Evaluation of Sleep Quality and Daytime Sleepiness in Dentistry Students

Abstract Objective: To evaluate sleep quality and excessive daytime sleepiness in undergraduate dentistry students. Material and Methods: This research is characterized as an observational study of transversal type, having analysed undergraduate students in dentistry from a public university in the State of Pernambuco, Brazil. The sample consisted of 325 students enrolled between the 1st and 10th academic semester. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), while excessive daytime sleepiness was analysed through the Epworth Sleepiness Scale (ESS). The t-Student and Mann-Whitney tests were used for the numerical values, with the F-test (ANOVA) or the Kruskal-Wallis test being used to compare more than two categories. Results: It was observed that 71.1% of students presented a poor sleep quality, with more than half of the students exhibiting excessive daytime sleepiness (58.1%). A relationship between sleep quality and the academic semester was verified. However, gender and age were not associated with sleep quality or with excessive daytime sleepiness. Conclusion: A high prevalence of poor sleep quality and excessive daytime sleepiness was observed among undergraduate students in dentistry. The data suggest that the undergraduate degree in Dentistry can influence the students' quality of sleep, regardless of age or gender.

Adiponectin levels and sleep deprivation in patients with endocrine metabolic disorders

SUMMARY BACKGROUND: Sleep abnormalities are frequent in patients with endocrine metabolic disorders (EMD) such as arterial hypertension, diabetes and obesity. Adiponectin is a peptide largely secreted by adipocytes and has various properties e.g. anti-inflammatory, antioxidant, antiatherogenic, pro-angiogenic, vasoprotective and insulin-sensitizing. Adiponectin inversely relates to body weight and when its concentration decreases, the resistin concentration increases resulting in greater insulin resistance. OBJECTIVE: The objective of this study is to examine factors influencing adiponectin levels in a population with EMD. METHODS: This was a cross-sectional evaluation of 332 patients (18 to 80y) presenting arterial hypertension, pre-diabetes, diabetes, and/or obesity. Investigation included clinical evaluation of comorbidities, general blood tests and adiponectin measures (ELISA). Chronic sleep deprivation was determined if habitual sleep was <6 hours >4 days/week. RESULTS: Arterial hypertension (78.5%), type-2 diabetes (82.3%), and overweight (45.0%)/obesity (38.8%) were frequent. Patients with type-2 diabetes tended to have more chronic sleep deprivation (p=0.05). Adiponectin levels increased with age and were inversely correlated with sagittal abdominal diameter (p=0.04) and fasting insulin (p=0.001). Chronic sleep deprivation was associated with higher adiponectin concentration [OR=1.34; CI=1.13-1.58; p<0.005] and this was maintained after adjustment for gender, age, body mass index, menopause, arterial hypertension, American Diabetes Association classification and physical exercise levels [OR=1.38; 0=1.14-1.66: p=0.001]. CONCLUSION: In patients with EMD, adiponectin is influenced not only by obesity but also by age and sleep deprivation. The latter finding may be explained by a compensatory effect or a counter regulation to minimize the harmful effects of sleep deprivation.

RESUMO INTRODUÇÃO: Problemas de sono são frequentes em pacientes com distúrbios endócrino-metabólicos (DEM), como hipertensão arterial, diabetes e obesidade. A adiponectina é um peptídeo segregado por adipócitos e apresenta diversas propriedades, como por exemplo, anti-inflamatória, antioxidante, antiaterogênica, pró-angiogênica e vasoprotetora. A adiponectina relaciona-se inversamente com o peso corporal. OBJETIVO: Examinar os fatores que influenciam os níveis de adiponectina em uma população com DEM. MÉTODOS: Trata-se de uma avaliação transversal com 332 pacientes (18 a 80 anos) apresentando hipertensão arterial, pré-diabetes, diabetes e/ou obesidade. A investigação incluiu avaliação clínica de comorbidades, exames de sangue e medidas de adiponectina (Elisa). A restrição crônica do sono foi determinada com o sono habitual <6 horas >4 dias/semana. RESULTADOS: Doenças como hipertensão arterial (78,5%), diabetes tipo 2 (82,3%) e sobrepeso (45,0%)/obesidade (38,8%) foram frequentes. Pacientes com diabetes tipo 2 apresentaram uma tendência na restrição crônica do sono (p=0,05). Os níveis de adiponectina aumentaram com a idade e foram inversamente correlacionados com o diâmetro abdominal sagital (p=0,04) e com a insulina em jejum (p=0,001). A restrição crônica do sono foi associada à maior concentração de adiponectina [OR=1,34; CI=1,13-1,58; p<0,005] e isso foi mantido após ajuste por gênero, idade, índice de massa corporal, menopausa, hipertensão arterial, classificação dos níveis da American Diabetes Association e exercício físico [OR=1,38; CI=1,14-1,66: p=0,001]. CONCLUSÕES: Em pacientes com DEM, a adiponectina é influenciada não apenas pela obesidade, mas também pela idade e pela restrição de sono. O último achado pode ser explicado por um efeito compensatório ou por um regulamento contrário para minimizar os efeitos nocivos da restrição do sono.

