Teresa Paiva | Universidade de Lisboa (original) (raw)
Papers by Teresa Paiva
BMC Pediatrics, Dec 1, 2014
Background: Poor sleep contributes to the developmental problems seen in preterm infants. We eval... more Background: Poor sleep contributes to the developmental problems seen in preterm infants. We evaluated sleep problems in preterm infants 6 months of post-gestational age using the subjective Brief Infant Sleep Questionnaire (BISQ) and objective sleep tests. We also compared the sleep of premature infants with that of full-term infants. Methods: The study included 68 6-month-old full-term healthy infants and 191 premature infants born at <37 weeks gestation. All parents completed the BISQ-Chinese version and sleep diaries. At the same time, all premature infants were submitted to one night of polysomnography (PSG) in the sleep laboratory and also were set up with an actigraph kept for 7 days. Statistical analyses were performed using correlation coefficients and the t-test with SPSS version 18 to compare questionnaire responses with other subjective and objective measures of sleep. Results: The sleep problems indicated in the subjective questionnaire for the premature infants, particularly: "the nocturnal sleep duration, number of night awakenings, daytime sleep duration, duration of time with mouth breathing, and loud-noisy breathing" had significant correlations with sleep diaries, actigraphy and PSG results. The BISQ showed that duration of infant's sleeping on one side, nocturnal sleep duration, being held to fall asleep, number of nighttime awakenings, daytime sleep duration, subjective consideration of sleep problems, loud-noisy breathing, and duration spent crying during the night were significantly different between the premature infants and the term infants. PSG confirmed the presence of a very high percentage (80.6%) of premature infants with AHI > 1 event/hour as indicated by the questionnaire. Conclusion: Premature infants have more sleep problems than full-term infants, including the known risk of abnormal breathing during sleep, which has been well demonstrated already with the BISQ-Chinese (CBISQ).
IEEE Transactions on Biomedical Engineering, Feb 1, 2014
Wrist actigraphy (ACT) is a low-cost and well-established technique for long-term monitoring of h... more Wrist actigraphy (ACT) is a low-cost and well-established technique for long-term monitoring of human activity. It has a special relevance in sleep studies, where its noninvasive nature makes it a valuable tool for behavioral characterization and for the detection and diagnosis of some sleep disorders. The traditional sleep/wakefulness state estimation algorithms from the nocturnal ACT data are unbalanced from a sensitivity and specificity points of view since they tend to overestimate sleep state, with severe consequences from a diagnosis point of view. They usually maximize the overall accuracy that does not take into account the highly unbalanced state distribution. In this paper, a method is proposed to appropriately deal with this unbalanced problem, achieving similar sensitivity and specificity scores in the state estimation process. The proposed method combines two linear discriminant classifiers, trained with two different criteria involving movement detection to generate a first state estimate. This result is then refined by a Hidden Markov Model-based algorithm. The global accuracy, the sensitivity, and the specificity of the method are 77.8%, 75.6%, and 81.6%, respectively, performing better than the tested algorithms. If the performance is assessed only for movement periods, this improvement is even higher.
Journal of Neurology, Neurosurgery, and Psychiatry, May 1, 1994
To evaluate if short (less than one hour) or recurrent, or both, episodes of transient global amn... more To evaluate if short (less than one hour) or recurrent, or both, episodes of transient global amnesia (TGA) have an epileptic origin or carry a subsequent risk of epilepsy a group of patients with these types of TGA attacks was studied. The group was selected from a prospective series of 103 patients with TGA. Sixteen patients had an episode lasting less than one hour, 13 had more than one episode, and five patients had both short and recurrent attacks. For each patient the number of recurrences was small (four or less) and they were separated by months or years. During short attacks of TGA many subjects showed other typical features of TGA including repeated questioning (12 subjects) and performance of purposeful complex acts (eight subjects). Twelve short attacks were closely related to a characteristic precipitating event. During follow up only one patient had a seizure (partial motor). No other association between either short or repeated attacks of TGA and past history of epilepsy or paroxysmal discharges were seen on the EEG. Short or recurrent, or both, attacks of TGA are not epileptic and do not carry a relevant risk of subsequent seizures.
Journal of Clinical Sleep Medicine, Aug 15, 2018
Study Objectives: This study has as its primary objective to evaluate the quality and effectivene... more Study Objectives: This study has as its primary objective to evaluate the quality and effectiveness of type II ambulatory polysomnography (Amb-PSG) versus type I attended laboratory polysomnography (Lab-PSG) in diagnosing obstructive sleep apnea (OSA). Its secondary objective is to evaluate the clinical efficacy, quality of life (QoL), and treatment adherence after diagnosis. Methods: An observational study of patients with OSA (n = 225) in whom diagnosis was made via Amb-PSG (n = 114) or Lab-PSG (n = 111). Patients' clinical data were retrospectively assessed (including general demographic and clinical data, Epworth Sleepiness Scale, blood pressure, indices from polysomnography, and treatment adherence. Cross-sectional assessment (patient questionnaire) was used to evaluate clinical efficacy indicators, comorbidities, current treatment, and QoL. Results: Polysomnography indices were comparable between Amb-PSG and Lab-PSG (apnea-hypopnea index: 38.9 ± 22.5 versus 35.8 ± 23.1 events/h; P > .05), except for an elevation of total sleep time (510 ± 54.7 versus 476.3 ± 79.4 minutes; P < .01) and loss of oximetry signal (9.8% versus 0.0%; P < .05). Based on polysomnography parameters, OSA was severe in 119 patients (52.9%), moderate in 88 (39.1%), and mild in 18 (8.0%). Diagnostic effect of Amb-PSG in clinical (body mass index, blood pressure, Epworth Sleepiness Scale) and treatment follow-up (CPAP adherence and QoL) indicators was comparable to that of Lab-PSG. Conclusions: Amb-PSG showed an OSA diagnostic capacity comparable to Lab-PSG. Secondary analyses (diagnostic quality, clinical efficacy, treatment compliance, QoL) underline the value of Amb-PSG as an emerging alternative to improve accessibility to care.
