LETICIA MARIA SANTORO FRANCO AZEVEDO SOSTER
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/63, Hospital das Clínicas, Faculdade de Medicina
LIM/63, Hospital das Clínicas, Faculdade de Medicina
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- Attention deficit hyperactivity disorder and restless leg syndrome across the lifespan: A systematic review and meta-analysis(2023) MIGUEIS, D. P.; LOPES, M. C.; CASELLA, E.; SOARES, P. V.; SOSTER, L.; SPRUYT, K.This systematic review aims to assess the association between attention deficit hyperactivity disorder (ADHD) and restless legs syndrome (RLS) in accordance with the Preferred Reporting Items for Sys-tematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched for original articles that reported prevalence data on ADHD and RLS until January 24th, 2023. Two independent reviewers evaluated the quality of the articles using the National Institutes of Health assessment tool. Among the 208 articles identified between 1996 and 2022, 29 were included. In large general population studies, 2.6-15.3% of participants met the RLS criteria, of which 3.2-17.4% presented with ADHD. In the ADHD group, RLS symptoms ranged from 11 to 42.9% in children and 20-33.0% in adults. This suggests a strong co-occurrence between RLS and ADHD. A common characteristic of these conditions is sleep fragmen-tation, as discussed in the reviewed papers. Although large-scale studies with comparable diagnostic criteria across the lifespan are required, our findings may advocate a possible common physiological pathway, including sleep fragmentation and dopaminergic system impairment.(c) 2023 Elsevier Ltd. All rights reserved.
- SLEEP DISORDER, CHOREA, AND DEMENTIA ASSOCIATED WITH IgLON5 ANTIBODIES(2015) SIMABUKURO, Mateus M.; SABATER, Lidia; ADONI, Tarso; CURY, Rubens Gisbert; HADDAD, Monica Santoro; MOREIRA, Camila Hohi; OLIVEIRA, Imam; BOAVENTURA, Mateus; ALVES, Rosana Cardoso; SOSTER, Leticia Azevedo; NITRINI, Ricardo; GAIG, Carles; SANTAMARIA, Joan; DALMAU, Josep; GRAUS, Francesc
- 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.
- Proposed management model for the use of telemonitoring of adherence to positive airway pressure equipment - position paper of the Brazilian Association of Sleep Medicine - ABMS(2021) VIDIGAL, T. De Aguiar; BRASIL, E. L.; FERREIRA, M. N.; MELLO-FUJITA, L. L.; MOREIRA, G. A.; DRAGER, L. F.; SOSTER, L. A.; GENTA, P. R.; POYARES, D.; HADDAD, F. L. M.This document ""Proposed management model for the use of telemonitoring to positive airway pressure adherence"" was prepared by a special commission of the Brazilian Association of Sleep Medicine, with the objective of recommending a follow-up model for patients undergoing positive airway pressure therapy using telemonitoring. This proposal was prepared based on a survey and analysis of the most up-to-date national and international literature and uses the best available evidence to facilitate the standardization of care by Sleep Science specialists with potential benefit for patients. Among the conclusions of the document, it is emphasized that telemonitoring is an important tool that allows health professionals trained in sleep-disordered breathing to remotely monitor PAP therapy, allowing prompt and, when necessary, daily adjustments to be made in order to increase adherence to treatment. The authors also conclude that the privacy of the data received and shared during the provision of telemonitoring must be respected by the physician or health professional trained in sleep, with the authorization of the patient and/or person responsible, who should be made aware of the short-, medium- and long-term provision of the service. © 2021 Brazilian Association of Sleep and Latin American Federation of Sleep Societies. All rights reserved.
- Obstructive sleep apnea in patients with chronic rhinosinusitis with nasal polyps: a cross-sectional study(2019) MIGUEIS, D. P.; LACERDA, G. C. B.; LOPES, M. C.; AZEVEDO-SOSTER, L. M. S. F.; THULER, L. C. S.; LEMES, L. N. A.; ARAUJO-MELO, M. H.Introduction: Adults with chronic rhinosinusitis with nasal polyps (CRSwNP) often suffer from sleep disruption and sleep apnea. As the apneic profile of CRSwNP may differ from obstructive sleep apnea (OSA) classic patients without nasal polyps (NP), it may prove useful to define a new profile for OSA screening in these patients. The aim of the current study was to compare baseline characteristics and apneic profile of OSA patients with CRSwNP to OSA patients without NP. Materials and methods: Thirty-one apneic patients with CRSwNP and 62 apneic cases without NP were included in our study. Both groups underwent nasal endoscopy, Epworth Sleepiness Scale (ESS) evaluation, and overnight polysomnography (PSG). We additionally accessed anthropometric characteristics such as snoring, tiredness, observed apnea, high blood pressure, body mass index (BMI), age, neck circumference, male gender, and OSA risk via the STOP-Bang questionnaire. Results: Although the patients were matched according to age and gender, the median BMI and STOP-Bang score were significantly higher in patients with OSA than in those with OSA and CRSwNP. Notably, the median ESS showed low somnolence and a low median apnea-hypopnea index in patients with CRSwNP, despite the fact that the lowest median oxygen saturation was not significantly different between groups. Conclusions: Anthropometric characteristics in individuals with apnea caused by CRSwNP were significantly different from those in individuals with typical. This finding will improve screening and treatment of apneic patients CRSwNP.
