Factors associated with the fragmentation and stability of the rest-activity rhythm in adults and older adults.

This cross-sectional study aimed to identify factors related to the fragmentation and stability of the rest-activity rhythm (RAR) in adults and older adults. It is part of a larger research project investigating aspects concerning sleep duration, quality, and disorders in a representative subsample of the population. Sociodemographic data, lifestyle, health habits and subjective sleep variables were obtained; RAR records were collected by means of actigraphy and analyzed using non-parametric variables (IS, IV, M10, L5, RA, sL5, and sM10). Study participants were 313 individuals with complete actigraphy records. There was a prevalence of older adults (50.2%) and females (51.1%). Females, individuals with 4-8 y of education, and those who used alcohol abusively exhibited lower RAR fragmentation. Higher fragmentation was observed in individuals who napped and those reporting poor sleep quality. Greater rhythm stability was evident in females, older adults, those with 4-8 y of education, and those who had a partner. Smokers demonstrated lower RAR stability. These findings may contribute valuable insights for decision-making aimed at preventing and treating issues related to fragmentation and instability of the rhythm and its possible consequences to health.

COVID-19 monitoring in workers at a Brazilian public university: a retrospective cohort study / Monitoramento da COVID-19 em trabalhadores de uma universidade pública brasileira: um estudo de coorte retrospectivo

Introduction: primary care action strategies are relevant for disease prevention and health promotion, as well as for the initial management of suspected cases and the individual monitoring of patients with confirmed diagnoses of COVID-19. This study aimed to evaluate the outcome of clinical worsening and demographic, occupational, and clinical variables of workers with COVID-19 in a community health center at a public university in southeastern Brazil. Methods: a retrospective cohort study was conducted with 1,459 symptomatic workers with COVID-19. Data were extracted from the database of the unit's epidemiological surveillance center between March 2020 and March 2021. Results: The average age of participants was 41.1 (SD 10.8) years, most women (71.1%), who had obesity (19.9%) and hypertension (17.0%). Among the symptoms, headache (75.3%) and cough (74.9%) stood out. The worsening of clinical outcome during follow-up occurred in 3.4% of cases. The demographic, occupational and clinical factors associated with clinical worsening were gender, professional category, hypertension, diabetes mellitus, obesity, dyslipidemia, olfactory disorders, cough, fever, and dyspnea. The Poisson regression showed that the prevalence of clinical worsening was greater with age, obesity, fever, and dyspnea. Conclusion: Clinical wors-ening occurred in 3.4% of the cases and was more prevalent according to age, obesity, fever, and dyspnea. The follow-up has shown promise in the early detection and treatment of COVID-19 (AU).

Introdução: as estratégias de ação da atenção primária são relevantes para a prevenção de doenças e promoção da saúde, bem como para o manejo inicial de casos suspeitos e acompanhamento individual de pacientes com diagnóstico confirmado de COVID-19. Este estudo teve como objetivo avaliar o desfecho da piora clínica e variáveis demográficas, ocupacionais e clínicas de trabalhadores com COVID-19 em um centro comunitário de saúde de uma universidade pública do sudeste do Brasil. Métodos: estudo de coorte retrospectivo com 1.459 trabalhadores sin-tomáticos com COVID-19. Os dados foram extraídos do banco de dados do núcleo de vigilância epidemiológica da unidade entre março de 2020 e março de 2021. Resultados: A média de idade dos participantes foi de 41,1 (DP 10,8) anos, sendo a maioria mulheres (71,1%), com obesidade (19,9%) e hipertensão (17,0%). Dentre os sintomas, destacaram-se a cefaleia (75,3%) e a tosse (74,9%). A piora do quadro clínico durante o seguimento ocorreu em 3,4% dos casos. Os fatores demográficos, ocupacionais e clínicos associados à piora clínica foram sexo, categoria profissional, hipertensão arterial, diabetes mellitus, obesidade, dislipidemia, distúrbios do olfato, tosse, febre e dispneia. A regressão de Poisson mostrou que a prevalência de piora clínica foi maior com a idade, obesidade, febre e dispneia. Conclusão: A piora clínica ocorreu em 3,4% dos casos e foi mais prevalente conforme idade, obesidade, febre e dispneia. O acompanhamento mostrou-se promissor na detecção precoce e no tratamento da COVID-19 (AU).