Sleep in the intensive care unit / Sono na unidade de terapia intensiva

ABSTRACT Poor sleep quality is a consistently reported by patients in the ICU. In such a potentially hostile environment, sleep is extremely fragmented and sleep architecture is unconventional, with a predominance of superficial sleep stages and a limited amount of time spent in the restorative stages. Among the causes of sleep disruption in the ICU are factors intrinsic to the patients and the acute nature of their condition, as well as factors related to the ICU environment and the treatments administered, such as mechanical ventilation and drug therapy. Although the consequences of poor sleep quality for the recovery of ICU patients remain unknown, it seems to influence the immune, metabolic, cardiovascular, respiratory, and neurological systems. There is evidence that multifaceted interventions focused on minimizing nocturnal sleep disruptions improve sleep quality in ICU patients. In this article, we review the literature regarding normal sleep and sleep in the ICU. We also analyze sleep assessment methods; the causes of poor sleep quality and its potential implications for the recovery process of critically ill patients; and strategies for sleep promotion.

RESUMO O sono de má qualidade é uma situação persistentemente descrita em UTIs. O sono nesse ambiente potencialmente hostil é caracterizado pela sua extrema fragmentação e arquitetura não convencional, com predomínio de fases leves e limitada quantidade de tempo nos estágios reparadores. Entre as causas da privação do sono na UTI estão fatores intrínsecos aos pacientes e à condição aguda de sua doença, assim como fatores relacionados ao ambiente da UTI e ao tratamento em curso, como o suporte ventilatório e a terapia medicamentosa. Embora as consequências da má qualidade do sono no processo de recuperação desses pacientes ainda sejam desconhecidas, ela parece influenciar os sistemas imune, metabólico, cardiovascular, respiratório e neurológico. Evidências sugerem que intervenções multifacetadas, focadas na minimização das perturbações do sono noturno, promovem melhora na qualidade do sono nesses pacientes. Este artigo revisa a literatura acerca do sono normal e do sono na UTI. Também analisa seus métodos de avaliação, as causas da má qualidade do sono, suas potenciais implicações no processo de recuperação de pacientes críticos e estratégias para sua promoção.

Association between sleep quality and quality of life in nursing professionals working rotating shifts / Associação entre qualidade do sono e qualidade de vida de profissionais de enfermagem que trabalham em turnos

OBJECTIVE To analyze the association between sleep quality and quality of life of nursing professionals according to their work schedules. METHODS A prospective, cross-sectional, observational study was conducted between January and December 2010, with 264 nursing professionals, drawn from 989 subjects at Botucatu General Hospital and stratified by professional category. The Pittsburg Sleep Quality Index and the WHOQOL-bref were administered to evaluate sleep quality and quality of life, respectively. Self-reported demographic data were collected with a standard form. Continuous variables were reported as means and standard deviations, and categorical variables were expressed as proportions. Associations were evaluated using Spearman’s correlation coefficient. The association of night-shift work and gender with sleep disturbance was evaluated by logistic regression analysis using a model adjusted for age and considering sleep disturbance the dependent variable. The level of significance was p < 0.05. RESULTS Night-shift work was associated with severe worsening of at least one component of sleep quality in the model adjusted for age (OR = 1.91; 95%CI 1.04;3.50; p = 0.036). Female gender was associated with sleep disturbance (OR = 3.40; 95%CI 1.37;8.40; p = 0.008). Quality of life and quality of sleep were closely correlated (R = -0.56; p < 0.001). CONCLUSIONS Characteristics of the nursing profession affect sleep quality and quality of life, and these two variables are associated. .

