obesity.
adaptation process based on clinical practice. Methods:
Quantitative documentary research based on the collection
ID: 851 and analysis of statistical data extracted from the reports
Clinical Studies provided by CPAP devices. Consultations were performed
in a physiotherapy office, in Belém / PA, from January
Evaluation of Swallowing in Obstructive 2016 to July 2019. A sample of 32 patients (M: 19 and F:
Sleep Apnea 13) aged 38 to 87 years old, previously submitted to type 1
PSG with moderate or serious AHI. All patients underwent
DIOGO, M P C C, MELLO, L F, CAPONE, F V the 4-week adaptation protocol, with 1 consultation and 3
returns. The analysis considered the % total use and % > 4h,
Hospital Federal da Lagoa - RIO DE JANEIRO - Rio de Janeiro - both within the last six months after two years of treatment
Brasil initiation. Patients used equipment with similar respiratory
Introduction: Obstructive Sleep Apnea (OSA) may cause comfort features. Results: The average percentages of
neuro / myopathy in the pharyngeal muscles of affected CPAP days of use and days of use >4h were 81% (M: 80%;
patients. Such alterations can lead to dysfunction in the F: 82%) and 66% (M: 65%; F: 68%), respectively. Patients
swallowing process, since the reflex evocation and the with moderate AHI (n = 8) had a total% use of 72% and
spread of the bolus are dependent on adequate pharyngeal a %>4h of 56%. Patients with severe AHI (n = 24) had a
sensitivity and function. In most cases, however, the total% use of 84% and %>4h of 70%. For patients up to 65
complaint of dysphagia is not mentioned spontaneously years (n = 19) the total% use was 78% and %>4h of 64%.
by OSA patients. Aim: To evaluate swallowing disorders For patients over 65 years (n = 13) the total% use was 85%
in OSA through the Swallowing Video Endoscopy (VED) and %>4h of 70%. Conclusions: The following aspects
exam in asymptomatic patients. Methods: Twelve patients are considered fundamental for better engagement and
with snoring (older than 18 years), diagnosed with OSA adherence to PAP: (1) cognitive behavioral (management
by polysomnography, underwent VED. Results: The of the emotional aspects involved); (2) educational (sleep
examination showed alteration in 8 patients (66.6%). The hygiene and understanding of the health-disease process);
following alterations were found in the studied sample: 8 (3) technicians (gradual and customized adjustments of
patients (66.6%) presented early bolus escape; 5 patients ventilatory parameters); (4) availability of interfaces; (5)
(41.6%), laryngeal penetration and 2 patients (16.6%), weekly feedbacks during the adaptation period and half-
residue formation. All were referred for speech therapy yearly in the first two years.
treatment. Conclusions: Alterations in the swallowing
Palavras-chave: adaptation; sleep apnea; CPAP; adherence

process are frequent in this patient population, even in ID: 853

asymptomatic patients. Larger and controlled studies
should be performed to better evaluate this finding. Thus, Basic Research
screening at risk patients can be considered for speech
therapy referral and prevention of future symptoms. Differences in sleep patterns and attention
Palavras-chave: sleep apnea, swallowing, dysphagia
according to sex and school level in adolescents
ID: 852 Crispim, F M D, Oliveira, M L C, Galina, S D, Valdez, P R,
Azevedo, C V M
Clinical Studies
Universidad Autónoma de Nuevo León - México, Universidade Federal
CPAP Adherence Assessment and Therapeutic do Rio Grande do Norte - Natal - Rio Grande do Norte - Brasil
Strategies

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Introduction: Adolescents present a phase delay with the Introduction: Childhood insomnia still is a challenging
arrival of puberty. However, the morning school hours diagnosis. Although apparently secondary to child and
decrease sleep duration on weekdays, causing insufficient caregiver relationship, there are current evidence that
and irregular sleep, and may have a greater detrimental effect supports a clinically oriented approach. As different cases
for women, whose have a greater sleep need. Aim: The of insomnia with organic etiology may have different
objective of this study was to compare habits and quality of pathophysiology and better respond to specific drug
sleep, sleepiness on awakening and attention according to approaches, when needed. Aim: The aim to report a
sex and school level (high school x college) in adolescents. case of a 2 year old child with Edwards Syndrome and
Methods: Participants were 88 adolescents (54 girls and 34 refectory insomnia that responded only to an Over the
boys), 48 from high school (G1 - 15.5 ± 0.7 years) and 40 Counter Medication. Methods: Meetings with parents and
from college (G2 - 20.4 ± 3.2 years). Sleep was evaluated by patient were conducted in Children’s Institute (University
questionnaires and attention by a cognitive task. Students of Sao Paulo Medical School) Pediatric Sleep Clinic.
filled a Sleep log containing the Maldonado Sleepiness Results: The patient is a 2 years-old female, who came
Scale for 10 days, the “Sleep and Health” questionnaire to Pediatric Sleep Clinic with her parents, and a previous
and the Pittsburgh Sleep Quality Index (PSQI). Attention diagnosis of Edwards Syndrome and cow’s milk protein
components were evaluated by the Continuous Performance allergy. The parents complaint was that the patient had
Task (CPT) applied in the morning.Results: G1 got up frequent arousals during the main sleep period and was
earlier (F(1,827) = 7,5, p <0,05), had the shortest time unable to stay longer than 2h sleeping. Patient went to
in bed (F(1,827) = 9,59, p<0,05) and most irregular time bed at 20h and had one arousal every 15min to 2 hours,
in bed in relation to G2 (F(1,82) = 6,7, p<0,05). Girls of crying, and returned to sleep after a few minutes. She
both groups got up earlier (F(1,827) = 7,54, p<0,05), had was in a diet free of cow’s milk and its derivates. She also
the shortest time in bed (F(1,827) 4,6, p<0,05) and most had difficulties in falling asleep and was diagnosed as a
irregular time in bed compared to boys (F(1,82) = 4,24, combined type of insomnia (both with difficulties falling
p<0,05). G1 showed the worst sleep quality (F(1.88) = 19,9, and maintaining sleep). She had been using Zolpidem,
p<0,05) and greater sleepiness on waking (F(1,82) = 4,62, Periciazine, Risperidone, Chlorpromazine and Morphine
p<0,05). The girls presented greater sleepiness on waking for this insomnia with no improvement on sleep pattern.
(F(1,81) = 4,24, p<0,05). G1 showed a longer reaction After a clinically oriented approach and psychoeducation
time in phasic alertness, a longer reaction time in selective for sleep hygiene and behavioral techniques she had little
attention compared to G2 (Anova, p<0.05). G1 also had improvement. Two weeks later, hydroxyzine 2ml at 23h
a greater percentage in wrong answers and omissions for was introduced with a good response. The number of
all attention components when compared to G2 (Anova, arousals lowered to once per night. Conclusions: Clinically
p<0.05). There was an interaction between groups and oriented approach of insomnia is a more comprehensive
sexes, showing G1 girls with the worst performance in approach that accounts clinical questions and behavioral
sustained attention compared to G2 girls (Tukey, p<0.05). issues to subtyping insomnia into three main probable
Conclusions: Thus, high school students presented worse physiologic pathways involved in childhood insomnia
sleep quality, which is associated with higher levels of (serotoninergic, histaminergic and dopaminergic). The
sleepiness and reduced attention, specially the girls. These patient had no response to previous drugs, including
sleep patterns and the impairment in attention may have a hypnotic agents. However, when hydroxizyne was
negative effect on academic performance. introduced, the patient began responding, which shows
Palavras-chave: adolescent sleep; attention; sleepiness; sleep quality.
that in this case, the hystaminergic might have a correlation
with the physiopathology.
ID: 854 Palavras-chave: childhood insomnia, Edward-syndrome, hydroxyne, histaminergic system

Case Reports ID: 856

Clinically Oriented Approach to Childhood Clinical Studies
Insomnia: A case of drug refractory childhood
Insomnia responsive to a Over The Counter Analysis of sleep quality in patients submitted
Medication to bariatric surgery.
Peixoto Ruthes, E M, de Matos, O, Alberto Petroski, C,
Vasconcellos, B S, Passini, V V, Yanagimori, M, Lacerda, C B,
Malaquias, D S d C
Fernandes, M D, Cano, T, Uneda, C B, Uneda, C B, Linares, I M
P, Linares, I M P, Soster, L M S F A, Bueno, C, Bueno, C UNIVERSIDADE TECNOLOGICA FEDERAL DO PARANA -
Curitiba - Parana - Brasil

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Introduction: Introduction: Obesity is one of the new activities, re-sponsibilities and concerns can be
greatest public health problems in the world, and it can considered an important risk factor for the development
cause comorbidities as well as a high mortality rate. To of health problems (Rodrigues, 2017). Sleep irregularities
treat this clinical picture, the importance of an effective also compromise the attention, memory, and academic
treatment is observed for patients who have tried other performance of these students. Due to impaired cognitive
non-invasive methods without success or for individuals functioning, sleep should be an important concern for
in whom bariatric surgery is the best indication. Among university students, for whom academic performance is
the comorbidities of these individuals are sleep disorders, a priority (Araújo, 2013). Aim: The aim of this study was
which are very significant in the life of these patients to identify the characteristics and pattern of sleep and to
because they cause daytime sleepiness that is usually verify if there is a correlation between the poor quality
caused by snoring and sleep apnea and hypopnea of sleep and the body composition of university students.
syndrome; causing fragmentation of the sleep and tire Methods: A descriptive cross-sectional study, with a
hormonal changes, as well as alteration in the percentage quali-quantitative approach, attended by 100 university
of fat. Aim: The objective of this study was to analyze students in of the Einstein Integrated College of Limeira.
the effects of bariatric surgery on sleep quality after six The subjects signed the consent term and began the
months of surgical intervention. Methods: This is a fulfillment of the sociodemographic questionnaire
quasi-experimental clinical trial, the study was carried out and PSQI (Pittsburgh Sleep Quality Index). Individual
in patients referred from the outpatient clinic of Angelina anthropometric assessments were performed to analyze
Caron Hospital, 19 patients, female, aged between 20 and body composition of the individuals, at scheduled dates and
65 years. The performed tests were total body mass, height according to the volunteer’s availability. Anthropometric
measure, cervical/abdominal circumference and Pittsburgh measurements of shoulder, chest, waist, abdomen, hip,
sleep quality test.Results: The mean values before and thighs, arms and calves were used. The protocol used to
after surgery were: total body mass: 109.5 kg and 81.6 kg, measure the percentage of fat was the formula of 4 Pollock
cervical circumference: 40.7 cm and 35.1 cm, abdominal folds (triceps, subscapu-laris, suprailiac and abdominal).
circumference: 127 cm and 106.6 cm, respectively. There The collected data was transferred to Microsoft Office
was a difference between the Pittsburgh sleep quality in spreadsheet Excel® and analyzed through the software
the pre- and post-surgical period through the Wilcoxon Prism 7 version 7.0. To evaluate the normality of the
test (p = 0.001), as well as strong correlations between data, the Shapiro-Wilk test was used, and for proportions
Pittsburgh components and their total and between pre and distribution, the chi-square.Results: We observed
and postoperative anthropometric indicators through that only 31% of the students were classified as Good
correlation of Spearman. Conclusions: There was a Sleep and 69% as Bad Sleep. Among the subjects who
significant improvement in sleep quality after six months don’t practice physical activity, 53.6% have Bad Sleep
of bariatric surgery according to patient’s perception. Quality, according to the PSQI result. it was possible to
Some parameters were highlighted in the postoperative verify correlation between higher body fat percentage and
period according to patient’s perception, a subjective worse PSQI. Conclusions: The data from this research
improvement of sleep quality, sleep efficiency, increased corroborate with others in the literature, in which students
sleep duration and decreased daytime sleepiness. have poor sleep quality and may be related to the presence
Palavras-chave: Obesity. Sleep. Bariatric surgery. Quality of life. Body composition.
of disturbances, excessive daytime sleepiness and higher
body fat values.
ID: 858 Palavras-chave: sleep, students, body fat

Basic Research ID: 859

Sleep quality and body composition Basic Research
assessment in college students
Sleep quality and stress levels between private
GARCIA, G D G, FERREIRA, L R C, CASSAVILANE, O institution medicine schools in Belém do Pará
Faculdades Integradas Einstein de Limeira - Limeira - São Paulo - Brasil
Oliveira, M C S, Penin, R S, Rodrigues, S L, Perinazzo, V M,
Introduction: Sleep, which is characterized as a basic Moraes, N M, Silva, R d A, Chaves, G C M, Mendonça, M C
human need whose preservation and maintenance are Centro Universitário Metropolitano da Amazônia (UNIFAMAZ) -
fundamental for the individual to lead a healthy life, has Belém - Para - Brasil
been studied in recent years. This is justified due to the
correlation between habits, quality and sleep duration Introduction: In recent years, the mental health of
and sever-al other factors. Admission to college with college students has become an important agenda and

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 87

of great attention of health experts. Within this scenario, Introduction: Progesterone has known hypnogenic
the issue of sleep deprivation should be mentioned. effects and the use of hormonal replacement therapy in
Aim: To analyze sleep quality and psychological stress postmenopausal women has brought improvements in
levels among medical students from a private institution their sleep quality. Previous reports have suggested that
in the city of Belém. Methods: An observational, cross- progestagen-only contraceptives may be a more adequate
sectional, descriptive and analytical study of 120 medical option for premenopausal women who complain of
students from a private Northern educational institution. insomnia. However, no information regarding the route
About 15 students from each semester were selected. of administration has been assessed to date. Aim: This
This number was chosen by estimating the researchers study aimed to evaluate the impact of different route
between the size of each class and the applicability of of administration of contraceptive (progestagens-only)
the questionnaires to the population. Information was using a sleep self-reported subjective study among
collected through the Pittsburgh Sleep Quality Index premenopausal women. Methods: This was a web-based
(PSQI) and the translation of the Perceived Stress Scale. cross-section trial. A set of questionnaires evaluating
Results: Primary school students, especially those in the contraceptive use, sleep-related characteristics and
first and second semester, showed, with a high percentage related features was available online between July 2016
(1st semester 71%, n = 10 / 2nd semester 78%, n = 11), and February 2017. The tools used to assess sleep were
that they were unexpectedly sad and feeling stressed. and the Epworth Sleepiness Scale (ESS) and the Insomnia
nervous (1st and 2nd semester 50%, n = 7) and feel that Severity Index (ISI). Only women between 18 a 40
they cannot overcome the difficulties faced daily in 50% of years-old were considered eligible. Considering that the
respondents. At the end of the basic cycle, which covers route of administration of the progestagens could have
the third and fourth semester, the difference between the a potential effect on sleep, levonorgestrel-releasing
statements is remarkable: according to the interviewees, intrauterine system (LNG-IUS) users were compared with
part of the students reports that they will never be able the users of oral progestagen-only contraceptives. Sleep-
to overcome the difficulties encountered, while another related comparisons were initially performed without
part shows that The percentage of nervousness and control (raw analysis). Further analysis were performed
stress decreased, which can be explained by the better in a controlled way in which the effects of hormonal
organization acquired over time. Regarding the clinical contraceptives were corrected by potential confounding
cycle (from the fifth to the eighth semester), most students factors (age, Body Mass Index and income).Results: A
report that they consider their sleep quality to be good, total of 2,055 premenopausal women between 18 and 40
and report that they can control daily situations even if years-old participated in answering an online questionnaire
they sometimes get out of control. In addition, especially evaluating hormonal contraceptive use, sleep-related
in the eighth semester, students pointed out that they are characteristics and other important health characteristics.
dealing positively with the changes that happen in their Of this total sample, 1,286 participants met the
lives, can control irritations and do not feel that daily inclusion criteria; of which only 70 were currently taking
situations are beyond their control. Conclusions: These progestagens-only contraceptives. Comparisons between
students, who are constantly being charged by themselves, users of LNG-IUS and oral pill users of progestagen-only
their families and the college itself, end up falling asleep to hormonal contraceptives demonstrated a lower sleepiness
be able to fulfill their academic activities, since the amount score, as measured by ESS, among LNG-IUS users in both
of content charged is extensive. raw and corrected analysis (LNG-IUS users: 9.12±4.57;
Palavras-chave: Medicine; Sleep Hygiene; Education Medical.
Oral pills users: 11.58±4.59). Conclusions: Sleepiness
was lower among LNG-IUS users when compared with
ID: 861 oral pills progestagens-only users. LNG-IUS is a better
Clinical Studies contraceptive choice for premenopausal women who
complain of sleepiness, as they seem to have smaller
Routes of Administration of Progestagen- impacts on self-reported sleep variables. Funding: IBRO,
only Contraceptives and Subjective Sleep AFIP, CAPES, CNPq.
Palavras-chave: Progesterone, Estrogen, Sexual hormones, Women, Contraceptives.

Reports on Women in Reproductive Age

ID: 862
Bezerra, A G, Andersen, M L, Pires, G N, Banzoli, C V, Polesel,
D N, Tufik, S, Hachul, H Basic Research
Santa Casa de São Paulo School of Medical Sciences - São Paulo - Sao Pulmonary function and sleep quality in
Paulo - Brasil, Universidade Federal de São Paulo - UNIFESP - São
asthmatic children and teenagers
Paulo - Sao Paulo - Brasil
DONZA, C B F, MEDEIROS, D, ALMEIDA, A C de A, DAHER,

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 88
S, de LIMA, A M J, DONZA, A Introduction: Cognitive disorders were described in
Centro de Pesquisas em Alergia e Imunologia Clínica HC - UFPE - patients with poor sleep quality. Obstructive sleep apnea
RECIFE - Pernambuco - Brasil, Universidade Federal de Pernambuco syndrome (OSA) is a natural condition that allows and
(UFPE) - RECIFE - Pernambuco - Brasil, Universidade Federal do favors the study of cognition in people affected by the
Pará (UFPA) - BELÉM - Para - Brasil, Universidade Federal Rural de disease, since it is possible to separate individuals with
Pernambuco (UFRPE) - RECIFE - Pernambuco - Brasil different degrees of sleep fragmentation, changes in their
macrostructure, efficiency, arterial saturation, and different
Introduction: Good sleep quality is a determining levels of education. Aim: To evaluate possible differences in
factor for productivity and dalily activities. The Night cognitive impairment (measured by validated instruments)
awakening is an indicator of worsening asthma control in people with different degrees of OSA (evaluated
and severity. Thus, the evaluation of sleep disorders in by full-night polyssomnography). Methods: A cross-
asthmatic patients is important to minimize symptoms sectional study with 200 patients over 18 years of age sent
and to improve quality of life. Aim: To evaluate the for polysomnographic examination conducted between
relationship between sleep quality and pulmonary function 2015-2017.The outcomes were based on the cognitive
in asthmatic children and adolescents. Methods: It was performance tests: Scales of similarities, verbal fluency,
a cross-sectional study in 40 children and adolescents Go-No-Go, metaphorical proverbs. The interest exposure
diagnosed with moderate and severe asthma. To assess was the diagnosis of OSA and, as potential confounders:
the sleep quality of the volunteers, patients completed the schooling, arterial hypertension, smoking, age, weight,
Pittsburgh sleep quality index (PSQI) and their guardians psychiatric disorders evaluated by the Montgomery and
filled out the sleep behaviour questionary (SBQ). The Hamilton scales.The analysis of the association between
evaluation of the pulmonary function was performed the presence of OSA and cognitive performance was
through spirometry.Results: The sample consisted of analyzed by the non-parametric Mann-Whitney and Chi-
32 (80%) boys and 8 (20%) girls with 9 ± 2 years old. square tests.Results: Subjects with OSA have a fragmented
Regarding the PSQI score, 11 (27.5%) had good sleep sleep, with% values of time in N1 and N2 higher, with%
quality, 4 (10%) had sleep disorder and 25 (62.5%) had of time in N3 lower, with more nocturnal awakenings and
poor sleep quality. 4 (10%) who had good sleep quality with a longer sleep time with oxygen saturation below 92%.
by the SBQ, only 2 (50%) had the same indication by the In the absence of confounders, the comparison between
PSQI. Twelve (30%) had FEV1 <80% or FEV1 / FVC subjects with/without sleep apnea didn’t reveal significant
<70% of the predicted value, with unchanged FVC. differences between these two groups in relation to
Among these, 10 (83.33%) showed poor sleep quality by cognitive performance on the similarity scale, Go-No-Go
the SBQ, while 9 (75%) presented poor sleep quality by scale,more metaphorical proverbs scores, less metaphorical
the PSQI. One (2.5%) participant had FVC <60% with proverbs and the general score.Analyzes made with SPSS
FEV1/FVC> 70% of the predicted value, indicating V21.0 software. When associating degrees of apnea with
sleep disturbance by PSQI and poor sleep quality by the cognitive performance, no significant differences were
SBQ. Fisher exact test showed an association between observed between the absent, mild, moderate and severe
sleep efficiency and FEF25-75%/FVC (p = 0.001) and groups. In addition, stratification was made between subjects
FVC (p= 0.05) measurements. Conclusions: There was according to schooling and no significant difference was
no association between PSQI and SBQ overall scores found. Conclusions: Cognitive and emotional assessment
and pulmonary function. All (100%) participants with a data showed that there was no significant difference.The
seemingly restrictive pattern of disturbance by spirometry findings refer to people with basic and secondary education
(FEF25-75% / FVC> 1.5) had poor sleep quality by SBQ and can’t be generalized to different levels of education.
and poor sleep quality or sleep disturbance by PSQI. It is Therefore, one may suspect that in the studied group, sleep
also suggested an association between sleep efficiency and fragmentation did not worsen intellectual performance, or
restrictive ventilatory disturbances. that the chosen instruments were not sensitive enough to
Palavras-chave: asthma; pulmonary function; sleep quality; youthful.
distinguish people with cognitive disorders.
Palavras-chave: Obstructive sleep apnea, cognition

