Research progress in circadian rhythms in the application of psychological rehabilitation of cancer patients / 中南大学学报(医学版)

The psychological distress of cancer patients seriously affects their therapeutic effects. Effective psychological rehabilitation of cancer patients significantly improves their survival chance and quality of life. Circadian rhythm results from adaptation to the environment during the organism's evolution. When the endogenous clock system is disrupted or the external environment is changed, the body and the environment are out of synchronization, and the circadian rhythm will be disrupted. Circadian rhythm disorder is a common phenomenon in cancer patients, and the changes of circadian rhythm are closely related to their psychological distress. Many studies believe that the circadian rhythm disorder of cancer patients may directly or indirectly affect their psychology through various mechanisms, and targeted intervention by regulating the circadian rhythm of patients may be an essential means to promote the psychological rehabilitation.

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

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

Chronotype in bipolar disorder: an 18-month prospective study

Objective: Circadian dysregulation plays an important role in the etiology of mood disorders. Evening chronotype is frequent in these patients. However, prospective studies about the influence of chronotype on mood symptoms have reached unclear conclusions in patients with bipolar disorder (BD). The objective of this study was to investigate relationship between chronotype and prognostic factors for BD. Methods: At the baseline, 80 euthymic BD patients answered a demographic questionnaire and clinical scales to evaluate anxiety, functioning and chronotype. Circadian preference was measured using the Morningness-Eveningness Questionnaire, in which lower scores indicate eveningness. Mood episodes and hospitalizations were evaluated monthly for 18 months. Results: Among the BD patients, 14 (17.5%) were definitely morning type, 35 (43.8%), moderately morning, 27 (33.7%) intermediate (neither) and 4 (5%) moderately evening. Eveningness was associated with obesity or overweight (p = 0.03), greater anxiety (p = 0.002) and better functioning (p = 0.01), as well as with mood episodes (p = 0.04), but not with psychiatric hospitalizations (p = 0.82). This group tended toward depressive episodes (p = 0.06), but not (hypo)mania (p = 0.56). Conclusion: This study indicated that evening chronotype predicts a poor prognostic for BD. It reinforces the relevance of treating rhythm disruptions even during euthymia to improve patient quality of life and prevent mood episodes.

Relationship between Circadian Rhythm Disorder of Blood Pressure and Ischemic Stroke / 中国医学科学院学报

Hypertension plays an important role in the pathogenesis of stroke,which,however,is only known at the blood pressure level.The relationship between circadian rhythm of blood pressure(especially the circadian rhythm disorder of blood pressure)and stroke has been a hot research topic.This article reviews the concept of circadian rhythm of blood pressure,classification of circadian rhythm disorder of blood pressure,and the relationship of circadian rhythm disorder of blood pressure with ischemic stroke.

Is Advancing Circadian Rhythm the Mechanism of Antidepressants?

Antidepressants usually require 2–8 weeks after drug administration to obtain a clinical response. In contrast, three fast-acting antidepressant treatments (sleep deprivation, electroconvulsive therapy, and ketamine) significantly reduced depressive symptoms within hours to days in a subgroup of patients with depressive disorder. This review addresses the mechanisms underlying these fast effects, with specific focus on treatment effects on circadian rhythms. Numerous recent studies have shown that circadian dysregulation may play an important role in the pathogenesis of mood disorders. These studies indicate that a common therapeutic mechanism underlying the three fast antidepressant therapies is related to circadian rhythm. Evidence suggests that depressive disorder is associated with circadian rhythm delay and that the mechanism of the antidepressant effect is a process in which the delayed circadian rhythm is restored to normal by the treatment.

