OBJECTIVE: To investigate sleep alterations and associated factors in pregnant diabetic women (n=141). METHODS: Sleep profile, sociodemographics and clinical information were collected. Poor sleep quality (Pittsburgh Sleep Quality Index >5) and excessive daytime sleepiness (Epworth Sleepiness Scale ≥10), sleep duration (h), sleep latency (min), frequent sleep interruption and short sleep (≤6 h) were assessed in type 1 diabetes mellitus (16.3%), type 2 diabetes mellitus (25.5%) and gestational diabetes mellitus (58.2%). RESULTS: Poor sleep quality was found in 58.8% of patients and daytime sleepiness in 25.7%, regardless of hyperglycemia etiology. No correlation existed between daytime sleepiness and poor sleep quality (Pearson correlation r=0.02, p=0.84). Short sleep duration occurred in 1/3 of patients (31.2%). Sleep interruptions due to frequent urination affected 72% of all and sleep interruptions due to any cause 71.2%. Metformin was used by 65.7% of type 2 diabetes mellitus and 28.7% of gestational diabetes mellitus. In gestational diabetes mellitus, parity number was independently associated with poor sleep quality (p=0.02; OR=1.90; 95%CI 1.07-3.36) and metformin use was also independently associated with poor sleep quality (p=0.03; OR=2.36; 95%CI 1.05-5.29).CONCLUSIONS: Our study originally shows that poor sleep quality and excessive daytime sleepiness are frequent in diabetic pregnancy due to different etiologies. Interestingly, only in gestational diabetes mellitus, metformin therapy and higher parity were associated with poor sleep quality.

RESUMO:O tumor pseudopapilar sólido, também conhecido como tumor de Frantz, é um tumor raro do pâncreas. Relatamos o caso de uma paciente de 25 anos com dor abdominal, febre, diarréia e perda de peso.TC de abdome com contraste revelou pâncreas alargado com lesão hipodensa de aparência nodular e calcificações periféricas. Foi decidido realizar pancreatectomia subtotal com linfadenectomia e optou-se pela esplenectomia com biópsia hepática intra-operatória. O anatomopatológico da ressecção cirúrgica do tumor pancreático revelou tumor pseudopapilar sólido compatível com o tumor de Frantz. A imuno-histoquímica confirmou os achados histopatológicos. Ela evoluiu com fístula pancreática e pancreatite resolvida após 15 dias. Atualmente, está sendo acompanhada ambulatorialmente em nosso serviço com remissão completa dos sintomas.Descritores: Neoplasias pancreáticas/terapia; Dor abdominal; Diarréia; Perda de peso.ABSTRACT: Solid pseudopapillary tumor, also known as frantz tumor, is a rare tumor of the pancreas. We report a case of 25-yearold female patient with abdominal pain, fever, diarrhea and weight loss. Contrast abdominal CT showed enlarged pancreas with a hypodense lesion of nodular appearance and peripheral calcifications.It was decided to perform subtotal pancreatectomy with lymphadenectomy, and opted for splenectomy and intraoperative liver biopsy. The pathology of surgical resection of the pancreatic tumor showed solid pseudopapillary tumor compatible with Frantz's tumor. Immunohistochemistry confirmed histopathological findings. She evolved with pancreatic fistula and pancreatitis resolved after 15 days. Currently, it is being followed up in our service with complete remission of symptoms.

Sleep disturbances in pregnancy are associated with depression, preterm delivery, hypertension, hyperglycemic disorders, and higher rate of cesarean as well as adverse perinatal outcomes. Diabetes is other prevalent condition in pregnancy related to these adverse outcomes, and insulin resistance is a common disruptor. As such, it is important to evaluate the quality of sleep and daytime somnolence in diabetic pregnancy. Aim: Evaluate sleep quality and excessive daytime sleepiness in pregnancy complicated by diabetes mellitus. This is a cross-sectional study involving 115 pregnant women with diabetes (PWD), gestational age from 10 to 39 weeks. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI-BR) and daytime sleepiness by the Epworth Sleepiness Scale (ESS). The study was approved by IPADE ethic board (1.801.860). Statistical analysis was performed using the software IBM SPSS. Results: Poor sleep quality (PSQI>5) was observed in60,4% of PWD, which is higher them most reported rates for normal pregnancy (60,4% vs. 45% p: 0.01, CI99%. SEDOV, 2017) but similar to reported data on Brazilian overweight pregnant women (65,9%; RIBEIRO 2015). The mean PSQI score was 6.91. Short sleep duration was present in 35,8% (mean sleep duration: 7,2 hours/night). Sleep was disturbed by frequent urination in 66,1% of PWD. Daytime somnolence reported in 20.8% of PWD, and was not related with the quality of sleep. The higher number of parity was independently associated with poor sleep quality [p=0.03; 0R=1.74; CI=1.03-2.97]. The presence of obesity, hypertension, educational level, type of diabetes or treatment were non-influential to sleep quality or daytime sleepiness. Conclusion: Poor sleep quality and excessive daytime sleepiness are frequent in PWD and a higher number of parity is independently associated with poor sleep quality. Given that sleep disturbances are related to adverse outcomes in PWD, we suggest that this group of patients should be the focus of therapeutic measures to improve sleep. Disclosure C. Facanha: None. F.L. Sousa: None. A.S. Facanha: None. A.C. Forti: None. H.L. Rocha: None. M. de Araujo: None. V.M.S. Bruin: None.

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