ID: 863
Clinical Studies ID: 864
Cognitive Evaluation in Patients With Clinical Studies
Obstructive Sleep Apnea Syndrome Acute effects of zolpidem versus exercise on
Silva, M M, Carvalho Nunes, H R d, Fonseca, R G sleep and serum serotonin of patients with
chronic insomnia: preliminary results

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 89
Rozales, A R C, Santana, M G, Youngstedt, S D, Assis, D E, sleep, with snoring, episodes of apnea and hypopnea, and
Assis, B P, Cerqueira, D, Passos, G S frequent arousals. Aim: We describe a case in which a child
Arizona State University - ASU/College of Nursing and Health diagnosed with Costello syndrome had rhythmic sleep
Innovation - Estados Unidos, Universidade Federal de Goiás/Regional movement disorders as well as non-REM sleep parasomnias.
Jataí - JATAÍ - Goias - Brasil Methods: A 6 years-old, male children, diagnosed with
CS, had craniofacial dysmorphisms, hydrocephalus, and
Introduction: The prevalence of chronic insomnia neuropsychomotor developmental delay. He also had
in the general population is between 10 and 15%. The snoring, nocturnal awakenings, mouth breathing, and
therapy most commonly prescribed for its treatment is episodes of witnessed apnea with cyanosis. His mother has
pharmacological, however, there are some negative effects reported rhythmic and repeated movements before sleep
of sleeping pills, including tolerance and dependence. onset, characterized by lateral body movements. Besides
Non-pharmacological alternatives have been studied, this, she has complained of violent actions, suggestive of
among them regular exercise. Although some studies have sleep terror, and episodes of confusional arousals. The
described positive effects of exercise on sleep in chronic children had poor sleep hygiene habits, with insufficient
insomnia, there are no studies comparing exercise and total sleep time. On examination, palatine tonsils were
drugs in the treatment of chronic insomnia. Aim: To grade III. Nasofibroscopy has revealed adenoid remnants.
assess the acute effects of aerobic exercise or zolpidem Polysomnography has shown a reduced total sleep time,
on sleep and serum serotonin level in patients with snoring, and obstructive apnea and hypopnea episodes
chronic insomnia. Methods: Six patients with chronic (AHI = 7.4 events/ h), with a minimum O2 saturation
insomnia (46.5 mean age [SD] 2.7; 83% female) were = 74%. Neuroimaging, echocardiogram, and abdominal
randomly assigned into two groups: EXERCISE (n=3) ultrasound were normal.Results: As far as we know, this is
or ZOLPIDEM (n=3). The patients in the EXERCISE the first description of Sleep-related Rhythmic Movement
group did one day of treadmill exercise for 50 min at Disorder and NREM sleep parasomnias in patients with
50% heart rate reserve, at 12:00 ±1h. The ZOLPIDEM CS. A previous study demonstrated rhythmic tongue
group consumed a 10mg tablet of zolpidem 5 min before movements in four patients with CS. On the other hand,
bedtime. Actigraphy was used to evaluate objective sleep the presence of OSA already described in this group of
pattern. Serum levels of serotonin (5-HT) were measured patient and, in this case, could be explained by retrolingual
by High-performance liquid chromatography (HPLC) airway obstruction, related to craniofacial alterations and
method.Results: Difference between proportions tests palatine tonsil hyperplasia, causing reduction of posterior
by STATISTICA® showed sleep duration and sleep respiratory space. Conclusions: We present a patient
efficiency increased after zolpidem and exercise (35% with CS with different sleep disorders (Obstructive Sleep
and 4%; 10% and 9%, respectively). In addition, WASO Apnea, Sleep-related Rhythmic Movement Disorder, and
and awakenings decreased after both treatments (63% NREM sleep parasomnias), highlighting the need for a
and 41%; 43% and 29%, respectively). Serum serotonin detailed assessment of sleep disorders in CS patients.
increased after zolpidem and exercise (8% and 11%, Palavras-chave: Costello Syndrome, sleep disorders, obstructive sleep apnea, sleep-related rhythmic movement disorder, parasomnia

respectively). Conclusions: The preliminary results

suggest positive effects on sleep and serum serotonin
ID: 867
levels after both zolpidem and exercise. Basic Research
Palavras-chave: insomnia, exercise, zolpidem, non-drug therapy.

Boosting problem-solving with a Siesta –

ID: 865
Preliminary analysis of a replication study of
Case Reports the role of sleep on videogame based problem-
Sleep Disorders in Costello Syndrome solving

MATOS, I D M, Pompeu, C M R, Bezerra, G d A M, Sousa, J d Lepechacki, R, Bianchin, S, Beijamini, F

C V, Muniz, C R, Silva, V C d, Damasceno, P G, Noronha, A C, Universidade Federal da Fronteira Sul - Realeza - Parana - Brasil
Sobreira, E S T, Neto, M A S
Introduction: Sleep is fundamental for memory
Hospital Universitário Walter Cantídio - Fortaleza - Ceara - Brasil
consolidation. Besides quantitative changes, sleep is
Introduction: Costello Syndrome (CS) results from a thought to promote qualitative changes on memory by
mutation in the protoncogene HRAS. The syndrome is means of an active system consolidation process. The
characterized by craniofacial dysmorphisms, intellectual sleep effect on problem solving supports this hypothesis.
disability, and verrucous papillomatosis. Patients have Aim: To replicate the effect of sleep on a videogame based
a high prevalence of upper airway obstruction during problem-solving task with a siesta protocol. Methods:

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 90

30 university students (20♀) participated. Subjects were is emerging as an alternative adjunct treatment for
randomly assigned to one of the two groups: Siesta or obstructive sleep apnea (OSA) improving apnea hypopnea
Wake. As soon as subjects arrived at the laboratory, index, sleep quality and excessive daytime sleepiness. The
they filled up a sleep habits questionnaire, the Epworth IMT is a home-based program, with previous orientation
Sleepiness Scale (ESS), and were prepared for a simplified by the physiotherapist, but unsupervised in the execution
polysomnography recording. EMG, EOG were recorded of the exercise training. However, the acute responses
as standard, and EEG was recorded from C3 and C4 using of the cardiovascular system autonomic control to
an OpenBciÒ amplifier. Following, began the practicing such exercise in OSA subjects remains unclear. Aim:
session playing the 3D-virtual maze videogame until being To determine the immediate and late acute responses
challenged by a non-solvable problem. Subjects who did of the cardiac autonomic balance in patients with OSA
not solve this challenge within 10min were assigned for submitted to IMT. Methods: 20 OSA subjects of both
the Wake or Siesta conditions with 90min of incubation genders (52,15 ± 11,00 years old) were randomized
interval. After the incubation interval subjects had another to a) experimental group (n =10) who performed IMT
opportunity to solve the same challenging problem. (powerbreathe®classiclight) with a load of 70% of the
Frequency of subjects who solved the problem where maximal inspiratory pressure (MIP), three sets of 30
compared with X2-square and Students t test were applied respiratory incursions each and resting 1 minute between
to test control variables between groups.Results: We are sets and b) control group (n=10), carried out the same
presenting here preliminary results from behavioral data. protocol, but with no load. The cardiovascular autonomic
From the Siesta group 13 (76%) out of 17 subjects were balance was assessed by the heart rate variability (HRV).
able to solve the challenging problem while 2 (16%) out The heart rate was continually registered (Polar RS 800Cx)
of 12 from the Wake group solved it (X2=10.07; p=0.002, at rest (10 min), immediately after (10min) and 1h after the
with a strong with an effect size of Phi=0.59). Groups IMT session (10 min). Then, the RR interval generates a
were compatible according to the sex distribution, 12 tachogram that was analyzed in the frequency domain by
and 8 females respectively at the Siesta and Wake groups Kubios HRV Analysis Software and decomposed into low
(p=1.0), age (Siesta 23.11±6.5; Wake 21.58±3.8; p=0.47) (LF: 0.04–0.15 Hz) and high (HF: 0.15–0.4 Hz) frequency
and sleep duration on weekdays (Siesta 458.88±66.39min; bands and the ratio HF/LF. HRV at rest, immediately after
Wake 444.16±49.67min; p=0.51), however, subjects and 1h and after the IMT was compared using two-way,
from the Siesta group presented higher scores for ESS repeated-measures ANOVAResults: Comparing the LF
(Siesta 11.5±3.43; Wake 7.75±2.63; p=0.003). To check values, there were no inter (p= 0,946) or even intragroup
for another possible confounding factors, we compared (experimental group; p= 0,835/control group; p= 0,670)
subjects from the Siesta group who solved the problem differences. Regarding to the HF analyses, there were also
with the ones who did not solve it. No significant difference no inter (p=0,94) or intragroup (at the experimental group;
was found. Conclusions: A siesta increases the chance to p= 0,845/control group; p= 0,667) differences. The
solve a videogame based visuospatial problem. This study ratio LF/HF also had no inter (p= 0,797) or intragroup
replicates previous findings and raises support to the role (experimental group; p =0,455/ control group; p = 0.818)
of sleep on promoting qualitative changes on memories. differences. Conclusions: The HRV analyzes showed no
Further analysis must evaluate electrophysiological aspects inter and intragroup differences related to the LF and HF
of sleep for a better understanding. components of and to the HF/LF ratio, showing discreet
Palavras-chave: learning; memory; creative solutions; sleep.
changes in the autonomic cardiac modulation in response
to one single session of IMT. Therefore, home-based
ID: 869 IMT without supervision can be considered as a safe and
Clinical Studies viable training modality for patients with OSA.
Palavras-chave: inspiratory muscle training; acute responses; heart rate variability; obstructive sleep apnea

Heart rate variability in obstructive sleep apnea ID: 870

patients submitted to one bout of inspiratory
muscle training Clinical Studies

FERREIRA, S T B P, CHAVES, S Í D, SIQUEIRA, P P S,

Sleep in Heathy Pregnancy: Preliminary
SANTOS, M D S B, SILVA, T N S, CARREIRO, P B P, FERRAZ, Results
T, SANTOS, J B O S, PINHO, M C, LIMA, A M J
Facanha, C F S, Cunha, A B A, Facanha, A S, Souza, F L L, de
Federal Rural University of Pernambuco e Federal University of Bruin, P F C, Queiroz, C B, Martins, A F C, Ballalai, M S, De
Pernambuco - Recife - Pernambuco - Brazil Bruin, V M S
Introduction: The inspiratory muscle training (IMT) Departamento de Pós-Graduação em Ciências Médicas - Universidade

Sleep Sci. 2020;13(Supl.1):1-118

 91
Federal Do Ceará - Fortaleza - Ceará - Brasil, Centro Universitario Maciel, R A M, Souza, L F X, Miguel, M A L
Christus - Fortaleza - Ceará - Brasil, Centro Integrado de Diabetes e
Universidade Federal do Rio Grande do Norte e Instituto Federal de
Hipertensão - Fortaleza - Ceará - Brasil
Educação, Ciência e Tecnologia do RN - Natal - Rio Grande do Norte
Introduction: Sleep disruption is frequent during - Brasil
pregnancy. An increased prevalence of insomnia, sleep
Introduction: From the neurobiological point of view,
fragmentation due to increased urination and discomfort,
several studies validate the importance of sleep for the health
excessive daytime sleepiness (EDS), sleep-disordered
and well-being of the population. At this stage, the brain is
breathing and restless leg syndrome are reported. Nowadays
in an active state in which there is a rearrangement of neural
the importance of sleep quality to a heathy pregnancy is
networks associated with learning and memory consolidation.
warranted, and sleep disturbances may be recognized as a
It is important to emphasize, however, that sleep expresses
novel risk factor to adverse pregnancy outcomes such as
itself differently according to age group. Particularly for
preeclampsia, gestational diabetes, prematurity, prolonged
adolescents, there is a greater need for sleep compared to
labor and depression. Furthermore, the sleep profile can
adulthood, as well as a natural delay in sleep onset time.
be influenced by regional characteristics. To date, studies
Aim: The aim of this study is to analyze the implications of
evaluating sleep quality and circadian preference in healthy
morning shift school hours on the various aspects related to
pregnancy are scarce in our country. Aim: To investigate
sleep and academic performance in students at IFRN’s Natal-
the quality of sleep and circadian preference in healthy
Central campus. Methods: The sample group consists of a
pregnant women (HPW) attending a low risk prenatal
randomized selection of students aged 14-19 years from the
clinic in Northeast BrazilMethods: A cross-sectional
various high school integrated technical courses that contain
study designed to investigate sleep profile of HPW
1637 enrolled students from the IFRN Natal-Central Campus.
attending a primary care unity. Diabetes or hypertension
Data related to the academic performance of the sample
backgrounds were excluded. Subjective sleep quality was
group were obtained from the records of the Unified Public
evaluated by Pittsburgh Sleep Quality Index (PSQI);
Administration System (SUAP). Students ‘sleep-related data
Insomnia (Insomnia Severity Index -ISI), EDS by the
were recorded and monitored using questionnaires, validated
Epworth Sleepiness Scale (ESS). Circadian preference
for the Portuguese language, containing information about
assessed by the Horne-Östberg Morningness-Eveningness
students’ sleep routine. Research already submitted and
Questionnaire (MEQ). The study was approved by Instituto
approved by the Research Ethics Committee.Results:
para Desenvolvimento da Educação Ltda-IPADE ethic
According to data obtained from the Munich Chronotype
board, approval number 88692918.1.0000.5049.Results:
Questionnaire, students who slept 08 or more hours per
Seventy two HPW aged 18 to 42 years (mean: 28±6),
night had an average academic achievement index of
gestational age (28 ± 7) and BMI (28.2±4) were evaluated.
86.9; those who slept less than 08 hours, yield 77.57. In
Poor sleep quality was found in 42% (PSQI:5.6±3); EDS
addition, according to the Horne and Ostberg Chronotype
in 28% (ESS: 7.6 ±4), mild to moderate insomnia in 27.8%
Questionnaire, 63% of students in the morning shift have
(ISI:5.3±3). Short sleep was reported in 24.3%, and 15%
more evening than morning or definitely evening chronotypes.
slept > 10 hours/day. Overall, mean sleep duration was
Also according to the Pittsburgh Sleep Quality Rating Scale,
8 ±1.9. Sleep quality was not related to physical activity
only 6% of students sleep 8 or more hours of sleep per night.
(p=0.2), years of study (p= 0.16) marital status (p=0.6).
From this study, chronobiological aspects, hours and sleep
Everningness was perceived in only 2 patients. Previous
quality per night influence the academic performance of
history of depression or anxiety was found by 12% and
IFRN adolescent students. Conclusions: From this study,
poor sleep quality and insomnia was present in 62% of
chronobiological aspects, hours and sleep quality per night
them. As expected, insomnia score was significantly related
influence the academic performance of IFRN adolescent
to PSQI score (p=0.001)Conclusions: In similarity with
students. Thus, it is necessary to promote actions in order
previously reported studies (SEDOV 2017; BOURJEILY
to optimize the formatting of some school activities and
2013), these preliminary findings suggest that sleep
to deepen scientific knowledge regarding chronobiological
disturbances are frequent in HPW. Interesting to note the
characteristics and their relation with academic performance
low prevalence of eveningness, even in this young group.
and biopsychosocial aspects in high school adolescents.
To our knowledge, this is the first report of sleep profile Palavras-chave: teenagers, chronotypes, sleep quality, school schedules

and circadian preference in HPW in the Northeast of

Brazil ID: 878
Palavras-chave: Sleep; pregnancy, Insomnia in pregnancy, chronotype

Basic Research
ID: 874
Sleep and quality of life of nursing students
Basic Research
Mendes, S S, Moraes, B F M, Salvi, C P P, Monteiro, S M C,
Relation between sleep and academic Miranda, L D L, De Martino, M M F
performance in ifrn students
Sleep Sci. 2020;13(Supl.1):1-118
 92
Universidade Estadual de Campinas - Campinas - Sao Paulo - Brasil, and sleep microstructure evaluation by means of cyclic
Universidade Federal de São Paulo - São Paulo - Sao Paulo - Brasil alternating pattern (CAP) to report this case of a 14-year-
old male child. He was clinically evaluated in Associação
Introduction: Nursing undergraduate students, especially Paulista para Altas Habilidades e Superdotação with a
seniors students, may have sleep and quality of life affected report including psychological, pedagogic and specific
by several factors experienced during clinical practice ability tests that showed above average abilities in such
activities such as concerns about future professional life, domains: artistic, linguistic, mathematical and musical
working and double working shifts. Aim: To analyze the areas.Results: On clinical history, patient reports difficulty
quality of sleep and life of senior nursing undergraduate in falling asleep, sleep fragmentation, nightmares and
students. Methods: Cross-sectional, comparative and reduced total sleep time. Physical examination showed
quantitative study with undergraduate nursing students Mallampati II and palatine tonsils III. Polysomnography
from a private institution in southern of Minas Gerais. evidenced an increased apnea/hypopnea index (12.4
For data collection, the Pittsburgh Sleep Quality Index events/h), with a predominance of obstructive events and
(PSQI), the WHOQOL-bref quality of life questionnaire, a minimum SpO2 of 82%, with normal sleep efficiency
and a sociodemographic characterization questionnaire and normal sleep architecture. CAP parameters showed an
were used. For data analysis, association, comparison and increased percentage of A1, decreased percentage of A2
descriptive statistics tests were performed. Results: The and A3 subtypes and increased CAP rate in slow wave sleep.
sociodemographic profile data showed that of the 55 Conclusions: This case report shows CAP modifications
students, 80% were female, 74.5% worked and of these in a gifted child and could represent a correlation of sleep
41.8% were nursing technicians. Between the different oscillations with the degree of mental ability. Although we
periods, the results showed a significant difference found obstructive sleep apnea (OSA) in this patient, OSA
regarding the psychological, social and environmental plays a different role in sleep microstructure (it reduces
Whoqol domains, and PSQI score. Regarding to the CAP rate and A1 index). Some studies showed that verbal
presence of insomnia there was a significant difference skills are correlated with CAP rate in sleep slow waves
for PSQI score and physical domain of quality of life. and with high A1 index. There is an interaction between
Conclusions: The environment of clinical practice has higher cognitive functions and the regulation of sleep. The
been configured as a possible factor to cause changes increase in A1 CAP subtypes might point to a possible
in sleep quality and reduced quality of life of nursing hyperfunction of these brain structures, which might play
students who are close to becoming nurses. a role in a better cognitive performance. The decreased
Palavras-chave: Sleep; Quality of Life; Students, Nursing.

percentage of A2 and A3 subtypes may be associated with

ID: 879 lower arrousability, therefore, lower activation of posterior
cortex.
Case Reports Palavras-chave: gifted child, sleep microstructure, cyclic alternating pattern.

