Rev Bras Neurol.

53(3):19-30, 2017

TRANSTORNOS DO SONO: ATUALIZAÇÃO (1/2)

SLEEP DISORDERS: UP TO DATE (1/2)
Gisele S. Moura L. Neves1, Philippe Macedo2, Marleide da Mota Gomes3

RESUMO ABSTRACT
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HH[DPHI¯VLFRH[DPHVVXEMHWLYRVTXHVWLRQ£ULRVHHVFDODVH[DPHV VLFDOH[DPLQDWLRQVXEMHFWLYHH[DPVTXHVWLRQQDLUHVDQGVFDOHVRE-
REMHWLYRVSROLVVRQRJUDȴDWHVWHGHODW¬QFLDVP¼OWLSODVHDFWLJUDȴD jective examinations - polysomnography, multiple latency tests and
‹YDORUL]DGDDWHUFHLUD&ODVVLȴFD©¥RΖQWHUQDFLRQDOGRV7UDQVWRUQRVGR DFWLJUDSK\7KHWKLUGΖQWHUQDWLRQDO&ODVVLȴFDWLRQRI6OHHS'LVRUGHUV
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ΖQV¶QLD 6RQRO¬QFLD H[FHVVLYD GLXUQD 0RYLPHQWRV H FRPSRUWDPHQ-
tos anormais durante o sono e Incapacidade de dormir na hora de-
VHMDGD 1HVWH DUWLJR DERUGDPRV DSHQDV ΖQV¶QLD  GLȴFXOGDGH HP
adormecer ou manter-ser dormindo, acordar cedo, ou um distúrbio
na qualidade do sono que faz com que o sono pareça inadequado ou
Q¥RUHVWDXUDGRUGXUD©¥RDJXGDRXFU¶QLFD6RQRO¬QFLDH[FHVVLYD
GLXUQDFRQVHTXHQWHDGLVW¼UELRVGRVRQRSULYD©¥RGRVRQRGLVW¼U-
ELRVFHQWUDLVGDKLSHUVRQLDGLVW¼UELRVP«GLFRVRXSVLTXL£WULFRV
Palavras-chave: transtorno do sono, insônia, sonolência excessiva
diurna, movimentos e comportamentos anormais durante o sono,
transtornos do ritmo circadiano.
1
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Excessive daytime drowsiness, Abnormal movements and behaviors
during sleep, and Inability to sleep at the desired time. In this pa-
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Key words: sleep disorders, insomnia, excessive daytime sleepiness,
abnormal movements and behaviors during sleep, circadian rhythm
disorders.
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Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017 19

Neves GSML et al.

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Quadro 1. Os transtornos do sono de acordo com a 3ª edição da Classificação Internacional de TS (ICSD-3)1

A-TRANSTORNO DE INSÔNIA 5.Transtorno dos trabalhadores em turnos.

