Effect of Tinnitus on Sleep Quality and Insomnia

Abstract Introduction Tinnitus is a conscious perception of a sound resulting from abnormal activity within the nervous system. A relevant percentage of tinnitus patients report symptoms severe enough to significantly affect quality of life, including sleep disorders. Objectives To analyze the sleep quality, insomnia, daytime sleepiness, and risk of obstructive sleep apnea (OSA) in participants with tinnitus. Methods The sample comprised 18 adults and older adults aged between 18 and 85 years old (mean age = 58.7 ± 17.5 years old), females and males, with complaint of continuous tinnitus for > 1 month. The instruments used were the Tinnitus Handicap Inventory (THI) questionnaire, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the STOP-Bang questionnaire. Results By means of the THI questionnaire, the tinnitus severity degree reported by most participants was mild (27.8%) and moderate (27.8%), having a positive (r = 0.582) and significant (0.011) correlation to sleep quality, measured by means of the Pittsburgh questionnaire. There was a positive correlation between the Insomnia Severity Index and tinnitus handicap (r = 0.499; p = 0.035). A total of 72.2% of the participants self-assessed their sleep quality as poor, in addition to moderate insomnia (27.8%), although there is low risk of OSA (66.7%), without complaints of excessive daytime sleepiness (72.2%). Conclusion Subjects with tinnitus complaint self-rated their sleep quality as poor. Moreover, the higher the reported tinnitus handicap, the greater the symptoms of insomnia. There was no influence of tinnitus in relation to daytime sleepiness and no relationship between the severity of tinnitus and the risk of OSA.

Dual orexin receptor antagonists for the treatment of insomnia: systematic review and network meta-analysis / Antagonistas duais do receptor de orexina para o tratamento da insônia: revisão sistemática e metanálise em rede

Abstract Background Several randomized clinical trials (RCTs) have shown that dual orexin receptor antagonists (DORAs) are effective in the treatment of chronic insomnia. However, the superiority of one particular DORA over the others remains unclear. Objective To perform a network meta-analysis to evaluate the efficacy of different DORAs in patients with chronic insomnia. Methods The Medline, Embase, and Cochrane Central databases were searched for RCTs that compared DORA with placebo in patients ≥ 18 years of age with a diagnosis of insomnia disorder. We pooled outcomes for wake time after sleep onset (WASO), latency to persistent sleep (LPS), total sleep time (TST), and adverse events (AEs). Results We included 10 RCTs with 7,806 patients, 4,849 of whom received DORAs as the intervention. Overall, we found that DORAs were associated with the improvement of all analyzed efficacy outcomes. Concerning TST, an apparent dose-dependent pattern was noticed, with higherdoses relating to a longerTST. Lemborexant 10mg provided the largest reduction in WASO (at month 1) in minutes (standardized mean difference [SMD] = −25.40; 95% confidence interval [95%CI] = −40.02- −10.78), followed by suvorexant 20/15mg (SMD = −25.29; 95%CI = −36.42- −14.15), which also appeared to provide the largest decrease in long-term WASO (SMD = −23.70; 95%CI = −35.89- −11.51). The most frequent AEs were somnolence, nasopharyngitis, and headache, with rates of up to 14.8%. Conclusion Our results suggest that DORAs are associated with greater efficacy when compared with placebo in the treatment of insomnia, a complex 24-hour sleep disorder. Additionally, dosing might play an important role in the management of chronic insomnia.

Resumo Antecedentes Inúmeros ensaios clínicos randomizados (ECRs) têm demonstrado que os antagonistas duais do receptor de orexina (dual orexin receptor antagonists, DORAs, em inglês) são eficazes no tratamento da insônia. Contudo, restam dúvidas quanto à superioridade de um DORA com relação aos outros. Objetivo Realizar uma meta-análise em rede para avaliar a eficácia de diferentes DORAs em pacientes com insônia. Métodos Foram feitas buscas nas bases de dados Medline, Embase e Cochrane Central por ECRs que comparassem DORAs e placebo em pacientes ≥ 18 anos de idade com diagnóstico de insônia. Os seguintes desfechos foram selecionados: tempo desperto após o início do sono (wake time after sleep onset, WASO, em inglês), latência para o sono persistente (latency to persistent sleep, LPS, em inglês), tempo total de sono (total sleep time, TST, em inglês), e efeitos adversos (EAs). Resultados Incluímos 10 ensaios clínicos com 7,806 pacientes, 4,849 dos quais receberam DORAs como intervenção. Os DORAs foram associados à melhoria de todos os desfechos de eficácia analisados. Em relação ao TST, um aparente padrão de dependência da dose foi identificado, com doses maiores se associando a um maior TST. Lemborexant 10 mg proporcionou a maior redução em WASO (no primeiro mês) em minutos (diferença padronizada das médias [standardized mean difference, [SMD], em inglês) = −25.40; intervalo de confiança de 95% [IC95%] = −40.02- −10.78), seguido de suvorexant 20/15mg (SMD = −25.29; IC95% = −36.42- −14.15), o qual também proporcionou a maior diminuição em WASO no longo prazo (SMD = −23.70; IC95% = −35.89- −11.51). Os EAs mais frequentes foram sonolência, nasofaringite e cefaleia, com taxas de até 14.8%. Conclusão Nossos resultados sugerem que os DORAs estão associados a uma maior eficácia quando comparados com placebo no tratamento da insónia, um complexo transtorno do sono de 24 horas. Além disso, a dosagem pode desempenhar um papel importante no manejo da insónia crônica.

A Study on Internet and Gaming Addiction, Hikikomori Trait and Insomnia Status among Medical Undergraduates at one of Cities of Western India

Background: College students appear more vulnerable in developing a dependence on the internet. Individuals with hikikomori are frequently reported to have social contact predominantly via the internet. Objectives: To find the prevalence of Internet addiction, gaming Addiction, Hikikomori Trait and Insomnia amongst medical undergraduates and to study their association with various determinants. Methodology: The present Cross-Sectional study was conducted among first to final-year medical students studying at various medical colleges in Indian City from February to May 2021. Data collection was done after obtaining the ethical permission of the Institute. A total of 400 students who gave consent were sent an electronic questionnaire. Results: The mean age of study participants was 20 ± 1.58 years. Internet addiction was present in 189(47.2%) participants, gaming addiction in 128 (32%) students and Hikikomori Trait was found in 98(24.5%) students. There was a statistically significant association between different grades of insomnia and internet, gaming addiction, and hikikomori trait (<?0.0001) in the present study. Conclusion: Internet addiction was present in almost half of the medical students while gaming addiction was seen in nearly one third of the students. Male gender and hostel stay had a statistically significant association with internet addiction, gaming addiction, insomnia and hikikomori trait.

