Working hours associated with unintentional sleep at work among airline pilots / Jornadas de trabalho associadas a cochilos não intencionais entre pilotos da aviação regular

ABSTRACT OBJECTIVE Tto identify factors associated with unintentional sleep at work of airline pilots. METHODS This is a cross-sectional epidemiological study conducted with 1,235 Brazilian airline pilots, who work national or international flights. Data collection has been performed online. We carried out a bivariate and multiple logistic regression analysis, having as dependent variable unintentional sleep at work. The independent variables were related to biodemographic data, characteristics of the work, lifestyle, and aspects of sleep. RESULTS The prevalence of unintentional sleep while flying the airplane was 57.8%. The factors associated with unintentional sleep at work were: flying for more than 65 hours a month, frequent technical delays, greater need for recovery after work, work ability below optimal, insufficient sleep, and excessive sleepiness. CONCLUSIONS The occurrence of unintentional sleep at work of airline pilots is associated with factors related to the organization of the work and health.

RESUMO OBJETIVO Identificar fatores associados aos cochilos não intencionais durante as jornadas de trabalho de pilotos da aviação regular. MÉTODOS Estudo epidemiológico transversal conduzido com 1.235 pilotos brasileiros de avião do transporte aéreo regular, que realizavam voos nacionais ou internacionais, sendo a coleta de dados realizada on-line. Foi realizada análise de regressão logística bivariada e múltipla, tendo como variável dependente o cochilo não intencional durante o horário de trabalho. As variáveis independentes foram relacionadas a dados biodemográficos, características do trabalho, estilo de vida e aspectos do sono. RESULTADOS A prevalência do cochilo não intencional enquanto pilotava o avião foi de 57,8%. Os fatores associados ao cochilo não intencional foram: voar por mais de 65 horas por mês, atrasos técnicos frequentes, maior necessidade de recuperação após o trabalho, capacidade para o trabalho inferior à ótima, sono insuficiente e sonolência excessiva. CONCLUSÕES A ocorrência do cochilo não intencional durante a jornada de trabalho de pilotos da aviação regular está associada a fatores relacionados à organização do trabalho e à saúde.

Circadian rhythm and profile in patients with juvenile myoclonic epilepsy and temporal lobe epilepsy / Ritmo e perfil circadiano em pacientes com epilepsia mioclônica juvenil e epilepsia de lobo temporal

Objective This study intended to compare the circadian rhythm and circadian profile between patients with juvenile myoclonic epilepsy (JME) and patients with temporal lobe epilepsy (TLE). Method We enrolled 16 patients with JME and 37 patients with TLE from the Outpatient Clinic of UNICAMP. We applied a questionnaire about sleep-wake cycle and circadian profile. Results Fourteen (87%) out of 16 patients with JME, and 22 out of 37 (59%) patients with TLE reported that they would sleep after seizure (p < 0.05). Three (19%) patients with JME, and 17 (46%) reported to be in better state before 10:00 AM (p < 0.05). Conclusion There is no clear distinct profile and circadian pattern in patients with JME in comparison to TLE patients. However, our data suggest that most JME patients do not feel in better shape early in the day. .

Objetivo Este estudo pretende comparar o ritmo circadiano e o perfil circadiano entre pacientes com epilepsia mioclônica juvenil (EMJ) e epilepsia de lobo temporal (ELT). Método Nós entrevistamos 16 pacientes com EMJ e 37 com ELT do ambulatório da UNICAMP. Nós aplicamos um questionário sobre ciclo sono-vigília e perfil circadiano. Resultados Quatorze (87%) de 16 pacientes com EMJ e 22 de 37 (59%) pacientes com ELT relataram que eles apresentam sonolência pós-crise (p < 0,05). Três (19%) pacientes com EMJ e 17 (46%) relataram um melhor estado geral antes das 10h00min (p < 0,05). Conclusão Não há uma clara diferença de ritmo e de perfil circadiano entre pacientes com EMJ e ELT. No entanto, nossos dados sugerem que a maioria dos pacientes com EMJ não se sentem em sua melhor forma cedo pela manhã. .

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

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

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

Sleep, ageing and night work

Studies have shown that the frequency or worsening of sleep disorders tends to increase with age and that the ability to perform circadian adjustments tends to decrease in individuals who work the night shift. This condition can cause consequences such as excessive sleepiness, which are often a factor in accidents that occur at work. The present study investigated the effects of age on the daytime and nighttime sleep patterns using polysomnography (PSG) of long-haul bus drivers working fixed night or day shifts. A total of 124 drivers, free of sleep disorders and grouped according to age (<45 years, N = 85, and ≥45 years, N = 39) and PSG timing (daytime (D) PSG, N = 60; nighttime (N) PSG, N = 64) participated in the study. We observed a significant effect of bedtime (D vs N) and found that the length of daytime sleep was shorter [D: <45 years (336.10 ± 73.75 min) vs N: <45 years (398 ± 78.79 min) and D: ≥45 years (346.57 ± 43.17 min) vs N: ≥45 years (386.44 ± 52.92 min); P ≤ 0.05]. Daytime sleep was less efficient compared to nighttime sleep [D: <45 years (78.86 ± 13.30 percent) vs N: <45 years (86.45 ± 9.77 percent) and D: ≥45 years (79.89 ± 9.45 percent) and N: ≥45 years (83.13 ± 9.13 percent); P ≤ 0.05]. An effect of age was observed for rapid eye movement sleep [D: <45 years (18.05 ± 6.12 percent) vs D: ≥45 years (15.48 ± 7.11 percent) and N: <45 years (23.88 ± 6.75 percent) vs N: ≥45 years (20.77 ± 5.64 percent); P ≤ 0.05], which was greater in younger drivers. These findings are inconsistent with the notion that older night workers are more adversely affected than younger night workers by the challenge of attempting to rest during the day.