Sleep microstructure evaluation in a gifted ID: 880

child Basic Research
FERRARI, M M H, TOSCANINI, G V, TOSCANINI, A C G, Sleep’s beneficial effect on problem solving
HASAN, R, SOSTER, L M S A, TOSCANINI, A C
is not additionally increased by Targeted
HOSPITAL DAS CLÍNICAS DA FACULDADE DE MEDICINA Memory Reactivation
DA USP (FMUSP) - SÃO PAULO - Sao Paulo - Brasil
Beijamini, F, Valentin, A S C, Jäger, R, Born, J, Diekelmann, S
Introduction: Gifted children are those who present
remarkable performance in any of the following domains: Federal University of Fronteira Sul - UFFS - Realeza - Parana - Brasil,
intellectual ability, academic performance, creative Institute of Medical Psychology and Behavioural Neurobiology,
or productive thinking, leadership, talent for arts or University of Tübingen - Alemanha, Werner Reichardt Centre for
psychomotor ability. Some studies showed that gifted Integrative Neuroscience, University of Tübingen - Alemanha
children present sleep disturbances, such as difficulties in
initiating and maintaining sleep, shorter sleep duration, Introduction: The active systems consolidation
earlier morning awakenings, obstructive sleep apnea and hypothesis proposes that memories undergo reactivations
parasomnias. Aim: The aim of this study is to report a during sleep that can give rise to qualitative changes of
case of a gifted child who presents sleep disturbance, to the representations. These changes may allow for the
evaluate its sleep microstructure and to correlate with generation of new knowledge such as gaining insights
cognition. Methods: We used clinical history, physical into solutions for problem-solving. Targeted Memory
examination, psychological assessment, polysomnography Reactivation (TMR) has been successfully applied to

Sleep Sci. 2020;13(Supl.1):1-118

 93

improve memory consolidation during sleep, however, of medications and comorbidities such as sleepwalking,
little is known about the effect of TMR on problem- restless legs syndrome, and OSA, and resolution with
solvingAim: To test whether TMR during slow-wave treatment. OSA-related headache is a type of problem
sleep (SWS) and/or rapid eye movement (REM) sleep that improves after controlling for respiratory events
increases problem-solving beyond the beneficial sleep during sleep. Aim: We aims to describe a patient with
effect. Methods: Young healthy volunteers participated SRED and OSAH, besides other commons symptoms of
in one of two experiments. Experiment 1 tested the OSAMethods: We reported a patient with Sleep-Related
effect of sleep on problem-solving. Subjects were trained Eating Disorder (SRED) and Obstructive Sleep Apnea
in a videogame-based problem-solving task until being related headache (OSAH), with significant improvement
presented with a non-solved challenge. Followed by an after appropriate treatment.Results: Case presentation:
incubation interval filled with sleep (n=21) or wakefulness Male, 48 years old, complaining of snoring, mouth
(n=21), subjects were tested on the problem-solving breathing, nocturia cough, and sleep sweating. Besides
challenge again. Experiment 2 tested the effect of TMR this, morning dry mouth, and excessive sleepiness (ES).
on problem-solving, with subjects receiving auditory Patient and caregiver reported unconscious food intake
TMR either during SWS (SWSstim, n=18), REM sleep during sleep, with a weight gain of 40kg in 5 years. An
(REMstim, n=19) or wakefulness (Wakestim, n=21), using attempt was made to ingest cosmetic and automotive
the same protocol as in experiment 1. Control tasks were wax. He has a normal daytime eating behavior. Also,
applied to test for mood, sleepiness, working memory and he complained about moderate to severe awakening
psychomotor vigilance.Results: In Experiment 1, sleep headache, with improvement after 10 minutes. Previous
improved problem-solving, with 61.9% of subjects from diagnosis of Bipolar Affective Disorder using quetiapine
the Sleep group being able to solve the problem after the and carbolitium. On examination, BMI of 42.21 kg/m²,
incubation interval in comparison to 23.8% from the Wake Mallampati class 4, and macroglossia. Polysomnography
group (p=0.013, with a medium effect size of Phi=0.39). showed a Respiratory Disturbance Index of 100.5 events/
Subjects who solved the problem in the Sleep group hour, with significant desaturation. Polysomnography for
presented more SWS in comparison to the ones who did continuous positive pressure titration (CPAP) determined
not solve the problem (p=0.01). No significant difference a fixed pressure of 15 cmH2O. After six months of
was found for control variables. In Experiment 2, TMR regular CPAP use, he has reported a decrease in ES, an
did not change the sleep effect on problem-solving: 55.6% improvement in eating episodes during sleep, and other
of subjects from the SWSstim group and 57.9% from the symptoms. Conclusions: It is essential in the evaluation
REMstim group solved the problem, while 57.1% from of OSA to consider other symptoms in addition to
the Wakestim group did so (p=0.86). No associations widespread respiratory complaints, as well as related
with sleep stages were found and there were no significant entities such as SRED and OSA-related headache.
differences in control variables. Conclusions: Sleep Palavras-chave: Obstructive Sleep Apnea; Sleep related eating disorder; Obstructive Sleep Apnea related headache

facilitates problem-solving. However, auditory TMR

during sleep does not provide additional benefits, neither ID: 886
TMR during SWS nor during REM sleep. Future studies Basic Research
may test varying protocols of TMR, which may produce
different results Timing of food intake and meal-sleep
relationships during pregnancy
Palavras-chave: Problem-solving; Active system consolidation; memory, insight; sleep,

ID: 881
Balieiro, L C T, Gontijo, C A, Teixeira, G P, Fahmy, W M, Maia,
Case Reports Y C d P, Crispim, C A

Department of Obstetrics, Hospital and Municipal Maternity of

Obstructive sleep apnea: far beyond sleepiness
Uberlandia - Uberlândia - Minas Gerais - Brasil, Federal University of
Sobreira, E S T, Pompeu, C M R, Bezerra, G A M, Sousa, J C V, Uberlandia - Uberlândia - Minas Gerais - Brasil
Muniz, C R, Damasceno, P G, Matos, I M, Caland-Noronha, A,
Introduction: Studies have suggested that timing of
Leite, C F, Sobreira-Neto, M A
food intake and meal-sleep relationships, particularly
eating close to sleep, plays a role in nutritional health, but
Introduction: Sleep related-eating disorder (SRED) this subject has not been sufficiently studied in pregnant
is a condition characterized by recurrent episodes of women. Aim: We analysed the relationship between
unconsciously eating during sleep, preferably by caloric timing of food intake and meal-sleep relationships in a
foods, and sometimes inedible items. Weight gain and prospective cohort study conducted with 100 pregnant
obesity are common adverse effects. Obstructive sleep women. Methods: Data were collected once per trimester:
apnea related headache (OSAH) is associated with the use

Sleep Sci. 2020;13(Supl.1):1-118

 94

≥12; 20th to 26th; and 30th to 37th weeks. Food intake so far, we have not found in the literature no studies using
was evaluated by three 24-Hour Dietary Recalls, which low power laser in OSA and snoring associated with BMT.
was used to assess the time of eating episodes. The Therefore, further studies are needed and that is why we
participants were asked to report usual bedtime, wake- started this research. Aim: The objective of this study is
up time, sleep-onset latency and usual sleep duration on to verify the effect of photobiomodulation on the speech
weekdays and weekends during the pregnancy. Meal-sleep therapy treatment for mild OSA and moderate snoring,
relationships were evaluated by the sleep end-first meal in a case study. Methods: SCGR patient, male, 53 years
and last meal-sleep onset. Pregnant women were classified old, polysomnography with AHI: 12.2 / h, moderate to
as early or late timing of first and last eating episodes high intermittent snoring, sleep efficiency 88.1%, N3:
if these values were below or above the median of the 30.2%, REM: 19.4%, minimum SaO2 82 % and Micro
population, respectively (first eating episode=8:38h; last Awakening Index at 17.7 / h. During sleep endoscopy,
eating episode=20:20h). Generalised Estimating Equation signs of previous nasal cavity surgery, multisegmental
models adjusted for confounders were used to determine pharyngeal collapse with anteroposterior predominance
the effects of timing - early or late - of the first and last in velopharyngeal and posterior laryngitis were found.
eating episodes (independent variable) on the meal-sleep The assessment and speech planning were based on the
relationships (dependent variables). Results: The timing reference of Diaféria et al 2013 and 2017. For orofacial
of food intake and meal-sleep relationships did not change myofunctional assessment, the modified mallampati index,
during pregnancy. The Late/Early and Late/Late groups the quality of life scale and the snoring analog scale were
showed a higher prevalence of skipping breakfast and considered. The speech therapy adapted to the patient
morning snacks, while the Early/Early and Late/Early addressed the lagged aspects of the evaluation, such as
groups present a higher prevalence of skipping night- adequacy of orofacial functions, combined with strength,
time snacks during pregnancy. The Early/Early group endurance and mobility exercises, to tone and rearrange
(Mean±Std.Error: 1:31±0:10) presented a smaller sleep the muscle groups of the oropharyngeal region, in
end-first meal interval compared to the Late/Early group addition to the use of laser and the ilib technique.Results:
(Mean±Std.Error: 2:18±0:14). In addition, the Late/Early The results suggest that the orofacial muscles acquired
group (Mean±Std.Error: 3:09±0:08) presented greater strength and tonicity, with greater mobility in the palatine
last meal-sleep onset than the pregnant women in the veil, tongue, and lateral and posterior pharyngeal regions,
Late/Early (Mean±Std.Error: 2:04±0:08) and Late/Late with a modified mallampati index reduction from 4 to
groups (Mean±Std.Error: 2:16±0:11). Conclusions: Our 1.5; the quality of life scale from 4 to 3.2 and the analog
results suggest that the timing of food intake and meal- snoring scale from 10 to 0. Conclusions: We conclude that
sleep relationships are new variables to be considered the effect of photobiomodulation associated with TMO
in nutritional guidelines in antenatal care to assist in potentiated the effect of short-term treatment, besides
promoting maternal-foetal health. providing improvement in sleep and sleep. patient’s well-
Palavras-chave: meal timing; eating late; sleep; pregnancy; chrononutrition
being. We consider photobiomodulation as an efficient
therapeutic resource and we hope that speech therapists
ID: 889 will research more about it.
Case Reports
Palavras-chave: Speech Therapy, Orofacial Myofunctional Therapy, Photobiomodulation, lib technique, Obstructive Sleep Apnea, Snoring

ID: 890
The effect of photobiomodulation on
orofacial myofunctional therapy in a patient Clinical Studies
with obstructive sleep apnea and moderate Influence of circadian patterns on emotional-
snoring: case report behavioral symptoms: a community study
Vieira, N M R, Diaferia, G
Carissimi, A, Martins, A C, Dresch, F, Zeni, C P, Hidalgo, M P
Consultorio particular - Sao Paulo - Sao Paulo - Brasil
Child and Adolescent Mood Disorders Program, University of Texas
Introduction: Orofacial Myofunctional Therapy (TMO) Health Science Center at Houston - Estados Unidos, Departamento de
performed by speech therapists in individuals with snoring Psiquiatria e Medicina Legal da Faculdade de Medicina, UFRGS - Porto
and Obstructive Sleep Apnea, has been consecrated in Alegre - Rio Grande do Sul - Brasil, Laboratório de Cronobiologia e
the scientific environment since 2009 by Guimarães, Sono do Hospital de Clínicas de Porto Alegre (HCPA), Universidade
K., 2012 by Diaféria, G., 2014 by Ieto, V. and in 2015 Federal do Rio Grande do Sul (UFRGS) - Porto Alegre - Rio Grande
by Kayamori, F. Already, photobiomodulation, is a new do Sul - Brasil, Programa de Pós-Graduação em Psiquiatria e Ciências
feature in Speech Therapy, in which the first work dates do Comportamento, UFRGS - Porto Alegre - Rio Grande do Sul -
from 2015 (França, FP, Coelho, JF and Alves, GAS) and Brasil

Sleep Sci. 2020;13(Supl.1):1-118

 95

Introduction: Disruption of the circadian system has Sleep Quality Index (IQSP), with scores greater than or
a negative impact on mental health. In addition, the equal to 5 considered suggestive of poor sleep quality.
focus of the studies has been on the effects of sleep The practice of physical activity was assessed by the
duration and sleep variability on emotional symptoms, International Physical Activity Questionnaire (IPAQ).
and few have evaluated the impact of circadian patterns. According to the IPAQ results, participants were
Aim: This study investigated the influence of circadian divided into 2 groups: Irregularly active group (IA-G),
sleep patterns on emotional and behavioral symptoms consisting of 17 participants classified as sedentary (n =
in a large community sample of Brazilian children and 2) and irregularly active (n = 15); and active group (A-G),
adolescents. Methods: This was a cross-sectional study consisting of 17 participants classified as regularly active.
of 454 school-aged children and adolescents (mean age The results between groups were compared by the Fisher’s
12.81±2.56 years; 58.6% female). The outcome, Clinical, test for qualitative variables and by Student’s test or Mann-
Borderline and Non-clinical behavior, was classified by Whitney test for quantitative variables (p<0.05).Results:
the Child Behavior Checklist. As factors, were considered It was observed that 65% of the IA-G participants and
school start time and circadian sleep parameters. Sleep 88% of the A-G were female. Regarding to the IQSP, it
parameters were assessed by self-reported sleep duration, was observed that the IA-G showed a significantly higher
bedtime and wake up time differences, sleep deficit, mean score than the A-G (8±4 and 5±3 points, respectively,
midpoint of sleep on weekdays and weekend, social jetlag p=0.004). Additionally, 82% of the IA-G participants had
and the Morningness-Eveningness Questionnaire. This a score suggestive of poor sleep quality, compared to 59%
study was performed according to international ethical of the A-G participants (p=0,274). Conclusions: The
guidelines (protocol number #12-0386 GPPG/HCPA). results suggest that the practice of physical activity can
Results: Students with a morning school start time and help to preserve sleep quality in elderly individuals. Thus,
classified as clinical group had shorter duration of sleep it is suggested that new researches should be carried out in
and earlier circadian sleep patterns. In a binary logistic order to promote the awareness of the population about
regression model, the variables that predicted emotional the benefit of physical activity.
and behavioral symptoms were older age, earlier midpoint Palavras-chave: Elderly; Physical Activity; Sleep Quality

of sleep on weekdays, shorter sleep duration on weekdays

and morning school start time. Conclusions: These ID: 892
findings emphasize the importance of circadian sleep Clinical Studies
patterns and the effects of school start time on emotional
and behavioral symptoms in children and adolescents. Prevalence of obstructive sleep apnea in obese
patients evaluated for bariatric surgery
Palavras-chave: child and adolescent psychiatry; sleep; behavior; chronobiology; circadian rhythm.

ID: 891
Rocha, M F L, Silva, W R, Fernandes, L G G, Rocha, V C, Lima,
Clinical Studies P V, Coelho, J A P d M, Mota, B R, Gitaí, L L G

Centro de Tratamento de Obesidade Dr.Bruno Mota - Maceió -

Does the practice of physical activity in the
Alagoas - Brasil, Faculdade de Medicina da Universidade Federal de
elderly preserve sleep quality Alagoas - Maceió - Alagoas - Brasil, Ssonoclin - Clínica de Medicina do
Sono - Maceió - Alagoas - Brasil
Brizola, L F P, da Cruz, M B, Correa, C d C, Weber, S A T,
Campos, L D Introduction: Obesity has reached epidemic levels
Faculdade Marechal Rondon - São Manuel - Sao Paulo - Brasil, globally and is a strong predictor of overall mortality and
Universidade Anhanguera UNIDERP - Campo Grande - Mato Grosso directly associated with the presence of comorbidities
do Sul - Brasil, Universidade de Brasília - Brasília - Distrito Federal such as diabetes, dyslipidemia and obstructive sleep apnea
- Brasil, Universidade Estadual Paulista Julio de Mesquita Filho - (OSA). Bariatric surgery should be provided as an option
Botucatu - Sao Paulo - Brasil to patients with morbid obesity for whom the procedure
induces weight loss and improves weight-related
Introduction: Elder individuals commonly complain of comorbidities. As untreated OSA seems to increase the
sleep problems. Changing habits, as practice of physical overall surgery-associated risk, screening for OSA prior to
activity, may improve sleep quality. Aim: The present study bariatric surgery has been recommended. Aim: The aim
aimed to evaluate the influence of physical activity on the of this study is to determine the prevalence and severity
sleep quality in elderly. Methods: 34 elderly individuals, of undiagnosed OSA in a population of patients evaluated
both genders, mean age of 70±6 years were prospectively for bariatric surgery. Methods: Consecutive obese patients
assessed. Individuals who used sleep-inducing drugs were evaluated for bariatric surgery from August 2018 to August
not included. Sleep quality was assessed by the Pittsburgh 2019 underwent a standard overnight polysomnography

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 96

(PSG) at a sleep study center. Each sleep study included volunteers underwent blood sample collection for lipid
supervised electroencephalography, electrooculography, profile analysis (Blood samples were collected for Hcy,
electrocardiography, oxygen saturation, oral and nasal total cholesterol, HDL, LDL, triglycerides) and filled out
airflow, respiratory effort monitoring, and submental and a set of sleep-related questionnaires (Pittsburgh Sleep
tibial electromyography. Evaluation and interpretation Quality Index, Insomnia Severity Index and Epworth
of the PSG followed the American Society of Sleep Sleepiness Scale were used). Women were classified as
Medicine criteria (version 2.5). Inclusion criteria included recent or late postmenopause according to the time of
age > 18 years and a body mass index (BMI) > 30 kg/ amenorrhea. Less than eight years recent. More than
m2. Exclusion criteria included a previous diagnosis of eight years late. The GzLM (Generalized Linear Model)
OSA and incomplete data.Results: The analysis sample was used to verify the association between the different
included 112 patients (83% female) with an average age variables. Dependent variables were used in binominal and
of 36.1 ± 9.4 (range = 18–63) and an average BMI of gama distribution when needed. Study approved by the
36.7 ± 2.3 (range = 32–42.3). More than two-thirds of Ethics Committee (CEP #0593/06) and registered with
the sample (77.7%) had OSA and nearly half had severe ClinicalTrials.gov (NCT00596713).Results: The sample
OSA (40.2%). Among female patients, average age was consisted of 193 postmenopausal women, with a mean
35.8 ± 9.2 (range=18-63), average BMI was 36.5 ± 2.1 age of 58 years (SD ± 9). The prevalence of Hhcy in this
(range=32-42.3) and 74.2% had OSA and 33.3% had sample was 4.7%, while 14.7% had dyslipidemia 22.8%
moderate to severe OSA. Among male patients, average with hypertriglyceridemia and 29% with low HDL levels.
age was 37.5 ± 10.3 (range=20-58), average BMI was 37.7 There was an association between Hcy and HDL. There
± 2.5 (range=33-42.1) and 94.7% had OSA and 73.7% was no association between Hcy and hot flushes, Hcy and
had moderate to severe OSA. Male gender was associated LDL, nor with Hcy and sleep parameters. Conclusions:
a higher prevalence of moderate to severe OSA(p=0.001). The studied population presented low prevalence of
Conclusions: OSA is highly prevalent in obese patients Hhcy and there was no association between Hcy and sleep
evaluated for bariatric surgery, particularly in male subjects. parameters. Acknowledgments: to funding agencies,
Palavras-chave: Obstructive sleep apnea; Bariatric Surgery; Obesity
CAPES, AFIP.
Palavras-chave: Menopause; Postmenopause; Homocysteine; Women; Sleep

ID: 893
ID: 896
Clinical Studies
Clinical Studies
Association between Homocysteine and sleep
in postmenopausal women Sleep disorders in elderly of long-term care
institution in northeast Brazil
Banzoli, C V, Bezerra, A G, DAlmeida, V, Pires, G N, Andersen,
M L, Tufik, S, Hachul, H Braga, I L S, de Matos, J C P, Castelo Filho, J, Oliveira, L C,
Silvestre, P P, Parente, T A, Joventino, C B, Galvão, N G, de
Santa Casa de São Paulo School of Medical Sciences - São Paulo - Sao
Barros, L S, Sobreira-Neto, M A
Paulo - Brasil
UNIVERSIDADE DE FORTALEZA - FORTALEZA - Ceara - Brasil
Introduction: Homocysteine (Hcy) is a sulfur amino acid,
considered as an independent risk factor for cardiovascular Introduction: Sleep disorders increase the risk of
disease. Excessive Hcy directly harms the endothelium and institutionalization, as the prevalence of sleep problems in
can lead to premature atherosclerosis, with progression to institutionalized older adults is high. Factors that contribute
stroke and acute myocardial infarction. One of the causes to sleep impairment in long-term care institution (LTCI)
of hyperhomocysteinemia (Hhcy) is hypoestrogenism. residents include changes related to age, the presence of
Low estrogen levels increase the cardiovascular risk as sleep disorders, dementia, depression, various medical
well as the occurrence of sleep disorders. Hhcy prevalence illnesses, as well as polypharmacy, institutional and
varies by population and its occurrence in postmenopausal environmental factors. Aim: This study aimed to verify
women in Brazil is unknown. Aim: To evaluate the if the sleep-related problems in the LTCI elderly at an
prevalence of Hhcy in postmenopausal women in the underdeveloped country have a higher prevalence than the
city of São Paulo, as well as to evaluate the association general population. Besides this, we checked the possible
of Hcy levels with lipid profile, hot flushes and subjective association of sleep disorders with the different variables
sleep parameters. Methods: This research is part of the related to institutionalization. Methods: A cross-sectional,
São Paulo Sleep Epidemiological Study (EPISONO), a observational study was carried out with institutionalized
population-based cross-sectional trial that included 1,042 elderly at the Lar Torres de Melo institution, located in
volunteers living in the city of São Paulo in 2007. All the city of Fortaleza, Ceará, Brazil. The control group

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 97

consisted of healthy elderly, matched by sex and age, from (3.33%) patient has good sleep quality. After treatment,
groups of older people in different parts of the city. We according to the index, no patient showed improvement
included a total of 208 participants. The study lasted 11 in PSQI_BR, 9 (90%) patients, decreased PCS index, 8
months, from June 2018 to May 2019.Results: LTCI (80%) patients had decreased OHIP-14 index, 05 (50%)
patients presented lower values on the Epworth sleepiness patients. obtained clinical improvement according to pain
scale, Bang STOP, and abdominal circumference in scale. Conclusions: TMD patients have poor sleep quality.
comparison to the control group. The LTCI elderly were TMD patients in this study did not show changes in sleep
more limited, used antidepressants more frequently, and quality after conservative treatment. This study suggests
had a higher prevalence of dementia in comparison to the that individuals with TMD should be investigated about
control group. We did not observe significant differences their sleep quality in order to establish an interdisciplinary
in the other variables. Conclusions: Institutionalization, treatment program between these two conditions in order
by itself, did not increase the frequency of problems to achieve satisfactory remission of symptoms.
related to sleep, as long as the elderly are attended and Palavras-chave: Temporomandibular disorders, sleep quality, Conservative treatment

adequately treated.
Palavras-chave: Sleep Disorders, Intrinsic; Nursing Homes; Aging
ID: 900

