Influence of sleep fragmentation in infancy and toddler period on emotional and behavioral problem at the age of 6 years: a birth cohort study / 中华儿科杂志

Objective: To investigate the influence of sleep fragmentation in infancy and toddler period on emotional and behavioral problems at the age of 6 years. Methods: Using a prospective cohort design, 262 children were extracted from mother-child birth cohort recruited from May 2012 to July 2013 in Renji Hospital, School of Medicine, Shanghai Jiao Tong University. Children's sleep and physical activities were assessed using actigraphy at 6, 12, 18, 24, and 36 months of age, from which the sleep fragmentation index (FI) at each follow-up point was calculated. Children's emotional and behavioral problems at 6 years of age were assessed using the strengths and difficulties questionnaire. Group-based trajectory model was applied to determine sleep FI in infancy and toddler period trajectory groups with Bayesian information criteria being used to determine the best fitting model. Children's emotional and behavioral problems between groups were examined with independent t test and linear regression models, etc. Results: A total of 177 children, with 91 boys and 86 girls, were included in the final analysis and were divided into 2 groups: high FI group (n=30) and low FI group (n=147). Compared with children in the low FI group, those in the high FI group presents with higher total difficulties score and higher hyperactivity or inattention score ((11.0±4.9) vs. (8.9±4.1), (4.9±2.7) vs. (3.7±2.3) scores, t=2.17, 2.23, both P<0.05, respectively), with the differences remaining significant after adjusting for covariates (t=2.08, 2.09, both P<0.05 respectively). Conclusion: High sleep fragmentation in infancy and toddler period is associated with more emotional and behavioral problems, especially hyperactivity or inattention problems, at 6 years of age.

Prevalence of unhealthy lifestyle among children and adolescents of Han nationality in China / 中华心血管病杂志

Objective: To explore the epidemiological characteristics and geographical distribution of unhealthy lifestyle among children and adolescents of Han nationality in China and obtain evidence for proposing the related strategies to improve the well-being of this population. Methods: Students aged 6-22 years old were selected from the Chinese National Survey on Students Constitution and Health in 2019. The prevalence of unhealthy lifestyles (physical inactivity, lack of outdoor activity, sedentary behavior, excessive screen time, sleep insufficiency, unhealthy eating behavior) between sex, residence, and age groups was calculated and compared. Multilevel logistic regression was used to explore the influencing factors of unhealthy lifestyle. Results: The prevalence of moderate-to-vigorous physical activity less than 1 h/d or 30 min/d were 82.06% and 54.69%, respectively. The prevalence of less than 2 h/d or 3 h/d of outdoor activities were 95.20% and 83.26%, respectively. The prevalence of more than 2 h/d or 3 h/d of sitting time were 50.64% and 31.92%, respectively. The prevalence of more than 2 h/d or 3 h/d of screen time were 42.02% and 27.79%, respectively. The prevalence of sleep insufficiency, excessive sugary beverages consumption (≥ 1 time/d), and insufficient consumption of eggs, milk, and breakfast (<7 d/week) were 66.49%, 20.97%, 83.36%, 70.71%, and 34.34%, respectively. The prevalence of severe sleep insufficiency, excessive sugary beverages consumption (≥ 3 times/d), and insufficient consumption of eggs, milk, and breakfast (≤2 d/week) were 27.77%, 8.21%, 47.21%, 32.36% and 9.73%, respectively. Conclusion: In 2019, unhealthy lifestyle is common among Han students aged 6-22 years in China. It is of importance to propose policies to strengthen the health education and initiatives to support healthy behaviors in Han children and adolescents. Jointly promotion on the creation of a healthy environment for Han children and adolescents, and formulation of targeted improvement measures in accordance with the epidemic characteristics in various regions are essential to improve the healthy lifestyle of this population.

Efecto de la privación de sueño sobre la variabilidad de la frecuencia cardíaca / Effect of sleep deprivation on heart rate variability

La privación de sueño es una entidad muy frecuente y con diversos efectos a nivel de losprocesos cognitivos y fisiológicos. A su vez, constituye tanto un problema médico como social por las consecuencias de sus efectos. Durante el sueño se distinguen dos estados comportamentales: el sueño no-REM (NREM) y REM. Durante el sueño NREM hay una escasa actividad cognitiva y un adecuado control homeostático de las funciones fisiológicas. Durante el sueño REM, existe un estado cognitivo particular, los sueños, asociado a una disminución del control de algunas variables fisiológicas como la temperatura, la frecuencia cardíaca y respiratoria. La variabilidad de la frecuencia cardíaca (VFC) medida a partir del electrocardiograma (ECG), constituye un correlato de su regulación autonómica. Con el objetivo de evaluar el impacto de la privación aguda de sueño sobre la VFC, se realizaron registros polisomnográficos y electrocardiográficos basales utilizando al gato como modelo animal, durante la privación de sueño y el período post-privación. Para ello se instrumentaron dos estrategias de privación de sueño: privación total de sueño y privación selectiva de sueño REM. Se analizaron diversos parámetros de la VFC en los estados de vigilia (W), sueño NREM y REM. En el dominio del tiempo se evaluó: intervalo RR promedio, desvío estándar de los intervalos RR normales ("standard deviation of normal R-R intervals" SDNN), el cual refleja todos los componentes cíclicos de la variabilidad, y rMSSD ("root mean squared difference of successive intervals") que permite estimar variaciones a corto plazo de la frecuencia. En el dominio de la frecuencia (obtenidas mediante la transformada rápida de Fourier) se evaluó: potencia de las bandas "Low Frequency" (LF), considerada tanto un marcador de la modulación simpática como un parámetro que incluye influencias vagales como simpáticas, y "High Frequency" (HF), determinada principalmente por la actividad vagal sobre el corazón, la frecuencia del "pico" o punto máximo de dichas bandas. También se estudió la relación LF/HF, relacionada con la modulación simpática. A su vez, se analizó la dinámica no-lineal de la VFC mediante el análisis de Poincaré, obteniendo los índices SD1, que permite valorar la variabilidad a corto plazo y SD2 que cuantifica la variabilidad total de los intervalos R-R. De los resultados se destaca que, en comparación con la W basal, durante la privación total de sueño aumentó el SDNN, la LF y SD2. En comparación con el sueño NREM basal, la potencia LF fue mayor durante el sueño NREM luego de su privación, y el índice LF/HF fue mayor durante el sueño NREM asociado a la privación de sueño REM. En este trabajo describimos que la VFC está fuertemente afectada tanto por el sueño como por su privación. Nuevas aproximaciones experimentales son necesarias para comprender los mecanismos neurales que subyacen a las alteraciones de la VFC gatilladas por la privación de sueño.