- Cardiac autonomic control during non-REM and REM sleep stages in paediatric patients with Prader-Willi syndrome(2021) BRITO, Leandro C.; QUEIROGA, Thereza; FRANCO, Ruth R.; PASSONE, Caroline G. B.; LOPES, Maria-Cecilia; SHEA, Steven A.; BUENO, Clarissa; SOSTER, Leticia M. S. F. A.Cardiac death is the second most prevalent cause in Prader-Willi syndrome (PWS). Paediatric patients with PWS often present cardiac autonomic dysfunction during wakefulness, obesity and sleep-disordered breathing. However, the extent of cardiac autonomic modulation during sleep in PWS has not been documented. The objective of this study was to assess alterations in cardiac autonomic modulation of paediatric patients with PWS during different sleep stages. Thirty-nine participants in three groups: 14 PWS, 13 sex and age-matched lean controls (LG) and 12 obese-matched controls (OB). All participants underwent overnight polysomnography, including continuous electrocardiogram recordings. Heart rate variability (HRV) was analysed during representative periods of each sleep stage through time and frequency domains calculated across 5-min periods. Between-within ANOVAs were employed (p < .05). The results show that total HRV was lower in PWS than OB and LG during slow-wave sleep (SWS) (standard deviation of all NN intervals [SDNN] ms,p = .006). Parasympathetic modulation assessed by time-domain analysis was lower during SWS in PWS compared to both OB and LG (square root of the mean of the sum of the squares of differences between adjacent NN intervals [RMSSD] ms,p = .004; SDSD, standard deviation of differences between adjacent NN intervals [SDSD] ms,p = .02; number of adjacent NN intervals differing by >50 ms [NN50] ms,p = .03; proportion of adjacent NN intervals differing by >50 ms [pNN50] ms,p = .01). Sympathovagal balance assessed by frequency-domain analysis was lower during both N2 and SWS than during the rapid eye movement (REM) sleep stage, but not different among groups. In conclusion, this group of paediatric patients with PWS had impaired cardiac autonomic balance due to reduced parasympathetic modulation during SWS. This result could imply an underlying increased cardiovascular risk in PWS even during early age and independent of obesity.
- Children with nocturnal enuresis have posture and balance disorders(2016) PEREIRA, R. Pavione Rodrigues; FAGUNDES, S. Nascimento; LEBL, A. Surry; SOSTER, L. Azevedo; MACHADO, M. G.; KOCH, V. H.; TANAKA, C.Introduction Integration of the neuromuscular system is required for maintaining balance and adequate voiding function. Children with enuresis have delayed maturation of the motor cortex, with changes in the sensory and motor systems. Along with various alterations, including the genetic, hormonal, behavioral, and sleep disturbances, and neuromotor and sensory deficits associated with nocturnal enuresis (NE) in children and adults, a consistent alteration in the posture of children with NE has been observed in the current practice. Because posture and the balance control system are strongly connected, this study aimed to investigate posture and balance in children and teenagers with NE. Material and methods A total of 111 children with enuresis were recruited to the enuretic group (EG) and 60 asymptomatic children made up the control group (CG). The participants were divided into two age subgroups: (A) 7-11 years old, N = 77 for EG/A, N = 38 for CG/A; and (B) 12-16 years old, N = 34 for EG/B, N = 22 for CG/B. Balance was assessed using an electronic force plate (100 Hz) to calculate the area of the center of pressure (COP) displacement. The COP is the point that results from the action of vertical forces projected onto the force plate. Sensory integration was analyzed using a 60-s trial with the subject standing under four conditions: (1) eyes open, stable surface; (2) eyes closed, stable surface; (3) eyes open, unstable surface; (4) eyes closed, unstable surface. Posture was assessed by placing reflective anatomical landmarks on the anterior superior iliac spine, the posterior superior iliac spine, the greater trochanter, and lateral malleolus. A photograph was taken while the subject stood quietly. The angles were obtained from landmark connections using software to assess the following posture variables: pelvic ante/retroversion and pelvic ante/retropulsion. Results The EG showed a greater area of COP displacement compared with the CG under all four sensory conditions and both subgroups, except for EG/B in condition 3. Regarding posture, EG showed higher pelvic anteversion angles than CG. Conclusions Enuretic children showed forward inclination of the pelvis and had worse balance compared with control children.
