Walter Fernando Araújo de Moraes | Universidade Federal de Pernambuco (original) (raw)

Uploads

Papers by Walter Fernando Araújo de Moraes

Arq Bras Endocrinol Metabol, 2007

Revista Brasileira de Psiquiatria

Sleep medicine, 2015

Insomnia in the elderly: the role of age-related changes in sleep homeostasis ☆ ☆ The article by ... more Insomnia in the elderly: the role of age-related changes in sleep homeostasis ☆ ☆ The article by Chinoy et al. was published in Sleep Medicine Volume 15, Issue 9, September 2014.

Arquivos de Neuro-Psiquiatria, 2015

The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian state... more The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine.

Sleep Medicine, 2014

Objective: Although many studies have shown the evolution of sleep parameters across the lifespan... more 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.

Sleep Medicine, 2009

neic and non-apneic and obese and non-obese groups and to determine the sensitivity and specifici... more neic and non-apneic and obese and non-obese groups and to determine the sensitivity and specificity of questions such as "Do you snore?". Methods: Three hundred and nine patients were referred to the sleep laboratory; each patient filled out our standard sleep questionnaires reporting age, gender, weight, height, body mass index (BMI), sleep habits, mood, snoring self-perception and listener's perception of snoring, snore frequency, snore intensity, family's snore history and Epworth sleepiness scale (ESS). The patients subsequently underwent polysomnographic study during which their snoring was scored by the technicians and scored for frequency, intensity, and noise using a technician snore scale (TSS). Results: The TSS results correlated with AHI (r=0.47, P<0.05) and with BMI, primarily in the OSA group (P<0.05). The question "Do you snore?" had 93.1% (P<0.05) positive predictive value, 66.7% (P<0.05) negative predictive value, 97.49% (P<0.05) sensibility, and 42.42% (P<0.05) specificity. The ESS did not correlate with the Apnea Hypopnea Index (AHI) (r=0.08, P<0.05). Conclusion: The TSS is a useful screening tool for OSA patients, primarily for those with AHI>10, BMI>30. The observed correlation of TSS with ADI and BMI suggests that snoring and OSA may perhaps share a similar obstructive mechanism.

Sleep Medicine, 2012

Introduction/objectives: Previous publications have shown beneficial effects of cholinergic medic... more Introduction/objectives: Previous publications have shown beneficial effects of cholinergic medication on obstructive sleep apnea (OSA) in Alzheimer's disease (AD) patients. We hypothesized that cholinergic medication could also improve OSA in non-AD patients. The present study evaluated the effects of donepezil on OSA in non-AD patients. Methods: A randomized, double-blind, placebo-controlled study was conducted. The final sample consisted of 21 male patients with mild to severe OSA and AHI >10 divided into two groups, a donepezil-treated group (n = 11) and a placebo-treated group (n = 10). The dosage was one tablet/day (5 mg) for the first two weeks and two tablets/day (10 mg) for the last two weeks. Polysomnography and sleepiness evaluations were performed at baseline and after one month of treatment. Groups were compared using twoway ANOVA for repeated measures with treatment-group and treatment-time as the main factors and time-treatment as an interaction effect. Results: Considering the effect of the interaction with time-treatment, there was a significant improvement in the obstructive apnea/hypopnea index, desaturation index, percentage of time with O 2 saturation 63% lower than baseline, lowest oxygen saturation, and the Epworth Sleepiness Scale (ESS) scores with donepezil treatment (p < 0.05). Sleep efficiency significantly decreased (p < 0.01). Conclusions: Donepezil treatment improved obstructive sleep apnea index, oxygen saturation, and sleepiness in parallel with a reduction in sleep efficiency. Our findings support the concept that cholinergic transmission may influence breathing regulation in OSA patients.