OBJETIVO Analisar a associação entre a qualidade do sono e a qualidade de vida dos profissionais de enfermagem segundo organização do trabalho. MÉTODOS Estudo transversal, observacional e prospectivo, com 264 profissionais de enfermagem em Botucatu, SP, entre janeiro e dezembro de 2010. Os sujeitos foram sorteados entre os 989 indivíduos que trabalhavam no Hospital Geral de Botucatu e estratificados por categoria profissional. O Índice de Qualidade de Sono de Pittsburgh e o WHOQOL-bref foram aplicados para avaliar qualidade do sono e qualidade de vida, respectivamente. Os dados demográficos foram coletados por meio de formulário padrão. Variáveis contínuas foram apresentadas como média e desvio padrão e variáveis categóricas, como proporções. As associações foram avaliadas por meio do coeficiente de correlação de Spearman. As associações entre turno e sexo com a qualidade do sono foram analisadas por meio de regressão logística, no modelo corrigido para idade. Distúrbio do sono foi a variável dependente. O nível de significância adotado foi p < 0,05. RESULTADOS Trabalho noturno foi associado com prejuízo importante de pelo menos um componente da qualidade do sono (OR = 1,91; IC95% 1,04;3,50, p = 0,036). O prejuízo da qualidade do sono também se associou com o sexo feminino (OR = 3,40; IC95% 1,37;8,40; p = 0,008). Houve correlação estreita entre a qualidade de vida e qualidade do sono (r = -0,56, p < 0,001). CONCLUSÕES Características próprias da profissão de enfermagem podem afetar a qualidade do sono e a qualidade de vida, e essas duas variáveis estão associadas entre si. .

Fatores que interferem na qualidade do sono de pacientes internados / Factors that affect inpatients' quality of sleep / Factores que interfieren en la calidad del sueño de pacientes internados

Este estudo objetivou identificar fatores que interferem na qualidade do sono de pacientes internados em hospital universitário do interior de São Paulo. Trata-se de estudo exploratório, de corte transversal, com amostragem não probabilística. Participaram 117 pacientes (59% homens, idade média de 48 anos, desvio padrão 16,9) internados há pelo menos 72 horas, em condições clínicas estáveis. Os instrumentos utilizados foram: questionário de identificação e Fatores Intervenientes na Qualidade do Sono (FIQS). O tratamento dos dados foi feito com estatística descritiva e cada item do FIQS foi submetido a teste e reteste. Os fatores apontados com maior frequência foram: acordar cedo (55,6%), sono interrompido (52,1%), iluminação excessiva (34,2%), recebimento de cuidados pela equipe de enfermagem (33,3%) e distúrbios orgânicos como dor e fadiga (26,5%). Sugere-se que os enfermeiros planejem intervenções buscando modificar fatores que propiciam ruídos e iluminação intensos à noite, visando reduzir interrupções e, consequentemente, a privação de sono.

The aim of this study was to identify factors that interfere with the sleep quality of patients admitted to a university hospital in a city in the state of São Paulo, Brazil. This was an exploratory, crosssectional study using non-probability sampling. Participants were 117 patients (59% men, mean age 48.0 years, standard deviation 16.9) hospitalized for at least 72 hours in stable clinical condition. The data were collected with an identification questionnaire and the Factors Affecting Sleep Quality (FASQ) questionnaire. Data processing was performed with descriptive statistics; each item of the FASQ underwent a test and a retest. The factors most often reported were waking up early (55.6%), disrupted sleep (52.1%), excessive lighting (34.2%), receipt of care by nursing staff (33.3%) and organic disorders such as pain and fatigue (26.5%). It is suggested that nurses should plan interventions to modify factors that require intense noise and lighting at night in order to reduce disruption and, consequently, sleep deprivation among patients.

Se objetivó identificar factores que interfieren en la calidad del sueño de pacientes internados en un hospital universitario del interior de São Paulo. Estudio exploratorio, transversal, con muestra no probabilística. Participaron 117 pacientes (59% masculinos, media etaria 48,0 años, desvío estándar 16,9) internados al menos hace 72 horas, en condiciones clínicas estables. Se utilizaron los instrumentos: cuestionario de identificación y Factores Intervinientes en la Calidad del Sueño (FIQS). Los datos se analizaron según la estadística descriptiva, cada ítem del FIQS fue sometido a prueba y contraprueba. Los factores señalados como más frecuentes fueron: despertar temprano (55,6%), sueño interrumpido (52,1%), iluminación excesiva (32,4%), recepción de cuidados de enfermería (33,3%) y disturbios orgánicos, como dolor y fatiga (26,5%). Se sugiere que los enfermeros planifiquen intervenciones buscando modificar factores generadores de ruidos e iluminación intensa por la noche, apuntando a reducir interrupciones y consecuentes privaciones en el sueño.

