ARAUJO, José Pereira de [1]
MELO, Hugo Cristiano Soares [2]
ARAUJO, José Pereira de; MELO, Hugo Cristiano Soares. Sleep disorders and learning disorders. Multidisciplinary Core Scientific Knowledge magazine, 1 Year. Vol. 10, PP. 102-113. November 2016. ISSN. 2448-0959
SUMMARY
The topic is of relevance to analyze the causes and consequences of daytime sleepiness in school environment, especially disorders occurred during the teaching/learning process. The aim with this analyze sleep disorders and your relationship with learning disorders. So we analyzed the causes and consequences of daytime sleepiness in school environment, the relationship between narcolepsy, Hypersomnia and learning disorders, such as the role of the educator on these situations in the classroom. The present study was conducted through literary review of exploratory and qualitative way. Searches were carried out in books, scientific articles, monographs, dissertations, theses, magazines and newspapers. He pointed out the existence of various sleep disorders, emphasizing among them narcolepsy, as well as its causes, signs and symptoms and apparent consequences. Thus, for professional education is important to recognize these signs, as these may be present in the classroom and can indicate which paths to the treatment.
Keywords: sleep disorders. Narcolepsy. Learning disorder.
INTRODUCTION
Sleep disorders occur with increasing frequency and bring with them consequences that require greater attention. Sleep quality, in General, directly affects the functions of both the brain and the body. According to Turkish et.al (2011), the knowledge about sleep and the discovery of its main disturbances were developed primarily from 1950 by Aserinsky and Kleitman that differentiated eye movements in slow and fast.
“Through the polysomnogram, one can evaluate the alternation of these sleep States. The stage of rapid eye movements — REM sleep (RapidEyeMovement) — which is the sleep out of sync — occurs approximately 90 minutes after the onset of sleep, with fluctuations in blood pressure and heart rate and reduction of muscular tonus. To stage N-REM sleep, sleeping sync, shows no eye movement, being accompanied by muscle relaxation and the predominance of the parasympathetic autonomic nervous system. “(TURKISH et.al, 2011, p. 173)
From then on, were described various sleep disorders. According to Reimão and Lemmi (1986) sleep apnoea obstructive type (ASO) and narcolepsy are considered the main sleep disorders.
According to Nunes and Bruni (2016) to obstructive sleep apnea is caused by the sum of several factors, among them and, in addition to neuromuscular Anatomy, of course, of genetic predisposition. Another important factor to be mentioned is the relation of sleep apnea with obesity. “Recent data indicate that obstructive sleep apnea in adults can be influenced by genetic factors related to obesity and body fat distribution, muscle control of the upper respiratory tract, craniofacial morphology (reduction in mandibular and airway size), respiratory control and sleep. “(NUNES and BRUNI, 2016, p. 4)
Narcolepsy is a sleep disorder, in that even though the person has slept all night will have an intense daytime sleepiness. As wrote Varela (2011), bearers of narcolepsy sleep slow step jump and enter straight into REM sleep (Rapid eye Movement or RapidEyeMovement), in which the eyes move and the brain is in constant activity, so these people can’t rest as the other.
According to Nunes and Bruni (2016) in 1877, Westphal reported for the first time narcolepsy, nearly a century after it was reported the association between human leukocyte antigen (HLA) DR2 and narcolepsy. In 1999, a second gene has been linked to narcolepsy: Orexin (hypocretin), located on chromosome 12. In narcoleptic patients there is a deficiency in hipocretinas binding. “Since the hypocretin usually participates in the maintenance of the Vigil, the loss of neurons that release this peptide could allow REM sleep occur at any time and determine the catalépticos attacks” (NUNES and BRUNI .2016, p. 3)
According to the aforesaid author, the most likely hypothesis is that environmental factors lead to an autoimmune process that reach hypocretin neurons. “The mutation on chromosome 6 HLA can increase the susceptibility of neurons that contain hypocretin immune attacks. “(NUNES and BRUNI .2016, p. 3)
According to Mathew (2011) stand out as major symptoms of the disorder cataplexy (sudden reduction or loss of muscle tone, without loss of consciousness), sleep paralysis (difficulty to move soon to fall asleep or wake up) and hallucinations Hypnagogic or hipnopômpicas (oneiric images that invade your waking state). It also States that Guilleminault, added as new symptom to narcoleptic obesity.
