Evaluation of flurazepam and placebo on sleep disorders in childhood

Reimão, Rubens; Lefévre, Antonio B.

doi:10.1590/S0004-282X1982000100001

Abstracts

The clinically observed results in 40 patients, from 1 to 15 years old, presenting sleep disturbances, in a comparative and statistically approached study of flurazepam 15mg daily against placebo, are reported. Placebo was administered, followed by the drug, during 14 days each. The chief complaints were sleepwalking, sleep-talking, sleep terror, sleep-related bruxism, sleep-related headbanging, insomnia and excessive movements during sleep. A significant effect of flurazepam on sleepwalking, sleep-talking, bruxism, sleep terror and excessive movement during sleep, was observed. The insomniac and headbanging patients were not enough for statistical analysis. Flurazepam side effects were excessive drowsiness during daytime in 3 cases; irritability, 3 cases; nausea and vomiting, 2 cases, and were not correlated with age. Placebo side effects were similar, except for nausea and vomiting which were not observed. It was necessary to discontinue flurazepam in 2 cases, because of excessive drowsiness during daytime, which did not improve when reducing the dose.

Os autores relatam os efeitos de flurazepam e placebo em estudo comparativo, em 40 crianças com distúrbios do sono. As alterações observadas são: sonambulismo, terror noturno, sonilóquio, bruxismo durante o sono, jactatio capitis nocturnus, insonia e movimentação excessiva durante o sono. São analisadas a ação da droga assim como a ocorrência de efeitos colaterais.

Evaluation of flurazepam and placebo on sleep disorders in childhood

Avaliação de flurazepam e placebo nos distúrbios do sono na infância

Rubens Reimão^I; Antonio B. Lefévre^II

^IAssociate Physician of Child Neurology. Department of Neuropsychiatry - "Hospital das Clínicas" - University of Sao Paulo School of Medicine

^IIHead of the Department of Child Neurology. Department of Neuropsychiatry - "Hospital das Clínicas" - University of Sao Paulo School of Medicine

SUMMARY

The clinically observed results in 40 patients, from 1 to 15 years old, presenting sleep disturbances, in a comparative and statistically approached study of flurazepam 15mg daily against placebo, are reported. Placebo was administered, followed by the drug, during 14 days each. The chief complaints were sleepwalking, sleep-talking, sleep terror, sleep-related bruxism, sleep-related headbanging, insomnia and excessive movements during sleep. A significant effect of flurazepam on sleepwalking, sleep-talking, bruxism, sleep terror and excessive movement during sleep, was observed. The insomniac and headbanging patients were not enough for statistical analysis. Flurazepam side effects were excessive drowsiness during daytime in 3 cases; irritability, 3 cases; nausea and vomiting, 2 cases, and were not correlated with age. Placebo side effects were similar, except for nausea and vomiting which were not observed. It was necessary to discontinue flurazepam in 2 cases, because of excessive drowsiness during daytime, which did not improve when reducing the dose.

RESUMO

Os autores relatam os efeitos de flurazepam e placebo em estudo comparativo, em 40 crianças com distúrbios do sono. As alterações observadas são: sonambulismo, terror noturno, sonilóquio, bruxismo durante o sono, jactatio capitis nocturnus, insonia e movimentação excessiva durante o sono. São analisadas a ação da droga assim como a ocorrência de efeitos colaterais.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Study performed by the Department of Neuropsychiatry - "Hospital das Clínicas" - University of Sao Paulo School of Medicine.

Acknowledgement: We thank Mrs. Jadwiga Myelinska for the statistical analysis.

Address reprints request to: Dr. Rubens Reimão - Clínica Neurológica, Departamento de Neuropsiquiatria - Faculdade de Medicina da Universidade de São Paulo - Caixa Postal 8461 - 01000 São Paulo, SP - Brasil.

