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

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

Hyperglycemia in pregnancy: sleep alterations, comorbidities and pharmacotherapy

SUMMARY OBJECTIVE: To investigate sleep alterations and associated factors in pregnant diabetic women (n=141). METHODS: Sleep profile, sociodemographics and clinical information were collected. Poor sleep quality (Pittsburgh Sleep Quality Index >5) and excessive daytime sleepiness (Epworth Sleepiness Scale ≥10), sleep duration (h), sleep latency (min), frequent sleep interruption and short sleep (≤6 h) were assessed in type 1 diabetes mellitus (16.3%), type 2 diabetes mellitus (25.5%) and gestational diabetes mellitus (58.2%). RESULTS: Poor sleep quality was found in 58.8% of patients and daytime sleepiness in 25.7%, regardless of hyperglycemia etiology. No correlation existed between daytime sleepiness and poor sleep quality (Pearson correlation r=0.02, p=0.84). Short sleep duration occurred in 1/3 of patients (31.2%). Sleep interruptions due to frequent urination affected 72% of all and sleep interruptions due to any cause 71.2%. Metformin was used by 65.7% of type 2 diabetes mellitus and 28.7% of gestational diabetes mellitus. In gestational diabetes mellitus, parity number was independently associated with poor sleep quality (p=0.02; OR=1.90; 95%CI 1.07-3.36) and metformin use was also independently associated with poor sleep quality (p=0.03; OR=2.36; 95%CI 1.05-5.29). CONCLUSIONS: Our study originally shows that poor sleep quality and excessive daytime sleepiness are frequent in diabetic pregnancy due to different etiologies. Interestingly, only in gestational diabetes mellitus, metformin therapy and higher parity were associated with poor sleep quality.

Sentimentos de enfermeiros que atuam junto a pacientes com câncer em fase terminal / Sentimientos de enfermeros que trabajan con pacientes con cáncer enfase terminal / Feelings of nurses who work with cancer patients in terminal phase

Objetivo: Identificar os sentimentos de enfermeiros que atuam junto a pacientes com câncer em fase terminal. Métodos: Pesquisa qualitativa, realizada com dez enfermeiros do setor de oncologia de um hospital de Teresina, Piauí, Brasil. Coleta de dados realizada por meio de entrevista semiestruturada, submetida à análise temática. Obtenção de parecer favorável pelo Comitê de Ética em Pesquisa da Faculdade Santo Agostinho, conforme Parecer nº 350/2010. Resultados: Para os enfermeiros, uma das maiores ansiedades enfrentadas é lidar com a morte, vista como fenômeno doloroso e de difícil aceitação. A maioria dos profissionais admitiu o despreparo no manejo e enfrentamento desta condição, experienciando de forma conflituosa, amarga e cruel tal vivência. Conclusão: Mediante a fragilidade dos sentimentos dos enfermeiros, urge apoio ao profissional da área oncológica com formações de grupos de apoio ao profissional, a fim de compartilhar experiências e minimizar o sofrimento emocional.

Objective: To identify the feelings of nurses who work with cancer patients in terminal phase. Methods: It is a qualitative research conducted with 10 nurses from the oncology department of a hospital in Teresina, Piauí, Brazil. Data collection occurred through semi-structured interviews submitted to thematic analysis. The Research Ethics Committee of the Santo Agostinho College approved the study under protocol No. 350/10. Results: One of the biggest anxieties nurses face is dealing with death, seen as a painful phenomenon and difficult to accept. Most professionals admitted not being prepared to manage and cope with this condition, experiencing it in a conflicting, bitter, and cruel way. Conclusion: Given the fragility of nurses’ feelings, there is urgent need to aid oncology professionals by creating professional support groups in order to share experiences and minimize the emotional distress.

Objetivo: Identificar los sentimientos de enfermeros que trabajan com pacientes con cáncer terminal. Métodos: Investigación cualitativa, con 10 enfermeros del departamento de oncología de un hospital de Teresina, Piauí, Brasil. Recogida de datos realizada a través de entrevistas semiestructuradas sometidas a análisis temático. Obtención de dictamen favorable del Comité de Ética de la Facultad de San Agustín, según parecer Nº 350/10. Resultados: Para los enfermeros, una de las mayores preocupaciones se fue con la muerte, vista como dolorosa y difícil de aceptar. La mayoría de los profesionales admitió falta de preparación em la gestión y hacer frente a esta condición, experimentando una forma de confrontación, amarga y cruel esta experiencia. Conclusión: Por La fragilidad de los sentimientos de los enfermeros, insta apoyar la oncologia profesional con la formación de grupos profesionales con el fin de compartir experiencias y minimizar el estrés emocional.