Trastornos del sueño en emergencias y desastres / Sleep disorders in emergencies and disasters

Los trastornos del sueño son frecuentes en la población y una causa importante de morbilidad. El objetivo de esta revisión es evaluar las alteraciones del sueño en periodos de emergencia y desastres. A lo largo de la historia, la esfera biopsicosocial y el sueño de las personas ha sido abrumada por múltiples eventos a gran escala, tales como desastres naturales, tragedias provocadas por el hombre, conflictos bélicos, crisis sociales y pandemias, cuya experiencia puede derivar en problemas de salud a corto, mediano y/o largo plazo. En los estudios analizados, se ha observado el impacto negativo de las emergencias y desastres en el sueño, por lo que ha cobrado gran relevancia la difusión y promoción de medidas que incentiven el buen dormir. Debido a la llegada del COVID-19 y a la situación de confinamiento por periodos prolongados en el hogar para prevenir su propagación, han surgido importantes consecuencias a nivel social. Ciertos factores ocupacionales y características de los desastres se asocian a mayor comorbilidad, un alto riesgo de experimentar agotamiento físico, trastornos psicológicos e insomnio en grupos altamente vulnerables, como lo son los profesionales de la salud, rescatistas y socorristas. El insomnio es el trastorno de sueño más frecuente en la población general y su empeoramiento en el contexto de pandemia por COVID-19 representa un nuevo problema en salud pública. Es por ello, que es indispensable promover campañas de prevención de salud física y mental orientados a la pesquisa precoz y manejo de patologías de la esfera psicosocial, dentro de las posibilidades socioeconómicas.

Sleep disorders are common in the population and are major cause of morbidity. The objective of this review is to assess sleep disturbances in times of emergency and disasters. Throughout history, the biopsychosocial field and sleep have been affected by multiple large-scale events, such as natural disasters, man-caused tragedies, armed conflicts, social crises and pandemics, the experience of which can lead to short, medium and/or long term health problems. In several studies, the negative impact of emergencies and disasters on sleep have been analyzed, emphasizing the importance of the diffusion and promotion of measures that encourage good sleep. The arrival of COVID-19 and consequent home confinement for prolonged periods caused important social consequences. Certain occupational factors and characteristics of disasters are associated with greater comorbidity: a high risk of experiencing physical exhaustion, psychological disorders and insomnia, especially in highly vulnerable groups, such as health professionals, rescuers and first aids-responders. Insomnia is the most frequent sleep disorder in the general population and its worsening in the context of the COVID-19 pandemic, represents a new public health problem. It is essential to promote physical and mental health prevention campaigns, aimed at early screening and management of pathologies in the psychosocial sphere, within socioeconomic possibilities.

The effectiveness of melissa officinalis l. Versus citalopram on quality of life of menopausal women with sleep disorder: a randomized double-blind clinical trial

Abstract Objective The present study aimed to assess the effect of Melissa Officinalis L. (a combination of lemon balm with fennel fruit extract) compared with citalopram and placebo on the quality of life of postmenopausal women with sleep disturbance. Methods The present study is a randomized, double-blind, placebo clinical trial among 60 postmenopausal women with sleep disturbance who were referred to a university hospital from 2017 to 2019. The participants were randomized to receive M. Officinalis L. (500 mg daily), citalopram (30 mg) or placebo once daily for 8 weeks. The Menopause-Specific Quality of Life (MENQOL) questionnaire was self-completed by each participant at baseline and after 8 weeks of the intervention and was compared between groups. Results The mean for all MENQOL domain scores were significantly improved in the M. Officinalis L. group compared with citalopram and placebo (p < 0.001). The mean ± standard deviation (SD) after 8 weeks in the M. Officinalis L., citalopram and placebo groups was 2.2 ± 0.84 versus 0.56 ± 0.58 versus 0.36 ± 0.55 in the vasomotor (p < 0.001), 1.02 ± 0.6 versus 0.28 ± 0.2 versus 0.17 ± 0.1 in the psychomotor-social (p < 0.001), 0.76 ± 0.4 versus 0.25 ± 0.1 versus 0.11 ± 0.1 in the physical and 2.3 ± 1.0 versus 0.35 ± 0.5 versus 0.41 ± 0.5 in the sexual domain, respectively. Conclusions The results revealed that M. Officinalis L. may be recommended for improving the quality of life of menopausal women with sleep disturbance. Trial registration The present study was registered by the name "Comparison of the efficacy of citalopram and compound of Asperugo procumbens and foeniculum vulgare in treatment of menopausal disorders" with the code IRCT2013072714174N1 in the Iranian Registry of Clinical Trials (IRCT).

How do stress, sleep quality, and chronotype associate with clinically significant depressive symptoms? A study of young male military recruits in compulsory service

Objective: Although studies have shown an association between poor sleep and chronotype with psychiatric problems in young adults, few have focused on identifying multiple concomitant risk factors. Methods: We assessed depressive symptoms (Beck Depression Inventory [BDI]), circadian typology (Morningness-Eveningness Questionnaire [MEQ]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), perceived stress (Perceived Stress Scale [PSS]), social rhythm (Social Rhythm Metrics [SRM]), and salivary cortisol (morning, evening and night, n=37) in 236 men (all 18 years old). Separate analyses were conducted to understand how each PSQI domain was associated with depressive symptoms. Results: Depressive symptoms were more prevalent in individuals with higher perceived stress (prevalence ratio [PR] = 6.429, p < 0.001), evening types (PR = 2.58, p < 0.001) and poor sleepers (PR = 1.808, p = 0.046). Multivariate modeling showed that these three variables were independently associated with depressive symptoms (all p < 0.05). The PSQI items subjective sleep quality and sleep disturbances were significantly more prevalent in individuals with depressive symptoms (PR = 2.210, p = 0.009 and PR = 2.198, p = 0.008). Lower levels of morning cortisol were significantly associated with higher depressive scores (r = -0.335; p = 0.043). Conclusion: It is important to evaluate multiple factors related to sleep and chronotype in youth depression studies, since this can provide important tools for comprehending and managing mental health problems.