The impact of the COVID-19 pandemic on sleep disorders among Nursing professionals / O impacto da pandemia de COVID-19 nas alterações do sono de profissionais de enfermagem / Impacto de la pandemia de COVID-19 en los trastornos del sueño de profesionales de enfermería

Abstract Objective: to analyze the factors related to sleep disorders reported by Nursing professionals during the COVID-19 pandemic. Method: this is a cross-sectional and analytical study conducted with Nursing professionals from all Brazilian regions. Sociodemographic data, working conditions and questions about sleep disorders were collected. The Poisson regression model with repeated measures was used to estimate the Relative Risk. Results: 572 answers were analyzed, which revealed that non-ideal sleep duration, poor sleep quality and dreams about the work environment were predominant during the pandemic, with 75.2%, 67.1% and 66.8% respectively; as well as complaints of difficulty sleeping, daytime sleepiness and non-restorative sleep during the pandemic were reported by 523 (91.4%), 440 (76.9%) and 419 (73.2%) of the Nursing professionals, respectively. The relative risk of having such sleep disorders during the pandemic was significant for all variables and categories studied. Conclusion: non-ideal sleep duration, poor sleep quality, dreams about the work environment, complaints regarding difficulty sleeping, daytime sleepiness and non-restorative sleep were the predominant sleep disorders among Nursing professionals during the pandemic. Such findings point to possible consequences on health, as well as on the quality of the work performed.

Resumo Objetivo: analisar os fatores relacionados às alterações no sono relatadas pelos profissionais de enfermagem durante a pandemia de COVID-19. Método: trata-se de um estudo transversal e analítico, realizado com profissionais de enfermagem de todas as regiões do Brasil. Foram coletados dados de caracterização sociodemográfica, condições de trabalho e questões sobre alterações de sono. Para estimar o Risco Relativo foi utilizado o modelo de regressão de Poisson com medidas repetidas. Resultados: foram analisadas 572 respostas, as quais revelaram que a duração não ideal do sono, a má qualidade do sono e os sonhos com o ambiente de trabalho foram predominantes durante a pandemia, com 75,2%, 67,1% e 66,8% respectivamente, assim como as queixas de dificuldade ao dormir, sonolência diurna e sono não restaurador durante a pandemia foram relatadas por 523 (91,4%), 440 (76,9%) e 419 (73,2%) dos profissionais de enfermagem, respectivamente. O risco relativo de apresentar tais alterações de sono, durante a pandemia foi significativo para todas as variáveis e as categorias estudadas. Conclusão: duração não ideal do sono, má qualidade do sono, sonhos com o ambiente de trabalho, queixas de dificuldade ao dormir, sonolência diurna e sono não restaurador foram as alterações do sono predominantes entre os profissionais de enfermagem durante a pandemia. Estes achados apontam para possíveis consequências na saúde, bem como na qualidade do trabalho realizado.

