Las orexinas como biomarcadores para demencia tipo Alzheimer y relación con síntomas neuropsiquiátricos / Orexins as biomarkers for Alzheimer dementia and their relationship with neuropsychiatric symptoms

RESUMEN: Los biomarcadores más estudiados en la demencia tipo Alzheimer (DA) son los niveles elevados de Aβ42 y de proteína Tau en líquido cefalorraquídeo. Dada la complejidad de la sintomatología cognitiva y síntomas neuropsiquiátricos (SNP) de esta patología, algunos estudios recientes proponen sustancias como las orexinas, como blanco terapéutico de DA y SNP. El presente trabajo tiene como objetivo revisar publicaciones científicas recientes que hayan analizado la asociación entre orexinas, SNP y DA en humanos, algunos modelos animales y que hayan evaluado a las orexinas como posibles biomarcadores tanto para investigación como en el área clínica. En esta revisión también se describen los estudios que sugieren a las orexinas como un posible biomarcador en la DA, dada su relación con el Aβ42 y la proteína Tau, y otros estudios que las asocian con presencia de SNP, especialmente alteración del sueño. Se plantea la hipótesis de que la presencia de SNP en DA se asocia con las orexinas, debido a que este sistema influye en el funcionamiento hipotalámico y de forma indirecta en áreas cerebrales que regulan el comportamiento. Sin embargo, aún falta mayor investigación, principalmente de estudios longitudinales para conocer claramente la influencia de las orexinas en los SNP.

ABSTRACT The most studied biomarkers in Alzheimer's dementia (AD) are elevated levels of Aβ42 and Tau protein in cerebrospinal fluid. Given the complexity of the cognitive symptomatology and neuropsychiatric symptoms (NPS) of this pathology, some recent studies propose substances such as orexins as a therapeutic target for AD and NPS. The present work aims to review recent scientific publications that have analyzed the association between orexins, PNS and AD in humans. There are some animal models that have evaluated orexins as possible biomarkers both for research and in the clinical area. This review also describes studies that suggest orexins as possible biomarkers in AD, given their relationship with Aβ42 and Tau protein, and other studies that associate them with the presence of SNPs, especially sleep disturbance. It is hypothesized that the presence of SNPs in AD is associated with orexins, because this system influences hypothalamic functioning and indirectly in brain areas that regulate behavior. However, further research is still lacking, mainly longitudinal studies to clearly know the influence of orexins on SNPs.

Research progress on the effect of noninvasive neuromodulation technique on patients with postoperative sleep disturbances after general anesthesia / 中国临床药理学与治疗学

Noninvasive neuromodulation technique is a non-invasive, safe and convenient research and treatment method, which is mainly regulated by electrical stimulation and magnetic stimulation. In recent years, it has been more and more used in the research and treatment of brain function. It has been confirmed in the regulation of cognitive impairment, depression, anxiety, delirium and insomnia in patients with stroke. Clinical departments such as neurology, rehabilitation department, pain department and other disciplines have widely used this technique of non-invasive neural regulation, but its application in the perioperative period is less, especially for postoperative sleep disorders in patients with general anesthesia. Postoperative sleep disorder is a common and easily neglected complication, which is often manifested as postoperative sleep structure disorder, sleep quality decline, sleep is obviously shortened, and the sleep function of patients with general anesthesia is more likely to be affected. Postoperative sleep disorder includes many influencing factors before, during and after operation, affecting the whole perioperative period and even a few years after discharge.

Effective Treatment of Nightmare with Saikokaryukotsuboreito in a Patient with Advanced Cancer

Nightmares are common in patients with advanced cancer. However, there are no standard treatment of nightmare in patients with cancer. We experienced a case with nightmares improved by Saikokaryukotsuboreito (SRBT). An 82-year-old man with malignant lymphoma experienced insomnia and nightmares. Antidepressants, orexin receptor antagonists, and atypical antipsychotics failed to improve the symptoms, but SRBT immediately eliminated his insomnia and nightmares. SRBT, an herbal medicine, has been used in a variety of clinical situations for treatment of stress-induced psychiatric symptoms, i.e., anxiety, depression, and insomnia, without serious adverse events. Several reports suggest that SRBT improves depression and anxiety with the effects on chronic stress-induced disruption of hypothalamo-pituitary-adrenal axis. The effects of SRBT might have improved nightmares in this case. SRBT may be a drug of choice in the treatment of nightmares in patients with cancer.

