Desenvolvimento de aplicativo para higiene do sono em adultos / Development of an application for sleep hygiene in adults / Desarrollo de una aplicación para la higiene del sueño en adultos

Introdução: Diferentes condições clínicas podem afetar a quantidade e a qualidade do sono. As medidas de higiene do sono interferem diretamente na qualidade deste. Elas podem ser propagadas à população por meio de aplicativos. Objetivo: Desenvolver, avaliar e disponibilizar um aplicativo que contemple as medidas de higiene do sono e que seja capaz de gerar mudança e verificar a ocorrência de sonolência diurna excessiva. Metodologia: O aplicativo "Somnum" foi desenvolvido e 26 fonoaudiólogos certificados em Sono pela Associação Brasileira do Sono foram convidados a avaliar usando o questionário Emory e outro questionário elaborado pelas autoras. Após, 38 estudantes usaram o aplicativo e responderam antes e depois do uso o Índice de Qualidade do Sono de Pittsburgh e a Escala de Epworth. Resultados: Após seu desenvolvimento, o aplicativo foi avaliado por 4 fonoaudiólogas que contribuíram com suas sugestões e 38 universitários participaram respondendo os questionários, sendo que 6 deles participaram antes e após o uso do aplicativo. Sobre o Índice de qualidade de sono de Pittsburgh, foi observado na análise estatística, comparando o antes e após o uso do aplicativo, melhora da qualidade de sono (p=0,04). No que se refere ao questionário Epworth, foi verificado na situação após o uso do aplicativo "Somnum", que não houve diferença significativa. Conclusão: Após o uso do aplicativo, verificou-se possível melhora na qualidade de sono. Houve ocorrência de sonolência diurna excessiva. (AU)

Introduction: Different clinical conditions can affect the quantity and quality of sleep. Sleep hygiene measures directly affect the quality of sleep. They can be disseminated to the population by means of applications. Objective: To develop, evaluate and make available an application that approach sleep hygiene and that is able to generate changes and verify the occurrence of excessive daytime sleepiness. Methodology: The application "Somnum" was developed and 26 speech therapists certified in sleep by the Brazilian Sleep Association were invited to evaluate it using the Emory questionnaire and another questionnaire developed by the authors. Afterwards, 38 students used the application and answered before and after the use the Pittsburgh Sleep Quality Index and the Epworth Scale. Results: After its development, the app was evaluated by 4 speech therapists who contributed with their suggestions, and 38 university students participated by answering the questionnaires, 6 of them before and after the use of the application. In the Pittsburgh Sleep Quality Index, it was observed in the statistical analysis, comparing before and after using the application, improvement in sleep quality (p=0.04). In the Epworth questionnaire, it was verified in the situation after using the "Somnum" application, that there was not significant difference. Conclusion: After using the application, there was a possible improvement in sleep quality. There was occurrence of excessive daytime sleepiness. (AU)

Introducción: Diferentes condiciones clínicas pueden afectar a la cantidad y calidad del sueño. Las medidas de higiene del sueño afectan directamente a la calidad del mismo. Pueden propagarse a la población mediante aplicaciones. Objetivo: Desarrollar, evaluar y poner a disposición una aplicación que incluya medidas de higiene del sueño y que sea capaz de generar cambios y verificar la aparición de somnolencia diurna excesiva. Metodología: Se desarrolló la aplicación "Somnum" y se invitó a 26 fonoaudiólogos certificados en soeño por la Asociación Brasileña del Sonido a evaluarla utilizando el cuestionario Emory y otro cuestionario elaborado por los autores. Posteriormente, 38 estudiantes utilizaron la aplicación y respondieron antes y después del uso de la misma al Índice de Calidad del Sueño de Pittsburgh y a la Escala de Epworth. Resultados: Tras su desarrollo, la aplicación fue evaluada por 4 fonoaudiólogos que aportaron sus sugerencias y 38 estudiantes universitarios participaron respondiendo a los cuestionarios, 6 de ellos antes y después del uso de la aplicación. Sobre el Índice de Calidad del Sueño de Pittsburgh, se observó en el análisis estadístico, comparando antes y después del uso de la aplicación, mejoría en la calidad del sueño (p=0,04). Con respecto al cuestionario de Epworth, se verificó en la situación posterior al uso de la aplicación "Somnum", que no hubo diferencia significativa. Conclusión:Después de usar la aplicación, hubo uma posible mejora em la calidad del sueño. Hubo ocurrencia de somnolencia diurna excesiva. (AU)

The past, present and future of sleep medicine in China / 北京大学学报(医学版)

