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176 FATIGUE, DEPRESSION SYMPTONS AND SLEEP DISTURBANCES IN SURVIVORS OF CHILDHOOD CANCER
S48
Abstracts of 3rd International Congress of the Association of Sleep Medicine (WASM) / Sleep Medicine 10, Suppl. 2 (2009) S1–S83
Results: 1 - There was a significant increase in frequency of abnormal BAI in the OSA group compared to non-OSA controls (7.46% vs. 0.0% p=0.00005). 2 - Patients’ mean ages for the abnormal BAI group (G1) and normal BAI (G2) group were 56.28±8.58 and 50.51±7.98, respectively (p=0.0005). Comparison between abnormal BAI and normal BAI subjects showed higher aortic left atrium and left ventricle diameters (3.54±0.34 vs. 3.26±0.28 p=0.04; 3.92±0.56 vs. 3.55±0.34 p=0.03; 5.20±0.36 vs. 4.63±0.58 p=0.03; respectively). Hematocrit (44.69±4.91 vs. 42.61±3.65 p=0.007), triglycerides (168.60±117.95 vs. 134.92±73.54 p=0.05), glycemia (111.2±22.12 vs. 100.02±20.58 p=0.008), brain natriuretic peptide (32.45±69.86 vs. 13.39±13.06 p=0.02) and C-reactive protein (0.60±0.87vs. 0.35±0.32 p=0.02) were also significantly altered among abnormal BAI OSA patients (AHI: 29.74±22.12 vs. 18.23±19.00, p=0.004), compared to controls. Logistic regression results showed that only AHI (1.9[C.I 95%: 1.03;1.16] p=0.002) and C-reactive protein (2.97 [C.I 95%: 1.06; 8.31] p=0.04) were independently associated with PAD. Conclusions: Peripheral arterial disease is more prevalent in OSA compared to non-OSA subjects. AHI and CRP were independent predictors of PAD.
175
SLEEP ASPECTS IN PATIENTS WITH HEPATIC CIRRHOSIS
V. Teodoro, L.M. Lucchesi, M. Bragagnolo Jr., M. Kondo, S. Tufik. UNIFESP/EPM Hepatic cirrhosis is a serious public health issue in the world, because it is a very common disease with a great impact. The occurrence of liver structural alterations has various consequences, including neurological ones. Patients with cirrhosis present several clinical manifestations that involve alterations of biological functions, such as sleep and waking. Study objective: The aim of this study was to characterize sleep parameters and sleepiness in cirrhotic patients and to assess a possible effect of the severity level of this disease on these parameters. Design: It was a case-control study. Setting: The hepatology outpatient service of Hospital São Paulo (UNIFESP/EPM) and the Sleep Institute and Diagnostic Center of the Associação Fundo de Incentivo à Psicofarmacologia (AFIP); 42 cirrhotic patients and 42 volunteers without hepatic disease were submitted to an all night polysomnographic evaluation. They also answered sleep questionnaires as well as the Epworth Sleepiness Scale. The severity of the illness was assessed by the prognostic model of Child-Turcotte-Pugh and MELD scores. Results: There was no difference in age, gender and BMI between cirrhotic patients and volunteers. However, the polysomnographic findings showed lower sleep efficiency (median±SD, 73.9±15.0% versus 84.4±8,5%; P<0.01), as well as an increase in the REM sleep latency (median±SD, 151.3±93.0 min. versus 90.6±54.7 min.; P<0.01) and a lower REM sleep percentage (median ± SD, 14.0±5.6% versus 20.7±6.7%; P<0.05) in the cirrhotic group when compared with the control group. The cirrhotic patients also showed higher frequency of Periodic Limb Movements in Sleep in comparison to controls (median±SD, 10.6±2.8 PMLSh versus 2.8±0.6 PMLSh.; P<0.01), respectively. There was a significant difference among Child-Turcotte-Pugh groups with regard to REM sleep percentage, significantly lower in group C when compared to group B and group A (P<0.02 and P<0.03, respectively). No significant differences were detected between the scores of both groups on the Epworth scale. Conclusion: These findings suggest that cirrhotic patients had a worse quality of sleep when compared with the control group and higher occurrence of PLMS. There was also an influence of the severity of liver failure on some sleep parameters.