A study of Mental Health Status in Healthcare Workers posted in a dedicated COVID-19 Hospital

Background: The massive toll due to COVID-19 has resulted in stretching of resources of healthcare systems and has led to unique demands on healthcare workers (HCWs) that are not seen in usual practice, which predispose them to mental health problems. The aim of the study was to assess mental health status in healthcare workers posted in COVID hospital as Mental health issues may impact decision making among HCWs, leading to medical errors and may also impact wellbeing in the long term. Methodology: This was a cross-sectional study. 799 HCWs posted in the COVID-19 wing of a tertiary care hospital were studied. Socio-demographic details were recorded and a Gujarati version of GHQ-28 was applied. A total score of ? 4 on GHQ-28 was considered indicative of ‘caseness’ or ‘psychiatric morbidity’. Association of outcomes like total GHQ-28 score, and responses on individual items of GHQ indicative of fatigue, sleep disturbances, stress, irritability, anxiety and others with variables like age, gender, profession, years of experience, marital status and family type was assessed. Results: 40 individuals (5%) reported at least one of the symptoms. The most commonly reported symptom was sleep disturbance, reported by 38 participants (4.75%), followed by stress in 34 participants (4.25%), fatigue in 29 participants (3.62%) and anxiety in 24 (3.00%). Decision-making problems, hopelessness, death wishes/suicidal ideation were rare. Conclusion: Age > 45 years was a significant predictor for GHQ-28 total score being ?4 and stress, experience > 5 years was statistically significantly associated with sleep disturbance, and being female was a significant predictor for fatigue.

Prevalence of sleep practices and sleep problems of schoolchildren in South Kanara

Background: Disturbances in sleep could affect normal growth as well as behavior of children. It could also impair their cognitive development. Sleep problems have been increasing over the past few years. However, there is a gap regarding information about sleep practices and sleep problems among Indian children. Aim: A sleep questionnaire was designed and validated to assess the frequency of sleep practices and sleep problems in 500 children. Materials and Methods: The study was conducted in 5 local schools in South Kanara district by administering the questionnaire to the parents/caretakers under the guidance of a trained investigator. We also sought to examine the association of demographics, medical/behavior/academic performance, sleep patterns, and home environment to sleep problems in these children. Statistical Analysis: Descriptive statistics were recorded as mean and standard deviation for quantitative data and in frequency and percentage for qualitative data. Results: We found a high prevalence of bedroom sharing (92.4%) and bed-sharing (91.2%). 46.4% of the children exhibited at least one sleep problem, the most prevalent being bed-wetting (17%). Sleep problems were considerably greater in older children and in children with behavioral problems. Practices such as watching TV and using computer after 8 pm/at bedtime were significantly associated with all sleep problems. Conclusion: Our study revealed definite and significant presence of sleep problems in the children of South Kanara. Strong associations were observed between certain sleep practices and problems.

Patient-Reported Outcomes in Subjects With A143T and R118C GLA Gene Variants

Abstract Background Fabry disease (FD) is caused by pathogenic variants in the GLA gene. A143T and R118C variants are considered not disease causing. Patient-reported outcomes provide information concerning the effects of their disease but should be carefully analyzed in rare diseases. Objectives To evaluate pain, depression, sleep disturbances, disability and quality of life in A143T or R118C Brazilian subjects and compare to data published for classic FD patients. Methods Nineteen subjects - 8:11 male:female - were evaluated and answered the questionnaires: Brief Pain Inventory (BPI), Hamilton Depression Rating Scale, Pittsburgh Sleep Quality Index, Health Assessment Questionnaire Disability Index (HAQ-DI), Short-Form Health Survey 36 (SF-36). Lyso-Gb3 and residual enzyme activity were obtained. Results Alpha-galactosidase A activity was low in males. Lyso-Gb3 levels were normal in all subjects. Comparing A143T/R118C subjects and FD patients, BPI severity, BPI interference, HAQ-DI values were not different (p>0.05) whereas raw scores for physical functioning (p=0.01) and general health perception (p<0.01) favored A143T/R118C. Depression and sleep disturbances were similar between groups. Conclusions A143T/R188C subjects had normal lyso-Gb3 levels. Depression, sleep disturbances and disability were frequent and under-recognized. However, findings depicted in this study are nonspecific and should not be considered as ground for diagnosing Fabry disease.