Revista Brasileira de Psiquiatria, 2005

O achado de padrões alterados de sono é notável na maioria dos transtornos psiquiátricos. Neste a... more O achado de padrões alterados de sono é notável na maioria dos transtornos psiquiátricos. Neste artigo são abordados os transtornos psiquiátricos que mais freqüentemente apresentam alterações de sono na prática clínica e a descrição dos achados polissonográficos. As queixas mais freqüentes dos pacientes são relacionadas à dificuldade para iniciar e manter o sono (insônia inicial e de manutenção, respectivamente) e sono não reparador, observadas na maioria dos transtornos. A insônia terminal ou despertar precoce é mais relacionada a quadros depressivos. A hipersonia pode aparecer em alguns quadros de depressão como sazonal, atípica ou em transtornos bipolares. Em relação aos achados polissonográficos, temos, em geral, redução significativa da eficiência e do tempo total do sono à custa da redução do sono de ondas lentas. A redução da latência para o sono de movimentos oculares rápidos (REM) é descrita principalmente para os quadros depressivos, mas pode aparecer em outras patologias.

Journal of the Neurological Sciences, 2013

likely of all the twelve inverted models. Model inversion of the five node model showed that olde... more likely of all the twelve inverted models. Model inversion of the five node model showed that older subjects had significantly increased inhibition of pyramidal cells (p b 0.05) with reduced modulation of this activity within the right inferior frontal gyrus (p b 0.02). Conclusion: Deterioration in frontal-based control mechanisms caused attenuation of MMN with age. Impairment of cortical dynamics in the right inferior frontal gyrus on stimulus change provided a neurobiological mechanistic explanation for the reduction of MMN and attention control in the ageing brain.

Chest, 2008

Background: There is an association between Alzheimer disease and sleep-disordered breathing. Don... more Background: There is an association between Alzheimer disease and sleep-disordered breathing. Donepezil is the drug most frequently used to treat cognitive symptoms in Alzheimer disease. This study evaluates the effects of donepezil on obstructive sleep apnea in patients with Alzheimer disease. Methods: Randomized, double-blind, placebo-controlled design. Twenty-three patients with mild-to-moderate Alzheimer disease and apnea-hypopnea index (AHI) > 5/h were allocated to two groups: donepezil treated (n ‫؍‬ 11) and placebo treated (n ‫؍‬ 12). Polysomnography and cognitive evaluation using Alzheimer disease assessment scale-cognitive (ADAS-cog) subscale were performed at baseline and after 3 months. Cognitive and sleep data were analyzed using analysis of variance. Results: AHI and oxygen saturation improved significantly after donepezil treatment compared to baseline and placebo (p < 0.05). Rapid eye movement (REM) sleep duration increased after donepezil treatment (p < 0.05). ADAS-cog scores improved after donepezil treatment, although they did not correlate with REM sleep increase and sleep apnea improvement (p < 0.01). Conclusions: Donepezil treatment improved AHI and oxygen saturation in patients with Alzheimer disease. Treatment also increased REM sleep duration and reduced ADAS-cog scores. Trial registration: ClinicalTrials.gov Identifier: NCT00480870.

Cellular and Molecular Life Sciences, 2007

Arquivos de Neuro-Psiquiatria, 2012

OBJECTIVE: To evaluate the combination of two factors: clinical dementia rating sum of boxes scor... more OBJECTIVE: To evaluate the combination of two factors: clinical dementia rating sum of boxes scores (CDR-SB) and hippocampal volume (HV) as predictors of conversion from mild cognitive impairment (MCI) to dementia. METHODS: Twenty-eight individuals (9 normal and 19 with MCI) were classified according to their CDR sum of boxes scores into 3 groups. RESULTS: The hippocampal volume was significantly lower in the high-risk group and in those who developed dementia after two years. The rate of conversion was crescent among the three groups. CONCLUSION: We were proposed an additional measurement of the hippocampal volume which may be helpful in the prognosis. However, we noted that the CDR-SB is a method as efficient as neuroimaging to predict dementia with the advantage of being a procedure for low cost and easy implementation, more consistent with public policy.