Study on homeostasis and circadian rhythm of attention performance of different chronotypes in sleep deprivation / 生物医学工程学杂志

Difference of chronotypes makes influence to cognitive performance of individuals in routine duties. In this paper, 55 subjects with different chronotypes were subjected to continuous sleep deprivation for 30 h by using the constant routine protocol, during which core body temperature was measured continuously, and subjective sleepiness self-rating and the performance of selective attention were measured hourly. The results showed that the phase difference of core body temperature has no significant difference, yet the amplitude and term difference among the three chronotypes are significant. There was an advance in phase between subjective sleepiness self-rating and core body temperature, and the self-rating sleepiness of evening type came the latest, and the self-rating sleepiness of morning type dissipated the fastest. The response time of selective attention showed a 2 h phase delay with subjective sleepiness self-rating. And the analysis of core body temperature showed that the later the chronotype was, the greater the phase delay was. The correct rate of selective attention of different chronotypes were inconsistent with delay of subjective sleepiness self-rating and core body temperature. We provide reference for industry, aviation, military, medical and other fields to make a more scientific scheduling/ shifting based on cognitive performance characteristics of different chronotypes.

Qualidade do sono e fatores associados em universitários do Centro-Oeste do Brasil / Sleep quality and associated factors in university students in the Midwest of Brazil

INTRODUÇÃO: A qualidade do sono é uma das queixas mais frequentes entre estudantes universitários. OBJETIVOS: Identificar a prevalência de má qualidade do sono e os fatores associados em acadêmicos da área da saúde de uma universidade do Centro-Oeste do Brasil. MÉTODOS: Estudo transversal com uma amostra de 2171 universitários com média de idade de 22,7 (±3,9). O desfecho, sono de má qualidade, foi avaliado por meio da versão brasileira do questionário Pittsburgh Sleep Quality Index (PSQI-BR). As variáveis independentes (demográficas, socioeconômicas e comportamentais) foram avaliadas por meio de um questionário padronizado. As análises multivariadas foram realizadas por meio de Regressão de Poisson, estimando-se as Razões de Prevalências (RP) ajustadas e seus respectivos Intervalos de Confiança de 95% (IC95%). RESULTADOS: A média do escore do PSQI-BR foi 7,0. A prevalência de má qualidade do sono foi de 63,5% (IC95% 61,4-65,5), sendo 60,3% nos homens e 64,8% nas mulheres. Após análise ajustada, auto percepção de saúde razoável/ruim esteve associada com má qualidade do sono em ambos os sexos. Além disso, para os homens, a prevalência de má qualidade do sono foi maior para os estudantes que fumavam; e foi menor para aqueles que consumiam adequadamente frutas, legumes e verduras e eram suficientemente ativos. Já para as mulheres, a prevalência de má qualidade do sono foi maior naquelas com 24 ou mais anos de idade, sem companheiro, que consumiam bebidas alcoólicas e que cursavam medicina. CONCLUSÃO: Verificou-se elevada prevalência do desfecho na amostra. Além disso, a má qualidade do sono ocorre de forma diferente entre homens e mulheres. Ressalva-se a importância do monitoramento da má qualidade do sono em estudantes universitários.

INTRODUCTION: Sleep quality is one of the most frequent complaints among college students. OBJETIVE: To identify the prevalence of poor sleep quality and associated factors in health care academics at a university in the Midwest of Brazil. METHODS: Cross-sectional study with a sample of 2171 university students with a mean age of 22.7 (±3.9). The outcome, poor quality sleep, was assessed using the Brazilian version of the Pittsburgh Sleep Quality Index (PSQI-BR) questionnaire. Independent variables (demographic, socioeconomic and behavioral) were assessed using a standardized questionnaire. Multivariate analyzes were performed using Poisson Regression, estimating the adjusted Prevalence Ratios (PR) and their respective 95% Confidence Intervals (95%CI). RESULTS: The mean score of the PSQI-BR was 7.0. The prevalence of poor sleep quality was 63.5% (95%CI 61.4-65.5), being 60.3% in men and 64.8% in women. After adjusted analysis, reasonable/poor self-rated health was associated with poor sleep quality in both sexes. Furthermore, for men, the prevalence of poor sleep quality was higher for students who smoked; and it was lower for those who adequately consumed fruits and vegetables and were sufficiently active. As for women, the prevalence of poor sleep quality was higher in those aged 24 or over, without a partner, who consumed alcoholic beverages and who were studying medicine. CONCLUSION: There was a high prevalence of the outcome in the sample. Furthermore, poor sleep quality occurs differently between men and women. Thus, we emphasize the importance of monitoring poor sleep quality in college students.