Resumen Objetivo: analizar los factores relacionados con los trastornos del sueño que informaron los profesionales de enfermería durante la pandemia de COVID-19. Método: se trata de un estudio transversal y analítico realizado con profesionales de enfermería de todas las regiones de Brasil. Se recolectaron datos sobre caracterización sociodemográfica, condiciones de trabajo y preguntas sobre trastornos del sueño. Para estimar el Riesgo Relativo se utilizó el modelo de regresión de Poisson con medidas repetidas. Resultados: se analizaron 572 respuestas, que revelaron que durante la pandemia predominaron la duración del sueño no ideal, la mala calidad del sueño y los sueños sobre el ambiente laboral, con 75,2%, 67,1% y 66,8% respectivamente, además 523 (91,4%), 440 (76,9%) y 419 (73,2%) profesionales de enfermería manifestaron quejas de dificultad para conciliar el sueño, somnolencia diurna y sueño no reparador durante la pandemia, respectivamente. El riesgo relativo de padecer trastornos del sueño durante la pandemia fue significativo para todas las variables y categorías estudiadas. Conclusión: la duración del sueño no ideal, la mala calidad del sueño, los sueños sobre el ambiente laboral, las quejas de dificultad para conciliar el sueño, la somnolencia diurna y el sueño no reparador fueron los trastornos del sueño predominantes en los profesionales de enfermería durante la pandemia. Estos hallazgos indican posibles consecuencias para la salud, así como para la calidad del trabajo realizado.

Quality of measurement properties of medication adherence instruments in cardiovascular diseases and type 2 diabetes mellitus: a systematic review and meta-analysis.

BACKGROUND: Medication adherence has a major impact on reducing mortality and healthcare costs related to the treatment of cardiovascular diseases and diabetes mellitus. Selecting the best patient-reported outcome measure (PROM) among the many available for this kind of patient is extremely important. This study aims to critically assess, compare and synthesize the quality of the measurement properties of patient-reported outcome measures to assess medication adherence among patients with cardiovascular diseases and/or type 2 diabetes mellitus. METHODS: This review followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The searches were performed in Web of Science, SCOPUS, PubMed, CINAHL, EMBASE, LILACS, PsycINFO, and ProQuest (gray literature). RESULTS: A total of 110 records encompassing 27 different PROMs were included in the review. The included records were published between 1986 and 2023, most of which reported studies conducted in the United States and were published in English. None of the PROMs were classified in the category "a", thus being recommended for use due to the quality of its measurement properties. The PROMs that should not be recommended for use (category "c") are the MTA, GMAS, DMAS-7, MALMAS, ARMS-D, and 5-item questionnaire. The remaining PROMs, e.g., MMAS-8, SMAQ, MEDS, MNPS, ARMS-12, MGT, MTA-OA, MTA-Insulin, LMAS-14, MARS-5, A-14, ARMS-10, IADMAS, MAQ, MMAS-5, ProMAS, ARMS-7, 3-item questionnaire, AS, 12-item questionnaire, and Mascard were considered as having the potential to be recommended for use (category "b"). CONCLUSION: None of the included PROMs met the criteria for being classified as trusted and recommended for use for patients with cardiovascular diseases and/or type 2 diabetes mellitus. However, 21 PROMs have the potential to be recommended for use, but further studies are needed to ensure their quality based on the COSMIN guideline for systematic reviews of PROMs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019129109.

The impact of the COVID-19 pandemic on sleep disorders among Nursing professionals.

OBJECTIVE: to analyze the factors related to sleep disorders reported by Nursing professionals during the COVID-19 pandemic. METHOD: this is a cross-sectional and analytical study conducted with Nursing professionals from all Brazilian regions. Sociodemographic data, working conditions and questions about sleep disorders were collected. The Poisson regression model with repeated measures was used to estimate the Relative Risk. RESULTS: 572 answers were analyzed, which revealed that non-ideal sleep duration, poor sleep quality and dreams about the work environment were predominant during the pandemic, with 75.2%, 67.1% and 66.8% respectively; as well as complaints of difficulty sleeping, daytime sleepiness and non-restorative sleep during the pandemic were reported by 523 (91.4%), 440 (76.9%) and 419 (73.2%) of the Nursing professionals, respectively. The relative risk of having such sleep disorders during the pandemic was significant for all variables and categories studied. CONCLUSION: non-ideal sleep duration, poor sleep quality, dreams about the work environment, complaints regarding difficulty sleeping, daytime sleepiness and non-restorative sleep were the predominant sleep disorders among Nursing professionals during the pandemic. Such findings point to possible consequences on health, as well as on the quality of the work performed.