176
FATIGUE, DEPRESSION SYMPTONS AND SLEEP DISTURBANCES IN SURVIVORS OF CHILDHOOD CANCER
R. Zeppini 1 , M. Pradella-Hallinan 2, A. Kurashima 3 , B. Camargo 3 . 1 AC Camargo; 2 Instituto do sono - UNIFESP; 3 AC. Camargo Treatments for children with cancer have improved significantly. The treatment can be associated with significant adverse effects, including fatigue. Different definitions have been suggested and they include tiredness, weariness, weakness, exhaustion and lack of energy. Fatigue has a multidimensional conception with several modes of expression: physical, behavioral, cognitive and affective. Fatigue can be correlated with other symptoms like depression and sleep disturbances. The objectives of the study were to evaluate fatigue, depression symptoms and sleep disturbances in sur-
vivors of childhood cancer. Seventy-two adolescents (13-18 yrs) were evaluated, with: acute lymphocytic leukemia (16), acute myelogenous leukemia (7), Hodgkin’s lymphoma (4), non-Hodgkin’s lymphoma (12), Ewing’s sarcoma (4), osteosarcoma (5), Wilms’ tumor (11), germ cell tumors (3), rhabdomyosarcoma (4), other soft tissue sarcoma (4), others (2). Time out of treatment ranged from 3-214 months. We used the pediatric quality of life inventory (PedsQL) - multidimensional fatigue scale for adolescents and the PedsQL parent proxy-report for the parents. This version encompasses three subscales: general fatigue, sleep-rest fatigue, cognitive fatigue. Survivors were divided in two groups: more fatigue (lower scores) and less fatigue (higher scores), calculated with score terciles. The Beck depression inventory (BDI) questionnaire and nocturnal polysomnography (NP) were also evaluated. Seventy-two patients and 65 parents completed the questionnaires. Thirty-two patients who were evaluated exhibited NP. Depression symptoms were correlated with gender; girls had more depression symptoms (p.008). Patients who had lower scores for sleep-rest fatigue, general fatigue and cognitive fatigue had more depression symptoms (p 0.002, OR 12,31, IC 2,00–97,27; p 0.029, OR 4,62, IC 0,94–23,81; p 0.001, OR 8,91, IC 1,66– 53,43). Twenty-two (68%) patients had reduced sleep efficiency (<85%). Total sleep time correlated with the cognitive and general fatigue scores: children who slept less than 6 hours had more fatigue (p 0.027, OR 6,67, IC 1,04–48,62; p 0.053, OR 5,6, IC 0,91–38,65). We also determined internal consistency reliability for the PedsQL Multidimensional fatigue scale (α: 0,89). Conclusion: Fatigue is a common symptom in survivors of cancer. This scale is a valid measure for fatigue and sleep disturbance.
Sleep in Patients with Neurological Disorders
177
SLEEP IN WILLIAMS SYNDROME: FROM APERIODIC LEG MOVEMENTS TO ARCHITECTURAL, EEG SPECTRAL AND SPINDLING PECULIARITIES
R. Bódizs, F. Gombos, I. Kovács. HAS-BME Cognitive Science Research Group, Hungarian Academy of Sciences, Budapest, Hungary Introduction: Alterations in macro- and microstructural characteristics of sleep are emerging features of several developmental disabilities [1], but polygraphic data on the sleep phenotype of adolescents and young adults with Williams Syndrome (WS, a genetically determined developmental disorder linked to a microdeletion in chromosome 7q11.23 and associated with mild to moderate mental retardation and with a distinctive cognitivelinguistic profile) is still lacking. Objectives: We aimed to carry out a careful polysomnographic analysis of subjects with WS in order to provide a detailed characterization of their sleep phenotype. Methods: EEG, EMG, ECG, and leg movement detection was carried out during two consecutive nights’ laboratory sleep of 9 WS and 9 age- and gendermatched healthy control subjects (age range: 14–29 yrs; mean: 20.76 yrs). Sleep architecture, NREM sleep EEG spectra and sleep spindling, measured according to the Individual Adjustment Method (IAM [2]), were analyzed. Results: WS subjects’ sleep was characterized by decreases in total sleep time and sleep efficiency as well as in REM duration and percent. The percentage of wake time, as well as that of NREM and slow wave sleep (SWS), was increased. Frequent uni- or bilateral aperiodic leg movements, occurring largely in NREM sleep, were also observed. WS subjects were characterized by decreases in 1 Hz bins of the 8–13 Hz range EEG spectra over all areas, as well as by increases in the 14–15 Hz bin over the central regions. The frequency of centro-parietal peaks in WS subjects’ EEG spectra consistently exceeded that of control subjects’ peaks. Both slow and fast sleep spindles were significantly more frequent in WS than in control subjects. Conclusion: We concluded that frequent aperiodic leg movements may lead to significant sleep disruption in adolescents and young adults with WS. This finding agrees partially with the only previous report on polysomnographic sleep in children with WS [3], as well as with actigraphy data of adults with WS [4]. Together with specific alterations in sleep EEG fingerprints and sleep spindling, these features are potential biomarkers of the characteristic cognitive profile of WS.
