Anxiolytic-like activity of Aloysia virgatavar. platyphylla leaves extract in mice / Actividad ansiolítica del extracto de hojas de Aloysia virgatavar. platyphylla en ratones

Background: Medicinal plants are part of traditional medicine and should be considered a therapeutic alternative for mental diseases. Several plants belonging to the Verbenaceae family have proved useful in treating general anxiety disorders, the most prevalent psychiatric disorders. Objective: This research aimed to verify the extract's safety, the effect on general behavior, and the effect on sleeping time, as well as to evaluate the anxiolytic-like effect of the methanol extract of Aloysia virgata var. platyphylla (Avp), in mice. Methodology: The toxicity test was done according to the OECD guide (mice groups n=5), and general behavior was observed during the assay. Sleeping time was assessed using the pentobarbital-induced hypnosis method (n=8). Male Swiss albino mice (n=6) were treated with 50 to 400 mg/kg of Avp extract and diazepam as a control. The anxiolytic-like effect was tested through the hole board and elevated plus-maze test. Results: The Avp extract has no side effects in tested doses, and no central nervous system depressant activity was noted. A. virgatavar. platyphyllaincreased exploration (number and time) in the hole board. In the elevated plus-maze, increased number and time into open arms were evidenced compared to the control group. Conclusion: With all these results, we concluded that the Avp extract is safe and has a potential anxiolytic-like activity in the animal model used

Antecedentes: Las plantas medicinales forman parte de la medicina tradicional y deben ser consideradas una alternativa terapéutica para las enfermedades mentales. Varias plantas pertenecientes a la familia Verbenaceae han demostrado su utilidad en el tratamiento de los trastornos de ansiedad, uno de los trastornos psiquiátricos más prevalentes. Objetivo: Esta investigación tuvo como objetivo verificar la seguridad del extracto, el efecto sobre el comportamiento general y el efecto sobre el tiempo de sueño, así como evaluar el efecto tipo ansiolítico del extracto metanólico de Aloysia virgata var. platyphylla(Avp), en ratones. Metodología: La prueba de toxicidad se realizó de acuerdo con la guía de la OCDE (grupos de ratones n=5), y se observó el comportamiento general durante el ensayo. El tiempo de sueño se evaluó mediante el método de hipnosis inducida por pentobarbital (n=8). Se trataron ratones albinos suizos macho (n=6) con 50 a 400 mg/kg de extracto de Avp y diazepam como control. El efecto ansiolítico se probó a través de la placa perforada y prueba del laberinto en cruz elevado. Resultados: El extracto de Avp no tiene efectos secundarios en las dosis probadas y no se observó actividad depresora del sistema nervioso central. A. virgata var. platyphylla aumentó la exploración (número y tiempo) en el tablero de agujeros. En el laberinto en cruz elevado, se evidenció un mayor número y tiempo en los brazos abiertos en comparación con el grupo de control. Conclusión: Con todos estos resultados, concluimos que el extracto de Avp es seguro y tiene una potencial actividad ansiolítica en el modelo animal utilizado

Importancia del buen dormir en nuestros pacientes / Importance of good sleep in our patients

El sueño es una necesidad biológica. Regula las funciones inmunitarias. Las funciones inmunológicas dependen de los ritmos circadianos y del sueño regular. Según estudios previos a la pandemia, la corta duración del sueño o privación de sueño, en la semana cercana a la vacunación, se asocia con respuestas más bajas de anticuerpos. La privación de sueño da como resultado una función inmunológica más deficiente (es decir, actividad reducida de las células natural killer, producción de IL-2 suprimida) así como un aumento de los niveles circulantes de marcadores inflamatorios (IL-6, TNF-α [factor de necrosis tumoral] y proteína C reactiva). Los médicos deben ser conscientes de que muchas enfermedades que mencionamos en esta resumida actualización son comórbidas con alteraciones del sueño, y es importante, por ello, enseñar a los pacientes a mejorar su comportamiento con respecto al sueño y fomentar la educación sobre higiene del sueño. Destacamos que, en el interrogatorio de cualquier especialidad médica, deben incorporarse preguntas sobre el "dormir", dado que el sueño de buena calidad es fundamental en la prevención y el tratamiento de diversas enfermedades. (AU)

Sleep is a biological necessity. Regulates immune functions. Immune functions depend on circadian rhythms and regular sleep. According to studies prior to the pandemic, short duration of sleep or sleep deprivation, in the week leading up to vaccination, is associated with lower antibody responses to vaccination. Sleep deprivation results in poorer immune function (i.e., reduced natural killer cell activity, suppressed IL-2 production) as well as increased circulating levels of inflammatory markers (IL-6, factor of tumor necrosis, C-reactive protein). Clinicians should be aware that many illnesses, which we mention in this brief update, are comorbid with sleep disturbances and it is therefore important to teach patients to improve their sleep behavior and should encourage sleep hygiene education . We emphasize that in the questioning of any medical specialty, questions about "sleep" should be incorporated, given that good quality sleep is essential in the prevention and treatment of various diseases. (AU)

Noise and sleep quality: study among physical education instructors / Ruído e qualidade do sono: estudo entre instrutores de educação física

ABSTRACT This study ivestigated the association between noise and impaired sleep quality in 150 physical education instructors, in bodybuilding gyms. Two questionnaires were applied: evaluation of subjective sleep quality and analysis of explanatory variables. Noise exposure was analyzed. For the data analysis, was used the technique of non-conditional logistic regression, to obtain the values of the adjusted odds ratios (OR) of the significant variables. Two proper adjustment models stood out. The first model presented the significant variables: incorrect performance of the meals (OR = 2.58, 95% CI 1.08 to 6.02); skin color - black ou brown (OR = 0.53, 95% CI 0.25 to 1.12) and exposure to noise level above or equal to 80 dB(A) (OR = 1.90; 95% CI 0.87 to 4.12). The second model presented the significant variables: incorrect performance of the meals (OR = 2.35, 95% CI 0.1 to 5.56); exposure level standardized above or equal to 80 dB(A) (OR = 2.03, 95% CI 0.92 to 4.47) and use 0of drugs for depression/anxiety (OR = 0.26; 95% CI 0.53 to 1.33). This research identified the variables that were significantly associated with impaired sleep quality, as exposure to noise, contributing to the adoption of preventive measures.