ID: 898 Clinical Studies

Clinical Studies Pulmonary Function predict success in apnea-

hipopnea index
Sleep quality index in temporomandibular
disorder patients submitted to conservative Soares, C F P, Silva, N G, Taglietti, M, Masson, D
treatment Centro Universitário Fundação Assis Gurgacz - cascavel - Parana -
Brasil
Hoyuela, C P, Lalue Sanches, M, Jennings, F, Natour, J
Introduction: The obesity impacts on respiratory
Disciplina de Reumatologia e Disciplina de Morfologia e Genética -
function, being also a risk factor for obstructive sleep
Universidade Federal de São Paulo - São Paulo - São Paulo - Brasil
apnea (OSA). Bariatric surgery has being proposed for
Introduction: Temporomandibular Disorders (TMD) treatment of severe obesity and impacts with improve
is a collective term embracing a number of medical and OSA, through decrease in apnea-hipopnea index
dental conditions affecting the temporomandibular joints, (AHI). The role of respiratory function in this complex
masticatory muscles and contiguous tissue components. relation between OSA and obesity still object of study.
They are the most common cause of non-dental pain in Aim: This study aims to describe preliminary results of
the orofacial region. The etiology of TMD is complex, polysomnograms changes after bariatric surgery, and
multifactorial, and consistent with the biopsychosocial appoint possible predictable variables of respiratory
model of illness. As sleep disorders are a frequent function and polyssomnographic data that influence on
manifestation in diseases where pain plays an important the OSA improvement. Methods: Prospective study,
role, in the management of patients with painful with consecutive volunteers, who agree to participate in
manifestations, sleep quality should be evaluated. Aim: To the study and perform pre-operative Spirometry, Maximal
evaluate the subjective quality of sleep in conservatively inspiratory pressure (MIP), maximum expiratory pressure
treated TMD patients. Methods: Thirty female individuals (MEP), full-night Polysomnography and body mass Index
with a mean age of 41.3 years with a diagnosis of TMD (BMI) measure. The AHI variance was analysed through
(according to the validated Research Diagnostic Criteria t-test paired and multiple regression was performed to
for Temporomandibular Disorders) were analyzed. They predict the variables involved in this variance.Results:
also answered the PSQI-BR questionnaire (Brazilian Thirteen patients, 84.6% female. Mean (SD) age of
version of the Pittsburgh Sleep Quality Index), which aims 45.2(9.5) years, BMI 44.1(5.2) kg/m2, and pre-operative
to measure the subjective quality of sleep. Ten patients AHI 46.9 (38.6) events/hour, a mean AIH reduction
were submitted to conservative treatment and evaluated was 30.1 (25.8; p= 0.0012) .The means for respiratory
by blind evaluator for six months and completed the capacity was: porcentage of forced expiratory volume
questionnaires, PSQI-BR, OHIP-14 (Brazilian version of (VEF1) = 95.5% (5.7); Forced vital capacity (FVC) = 67%
the short-form of the oral health impact profile), B-PCS (19.8); MIP = 103.1 (25.6) and MAP = 97.7 (26.5). The
(Brazilian version of the pain Catastrophizing Scale ) and multiple regression showed that the pre-operative AHI
visual analogue scale at the beginning and end of treatment. were independently associated with the improvements in
Results: In 20 (66.6%) patients the quality of sleep is AHIConclusions: In this study, a significant reduction in
poor, 9 (30%) patients present sleep disturbance and 1 the number of events/hour in AHI was obntained with

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 98

bariatric surgery. The analysis has shown that preoperative (-4.2 to 12.7) vs. -13.2 (-22.7 to -7) events/h; p=0.001).
AHI was the only independent predictor for this remission The frequency of moderate to severe OSA (AHI (≥15
and none pulmonary function influenced. events/h) at baseline was 62.5% in the RYGB group vs.
Palavras-chave: Pulmonary Function; Apnea-Hipopnea Index; Obstructive Sleep Apnea; Obesity; Bariatric Surgery;
46.2% in the OCT group; p=0.175. After the procedure,
only 8.3% has moderate OSA (none with severe OSA) in
ID: 904 the RYGB group vs 69.3% in the OCT group; p< 0.001.
Clinical Studies Consistently, the frequency of excessive daytime sleepiness
did not showed significantly differences at baseline but
Long-term effects of bariatric surgery on lower rate in the RYGB group (20.8 vs. 69.2%); p< 0.006
obstructive sleep apnea in patients with grade . Conclusions: In this sub analysis from Gateway study,
bariatric surgery is an effective strategy for decrease long-
1 and grade 2 obesity: a sub analysis from term OSA severity in patients with obesity grade 1 or 2.
GATEWAY study Palavras-chave: obstructive sleep apnea, body mass index, bariatric surgery

Furlan, SF, Drager, L F, Martins, F C, Santucci, E V, Santos, R H ID: 905

N, Damiani, L, Lorenzi-Filho, G, Cavalcante, A B, Schiavon, C A

Laboratório de Pneumologia e Instituto do Coração - Hospital das Clinical Studies

Clínicas - Faculdade de Medicina - Universidade de São Paulo - São Temporal trends in Polysomnography Request
Paulo - São Paulo - Brazil
by Specialties in a Large Private Service in
Introduction: Obesity is a well-established risk factor for Brazil: the Importance of Cardiology in OSA
obstructive sleep apnea (OSA). Weight loss is associated
with OSA severity improvement. In this scenario, diagnosis
bariatric surgery may be an effective therapy for OSA in
Furlan, S F, Campos, B A, Pintão, M C T, Smanio, P E P, Drager,
obese patients. Previous evidence (most observational)
L F, Alves, R S C
is limited by short-term analysis in obese grade 3. Here,
we hypothesized that Roux-en-Y gastric bypass (RYGB) Laboratório de Pneumologia e Instituto do Coração - Hospital das
surgery has a long-term effect in the OSA severity in obese Clínicas - Faculdade de Medicina - Universidade de São Paulo - São
grade 1 or 2 patients. Aim: Here, we hypothesized that Paulo - São Paulo - Brazil
Roux-en-Y gastric bypass (RYGB) surgery has a long-term
effect in the OSA severity in obese grade 1 or 2 patients Introduction: In the last decades, Obstructive Sleep Apnea
and we aim to verify this hypothesisMethods: This is (OSA) has gained growing interest in the cardiovascular
a sub analysis of the GATEWAY study (Schiavon et al. field by the evidence linking OSA with hypertension, atrial
Circulation 2018), a randomized controlled clinical trial fibrillation, coronary artery disease, congestive heart failure
addressing the impact of RYGB on blood pressure (BP) and stroke. The translation of the scientific evidence into
control in obese patients with body mass index (BMI) clinical practice is challenging, especially in nontraditional
<40Kg/m2; Patients were randomly allocated to receive sleeprelated areas such as in Cardiology. The lack of formal
either RYGB plus optimized clinical treatment (OCT) training in sleep medicine, medical inertia and the recent
or OCT treatment alone. During the ongoing trial, a neutral results from large randomized trials addressing
subsample of patients was invited to perform portable the impact of OSA treatment on cardiovascular disease
sleep monitoring (Embletta GoldTM) before and after may influence the OSA awareness in the Cardiology
3 years follow-up. OSA was defined in mild (apnea- setting. Aim: Here, we tested this concept evaluating the
hypopnea-index, AHI 5-14.9 events/h), moderate (15- temporal trend (11 years) of polysomnography (PSG)
29.9 events/h) and severe (≥30 events/h) forms. We also requesting from different specialties from a large private
evaluated excessive daytime sleepiness (>10 points) by service of sleep medicine in Brazil. Methods: This is a
Epworth Sleepiness Scale. All analyses were performed in retrospective study conducted by the FleuryTM group
a blinded fashion. Results: A total of 37 patients (n=24 from 2008 to 2018. We revised all PSG performed at
allocated in the RYGB group and n=13 in the OCT group) this 10 years period checking the medical specialty (based
were studied in this sub-analysis (83.7% female, mean age: on the medical license number and database from the
42±8 years and BMI: 36.7 (35.8-38.5) Kg/m2. Compared service) who requested the sleep study. For each year,
to the OTC group, RYGB presented a significant decrease we measured the percentage of PSG exams requested by
in BMI (1.7 (-1.9 to 2.7 vs -10.6 (-12.7 to -9.2 ) Kg/m2; each specialty.Results: During this period, a number of
p< 0.001), neck circumference (- 1.5 (-2.5 to 2) vs. -7.5 16.670 PSG were performed at the FleuryTM. Beyond
(-10.5 to -4.8 cm; p< 0.001), waist circumference (3 (-3 the expected role of a sleep-related specialty in requesting
to 9) vs. - 25 (-30.8 to -20) cm; p< 0.001) and AHI (5 PSG (Otorhinolaryngology was the top one with 29% of
the total requests), Cardiology was surprisingly the second

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 99

most PSG requesting (16%), followed by Neurology (8%), strong trend for higher decrease in the OSA versus no
Endocrinology (8%) and Internal Medicine (5%). In the OSA subjects (-5.4 ±15.9 vs. -2.03±21.3 mL/min/1.73m2;
temporal trend analysis, we observed a huge increase p=0.053). The incidence of CKD was higher in the OSA
of PSG requesting by Cardiologists from 2009 to 2013 group (from 82.9 to 91.4%) as compared to no OSA (from
(2009:+7%, 2010: +22%, 2011: +59%, 2012: +11%, 62.2 to 65%; p=0.05). Conclusions: OSA is associated
2013: +30% as compared to 2008). From 2014 to 2018 we with higher CKD incidence in patients who recovered
observed an oscillatory pattern, but Cardiology specialties from an ACPE episode. This finding may partially explain
remained in the second position during the whole period. the poor prognosis of patients with OSA who recovered
Conclusions: Despite the aforementioned barriers for from a previous ACPE.
OSA awareness in the Cardiology setting, Cardiologists Palavras-chave: Obstructive sleep apnea, renal function, cardiovascular disease

in Brazil may have an important role for triggering

sleep studies for OSA diagnosis. Considering the huge ID: 908
frequency of OSA among the cardiovascular diseases, Clinical Studies
continuous efforts for provide formal training in sleep
medicine in Cardiology may be useful for decreasing OSA Awareness for OSA diagnosis in a tertiary
underdiagnosis in clinical practice. cardiology center: a temporal survey
Palavras-chave: obstructive sleep apnea, sleep medicine, cardiologists, polysomnography

ID: 906 Furlan, S F, Costa, L E, Sinkunas, V, Alves, R S C, Pintão, M C,

Campos, B A, Lorenzi-Filho, G, Drager, L F
Clinical Studies Laboratório de Pneumologia e Instituto do Coração - Hospital das
Clínicas - Faculdade de Medicina - Universidade de São Paulo - São
The impact of Obstructive Sleep Apnea on
Paulo - São Paulo - Brazil
Chronic Kidney Disease Incidence after
Acute Cardiogenic Pulmonary Edema: A sub- Introduction: Despite the advancements on the evidence
pointing the high frequency and potential cardiovascular
analysis of OSA-CARE study.
(CV) impact of Obstructive Sleep Apnea (OSA), the
Furlan, S F, de Macedo, T A, Geovanini, G, Junior, M T,
sub diagnosis and overall acceptance of OSA among
Bortolloto, L A, Lorenzi-Filho, G, Drager, L F
cardiologists may vary. This scenario may be exacerbated by
the poor accuracy of sleep questionnaires in the Cardiology
Laboratório de Pneumologia e Instituto do Coração - Hospital das setting and the neutral CV results of OSA treatment from
Clínicas - Faculdade de Medicina - Universidade de São Paulo - São recent randomized controlled trials (RCTs) in patients with
Paulo - São Paulo - Brazil high CV risk. Aim: Evaluate the awareness and relevance
of OSA as a CV risk factor decreased overtime. Methods:
Introduction: Recent evidence suggests that obstructive
We applied a survey for staff physicians and physicians in
sleep apnea (OSA) is associated with higher rate of acute
training (residents) from the Cardiology Division at the
cardiogenic pulmonary edema (ACPE) recurrence but
Heart Institute (InCor). This survey was applied twice for
whether OSA may impair the renal function in these
the medical staff and once for each residence team that
patients is not clear. Aim: Evaluate whether OSA may
rotated in 2014 and 2019 in our Institution and comprised
impair the renal function in patients with ACPE after
questions addressing the availability of sleep medicine
one year follow upMethods: We recruited consecutive
classes during medical graduation, importance of OSA
cases with confirmed ACPE from the Emergency Unit
as a CV risk factor, number of consultations per month
Department at Heart Institute (InCor). After usual
vs number of diagnostic suspicious of OSA as well as
treatments for ACPE and clinical stabilization (~30 days),
knowledge and clinical applicability of OSA screening
all patients were invited to perform a portable sleep
methods (Berlin Questionnaire).Results: We applied the
monitoring (Embletta GoldTM). OSA was defined by
survey twice for 77 physicians. Of them 32.5% were staff
an apnea-hypopnea-index (AHI) ≥15 events/hour. We
physicians and 67.5% were residents. On average, the
estimated the glomerular filtration rate (eGFR) using
Cardiologists reported a mean number of consultations
the Chronic Kidney Disease: Epidemiology Consortium
in the last month of 153±89 and 176±118 patients per
(CKD-EPI) equations. We calculated the incidence of
month but only a mean number of suspected diagnoses
chronic kidney disease (CKD), defined by an eGFR <
of OSA of 6±9 and 6±8 in 2014 and 2019, respectively.
60mL/min/1.73m2 after one year follow up. Results: A
Interestingly, the vast majority of them considered OSA
total of 55 patients were studied in this sub-analysis (40%
a CV risk factor and the percentages did not significantly
males, mean age: 67±11 years and body mass index [BMI]
change overtime (from 97.4% in 2014 to 94.7% in
27.1(24.6-31.2) Kg/m2. The frequency of OSA was
2019, P=0.44). Regarding the questions about sleep, we
63.6%. Compared to the baseline, the eGFR presented a

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 100

found that 14.3% of them asked about snore in 2014 latter variable was used only for BP endpoint); Model 3:
vs 76.3% of them in 2019 (p< 0.001). In contrast, we model 2 + subjective insomnia and sleep efficiency; Model
observed a significant decrease in using OSA screening 4: model 3 + OSA.Results: We studied 2,010 participants
questionnaires (from 80.5% in 2014 to 23.7% in 2019, (age 49±8 years; BMI: 27.1±4.7Kg/m2, 42.6% of men).
P< 0.001). We did not find any difference through the The frequency of subjective SD <5hs, 5-6hs, 6-7hs, and
years regarding their self evaluation about knowledge >7hs were 4.0, 43.3, 30.2, and 22.4%, respectively. The
of sleep medicineConclusions: the vast majority of frequency of objective SD <5hs, 5-6hs, 6-7hs, and >7hs
the Cardiologists consider OSA as a CV risk factor but were 5.5, 21.8, 41.4 and 31.3%, respectively. OSA was
the sleep medicine field still remains largely unknown observed in 658 participants (32.7%). The frequency of
among them. We observed a significant decrease in the HTN was 26.1 % (525 participants). Participants with both
use of sleep questionnaires in the last five years (probably subjective and objective SD<5hs had a higher frequency
reflecting evidence showing low accuracy of these tolls in of HTN than the remaining groups. Consistently, systolic
screening OSA in the Cardiology setting). and diastolic BP values were higher in the objective
Palavras-chave: Obstructive sleep apnea, cardiology, risk factors
SD<5hs group. In the fully adjusted multivariate analysis,
no single SD category (for subjective or objective data)
ID: 909 was independently associated with HTN or BP values.
Clinical Studies Conclusions: Both subjective and objective SD are not
associated with HTN and BP levels in the ELSA-Brasil
Association of Short Sleep Duration and cohort.
Hypertension: The ELSA-Brasil study
Palavras-chave: obstructive sleep apnea, sleep duration, hypertension.

ID: 913
Parise, B K, Mesas, A E, Santos, R B, Silva, W A, Souza, S P,
Giatti, S, Bortolotto, L A, Lotufo, P A, Bensenor, I M, Drager, L F Clinical Studies
Center of Clinical and Epidemiologic Research - São Paulo - Sao Paulo
Association between Obstructive Sleep Apnea
- Brasil, Heart Institute - University of São Paulo - São Paulo - Sao
Paulo - Brasil, Hypertension Unit and Renal Division - University of
and Arterial Stiffness: data from the ELSA-
São Paulo - São Paulo - Sao Paulo - Brasil Brasil cohort
Introduction: Short sleep duration (SD) has been Cunha, L F, Santos, R B, Silva, W A, Aiello, A N, Giatti, S, Parise,
associated with hypertension (HTN). However, most of B K, Souza, S P, Lotufo, P A, Bensenor, I M, Drager, L F
these studies evaluated SD in a subjective way and did not
Center of Clinical and Epidemiologic Research - SAO PAULO - Sao
explore the potential influence of another sleep disorder,
Paulo - Brasil, Heart Institute - São Paulo - Sao Paulo - Brasil, Renal
namely obstructive sleep apnea (OSA). Aim: To explore the
Division and Hypertension Unit - São Paulo - Sao Paulo - Brasil
association of subjective and objective SD with prevalent
HTN and blood pressure (BP) levels in the ELSA- Introduction: Arterial stiffness is an independent marker
Brasil study, a cohort of adult civil servants. Methods: for cardiovascular disease. Several factors may contribute
Consecutive participants performed a clinical evaluation to increase arterial stiffness such as age, smoking, diabetes
including data on subjective SD. For capturing objective and high blood pressure. Growing evidence suggest that
SD, we used pulse actigraphy for 1 week (Actiwatch 2TM). Obstructive Sleep Apnea (OSA) may also contribute to
A home portable sleep monitor (Embletta GoldTM) for increase arterial stiffness but the following issues remain
one night was used to evaluate the presence of OSA. The unclear: 1) Is mild OSA associated with increased arterial
SD was stratified in the following categories: <5hs, 5-6hs, stiffness?; 2) Does sleep duration modulate the association
6-7hs (reference group) and >7hs. OSA was defined by of OSA with arterial stiffness?Aim: The study aimed to
an apnea-hypopnea index ≥15 events/hour. BP was compare a validated marker of arterial stiffness, namely
measured 3 times in the seated position after 5 minutes pulse wave velocity (PWV), in participants without OSA
of rest (the mean of two last measurements were used for (no-OSA; apnea-hypopnea index, AHI, <5 events/h),
the analysis). HTN was defined by a BP ≥140x90mmHg mild OSA (AHI 5-14.9 events/h) and moderate/severe
or previous use of antihypertensive medications. OSA (AHI ≥15 events/h), adjusting for common
A multivariate analysis was used to determine the cardiovascular risk factors and objective sleep duration.
independent associations of the SD categories with HTN Methods: Participants from the ELSA-Brasil cohort (Sao
(primary endpoint) and BP values (secondary endpoints). Paulo center) were included in this study. The participants
We built 4 models of adjustments: Model 1: unadjusted; performed sleep assessments with portable polygraph
Model 2: adjusted for age, gender, race, body mass index (Embletta GoldTM) and 7-days of wrist actigraphy
(BMI), alcoholism, and antihypertensive medications (the (Actiwatch 2TM). Common carotid artery and femoral

Sleep Sci. 2020;13(Supl.1):1-118

 101

artery pressure waveforms were recorded noninvasively clinic at a University Hospital, who were referred for PR,
by using a pressure-sensitive transducer (Complior, were randomized to receive 3 mg MLT (n = 18) or placebo
Arthech Medicale, France). The final PWV value was (n = 21) for the duration of the PR program (12 weeks).
obtained by the arithmetic average of 10 consecutive At baseline, sleep quality was assessed subjectively by the
cardiac cycles in regular rhythm. The analysis was adjusted Pittsburgh Sleep Quality Index (PSQI) and objectively
for the following risk factors: age, gender, education, body by actigraphy for 7 consecutive days. Daytime sleepiness
mass index, hypertension, diabetes, LDL-cholesterol, was measured by the Epworth Sleepiness Scale (ESS). All
HDL-cholesterol, smoking, alcoholism and objective patients filled a Two Week Sleep Diary. Measures were
sleep duration.Results: The sample consisted of 1,993 repeated at the end of the PR program for comparison.
participants (mean age 49±8 years, 57% female). There Results: On average, patients who received MLT, but
was a significant linear trend for increasing PWV across not placebo, showed a significant improvement in PSQI
no-OSA (n=603), mild (n=746), and moderate/severe global score (respectively, 9.44 ± 4.47 – 4.39 ± 1.88; p <
OSA (n=644) (P for trend <0.001). The estimated mean 0.05 vs 7.86 ± 2.97 - 7.62 ± 2.55 p = 0.6). A reduction
PWV after adjustment for confounding factors for no- in the EES score was observed only for the MLT group
OSA, mild and moderate/severe groups were 9.63 (95% (respectively, 9.1 ± 6.0 - 6.7 ± 4.5; p = 0.02 vs 10.1 ± 5.0 -
CI: 9.43, -9.84), 9.90 (95% CI: 9.71, 10.08) and 10.12 9.5 ± 5.1; p = 0.2). Data obtained from sleep diary showed
m/s (95% CI: 9.94, 10.30), respectively. In the analysis of an increase in total sleep time (329.1±667.0 - 391.9±73.0;
post-hoc differences adjusted for multiple comparisons p<0.05) and sleep efficiency (80.64 ± 9 – 87.44 ± 6.7;
using the Sidak method, there were significant differences p<0.05) and a reduction in sleep onset latency (-27.40
between all three groups (no-OSA vs mild and moderate/ minutes; p < 0.05) in patients who received MLT, but
severe groups, and mild vs moderate/severe groups, not placebo. Actigraphy showed a significant increase in
p<0.05). Conclusions: In this large cohort, all kinds of sleep effciency (68.5 ± 14.1 – 80.3 ± 12.9; p<0.05) for
OSA severity (from mild to severe OSA) contributed to the MLT group, despite no changes in sleep latency or
increase PWV regardless of traditional risk factors and duration. Conclusions: Melatonin supplementation 3 mg
objective sleep duration. over a 12-week period can reduce daytime sleepiness and
Palavras-chave: obstructive sleep apnea, sleep duration, pulse wave velocity and arterial stiffness.
improve subjective sleep quality as well as some aspects of
objective sleep quality in patients with COPD undergoing
ID: 915 pulmonary rehabilitation.
Clinical Studies
Palavras-chave: COPD, melatonin, sleep, pulmonary rehabilitation, actigraphy