Is the Circadian Rhythm Dysregulation a Core Pathogenetic Mechanism of Bipolar Disorder? / 신경정신의학

Circadian rhythm is a periodic and continuous change in physiological, behavioral, and mental characteristics that occurs in most organisms on the Earth, because the Earth rotates in a 24-hour cycle. The circadian system regulates daily rhythms of physiology and behavior, such as the sleep/wake cycle, body temperature, hormonal secretion, and mood. The influence of circadian rhythm is very powerful, but limited research has addressed its effects. However, many recent studies have shown that circadian dysregulation may play an important role in the pathogenesis of bipolar disorder. This review study examined current and noteworthy studies, including the authors' own works, and proposes a possible clinical application of bipolar disorder based on evidence that circadian rhythm dysregulation in bipolar disorder may be a key pathogenetic mechanism.

Wnt and GSK3 Signaling Pathways in Bipolar Disorder: Clinical and Therapeutic Implications

The neurobiology of bipolar disorder, a chronic and systemic ailment is not completely understood. The bipolar phenotype manifests in myriad ways, and psychopharmacological agents like lithium have long term beneficial effects. The enzyme glycogen synthase kinase 3 (GSK3) has come into focus, as lithium and several other mood stabilizing medications inhibit its activity. This kinase and its key upstream modulator, Wnt are dysregulated in mood disorders and there is a growing impetus to delineate the chief substrates involved in the development of these illnesses. In May 2016, a comprehensive literature search was undertaken which revealed that there is over activity of GSK3 in bipolar disorder with deleterious downstream effects like proinflammatory status, increased oxidative stress, and circadian dysregulation leading to declining neurotrophic support and enhanced apoptosis of neural elements. By developing specific GSK3 inhibitors the progressive worsening in bipolar disorder can be forestalled with improved prospects for the sufferers.

Sleep Disorder and Alcohol / 수면정신생리

The use of alcohol is associated with the development and worsening of sleep disorder. Alcohol is generally known to have a sedative effect, but it has an arousal or sedative effect depending on the timing and drinking dose and directly affects REM sleep physiology. Alcohol acts on the central nervous system (CNS) to interfere with the sleep-wake cycle and to affect sleep-related hormone secretion. In addition, the ingestion of alcohol pre-sleep is associated with deterioration and development of sleep related breathing disorders (SBD). The increase in resistance of the upper respiratory tract and the decrease in sensitivity of the CNS respiratory center and the respiratory muscles are major mechanisms of alcohol-induced SBD, and result in snoring or apnea in healthy men or aggravating apnea in patients with OSA. Sleep-related restless leg syndrome and circadian rhythm disorders are common in alcohol use disorder patients. This review provides an assessment of scientific studies that investigated on the impact of alcohol ingestion on nocturnal sleep physiology and sleep disorders.

Avaliação do reparo ósseo na interface osso/implante em ratos pinealectomizados: análise histológica, imunoistoquimica, histométrica, biomecânica e por microct / Bone repair evaluation in bone/implant interface in pinealectomized rats: histological, immunohistochemistry, histometric, biomechanics and microCT analysis

O presente estudo teve como objetivo investigar a interface osso / implante em ratos pinealectomizados tratados com melatonina. Métodos: 30 ratos, machos, adultos foram divididos em 3 grupos: controle (CO), pinealectomizados (PnX) e pinealectomizado com melatonina (PNXm). Após 30 dias da Pinealectomia, um implante foi instalado em cada tíbia e a eutanásia foi realizada aos 42 dias. As amostras foram submetidas a histomorfométrica (ELCOI e AON), biomecânica (de torque reverso), microtomografia e análise imunoistoquímica. Os dados quantitativos foram submetidos à análise estatística (P <0,05). Para os resultados histométricos, valores ELCOI para PNX foram menores quando comparados com PNXm (P = 0,0393), enquanto AON não mostrou diferença entre os grupos (P = 0,761). Os valores de torque reverso não mostraram diferença entre os grupos PNX e PNXm (P = 0,5000), e as interações CO vs PNXm, e CO vs PNX mostraram diferença significativa (P <0,05). Os parâmetros volumétricas BV/TV (P = 0,933); Tr.N (P = 0,933); Tb.Th (P = 0,933), Tb.Sp (P = 0,200) não apresentaram diferença estatística. A imunomarcação para OPG, RANKL, TRAP e osteocalcina mostrou similaridade entre os grupos, apesar da PNXm parece assemelhar-se às condições fisiológicas (CO). Portanto, a melatonina melhorou a remodelação óssea na região peri-implante em ratos pinealectomizados.