Consequences of chronic non-cancer pain in adulthood. scoping review / Consecuencias del dolor crónico no oncológico en la edad adulta. scoping review

ABSTRACT OBJECTIVE To examine and map the consequences of chronic pain in adulthood. METHOD Documents addressing the impact of chronic pain on the psychological and social spheres of people suffering from chronic pain, published in Spanish and English between 2013 and 2018, were included. Those who addressed pharmacological treatments, chronic pain resulting from surgical interventions or who did not have access to the full text were excluded. Finally, 28 documents from the 485 reviewed were included RESULTS Studies show that pain is related to high rates of limitation in daily activities, sleep disorders and anxiety-depression spectrum disorders. People in pain have more problems to get the workday done and to maintain social relationships. Chronic pain is also associated with worse family functioning. CONCLUSIONS This review shows that limitations in the ability to perform activities of daily living, sleep, psychological health, social and work resources and family functioning are lines of interest in published articles. However, knowledge gaps are detected in areas such as the influence of having suffered pain in childhood or adolescence, the consequences of non-fulfillment of working hours and gender inequalities.

RESUMEN OBJETIVO Examinar y mapear las consecuencias del dolor crónico en la edad adulta. MÉTODO Se incluyeron documentos que abordaban las repercusiones del dolor crónico en las esferas psicológica y social de las personas que lo padecen, publicados en español e inglés entre los años 2013-2018. Aquellos que abordaban tratamientos farmacológicos, dolor crónico derivado de intervenciones quirúrgicas o que no tenían acceso a texto completo fueron excluidos. Finalmente, se incluyeron 28 documentos de los 485 revisados. RESULTADOS Los estudios muestran que el dolor se relaciona con altas tasas de limitación en las actividades de la vida diaria, alteraciones del sueño y trastornos del espectro ansiedad-depresión. Las personas con dolor experimentan más problemas para rendir en la jornada laboral y mantener relaciones sociales. Con respecto a la familia, el dolor crónico se ha asociado con un peor funcionamiento familiar. CONCLUSIONES Esta revisión pone de manifiesto que las limitaciones en la capacidad para realizar actividades de la vida diaria, el sueño, la salud psicológica, los recursos sociales y laborales y el funcionamiento familiar son líneas de interés en los trabajos publicados. Sin embargo, se detectan lagunas de conocimiento en áreas como la influencia de haber padecido dolor en la infancia o adolescencia, las consecuencias por incumplimiento de la jornada laboral y las desigualdades de género.

Standardization of the duty shift in a General Adult Intensive Care Unit / Estandarización del paso de turno en Unidad de Terapia Intensiva General Adulto / Padronização da passagem de plantão em Unidade de Terapia Intensiva Geral Adulto

ABSTRACT Objective: To standardize the duty shift in a General Adult Intensive Care Unit. Method: Multi-method research, which used action research, descriptive study and content validation. Participants included 11 care nurses and 4 intensive care nurses. For the data collection, a semi-structured questionnaire was used, meetings with participants and validation with specialists. In this step, the modified online Delphi Technique was used. For data treatment, the Discourse of the Collective Subject (DCS) was used, descriptive analysis and Content Validity Index. Results: Three DCS on duty change, a Standard Operating Procedure (SOP) and an information registration instrument, validated in appearance, clarity, suitability and content. Final considerations: The instrument assists in the transmission of information, strengthening patient safety and SOP will outline the shift, these tools can improve ICU shift, minimizing the risks of communication failure.

RESUMEN Objetivo: Padronizar el paso de turno en una Unidad de Terapia Intensiva General Adulto. Método: Investigación multiuso, que utilizó la investigación-acción, el estudio descriptivo y la validación de contenido. Los participantes fueron 11 enfermeros asistenciales y cuatro enfermeros especialistas en cuidados intensivos. Para la recolección de datos se aplicó un cuestionario semiestructurado, reuniones con participante y validación con especialistas. En esta etapa, se utilizó la Técnica Delphi online modificada. Para el tratamiento de los datos, se empleó el Discurso del Sujeto Colectivo (DSC), análisis descriptivo e Índice de Validez de Contenido. Resultados: Tres DSC sobre pasaje de turno, un Procedimiento Operativo Estándar (POP) y un instrumento de registro de informaciones, validado en apariencia, claridad, adecuación y contenido. Consideraciónes finales: El instrumento auxilia en la transmisión de informaciones, fortaleciendo la seguridad del paciente y el POP va delineando el paso de turno, esas herramientas pueden mejorar el paso de turno de la UTI, minimizando los riesgos de fallas de comunicación.

RESUMO Objetivo: Padronizar a passagem de plantão em uma Unidade de Terapia Intensiva Geral Adulto. Método: Pesquisa multimétodo, que utilizou a pesquisa-ação, o estudo descritivo e a validação de conteúdo. Os participantes foram 11 enfermeiros assistenciais e quatro enfermeiros especialistas em cuidados intensivos. Para a coleta de dados foi aplicado um questionário semiestruturado, reuniões com participante e validação com especialistas. Nesta etapa, utilizou-se a Técnica Delphi online modificada. Para tratamento dos dados, empregou-se o Discurso do Sujeito Coletivo (DSC), análise descritiva e Índice de Validade de Conteúdo. Resultados: Três DSC sobre passagem de plantão, um Procedimento Operacional Padrão (POP) e um instrumento de registro de informações, validado em aparência, clareza, adequabilidade e conteúdo. Considerações finais: O instrumento auxilia na transmissão de informações, fortalecendo a segurança do paciente e o POP vai delinear a passagem de plantão, essas ferramentas podem melhorar a passagem de plantão da UTI, minimizando os riscos de falhas de comunicação.