At the crossroads of epilepsy and sleep: some issues / Na encruzilhada da epilepsia e do sono: algumas questões

There is a close association between sleep and epilepsy, and this literature review aims to raise issues regarding sleep time control, circadian and ultradian rhythms, epilepsy and its interaction with sleep and circadian rhythm, epilepsy and sleep disorders, and finally epilepsy management and medications. It is mentioned that sleep may provide a hypersynchronous state, as occurs in non-rapid eye movement sleep (NREM), and hyperexcitability, in cyclic alternating pattern (CAP), allowing more frequent interictal epileptiform abnormalities and seizures. In some epilepsy syndromes, seizures occur broadly / or entirely during sleep or on awakening, mainly in childhood, and maybe exacerbated in adults during the sleep or sleep-deprived, and there are the so-called Sleep-related epilepsies that are divided as sleep-associated, sleep-accentuated and arousal/awakening related. Sleep quality may be reduced in patients with epilepsy also due to nocturnal seizures or concomitant sleep disorders. Sleep disorders are common in patients with epilepsy and treatment of them mainly sleep-disordered breathing may improve seizure control. Besides, some parasomnias may mimic seizures, and also they can adversely affect the quality and quantity of sleep whereas antiepileptic therapy can have a negative or positive effect on sleep. Nocturnal epileptic seizures may be challenging to discern from parasomnias, in particular NREM parasomnias such as night terrors, sleepwalking and confusional arousals.

Há uma estreita associação entre sono e epilepsia, e esta revisão de literatura tem como objetivo levantar questões relacionadas ao controle do tempo do sono, ritmos circadianos e ultradianos, epilepsia e sua interação com sono e ritmo circadiano, epilepsia e transtornos do sono e, finalmente, o tratamento e medicamentos para epilepsia. Menciona-se que o sono pode proporcionar um estado hipersincrônico, como ocorre no sono "non-rapid eye movement" (NREM), e hiperexcitabilidade, no "cyclic alternating pattern" (CAP), permitindo anormalidades epileptiformes interictais e crises epilépticas mais frequentes. Em algumas síndromes epilépticas, as crises ocorrem ampla / ou inteiramente durante o sono ou despertar, principalmente na infância, e podem ser exacerbadas em adultos durante o sono ou privação de sono, e as chamadas epilepsias relacionadas ao sono se dividem em sono associadas, sono acentuadas e relacionadas com o despertar. A qualidade do sono pode ser reduzida em pacientes com epilepsia também devido a crises epilépticas noturnas ou transtornos do sono concomitantes. Esses são comuns em pacientes com epilepsia e o seu tratamento, principalmente dos transtornos respiratórios do sono, pode melhorar o controle das crises epilépticas. Além disso, algumas parassonias podem mimetizar crises epilépticas, e também elas podem afetar adversamente a qualidade e a quantidade do sono, enquanto a terapia antiepiléptica pode ter um efeito negativo ou positivo sobre o sono. Pode ser difícil discernir as crises epilépticas noturnas das parassonias, em particular das parassonias NREM, como terrores noturnos, crises de sonambulismo e despertares confusionais.

Insomnia and sleep deprivation in patients with epilepsy: issues about the pathophysiological interaction between them / Insônia e privação de sono em pacientes com epilepsia: questões sobre a interação fisiopatológica entre eles

There is a known relationship between seizures and sleep deprivation that increases epileptiform abnormalities and slow waves expressed in the EEG, but chronic insomnia, greater in patients with epilepsy (PWEs) than in healthy control, supposedly has a different mechanism linked to a hyperarousability state with increased rapid EEG activity and associated "restless REM". Therefore, there is a complex interaction at various levels between insomnia and epilepsy that may play a role in seizure presentation. The recognized interconnection between mood and anxiety disorders and insomnia should also advise special care in the management of psychiatric comorbidities in PWEs. This article raises questions related to the interaction between the brain basis of insomnia and epilepsy and the triggers of seizures, particularly sleep deprivation.

Há uma relação conhecida entre crises epilépticas e privação de sono que aumenta as anormalidades epileptiformes e as ondas lentas expressas no EEG, mas a insônia crônica, maior em pacientes com epilepsia (PCE) do que no controle saudável, supostamente tem um mecanismo diferente ligado a um estado de hiperexcitabilidade com aumento da atividade rápida do EEG e associado "REM inquieto". Consequentemente, existe uma complexa interação em vários níveis entre a insônia e a epilepsia que pode desempenhar um papel na apresentação das crises. A reconhecida interligação entre transtornos de humor e ansiedade com a insônia também deve aconselhar um cuidado especial no manejo das comorbidades psiquiátricas do PCE. Este artigo levanta questões relacionadas à interação entre a base cerebral da insônia e da epilepsia e os desencadeadores de crises epilépticas, principalmente a privação do sono.

Distúrbios do sono e estados de humor em pilotos civis / Sleep disorders and mood states in civilian pilots

Distúrbios do sono e as alterações do estado de humor, quando não tratados, estão associados à perda de produtividade e acidentes de trabalho, resultando em lesões e fatalidade. Esses distúrbios são subdiagnosticados e subtratados em contextos clínicos, porque podem ser assintomáticos e o exame de polissonografia tem custo elevado. Por isso, questionários são usados para realizar uma triagem e detectar profissionais com alto risco de síndrome da apneia obstrutiva do sono, de sonolência diurna excessiva e fadiga. Este estudo teve como objetivo aplicar questionários validados para triagem dos distúrbios do sono e do humor em pilotos civis e analisar os resultados obtidos com a aplicação desses instrumentos. Foram coletados dados de 44 pilotos civis por meio de quatro instrumentos: um questionário para a caracterização sociodemográfica e ocupacional da amostra, a Escala de Sonolência de Epworth para avaliar a presença de sonolência diurna excessiva, o Questionário de Berlim para avaliar a Síndrome da Apneia Obstrutiva do Sono e a Escala de Humor de Brunel para avaliar o estado de humor. A Escala de Sonolência de Epworth mostrou que 25% dos pilotos apresentaram pontuação para sonolência diurna excessiva. De acordo com o Questionário de Berlim, 29,5% apresentaram alto risco para a Síndrome da Apneia Obstrutiva do Sono e pela Escala de Humor de Brunel, o domínio vigor, teve a média mais alta (5,09 ±4,06). Portanto, a utilização dos questionários nos exames de admissão e nos periódicos, pode auxiliar na identificação precoce e no monitoramento de distúrbios do sono e dos estados de humor ao longo do tempo em pilotos civis, priorizando aqueles que deverão ser encaminhados para realizarem estudos do sono.