Papel de las alteraciones del sueño durante la gestación en la programación del feto para el desarrollo de obesidad y enfermedades crónicas degenerativas / Role of sleep disturbances during pregnancy in the programming of the fetus for development

Resumen En el tercer trimestre del embarazo son frecuentes las alteraciones del sueño, las cuales generan cambios en la secreción de melatonina en mujeres gestantes que duermen menos de ocho horas o presentan alteraciones de sueño, promoviendo diversos cambios fisiológicos en la madre, que a su vez derivan en bajo peso al nacimiento (BPN) en el producto. El bajo peso al nacimiento está asociado con un fenómeno conocido como "programación metabólica", en la que el feto es sometido a estrés que tiene como resultado alteraciones metabólicas irreversibles que lo predisponen al desarrollo de obesidad en la edad adulta.

Abstract Sleep disturbances are common in the third trimester of pregnancy and generate changes in the secretion of melatonin in pregnant women who sleep less than eight hours or have sleep disturbances, which promote various physiological changes in the mother that in turn result in low birth weight (LBW) in the fetus. LBW is associated with a phenomenon known as "metabolic programming," in which the fetus is subjected to a stressful situation that results in irreversible metabolic alterations that predispose it to the development of obesity in adulthood.

Alteraciones del sueño en el enfermo grave. Un evento de gran repercusión y poco tomado en cuenta / Sleep disorders in the critically ill patient. An event of great impact and little taken into account

Resumen: El sueño favorece una mejor evolución y recuperación en los enfermos graves. Las alteraciones del sueño afectan con frecuencia a los enfermos internados en la unidad de terapia intensiva, su causa es multifactorial y se asocia con alteraciones del sistema inmunitario, disfunción en el anabolismo, retardo en los procesos regenerativos, desorganización neurofisiológica, disfunción cognitiva, delirio, incremento en los días de hospitalización y mortalidad. Las alteraciones del sueño en el paciente grave se caracterizan por anomalías del ritmo circadiano sueño-vigilia, índice elevado de despertares, fragmentación, reducción del sueño de ondas lentas y disfunción grave de la fase de movimientos oculares rápidos. Las intervenciones para su tratamiento son no farmacológicas y farmacológicas. De las farmacológicas la melatonina es un agente terapéutico promisorio para la profilaxis y para el tratamiento. El objetivo de este trabajo es revisar los conceptos actuales relacionados con la disfunción del sueño en el enfermo grave, su repercusión en la práctica clínica y las medidas a implementar para su profilaxis y tratamiento.

Abstract: Sleep is important for good outcome and recovery in critically ill patients. Sleep disturbances affect commonly critically ill patients and are associated with impair of immune system, anabolic and regenerative processes, neurophysiologic organization, cognitive dysfunction, delirium, prolonged Intensive Care Unit stay and mortality. The critically ill present pathologic sleep patterns characterized by abnormal circadian rhythm, high arousal and awakening index, reduced slow wave sleep and rapid eye movement sleep. Melatonin is a promissory prophylactic or therapeutic agent in the management of sleep disturbances. The aim of this paper is to review current concepts related to sleep disturbances in the critically ill, their clinical impact, prevention and the new therapeutic alternatives.

Mobile Phone Use and Risk of Adverse Health Impacts among Medical Students in Jeddah, Saudi Arabia.