Quality of life and urolithiasis: the patient - reported outcomes measurement information system (PROMIS)

ABSTRACT Background: With a high rate of recurrence, urolithiasis is a chronic disease that impacts quality of life. The Patient Reported Outcomes Measurement Information System is an NIH validated questionnaire to assess patient quality of life. We evaluated the impact of urolithiasis on quality of life using the NIH-sponsored PROMIS-43 questionnaire. Materials and Methods: Patients reporting to the kidney stone clinic were interviewed to collect information on stone history and demographic information and were asked to complete the PROMIS-43 questionnaire. Quality of life scores were analyzed using gender and age matched groups for the general US population. Statistical comparisons were made based on demographic information and patient stone history. Statistical significance was P<0.05. Results: 103 patients completed the survey. 36% of respondents were male, the average age of the group was 52 years old, with 58% primary income earners, and 35% primary caregivers. 7% had never passed a stone or had a procedure while 17% passed 10 or more stones in their lifetime. Overall, pain and physical function were worse in patients with urolithiasis. Primary income earners had better quality of life while primary caregivers and those with other chronic medical conditions were worse. Patients on dietary and medical therapy had better quality of life scores. Conclusions: Urolithiasis patients subjectively have worse pain and physical function than the general population. The impact of pain on quality of life was greatest in those patients who had more stone episodes, underscoring the importance of preventive measures. Stone prevention measures improve quality of life.

Distúrbios do sono na população brasileira: análise dos fatores associados às queixas de redução da função reparadora do sono, insônia, sonolência e suas implicações em morte e eventos cardio-cerebrovasculares / Sleep disorders in the Brazilian population: analysis of factors associated with complaints of reduced sleep reparative function, insomnia, drowsiness and their implications for death and cardio-cerebrovascular events

Os distúrbios do sono são caracterizados por alterações no ciclo sono-vigília. Os estudos relativos às condições do sono e suas repercussões na população brasileira são em sua grande maioria de contexto clínico, reduzindo a representatividade dos achados. O objetivo do estudo foi identificar fatores biológicos/saúde, comportamentais e sociais associados com as queixas de redução da função reparadora do sono (FRS), insônia e sonolência excessiva diurna (SED) na população brasileira assim como os efeitos destas queixas na ocorrência de morte e eventos cardio-cerebrovasculares em idosos. O estudo foi desenvolvido em dois delineamentos. O primeiro foi uma análise de dados transversais oriundos da Pesquisa Nacional de Saúde de 2013. Neste delineamento visava-se estimar a ocorrência da redução da FRS, queixas de insônia e sonolência excessiva e suas associações. O segundo desenho trata-se de uma coorte prospectiva de idosos comunitários com linha base em 2009, dividida em grupo de expostos às queixas de insônia e sonolência e não expostos, para estimar seus efeitos sobre a mortalidade e eventos cardiovasculares, em oito anos de seguimento. As análises dos dados transversais ocorreram através de modelagem de Cox com a inclusão dos pesos amostrais no cálculo das estimativas e para os dados prospectivos aplicou-se modelagem de Poisson. Adotou-se um α≤0,05. O estudo foi submetido ao Comitê de Ética em Pesquisa do Hospital Onofre Lopes, recebendo o parecer 2.048.708. Os resultados do primeiro estudo indicam que aproximadamente 28,2% (IC95%:27,4%-29,0%) dos adultos e 34,1% (IC95%:32,6%-35,7%) em idosos relatam queixas de insônia e sonolência. A FRS estava reduzida em 34,1% (IC95%:32,6%-35,7%) em adultos e 29,2% (IC95%:27,2%-30,6%) nos idosos. As queixas de insônia/SED foram relatadas em 28,2% (IC95%: 27,4%-29,0%) nos adultos e 34,1% (32,6%-35,7%) no idosos. Nos adultos, a redução da FRS associa-se com as mulheres (RPaj1=1,12; IC95%: 1,05-1,20/ RPajus2=1,22; IC95%:1,09-1,37), baixos estratos sociais DE (RPaj1=1,21;1,07-1,35, RPaj2=1,42;1,18-1,71) e C (RPaj1=1,30;1,12-1,50), sintomas depressivos (RPaj1=3,22;2,94-3,52/RPaj=3,29;2,83-3,83), oscilação comportamental (RPaj1=1,51;1,41-1,63/ RPaj2=1,66;1,46-1,89), má percepção de saúde geral (RPaj=1,32;1,20-1,38/ RPaj2=2,30;1,92-2,75), má percepção de saúde bucal (RPaj=1,11;1,04-1,19), ter condição crônica de saúde (RPaj1=1,23;1,15-1,31/ RPaj2=1,42;1,26-1,61), ter queixas de insônia/SED (RPaj1=2,47;2,28-2,67/ RPaj2=3,03;2,66-3,47), possuir atividade laboral (RPaj1=1,32;1,23-1,42/ RPaj2=1,27;1,13-1,44)e morar em zona urbana (RPaj2=1,31;1,10-1,55). Baixo peso (RPaj1=0,82;0,69-0,98), estilo de vida saudável (RPaj1=0,91;0,83-0,99/ RPaj2=0,74;0,64-0,87) e reduzido apoio social (RPaj1=0,88;0,80-0,96) são inversamente associados a redução da FRS em adultos. Em idosos, a redução da FRS associa-se com a raça/cor branca (RPaj2=1,18;1,01-1,39), dificuldade em atividades diárias (RPaj1=1,13;1,01-1,27/ RPaj2=1,36;1,12-1,65), usar computador/internet (RPaj1=1,14;1,01-1,30) e, assim como nos adultos, sintomas depressivos (RPaj1=3,37;2,87-3,97/ RPaj2=3,77;2,88-4,96), oscilação comportamental (RPaj1=1,75;1,53-1,99/ RPaj2=1,81;1,46-2,24), má percepção de saúde geral (RPaj1=1,50;1,23-1,82/ RPaj2=3,12;2,31-4,21), regular percepção de saúde bucal (RPaj=1,21;1,08-1,37), ter condição crônica de saúde (RPaj2=1,58;1,11-2,40), ter queixas de insônia/SED (RPaj1=2,45;2,14-2,79/ RPaj2=3,46;2,77-4,33), ter apoio social (RPaj1=1,14;1,01-1,30) e morar em zona urbana (RPaj2=1,32;1,02-1,72). O delineamento prospectivo revelou 40 (25,97%:19,04-32,89) mortes no período e 48 (30,76%:23,52-38,01) eventos cardio-cerebrovasculares. Os homens apresentaram maior risco (RR=1,88; 1,01-3,50) de morte. A depressão (RR=2,04;1,06-3,89), gravidade da insônia (RR=2,39;1,52-4,56) e latência do sono entre 16-30 minutos (RR=3,54;1,26-9,94) e 31-60 minutos (RR=2,23;1,12-4,47) aumentam o risco de morte independentemente em idosos comunitários. Os eventos cardio-cerebrovasculares foram preditos apenas por idosos hipertensos e/ou diabéticos (RR=8,30;1,98-34,82). As queixas de redução da FRS, insônia e sonolência atingem quase um terço da população brasileira e está intimamente relacionada às condições emocionais, cronicidade e urbanização. As queixas de gravidade da insônia e a dificuldade de iniciar o sono parecem aumentar a mortalidade em idosos, juntamente com sintomas depressivos (AU).