1. ADAM, K.; ADAMSON, L.; BREZINOVA, V. & OSWALD, I. - Do placebos alter sleep? British Med. J. 1:195, 19766.
2. ANDERS, T. F. & WE1NSTEIN, P. - Sleep and its disorders in infants an: children: a review. Pediatrics 50:312, 1972.
3. ARKIN, A. M. - Sleep-talking: a review J. Nerv. Ment. Dis. 143:101, 1966.
4. ARKIN, A. M. - Night-terrors and anomalous REM sleep component manifestation in slow-wave sleep. Waking Sleeping 2:143, 1978.
5. Association of Sleep Disorders Centers. Diagnostic Classification of Sleep and Arousal disorders. First Edition, prepared by the Sleep Disorders Classification Commitee, H. P. Roffwarg, Chairman. Sleep 2:1, 1979.
6. BENOIT, O. - Sommeil normal et pathologique chez l'enfant. Rev. Neuropsychiat. Infant. 23:651, 1975.
7. BERMEJO, E. & REY-BELDET, J. - Étude comparative de l'effect hypnotique du flurazepam et de l'heptabarbital. Rev. Med. Suisse Rom. 95:635, 1975.
8. BOND, A. J. & LADER, M. H. - The residual effetcs of flurazepam. Psychopharmacologia (Berlin) 32:223, 1973.
9. BOWEN, A J. - Comparative efficacy of triazolam, flurazepam and placebo in out patients insomniacs. J. Int. Med. Res. 6:337, 1978.
10. BROADHURST, A. D. & ARENILLAS, L. - A clinical and psychometric evaluation of flurazepam as a hypnotic in psychiatric patients. Curr. Med. Res. Opin. 3:413, 1975.
11. CHURCH, M. W. & JOHNSON, L. C. - Mood and performance of poor sleepers during repeated use of flurazepam. Psychopharmacology 61:309, 1979.
12. COMLY, H. H. - Successful treatment of night terrors. Am. J. Psychiatry 132:761, 1975.
13. EVANS, J. - Rocking at night. J. Child Psychol. Psychiat. 2:71, 1961.
14. FEINBERG, I.; FEIN, G.; WALKER, J. M.; PRICE, L. J.; FLOYD, T. C. & MARCH, J. D. - Flurazepam effects on slow-wave sleep: stage 4 suppressed but number of delta "waves constant. Science 198:847, 1977.
15. FISHER, C; BYRNE, J.; EDWARDS, A. & KAHN, E. - A psychophysiological study of nightmares. J. Amer. Psychoanal. Ass. 18:747, 1970.
16. FISHER, C; KAHN, E.; EDWARDS, A. & DAVIS, D. M. - A psychophysiological study of nightmares and night terrors: the suppression of stage 4 night terrors with diazepam. Arch. Gen. Psychiat 28:252, 1973.
17. FISHER, A.; KAHN, E.; EDWARDS, A. & DAVIS, D. M. - A psychophysiological study of nightmares and night terrors. J. Nerv. Ment. Dis. 157:75, 1973.
18. FREIDIN, M. R.; JANKOWSKI, J. J. & SINGER, W. D. - Nocturnal head banging as a sleep disorder: a case report. Am. J. Psychiatry 136:1469, 1979.
19. FÚSTER, B.; CASTELLS, C. & ETCHEVERRY, M. - Epileptic sleep terrors. Neurology (Minneapolis) 4:531, 1954.
20. GAMBI, D.: PINTO, F.: TORRIOLI, M. G.; STEFANINI, M. C. & BARBA, C. - Analisi quantitativa degli stati di sonno in bambini con pavor notturno trattati con Ro-54200. Riv. Neurol. 47:129, 1977.
21. GLICK, B. S.; SCHULMAN, D. & TURECKI, S. - Diazepam (Valium) treatment in childhood sleep disorders. Dis. Nerv. Syst. 32:565. 1971.
22. GREENBLATT, D. J.; SCHADER, R. I. & KOCH-WESER, J. - Flurazepam hydrochloride. Clin. Pharmacol. Ther. 17:1, 1975.
23. GUILLEMINAULT, C. & LEYGONY, F. - Drogues et sommeil. Rev. Neuropsychiatr. Infant. 20:871, 1972.