Background: Internationally, there is growing concern about the adverse health effects of mobile phone use by young people. Aim: To determine the pattern of mobile phone use among medical students and determine the potential association between degree of use and self-reported health impacts. Methods: A cross-sectional study was carried out on 472 medical students in King Abdulaziz University. Self-administered specially designed questionnaire was used to collect data regarding the following: Socio-demographic characteristics, pattern of phone use and self-reported health complaints. Results: The students’ median duration of mobile phone use was 330 min/day and was significantly higher in females (P= 0.04). A positive significant correlation was observed between the health complaints score and the average daily duration of use (r =0.139, P=0.002). Adjusted multiple logistic regression analysis revealed that heavy mobile use was significantly associated with self-reported sleep disturbances, headache (AOR=4.76), fatigue (AOR=4.67), depression (AOR=2.63), nervousness (AOR=1.64), musculoskeletal pain (AOR=2.14) and visual problems (AOR=2.40). Conclusion: mobile phone use occupies a significant part in the daily life of medical students. The heavy use of mobile phone in calling and non-calling activities was associated with a high level of subjective health complaints with dose dependent pattern. After controlling for other important predictors, heavy mobile use was associated with sleep disturbances, headache, depression, nervousness, eye and musculoskeletal problems. Excessive use of mobile phones should be avoided and social awareness increased through health education activities. In addition, employing a speaker-phone device for longer daily use and recommended parental procedures are taken to prevent young people being woken by their mobile phones.

A prospective study on sleep disorders related to antidepressant drugs use in a tertiary care teaching hospital.

Background: Prescription of antidepressants has been increased from the last decade and responsible for producing sleep disorders as adverse drug reactions (ADRs). Sleep disorders can be divided into 3 large groups: (1) insomnia, (2) primary complaint of daytime sleepiness, and (3) Association of disruptive behaviours during sleep, the disorders of arousal. So active surveillance is needed to access these ADRs. Aims and Objective: To analyze the sleep disturbances as ADRs of various antidepressants prescribed to the patients attending psychiatry outpatient department (OPD). Methods: This prospective study was conducted on patients aged ≤74 years attending Department of Psychiatry OPD and were prescribed Antidepressants for the duration of 8 months (December, 2013-July, 2014). The ADRs reported were confirmed by WHO UMC Causality Assessment Scale. Results: Total number of patients enrolled on the basis of inclusion and exclusion criteria (n=50). Total number of ADRs related to drugs prescribed were found to be n=69. Total number of patients with sleep disturbances as ADRs were found to be n=28. Conclusion: The drug, most frequently implicated to cause sleep disturbances, was mirtazapine. Increased sleep was the most common ADR, found to occur. Unusual ADRs such as sleep talking was also seen.

Common High Altitudes Illnesses a Primer for Healthcare Provider.

Exposure to high altitude imposes significant strain on cardiopulmonary system and the brain. As a consequence, sojourners to high altitude frequently experience sleep disturbances, often reporting restless and sleepless nights. At altitudes above 3,000 meters (9,800 ft) almost all healthy subjects develop periodic breathing especially during NREM sleep. Sleep architecture gradually improves with increased NREM and REM sleep despite persistence of periodic breathing. The primary reason for periodic breathing at high altitude is a hypoxic-induced increase in chemoreceptor sensitivity to changes in PaCO2 – both above and below eupnea, leading to periods of apnea and hyperpnea. Acetazolamide improves sleep by reducing the periodic breathing through development of metabolic acidosis and induced hyperventilation decreasing the plant gain and widening the PCO2 reserve. This widening of the PCO2 reserve impedes development of central apneas during sleep. Benzodiazepines and GABA receptor antagonist such as zolpidem improve sleep without affecting breathing pattern or cognitive functions.

La alteración en el patrón de sueño se asocia a la persistencia de síntomas depresivos en pacientes hipotiroideos después del tratamiento con LT4 / The sleep pattern disturbance may be associated to the persistence of depressive symptoms in hypothyroid patients after LT4 treatment