Sleep disorders and mood state changes, when untreated, are associated with loss of productivity and accidents at work, resulting in injuries and fatality. These disorders are underdiagnosed and undertreated in clinical contexts due to them being asymptomatic and the prohibitive cost of polysomnography exams. For this reason, questionnaires are used to screen and detect professionals at high risk for obstructive sleep apnea syndrome, excessive daytime sleepiness, and fatigue. This study aimed at applying validated questionnaires for screening sleep and mood disorders in civilian pilots and analyzing the results obtained with the application of these instruments. Data were collected from 44 civilian pilots using four instruments: a questionnaire for sociodemographic and occupational characterization of the sample; the Epworth Sleepiness Scale to assess the presence of excessive daytime sleepiness; the Berlin Questionnaire to assess Obstructive Sleep Apnea Syndrome; and the Brunel Mood Scale to assess the mood state. The Epworth Sleepiness Scale showed that 25% of the pilots presented scores for excessive daytime sleepiness. According to the Berlin Questionnaire, 29.5% were at high risk for Obstructive Sleep Apnea Syndrome, and according to the Brunel Mood Scale, the vigor domain presented the highest mean (5.09 ± 4.06). Therefore, the use of questionnaires in admission and periodic exams can assist in the early identification and monitoring of sleep disorders and mood states over time in civilian pilots, prioritizing those who should be referred to sleep studies.

Efeitos da privação de sono na tomada de decisão em militares: uma revisão sistemática / Effects of sleep deprivation on military's decision making: a systematic review

A privação de sono é o estado ininterrupto de vigília, ocorrendo quando o sono inadequado leva à diminuição do desempenho e do estado de alerta até uma possível deterioração com efeitos danosos à saúde. O objetivo dessa pesquisa foi sistematizar o conhecimento já produzido a respeito do efeito da privação de sono na tomada de decisão em militares. A revisão sistemática de literatura foi o método escolhido, seguindo os passos preconizados pelo Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA). A busca foi realizada nas bases PubMed; Scopus; SciELO; biblioteca Cochrane e Web of Science. Critérios de inclusão e exclusão foram previamente definidos para seleção do material encontrado. Um total de 14 artigos, sendo a sua maioria com baixo risco de viés, foram selecionados. Os temas explorados versaram sobre perda de confiança, relativização moral, trabalho em equipe, queda de níveis cognitivos e mudança de atividade elétrica cerebral na privação de sono. As pesquisas apontam para um comprometimento importante para a tomada de decisão frente à privação ou restrição de sono nos temas investigados, evidenciando poucos recursos para minimizar esses efeitos.

Sleep deprivation is the uninterrupted state of wakefulness, occurring when inadequate sleep leads to a decrease in performance and alertness, possibly reaching a level of deterioration with harmful health effects. The aim of this research wasto systematize the knowledge produced about the effect of sleep deprivation on decision making in the military. The systematic literature review was the method chosen, following the steps recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The search was carried out on the following databases: PubMed; Scopus; SciELO; Cochrane library and Web of Science. Inclusion and exclusion criteria were previously defined for the selection of the found material. A total of 14 articles, most of them with a low risk of bias, were selected to compose the research results. The themes explored in these articles dealt with the loss of confidence, moral relativization, teamwork, drop-in cognitive levels, and changes in brain electrical activity in sleep deprivation. The research demonstrated significant damage to decision-making under sleep restriction or deprivation regarding the investigated topics, presenting few resources capable of minimizing these effects. There is an urge to investigate the role of physical exercise in this process and, especially, in Brazilian samples.

Importancia del buen dormir en nuestros pacientes / Importance of good sleep in our patients

El sueño es una necesidad biológica. Regula las funciones inmunitarias. Las funciones inmunológicas dependen de los ritmos circadianos y del sueño regular. Según estudios previos a la pandemia, la corta duración del sueño o privación de sueño, en la semana cercana a la vacunación, se asocia con respuestas más bajas de anticuerpos. La privación de sueño da como resultado una función inmunológica más deficiente (es decir, actividad reducida de las células natural killer, producción de IL-2 suprimida) así como un aumento de los niveles circulantes de marcadores inflamatorios (IL-6, TNF-α [factor de necrosis tumoral] y proteína C reactiva). Los médicos deben ser conscientes de que muchas enfermedades que mencionamos en esta resumida actualización son comórbidas con alteraciones del sueño, y es importante, por ello, enseñar a los pacientes a mejorar su comportamiento con respecto al sueño y fomentar la educación sobre higiene del sueño. Destacamos que, en el interrogatorio de cualquier especialidad médica, deben incorporarse preguntas sobre el "dormir", dado que el sueño de buena calidad es fundamental en la prevención y el tratamiento de diversas enfermedades. (AU)

Sleep is a biological necessity. Regulates immune functions. Immune functions depend on circadian rhythms and regular sleep. According to studies prior to the pandemic, short duration of sleep or sleep deprivation, in the week leading up to vaccination, is associated with lower antibody responses to vaccination. Sleep deprivation results in poorer immune function (i.e., reduced natural killer cell activity, suppressed IL-2 production) as well as increased circulating levels of inflammatory markers (IL-6, factor of tumor necrosis, C-reactive protein). Clinicians should be aware that many illnesses, which we mention in this brief update, are comorbid with sleep disturbances and it is therefore important to teach patients to improve their sleep behavior and should encourage sleep hygiene education . We emphasize that in the questioning of any medical specialty, questions about "sleep" should be incorporated, given that good quality sleep is essential in the prevention and treatment of various diseases. (AU)

Nível de atividade física, qualidade do sono e de vida em pacientes com doença arterial periférica / Level of physical activity, quality of sleep and life in patients with peripheral arterial disease