RESUMO Este estudo investigou a associação entre ruído e qualidade prejudicada do sono em 150 instrutores de educação física, em academias de musculação. Dois questionários foram aplicados: avaliação da qualidade subjetiva do sono e sobre variáveis explanatórias. A exposição ao ruído foi avaliada. Para a análise dos dados, utilizou-se a técnica de regressão logística não-condicional, para obter os valores das Razões de Chances (RC) das variáveis significativas. Dois modelos finais se destacaram. O primeiro apresentou as variáveis significativas: realização incorreta das refeições (RC = 2,58, IC 95% 1,08 a 6,02); cor da pele - preta ou parda (RC = 0,53; IC 95% 0,25 a 1,12) e exposição ao ruído acima ou igual a 80 dB(A) (RC = 1,90; IC95% 0,87 a 4,12). O segundo modelo apresentou as variáveis significativas: realização incorreta das refeições (RC = 2,35, IC 95% 0,1 a 5,56); nível de exposição padronizado acima ou igual a 80 dB (A) (RC = 2,03, IC 95% 0,92 a 4,47) e uso de medicamentos para depressão/ansiedade (RC = 0,26; IC95% 0,53 a 1,33). Esta pesquisa identificou as variáveis que se associaram significativamente com a qualidade do sono prejudicada, como a exposição ao ruído, contribuindo para a adoção de medidas preventivas.

Effect of melatonin on the daytime sleepiness side-effect of gabapentin in adults patients with neuropathic pain / Efeito da melatonina sobre o efeito colateral de sonolência diurna da gabapentina em pacientes adultos com dor neuropática

Abstract Background and objectives: Gabapentin is an antiepileptic drug. Widely used for the management of neuropathic pain. Although it is known to be well tolerated, somnolence and dizziness are the most frequent adverse effects. In this study, we aimed to evaluate the effect of melatonin on daytime sleepiness side effect of gabapentin, sleep quality and pain intensity of patients with neuropathic pain. Methods: Patients suffering from "neuropathic pain" and planed to receive gabapentin therapy were randomly divided into two groups. Group 1 received melatonin 3 mg and gabapentin 900 mg orally, group 2 received matching placebo capsule and gabapentin 900 mg. The Epworth Sleepiness Scale, the Pittsburgh sleep quality index for assessment of sleep quality and Verbal Rating Scale were completed at the 0th, 10th and 30th days of treatment. Additive analgesic drug requirements were recorded. Results: Eighty patients were enrolled to the study; age, gender, ratio of additive analgesic consumption, baseline Epworth Sleepiness Scale, Pittsburg Sleep Quality index and Verbal Rating Scale scores were similar between the groups. Epworth Sleepiness Scale scores, Pittsburgh sleep quality index scores and Verbal Rating Scale scores in Group 1 were significantly lower than group 2 at the 10th day of treatment (p = 0.002, p = 0.003, p = 0.002 respectively). At the 30th day of treatment, Epworth Sleepiness Scale scores and Verbal Rating Scale scores were significantly lower in Group 1 (p = 0.002, p = 0.008 respectively). However, Pittsburgh sleep quality index scores did not significantly differ between the groups (p = 0.0566). Conclusions: Melatonin supplementation rapidly and significantly improved daytime sleepiness side-effect of gabapentin, however sleep quality of the patients with neuropathic pain was similar between groups.

Resumo Justificativa e objetivos: Gabapentina é um agente antiepiléptico, amplamente utilizado para o tratamento da dor neuropática. Embora conhecida por ser bem-tolerada, sonolência e tontura são os seus efeitos adversos mais frequentes. Neste estudo, nosso objetivo foi avaliar o efeito da melatonina sobre o efeito colateral de sonolência diurna da gabapentina, a qualidade do sono e a intensidade da dor em pacientes com dor neuropática. Métodos: Os pacientes que sofriam de "dor neuropática" e com prescrição para receber terapia com gabapentina foram divididos aleatoriamente em dois grupos. O Grupo 1 recebeu 3 mg de melatonina e 900 mg de gabapentina por via oral, o Grupo 2 recebeu uma cápsula de placebo correspondente e 900 mg de gabapentina. A escala de sonolência de Epworth (ESS), o índice de qualidade do sono de Pittsburgh para avaliação da qualidade do sono (PSQI) e a escala de avaliação verbal (VRS) foram aplicados nos dias 0, 10 e 30 de tratamento. A necessidade de medicamentos analgésicos adicionais foi registrada. Resultados: Oitenta pacientes foram incluídos no estudo; idade, sexo, quantidade de analgésico adicional consumida e os escores basais de ESS, PSQI e VRS foram semelhantes entre os grupos. Os escores ESS, PSQI e VRS do Grupo 1 foram significativamente menores que os do Grupo 2 no décimo dia de tratamento (p = 0,002, p = 0,003, p = 0,002, respectivamente). No trigésimo dia de tratamento, os escores ESS e VRS foram significativamente menores no Grupo 1 (p = 0,002, p = 0,008, respectivamente). No entanto, os escores PSQI não diferiram significativamente entre os grupos (p = 0,0566). Conclusões: A suplementação de melatonina melhorou de forma rápida e significativa o efeito colateral de sonolência diurna da gabapentina, mas a qualidade do sono dos pacientes com dor neuropática foi semelhante entre os grupos.