Introduction: Given the frequent association between thyroid hormones and emotional symptoms, the aims of this research were to check the occurrence of depressive symptoms in patients with primary hypothyroidism, to study the reversibility of such symptoms after LT4 treatment and to evaluate the existence of predictive symptoms of response/no-response to LT4 only treatment. Methods: 70 primary hypothyroidism female patients (TSHmean: 16 uU/m0l) were assessed with Beck Depression Inventory (BDI).They were all treated solely with LT4. TSH value was tested after treatment and patients who had previously shown depressive symptoms were re-assessed with BDI. Results: 51.4 percent showed depressive symptoms prior to treatment (TSH: 20.1 uU/ml SE: 4.7; BDI: 23.8 SE: 1.1), 75 percent of those patients showed no symptoms after LT4 treatment (TSH: 1.63 uU/ml SE: 0.28; BDI: 8 SE: 1), but in the remaining 25 percent those symptoms persisted (TSH: 1.25 uU/ml SE: 0,29; BDI24 SE: 2). Sleep disturbance, item 16, is the only factor with significant persistence (p. ≥ 0.045) after treatment. Conclusions: 51.4 percent of the hypothyroidism patients showed depressive symptoms; hypothyroidism treatment was adequate to normalize TSH values in all the cases and to reverse depressive symptoms in 75 percent of them while 25 percent remain with depressive symptoms. Within this group, the persistence of sleep disturbance could be considered to be a predictive, no-response symptom and would point to the need to re-evaluate diagnosis and to consider the addition of another treatment.

Introducción: Dada la frecuente asociación entre hormonas tiroideas y síntomas emocionales, los objetivos de este trabajo fueron verificar la presencia de síntomas depresivos en pacientes con hipotiroidismo primario, estudiar su reversibilidad post tratamiento con LT4 y evaluar la existencia de síntomas predictivos de la respuesta/no respuesta al tratamiento. Métodos: 70 mujeres con hipotiroidismo primario (TSHmedia:16 uU/ml) fueron evaluadas mediante el Cuestionario para Depresión de Beck (BDI), luego del tratamiento del hipotiroidismo se retomó el BDI a las pacientes que hubieran presentado síntomas depresivos en la primera parte del trabajo, se determinó TSH en todas la pacientes pre y post tratamiento. Resultados: 51,4 por ciento de las pacientes hipotiroideas presentaron síntomas depresivos (TSH: 20,1 uU/ml, ES: 4,7; BDI: 23,8, ES: 1,1), 75 por ciento no presentaron síntoma depresivos post tratamiento con LT4 (TSH: 1,63 uU/ml ES 0,28; BDI: 8,ES: 1), pero en el 25 por ciento restante esos síntomas persistieron (TSH: 1,25 uU/ml ES 0,29; BDI: 24, ES: 2). El ítem 16, Dificultad en el sueño, es el único con persistencia significativa (p ≥ 0,045) post tratamiento. Conclusión: el 51,4 por ciento de las pacientes hipotiroideas presentó síntomas depresivos; el tratamiento con LT4 fue el adecuado para normalizar TSH en todos los casos y para revertir los síntomas depresivos en el 75 por ciento de ellos, mientras que en un 25 por ciento los síntomas permanecieron. Dentro de este grupo, el síntoma dificultad en el sueño fue el que persistió significativamente y se podría considerar a esta asociación como un predictor de la falta de respuesta, esto nos estaría indicando que el tratamiento con LT4 solamente no sería eficaz.

The effect of impaired sleep on preterm labour / Efecto de los trastornos del sueño en el trabajo de parto prematuro

BACKGROUND: Sleep disturbance has become an important health problem for pregnant women. In fact, pregnancy-associated sleep disorder has been recognized as a distinct clinical entity. We aimed to study the relationship between sleep disturbance and preterm birth during pregnancy in a sample of Iranian women. METHODS: In this analytical cohort study, 231 pregnant women in their 28th-32nd gestational week were recruited, using the multistage sampling method, from four healthcare centres in Ardabil, Iran, during 2010. The women were followed-up until 37-week gestation. One hundred and twelve women did not have sleep disturbances while 119 women had sleep disturbances. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and a demographic data questionnaire were used for data collection. Data were analysed using SPSS software. Descriptive statistics, t, Chi-square, Fisher's exact, and Mann-Whitney tests were used as appropriate. RESULTS: The prevalence of preterm labour was 11.8%in women with sleep disorder compared with 11.6% in women without sleep disorder (p = 0.9). Sleep duration less than eight hours, daytime dysfunction and impaired quality of life as a component of ISI showed a significant relationship with preterm birth (p = 0.02, p = 0.044, and p = 0.047, respectively). CONCLUSION: Although daily dysfunction and lower quality of life because of sleep problems, and total sleep duration were variables associated with preterm birth, we found no significant relationship between sleep disorder and preterm birth.