1.Transtorno de insônia crônica. 6.Jet Leg.
2.Transtorno de insônia de curto prazo 7.Transtorno do ritmo circadiano de sono-vigília não especificado.
3.Outro transtorno de insônia.
4.Sintomas isolados e variantes da normalidade. E-PARASSONIAS
5.Tempo excessivo na cama. 1.Parassonias do sono NREM.
6.Dormidor curto. (a) Transtornos do despertar (a partir do sono NREM).
(b) Despertar confusional.
B-TRANSTORNOS RESPIRATÓRIOS RELACIONADOS AO SONO (c) Sonambulismo.
1.Apneia obstrutiva do sono. (d) Terror noturno.
(a) Adulto (e) Transtornos alimentares relacionados ao sono.
(b) Pediátrico. 2.Parassonias do sono REM.
2.Apneia central do sono. (a) Transtorno Comportamental do sono REM.
(a) Com respiração de Cheyne-Stokes. (b) Paralisia do sono isolada recorrente.
(b) Devido à condição médica sem respiração de Cheyne-Stokes. (c) Pesadelos.
(c) Devido à respiração periódica da alta altitude. 3.Outras parassonias.
(d) Devido a drogas ou substâncias. (a) Síndrome da cabeça explosiva.
(e) Apneia central do sono primária. (b) Alucinações relacionadas ao sono.
(f) Apneia central do sono primária da infância. (c) Enurese noturna.
(g) Apneia central do sono primária da prematuridade. (d) Parassonia secundária a condição médica.
(h) Apneia central do sono decorrente do tratamento. (e) Parassonia devido a uso de droga ou substância.
3.Transtorno de hipoventilação relacionados ao sono. (f) Parassonia, não especificada
(a) Síndrome da hipoventilação da obesidade. 4.Sintomas isolados e variantes da normalidade.
(b) Síndrome de hipoventilação alveolar central congênita. (a) Sonilóquio.
(c) Hipoventilação central de início tardio com disfunção hipotalâmica.
(d) Hipoventilação alveolar central idiopática. F-TRANSTORNOS DO MOVIMENTO RELACIONADO AO SONO
(e) Hipoventilação relacionada ao sono devido ao uso de drogas ou substâncias. 1.Síndrome das pernas inquietas.
(f) Hipoventilação relacionada ao sono devido à condição médica. 2.Síndrome dos movimentos periódicos dos membros.
4.Hipoxemia relacionada ao sono. 3.Câimbras nas pernas relacionadas ao sono.
(a) Transtorno de hipoxemia relacionada ao sono. 4.Bruxismo relacionado ao sono.
5.Sintomas isolados e variantes da normalidade. 5.Transtorno do movimento rítmico relacionados ao sono.
(a) Roncos. 6.Mioclonia benigna do sono da infância.
(b) Catatrenia. 7.Mioclonia espinhal do início do sono.
8.Transtorno do movimento relacionado ao sono secundário à condição médica.
C-TRANSTORNOS DE HIPERSONOLÊNCIA CENTRAL. 9.Transtorno do movimento relacionado ao sono devido a uso de droga ou substância.
1.Narcolepsia tipo 1. 10.Transtorno do movimento relacionado ao sono, não especificado.
2.Narcolepsia tipo 2. 11.Sintomas isolados e variantes da normalidade.
3.Hipersonia idiopática. (a) Mioclonia fragmentária excessiva.
4.Síndrome de Kleine-Levin. (b) Tremor hipnagógico do pé e ativação muscular alternante das pernas.
5.Hipersonia devido a uso de droga ou substância. (c) Espasmos hípnicos.
6.Hipersonia associada a transtorno mental.
7.Síndrome de sono insuficiente. G-OUTROS TRANSTORNOS DO SONO
8.Sintomas isolados e variantes da normalidade.
(a) Dormidor longo. APÊNDICE A- CONDIÇÕES MÉDICAS E NEUROLÓGICAS RELACIONADAS AO SONO
1.Insônia Familiar fatal.
D-TRANSTORNO DO RITMO CIRCADIANO DE SONO-VIGÍLIA. 2.Epilepsia relacionada ao sono.
1.Tipo atraso de fase do sono. 3.Cefaléia relacionada ao sono
2.Tipo avanço de fase do sono. 4.Laringoespasmo relacionado ao sono
3.Tipo sono-vigília irregular. 5.Refluxo gastresofágico relacionado ao sono.
4.Tipo sono-vigília não de 24 horas. 6.Isquemia miocárdica relacionada ao sono.

20 Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017

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Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017 21

Neves GSML et al.

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22 Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017
 Transtornos do sono

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Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017 23

Neves GSML et al.
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24 Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017

 Transtornos do sono

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Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017 25

Neves GSML et al.

&DVRKDMDSHUVLVWrQFLDGDLQV{QLDDSyVD7&&H Quadro 2.Terapia farmacológica no transtorno de insônia (adaptado de Neves et

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26 Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017

 Transtornos do sono

Figura 1. Algoritmo para o diagnóstico e tratamento da insônia (ANBRG- agonista do receptor GABA não benzodiazepínico)

DGDSRSXODomRJHUDOHSRGHVHUGH¿QLGDFRPR Quadro 3. Causas de sonolência excessiva diurna (adaptado de Neves et al.,

XPD LQFDSDFLGDGH GH VH PDQWHU DFRUGDGR HRX DOHUWD GX 201317

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Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017 27

Neves GSML et al.

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28 Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017

 Transtornos do sono

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Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017 29

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30 Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017