- A questionnaire study on sleep disturbances associated with Prader-Willi syndrome(2020) QUEIROGA, Thereza Lemos de Oliveira; DAMIANI, Durval; LOPES, Maria Cecilia; FRANCO, Ruth; BUENO, Clarissa; SOSTER, LeticiaBackground: This study aimed to investigate the presence of sleep disturbances in children with Prader-Willi syndrome (PWS) using the Sleep Disturbance Scale for Children (SDSC). Methods: The SDSC, which was designed to identify the presence and severity of different sleep disorders, was applied to 50 patients with PWS and 112 controls. Results: Patients with PWS achieved worse scores in the sleep-disordered breathing and disorders in initiating and maintaining sleep in the SDSC questionnaire as compared with controls. We also observed that patients with PWS were more prone to having hyperhidrosis. We did not observe significant differences in the presence of other types of sleep disorders (such as hypersomnolence) between the PWS and control groups. Conclusions: The results obtained with the SDSC questionnaire showed that children with PWS have more sleep breathing disorders and disorders in initiating and maintaining sleep as compared to controls. Additionally, we demonstrated that patients with PWS associates significantly with the presence of hyperhidrosis during sleep. However, SDSC was not reliable to identify the excessive daytime somnolence in patients with PWS, as previously reported in the literature.
- Monosymptomatic nocturnal enuresis in pediatric patients: multidisciplinary assessment and effects of therapeutic intervention(2017) FAGUNDES, Simone N.; LEBL, Adrienne Surri; SOSTER, Leticia Azevedo; SILVA, Guilherme Jorge Sousa e; SILVARES, Edwiges Ferreira de Mattos; KOCH, Vera H.Few studies manage patients with isolated monosymptomatic enuresis (MNE) with multidisciplinary evaluation and pre- and long-term post-intervention monitoring. This was a prospective study of MNE patients, aged 6-16 years, diagnosed by multidisciplinary assessment. Of the 140 initial applicants (58.6%) with MNE, 82 were included in the study and randomized for therapeutic intervention in three treatment groups, namely: alarm, desmopressin and alarm + desmopressin. Therapeutic response was evaluated 12 months after treatment withdrawal. Of the 82 patients [mean age 9.5 (SD +/- 2.6) years, n = 62 males (75.6%)], 91.1% had a family history of nocturnal enuresis (NE) in first-/second-degree relatives, 81.7% had constipation and 40.7% had mild-to-moderate apnea. Prior to randomization, management of constipation and urotherapy led to remission in seven of the 82 patients; 75 patients were randomized to intervention. There were 14/75 (18.7%) dropouts during the intervention, especially in the alarm group (p = 0.00). Initial complete/partial response was achieved in 56.6% of the alarm group, 70% of the desmopressin group and 64% in the combined group (p = 0.26). Continued success occurred in 70% of the alarm group, 84.2% of the desmopressin group and 100% of the combined group (p = 0.21). Recurrence occurred in 3/20 (15%) patients in the alarm group and 1/19 (5.2 %) patients of the desmopressin group. Post-intervention Child Behavior Checklist (CBCL) and PedsQL 4.0 scores showed significant improvement. The three therapeutic modalities were effective in managing MNE with low relapse rates; the alarm group showed the highest dropout rate. Therapeutic success was associated with improvement of behavioral problems and quality of life scores.
- Impact of a multidisciplinary evaluation in pediatric patients with nocturnal monosymptomatic enuresis(2016) FAGUNDES, Simone Nascimento; SOSTER, Leticia Azevedo; LEBL, Adrienne Surri; PEREIRA, Rita Pavione Rodrigues; TANAKA, Clarice; PEREIRA, Rodrigo Fernando; SILVARES, Edwiges Ferreira de Mattos; KOCH, Vera H.Background Enuresis (NE) is a clinical condition of multifactorial etiology that leads to difficulties in child/adolescent social interaction. This was a prospective study on the impact of multidisciplinary assessment of 6- to 17-year-old patients with monosymptomatic nocturnal enuresis (MNE), including a structured history, clinical/neurological examination, bladder and bowel diaries, sleep diary and questionnaires, psychological evaluation [Child Behavior Checklist (CBCL) and PedsQL 4.0 questionnaires], urinary sonography, blood and urine laboratory tests, polysonography (PSG), and balance evaluation. A total of 140 enuretic participants were evaluated, of whom 27 were diagnosed with NE complicated by urinary disorder, four with hypercalciuria, three with nephropathy and one with attention-deficit hyperactivity disorder. Among the 87 participants who underwent PSG, six were diagnosed with severe apnea. Of the 82 MNE patients who underwent full assessment, 62 were male (75.6 %), and the mean age was 9.5 (+/- 2.6) years. A family history of NE was diagnosed in 91.1 % of first- and second-degree relatives, constipation in 89.3 % and mild/moderate apnea in 40.7 %. Balance control alteration was identified by physical therapy evaluation of MNE patients. Participants' quality of life evaluation scores were significantly lower than those of their parents. Enuresis is a multifactorial disorder that requires a structured diagnostic approach.