Sleep disturbances are characterized by changes in the sleep-wake cycle. Studies on sleep conditions and their repercussions on the Brazilian population are mostly in the clinical context, reducing the impact of the findings. The aim was to identify biological/health, behavioral and social factors associated with complaints of reduction of sleep repair function (SRF), insomnia and excessive daytime sleepiness (EDS) in the Brazilian population, as well as the effects of these complaints on the occurrence of death and cardio-cerebrovascular events in the elderly. The study was developed in two designs. The first was an analysis of cross-sectional data from the National Health Survey of 2013. This study aimed to estimate the occurrence of reduced SRF, complaints of insomnia and excessive sleepiness and their associations. The second design is a prospective cohort of community-based older adults in 2009, divided into a group of exposed to insomnia and EDS and unexposed complaints, to estimate their effects on mortality and cardiovascular events at eight years follow-up. The cross-sectional data analyzes were performed using Cox modeling with inclusion of sample weights in the estimation of the estimates and for the prospective data, Poisson modeling was applied. It was adopted α≤0.05. The study was submitted to the Research Ethics Committee of Hospital Onofre Lopes, receiving opinion 2,048,708. The results of the first study indicate that approximately 28.2% (95% CI: 27.4% -29.0%) of adults and 34.1% (95% CI: 32.6% -35.7%) in the elderly report complaints of insomnia and drowsiness. Sleep RF was reduced by 34.1% (95% CI: 32.6% -35.7%) in adults and 29.2% (95% CI: 27.2% -30.6%) in the elderly. Complaints of insomnia/EDS were reported in 28.2% (95% CI: 27.4% -29.0%) in adults and 34.1% (95% CI: 32.6% -35.7%) in the elderly. In adults, the reduction of RF stands out in relation to women (PRadj1=1.12; 95%CI:1.05-1.20/PRadj2=1.22; 95%CI:1.09-1,37), low social strata DE (PRadj1=1.21; 1.07-1.35/PRadj2=1.42;1.18-1.71) and C (PRadj1=1.30;1.12-1.50), depressive symptoms (PRadj1=3.22;2.94-3.52/PRadj2=3.29;2.83-383), emotional behavioral oscillation (PRadj1=1.51;1.41-1.63 /PRadj2=1.66;1.46-1.89), bad general health perception (PRadj1= 1.32;1.20-1.38 / PRadj2=2.30;2.05-2.90), bad perception of oral health (PRadj1=1.11;1.04-1.19), chronic health condition (PRadj1=1.23;1.15-1.31/PRadj2=1.42;1.26-1.61), insomnia/EDS complaints (PRadj1=2.47:2.28-2.67/PRadj2=3.03;1.23-1.42), livening urban areas (PRadj2=1.31;1.101.5). Low weight (PRadj1=0.82;0.690.98), healthy life style (PRadj1=0.91:0.830.99/PRadj2=0.74;0,64-0,87) and low social support (PRadj1=0.88;0.80-0.96) are inversely associated with reduction of RF in adults. In the elderly, the reduction in RF is associated with white (PRadj2=1.18;1.01-1.39), daily activities difficulty (PRadj1=1.13;1.01-1,27/PRadj2=1.36;1,12-1,65), use computer/internet (PRadj1=1.14;1.01-1.30) and, as well as in adults, depressive symptoms(PRadj1=3.37;2.87-3.97/PRadj2=3.77;2.88-4.96), behavioral oscillation (PRadj1=1.75;1.46-2.24), bad general health perception (PRadj1=1.50;1.23-1.82/PRadj2=3,12;2,31-4,21), regular oral health perception (PRadj=1.21;1.08-1.37), chronic health condition (PRadj1=1.58;1.11-2.40), insomnia/EDS complaints (PRadj1=2.45;2.14-2.79/PRadj2=3.46;2.77-4.33), social support (PRadj1=1.14;1.01-1.30) and living in urban areas (PRadj2=1.32;1.02- 1.72). The prospective design revealed 40 (25.97%;19.04-32.89) deaths in the period and 48 (30.76%;23.52-38.01) cardio-cerebrovascular events. Men presented higher risk (RR=1.88;1.01-3.50) of death. Depression (RR=2.04; 1.06-3.89), insomnia severity (RR=2.39;1.52-4.56) and sleep latency between 16-30 minutes (RR=3.54;1.26-9.94) and 31-60 minutes (RR=2.23;1.12-4.47) increase the risk of death independently in community-dwelling elderly. Cardiovascular events were predicted only by hypertensive and/or diabetic elderly (RR=8.30;1.98-34.82). The complaints of RFS reduction, insomnia/EDS affect almost a third of the Brazilian population and are closely related to emotional conditions, chronicity and urbanization. Complaints of insomnia severity and difficulty in initiating sleep seem to increase mortality in the elderly along with depressive symptoms (AU).

Pain, depression and sleep disorders in patients with diabetic and nondiabetic carpal tunnel syndrome: a vicious cycle / Dor, depressão e distúrbios do sono em pacientes diabéticos e não diabéticos com síndrome do tumor do carpo: um ciclo vicioso

ABSTRACT Carpal tunnel syndrome (CTS) is a condition involving nerve entrapment that often leads to chronic neuropathic pain. We aimed to evaluate sleep quality and related parameters in diabetic and non-diabetic CTS patients. Method This study included a total of 366 patients with chronic CTS. These patients’ sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and depression using the Beck Depression Inventory (BDI). The severity of neuropathic pain was evaluated using the Douleur Neuropathique-4 (DN4) questionnaire and a visual analogue scale (VAS). Results In the non-diabetic patient group, the total PSQI score was found to affect BDI and VAS, while in the diabetic patient group, the duration of symptoms affected VAS, BDI and fasting glucose levels. Conclusion For diabetic patients, hyperglycemia depression and chronification of neuropathic pain may lead to deterioration of sleep quality. Therefore, consideration of these parameters in the treatment may break a vicious cycle.

