Self-reported and objective sleep duration in patients with CKD: are they telling the same story? / Duração do sono autorrelatada e objetiva em pacientes com DRC: contam a mesma história?

Abstract Introduction: There is disagreement between data on sleep duration obtained from questionnaires and objective measurements. Whether this is also true for individuals with CKD is unknown. Here we compared self-reported sleep duration with sleep duration obtained by actigraphy. Methods: This prospective study included adult individuals with stage 3 CKD recruited between September/2016 and February/2019. We evaluated subjective sleep duration by asking the following question: "How many hours of actual sleep did you get at night?" Results: Patients (N=34) were relatively young (51 ± 13 years). Self-reported and measured sleep duration were 7.1 ± 1.7 and 6.9 ± 1.6 hours, respectively, with no correlation between them (p=0.165). Although the mean difference between measurements was 0.21 h, the limits of agreement ranged from -3.7 to 4.1 h. Conclusion: Patients with CKD who are not on dialysis have an erroneous sleep perception. Data on sleep duration should be preferentially obtained from objective measurements in patients with CKD.

Resumo Introdução: Há discordância entre os dados sobre duração do sono obtidos a partir de questionários e medições objetivas. Não se sabe se isto também é verdade para indivíduos com DRC. Aqui comparamos a duração do sono autorrelatada com a duração do sono obtida por meio de actigrafia. Métodos: Este estudo prospectivo incluiu indivíduos adultos com DRC estadio 3 recrutados entre Setembro/2016 e Fevereiro/2019. Avaliamos a duração subjetiva do sono, fazendo a seguinte questão: "Quantas horas de sono real você teve à noite?" Resultados: Os pacientes (N=34) eram relativamente jovens (51 ± 13 anos). A duração do sono autorrelatada e mensurada foi de 7,1 ± 1,7 e 6,9 ± 1,6 horas, respectivamente, sem correlação entre elas (p=0,165). Embora a diferença média entre as medições tenha sido de 0,21 h, os limites de concordância variaram de -3,7 a 4,1 h. Conclusão: Pacientes com DRC que não estão em diálise apresentam uma percepção equivocada do sono. Dados sobre a duração do sono devem ser obtidos preferencialmente a partir de medições objetivas em pacientes com DRC.

Morningness/eveningness in gestational diabetes mellitus: clinical characteristics and maternal-neonatal outcomes

ABSTRACT Objective: This study aims to evaluate the impact of morning-evening preference in pregnancy outcomes in gestational diabetes mellitus (GDM). Materials and methods: This is a prospective cohort study of 2nd-3rd trimester GDM outpatient care in Fortaleza, Brazil (2018-2020). Eveningness was defined by the Horne-Östberg Morningness-Eveningness-Questionnaire (MEQ ≤ 41). Furthermore, we obtained a 7-day actigraphic register. Subjective sleep quality, daytime somnolence, insomnia, fatigue and depressive symptoms were also evaluated. Associations with pregnancy outcomes were investigated. Results: Among 305 patients with GDM, evening preference was found in 21 (6.9%). Patients with evening preference had worse sleep quality (p < 0.01), greater severity of insomnia (p < 0.005), fatigue (p < 0.005) and depressive symptoms (<0.009). Evening chronotype was associated with preeclampsia [p = 0.01; OR = 0.27; CI 0.09-0.79] and a greater need for admission to a neonatal intensive care unit (NICU) [p = 0.02; OR = 0.23; CI .0.06-0.80]. A lower MEQ score confirmed an association with preeclampsia [p = 0.002; OR = 0.94; CI 0.90-0.97] and this was maintained after controlling for age, arterial hypertension, sleep quality, fatigue and depressive symptoms [p < 005; OR = 0.91; CI 0.87-0.95]. Conclusion: In GDM, patients with evening preference had worse sleep quality, more insomnia, fatigue, and depressive symptoms. Furthermore, eveningness was independently associated with preeclampsia. These results indicate the important role of eveningness in adverse pregnancy outcomes.

Sleep responses of young swimmers to training load and recovery during tapering / Respuestas del sueño a las cargas de entrenamiento y recuperación en jóvenes nadadores durante el tapering / Respostas do sono às cargas de treinamento e recuperação em jovens nadadores durante o polimento

ABSTRACT Introduction: Tapering is a decisive phase in planning a young swimmer's preparation for competition. During this period, not only training loads, but also recovery, which includes sleep quality, must be constantly monitored. Objective: This study aims to investigate sleep behavior as a variable directly influenced by training load during the tapering phase of training for young swimmers. Methods: A polysomnography test was performed at the beginning of the tapering phase, as a baseline for sleep variables. In each daily training session, the overload and recovery variables were measured. The internal training load was evaluated in the PSE session and the external load by quantifying the training. The recovery variables were divided into the recovery variable, assessed using the TQR questionnaire, and sleep variables, which included sleepiness, scored using the Karolinska scale, and sleep behavior, using an actigraph and a sleep diary. Conclusion: It is concluded that there is no significant influence between training loads and sleep variables. However, a strong association was observed between TST and EL (External load), in the irregular sleep group. Level of evidence III, Study of behavior.

RESUMEN Introducción: El tapering es una fase decisiva en la planificación de la preparación de un joven nadador para la competición. Durante este período, deben monitorearse constantemente no sólo las cargas de entrenamiento, sino también la recuperación, que incluye la calidad del sueño. Objetivo: Este estudio tiene como objetivo investigar el comportamiento del sueño como variable directamente influenciada por la carga de entrenamiento durante la fase de tapering del entrenamiento de jóvenes nadadores. Métodos: Se realizó una polisomnografía al inicio de la fase de tapering como base de las variables del sueño. En cada sesión diaria de entrenamiento se midieron las variables de sobrecarga y recuperación. La carga interna de entrenamiento fue evaluada por la sesión de PSE y la carga externa mediante cuantificación del entrenamiento. Las variables de recuperación se dividieron variables de recuperación, con el cuestionario QTR y variables de sueño, que incluían somnolencia mediante la escala de Karolinska y comportamiento del sueño con un actígrafo y diario de sueño. Conclusiones: Se concluyó que no existe una influencia significativa entre las cargas de entrenamiento y las variables del sueño. Sin embargo, se observó una fuerte asociación entre TTS y el CE, en el grupo de sueño irregular. Nivel de evidencia III, Estudio de comportamiento.