Sleep is a highly conserved phenomenon in endotherms, and has a universal physiological function across all species. In mammals, sleep can be divided into two stages: rapid eye movement (REM) sleep and non-REM (NREM) sleep, which alternate in a cyclic manner. Humans spend about one-third of their lives asleep. Sufficient sleep is necessary for humans to sustain everyday functioning. Sleep plays an important role in regulating energy metabolism, immune defense, endocrine function, and the consolidation of memory process. With the development of social economy and the change of life style, sleep duration of the residents has gradually decreased and the incidence of sleep disturbances has increased. Sleep disturbances can lead to severe mental disorders, such as depression, anxiety disorders, dementia, and other mental diseases, and may increase the risk of physical diseases, such as chronic inflammation, heart disease, diabetes, hypertension, atherosclerosis and others. Maintaining good sleep is of great significance for developing social productive forces, promoting sustainable development of economic society, and is a necessary condition for carrying out the "Healthy China Strategy". The sleep research in China started in 1950s. After decades of development, researchers have made great progress in the molecular mechanisms of sleep and wakefulness, the pathogenesis of sleep disorders and the development of new therapies. With the advancement of science and technology and the public's attention to sleep, the level of clinical diagnosis and therapy of sleep disorders in China is gradually brought in line with international standards. The publication of diagnosis and treatment guidelines in the field of sleep medicine will promote the standardization of the construction. In the future, it is still necessary to promote the development of sleep medicine in the following aspects: Strengthening the professional training and discipline construction, improving the cooperation of sleep research, promoting the intelligent diagnosis and treatment of sleep disorders, and developing the new intervention strategies. Therefore, this review will comprehensively summarize the origin, current situation, and future expectations of sleep medicine in China, including discipline construction of sleep medicine, the number of sleep project grants, research findings, the status and progress of diagnosis and treatment of sleep disorders, and the development direction of sleep medicine.

Effect of Tiaoshen Qianyang acupuncture on blood pressure and sleep quality in patients with stroke-related sleep disorders complicated with hypertension / 中国针灸

OBJECTIVE@#To observe the effect of Tiaoshen Qianyang acupuncture on morning blood pressure, sleep quality and post-stroke nerve function recovery in patients with stroke-related sleep disorders (SSD) complicated with hypertension.@*METHODS@#A total of 120 patients were randomized into an observation group (60 cases) and a control group (60 cases, 1 case dropped off). Both groups were treated with Xingnao Kaiqiao acupuncture (Neiguan [PC 6], Shuigou [GV 26], Sanyinjiao [SP 6], Jiquan [HT 1], Chize [LU 5] and Weizhong [BL 40]). In addition, Tiaoshen Qianyang acupuncture was applied in the observation group, deep needling at Baihui (GV 20) and Sishencong (EX-HN 1) for 5 h. Once a day, 5 times a week, 30 times in total. The morning blood pressure was measured during treatment in the two groups, the Pittsburgh sleep quality index (PSQI) and National Institute of Health stroke scale (NIHSS) scores before and after treatment were observed in the two groups.@*RESULTS@#Compared before treatment, the morning systolic blood pressure (SBP) after treatment were decreased in the two groups (P<0.05), and the morning diastolic blood pressure (DBP) after treatment was decreased in the observation group (P<0.05). The levels of SBP and DBP after treatment in the observation group were lower than the control group (P<0.05). Compared before treatment, the total score of PSQI and NIHSS score after treatment in the observation group were decreased (P<0.01, P<0.05), which were lower than the control group (P<0.01, P<0.05), the decreasing rate of NIHSS score in the observation group was higher than the control group (P<0.05).@*CONCLUSION@#On the basis of Xingnao Kaiqiao acupuncture, Tiaoshen Qianyang acupuncture could improve morning blood pressure and sleep quality for patients with SSD complicated with hypertension, promote the recovery of nerve function.

To "tell or not to tell"-Exploring disclosure about medicine use by people living with sleep disorders / 中西医结合学报

OBJECTIVE@#To explore the difference in rates and reasons for disclosure of either conventional or complementary medicine (CM) to healthcare practitioners between people living with sleep disorders (SDs) and those without SDs.@*METHODS@#A cross-sectional survey (N = 2019 adults) that measured sociodemographic characteristics, health status, health service utilisation, health literacy and health communication (medicine disclosure) of a representative sample of Australians was conducted. Data from participants reporting an SD (n = 265) were compared to those not reporting an SD to assess measures of health communication and disclosure about medicine use.@*RESULTS@#Overall, rates of medicine disclosure to both conventional and CM practitioners were high, in respondents with (70%) and without an SD (57%). Those reporting an SD had higher expectations of their conventional health practitioner's knowledge of CM, associated clinical decision-making skills, and approval of CM use, and held a higher degree of concern about drug interactions (P < 0.05). The main reasons cited for disclosing CM use to conventional health practitioners and conventional medicine use to CM practitioners were "I want them to fully understand my health status" and "I was concerned about drug interactions with the CMs used."@*CONCLUSION@#The high rate of medicine use disclosure by people with SDs is driven by an intention to inform their healthcare practitioner about their health status and concerns about potential medicine interactions. Therefore, research about the expectations that people with an SD have of their conventional healthcare practitioners' knowledge of CM and CM-drug interactions requires further examination. Likewise, further examination of CM practitioner's conventional medicine knowledge is encouraged.

Hot Topics in Recent Parkinson's Disease Research: Where We are and Where We Should Go / 神经科学通报·英文版

Parkinson's disease (PD), the second most common neurodegenerative disease, is clinically characterized by both motor and non-motor symptoms. Although overall great achievements have been made in elucidating the etiology and pathogenesis of PD, the exact mechanisms of this complicated systemic disease are still far from being clearly understood. Consequently, most of the currently-used diagnostic tools and therapeutic options for PD are symptomatic. In this perspective review, we highlight the hot topics in recent PD research for both clinicians and researchers. Some of these hot topics, such as sleep disorders and gut symptoms, have been neglected but are currently emphasized due to their close association with PD. Following these research directions in future PD research may help understand the nature of the disease and facilitate the discovery of new strategies for the diagnosis and therapy of PD.