Sleep Medicine, Dec 1, 2015
ABSTRACT The present study aimed to evaluate the influences of sleep duration, sleep deprivation,... more ABSTRACT The present study aimed to evaluate the influences of sleep duration, sleep deprivation, and weekend variability of sleep upon other adolescents' features, namely those related to health and health-related quality of life. The Health Behaviour in School-Aged Children (HBSC) survey is based on a self-completed questionnaire. The participants in the present study were 3476 students (53.8% were girls) in the 8th and 10th grades at school; the mean age was 14.9 years (range 12.5-19.0). Subjective sleep duration during the weeknights and weekends was collected; sleep deprivation (SD) was considered whenever the difference was greater than 3 h. Health complaint frequency and health-related quality of life (with the Kidscreen 10) were collected. Sleep deprivation was present in 18.9% of the students. It was negatively correlated with sleep duration on weeknights. There were no gender differences, but SD increased with age and grade. Higher school grades were mainly associated with fatigue. A considerable number of adolescents had sleep problems (37.2%); 25.5% had difficulties in sleep initiation, which was more prevalent in adolescents with SD. The sleep duration on weeknights was decreased in the SD group. The average health-related quality of life was reduced in adolescents with SD. The frequency of health complaint was higher is adolescents with SD. Girls had significantly more health complaints than boys, with special focus on headaches. Sleep deprivation is associated with the perception of health-related quality of life and perceived physical and mental health. Copyright © 2014. Published by Elsevier B.V.
Springer eBooks, 2009
In this paper a definition of the activity (ACT) variable is proposed and a method to estimate it... more In this paper a definition of the activity (ACT) variable is proposed and a method to estimate it from the noisy actigraph output sensor data is described. A statistical model for the actigraph data generation process is suggested based on its working physical principles and on physiological considerations about human activity. The purposeless nature of the sleeping movements is used
DOAJ (DOAJ: Directory of Open Access Journals), Apr 1, 2020
Daytime napping should be encouraged for children up to 5-6 years of age. Risks: There is an asso... more Daytime napping should be encouraged for children up to 5-6 years of age. Risks: There is an association of sleep deprivation in children with potentially short-and long-term consequences, including emotional and behavioral dysfunction, risk of accidental falls, low cognitive performance and learning, obesity, and hypertension. Target groups: Children in nursery (3-36 months of age) and preschool (3 to 5-6 years of age) Places: Nurseries, preschools, and public or private establishments. Preliminary note The Secção de Pediatria Social (SPS) of the Sociedade Portuguesa de Pediatria (SPP), in accordance with article 4 of its statutes, aims to protect and promote the defense of the rights of children and young individuals, as part of an evolving society. The current lack of clear recommendations on naps for children in nurseries and preschools puts the current and future health and wellbeing of our children at significant risk. Children in Portugal, especially those attending public establishments, do not usually have a nap after 3 years of age. The aim of these recommendations is to standardize and encourage best practice for daytime sleep or napping for children from 3 months to 36 months of age (nursery) and from 3 to 6 years of age (preschool) in public or private establishments.
para tomarem consciência do tema e de mudarem de ideias em relação á influência dos agentes de so... more para tomarem consciência do tema e de mudarem de ideias em relação á influência dos agentes de sociabilização relacionados com a publicidade, os contos e as canções.
O objetivo deste artigo consiste em apresentar os resultados da nossa investigação focada no estu... more O objetivo deste artigo consiste em apresentar os resultados da nossa investigação focada no estudo dos processos organizacionais relacionados com o conhecimento e na sua dependência operacional da natureza dos pressupostos dos processos de gestão de recursos humanos (GRH) nas organizações. Foca-se nos processos relacionados com a análise e descrição de funções, recrutamento e seleção e acolhimento. O estudo empírico de natureza quantitativa pretende responder à questão central de investigação, segundo a qual a perspetiva que configura as práticas GRH implementadas numa organização tem impacto na forma como nesta operam os processos de gestão do conhecimento (GC). A amostra é constituída por 5306 colaboradores de 634 organizações pertencentes a um grupo económico português do subsetor da banca. Os resultados obtidos permitem-nos concluir que nas organizações estudadas os processos de GRH e de GC estão bastante operantes e que os relativos à gestão das pessoas assentam em pressupostos tendencialmente orgânicos, valorativos e de desenvolvimento. As análises de regressão múltipla permitem-nos concluir pela capacidade preditiva das práticas de gestão de recursos humanos estudadas, relativamente aos processos de gestão do conhecimento. Palavras-chave-Gestão de recursos humanos, gestão do conhecimento, práticas e processos.
