- Email: [email protected]
L0052 Dream content in congenital deafness
Posters / Sleep Medicine 8 Suppl. 1 (2007) S69–S114 L0052 Dream content in congenital deafness J. Pires, T. Paiva, A.R. Peralta, R. Santos, L. Ferreira, H. B´ertolo, I. Galhardo, A. Najmark, O. Dias. Lab EEG Sono, Neurologia, FML-IMM, Lisboa, Portugal Dream content studies have shown that characters and their interactions and emotions, misfortune and good fortune events are similar between individuals and relatively independent of culture. Despite the significant sensorial attenuation that occurs during sleep, previous studies have shown that auditory stimuli activate cortical structures similar to wakefulness. Experimental studies have also shown that auditory stimuli during sleep can modify dream content. Dreams are also based upon awakening memories. Congenital deafness constitutes an interesting model to study both these issues regarding auditory memories and events. Systematic dream content studies in deaf people are nonexistent. Objectives: Dream content analysis in congenital deaf with specific analysis of auditory and verbal activity. Material and Methods: Cases: 8 congenital deaf subjects; dreams were collected by dream diaries (15 days) followed by nocturnal REM awakenings in the laboratory under full PSG. Dream content was analyzed by the Hall and Van Castle coding system. Cases were compared to published normative Hall and Van Castle data, through DREAMSTAT Excel spreadsheet. Statistical analysis was based on frequencies and comparisons of percentages through the “h” statistic (Cohen). The significance level was 0.05. Results: Deaf subjects’ dream reports have auditory contents (e.g “I heard the noise of the sea”) (6/296 activities) and frequent verbal activities (25/296). Their dreams had significantly less male characters, familiar characters, negative events and emotions and more aggressive interactions. Conclusions: Despite the absence of auditory stimulation, auditory elements seem to persist in congenital deaf subjects’ dreams. Verbal communication is frequent, although it is not possible to discriminate between oral and sign language in our study. Changes in other dream contents require a systematic evaluation of the psychopathology probably common in these subjects. This preliminary work shows interesting results that will be substantiated in future studies, mainly focusing on a more accurate description of the experienced auditory sensations and verbal activity.
L0053 Sleepiness and sleep quality in epilepsy patients: an outpatient clinic-based study T. Mestre *, C. Bentes, I. Henriques, A. Lomba, T. Paiva. EEG/Sleep Laboratory; Neuroscience and Mental Health Department, Hospital de Santa Maria, Lisbon, Portugal Background: Sleep and epilepsy have multiple reciprocal relations. Sleep complaints are more frequent in epilepsy patients. Epilepsy-related mood disturbances, anti-epileptic drugs (AEDs) effects and sleep-related seizures are possible contributing factors. Aim: To evaluate sleepiness and sleep quality in epilepy patients. Methods: In an outpatient epilepsy clinic environment, a questionnairebased study was conducted using a booklet filled up by the patient that included the following: demographic data, Brief Symptom Inventory (BSI), Epsworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI). The assistant-epileptologist completed a clinical report concerning seizure type and frequency, disease duration, number of AEDs in use. Results: The studied population (n = 52; F:28, M:24; median age: 35, min: 16, max: 80), had a median disease duration of 15 years (0−47). 26 patients had partial seizures and 19 patients had generalised seizures. 36 patients (69.2%) were on monotherapy and 15 on duotherapy. 29 patients (55.8%) were seizure-free in the month before. The median ESS score was 7 (0−17) and PSQI score was 5 (1−17). The median Positive Symptom Distress Index on BSI scale was 1.48. An ESS score of 11.67 for patients >50 years old and a PSQI = 6.0 was found for patients >25 years old. No difference was found on ESS and PSQI scales when seizure type and frequency, and number of AED drugs were taken in account. Conclusions: Globally, the studied population does not have an excessive daily sleepiness but sleep quality is near-pathological. The studied epilepsyrelated factors did not show an influence on sleepiness nor on sleep quality.
S111
The good overall control of seizure frequency with monotherapy observed in the majority of patients may have contributed to the these results.