Effects of traditional Chinese exercises and general aerobic exercises on older adults with sleep disorders: A systematic review and meta-analysis / 中西医结合学报

BACKGROUND@#Sleep disorders are common in older adults and have a negative influence on their physical and mental health. General aerobic exercises (GAEs) have long been used in the treatment of sleep disorders as a non-pharmacological measure. However, there is no consensus on the efficacy of traditional Chinese exercises (TCEs) for treating sleep disorders in older adults and the difference between TCEs and GAEs.@*OBJECTIVE@#This study assessed the effects of TCEs and GAEs on the sleep quality of older adults and the differences between these two interventions.@*SEARCH STRATEGY@#PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, China Science Journal Database and Wanfang Data were searched from their inception to August 2020.@*INCLUSION CRITERIA@#Randomized controlled trials (RCTs) that evaluated the effects of TCEs and GAEs on older adults with sleep disorders were included.@*DATA EXTRACTION AND ANALYSIS@#Data were extracted by two researchers working independently. The risk bias of included studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 and the quality of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation approach. The Pittsburgh Sleep Quality Index (PSQI) was used to estimate sleep quality. Meta-analyses were performed to assess the total PSQI score of the exercise intervention as the primary outcome, and the scores of subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleep medication and daytime dysfunction were assessed as secondary outcomes. Subgroup, sensitivity, and meta-regression analyses were conducted to assess the contribution of covariables to heterogeneity.@*RESULTS@#A total of 22 RCTs (including 1747 participants) were included in the meta-analysis. The results indicated that TCEs (weighted mean difference [WMD] = -2.14, 95% confidence interval [CI] [-2.82, -1.46], P < 0.001; heterogeneity: P < 0.001, I@*CONCLUSION@#Current evidence shows that both TCEs and GAEs, as complementary and non-pharmacological approaches, help to improve the sleep quality in older adults with potentially clinical implications; however, there was not enough evidence to conclude the difference between them. More rigorous and high-quality RCTs are needed to arrive at reliable conclusions.

Trastorno de hipoventilación central del sueño en pediatría: causas poco frecuentes / Central hypoventilation disorders sleep-related in pediatrics: unusual causes

Congenital central hypoventilation syndrome (CCHS) and rapid-onset obesity syndrome with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) are rare causes of hypoventilation during sleep in the pediatric population. This group of disorders are characterized by the absence or decrease in the automatic control of ventilation, decreased sensitivity of chemoreceptors to CO2, causing hypoventilation during sleep and even in wakefulness, in the most severe cases. For these reasons it is important to diagnose and treat them promptly. The objective of this review is to provide current and complete literature, to be able to identify, treat and refer this group of children early, and thus reduce the complications and/or associated comorbidities in the short and long term, improving their quality of life.

El síndrome de hipoventilación central congénita (CCHS) y síndrome de obesidad de inicio rápido con disfunción hipotalámica, hipoventilación y desregulación autonómica (ROHHAD), son causas poco comunes de hipoventilación durante el sueño en la población pediátrica. Este grupo de trastornos se caracterizan por ausencia o disminución en el control automático de la ventilación, sensibilidad disminuida de los quimioreceptores al CO2, provocando hipoventilación durante el sueño e incluso en vigilia, en los casos más severos. Por estas razones es importante diagnosticarlos y tratarlos oportunamente. El objetivo de esta revisión es proporcionar literatura actual y completa, para poder identificar, tratar y referir a éste grupo de niños tempranamente, y así disminuir las complicaciones y/o comorbilidades asociadas a corto y largo plazo, mejorando su calidad de vida.

Validación al Español de un cuestionario de hábitos de sueño en los niños / Validation to Spanish version of the Children's Sleep Habits Questionnaire

Introducción: Los trastornos del sueño en la infancia constituyen un fenómeno de elevada frecuencia. Los cuestionarios de sueño constituyen un instrumento de innegable valor que complementa los estudios objetivos del sueño. Objetivo: Validar al español un cuestionario que indaga acerca de los hábitos de sueño en niños en el contexto sociocultural cubano. Métodos: Se seleccionó el cuestionario CHILDREN'S SLEEP HABITS QUESTIONNAIRE (NICHD SECCYD-Wisconsin) para su uso en el laboratorio de neurofisiología del Centro Internacional de Restauración Neurológica. En una primera etapa del estudio, el cuestionario se tradujo y adaptó al español según las reglas internacionales. Se entregaron 330 cuestionarios a los padres en una muestra poblacional cubana de niños en edades comprendidas entre los 2 a 10 años. Estos se distribuyeron en escuelas y círculos infantiles con una tasa de respuesta de 93 por ciento. Se recuperaron 295 (96 por ciento) cuestionarios útiles, 25 atendieron a los criterios de exclusión, 270 se aceptaron para estudios de validación. Resultados: La consistencia interna del cuestionario (alfa de Cronbach) fue de 0,67 para la escala completa y varió de 0,42 a 0,61 para las subescalas. Para la confiabilidad test-retes de las subescalas se aplicó una t de students para muestras dependientes, con una n= de 86. Las diferencias fueron significativas en las subescalas 3 y 8 (p= 0,04) Conclusiones: El cuestionario según su versión original y en comparación con la de otros países presentó propiedades psicométricas adecuadas para evaluar los problemas de sueño en niños cubanos entre 2 y 10 años de edad(AU)