Sleep Medicine, Dec 1, 2015
Objectives: The aim is to evaluate the mutual influences between sleep duration/sleep deprivation... more Objectives: The aim is to evaluate the mutual influences between sleep duration/sleep deprivation (SD) and the sleep stealers/adolescent risk behaviours. Methods: The national survey is a component of the Health Behaviour in School-Aged Children (HBSC) study, it is based on a school-based self-completed questionnaire; 3476 students were randomly selected from 139 randomly chosen Portuguese schools using as an unit the class, 53.8% were girls; 45.9% attended the 8th grade and 54.1% the 10th grade; the mean age was 14.9 years. The measured variables were: 1) gender and age; 2) sociodemographics; 3) sleep duration during the week and during weekends and computed SD; 4) screen time (computer use during the week and during the week end (PC use); watching TV and mobile phone use; 5) earlier sexual behaviour; 6) violent behaviours: fights, use of weapons; 7) use of tobacco, alcohol and drugs. The statistical analysis included Pearson chi-square tests and logistic regression. Results: Excessive use of mobile phone, of computer use during weekdays, and internet facilities; substance use; violence and earlier sexual relations had significantly higher prevalence in sleep deprived adolescents. By logistic regression only using PC during weekdays, tobacco, drugs and weapons were associated to SD, while SD was associated to PC use during weekdays, tobacco use and drugs' use. Computer uses tend to be associated among themselves. Mobile phone is associated with computer practices and with alcohol and tobacco use. Tobacco is associated with most risk behaviours. Alcohol use is associated with other substance use, computer use and violent behaviours. Violence behaviours, earlier sex and drugs use tend to be associated among themselves.
Portuguese Journal of Pediatrics, 2000
Os autores apresentam um caso grave de hipersónia recorrente de tipo monossintomático numa crianç... more Os autores apresentam um caso grave de hipersónia recorrente de tipo monossintomático numa criança de 2 anos de idade que desde os 6 meses de vida tinha episódios frequentes de sonolência que duravam de várias horas a alguns dias. Fazem referência à extensa investigação realizada até ao diagnóstico definitivo e à dificuldade encontrada para controlar os sintomas com recurso aos fármacos habitualmente usados neste tipo de patologias. Por fim, com base na literatura mais recente, foi iniciada terapêutica com vitamina B12 (cianocobalamina) na dose de 1 mg/dia, per os, com resultados surpreendentes. A última crise de sonolência prolongada ocorreu 5 dias após o início do tratamento. À data desta publicação, passados três anos desde o início da terapêutica, a criança continua assintomática.
Psychology, community & health, Jul 31, 2015
Aim: The prevalence of obesity has been steadily increasing and is a major worldwide public healt... more Aim: The prevalence of obesity has been steadily increasing and is a major worldwide public health problem. It is associated with multiple medical and psychological conditions and recent research supports a link to several cognitive deficit domains, including executive functioning. The aim of this article is to describe socio-demographic, clinical and neuropsychological characteristics of a sample of candidates for bariatric surgery (BS) and to compare their performance with normative values. Method: Between May 2012 and May 2013 we evaluated the neuropsychological performance of 42 patient candidates for BS at the Morbid Obesity Consultation at Centro Hospitalar Lisboa Norte (CHLN). Results: The population was predominantly female and education was equally distributed between basic, secondary and tertiary levels. The neuropsychological results showed a significant decrease on Recall (p < .01), Learning (p < .10), Nonverbal Memory (p < .001), Cognitive Flexibility (p < .01) and Resistance to Interference (p < .05). Conclusion: Despite the limitations inherent to a small sample, the results obtained in the Portuguese population coincide with those of earlier studies; namely that obesity differentially effects instrumental functions.
International Journal of Psychiatry in Clinical Practice, 1997
Clinical and sleep EEG effects of trazodone in major depression were investigated using a 5-week ... more Clinical and sleep EEG effects of trazodone in major depression were investigated using a 5-week single-blind study design. Nine patients with DSM-N major depression were selected. Trazodone (50-250 mg) was given following a 2-week placebo run-in period. Both sleep and psychiatric evaluations were performed at different time points. Early and persistent sleep-inducing effects were detected, including the improvement of objective insomnia features and increased amounts of slow wave sleep. However, no significant changes of REM sleep measures were found. The sleep EEG changes seem to be related to the clinical improvement of both anxiety and insomnia, but there is no apparent relationship with the antidepressant action, which occurs at a later stage of the treatment. Trazodone may be useful in depressed patients, either as a hypnotic-like agent or as an effective antidepressant drug with beneficial effects on sleep.
Sleep, May 1, 1993
A model-based automatic K-complex (Kc) detector was applied to all-night single-channel sleep ele... more A model-based automatic K-complex (Kc) detector was applied to all-night single-channel sleep electroencephalographic (EEG) recordings from normal and dysthymic patients. The performance of the detector was analyzed in the two groups, and the differences obtained were discussed. The results showed that the detection rate of Kc in the normal group was around 92% through all stages of non-rapid eye movement (NREM) sleep, but with high numbers of "false" positives in stage 4 NREM, which reached 57%. In the dysthymic patients "true" detection included 85% of the Kc, but the percentage of "false" positives dropped to 25% in stage 4 NREM. Most of the "false" detections in the normal group were due to sharp delta activity during slow wave sleep (SWS). The results in the patient group were expected, because sleep in dysthymics showed a reduction in SWS when compared to normals. The behavior and automatic artifact rejection mechanisms ofthe detector are briefly presented. The modelbased Kc detector performed significantly better than other automatic detectors described in the literature; it was found to be a useful tool for routine sleep EEG studies.