ANTECEDENTES: La alteración del sueño se ha convertido en un importante problema de salud para las mujeres embarazadas. De hecho, los trastornos del sueño asociados con el embarazo han sido reconocidos como una entidad clínica distinta. El objetivo del presente trabajo fue estudiar la relación entre los trastornos del sueño y los nacimientos prematuros durante el embarazo en una muestra de mujeres iraníes MÉTODOS: En este estudio de cohorte analítica, se reclutaron 231 mujeres embarazadas en su semana gestacional de 28 - 32, utilizando el método de muestreo por etapas, de cuatro centros de atención a la salud en Ardabil, Irán, durante el año 2010. Las mujeres tuvieron seguimiento hasta la semana 37 de gestación. Ciento doce mujeres no tuvieron trastornos del sueño, en tanto que 119 mujeres tuvieron trastornos del sueño. El índice de severidad de insomnio (ISI), la escala de somnolencia de Epworth (ESS) y un cuestionario de datos demográficos, fueron utilizados para la recolección de datos. Los datos fueron analizados usando el software SPSS. La estadística descriptiva, t, Chi-cuadrado, el test exacto de Fisher, y las pruebas de Mann-Whitney, fueron usadas según correspondiera. RESULTADOS: La prevalencia del trabajo de parto prematuro fue de 11.8% en las mujeres con trastorno del sueño, en comparación con el 11.6% en las mujeres sin trastorno del sueño (p = 0.9). La duración del sueño de menos de ocho horas, la disfunción diurna, así como el deterioro de la calidad de vida como um componente de ISI, mostraron una relación significativa con los nacimientos prematuros (p = 0.02, p = 0.044 y p = 0.047, respectivamente). CONCLUSIÓN: Aunque la disfunción diurna y el deterioro de la calidad de vida debido a problemas con el sueño, al igual que la duración total del sueño, fueron variables asociadas con el parto prematuro, no hallamos ninguna relación significativa entre el trastorno del sueño y los nacimientos prematuros.

Relationship between Sleep Disturbances and Cognitive Impairments in Older Adults with Depression / 수면정신생리

OBJECTIVES: Depression, sleep complaints and cognitive impairments are commonly observed in the elderly. Elderly subjects with depressive symptoms have been found to show both poor cognitive performances and sleep disturbances. However, the relationship between sleep complaints and cognitive dysfunction in elderly depression is not clear. The aim of this study is to identify the association between sleep disturbances and cognitive decline in late-life depression. METHODS: A total of 282 elderly people who underwent nocturnal polysomnography in a sleep laboratory were enrolled in the study. The Korean version of the Neuropsychological Assessment Battery developed by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) was applied to evaluate cognitive function. Depressive symptoms were assessed with the geriatric depression scale (GDS) and subjective sleep quality was measured using the Pittsburg sleep quality index (PSQI). RESULTS: The control group (GDS< or =9) when compared with mild (10< or =GDS< or =16) and severe (17< or =GDS) depression groups, had significantly different scores in the Trail making test part B (TMT-B), Benton visual retention test part A (BVRT-A), and Stroop color and word test (SCWT)(all tests p<0.05). The PSQI score, REM sleep duration, apnea-hypopnea index and oxygen desaturation index were significantly different across the three groups (all indices, p<0.05). A stepwise multiple regression model showed that educational level, age and GDS score were predictive for both TMT-B time (adjusted R2=35.6%, p<0.001) and BVRT-A score (adjusted R2=28.3%, p<0.001). SCWT score was predicted by educational level, age, apnea-hypopnea index (AHI) and GDS score (adjusted R2=20.6%, p<0.001). Poor sleep quality and sleep structure alterations observed in depression did not have any significant effects on cognitive deterioration. CONCLUSION: Older adults with depressive symptoms showed mild sleep alterations and poor cognitive performances. However, we found no association between sleep disturbances (except sleep apnea) and cognitive difficulties in elderly subjects with depressive symptoms. It is possible that the impact of sleep disruptions on cognitive abilities was hindered by the confounding effect of age, education and depressive symptoms.

