Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated.

To investigate the association among temporomandibular disorders (TMD), sleep bruxism, and primary headaches, assessing the risk of occurrence of primary headaches in patients with or without painful TMD and sleep bruxism. The sample consisted of 301 individuals (253 women and 48 men) with ages varying from 18 to 76 years old (average age of 37.5 years). The Research Diagnostic Criteria for Temporomandibular Disorders were used to classify TMD. Sleep bruxism was diagnosed by clinical criteria proposed by the American Academy of Sleep Medicine, and primary headaches were diagnosed according to the International Classification of Headache Disorders-II. Data were analyzed by chi-square and odds ratio tests with a 95% confidence interval, and the significance level adopted was .05. An association was found among painful TMD, migraine, and tension-type headache (P < .01). The magnitude of association was higher for chronic migraine (odds ratio = 95.9; 95% confidence intervals = 12.51-734.64), followed by episodic migraine (7.0; 3.45-14.22) and episodic tension-type headache (3.7; 1.59-8.75). With regard to sleep bruxism, the association was significant only for chronic migraine (3.8; 1.83-7.84). When the sample was stratified by the presence of sleep bruxism and painful TMD, only the presence of sleep bruxism did not increase the risk for any type of headache. The presence of painful TMD without sleep bruxism significantly increased the risk in particular for chronic migraine (30.1; 3.58-252.81), followed by episodic migraine (3.7; 1.46-9.16). The association between painful TMD and sleep bruxism significantly increased the risk for chronic migraine (87.1; 10.79-702.18), followed by episodic migraine (6.7; 2.79-15.98) and episodic tension-type headache (3.8; 1.38-10.69). The association of sleep bruxism and painful TMD greatly increased the risk for episodic migraine, episodic tension-type headache, and especially for chronic migraine.

Estudo das lesões laríngeas e do grau de disfonia em pacientes com paracoccidioidomicose

Pós-graduação em Doenças Tropicais - FMB

Monitorização ambulatorial da pressão arterial (MAPA) em crianças com distúrbios respiratórios obstrutivos pré e após adenotonsilectomia

Pós-graduação em Bases Gerais da Cirurgia - FMB

Avaliação cardíaca em crianças com distúrbios respiratórios obstrutivos, antes e pós adenotonsilectomia

Pós-graduação em Bases Gerais da Cirurgia - FMB

Classificação de Mallampati em fonação para predição da dificuldade de intubação traqueal em obesos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influencia da obesidade na correlacao entre refluxo faringolaringeo e apneia obstrutiva do sono

Introdução:A apneia obstrutiva do sono (AOS) é causada por episódios recorrentes de obstrução total ou parcial da via aérea superior com duração superior a 10 segundos durante o sono. Refluxo faringolaríngeo (RFL) é uma variante da doença do refluxo gastroesofágico que afeta a laringe e a faringe.Objetivos:Avaliar a influência da obesidade na relação entre RFL e AOS em pacientes com SAOS.Materiais e métodos:Estudo observacional transversal retrospectivo. Foram revisados protocolos de atendimento de pacientes com AOS que incluem questionários validados para RFL como Reflux Sympton Index (RSI) e Reflux Finding Score (RSI), nasolaringofibroscopia e polissonografia.Resultados:Cento e cinco pacientes foram divididos em grupo de obesos (39 pacientes) e não obesos (66 pacientes). Na avaliação das médias do RSI o grupo de não obesos foi semelhante entre pacientes com AOS leve (11,96) e moderada (11,43). No grupo de obesos a média do RSI foi de 6,7 em pacientes com AOS leve e de 11,53 em pacientes com AOS moderada a grave (p < 0,05).Discussão:O subgrupo de pacientes com AOS e RFL apresenta vários fatores que promovem a inflamação da via aérea superior. Pacientes com AOS devem ser pesquisados e tratados quanto a RFL, aumentando a qualidade de vida.Conclusão:O RFL e a AOS se correlacionam positivamente em pacientes obesos.

Sleep quality and its associations with leisure-time exercise and excess weight among civil servants

O objetivo do estudo foi analisar a associação entre qualidade do sono, prática de exercícios físicos no lazer e obesidade entre servidores públicos de uma universidade. A amostra foi composta por 92 adultos de ambos os sexos. Qualidade do sono e atividade física foram coletadas por meio de questionário. O excesso de peso/obesidade foi diagnosticado pelo índice de massa corporal, o qual foi calculado com valores de peso e estatura relatados pelos avaliados. A prevalência de pessoas com sono alterado foi de 53,84%. Houve associação entre obesidade (OR= 7,22 [ORIC95%: 1,65-31,5]) e pior qualidade do sono, bem como, prática de atividade física e melhor qualidade do sono (OR= 0,19 [ORIC95%: 0,04-0,95]), independente de outros fatores de confusão. Concluiu-se que há alta ocorrência de distúrbios do sono, a qual foi associada de maneira independente com a prática de exercícios físicos e a obesidade.