This study aimed to investigate the interface bone/implant in pinealectomized rats treated with melatonin. 30 rats, male, adults were divided into 3 groups: control (CO), pinealectomized (PNX) and pinealectomized with melatonin (PNXm). After 30 days of the pinealectomy, one implant was installed on each tibia and euthanasia was performed at 42 days. The samples were submitted to histometric (BIC and NB), biomechanical (reverse torque), microtomography and immunohistochemical analysis. The quantitative data were subjected to statistical analysis (P<0.05). For the histometric results, BIC values to PNX were lower when compared to PNXm (P=0.0393), whereas NB did not showed difference among the groups (P=0.761). Reverse torque did not show difference between the groups PNX and PNXm (P=0,5000), and the interactions CO vs PNXm, and CO vs PNX showed significantly difference (P<0.05). The volumetric parameters BV/TV (P=0.933); Tr.N (P=0.933); Tb.Th (P=0.933), Tb.Sp (P=0.200) did not present statistical difference. The immunolabeling for OPG, RANKL, TRAP and osteocalcin showed similarity among the groups, despite the PNXm it seems to resemble to physiological conditions (CO). Therefore, melatonin improved the bone turnover in peri-implant region in pinealectomized rats.

Differential susceptibility of BALB/c, C57BL/6N, and CF1 mice to photoperiod changes

Objective:Circadian disturbances common to modern lifestyles have been associated with mood disorders. Animal models that mimic such rhythm disturbances are useful in translational research to explore factors contributing to depressive disorders. This study aimed to verify the susceptibility of BALB/c, C57BL/6N, and CF1 mice to photoperiod changes.Methods:Thermochron iButtons implanted in the mouse abdomen were used to characterize temperature rhythms. Mice were maintained under a 12:12 h light-dark (LD) cycle for 15 days, followed by a 10:10 h LD cycle for 10 days. Cosinor analysis, Rayleigh z test, periodograms, and Fourier analysis were used to analyze rhythm parameters. Paired Student's t test was used to compare temperature amplitude, period, and power of the first harmonic between normal and shortened cycles.Results:The shortened LD cycle significantly changed temperature acrophases and rhythm amplitude in all mouse strains, but only BALB/c showed altered period.Conclusion:These findings suggest that BALB/c, the preferred strain for stress-induced models of depression, should also be favored for exploring the relationship between circadian rhythms and mood. Temperature rhythm proved to be a useful parameter for characterizing rhythm disruption in mice. Although disruption of temperature rhythm has been successfully documented in untethered mice, an evaluation of desynchronization of other rhythms is warranted.

Changes of biological clock protein in neonatal rats with hypoxic-ischemic brain damage / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effects of biological clock protein on circadian disorders in hypoxic-ischemic brain damage (HIBD) by examining levels of CLOCK and BMAL1 proteins in the pineal gland of neonatal rats.</p><p><b>METHODS</b>Seventy-two 7-day-old Sprague-Dawley (SD) rats were randomly divided into sham-operated and HIBD groups. HIBD model was prepared according to the modified Levine method. Western blot analysis was used to measure the levels of CLOCK and BMAL1 in the pineal gland at 0, 2, 12, 24, 36 and 48 hours after operation.</p><p><b>RESULTS</b>Both CLOCK and BMAL levels in the pineal gland increased significantly 48 hours after HIBD compared with the sham-operated group (P<0.05). There were no significant differences in levels of CLOCK and BMAL proteins between the two groups at 0, 2, 12, 24 and 36 hours after operation (P>0.05).</p><p><b>CONCLUSIONS</b>Levels of CLOCK and BMAL1 proteins in the pineal gland of rats increase significantly 48 hours after HIBD, suggesting that both CLOCK and BMAL1 may be involved the regulatory mechanism of circadian disorders in rats with HIBD.</p>