The Association between Statin Use and the Risk of Sleep Disturbances: Data Mining of Claims Database / 医薬品情報学

<b>Objective: </b>To examine the association between statin use and the risk of sleep disturbances, data mining was performed on a claims database. <br><b>Methods: </b>Symmetry analysis was carried out to identify the risk of sleep disturbances after statin use during the period from January 2005 to December 2011.  Statin use in combination with hypnotic drugs was examined by prescription sequence symmetry analysis.  In this study, hypnotic drugs that are commonly prescribed for the treatment of insomnia were used as markers of sleep disturbances produced by statins. Likewise, event sequence symmetry analysis was undertaken to evaluate the association between statin use and the diagnosis of sleep disturbances.<br><b>Results: </b>Significant associations of statin use with short-acting hypnotic drugs were found, with an adjusted SR (sequence ratio) of 1.23 (95%CI: 1.04-1.45) at an interval of 12 months.  Otherwise, significant associations between individual statin use and hypnotic drug use were not found.  Significant associations between use of statins and the diagnosis of sleep disturbances were not also found in this study.<br><b>Conclusions: </b>Analysis of the claim database demonstrated that statin therapy might be associated with an emergence of sleep disturbances.  Therefore, individuals prescribed statins should be considered as having an increased risk of sleep disturbances.

Hypnotic Use for Sleep Disturbances in Breast Cancer: A Systematic Review.

Aims: Sleep disturbances are common in patients with breast cancer. The aim of this systematic review was to present the literature on pharmacological interventions against sleep disturbances and use of hypnotics in patients with breast cancer. We wanted to study patients both in the perioperative period as well as when they were receiving oncological (medical) treatment. Study Design: Systematic review. Methodology: According to the PRISMA guidelines, a literature search was performed on May 10th 2012 in Pubmed and Embase. Primary outcomes were pharmacological interventions against sleep disturbances. No restriction on publication status was made. Only articles in English were included. Case reports and studies with less than ten patients were excluded. Results: Five studies met the inclusion criteria and were included in the review. One study investigated pharmacological intervention in the perioperative period and showed that treatment with triazolam significantly improved sleep three consecutive nights after surgery. Two studies investigated patients undergoing endocrine oncological treatment. The studies showed that zolpidem combined with an SSRI/SNRI improved sleep in patients having hot flashes, and that hypnotics were prescribed significantly more often in patients undergoing endocrine treatment compared with healthy patients not receiving endocrine treatment. Two studies investigated patients receiving chemotherapy. The studies showed that hypnotics were prescribed to almost every second patient. Prior users of hypnotics and patients with a psychiatric diagnosis were more likely to take hypnotics during chemotherapy. Conclusion: Sleep disturbances occur frequently in patients with breast cancer indicated by the high prevalence of hypnotic use. It therefore is of concern that only few clinical trials exist on pharmacological intervention against sleep disturbances in the different treatment time periods. At present, there is insufficient evidence to recommend one single pharmacological intervention in this patient group.

Prevalência de transtornos mentais comuns em jovens brasileiros recém-incorporados ao Serviço Militar Obrigatório e fatores associados / Prevalence of common mental disorders in recently-drafted young Brazilians to mandatory military service and associated factors

A saúde mental de militares das Forças Armadas é uma área de investigação ainda pouco explorada no Brasil. O presente estudo teve por objetivo estimar a prevalência de transtornos mentais comuns (TMC) e identificar os fatores a estes associados em jovens brasileiros recém-incorporados ao serviço militar obrigatório: os recrutas. A população de estudo foi composta de 78 jovens adultos do sexo masculino. A ocorrência de TMC (variável dependente) foi avaliada por meio do General Health Questionnaire, versão 12 itens (GHQ-12). Para estimar as associações entre TMC e as variáveis independentes foram utilizados o teste χ²(Qui-quadrado)e a regressão logística. Os resultados mostraram uma prevalência de TMC de 43,6% (IC 95% 33,14 - 54,64). As razões de prevalência de TMC mostraram-se entre 4 e 5 vezes maiores entre os que apresentavam distúrbios do sono, sendo que estes se mostraram como único fator associado a TMC. Estes resultados parecem indicar que as situações vivenciadas pelos recrutas em seu ambiente de trabalho podem estar associadas com TMC de forma causal. Outros estudos, com desenho longitudinal, são necessários para que tal efeito seja confirmado.