RESUMO Introdução: A etapa de polimento é uma fase decisiva no planejamento da preparação de um jovem nadador para a competição. Durante esse período, não somente as cargas de treinamento, mas também a recuperação, que inclui a qualidade do sono, devem ser constantemente monitoradas. Objetivos: Este estudo objetiva investigar o comportamento do sono como variável diretamente influenciada pela carga de treinamento durante a fase de polimento do treinamento de jovens nadadores. Métodos: O exame de polissonografia foi realizado no início da fase de polimento, como base para as variáveis do sono. Em cada sessão diária de treinamento foram medidas as variáveis de sobrecarga e de recuperação. A carga interna de treinamento foi avaliada pela sessão de PSE e a carga externa, pela quantificação do treinamento. As variáveis de recuperação foram divididas em variável de recuperação, com o questionário QTR e variáveis de sono, que incluíram sonolência pela escala de Karolinska e comportamento do sono com actígrafo e diário de sono. Conclusões: Conclui-se que não há influência significativa entre as cargas de treinamento e as variáveis do sono. Entretanto, foi observada forte associação entre TTS e CE no grupo sono irregular. Nível de evidência III; Estudo de comportamento.

A study on the effect of mobile phone use on sleep

Background & objectives: Several studies have been conducted globally to assess the impact of usage of mobile phones on quality and duration of sleep as also on day time sleepiness. The objective of the present study was to assess the effect of mobile phone usage on the quality and composition of sleep in a sample from Indian population. Methods: The study was conducted at two tertiary care hospitals in north India from July 2014 to September 2019. A total of 566 participants were recruited in this study from both the centres. Sleep quality was assessed with the help of the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Subsequently, actigraphy was done in 96 participants and polysomnography in 95 participants. Results: Of the 566 participants, 128 (22.61%) had PSQI ?5, reflecting poor sleep quality. A higher use of mobile phone was significantly associated with a poor sleep quality as a component of PSQI questionnaire (P=0.01) and higher overall PSQI score (P=0.01). The latency from sleep onset to N2 and N3 sleep stages was significantly shorter in participants having a higher mobile phone usage as compared to those with a lower usage [Median (range): 13.5 min (1.5-109) vs. 6.5 min (0-89); P=0.02] and [Median (range): 49 min (8.5-220.5) vs. 28.75 min (0-141); P=0.03], respectively. Interpretation & conclusions: This study focused on the maladaptive changes brought on by mobile phone usage on sleep. More studies with larger sample sizes need to be done that may serve to confirm the hypothesis generating findings of our study

¿Los hijos de pacientes con trastorno bipolar tienen una peor percepción de la calidad de sueño? / Do Children of Patients with Bipolar Disorder have a Worse Perception of Sleep Quality?

RESUMEN Introducción: los Hijos de Padres con Trastorno Bipolar (HPTB) constituyen una población de riesgo ya que pueden heredar el Trastorno Bipolar (TB) como también manifestaciones clínicas tempranas como seria las alteraciones en el sueño. Objetivo: comparar la presencia de trastornos psiquiátricos y las alteraciones en el sueño de los HPTB con los Hijos de Padres Control (HPC). Métodos: Se realizó un estudio analítico de corte transversal, que comparó HPTB versus HPC. Se entrevistaron con instrumentos validados para determinar la existencia de síntomas y trastornos psiquiátricos. Utilizamos las escalas: "Cuestionario de evaluación de sueño" y "Encuesta sobre hábitos de sueño en escolares" para determinarlas características del sueño y factores asociados con el mismo. Adicionalmente se obtuvo el registro de sueño (7-21 días) por medio de un reloj de actígrafia. Resultados: Se reunió una muestra con 42 sujetos (18 HPTB y 24 HPC). Se encontraron diferencias en la presentación de los trastornos psiquiátricos. El grupo de HPTB presento mayor frecuencia del trastorno depresivo mayor (TDM; p = 0,04) y el trastorno disruptivo de la regulación emocional (TDRE, p = 0,04). En el grupo de HPC por su parte se presentó una mayor frecuencia de Trastorno por Déficit de Atención e Hiperactividad (TDAH; p = 0,65) y de Trastorno de Ansiedad por Separación (TAS; p = 0,46). También se encontraron diferencias a nivel del sueño en las medidas subjetivas. En comparación con el HPC, el grupo de HPTB presento una peor percepción de la calidad de sueño (p = 0,02), una mayor presencia de pesadillas (p = 0,01), un menor tiempo total de sueño y una mayor latencia de sueño. Sin embargo, no se encontraron diferencias entre los dos grupos en las mediciones de actigrafías. Conclusiones: el grupo de HPTB presenta mayor frecuencia de trastornos del estado de ánimo, y a su vez una mayor presencia de alteraciones del sueño en las medidas subjetivas. Es posible que exista una asociación entre los síntomas afectivos, las alteraciones en el sueño y el consumo de café. No se encontraron diferencias en el perfil de sueño por actígrafía. © 2020 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. Todos los derechos reservados. Children

ABSTRACT Introduction: The offspring of bipolar parents (BO) is a high-risk population for inheriting the bipolar disorder (BD) and other early clinical manifestations, such as sleep disturbances. Objective: To compare the presence of psychiatric disorders and sleep disturbances of BO versus offspring of control parents (OCP). Methods: A cross-sectional analytical study was conducted that compared BO versus OCP. The participants were assessed using valid tools to determine the presence of psychiatric symptoms or disorders. The "Sleep Evaluation Questionnaire" and "School Sleep Habits Survey" were used to determine sleep characteristics and associated factors. Sleep records (7-21 days) were also obtained by using an actigraphy watch. Results: A sample of 42 participants (18 BO and 24 OCP) was recruited. Differences were found in the presentation of the psychiatric disorder. The BO group showed a higher frequency of major depression disorder (MDD; P = .04) and Disruptive Mood Dysregulation Disorder (DMDD; P = .04). The OCP group showed a higher frequency of Attention Deficit and Hyperactivity Disorder (ADHD; P = .65), and Separation Anxiety Disorder (SAD; P = .46). Differences were also found in sleep by using subjective measurements. Compared to the OCP group, BO had a worse perception of quality of sleep (P = .02), a higher frequency of nightmares (P = .01), a shorter total sleep time, and a higher sleep latency. Nevertheless, no differences were found between groups in the actigraphy measurements. Conclusions: The BO group had a higher frequency of Mood Disorders, and at the same time a higher number of sleep disturbances in the subjective measurements. It is possible that there is an association between mood symptoms, sleep disturbances, and coffee intake. No differences were found in the sleep profile by using actigraphy. © 2020 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.