Autocuidado de pacientes com insuficiência cardíaca nos primeiros três meses após a alta hospitalar / Self-care in patients with heart failure in the first three months after hospital discharge

Introdução. A insuficiência cardíaca (IC) é uma síndrome que acomete principalmente os idosos. As ações de autocuidado são fundamentais para estes pacientes, envolvendo medidas farmacológicas e não farmacológicas. Quando há uma falha em algumas destas ações, os pacientes podem passar por um período de descompensação. Objetivos. 1) analisar a evolução das ações de autocuidado, durante o primeiro retorno ambulatorial após a alta hospitalar e aos três meses após o primeiro contato de pacientes que foram internados com IC descompensada; 2) analisar quais variáveis estão associadas na determinação das ações de autocuidado, nos dois momentos da avaliação dos participantes do estudo; 3) caracterizar e analisar a evolução dos pacientes segundo a presença de sintomas de ansiedade e de depressão, comprometimento cognitivo, qualidade de sono e apoio social no o primeiro retorno ambulatorial após a alta hospitalar e aos três meses após o primeiro encontro ambulatorial. Método. Estudo observacional, analítico e longitudinal realizado nos ambulatórios de cardiologia de dois hospitais públicos de Ribeirão Preto. Os dados foram coletados por meio de consulta aos prontuários e entrevistas individuais com os participantes no primeiro retorno ambulatorial após a alta hospitalar (T0) e três meses após o primeiro retorno (T1). As variáveis de interesse foram avaliadas pelas versões validadas para o português do Brasil dos instrumentos: Self-Care of Heart Failure Index (SCHFI), Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS), Medical Outcome Survey- Social Support (MOS-SS) e Pittsburgh Sleep Quality Index (PSQI-BR). Os dados foram analisados pelos testes de comparação de médias (t de Student pareado e não pareado) e distribuição pareada (McNemar) e não pareada (Qui-quadrado e Exato de Fisher) com nível de significância de 0,05. Resultados. Na avaliação da evolução do autocuidado, as três subescalas (Manutenção, Manejo e Confiança) apresentaram melhoras três meses após o primeiro retorno ambulatorial (p<0,001). O comprometimento cognitivo, sintomas de ansiedade e depressão e apoio social obtiveram médias inferiores no T1 quando comparadas com T0, indicando uma piora dos participantes após o primeiro retorno ambulatorial. A qualidade de sono apresentou melhora em T1 (p<0,001). Não encontramos nenhuma diferença estatisticamente significante ao compararmos os escores do SCHFI com as variáveis explanatórias. Conclusão. O autocuidado e a qualidade de sono melhoraram três meses após o primeiro retorno ambulatorial por descompensação da IC. Mais estudos precisam ser realizados para verificar quais são as variáveis associadas com a melhora do autocuidado após a internação

Introduction. The heart failure (HF) is a syndrome that attacks mainly the elderly people. The actions of self-care are fundamental for these patients, involving pharmacological and non-pharmacological measures. When there is an error in some of these actions, the patients may have a period of decompensation. Aims. 1) To analyse the evolution of self-care actions, during the first outpatient return after hospital discharge and three months after the first contact of patients that had been admitted with decompensated HF; 2) To analyse which variables are associated on the determination of self-care actions, in both moments of evaluation of the study's participants; 3) To characterise and to analyse the patients' evolution according to the presence of symptoms of anxiety and depression, cognitive impairment, sleep quality and social support on the first outpatient return after hospital discharge and on the three months following the first outpatient meeting. Method. Observational, analytical and longitudinal study realized at the cardiology ambulatories of two Ribeirão Preto's public hospitals. The data was collected through consultation of the medical records and through individual interviews with participants on the first outpatient return after hospital discharge (T0) and three months following the first return (T1). The relevant variables were evaluated by Brazilian Portuguese validated versions of the following instruments: Self-Care of Heart Failure Index (SCHFI), Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS), Medical Outcome Survey- Social Support (MOS-SS) and Pittsburgh Sleep Quality Index (PSQI-BR). The data was analysed by rate comparison tests (paired and non-paired t Student tests) and paired (McNemar) and non-paired (chisquare and Fisher's exact) distribution with a 0,05 significance level. Results. On the evaluation of the self-care evolution, the three subscales (Maintenance, Management and Confidence) present recoveries three months following the first outpatient return (p<0,001). The cognitive impairment, symptoms of anxiety and depression and social support obtained lower rates in T1 when compared to T0, indicating the participant's worsening after the first outpatient return. The sleep quality presented a recovery in T1 (p<0,001). We have not found any statistically significant difference when comparing the SCHFI scores to the explanatory variables. Conclusion. Self-care and sleep quality improve three months following the first outpatient return for HF decompensation. More studies should be realized to verify which are the variables that are associated to self-care recovery after hospital admission

Impacto das drogas na saúde física e mental de dependentes químicos / Drug use impact in drug addicts' physical and mental health

Pesquisa qualitativa e exploratória -desenvolvida em 2012 e 2013 -em uma unidade de reabilitação para dependentes químicos no Paraná, com objetivo de verificar o impacto do uso de drogas na saúde física e mental do dependente químico. Foram entrevistados vinte dependentes químicos em tratamento. Os dados foram coletados mediante entrevista semiestruturada e tratados com a técnica de análise categorial temática. Os resultados demonstraram impactos na condição física do dependente químico relacionados à intoxicaçãopor drogas, estado de abstinência, alterações de alimentação, sono, higiene e aparência pessoal. Em relação ao impacto das drogas na saúde mental, os resultados apontaram a presença de comorbidades psiquiátricas, como: esquizofrenia e transtorno afetivo bipolar, bem como alterações de pensamento, percepção, memória, cognição e comportamento. Conclui-se que as drogas ocasionam graves impactos na saúde física e mental dos dependentes químicos a partir de consequências nocivas na condição física, no autocuidado, no pensamento, na cognição e no comportamento.