Springer eBooks, Oct 4, 2016
Epidemiologic analysis of sleep disorders (SDs) in children and adolescents faces several difficu... more Epidemiologic analysis of sleep disorders (SDs) in children and adolescents faces several difficulties. There is a marked interindividual variability during the first years of life, which is more relevant in the first 2 years, and consequently the definition of what is “normal” can become a difficult issue to which cultural and ethnic differences might add clear complexity. Furthermore many available survey lack objective data; this issue is particularly relevant whenever data are provided by the caregivers, since known discrepancies do exist between children and caregivers information, and the fact that data obtained from younger individual are subjected to important ethical regulations is likely to reduce the number of available studies. Other contributing issues are the position of pediatric sleep in the field of sleep medicine and the successive classifications of sleep disorders and the methodologic modifications, rendering difficult comparisons across decades.
Acta Médica Portuguesa, Jan 3, 2020
Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com RESUMO Introdução: A obesida... more Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com RESUMO Introdução: A obesidade é fator de risco significativo para múltiplas comorbilidades e a sua relação com a disfunção neurocognitiva é de particular importância no declínio cognitivo particularmente na meia-idade. Explorámos o perfil neuropsicológico, a reserva cognitiva e o desajustamento emocional, em doentes com obesidade grave, devido ao seu impacto na neuro-degeneração. Material e Métodos: Questionário sociodemográfico e clínico, provas neuropsicológicas e de avaliação de sintomas de desajustamento emocional, na avaliação do desempenho cognitivo de 120 doentes, entre os 18 e os 65 anos, em tratamento da sua obesidade grave em Portugal, entre maio de 2012 e dezembro de 2015. Resultados: O desempenho cognitivo situou-se abaixo do valor médio da população portuguesa, para a memória imediata, visuoperceção, resistência à interferência e flexibilidade cognitiva. A reserva cognitiva foi maioritariamente baixa, principalmente nos grupos de pacientes com mais idade e com status profissional mais baixo. A sua elevação associou-se a melhores resultados cognitivos. O desajustamento emocional denotou significativa elevação comparativamente com uma amostra normativa. Os fatores de risco avaliados foram importantes no agravamento das funções cognitivas e o desempenho cognitivo decresceu com o aumento da idade. Discussão: A obesidade grave esteve associada a um pior desempenho cognitivo da amostra. A reserva cognitiva foi superior nos mais jovens. Houve presença expressiva de mal-estar emocional particularmente entre as mulheres. Conclusão: A obesidade grave está associada a uma diminuição do desempenho cognitivo e emocional que é coadjuvada pelo envelhecimento, reserva cognitiva baixa e comorbilidade. Sublinha-se, neste trabalho, a necessidade de ações preventivas entre as quais o screening neuropsicológico na deteção de alterações e conceção de melhores intervenções.
Journal of Telemedicine and Telecare, Jun 1, 2001
A neurology teleconsulting network was implemented between a university hospital in Lisbon and fi... more A neurology teleconsulting network was implemented between a university hospital in Lisbon and five nearby health centres. PCs equipped for videoconferencing were installed, connected by ISDN lines at 128 kbit/s. Fifty-three general practitioners (GPs) were surveyed. The survey showed that the GPs had difficulties in using computers, but they had definite intentions to use teleconsultation for neurology cases and 83% of the respondents stated that they would probably use the technique. During the study, 90 neurology teleconsultations took place over 55 weeks. The average consultation rate was 1.6 teleconsultations per week (SD 1.3, range 0-6). The conferences lasted 10-45 min. Longer teleconsultations were mainly due to technical difficulties in using computers on the part of users with a low level of computer literacy. The patients were 42 males and 46 females, with a mean age of 38 years (SD 20, range 1-84); two patients were discussed twice. The benefits consisted mainly of advice on patient medication, diagnosis and the prevention of unnecessary specialist consultations or laboratory examinations. Doctor-doctor teleconsultation allows the rapid resolution of queries which otherwise cause stress to patients and increase the cost and complexity of care.
World Journal of Biological Psychiatry, Jan 15, 2013
The aim of this study was to examine the differences between a sample of patients with schizophre... more The aim of this study was to examine the differences between a sample of patients with schizophrenia and a sample of healthy controls in terms of sleep patterns and self-reported sleep quality and quality of life (QoL). Thirty-four schizophrenia outpatients (SP), 12 women and 22 men and 34 healthy subjects (HS), 15 women and 19 men, participated in this study. Wrist-actigraphy recordings and a sleep diary were used for sleep-wake cycle assessment. The quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI), the QoL was evaluated using the World Health Organization Quality of Life - Abbreviated version (WHOQOL-Bref). The Positive and Negative Syndrome Scale (PANSS) was used for psychopathology assessment. Patients sleep more at night, but have poorer sleep efficiency, than HS. Sleep latency and nighttime awakenings were significantly higher in SP. Self-reported QoL scores were significantly higher, in all four domains, in HS. Scores on PSQI were significantly higher in SP, indicating a worse quality of sleep. Two disturbed patterns of sleep-wake phase were found in SP: advance sleep-phase syndrome (ASPS) (N = 3) and irregular sleep-wake rhythm (N = 3). Schizophrenia patients have more disturbed sleep-wake patterns and poor sleep quality and quality of life compared with healthy controls.