Nocturnal symptoms and sleep disturbances in clinically stable asthmatic children.

Presence of nocturnal symptoms is related to asthma severity. Clinically stable asthmatic children, too, report frequent nocturnal symptoms and sleep disturbances. The study determined these parameters in stable, asthmatic children, in their home environment. This case-control, questionnaire-based study in 70 school-going children comprised 40 asthmatics (Group 1) and 30, age/gender matched, healthy children (Group 2). Parents maintained peak expiratory flow (PEF) and sleep diaries for one week. Group 1 had significantly lower mean morning (250.3 vs. 289.1 I/minute) and mean evening PEF values (261.7 vs. 291.3 I/minute). Group 1 (38.95%), reported frequent nocturnal symptoms like cough (36.90%), breathlessness (32.80%), wheeze (27.68%) and chest tightness (14.35%). Sleep disturbances, significant in Group 1 (38, 95% vs. 14.35%), included daytime sleepiness (24.60%), daytime tiredness (20.50%), difficulty in maintaining sleep (15.38%), early morning awakening (14.35%), struggle against sleep during daytime (12.30%), and involuntarily falling asleep (17.43%). On a scale of 1-6, Group 1 scored significant sleep disturbances/patient (3 vs. 0.8); lethargy/tiredness in morning (2.9 vs. 2.2), poorer sleep quality (4.7 vs. 5.4), less parents' satisfaction with child's sleep (4.5 vs. 5.5) and daytime fitness (4.1 vs. 5.3). Group 1, when exposed to environmental tobacco smoke (22, 55%), reported significant nocturnal symptoms (18/22, 81%) and reduced mean morning and evening PEF values (17/22, 77%). It is concluded that clinically stable, asthmatic children reported increased nocturnal symptoms, sleep disturbances and poorer sleep quality. Lack of awareness of asthma-sleep association and its clinical implications could lead to poor asthma control and impaired daytime activity.

Effects of low frequency noise on man--a case study.

Based on a real case effects of long-term exposure of infrasound on man are outlined. Beside a description of the background of the case together with remarks on the occurred health problems, the main view lies on the proceeding in identifying the special kind of exposure just as possible technical causes. As a source of annoyance a small heating plant was identified, which immitted into the house of the exposed people very low frequency airborne sound far below the common hearing thresholds. The results show clearly the general deficit of research on the effects of low level infrasound on man.

Nocturnal awakenings due to aircraft noise. Do wake-up reactions begin at sound level 60 dB(A)?

Night-time wake-up thresholds at noise levels of 60 dB(A) are frequently employed in Germany to establish "noise polluted areas". The criterion is, however, based on an incorrect processing of statistical data gathered from an evaluation of literature performed by Griefahn et al. (1976). This finding has emerged from an extensive revision of the study. Using appropriate statistical methods, maximum levels of under 48 dB(A) are assessed as waking-up thresholds at ear level in sleeping persons, in contrast to maximum levels of 60 dB(A) calculated by Griefahn et al. in 1976. The linear dose-response relationship, which in the course of the revision could be derived from the early publications, agrees with the results of more recent literature evaluations. The present contribution is not intended to give rise to the question whether in the interest of medical prevention it is reasonable to develop night-time protective policies merely founded on noise levels marking the "statistical" onset of nocturnal wake-up reactions. In this context, emphasis is laid on the deformation of the biological rhythm of sleep.

Protection goals for residents in the vicinity of civil airports.

Based on extensive and detailed reviews the present paper suggests evaluation criteria for aircraft noise for the prediction of noise effects and for the protection of residents living in the vicinity of (newly constructed or extended) civil airports. The protection concept provides graded evaluation criteria: Critical loads indicate noise loads that shall be tolerated only exceptionally during a limited time. Protection Guides are central evaluation criteria for taking actions to reduce noise immission. Threshold values inform about measurable physiological and psychological reactions due to noise exposures where long term adverse health effects are not expected. Evaluation criteria are provided for various protection goals, for hearing, communication and sleep, for the avoidance of annoyance and of suspected cardiovascular diseases. As protection of the residents is understood as a dynamic process, these criteria must be repeatedly tested and adapted to new scientific findings.