This is a qualitative study of exploratory method, developedin2012 and 2013,in a rehab unity to drug addicts, Paraná, Curitiba, Brazil, its aim is verify the drug use impact in addicts' physical and mental health. Twenty drug addicts in treatment were interviewed.Data collected by through of semi-structured interviews andprocessed using the categorical thematic analysis.The results showed impacts on physical medical condition related to drug poisoning, the state of abstinence, changes on feed, sleep, rest, hygiene and personal appearance.Regarding the impact of substance abuse in mental health, the results indicated the presence of psychiatric comorbidies as schizophrenia and bipolar affective disorder, thought changes, perception, memory and cognition, also behavioral changes. As conclusion, drugs are responsible for huge impacts in addicts' physical and mental health considering the harmful consequences in the physical conditions, self-care, thought, cognition and in the behavior.

Evaluación de la ingesta diaria de cafeína en niños y adolescentes de Argentina / Assessment of caffeine daily intake in children and adolescents from Argentina

. La cafeína (1,3,7 trimetilxantina) es un alcaloide de la familia de las xantinas. Está presente en una gran cantidad de bebidas como café, té, cacao, mate, guaraná, bebidas gaseosas y bebidas energizantes, y alimentos que son consumidos por adultos, adolescentes y niños. A fin de obtener información acerca de la ingesta de cafeína en población infantil y adolescente de Argentina, se plantearon los siguientes objetivos de trabajo: a) estimar la ingesta diaria de cafeína en niños y adolescentes que residen en conglomerados urbanos de Argentina; b) estudiar la asociación de dicha ingesta con distintas variables tales como el género, la edad, el nivel socioeconómico (NSE) y el lugar de residencia; c) estudiar la relación de la ingesta de cafeína con la duración del sueño y d) valorar la contribución de las distintas bebidas a la ingesta diaria de cafeína. Se obtuvieron los datos de consumo de bebidas de 425 participantes de hasta 20 años de edad, residentes de distintas ciudades del país y de diferente NSE. Los resultados mostraron que la ingesta diaria promedio de cafeína (11, 43, 76, 132 y 233 mg/día) aumentó con la franja etaria (menores de 2, de 3 a 5, de 6 a 12, de 13 a 17 y de 18 a 20 años, respectivamente), aunque al relacionarla con el peso corporal (mg/kg/día) el aumento no fue tan marcado. El 50 % de los niños de hasta 2 años evaluados, nunca había consumido bebidas con cafeína. Por el contrario, a partir de 3 años en adelante más del 90 % sí consumieron regularmente por lo menos una bebida con cafeína. Las ingestas promedio calculadas para los niños y adolescentes evaluados resultaron ser superiores a las reportadas por otros autores para otros países. No se encontraron diferencias en la ingesta según el género, el lugar de residencia o el NSE. No se encontró relación entre la ingesta de cafeína y la duración del sueño para ningún grupo etario, a excepción de la franja etaria de 18 a 20 años en la que se observó una disminución significativa en la duración promedio del sueño para el grupo de individuos con ingesta extrema. Las bebidas gaseosas cola se mostraron como principales contribuyentes a la ingesta promedio de cafeína, aunque el mate también se destacó en ese aspecto. Como conclusiones generales de este trabajo se destaca que se logró caracterizar la ingesta de cafeína en niños y adolescentes y establecer la composición de dicha ingesta en cuanto a sus contribuyentes mayoritarios y minoritarios. Por último, si bien se podría clasificar a las ingestas promedio obtenidas en este estudio como elevadas con respecto a las reportadas para otros países, se debe considerar que no se ha definido un valor de ingesta diaria recomendada para niños y adolescentes.

Caffeine (1,3,7 trimethylxanthine) is an naturally occurring alkaloid. It is present in many beverages such as coffee, tea, cocoa, mate, guarana, soft drinks and energy drinks, and foods, widely consumed by adults, adolescents and children. Since information about caffeine intake in children and adolescents in our country is scarce, the aims of the study were set as follows: a) estimate the caffeine daily intake of children and adolescents from Argentina, b) associate the intake to different variables such as gender, age, socioeconomic status (SES) and place of residence; c) study the relationship between caffeine intake and sleep duration, and d) assess the contribution of different beverages to the caffeine daily intake. Information on non alcoholic beverages consumption was obtained from 425 participants up to 20 years old. Participants were from different cities and of different SES all over the country. Results showed that the caffeine mean daily intake increased (11 , 43 , 76 , 132 and 233 mg/day ) with age range (up to 2 , 3 to 5, 6 to 12 , 13 to 17 and 18 20 years old, respectively), but when the intake was related to body weight (mg/ kg/day) the increase was not so marked. Fifty percent of children up to 2 years old had never consumed any caffeinated beverage. However, from ages 3 and up, more than 90% of children regularly consumed at least one caffeinated beverage. The mean daily intakes for the evaluated children and adolescents were higher to those reported by other authors for other countries. When data were analyzed by gender, place of residence or SES, no differences in caffeine intake were observed. No relationship between caffeine intake and sleep duration for any age group was found, except for the age group of 18-20 years, where a significant decrease in average sleep duration for the group of individuals with extreme intake was observed. Soft drinks showed to be main contributors to the mean caffeine daily intake, although mate also highlighted in that aspect. Characterization of the caffeine daily intake and identification of the major and minor contributors to that intake are remarked as achievements of this study. And finally, although caffeine mean daily intake obtained in this study could be considered as elevated when compared with those reported for other countries, it should be noted that a recommended daily intake value for children and adolescents has not already been set.