ID: 917
Effects of oral melatonin associated with
pulmonary rehabilitation on sleep quality and Clinical Studies
daytime sleepiness in COPD Duration and quality of sleep associated with
Souza, C V, Viana, S M N R, Bruin, V M S, Bruin, P F C, Farias, food consumption among overweight night
T A R, Rego, O M V, Viana, G d N R workers
Universidade Federal do Ceará - Fortaleza - Ceara - Brasil
Rodrigues, G H, Duarte, A S, Garrido, A L F, Santana, P T,
Introduction: Sleep problems are common in COPD. Nogueira, L F R, Pellegrino, P, Cipolla-Neto, J, Moreno, C R C,
Melatonin (MLT), the main product of the pineal Marqueze, E C
gland, is central to circadian rhythm regulation and its 1Department of Epidemiology, Public Health Graduate Program,
administration reportedly improves sleep in COPD. MLT Catholic University of Santos - Santos - Sao Paulo - Brasil, 2Department
has also been shown to improve lung oxidative stress in of Health, Life Cycles and Society, School of Public Health, University
these patients. Pulmonary rehabilitation (PR) can increase of São Paulo - São Paulo - Sao Paulo - Brasil, 3Stress Research Institute,
exercise tolerance and quality of life and reduce symptoms University of Stockholm, Sweden - Suécia
but it is still unclear if it can improve sleep in patients with
COPD. We hypothesized that concomitant administration Introduction: Short sleep duration and poor sleep quality
of MLT could potentialize benefitial effects of PR. have been associated with inadequate food intake among
Aim: To investigate the effects of oral MLT (3 mg/day) night shift workers and may contribute to overweight.
associated with pulmonary rehabilitation for 12 weeks on Aim: To evaluate the association between sleep duration
sleep quality and daytime sleepiness in COPD. Methods: and sleep quality with food intake among overweight
This was a double-blind, randomized, placebo-controlled night workers, according work day and one day off.
trial. Thirty-nine patients [24 males; mean age (±SD) = Methods: We performed a double-blind randomized
66.6±10,4 years] regularly attending a COPD outpatient clinical crossover trial.The present study used only data
extracted from the baseline, performed with 39 overweight

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nursing professionals who worked permanent night performed with 43 overweight nursing professionals
shifts. Calories and macronutrients intake were assessed who worked permanent night shifts. Self-reported
by food diaries (from 19:00 to 19:00 h) on one work day mild emotional disorders (mild depression, tension and
and one day off. Self-reported sleep quality was taken anxiety) were taken from the Work Ability Index and self-
from a single question of the Pittsburgh Sleep Quality reported sleep quality was taken from a single question
Index and overall sleep duration was calculated from of the Pittsburgh Sleep Quality Index.Results: The mean
the Munich ChronoType Questionnaire (MCTQshift). age of participants was 39.8 years (SD=6.3 years), most
Results: The mean age of the participants was 39.2 years were nursing technicians (51.2%), married (65.1%), with
(SE=0.9 years). Most of them were nurses (51.3%) and mean hospital working time of 8.3 years (SD=4.5 years)
married (64.1%). A total of 43.6% reported poor sleep and night shift of 5.6 years (SD=3.8 years). A total of
quality and 20.5% had short sleep duration (<5 hours). 25.6% of participants reported mild emotional disorders
The mean time working in the current night shift was 5.6 and 44.2% perceived their sleep quality as poor or very
years (SE=0.6 years). On the working day, there was lower poor. It was verified that a higher proportion of those
protein intake (65.8g, SE=8.2g) among those with poor who reported no mild emotional disorders had good
sleep quality compared to those who reported good sleep sleep quality (59.4%) compared to those who had poor
quality (88.9g, SE=7.2g). There was a tendency of lower sleep quality (6.3%). Among those who reported mild
carbohydrate consumption, on the working day, among emotional disorders, a higher proportion of poor sleep
those who slept < 5h (166.4g, SE=32g) and reported poor quality (36.4%) was observed compared to those with
sleep quality (189.3g, SE=22g) compared to those who good sleep quality (27.3%). Conclusions: Mild emotional
slept ≥5h (232.1g, SE=16.3g) and reported good sleep disturbances were proportionally higher among the
quality (241,3g, SE=19,3g). There was no association participants with poor sleep quality. It’s noteworthy that
between total calories and fat consumption with the night work can be determinant in this binomial between
aspects of sleep on the working day. No association was the presence of emotional disorders and the poor sleep
verified among the variables on the day off. Conclusions: quality, signalizing that preventive measures and strategies
A lower carbohydrate and protein intake was observed are required in order to improve emotional health and
on the workday among the participants with short sleep sleep patterns among these workers.
duration and poor sleep quality, so these aspects of sleep Palavras-chave: Emotional disorders; Sleep quality; Nursing.

did not impair the dietary pattern of these macronutrients.

Palavras-chave: Food Consumption; Night work; Nursing; Nutrition; Public Health Nutrition.
ID: 919

ID: 918 Clinical Studies

Clinical Studies Polysomnographic findings on obese patients

submitted to bariatric surgery
Emotional disorders and poor sleep quality
among night workers BARRETO, D M, Fernandes, V M, Pithon, K R, Miranda, J F,
Rocha, G R
Garrido, A L F, Duarte, A S, Rodrigues, G H, Santana, P T,
Universidade Estadual do Sudoeste da Bahia - Vitória da Conquista -
Nogueira, L F R, Pellegrino, P, Cipolla-Neto, J, Moreno, C R C,
Bahia - Brasil
Marqueze, E C

1Department of Epidemiology, Public Health Graduate Program, Introduction: : The Obstructive Sleep Apnea Syndrom
Catholic University of Santos, Santos, Brazil - Santos - Sao Paulo - (OSAS) worses a variety of comorbitys and affects the
Brasil, 2Department of Health, Life Cycles and Society, School of quality of life. One importante risk fator is the obesity and
Public Health, University of São Paulo, São Paulo, Brazil - São Paulo - the polissomnography is the gold standard to diagnosis.
Sao Paulo - Brasil, 3Stress Research Institute, University of Stockholm, Aim: To analyze the sleep findings on obese patients on
Stockholm, Sweden - Suécia bariatric surgery preoperatory. Methods: Transversal
study of 58 polysomnographies of patients on bariatric
Introduction: The conflict between social and biological surgery preoperatory in sleep lab in the year of 2017.
clocks experienced by night shift workers has been Results: 56,9% had obesity degree III and 43,1% degrees
associated with the occurrence of emotional disorders. I and II; 84,5% females and 15,2% males. 70,7% had
These disorders, in turn, can aggravate poor sleep quality. OSAS diagnosis and the Apnea-Hipopnea Index (AHI)
Aim: To evaluate the relationship between mild emotional stayed between 0 and 84,6 (media 19,47±22,89 /h). The
disorders and the self-reported sleep quality among Corporal Mass Index (CMI) situated between 33,30 and
overweight night shift workers. Methods: We performed 66,90 (media 41,37±5,83 kg/m²). The variables that
a double-blind randomized clinical crossover trial. The were statisticaly significant in the group obese degree III
present study used only data extracted from the baseline,

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 103

versus degrees I and II: satturation time below 80% and ID: 921
90% (p=0,02 both), Respiratory Disturbance Index RDI
(p=0,02), AHI (p=0,02), Hipopnea Index (p=0,006) and Clinical Studies
minimal satturation (p=0,004). The factors associated with
increase of AHI are: wheight (p=0,007), CMI (p=0,03)
The effect of urbanization on sleep and
and minimal and mean oxygen saturation (p<0,00001 metabolic indicators
both). The older age (p=0,04) and female sex (p=0,03)
were more associated with OSAS. Conclusions: The high Martins, A J, Isherwood, C, Vasconcelos, S P, Skene, D J, Lowden,
prevalency of OSAS in the study shows the importance of A, Moreno, C R d C
the polysomnography on bariatric surgery preoperatory. Faculty of Health & Medical Sciences, University of Surrey - Grã-
The hipopneas are the main obstructive event in these Bretanha (Reino Unido), Centro de Ciências da Saúde e do Esporte,
patients. Universidade Federal do Acre - Rio Branco - Acre - Brasil, Faculdade
Palavras-chave: obstructive sleep apnea syndrom; obesity; bariatric surgery
de Saúde Pública da Universidade de São Paulo - São Paulo - Sao Paulo
- Brasil, Stress Research Institute, Stockholm University - Suécia
ID: 920
Introduction: The urbanization process has been
Basic Research
associated with an increase in risk factors to non-
Association between social jetlag and diet communicable diseases. Aim: To evaluate the sleep,
biological rhythms and metabolism among workers of an
quality throughout pregnancy
Amazonian community of Acre, according to different
Balieiro, L C T, Gontijo, C A, Teixeira, G P, Marot, L P, Fahmy, W
degrees of urbanization. Methods: A cross-sectional
M, Maia, Y C d P, Crispim, C A
study of rural and urban residents (22 and 20, respectively)
from the municipality of Xapuri, Acre. Sociodemographic,
Department of Obstetrics, Hospital and Municipal Maternity of life habits, anthropometric, metabolic parameter variables
Uberlandia - Uberlândia - Minas Gerais - Brasil, Federal University of (triglycerides, total cholesterol and fractions, fasting glucose
Uberlandia - Uberlândia - Minas Gerais - Brasil and insulin resistance), chronotype and food intake were
evaluated. Sleep, light exposure and activity levels variables
Introduction: Social jetlag (SJL) - a measured of the
were obtained by actigraphy and daily activity protocols
misalignment between biological and social time – is
during 10 days. The studied groups were compared with
highly prevalent in modern society and has been associated
Student’s t and Mann-Whitney tests for anthropometric
with obesity and changes in food consumption. Aim:
variables, food intake and metabolic parameters. ANOVA
The focus of this study was to evaluate the influence of
for repeated measures tests were performed to compare
SJL throughout the gestational trimesters on diet quality.
the sleep variables, light and acitivity levels between
Methods: A longitudinal study was conducted with 100
groups.Results: Urban residents showed higher averages
pregnant women who were evaluated at the first, second
to all anthropometric variables, fasting glucose levels,
and third trimester of pregnancy. Pregnant women were
fasting insulin and insulin resistance (p<0.05) when
classified in four clusters according to the occurrence of
compared with rural residents. The lipid profile showed
SJL during pregnancy: without SJL during pregnancy (No-
no statistically relevant differences among the groups.
SJL); SJL in one trimester (1-SJL); SJL in two trimesters
Rural residents showed higher averages of sleep length
(2-SJL); and SJL in three trimesters (3-SJL). Food intake
(p<0.01) and earlier sleep onset (p=0.01). Conclusions:
was evaluated by three 24-h food recall in each gestational
The findings show an association between urbanization
trimester. Diet quality was assessed using the Brazilian
and the presence of risk factors like overweight, serum
Healthy Eating Index-Revised (BHEI-R). Generalized
lipid level alteration, and insulin resistance.
Estimating Equation models were used to determine the Palavras-chave: Urbanization; non-communicable diseases; metabolic parameters; sleep; rural communities.

effects of the SJL in the diet quality during pregnancy.

Results: Higher scores of the whole grains component ID: 922
(p=0.022) were found in the “3-SJL” group when
compared to pregnant from “NO-SJL”, “1-SJL” and “2- Basic Research
SJL” clusters throughout gestation. Furthermore, higher
scores of the sodium component (p=0.002) were found in Excessive daytime sleepiness in high school
the “NO-SJL” cluster when compared to “2-SJL” and “3- students
SJL clusters throughout gestation. Conclusions: Pregnant
women presented a difference in the score of components Siqueira, P S, Silva, A L, Carneiro, P B, Ferreira, S T, Daher, S,
of the BHEI-R, demonstrating that the occurrence of SJL Lima, A M
during pregnancy seems to modify the quality of the diet. Universidade Federal de Pernambuco e Universidade Federal Rural de
Palavras-chave: social jetlag, diet quality, pregnancy

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 104
Pernambuco - Recife - Pernambuco - Brasil risk of developing type 2 diabetes. Aim: To evaluate
the association between social jetlag and parameters of
Introduction: Excessive daytime sleepiness (EDS) has diabetes control (HbA1c, glycemia and insulin) among
become one of the most common complaints among overweight night workers. Methods: We performed a
teenagers and affects 10% to 25% of them, especially in double-blind randomized clinical crossover Trial. The
the final stages of puberty. In this step, the physiological present study used only data extracted from the baseline
and cyclical hormone variations in females can affect with 43 female overweight night workers of the nursing
the sleep-wake cycle when compared to male teenagers. team at a large hospital in São Paulo/SP. Parameters of
Exaggerated use of technological devices, such as diabetes control were assessed from a single 12 hour
smartphones and tablets, is also related to weight gain and fasting blood sample. Social jetlag was quantified through
change in sleep patterns in this population. Aim: Thus, the the Munich Chronotype Questionnaire (MCTQshift).
aim of the present work was to compare excessive daytime Results: The mean age of participants was 39.8 years
sleepiness in high school female and male teenage students. (SD=6.3 years). Most of them were nursing technicians
Methods: This is a cross-sectional study. One hundred (51.2%) and married (65.1%). The mean time in the
and forty-nine (76 female teenagers and 73 male teenagers) current night shift was 5.6 years (SD=3.8 years) and the
high school students of a public school located in the mean social jetlag was 3:52h (SD=1:25h). There was no
state of Pernambuco were underwent to anthropometric difference in proportions of the parameters of diabetes
evaluation and answered 1 (one) self-applied questionnaire control according to social jetlag. Similarly, there was no
(Epworth sleepiness scale) to assess excessive daytime association between social jetlag and HbA1 (2nd tertile
sleepiness (EDS). Student’s t-test for independent samples OR=0.35, 95%CI 0.11-1.10), nor blood glucose (2nd tertile
was used for statistical analysis. A p‐value less than 0.05 OR=0.47, 95%CI 0.18-1.23, 3rd tertile OR=1.06, 95%CI
was considered statistically significant. Results: There was 0.38-2.94). Insulin modeling could not be performed due
no gender difference in the sample characteristics (female to the small number of participants with inadequate levels
teenagers: 16.6±1.2 years old vs. male teenagers: 17.3±1.1 of this parameter. Conclusions: Although the participants
years old; p = 0.181); body mass index (BMI) (female experienced high levels (>2 hours) of social jetlag, it was
teenagers: 22.6±3.9 kg/m2 vs. male teenagers: 22.2±4.3 not associated with the parameters of diabetes control. It
kg/m2; p = 0.512). Regarding the evaluation of the EDS, is noteworthy that more studies are needed to understand
female teenagers have shown a significantly higher score what effects social jet lag can have on metabolic disorders
than male teenagers (female teenagers: 11.1±4.8 vs. male in night workers.
teenagers: 9.6±4.0; p = 0.035). Conclusions: Our results Palavras-chave: Social jet lag, Diabetes markers, Night work, Melatonin supplementation.

corroborate the notion that EDS is more prevalent among

females, even they were teenagers. It is suggested that ID: 924
prevalence studies, using objective methods for sleeping
pattern assessment should be carried out to investigate the Clinical Studies
EDS associated factors between genders.
Palavras-chave: Excessive daytime sleepiness; gender; high school students.
Comparison between group and individual
cognitive-behavioral therapy for insomnia
ID: 923 approach: a pilot study
Clinical Studies
Toscanini, A C, Lacerda, C B, Borges, D S, Brasil, I P, Gallinaro,
Relationship between social jet lag and J M, Zago, J H, Azevedo, A P, Hasan, R
diabetes markers in overweight night workers Instituto de Psiquiatria (IPq) - SAO PAULO - Sao Paulo - Brasil

Duarte, A S, Garrido, A L F, Rodrigues, G H, Santana, P T, Introduction: Insomnia is the most common sleep
Nogueira, L F R, Pellegrino, P, Cipolla-Neto, J, Moreno, C R C, disorder in the general population. Cognitive-behavioral
Marqueze, E C therapy for insomnia (CBT-I) is a gold standard treatment
and it’s preferable to pharmacotherapy. However, there are
1Department of Epidemiology, Public Health Graduate Program, few trials on the effectiveness of group CBT-I approach.
Catholic University of Santos - Santos - Sao Paulo - Brasil, 2Department Aim: To assess the clinical effectiveness of group mode
of Health, Life Cycles and Society, School of Public Health, University of CBT-I compared with the individual CBT-I. Methods:
of São Paulo - São Paulo - Sao Paulo - Brasil, 3Stress Research Institute, This interventional study evaluated 25 subjects, recruited
University of Stockholm, Sweden - Suécia from 2015 to 2019 at a sleep clinic, all of whom met ICSD-
Introduction: Night shift work promotes chronic 3 criteria for a diagnosis of chronic insomnia. Subjects
discrepancy between social and biological clocks defined
as social jetlag, which has been associated with an increased

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 105

were assigned successively to receive 6-8 sessions of Introduction: Bed partners of patients with obstructive
either group cognitive-behavioral therapy (until 6 patients) sleep apnea (OSA) frequently report sleep disruptions due
or individual cognitive-behavioral therapy (control). to the loud snoring. It is not clear, however, the profile
Treatment evaluation was non-blind and used self-report of sleep quality, sleep duration, daytime sleepiness and
scales and sleep diaries. The primary outcome measure potential cardiovascular consequences of OSA in the bed
was the improvement of insomnia as assessed by the partners. Aim: This is a cross-sectional analysis exploring
Insomnia Severity Index (ISI) and Dysfunctional Beliefs sleep quality and quantity, excessive daytime sleepiness,
and Attitudes about Sleep Scale 10 (DBAS-10). Secondary ambulatory blood pressure monitoring (ABPM) and
measures included scores on the Beck Depression endothelial function in the bed partners of patients with
Inventory (BDI), the Beck Anxiety Inventory (BAI), and untreated OSA. Methods: Consecutive bed partners
the Epworth Sleepiness Scale (ESS). Successful treatment from both genders of patients with moderate to severe
was considered when observed clinical remission of the OSA (apnea-hypopnea index >15 events/hour) were
insomnia symptoms and improvement of the sleep diaries recruited. The Pittsburgh sleep quality index (PSQI) and
parameters.Results: 25 patients were assigned to group the wrist actigraphy for 1 week (Actiwatch 2TM) were
CBT-I (13 subjects) or individual CBT-I (12 subjects) used to assess the sleep quality and quantity, respectively.
and followed-up for 2 months; 68% were women (84% The Epworth Sleepiness Scale was used to determine the
in group CBT-I); mean age was 54.4±11,8 years in group subjective daytime sleepiness. 24hs-ABPM and a marker
CBT-I and 51.5±14,3 years in individual CBT-I (P=0.640). of endothelial function, namely flow-mediated dilation
Both arms of treatment improved subjective measures (FMD) in the brachial artery by ultrasound, were assessed
of sleep (sleep efficiency and awaked time in bed), and to evaluate the cardiovascular risk. All measurements were
reduced ISI (-11.8±2,7 and -6.2±8.7; P=0.008 and 0.020, performed without access to the severity of OSA.Results:
respectively, group and individual CBT-I) and DBAS-10 We evaluated 26 bed partners (age: 47±10 years, 85%
scores (-19.4±25.7 and -26.8±26.3; P=0.046 and P=0.002, females, body mass index: 27±4 kg/m2). The mean PSQI
respectively, group and individual CBT-I). No statistically score and sleep duration were 7±3 and 6.5±1.1 hours/
differences were found in the variations of ISI and DBAS- night. 84% presented low sleep quality, 32% presented
10 scores between group or individual CBT-I (P=0.279 and short sleep duration (<6hs) and 35% complained of
0.558, respectively). Variations in psychometric features excessive daytime sleepiness. The mean systolic 24-hs,
– depression, anxiety and sleepiness scores – between daytime and nighttime blood pressure were 111±10,
group and individual CBT-I, before and after intervention, 115±10 and 103±10mmHg, respectively. Interestingly,
had not statistically difference. Conclusions: Findings 42% presented systolic non-dipping pattern (<10%
suggest that group CBT-I may have clinical effectiveness reduction in blood pressure during sleep compared with
if compared to usual treatment and it could be an option during the awake period). The mean FMD varied from
for insomnia treatment. Further studies are needed to -1.87 to 16.55%, revealing that 52% of them presented
establish the most appropriate selection of patients for endothelial dysfunction. Conclusions: The bed partners
group CBT-I. of OSA patients presented a huge percentage of poor
Palavras-chave: Sleep Initiation and Maintenance Disorders; Chronic Insomnia; Cognitive Behavioral Therapy.
sleep quality and a significant proportion of short sleep
duration, daytime sleepiness, non-dipping blood pressure
ID: 925 and endothelial dysfunction. These findings suggest
Clinical Studies that OSA may contribute to sleep and cardiovascular
consequences in bed partners.
Quality and Quantity of Sleep, Sleepiness and Palavras-chave: Obstructive sleep apnea, bed partners, consequences.

