Insomnia current diagnosis: an appraisal / Diagnóstico atual de insônia: uma apreciação

Chronic insomnia is the most common sleep disorder in adults andits diagnosis is fundamental for adequate clinical management. The aim of this paper is to present recently published definitions of insomnia according to current international classifications, such as the International Classification of Sleep Disorders - Third Edition and the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition. For the first time, these classifications are congruent related to thei rdiagnostic criteria; both present insomnia as a distinct disorder and divide it into acute, chronic and other. This emphasizes the necessityof a specific insomnia approach. Furthermore, it is necessary torecognize those insomniacs with physiological hyperarousal, whichmay be identified by objective measures (short total sleep time, forinstance). These patients may have poorer outcome, as they are athigher risk of developing cardiometabolic conditions and neurocognitive impairment. Diagnosis is primarily made on a clinical basis (anamnesis and physical examination), while sleep diaries and questionnaires (such as Insomnia Severity Index) can help evaluate these patients. Objective measures, such as polysomnography, arenot required in most cases, except when suspicion of another sleep disorder arises.

A insônia crônica é o transtorno do sono mais comum em adultos,e seu diagnóstico é fundamental para o manejo clínico adequado.O principal objetivo deste trabalho é apresentar, em relação à insônia,as definições publicadas recentemente segundo as novas classificações internacionais, como a Classificação Internacional de Distúrbios do Sono - Terceira Edição e o Manual Diagnóstico e Estatístico de Transtornos Mentais - Quinta Edição. Pela primeira vez, essas classificações são congruentes a respeito de seus critérios diagnósticos,pois ambas apresentam a insônia como uma doença em si ea dividem em aguda, crônica e outras. Isso enfatiza a necessidade de uma abordagem específica da insônia. Além do mais, é necessário reconhecer os insones com estado fisiológico de hiper alerta que podem ser identificados por medidas objetivas (tempo total de sono curto, por exemplo). Esses pacientes podem ter pior prognóstico, por causa do maior risco de desenvolver condições cardiometabólicas e comprometimento neurocognitivo. O diagnóstico da insônia é feito principalmente com base em dados clínicos (anamnese e exame físico),e o uso de diário de sono e questionários (tais como o Índice de Gravidade de Insônia) pode ajudar na avaliação desses pacientes.Análises objetivas, como aquelas obtidas pela polissonografia, não são rotineiramente necessárias na maioria dos casos, exceto quando há a suspeita de outro distúrbio do sono.

Objective short sleep duration is associated with the activity of the hypothalamic-pituitary-adrenal axis in insomnia / Insônia, com tempo de sono curto, medido objetivamente, esta associada a atividade do eixo hipotálamo-hipófise-adrenal

Objective To evaluate the association between objective short sleep duration in patients with insomnia and changes in blood parameters related to hypothalamic-pituitary-adrenal (HPA) axis activity.Method A cross-sectional pilot study was conducted in 30 middle-aged adults with chronic insomnia who were divided into 2 groups according to polysomnography (PSG) total sleep time (TST) (TST > 5h and < 5h). All patients underwent subjective analysis of sleep quality, anthropometric measurements, PSG, and determination off asting blood parameters.Results The results revealed lower sleep efficiency and higher sleep latency for those with a TST < 5h. The subjective sleep quality was worse in the TST < 5h. Significantly, higher glucose and cortisol levels were observed with a TST < 5h. Glucose, cortisol and ACTH levels were inversely correlated with the PSG total sleep time.Conclusion Patients with insomnia with objective short sleep duration had HPA-associated endocrine and metabolic imbalances chronically linked to increases in cardiovascular risk observed with this more severe insomnia phenotype.

Objetivo Avaliar a associação entre insônia com tempo de sono curto e alterações sanguíneas relacionados com a atividade do eixo hipotálamo-hipófise-adrenal (HPA).Método Estudo piloto transversal, com 30 adultos de meia-idade, distribuídos em 2 grupos de acordo com o tempo total de sono (TTS) pela polisonografia (PSG) (TTS > 5h e < 5h). Os pacientes foram submetidos a análise subjetiva da qualidade do sono, medidas antropométricas, PSG e parâmetros sanguíneos em jejum.Resultados Revelaram baixa eficiência do sono e maior latência do sono para aqueles com TTS < 5h. A qualidade subjetiva do sono foi pior no TTS < 5h. Significativamente, os níveis de glicose e cortisol mais elevados foram observados no grupo com TTS < 5h. Os níveis de glicose, cortisol e ACTH foram inversamente correlacionados com o TTS da PSG.Conclusão Pacientes com insônia com tempo de sono curto apresentaram desequilíbrios endócrinos e metabólicos associados a atividade do eixo HPA, correlacionados ao aumento do risco cardiovascular observado neste fenótipo mais grave de insônia.