Delta sleep instability in children with chronic arthritis

The objective of the present study was to evaluate the expression of a cyclic alternating pattern (CAP) in slow wave sleep (SWS) in children with the well-defined chronic syndrome juvenile idiopathic arthritis (JIA). Twelve patients (9-17 years of age), 7 girls, with JIA were compared to matched controls by age, pubertal stage and gender. After one night of habituation in the sleep laboratory, sleep measurements were obtained by standard polysomnography with conventional sleep scoring and additional CAP analyses. The sleep parameters of the JIA and control groups were similar for sleep efficiency (91.1 ± 6.7 vs 95.8 ± 4.0), sleep stage in minutes: stage 1 (16.8 ± 8.5 vs 17.8 ± 4.0), stage 2 (251.9 ± 41 vs 262.8 ± 38.1), stage 3 (17.0 ± 6.0 vs 15.1 ± 5.7), stage 4 (61.0 ± 21.7 vs 77.1 ± 20.4), and rapid eye movement sleep (82.0 ± 27.6 vs 99.0 ± 23.9), respectively. JIA patients presented nocturnal disrupted sleep, with an increase in short awakenings, but CAP analyses showed that sleep disruption was present even during SWS, showing an increase in the overall CAP rate (P < 0.01). Overall CAP rate during non-rapid eye movement sleep was significantly higher in pediatric patients who were in chronic pain. This is the first study of CAP in pediatric patients with chronic arthritis showing that CAP analyses can be a powerful tool for the investigation of disturbance of SWS in children, based on sleep EEG visual analysis.

Efeito da inversão dos turnos de trabalho sobre capacidade aeróbia e respostas cardiovasculares ao esforço máximo / Effect of the work shift reversal on the aerobic capacity and cardiovascular responses to maximal exercise

Os distúrbios do sono e alterações associadas atingem grande parte da população que trabalha no turno noturno, afetando a sua qualidade de vida. O objetivo do presente trabalho foi comparar a capacidade aeróbia e as respostas cardiovasculares ao exercício máximo em indivíduos com ciclo sono vigília fisiológico e com inversão dos turnos de trabalho. Foram analisados 18 indivíduos do sexo masculino, sedentários, com idade entre 23-35 anos, divididos em 2 grupos: a) grupo controle, formado por estudantes (n=9) e b) grupo experimental, composto por controladores de tráfego aéreo que trabalhavam com inversão dos turnos de trabalho (n=9). Para a medida da capacidade aeróbia, foi determinado o VO2máx. por meio do analisador de gases metabólicos (VO-2000, Aerosport, Medgraphics). Para o teste de esforço máximo foi realizado o protocolo de rampa em esteira (Millenniun ATL Inbramed) e as respostas cardiovasculares (FC, PAS e PAD) foram verificadas antes e após a realização do exercício. De acordo com os resultados, o grupo experimental apresentou valores inferiores de FC no repouso (79,8 ± 11,5 bpm vs. 70,3 ± 3,8 bpm), no 5º (112,7± 15,1 bpm vs. 98,7 ± 6,3 bpm) e no 7º minuto (108,7 ± 16,6 bpm vs. 93,9 ± 6,8 bpm) de recuperação. Quanto à PAS, foram observados valores superiores durante o repouso (110,0 ± 11,2 mmHg vs. 104,0 ± 5,7 mmHg), nos indivíduos do grupo controle. Já a PAD, mostrou níveis superiores no 5º minuto da recuperação no grupo experimental (67,0 ± 4,4 mmHg vs. 58,9 ± 6,0 mmHg). Por fim, foram verificados valores superiores de VO2máx. para os indivíduos do grupo controle (58,9 ± 6,1 ml/kg/min) em relação ao experimental (53,7 ± 2,5 ml/kg/min). Desta forma, podemos concluir que a inversão nos turnos de trabalho, afetando o ciclo sono-vigília, altera não apenas o ciclo circadiano das variáveis cardiovasculares no repouso e na recuperação do esforço, como também traz prejuízos à capacidade funcional, podendo comprometer o desempenho...