Cardiovascular Parameters of Bed Partners of ID: 926

Patients with Obstructive Sleep Apnea: Cross-
sectional data from the SLEEP-PARTNERS Clinical Studies
study Sleep disorders in resident physicians and
their influence on quality of life
Giampá, S Q d C, Costa-Hong, V, Freitas, L S, Furlan, S F, Azam,
I F B, Bortolotto, L A, Lorenzi-Filho, G, Drager, L F Silva, D P F d S F, Martinez, J E M E
Unidade de Hipertensão, Unidade de Hipertensão, Divisão da Hospital de Base de São José do Rio Preto - São José do Rio Preto - Sao
Nefrologia e Laboratório do Sono, Divisão da Pneumologia - Instituto Paulo - Brasil
do Coração (InCor) - Faculdade de Medicina da Universidade de São
Paulo - São Paulo - São Paulo - Brazil Introduction: Introduction: Medical residency is the most
suitable model for the physician to specialize through

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 106

the practice with the supervision of more experienced Introduction: Burnout syndrome (BS) is defined as
professionals. Medical residency is considered the most occupational stress in a workplace with low emotional
suitable model for the physician to specialize. This period reward. Regarding the relationship with teaching, the
is characterized by major changes and challenges in the influence of technological, political and socioeconomic
medical career since more attention and dedication is issues in the teaching environment, lead these professionals
needed from the professionals who have chosen a form to handle the demands of the university career. High
of specialization considered a gold standard¨. However, levels of stress are known to affect the quality of life
when medical residency offers inadequate working and sleep and a good level of physical fitness can relieve
conditions, it can cause harm to the work and safety of the stress and improve the sleep quality. Aim: Thus, the
resident physicians and their own patients. Among these objective of this study was to determine the relationship
problems we can mention sleep disturbances by the between burnout syndrome, sleep quality and physical
shift regime. Aim: Objectives: To evaluate the impact of fitness in university teachers. Methods: Thirty-one
hypersomnolence and quality of life in resident physicians university teachers from the Federal Rural University of
and to evaluate the association between hypersensitivity Pernambuco were evaluated. The assessment of burnout
and sociodemographic characteristics. Methods: Material syndrome, sleep quality and physical fitness were made
and Methods: Nine hundred resident physicians were using the preliminary burnout identification questionnaire
interviewed enrolled in the medical residency program (QPIB), the Pittsburgh Sleep Quality Index (PSQI) and
of the São José do Rio Preto Base Hospital. The subjects the International Physical Activity Questionnaire (IPAQ),
answered a questionnaire containing instruments for short form, respectively. The Spearman correlation test
assessing sleep, quality of life and risk of depression. Sleep was used to correlate the components and total score of
assessment was performed using the Epworth Daytime PSQI, QIPB, and IPAQ. Statistical significance is defined
Sleepiness Scale, a self-administered questionnaire to as p < 0.05. Results: There was a moderate positive
assess hypersensitivity. Quality of life was assessed correlation between emotional exhaustion and subjective
through the Medical Outcomes Study 36, a 36-item sleep quality (r = 0.558; p = 0.001) and sleep latency (r
multidimensional questionnaire and the risk of depression = 0.406; p = 0.024), emotional exhaustion and sleep
was studied through the Self-Reporting Questionnaire disturbance (r = 0.558; p = 0.001), emotional exhaustion
(SRQ-20) developed by the World Health Organization. and daytime dysfunction (r = 0.429; p = 0.016). Moreover,
Results: Results: Sociodemographic variables do not there was showed a moderate positive correlation between
seem to influence the hypersomnolence of resident depersonalization and sleep disorders (r = 0.538; p =
physicians. In relation to the quality of life scales, the risk 0.002), personal accomplishment and subjective sleep
of depression and functional capacity were not correlated quality (r = 0.454; p = 0.010) and sleep disorders (r = 0.476;
with hypersomnolence, while the variables variables p = 0.007). A moderate positive correlation was observed
of general health status, vitality, social aspects and pain between the total PSQI score and the total QPIB score
domain were predictors of somnolence. We observed that (r = 0.530; p = 0.001). There was no correlation between
hypersomnolence interferes in the residents’ quality of the physical fitness and the total QPIB score (r = -0.216;
life, so that for all SF-36 domains, the mean score is lower p = 0.243). Conclusions: According to the results, the
for the hypersolent. Conclusions: Conclusions: There is BS seems to compromise the quality of sleep in university
a correlation between hypersomnolence and quality of teachers, but there was no association between BS and the
life and that hypersomnia is a significant predictor for the physical fitness. It is suggested that studies using objective
perception of the quality of life of resident physicians. methods to determine the sleep quality and the physical
The sociodemographic characteristics do not seem to fitness should be carried out to evaluate a more reliable
influence the sleep quality of these physicians. relationship between these variables.
Palavras-chave: Keywords: Sleep Disorders. Sleepiness Scales. Residence. Palavras-chave: Occupational stress, teaching, sleep quality, physical fitness.

ID: 927 ID: 928

Basic Research Basic Research
Burnout syndrome, sleep quality and fitness Evaluation of physical activity level, sleep and
level in university teachers life quality in HIV/AIDS patients
Silva, A L, Siqueira, P S, Lima, A M Barbosa, R A, de Souza, L I S, Rocha, A I S S, Araújo, A A, Santos,
M S B, Santos, A d C, Nóbrega Rabay, A A
Universidade Federal de Pernambuco e Universidade Federal Rural de
Pernambuco - Recife - Pernambuco - Brasil UNIVERSIDADE FEDERAL DA PARAÍBA - JOÃO PESSOA -
Paraiba - Brasil

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 107

Introduction: Studies demonstrated that HIV/AIDS Introduction: Night shift work promotes chronic circadian
carriers presents an inactive lifestyle and bad sleep quality. desynchronization, which may lead to suppression of
Both parameters interfere negatively in these individuals’ melatonin and metabolic disorders. Aim: To evaluate
life quality. However, little is known about these indicators the effectiveness of melatonin supplementation versus
between this population. Then, this research hypotheses placebo on metabolic parameters (glucose, glycated
that HIV/AIDS carriers has a reduce level of physical hemoglobin, insulin, total cholesterol, HDL-cholesterol,
activity, bad sleep quality and compromised lif quality. LDL-cholesterol, VLDL-cholesterol and triglycerides)
Aim: Evaluate physical activity level, sleep and life quality of overweight night workers. Methods: A randomized,
among HIV/AIDS carriers and the relation between life double-blind, placebo-controlled crossover trial conducted
and sleep qualities. Methods: Observational study with with 26 nursing professionals who worked permanent
quantitative approach has evaluated the physical activity night shifts. Intervention was carried out in two phases
level (PAL) by the IPAQ, short version; life quality (LQ) by (three months each) and consisted of the administration
WHOQOL-HIV-bref, sleep quality (SQ) by the Pittsburg of 3 mg of fast-release melatonin and placebo in the nights
Index (PSQI) and insomnia by the insomnia gravity index between shifts and days off, that is, only when the sleep was
(IGI), between men with HIV/AIDS. Normalcy of the performed at night. Metabolic parameters were assessed
data was analyzed by the Shapiro-Wilk test, with the from a single 12 hour fasting blood sample at the baseline
Effect Size test applied with life and sleep quality between and after each phase of intervention. To compare the
the poorly active, the active and the largely active groups. effectiveness of melatonin and placebo, the percentages
For those, was utilized Cohen d and we considered the of improvement or worsening of the parameters after the
respectively sizes: small effect d > 0.2, moderate effect proposed interventions were evaluated and the difference
>0.5, and great effect d> 0.8, with the Kruskal-Wallis test between the baseline and each group of intervention was
used to evcaluate the LQ, SQ and IGI between groups with calculated. Results: The mean age of the participants
PAL poorly, active and largely active levels. To evaluate was 37.8 years (SE=1.1 years). Most of them were nurses
the correlation between LQ, SQ and IGI, the Spearman (53.8%) and married (65.5%). The mean time working
Correlation test was used. A significance level of o< 0.05 in the current night shift was 4.8 years (SE=0.8 years).
was considered.Results: In this study, 39% if the subjects It was verified that 50% of participants had a significant
were considered largely active, 39% active and 22% poorly improvement in HDL-cholesterol levels after melatonin
active. There was no statistic difference in sleep quality, supplementation whereas 42.3% showed an improvement
insomnia and life quality in the evaluated groups (P > among those who took placebo. Although the proportion
0.05). We noticed strong positive correlation between of participants who showed an improvement in
life and sleep quality (r = 0.757; p = 0.000) and negative glucose levels (46.2%); glycated hemoglobin (53.9%)
correlation between sleep quality and the insomnia gravity and insulin (46.2%) after melatonin supplementation
index (r = 0.479; p = 0.006). Conclusions: In young was higher compared to placebo (30.8%, 42.3% and
adult male with HIV/AIDS, we checked that the physical 38.5%, respectively), no statistically significant effects
activity level seems to interfere with life and sleep quality, were observed. No differences in proportions of total
and also with insomnia. There was correlation between life cholesterol, LDL, VLDL and triglyceride levels were found
and sleep quality and between sleep quality and insomnia. according to the group of intervention. Conclusions: In
Palavras-chave: HIV/AIDS, physical activity, sleep quality.
comparison with placebo, melatonin supplementation was
effective in improving HDL-cholesterol levels and showed
ID: 929 a tendency to improve glucose, glycated hemoglobin and
Clinical Studies insulin levels.
Palavras-chave: Melatonin; Effectiveness; Nursing; Shift Work Schedule.

Effectiveness of melatonin supplementation ID: 931

versus placebo on metabolic parameters
among overweight night workers Case Reports

Santana, P T, Duarte, A S, Garrido, A L F, Rodrigues, G H,

Schizophrenia, Hypoxemia or both: a Case
Nogueira, L F R, Pellegrino, P, Cipolla-Neto, J, Moreno, C R C, Report
Marqueze, E C
De Quadros, A C, Soares, C F d P, Godoy, L P, Schenider, L P
Department of Epidemiology, Public Health Graduate Program, B, Farias, I R, Lopes, P d M R, Rubert, L, Pinheiro, A F d C,
Catholic University of Santos - Santos - Sao Paulo - Brasil, Department Cordeiro, J d P, Hata, M M
of Health, Life Cycles and Society, School of Public Health, University
of São Paulo - São Paulo - Sao Paulo - Brasil, Stress Research Institute, Centro Universitário FAG - Cascavel - Parana - Brasil
University of Stockholm, Stockholm, Sweden. - Suécia

Sleep Sci. 2020;13(Supl.1):1-118

 108

Introduction: Schizophrenia is a serious mental disorder Aielo, A N, Santos, R B, Giatti, S, Silva, W, Souza, S P, Cunha, L,
characterized by distortions of thought and perception. Bensenor, I M, Lotufo, P, Drager, L F
The difficulty in achieving or maintaining restful sleep is a Hospital Universitário - USP - São Paulo - Sao Paulo - Brasil
relevant symptom of this condition, in which a decrease on
the duration and quality of REM sleep is commonly seen. Introduction: Hypertension (HTN) is the leading cause
Other sleep disorders can worsen schizophrenic symptoms. of cardiovascular mortality. One of the crucial steps for
The current literature shows that Obstructive Sleep Apnea its successful treatment is the appropriate adherence to
(OSA) is twice as frequent among schizophrenics than in the anti-hypertensive therapy. It is conceivable that sleep
general population. Animal studies showed that repetitive disorders such as Obstructive Sleep Apnea (OSA) and
intermittent hypoxemia have an impact on dysfunction- Short Sleep Duration (SSD) may impair this adherence
dysregulation of dopaminergic and glutamate pathways in due to poor sleep quality and potential impact on cognitive
the striatum, mesolimbic area and pre-frontal cortex, and performance but the evidence is scanty. Aim: To evaluate
a few cases of improvement in schizophrenic symptoms the association between OSA and SSD with the adherence
after treatment of OSA have been reported. Aim: To to antihypertensive treatment in civil servants from
illustrate with a case report the benefit of OSA treatment in the ELSA-Brasil cohort study. Methods: Consecutive
schizophrenic patients. Methods: After obtaining patient’s participants with a previous diagnosis of HTN under
consent, the case description was made by reviewing specific drug treatment performed clinical evaluation,
medical records.Results: Male, 28 years, went through home sleep monitoring (Embletta GoldTM) for one night
surgery to correct an Atrial Sept Defect in 1995 and has and wrist actigraphy (Actiwatch2TM) for seven days to
a mild mitral regurgitation since childhood was diagnosed determine OSA and SSD, respectively. OSA was defined
with schizophrenia at 19 years old after he began to by an apnea-hypopnea index ≥15 events/hour. SSD was
have visual and auditory hallucinations related to violent defined by a mean sleep duration <6 hours. Adherence to
behavior. In use of Olanzapine and Clonazepam, he had therapy was evaluated by the 4-itens Morisky questionnaire.
already had aspiration pneumonia. Hospitalized with severe We defined poor/medium adherence by the presence of
hypoxemia due to decompensated Primary Pulmonary >0 score. We performed a logistic regression analysis
Hypertension (PPH). Admission arterial gasometry: pH: to evaluate the predictors of poor/medium medication
7,314; pCO2: 33,80mmHg; pO2: 41,80mmHg; HCO3: adherence in these participants. Results: A total of
17,20; O2 saturation: 73,50%. After cardio-pulmonary 411 hypertensive participants were analyzed (mean age:
stabilization, was discharged and referred to sleep specialist 54±8 years, 47% men). Medium/low adherence to anti-
due to poor sleep quality, many awakenings, difficulty hypertensive therapy were observed in 62%. Compared
sleeping lying down and excessive daytime sleepiness. to the high adherence (score=0), the participants with
Polysomnography was performed, which found: REM medium/poor adherence had higher frequency of excessive
sleep latency of 303 minutes, 5,8% of REM sleep, 99,8 daytime sleepiness (35.9 vs. 46.1%), lower frequency of
awakenings per hour, apnea-hypopnea index (AHI) 88/ high degree education (50.6 vs. 40%) and lower monthly
hour, basal oxyhemoglobin saturation of 95%, with the per capita income ($1021.9 vs. $805.2). No differences
average saturation 84% and minimum 74%, remaining were observed for OSA (50.6 vs. 47.5%) and SSD (24.4
99,4% of the recording time with saturation below 90%. vs. 29%). Logistic regression analysis showed that race
After initiation of treatment with BiPAP and hypoxemia other than whites (OR: 1.66;95% IC: 1.06-2.61), lower per
improvement (post-treatment AHI: 3,3/hour) there was capita income (OR: 1.76;95% IC: 1.05-2.94) and excessive
a significant improvement in schizophrenic symptoms, daytime sleepiness (OR: 1.55;95% IC: 1.01-2.40) were
without hallucinations since 2017, but PPH difficult to the independent variables associated with medium/poor
control. Conclusions: This case illustrates the association adherence to anti-hypertensive treatment. Conclusions:
between severe Obstructive Sleep Apnea and schizophrenic In a large cohort of patients with HTN, non white race,
patient that has benefit of psychiatric condition and quality lower economical status, escessive daytime sleepiness, but
of life after OSA treatment. not OSA or SSD, were associated to impaired adherence
Palavras-chave: Obstructive Sleep Apnea, Schizophrenia, Hypoxemia
to anti-hypertensive therapy.
Palavras-chave: Sleep Apnea, sleep duration, Medication Adherence, hypertension

ID: 932
ID: 934
Clinical Studies
Clinical Studies
Obstructive Sleep Apnea, Short Sleep
Duration and Drug Adherence in Patients Reduction in calories and carbohydrates
with Hypertension: The ELSA-Brasil study intake among overweight night workers after
melatonin supplementation

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 109
Nogueira, L F R, Duarte, A S, Garrido, A L F, Rodrigues, G H, Basic Research
Santana, P T, Pellegrino, P, Cipolla-Neto, J, Moreno, C R C,
Marqueze, E C Sleep and health variables of nursing
Department of Epidemiology, Public Health Graduate Program, profesionals in different work shifts
Catholic University of Santos - Santos - Sao Paulo - Brasil, Department
Marçal, J A, Moraes, B F M, Mendes, S S, Salvi, C P P, Monteiro,
of Health, Life Cycles and Society, School of Public Health, University
S M C, Miranda, L D L, De Martino, M M F
of São Paulo - São Paulo - Sao Paulo - Brasil, Stress Research Institute,
University of Stockholm - Suécia Universidade Estadual de Campinas - Campinas - Sao Paulo - Brasil,
Universidade Federal de São Paulo - São Paulo - Sao Paulo - Brasil
Introduction: Night shift workers frequently report
poor sleep quality. This aspect, in parallel to the nocturnal Introduction: The relationship between synchronizers
nibbling, seems to promote changes in dietary pattern and internal temporal organization can be disturbed by
and energy metabolism, resulting in overweight. Aim: changes caused by shift work, manifesting as cardiovascular,
To verify whether the effect of exogenous melatonin metabolic and sleep disorders. Aim: To evaluate the
supplementation on sleep quality may alter food intake sleep pattern, mean blood pressure, anthropometric data
on the workday and the day off among overweight and blood glucose levels of nursing professionals into
night workers. Methods: We performed a double-blind the different work shifts. Methods: A descriptive and
randomized clinical crossover trial in 27 female overweight cross-sectional study of 88 day and night shift nursing
night workers of the nursing team at a large hospital in professionals, performed in public emergency services
São Paulo/SP. Intervention was carried out in two phases of a municipality in the southern state of Minas Gerais.
(three months each) and consisted of the administration For data collection, a sociodemographic questionnaire
of 3 mg of fast-release melatonin and placebo in the and the Sleep Diary were used. For the anthropometric
nights between shifts and days off, i.e. only when sleep was data, a vertical anthropometer, malleable and inelastic
performed at night. Self-reported sleep quality was taken measuring tape and digital scale were used. To measure
from a single question of the Pittsburgh Sleep Quality blood pressure, the auscultatory method with aneroid
Index (PSQI). Total calories, carbohydrates, fats and sphygmomanometers with cuffs appropriate to the arm
proteins were assessed by food diaries on one workday and diameter of each participant was used. Capillary blood
one day off (from 19:00 to 19:00 h) at the baseline and at glucose was fasted with a portable glucometer. Results:
the end of each phase.Results: Mean age of participants Night shift workers had lower average night sleep quality,
was 38.5 years (SE=1.2 years). Most of them were nurses with more nap episodes, as well as lower average sleep
(56%), married (64%) and 19.2% reported poor sleep duration compared to day workers. However, there was
quality. The mean time in the current night shift was 5.2 not statistically significant relationship between sleep
years (SE=0.9 years). On the workday, among those with data and the other variables. Mean arterial pressure was
good sleep quality, there was a significant reduction in within the optimal value classification and there was no
caloric intake after melatonin supplementation (1363.4 statistically significant difference in the comparison of
kcal, SE=134.6 kcal) compared to baseline (1844.4 kcal, this variable between work shifts. High BMI values were
SE=190.3 kcal). However, carbohydrates intake were also observed in the studied sample, in which 59.09%
reduced after melatonin (158.9 g, SE=16.3 g) and placebo of professionals are obese or overweight, as well as high
supplementation (180.5 g, SE=17.4 g) compared to waist circumference levels (70.46%). Workers also had
baseline (247.9 g, SE=23 g). On the day off, among those a high rate of physical inactivity. The other variables
with poor sleep quality, carbohydrates intake were reduced studied did not show statistically significant difference
after placebo supplementation (140.2 g, SE= 140.2 g) in relation to shifts. Conclusions: The night shift may
compared to baseline (219.1 g, SE=17.1 g). There was influence the quality and duration of sleep of its workers,
no effect on caloric intake on the day off neither on fats but has no relationship with other variables. However,
and proteins intake both on the workday and the day off. higher anthropometric values can lead to long-term health
Conclusions: Melatonin supplementation reduced caloric problems.
and carbohydrates intake on the workday among those Palavras-chave: Shift Work Schedule; Nursing; Blood Pressure; Sleep; Body Mass Index.

with good sleep quality, however, the latter effect was also
observed after placebo supplementation among those with ID: 937
poor sleep quality. Given its potential relationship with Clinical Studies
sleep and health outcomes, changes in the dietary pattern
of night shift workers still needs to be better investigated. Pulmonary rehabilitation and its impact on
the quality of life of patients with copd
Palavras-chave: Food Consumption; Melatonin supplementation; Night work; Nursing; Nutrition, Public Health.