BMC Pediatrics, Dec 1, 2014
Background: Poor sleep contributes to the developmental problems seen in preterm infants. We eval... more Background: Poor sleep contributes to the developmental problems seen in preterm infants. We evaluated sleep problems in preterm infants 6 months of post-gestational age using the subjective Brief Infant Sleep Questionnaire (BISQ) and objective sleep tests. We also compared the sleep of premature infants with that of full-term infants. Methods: The study included 68 6-month-old full-term healthy infants and 191 premature infants born at <37 weeks gestation. All parents completed the BISQ-Chinese version and sleep diaries. At the same time, all premature infants were submitted to one night of polysomnography (PSG) in the sleep laboratory and also were set up with an actigraph kept for 7 days. Statistical analyses were performed using correlation coefficients and the t-test with SPSS version 18 to compare questionnaire responses with other subjective and objective measures of sleep. Results: The sleep problems indicated in the subjective questionnaire for the premature infants, particularly: "the nocturnal sleep duration, number of night awakenings, daytime sleep duration, duration of time with mouth breathing, and loud-noisy breathing" had significant correlations with sleep diaries, actigraphy and PSG results. The BISQ showed that duration of infant's sleeping on one side, nocturnal sleep duration, being held to fall asleep, number of nighttime awakenings, daytime sleep duration, subjective consideration of sleep problems, loud-noisy breathing, and duration spent crying during the night were significantly different between the premature infants and the term infants. PSG confirmed the presence of a very high percentage (80.6%) of premature infants with AHI > 1 event/hour as indicated by the questionnaire. Conclusion: Premature infants have more sleep problems than full-term infants, including the known risk of abnormal breathing during sleep, which has been well demonstrated already with the BISQ-Chinese (CBISQ).
IEEE Transactions on Biomedical Engineering, Feb 1, 2014
Wrist actigraphy (ACT) is a low-cost and well-established technique for long-term monitoring of h... more Wrist actigraphy (ACT) is a low-cost and well-established technique for long-term monitoring of human activity. It has a special relevance in sleep studies, where its noninvasive nature makes it a valuable tool for behavioral characterization and for the detection and diagnosis of some sleep disorders. The traditional sleep/wakefulness state estimation algorithms from the nocturnal ACT data are unbalanced from a sensitivity and specificity points of view since they tend to overestimate sleep state, with severe consequences from a diagnosis point of view. They usually maximize the overall accuracy that does not take into account the highly unbalanced state distribution. In this paper, a method is proposed to appropriately deal with this unbalanced problem, achieving similar sensitivity and specificity scores in the state estimation process. The proposed method combines two linear discriminant classifiers, trained with two different criteria involving movement detection to generate a first state estimate. This result is then refined by a Hidden Markov Model-based algorithm. The global accuracy, the sensitivity, and the specificity of the method are 77.8%, 75.6%, and 81.6%, respectively, performing better than the tested algorithms. If the performance is assessed only for movement periods, this improvement is even higher.
Journal of Neurology, Neurosurgery, and Psychiatry, May 1, 1994
To evaluate if short (less than one hour) or recurrent, or both, episodes of transient global amn... more To evaluate if short (less than one hour) or recurrent, or both, episodes of transient global amnesia (TGA) have an epileptic origin or carry a subsequent risk of epilepsy a group of patients with these types of TGA attacks was studied. The group was selected from a prospective series of 103 patients with TGA. Sixteen patients had an episode lasting less than one hour, 13 had more than one episode, and five patients had both short and recurrent attacks. For each patient the number of recurrences was small (four or less) and they were separated by months or years. During short attacks of TGA many subjects showed other typical features of TGA including repeated questioning (12 subjects) and performance of purposeful complex acts (eight subjects). Twelve short attacks were closely related to a characteristic precipitating event. During follow up only one patient had a seizure (partial motor). No other association between either short or repeated attacks of TGA and past history of epilepsy or paroxysmal discharges were seen on the EEG. Short or recurrent, or both, attacks of TGA are not epileptic and do not carry a relevant risk of subsequent seizures.
Journal of Clinical Sleep Medicine, Aug 15, 2018
Study Objectives: This study has as its primary objective to evaluate the quality and effectivene... more Study Objectives: This study has as its primary objective to evaluate the quality and effectiveness of type II ambulatory polysomnography (Amb-PSG) versus type I attended laboratory polysomnography (Lab-PSG) in diagnosing obstructive sleep apnea (OSA). Its secondary objective is to evaluate the clinical efficacy, quality of life (QoL), and treatment adherence after diagnosis. Methods: An observational study of patients with OSA (n = 225) in whom diagnosis was made via Amb-PSG (n = 114) or Lab-PSG (n = 111). Patients' clinical data were retrospectively assessed (including general demographic and clinical data, Epworth Sleepiness Scale, blood pressure, indices from polysomnography, and treatment adherence. Cross-sectional assessment (patient questionnaire) was used to evaluate clinical efficacy indicators, comorbidities, current treatment, and QoL. Results: Polysomnography indices were comparable between Amb-PSG and Lab-PSG (apnea-hypopnea index: 38.9 ± 22.5 versus 35.8 ± 23.1 events/h; P > .05), except for an elevation of total sleep time (510 ± 54.7 versus 476.3 ± 79.4 minutes; P < .01) and loss of oximetry signal (9.8% versus 0.0%; P < .05). Based on polysomnography parameters, OSA was severe in 119 patients (52.9%), moderate in 88 (39.1%), and mild in 18 (8.0%). Diagnostic effect of Amb-PSG in clinical (body mass index, blood pressure, Epworth Sleepiness Scale) and treatment follow-up (CPAP adherence and QoL) indicators was comparable to that of Lab-PSG. Conclusions: Amb-PSG showed an OSA diagnostic capacity comparable to Lab-PSG. Secondary analyses (diagnostic quality, clinical efficacy, treatment compliance, QoL) underline the value of Amb-PSG as an emerging alternative to improve accessibility to care.