Calidad de sueño en docentes en una institución educativa durante la emergencia sanitaria COVID-19, Perú, 2021

Objetivo: La pandemia del COVID-19 afectó la calidad de vida de la población a nivel mundial. Los países tomaron varias medidas de protección para evitar el contagio como el aislamiento social, el teletrabajo y la educación a distancia. A medida que las escuelas cerraron, los maestros se encargaron principalmente de la enseñanza en línea. El objetivo principal fue determinar la calidad de sueño en los docentes de una institución educativa pública en el distrito de Máncora, Perú, durante el aislamiento social en pandemia por COVID-19. Materiales y métodos: Estudio observacional, transversal y prospectivo. Se usó el cuestionario de Índice de Calidad de Sueño de Pittsburgh en 59 docentes de los niveles educativos inicial, primario y secundario que utilizaron la modalidad de educación a distancia de marzo a diciembre del 2021. Resultados: La edad promedio fue 44,3 ± 8,89 años. Las mujeres fueron 64,4 %; los docentes con especialidad, es decir, el área que enseñaba el docente, 55,9 %. Los de nivel secundario fueron el 55,9 %; el nivel primario, 30,5 %, y el nivel inicial, 13,6 %. Los parámetros de calidad de sueño afectados fueron los siguientes: 69,5 % presentaron mala calidad de sueño; 67,8 %, inadecuada latencia de sueño, y 61,00 %, duración de sueño menor de 5 horas. El 27,1 % presentó eficiencia habitual del sueño menor al 65 % y 49,2 % reportó perturbaciones del sueño. Asimismo, 50,8 % usaron medicación hipnótica más de una vez a la semana. Por último, el 39 % presentó severa disfunción diurna. Se encontró asociación entre la calidad de sueño con los componentes calidad subjetiva del sueño, latencia de sueño, duración del sueño, eficiencia habitual del sueño y disfunción diurna. No hubo asociación con el sexo, nivel educativo y especialidad docente. Conclusiones: Los docentes de una institución educativa en Máncora presentaron alta prevalencia de mala calidad de sueño y los componentes más afectados fueron latencia de sueño, disfunción diurna y perturbaciones del sueño.

Objective: The COVID-19 pandemic affected the quality of life of the population worldwide. The countries took several protective measures to avoid contagion, including social isolation, teleworking and distance education. As schools closed, teachers took over primarily online teaching. The study main objective was to determine the sleep quality among teachers of a public educational institution in the district of Máncora, Peru, during the COVID-19 pandemic social isolation. Materials and methods: An observational, cross-sectional and prospective study. The Pittsburgh Sleep Quality Index was used to assess 59 preschool, primary and secondary school teachers who taught through distance education from March to December 2021. Results: The average age was 44.3 ± 8.89 years. Women accounted for 64.4 %, specialist teachers-i.e., those who have expertise in a particular field-55.9 %, secondary school teachers 55.9 %, primary school teachers 30.5 % and preschool teachers 13.6 %. The affected sleep quality parameters were the following: 69.5 % had poor sleep quality, 67.8 % inadequate sleep latency, 61 % sleep duration of less than five hours, 27.1 % habitual sleep efficiency of less than 65 % and 49.2 % sleep disturbances. Moreover, 50.8 % reported using a sleeping medication more than once a week and 39 % severe daytime dysfunction. There was an association between sleep quality and the components subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency and daytime dysfunction. Nonetheless, there was no association with sex, educational level and teaching specialty. Conclusions: Teachers of an educational institution in Máncora had a high prevalence of poor sleep quality and the most affected components were sleep latency, daytime dysfunction and sleep disturbances.

Insomnia symptoms during the covid-19 pandemic: a case-control study / Sintomas de insônia durante a pandemia de covid-19: um estudo caso-controle

ABSTRACT OBJECTIVE To identify lifestyle-related, sociodemographic, and mental health characteristics of people with insomnia symptoms and people without insomnia during the pandemic. METHODS A case-control study was conducted with data collected by snowball sampling using an online questionnaire. From November 2020 to April 2021, 6,360 people with a mean age of 43.5 years (SD = 14.3) participated in the survey. For this study, we considered 158 cases of insomnia disorder and 476 controls (three controls per case) randomly selected from the participants without sleep problems. RESULTS The results of the comparative analysis between cases and controls showed that sleeping less than six hours daily (OR = 3.89; 95%CI 2.50-6.05), feeling sadness frequently (OR = 2.95; 95%CI 1.69-5.17), residing in metropolitan areas (OR = 1.71; 95%CI 1.04-2.84), being 40 years or older (OR = 1.93; 95%CI 1.22-3.06), and the interaction between occupation and poorer education (OR = 2.12; 95%CI 1.22-3.69) were predictors for symptoms of insomnia disorder during the pandemic. CONCLUSIONS In addition to confirming the hypothesis that mental health problems are associated with insomnia symptoms, the results point to insomnia as an important outcome for studies on the effects of unemployment, vulnerability and low education of the population, especially in large cities, highlighting that the effects of the crisis on health and the economy are extremely unequally distributed.

RESUMO OBJETIVO Identificar características relacionadas ao estilo de vida, sociodemográficas e saúde mental de pessoas com sintomas de insônia e pessoas sem insônia durante a pandemia. MÉTODOS A partir de dados coletados por amostragem em bola de neve, por meio de um questionário online foi realizado um estudo caso-controle. Durante o período de novembro de 2020 a abril de 2021, 6.360 pessoas com idade média de 43,5 anos (DP = 14,3) participaram da pesquisa. No presente estudo, foram considerados 158 casos de transtorno de insônia e 476 controles (três controles por caso) selecionados aleatoriamente dentre os participantes sem problemas de sono. RESULTADOS Os resultados da análise comparativa entre casos e controles mostraram que dormir menos de seis horas diárias (OR = 3,89; IC95% 2,50-6,05), sentir tristeza frequentemente (OR = 2,95; IC95% 1,69-5,17), residir em metrópoles (OR = 1,71; IC95% 1,04-2,84), estar com 40 anos ou mais (OR = 1,93; IC95% 1,22-3,06) e a interação entre ocupação e escolaridade mais precária (OR = 2,12; IC95% 1,22-3,69) foram fatores preditores para sintomas de transtorno de insônia durante a pandemia. CONCLUSÕES Além da confirmação da hipótese de que problemas de saúde mental estão associados a sintomas de insônia, os resultados apontam para a insônia como um desfecho importante para estudos sobre efeitos do desemprego, vulnerabilidade e baixa escolaridade da população, sobretudo nas grandes metrópoles, ressaltando que os efeitos da crise sobre a saúde e a economia são distribuídos de forma extremamente desiguais.

