L. R. A. Bittencourt

Universidade Federal de São Paulo, San Paulo, São Paulo, Brazil

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Publications (63)141.46 Total impact

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    H. Hachul · D.S. Oliveira · L.R.A. Bittencourt · M.L. Andersen · S. Tufik
    [Show abstract] [Hide abstract] ABSTRACT: With increases life expectancy, the incidence of undesirable manifestations of menopause has increased as well. The effects of lost ovarian function include progressive decrease in estradiol secretion, trophic changes in the breast, vasomotor symptoms, anxiety, depression, and sleep disorders. Insomnia, which has physiological consequences and can result in a loss of quality of life, is prevalent in women after menopause. Hormone therapy has been widely used to reduce menopausal symptoms, but its use in recent years has been questioned because of the reported risks of cardiovascular events and increased incidence of tumors. This controversy has generated significant interest in non-hormonal treatments among both physicians and patients. Our previous research has shown a positive effect of massage therapy on menopausal symptoms. We explored the hypothesis that massage therapy would produce beneficial effects in postmenopausal women through inflammatory and immunological changes. Recent results from self-report questionnaires have shown improvements in sleep pattern and quality of life following massage therapy. These findings demonstrate the effectiveness of massage therapy for the treatment of postmenopausal symptoms, particularly insomnia, and indicate that it is a promising line of research.
    Preview · Article · Jun 2014 · Sleep Science
  • [Show abstract] [Hide abstract] ABSTRACT: This article presents a brief history of the identification and characterization of circadian rhythm sleep disorders, as well as of the nosology and treatment of the disorders.
    No preview · Chapter · Dec 2013
  • No preview · Article · Oct 2013
  • [Show abstract] [Hide abstract] ABSTRACT: The Brazilian physiotherapists are working in Sleep field in Brazil, both in clinical practice and research. There are only a few professionals in light of the huge demand of sleep disorder's patients. This text aims to gather evidence and propose protocols to produce guidelines of clinical practice in the performance of physiotherapists in Brazil. It addresses Obstructive Sleep Apnea Syndrome, Neuromuscular Disorders, Restless Legs Syndrome, Periodic Leg Movements, Fibromyalgia and Sleep Bruxism.
    No preview · Article · Jan 2013
  • F.M.S. Coelho · M. Pradella-Hallinan · S. Tufik · L.R.A. Bittencourt
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Narcolepsy is a primary disturbance of the Central Nervous System with a prevalence of 0.02%. It is characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, sleep palsy, and sleep fragmentation. Diagnosis: Narcolepsy diagnosis is defined by clinical defaults and analysis of five naps during multiple sleep latency tests Pathophysiology: Higher prevalence of HLA-DQB1&z.ast;0602 allele and lower hypocretin-1 levels were demonstrated in patients with narcolepsy and cataplexy. However, the pathophysiology is not completely known, although a few theories are currently under discussion. Recently, authors described different patterns in the alpha T cell receptor locus and higher prevalence of specific trebles homolog 2 antibodies in the narcoleptic population. Treatment: The treatment must ensure the familial and social integration of the patient. Conclusion. Narcolepsy is an interesting disease, which involves neurology, immunology, sleep medicine, psychiatry, and genetics. Narcoleptic patients have various difficulties in personal, professional and familial scenarios. Although many advances have been made, the best tool is information for physicians and the general population. Copyright © Sociedad Iberoamericana de Información Científica (SIIC), 2012.
    No preview · Article · May 2012
  • D.S. Oliveira · H Hachul · V Goto · S Tufik · L R A Bittencourt
    [Show abstract] [Hide abstract] ABSTRACT: Physiological and psychological alterations in the climacteric period frequently influence women's quality of life. Hot flushes, nocturia, mood alterations, respiratory disturbances, insomnia and restless leg syndrome all affect sleep, and the altered hormonal state in this period impacts the aging process. As hormonal therapy is not indicated in some cases, the search for complementary therapies, such as massage therapy, to improve insomnia in the climacteric period is increasing. To evaluate the effect of therapeutic massage on insomnia and climacteric symptoms in postmenopausal women. Forty-four volunteers were randomly distributed into three groups: therapeutic massage (TM), passive movement (PM) and control (CTL). The women received 32 therapeutic massage sessions and passive movement twice a week. Questionnaires were given in the pre-trial and the 16th and 32nd sessions. The Insomnia Severity Index (ISI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Menopause Quality of Life questionnaire (MENQOL), Kupperman Menopausal Index and Lipp Symptoms of Stress Inventory were assessed. In addition, the women underwent polysomnography at baseline and post-treatment. Statistical analyses were calculated using Friedman and Wilcoxon non-parametric tests. The level of significance was fixed at p ≤ 0.05. There was an improvement in ISI in the TM group (p = 0.000) and in the PM group (p = 0.001). A decrease in the BDI occurred in the TM group (p = 0.004), and the MENQOL improved in the TM group (p = 0.015). Furthermore, there were no significant differences in polysomnography parameters in the TM group, with only an increase in minimal saturation (p = 0.053). The TM group exhibited improved subjective data considering the changes in symptoms according to the ISI and the MENQOL and a decrease in symptoms according to the BDI.
