L. R. A. Bittencourt

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

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Publications (90)201.36 Total impact

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    ABSTRACT: Studies that assess the upper airways in sleep-related breathing disorders have been performed only in patients with obstructive sleep apnea syndrome who seek medical attention. Therefore, in addition to the need for population studies, there are no data on the orofacial-cervical physical examination in subjects with upper airway resistance syndrome.
    Preview · Article · Nov 2015 · Brazilian journal of otorhinolaryngology
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    ABSTRACT: The sleep of patients admitted to coronary care unit (CCU) may be compromised. A feasible and cost-effective tool to evaluate sleep in this scenario could provide important data. The aim of this study was to evaluate sleep with a questionnaire developed specifically for the CCU and to validate it with polysomnography (PSG). Ninety-nine patients (68% male; 56 ± 10 years old) with acute coronary syndrome were included. PSG was performed within 36 h of admission. A specific 18-question questionnaire (CCU questionnaire) was developed and applied after the PSG. Cronbach's alpha test was used to validate the questionnaire. The Spearman test was used to analyze the correlation between the PSG variables and the questionnaire, and the Kruskal-Wallis test was used to compare the PSG variables among patients with good, regular, or poor sleep. The total sleep time was 265 ± 81 min, sleep efficiency 62 ± 18%, REM sleep 10 ± 7%, apnea/hypopnea index 15 ± 23, and the arousal index 24 ± 15. Cronbach's alpha test was 0.69. The CCU questionnaire showed correlation with the sleep efficiency evaluated by PSG (r: 0.52; p < 0.001). Sleep quality was divided into three categories according to the CCU questionnaire: patients with good sleep had a sleep efficiency of 72 ± 9%, better than those with a regular or poor sleep (60 ± 16% and 53 ± 20%, respectively; p < 0.01). The CCU questionnaire is a feasible and reliable tool to evaluate sleep in the CCU, showing correlation with the PSG sleep efficiency. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Apr 2015 · Sleep Medicine
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    Dataset: SLEEP2387

    Full-text · Dataset · Nov 2014
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    H. Hachul · D.S. Oliveira · L.R.A. Bittencourt · M.L. Andersen · S. Tufik
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    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