According to the author above, the ICSD (International Classification of Sleep Disorders-international classification of sleep disorders), ranked the narcolepsy in four subtypes: Narcolepsy with cataplexy; Narcolepsy without cataplexy; Due to narcolepsy Narcolepsy unspecified medical condition. Narcolepsy without cataplexy is characterized by excessive sleepiness is generally relieved by naps throughout the day, while the nocturnal sleep is normal or moderately disturbed. Narcolepsy due to medical condition is the coexistence of a medical or neurological disorder, such as tumors or hypothalamus Sarcoidosis, multiple sclerotic plates from the hypothalamus and other conditions. In narcolepsy unspecified diagnosis is used temporarily when the patient meets the clinical criteria and the testing of Multiple sleep Latencies (TLMS) for narcolepsy.
According to the author above mentioned narcolepsy with cataplexy has as fundamental symptom to diagnose muscle tone loss on both sides, which can vary in frequency, default and severity. Most of the time this symptom is directly linked to strong emotions, as for example, surprises and crises of laughter. Catapléticos attacks may occur in only some of the muscular groups or affect all at the same time, which may last a few minutes or even 1 hour depending on the severity of the case. While some patients report blurred vision, but consciousness is maintained. Memory lapses are among the most frequent complaints pós-transtorno, these can be related to quickly transition to REM sleep. It is also known that occurrence of strong emotions can cause outbreaks catapléticos repeated over and over again. “Very intense Emotions can lead to successive episodes of cataplexy, named” cataplecticus “, status of very rare occurrence. “(MATHEW .2011, page 5)
Second Reimão and Lemmi (1986) the two disorders mentioned above can be easily confused when taking into account the clinical symptoms, requiring, therefore, of two tests for diagnosis: multiple latency test sleep (TLMS) and polysomnography during all night.
Other sleep disorders that often affects children and adolescents of school age, according to Nunes and Bruni (2016), is the phase delay syndrome (SAFS), developed by two genes involved in circadian disorders. The SAFS is mainly characterized by the onset of sleep delay and delay and difficulty waking up in the morning, that compared to conventional considered these actions times. “The typical patients don’t usually fall asleep before the 2:00 in the morning and don’t wake up before 10 12:00, despite the sleep architecture can be considered normal. “(NUNES and BRUNI, 2016, p. 3). Patients report that, typically, are more sleepy in the morning and more alert at night. “When the patient is forced to wake up early due to school commitments, the result can be the chronic failure of sleep and excessive daytime sleepiness. “(NUNES and BRUNI .2016, p. 4)
SLEEP DISORDERS AND RELATED DIAGNOSIS NARCOLEPSY
You can define as sleep disorder all changes that occur while the subject sleeps. Among these changes we can highlight the insomnia, Hypersomnia, sleepwalking, night terrors and nightmares, disorders and of course of narcolepsy.
According to Nunes (2002) insomnia is difficulty initiating sleep, mainly at night, and may affect since babies up to teenagers. The most common causes of insomnia in schools include emotional changes, such as depression and schizophrenia, anxiety and the pressure of family in teenagers ‘ preparatory phases, the fear and the nightmares in children and chronic acute diseases as much as both phases. Among the diseases causing the insomnia can highlight inflammation in ear and throat, fever, acid reflux disease and respiratory changes. For the diagnosis of insomnia uses a history day reporting, provided routine before bed, night feeding, fears and emotional disorders. Then conducts a physical examination to aid in the diagnosis.
The Hypersomnia, excessive daytime sleepiness aka (SED) is defined by Giorelli et. Al (2012) as the lack of ability to stay alert during the day, sedo unable to stay awake and having moments of sudden sleep. The severity levels of Hypersomnia are variable and range from momentary distractions throughout the day until uncontrollable sleep lapses. Among the main causes of SED can highlight neurologic and psychiatric changes, general health, drug effects, the usual time to wake up and of course the sleep quality and quantity. The diagnosis must be performed to anamnesis and a detailed physical examination, taking into account the blood pressure and changes such as obesity. Shortly after three examinations specific is to aid in the diagnosis, and maintenance of test West Vigil (TMV), polysomnography (PSG) and the test of multiple sleep latencies (TLMS).