24. HART, H. H. - Practical psychiatric problems in dentistry. J. Dent. Med. 3:83, 1948.
25. HARTMANN, E. - The effect of four drugs on sleep patterns in man. Psychopharmacologia (Berlin) 12:346, 1968.
26. HEIMANN, H. & SCHMOCKER, A. M. - Les troubles du sommeil; leur origine et leur traitment. Rev. Med. Suisse Romande 94:525, 1974.
27. HIRSCHBERG, J. C. - Parental anxieties accompanying sleep disturbance in young children. Bull. Menninger Clin. 21:129, 1957.
28. JACOBSON, A.; KALES, A.: LEHMAN, D. & ZWEZIG, J. R. - Somnambulism: All-night electroencephalographs studies. Science 148:975, 1965.
29. JOHNSON, L. C; HANSON, K. & BICKFORD, R. G. - Effect of flurazepam on sleep spindles and K-complexes. Electroencephalogr. Clin. Neurophysiol. 40:67, 1976.
30. JOHNSON, L. C.; SEALES, D. M.; NATOH, P.; CHURCH, M. W. & SINCLAIR, M. - The effects of flurazepam hydrochloride on brain electrical activity during sleep. Electroencephalogr. Clin. Neurophysiol. 47:309, 1979.
31. JOVANOVIC, U. I. - Suggestions for the treatment of sleep diisturbances and conclusions. In: Sleep: Physiology, Biochemistry, Psychology, Pharmacology, Clinical Implications. 1st Europ. Congr. Sleep Res., Karger, ed., Basel, 1973.
32. KALES, A. - Treating sleep disorders. Am. Fam. Physician. 8:158, 1973.
33. KALES, A.; ALLEN, C; SCHARF, M. B. & KALES, J. D. - Hypnotic drugs, and their effectiveness. All-night EEG studies of insomniac patients. Arch. Gen. Psychiatry. 23:226, 1970.
34. KALES, A.; BIXLER, E. O.; SCHARF, M. B. & KALES, J. D. - Sleep laboratory studies of flurazepam: a model for evaluating hypnotic drugs. Clin. Pharmacol. Ther. 19:576, 1976.
35. KALES, A. & KALES, J. D. - Sleep disorders. New Eng. J. Med. 290:487, 1974.
36. KALES, A.; KALES, J. D.; BIXLER, E. O. & SCHARF, M. - Effectiveness of hypnotic drugs with prolonged use: flurazepam and pentobarbital. Clin. Pharmacol. Ther. 18:356, 1975.
37. KALES, J. D.; KALES, A.; BIXLER, E. O. & SLYE, E. S. - Effects of placebo and flurazepam on sleep patterns of insomniac patients. Clin. Pharmacol. Ther. 12:691, 1971.
38. KALES, J. D.; KALES, A.; LEO, L. A. & BIXLER, E. O. - Evaluation of the effectiveness of hypnotic drugs under conditions of prolonged use. In: Sleep Research. Vol. 2. Chase, M. H., Stern, W. C, Walton, P. L., ed. Brain Information Service, UCLA, Los Angeles, 1973.
39. KALES, J. D.; KALES, A.; SCHARF, M. B. & TAN, T. L. - Hypnotics and altered sleep-dream patterns: all night EEG studies of chloral hydrate, flurazepam and methaqualone. Arch. Gen. Psychiatry 23:219, 1970.
40. KEITH, P. R. - Night terrors: a review of the psychology, neurophysiology and therapy. J. Am. Acad. Child Psychiatry 14:477, 1975.
41. KINZIE, J. D. & MARKOFF, R. - A systematic appproach of sleep disorders: a review and treatment. Hawaii Med. J. 33:412, 1974.
42. KRAVITZ, H.; ROSENTHAL, V.; TEPLITZ, Z.; MURPHY, J .B. & LESSER. R. E. - A study of head-banging in infants and children. Dis. Nerv. Syst. 21:203, 1960.
43. LASAGNA, L. - Hypnotic drugs. New Eng. J. Med. 287:1182, 1972.