L0054 Gender and obstructive sleep apnea syndrome: one diagnosis, different clinical presentations A.R. Peralta, R. Geraldes, M.A. Lomba, I. Henriques, T. Paiva. Sleep/EEG lab, Neurology Department, Santa Maria Hospital, Lisbon, Portugal Introduction: Populational based studies have shown that despite previous contrary beliefs, obstructive sleep apnea syndrome (OSAS) is frequent in females. However, in females this syndrome remains under-diagnosed and there is an important delay in the diagnosis. Some recent studies have shown that gender may be responsible for different clinical presentations of OSAS. Objective: Evaluate the nocturnal, diurnal and sleep onset symptoms in Portuguese female and male OSAS patients. Methods: retrospective study based on structured clinical questionnaires and ambulatory polysomnographic studies. Population: 719 patients (150 females; 569 males) from a university hospital sleep clinic. Results: In the sample tested BMI and ages were similar in males and females. Sleep complaints had similar duration. Severe OSAS was more frequent in males. Women had significantly more insomnia, anxiety, headaches, palpitations, fatigue, confusional arousals and difficulties to work in the mornings. In the male sample nasal congestion, sleep apneas and excessive daytime somnolence were significantly more frequent. Conclusion: The typical OSAS clinical picture is more frequent in males. This study confirms previous data regarding different clinical presentations of OSAS in males and females. These differences are fundamental for a more rapid diagnosis of OSAS in females. The physiopathological mechanisms behind these differences should be sought in future studies.
L0055 Correlation between head and neck physical examination and polysomnographycs findings in morbid obese patients F.L. Martinho, R.P. Tangerina, L.R.A. Bittencourt *, S.M. Togeiro, L.C. Greg´orio, S. Tuf´ık. Sleep Institute, Department of Psychobiology, UNIFESP, S˜ao Paulo, SP, Brazil Objective: To evaluate if the anatomic abnormalities of the upper airway (UA) and facial skeletal observed on physical examination of morbidly obese patients are related to the presence and severity of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Materials and Methods: 45 patients were consecutively selected from the bariatric surgery ambulatory service of the Federal University of S˜ao Paulo, with body mass index (BMI) over 40 kg/m2 . All patients were subjected to a historical review, UA and facial skeletal examination and polysomnography. The findings were compared between OSAHS and no OSAHS patients (two tailed student t test), and between the different severity OSAHS groups (two-way ANOVA). Results: 68.9% were female and 31.1% male. The average age was 46.5±10.8 years, the average BMI was 49±7 kg/m2 and the average neck circumference was 43.4±5.1 cm. All patients were habitual snorers and 48.9% had daily hypersomnolence. Polysomnographic findings showed: 22.2% had normal apnea–hypopnea index (AHI) and 87.8% had AHI over 5, with average of 30.8±31.9, and the average minimum oxyhemoglobin saturation was 75.6±9.7%. The findings associated with OSAHS were: younger age (p = 0.02), biggest neck circumference (p = 0.004), presence of medialized tonsillar pillars (p = 0.0002), posteriorly displaced soft palate in relation to oropharynx (p = 0.0053), thick soft palate (p = 0.0014), long uvula (p = 0.04), thick uvula (p = 0.0052) and inferior turbinate hypertrophy (p = 0.04). The findings that have association with OSAHS severity were: biggest neck circumference (p = 0.02), presence of medialized tonsillar pillars (p = 0.04), posteriorized soft palate (p = 0.03), thick soft palate (p = 0.04). Conclusion: A high OSAHS prevalence was found in these obese group and the neck circumference was a predictor of the presence and severity of OSAHS. Soft tissue abnormalities of UA were related to the presence and severity of OSAHS in thisgroup; however, facial skeletal findings were not associated with OSAHS.
L0053 Sleepiness and sleep quality in epilepsy patients: an outpatient clinic-based study T. Mestre *, C. Bentes, I. Henriques, A. Lomba, T. Paiva. EEG/Sleep Laboratory; Neuroscience and Mental Health Department, Hospital de Santa Maria, Lisbon, Portugal Background: Sleep and epilepsy have multiple reciprocal relations. Sleep complaints are more frequent in epilepsy patients. Epilepsy-related mood disturbances, anti-epileptic drugs (AEDs) effects and sleep-related seizures are possible contributing factors. Aim: To evaluate sleepiness and sleep quality in epilepy patients. Methods: In an outpatient epilepsy clinic environment, a questionnairebased study was conducted using a booklet filled up by the patient that included the following: demographic data, Brief Symptom Inventory (BSI), Epsworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI). The assistant-epileptologist completed a clinical report concerning seizure type and frequency, disease duration, number of AEDs in use. Results: The studied population (n = 52; F:28, M:24; median age: 35, min: 16, max: 80), had a median disease duration of 15 years (0−47). 26 patients had partial seizures and 19 patients had generalised seizures. 36 patients (69.2%) were on monotherapy and 15 on duotherapy. 29 patients (55.8%) were seizure-free in the month before. The median ESS score was 7 (0−17) and PSQI score was 5 (1−17). The median Positive Symptom Distress Index on BSI scale was 1.48. An ESS score of 11.67 for patients >50 years old and a PSQI = 6.0 was found for patients >25 years old. No difference was found on ESS and PSQI scales when seizure type and frequency, and number of AED drugs were taken in account. Conclusions: Globally, the studied population does not have an excessive daily sleepiness but sleep quality is near-pathological. The studied epilepsyrelated factors did not show an influence on sleepiness nor on sleep quality.