The mental health of the military enlisted in the Armed Forces is an as yet area little explored of research in Brazil. This study aimed to investigate the prevalence of common mental disorders (CMD) and associated factors among recently-drafted young Brazilians to mandatory military service: the recruits. A total of 78 young adults participated in the study. The incidence of CMD (dependent variable) were evaluated by the 12-item General Health Questionnaire (GHQ-12). The tests ?² (chi-squared) and logistic regression were used to estimate the associations between CMD and independent variables. The results showed a prevalence of CMD de 43.6% (CI 95% 33.14 to 54.64). The CMD prevalence ratios were from 4 to 5 times higher among those who reported sleep disturbances, which was the only factor associated with the occurrence of CMD. These results seem to indicate that the situations experienced by the recruits in their work environment may be causally associated with CMD. Further studies are needed, with longitudinal design, for this effect to be confirmed.

Aromatherapy for stress relive.

Most people work a 48 hour week so we can estimate that we typically spend almost about 3,000 hours at work each year. And many people work even more than this. Our jobs are often very stressful and stress is a known trigger for many common ailments and diseases. Mood and sleep disturbances, upset stomach, headaches and disturbed relationships with family and friends are examples of stress related problems that are quick to develop. Before you think about stress reduction, start by identifying the particular stresses in your work and the effect they have on you. What, specifically, is it about your work situation that makes you feel anxious, angry, frustrated, burned out, depressed, etc this question is unknown. For this aromatherapy enhance your mood and encourage a sense of general wellbeing. And if that’s not enough for you, aromatherapy has also been shown to relieve minor pains and discomfort and to boost the circulation and the immune system.

Impact of allergic rhinitis in school going children

Allergic rhinitis (AR) is the most common chronic pediatric disorder. The International Study for Asthma and Allergies in Childhood phase III found that the global average of current rhinoconjunctivitis symptoms in the 13-14 year age-group was 14.6% and the average prevalence of rhinoconjunctivitis symptoms in the 6-7 year age-group was 8.5%. In addition to classical symptoms, AR is associated with a multidimensional impact on the health related quality of life in children. AR affects the quality of sleep in children and frequently leads to day-time fatigue as well as sleepiness. It is also thought to be a risk factor for sleep disordered breathing. AR results in increased school absenteeism and distraction during class hours. These children are often embarrassed in school and have decreased social interaction which significantly hampers the process of learning and school performance. All these aspects upset the family too. Multiple co-morbidities like sinusitis, asthma, conjunctivitis, eczema, eustachian tube dysfunction and otitis media are generally associated with AR. These mostly remain undiagnosed and untreated adding to the morbidity. To compound the problems, medications have bothersome side effects which cause the children to resist therapy. Children customarily do not complain while parents and health care professionals, more often than not, fail to accord the attention that this not so trivial disease deserves. AR, especially in developing countries, continues to remain a neglected disorder.

Dysfunctional beliefs and attitudes on sleep and sleep disturbances pre- and post-antidepressant treatments in patients with major depression / 中南大学学报(医学版)

Objective To explore the relationship between dysfunctional beliefs and attitudes on sleep and sleep disturbances before and after a short-term pharmacotherapy in patients with major depression. Methods Sixty-six (29 male, 37 female, 34.0±9.5 years old) patients with major depression were recruited before the treatment. Dysfunctional Beliefs and Attitudes about Sleep (DBAS) questionnaire, Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Rating Scale (HDRS), and Hamilton Anxiety Scale (HAMA) were assessed before and after a 4-week antidepressant treatment. Results After the 4-week antidepressant treatment, depressive and anxiety symptoms were alleviated significantly, whereas sleep disturbance still persisted. And sleep quality was closely related with problematic sleep beliefs after the treatment.Conclusion Some evidences are provided for cognitive behavioral therapy during antidepressant therapy, and the therapy should be matched with problematic beliefs and attitudes.