Sleep-onset time variability and sleep characteristics on weekday and weekend nights in patients with COPD / Variabilidade do tempo de início do sono e características do sono durante a semana e o fim de semana em pacientes com DPOC

ABSTRACT Objective: To evaluate sleep-onset time variability, as well as sleep characteristics on weekday and weekend nights, in individuals with moderate-to-severe COPD. Methods: Sleep was objectively assessed by an activity/sleep monitor for seven consecutive nights in individuals with COPD. For analysis, individuals were divided into two groups according to sleep-onset time variability results, characterized by intrasubject standard deviation of sleep-onset time (SOTV) ≥ 60 min or < 60 min. Results: The sample comprised 55 individuals (28 males; mean age = 66 ± 8 years; and median FEV1 % of predicted = 55 [38-62]). When compared with the SOTV<60min group (n = 24), the SOTV≥60min group (n = 31) presented shorter total sleep time (5.1 ± 1.3 h vs. 6.0 ± 1.3 h; p = 0.006), lower sleep efficiency (73 ± 12% vs. 65 ± 13%; p = 0.030), longer wake time after sleep onset (155 ± 66 min vs. 115 ± 52 min; p = 0.023), longer duration of wake bouts (19 [16-28] min vs. 16 [13-22] min; p = 0.025), and higher number of steps at night (143 [104-213] vs. 80 [59-135]; p = 0.002). In general, sleep characteristics were poor regardless of the day of the week, the only significant difference being that the participants woke up about 30 min later on weekends than on weekdays (p = 0.013). Conclusions: Sleep-onset time varied over 1 h in a standard week in the majority of individuals with COPD in this sample, and a more irregular sleep onset indicated poor sleep quality both on weekdays and weekends. Sleep hygiene guidance could benefit these individuals if it is integrated with their health care.

RESUMO Objetivo: Avaliar a variabilidade do tempo de início do sono, bem como as características do sono durante a semana e o fim de semana, em indivíduos com DPOC moderada a grave. Métodos: O sono foi avaliado objetivamente por meio de um monitor de atividade/sono durante sete noites consecutivas em indivíduos com DPOC. Para a análise, os indivíduos foram divididos em dois grupos, de acordo com a variabilidade do tempo de início do sono, caracterizada pelo desvio-padrão do tempo de início do sono (TISV) ≥ 60 min ou < 60 min em um mesmo indivíduo. Resultados: A amostra foi composta por 55 indivíduos [28 homens; média de idade = 66 ± 8 anos; mediana do VEF1 em % do previsto = 55 (38-62)]. Em comparação com o grupo TISV<60min (n = 24), o grupo TISV≥60min (n = 31) apresentou menor tempo total de sono (5,1 ± 1,3 h vs. 6,0 ± 1,3 h; p = 0,006), menor eficiência do sono (73 ± 12% vs. 65 ± 13%; p = 0,030), maior tempo de vigília após o início do sono (155 ± 66 min vs. 115 ± 52 min; p = 0,023), blocos de vigília mais longos [19 (16-28) min vs. 16 (13-22) min; p = 0,025] e maior número de passos dados à noite [143 (104-213) vs. 80 (59-135); p = 0,002]. Em geral, as características do sono foram ruins independentemente do dia da semana; a única diferença significativa foi que os participantes acordaram cerca de 30 min mais tarde nos fins de semana do que nos dias de semana (p = 0,013). Conclusões: O tempo de início do sono variou mais de 1 h em uma semana-padrão na maioria dos indivíduos com DPOC da amostra, e um início de sono mais irregular indicou má qualidade do sono tanto nos dias de semana como nos fins de semana. A orientação a respeito da higiene do sono pode ser benéfica se for integrada à atenção à saúde desses pacientes.

Acupuncture for perimenopausal early-wake insomnia: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical effect of acupuncture for perimenopausal early-wake insomnia.@*METHODS@#A total of 60 patients with perimenopausal early-wake insomnia were randomly divided into an observation group (30 cases, 3 cases dropped off) and a control group (30 cases, 2 cases dropped off, 2 cases were removed). In the observation group, acupuncture was applied at Baihui (GV 20), Yintang (GV 24+), Anmian (Extra), Hegu (LI 4), Shenmen (HT 7), Taichong (LR 3), Taixi (KI 3), etc., once every other day, 3 times a week. In the control group, oryzanol tablets were taken orally, 20 mg each time, 3 times a day. Both groups were treated for 4 weeks. Before and after treatment, the sleep actigraphy (ACT) was used to measure the effective sleep time, sleep quality, wake-up time, wake-up frequency, each wake-up time, and the Pittsburgh sleep quality index (PSQI) score and early-wake score were compared in the two groups, and the clinical effect was assessed.@*RESULTS@#After treatment, compared before treatment, the effective sleep time was prolonged and the sleep quality was improved (P<0.05), the wake-up time, each wake-up time were shortened and wake-up frequency was decreased (P<0.05), the PSQI score and early-wake score were decreased (P<0.05) in the observation group. After treatment, the wake-up frequency, PSQI score and early-wake score were decreased in the control group (P<0.05). The effective sleep time, sleep quality, wake-up time, wake-up frequency, each wake-up time, PSQI score and early-wake score after treatment in the observation group were superior to the control group (P<0.05). The total effective rate was 88.9% (24/27) in the observation group, which was higher than 38.5% (10/26) in the control group (P<0.05).@*CONCLUSION@#Acupuncture can increase the effective sleep time and improve sleep quality in patients with perimenopausal early-wake insomnia.