S111
The good overall control of seizure frequency with monotherapy observed in the majority of patients may have contributed to the these results.
L0054 Gender and obstructive sleep apnea syndrome: one diagnosis, different clinical presentations A.R. Peralta, R. Geraldes, M.A. Lomba, I. Henriques, T. Paiva. Sleep/EEG lab, Neurology Department, Santa Maria Hospital, Lisbon, Portugal Introduction: Populational based studies have shown that despite previous contrary beliefs, obstructive sleep apnea syndrome (OSAS) is frequent in females. However, in females this syndrome remains under-diagnosed and there is an important delay in the diagnosis. Some recent studies have shown that gender may be responsible for different clinical presentations of OSAS. Objective: Evaluate the nocturnal, diurnal and sleep onset symptoms in Portuguese female and male OSAS patients. Methods: retrospective study based on structured clinical questionnaires and ambulatory polysomnographic studies. Population: 719 patients (150 females; 569 males) from a university hospital sleep clinic. Results: In the sample tested BMI and ages were similar in males and females. Sleep complaints had similar duration. Severe OSAS was more frequent in males. Women had significantly more insomnia, anxiety, headaches, palpitations, fatigue, confusional arousals and difficulties to work in the mornings. In the male sample nasal congestion, sleep apneas and excessive daytime somnolence were significantly more frequent. Conclusion: The typical OSAS clinical picture is more frequent in males. This study confirms previous data regarding different clinical presentations of OSAS in males and females. These differences are fundamental for a more rapid diagnosis of OSAS in females. The physiopathological mechanisms behind these differences should be sought in future studies.
L0055 Correlation between head and neck physical examination and polysomnographycs findings in morbid obese patients F.L. Martinho, R.P. Tangerina, L.R.A. Bittencourt *, S.M. Togeiro, L.C. Greg´orio, S. Tuf´ık. Sleep Institute, Department of Psychobiology, UNIFESP, S˜ao Paulo, SP, Brazil Objective: To evaluate if the anatomic abnormalities of the upper airway (UA) and facial skeletal observed on physical examination of morbidly obese patients are related to the presence and severity of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Materials and Methods: 45 patients were consecutively selected from the bariatric surgery ambulatory service of the Federal University of S˜ao Paulo, with body mass index (BMI) over 40 kg/m2 . All patients were subjected to a historical review, UA and facial skeletal examination and polysomnography. The findings were compared between OSAHS and no OSAHS patients (two tailed student t test), and between the different severity OSAHS groups (two-way ANOVA). Results: 68.9% were female and 31.1% male. The average age was 46.5±10.8 years, the average BMI was 49±7 kg/m2 and the average neck circumference was 43.4±5.1 cm. All patients were habitual snorers and 48.9% had daily hypersomnolence. Polysomnographic findings showed: 22.2% had normal apnea–hypopnea index (AHI) and 87.8% had AHI over 5, with average of 30.8±31.9, and the average minimum oxyhemoglobin saturation was 75.6±9.7%. The findings associated with OSAHS were: younger age (p = 0.02), biggest neck circumference (p = 0.004), presence of medialized tonsillar pillars (p = 0.0002), posteriorly displaced soft palate in relation to oropharynx (p = 0.0053), thick soft palate (p = 0.0014), long uvula (p = 0.04), thick uvula (p = 0.0052) and inferior turbinate hypertrophy (p = 0.04). The findings that have association with OSAHS severity were: biggest neck circumference (p = 0.02), presence of medialized tonsillar pillars (p = 0.04), posteriorized soft palate (p = 0.03), thick soft palate (p = 0.04). Conclusion: A high OSAHS prevalence was found in these obese group and the neck circumference was a predictor of the presence and severity of OSAHS. Soft tissue abnormalities of UA were related to the presence and severity of OSAHS in thisgroup; however, facial skeletal findings were not associated with OSAHS.