44. LEFÈVRE, A. B. - Exame Neurológico Evolutivo. 2Ş ed., Sarvier, São Paulo, 1977.
45. MENDELSON, W. B.; GILLIN, J. C. & WYATT, R. J. - Human sleep and its disorders. Plenum Press ed., New York, 1977.
46. NIGRO, N. & EANDI, M. - Il sonno: considerazioni di farmacoterapia pediatrica. Minerva Pediatr. 27:1999, 1975.
47. OSWALD, I. - Drugs and sleep. Pharmacol. Rev. 20:273, 1968.
48. OSWALD, I. - Human brain protein, drugs and dreams. Nature 223:893, 1969.
49. OSWALD, I. - Drug research and human sleep. Prog. Drug. Res. 22:355, 1978.
50. PESIKOFF, R. B. & DAVIS, P. C. - Treatment of pavor nocturnus and somnambulism in children. Amer. J. Psychiat. 128:778, 1971.
51. POPOVICIU, L. & SZABÓ, L. - Étude polygraphique du sommeil dans les automatismes ambulatoires nocturnes. Rev. Roum. Neurol. 7:27, 1970.
52. RECHTSCHAFFEN, A.; GOODENOUGH, D. R. & SHAPIRO, A. - Patterns of sleep-talking. Arch. Gen. Psychiat. 7:418, 1962.
53. REDING, G. R.; ZEPELIN, H.; ROBINSON, J. E. Jr.; ZIMMERMAN, S. O. & SMITH, V. H. - Nocturnal teeth-grinding: all-night psychophysiologic studies. J. Dent. Res. 47:786, 1968.
54. REDING, G. R.; RUB RIGHT, W. C; RECHTSCHAFFEN, A. & DANIELS, R. S. - Sleep pattern of tooth-grinding: its relationship to dreaming. Science 145:725, 1964.
55. REDING, G. R.; ZEPELIN, H.; ROBINSON, J. E. Jr.; SMITH, V. H. & ZIMMERMAN, S. O. - Sleep pattern of bruxism: a review. Psychophysiology 4:396, 1968.
56. REDING, G. R.; ZEPELIN, H.; ROBINSON, J. E. Jr.; ZIMMERMAN, S. O. & SMITH, V. H. - Nocturnal teeth-frinding: all-night psychophysiologic studies. Int. J. Orthodont. 6:111, 1968.
57. REIMÃO, R. & LEFÈVRE, A. B. - Distúrbios do sono na infância. Pediat. (São Paulo) 2:222, 1980.
58. REIMÃO, R. & LEFÈVRE, A. B. - Prevalence of sleep-talking in childhood. Brain Development 2:353, 1980.
59. REIMÃO, R. & NASSIF, M. R. G. - Sono normal e patológico na criança. In: Neurologia Infantil. Lefèvre, A. B., Diament, A. J. ed., Sarvier, São Paulo, 1980.
60. SCHON, D. & JAHN, H. - Action du flunitrazépan sur les troubles du sommeil organiques et fonctionnels. Nouv. Prèsse Méd. 8:2550, 1979.
61. SHIRLEY, H. F. & KAHN, J. P. - Sleep disturbances in children. Pediat. Clin. N. Amer. 5:629, 1958.
62. SIEGEL, S. - Nonparametric Statistics for the Behavioral Sciences. McGraw-Hill Book Co., New York, 1956.
63. SOLOMON, F.; WHITE, C. C; PARRON, D. L. & MENDELSON, W. B. - Sleeping pills, insomnia and medical practice. New Engl. J. Med. 300:803, 1979.
64. STROTHER, E. W. & MITCHELL, G. E. - Bruxism: a review and a case report. J. Dent. Med. 9:189, 1954.
65. TASSINARI, C. A.; MANCIA, D.: DALLA-BERNARDINA, B. & GASTAUT, H. - Pavor nocturnus of non-epileptic nature in epileptic children. Electroencephalogr. Clin. Neuropsysiol. 33:603, 1972.
66. VOGEL, G. W.; BARKER, K.; GIBBONS, P. & THURMOND, A. - A comparison of the effects of flurazepam 30mg and triazolam 0,5mg on the sleep of insomniacs. Psychopharmacology 47:81, 1976.
67. VOGEL, G. W.; HICKNAN, J.; THURNOND, A.; BARROWCLOUGH, B. & GIESLER, D. - The effect of Dalmane (flurazepam) on the sleep cycle of good and poor sleepers. Psychophysiology 9:96, 1972.