Nonalcoholic fatty liver disease and metabolic syndrome in postmenopausal women

Nonalcoholic fatty liver disease (NAFLD) is considered the most common cause of chronic liver disease in the Western countries. NAFLD includes a spectrum ranging from a simple steatosis to a nonalcoholic steatohepatitis (NASH) which is defined by the presence of inflammatory infiltrate, cellular necrosis, hepatocyte ballooning, and fibrosis and cirrhosis that can eventually develop into hepatocellular carcinoma. Studies emphasize the role of insulin resistance, oxidative stress, pro-inflammatory cytokines, adipokines in the development and progression of NAFLD. It seems to be independently associated with type II diabetes mellitus, increased triglycerides, decreased HDL-cholesterol, abdominal obesity and insulin resistance. These findings are in accordance with the criteria used in the diagnosis of metabolic syndrome (MetS). Here, we will discuss the current knowledge on the epidemiology, pathophysiology and diagnosis of NAFLD and the association of metabolic syndrome in postmenopausal women.

Chronic obstructive pulmonary disease and heart rate variability: a literature update

Background: The literature indicates that chronic obstructive pulmonary disease (COPD) affects cardiac autonomic control. In this study, we conducted a literature review in order to investigate the heart rate variability (HRV) in COPD subjects. Methods: A search was performed in Medline database, using the link between the keywords: “autonomic nervous system”, “cardiovascular system”, “COPD” and “heart rate variability”. Results: The search resulted in a total of 40 references. Amongst these references, the first exclusion resulted in the barring of 29 titles and abstracts, which were not clearly related to the purpose of review. This resulted in a total of 11 articles that were then read and utilized in the review. The selected studies indicated that there is significant reduction of HRV in patients with COPD, characterized by reduction of indices that assess parasympathetic activity in addition to dealing with the global autonomic modulation. We also established that supervised exercise can reduce these harmful effects in COPD patients. Also, it was reported that the use of non-invasive ventilation in these patients may contribute to the improvement of respiratory symptoms, with no impairing, and may even induce positive responses in cardiac autonomic regulation. Conclusion: The studies indicate a need for further investigations to guide future therapies to improve the treatment of cardiovascular system in the respiratory diseases.

Association between painful temporomandibular disorders, sleep bruxism and tinnitus

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Association between sleep quality and quality of life in nursing professionals working rotating shifts

Objective: To analyze the association between sleep quality and quality of life of nursing professionals according to their work schedules. Methods: A prospective, cross-sectional, observational study was conducted between January and December 2010, with 264 nursing professionals, drawn from 989 subjects at Botucatu General Hospital and stratified by professional category. The Pittsburg Sleep Quality Index and the WHOQOL-bref were administered to evaluate sleep quality and quality of life, respectively. Self-reported demographic data were collected with a standard form. Continuous variables were reported as means and standard deviations, and categorical variables were expressed as proportions. Associations were evaluated using Spearman's correlation coefficient. The association of night-shift work and gender with sleep disturbance was evaluated by logistic regression analysis using a model adjusted for age and considering sleep disturbance the dependent variable. The level of significance was p < 0.05. Results: Night-shift work was associated with severe worsening of at least one component of sleep quality in the model adjusted for age (OR = 1.91; 95% CI 1.04; 3.50; p = 0.036). Female gender was associated with sleep disturbance (OR = 3.40; 95% CI 1.37; 8.40; p = 0.008). Quality of life and quality of sleep were closely correlated (R = -0.56; p < 0.001). Conclusions: Characteristics of the nursing profession affect sleep quality and quality of life, and these two variables are associated.

Acute physical exercise under hypoxia improves sleep, mood and reaction time

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Perfil clínico de crianças com indicação da cirurgia das tonsilas em um hospital terciário universitário

The indications for adenotonsillectomy in pediatric patients have changed considerably during the 90th decade. Local or systemic complications of the adenoid or tonsil hypertrophy itself have now been substituted by signs of obstructive ventilatory disturbances, including obstructive sleep apnea as the major indications for surgery. Objective: This study analyses the clinical profile of children submitted to adenotonsilectomy in their pre and postoperative state, at Botucatu Medical School-State University São Paulo, UNESP. Methods: 332 children of both genders, aged 1 to 12 years, who underwent adenotonsillectomy between 1999 and 2004, were studied, focused on epidemiological profile, pre and postoperative (1 month) symptoms, obtained from medical records. Height and weight were compared to brazilian normal age related values. Results: We found a predominance of the male gender, except in he group aged from 10 to 12 years. Considering wheight and height, we found important failure to thrive, mostly for height deficit. Among clinical aspects, we found a significant reduction in obstructive symptoms like snoring or apneia (p<0001) in the postoperative period. Conclusion: Our results were similar to the literature findings of patients clinical profile. The major indication for adenotonsillectomy in our service was clinical diagnosis of obstructive sleep apnea.