  • No preview · Conference Paper · May 2014
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    ABSTRACT: Objective Although many studies have shown the evolution of sleep parameters across the lifespan, not many have included a representative sample of the general population. The objective of this study was to describe age-related changes in sleep structure, sleep respiratory parameters and periodic limb movements of the adult population of São Paulo. Methods We selected a representative sample of the city of São Paulo, Brazil that included both genders and an age range of 20–80 years. Pregnant and lactating women, people with physical or mental impairments that prevent self-care and people who work every night were not included. This sample included 1024 individuals who were submitted to polysomnography and structured interviews. We subdivided our sample into five-year age groups. One-way analysis of variance was used to compare age groups. Pearson product–moment was used to evaluate correlation between age and sleep parameters. Results Total sleep time, sleep efficiency, percentage of rapid eye movement (REM) sleep and slow wave sleep showed a significant age-related decrease (P < 0.05). WASO (night-time spent awake after sleep onset), arousal index, sleep latency, REM sleep latency, and the percentage of stages 1 and 2 showed a significant increase (P < 0.05). Furthermore, apnea–hypopnea index increased and oxygen saturation decreased with age. The reduction in the percentage of REM sleep significantly correlated with age in women, whereas the reduction in the percentage of slow wave sleep correlated with age in men. The periodic limb movement (PLM) index increased with age in men and women. Conclusions Sleep structure and duration underwent significant alterations throughout the aging process in the general population. There was an important correlation between age, sleep respiratory parameters and PLM index. In addition, men and women showed similar trends but with different effect sizes.
    Full-text · Article · Apr 2014 · Sleep Medicine
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    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
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    ABSTRACT: Recurrent hypoxia, which is associated with obstructive sleep apnea syndrome (OSAS), leads to an increase in the degradation of adenosine triphosphatase into xanthine, which in turn increases uric acid concentrations. The current study aimed to determine whether an association exists between OSAS and uric acid levels in the peripheral blood from a representative population of Sao Paulo (Brazil). A population-based survey adopting a probabilistic 3-stage cluster sample of Sao Paulo was used to represent the population according to gender, age, and socioeconomic class. A total of 1,042 volunteers underwent polysomnography recordings for OSAS diagnosis, blood pressure assessment, and biochemical blood analysis, and answered questionnaires. Uric acid levels were correlated with most important risk factors for OSAS, such as AHI, desaturation time and index, minimum oxyhemoglobin saturation (SpO2), blood pressure, cholesterol, BMI, triglycerides and arousal, and with OSAS itself. Also, uric acid was increased in OSAS volunteers even after controlling for all confounders. Hyperuricemic volunteers presented lower mean and minimum SpO2 and increased desaturation index. Importantly, minimum SpO2 was a significant predictor of uric acid levels, which in turn was considered an independent predictor for OSAS in the binary logistic model. However, a ROC curve analysis for establishing cut-off points for uric acid levels as a biomarker of OSAS revealed moderate sensitivity and specificity. A strong association was found between uric acid levels and OSAS in a representative sample of the population of Sao Paulo. Although they do not qualify for a biomarker alone, uric acid levels may be involved in OSAS severity and should be considered in sleep apnea management in the future.
    Full-text · Article · Jun 2013 · PLoS ONE
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    Preview · Article · Jun 2013 · Critical Care
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    Full-text · Article · Apr 2013 · Osteoarthritis and Cartilage
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    Full-text · Article · Apr 2013 · Osteoarthritis and Cartilage
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    W Moraes · D Poyares · I Zalcman · M.T. de Mello · L.R. Bittencourt · R Santos-Silva · S Tufik
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    ABSTRACT: Introduction: Sleep duration has been associated with overweight individuals in many epidemiological studies; however, few studies have assessed sleep using objective methods. Our study was designed to evaluate the association between body mass index (BMI) and sleep duration measured by actigraphy (Acti), polysomnography (PSG) and the Pittsburgh sleep quality index questionnaire (PSQIO). Furthermore, we evaluated other biochemical and polysomnographic parameters. Methods: A representative sample of 1042 individuals from Sao Paulo, Brazil, including both genders (20-80 yrs), participated in our protocol. Weight and other anthropometric parameters were measured at the onset of the study. Sleep duration was calculated by Acti, PSG, and the PSQIQ. The population was sorted by sleep duration, body, slow wave sleep (SWS) and REM sleep (REMS) duration subsets. In addition, other biochemical and polysomnographic parameters were analyzed. Differences between population subsets were analyzed by one-way analysis of variance (ANOVA). Linear regression analysis was performed between sleep and anthropometric parameters. Results: Shorter sleep duration was associated with higher BMI and waist and neck circumference when measured by Acti and PSG (p<0.05). Lower leptin levels were associated with short sleep in normal-weight (BMI>18 and ⩽25) individuals (p<0.01). The association between short sleep duration Acti and higher BMI was present when apnea-hypopnea index (AHI) was less than 15 (p=0.049). Shorter REMS and SWS also were associated with higher BMI (p<0.01). Normal-weight individuals tended to sleep longer, have higher sleep efficiency and longer SWS and REMS than obese individuals (Acti, PSG; p=0.05). Sleep duration was negatively correlated with BMI (Acti, PSG; p<0.05). Short SWS and REMS were associated with higher cardiovascular risk factors (p<0.05). Conclusion: Shorter sleep, SWS, and REMS duration were associated with higher BMI, central adiposity measurements, and cardiovascular risk factors when measured by objective methods.
    Full-text · Article · Feb 2013 · Sleep Medicine
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    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
  • L.M. Oliveira · S. Tufik · L.R. Pinto · S. Garbuio · L.R. Bittencourt · M. Pedrazzoli
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    ABSTRACT: Hypocretin system has been described as one of the most important neurotransmission systems involved in the waking process. The system's lack of function, caused by mutation or neuron death, leads to sharp sleepiness in mammals. It has been proposed that a hyperactive hypocretin system can result in hyperarousal episodes and insomnia. Hypocretins 1 and 2 are bind to two known receptors that are widely distributed in the brain. The current study sought to analyze if either polymorphism in hypocretin receptor 1 or in hypocretin receptor 2 are associated to insomnia. We enrolled 83 insomnia patients, confirmed their clinical insomnia symptoms by means of polysomnographic recordings, comparing single nucleotide polymorphism frequencies in both hypocretin receptors and to those from healthy control patients who had no sleep disorders as confirmed by two nights of sleeping records. Our results show no association to either receptor polymorphism or insomnia.
    No preview · Article · Jan 2013
  • F.M.S. Coelho · M. Pradella-Hallinan · S. Tufik · L.R.A. Bittencourt
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    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
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    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
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    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
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    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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    ABSTRACT: There is no consensus in the literature about the impact of complete denture wear on obstructive sleep apnea (OSA). The goal of this randomized clinical study was to assess if complete denture wear during sleep interferes with the quality of sleep. Elderly edentulous OSA patients from a complete denture clinic were enrolled and received new complete dentures. An objective sleep analysis was determined with polysomnography performed at the sleep laboratory for all patients who slept either with or without their dentures. Twenty-three patients (74% females) completed the study with a mean age of 69.6 years and a mean body mass index of 26.7 kg/m(2). The apnea and hypopnea index (AHI) was significantly higher when patients slept with dentures compared to without (25.9 ± 14.8/h vs. 19.9 ± 10.2/h; p > 0.005). In the mild OSA group, the AHI was significantly higher when patients slept with the dentures (16.6 ± 6.9 vs. 8.9 ± 2.4; p < 0.05), while in moderate to severe OSA patients, the AHI was not significantly different when sleeping with dentures (.30.8 ± 15.6 vs. 25.7 ± 7.5; p = 0.2). The supine AHI in mild patients was related to a higher increase in AHI while wearing dentures (12.7 ± 8.4/h vs. 51.9 ± 28.6/h; p < 0.001). A limitation of the study is that the mild OSA patients had a higher BMI when compared to the moderate to severe OSA patients. Ten out of 14 patients who preferred to sleep with their upper and lower dentures showed an increase in their AHI while wearing dentures to sleep. Contrary to previous studies, we found that OSA patients may experience more apneic events if they sleep with their dentures in place. Specifically, in mild OSAS patients, the use of dentures substantially increases the AHI especially when in the supine position.
    No preview · Article · Sep 2011 · Sleep And Breathing