Sleep and Professional Burnout in Nurses, Nursing Technicians, and Nursing Assistants During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic may trigger sleep disorders and burnout in nursing professionals. PURPOSE: This study was designed to describe the occurrence of sleep disorders and burnout in a nursing team during the COVID-19 pandemic and to identify the associated factors. METHODS: A cross-sectional approach was used. The questionnaire was administered via the Internet. All of the participants were nursing professionals who had provided care during the COVID-19 pandemic, and data were collected between June and August 2020. Sociodemographic and work characterization instruments, the Jenkins Sleep Scale, and the Maslach Burnout Inventory were used. RESULTS: Five hundred seventy-two nursing professionals (nurses, nursing technicians, and nursing assistants) responded. Slightly over one quarter (26.4%) presented a sleep disorder, and 17.3% presented burnout. Professional category was a factor found to be associated with having a sleep disorder. Moreover, a lower prevalence both of disorders and of starting to use sleep medication was found among nurses than nursing assistants. Moreover, an association was found between having a high level of emotional exhaustion burnout and being a nursing technician, having a higher number of patients needing care, and starting to use sleep medication. The level of burnout related to depersonalization was significantly higher for nursing assistants, those with a weekly workload of 50 hours or more, and those starting to use sleep medication. Furthermore, burnout related to personal accomplishment was significantly higher in those starting to use sleep medication. Among the participants with sleep disorders, according to Jenkins Sleep Scale results, all of the participants presented a high or moderate level of emotional exhaustion and a high level of burnout related to personal accomplishment. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings indicate that the incidence of sleep disorders and burnout were high among nursing professionals during the COVID-19 pandemic and mainly related with starting to use sleep medication. The results demonstrate the importance of detecting and assessing the frequency of sleep disorders and professional exhaustion. Interventions that aim to improve sleep quality and working conditions for these professionals should be developed.

Quality of life of nurse practitioners during the COVID-19 pandemic / Calidad de vida de los profesionales de enfermería durante la pandemia del COVID-19 / Qualidade de vida dos profissionais de enfermagem durante a pandemia de COVID-19

ABSTRACT Objective: to assess the quality of life of nurse practitioners during the COVID-19 pandemic and analyze related factors. Methods: cross-sectional and analytical study carried out with nurse practitioners. A questionnaire on sociodemographic characterization, work activities and changes perceived with the pandemic and WHOQOL-bref were used. To compare the groups of interest, analysis of covariance was used. Results: 572 professionals participated, who had a mean total quality of life score of 56.79 (SD=13.56). In the relationship of variables with WHOQOL-bref, having two or more jobs and being a nurse were associated with better quality of life, but being a woman and working more than 50 hours a week was associated with a worse perception of the construct. Conclusions: the factors analyzed indicate a lower perception of quality of life associated with the social domain, requiring interventions that reduce the damage to professionals' health and contribute to quality of care provided.

RESUMEN Objetivo: evaluar la calidad de vida de los profesionales de enfermería durante la pandemia del COVID-19 y analizar los factores relacionados. Métodos: estudio transversal y analítico realizado con profesionales de enfermería. Se utilizó un cuestionario sobre caracterización sociodemográfica, actividades laborales y cambios percibidos con la pandemia y WHOQOL-bref. Para comparar los grupos de interés se utilizó el análisis de covarianza. Resultados: participaron 572 profesionales, quienes tuvieron una puntuación media de calidad de vida total de 56,79 (DE=13,56). En la relación de las variables con el WHOQOL-bref, tener dos o más trabajos y ser enfermera se asociaron a una mejor calidad de vida, pero ser mujer y trabajar más de 50 horas semanales se asoció a una peor percepción del constructo. Conclusiones: los factores analizados indican una menor percepción de la calidad de vida asociada al dominio social, requiriendo intervenciones que reduzcan el daño a la salud de los profesionales y contribuyan a la calidad de la atención brindada.