eHealth tools for assessing psychomotor activity in schizophrenia: a systematic review

Objective: Psychomotor abnormalities are relevant symptoms in the clinical presentation of schizophrenia, and assessing them could facilitate monitoring. New technologies can measure psychomotor activity objectively and continuously, but evidence on the topic is scarce. Our aim is to systematically review the existing evidence about eHealth tools for assessing psychomotor activity in patients diagnosed with schizophrenia. Method: We performed a systematic search of the PubMed and Embase databases and identified 15 relevant articles on eHealth tools for assessing psychomotor activity in schizophrenia. Results: eHealth devices accurately assessed psychomotor activity and were well accepted. Abnormalities in psychomotor activity helped differentiate between different subtypes of schizophrenia. Abnormal increases in psychomotor activity were correlated with acute presentations, while lower activity was associated with relapses, deterioration, and negative symptoms. Conclusion: Actigraphy is still the preferred eHealth device in research settings, but mobile applications have great potential. Further studies are needed to explore the possibilities of psychomotor monitoring and mobile health applications for preventing relapses in schizophrenia. eHealth could be useful for monitoring psychomotor activity, which might help prevent relapses.

Comparison and correlation analysis of sleep parameters between watch-type sleep monitor (Actiwatch) and polysomnography / 北京大学学报(医学版)

OBJECTIVE@#With the rapid development of sleep medicine, there are various methods for detecting sleep diseases. This study compared the correlation between the lightweight watch-type sleep monitor (Actiwatch) and the "gold standard" polysomnography (PSG) in the Chinese population, in order to provide a basis for clinical application.@*METHODS@#From August 2018 to December 2019, 121 subjects who simultaneously performed sleep breathing monitoring (PSG) and wearing a watch-type sleep monitor (Actiwatch) in the Sleep Center of Peking University People's Hospital were enrolled. All subjects received PSG and Actiwatch at the same time, and filled out the sleep diary next morning. Monitoring indicators were collected for linear correlation analysis and paired t test to compare the differences.@*RESULTS@#Under low sensitivity conditions, the correlation coefficient of total sleep time (TST) between PSG and Actiwatch was 0.53 (P < 0.05). Paired t test analysis showed that there was no significant difference between the TSTs of Actiwatch and PSG (t=-0.890, P=0.36). According to age stratification, the smaller the age, the stronger the correlation between the TSTs of Actiwatch and PSG, and the coefficient could be up to 0.92 (P < 0.05). Paired t test showed that there was no significant difference between them (t=-1.057, P=0.35). According to the stratification by diagnosis, the correlation coefficient between the TSTs of Actiwatch and PSG in normal PSG group could be as high as 0.79 (P < 0.05), the results of paired t test showed that there was no significant difference between the TSTs of Actiwatch and PSG in normal PSG group (t=-0.784, P=0.44).@*CONCLUSION@#As a wearable home recorder, when the analysis parameters of Actiwatch were set as low sensitivity, PSG and Actiwatch had the highest TST correlation. The younger the age, the stronger correlation between the TSTs of Actiwatch and PSG. The PSG and Actiwatch subjects with normal PSG presentation had a higher TST correlation.

Duration and quality of sleep in sprint and recovery performances among elite swimmers / Duração e qualidade de sono no desempenho do sprint e na recuperação de nadadores de elite / Duración y calidad del sueño en el desempeño en el sprint y recuperación d nadadores de élite

ABSTRACT Introduction: Circadian rhythms can impact athletes' sports performance, where the plateau occurs between 15 and 21 hours. Swimming is a peculiar case, as athletes perform training and final sessions in competitions at different times, as in the Rio2016 Olympic Games for example, where the semifinal and final competitions took place from ten o'clock at night. Objectives: (1) to present the protocol of an intervention performed with elite athletes of the Brazilian swimming team during the 2016 Olympic Games in Rio; (2) to find out whether the time at which the competitions were held affected the swimming performances of these athletes during the competition. Materials and Methods: Fourteen athletes of the Brazilian swimming team (males: n= 10; 71% and females: n= 4; 29%) participated in the study. They were followed up during two preparation periods (baseline and intervention) for the 2016 Olympic Games in Rio during June and July 2016. During the competition, we recorded the Reaction Time (RT) and Competition Time (CT) of each athlete in different modalities. The intervention strategies used were light therapy and sleep hygiene. The values of RT at the starting block and CT were registered and conferred with the official results. Results: The athletes showed a decrease in the total time awake (Δ = −13%; Effect size [ES] = 1.0) and sleep latency (Δ = −33%; ES = 0.7), and an increase in total sleep time (Δ = 13%; ES = 1.1; p = 0.04) between the baseline and the period of the intervention, pre-competition. We identified an improvement in the RT (Δ = −2.2% to −1.0%; ES = 0.2 to 0.5) during the competition only for the athletes who participated in the competition finals. Conclusion: We conclude that the intervention carried out was effective in mitigating any negative influence of competition time on the RT and CT of elite athletes of the Brazilian swimming team. Level of evidence II; Prospective comparative study.

RESUMO Introdução: Os ritmos circadianos podem exercer impacto no desempenho esportivo dos atletas, onde o platô ocorre entre as 15 e 21 horas. A natação é um caso peculiar, uma vez que os nadadores realizam sessões de treinamento e provas finais em competições em diferentes horários, como por exemplo, nos Jogos Olímpicos Rio2016, onde as competições semifinais e finais da natação ocorreram a partir das 22 horas. Objetivos: O presente estudo teve como objetivos: (1) apresentar o protocolo de uma intervenção realizada com atletas de elite da equipe de natação brasileira durante os Jogos Olímpicos Rio 2016; (2) identificar se o desempenho dos atletas de natação foi afetado devido aos horários das provas durante a competição. Materiais e Métodos: Participaram do estudo 14 atletas da equipe de natação brasileira (masculino: n= 10; 71% e feminino: n= 4; 29%). Foi realizado acompanhamento dos atletas durante dois períodos de preparação (baseline e intervenção) para os Jogos Olímpicos Rio2016 nos meses de junho e julho de 2016. Durante a competição, foi realizado o registro do Tempo de Reação (TR) e Tempo de Prova (TP) de cada atleta nas diferentes modalidades. As estratégias de intervenção utilizadas foram: terapia de luz e higiene do sono. Os valores de TR no bloco de partida e TP foram registrados e conferidos com os resultados oficiais. Resultados: Os atletas apresentaram decréscimo no tempo total de vigília (Δ = −13%; Tamanho do Efeito (TE) = 1,0) e latência de sono (Δ = −33%; TE = 0,7), e aumento do tempo total de sono (Δ = 13%; TE = 1,1; p = 0,04) entre o baseline e o período de intervenção pré-competição. Nós identificamos melhorias no TR (Δ = −2,2% à −1,0%; TE = 0,2 a 0,5) ao longo da competição somente para os atletas que participaram da fase final da competição. Conclusão: Concluímos que a intervenção realizada foi efetiva para minimizar qualquer influência negativa do horário da competição sobre o TR e TP dos atletas de elite da natação brasileira. Nível de evidência II; Estudo prospectivo comparativo.