Pharmacological interventions for sleepiness and sleep disturbances caused by shift work

BACKGROUND: Shift work results in sleep-wake disturbances, which cause sleepiness during night shifts and reduce sleep length and quality in daytime sleep after the night shift. In its serious form it is also called shift work sleep disorder. Various pharmacological products are used to ameliorate symptoms of sleepiness or poor sleep length and quality. OBJECTIVES: To evaluate the effects of pharmacological interventions to reduce sleepiness or to improve alertness at work and decrease sleep disturbances whilst of work, or both, in workers undertaking shift work. METHODS: Search methods: We searched CENTRAL, MEDLINE, EMBASE, PubMed and PsycINFO up to 20 September 2013 and ClinicalTrials.gov up to July 2013. We also screened reference lists of included trials and relevant reviews. Selection criteria: We included all eligible randomised controlled trials (RCTs), including cross-over RCTs, of pharmacological products among workers who were engaged in shift work (including night shifts) in their present jobs and who may or may not have had sleep problems. Primary outcomes were sleep length and sleep quality while of work, alertness and sleepiness, or fatigue at work. Data collection and analysis: Two authors independently selected studies, extracted data and assessed risk of bias in included trials. We performed meta-analyses where appropriate. ...

Effect of a Sleep Aid in Analgesia after Arthroscopic Rotator Cuff Repair

PURPOSE: The aim of this study was to evaluate the effects and safety of a sleep aid for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair. MATERIALS AND METHODS: Seventy-eight patients were prospectively assigned to either the zolpidem group (multimodal analgesia+zolpidem; 39 patients) or the control group (multimodal analgesia; 39 patients). Self-rated pain levels were assessed twice a day using a visual analog scale (VAS). The need for additional rescue analgesic, duration of functional recovery, and adverse effects were assessed for the first 5 days after surgery. RESULTS: The mean number of times that additional rescue analgesic was required during 5 days after surgery was 2.1+/-2.0 in the zolpidem group and 3.3+/-2.8 in the control group, a significant difference. There were no significant differences between the two groups in mean VAS pain scores during the first 5 days after surgery, although the zolpidem group had lower VAS pain scores than the control group. Additionally, there were no significant differences in duration of functional recovery and adverse effects between the two groups. CONCLUSION: The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects. Nevertheless, mean VAS pain scores during the first 5 days after surgery did not differ between the zolpidem group and the control group.

The Effect of Combined Therapy with Tamsulosin Hydrochloride and Meloxicam in Patients with Benign Prostatic Hyperplasia Symptoms and Impact on Nocturia and Sleep Quality

Purpose We aimed to compare the effect and feasibility of a combined therapy with tamsulosin hydrochloride plus meloxicam, and tamsulosin hydrochloride alone in patients with benign prostate hyperplasia symptoms and impact on nocturia and sleep quality. Materials and Methods Four hundred male patients were included in this study between 2008 and 2011. Patients were randomly divided into two groups: one received tamsulosin hydrochloride 0.4 mg (Group 1, 200 patients) and the other tamsulosin hydrochloride 0.4 mg plus meloxicam 15 mg (Group 2, 200 patients) prospectively. Patients were evaluated for benign prostate hyperplasia (BPH) symptoms according to the American Urological Association clinical guidelines and sleep quality according to Pittsburgh Sleep Quality Index (PSQI). Patients were reevaluated after three months of treatment. The International Prostatic Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), maximal urinary flow rates (Qmax), average urinary flow rates (AFR), post void residual urine volumes (PVR), nocturia and Pittsburgh Sleep Quality Score (PSQS) were recorded at baseline and after three months. Results Mean age was 63.3 ± 6.6 and 61.4 ± 7.5 years in groups 1 and 2, respectively (p = 0.245). There were no statistically significant differences between both groups. Also, baseline prostate specific antigen (PSA), prostate volume, creatinine, International Prostatic Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), maximal urinary flow rates (Qmax), average urinary flow rates (AFR), post void residual urine volumes (PVR), nocturia and Pittsburgh Sleep Quality Score (PSQS) were similar in both groups. In addition, the total IPSS, IPSS-QoL, PVR, nocturia, and PSQS were significantly lower in Group 2 compared with Group 1 after treatment (p < 0.05). Qmax and AFR were higher significantly in Group 2 compared with Group 1 after treatment (p < 0.05). Conclusions Cyclooxygenase (COX)-2 inhibitors ...