Introduction: Sleep disorders in childhood constitute a highly frequent phenomenon. The sleep habits´ questionnaires are instruments of undeniable value that complement the sleep's objective studies. Objective: To validate the Spanish version of a Questionnaire (NICHD SECCYD-Wisconsin) and compare it with the results of previous studies in other countries. Methods: It was selected the Children's Sleep Habits Questionnaire for its use in the neurophysiology laboratory of the International Center of Neurological Restoration (CIREN, by its acronym in Spanish). In the first stage of the study, the questionnaire was translated and adapted to Spanish according to the international standards. 330 questionnaires were delivered to the parents of a Cuban community sample of children aged 2 to10 years old, with a response rate of 93 percent. 295 (96 percent) useful questionnaires were obtained, 25 met the exclusion criteria, 270 were accepted for validation studies. The results were compared with the results of other countries. Results: The Children's Sleep Habits Questionnaire´s internal consistency (Cronbach) was 0.67 for the total scale and ranged from 0.42 to 0.61 for subscales. The test-retest reliability for subscales used t for students in dependent samples, being n= 86.The differences were meaningful for subscales 3 y 8 (p= 0,4). Conclusion: The questionnaire according to its original version and in comparison with that of other countries has adequate psychometric properties to evaluate sleep problems in Cuban children between 2 and 10 years(AU)

El sueño del niño con trastornos del neurodesarrollo / The sleep in children with neurodevelopmental disorders

El sueño adecuado es necesario para el desarrollo sináptico y la maduración cerebral, un sueño de mala calidad tiene efectos perjudiciales en las funciones cognitivas, de atención, memoria y conducta de los niños. La preocupación sobre la alta prevalencia de los problemas del sueño es amplia en todo el mundo; las consecuencias de estos problemas son incluso más importantes en los niños portadores de trastornos del neurodesarrollo; estos niños a menudo tienen dificultades de inicio y mantenimiento del sueño y despertares nocturnos frecuentes que afectan a sus problemas de conducta. El propósito de este escrito es revisar el estado del arte de los problemas del sueño en los niños con trastornos del neurodesarrollo. En este punto, es importante tener en cuenta el ritmo circadiano, un reloj que genéticamente dirige los ritmos celulares de transcripción, traslación y metabolismos. Este reloj se combina con el ambiente diurno y nocturno coordinando estos mecanismos durante los ciclos luz/oscuridad, sueño/vigilia, frío/calor, ingesta/ayuno, tanto diariamente como en las diferentes estaciones. En conclusión, los problemas del sueño son un factor condicionante de la evolución y calidad de vida de los niños con trastornos del neurodesarrollo, que debe ser tenido en cuenta en todos los casos y ocupar un lugar preferente tanto en la etapa diagnóstica como en la terapéutica.

Adequate sleep is of critical need for a typical synaptic development and brain maturation, a poor quality sleep can have detrimental effects on children's' cognitive attention, memory, mood regulation, and behavior functions. Great concern has been voiced out regarding the high prevalence of poor sleep in children worldwide, the effects of poor sleep may be even more pronounced in children with neurodevelopmental disorders; these children often have difficulties with falling and staying asleep and with night awakenings, this has a strong association with daytime behavior problems. The purpose of this article is to provide an overview of the state of the science of sleep in children with a neurodevelopmental disorder. In this context, it is important to take the circadian cycle into account, a genetically encoded clock that drives cellular rhythms of transcription, translation and metabolism. The circadian clock interacts with the diurnal and nocturnal environment that also drives transcription and metabolism during light/dark, sleep/wake, hot/cold and feast/fast daily and seasonal cycles In conclusion, the sleep problems are a conditioning factor in the evolution and quality of life of children with neurodevelopmental disorders that must be taken into account in all cases and occupy a preferential place in both the diagnostic and the therapeutic stages.

Botulinum toxin A (BT-A) versus low-level laser therapy (LLLT) in chronic migraine treatment: a comparison / Toxina botulínica A (BT-A) versus laser terapia de baixa potência (LLLT) em enxaqueca crônica: Uma triagem comparativa

ABSTRACT The aim of this work was to evaluate patients with chronic migraine treated with botulinum toxin A (BT-A) and compare this with low level laser therapy (LLLT), referencing: pain days, pain intensity, intake of drugs/self-medication, anxiety and sleep disorders. Methods: Patients were randomized into two groups: BT-A group (n = 18) and LLLT group (n = 18). Each patient kept three pain diaries: one before (baseline) (30 days), one during treatment (30 days) and one after the post-treatment phase (30 days). Repeated ANOVA plus the Bonferroni post-test, Student's t test, and factorial analysis were applied, and p < 0.05 was accepted as significant. Results: Our data showed that both treatments were able to reduce headache days, acute medication intake and decrease the intensity of pain. Anxiety was reduced in the BT-A group, while sleep disturbance was reduced in the LLLT group. Conclusion: Our data showed that both treatments can be used to treat chronic migraine, without notable differences between them.