RESUMEN Introducción: Los ritmos circadianos pueden ejercer impacto en el desempeño deportivo de los atletas, donde la meseta ocurre entre las 15h y las 21 horas. La natación es un caso peculiar, ya que los nadadores realizan sesiones de entrenamiento y pruebas finales en competiciones en diferentes horarios, como por ejemplo, en los Juegos Olímpicos Rio 2016, en donde las competiciones semifinales y finales de natación ocurrieron a partir de las 22 horas. Objetivos: El presente estudio tuvo como objetivos: (1) presentar el protocolo de una intervención realizada con atletas de élite del equipo de natación brasileño durante los Juegos Olímpicos Rio 2016; (2) identificar si el desempeño de los atletas de natación fue afectado debido a los horarios de las pruebas durante la competición. Materiales y Métodos: Participaron en el estudio 14 atletas del equipo de natación brasileño (masculino: n = 10; 71% y femenino: n= 4; 29%). Fue realizado acompañamiento de los atletas durante dos períodos de preparación (baseline e intervención) para los Juegos Olímpicos Rio 2016 en los meses de junio y julio de 2016. Durante la competición, se realizó el registro del Tiempo de Reacción (TR) y Tiempo de Prueba (TP) de cada atleta en las diferentes modalidades. Las estrategias de intervención utilizadas fueron: terapia de luz e higiene del sueño. Los valores de TR en el bloque de partida y TP fueron registrados y verificados con los resultados oficiales. Resultados: Los atletas presentaron disminución en el tiempo total de vigilia (Δ = −13%; Tamaño de efecto (TE) = 1,0), y latencia del sueño (Δ = −33%; TE = 0,7), y aumento del tiempo total de sueño (Δ = 13%; TE = 1,1; p = 0,04) entre baseline y el período de intervención precompetición. Identificamos mejoras en el TR (Δ = −2,2% a −1,0%; TE = 0,2 a 0,5) a lo largo de la competición sólo para los atletas que participaron en la fase final de la competición. Conclusión: Concluimos que la intervención realizada fue efectiva para minimizar cualquier influencia negativa del horario de la competición sobre el TR y TP de los atletas de élite de la natación brasileña. Nivel de evidencia II; Estudio prospectivo comparativo.

Effect of number of hours and days of accelerometer use on physical activity estimates in adolescents / Efeito da quantidade de horas e dia de uso do acelerômetro sobre as estimativas de atividade física em adolescentes

Abstract The study analyzed the effect of number of hours and days of accelerometer use on estimates of physical activity (PA) time in adolescents. Cross-sectional study of 784 adolescents from 10 to 14 years old (53.9% girls). Overlapping 95% confidence intervals (95%CI) were used to compare mean light (LPA), moderate (MPA), vigorous (VPA) and moderate to vigorous (MVPA) physical activity times and prevalence of sufficient PA levels between different numbers of hours (≥6, ≥8 and ≥10 hours/day) and days (≥3, ≥4, ≥5 and 7 days of use). The criterions of ≥6 hours/day with ≥3, ≥4, ≥5 e 7 days and ≥8 hour/day with ≥3, ≥4 e ≥5 days of accelerometer use underestimated, in average, the LPA time in 23.1 and 12.6 min/day, respectively, compared ≥10 hours/day. There were no significant differences in mean MPA, VPA and MVPA times and prevalence of sufficient PA levels between the number of hours and days of use analyzed. To produce accurate estimates of PA time in teenagers, ≥3 days of accelerometer use was adopted for ≥10 hours/day of LPA and ≥ 6 hours/day of MPA, VPA and MVPA.

Resumo Objetivou-se analisar o efeito da quantidade de horas e dias de uso do acelerômetro sobre as estimativas de tempo de atividade física (AF) em adolescentes. Estudo transversal com 784 adolescentes de 10 a 14 anos de idade (53,9% do sexo feminino). Os tempos médios de atividade física leve (AFL), moderada (AFM), vigorosa (AFV), moderada a vigorosa (AFMV) e as prevalências de níveis suficientes de AF entre diferentes quantidades de horas (≥6, ≥8 e ≥10 horas/dia) e dias (≥3, ≥4, ≥5 e 7 dias/uso) de uso do acelerômetro foram comparadas pelas interseções dos intervalos de confiança de 95% (IC95%). Os critérios de ≥6 horas/dia com ≥3, ≥4, ≥5 e 7 dias e ≥8 horas/dia com ≥3, ≥4 e ≥5 dias de uso do acelerômetro subestimaram, em média, o tempo de AFL em 23,1 e 12,6 min/dia, respectivamente, comparados a ≥10 horas/dia.Não houve diferenças significativas nos tempos médios de AFM, AFV, AFMV e nas prevalências de níveis suficientes de AF entre as quantidades de horas e dias de uso analisadas. Para produzir estimativas precisas do tempo de AF em adolescentes foi necessário adotar ≥3 dias de uso do acelerômetro durante ≥10 horas/dia para AFL e ≥6 horas/dia para AFM, AFV e AFMV.