Potentiating effects of Lactuca sativa on pentobarbital-induced sleep

Traditionally, Lactuca sativa [lettuce] has been recommended for its hypnotic property. The present study was planned to investigate sleep-prolonging effect of this plant. The hydro-alcoholic extract [HAE] of lettuce and its water fraction [WF], ethyl acetate fraction [EAF], and n-butanol fraction [NBF] were administrated [IP] to mice 30 min before the pentobarbital injection. Moreover, both in-vivo and in-vitro toxicity of the extracts were determined. The quality of HAE and NBF was also evaluated using HPLC fingerprint. The HAE prolonged the pentobarbital-induced sleep duration at dose of 400 mg/Kg. The NBF was the only fraction which could increase the sleep duration and decrease sleep latency. The effects of NBF were comparable to those of induced by diazepam. The LD[50]-value for HAE was found to be 4.8 g/Kg. No neurotoxic effect was observed either by HAE or by its fractions in cultured PC12 neuron-like cells. The results suggest that lettuce potentiates pentobarbital hypnosis without major toxic effect. The main component[s] responsible for this effect is most likely to be non-polar agent[s] which found in NBF of this plant

Factors associated with sleep quality in the elderly receiving chemotherapy / Fatores associados à qualidade do sono de idosos submetidos à quimioterapia / Factores asociados a la calidad del sueño de mayores sometidos a la quimioterapia

OBJECTIVE: to evaluate the characteristics of sleep and the factors associated with the quality of sleep in elderly patients receiving outpatient chemotherapy treatment. METHOD: cross-sectional study with 140 elderly patients (51.2% female, average age 69.8 years) with stage III or stage IV cancer (67.9%), undertaken in a university hospital in the state of São Paulo in 2010. The following instruments were used: sociodemographic and clinical characterization questionnaire, validated by specialists; Pittsburgh Sleep Quality Index; Piper Fatigue Scale-reviewed; and a scale for the subjective measurement of pain. RESULTS: the majority of the elderly (62.9%) had a score compatible with poor sleep quality. On average, the duration of sleep was 388.0 minutes, latency was 44.6 minutes and efficiency of 83.8%. Through multiple logistic regression analysis, an increase of 21% in the probability of having poor sleep quality was observed for each single-point increase in the intensity of the pain. CONCLUSION: nursing interventions aiming to promote better sleep quality for elderly patients with cancer must include measures for pain control.

OBJETIVO: avaliar as características do sono e os fatores associados à qualidade do sono de pacientes idosos, submetidos ao tratamento quimioterápico ambulatorial. MÉTODO: estudo transversal, com 140 pacientes idosos (51,2% do sexo feminino, média de idade 69,8 anos), com câncer em estádio III ou IV (67,9%), conduzido em um hospital universitário do Estado de São Paulo, em 2010. Utilizaram-se os instrumentos: questionário de caracterização sociodemográfica e clínica, validado por especialistas; Índice de Qualidade do Sono de Pittsburgh; Escala de Fadiga de Piper-revisada; Escala de Mensuração Subjetiva de Dor. RESULTADOS: a maioria dos idosos (62,9%) apresentou pontuação compatível com má qualidade do sono. Em média, a duração do sono foi de 388,0 minutos, latência de 44,6 minutos e eficiência, 83,8%. À análise de regressão logística múltipla observou-se aumento de 21% da probabilidade de apresentar má qualidade do sono a cada acréscimo de um ponto na intensidade da dor. CONCLUSÃO: intervenções de enfermagem, visando promover melhor qualidade do sono aos pacientes idosos com câncer, devem agregar medidas para controle da dor.

OBJETIVO: evaluar las características del sueño y los factores asociados a la calidad del sueño de pacientes mayores sometidos al tratamiento de quimioterapia de ambulatorio. MÉTODO: estudio transversal con 140 pacientes mayores (51,2% del sexo femenino, media mayores 69,8 años) con cáncer en estadio III o IV (67,9%), acarreado en un hospital universitario de la provincia de São Paulo, en 2010. Se utilizaron los instrumentos: cuestionario de caracterización socio-demográfica y clínica, validado por expertos; Índice de Calidad del Sueño de Pittsburgh; Escala de Fatiga de Piper-revisada; Escala de mensuración subjetiva de dolor. RESULTADOS: la mayoría de los mayores (62,9%) presentó puntuación compatible con mala calidad del sueño. En media, la duración del sueño fue de 388,0 minutos, latencia de 44,6 minutos y eficiencia, 83,8%. Al análisis de regresión logística múltiple se observó aumento del 21% de la probabilidad de presentar mala calidad del sueño a cada añadidura de un punto en la intensidad del dolor. CONCLUSIÓN: intervenciones de enfermería objetivando promover mejor calidad del sueño a los pacientes mayores con cáncer deben agregar medidas para control del dolor.

[ effect of valerian on sleep component among menopausal women]

About 50 percent of menopausal women have sleep problems that can lead to reduced quality of life; according to the population growth in postmenopausal women today, raising the level of their health issues are deemed important. The aim of this study was to investigate the effect of valerian on sleep component among 60-50 year women. In this study, a randomized controlled trial design was employed. Participants consisted of 100 women with menopause aged 50-60, who suffered from insomnia. Instruments included demographic data form and Pittsburg sleep quality index. Descriptive and inferential statistics were used to analyze the data. Prevalence of sleep disorders by Pittsburg sleep quality index in this group was 70%. A statistically significant change was reported in the six component of sleep disturbance in intervention group in comparison to the placebo group [p=0.000]. But the sixth component [the mount of drugs] was not statistically different. The results show that valerian improves the component of sleep in women with insomnia. So, it is essential that health providers would be familiar with these herb supplements

Anti-oxidant treatment in obstructive sleep apnoea syndrome.