RESUMO Objetivo: avaliar a qualidade de vida dos profissionais de enfermagem durante a pandemia de COVID-19 e analisar os fatores relacionados. Métodos: estudo transversal e analítico, realizado com profissionais de enfermagem. Utilizaram-se questionário de caracterização sociodemográfica, atividades do trabalho e mudanças percebidas com a pandemia e WHOQOL-bref. Para comparar os grupos de interesse, adotou-se a análise de covariância. Resultados: participaram 572 profissionais, os quais apresentaram escore total médio de qualidade de vida de 56,79 (DP=13,56). Na relação das variáveis com o WHOQOL-bref, ter dois ou mais vínculos de trabalho e ser enfermeiro estavam associados à melhor qualidade de vida, mas ser mulher e cumprir carga horária superior a 50 horas semanais associou-se à pior percepção do construto. Conclusões: os fatores analisados indicam menor percepção de qualidade de vida associados ao domínio social, sendo necessárias intervenções que reduzam os prejuízos à saúde dos profissionais e contribuam com a qualidade da assistência oferecida.

Quality of life of nurse practitioners during the COVID-19 pandemic.

OBJECTIVE: to assess the quality of life of nurse practitioners during the COVID-19 pandemic and analyze related factors. METHODS: cross-sectional and analytical study carried out with nurse practitioners. A questionnaire on sociodemographic characterization, work activities and changes perceived with the pandemic and WHOQOL-bref were used. To compare the groups of interest, analysis of covariance was used. RESULTS: 572 professionals participated, who had a mean total quality of life score of 56.79 (SD=13.56). In the relationship of variables with WHOQOL-bref, having two or more jobs and being a nurse were associated with better quality of life, but being a woman and working more than 50 hours a week was associated with a worse perception of the construct. CONCLUSIONS: the factors analyzed indicate a lower perception of quality of life associated with the social domain, requiring interventions that reduce the damage to professionals' health and contribute to quality of care provided.

Psychometric properties of medication adherence instruments in cardiovascular diseases and type 2 diabetes mellitus: systematic review protocol.

BACKGROUND: The pharmacological treatment of cardiovascular diseases and type 2 diabetes mellitus reduces the risk of cardiovascular events.; however, most patients do not adhere to the treatment. There are several self-reported measures for assessing medication adherence. Identifying the instruments with the best psychometric evidence is essential for selecting an accurate measure. The aim of this study is to critically assess, compare and synthesize the quality of the measurement properties of patient-reported outcome measures to access medication adherence among patients with cardiovascular diseases and/or type 2 diabetes mellitus. METHODS: This protocol is reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. The following databases will be searched: Web of Science, SCOPUS, PubMed, CINAHL, EMBASE, LILACS, PsycINFO and ProQuest. DISCUSSION: This review will provide a detailed assessment of the measurement properties of self-reported medication adherence instruments in patients with cardiovascular diseases and/or type 2 diabetes mellitus to support clinical practice and research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019129109.

Is napping related with health-related behaviors and sleep habits among adolescents? A population-based study.