Sleep disturbs and associated alterations reach great part of the population which works at night, affecting their quality of life. The aim of the present study was to compare the aerobic capacity and the cardiovascular responses to maximal exercise in subjects with physiological sleep/wake cycle and with work shift inversion. 18 male subjects, aged 23-35 years, were assigned to either a shift-workers (Experimental; n=9) or a control group (Control; n=9). All the subjects underwent a treadmill exercise test in order to obtain the BP, HR behavior in the recovery period. Exhaled air was collected every 10 minutes for VO2max. Shift-workers presented lower heart rate values at rest (79.8 ± 11.5 bpm vs. 70.3 ± 3.8 bpm), 5th (112.7 ± 15,1 bpm vs. 98,7 ± 6,3 bpm) and 7th min. (108.7 ± 16.6 bpm vs. 93.9 ± 6.8 bpm) at recovery. SBP showed significant increased values in control group just at rest (110.0 ± 11.2 mmHg vs. 104.0 ± 5.7 mmHg). The control group presented lower values of DBP at the 5th min. (67.0 ± 4.4 mmHg vs. 58.9 ± 6.0 mmHg) and higher values of VO2max. (58.9 ± 6.1 ml/kg/min vs. 53.7 ± 2.5 ml/kg/min). We concluded that the alterations in the working shifts affect the circadian rhythms and the cardiovascular variables at rest and recovery periods of the exercise stress testing and can compromise the functional capacity of the subjects.

Diagnóstico dos transtornos do sono relacionados ao ritmo circadiano / Diagnosis of circadian rhythm sleep disorders

Queixas de insônia e sonolência excessiva são comuns na investigação dos distúrbios respiratórios do sono; os transtornos do sono relacionados ao ritmo circadiano talvez sejam as causas mais freqüentemente esquecidas no diagnóstico diferencial destes sintomas. Estes transtornos se manifestam por desalinhamento entre o período do sono e o ambiente físico e social de 24 h. Os dois transtornos do sono relacionados ao ritmo circadiano mais prevalentes são o de fase atrasada (comum em adolescentes) e avançada do sono (comum em idosos), situações nas quais o período de sono se desloca para mais tarde e mais cedo, respectivamente. As possíveis confusões com insônia e sonolência excessiva tornam importante ter sempre em mente estes transtornos. Entretanto, há nove possíveis diagnósticos, e todos são de interesse clínico. Como a luz é o principal sinal para sincronizar os relógios biológicos, pessoas cegas e trabalhadores em turnos e noturno são os mais propensos a desenvolver transtornos do sono relacionados ao ritmo circadiano. Neste artigo, revisa-se a nova classificação internacional dos transtornos do sono relacionados ao ritmo circadiano.

Insomnia and excessive sleepiness are common in the investigation of sleep-disordered breathing. Circadian rhythm sleep disorders are perhaps the most often overlooked conditions in the differential diagnosis of these symptoms. Circadian rhythm sleep disorders manifest as misalignment between the sleep period and the physical/social 24-h environmental cycle. The two most prevalent circadian rhythm sleep disorders are delayed sleep phase (common in adolescents) and advanced sleep phase (common in the elderly), situations in which the sleep period is displaced to a later or earlier time, respectively. It is important to keep these two disorders in mind, since they can be confused with insomnia and excessive sleepiness. However, there are nine possible diagnoses, and all nine are of clinical interest. Since light is the principal cue used in synchronizing the biological clock, blind individuals and night-shift/swing-shift workers are more prone to develop circadian rhythm sleep disorders. In this article, the new international classification of circadian rhythm sleep disorders is reviewed.

Special assessment of aircraft noise effects during night by the Council of Experts for Environmental Questions of FRG.

The "Special Assessment of Environment and Health" (SAEH) by the Council of Experts for Environmental Questions of Federal Republic of Germany is presented regarding to it's statements concerning the consequences of aircraft noise during night. Considering the issue of sustainability it is emphasized that lower limit values of the validity of scientific results need to be accepted. As the discussion of the literature shows the statements of the Council are rather vague and warily. This is a question of used parameters of noise effects during the night as well as its interpretation. It seems necessary to utilize a hierarchical structure of limit values and with interpretation of the term "threshold" as normal physiological reactions. More investigations are necessary in this field.

Stress hormones and sleep disturbances - electrophysiological and hormonal aspects.

In noise effect research often the awakening reaction is maintained to be the only important health related reaction. The main argument is that sleep represents a trophotropic phase ("energy storing"). In contrast to this awakening reactions or lying awake belong to the ergotropic phase ("energy consuming"). Frequent or long awakening reactions endanger therefore the necessary recovery in sleep and, in the long-run, health. Findings derived from arousal and stress hormone research make possible a new access to the noise induced nightly health risk. An arousal is a short change in sleeping condition, raising the organism from a lower level of excitation to a higher one. Arousals have the function to prevent life-threatening influences or events through activation of compensation mechanisms. Frequent occurrences of arousal triggered by nocturnal noise leads to a deformation of the circadian rhythm. Additionally, the deep sleep phases in the first part of the night are normally associated with a minimum of cortisol and a maximum of growth hormone concentrations. These circadian rhythms of sleep and neuroendocrine regulation are necessary for the physical as well as for the psychic recovery of the sleeper. Noise exposure during sleep which causes frequent arousal leads to decreased performance capacity, drowsiness and tiredness during the day. Long-term disturbances of the described circadian rhythms have a deteriorating effect on health, even when noise induced awakenings are avoided.