The sleepwalking according to Varella (2014) consists of a type of parasomnia, characterized by the movement of walking and carrying out activities as part of the brain this asleep. Usually the bearers of sleepwalking do not remember anything that happened when awake and don’t appear to be tired or sleepy. While roam normally perform routine activities like folding the clothes of bed, go to the kitchen to feed or drink a glass of water and even go to the bathroom. In some cases open Windows and doors while walking through the House, but rarely go out to the street. Sleepwalking does not have specific causes, it is known only that has a predilection for males and also occurs by genetic factor (several demonstrations in the family). Some factors may predispose to the development of the disorder, such as fatigue and high stress, respiratory changes, high fever, psychiatric disorders and drugs that cause changes in sleep. To the diagnosis should be performed a detailed history with the patient and those who live with it day by day and then specific examinations such as polysomnography (PSG) and the EEG.
The night terrors according to Abreu and innocent (2005) is more common in children and usually happens in the deepest sleep phase. Have as main characteristics the child wakes up in the middle of the night extremely scared and pale, sweating excessively and going back to sleep then. Just as in the sleepwalking disorder carrier typically do not remember anything that happened to wake up.
The disorders of nightmares can be defined according to Adhikari (2010) as dreams that bring terror and extreme fear, leading to a sense of deep anguish until your wake up carrier. Occurs during REM sleep. Among the main causes include high fever, reactions to medications, alcohol or drug withdrawal, anxiety or stress, excessive use of drugs and sleep-inducing high levels of post-traumatic stress caused by accidents, incidents or even by the passing of a friend or relative recently.
According to Rodrigues (2012) each 100,000 people at 50 25 suffer from narcolepsy. According to Alóe et. Al (2010) of 15 to 50 people each 100,000 are diagnosed with the same condition.
According to the aforementioned author will predisposition narcolepsy can be directly related to environmental and genetic factors.
“The risk of a first degree relative of a patient being diagnosed with narcolepsy is 10 to 40 times greater than the general population. The frequency of narcolepsy-cataplexy in first-degree relatives is 2.90% to 3.20%. The concordance in monozygotic twins for narcolepsy with cataplexy varies between 25-31%. “(ALÓE et.al. 2010. p. 295).
Before performing the tests specific to the diagnosis must be observed symptoms characteristic to each sleep disorder. The pentade of symptoms is essential for the diagnosis of narcolepsy and to your other sleep disorders differentiation. Alóe et.al (2010) States that this pentade is composed of two main symptoms and three symptoms accessories, these being respectively excessive drowsiness (SE) and Cataplexy, night fragmented sleep, sleep paralysis and hypnagogic hallucinations. The author also States that more than 90% of carriers has as initial symptom that can be perceived in different ways, ranging from daytime sleep attacks until sonolências.
“Drowsiness, constant or variable intensity and duration from one to several hours, irresistible sleep attacks, despite an attempt to remain awake, naps to relieve drowsiness for up to a few hours in adults, multiple naps to during the main period of wakefulness, sleepiness relief provided by naps reflects the degree of intensity of sleepiness and have value for the differential diagnosis, the sleepiness can express themselves as fluctuation in the level of attention and concentration. ” (ALÓE et.al. 2010. p. 295)
To complement the main symptoms we have yet another modification called cataplexy. Coelho et. Al. (2007) States that acataplexia is present in approximately 70% of cases of narcolepsy. This is characterized by sudden loss of muscle tone, but with maintenance of consciousness and usually occurs after strong emotions, whether positive or not, without changes in breathing and with sudden finish.
Composing the triad of symptoms we have fragmented sleep accessories, which according to the author above consists of waking up several times during the night and because of this sleep loses quality. In addition to the previously described features Alóe et. Al. (2010) adds that during sleep there is excessive movement, which helps to decrease your quality. Sleep paralysis is characterized by the patient to wake up do not have ability to move while the consciousness is maintained. As well as the episodes of cataplexy, sleep paralysis also features finish sudden. “May be accompanied by a feeling of inability to breathe and varied hallucinations in up to 50% of cases, lasting from 1 to 10 minutes (with an average of 2 minutes), ending abruptly after mental effort or by some external sensory stimulation. “(ALÓE et. Al. p. 296, 2010)
The last of the symptoms of the triad, the hypnagogic hallucinations-hiponopômpicas (OH), in accordance with the aforementioned author are “oneiric experiences that occur in sleep or sleep-wake transitions, respectively”, i.e. a kind of dream confuses with reality.