Publication Dates

Publication in this collection
16 Aug 2012
Date of issue
Mar 1982

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ADAM, K.; ADAMSON, L.; BREZINOVA, V. & OSWALD, I. - Do placebos alter sleep? British Med. J. 1:195, 19766.

[2] 2. ANDERS, T. F. & WE1NSTEIN, P. - Sleep and its disorders in infants an: children: a review. Pediatrics 50:312, 1972.

[3] 3. ARKIN, A. M. - Sleep-talking: a review J. Nerv. Ment. Dis. 143:101, 1966.

[4] 4. ARKIN, A. M. - Night-terrors and anomalous REM sleep component manifestation in slow-wave sleep. Waking Sleeping 2:143, 1978.

[5] 5. Association of Sleep Disorders Centers. Diagnostic Classification of Sleep and Arousal disorders. First Edition, prepared by the Sleep Disorders Classification Commitee, H. P. Roffwarg, Chairman. Sleep 2:1, 1979.

[6] 6. BENOIT, O. - Sommeil normal et pathologique chez l'enfant. Rev. Neuropsychiat. Infant. 23:651, 1975.

[7] 7. BERMEJO, E. & REY-BELDET, J. - Étude comparative de l'effect hypnotique du flurazepam et de l'heptabarbital. Rev. Med. Suisse Rom. 95:635, 1975.

[8] 8. BOND, A. J. & LADER, M. H. - The residual effetcs of flurazepam. Psychopharmacologia (Berlin) 32:223, 1973.

[9] 9. BOWEN, A J. - Comparative efficacy of triazolam, flurazepam and placebo in out patients insomniacs. J. Int. Med. Res. 6:337, 1978.

[10] 10. BROADHURST, A. D. & ARENILLAS, L. - A clinical and psychometric evaluation of flurazepam as a hypnotic in psychiatric patients. Curr. Med. Res. Opin. 3:413, 1975.

[11] 11. CHURCH, M. W. & JOHNSON, L. C. - Mood and performance of poor sleepers during repeated use of flurazepam. Psychopharmacology 61:309, 1979.

[12] 12. COMLY, H. H. - Successful treatment of night terrors. Am. J. Psychiatry 132:761, 1975.

[13] 13. EVANS, J. - Rocking at night. J. Child Psychol. Psychiat. 2:71, 1961.

[14] 14. FEINBERG, I.; FEIN, G.; WALKER, J. M.; PRICE, L. J.; FLOYD, T. C. & MARCH, J. D. - Flurazepam effects on slow-wave sleep: stage 4 suppressed but number of delta "waves constant. Science 198:847, 1977.

[15] 15. FISHER, C; BYRNE, J.; EDWARDS, A. & KAHN, E. - A psychophysiological study of nightmares. J. Amer. Psychoanal. Ass. 18:747, 1970.

[16] 16. FISHER, C; KAHN, E.; EDWARDS, A. & DAVIS, D. M. - A psychophysiological study of nightmares and night terrors: the suppression of stage 4 night terrors with diazepam. Arch. Gen. Psychiat 28:252, 1973.

[17] 17. FISHER, A.; KAHN, E.; EDWARDS, A. & DAVIS, D. M. - A psychophysiological study of nightmares and night terrors. J. Nerv. Ment. Dis. 157:75, 1973.

[18] 18. FREIDIN, M. R.; JANKOWSKI, J. J. & SINGER, W. D. - Nocturnal head banging as a sleep disorder: a case report. Am. J. Psychiatry 136:1469, 1979.

[19] 19. FÚSTER, B.; CASTELLS, C. & ETCHEVERRY, M. - Epileptic sleep terrors. Neurology (Minneapolis) 4:531, 1954.

[20] 20. GAMBI, D.: PINTO, F.: TORRIOLI, M. G.; STEFANINI, M. C. & BARBA, C. - Analisi quantitativa degli stati di sonno in bambini con pavor notturno trattati con Ro-54200. Riv. Neurol. 47:129, 1977.

[21] 21. GLICK, B. S.; SCHULMAN, D. & TURECKI, S. - Diazepam (Valium) treatment in childhood sleep disorders. Dis. Nerv. Syst. 32:565. 1971.