Short Sleep Duration and Correlates among Sero-positive HIV Patients in Nigeria, West Africa.

Introduction: Short sleep duration is a salient issue because it is a major public health concern and has more wide-reaching problems among HIV/AIDS patients. Short sleep duration was said to be associated with lower CD4 count, higher viral load values, depression, high blood pressure, high body mass index and disease progression. It was also documented that patients receiving efavirenz had shorter duration of deep sleep. Incidentally there is paucity of data in Nigeria to support these claims hence the need to investigate. Methods: Four hundred HIV zero-positive patients were recruited at the HIV clinic of Kwara State Specialist Hospital, Sobi, Ilorin, after institutional ethical approval and informed consent was obtained. Blood pressure was measured. Classification of hypertension was made according to the seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure (JNC-7). Body Mass Index was calculated as (kg/m2). The Patient Health Questionnaire (PHQ-9) was administered to the respondents to screen for depressive symptoms. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep duration. The respondents were categorized into four groups viz, sleeping more than 7 hours, 6-7 hours, 5-6 hours and less than 5 hours. Subjects with <5hrs are poor sleepers while those with >7hrs were good sleepers. Results: Four hundred HIV-infected patients were recruited with a mean age of 39yrs (SD 9). Eighty four (21%) were male, while 316 (79%) were female. The mean body mass index was 22.0 (SD 4.6), mean present CD4 count was 339.0 (SD 180.6). One hundred and eighty three respondents (45.8%) slept less than 5 hours, while 58 (14.5%) sleep more than 7hours. Short sleep was commoner in the age group 31-40 73(39.9%), among the female 145(79.2%) and those that were married 103(56.7%), and those with non-formal education 84(45.9%). Traders 80(43.7%) had highest number than other occupation. Short sleepers of less than 5 hours were prone to high blood pressure; higher body mass index and depression. This was statistically significant. The lower the CD4 count, the more the short sleep duration observed among the respondents. Patients receiving HAART containing efavirenz had shorter duration of deep sleep. Conclusion: Almost half of the respondents were poor sleepers with associated high blood pressure and increased body mass index (BMI). Both effects of the virus and antiretroviral drugs may cause short sleep duration. Health providers managing HIV positive patients, need to take complaints of short sleep duration seriously, because they can indicate an increased risk for low CD4 counts, high viral load, depression, high blood pressure and increase body mass index. There is the need for targeting efforts to improve short sleep duration for the majority of adults living with HIV/AIDS and tailoring appropriate interventions.

A case-control study on the duration of sleeping and cerebral infarction / 中华流行病学杂志

Objective To explore the relationship between duration of sleeping and cerebral infarction.Methods A case-control study involved 1037 cerebral infarction patients admitted by the Second Affiliated Hospital of Harbin Medical University,December 2011-December 2012 as cases.Another 1205 adults free from cerebro-vascular diseases who had undergone physical examination in the hospital at the same period,were served as controls.All the subjects were interviewed with unified questionnaire.Chi-square test,u-test and multivariate logistic regression analysis were performed.Results After adjustment for potential confounding factors including age,sex,body mass index,wrist-hip ratio,smoking,alcohol intake,hypertension,diabetes mellitus,coronary artery disease and lipid parameters,data from the multivariate logistic regression analysis showed that the risk of cerebral infarction was greater in people who slept less than 6 hours per night than those who slept between 6 hours and 8 hours per night,with an odds ratio (95％ CI) as 2.81 (95％ CI:1.68-4.70).There was no significant association between factor as ‘sleeping longer than 8 hours/pre day' and cerebral infarction.Through the subgroup analysis,data showed that the association between ‘ shorter than 6 hour sleep/night' and cerebral infarction consistently exsited,across the categories of sex,and the degree of association was greater in women than in men,with the odds ratio as 5.58 (95％CI:1.78-17.52) and 2.00(95％CI:1.10-3.64) respectively.Conclusion Short sleeping duration might increase the risk of developing cerebral infarction.