Circadian Rhythm Hypotheses of Mixed Features, Antidepressant Treatment Resistance, and Manic Switching in Bipolar Disorder

Numerous hypotheses have been put forth over the years to explain the development of bipolar disorder. Of these, circadian rhythm hypotheses have gained much importance of late. While the hypothalamus-pituitary-adrenal (HPA) axis hyperactivation hypothesis and the monoamine hypothesis somewhat explain the pathogenic mechanism of depression, they do not provide an explanation for the development of mania/hypomania. Interestingly, all patients with bipolar disorder display significant disruption of circadian rhythms and sleep/wake cycles throughout their mood cycles. Indeed, mice carrying the Clock gene mutation exhibit an overall behavioral profile that is similar to human mania, including hyperactivity, decreased sleep, lowered depression-like behavior, and lower anxiety. It was recently reported that monoamine signaling is in fact regulated by the circadian system. Thus, circadian rhythm instability, imposed on the dysregulation of HPA axis and monoamine system, may in turn increase individual susceptibility for switching from depression to mania/hypomania. In addition to addressing the pathophysiologic mechanism underlying the manic switch, circadian rhythm hypotheses can explain other bipolar disorder-related phenomena such as treatment resistant depression and mixed features.

Rol del sistema de genes CLOCK en las alteraciones del ritmo circadiano en pacientes con Trastorno Bipolar. Estudio de asociación genómica amplia / Role of CLOCK Genes in Circadian Rhythm Alterations, in Patients with Bipolar Disorder. Genome-wide Association Study

Introducción: Las anomalías del ritmo circadiano en el transcurso del TB ha motivado la búsqueda de anomalías en los genes CLOCK asociados a la génesis de ritmos circadianos que podrían estar involucrados en este aspecto de la compleja patología del TB. A pesar de ingentes búsquedas, no se han registrado hallazgos significativos en estudios de asociación amplia de genoma (GWAS/genome-wide association studies). Hay por lo menos 3 razones para explicar estos resultados negativos. En primer lugar el hecho de que los rasgos genéticos de patologías complejas, como es el caso del TB, son habitualmente poligénicos. En segundo término, la organización del reloj/es circadiano/s es bastante más compleja de lo que habitualmente se está dispuesto a admitir; y en tercer lugar, el riesgo genético para TB podría ser compartido entre varias patologías diferentes. Objetivos. Investigar la posibilidad de una asociación entre anomalías en las agrupaciones genéticas responsables de la generación de ritmos circadianos y TB, para lo cual se analizaron las redes constitutivas de los genes CLOCK en por lo menos tres niveles: 1) los genes CLOCK centrales, 2) los genes moduladores de genes CLOCK centrales y 3) los genes controlados por los genes CLOCK centrales. Método: Mediante el uso de método de asociación amplia de genoma con umbrales permisivos se intentó establecer asociaciones significativas entre genes CLOCK y TB comparados con genes control, ademas de incluir asociaciones significativas entre genes CLOCK y TB comparados con genes control, además de incluir asociaciones con otras enfermedades que comparten rasgos clínicos y/o genéticos con el TB, como la Depresión Mayor (DM), Esquizofrenia (E), Trastorno por Déficit de Atención e Hiperactividad (TDAH). Luego de establecer estas asociaciones se compararon los resultados con un conjunto de genes sensibles al litio (Li) y otro grupo sensible a valproato (VPO). Las asociaciones entre TEB y respuesta al litio y/o valproato ...