RESUMO O estudo comparou pacientes com cefaleia crônica (CM) tratados com toxina botulínica A (BT-A) versus terapia a laser de baixa intensidade (LLLT), relativos a: dias de dor, automedicação, nervosismo e distúrbios do sono. Métodos: Os pacientes foram randomizados em dois grupos: Grupo BT-A (n = 18) e Grupo LLLT (n = 18). Cada paciente preencheu três diários de dor, sendo um antes do início do tratamento (30 dias), durante o tratamento (30 dias) e um após tratamento (30 dias). ANOVA e pós-teste Bonferroni, teste T de Student e análise fatorial foram utilizados e valores de p < 0,05 foram considerados significativos. Resultados: Ambos os tratamentos foram capazes de reduzir os dias de dor e a ingestão aguda de medicação. Além disso, a ansiedade foi reduzida no grupo BT-A, enquanto que o distúrbio do sono foi reduzido no grupo LLLT. Conclusão: Nossos resultados mostraram que ambos os tratamentos são eficientes contra CM, sem diferença entre eles.

Outpatient treatment of sleep disorders in Alzheimer patients / Tratamento ambulatorial dos transtornos do sono em pacientes com doença de Alzheimer

Sleep disorders are common in patients with Alzheimer dementia and affect the quality of life of patients and of their caregivers. Despite the rising number of studies in the area, almost all of them are about non-pharmacological treatment. Our objective was to review the literature concerning pharmacological and non-pharmacological approaches to treat sleep disorders of elderly patients with Alzheimer dementia in the ambulatory setting. The treatments revised consisted of sleep hygiene and/or use of intense light coupled or not with use of melatonin, cholinesterase inhibitors, antipsychotics, hypnotics or antidepressants. In addition to the non-pharmacological measures, there is evidence that the use of trazodone may aid the treatment of sleep disorders of older individuals with Alzheimer dementia. More studies are necessary to examine the non-pharmacological and pharmacological treatments revised herein.

Os transtornos do sono são comuns nos pacientes com doença de Alzheimer e interferem na qualidade de vida do paciente e de seu cuidador. Apesar da alta prevalência desses transtornos, existe pouca evidência em relação ao seu tratamento. Nosso objetivo foi revisar a literatura em relação ao tratamento não farmacológico e farmacológico dos transtornos do sono nos idosos com doença de Alzheimer em comunidade. Os tratamentos incluídos consistiram na higiene do sono e/ou no uso da luz intensa, combinados ou não com o uso da melatonina, nos inibidores de acetilcolinesterases, antipsicóticos, hipnóticos ou antidepressivos. Para além das medidas não farmacológicas, há evidência de que o uso da trazodona é efetivo no tratamento dos transtornos do sono de pacientes com doença de Alzheimer. Mais estudos sobre as estratégias farmacológicas e não farmacológicas aqui revisadas ou outras são desejáveis.

Medidas de transmissão intergeracional da obesidade no Brasil / Measures of intergenerational transmission of obesity in Brazil

A crescente parcela de indivíduos com excesso de peso na população brasileira realça a relevância de pesquisas nessa área. Assim, este artigo investiga o problema da obesidade do ponto de vista intergeracional, a partir dos índices de massa corporal (IMC) de pais e filhos. As informações sobre o IMC e as variáveis de controle socioeconômicas são oriundas da Pesquisa de Orçamentos Familiares (POF) 2008-2009. A metodologia de análise considera as matrizes de transição markovianas e regressões quantílicas e logísticas com separação por gênero e estrutura da família. Os principais resultados sugerem a existência de uma forte associação entre o IMC dos pais e filhos, com o aumento da fração de crianças obesas em cenários familiares monoparentais e em lares em que ambos os pais são obesos. Pela análise da elasticidade intergeracional quantílica, quanto maior a idade da criança e o seu nível de IMC, maior é o efeito intergeracional das condições de saúde dos pais. Por fim, o papel da obesidade materna sobrepõe-se ao da paterna em termos de transmissão intergeracional da obesidade para os filhos, independentemente do gênero.

A growing proportion of overweight individuals in Brazilian population highlights the importance of research in this area. Thus, this paper investigates the obesity problem from the point of view of intergenerational approach using Body Mass Index (BMI) of parents and their children. The information concerning BMI and socioeconomic control variables are obtained from the Household Budget Survey (POF) 2008-2009. The methodology of analysis considers the Markov transition matrix, quantile regressions and logistic regressions taking into account gender and family structure. The results suggest the existence of a strong association of BMI between parents and children, with the fraction of obese children increasing in families with single parents and households where both parents are obese. The analysis of quantile intergenerational elasticity indicates the higher children's age and their more intense BMI index is the intergenerational effect of parental health. Finally, the effect of maternal obesity is greater than the effect of paternal obesity in terms of intergenerational transmission of obesity for the children, regardless of gender.

Trastornos del sueño en la adolescencia / Sleep disorders in adolescence

El sueño forma parte de un ciclo circadiano (vigilia/sueño), proceso fisiológico necesario para el organismo. Durante la adolescencia, un período de importantes cambios fisiológicos, se producen en forma frecuente una serie de alteraciones en dicho proceso. Algunas de las principales causas son el cambio de hábito y la regulación de las normas sociales. El principal trastorno en esta edad es la privación crónica de sueño, que provoca trastornos en el aprendizaje, en la conducta y hor- monales. En el presente artículo se comentan además otros trastornos frecuentes como el insomnio, Síndrome de la Fase Retardada de Sueño e hipersomnias.

