VERA HERMINA KALIKA KOCH
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
3 resultados
Resultados de Busca
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- Non-REM Sleep Instability in Children With Primary Monosymptomatic Sleep Enuresis(2017) SOSTER, Leticia Azevedo; ALVES, Rosana Cardoso; FAGUNDES, Simone Nascimento; LEBL, Adrienne; GARZON, Eliana; KOCH, Vera H.; FERRI, Raffaele; BRUNI, OlivieroStudy Objectives: Sleep enuresis is one of the most common sleep disturbances in childhood. Parental perception of deeper sleep in children with sleep enuresis is not confirmed by objective studies. However, evidence of disturbed sleep has been demonstrated by questionnaire, actigraphy, and polysomnographic studies, but no neurophysiological correlation with low arousability has been found. The goal of this study was to analyze the sleep microstructure of children with sleep enuresis using cyclic alternating pattern (CAP) analysis. Methods: Forty-nine children were recruited, 27 with enuresis (19 males and 8 females, mean age 9.78 years, 2.52 standard deviation) and 22 normal control patients (11 males and 11 females, mean age 10.7 years, 3.43 standard deviation); all subjects underwent clinical evaluation followed by a full-night polysomnographic recording. Psychiatric, neurological, respiratory, and renal diseases were excluded. Results: No differences in sex, age, and apnea-hypopnea index were noted in the patients with enuresis and the control patients. Sleep stage architecture in children with sleep enuresis showed a decrease in percentage of stage N3 sleep. CAP analysis showed an increase in CAP rate in stage N3 sleep and in phase A1 index during stage N3 sleep in the sleep enuresis group, but also a significant reduction of A2% and A3% and of phases A2 and A3 indexes, supporting the concept of decreased arousability in patients with sleep enuresis. The decrease of phase A2 and A3 indexes in our patients might reflect the impaired arousal threshold of children with sleep enuresis. Sleep fragmentation might result in a compensatory increase of slow wave activity (indicated by the increase of CAP rate in stage N3 sleep) and may explain the higher arousal threshold (indicated by a decrease of phase A2 and A3 indexes) linked to an increased sleep pressure. Conclusions: The findings of this study indicate the presence of a significant disruption of sleep microstructure (CAP) in children with sleep enuresis, supporting the hypothesis of a higher arousal threshold.
- Sleep disturbances associated with sleep enuresis: A questionnaire study(2016) SOSTER, Leticia Azevedo; ALVES, Rosana; FAGUNDES, Simone N.; KOCH, Vera H. K.; BRUNI, OlivieroPurpose: Sleep enuresis (SE) is the second most common sleep complaint in childhood. It has been associated with bladder hyperactivity, excessive urine production and deeper sleep. Several sleep disorders have been described in association with SE like parasomnias and sleep apnea. The aim of this study was to analyze the presence of sleep disturbances in children with SE through the use of Sleep Disturbance Scale for Children (SDSC) compared to normal children matched for age and sex. Methods: A questionnaire evaluation was performed in 76 enuretic and 112 normal children through the Sleep Disturbance Scale for Children (SDSC) validated for Portuguese language. The Scale is grouped into six subscales: Disorders in Initiating and Maintaining Sleep (DIMS), Sleep Breathing Disorders (SBD), Disorders of Arousal (DA), Sleep-Wake Transition Disorders (SWTD), Disorders Of Excessive Somnolence (DOES), and Nocturnal Hyperhidrosis (SHY). Children with renal and neurological problems were excluded from both groups. Results: Enuretics scored higher in several of the subscales (SBD, DOA, SWTD) and also in the total scale scores while scored low in the DIMS subscale. No differences were found for the DOES and SHY subscales. Conclusions: Enuretic children showed a high comorbidity with other sleep disturbances like sleep disordered breathing and parasomnias. The novel finding of this study is that we found a decreased incidence of DIMS that is consistent with the parental perception of a more deep sleep and a high arousal threshold in SE.