“Occurring in 20 to 65% of the narcoleptic. Are usually Visual, somatossensoriais (sensation of being “out of body”), but are also described hearing forms, or vestibular multi-sensorial. The hallucinations can accompany or follow the attacks of cataplexy and sleep paralysis. Hipnagógicasaterrorizantes hallucinations occur in about 4 to 8% of narcoleptic “(ALÓE et. Al. p. 296, 2010)
After observing all these symptoms one of the methods to evaluate the daytime drowsiness, according to Cheema et. Al. (2007) is through the Epworth sleepiness Scale of (ESE).
“It’s a routine situations in which the eight patient graduates of 0 to 3 the possibility of sleep (0: no chance of sleep; 3: chance total of sleep). Drowsiness is considered excessive when the score is greater than 9 points in the afternoon. “(COELHO et. Al. p. 135, 2007)
According to the aforementioned author another method used in the diagnosis of sleep disorders are the electrophysiological studies, composed by polysomnography (PSG) and the multiple testing for sleep latencies (TMLS). “Are shown to all patients with that without evidence of other symptoms during sleep, such as snoring and choking, leg movements, automatisms, among others. “(COELHO et. Al. p. 135, 2007).
For Alóe et. Al (2010) to be diagnosed narcolepsy PSG must bear as a result
“Efficiency of normal sleep in younger patients, and may be reduced in people with more clinical time; NREM sleep latency below 10 minutes; reduction of REM sleep latency below 70 minutes; increase in the number of micro Awakenings; increase of transitions between the stages of sleep and wakefulness; increase of time awake after the onset of sleep. “(ALÓE et. Al. p. 299-300, 2010)
TLMS already must submit as a result “A sleep latency 8 minutes or less, with the presence of two or more episodes of REM sleep” (ALÓE et. Al. p. 300, 2010)
In addition it is important to stress that you should pay attention to the previous examination criteria to avoid false positive. “Remove REM sleep suppressors, agents like antidepressants (tricyclics, monomial-oxidase inhibitors, inhibitors of fencing of monomanias etc.) and CNS stimulants. These medications should be suspended for a period of 14 days before the exams (in the case of fluoxetine, six weeks); withdraw sedatives, hypnotics and antihistamines at least one week before the tests; stimulants, such as caffeine and nicotine should be reduced or dropped in the week of the exam; keep regular hours and at least 6 hours of sleep per night to sleep and wake up in the two weeks prior to the examination. “(ALÓE et. Al p. 299, 2010).
TREATMENT FOR SLEEP DISORDERS AND LEARNING DISORDERS
The treatment for sleep disorders in your most usually performed with psychological monitoring and use of medicines. According to Alóe et al. (2010) treatment for narcolepsy controls excessive sleepiness and assists the bearer of the disturbance to readjust to their activities. Currently in Brazil follows the Brazilian guidelines for the treatment of narcolepsy, these consist of measures of sleep hygiene, naps, social measures, psychological support and of course of pharmacological treatment. According to the guidelines the pharmacological treatment of excessive sleepiness is accomplished using stimulants of the central nervous system, which lead to a reduction in sleepiness.
According to Rovere et al (2006) one of the main difficulties for bearers of narcolepsy is the fact of routine activities, such as study or even drive and operate machines, stay committed. We can prove this by traffic accidents involving index narcoleptic be approximately six times greater.
For Turkish et al (2011) between the main problems caused due to sleep disorders in school age is the difficulty of concentration and attention resulting in learning disabilities. Another big problem is that most of the time the diagnosis is late or erroneous, since due to poor quality of sleep, the bearer of these disorders school becomes angry and suffers mood swings constantly, these symptoms being associated with the learning disabilities can result in diagnoses such as depression or hyperactivity.
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[1] Degree in biological sciences from the College Patos de Minas
[2] Professor of Genetics and biochemistry faculty Patos de Minas. Doctor in genetics and Biochemistry from the Universidade Federal de Uberlândia. [email protected]