The sleep is circadian rhythms (wake/sleep), physiologic process necessary for the organism. The Adolescence, it's a very important time of physiologic changes. As with most sleep behaviors, these trends reflect the physiologic- chronobiologic, developmental, and social-environmental changes. The chronic sleep deprivation is the principal sleep problem in this age. Psychiatric, learning and hormonal disturbances can result from chronic sleep deprivation. Furthermore, another sleep problem can be insomnia, delayed sleep phase syndrome and hypersomnia.

Dispositivo bucal de baixo custo para controle de ronco primário e de apneia obstrutiva do sono: desenvolvimento e resultados preliminares / Low cost oral device for primary snore and obstructive sleep apnea control. Development and preliminary results", "_e": "n

Introdução: dispositivos intrabucais (ou aparelhos intrabucais) têm sido propostos para o avanço mandibular, apoio e retenção lingual em posição anterior, evitando o ronco primário e a apneia obstrutiva do sono, reduzindo ou eliminando os riscos à saúde relacionados à apneia. Esses dispositivos precisam interferir o mínimo possível na capacidade de movimentação mandibular — interferência que pode ser danosa ao sistema musculoarticular. Dispositivos com essa característica têm um custo relativamente alto. Assim, foi elaborado um dispositivo simples, de baixo custo, manufaturado com materiais de uso corriqueiro em qualquer ambulatório de Odontologia. Objetivo: o objetivo principal do presente projeto é apresentar um dispositivo bucal de baixo custo e de fácil confecção para o controle do ronco simples e da apneia obstrutiva do sono, possibilitando seu uso na saúde publica. Métodos: visando testar sua efetividade, foram realizados exames clínicos e de polissonografia para fins de diagnóstico. Depois houve uma fase laboratorial e outra de utilização clínica monitorada do aparato por até três meses. Nesse período, seis pacientes foram avaliados clinicamente e por meio de um novo exame polissonográfico. Conclusão: concluímos que os níveis de apneia e de ronco, com o uso do presente aparelho, atingem padrões de normalidade em um curto período de tempo.

Transtornos do sono: visão geral / Sleep disorders: overview

Os transtornos do sono (TS) são um problema clínico relevante. Oobjetivo deste trabalho é compreender as características do ciclovigília-sono e das fases do sono, além de suas manifestações, e conhecera classificação, as abordagens diagnósticas e os tratamentos(farmacológicos ou não) dos TS, para melhor controlá-los, principalmenteem relação a adultos. Critérios comportamentais e fisiológicosdefinirão o ciclo vigília-sono e seus componentes (vigília, sonoREM ou NREM ? N1, N2, N3), que são regulados por mecanismoscerebrais integrados. As quatro queixas principais de sono incluem:(1) insônia (tempo: do início do sono, de manutenção do sono e definal do sono; duração: aguda ou crônica; etiologia: primária ou secundária); (2) sonolência excessiva diurna (provocada por causasprimárias ou secundárias, como narcolepsia, hipersonia idiopáticae apneia obstrutiva do sono, além de várias outras); (3) movimentosou comportamentos anormais durante o sono (como pernasinquietas e transtornos de movimentos periódicos dos membros,bruxismo do sono, transtornos comportamentais do sono REM, sonambulismo, terrores noturnos, excitação confusional, pesadelos);(4) incapacidade de dormir na hora desejada (como fase atrasadado sono, fase avançada do sono, trabalho por turnos; jet lag). A segundaedição da Classificação Internacional de Transtornos do Sono (ICSD-2) classifica os TS em oito categorias principais: insônia; transtornosrespiratórios relacionados com o sono; hipersonias de origemcentral; transtornos do ritmo circadiano; parassonias; transtornos domovimento relacionados com o sono; sintomas isolados e variantesnormais; outros TS. Em relação ao tratamento, em primeiro lugar, énecessário reconhecer a causa do TS e/ou sua comorbidade e verificarse o paciente segue as regras básicas de higiene do sono, depois,se for necessário, considerar o tratamento farmacológico e/ou nãofarmacológico, examinando caso a caso...

The sleep disorders (SD) are relevant clinical problem to be bettermanaged by understanding the characteristics of the wake-sleepcycle and sleep stages, the SD manifestations and their classification,diagnostic and treatment approach (pharmacological or not),all the aims of this paper, mainly regarding adults. Behavioral andphysiological criteria define the wake-sleep cycle and its components(wake, sleep REM or NREM ? N1, N2, N3) that are regulatedby integrated brain mechanisms. The four major sleep complaintsinclude: (1) insomnia (timing: sleep onset, sleep maintenance, sleepoffset; duration: acute or chronic; etiology: primary or secondary);(2) excessive daytime sleepiness (caused by primary or secondarycauses, narcolepsy or idiopathic hypersomnia, and obstructive sleepapnea, besides several other causes); (3) abnormal movements orbehavior during sleep (such as restless leg and periodic limb movementdisorder, sleep bruxism, REM behavior disorders, and otherssuch as sleep walking, sleep terrors, confusional arousal, nightmares);(4) inability to sleep at the desired time (such as delayed sleepphase; advanced sleep phase; shift work; jet lag). The second editionof the International Classification of SD (ICSD-2) classifies SD intoeight major categories: insomnia; sleep related breathing disorders;hypersomnias of central origin; circadian rhythm SD; parasomnias;sleep related movement disorders; isolated symptoms and normalvariants; other SD. Regarding treatment, first, it is necessary to recognizethe cause of the sleep disturbance and/or its comorbidity, and to check if the patient follows basic rules of sleep hygiene, after, if necessary, consider non-pharmacological or/and pharmacological management, examining case by case...