Abstracts of 3rd International Congress of the Association of Sleep Medicine (WASM) / Sleep Medicine 10, Suppl. 2 (2009) S1–S83
Results: 1 - There was a significant increase in frequency of abnormal BAI in the OSA group compared to non-OSA controls (7.46% vs. 0.0% p=0.00005). 2 - Patients’ mean ages for the abnormal BAI group (G1) and normal BAI (G2) group were 56.28±8.58 and 50.51±7.98, respectively (p=0.0005). Comparison between abnormal BAI and normal BAI subjects showed higher aortic left atrium and left ventricle diameters (3.54±0.34 vs. 3.26±0.28 p=0.04; 3.92±0.56 vs. 3.55±0.34 p=0.03; 5.20±0.36 vs. 4.63±0.58 p=0.03; respectively). Hematocrit (44.69±4.91 vs. 42.61±3.65 p=0.007), triglycerides (168.60±117.95 vs. 134.92±73.54 p=0.05), glycemia (111.2±22.12 vs. 100.02±20.58 p=0.008), brain natriuretic peptide (32.45±69.86 vs. 13.39±13.06 p=0.02) and C-reactive protein (0.60±0.87vs. 0.35±0.32 p=0.02) were also significantly altered among abnormal BAI OSA patients (AHI: 29.74±22.12 vs. 18.23±19.00, p=0.004), compared to controls. Logistic regression results showed that only AHI (1.9[C.I 95%: 1.03;1.16] p=0.002) and C-reactive protein (2.97 [C.I 95%: 1.06; 8.31] p=0.04) were independently associated with PAD. Conclusions: Peripheral arterial disease is more prevalent in OSA compared to non-OSA subjects. AHI and CRP were independent predictors of PAD.
175
SLEEP ASPECTS IN PATIENTS WITH HEPATIC CIRRHOSIS
V. Teodoro, L.M. Lucchesi, M. Bragagnolo Jr., M. Kondo, S. Tufik. UNIFESP/EPM Hepatic cirrhosis is a serious public health issue in the world, because it is a very common disease with a great impact. The occurrence of liver structural alterations has various consequences, including neurological ones. Patients with cirrhosis present several clinical manifestations that involve alterations of biological functions, such as sleep and waking. Study objective: The aim of this study was to characterize sleep parameters and sleepiness in cirrhotic patients and to assess a possible effect of the severity level of this disease on these parameters. Design: It was a case-control study. Setting: The hepatology outpatient service of Hospital São Paulo (UNIFESP/EPM) and the Sleep Institute and Diagnostic Center of the Associação Fundo de Incentivo à Psicofarmacologia (AFIP); 42 cirrhotic patients and 42 volunteers without hepatic disease were submitted to an all night polysomnographic evaluation. They also answered sleep questionnaires as well as the Epworth Sleepiness Scale. The severity of the illness was assessed by the prognostic model of Child-Turcotte-Pugh and MELD scores. Results: There was no difference in age, gender and BMI between cirrhotic patients and volunteers. However, the polysomnographic findings showed lower sleep efficiency (median±SD, 73.9±15.0% versus 84.4±8,5%; P<0.01), as well as an increase in the REM sleep latency (median±SD, 151.3±93.0 min. versus 90.6±54.7 min.; P<0.01) and a lower REM sleep percentage (median ± SD, 14.0±5.6% versus 20.7±6.7%; P<0.05) in the cirrhotic group when compared with the control group. The cirrhotic patients also showed higher frequency of Periodic Limb Movements in Sleep in comparison to controls (median±SD, 10.6±2.8 PMLSh versus 2.8±0.6 PMLSh.; P<0.01), respectively. There was a significant difference among Child-Turcotte-Pugh groups with regard to REM sleep percentage, significantly lower in group C when compared to group B and group A (P<0.02 and P<0.03, respectively). No significant differences were detected between the scores of both groups on the Epworth scale. Conclusion: These findings suggest that cirrhotic patients had a worse quality of sleep when compared with the control group and higher occurrence of PLMS. There was also an influence of the severity of liver failure on some sleep parameters.