Introduction. Circadian rythm abnormalities during bipolar disoder has prompetd the search for alterations in CLOCK genes responible for generating circadian rythms, which could be envolved with this complex issue of biipolar disorder. In spite of urgent search, no sinificative results ave been reached in genome wide association scales studies (GWAS). At least three rehaznos could account for this fact: first, genetic traits of complex pathology are usually poligenic, second circadian clock organization is far more complex than usually admitted, and third bipolar disorder genetic risk could be shared with other different diseases. Goals. Search for the possibiity of an association between genetic assemblies anormalies responsible for circadian clock rhythm generation and bipolar disorder. Whith that objective, CLOCK genes networks were analyzed n at least three levels: 1) central CLOCK genes, 2) central CLOCK genes modulators and 3) central CLOCK controlled genes. Method. Using GWAS with permissive tresholds and control comparison, a significative association between CLOCK genes and bipolar disorder was searched, including involvement with other diseases that share common (ADHD). After establishing these associations, results were compared for Lithium and valproate sensitive genes associations. Associations between bipolar disorder, CLOCK genes, lithium and valproate sensitive genes were enriched through comparisons with rhythmic, weakly rhythmic and arrhythmic genes. Results. Significative enrichments were found between CLOCK central genes, bipolar disorder and lithium and valproate sensitive genes, not incluiding CLOCK genes modulators. Associations between bipolar disorder, lithium and valproate sensitive genes and rhythmic genes also were significative, excluding weakly rhythmic and arrhythmic genes. GWAS analysis with flexible tresholds made possible the regognition of association between central CLOCK genes and bipolar disorder, identifying candidate ..

The progress of studies on the relation between circadian rhythm disruption and cancer / 生物医学工程学杂志

Like functions of other organisms, most of the physiological and behavioral functions of human are characterized by day-night rhythms. The rhythms which exhibit approximately 24-hour periodicity are called as circadian rhythms. This review is to summarize the progress of studies on relation of circadian rhythum disruption and cancer. The research results from animal experiments and population-based epidemiological studies have showed that cancer is closly related to circadian rhythm. Although numrous studies have demonstrated the close relation between circadian rhythm disruption and cancer, the mechanism is not yet clear. The current studies attributed decreased level of melatonin secretion and disruption of clock genes expression to the mechanism of carcinogenesis of circadian rhythm disruption.

The Relationship between Shift Work and Work-related Injuries among Korean Workers / 대한산업의학회지

OBJECTIVES: The aim of this study was to evaluate the relationship between shift work and work-related injuries in a representative sample of Korean workers. METHODS: We used data from the Korean Working Condition Survey of 2006. The participants were 7,075 Korean workers 15 to 64 years of age. Logistic regression was employed to estimate the relationship between shift work and work-related injury using the SAS version 9.2 program. RESULTS: Shift work was significantly related to work-related injuries compared to non-shift workers(OR 2.40, 95% CI=1.65~3.48). When personal and occupational risk factors were accounted for, shift work had a statistically meaningful relationship with work-related injuries compared to non-shift work(OR 1.79, 95% CI=1.20~2.66). CONCLUSIONS: In this study, shift workers appear to have a higher risk of work-related injuries compared to non-shift workers. Work-related injuries in shift workers could be attributed to circadian rhythm disorder and sleep problems. Suitable arrangements that ensure flexible working times are needed for shift workers. Further study will be needed to identify and mitigate work-related injuries among shift workers.

Trabalho em turnos e aspectos nutricionais: uma revisão / Shift work and nutritional aspects: a review

Shift workers are individuals more prone to having nutritional problems.Recent evidences have showed that problems such as obesity, lack of control over the food intake, insulin resistance, diabetes and dyslipidemias are more common in these individuals. This review analyzed the diet of shift workers, pointing out the main factors that are capable to change it. Current studies show that these individuals present an inadequate and in several aspects peculiar food intake pattern. On the other hand, recent data have pointed that shorter sleeping periods, desynchronization of the circadian rhythm and alteration of the environmental aspects are the main factors capable to trigger such problems. In view of the harmful effects on the nutritional status of shift workers, it is important to monitor the health ofthese individuals and encourage the development of nutritional educationprograms for this population.