Introdução: a Doença Arterial Periférica (DAP) decorre do estreitamento ou oclusão arterial, que interfere no aporte sanguíneo das extremidades inferiores. A DAP pode levar a um repouso prolongado, causando prejuízos à qualidade de vida e do sono dos pacientes, devido à dor e receio de lesão. Objetivo: descrever o nível de atividade física, a qualidade de vida e do sono em pacientes com DAP. Metodologia: trata-se de um estudo observacional, epidemiológico e transversal, realizado no Hospital Geral de Camaçari-BA. Foram incluídos pacientes com diagnóstico de DAP, ambos os sexos, com idade superior a 18 anos, internados no referido hospital. Foram excluídos os pacientes com distúrbios psiquiátricos e dificuldade de compreensão dos questionários. Para a avaliação do nível de atividade física foi utilizado o Questionário Internacional de Atividade física, para Qualidade de Vida o questionário Short Form Health Survey 36, para qualidade do sono Índice de Qualidade do Sono de Pittsburgh e para Claudicação Intermitente o Questionário de Edimburgo. Resultados: dos 27 pacientes analisados, 55,6% (15/27) eram do sexo feminino e 44,4% (12/27) masculino, 37% (10/27) de cor/raça preta. A média de idade foi de 62,6±8,3 anos, peso 71,8±16,2kg, altura 164,8±8,3cm e IMC 26,3±5. A maioria relatou ser ativo, 33,3% (9/27). Segundo a SF-36 o domínio mais limitante foi "dor" (28,6), o escore global do PSQI foi de 10,4 e a maioria (81,5%) não apresentava claudicação intermitente. Conclusão: a presença de DAP foi mais frequente nos idosos e foram identificados a presença de distúrbios do sono e diminuição da qualidade de vida.

Introduction: peripheral Arterial Disease (PAD) is due to narrowing or arterial occlusion, which interferes with the blood supply of the lower extremities. PAD can lead to prolonged rest, causing damage to the quality of life and sleep of patients, due to pain and fear of injury. Objective: to describe the level of physical activity, quality of life and sleep in patients with PAD. Methodology: this is an observational, epidemiological and cross-sectional study, carried out at the Hospital Geral de Camaçari-BA. Patients diagnosed with PAD, both sexes, aged over 18 years, admitted to the hospital were included. Patients with psychiatric disorders and difficulty in understanding the questionnaires were excluded. To assess the level of physical activity, the International Physical Activity Questionnaire was used, for Quality of Life the Short Form Health Survey 36 questionnaire, for sleep quality Sleep Quality Index of Pittsburgh and for Intermittent Claudication the Edinburgh Questionnaire. Results: of the 27 patients analyzed, 55.6% (15/27) were female and 44,4% (12/27) were male, 37% (10/27) were black / colored. The mean age was 62.6 ± 8.3 years, weight 71.8 ± 16.2 kg, height 164.8 ± 8.3 cm and BMI 26.3 ± 5. The majority reported being active, 33.3% (9/27). According to SF-36, the most limiting domain was "pain" (28.6), the global PSQI score was 10.4 and the majority (81.5%) did not have intermittent claudication. Conclusion: the presence of PAD was more frequent in the elderly and the presence of sleep disorders and decreased quality of life was identified.

CX3C-chemokine receptor 1 modulates cognitive dysfunction induced by sleep deprivation / 中华医学杂志(英文版)

BACKGROUND@#Microglia plays an indispensable role in the pathological process of sleep deprivation (SD). Here, the potential role of microglial CX3C-chemokine receptor 1 (CX3CR1) in modulating the cognition decline during SD was evaluated in terms of microglial neuroinflammation and synaptic pruning. In this study, we aimed to investigat whether the interference in the microglial function by the CX3CR1 knockout affects the CNS's response to SD.@*METHODS@#Middle-aged wild-type (WT) C57BL/6 and CX3CR1-/- mice were either subjected to SD or allowed normal sleep (S) for 8 h to mimic the pathophysiological changes of middle-aged people after staying up all night. After which, behavioral and histological tests were used to explore their different changes.@*RESULTS@#CX3CR1 deficiency prevented SD-induced cognitive impairments, unlike WT groups. Compared with the CX3CR1-/- S group, the CX3CR1-/- SD mice reported a markedly decreased microglia and cellular oncogene fos density in the dentate gyrus (DG), decreased expression of pro-inflammatory cytokines, and decreased microglial phagocytosis-related factors, whereas increased levels of anti-inflammatory cytokines in the hippocampus and a significant increase in the density of spines of the DG were also noted.@*CONCLUSIONS@#These findings suggest that CX3CR1 deficiency leads to different cerebral behaviors and responses to SD. The inflammation-attenuating activity and the related modification of synaptic pruning are possible mechanism candidates, which indicate CX3CR1 as a candidate therapeutic target for the prevention of the sleep loss-induced cognitive impairments.

The impact of sleep deprivation on work performance towards night-shift healthcare workers: An evidence-based case report

Background@#Poor sleep and excessive fatigue among workers can reduce well-being and physical fitness. However, not many studies have mentioned how sleeping deprivation among night-shift healthcare workers impacted their work performance in multiple aspects. @*Method@#We conducted an evidence-based case report (EBCR) of a night shift nurse who was worried about the impact of her sleep deprivation on her work performance in the future due to prior history of needle-stick injuries. We aimed to determine whether sleeping deprivation caused by regular night shifts leads to decreased work performance among night-shift healthcare workers by formulating a clinical question. Evidence was searched systematically using five major journal databases (Proquest, EBSCO-Host, PubMed, ScienceDirect, and Cochrane) and was assessed thoroughly using inclusion and exclusion criteria. @*Results@#Eleven eligible studies were obtained with a medium level of evidence (III-IV), three systematic reviews with meta-analyses (SR-MA), three SR without MA, and five observational studies. All of them were analyzed and critically appraised using Oxford Evidence-Based Medicine and Joanna Briggs Institute tools. We found that reduced quantity and quality of sleep impacted all dimensions of work performance among healthcare professionals, be it in task performance (e.g., skill proficiency), contextual performance (e.g., communication skill and mental health issues), and patient and health worker safety (accident and medication error). It could also encourage counterproductive work behavior, such as absenteeism. Furthermore, sleep deprivation changes circadian rhythms, causing decreased information processing and affective recognition functions in some vital brain areas, ultimately affecting several work dimensions. @*Conclusion@#In conclusion, stakeholders need to adjust proper shift scheduling for health care workers, practice sleep hygiene, maintain physical fitness, and consume nutritional food, positively correlated to health and productivity.