Fatores preditores de insônia em acadêmicos de enfermagem de universidade pública / Factores predictores de insomnio en académicos de enfermería de universidad pública / Predictors of insomnia in public university nursing students

Objetivo: identificar fatores preditores de insônia em estudantes de Enfermagem. Método: estudo transversal, realizado com 199 alunos do 1º ao 10º semestre do curso de Enfermagem de uma Universidade Federal, Brasil. Os dados foram coletados no período de junho a setembro de 2019. Aplicou-se o questionário sociodemográfico e de saúde e o Sense of Coherence de Antonovsky. Resultados: as variáveis renda (p=0,016), tempo de lazer (p=0,021), horas suficientes de sono (p=0,005), uso de drogas psiquiátricas (p=0,002), plano de saúde (p=0,006), menor sensação de coerência (p=0,003), depressão moderada-grave (p=0,004) foram significativas. Regressão logística: as variáveis idade (p=0,008) e raça negra (p=0,028) foram significativas. Conclusão: os fatores sociais, individuais, acadêmicos e de saúde influenciam no desfecho da insônia.

Objetivo: identificar factores predictores de insomnio en estudiantes de Enfermería. Método: estudio transversal, realizado con 199 alumnos del 1º al 10º semestre del curso de Enfermería de una Universidad Federal, Brasil. Los datos se recopilaron entre junio y septiembre de 2019. Se aplicó el cuestionario sociodemográfico, y de salud y el Sense of Coherence de Antonovsky. Resultados: las variables renta (p=0,016), tiempo de ocio (p=0,021), horas suficientes de sueño (p=0,005), uso de drogas psiquiátricas (p=0,002), plan de salud (p=0,006), menor sensación de coherencia (p=0,003), depresión moderada-grave (p=0,004) fueron significativas. Regresión logística: las variables edad (p=0,008) y raza negra (p=0,028) fueron significativas. Consideraciones finales: se evidencia que factores sociales, individuales, académicos y de salud influyen en el desenlace del insomnio.

Objective: to identify predictors of insomnia in nursing students. Method: cross-sectional study, conducted with 199 students from the 1st to the 10th semester of the Nursing course of a Federal University, Brazil. Data were collected from June to September 2019. The sociodemographic and health questionnaire and Antonovsky's Sense of Coherence were applied. Results: income (p=0.016), leisure time (p=0.021), sufficient sleep (p=0.005), use of psychiatric drugs (p=0.002), health insurance (p=0.006), lower sense of coherence (p=0.003), moderate-severe depression (p=0.004) were significant. Logistic regression: the variables age (p=0.008) and black race (p=0.028) were significant. Final considerations: social, individual, academic and health factors influence the outcome of insomnia.

Curative effects of Beck's cognitive therapy combined with transcranial magnetic stimulation on post-stroke sleep disorders in patients / 中国基层医药

Objective:To investigate the curative effects of Beck's cognitive therapy (BCT) combined with transcranial magnetic stimulation (TMS) on post-stroke sleep disorders in patients.Methods:A total of 120 patients with post-stroke sleep disorders who were diagnosed and treated in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between January and December 2020 were included in this study. They were randomly assigned to undergo TMS (TMS group), BCT (BCT group), or TMS plus BCT (combined group) ( n = 40/group). Before and after treatment, sleep quality and mental state scores were evaluated in each group. Results:After treatment, the Pittsburgh Sleep Quality Index (PSQI) score in the combined group [(5.68 ± 0.33) points] was significantly lower than that in the TMS group [(9.11 ± 0.83) points] and BCT group [(11.37 ± 1.06) points, F = 512.63, P < 0.001]. Sleep efficiency in the combined group [(56.73 ± 2.62)%] was significantly higher than that in the TMS group [(39.55 ± 3.02)%] and BCT group [(35.23 ± 1.41)%, F = 863.59, P < 0.001]. The Self-Rating Anxiety Scale (SAS) scores and Self-Rating Depression Scale (SDS) scores were significantly lower in the combined group compared with the TMS and BCT groups ( F = 412.52, 310.60, both P < 0.001). Conclusion:BCT combined with TMS can effectively improve sleep quality and reduce negative emotions in patients with post-stroke sleep disorders.

Effects of low-frequency repetitive transcranial magnetic stimulation combined with music biofeedback on insomnia / 中国基层医药

Objective:To investigate the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with music biofeedback on insomnia.Methods:Sixty patients with insomnia who received treatment in Outpatient Department of Seventh People's Hospital of Dongyang from January to August 2021 were included in this study. They were randomly divided into an observation group ( n = 30) and a control group ( n = 30) using the random number table. The control group was given music biofeedback therapy and conventional drug treatment, and the observation group was treated with rTMS based on music biofeedback therapy. The changes in polysomnography sleep structure and Pittsburgh Sleep Quality Index score after 1 month of treatment relative to before treatment were determined in each group. Results:After 1 month of treatment, the total sleep time, sleep efficiency, rapid eye movement (REM) sleep, non-REM sleep phase II (N2%) and non-REM sleep phase III (N3%) in the observation group were (419.87 ± 42.63) minutes, (83.69 ± 13.39)%, (25.27 ± 3.26)%, (53.75 ± 11.36)% and (16.27 ± 2.25)%, respectively, and they were (388.74 ± 40.39) minutes, (76.38 ± 13.17)%, (23.16 ± 2.68)%, (51.62 ± 12.27)%, and (14.36 ± 2.21)%, respectively. There were significant differences in these indices between the two groups ( t = -2.90, -2.13, -2.22, -2.26, -3.31, P = 0.005, 0.037, 0.030, 0.027, 0.002). The sleep latency, actual wake time, numbet of awakenings, non-REM sleep phase I (N1%), and total score of Pittsburgh Sleep Quality Index in the observation group were (24.16 ± 7.82) minutes, (23.18 ± 6.95) minutes, (1.76 ± 0.28) times, (9.74 ± 2.12)%, (9.17 ± 1.56) minutes, respectively. They were (28.35 ± 7.74) minutes, (28.36 ± 7.21) minutes, (2.25 ± 0.79) times, (11.12 ± 1.17)%, and (10.26 ± 1.42) minutes, respectively in the control group. There were significant differences in these indices between the two groups ( t = 2.09, 2.83, 3.20, 3.12, 2.83, P = 0.041, 0.006, 0.002, 0.003, 0.038). Conclusion:rTMS combined with music biofeedback for the treatment of insomnia can effectively improve sleep quality in patients with insomnia.

Chronic insomnia disorder as risk factor for stroke: a systematic review / Distúrbio de insônia crônica como fator de risco para acidente vascular cerebral: uma revisão sistemática

Abstract Background Stroke is one of the main causes of mortality worldwide. Nonetheless, there are still risk factors that have not been fully elucidated, such as chronic insomnia disorder. Objective To evaluate the association between chronic insomnia disorder and the risk of stroke in adults, through a systematic review. Methods Multiple studies available in the Embase, Lilacs, and Medline platforms were evaluated in English, Spanish, French, and Portuguese. The selection of papers was restricted to those that had investigated the association between chronic insomnia disorder and stroke in adults, regardless of gender or nationality, without a previous history of stroke. The data was extracted with the Cochrane Effective Practice and Organization of Care (EPOC) form. The risk of bias was evaluated by the EPOC Risk of bias tool. Results A total of 138 articles were identified. After a detailed evaluation with the eligibility criteria, four articles were included in the present systematic review. Three of them recognized the association between chronic insomnia disorder and stroke. The comparative analysis was limited, since the studies used distinct insomnia classifications. Regarding the risk of bias, the analysis displayed an important risk in the selection and allocation of participants, besides the use of own insomnia diagnosis criteria, disrespecting chronology and factors indicated by already established classifications. Conclusions There is not enough data to determine that chronic insomnia disorder is a risk factor for stroke. The present study points out the existence of a possible relationship between insomnia disorder and stroke, suggesting that further studies adopt standardized criteria and instruments.

