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.
- 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.
conferenceObject UPPER AIRWAY RESISTANCE SYNDROME IS ASSOCIATED WITH HIGH CYCLIC ALTERNATING PATTERN(2022) GODOY, L.; SOSTER, L.; BUENO, C.; TOGEIRO, S.; POYARES, D.; TUFIK, S.; PALOMBINI, L.- 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.
conferenceObject Non-rapid-eye movement and rapid-eye-movement parasomnia with sleep breathing disorder, chorea and dementia associated with antibodies to IgLON5: Case report(2015) SIMABUKURO, M. M.; SABATER, L.; ADONI, T.; CURY, R. G.; HADDAD, M. S.; MOREIRA, C. H.; OLIVEIRA, L.; ALVES, R. C.; SOSTER, L. A.; NOGUEIRA, R. A.; GRAIG, C.; NITRINI, R.- 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.
- NEW POLYSOMNOGRAPHIC FINDINGS IN PINEALECTOMIZED PATIENTS(2017) BUENO, C.; ALVES, R.; SOSTER, L. Azevedo; BARCELOS, I.; AMARAL, F.; CIPOLLA-NETO, J.