RESUMO A síndrome do túnel do carpo (STC) é uma condição que envolve compressão do nervo frequentemente determinando dor neuropática crônica. Procuramos avaliar a qualidade do sono e parâmetros correlatos em pacientes diabéticos e não-diabéticos com STC. Método Este estudo incluiu 366 pacientes com STC crônica. A qualidade de sono destes pacientes foi avaliada pelo Pittsburgh Sleep Quality Index (PSQI) e a depressão foi avaliada usando Beck Depression Inventory (BDI). A gravidade da dor neuropática foi avaliada usando o questionário Douleur Neuropathique-4 (DN4) e a escala visual analógica (EVA). Resultados No grupo de pacientes não-diabéticos, o valor total do PSQI afetou BDI e VAS, enquanto no grupo de diabéticos a duração dos sintomas afetou VAS, BDI e níveis de glicemia de jejum. Conclusão Em pacientes diabéticos, depressão e cronificação da dor neuropática podem levar à deterioração da qualidade do sono. Assim, considerar todos estes parâmetros no tratamento pode quebrar este círculo vicioso.

Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers

OBJECTIVE: To assess short-term tomographic changes in the upper airway dimensions and quality of life of mouth breathers after rapid maxillary expansion (RME). METHODS: A total of 25 mouth breathers with maxillary atresia and a mean age of 10.5 years old were assessed by means of cone-beam computed tomography (CBCT) and a standardized quality of life questionnaire answered by patients' parents/legal guardians before and immediately after rapid maxillary expansion. RESULTS: Rapid maxillary expansion resulted in similar and significant expansion in the width of anterior (2.8 mm, p < 0.001) and posterior nasal floor (2.8 mm, p < 0.001). Although nasopharynx and nasal cavities airway volumes significantly increased (+1646.1 mm3, p < 0.001), oropharynx volume increase was not statistically significant (+1450.6 mm3, p = 0.066). The results of the quality of life questionnaire indicated that soon after rapid maxillary expansion, patients' respiratory symptoms significantly decreased in relation to their initial respiratory conditions. CONCLUSIONS: It is suggested that RME produces significant dimensional increase in the nasal cavity and nasopharynx. Additionally, it also positively impacts the quality of life of mouth-breathing patients with maxillary atresia. .

OBJETIVO: avaliar, por meio de tomografias, as mudanças em curto prazo nas vias aéreas superiores e na qualidade de vida em pacientes respiradores bucais, após expansão rápida da maxila (ERM). MÉTODOS: foram avaliados 25 pacientes respiradores bucais com atresia maxilar, com idade média de 10,5 anos, por meio de tomografia computadorizada de feixe cônico (TCFC) e questionário padronizado de qualidade de vida submetido aos pais/responsáveis, antes e imediatamente após a ERM. RESULTADOS: a ERM promoveu uma expansão, de forma semelhante e significativa, tanto na largura do soalho nasal anterior (2,8mm, p < 0,001) quanto na largura do soalho nasal posterior (2,8mm, p < 0,001). No volume aéreo da nasofaringe e fossas nasais, houve aumento significativo (+1646,1mm3 p < 0,001); entretanto, no volume aéreo da orofaringe, houve aumento não significativo (+1450,6 mm3 p = 0,066). Os resultados do questionário de qualidade de vida indicaram melhora significativa na qualidade de vida dos pacientes após a ERM, em comparação ao questionário inicial. CONCLUSÕES: a ERM promoveu aumento dimensional significativo nas fossas nasais e na nasofaringe, bem como melhorou significativamente a qualidade de vida dos pacientes. .

La mala calidad de sueño se asocia a una menor adherencia al tratamiento antirretroviral de gran actividad en pacientes peruanos con infección por VIH/SIDA / Poor quality of sleep associated with low adherence to highly active antiretroviral therapy in Peruvian patients with HIV/AIDS / A má qualidade do sono associada à menor aderência à terapia antirretroviral de alta atividade em pacientes peruanos com infecção pelo HIV/AIDS

Con el objetivo de evaluar si existe asociación entre la mala calidad de sueño y la adherencia al tratamiento antirretroviral de gran actividad (TARGA) en personas con infección por VIH/ SIDA; llevamos a cabo un estudio analítico de corte transversal que incluyó 389 pacientes peruanos en TARGA. La mala calidad de sueño fue medida con la Escala de Calidad de Sueño de Pittsburgh y la adherencia con el CEAT-VIH. Realizamos un modelo lineal generalizado de familia Poisson, con errores estándar robustos para estimar razones de prevalencia y su IC95%. A nivel crudo la mala calidad de sueño leve, moderada y severa se asoció a la adherencia inadecuada. Al ajustar por las variables asociadas en el análisis bivariado o por las variables teóricamente asociadas a la adherencia, sólo la mala calidad de sueño moderada/severa se mantuvo asociada (RP = 1,34; IC95%: 1,17-1,54 y RP = 1,34; IC95%: 1,16-1,57; respectivamente). Se concluye que la mala calidad de sueño moderada/severa se asocia de manera independiente con la adherencia al TARGA. La evaluación de la calidad de sueño podría por ende ser útil en la valoración integral de los pacientes con VIH.

This cross-sectional study analyzed the association between poor quality of sleep and adherence to highly active antiretroviral therapy (HAART) in 389 Peruvian patients with HIV/AIDS. Poor quality of sleep was measured with the Pittsburgh Sleep Quality Index (PSQI) and adherence with the CEAT-VIH (Peruvian adaptation). A Poisson generalized linear model with robust standard errors was used to estimate prevalence ratios and 95%CI. A crude model showed that mild, moderate, and severe poor quality of sleep were associated with inadequate treatment adherence. In the adjusted model for variables associated in the bivariate analysis or variables theoretically associated with adherence, only moderate/severe poor quality of sleep remained associated (PR = 1.34, 95%CI: 1.17-1.54; and PR = 1.34, 95%CI: 1.16-1.57, respectively). The study concluded that moderate/severe poor quality of sleep was independently associated with adherence to HAART. Assessing quality of sleep may be helpful in the comprehensive evaluation of HIV patients.