    No preview · Article · Feb 2012 · Climacteric
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: The loss of vertical dimension of occlusion (VDO) is a problem that affects stomatognathic system performance, mainly in edentulous patients. Thus, diseases related to musculature failure such as obstructive sleep apnea syndrome (OSAS) are common in these patients. Consequently, efficient and low-cost therapeutic strategies such as intraoral devices (IOD) used to expand the upper airway (UA) are needed to improve the quality of sleep in these patients. The aim of this study was to assess both the subjective and objective effect of VDO increase on the quality of sleep in 19 elderly patients using bimaxillary total prostheses (TPs) before and after placement of new TPs and therapy with intraoral devices (IOD) especially designed to increase VDO without causing mandibular advancement. Methods: For this purpose, questionnaires surveying quality of sleep (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and sleep anamnestic questionnaire) and polysomnography tests (PSG) were performed at three different phases: baseline without TPs, with TPs and with IODs. Conclusions: It was concluded that the tested IODs may contribute to improvements in the quality of sleep for patients and their sleeping partners because they led to significant decreases in snoring. Most patients also expressed a preference for IOD use while sleeping. However, the use of IOD did not significantly improve polysomnography parameters compared to the baseline and thus cannot be indicated for the treatment of OSAS.
    No preview · Article · Jan 2012
  • P Araujo · H Hachul · R Santos-Silva · L.R.A. Bittencourt · S Tufik · M.L. Andersen
    [Show abstract] [Hide abstract] ABSTRACT: Menstrual pain is a common problem in women of reproductive age and often interferes with the ability to work and with general well-being. Because painful conditions frequently affect sleep, we investigated the impact of this menstrual disorder on sleep patterns in adult women. Additionally, we examined whether medications used to alleviate menstrual pain promoted changes in sleep. According to their hormone profiles and menstrual histories, a total sample of 24 women (25-48 years old) who were experiencing their menstrual periods on the day of the polysomnogram (PSG) were included in the study. All of the participants answered questions regarding the presence of menstrual pain and use of medication. Menstrual pain was reported by 66.6% of the women on the night of the PSG. No marked effects were observed on the sleep pattern of these subjects compared with women without menstrual pain. The use of medication did not promote significant changes in the sleep pattern. None of the women were taking oral contraceptives. The presence of menstrual pain or the use of medication to alleviate pain did not significantly alter sleep patterns. Thus, the results suggest that the presence of self-described menstrual pain does not affect sleep patterns in adult women.
    No preview · Article · Dec 2011 · Sleep Medicine
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    R Pellegrino · D R Mazzotti · C Guindalini · R Santos-Silva · L R A Bittencourt · S Tufik
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study was to evaluate the influence of polymorphism on sleep parameters of Obstructive Sleep Apnea Syndrome (OSAS) patients. Patients were genotyped after a full-night polysomnography using the large Epidemiologic Sleep Study of São Paulo population-based sample. Individuals who carry the APOE ε2 allele showed longer sleep latency, lower sleep efficiency and higher numbers of arousals/hour, when compared to ε3 allele homozygous and carriers of ε4 allele (p<0.05). These findings remained significant even after correction for potential confounders, such as sex, age and African genetic ancestry. The APOE polymorphisms may modulate the effects of intermittent hypoxia and sleep fragmentation in the sleep architecture of OSAS patients, and that the presence of the ε2 allele may serve as a biological marker for the identification of a subgroup of patients who are more likely to suffer with OSAS detrimental effects on sleep, impacting not only the daily functioning, but also their quality of life.