Chronic sleep deprivation exacerbates cognitive and pathological impairments in APP/PS1/tau triple transgenic Alzheimer's disease model mice / 生理学报

Sleep exerts important functions in the regulation of cognition and emotion. Recent studies have found that sleep disorder is one of the important risk factors for Alzheimer's disease (AD), but the effects of chronic sleep deprivation on the cognitive functions of AD model mice and its possible mechanism are still unclear. In the present study, 8-month-old male APP/PS1/tau triple transgenic AD model (3xTg-AD) mice and wild type (WT) mice (n = 8 for each group) were subjected to chronic sleep deprivation by using the modified multiple platform method, with 20 h of sleep deprivation each day for 21 days. Then, open field test, elevated plus maze test, sugar water preference test, object recognition test, Y maze test and conditioned fear memory test were performed to evaluate anxiety- and depression-like behaviors, and multiple cognitive functions. In addition, the immunohistochemistry technique was used to observe pathological characteristics in the hippocampus of mice. The results showed that: (1) Chronic sleep deprivation did not affect anxiety- (P = 0.539) and depression-like behaviors (P = 0.874) in 3xTg-AD mice; (2) Chronic sleep deprivation exacerbated the impairments of object recognition memory (P < 0.001), working memory (P = 0.002) and the conditioned fear memory (P = 0.039) in 3xTg-AD mice; (3) Chronic sleep deprivation increased amyloid β (Aβ) deposition (P < 0.001) and microglial activation (P < 0.001) in the hippocampus of 3xTg-AD mice, without inducing abnormal tau phosphorylation and neurofibrillary tangles. These results indicate that chronic sleep deprivation exacerbates the impairments of recognition memory, working memory and conditioned fear memory in 3xTg-AD mice by aggravating Aβ deposition and the excessive activation of microglia in the hippocampus.

Disturbed sleep pattern (000198): content analysis in patients with acute coronary syndrome / Patrón de sueño perjudicado (000198): análisis de contenido en pacientes internados con síndrome coronario agudo / Padrão de sono prejudicado (000198): análise de conteúdo em pacientes internados com síndrome coronariana aguda

ABSTRACT Objective: to analyze the content of the defining characteristics of the Disturbed Sleep Pattern Nursing Diagnosis (00198) in patients with Acute Coronary Syndrome. Method: content analysis performed by specialists who achieved a score equal to or greater than five, according to established criteria: clinical experience, teaching and/or research; participation in research groups; doctorate degree; master's degree; specialization and/or residency in cardiology and/or sleep and/or nursing classifications. Eight defining characteristics were evaluated for their relationship to population, relevance, clarity and accuracy. Descriptive statistics were performed to characterize the sample, binomial statistical test to establish if there is agreement between the experts and chi-square and Fisher's exact to establish associations between the evaluated items and the experts' variables. Results: 54 experts participated in the study. The defining characteristics validated by the experts were the following: dissatisfaction with sleep, feeling unrested, sleep deprivation, alteration in sleep pattern, unintentional awakening, difficulty initiating sleep and daytime sleepiness. There was a statistically significant association between evaluated items and the variables time of training, time of operation and punctuation. Conclusion: seven of the eight defining characteristics were considered valid after the application of binomial test. This study will contribute to the refinement of the Disturbed Sleep Pattern Nursing Diagnosis (000198) and may enable the improvement of the quality of care of patients hospitalized with Acute Coronary Syndrome regarding changes in sleep pattern. The content analysis stage will support the next stage of the validation process of the present diagnosis, the clinical validation.

RESUMEN Objetivo: analizar el contenido de las características definidoras del Diagnóstico de Enfermería de Patrón de Sueño Perjudicado (00198) en pacientes con Síndrome Coronario Agudo. Método: análisis de contenido realizado por especialistas que obtuvieron una puntaje mayor o igual a cinco, de acuerdo con los criterios establecidos: experiencia clínica, en docencia y/o en investigación; participación en grupos de investigación; doctorado; maestría; especialización y/o residencia en cardiología y/o en clasificaciones de enfermería. Se evaluaron ocho características definidoras en cuanto a su relación con la población, relevancia, claridad y precisión. Se realizó un análisis estadístico descriptivo para caracterizar la muestra, una prueba estadística de binomios para establecer si había concordancia entre los especialistas y las pruebas de chi-cuadrado y exacto de Fisher para establecer asociaciones entre los puntos evaluados y las variables de los especialistas. Resultados: del estudio participaron 54 especialistas. Las características definidoras que evaluaron los especialistas fueron las siguientes: insatisfacción con el sueño, no sentirse descansado, privación del sueño, alteración en el patrón de sueño, despertar no intencional, dificultad para iniciar el sueño y somnolencia diurna. Se registró una asociación estadística significativa entre los puntos evaluados y las siguientes variables: tiempo de formación, tiempo de ejercicio en la profesión y puntuación. Conclusión: siete de las ocho Características definidoras se consideraron válidas después de aplicar la prueba de binomios. El presente estudio contribuirá a perfeccionar el Diagnóstico de Enfermería de Patrón de Sueño Perjudicado (000198) y podrá hacer posible que se mejore la calidad de la atención de pacientes internados con Síndrome Coronario Agudo en lo referente a alteraciones en el patrón de sueño. La etapa del análisis de contenido servirá de ayuda para la próxima etapa del proceso de validación del presente diagnóstico: la validación clínica.