Apneia obstrutiva do sono: da suspeita diagnóstica ao tratamento / Obstructive sleep apnea: the suspected diagnosis to treatment

Dentre os diversos distúrbios do sono, a apneia obstrutiva é um dos mais prevalentes. Sua dinâmica causa o colapso transitório da faringe, impedindo o fluxo de ar entre o ambiete e os pulmões. Estes eventos costumam levar à redução da oxigenação do organismo e à fragmentação do sono. Com evolução insidiosa, a suspeita diagnóstica parte de queixas de sonolência diurna excessiva, roncos e apneia testemunhada. O atual padrão ouro para o diagnóstico é o exame de polissonografia. O tratamento inclui a higiene do sono e a perda ponderal. Existem três linhas de tratamento usuais: dispositivos intraorais, correções cirúrgicas ou aparelhos de pressão positiva. Por tratar-se de doença crônica, progressiva, deve ter acompanhamento, mesmo com o tratamento instituído

Among various sleep disorders, obstructive apnea is one of the most prevalent. Its dynamic causes the transient collapse of pharynx, avoiding the air flow between the environment and the lungs. These events often lead to low body oxygenation and sleep frangmentation. With insidious onset, it's possible to suspect when complains occurs: excessive daytime sleepiness, snoring and witnessed apnea. The current gold standard for diagnosis is polysomnography. Treatment of obstructive sleep apnea includes sleep hygiene and wight loss. There are three lines of treatment as usual: intraoral devices, surgical corrections or positive pressure devices. By being a chronic, progressive disease, even when treatment is instituted, the patients must have follow up

Efeito da hidrocinesioterapia sobre qualidade de vida, capacidade funcional e qualidade do sono em pacientes com fibromialgia / Effect of hydrotherapy on quality of life, functional capacity and sleep quality in patients with fibromyalgia

INTRODUÇÃO: A síndrome da fibromialgia acomete 8% da população com mais de 40 anos de idade. Dos pacientes com fibromialgia, 75% queixam-se de má qualidade do sono. OBJETIVO: Avaliar os efeitos da hidrocinesioterapia sobre a capacidade funcional e a qualidade de sono em pacientes com fibromialgia. MÉTODOS: As pacientes foram atendidas na policlínica da UNASP. Foram avaliadas 60 pacientes portadoras de fibromialgia na faixa etária entre 30 e 65 anos. Das pacientes avaliadas, 20 foram excluídas e 10 desistiram devido à impossibilidade de apresentar-se no horário do programa de exercícios. Todas as pacientes responderam aos seguintes questionários: Questionário sobre o Impacto daFibromialgia (QIF), Índice da Qualidade do Sono de Pittsburgh e Escala de Sonolência de Epworth. As sessões foram realizadas duas vezes por semana, com duração de 60 minutos cada, por um período de dois meses. RESULTADOS: A média da idade das pacientes foi de 45 anos; 66% eram trabalhadoras ativas e 34% estavam afastadas do trabalho. Verificouse que imediatamente após participarem do programa da hidrocinesioterapia, as pacientes apresentaram melhora nos seguintes aspectos avaliados por meio do QIF: capacidade funcional, absenteísmo ao trabalho, capacidade de serviço, intensidade da dor, fadiga, cansaço matinal, rigidez (P < 0,0001), ansiedade (P = 0,0013) e depressão (P < 0,0001). Houve também melhora da qualidade do sono (P < 0,0001) e no grau de sonolência diurna (P = 0,0003). CONCLUSÃO: A hidrocinesioterapia promove melhora de qualidade do sono, capacidade funcional, situação profissional, distúrbio psicológicos e sintomas físicos da síndrome em pacientes com fibromialgia.

INTRODUCTION: Fibromyalgia affects 8% of the population over the age of 40 years, and 75% of the patients with fibromyalgia have poor sleep quality. OBJECTIVE: To assess the effects of hydrotherapy on the physical function and sleep quality of patients with fibromyalgia. METHODS: Patients were under clinical care at the UNASP Outpatient Clinic. This study assessed 60 female patients with fibromyalgia aged between 30 and 65 years. Out of the 60 patients assessed, 20 were excluded and 10 left the study because they could not comply with the time schedule. All patients completed the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ); Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. Training sessions were performed twice a week for two months, each session lasting 60 minutes. RESULTS: Patients' mean age was 45 years, 66% were active workers, and 34% had quit work. Right after the hydrotherapy program, the patients improved the following aspects assessed by use of the FIQ: physical function, work absenteeism, ability to do job, pain intensity, fatigue, morning tiredness, stiffness (P < 0.0001), anxiety (P = 0,0013), and depression (P < 0.0001). Sleep quality (P < 0.0001) and daytime sleepiness (P = 0.0003) also improved. CONCLUSION: Hydrotherapy improves sleep quality, physical function, professional status, psychological disorders and physical symptoms in patients with fibromyalgia.