Caracterización del Insomnio en Lactantes a través de Actigrafía / Characterization of Insomnia In Infants through Actigraphy

Resumen. El Insomnio infantil definido como la dificultad mantenida, a pesar de la oportunidad y en función etaria, para iniciar o mantener el sueño o su calidad que provoca alteraciones funcionales en el niño y/o familia. Puede repercutir significativamente en la conducta, aprendizaje y metabolismo del niño y en su familia afectando su calidad de vida. La actigrafía nos permite a través de un dispositivo identificar periodos de vigilia y sueño. El objetivo de este trabajo es caracterizar a través de la actigrafía el patrón sueño-vigilia y evaluar la exposición a luz azul en niños menores de 2 años que consultan por insomnio. Se realizó un estudio observacional, descriptivo, transversal de lactantes derivados por insomnio al Centro de Sueño de Red de Salud UC Christus, durante: Marzo 2017-2018, con actigrafía. Fueron 20 actigrafías de 7 días. Edades entre 5 y 22 meses con diagnóstico de insomnio que no respondió al manejo inicial. 8 hombres, 12 mujeres. Horarios promedios: Acostarse: 20:31 hrs. Levantarse: 7:43 hrs. Horarios variables para acostarse: 15/20. 10/20 siestas después de las 16 hrs. Todos presentaron tiempo total de sueño disminuido, con aumentos del tiempo despierto una vez iniciado el sueño. Latencias del sueño aumentadas: 6/20. Eficiencia del sueño disminuidas en 4/20. Despertares nocturnos: promedio: 10.58. Expuestos a luz azul: 14/20. Horas exposición media: 2,4 hr/evento. Concluimos de este estudio que las principales dificultades fueron los despertares nocturnos con largos tiempo de vigilia, con disminución del tiempo total de sueño para la edad, y la actigrafía fue una herramienta de apoyo para objetivar conductas que dificultan la adquisición de un buen patrón de sueño.Palabras Clave: Insomnio infantil, sueño en lactantes, actigrafía, luz azul, despertares.

Abstract. Child insomnia is defined as sustained difficulty, despite the opportunity and according to age group, to initiate or maintain sleep, or a sleep quality causing that causes alterations in the child or family. It can significantly impact behavior, learning and metabolism of the child and his or her family, affecting their quality of life. The actigraphy through a device allows us to identify periods of wakefulness and sleep. The purpose of this work is to characterize sleep-wake patterns through actigraphy and to determine exposure to blue light in children younger than 2 years old, consulting for insomnia. An observational, descriptive, cross-sectional study of infants consulting for insomnia at the Sleep Center of UC Christus health network, in the period from March 2017 to 2018, with actigraphy. Twenty week long actigraphies were performed. The ages of the patients varied between 5 and 22 months, all had a diagnosis of insomnia that did not respond to initial management. Eight patients were male and 12 female. Hourly averages: bedtime: 8:31 PM. Waking up: 7:43 AM. Time variable for bedtime: 15/20. 10/20 NAPs after 16 hrs. All showed decreased sleep, with increases of total awake time once sleep began. Increased sleep latency: 6/20. Sleep efficiency decreased in 4/20. Nighttime Awakenings: average: 10.58. Exposed to blue light: 14/20. Average exposure in hours: 2.4 hr/event. We conclude from this study that the main difficulties were the nighttime awakenings with long time vigil, with decrease of the total sleep time for the age, and the actigraphy was a support tool to record behaviors that hinder a normal sleep pattern acquisition.Key words: Child insomnia, sleep in infants, actigraphy, blue light, awakenings

Uso da actigrafia na avaliação do ritmo atividade-repouso em pacientes com doença de Parkinson / Use of actigraphy on assessment of activity-rest rhythm in patients with Parkinson's disease

Distúrbios do sono são os mais comuns sintomas não-motores encontrados na doença de Parkinson (DP). OBJETIVOS: Avaliar a relação entre actigrafia e distúrbios do sono mais incidentes na DP. MÉTODOS: Pacientes com e sem DP foram avaliados quanto aos sintomas motores, qualidade do sono, cronotipo e objetivamente através do uso do actímetro. RESULTADOS: Encontrou-se uma significante redução da qualidade do sono entre os pacientes com DP (p = 0.0023), uma pior qualidade subjetiva do sono, maior uso de medicamentos para insônia, mais distúrbios do sono e uma maior fragmentação do ritmo atividade-repouso (IV) (p=0.0271). CONCLUSÃO: Pacientes com DP possuem uma pior qualidade de sono e um ritmo atividade-repouso mais fragmentado. A actigrafia pode ser útil na avaliação da qualidade do sono e do ciclo atividade repouso em pacientes com DP, contribuindo para o rastreio e acompanhamento de eventuais distúrbios do ritmo circadiano a esta doença associados. (AU)

Sleep disorders are the most common non-motor symptom found in Parkinson's Disease (PD). OBJECTIVES: To evaluate the relationship between actigraphy and more incidents sleep disorders in PD. METHODS: Patients with and without PD were assessed regarding motor symptoms, sleep quality, chronotype and objectively through the use of an actimeter. RESULTS: It was found a significant reduction of sleep quality among the patients with PD (p = 0.0023), a worse subjective sleep quality, they used more medications to sleep, they had more sleep disorders and a significantly higher fragmentation of pace (IV) (p = 0.0271). CONCLUSION: Patients with PD have a worse sleep quality and a rest-activity rythm fragmented. Actigraphy can be useful for assessing the quality of sleep and activity/rest cycle in patients with PD, contributing to the screening and follow-up of any circadian rhythm disorders associated to this disease. (AU)

Perfil do sono de pacientes idosos submetidos à hemodiálise / Sleep profile of elderly patients undergoing hemodialysis

Introdução: Distúrbios do sono são frequentemente observados na população idosa. O objetivo deste estudo foi avaliar, por meio de análises qualitativas e paramétricas, o sono de pessoas idosas submetidas à hemodiálise. Métodos: Trata-se de um estudo transversal realizado em três centros de hemodiálise, com amostra de conveniência composta por 28 pacientes que preencheram os critérios de inclusão. Foi analisada a qualidade do sono por meio do índice de Pitsburgh e medidas actimétricas por sete dias com as seguintes variáveis: tempo total de sono noturno (TTSN), tempo acordado após iniciar o sono (TAIS), número de despertares noturnos (despertares), tempo total de sono diurno (TTSD), número de cochilos e percentual de sono noturno (% sono). RESULTADOS: 17 pacientes (58,6%) apresentavam PSQI > 5, caracterizando um sono de má qualidade nos últimos 30 dias. As análises actimétricas demonstraram parâmetros ruins na média: TTSN de 341,2 ± 90,8 minutos por noite; TAIS de 91,1 ± 46,44 minutos por noite; %sono de 79,6 ± 9,8 por noite; 28,5 ± 11,4 despertares por noite; 48,5 ± 14,6 cochilos por dia e TTSD de 222,4 ± 73,9 minutos por dia. Conclusão: Este estudo observou, por meio de análise qualitativa subjetiva (PSQI) e por parâmetros actimétricos (actimetria), que idosos submetidos à hemodiálise apresentam má qualidade do sono.