Resumo Antecedentes O acidente vascular cerebral (AVC) é uma das maiores causas de mortalidade do mundo. Ainda assim, existem fatores de risco não identificados, como o transtorno de insônia crônica. Objetivo Avaliar a associação entre distúrbio crônico de insônia e o risco de AVC em adultos, por meio de uma revisão sistemática. Métodos Foram avaliados estudos publicados em inglês, espanhol, francês e português, disponíveis nas plataformas Embase, Lilacs e Medline. Os estudos incluídos foram aqueles que investigaram a associação entre transtorno de insônia crônica e AVC em adultos, sem restrição de gênero ou de nacionalidade, sem história prévia de AVC. Os dados foram extraídos baseados no formulário da Cochrane Effective Practice and Organisation of Care (EPOC, na sigla em inglês). O risco de viés foi avaliado por meio da ferramenta EPOC Risk of bias tool. Resultados Foram identificados 138 artigos, entre os quais, após avaliação detalhada para os critérios de elegibilidade, 4 foram incluídos na revisão sistemática. Destes, três encontraram associação entre insônia e AVC. Contudo, a análise comparativa apresenta limitações, pois nenhum dos estudos utilizou uma classificação comum de insônia. Quanto à análise do risco de viés, os estudos demonstraram um importante risco de viés na seleção e na alocação de participantes, além de utilizarem critérios diagnósticos de insônia próprios, sem respeitar cronologia e fatores indicados por classificações já estabelecidas. Conclusões Não existem dados suficientes para determinar que o transtorno crônico de insônia se configura como fator de risco para AVC. A análise aponta para a existência de uma possível relação, sugerindo-se para estudos posteriores o uso de critérios e instrumentos padronizados.

What's new in insomnia? Diagnosis and treatment / Quais a novidades em insônia? Diagnóstico e tratamento

ABSTRACT Although, insomnia is one of the most common diseases that health professionals face in their practice, it receives little attention in medical training. Diagnosis is based on a careful history taking, and physicians must be aware of the diagnostic criteria. Insomnia should not be considered a symptom, but a comorbid condition. Although cognitive behavioral therapy (CBT) has been the mainstay treatment for insomnia for many years, it is usually regarded as a novel therapeutic strategy, both because of scarcity of qualified psychologists and of limited knowledge about insomnia among physicians. GABA receptor acting drugs are being abandoned in the treatment of insomnia because of abuse and dependence potential and accident risk. Two main current therapeutic options with the best scientific evidence are the tricyclic antidepressant, doxepin, and a new melatoninergic receptor agonist, ramelteon. Newer drugs to treat insomnia are in the pipeline. Hypocretine blocking agents will be marketed in the near future.

RESUMO Embora a insônia seja uma das doenças mais comuns encontrada por profissionais de saúde em sua prática quotidiana, está ainda é negligenciada nos currículos médicos. O diagnóstico baseia-se em anamnese cuidadosa e os médicos devem conhecer os critérios diagnósticos. A insônia não deve ser considerada apenas um sintoma, mas uma comorbidade. Apesar de a terapia cognitivo comportamental (TCC) para insônia ser a principal opção terapêutica há muito anos, esta modalidade terpêutica ainda é considerada uma nova estratégia pela escassez de psicólogos qualificados e pelo desconhecimento médico acerca da insônia. Os fármacos que atuam nos receptores GABA vêm sendo abandonados no tratamento da insônia devido ao potencial de abuso e dependência e pelo risco de acidentes. As duas principais opções terapêutica para insônia com melhor evidência científica são um antigo antidepressivo tricíclico, a doxepina, e um novo agonista do receptor melatoninérgico, a ramelteona. Novas drogas para insônia estão em processo de aprovação regulatória e comercialização. As mais próximas de serem liberadas para o mercado são as drogas bloqueadoras do sistema da hipocretina.

Saúde Mental, Uso de Álcool e Qualidade do Sono em Estudantes de uma Universidade Pública / Mental Health, Alcohol Use and Sleep Quality by Students in a Public University / Salud Mental, Consumo de Alcohol y Calidad del Sueño en Estudiantes de una Universidad Pública

Este estudo analisou os aspectos cognitivos e comportamentais dos estudantes de uma universidade pública durante a graduação, considerando autopercepção de depressão, ansiedade e estresse, bem como uso de substâncias psicoativas e qualidade do sono. Foi realizado um delineamento longitudinal com 34 estudantes ingressantes em 2015/1 e formandos em 2018/2, aplicando-se questionário online. Do total de universitários, 22 eram mulheres e 12 eram homens, sendo que o consumo de drogas aumentou para ambos os sexos. A frequência da percepção de processos depressivos aumentou no fim do curso, enquanto a de ansiedade diminuiu, para ambos os sexos. Os dados de percepção do estresse mostraram aumento na frequência total. Houve correlação positiva fraca entre depressão e ansiedade ou estresse, mas correlação positiva moderada entre estresse e ansiedade no final do curso. Ainda, obteve-se um aumento expressivo de distúrbio do sono em homens e mulheres, porém de forma significativa apenas para os primeiros. Foi notada correlação positiva fraca entre a percepção de depressão, ansiedade ou estresse no final do curso. Faz-se necessário o acompanhamento multiprofissional do universitário, auxiliando na maneira de lidar com as dificuldades, bem como medidas de melhoria da qualidade de vida e sono.

This study analyzed cognitive and behavioral aspects of students at a public university during undergraduate study, considering self-perception of anxiety, depression and stress, as well as psychoactive substance use and sleep quality. A longitudinal project was conducted with 34 students entering in 2015/1 and graduating in 2018/2, applying an online questionnaire. Of the total of students, 22 were women and 12 were men, and drug use increased for both sexes. The frequency of perception of depressive processes increased at the end of the course, while anxiety decreased, for both sexes. Stress perception data showed an increase in total frequency. There was a weak positive correlation between depression and anxiety or stress, but a moderate positive correlation between stress and anxiety at the end of the course. It is still possible to notice that there was a significant increase in sleep disorders in men and women, but significantly only for the first. A weak positive correlation was noticed between the perception of depression, anxiety or stress at the end of the course. The multidisciplinary follow-up of the university student is necessary in order to assist in dealing with difficulties, as well as measures to improve quality of life and sleep.