Los trabajadores a turnos son individuos notadamente más predispuestos a problemas nutricionales. Diversas evidencias indican que problemas como obesidad, descontrol de la ingestión alimentaria, resistencia a la insulina, diabetes y dislipidemias son más comunes en este tipo de trabajadores. En este trabajo analizamos los datos disponibles en la literatura científ ica referente al comportamiento alimentario de trabajadores a turnos, destacando las principales modifi caciones observadas. Los estudios muestran que estos individuos presentanun padrón característico e inadecuado de ingestión alimentaria bajo varios puntos de vista. Por otro lado, datos recientes postulan que la disminución del tiempo de sueño, la alteración del ritmo circadiano y los aspectos ambientales son los principales factores capaces de desencadenar esos problemas. Considerando los factores que deterioran el equilibrio nutricional de trabajadores a turno, es importante invertir en el monitoreo de la salud y promover la elaboración de programas de educaciónnutricional dirigidos a esta población.

Trabalhadores em turnos são indivíduos conhecidamente mais predispostos a problemas nutricionais. Diversas evidências atuais têmindicado que problemas como a obesidade, descontrole da ingestão alimentar, resistência à insulina, diabetes e dislipidemias são mais comuns neste tipo de trabalhadores. Com base nisso, a presente revisão analisou os dados disponíveis na literatura científi ca referentes ao comportamento alimentar de trabalhadores em turnos, destacando os principais fatores capazes de alterá-lo. Estudos da atualidade apontam que estes indivíduos apresentam um padrão de ingestão alimentar inadequado e peculiar sobvários pontos de vista. Por outro lado, dados recentes postulam que a diminuição da duração do sono, a dessincronização do ritmo circadianoe a alteração dos aspectos ambientais são os principais fatores capazes de desencadear tais problemas. Tendo em vista os efeitos prejudiciaisno equilíbrio nutricional de trabalhadores em turnos, é importante investir no monitoramento da saúde e incentivar a elaboração de programasde educação nutricional nesta população.

Chronobiological rhythms in onset of massive pulmonary embolism in iranian population

To investigate whether there is any chronobiological rhythms in onset of massive pulmonary embolism in Iranian population and to study any time variation in occurrence of this disease in patients' subgroups. This study was conducted in an emergency department of a referral teaching hospital from March 2003 to March 2007. All medical records of patients with definite diagnosis of massive pulmonary embolism were reviewed for chronobiological rhythms in hourly, daily, monthly and season periods. One hundred and twenty patients [49 women and 71 men] included in the study. The mean age of patients was 63.63 +/- 17.21 years. Massive pulmonary embolism showed a statistical increase in onset in the morning period [p=0.004] with peak of occurrence between 9:00 to 10:00, in the first three day of the week [p<0.001], and during winter [p=0.003]. In addition, hourly and weekly rhythms in onset of massive pulmonary embolism in diabetic patients is different from non-diabetic patients and occur most frequent in evening hours and in the end of week. Our findings revealed that massive pulmonary embolism has a peak of onset during morning hours and in the winter. We also found that massive pulmonary embolism also has a weekly rhythm. Circadian and weekly rhythms of massive pulmonary embolism were different in diabetic patients and this is a novel finding of this study

[Twenty four hours circadian cortisol profile in shift work nurses]

