Sleep disorders in children and adolescents with tension-type headaches

Introduction. Tension-type headache (TTH) represents a widespread and recurrent disease in adults, children, and adolescents, adversely affecting the quality of life, learning achievements, and social functioning. In recent publications, a high incidence of comorbid disorders in patients with TTH is discussed, in particular sleep disorders. The aim of the study was to assess the nature and prevalence of sleep disorders in children and adolescents with frequent episodic TTH and chronic TTH. Materials and methods. One hundred fifty patients aged from 8 years to 16 years 11 months with TTH were examined. Of them, 91 (49 boys, 42 girls) had frequent episodic TTH, 59 (26 boys, 33 girls) had chronic TTH. There was used Sleep Disturbance Scale for Children including 26 questions for parents. Results. The present study confirms the high incidence of sleep disorders among TTH children and adolescents. TTH was diagnosed in 129 (86.0%) out of 150 patients. The most frequently diagnosed varying degrees of severity (clinically relevant and borderline, when assessing sleep disorders in children) were insomnia (disorders of initiating and maintaining sleep) - in 65.3% of patients (including 60.4% with frequent episodic TTH and 72.9% with chronic TTH), excessive somnolence - in 74.7% (67.1% and 86.4%), sleep breathing disorders - in 26.7% (23.1% and 32.2%), disorders of arousal/nightmares - in 46.0% (42.9% and 50.8%), sleep-wake transition disorders - in 65.3% (67.1% and 62.7%), sleep hyperhidrosis - in 31.3% (26.4% and 39.0%). Thus, all sleep disorders (except for sleep-wake transition disorders) were significantly more common among the patients with chronic TTH. At the same time, in the subgroup of patients with TTH and any sleep disorders, significantly more prominent indicators of the frequency, the intensity of TTH and its negative impact on the daily activity were revealed, compared to patients with TTH lacking sleep disorders. Conclusion. The results of the assessment of children and adolescents with TTH show that when planning preventive therapy for TTH and evaluating its results, not only main clinical characteristics of TTH should be taken into account, but also the manifestations and severity of comorbid disorders, including sleep disorders observed in most patients with TTH. The revealed prevalence of various sleep disorders in the subgroup of patients with chronic TTH confirms that sleep disorders and anxiety disorders refer to significant risk factors for the transition of TTH to a chronic form, and such patients need more active multimodal treatment.

Circadian dependence of the acute immune response to myocardial infarction

Aim Circadian rhythms control many physiological processes, including numerous aspects of the immune system. Whether these immunological oscillations play a role in the pathophysiology after ischemic injury, such as myocardial infarction (MI), remains unclear. In this study, we aimed to characterize circadian rhythms during the acute inflammatory responses after MI. Methods and results Balb/c mice were operated at Zeitgeber Time (ZT) 2, 8, 14 and 20. Three hours after MI, animals were terminated and blood and hearts were collected to assess immunological status and damage. We observed diurnal fluctuation in leukocyte numbers in the blood, peaking during the rest-phase (ZT2 and 8) of the circadian cycle. Interestingly, the homing and infiltration of neutrophils to the injured myocardium was more pronounced during the active-phase of the mice (ZT14 and 20), at which time higher levels of Troponin-T were measured in the serum. Higher neutrophil extravasation during the active phase (especially the sleep-to-wake transition, ZT14) was also correlated to greater chemokine release in the blood and adhesion molecule expression in the heart. Conclusion The occurrence of a myocardial infarction during the early-morning hours leads to greater myocardial damage in patients. In the present study, we showed that the neutrophil response in the first hours after MI is stronger during the sleep-to-wake transition, thereby potentially playing a role in the worse clinical outcome observed during this time period. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This research received funding from the EU's H2020 research and innovation programme under Marie S. Curie cofund RESCUE grant agreement No 801540.

553 Assessment of sleep disorders in children and adolescents with obesity

Introduction When studying the inherent aspects of sleep it is important to assess how the quality and quantity of sleep in the last two decades may be one of the reasons for the increase in childhood obesity, which has been growing rapidly worldwide. This study aims to assess the presence of sleep disorders in overweight children and adolescents. Methods An descriptive study was conducted with data collection from 43 patients between 6 and 13 years old diagnosed as overweight. They were patients of a specialized service for children and adolescents with obesity that is part of the Hospital de Clínicas of the Federal University of Paraná, located in Curitiba, Brazil. To investigate the presence of sleep disorders, the Sleep Disturbance Scale for Children (SDSC) questionnaire was administered. The factors assessed were: Disorders of Initiating and Maintaining Sleep, Sleep Breathing Disorders, Disorders of Arousallnightmures, Sleep Wake Transition Disorders, Disorders of Excessive Somnolence and Sleep Hyperhydrosis. Results The mean age of the patients that took part in the research was 10 years and 7 months (± 1.95). The mean BMI of the participants was 29.57 kg/m2 (± 4.38), the majority being diagnosed with obesity. The sum of all SDSC factors demonstrated the presence of pathological sleep in 58.1% (25) of the sample, whereas 51.2% (22) of the patients had Sleep Breathing Disorders and 58.1% (25) had the Sleep Wake Transition Disorder. Conclusion The present study demonstrated the presence of sleep disorders in overweight children and adolescents. As for Sleep Respiratory Disorder, a situation has already been advocated in the current literature for this audience. In relation to the Sleep-Wake Transition Disorder and pathological sleep, further research is needed to prove the presence of the disorder in other groups studied. Here is the suggestion that future research be done with subjective and objective data collection on sleep within a larger sample, in order to confirm the association between sleep disorders and childhood obesity. Support (if any):