Sleep Medicine, Dec 1, 2015
ABSTRACT The present study aimed to evaluate the influences of sleep duration, sleep deprivation,... more ABSTRACT The present study aimed to evaluate the influences of sleep duration, sleep deprivation, and weekend variability of sleep upon other adolescents' features, namely those related to health and health-related quality of life. The Health Behaviour in School-Aged Children (HBSC) survey is based on a self-completed questionnaire. The participants in the present study were 3476 students (53.8% were girls) in the 8th and 10th grades at school; the mean age was 14.9 years (range 12.5-19.0). Subjective sleep duration during the weeknights and weekends was collected; sleep deprivation (SD) was considered whenever the difference was greater than 3 h. Health complaint frequency and health-related quality of life (with the Kidscreen 10) were collected. Sleep deprivation was present in 18.9% of the students. It was negatively correlated with sleep duration on weeknights. There were no gender differences, but SD increased with age and grade. Higher school grades were mainly associated with fatigue. A considerable number of adolescents had sleep problems (37.2%); 25.5% had difficulties in sleep initiation, which was more prevalent in adolescents with SD. The sleep duration on weeknights was decreased in the SD group. The average health-related quality of life was reduced in adolescents with SD. The frequency of health complaint was higher is adolescents with SD. Girls had significantly more health complaints than boys, with special focus on headaches. Sleep deprivation is associated with the perception of health-related quality of life and perceived physical and mental health. Copyright © 2014. Published by Elsevier B.V.
Springer eBooks, 2009
In this paper a definition of the activity (ACT) variable is proposed and a method to estimate it... more In this paper a definition of the activity (ACT) variable is proposed and a method to estimate it from the noisy actigraph output sensor data is described. A statistical model for the actigraph data generation process is suggested based on its working physical principles and on physiological considerations about human activity. The purposeless nature of the sleeping movements is used
DOAJ (DOAJ: Directory of Open Access Journals), Apr 1, 2020
Daytime napping should be encouraged for children up to 5-6 years of age. Risks: There is an asso... more Daytime napping should be encouraged for children up to 5-6 years of age. Risks: There is an association of sleep deprivation in children with potentially short-and long-term consequences, including emotional and behavioral dysfunction, risk of accidental falls, low cognitive performance and learning, obesity, and hypertension. Target groups: Children in nursery (3-36 months of age) and preschool (3 to 5-6 years of age) Places: Nurseries, preschools, and public or private establishments. Preliminary note The Secção de Pediatria Social (SPS) of the Sociedade Portuguesa de Pediatria (SPP), in accordance with article 4 of its statutes, aims to protect and promote the defense of the rights of children and young individuals, as part of an evolving society. The current lack of clear recommendations on naps for children in nurseries and preschools puts the current and future health and wellbeing of our children at significant risk. Children in Portugal, especially those attending public establishments, do not usually have a nap after 3 years of age. The aim of these recommendations is to standardize and encourage best practice for daytime sleep or napping for children from 3 months to 36 months of age (nursery) and from 3 to 6 years of age (preschool) in public or private establishments.
para tomarem consciência do tema e de mudarem de ideias em relação á influência dos agentes de so... more para tomarem consciência do tema e de mudarem de ideias em relação á influência dos agentes de sociabilização relacionados com a publicidade, os contos e as canções.
O objetivo deste artigo consiste em apresentar os resultados da nossa investigação focada no estu... more O objetivo deste artigo consiste em apresentar os resultados da nossa investigação focada no estudo dos processos organizacionais relacionados com o conhecimento e na sua dependência operacional da natureza dos pressupostos dos processos de gestão de recursos humanos (GRH) nas organizações. Foca-se nos processos relacionados com a análise e descrição de funções, recrutamento e seleção e acolhimento. O estudo empírico de natureza quantitativa pretende responder à questão central de investigação, segundo a qual a perspetiva que configura as práticas GRH implementadas numa organização tem impacto na forma como nesta operam os processos de gestão do conhecimento (GC). A amostra é constituída por 5306 colaboradores de 634 organizações pertencentes a um grupo económico português do subsetor da banca. Os resultados obtidos permitem-nos concluir que nas organizações estudadas os processos de GRH e de GC estão bastante operantes e que os relativos à gestão das pessoas assentam em pressupostos tendencialmente orgânicos, valorativos e de desenvolvimento. As análises de regressão múltipla permitem-nos concluir pela capacidade preditiva das práticas de gestão de recursos humanos estudadas, relativamente aos processos de gestão do conhecimento. Palavras-chave-Gestão de recursos humanos, gestão do conhecimento, práticas e processos.