A fim de avaliar se a associação entre a má qualidade do sono e adesão à terapia antirretroviral (TARV) em pessoas com infecção pelo HIV/AIDS, realizamos um estudo analítico de corte transversal que incluiu 389 pacientes peruanos em TARV. A má qualidade do sono foi medida com a escala Índice de Qualidade de Sono de Pittsburgh (IQSP) e a aderência com o CEAT- (adaptação peruana). Foi realizado um modelo linear generalizado da família Poisson com padrão de erros robustos, para estimar as razões de prevalência e IC95%. No nível cru, a má qualidade do sono leve, moderada e grave foram associadas com adesão inadequada. Quando fizemos o ajuste para as variáveis associadas na análise bivariada ou variáveis teoricamente associadas à adesão, somente a má qualidade moderada/grave manteve-se associada (RP = 1,34; IC95%: 1,17-1,54 e RP = 1,34; IC95%: 1,16-1,57; respectivamente). Concluímos que a má qualidade do sono moderada/grave está independentemente associada com a adesão a TARV. Avaliar a qualidade do sono pode ser útil na avaliação global do paciente com HIV.

Temporomandibular disorder and anxiety, quality of sleep, and quality of life in nursing professionals

To evaluate the association between temporomandibular disorder (TMD) and anxiety, quality of sleep, and quality of life in nursing professionals at theHospital de Clínicas de Uberlândiaof theUniversidade Federal de Uberlândia – HCU-UFU (Medical University Hospital of the Federal University of Uberlândia), four questionnaires were given to nursing professionals. The questionnaires were completed by 160 of these professionals. The Fonseca’s questionnaire was used to evaluate the presence and severity of TMD, the IDATE was used to evaluate anxiety, the SAQ was used to evaluate quality of sleep, and the SF-36 was used to evaluate quality of life. Forty-one nurses (25.6%) reported having no TMD (Fonseca’s questionnaire score ≤ 15), 66 (41.3%) had mild TMD (Fonseca’s questionnaire score 20–40), 39 (24.4%) had moderate TMD (Fonseca’s questionnaire score 45–65), and 14 (8.8%) had severe TMD (Fonseca’s questionnaire score ≥ 70). According to Fonseca’s questionnaire, the presence of TMD was associated with trait anxiety, but the TMD severity was associated with state anxiety classification (mild, moderate, severe). The SAQ score differed significantly from Fonseca classification. The Fonseca’s questionnaire score correlated negatively with the score of each dimension of the SF-36 (r = –0.419 to –0.183). We conclude that TMD is common among nursing professionals; its presence was associated with trait anxiety, and its severity was associated with state anxiety. Hence, the presence of TMD may reduce quality of sleep and quality of life.

The relationship between sleep quality, depression, and anxiety in patients with epilepsy and suicidal ideation / A relação entre qualidade de sono, depressão e ansiedade em pacientes com epilepsia e ideação suicida

The relationships among suicidal ideation, sleep, depression, anxiety, and effects on epilepsy require more research. Objective: The aim of this study was to estimate the prevalence of suicidal ideation in outpatients with epilepsy, and relate this to sleep quality, daytime sleepiness, depression, and anxiety. Method: Ninety-eight non-selected patients were evaluated. The subjects were classified as “suicidal ideators” or “non-ideators”, based on their response to item 9 of the Beck Depression Inventory. Results: The prevalence of suicidal ideation was 13.3% (χ2=50.46, p<0.001). The differences between cases with or without suicidal ideation were statistically significant in relation to sleep quality (p=0.005) and symptoms of depression (p=0.001) and anxiety (p=0.002). Conclusion: Our results revealed that depression and anxiety were associated with sleep quality, daytime sleepiness, and suicidal ideation and that depression and sleep disturbance were good predictors of suicide in subjects with epilepsy. .

A relação entre ideação suicida, sono, depressão e ansiedade, bem como as implicações da epilepsia nessa relação ainda exigem mais pesquisa. Objetivo: Estimar a prevalência de ideação suicida em pacientes ambulatoriais com epilepsia e relacioná-la com qualidade do sono, sonolência diurna, depressão e ansiedade. Método: Foram avaliados 98 pacientes não-selecionados. Os indivíduos foram classificados como tendo ou não ideação suicida, com base nas respostas ao item 9 do Inventário Beck de Depressão. Resultados: A prevalência de ideação suicida foi de 13,3% (χ2=50,46; p<0,001). As diferenças entre os casos com e sem ideação suicida foram estatisticamente significativas em relação à qualidade do sono (p=0,005), sintomas depressivos (p=0,001) e ansiosos (p=0,002). Conclusão: Depressão e ansiedade mostraram associação com qualidade do sono, sonolência diurna e ideação suicida; depressão e distúrbios do sono foram bons preditores de suicídio em epilepsia. .

Sleep Forensics: a critical review of the literature and brief comments on the Brazilian legal situation / Medicina do sono Forense: uma revisao critica da literatura e breves comentarios sobre a situacao brasileira

Sleep medicine is a relatively new field among Medical Sciences. Its legal aspects are still obscure, either for lack of knowledge of the biological mechanisms underlying violent behaviour during sleep or the virtual absence of clear legal and uniformly accepted guidelines as to whether to punish or treat those disorders. An updated review of the pertinent literature was performed to determine the most prevalent pathological conditions involving violence and sleep and to identify their most common precipitating factors, attempting to provide some technical support to aid Brazilian medical-experts or assistants in preparing substantial and scientific-based reports in a legal environment.

A medicina do sono é um campo relativamente novo dentro das Ciências Médicas. Seus aspectos legais encontram-se ainda na obscuridade, seja por falta de conhecimento dos mecanismos biológicos do desenvolvimento dos transtornos de comportamento e da violência praticada em estados alterados de sono, seja por virtual ausência de previsão legal do binômio tratamento/punição. Realizamos revisão atualizada da literatura para determinar as condições patológicas mais prevalentes envolvendo violência e sono, identificar seus fatores precipitantes mais comuns e os critérios médico-legais que podem auxiliar eventuais médicos-peritos ou assistentes na elaboração de pareceres abalizados em âmbito legal.