Introduction: Sleep disturbances are frequently observed in the elderly population. The objective of this study was to evaluate, by means of qualitative and parametric analyses, the sleep pattern of elderly people undergoing dialysis. Methods: This cross-sectional study was performed at three hemodialysis centers, with a convenience sample composed of 28 patients who fulfilled the inclusion criteria. Their sleep quality was analyzed by means of the Pittsburgh index and actimetric measurements for seven days with the following variables: total nocturnal sleep time (TNST), time awake after the onset of sleep (TAOS), number of nocturnal awakenings (awakenings), total daytime sleep time (TDST), number of naps, and percentage of nocturnal sleep (% sleep). RESULTS: Seventeen patients (58.6%) presented PSQI > 5, characterizing poor quality sleep in the last 30 days. The actimetric analyses demonstrated poor parameters on average: TNST of 341. 2 ± 90.8 minutes per night; TAOS of 91.1 ± 46.44 minutes per night, % sleep of 79.6 ± 9.8 per night; 28.5 ± 11.4 times woken up per night; 48.5 ± 14.6 naps per day, and TDST of 222.4 ± 73.9 minutes per day. Conclusion: This study observed, by means of a subjective qualitative analysis (PSQI) and actimetric parameters (actimetry), that elderly people undergoing hemodialysis demonstrate having poor sleep quality.

Comparisons of Subjective and Actigraphic Measurements of Sleep between Shift-working and Daytime Psychiatric Nurses / 정신신체의학

OBJECTIVES: Shiftwork is known to be one of the common causes of sleep and health problems and finally causes the decreased quality of life. The purpose of this study was to investigate the sleep patterns of shiftworking and daytime psychiatric nurses using actigraphy and compare it with subjective assessment for sleep. METHODS: Twenty-three shift-working and 25 daytime nurses were enrolled. They rated their sleep quality using Pittsburgh Sleep Quality Index(PSQI) and other self-rating scales were measured for psychosocial aspects. Actigraphy was applied to the subjects for a total of 7 days to measure the sleep parameters. They also wrote sleep diaries during the period of wearing actigraphy. Sleep-related parameters of actigraphy, global score and components of PSQI, and the results of other self-rating scales were compared between shift-working and daytime nurses. RESULTS: Although the global score of PSQI did not show significant difference, the PSQI components showed significant differences between two groups: the shift-working nurses showed lower sleep quality, more sleep disturbance and hypnotic medication use, and worsened daytime dysfunction than daytime nurses. The shift-working nurses showed significantly shorter total time in bed and total sleep time, lower sleep efficiency, and longer average awakening time than those of daytime nurses in actigraphy. CONCLUSIONS: The results showed that shift-working nurses experienced more sleep disturbances in both subjective and objective aspects of sleep than daytime nurses. This study also suggests that actigraphy may be useful to measure the objective aspects of sleep that are difficult to assess with subjective questionnaires alone.

Comparison of Wearable Activity Tracker with Actigraphy for Sleep Evaluation and Circadian Rest-Activity Rhythm Measurement in Healthy Young Adults

OBJECTIVE: The purpose of this study was to evaluate the applicability of data obtained from a wearable activity tracker (Fitbit Charge HR) to medical research. This was performed by comparing the wearable activity tracker (Fitbit Charge HR) with actigraphy (Actiwatch 2) for sleep evaluation and circadian rest-activity rhythm measurement. METHODS: Sixteen healthy young adults (female participants, 62.5%; mean age, 22.8 years) wore the Fitbit Charge HR and the Actiwatch 2 on the same wrist; a sleep log was recorded over a 14-day period. We compared the sleep variables and circadian rest-activity rhythm measures with Wilcoxon signed-rank tests and Spearman's correlations. RESULTS: The periods and acrophases of the circadian rest-activity rhythms and the sleep start times did not differ and correlated significantly between the Fitbit Charge HR and the Actiwatch 2. The Fitbit Charge HR tended to overestimate the sleep durations compared with the Actiwatch 2. However, the sleep durations showed high correlation between the two devices for all days. CONCLUSION: We found that the Fitbit Charge HR showed high accuracy in sleep evaluation and circadian rest-activity rhythm measurement when compared with actigraphy for healthy young adults. The results suggest that the Fitbit Charge HR could be applicable on medical research as an alternative tool to actigraphy for sleep evaluation and measurement of the circadian rest-activity rhythm.

Comparison between self-reported sleep duration and actigraphy among adolescents: gender differences / Comparação entre duração do sono autodeclarada e actigrafia entre adolescentes: diferenças de gênero

ABSTRACT: Introduction: There are only few agreement studies between subjective measures of sleep and actigraphy among adolescents. Objective: To compare self-reported sleep and actigraphy in this age group, by studying gender differences and, using a new graphical approach, the survival agreement plot. Methods: Thirty-seven subjects, aged 12 to 17 years, answered questions about nocturnal sleep duration and used actigraphy for seven days. The mean and median differences between the informed sleep and the recorded one, the intraclass correlation coefficient, the Bland-Altman plot and the survival-agreement plot were used. Results: A mean difference of about one hour (SD = 2.1; median = 0.5; p < 0.01) was found between both strategies, which was higher among boys, 1.9 hours (SD = 2.8; median = 1.6; p < 0.05), than among girls, 0.5 hours (SD = 1.4; median = 0.3; p = 0.11). The graphical evaluation showed similar results, as well as the intraclass correlation coefficient: 0.06 (95%CI = -0.33 - 0.46; p = 0.489) for boys and 0.43 (95%CI = 0.12 - 0.83; p < 0.001) for girls. Conclusions: Our data are consistent with previous studies as to non-agreement between the two methods. These results are relevant because this is the first study of concordance between subjective measures of sleep and actigraphy among Brazilian adolescents, as far as we know. In addition, they reinforce the need of a careful use of nocturnal sleep measures among adolescents, mainly among boys.