    Full-text · Article · Aug 2011 · Clinica chimica acta; international journal of clinical chemistry
  • T.A. Vidigal · F.L.M. Haddad · L.C. Gregório · S. Tufik · L.R.A. Bittencourt
    [Show abstract] [Hide abstract] ABSTRACT: Obstructive sleep apnea syndrome is a prevalent disease that results in cardiovascular, metabolic, and cognitive complications. The major treatment modality has been the positive airway pressure device, but adherence to this form of treatment has been limited. For this reason, other forms of treatment may help to control this disease, such as the upper airway and cranial-facial surgical procedures. Therefore, the objective of this paper was to investigate surgical procedures that could be used for obstructive sleep apnea syndrome treatment in adults, as well as their indications and success rates. There are many proposed surgical procedures for the treatment of obstructive sleep apnea syndrome; these include upper airway and cranial-facial surgeries. Although few studies have confirmed the exact benefit of these procedures in the obstructive sleep apnea syndrome treatment, the presence of anatomical alterations in these sites and the severity of obstructive sleep apnea syndrome have been the main factors taken into consideration in the selection of patients to undergo this type of treatment.
    No preview · Article · Jan 2011
  • J. C. Perry · C. Guindalini · L. A. Bittencourt · S. Garbuio · D. R. Mazzotti · L. Zanin · S. Tufik
    No preview · Conference Paper · Jan 2011
  • [Show abstract] [Hide abstract] ABSTRACT: The treatment of choice for obstructive sleep apnea syndrome (OSAS) has been done with positive airway pressure devices, especially in moderate to severe cases. However, many patients do not adequately adhere to this therapy. Thus, other treatment modalities should be taken into consideration, including surgical procedures on the upper airway. This study describes the main techniques used on the soft palate and lateral pharyngeal wall to treat OSAS, as well as their indicators for success and their success rates. We also note the progress that has been made over the years in improving the surgical techniques that address the soft palate and lateral pharyngeal wall. We also highlight a critical selection of patients who have been treated using these procedures. When the indicators are carefully considered, surgical procedures may be beneficial in the treatment of OSAS.
    No preview · Article · Jan 2011
  • [Show abstract] [Hide abstract] ABSTRACT: The aim of the present study was to evaluate the influence of ethnicity on the risk of developing obstructive sleep apnoea syndrome (OSAS) using genomic analysis methods to estimate ancestry. DNA samples were obtained from 1,010 individuals participating in the São Paulo Epidemiologic Sleep Study, who underwent full-night polysomnography. A total of 31 genetic ancestry-informative markers were selected in order to estimate individual admixture proportions. Of patients with a diagnosis of OSAS, a higher number self-reporting Caucasian ethnicity (65.3%), as well as an increased percentage of European ancestry (78.2±16.7%) and lower percentage of West African ancestry (16.1±15.3%), than among individuals without OSAS (53.6, 73.5±18.1 and 20.1±16.8%, respectively) (p<0.001) was observed. Moreover, after correcting for sex, age, body mass index and socioeconomic status, logistic regression demonstrated that European ancestry was significantly associated with an increased risk of manifesting OSAS (OR 2.80, 95% CI 1.11-7.09). Conversely, West African ancestry was associated with a reduced risk of the OSAS phenotype (OR 0.26, 95% CI 0.09-0.72). This is the first study to incorporate genomic analysis methods to measure the influence of ethnicity on the risk of OSAS. Since genetically determined ancestry may not capture unmeasured cultural and lifestyle differences, the contribution of environmental factors to the current findings should not be disregarded.
    No preview · Article · Mar 2010 · European Respiratory Journal
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    Full-text · Article · Jan 2010 · Revista Brasileira de Psiquiatria
  • [Show abstract] [Hide abstract] ABSTRACT: There is evidence that regular exercises promote a number of changes and physiological benefits, and can be considered a non-pharmacological intervention, which improves the sleep quality of people who really do not have any sleep disorders. Yet, few studies have assessed how exercise can benefit a specific population with sleep disturbance. The aim of this study was to examine the influence of an aerobic training (AT) program of variable intensity in a sample of volunteers who had periodic leg movement (PLM) and obstructive sleep apnea syndrome (OSAS). The 51 year-old volunteer, body mass index (BMI) 28.67 kg/m2, sedentary, presenting PLM (rate>53.5/hour) and OSAS (AHI index >12.8/hour) was submitted to aerobic training on a treadmill in the mornings 3 times a week, each session lasting 40 minutes, thus totaling 72 sessions. Prior to aerobic training, the volunteer took a maximum effort test (MET) so that prescription of safe aerobic training could be made. The first aerobic training was done at 60% of the VO2peak so that acute effects of exercise could be assessed. Sessions 2 up to 24 were performed at ventilation threshold 1 (VT1) and sessions 25 to 48 were performed between ventilation threshold 1 and ventilation threshold 2 while sessions 49 to 72 were done between VT1 and VT2, with predominance at VT2. Polysomnographic and maximum effort test tests were carried out every 6 months throughout the aerobic training period and one month after the 72 sessions (suspension of training). We demonstrate that aerobic training at the intensity of VT1 promoted a reduction in the rate of periodic leg movement in relation to baseline values (53.5/h to 38.6/h). After the increase in intensity of aerobic training and a shift to the VT1 and VT2 range with predominance in VT2, the rate of periodic leg movement rose (63.8/h), and after one month of training suspension this rate was still higher than that of its corresponding moment baseline value (72.8/h). The AHI also increased during heightened AT when AT was performed at the intensity of VT1 27.8/h during AT compared to baseline 12.8. Such rates approached baseline values at VT1 and VT2 with predominance at VT2 (13.0/h) only to increase once again after one month suspension of training. AT at loads compatible with VT1 promoted enough improvement in the rate of periodic leg movement to down-grade the condition from severe to moderate, but sleep apnea syndrome increased at that intensity of exercise climbing from mild to moderate. Such results suggest that the benefits credited to AT have distinct mechanisms of action in periodic leg movement and sleep apnea syndrome.