Relationship between mental health and spiritual wellbeing among hemodialysis patients: a correlation study / Relacao entre saude mental e bem-estar espiritual em pacientes de hemodialise: um estudo correlacional

CONTEXT AND OBJECTIVE: The stress of living with a terminal disease has a negative impact on the mental health of hemodialysis (HD) patients. Spirituality is a potential coping mechanism for stressful experiences. Studies on the relationship between spirituality and mental health among HD patients are scarce. The purpose of this study was to evaluate the relationship between mental health and spiritual well-being among HD patients. DESIGN AND SETTING: Cross-sectional observational study on hemodialysis patients at a single center in Brazil, between January and December 2011. METHODS : Mental health was assessed using the General Health Questionnaire and spiritual wellbeing was assessed using the Spiritual Wellbeing Scale; 150 HD patients participated in the study. RESULTS : A significant correlation was found between mental health and spiritual wellbeing (P = 0.001). Spiritual wellbeing was the strongest predictor of mental health, psychological distress, sleep disturbance and psychosomatic complaints. CONCLUSION: Poor mental health was associated with lower spiritual wellbeing. This has important implications for delivery of palliative care to HD patients. .

CONTEXTO E OBJETIVO: O estresse de viver com uma doença terminal tem impacto negativo sobre a saúde mental de pacientes em hemodiálise. A espiritualidade é um mecanismo de enfrentamento em potencial para experiências estressantes. Estudos sobre a relação entre espiritualidade e saúde mental de pacientes em hemodiálise são escassos. O objetivo deste estudo foi avaliar a relação entre saúde mental e bem-estar espiritual dos pacientes em hemodiálise. TIPO DE ESTUDO E LOCAL: Estudo observacional e transversal de pacientes em tratamento de hemodiálise de centro único no Brasil, no período de janeiro a dezembro de 2011. MÉTODOS: A saúde mental foi avaliada pelo Questionário Geral de Saúde e o bem-estar espiritual foi avaliado usando a Escala de Bem-Estar Espiritual. Participaram do estudo 150 pacientes em hemodiálise. RESULTADOS: Foi encontrada correlação significante entre a saúde mental e o bem-estar espiritual (P = 0,001). Bem-estar espiritual foi o mais forte preditor de saúde mental, sofrimento psíquico, distúrbios do sono e queixas psicossomáticas. CONCLUSÃO: A saúde mental deficiente associou-se com menor bem-estar espiritual. Isso tem implicações importantes para a prestação de cuidados paliativos para pacientes em hemodiálise. .

Dificultades del sueño y síntomas psicológicos en estudiantes de medicina de la Ciudad de México / Sleep difficulties and psychological symptoms in medicine students in Mexico

El objetivo del estudio fue describir las dificultades del sueño en estudiantes de Medicina de primer año de una institución pública en la Ciudad de México, en relación con algunos síntomas psicológicos. Se realizó un estudio transversal en 572 alumnos de primer año de Medicina, quienes fueron evaluados mediante la Symptom Check List-90 (SCL-90). Un 3.5% de los estudiantes manifestó tener muchas dificultades para conciliar el sueño, 6.3% para mantenerlo y 11.4% despertaban muy temprano. Las dificultades del sueño se asociaron en forma significativa con todas las dimensiones de psicopatología. Sus mejores predictores fueron la ansiedad, la hostilidad y la sensibilidad interpersonal. Se concluye que los síntomas asociados a tensión, enojo, preocupación, hiperactivación cognitiva e hipervigilancia son los mejores predictores para las dificultades del sueño en esta población.

The purpose of this study was to describe sleep difficulties in first year medical students associated with psychopathological symptoms. A cross-sectional study in 572 Medicine students, who were assessed by the Symptom Check List-90 (SCL-90), was performed. A 3.5% of students reported having a hard time sleeping, 6.3% had difficulty staying asleep and 11.4% waking up very early. Sleep difficulties were significantly associated with all psychopathological symptoms. The best predictors of sleep difficulties were anxiety, hostility and interpersonal sensitivity. In conclusion, the symptoms associated with stress, anger, worry, cognitive hyperarousal and hypervigilance are the best predictors for sleep difficulties in this population.

Quality of life and sleep in obese adolescents / Qualidade de vida e do sono de adolescentes obesos

Obesity and sleep disorders in adolescence are strongly associated, and they impact both on the health and on quality of life (QL) in this age group. OBJECTIVE: To comparatively assess QL and sleep in obese and eutrophic adolescents, who are older than ten years of age. METHODS: Cross-sectional study including obese adolescents. This analysis was carried out between August 2009 and August 2010. The Control (eutrophic) Group comprised schoolchildren recruited from State schools in the city of Americana, in São Paulo State, Brazil. Instruments applied included a standardized questionnaire, the Sleep Behavior Questionnaire (SBQ), and the Pediatric QL Inventory (PedsQL TM 4.0). RESULTS: The obese adolescents had poorer QL on physical (p<0.001), emotional (p=0.03), and social (p=0.002) functioning domains. A difference in mean psychosocial functioning was found between the groups (p=0.009) with obese subjects having a mean score of 69.5 (±16.0) and in eutrophic individuals of 76.2 (±16.7). A greater number of sleep problems was evident in the Obese Group (p=0.03). Conclusions: The obese adolescents had an impaired QL and a higher frequency of sleep problems compared to the eutrophic subjects.