It is well established that adrenal hormone cortisol has long been used in human psychobiological studies as a biological marker of circadian rhythm, stress, and anxiety. There is little information, however, about the anxiety. There is little information, however, about the interrelationships of night work, plasma cortisol levels in females' nurses of the developing countries. The aim of the present study was to compare circadian cortisol profile between two groups of nurses with shift and permanent work in a hospital affiliated to Shiraz University of Medical Sciences, Iran, between January 2006 to September 2008. In this experimental study, we examined the reproducibility of plasma cortisol levels during one month period in 34 shift work nurses and 10 permanent day shift works. We evaluated potential associations between night work and hormone levels, using current and shift work information for the health care shift workers. The results clearly revealed that shift work significantly increased nighttime cortisol levels [34.93 micro g/dl] during night shift and decreased the peak levels of cortisol in the morning [39.03 microg/dl]. During the work shift the plasma cortisol presented a decreased concentration in the morning and increasing levels [44.93 micro g/dl] by the end of the evening. In contrast, the permanent day work nurses, who had never worked at night shits, showed a lowest secretion of cortisol during the first half of night time sleep [10.02 micro g/dl], and a peak value of the cortisol after awakening at 07:00h [59.75 micro g/ml]. We also observed a significant association between night work and increased levels of cortisol over the remaining of the day. It can be concluded that nurses with night shift work have an abnormal cortisol secretion profile. Shift work nurses on rotating night shifts seem to experience changes in hormones levels that may be associated with increased of circadian disorders risk observed among night -shift workers

Excessive Daytime Sleepiness

Excessive daytime sleepiness (EDS) is a prevalent complaint among patients in psychiatric and medical care. Patients with EDS have often been misdiagnosed with depression due to their complaints of lack of energy and poor concentration. Also, they have even been diagnosed erroneously with a psychotic disorder in case of coexistence with hypnagogic hallucination. EDS can seriously affect the person's quality of life by causing decreased academic achievement or work performance, low self esteem, and social withdrawal. EDS is also frequently associated with various medical and psychiatric conditions, and often fatal traffic or on-the-job accidents. The causes of EDS range from insufficient sleep to central nervous system-originated hypersomnia. The conditions that can lead to EDS include circadian rhythm disorders, primary disorders of alertness such as narcolepsy, sleep-related breathing disorders such as obstructive sleep apnea syndrome, sleep-related movement disorders such as periodic limb movement disorder and restless legs syndrome, chronic medical conditions such as cancer, and medications causing sleepiness. Treatment options should be tailored according to the underlying condition and include sufficient sleep time, light therapy, sleep scheduling, wakefulness-promoting medications, or mechanical airway managements such as nasal continuous positive airway pressure (CPAP).

Impacto de los calendarios laborales del anestesiólogo en la salud, el rendimiento y la seguridad / Impact of the anesthesiologist's working schedule on health, performance and safety

La realidad actual nos muestra a los anestesiólogos trabajando largas horas diurnas y nocturnas en ambientes estresantes, sin el descanso adecuado. Estos calendarios laborales pueden tener consecuencias sobre el organismo, como alteraciones del ritmo circadiano, deprivación del sueño y fatiga, y así producir un impacto principalmente sobre la salud y, por lo tanto, en el rendimiento del profesional médico, comprometiendo la seguridad de los pacientes. Las alteraciones del ritmo circadiano generan un patrón de desincronizacíón en la vida que produce un impacto sobre la salud provocando alteraciones digestivas, del patrón de sueño y de la temperatura corporal, secreción de adrenalina, problemas cardiovasculares, y perturbaciones en el comportamiento y en la actividad hormonal. La deprivación del sueño impacta sobre la salud causando desórdenes gastrointestinales, endocrinos y psiconeuróticos, y sobre el rendimiento y la seguridad; además provoca alteraciones psicomotoras y cognoscitivas afectando el desempeño clínico, lo que contribuye al "error humano". La fatiga impacta la salud provocando cansancio físico, estrés, depresión, cefaleas, trastornos ginecológicos y obstétricos; afecta el rendimiento y la seguridad disminuyendo el desempeño intelectual y psicomotor, todo lo cual favorece al error humano. La fatiga fue responsable por el 60 por ciento de los errores en cuidados anestésicos, el 86 por ciento de los errores en el manejo clínico anestésico, 6 por ciento de los incidentes críticos en anestesia y el 10 por ciento de los errores en la administración de drogas equivocadas. Los inadecuados calendarios laborales de los anestesiólogos generan situaciones que suponen un costo alto en la salud, afectan el rendimiento profesional y exponen a los pacientes a situaciones de riesgo.