Purpose. To investigate whether oral intake of N-acetylcysteine (NAC) is a treatment option in patients with obstructive sleep apnoea syndrome (OSAS). Methods. Twenty patients with OSAS were enrolled in the study. After polysomnography (PSG), they were randomly assigned to receive a placebo (n=10) and NAC (n=10). A repeat PSG was done after the treatment period of 30 days. Fasting venous samples were collected for various biochemical analysis. Results. In the patients of NAC group, compared to their baseline values, slow wave sleep as sleep percent time (27.9±2.7 vs 42.3±4.2; p<0.01) and sleep efficiency (90.8±1.3 vs 94.4±1.5; p<0.05) improved considerably. The apnoea-hypopnoea index (61.2±8.5 vs 43.1±8.6; p<0.05), apnoea related arousals (22.2±7.6 vs 11.6±4.7; p<0.05), longest apnoeic episode duration (seconds) (54.9±7.1 vs 37.8±5.6; p<0.01), oxygen desaturation events per hour (51.8±7.7 vs 37±7.8; p<0.01) and epworth sleepiness score (16.6±0.8 vs 9.2±0.9; p<0.001) decreased significantly. The relative snore time (%) (10.2±2.9 vs 4.9±1.9; p<0.01), number of snore episodes (63.8±23.9 vs 28.2±9.9; p<0.05) and duration of longest snore episode (min) (2.5±0.7 vs 0.6±0.1; p<0.05) also decreased significantly. Such responses were not evident in the placebo group. N-acetylcysteine produced significant decrease in lipid peroxidation and increase in total reduced glutathione. Conclusions. Oral NAC administration appears to have a therapeutic potential in the treatment of OSAS. It is proposed that long-term treatment with NAC in patients with OSAS may reduce their dependency on continuous positive airway pressure therapy.

Effectiveness of cognitive-behavioral therapy and amitriptyline in patients with chronic temporomandibular disorders: a pilot study

The aim of this pilot study was to evaluate the effectiveness of cognitive-behavioral therapy (CBT) and use of amitriptyline, a tricyclic antidepressant, in patients with chronic temporomandibular disorders (TMD). Forty-seven women (mean age = 35.4 years old) with chronic TMD were enrolled in the study and divided into 4 groups: amitriptyline; amitriptyline and CBT; placebo and CBT; and placebo only (control). Patients were managed for 7 consecutive weeks. Follow-up evaluations were done at the 1st, 7th and 11th weeks of treatment. The presence and severity of pain, levels of depression, and quality of life and sleep were measured. Data were analyzed using ANOVA, Chi-square and Cochran tests, considering a significance level of 5 percent. Improvements were found for all factors considered in the intragroup analysis, although no significant differences were detected among groups. However, at the end of the treatment (11 weeks of follow-up), these positive outcomes persisted only for the women treated with amitriptyline and CBT. The obtained results suggest that the combination of amitriptyline and CBT may be effective in reducing pain and depression levels as well as in improving the quality of life and sleep in patients with chronic TMD.

O objetivo deste estudo piloto foi avaliar a eficácia do uso de uma terapia cognitivo comportamental (TCC) e da amitriptilina, um antidepressivo tricíclico, no tratamento de pacientes portadores de disfunções temporomandibulares (DTM) crônicas. Quarenta e sete mulheres (com 35,4 anos em média) diagnosticadas com DTM crônica foram selecionadas e divididas em 4 grupos: amitriptilina; amitriptilina + TCC; placebo + TCC; e placebo (controle) e controle. As pacientes foram submetidas às terapias por 7 semanas consecutivas. As reavaliações aconteceram 1, 7 e 11 semanas após o início da terapia (11 semanas de avaliações). Foram avaliados a presença e severidade de dor, o nível de depressão, a qualidade de vida e do sono. Os dados foram avaliados através de ANOVA, Qui-quadrado e teste de Cochran, considerando um nível de significância de 5 por cento. Foram observadas melhoras significantes em todos os fatores avaliados para todos os grupos, porém não foram observadas diferenças entre os grupos. Após o final da terapia, os resultados positivos persistiram apenas para o grupo amitriptilina + TCC. Os resultados sugerem que o uso associado de amitriptilina e TCC no tratamento de pacientes portadores de DTM crônicas pode ser efetivo na melhora da dor, nível de depressão, qualidade de vida e do sono.

[Effect of intravenous vitamin C on sleep quality in hemodialysis patients]

Poor sleep quality is common among hemodialysis patients and can potentially predict morbidity, mortality and quality of life in these patients. On the other hand, hemodialysis patients are encountered with vitamin C deficiency. The purpose of this study was to determine the effect of intravenous vitamin C on sleep quality in hemodialysis patients. In this double blind randomized clinical trial, 60 qualified hemodialysis patients were gone under investigation in Sari a city located in North of Iran during 2010. Patients randomly allocated in two equal intervention and control groups. The main measured outcome was the Pittsburg sleep quality index [PSQI] which consists of seven components. At the end of each hemodialysis session, Intervention group received vitamin C vial [500mg/5cc] intravenously, three times a week for 8 weeks and control group received normal saline in a same way. Data were collected at pretreatment and after two months of treatment. Data were analyzed by Independent t test, Paired t test, Wilcoxon and Chi-Square tests. The result indicated that the sleep quality improves significantly in vitamin C group but not in control group [P<0.001]. Vitamin C caused significant improvement in subjective sleep quality, sleep latency, habitual sleep efficiency and sleep disturbances in intervention group [p<0.05]. Also, Global PSQI score of intervention group had a greater improvement than control group. Moreover vitamin C caused significant improvement in subjective sleep quality, sleep latency, habitual sleep efficiency and sleep disturbances in intervention group after treatment [p< 0.05]. This study showed that intravenous vitamin C can effectively improve sleep quality in hemodialysis patients

Síndrome de ingesta nocturna como efecto colateral del zolpidem / Sleep related eating disorders as a side effect of zolpidem