Este estudio analizó los aspectos cognitivos y conductuales de los estudiantes en una universidad pública durante la graduación, considerando la autopercepción de depresión, ansiedad y estrés, así como el uso de sustancias psicoactivas y la calidad del sueño. Se realizó un diseño longitudinal con 34 estudiantes que ingresaron en 2015/1 y graduaron en 2018/2 aplicando un cuestionario en línea. El total de estudiantes universitarios, 22 eran mujeres y 12 hombres, con un mayor consumo de drogas para ambos los sexos. La frecuencia de percepción de los procesos depresivos aumentó al final del curso, mientras que la ansiedad disminuyó para ambos os sexos. Los datos para el estrés aumentaron en la frecuencia total. Hubo una correlación positiva débil entre la depresión y la ansiedad o el estrés, pero una correlación positiva moderada entre el estrés y la ansiedad al final del curso. Aun así, el aumento significativo en los trastornos del sueño en hombres y mujeres, sin embargo significado solamente para él primer. Una correlación positiva débil con depresión, ansiedad o estrés fue percibida al final del curso. Se hace necesario el acompañamiento multiprofesional de estudiantes universitarios, a fin de ayudar en la forma de tratar las dificultades, así como medidas para mejorar la calidad de vida y el sueño.

Physical exercise as a therapeutic approach for adults with insomnia: systematic review and meta-analysis

ABSTRACT Objective To systematically review the effects (benefits and harms) of different types of physical exercise on insomnia outcomes in adult populations with no mood disorders. Objective and subjective sleep outcomes and related mismatches were analyzed. Methods Systematic review and meta-analysis. Quality of evidence was also examined. Results Six studies including 295 participants with insomnia diagnosis were selected. Yoga, Tai Chi, resistance exercise and aerobic exercise were used in protocols with different duration, intensity and frequency. Studies involved different populations, including inactive or sedentary individuals, older adults and postmenopausal women. Physical exercise improved subjective sleep quality (very low quality of evidence) and reduced insomnia severity (high quality of evidence). Conclusion Findings suggest individualized physical exercise must be addressed to design optimal protocols, with standardized type, duration, intensity, and frequency. For the time being, physical exercise may be considered an alternative and/or ancillary therapeutic modality for patients diagnosed with insomnia. Physical exercise can be used to improve subjective complaints, but not objective sleep outcomes.

Factors associated with sleep problems and sleeping pill use in Brazilians / Fatores associados aos problemas de sono e ao uso de medicação para dormir em brasileiros

ABSTRACT OBJECTIVE To estimate the prevalence of sleep problems and sleeping pill use and associated factors in the Brazilian population. METHODS This study was conducted with data from the 2019 Brazilian National Health Survey. Our sample consisted of 94,114 participants and the outcomes analyzed were sleep problems and sleeping pill use. Sociodemographic, lifestyle, and health characteristics were explored in a descriptive and multivariate analysis with Poisson regression, robust variance, and 5% significance. RESULTS We found a 35.1% (95%CI: 34.5-35.7) and 8.5% (95%CI: 8.2-8.9) prevalence of sleep problems and sleeping pill use, respectively. Sleep problems were associated with women (PR = 1.41; 95%CI: 1.36-1.46), individuals who self-assess their health as regular/poor/very poor (PR = 1.56; 95%CI: 1.51-1.62), those with chronic diseases (PR = 1.70; 95%CI: 1.64-1.78), those who use alcohol excessively (PR = 1.14; 95%CI: 1.09-1.20), and smokers (PR = 1.16; 95%CI: 1.10-1.22). Sleeping pill use was associated with women (PR = 1.57; 95%CI: 1.43-1.73), divorcees (PR = 1.46; 95%CI: 1.30-1.65), urban denizens (PR = 1.32; 95%CI: 1.21-1.45) those who self-assess their health as regular/poor/very poor (PR = 1.79; 95%CI: 1.64-1.95), those with chronic diseases (PR = 4.07; 95%CI: 3.48-4.77), and smokers (PR = 1.49; IC95%: 1.33-1.67). CONCLUSION This study found that the prevalence of sleep problems and sleeping pill use in Brazilians indicates the need for attention and sleep care for this population, especially in women and those with lifestyle and health conditions associated with the analyzed outcomes.

RESUMO OBJETIVO Estimar a prevalência e fatores associados a problemas de sono e uso de medicamentos para dormir na população brasileira. MÉTODOS Estudo executado com os dados da Pesquisa Nacional de Saúde realizada no Brasil, nos anos de 2019 e 2020. A amostra foi composta por 94.114 participantes e os desfechos analisados foram problemas de sono e uso de medicamentos para dormir. Aspectos sociodemográficos, de estilo de vida e condições de saúde foram explorados em uma análise descritiva e multivariada, utilizando a regressão de Poisson com variância robusta, considerando nível de significância de 5%. RESULTADOS As prevalências de problemas de sono e uso de medicamentos indutores do sono foram de 35,1% (IC95% 34,5-35,7) e 8,5% (IC95% 8,2-8,9), respectivamente. Os problemas de sono foram associados ao sexo feminino (RP = 1,41; IC95% 1,36-1,46), aos indivíduos que autoavaliam a saúde como regular/ruim/muito ruim (RP = 1,56; IC95% 1,51-1,62), aos que possuem alguma doença crônica (RP = 1,70; IC95% 1,64-1,78), aos que fazem uso excessivo de álcool (RP = 1,14; IC95% 1,09-1,20) e aos fumantes (RP = 1,16; IC95% 1,10-1,22). O uso de medicamentos para dormir foi associado ao sexo feminino (RP = 1,57; IC95% 1,43-1,73), a indivíduos divorciados (RP = 1,46; IC95% 1,30-1,65), aos que vivem no meio urbano (RP = 1,32; IC95% 1,21-1,45), que autoavaliam sua saúde como regular/ruim/muito ruim (RP = 1,79; IC95% 1,64-1,95), com diagnóstico de doença crônica (RP = 4,07; IC95% 3,48-4,77) e aos fumantes (RP = 1,49; IC95% 1,33-1,67). CONCLUSÃO As prevalências de problemas de sono e uso de medicamentos para dormir na população brasileira observadas neste estudo indicam a necessidade de atenção e cuidado com o sono dessa população, principalmente nas mulheres e aqueles que apresentam estilo de vida e condições de saúde que se associaram aos desfechos.