Obesidade e distúrbios do sono na adolescência estão amplamente associados, afetando a saúde e a qualidade de vida (QV) de tal grupo etário. OBJETIVO: Foi avaliar comparando a QV e o sono em adolescentes obesos e eutróficos maiores de dez anos. MÉTODOS: Estudo transversal realizado entre agosto de 2009 e agosto de 2010, com adolescentes obesos. O Grupo Controle (eutróficos) foi constituído por estudantes da rede pública de ensino da cidade de Americana, em São Paulo. Foram utilizados ficha de identificação, Questionário do Comportamento do Sono (SBQ), Questionário de QV (PedsQL TM 4.0) como instrumentos. RESULTADOS: Os adolescentes obesos apresentaram QV inferior à dos controles nos domínios físico (p<0,001), emocional (p=0,03) e social (p=0,002). Houve diferença em relação à avaliação psicossocial entre obesos e eutróficos (médias de 69,5±16,0 e 76,2±16,7, respectivamente). O grupo de adolescentes obesos apresentou maior quantidade de distúrbios do sono (p=0,03). Conclusões: Adolescentes obesos apresentaram prejuízo na QV e maior quantidade de distúrbios do sono comparados aos indivíduos eutróficos.

Qualidade subjetiva do sono e sua repercussão na qualidade de vida de pacientes com epilepsia: revisão / Subjective sleep quality and its impact on quality of life of patients with epilepsy: review

OBJETIVOS: Estudar a qualidade do sono (QS) ou a sua repercussão na qualidade de vida relacionada à saúde (QVRS) em pacientes com epilepsia. METODOLOGIA: Revisão do tipo sistemática qualitativa a partir da pesquisa com o uso de descritores no PubMed e no Lilacs (últimos 10 anos) sobre qualidade de sono e de QVRS. DISCUSSÃO: Existem poucas publicações na literatura sobre QS (nove) ou a sua repercussão na QVRS dos pacientes com epilepsia (oito). Os instrumentos para avaliar a QS ou sonolência excessiva diurna (SED) são heterogêneos, o que expressa a dificuldade de se definir QS e consequentemente há dificuldade de se comparar os resultados. Oito estudos avaliaram SED através da Escala de Epworth, mas apenas um aplicou o Índice de QS de Pittsburgh (IQSP). Vários autores ressaltam a importância de fatores psiquiátricos na baixa QS e/ou QVRS. Ainda há necessidade de estudos complementares em pacientes com epilepsia: com o uso de instrumentos específicos sobre QS como o IQSP, com o confronto da avaliação subjetiva de QS com achados da polissonografia para avaliação da macro e microestrutura do sono.

OBJECTIVES: To study the sleep quality (SQ) or its impact on the health related quality of life (HRQoL) in patients with epilepsy. METHODOLOGY: Qualitative systematic review from search on PubMed and Lilacs databases using descriptors on SQ and HRQoL (last 10 years). DISCUSSION: There are few papers on SQ (nine) or its impact on HRQoL (eight) in patients with epilepsy. Instruments to assess the SQ or excessive daytime sleepiness (EDS) are heterogeneous, which reflects the difficulty of defining SQ and consequently, comparing results. Eight works assessed SED by the Epworth Sleepiness Scale, but only one applied the Pittsburgh Sleep Quality Index (PSQI). Several authors emphasized the importance of psychiatric factors in the low SQ and / or HRQoL. There is still room for further studies in patients with epilepsy: with the use of specific instruments to evaluate SQ such as the PSQI, for the comparison of findings between the SQ subjective evaluation and the sleep macro and microstructure assessed by the polysomnography.

Affective state dependence and relative trait stability of perfectionism in sleep disturbances / Dependência do estado afetivo e estabilidade relativa do traço do perfeccionismo nas perturbações de sono

OBJECTIVE: To evaluate the degree of absolute change, relative stability and state dependence of trait perfectionism in sleep disturbances in a sample of university students. METHOD: Participants completed the Multidimensional Perfectionism Scale and two items concerning sleep difficulties. The mean age at T0 (baseline) was 19.59 years (SD = 1.61, range = 17-25) and 62.5 percent of the sample were female. RESULTS: Absolute changes in self-oriented and socially-prescribed perfectionism were found. Relative stability was found for all perfectionism dimensions. Prior and concurrent sleep disturbances explained a significant amount of variance in perfectionism. Controlling for the effects of sleep measures, prior self-oriented perfectionism and other-oriented perfectionism were the only significant predictors of subsequent self-oriented perfectionism and other-oriented perfectionism, at T1 and T2. Difficulties falling asleep at T1 and socially-prescribed perfectionism at T0 were significant predictors of socially-prescribed perfectionism at T1. CONCLUSION: Despite significant changes in perfectionism mean scores over the follow-up, the correlation analyses demonstrated that participants remained quite stable in regard to their relative levels of perfectionism. As concurrent difficulties initiating sleep also predicted concurrent socially-prescribed perfectionism, this seems to be one dimension of perfectionism with trait-state characteristics.

OBJETIVOS: Avaliar o grau de mudança absoluta, de estabilidade relativa e dependência do estado do perfeccionismo nas perturbações de sono numa amostra de estudantes universitários. MÉTODO: Os sujeitos completaram a Escala Multidimensional do Perfeccionismo e dois itens sobre dificuldades em dormir. Os dados foram recolhidos em três momentos de avaliação, separados por um intervalo de um ano acadêmico. A idade média dos sujeitos no T0 era de 19,59 anos (DP = 1,61, variação = 17-25); 62,5 por cento eram mulheres. RESULTADOS: Foram encontradas ao longo do follow-up mudanças absolutas para o perfeccionismo auto-orientado e para o perfeccionismo socialmente prescrito. Foi encontrada estabilidade relativa para todas as dimensões do perfeccionismo. As dificuldades de sono prévias e concorrentes explicaram significativamente a variância do perfeccionismo. Controlando o efeito das dificuldades em dormir, o perfeccionismo auto-orientado e o perfeccionismo orientado para o outro prévios foram os únicos preditores significativos de perfeccionismo auto-orientado e perfeccionismo orientado para o outro (T1 e T2). As dificuldades em iniciar o sono no T1 e o perfeccionismo socialmente prescrito prévio (T0) revelaram-se preditores significativos de perfeccionismo socialmente prescrito no T1. CONCLUSÃO: Apesar das mudanças significativas nas pontuações médias de perfeccionismo ao longo do follow-up, as análises de correlação demonstraram que os participantes permaneceram relativamente estáveis nos seus níveis de perfeccionismo. Uma vez que as dificuldades em iniciar o sono concorrentes se revelaram um preditor significativo de perfeccionismo socialmente prescrito, esta é a dimensão do perfeccionismo que possui características traço-estado.