El zolpidem es una droga hipnótica utilizada para el tratamiento del insomnio. Disminuye la latencia del sueño, el número total de despertares y aumenta el tiempo total del sueño respetando en general su arquitectura. Se cree que aumenta la fase 3 del sueño lento profundo. Nuestro objetivo es comunicar 8 casos de síndrome de ingesta nocturna relacionado al sueño y conductas automáticas complejas asociadas a sonambulismo como efecto colateral del zolpidem. Se analizaron las historias clínicas de 8 pacientes tratados con zolpidem que referían ingesta nocturna de alimentos con amnesia total o parcial del episodio. Se presentan 6 mujeres y 2 hombres, entre 32 y 72 años (media: 58 años), 7 tratados con zolpidem 10 mg/noche y 1 con zolpidem 12.5 mg/noche de liberación prolongada. El tiempo de exposición previo al desarrollo de eventos fue de 1 a 180 días (media de 39.8). El número de episodios relatados era de 1 a 8/noche (media 2.5) asociado con amnesia. Los episodios desaparecieron por completo en el 100% de los casos al suspender la medicación. El síndrome de ingesta nocturna relacionado al sueño es una parasomnia de sueño lento profundo que consiste en episodios de ingesta de alimento o bebida durante la noche, con amnesia parcial o completa del episodio. El zolpidem podría inducir el síndrome de ingesta nocturna relacionado al sueño en aproximadamente el 1% de pacientes, aunque creemos que es un efecto adverso que está subdiagnosticado. Se resuelve simplemente suspendiendo la medicación.

Zolpidem is a hypnotic drug used in sleep disorders. It binds selectively to alpha 1 subunit of the GABA A benzodiazepine receptor. Zolpidem reduces sleep latency, number of arousals and increases the total time of sleep. However, it is considered that it may increase phase 3 of non rapid eye movement sleep, where somnambulism can take place. Our aim is to report 8 cases of sleep related eating disorders associated with the use of this drug. We have evaluated the medical history of 8 patients who had received zolpidem for sleeping disorders and who have presented sleep related eating disorders. Eight patients (6 women, 2 men) aged between 32 to 72 years old, which received 10 mg of zolpidem/night except 1 that received 12.5 mg, were presented. They have referred strange eating behavior compatible to sleep related eating disorder. Symptoms appeared at a mean of 39.8 days after starting the medication. The numbers of nocturnal episodes recorded by the family or by the patient were 1 to 8 episodes of nocturnal eating per night. The morning after, patients found leftovers from the night before which they did not recall to have eaten. The remission was complete after discontinuing zolpidem. Zolpidem may induce sleep related eating disorder in about 1% of patients, although we consider there may be a subdiagnosis of this phenomenon. It will be important to bear in mind and look for this side effect because all the episodes could easily be controlled by withdrawing the drug.

Evaluation of antianxiety and sedative effects of essential oil of Ducrosia anethifolia in mice

INTRODUCTION: We investigated the antianxiety and sedative effects of the essential oil of Ducrosia anethifolia. Boiss. (Apiaceae). METHODS: We used elevated plus maze, spontaneous motor activity and ketamine-induced sleep tests in mice. In addition, the essential oil was analyzed by GC/MS. Twenty compounds were identified, and n-decanal (70.1 percent) and alpha-pinene (12.4 percent) constituted the major components. RESULTS: In elevated plus maze, Ducrosia anethifolia essential oil at doses of 25-200 mg/kg increased the percentage of open arm time and entries. Unlike diazepam, ducrosia anethifolia essential oil could not suppress spontaneous motor activity and did not alter ketamine-induced sleep parameters. These results are indicative of antianxiety effect of Ducrosia anethifolia essential oil without sedative effect.

Effects of sildenafil on autonomic nervous function during sleep in obstructive sleep apnea

OBJECTIVE: To evaluate the effects of sildenafil on the autonomic nervous system in patients with severe obstructive sleep apnea. METHODS: Thirteen male patients with severe obstructive sleep apnea (mean age 43±10 years with a mean body mass index of 26.7±1.9 kg/m²) received a single 50-mg dose of sildenafil or a placebo at bedtime. All-night polysomnography and heart rate variability were recorded. Frequency domain analysis of heart rate variability was performed for the central five-minute sample of the longest uninterrupted interval of slow wave and rapid eye movement sleep, as well as for one-minute samples during apnea and during slow wave and rapid eye movement sleep after resumption of respiration. RESULTS: Compared to the placebo, sildenafil was associated with an increase in the normalized high-frequency (HFnu) components and a decrease in the low/high-frequency components of the heart rate variability ratio (LF/HF) in slow wave sleep (p<0.01 for both). Differences in heart rate variability parameters between one-minute post-apnea and apnea samples (Δ= difference between resumption of respiration and apnea) were assessed. A trend toward a decreasing magnitude of ΔLF activity was observed during rapid eye movement sleep with sildenafil in comparison to placebo (p=0.046). Additionally, Δ LF/HF in SWS and rapid eye movement sleep was correlated with mean desaturation (sR= -0.72 and -0.51, respectively, p= 0.01 for both), and Δ HFnu in rapid eye movement sleep was correlated with mean desaturation (sR= 0.66, p= 0.02) and the desaturation index (sR= 0.58, p = 0.047). CONCLUSIONS: The decrease in arousal response to apnea/hypopnea events along with the increase in HFnu components and decrease in LH/HF components of the heart rate variability ratio during slow wave sleep suggest that, in addition to worsening sleep apnea, sildenafil has potentially immediate cardiac effects in patients with severe obstructive sleep apnea.