[22] 22. GREENBLATT, D. J.; SCHADER, R. I. & KOCH-WESER, J. - Flurazepam hydrochloride. Clin. Pharmacol. Ther. 17:1, 1975.

[23] 23. GUILLEMINAULT, C. & LEYGONY, F. - Drogues et sommeil. Rev. Neuropsychiatr. Infant. 20:871, 1972.

[24] 24. HART, H. H. - Practical psychiatric problems in dentistry. J. Dent. Med. 3:83, 1948.

[25] 25. HARTMANN, E. - The effect of four drugs on sleep patterns in man. Psychopharmacologia (Berlin) 12:346, 1968.

[26] 26. HEIMANN, H. & SCHMOCKER, A. M. - Les troubles du sommeil; leur origine et leur traitment. Rev. Med. Suisse Romande 94:525, 1974.

[27] 27. HIRSCHBERG, J. C. - Parental anxieties accompanying sleep disturbance in young children. Bull. Menninger Clin. 21:129, 1957.

[28] 28. JACOBSON, A.; KALES, A.: LEHMAN, D. & ZWEZIG, J. R. - Somnambulism: All-night electroencephalographs studies. Science 148:975, 1965.

[29] 29. JOHNSON, L. C; HANSON, K. & BICKFORD, R. G. - Effect of flurazepam on sleep spindles and K-complexes. Electroencephalogr. Clin. Neurophysiol. 40:67, 1976.

[30] 30. JOHNSON, L. C.; SEALES, D. M.; NATOH, P.; CHURCH, M. W. & SINCLAIR, M. - The effects of flurazepam hydrochloride on brain electrical activity during sleep. Electroencephalogr. Clin. Neurophysiol. 47:309, 1979.

[31] 31. JOVANOVIC, U. I. - Suggestions for the treatment of sleep diisturbances and conclusions. In: Sleep: Physiology, Biochemistry, Psychology, Pharmacology, Clinical Implications. 1st Europ. Congr. Sleep Res., Karger, ed., Basel, 1973.

[32] 32. KALES, A. - Treating sleep disorders. Am. Fam. Physician. 8:158, 1973.

[33] 33. KALES, A.; ALLEN, C; SCHARF, M. B. & KALES, J. D. - Hypnotic drugs, and their effectiveness. All-night EEG studies of insomniac patients. Arch. Gen. Psychiatry. 23:226, 1970.

[34] 34. KALES, A.; BIXLER, E. O.; SCHARF, M. B. & KALES, J. D. - Sleep laboratory studies of flurazepam: a model for evaluating hypnotic drugs. Clin. Pharmacol. Ther. 19:576, 1976.

[35] 35. KALES, A. & KALES, J. D. - Sleep disorders. New Eng. J. Med. 290:487, 1974.

[36] 36. KALES, A.; KALES, J. D.; BIXLER, E. O. & SCHARF, M. - Effectiveness of hypnotic drugs with prolonged use: flurazepam and pentobarbital. Clin. Pharmacol. Ther. 18:356, 1975.

[37] 37. KALES, J. D.; KALES, A.; BIXLER, E. O. & SLYE, E. S. - Effects of placebo and flurazepam on sleep patterns of insomniac patients. Clin. Pharmacol. Ther. 12:691, 1971.

[38] 38. KALES, J. D.; KALES, A.; LEO, L. A. & BIXLER, E. O. - Evaluation of the effectiveness of hypnotic drugs under conditions of prolonged use. In: Sleep Research. Vol. 2. Chase, M. H., Stern, W. C, Walton, P. L., ed. Brain Information Service, UCLA, Los Angeles, 1973.

[39] 39. KALES, J. D.; KALES, A.; SCHARF, M. B. & TAN, T. L. - Hypnotics and altered sleep-dream patterns: all night EEG studies of chloral hydrate, flurazepam and methaqualone. Arch. Gen. Psychiatry 23:219, 1970.

[40] 40. KEITH, P. R. - Night terrors: a review of the psychology, neurophysiology and therapy. J. Am. Acad. Child Psychiatry 14:477, 1975.

[41] 41. KINZIE, J. D. & MARKOFF, R. - A systematic appproach of sleep disorders: a review and treatment. Hawaii Med. J. 33:412, 1974.