    No preview · Article · Jan 2010
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    A. M. Esteves · M. M. T. de · R. Santos-Silva · L. R. A. Bittencourt · S. Tufik
    Full-text · Article · Dec 2009 · Sleep Medicine
  • L. R. A. Bittencourt · R. Santos-Silva · L. O. Palombini · S. Tufik
    No preview · Article · Dec 2009 · Sleep Medicine
  • S. Garbuio · C. Dal-Fabbro · V. D'Almeida · S. Tufik · L. R. A. Bittencourt
    No preview · Article · Dec 2009 · Sleep Medicine
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    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Studies relating otorhinolaryngological with phono-audiological and polysomnographic assessments in patients with the obstructive sleep apnea syndrome (OSAS) are rare, and the paucity of information on this topic is apparent when outlining treatments for the OSAS. Objectives: The purpose of this investigation was to thor-oughly describe possible alterations in orofacial motricity structure and function in the OSAS patients by means of a phonoaudiological evaluation model. Methods: Orofacial structures and functions were examined in male OSAS patients with respect to anthropometric, oto-rhinolaryngological, and phonoaudiological parameters. Results: A total of 22 patients was recruited, with an average age of 47±11 years old, body mass index of 26.2±4.9 kg/m 2 , and cervical circumference of 43.9±3.4 cm. The otorhinolaryngological and phonoaudiological assessments revealed that 73% of patients had reductions related to tongue tension; 64% of them showed an elevated genioglossus with the tip of the tongue laying behind the inferior central incisive teeth; 55% showed failed teething; 27% exhibited normal occlusion; 18% had class II occlusions; 100% had facial asymmetry; 36% had a nar-row, deep, hard palate; 55% had nasal obstruction; 100% presented with oropharynx alterations; 72% showed unilateral chewing; 63% had ineffective chewing, and 83% exhibited advanced tongue projec-tion during swallowing. Conclusions: The phonoaudiological model adopted in this study produced relevant findings about modifications in orofacial motricity in the treatment of OSAS patients.
    Full-text · Article · Dec 2009 · Sleep Medicine
  • H Hachul · M L Andersen · L R A Bittencourt · R Santos-Silva · S G Conway · S Tufik
    [Show abstract] [Hide abstract] ABSTRACT: The aim of the present study was to investigate how prominent gynecological factors (regular/irregular menstrual cycle, premenstrual complaints, or menopause) can influence both subjective and objective sleep data. A total of 931 women who sought clinical assistance because of a sleep complaint were included in the investigation. All subjects filled out a sleep and gynecological questionnaire prior to undergoing a polysomnography (PSG) recording. Premenopausal women with an irregular menstrual cycle were more likely to report sleep difficulties (related to falling sleep and insomnia symptoms) than those with a regular cycle (odds ratio 2.1; 95% confidence interval 1.2-3.5). These women showed increased light sleep stages and awakenings. Premenstrual complaints were reported by a higher percentage of women with periodic leg movement, lower time in saturation under 90%, and higher sleep efficiency. A lower percentage of women who took hormonal contraceptives reported snoring, had fewer arousals and longer REM latency compared to those not taking hormonal contraceptives. Menopausal women with hot flushes had more restless leg complaints. Awake time was shorter in hormone therapy users compared with non-users. Women with menopause are more likely to have an apnea-hypoapnea index greater than 5/h. The present findings suggest that gynecological status is associated with subjective sleep quality and objective sleep parameters in women with sleep complaints.
    No preview · Article · Dec 2009 · Climacteric