An adjustable anti-snoring device improves brain oxygen supply and chronic cerebral circulation insufficiency in patients with obstructive sleep apnea syndrome / 中国基层医药

Objective:To investigate the efficacy of an adjustable anti-snoring device in improving brain oxygen supply and chronic cerebral circulation insufficiency in patients with obstructive sleep apnea syndrome (OSAS).Methods:Thirty-four patients with OSAS who received treatment in Huidong People's Hospital from January to September 2018 were included in the OSAS group. An additional 34 sex- and age-matched healthy volunteers who concurrently received physical examination were included in the control group. Apnea-hypopnea index score for each patient was determined by polysomnography. Cerebral blood flow velocity was measured by transcranial Doppler ultrasonography. Forearm blood flow was measured by venous occlusion plethysmography. Heart rate was obtained by electrocardiography. Arterial oxygen saturation (SaO 2) was obtained using pulse oximetry. Blood pressure was obtained by an automatic sphygmomanometer. Peripheral and cerebral hemodynamics of patients with OSAS were measured. Nighttime sleep quality of patients was assessed using polysomnography. Lateral projection of the skull was photographed using an X-ray machine for correcting measurement results. Results:There were no significant differences in sex and age between OSAS and control groups (both P > 0.05). Body mass index, Apnea-hypopnea index score and the percentage of time spent at SaO 2 below 90% in the OSAS group were significantly higher than those in the control group (all P < 0.05). The lowest SaO 2 value in the OSAS group was significantly lower than that in the control group ( P < 0.05). Heart rate and forearm blood flow in the OSAS group were (76.27 ± 9.34) beats/min and (7.24 ± 3.13) mL·100 mL -1·min -1, respectively, which were significantly higher than those in the control group [(65.42 ± 6.38) beats/min, (4.11 ± 1.25) mL·100 mL -1·min -1]. After treatment with an adjustable anti-snoring device, heart rate and forearm blood flow in the OSAS group were (66.17 ± 4.53) beats/min and (4.54 ± 3.26) mL·100 mL -1·min -1, respectively, which were significantly lower than those in the control group ( F = 2.66, 0.85, both P < 0.05). Peripheral oxygen saturation, tissue oxygen saturation, and total hemoglobin in the OSAS group were significantly lower than those in the control group. These indexes in the anti-snoring device treatment group were significantly higher than those in the OSAS group ( F = 12.33, 13.57, 14.22, all P < 0.05). The number of snorings and number of wake-ups from sleep in the anti-snoring device treatment group were significantly lower compared with those in the OSAS group ( χ2 = 13.14, 12.36, both P < 0.05).Palatopharyngeal diameter, glossopharyngeal diameter and laryngopharyngeal diameter in the anti-snoring device treatment group were significantly higher than those in the OSAS group, and they were almost close to the levels of healthy people ( t = 11.46, 15.13, 12.58, all P < 0.05). Conclusion:Adjustable anti-snoring device can improve brain oxygen supply and chronic cerebral circulation insufficiency in patients with OSAS, in particular with mild and moderate OSAS.

Using "WeChat Sports" program to explore the relationship between number of steps and insomnia in patients with chronic insomnia / 中国基层医药

Objective:To investigate the relationship between number of daily steps and insomnia in patients with chronic insomnia using "WeChat Sports" program.Methods:A total of 190 patients with insomnia who received treatment in Department of Neurology, Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou Hospital between October 2017 and October 2019. General data (age, sex, body mass index, history of smoking and alcohol use) and the number of daily steps recorded by "WeChat Sports" program were collected. Patients whose average number of daily steps was greater than 7500 were assigned to the sufficient exercise group ( n = 68), and the remaining patients were assigned to the insufficient exercise group ( n = 122). Patient symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), The Patient Health Questionnaire-9, and generalized Anxiety Disorder scale-7. Scale evaluation and data collection were performed by two trained investigators. Data were compared between the two groups. The correlation between average number of daily steps and each scale score was analyzed. Results:Total PSQI score in the sufficient exercise group was significantly lower than that in the insufficient exercise group [(12.94 ± 3.14) points vs. (14.93 ± 2.99) points, t = 4.31, P < 0.001]. Scores of subjective sleep quality, sleep latency, habitual sleep efficiency, use of sleep medication, and daytime dysfunction were significantly lower in the sufficient exercise group than those in the insufficient exercise group ( P = 0.011, 0.008, 0.025, 0.039, 0.006). The Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7 scores in the sufficient exercise group were significantly lower than those in the insufficient exercise group ( P = 0.011, P = 0.002). The average number of daily steps was significantly negatively correlated with total PSQI score, Patient Health Questionnaire-9 score, Generalized Anxiety Disorder Scale-7 score, and score of each PSQI component (subjective sleep quality, sleep latency, habitual sleep efficiency, and daytime dysfunction) ( r = -0.29, -0.16, -0.19, -0.24, -0.15, -0.18, -0.23). Conclusion:Insomnia patients with insufficient daily exercise have more serious insomnia and emotional symptoms than those with sufficient daily exercise. Daily average exercise is correlated with the severity of insomnia and emotional symptom.

Uso de hipnóticos, qualidade do sono e síndrome de Burnout em estudantes de medicina / Use of hypnotics, sleep quality and Burnout syndrome in medical students / Uso de hipnóticos, calidad del sueño y síndrome de Burnout en estudiantes de medicina

OBJETIVO: o objetivo deste estudo foi investigar possíveis associações entre Burnout, uso de hipnóticos e qualidade do sono em estudantes de medicina. MÉTODO: foi realizado um estudo transversal quantitativo com estudantes de medicina de um centro universitário do nordeste do Brasil, com metodologia de Aprendizagem Baseada em Problemas (ABP). O Maslach Burnout Inventory-Student Survey, o Pittsburgh Sleep Quality Index (PSQI) e um questionário sociodemográfico foram aplicados entre os alunos do pré-internato do curso. RESULTADOS: o estudo incluiu 523 alunos e encontrou 48 (9,2%) com critérios de diagnóstico tridimensional para Síndrome de Burnout (SB). A má qualidade do sono e o uso de hipnóticos para dormir foram associados à SB (p < 0,001 e p = 0,003, respectivamente). Não houve diferenças estatísticas quanto à idade, sexo, religião, estado civil, financiamento escolar e realização de trabalho remunerado, entre indivíduos com e sem SB. CONCLUSÃO: houve associação entre SB, uso de hipnóticos e má qualidade do sono em estudantes de medicina pré-internato.

OBJECTIVE: the aim of this study was to investigate possible associations between Burnout, use of hypnotics and sleep quality among medical students. METHOD: a cross-sectional quantitative study was conducted among medical students of a university center of northeastern Brazil, with the problem-based learning (PBL) methodology. The Maslach Burnout Inventory-Student Survey, the Pittsburgh Sleep Quality Index (PSQI) and a sociodemographic questionnaire were applied among pre-clerkship students of the course. RESULTS: the study included 523 students and found 48 (9.2%) with tridimensional diagnosis criteria for Burnout syndrome (BS). Poor sleep quality and use of hypnotic drugs for sleep were associated with BS (p < 0.001 and p = 0.003, respectively). There were no statistical differences in age, gender, religion, marital status, student financing and performing paid work, between individuals with and without BS. CONCLUSION: there was an association between BS, use of hypnotics and poor sleep quality among pre-clerkship medical students.