- Global Variation of Nutritional Status in Children Undergoing Chronic Peritoneal Dialysis: A Longitudinal Study of the International Pediatric Peritoneal Dialysis Network(2019) SCHAEFER, Franz; BENNER, Laura; BORZYCH-DUZALKA, Dagmara; ZARITSKY, Joshua; XU, Hong; REES, Lesley; ANTONIO, Zenaida L.; SERDAROGLU, Erkin; HOOMAN, Nakysa; PATEL, Hiren; SEVER, Lale; VONDRAK, Karel; FLYNN, Joseph; REBORI, Anabella; WONG, William; HOLTTA, Tuula; YILDIRIM, Zeynep Yuruk; RANCHIN, Bruno; GRENDA, Ryszard; TESTA, Sara; DROZDZ, Dorota; SZABO, Attila J.; EID, Loai; BASU, Biswanath; VITKEVIC, Renate; WONG, Cynthia; POTTOORE, Stephen J.; MUELLER, Dominik; DUSUNSEL, Ruhan; CELEDON, Claudia Gonzalez; FILA, Marc; SARTZ, Lisa; SANDER, Anja; WARADY, Bradley A.; ADRAGNA, M.; COCCIA, P. A.; SUAREZ, A.; VALLES, P. G.; SALIM, R.; ALCONCHER, L.; ARBEITER, K.; HOECK, K. van; KOCH, V; FEBER, J.; HARVEY, E.; WHITE, C.; VALENZUELA, M.; VILLAGRA, J.; CANO, F.; CONTRERAS, M. A.; VOGEL, A.; ZAMBRANO, P.; HEVIA, P.; CHIU, M. C.; DING, Jie; VANEGAS, J. J.; HIGUITA, L. M.; ROUSSEY, G.; ULINSKI, T.; KRID, S.; FISCHBACH, M.; HARAMBAT, J.; SAMAILLE, Ch; BUESCHER, R.; OH, J.; PAPE, L.; JOHN, U.; KLAUS, G.; BILLING, H.; STAFANIDIS, C.; PAPACHRISTOU, F.; BAGGA, A.; KANITKAR, M.; SINHA, R.; SETHI, S.; VERRINAM, E.; VIDAL, E.; LEOZAPPA, G.; LANDAU, D.; Ha; PAIK, K. H.; BILAL, A.; SAHPAZOVA, E.; LIM, Y. N.; BARBOSA, L. Sanchez; GROOTHOFF, J. W.; KONIJENBERG, Y.; SILVA, Y.; RYAMI, M. Al; MUNARRIZ, R. Loza; LESZEPANSKA, B.; SZCZEPANSKA, M.; BRUMARIU, O.; KARI, J.; KRUSCIC, D.; YAP, H. K.; ARICETA, G.; AGUIRRE, M.; SANTOS, F.; NIWHISKA-FARYNA, B.; BAYAZIT, A.; BAKKALOGLU, C. A. S.; BAKKALOGLU, S.; BILGE, I; YAVASCAN, O.; MIR, S.; SIMKOVA, Eva; CHRISTIAN, M.; GREENBAUM, L.; NEU, A.; ASKENAZI, D.; AL-AKASH, A.; SWARTZ, S.; BROPHY, P.; RHEAULT, M.; PRADHAN, M.While children approaching end-stage kidney disease (ESKD) are considered at risk of uremic anorexia and underweight they are also exposed to the global obesity epidemic. We sought to investigate the variation of nutritional status in children undergoing chronic peritoneal dialysis (CPD) around the globe. The distribution and course of body mass index (BMI) standard deviation score over time was examined prospectively in 1001 children and adolescents from 35 countries starting CPD who were followed in the International Pediatric PD Network (IPPN) Registry. The overall prevalence of underweight, and overweight/obesity at start of CPD was 8.9% and 19.7%, respectively. Underweight was most prevalent in South and Southeast Asia (20%), Central Europe (16.7%) and Turkey (15.2%), whereas overweight and obesity were most common in the Middle East (40%) and the US (33%). BMI SDS at PD initiation was associated positively with current eGFR and gastrostomy feeding prior to PD start. Over the course of PD BMI SDS tended to increase on CPD in underweight and normal weight children, whereas it decreased in initially overweight patients. In infancy, mortality risk was amplified by obesity, whereas in older children mortality was markedly increased in association with underweight. Both underweight and overweight are prevalent in pediatric ESKD, with the prevalence varying across the globe. Late dialysis start is associated with underweight, while enteral feeding can lead to obesity. Nutritional abnormalities tend to attenuate with time on dialysis. Mortality risk appears increased with obesity in infants and with underweight in older children.