RESUMO Objetivo: analisar o conteúdo das características definidoras do Diagnóstico de Enfermagem Padrão de Sono Prejudicado (00198) em pacientes com Síndrome Coronariana Aguda. Método: análise de conteúdo realizada por especialistas que atingiram pontuação igual ou maior a cinco, de acordo com critérios estabelecidos: experiência clínica, no ensino e/ou pesquisa; participação em grupos de pesquisa; doutorado; mestrado; especialização e/ou residência em cardiologia e/ou sono e/ou classificações de enfermagem. Oito características definidoras foram avaliadas quanto a sua relação com a população, relevância, clareza e precisão. Realizou-se estatística descritiva para caracterização da amostra, teste estatístico binomial para estabelecer se há concordância entre os especialistas e qui-quadrado e exato de Fisher para estabelecer associações entre os itens avaliados e variáveis dos especialistas. Resultados: 54 especialistas participaram do estudo. As características definidoras validadas pelos especialistas foram: insatisfação com o sono, não se sentir descansado, privação do sono, alteração do padrão de sono, despertar não intencional, dificuldade para iniciar o sono e sonolência diurna. Houve associação estatística significativa entre itens avaliados e as variáveis tempo de formação, tempo de atuação e pontuação. Conclusão: sete das oito características definidoras foram consideradas válidas após aplicação de teste binomial. O presente estudo contribuirá para o refinamento do Diagnóstico de Enfermagem Padrão de Sono Prejudicado (000198) e poderá possibilitar a melhoria da qualidade do atendimento de pacientes internados com Síndrome Coronariana Aguda no que tange a alterações do padrão de sono. A etapa de análise de conteúdo subsidiará a próxima etapa do processo de validação do presente diagnóstico, a validação clínica.

Distúrbios do sono: escalas subjetivas e fatores associados em profissionais da saúde em jornada de plantões / Sleep disorders: subjective scales and associated factors in healthcare professionals during their duties

Objetivo: Demonstrar fatores envolvidos nos distúrbios do sono em profissionais que fazem plantões. Métodos: Trata-se de estudo transversal, cuja amostra foi composta de 244 voluntários, plantonistas da área da saúde, sendo 191 do sexo feminino, que responderam a um questionário socioeconômico, associado à aplicação da Escala de Sonolência de Epworth e ao Índice de Qualidade do Sono de Pittsburgh. Os dados foram analisados pelos coeficientes de Spearman e de Kendall Tau, com distribuição de probabilidade gama. Resultados: Houve significância (p<0,05) com o Índice de Qualidade do Sono de Pittsburgh e a atividade física (+0,216), ergonomia (+0,148), filhos (-0,146), valor da remuneração (+0,112) e disfunção durante o dia (+0,352). Também houve significância com a Escala de Sonolência de Epworth e atividade física (+0,138), renda familiar (-0,118), trabalho semanal (-0,151), latência do sono (-0,106), duração do sono (-0,107), eficiência do sono (-0,139) e disfunção durante o dia (+0,170). Por fim, a eficiência do sono teve significiância com profissão (-0,209), tabagismo (+0,402), Escala de Sonolência de Epworth (-0,139) e dissonias com a obesidade (índice de massa corporal >30; razão de chance de 1,40; intervalo de confiança de 95% de 1,02-1,94). Conclusão: As medidas autorrelatadas são prontamente obtidas com questionários validados, como a Escala de Sonolência de Epworth e o Índice de Qualidade do Sono de Pittsburgh, encontrando-se correlações com renda familiar, ter ou não filhos, índice de massa corporal, atividade física, ergonomia, condições de trabalho, tabagismo e componentes biopsicossociais. Em virtude do caráter transversal deste estudo é indispensável mais estudos com maior follow-up.

Objective: To demonstrate factors involved in sleep disorders in professionals who take shifts. Methods: This is a cross-sectional study whose sample consists of 244 volunteers, on-duty health workers, 191 females, who answered a socioeconomic questionnaire, associated with application of the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index. Data were analyzed with Spearman's and Kendall Tau coefficients, and gamma probability distribution. Results: There was significance (p<0,05) with the Pittsburgh Sleep Quality Index and physical activity (+0,216), ergonomics (+0,148), children (-0,146), the wage (+0,112), dysfunction during the day (+0,352). Also there was significance with the Epworth Sleepiness Scale and physical activity (+0,138), family income (-0,118), weekly workload (-0,151), sleep latency (-0,106), sleep duration (-0,107), sleep efficiency (-0,139), and dysfunction during the day (+0,170). Finally, sleep efficiency was significant with occupation (-0,209), smoking habits (+0,402), Epworth Sleepiness Scale (-0,139), dyssomnia with obesity (body index mass >30; OR of 1,40; CI 95% 1,02-1,94). Conclusion: Self-reported measures are readily obtained with validated questionnaires such as Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, with correlations with family income, having children or not, body mass index, physical activity, ergonomics, working conditions, smoking habits, and biopsychosocial components. Due to the cross-sectional nature of this study, further research with longer follow-up is indispensable.