Sleep Medicine, Dec 1, 2015
Objectives: The aim is to evaluate the mutual influences between sleep duration/sleep deprivation... more Objectives: The aim is to evaluate the mutual influences between sleep duration/sleep deprivation (SD) and the sleep stealers/adolescent risk behaviours. Methods: The national survey is a component of the Health Behaviour in School-Aged Children (HBSC) study, it is based on a school-based self-completed questionnaire; 3476 students were randomly selected from 139 randomly chosen Portuguese schools using as an unit the class, 53.8% were girls; 45.9% attended the 8th grade and 54.1% the 10th grade; the mean age was 14.9 years. The measured variables were: 1) gender and age; 2) sociodemographics; 3) sleep duration during the week and during weekends and computed SD; 4) screen time (computer use during the week and during the week end (PC use); watching TV and mobile phone use; 5) earlier sexual behaviour; 6) violent behaviours: fights, use of weapons; 7) use of tobacco, alcohol and drugs. The statistical analysis included Pearson chi-square tests and logistic regression. Results: Excessive use of mobile phone, of computer use during weekdays, and internet facilities; substance use; violence and earlier sexual relations had significantly higher prevalence in sleep deprived adolescents. By logistic regression only using PC during weekdays, tobacco, drugs and weapons were associated to SD, while SD was associated to PC use during weekdays, tobacco use and drugs' use. Computer uses tend to be associated among themselves. Mobile phone is associated with computer practices and with alcohol and tobacco use. Tobacco is associated with most risk behaviours. Alcohol use is associated with other substance use, computer use and violent behaviours. Violence behaviours, earlier sex and drugs use tend to be associated among themselves.
Portuguese Journal of Pediatrics, 2000
Os autores apresentam um caso grave de hipersónia recorrente de tipo monossintomático numa crianç... more Os autores apresentam um caso grave de hipersónia recorrente de tipo monossintomático numa criança de 2 anos de idade que desde os 6 meses de vida tinha episódios frequentes de sonolência que duravam de várias horas a alguns dias. Fazem referência à extensa investigação realizada até ao diagnóstico definitivo e à dificuldade encontrada para controlar os sintomas com recurso aos fármacos habitualmente usados neste tipo de patologias. Por fim, com base na literatura mais recente, foi iniciada terapêutica com vitamina B12 (cianocobalamina) na dose de 1 mg/dia, per os, com resultados surpreendentes. A última crise de sonolência prolongada ocorreu 5 dias após o início do tratamento. À data desta publicação, passados três anos desde o início da terapêutica, a criança continua assintomática.
Psychology, community & health, Jul 31, 2015
Aim: The prevalence of obesity has been steadily increasing and is a major worldwide public healt... more Aim: The prevalence of obesity has been steadily increasing and is a major worldwide public health problem. It is associated with multiple medical and psychological conditions and recent research supports a link to several cognitive deficit domains, including executive functioning. The aim of this article is to describe socio-demographic, clinical and neuropsychological characteristics of a sample of candidates for bariatric surgery (BS) and to compare their performance with normative values. Method: Between May 2012 and May 2013 we evaluated the neuropsychological performance of 42 patient candidates for BS at the Morbid Obesity Consultation at Centro Hospitalar Lisboa Norte (CHLN). Results: The population was predominantly female and education was equally distributed between basic, secondary and tertiary levels. The neuropsychological results showed a significant decrease on Recall (p < .01), Learning (p < .10), Nonverbal Memory (p < .001), Cognitive Flexibility (p < .01) and Resistance to Interference (p < .05). Conclusion: Despite the limitations inherent to a small sample, the results obtained in the Portuguese population coincide with those of earlier studies; namely that obesity differentially effects instrumental functions.
International Journal of Psychiatry in Clinical Practice, 1997
Clinical and sleep EEG effects of trazodone in major depression were investigated using a 5-week ... more Clinical and sleep EEG effects of trazodone in major depression were investigated using a 5-week single-blind study design. Nine patients with DSM-N major depression were selected. Trazodone (50-250 mg) was given following a 2-week placebo run-in period. Both sleep and psychiatric evaluations were performed at different time points. Early and persistent sleep-inducing effects were detected, including the improvement of objective insomnia features and increased amounts of slow wave sleep. However, no significant changes of REM sleep measures were found. The sleep EEG changes seem to be related to the clinical improvement of both anxiety and insomnia, but there is no apparent relationship with the antidepressant action, which occurs at a later stage of the treatment. Trazodone may be useful in depressed patients, either as a hypnotic-like agent or as an effective antidepressant drug with beneficial effects on sleep.
Sleep, May 1, 1993
A model-based automatic K-complex (Kc) detector was applied to all-night single-channel sleep ele... more A model-based automatic K-complex (Kc) detector was applied to all-night single-channel sleep electroencephalographic (EEG) recordings from normal and dysthymic patients. The performance of the detector was analyzed in the two groups, and the differences obtained were discussed. The results showed that the detection rate of Kc in the normal group was around 92% through all stages of non-rapid eye movement (NREM) sleep, but with high numbers of "false" positives in stage 4 NREM, which reached 57%. In the dysthymic patients "true" detection included 85% of the Kc, but the percentage of "false" positives dropped to 25% in stage 4 NREM. Most of the "false" detections in the normal group were due to sharp delta activity during slow wave sleep (SWS). The results in the patient group were expected, because sleep in dysthymics showed a reduction in SWS when compared to normals. The behavior and automatic artifact rejection mechanisms ofthe detector are briefly presented. The modelbased Kc detector performed significantly better than other automatic detectors described in the literature; it was found to be a useful tool for routine sleep EEG studies.