Utilidad de la fitoterapia en el insomnio / Fitotherapy usefulness in the insomnia

Se realizó un ensayo clínico fase II, controlado, en el que se demostró el efecto hipnótico del extracto fluido de pasiflora en pacientes con insomnio primario que acudieron a la consulta creada para dichos efectos en el servicio de medicina tradicional del policlínico norte en el periodo comprendido entre los meses de enero–noviembre del año 2010. El universo de estudio quedó constituido por los 92 pacientes que acudieron a la citada consulta aquejados de insomnio primario, entre las edades de 15 a 50 años, de uno y otro sexo, a los que se les aplicaron los instrumentos diseñados y validados para estos fines y se trataron con extracto fluido de pasiflora 46 de ellos pertenecientes al grupo de estudio, a igual número se le suministró nitrazepam, incluidos en el grupo control, terapéutica en ambos casos que se cumplió por 21 días. La pasiflora ha demostrado ser igualmente efectiva en el tratamiento del insomnio que las modalidades terapéuticas alopáticas con nitrazepam, en menos consultas se obtuvo la mejoría, asociadas a muchas ventajas y a ningún efecto adverso, los que aparecen con carácter absoluto en las terapias convencionales, lo que indica que la relación riesgo-beneficio, con la utilización de la pasiflora, justifica el uso de esta terapia.

Fisiopatologia da narcolepsia / Pathophysiology of narcolepsy

Introdução: A narcolepsia é um distúrbio primário do sistema nervoso central com uma prevalência ao redor de 0.02%. A narcolepsia é caracterizada por sonolência diurna excessiva, cataplexia, alucinações hipnagógicas, paralisia do sono e fragmentação do sono. Diagnóstico: O diagnóstico da narcolepsia é estabelecido pela clínica e análise de cinco cochilos diurnos durante o teste de múltiplas latências do sono. Fisiopatologia: A fisiopatologia da narcolepsia não é totalmente esclarecida. Existem várias teorias que são discutidas. Há uma maior prevalência do alelo HLA DQB1*0602 e uma diminuição da concentração da hipocretina-1 na forma de narcolepsia associada à cataplexia. Recentemente foram descritos diferentes padrões no loco do receptor de linfócito T alfa e a presença de anticorpos específicos tribbles homolog 2 em pacientes com narcolepsia. Estes achados fortalecem a teoria imunológica. Tratamento: O tratamento da narcolepsia deve garantir a integração social e familiar podendo ser dividido em comportamental e medicamentoso. Conclusão: A narcolepsia é uma fascinante doença que integra a neurologia, a imunologia, a medicina do sono, a psiquiatria e a genética. Pacientes com narcolepsia possuem prejuízo no campo pessoal, profissional e familiar. Embora muitos avanços tenham sido feitos, a melhor ferramenta ainda é a informação para os colegas médicos e para a população em geral.

Qualidade de sono de trabalhadores obesos de um hospital universitário: acupuntura como terapia complementar / Sleep quality of obese workers of a teaching hospital: acupuncture as a complementary therapy / Calidad de sueño de trabajadores obesos de un hospital universitario: acupuntura como terapia complementaria

O objetivo do estudo foi verificar o efeito da acupuntura na qualidade de sono de trabalhadores obesos em um hospital universitário. Os dados foram coletados no período de julho a outubro de 2009, junto a 37 funcionários, submetidos a oito aplicações semanais de acupuntura. O Índice de Qualidade de Sono de Pittsburgh foi utilizado para identificar a qualidade de sono dos sujeitos antes e após a intervenção. Os resultados mostram que antes da intervenção cinco (13,5%) pessoas apresentaram boa qualidade de sono e, ao final da intervenção, 14 (37,8%) relataram este quadro. A diferença obtida na comparação das médias dos escores obtidos antes e após a acupuntura foi significativa (p=0,0001). Concluiu-se que a acupuntura produziu um efeito positivo sobre a qualidade do sono na amostra estudada, apresentando-se como uma técnica adjuvante no tratamento dos distúrbios do sono e consequentemente na melhoria da qualidade de vida desta população.

The objective of this study was to verify the effect of acupuncture on the sleep quality of obese workers in a teaching hospital. Data were collected from July to October 2009, focusing on 37 workers who attended eight weekly acupuncture sessions. The Pittsburgh Sleep Quality Index was used to assess their sleep quality before and after the intervention. Results show that before the intervention, five (13.5%) people experienced good quality of sleep whereas at the end of the study 14 (37.8%) showed this condition. Statistic significance (p=0.0001) was found in comparing the mean scores obtained before and after acupuncture. Acupuncture had effects on the quality of sleep in the studied sample, presenting itself as a complementary technique for treating sleep disorders and consequently improving the quality of life in this population.

El estudio objetivó verificar el efecto de la acupuntura en la calidad de sueño de trabajadores obesos de un hospital universitario. Los datos se recogieron entre julio y octubre de 2009, de 37 empleados sometidos a ocho sesiones semanales de acupuntura. El Índice de Calidad del Sueño de Pittsburgh fue utilizado para identificar la calidad de sueño de los sujetos antes y luego de la intervención. Los resultados muestran que antes de la intervención, cinco (13,5%) personas presentaban buena calidad de sueño, y al finalizar la intervención, 14 (37,8%) relataron tal cuadro. La diferencia obtenida en comparación de promedios de puntajes antes y después de la acupuntura fue significativa (p=0,0001). En conclusión, la acupuntura generó efecto positivo sobre la calidad de sueño en la muestra estudiada, presentándose como una técnica adyuvante en el tratamiento de disturbios del sueño y, consecuentemente, en la mejora de calidad de vida de esta población.