OBJETIVO: el objetivo de este estudio fue investigar las posibles asociaciones entre el síndrome de Burnout, el uso de hipnóticos y la calidad del sueño entre estudiantes de medicina. MÉTODOS: se realizó un estudio cuantitativo transversal entre estudiantes de medicina de un centro universitario del noreste de Brasil, con metodología de aprendizaje basado en problemas (ABP). Se aplicó el Maslach Burnout Inventory-Student Survey, el Pittsburgh Sleep Quality Index (PSQI) y un cuestionario sociodemográfico entre los estudiantes de pre-administrativo del curso. RESULTADOS: el estudio incluyó a 523 estudiantes y encontró 48 (9,2%) con criterios de diagnóstico tridimensional de síndrome de Burnout (SB). La mala calidad del sueño y el uso de fármacos hipnóticos para dormir se asociaron con SB (p <0,001 y p = 0,003, respectivamente). No hubo diferencias estadísticas en edad, sexo, religión, estado civil, financiamiento de los estudiantes y realización de trabajo remunerado, entre individuos con y sin SB. CONCLUSIÓN: hubo asociación entre SB, uso de hipnóticos y mala calidad del sueño entre los estudiantes de medicina antes de la rotación clínica.

Trastornos del sueño en personas mayores. ¿Cómo duermen las personas mayores de la Ciudad de México? / Sleep disorders in older people. How do older people from Mexico City sleep?

Introducción: el buen sueño es esencial para la salud física y mental a lo largo de la vida. Sin embargo, existen pocos reportes sobre los problemas del sueño que enferentan las personas mayores que viven en la comunidad. Objetivo: describir la prevalencia de los principales problemas de sueño y su relación con condiciones médicas en las personas mayores que viven en la comunidad. Material y métodos: estudio transversal descriptivo con 1678 personas de 60 años y más, derechohabientes del Instituto Mexicano del Seguro Social (IMSS) en la Ciudad de México. Se evaluó la duración del sueño, la calidad del sueño, la somnolencia diurna, el insomnio y el riesgo de apnea obstructiva de sueño, junto con algunas variables sociodemográficas y condiciones médicas. Resultados: las personas mayores reportaron dormir, en promedio, 6.04 (± 1.5) horas por noche; el 49.1% tenía baja calidad del sueño y el 19.1% experimentaba somnolencia diurna; el 30.8% presentó insomnio y el 27.5% tenía riesgo de apnea obstructiva del sueño. Se observó un patrón de mayor prevalencia de problemas de sueño en las personas mayores con depresión, deterioro cognitivo, dificultades para realizar actividades básicas de la vida diaria y en quienes consumían medicamentos para el sistema nervioso. Conclusiones: este estudio mostró que las personas mayores duermen pocas horas, tienen baja calidad de sueño y prevalencia alta de trastornos del sueño. La identificación y el tratamiento de los problemas del sueño en las personas mayores debe ser una prioridad en el IMSS.

Background: Good sleep is essential for physical and mental health throughout life. However, there are few reports describing the sleep problems experienced by community-dwelling older people. Objective: To describe the prevalence of sleep disorders and their relationship with medical conditions in community-dwelling older people. Methods: Cross-sectional study with 1678 older people (60 years and over) from the Mexican Institute of Social Security (IMSS) in Mexico City. Sleep duration, sleep quality, daytime sleepiness, insomnia and risk of obstructive sleep apnea were evaluated, alongside with sociodemographic variables and medical conditions. Results: Participants self-reported an average sleep duration of 6.04 (± 1.5) hours per night, approximately half had poor sleep quality (49.1%), and 2 out of 10 experienced daytime sleepiness (19.1%); one third had insomnia (30.8%) and risk of obstructive sleep apnea (27.5%). A pattern of higher prevalence of sleep problems was observed in older adults with depression, with cognitive impairment, with difficulties in basic activities of daily living and in those taking medications for the nervous system. Conclusions: This study showed that older people sleep few hours, have low sleep quality, and have a high prevalence of sleep disorders. The identification and treatment of sleep disordes in older people should be a priority in the IMSS.

Somnolencia diurna y calidad de sueño en el rendimiento escolar de adolescentes de una institución educativa estatal

Objetivo. Determinar la asociación entre la somnolencia diurna (SD) y calidad de sueño (CS) con el rendimiento escolar (RE) de adolescentes de la Institución Educativa "Emblemática" Ventura Ccalamaqui, Barranca, 2018. Métodos. Estudio no experimental y transversal. Participaron 217 adolescentes del tercer y cuarto año de educación secundaria. Se aplicó la Escala de Somnolencia de Epworth y el Índice de Calidad de Sueño de Pittsburgh. El rendimiento escolar se determinó por la calificación en comunicación y matemática (asignaturas usadas por la comunidad internacional) y se clasificó de acuerdo al currículo nacional (AD, A, B, C). Resultados. La edad promedio de los adolescentes fue de 15,9 ± 0,6 años, donde el 51,2% fueron del sexo femenino, el 51,6% consumía café, té y/o gaseosas menos de una vez por semana. Se observó que el 49,7% presentaba somnolencia diurna, el 84,8% tenía problemas de sueño y el 52,1% presentó un rendimiento esperado. La somnolencia diurna se asoció significativamente con el rendimiento escolar (p=0,004); los estudiantes con SD presentaron RE esperado y en proceso, los estudiantes sin SD presentaron RE destacado, esperado y en proceso. La calidad de sueño de los adolescentes se asoció significativamente con su rendimiento escolar (p=0,045) y en la somnolencia diurna (p=0,015). Conclusiones. La somnolencia diurna y la calidad de sueño se asociaron con el rendimiento escolar de los adolescentes de la Institución Educativa "Emblemática" Ventura Ccalamaqui, Barranca, 2018.

Objective. To determine the association between daytime sleepiness and sleep quality with school performance in adolescents of the Institution Educative "Emblemática" Ventura Ccalamaqui, Barranca, 2018. Methods. Non-experimental and cross-sectional study. The sample included 217 adolescents of third and fourth year of secondary school. The Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index were applied. School performance was determined by the grade in communication and mathematics (subjects used by the international community) and was classified according to the National Curriculum (AD, A, B, C). Results. The average age of the adolescents was 15.9 ± 0.6 years, where 51.2% were female, 51.6% consumed coffee, tea and / or soft drinks less than once a week. It was observed that 49.7% suffered from daytime sleepiness, 84.8% had sleep problems and 52.1% presented an expected performance. Daytime sleepiness was significantly associated with school performance (p=0.004); students with daytime sleepiness presented expected and in-process school performance, students without daytime sleepiness presented outstanding, expected and ongoing school performance. The quality of sleep of adolescents was significantly associated with their school performance (p=0.045) and daytime sleepiness (p=0.015). Conclusions. Daytime sleepiness and sleep quality were associated with school performance, in adolescents of the Institution Educative "Emblemática" Ventura Ccalamaqui, Barranca, 2018.