ID: 935
Rodrigues, A R, Lopes, A C, Ferreira, V B, Faleiros, P A d M

Sleep Sci. 2020;13(Supl.1):1-118

 110
Centro Universitário Municipal de Franca - Franca - São Paulo - Brasil dos Santos, G D, Borgio, J G F, Louzada, F M

Introduction: Chronic obstructive pulmonary disease Universidade Federal do Paraná - Curitiba - Parana - Brasil
(COPD) is characterized by chronic airflow limitation,
Introduction: In modern society, many individuals
which is not completely reversible after bronchodilator
show conflict between circadian preferences and social
use. Airflow limitation is often progressive and associated
schedules (working hours, early morning classes), so that
with the abnormal inflammatory response of the lungs to
the most affected are evening-type individuals. These
toxic gases or particles. This disease is one of the major
individuals suffer a sleep debt, due to sleep deprivation on
causes of morbidity and mortality in the world, defined by
weekdays, trying to compensate on weekends by extending
such nomenclature due to the difficulty of differentiating
sleep, delayed start and midpoint times of sleep. This
pulmonary emphysema from chronic bronchitis
phenomenon is called social jetlag (SJL). Literature shows
(PRESTO and DAMÁZIO, 2005; ZANCHET et al, 2005
that sleep deprivation is associated with cardiovascular
FERNANDES, 2009). Pulmonary rehabilitation (PR) is
risk factors. Thus, SJL may be a measure of chronic sleep
recommended for the treatment of COPD, as it generates
deprivation in these individuals and may indicate changes
improvement in exercise capacity, respiratory muscle
in the autonomic nervous system’s control over the
strength and quality of life. Studies have found increased
cardiovascular system. These changes in the autonomic
walking distance on the six-minute walk test, maximal
nervous system can be measured by heart rate variability.
upper limb load, maximal inspiratory pressure, and quality
Aim: The aim of this study was to investigate whether
of life (ZANCHET et al, 2005). In relation to sleep, COPD
there is an association between SJL and chronotype with
causes intermittent hypoxemia with pulmonary alterations
heart rate variability in university students. Methods:
in patients, which can alter sleep and generate cough,
Volunteers answered the following questionnaires: Munich
dyspnea, decrease oxygen saturation and consequently
Chronotype Questionnaire (MCTQ), Morningness-
worsen the quality of sleep and life of these individuals
Eveningness Questionnaire (MEQ), Epworth Sleepiness
(MARTIN et al, 2018). Aim: The aim of this report is
Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and
to show the importance of pulmonary rehabilitation
were submitted to EKG monitoring, Bioimpedance,
in sleep and life quality in COPD patientsMethods:
and Actigraphy.Results: The study had a final sample
The experience took place through a meeting with the
of 65 individuals, 63.1% female and 36.9% male. In the
presence of 21 people, aged 50 to 80 years, with COPD,
comparison between groups for SJL it was identified that
participants of a Pulmonary Rehabilitation program in a
individuals with SJL ≥ 2 hours had worse sleep quality
city in the interior of São Paulo. In the first moment, the
when compared with individuals with SJL <2 hours. The
COPD theme was approached with the participants and
groups did not present statistical differences on daytime
their families, in order to generate knowledge for them
sleepiness, anthropometric data and HRV parameters.
about their illnesses and enable them to recognize their
Correlation tests showed correlation between MEQ score
potential and difficulties. After this presentation, a space
and heart rate (r = - 0.350; p = 0.005), RMSSD index (r
was provided for participants, family members and / or
= 0.278; p = 0.026), SDNN index (r = 0.281; p = 0.024)
companions present to reflect and discuss the theme and
and RR intervals (0.346; p = 0.005). Conclusions: This
their experiences with the disease, in addition to exposing
work suggests that eveningness is associated to reduction
their doubts and sharing their progress after pulmonary
of HRV. However, no relation between SJL and HRV was
rehabilitation.Results: Participants were pleased to
found.
participate, showing that opportunities such as these are Palavras-chave: Chronotype, social jetlag, cardiovascular risk

critical for them to share their anxieties, answer questions

and report on their progress. Moreover, they showed ID: 942
that participating in experiences such as these enables
improvements in quality of life, even with the presence Clinical Studies
of the disease, and correct attitudes towards treatment.
Conclusions: Pulmonary rehabilitation has been shown
The relationship between lifestyle habits,
to be critical for patients with lung disease and COPD physical and emotional health and the quality
treatment. of sleep of university
Palavras-chave: Rehabilitation, COPD, Sleep, Empowerment for Health

Silva, J H C d, Martins, N d C e S, Cordeiro, M d A, Arruda, J E

ID: 940 d S, Studart-Pereira, L M

Basic Research Universidade Federal de Pernambuco - Recife - Pernambuco - Brasil

Chronotype is associated with heart rate Introduction: Sleep disturbances are common grievances
variability during the period of youth. Students who do not have a

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 111

good quality of sleep are prone to difficulties with their of rotating shift schedule and body mass index (BMI) on
learning, impairment in problem solving, physical and sleep duration among shift workers. Methods: The study
mental health disorders, and changes in the performance included 30 males shift workers. The rotation shift schedule
of cognitive and psychosocial functions. Sleep deprivation was carried out as follow: two days during the day (8:00 a.
brings disastrous repercussions in the period of youth and M. – 4:00p. M.); two days during the afternoon (4:00p. M.
has compromising implications due to age demands. Aim: – 0:00a. M.); 24h free-day (0:00a. M. – 0:00a. M.); two days
Assessing the quality of sleep of young undergraduate during the night (0:00a. M. – 8:00a. M.) and three days
students of speech therapy and dentistry, according to free. Sleep duration and the fragmentation of rest- activity
lifestyle habits related to sleep, anxiety, stress and disease. rhythm (Intradaily Variability; IV) were evaluated by
Methods: Analytical, observational and transversal study, actigraphy. The effect of the interaction between shift and
conducted in the period from August 2018 to February BMI on sleep duration was evaluated using Generalized
2019, registered under opinion: No.: 2,891,458. 150 Estimating Equations (GEE). The correlation between
students of speech therapy and dentistry courses of both BMI and IV was accessed using Spearman’s rho test.
sexes participated, with a mean age of 22.83 years old. Data Results: The interaction between shift schedule and BMI
was collected using a specific instrument and a Pittsburgh had effect on sleep duration. Eutrophic subjects did not
questionnaire. Pearson’s Chi-square and Fisher’s exact show differences on sleep duration throughout the shifts,
test were used to identify association. To determine the while overweight and obese ones had a smaller sleep
percentage of students with a sleep disorder, an initial duration in the 24h free-day (overweight: 4.6h and obese:
multivariate logistic regression model was adjusted with 4.5h) and in night shift (overweight: 5.8h and obese: 6.2h)
the variables that presented p < 0.20 in the bivariate. The than morning shift (overweight: 7.2h and obese: 8.2h) and
final model was determined by the Backward method with free days (overweight: 7.1h and obese: 7.9h) (p<0.05).
p < 0.20. The margin of error was 5%, intervals of OR The BMI had positive correlation with IV (p<0.001).
with 95% confidence and the program used was IBM Conclusions: Excessive BMI influences the sleep
SPSS version 23. Results: The habit of making heavy duration throughout the rotating shift schedule, while the
meals (p = 0.004), the use of relaxants (p = 0.025), coffee eutrophic subjects maintain a routine of sleep duration.
or nicotine before sleeping (p = 0.001), consumption of Palavras-chave: Shift workers; Rotation shift schedule; Sleep duration, BMI.

psychoactive substances for studying (p = 0.025), being

anxious (p = 0.001) or stressed (p = 0,017) may incisively ID: 945
compromise the quality of sleep. Although variables such Case Reports
as alcohol consumption (p = 0,562), habits of abdicating
sleep to study (p = 0,064) and using electronics before Sexomnia in a health professional and its
sleeping (p = 0,321) did not have significant effect, they Implications to clinical practice
may have contributed to poor quality sleep or sleep
disturbance. Conclusions: The quality of sleep of the Damasceno, P G, de Paula, R C d A, de Castro, M G, Braga-Neto,
population studied is severely compromised and suffers P, Sobreira-Neto, M A
the influence of life habits.
Palavras-chave: sleep disorders; sleep deprivation; sleep; young adult
Introduction: Non-REM sleep parasomnias are a
ID: 944 heterogeneous group of sleep disorders that occur in
any age group. Pathophysiology is related to changes
Basic Research in sleep state stability, dissociation and expression of
subcortical areas, without conscious cortical control,
Effect of the interaction between rotating shifts and genetic predisposition. Sexomnia is a variant of
and BMI on sleep duration: an observational sleepwalking characterized by sexual behavior during
and prospective study sleep. Its occurrence in inappropriate environments can
lead to embarrassing situations, as well as legal problems.
Marot, L P, Rosa, D E, Lopes, T d V C, Balieiro, L C T, Moreno, Aim: To describe a clinical case of sexomnia Methods:
C R, Crispim, C A Case report Results: We here describe a medical doctor,
26 years old, who came to our sleep outpatient clinic
Universidade Federal de Uberlândia - UBERLÂNDIA - Minas Gerais
complaining of sleepwalking since her childhood. Family
- Brasil
members describe episodes of getting up from bed,
Introduction: Studies have highlighted that there is an walking around the house and opening doors. Episodes
association between irregular eating and sleeping patterns were more frequent until 18 years of age. About a year ago,
and obesity among shift-workers, caused by the shiftwork after she started a medical residency, she reported sexual
schedules. Aim: To evaluate the effect of the interaction activity with her husband during sleep, less than once a

Sleep Sci. 2020;13(Supl.1):1-118

 112

month, between 1:00 and 2:00 am (she sleeps around measurement and laboratory data analysis. The project
10:00 pm). She kisses, caresses him and practices oral sex was approved by CEP / UFRN under number 2,401,132.
and penile penetration. She then wakes up confused and For the analysis of the variables we used the Pearson
does not remember anything about what have happened. correlation test.Results: Information was obtained from
She has positive familiar history for somnambulism. Her 92 teachers, of which 40% were men and 60% women,
concern is about happening these episodes of sexsomnia with a mean age of 44.9 ± 1.1 years and teaching time
during night shifts of medical residency colleagues. She of 12.7 ± 1.1 years. Among the survey participants, 57
sleeps 7 hours per night in the week and 10 hours in teachers answered the questionnaires. As a result it was
the weekends. She also has excessive daytime sleepiness found an average of 6.97 ± 1.0 total hours of sleep,
(Epworth Scale 10). She does not have obstructive apnea among which 65.5% of the teachers had social jetlag ≤1 h
of sleep or restless leg syndrome. Her physical exam and 34.5%> 1h, representing an average of social jetlag of
has no abnormalities. We recommended sleep hygiene, 0, 9 ± 0.0 hours of the total sample. It was also found that
environmental protection. We also prescribed melatonin 44% of teachers had good sleep quality, 45% and 11%
during night shifts. Conclusions: This case exemplifies had poor sleep quality and sleep disorder, respectively.
the social repercussion of this parasomnia, which although There was a positive correlation between stress level,
rare, impairs the quality of life of the referred patient. It anxiety, sleep quality and sleep duration, also evidencing
is worth mentioning the family and previous pathological metabolic alterations, such as elevated triglyceride levels,
history of the patient with reported sleepwalking episodes. fasting LDL cholesterol and fasting glucose with age,
It is also necessary to report as a possible fragmenting longer contribution time to the institution and increased
factor sleep deprivation due to the beginning of medical systolic pressure over commuting time to university.
residency. Although pharmacological treatment is Conclusions: Therefore, our results suggest that sleep
performed in situations with frequent episodes, it may time misalignment is associated with cardiometabolic
be initiated in situations involving risk to the patient. risk factors such as stress and anxiety. In this context, it
However, the possible side effects of clonazepam, such as is important to develop actions and strategies to improve
amnesia, awakening difficulties and cognitive impairment the sleep quality of the teaching population and promote
make it impossible to use in the workplace. health benefits, since the changes compromise the quality
Palavras-chave: Sexomnia; Parasomnia; Sleepwalking
of life and occupational profile of those involved.
ID: 947 Palavras-chave: Social Jetlag, Occupational Stress, Anxiety, Sleep Quality, Cardiometabolic Risks.

Basic Research ID: 948

Study of cardiometabolic risk factors and Basic Research

social jetlag in teachers of Universidade Evaluation of sleep quality and associated
Federal do Rio Grande do Norte factors in community-dwelling elderly in a
Barros da Silva, A C, Peixoto, H J A, Pires, K V L, Carneiro, B T
central western Brazil
S, Barbosa, M N, Miguel, M A L, Galeno, D M L
Grangeiro, A F B, Gomes, L d O, Neiva, T S, Magalhães, P R d
UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE - M, Cunha, C d S, Nóbrega, O d T
NATAL - Rio Grande do Norte - Brasil
Departamento de Gerontologia - Universidade Católica de Brasília,
Introduction: Epidemiological evidence indicates that Centro Universitário de Brasília, Secretaria de Saúde e Instituto do
occupational stress affects 90% of the world’s population Sono - Brasília - DF - Brazil
and imposes a habitual disturbance of the circadian
system, such as social jetlag that is strongly related to Introduction: The rapid advance of the aging process
the development of cardiometabolic diseases. Studies associated with demographic and epidemiological
have shown that the teacher is always subjected to transition implies consequences for the elderly, leading
different degrees of stress that can compromise physical, to the emergence of new health demands, especially
mental health and sleep quality. Aim: This research is “epidemic of chronic diseases and functional disabilities”.
an epidemiological study that aimed to estimate the Thus, changes in sleep quality stand out, being a deleterious
prevalence of cardiometabolic risk related to social jetlag factor for the impairment of the physical, mental health
in professors of the Federal University of Rio Grande and well-being of older people, resulting in greater and
do Norte (UFRN)Methods: Data were acquired by more prolonged use of Health Services at the Primary
completing validated online forms and physical assessment Health Care level. justifying the social relevance of this
for anthropometric data collection, blood pressure research. Aim: To evaluate sleep quality and its relationship
with associated factors in the elderly of a community in

Sleep Sci. 2020;13(Supl.1):1-118

 113

the Midwest regionMethods: Cross-sectional study with in animal studies are internally inconsistent. Aim: Based
elderly people from the Basic Health Unit of Granja do on that, we aimed at conducting a preclinical systematic
Torto, being considered chosen according to medical review and meta-analysis of studies evaluating the effects
appointments made at this unit during 2017. For data of experimental sleep deprivation during pregnancy on
collection, sociodemographic and health characteristics maternal behavior in animals. Methods: A bibliographic
were evaluated, and sleep quality was assessed using the search was conducted in five databases: Pubmed, Scopus,
Pittsburgh Sleep Quality Index. The scores of these Web of Science, Psychinfo and Lilacs. Search strategy
components produce an overall score ranging from 0 to 21 encompassed three domains: sleep deprivation during
points, so that 0-4 points indicate good sleep quality and pregnancy (as intervention), maternal behavior (as
≥ 5 indicate poor sleep quality. The project was approved outcomes) and animals (as population). Studies were
by the Research Ethics Committee (Opinion 1,861,003) selected in a two steps process, first based on titles and
and the participants signed an informed consent form. In abstracts, followed by full text analysis and data extraction.
the data analysis, the normality of the groups was verified Individual effect size for each articles was calculated
using the Shapiro-Wilk test, followed by the chi-square using standardized mean difference and meta-analysis
test, adopting p≤0.05.Results: Sample of 70 elderly, with was conducted using a random effects model.Results:
a predominance of females (72.9%). The prevalence of After bibliographic search, 144 non-duplicated articles
poor sleep quality in females and males, respectively, 54.3% were included in our initial data screening. Sample was
and 17.1%.Age ranged from 60 to 90 years (M =71.90; SD reduced to six records after screening and analyses. A
=7.07). Among the elderly aged 70-79 years, 38.6% have meta-analysis was performed, including data from either
poor sleep quality. 37.1% who have poor sleep quality are the pup retrieval test (latency to retrieve the last pup) and
married.No significant differences were found between ethogram-derived maternal variables (maternal score or
sociodemographic variables, sleep quality index (SQI), but licking and grooming frequency), including 115 animals.
34.3% of the elderly with poor sleep use polypharmacy. No effect was observed regarding the impact of sleep
The variables dyslipidemia (p =0.007) and Regular deprivation during pregnancy on maternal behavior (-0.14
Physical Activity (p =0.01) showed significant differences [-0.52; 0.23], p=0.57). Conclusions: Despite clinical data
when compared to the IQS. Conclusions: It is of great point to an increased likelihood of postpartum depression
magnitude to be aware of the aspects related to sleep in and impaired mother-infant relationship, preclinical data
Primary Health Care, seeking strategies such as studies failed to replicate this effect, demonstrating that gestational
using pharmacological and mainly non-pharmacological impaired sleep does not change maternal behavior. This
strategies, enabling greater integration of the Primary might reinforce the importance of social and cultural
Health Care team with the elderly, family members and factors into the sleep deprived-dependent postpartum
caregivers depression in human beings, since these factors are absent
Palavras-chave:
Sleep Medicine Primary Health Care.Disorder of onset and maintenance of sleep.Family and community medicine. Health services for the elderly. in rodents. When not affected by these additional factors,
maternal behavior seem to be maintained even in face of
ID: 951 environmental stress. This behavioral maintenance might
be part of an adaptive behavior, assuring maternal behavior
Basic Research
to be properly displayed even in adverse conditions,
Effects of sleep deprivation during pregnancy assuring the viability and survival of the offspring.
on maternal behavior – a systematic review
Palavras-chave: Sleep restriction, maternal care, pregnancy

and meta-analysis of preclinical data ID: 952

Baenninger, T, Mello, V, Tufik, S, Andersen, M L, Pires, G N Clinical Studies

Departamento de Psicobiologia - Universidade Federal de São Paulo - Screening Questionnaires for Obstructive
São Paulo - Sao Paulo - Brasil, Department of Physiological Sciences Sleep Apnea in patients evaluated for Bariatric
- Santa Casa de São Paulo School of Medical Sciences - São Paulo - Sao
Paulo - Brasil
Surgery

Introduction: Previous studies have hypothesized Silva, E V L, Rocha, M F L, Fernandes, L G G, Lima, P V, Rocha,
that sleep deprivation during pregnancy might lead V C, Coelho, J A P M, Mota, B R, Gitaí, L L G
to impairment into mother-infant relationship and
postpartum depression. Multiples studies have been Introduction: Obstructive Sleep Apnea (OSA) affects
conducted in preclinical models of sleep deprivation and nearly 1 billion people worldwide and obesity is its
maternal behavior, as a way to evaluate the mechanisms main reversible risk factor. Bariatric surgery is the most
behind this relationship. However, the data raised so far effective and long-lasting treatment for morbid obesity. As

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untreated OSA increases the frequency of perioperative Introduction: Quality of life and sleep quality have a
complications, screening for OSA prior to bariatric surgery bidirectional relationship. Contemporary society presents
has been recommended. Polysomnography is the gold a wide variety of challenges to teenagers’ quality of life
standard method for diagnosis and, although there are and sleep quality. Aim: The purpose of the present study
OSA clinical screening assessment tools, a key knowledge was to assess reported sleep duration, sleepiness, quality
gap is identifying which tools are most clinically relevant to of life and sleep quality among high school students.
use in clinical practice models. Aim: The aim of this study Methods: High school students from a private school in
is to evaluate three standardized screening questionnaires Sao Paulo were invited to participate. Subjects answered
to identify high-risk patients for OSA among patients three questionnaires: World Health Organization Quality
undergoing bariatric surgery. Methods: Consecutive of Life Questionnaire (WHOQOL-BREF), Pittsburgh
obese patients evaluated for bariatric surgery from August Sleep Quality Index (PSQI) and Epworth Sleepiness
2018 to August 2019 underwent clinical screening with Scale (ESS). In addition, students were asked about
STOP-BANG, NoSAS and Epworth Sleepinesse Scale average sleep duration.Results: Out of 220 students, 152
(ESS) and a standard overnight polysomnography (PSG) (42% men) accepted to participate. Mean reported sleep
at a sleep study center. Evaluation and interpretation of duration was 7:36 ± 0:53 hours. Most students (53.4%)
the PSG followed the American Society of Sleep Medicine had excessive daytime sleepiness (defined as an ESS > 10).
criteria (2.5). Inclusion criteria included age > 18 years and In addition, most students (73.8%) reported poor sleep
a body mass index (BMI) > 30 kg/m2. Exclusion criteria quality (defined as a PSQI > 4). There was a negative
included a previous diagnosis of OSA and incomplete correlation between sleep quality and the different domains
data.Results: 112 subjects were analyzed. The mean age of WHOQOL-BREF: Physical (r= -0.636; p < 0.001);
was 36.1 ± 9.4 (range = 18–63) and 83% were female. Psychological (r = - 0.548; p < 0.001); Social (r = - 0.219;
The prevalence of OSA and moderate to severe OSA p = 0.011); Environment (r = - 0.327; p < 0.001). Daytime
were 77.7 and 40.2%, respectively. The frequency of sleepiness was associated with physical, psychological and
subjects who were classified as high risk by the NoSAS environment WHOQOL-BREF domains (r ranging from
was 41.1% and by the STOP-BANG was 52.7%. The -0.260 to -0.343; p < 0.01) and sleep quality (r = 0.311; p
NoSAS score identified individuals at risk of moderate to < 0.001). Conclusions: High school students report poor
severe OSA, with an area under the curve (AUC) of 0·67 sleep quality and daytime sleepiness, which affects quality
(95% CI 0·56–0·77; p=0,003). Stop-BANG questionnaire of life. Interventions to improve sleep quality and quality
identified individuals at risk of clinically significant OSA, of life among high school students are warranted.
with an AUC of 0·71 (95% CI 0·61–0·81; p<0,001). ESS Palavras-chave: Sleep quality, quality of life, daytime sleepiness

score was not predictive of moderate to severe OSA, with

an area under the curve (AUC) of 0·54 (95% CI 0·43– ID: 955
0·65; p=0,4). The sensitivity and specificity values of the Basic Research
NoSAS score to predict moderate to severe OSA were
53.3 and 67.2%, respectively. The sensitivity and specificity Sleep Quality and Insomnia in Adolescents
values of STOP-BANG to predict moderate to severe Athletes Before Competitions
OSA were 71.1 and 59.7%, respectively. Conclusions:
In obese patients evaluated for bariatric surgery, STOP- Brasileiro-Santos, M S, Rocha, A I S S, Souza, L I S, Diniz, J S,
BANG questionnaire performed better than NoSAS score Alves, C S R, Ferreira, L R M, Barbosa, R A, Mello, B L C, Araújo,
and ESS to identify patients with moderate to severe OSA, A A, Santos, A C
although neither screening tool seemed able to replace the
need for polysomnography. Universidade Federal da Paraíba - JOÃO PESSOA - Paraiba - Brasil
Palavras-chave: Sleep apnea; Bariatric surgery; STOP-BANG
Introduction: Adolescents who participate in
ID: 954 competitions experience high levels of stress, which
can alter sleep quality, promotes insomnia and affect
Clinical Studies the performance. Aim: We assessed the subjective sleep
quality and insomnia of adolescents athletes during a
Poor sleep quality among high students is competitive period. Methods: One hundred and nineteen
associated with impaired quality of life Brazilian adolescents athletes (69 boys and 50 girls)
of individual and team sports participated in this study
Genta, F D, Rodrigues Neto, G B, Sundfeld, J P V, Porto, J F, (swimming, soccer and volleyball). The sleep quality was
Xavier, A D, Lorenzi-Filho, G, Genta, P R evaluated by Pittsburg Questionnaire and insomnia was
Escola Waldorf Rudolf Steiner - São Paulo - Sao Paulo - Brasil, assessed by Insomnia Severity Index. Both questionnaires
HCFMUSP - São Paulo - Sao Paulo - Brasil were performed up to 60 minutes before national sports