[42] 42. KRAVITZ, H.; ROSENTHAL, V.; TEPLITZ, Z.; MURPHY, J .B. & LESSER. R. E. - A study of head-banging in infants and children. Dis. Nerv. Syst. 21:203, 1960.

[43] 43. LASAGNA, L. - Hypnotic drugs. New Eng. J. Med. 287:1182, 1972.

[44] 44. LEFÈVRE, A. B. - Exame Neurológico Evolutivo. 2Ş ed., Sarvier, São Paulo, 1977.

[45] 45. MENDELSON, W. B.; GILLIN, J. C. & WYATT, R. J. - Human sleep and its disorders. Plenum Press ed., New York, 1977.

[46] 46. NIGRO, N. & EANDI, M. - Il sonno: considerazioni di farmacoterapia pediatrica. Minerva Pediatr. 27:1999, 1975.

[47] 47. OSWALD, I. - Drugs and sleep. Pharmacol. Rev. 20:273, 1968.

[48] 48. OSWALD, I. - Human brain protein, drugs and dreams. Nature 223:893, 1969.

[49] 49. OSWALD, I. - Drug research and human sleep. Prog. Drug. Res. 22:355, 1978.

[50] 50. PESIKOFF, R. B. & DAVIS, P. C. - Treatment of pavor nocturnus and somnambulism in children. Amer. J. Psychiat. 128:778, 1971.

[51] 51. POPOVICIU, L. & SZABÓ, L. - Étude polygraphique du sommeil dans les automatismes ambulatoires nocturnes. Rev. Roum. Neurol. 7:27, 1970.

[52] 52. RECHTSCHAFFEN, A.; GOODENOUGH, D. R. & SHAPIRO, A. - Patterns of sleep-talking. Arch. Gen. Psychiat. 7:418, 1962.

[53] 53. REDING, G. R.; ZEPELIN, H.; ROBINSON, J. E. Jr.; ZIMMERMAN, S. O. & SMITH, V. H. - Nocturnal teeth-grinding: all-night psychophysiologic studies. J. Dent. Res. 47:786, 1968.

[54] 54. REDING, G. R.; RUB RIGHT, W. C; RECHTSCHAFFEN, A. & DANIELS, R. S. - Sleep pattern of tooth-grinding: its relationship to dreaming. Science 145:725, 1964.

[55] 55. REDING, G. R.; ZEPELIN, H.; ROBINSON, J. E. Jr.; SMITH, V. H. & ZIMMERMAN, S. O. - Sleep pattern of bruxism: a review. Psychophysiology 4:396, 1968.

[56] 56. REDING, G. R.; ZEPELIN, H.; ROBINSON, J. E. Jr.; ZIMMERMAN, S. O. & SMITH, V. H. - Nocturnal teeth-frinding: all-night psychophysiologic studies. Int. J. Orthodont. 6:111, 1968.

[57] 57. REIMÃO, R. & LEFÈVRE, A. B. - Distúrbios do sono na infância. Pediat. (São Paulo) 2:222, 1980.

[58] 58. REIMÃO, R. & LEFÈVRE, A. B. - Prevalence of sleep-talking in childhood. Brain Development 2:353, 1980.

[59] 59. REIMÃO, R. & NASSIF, M. R. G. - Sono normal e patológico na criança. In: Neurologia Infantil. Lefèvre, A. B., Diament, A. J. ed., Sarvier, São Paulo, 1980.

[60] 60. SCHON, D. & JAHN, H. - Action du flunitrazépan sur les troubles du sommeil organiques et fonctionnels. Nouv. Prèsse Méd. 8:2550, 1979.

[61] 61. SHIRLEY, H. F. & KAHN, J. P. - Sleep disturbances in children. Pediat. Clin. N. Amer. 5:629, 1958.

[62] 62. SIEGEL, S. - Nonparametric Statistics for the Behavioral Sciences. McGraw-Hill Book Co., New York, 1956.

[63] 63. SOLOMON, F.; WHITE, C. C; PARRON, D. L. & MENDELSON, W. B. - Sleeping pills, insomnia and medical practice. New Engl. J. Med. 300:803, 1979.

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