Springer eBooks, Oct 4, 2016
Epidemiologic analysis of sleep disorders (SDs) in children and adolescents faces several difficu... more Epidemiologic analysis of sleep disorders (SDs) in children and adolescents faces several difficulties. There is a marked interindividual variability during the first years of life, which is more relevant in the first 2 years, and consequently the definition of what is “normal” can become a difficult issue to which cultural and ethnic differences might add clear complexity. Furthermore many available survey lack objective data; this issue is particularly relevant whenever data are provided by the caregivers, since known discrepancies do exist between children and caregivers information, and the fact that data obtained from younger individual are subjected to important ethical regulations is likely to reduce the number of available studies. Other contributing issues are the position of pediatric sleep in the field of sleep medicine and the successive classifications of sleep disorders and the methodologic modifications, rendering difficult comparisons across decades.
Acta Médica Portuguesa, Jan 3, 2020
Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com RESUMO Introdução: A obesida... more Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com RESUMO Introdução: A obesidade é fator de risco significativo para múltiplas comorbilidades e a sua relação com a disfunção neurocognitiva é de particular importância no declínio cognitivo particularmente na meia-idade. Explorámos o perfil neuropsicológico, a reserva cognitiva e o desajustamento emocional, em doentes com obesidade grave, devido ao seu impacto na neuro-degeneração. Material e Métodos: Questionário sociodemográfico e clínico, provas neuropsicológicas e de avaliação de sintomas de desajustamento emocional, na avaliação do desempenho cognitivo de 120 doentes, entre os 18 e os 65 anos, em tratamento da sua obesidade grave em Portugal, entre maio de 2012 e dezembro de 2015. Resultados: O desempenho cognitivo situou-se abaixo do valor médio da população portuguesa, para a memória imediata, visuoperceção, resistência à interferência e flexibilidade cognitiva. A reserva cognitiva foi maioritariamente baixa, principalmente nos grupos de pacientes com mais idade e com status profissional mais baixo. A sua elevação associou-se a melhores resultados cognitivos. O desajustamento emocional denotou significativa elevação comparativamente com uma amostra normativa. Os fatores de risco avaliados foram importantes no agravamento das funções cognitivas e o desempenho cognitivo decresceu com o aumento da idade. Discussão: A obesidade grave esteve associada a um pior desempenho cognitivo da amostra. A reserva cognitiva foi superior nos mais jovens. Houve presença expressiva de mal-estar emocional particularmente entre as mulheres. Conclusão: A obesidade grave está associada a uma diminuição do desempenho cognitivo e emocional que é coadjuvada pelo envelhecimento, reserva cognitiva baixa e comorbilidade. Sublinha-se, neste trabalho, a necessidade de ações preventivas entre as quais o screening neuropsicológico na deteção de alterações e conceção de melhores intervenções.
Journal of Telemedicine and Telecare, Jun 1, 2001
A neurology teleconsulting network was implemented between a university hospital in Lisbon and fi... more A neurology teleconsulting network was implemented between a university hospital in Lisbon and five nearby health centres. PCs equipped for videoconferencing were installed, connected by ISDN lines at 128 kbit/s. Fifty-three general practitioners (GPs) were surveyed. The survey showed that the GPs had difficulties in using computers, but they had definite intentions to use teleconsultation for neurology cases and 83% of the respondents stated that they would probably use the technique. During the study, 90 neurology teleconsultations took place over 55 weeks. The average consultation rate was 1.6 teleconsultations per week (SD 1.3, range 0-6). The conferences lasted 10-45 min. Longer teleconsultations were mainly due to technical difficulties in using computers on the part of users with a low level of computer literacy. The patients were 42 males and 46 females, with a mean age of 38 years (SD 20, range 1-84); two patients were discussed twice. The benefits consisted mainly of advice on patient medication, diagnosis and the prevention of unnecessary specialist consultations or laboratory examinations. Doctor-doctor teleconsultation allows the rapid resolution of queries which otherwise cause stress to patients and increase the cost and complexity of care.
World Journal of Biological Psychiatry, Jan 15, 2013
The aim of this study was to examine the differences between a sample of patients with schizophre... more The aim of this study was to examine the differences between a sample of patients with schizophrenia and a sample of healthy controls in terms of sleep patterns and self-reported sleep quality and quality of life (QoL). Thirty-four schizophrenia outpatients (SP), 12 women and 22 men and 34 healthy subjects (HS), 15 women and 19 men, participated in this study. Wrist-actigraphy recordings and a sleep diary were used for sleep-wake cycle assessment. The quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI), the QoL was evaluated using the World Health Organization Quality of Life - Abbreviated version (WHOQOL-Bref). The Positive and Negative Syndrome Scale (PANSS) was used for psychopathology assessment. Patients sleep more at night, but have poorer sleep efficiency, than HS. Sleep latency and nighttime awakenings were significantly higher in SP. Self-reported QoL scores were significantly higher, in all four domains, in HS. Scores on PSQI were significantly higher in SP, indicating a worse quality of sleep. Two disturbed patterns of sleep-wake phase were found in SP: advance sleep-phase syndrome (ASPS) (N = 3) and irregular sleep-wake rhythm (N = 3). Schizophrenia patients have more disturbed sleep-wake patterns and poor sleep quality and quality of life compared with healthy controls.