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competitions began. Spearman Coefficient was employed the SRM in participants with and without depression.
to evaluate the relationship between sleep quality (SQ Methods: This was a cross-sectional study with a sample
score) and insomnia. Wilcoxon-Mann-Whitney test of 36 patients (94.4% female), 36 controls (63.9% female),
was used to analyzed the sleep quality (bad and good with a mean age of 45.14±15.75 and 45.61±15.27,
sleepers) and Insomnia (with and without indicative). Was respectively. The interviews took place in person at the
considerated as level of statistical significance p < 0.05. Hospital de Clínicas de Porto Alegre (HCPA) and at the
Results: Sixty and fifty – nine adolescent athletes were Hospital Materno Infantil Presidente Vargas (HMIPV),
considered bad and good sleepers (3.4 ± 1.5 and 8.2 ± 2.2, obtaining approval from the Ethics Committee of the two
respectively; p < 0.001), 56 had presence of insomnia and hospitals (HCPA nºGPPG: #2018-0437; HMIPV nºCAE:
63 without insomnia (4.2 ± 2 and 12.1 ± 3.8, respectively; 57352416.0.0000.5329). Volunteers invited to participate
p < 0.001). Overall, we observed a significant relationship in the study signed an informed consent form. The
between sleep efficiency and duration (r = 0.538; p < following questionnaires were applied: Sociodemographic
0.001), SQ score with sleep efficiency (r = 0.371; p < Questionnaire, Beck Depression Inventory (BDI) and
0.001), duration (r = -0.664; p < 0.001) and sleep latency SRM. The last scale was completed for 15 days.Results:
(r = 0.452; p < 0.001) and, sleep latency with duration (r = The preliminary results indicated that BDI score was
-0.252; p = 0.006). Conclusions: Most of the adolescents 22.94±14.38 for patients and 5.78±3.96 for control
athletes showed bad sleep quality and 47% had presence group. In the patient group, only 61.1% of participants
of insomnia before competition. To evaluate the sleep completed the scale correctly during 15 days, 19.4%
of adolescent athletes before competitions could be an partially completed and 19.4% did not complete the
interesting monitoring strategy for coaching staffs that scale. For the control group, only 54.3% of participants
may impact upon their performance. completed the scale correctly, 11.1% partially completed,
Palavras-chave: Sleep quality, insomnia, athletes and adolescents.
and 33.3% did not complete the scale. Conclusions:
The SRM proved to be a difficult scale to fill for both
ID: 956 depressed and non-depressed individuals. Further studies
Clinical Studies are suggested to improve the definition and constructs of
the Social Rhythm as well as its evaluation.
The use of the Brief Version of the Social Palavras-chave: Depression; Social rhythm; Instrument of social rhythm.

Rhythm Metric in individuals with and ID: 957

without depression
Clinical Studies
Garay, L L d S, Steibel, E G, Amando, G, Greco, T M, Serafim, P
H M, de Oliveira, M A B, Medeiros, M S, Frey, B N, Carissimi,
Inspiratory flow limitation in normal and
A, Hidalgo, M P UARS patients in a general population sample
Hospital Materno Infantil Presidente Vargas - Porto Alegre - Rio Grande Palombini, L, Godoy, L B M, Andersen, M L, Poyares, D, Tufik, S
do Sul - Brasil, Laboratório de Cronobiologia e Sono do Hospital de
Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande Departamento de Psicobiologia - Universidade Federal de São Paulo -
do Sul (UFRGS) - Porto Alegre - Rio Grande do Sul - Brasil, McMaster São Paulo - São Paulo - Brazil
University - Canadá, Mood Disorders Program and Women’s Health Introduction: Inspiratory flow limitation (IFL) is defined
Concerns Clinic, St. Joseph’s Healthcare - Canadá, Programa de Pós- as a “flattened shape” of inspiratory airflow contour
Graduação em Psiquiatria e Ciências do Comportamento, UFRGS - detected by nasal cannula pressure during sleep and can
Porto Alegre - Rio Grande do Sul - Brasil indicate increased upper airway resistance especially in
mild Sleep Related Breathing Disorders (SRBD). It is
Introduction: Social Rhythm refers to the manifestation
commonly caused by narrowing of a hypotonic upper
of regular daily activities, determined by social relations.
airway in response to the negative intrathoracic pressure
People with depression have less stability in social rhythms
developed during inspiration. However IFL cut-off value
and are generally more susceptible to the cognitive and
for SRBD is not established yet. Aim: The objective of the
somatic effects caused by breaking the rhythm. The
study was to determine the cut-off value of IFL in potential
Brief Version of Social Rhythm Metric (SRM) has been
Upper Airway Resistance Syndrome (UARS) subjects
validated for the assessment of Social Rhythm in healthy
considering clinical outcomes in a general population
adults. It consists of a self-administered questionnaire,
sample. Methods: The baseline sample was derived from
which evaluates the performance of 6 daily activities
a prospective population-based study designed to assess
(getting out of bed, talking to someone for the first time,
the prevalence of sleep disorders in Sao Paulo, Brazil. A
starting work, having lunch, dinner and going to bed) and
total of 1,042 subjects completed all the study assessments
at what time they occurred. Aim: To evaluate the use of
in 2007 and, from July 2015 to April 2016, 712 from these

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participants were reassessed and underwent a second the Human Ethics Committee. 3 patients underwent an
examination. Full night polysomnography (PSG) at both oral oil containing 1mg THC and 112µg CBD daily while
baseline and follow-up was performed. IFL was scored 1 patient received the oil containing 250µg THC and 28µg
based on nasal cannula recording if there were at least four CBD, daily. The treatment lasted for 60 days. During this
consecutive breaths with flattening of the airflow curve in period, patients used an actimeter on non-dominant wrist
a 30 second epoch. We manually scored each participant to monitor the following parameters: bed time, wake up
and calculated their total sleep time (TST) spent in IFL time, time in bed, sleep duration, sleep efficiency, number
during sleep. Clinical outcomes (excessive daytime of awakenings and WASO. A total of 33 days of actigraphy
sleepiness, fatigue, mood and quality of sleep) of no OSAS per subject was considered for this exploratory analysis,
subjects (normal individuals and potential UARS patients) resulting in 132 nights evaluated in three times (T1=48
were analyzed at baseline and after 8 years.Results: From nights, T2=48 nights, and T3=36 nights). Due the small
the 712 participants evaluated, 242 subjects without OSAS sample size, the nights were considered as independent
(normal individuals and potential UARS patients) were measures and means were compared using factorial
clinically evaluated at baseline and after 8 years. When ANOVA, with dose time of evaluation as between factors.
an IFL cut-off value of equal to or greater than 5% of Values are presented as means±SEResults: Patient aged
TST was considered for UARS diagnosis, there was not from 49-65 years old. ANOVA did not identified effects of
any statistical significant difference in clinical outcomes dose, or time of treatment for Bedtime (1mg 21:42±00:07;
though 8 years. Otherwise, when an IFL cut-off value of 250 21:52±00:12, p>0.05), time in bed (1mg 08:05±0:08;
equal to or greater than 15% of TST was considered for 250 07:45±00:14; p>0.05). However, there was significant
UARS diagnosis, normal subjects in 2007 that had potential effect of dose and time of treatment for the waking up
UARS in 2016 and patients with potential UARS in 2007 time at with earlier waking up for the 250 g at the T3 (1mg
that maintain their diagnosis in 2016 had more severity of 5:38±0:13; 250 4:32±0:23; p<0.05). The lower dose of
depressive symptoms than normal subjects in 2007/2016. treatment also was associated with shorter sleep duration,
Conclusions: In a general population sample, we suggest with ANOVA detecting effect of dose (1mg 6:51±0:07; 250
a cut-off value of IFL in normal subjects and in potential 6:00±00:12; p<0.05). Dose was associated with increasing
UARS patients of equal or greater than 15% of TST when sleep efficiency for the 250 condition, from 75.75%±2.36
clinical outcomes are considered. at T1 to 82.2.37%±2.73 at T3, as a consequence of reduced
Palavras-chave: flow limitation, upper airway resistance Palavras-chave: hábitos de sono, adolescentes, área urbana, área suburbana
WASO from T1 to T3 (115.91±10.5min to 77.22±12.54min
p<0.05). Conclusions: Our preliminary findings suggest
ID: 959 that cannabinoids microdosing have potential as a
pharmacological tool to treat SD with significant benefits in
Clinical Studies sleep characteristics. Notwithstanding, further studies with
larger sample sizes are needed
Oral treatment with cannabinoids microdosing Palavras-chave: Parkinson Disease, Cannabinoids, microdosing, sleep disorders

improves sleep in Parkinson Diseases -

Preliminary Findings ID: 960
Case Reports
Pauli, K B, Gomes, A C M, Hollas, V G, Nascimento, F P,
Beijamini, F Sleep Hygiene in Children - A Case Report
Programa de Pós-Graduação stricto sensu em Biociências (PPG-BC) -
Watanabe, N, Watanabe, N, Nandi, T A, Nandi, T A, Demathé,
Universidade Federal da Integração Latino-Americana - UNILA - Foz
T, Demathé, T
do Iguacu - Parana - Brasil, Universidade Federal da Fronteira Sul -
UFFS - Realeza - Parana - Brasil UNISUL - Tubarão - Santa Catarina - Brasil

Introduction: Sleep disorders (SD) are very common Introduction: Sleep disorders are prevalent in pediatrics,
and can occur before the beginning of motor symptoms affecting about 1 in 4 children after the first years of
in Parkinson’s disease (PD) patients. Current therapies to life. Can impact on attention and memory which are the
treat SD in PD patients are very ineffective. On the other functions of importance for child development, can
hand, several studies have shown the potential of Cannabis being involved in increased hyperactivity, mood disorders
sativa (CS) and cannabinoids to treat SD in many kind of and aggression. They may be of organic or behavioral
patients. Then, our hypothesis is that CS treatment could etiology. Behavioral insomnia is based on sleep hygiene
improve the SD in PD patientsAim: To evaluate the effect and treatment and precautionary measures, which uses
of a CS extract with cannabinoids low doses on SD in PD a range of changes in habits of children and families, as
patientsMethods: Four patient diagnosed with PD for at well as environmental changes, providing to the patient
least 10 years were selected. The project was approved by with conditions suitable for a quality sleep. Aim: Report

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 117

a caseMethods: DescriptiveResults: CR, male, 1 year upper airway collapsibility, often in a dose-dependent
and 7 months comes to outpatient clinic accompanied manner, by increasing the pharyngeal dimensions upon
by his mother, complaining of nocturnal awakening and protrusion of the lower jaw. The apnea hypopnea index
irritability. He had been using risperidone for 2 months (AHI) has been found to be a weaker predictor to identify
as indicated by the neuropediatrician due to the difficulty MAD treatment responders and patients with moderate
in maintaining sleep and agitated and aggressive behavior to severe OSA might also have a good outcome. Aim: To
during the day, without showing improvement in the period. describe three cases of moderate to severe OSA treated
He sleeps from 9pm to 7am, with awakening between 2 and with MAD presenting improvement of clinical complaints
3am, when he has narrowed eyes, confused, not obeying and AHI. Methods: We describe three patients being
the commands of parents.Denies snoring or stereotyped followed-up in the Otolaryngology or Neurophysiology
movements.He takes a nap about 1:30 after lunch, when he Laboratory, complaining excessive daytime sleepiness,
is awakened “to not affect night sleep”. He does not have snoring, fatigue and other clinical symptoms, diagnosed
a well-established bedtime routine.We suggest letting him with OSA, as follow: Case 1: 42-year-old male patient,
sleep for free in the afternoon nap to assess the actual need presenting in 2012 an apnea hypopnea index (AIH) 57.5
for sleep and the mother was advised about new routine. events/hour, submitted to otolaryngology surgeries with
After 14 days, there was a significant improvement in no improvement of symptoms and AHI 53.3 events/
daytime and sleep behavior. A consistent routine has been hour. Case 2: 45-year-old male patient, presenting in
adopted with the child: after coming home from school, 2010 an AIH 18.4 events/hour, after two otolaryngology
receives dinner, takes a shower and goes to the dimly lit surgeries (2010 and 2011) presented an AHI 23.7 events/
room, where the mother tells stories until the child sleeps. hour. Case 3: 55-year-old male patient, presenting AHI 25
The patient remained consistent at bedtime 21h and woke events/hour had no adherence to CPAP treatment due to
up at 6am, without awakening.He increased spontaneously limited economic condition. All patients were referred to
about an hour in the afternoon nap (total 2h30).After one Dentistry Division of the Hospital for MAD treatment for
week of sleep hygiene, the mother reports having finished OSA and submitted to clinical and radiological evaluation.
risperidone and chose not to give the medication again, The installed model was one-piece, allowing 70% retrusion
considering the improvement of the child’s overall behavior. and protrusion and its efficiency were determined with
Conclusions: Sleep deprivation has consequences on child a new polysomnography.Results: All patients reported
health, such as metabolic disorders, memory deficit, reduced improvement in clinical complaints after MAD use and
cognitive performance and behavioral impairment.Recent there was a significant improvement in AHI observed in
studies show the negative effect on their ability to regulate subsequent polysomnography. Case 1: AHI 1.1 event/
behavior Therefore, it is essential to adopt adequate sleep hour, case 2: AHI 7,3 events/hour and case 3: AHI 11.8
hygiene measures before drug interventions for children events/hour. Conclusions: Advanced ways to interpret
with insomnia and behavioral alterations that do not delay sleep apnea recordings will allow the identification of
neurological development. various phenotypes of sleep apnea patients and provide a
Palavras-chave: Sleep Hygiene
more promising way forward to find patients who respond
to OSA treatment in different ways. MAD therapy alone is
ID: 963 sufficient in a quarter of severe OSA patients.
Clinical Studies
Palavras-chave: Sleep Apnea, Obstructive; Mandibular Advancement; Therapeutics.

ID: 965
Mandibular advancement device (MAD)
treatment for moderate to severe obstructive Basic Research
sleep apnea (OSA) Effects of female sexual hormones on sleep –
Vilarim, R C B, Toscanini, A C, Jales, S M C P, Lacerda, C B, a bibliometric review of preclinical data
Borges, D S, Formigoni, G G, Cahali, M B, Hasan, R, Siqueira,
JTT Malfa, V, Selva, V, Bezerra, A G, Tufik, S, Andersen, M L,
Pires, GN
HC-FMUSP - SAO PAULO - Sao Paulo - Brasil
Departamento de Psicobiologia - Universidade Federal de São Paulo -
Introduction: Obstructive sleep apnea (OSA) is a highly São Paulo - Sao Paulo - Brasil, Department of Physiological Sciences
prevalent sleep-related breathing disorder characterized - Santa Casa de São Paulo School of Medical Sciences - São Paulo - Sao
by periods of recurrent cessation of breathing caused by Paulo - Brasil
partial or complete collapse of the upper airway. Mandibular
advancement device (MAD) represents a well-tolerated Introduction: Previous clinical and preclinical data have
treatment for selected patients with OSA. MAD reduces

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raised the possibility that female sexual hormones may Passini, V V, Lacerda, C B, Fernandes, M D, Toscanini, A C,
influence sleep physiology, being used as an alternative to Borges, D G S, de Azevedo, A P, Hasan, R
hypnotics. Due to the diversity of formulations and other IPq- HC-FMUSP - São Paulo - Sao Paulo - Brasil
methodological factors have impaired to draw definitive
conclusions on this topic, especially in preclinical studies. Introduction: Narcolepsy type 1 is a sleep disorder
Up to now, no comprehensive reassessment have been characterized by excessive daytime sleepiness, cataplexy,
performed. Aim: The current study intended to perform a sleep paralysis and it is usually associated with other sleep
bibliometric review of studies evaluating the effects of sexual conditions. We report a case of a patient with narcolepsy
hormones interventions on sleep, focusing on preclinical type 1, who presented with REM Sleep Behavior Disorder
animals models. It aimed at understand the publication trends (RBD) features and obstructive sleep apnea (OSA) in sleep
on this field, including the most used hormonal interventions studies. Aim: The purpose of this case report is to highlight
and animal species. This is a previous step to a systematic the importance of evaluating other sleep conditions
review, which aim at explored the available data and research associated with Narcolepsy. Methods: A 34-year-old man
trends, as well as to evaluate which interventions, outcomes with a history of excessive daytime sleepiness since he
and species are more likely to result in a meta-analysis. was 15 years old, associated to loss of muscle tone often
Methods: An initial bibliographic search was conducted in triggered by pleasant emotions. He had been hospitalized
Pubmed, aiming at retrieving studies evaluating the effects at age 17 for hypnagogic and hypnopompic hallucinations,
of female sexual hormones on objectively assessed sleep being medicated with benzodiazepines, antidepressants
in preclinical animal models. Search strategy encompassed and antipsychotics, leading to deterioration of its clinical
three domains: female sexual hormones (as intervention), condition, over the years. The consequences were weight
sleep evaluate by polysomnography or related recordings (as gain, learning disability and irritability; frequente he was
outcomes) and experimentation animals (as intervention). fired from his jobs. At 32 years old, he was diagnosed
Studies were screened by two independent reviewers. A with Narcolepsy, and treatment with Modafinil and
bibliometric analysis was made, in order to understand the Nortriptyline lead to partial symptom improvement.
publication trends on this field.Results: After bibliographic Results: Due to residual symptoms of excessive daytime
search, 288 records were retrieved. Among these, 38 were sleepiness, cataplexy and hypnagogic and hypnopompic
considered eligible for this systematic review. Concordance hallucinations, as well as his wife’s report of abnormal
rate between reviewers were of 97.92%. Publication record behaviors during sleep and a 10 kg weight gain in the last
seems to be in decline on this field, as most studies were year, with increased snoring intensity, polysomnography,
published during the 90’s (12 – 31%), while 13 were published actigraphy and multiple sleep latency test were requested.
from 2000 to date. Most commonly used species were rats (20 Polysomnography showed severe obstructive sleep apnea,
studies) followed by mice (2 studies). All other species were and motor behaviors compatible with diagnosis of RDB.
used in an only one study (including marmoset, rabbit, sheep, The multiple sleep latency test revealed a mean sleep
canary, cat and guinea pig). Regarding the interventions, 10 latency of less than 8 min with 5 episodes of REM sleep,
studies evaluated the effects of estradiol, seven were related confirming diagnostic of Narcolepsy. Actigraphy pattern
to progesterone. Conclusions: Heterogeneity is observed indicated sleep fragmentation. In narcolepsy, RBD and
on hormonal interventions and animal species, reducing RSWA are associated conditions, probably related to
the likelihood of performing a robust meta-analysis on the the role of hypocretin in REM tone loss. In narcoleptic
field. The reduction on the number of articles might reflect patients, the RDB age onset is earlier than usual, the
an understanding that hormonal-derived interventions have movements during the episode are less complex and
no clinical value as a possible therapeutic strategy for sleep less violent. Isolated obstructive sleep apnea may cause
disorders. abnormal behaviors during sleep, but it is usually less
Palavras-chave: Estrogen, progesterone, Sexual hormones
severe, due to maintainance of tone in this situations.
Conclusions: Given Narcolepsy with difficulty in
ID: 966 controlling symptoms, it is important to investigate other
Case Reports sleep disorders, like RDB and OSA. Asking about dream
enactement or symptons of sleep apnea, may help to
Narcolepsy type 1 and rem sleep without better define the differential diagnosis.
atonia (RSWA): what is the relationship to rem
Palavras-chave: narcolepsy, apnea, REM sleep behavior disorder

sleep behavior disorder (RBD) and obstructive

sleep apnea ?: case report

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