Reacciones adversas a montelukast: de la teoría a la práctica. Serie de casos / Adverse drug reactions of montelukast: from theory to practice. Case report

El montelukast se utiliza ampliamente en el tratamiento de sibilancias recurrentes y/o asma. Están descritas numerosas reacciones adversas medicamentosas (RAM) en niños relacionadas con montelukast; se destacan las neuropsiquiátricas. Realizamos un estudio observacional, retrospectivo, descriptivo, sobre RAM relacionadas con montelukast. Entre enero de 2012 y diciembre de 2017, en la Unidad de Neumonología Pediátrica se trataron con Montelukast 348 pacientes; de ellos, 20 presentaron RAM. Los síntomas más frecuentes fueron insomnio (n = 7), hiperactividad (n = 4), pesadillas (n = 3), dolor abdominal (n = 2) y parestesias en extremidades (n = 2). Se presentaron desde días hasta meses tras iniciar el tratamiento, y desaparecieron tras su suspensión. Se destacan dos pacientes con parestesias en extremidades, síntoma no descrito antes en niños. El 5,7 % de los pacientes tratados con montelukast presentaron RAM que requirieron suspender el tratamiento. Los trastornos del sueño fueron los más frecuentes.

Montelukast is widely used in recurrent wheezing and/or asthma treatment. Several adverse drug reactions (ADRs) have been described in children related to montelukast. Neuropsychiatric reactions are one of the most important. We designed an observational, retrospective, descriptive study on ADRs related to montelukast in the Pediatric Pulmonology Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain. Between January 2012 and December 2017, in the Pediatric Pulmonology Unit, 348 patients were treated with Montelukast; of them, 20 presented RAM. The main symptoms described were insomnia (n = 7), hyperactivity (n = 4), nightmares (n = 3), abdominal pain (n = 2) and paraesthesia in extremities (n = 2). They appeared from the first days to months after the start of treatment and disappeared after stopping it. Two patients presented limb paresthesia, not described previously in children. The 5.7 % of our patients treated with montelukast had ADRs that required treatment discontinuation. Sleep disorders were the most frequent.

Somnolencia diurna excesiva identificada con la escala de Epworth en gestantes que acuden a consulta prenatal ambulatoria / Excessive daytime sleepiness identified with the Epworth scale in pregnant women attending an outpatient prenatal consultation

INTRODUCCIÓN: Durante el embarazo se reportan a menudo trastornos del sueño, pero son poco explorados en el control prenatal. El objetivo fue estimar la frecuencia e identificar los factores asociados a somnolencia diurna excesiva (SDE) en gestantes de bajo riesgo obstétrico que acudieron a consulta prenatal. MÉTODO: Estudio transversal dentro del proyecto «Salud biopsicosocial en gestantes», aprobado por el comité de ética de la Clínica Santa Cruz de Bocagrande, Cartagena, Colombia. Se estudiaron mujeres con 12 o más semanas de gestación. Se aplicó un formulario que incluía las escalas de somnolencia diurna de Epworth (ESE), de estrés percibido de 10 ítems (EPP-10) y revisada de depresión del Centro de Estudios Epidemiológicos (CESD-R10). Se realizó regresión logística ajustada y no ajustada de SDE con las otras escalas y variables cualitativas. Se buscó correlación entre variables cuantitativas y la escala de Epworth. Se consideró significativo p < 0,05. RESULTADOS: Se estudiaron 683 mujeres de 28,3 ± 6,3 años y 31,5 ± 6,9 semanas de gestación. Puntuación en la escala de Epworth: 3,82 ± 3,45. En el 4,9% se identificó SDE: 50% leve, 32,2% moderada y 17,6% importante. No se observó en el primer trimestre de gestación y la frecuencia fue similar en los otros; la SDE importante solo se observó en el tercer trimestre. Depresión: odds ratio [OR]: 3,69, intervalo de confianza del 95% [IC95%]:1,83-7,43. Anemia: OR 3,10, IC95%:1,50-6,38. Fatiga: OR 3,22, IC95%:1,23-8,44. Nerviosismo: OR 2,49, IC95%:1,22-5,12. Estrés: OR: 2,38, IC95%:1,12-5,05. Gran paridad: OR: 2,64, IC95%: 1,01-6,89. Trabajar fuera de casa: OR: 2,33, IC95%: 1,05-5,15. Todas estas variables se asociaron con SDE. En el modelo ajustado, la anemia (OR: 3,05, IC95%: 1,44-6,45) y la depresión (OR: 2,72, IC95%: 1,26-5,85) conservaron la asociación. Se observó correlación positiva, despreciable y estadísticamente significativa, de la ESE con la CESD-R10 y con la EPP-10; y ausencia de correlación con la edad materna, la edad gestacional, el número de abortos y el número de cesáreas. CONCLUSIONES: En una de cada 20 gestantes de bajo riesgo obstétrico se identificó SDE, y varias situaciones biopsicosociales se asociaron con mayor presencia.

INTRODUCTION: Sleep disturbances are constantly reported during pregnancy, although they are not often taken care of in prenatal care. The aim was to estimate the regularity and identify factors associated with excessive daytime sleepiness (EDS) in pregnant women at low obstetric risk who attended prenatal consultation. METHOD: Cross-sectional study belonging to the project “Biopsychosocial health in pregnant women”, approved by the ethics committee of the Santa Cruz de Bocagrande Clinic, Cartagena, Colombia. Pregnant women with 12 or more weeks of gestation were studied. A form including: Epworth Daytime Sleepiness Scale, 10-item Perceived Stress and the Revised Depression Scale of the Centre for Epidemiological Studies was applied. Adjusted and unadjusted logistic regression was performed between EDS with the other scales and qualitative variables. In addition, correlation between quantitative variables and the Epworth scale. P<0.05 was significant. RESULTS: 683 pregnant women were studied, maternal age 28.3 ± 6.3 years and gestational age 31.5±6.9 weeks. Epworth Scale score: 3.82 ± 3.45. EDS was identified in 4.9%, 50% mild, 32.2% moderate and 17.6% severe. It was not observed in the first gestational trimester and the frequency was similar in the others, severe EDS only in the third trimester. Depression OR: 3.69 [95% CI: 1.83-7.43], anemia OR: 3.10 [95% CI: 1.50-6.38], fatigue OR: 3.22 [95% CI: 1.23-8.44], nervousness OR: 2.49 [95% CI: 1.22-5.12, stress OR: 2.38 [95% CI: 1.12-5.05], high parity OR: 2.64 [95% CI: 1.01-6.89] and working outside the home OR: 2.33 [95% CI: 1.05-5.15, were associated with EDS. In the adjusted model, anemia OR: 3.05 [95% CI: 1.44-6.45] and depression OR: 2.72 [95% CI: 1.26-5.85] retained the association. CONCLUSIONS: In one out of every twenty low obstetric risk pregnant women EDS was identified and several biopsychosocial situations were associated with more presence.