176
FATIGUE, DEPRESSION SYMPTONS AND SLEEP DISTURBANCES IN SURVIVORS OF CHILDHOOD CANCER
R. Zeppini 1 , M. Pradella-Hallinan 2, A. Kurashima 3 , B. Camargo 3 . 1 AC Camargo; 2 Instituto do sono - UNIFESP; 3 AC. Camargo Treatments for children with cancer have improved significantly. The treatment can be associated with significant adverse effects, including fatigue. Different definitions have been suggested and they include tiredness, weariness, weakness, exhaustion and lack of energy. Fatigue has a multidimensional conception with several modes of expression: physical, behavioral, cognitive and affective. Fatigue can be correlated with other symptoms like depression and sleep disturbances. The objectives of the study were to evaluate fatigue, depression symptoms and sleep disturbances in sur-
vivors of childhood cancer. Seventy-two adolescents (13-18 yrs) were evaluated, with: acute lymphocytic leukemia (16), acute myelogenous leukemia (7), Hodgkin’s lymphoma (4), non-Hodgkin’s lymphoma (12), Ewing’s sarcoma (4), osteosarcoma (5), Wilms’ tumor (11), germ cell tumors (3), rhabdomyosarcoma (4), other soft tissue sarcoma (4), others (2). Time out of treatment ranged from 3-214 months. We used the pediatric quality of life inventory (PedsQL) - multidimensional fatigue scale for adolescents and the PedsQL parent proxy-report for the parents. This version encompasses three subscales: general fatigue, sleep-rest fatigue, cognitive fatigue. Survivors were divided in two groups: more fatigue (lower scores) and less fatigue (higher scores), calculated with score terciles. The Beck depression inventory (BDI) questionnaire and nocturnal polysomnography (NP) were also evaluated. Seventy-two patients and 65 parents completed the questionnaires. Thirty-two patients who were evaluated exhibited NP. Depression symptoms were correlated with gender; girls had more depression symptoms (p.008). Patients who had lower scores for sleep-rest fatigue, general fatigue and cognitive fatigue had more depression symptoms (p 0.002, OR 12,31, IC 2,00–97,27; p 0.029, OR 4,62, IC 0,94–23,81; p 0.001, OR 8,91, IC 1,66– 53,43). Twenty-two (68%) patients had reduced sleep efficiency (<85%). Total sleep time correlated with the cognitive and general fatigue scores: children who slept less than 6 hours had more fatigue (p 0.027, OR 6,67, IC 1,04–48,62; p 0.053, OR 5,6, IC 0,91–38,65). We also determined internal consistency reliability for the PedsQL Multidimensional fatigue scale (α: 0,89). Conclusion: Fatigue is a common symptom in survivors of cancer. This scale is a valid measure for fatigue and sleep disturbance.
Sleep in Patients with Neurological Disorders
177
SLEEP IN WILLIAMS SYNDROME: FROM APERIODIC LEG MOVEMENTS TO ARCHITECTURAL, EEG SPECTRAL AND SPINDLING PECULIARITIES
R. Bódizs, F. Gombos, I. Kovács. HAS-BME Cognitive Science Research Group, Hungarian Academy of Sciences, Budapest, Hungary Introduction: Alterations in macro- and microstructural characteristics of sleep are emerging features of several developmental disabilities [1], but polygraphic data on the sleep phenotype of adolescents and young adults with Williams Syndrome (WS, a genetically determined developmental disorder linked to a microdeletion in chromosome 7q11.23 and associated with mild to moderate mental retardation and with a distinctive cognitivelinguistic profile) is still lacking. Objectives: We aimed to carry out a careful polysomnographic analysis of subjects with WS in order to provide a detailed characterization of their sleep phenotype. Methods: EEG, EMG, ECG, and leg movement detection was carried out during two consecutive nights’ laboratory sleep of 9 WS and 9 age- and gendermatched healthy control subjects (age range: 14–29 yrs; mean: 20.76 yrs). Sleep architecture, NREM sleep EEG spectra and sleep spindling, measured according to the Individual Adjustment Method (IAM [2]), were analyzed. Results: WS subjects’ sleep was characterized by decreases in total sleep time and sleep efficiency as well as in REM duration and percent. The percentage of wake time, as well as that of NREM and slow wave sleep (SWS), was increased. Frequent uni- or bilateral aperiodic leg movements, occurring largely in NREM sleep, were also observed. WS subjects were characterized by decreases in 1 Hz bins of the 8–13 Hz range EEG spectra over all areas, as well as by increases in the 14–15 Hz bin over the central regions. The frequency of centro-parietal peaks in WS subjects’ EEG spectra consistently exceeded that of control subjects’ peaks. Both slow and fast sleep spindles were significantly more frequent in WS than in control subjects. Conclusion: We concluded that frequent aperiodic leg movements may lead to significant sleep disruption in adolescents and young adults with WS. This finding agrees partially with the only previous report on polysomnographic sleep in children with WS [3], as well as with actigraphy data of adults with WS [4]. Together with specific alterations in sleep EEG fingerprints and sleep spindling, these features are potential biomarkers of the characteristic cognitive profile of WS.