RESUMO: Introdução: Existem poucos estudos de concordância entre as medidas subjetivas de sono e a actigrafia entre adolescentes. Objetivo: Comparar o sono autodeclarado e a actigrafia neste grupo etário, estudando as diferenças quanto ao sexo e, usando uma nova abordagem gráfica, o gráfico de concordância e sobrevivência. Métodos: Trinta e sete indivíduos de 12 a 17 anos responderam a questões sobre a duração do sono noturno e usaram actigrafia por sete dias. As diferenças entre as médias e as medianas entre sono informado e a medida objetiva, o coeficiente de correlação intraclasse e os gráficos de Bland-Altman e de concordância e sobrevivência foram aplicados. Resultados: Uma diferença média de aproximadamente uma hora (DP = 2,1; mediana = 0,5; p < 0,01) foi encontrada entre ambas as estratégias, a qual foi maior entre os meninos, com 1,9 horas (DP = 2,8; mediana = 1,6; p < 0,05), do que entre as meninas, 0,5 horas (DP = 1,4; mediana = 0,3; p = 0,11). A avaliação gráfica mostrou resultados semelhantes, bem como o coeficiente de correlação intraclasse: 0,06 (IC95% = -0,33 - 0,46; p = 0,489) para os meninos e 0,43 (IC95% = 0,12 - 0,83; p < 0,001) para as meninas. Conclusões: Nossos dados são consistentes com prévios estudos em relação à não concordância entre os dois métodos. Esses resultados são relevantes porque este é o primeiro estudo de concordância entre medidas subjetivas de sono e actigrafia em adolescentes brasileiros, do nosso conhecimento. Além disso, eles reforçam a necessidade de um cuidadoso uso das medidas de sono noturno entre adolescentes, principalmente entre os meninos.

Light Exposure and Sleep-Wake Pattern in Rapidly Rotating Shift Nurses

OBJECTIVES: Shift workers are at risk for various sleep and health-related problems. To investigate light exposure and sleep-wake pattern according to shift schedules in shift workers. METHODS: We enrolled 12 full-time, rapidly rotating three-shift female nurses (age 26.4±4.01 years). They completed sleep logs and actigraphy monitoring of sleep-wake parameters, light exposure, and activity levels for over 14 days (mean numbers of night shifts 2.5). RESULTS: Before beginning shift work, participants were healthy and had no history of hypnotics. One third of participants (33.3%) had clinically significant insomnia-related symptoms (insomnia severity index ≥15, mean 14.0). Reported health problems were irregular menstruation cycles (75%), nightmares (25%), and irritable bowel syndrome (16.7%). Mean sleep time was less than 6 h regardless of the shift periods and wakefulness after sleep onset was prolonged more than 30 min. Light exposure in night-shift periods was the lowest during working hours and the highest during non-working hours. Activity levels were not different during working hours throughout the schedules. CONCLUSIONS: Fast-rotating shift nurses sleep less and unsatisfactorily. Health-related problems were frequent in shift nurses. Rapidly rotating shift schedules and related inappropriate light exposure may be detrimental to sleep and health in shift workers.

Factors Influencing Sleep Patterns during Clinical Practice Weeks among Nursing Students : Based on Spielman's Model

PURPOSE: The purpose of this study was to identify the sleep patterns of nursing students using self-report questionnaire and physiologic measurement, to examine the factors influencing sleep patterns in based on Spielman's model. METHODS: Participants were 119 nursing students who were in the clinical practice period. Self-report questionnaires and actigraphy were used to collect the data. Data were analyzed using descriptive statistics, correlation and regression by the SPSS/WIN 21.0 programs. RESULTS: When sleep was measured by self-report questionnaire, 84 students (70.6%) showed poor sleep quality. The mean sleep efficiency was 82.6%, and 67 students(56.3%) showed low sleep efficiency (less than 85.0%). The factors affecting subjective sleep pattern measured by KMLSEQ were circadian sleep type (β=.28, ρ=.003) and alcohol (β=.20, ρ=.031). The factors affecting total sleep time were sedentary behavior (β=-.27, ρ=.003) and daytime sleepiness (β=-.33, ρ<.001). CONCLUSION: Many nursing students in their clinical practice period expressed sleep disturbance. Factors affecting the perceived sleep measured by the self-report questionnaire and objective sleep evaluated by physiologic measures were different. The evening type of students perceived poor sleep quality, however, sedentary life style and daytime sleepiness resulted in short sleep time. Therefore, more studies measuring the objective sleep characteristics are needed using subjective and objective characteristics.

Distribution of Active and Resting Periods in the Motor Activity of Patients with Depression and Schizophrenia

OBJECTIVE: Alterations of activity are prominent features of the major functional psychiatric disorders. Motor activity patterns are characterized by bursts of activity separated by periods with inactivity. The purpose of the present study has been to analyze such active and inactive periods in patients with depression and schizophrenia. METHODS: Actigraph registrations for 12 days from 24 patients with schizophrenia, 23 with depression and 29 healthy controls. RESULTS: Patients with schizophrenia and depression have distinctly different profiles with regard to the characterization and distribution of active and inactive periods. The mean duration of active periods is lowest in the depressed patients, and the duration of inactive periods is highest in the patients with schizophrenia. For active periods the cumulative probability distribution, using lengths from 1 to 35 min, follows a straight line on a log-log plot, suggestive of a power law function, and a similar relationship is found for inactive periods, using lengths from 1 to 20 min. For both active and inactive periods the scaling exponent is higher in the depressed compared to the schizophrenic patients. CONCLUSION: The present findings add to previously published results, with other mathematical methods, suggesting there are important differences in control systems regulating motor behavior in these two major groups of psychiatric disorders.