Associação entre o padrão de sono e marcadores de risco cardiometabólicos de adolescentes / Adolescents sleep pattern association with cardiometabolic risk markers

Introdução: O sono é uma função cerebral importante, e seu padrão sofre importantes mudanças desde a infância até a adolescência, assinalado por um atraso progressivo na fase de sono no início da puberdade. A privação de sono compromete cognição, vigilância e memória, distúrbios do humor e implicações metabólicas. Objetivo: Investigar a associação entre o padrão de sono, estado nutricional e risco cardiometabólico em adolescentes. Materiais e método: Tratou-se de pesquisa transversal, com 339 adolescentes das escolas municipais de Santana de Parnaíba, com idade entre 12 e 15 anos. Medidas antropométricas como peso, altura, circunferência de cintura e pescoço e maturação sexual foram aferidas. Utilizou-se a escala de sonolência diurna, bem como os questionários de cronotipo de Munique e jet lag social. Resultados: A pontuação na Escala de sonolência diurna pediátrica (ESDP) em meninas e meninos foi de 16,06 e 13,81, respectivamente. Segundo a classificação das horas de sono, não houve diferença no índice de massa corporal, circunferência de cintura e de pescoço. Verificaram-se mais horas de sono durante final de semana, independentemente do estado nutricional. A análise de regressão apontou que o sexo masculino e atividade física foram fatores protetores da sonolência diurna, já quanto maior a idade, cronotipo e jet lag social maior foi a sonolência diurna. O sexo masculino, pós-púbere, elevada circunferência de pescoço, excesso de peso e maior pontuação da ESPD associaram-se positivamente ao risco cardiovascular, já o jet lag social desempenhou fator protetor a esse risco. Conclusão: O sono insuficiente em adolescentes gerou sonolência diurna e jet lag social, enquanto este último exerceu efeito protetor para doenças cardiometabólicas. (AU)

Introduction: Sleep is an important brain function, and its pattern undergoes important changes from childhood to adolescence, marked by a progressive delay in the sleep phase at the beginning of puberty. Sleep deprivation hampers cognition, alertness and memory, mood disorders and metabolic implications. Objective: To investigate the association between sleep patterns, nutritional status and cardiometabolic risk in adolescents. Method: This was a cross-sectional study involving 339 adolescents from the municipal schools in a municipality of the Greater São Paulo, aged between 12 and 15 years. Anthropometric measurements such as weight, height, waist and neck circumference and sexual maturation were measured. The daytime sleepiness scale was used, as well as the Munich chronotype and social jetlag questionnaires. Results: The score on the Pediatric Daytime Sleepiness Scale (PDSS) in girls and boys was 16.06 and 13.81, respectively. According to the classification of hours of sleep, there was no difference in body mass index, waist and neck circumference. More hours of sleep were observed during weekends, regardless of nutritional status. The regression analysis showed that male gender and physical activity were protective factors against daytime sleepiness; in contrast, the older the age, the chronotype and social jetlag, the greater the daytime sleepiness. Male gender, post-pubertal, high neck circumference, overweight and higher PDSS score were positively associated with cardiovascular risk, whereas the social jetlag played a protective factor against this risk. Conclusion: Insufficient sleep in adolescents generated daytime sleepiness and social jetlag. The latter had a protective effect against cardiometabolic diseases. (AU)

Recent Updates on Narcolepsy and Hypersomnia / 신경정신의학

Narcolepsy is a chronic neurological sleep disorder caused by hypocretin neuron loss, resulting in excessive daytime sleepiness, disturbed nocturnal sleep, and intrusions of aspects of rapid eye movement sleep in wakefulness, such as cataplexy, sleep paralysis, and hypnopompic/hypnagogic hallucinations. Narcolepsy disrupts the maintenance and orderly occurrence of the wake and sleep stages. Cataplexy is a highly specific symptom of narcolepsy, but many other symptoms can be observed in a variety of sleep disorders. The diagnosis of narcolepsy type 1 requires a history of excessive daytime sleepiness and one of the following : 1) a low cerebrospinal fluid hypocretin-1 level or 2) cataplexy and a positive multiple sleep latency test result. The diagnosis of narcolepsy type 2 requires a history of excessive daytime sleepiness and a positive mean sleep-latency test result. The mean sleep-latency test must be preceded by nighttime polysomnography to exclude other sleep disorders and to document adequate sleep. The mean sleep-latency test result can be falsely positive in other sleep disorders, such as shift work, sleep apnea, or sleep deprivation, and it is influenced by age, sex, and puberty. Modafinil and armodafinil can reduce the excessive daytime sleepiness without many of the side effects associated with older stimulants. Although there is no cure for narcolepsy, the treatments are often effective and include both behavioral and pharmacologic approaches.

Curcumin prevents neuronal loss and structural changes in the superior cervical (sympathetic) ganglion induced by chronic sleep deprivation, in the rat model

BACKGROUND: In modern societies, sleep deprivation is a serious health problem. This problem could be induced by a variety of reasons, including lifestyle habits or neurological disorders. Chronic sleep deprivation (CSD) could have complex biological consequences, such as changes in neural autonomic control, increased oxidative stress, and inflammatory responses. The superior cervical ganglion (SCG) is an important sympathetic component of the autonomic nervous system. CSD can lead to a wide range of neurological consequences in SCG, which mainly supply innervations to circadian system and other structures. As the active component of Curcuma longa, curcumin possesses many therapeutic properties; including neuroprotective. This study aimed to evaluate the effect of CSD on the SCG histomorphometrical changes and the protective effect of curcumin in preventing these changes. METHODS: Thirty-six male rats were randomly assigned to the control, curcumin, CSD, CSD + curcumin, grid floor control, and grid floor + curcumin groups. The CSD was induced by a modified multiple platform apparatus for 21 days and animals were sacrificed at the end of CSD or treatment, and their SCGs removed for stereological and TUNEL evaluations and also spatial arrangement of neurons in this structure. RESULTS: Concerning stereological findings, CSD significantly reduced the volume of SCG and its total number of neurons and satellite glial cells in comparison with the control animals ( P < 0.05). Treatment of CSD with curcumin prevented these decreases. Furthermore, TUNEL evaluation showed significant apoptosis in the SCG cells in the CSD group, and treatment with curcumin significantly decreased this apoptosis ( P < 0.01). This decrease in apoptosis was observed in all control groups that received curcumin. CSD also changed the spatial arrangement of ganglionic neurons into a random pattern, whereas treatment with curcumin preserved its regular pattern. CONCLUSIONS: CSD could potentially induce neuronal loss and structural changes including random spatial distribution in the SCG neurons. Deleterious effects of sleep deprivation could be prevented by the oral administration of curcumin. Furthermore, the consumption of curcumin in a healthy person might lead to a reduction of cell death.