INTRODUCTION: Changes in sleep quality and quantity occur in adolescence and can lead to the compensatory behavior of daytime napping. OBJECTIVE: Analyze factors related to napping in adolescents. METHODS: A population-based cross-sectional study was conducted with 1022 adolescents who participated in the 2014-2015 Health Survey of the city of Campinas, state of São Paulo, Brazil. Napping was the dependent variable. Sociodemographic characteristics, living habits, health-related behaviors, feelings of loneliness, satisfaction with life and nocturnal sleep habits were the independent variables. Data analysis was performed using Rao-Scott chi-square test, unpaired Student's t-test and Poisson regression analysis; p < 0.05 was considered significant. The software STATA was used for analysis. RESULTS: Mean participant age was 14.6 years (SD: 2.7; range: 10 to 19 years). Males accounted for 50.9% of the sample and 55.7% had white skin color. A total of 40.5% reported napping. Napping was more common in females (p = 0.006), the 14-to-17-year-old age group (p = 0.002), those who took medications in the previous 15 days (p = 0.001), those who were insufficiently active (p = 0.036), those who reported little or no satisfaction with life (p = 0.008) and those who woke up in bad mood (p = 0.004). Adolescents who napped also reported shorter sleep during the week (p < 0.001) and a perceived greater need for sleep (p < 0.001). CONCLUSION: The prevalence of napping among the adolescents was independently associated with shorter average sleep, a perceived greater need for sleep than that obtained and waking up in a bad mood.

Is Sleep Quality Impaired and Is There Increased Risk of Obstructive Sleep Apnea Syndrome in Patients With Compensated Liver Cirrhosis?

As liver cirrhosis worsens, sleep pattern impairment and related complaints increase. The objective of this study was to identify the prevalence of poor sleep, excessive daytime sleepiness, and increased risk for obstructive sleep apnea syndrome in adults with Child-Pugh Class A liver cirrhosis; to investigate the association between poor sleep quality, daytime sleepiness, and risk for obstructive sleep apnea syndrome; and to verify the relationship between these 3 variables and clinical, laboratory, and sociodemographic data. A cross-sectional study was conducted with 100 individuals at the outpatient clinic of a university hospital in the interior of Sao Paulo, Brazil. Questionnaires were used in the form of interviews and consultation of medical records. There was a prevalence of 35.0% of poor sleep quality, 29.0% of excessive daytime sleepiness, and 38.0% of high risk for obstructive sleep apnea syndrome, as well as a significant association between high risk for obstructive sleep apnea syndrome and poor sleep quality. There was no significant association between laboratory variables and sleep quality, daytime sleepiness, and high risk for obstructive sleep apnea syndrome. There is a high prevalence of poor sleep, excessive sleepiness, and high risk for obstructive sleep apnea syndrome, and poor sleep quality is related to a high risk for obstructive sleep apnea syndrome among patients with compensated liver cirrhosis.

What methods have been used to estimate salt intake? A systematic review.

The relationship between salt intake and cardiovascular diseases is a contemporary scientific controversy, which has been attributed to the limits of the measures of salt intake used in the studies. Thus, this article sought to systematically review the literature on the methods used to estimate salt intake in different study designs. Of the 124 articles, 60.5% used only biochemical measures, 26.6% only self-report measures and 12.9% reported the combined use of both methods. The 24-hour urinary sodium excretion was the predominant biochemical method (79.1%) and the Food Frequency Questionnaire was the predominant self-report measure (36.4%). Interventional studies used mostly 24-hour urinary sodium excretion; while longitudinal studies used self-report measures. The question guiding the study and its design, as well as constraints related to costs, sample size and feasibility seems to influence the choice of the type of measurement.

Cultural adaptation and evaluation of the measurement properties of the Berlin Questionnaire for Brazil.

OBJECTIVE: to produce the Brazilian version of the Berlin Questionnaire (BQ) with evidence of reliability and validity. METHOD: The cultural adaptation was carried out in the following stages: translation, synthesis of translations, back-translation, evaluation by an expert committee and pre-test with 30 participants. Next, the psychometric properties were evaluated with 104 participants who answered the Brazilian version of the BQ and underwent polysomnography (PSG). They also completed a sociodemographic and clinical characterization instrument and the Epworth Sleepiness Scale. Reliability was assessed concerning homogeneity of the items (internal consistency), and criterion validity was tested by comparing the Brazilian version of the BQ with the apnea and hypopnea index (AHI) obtained through PSG. RESULTS: The Brazilian version of the BQ presented evidence of semantic-idiomatic, conceptual and cultural equivalence, with good acceptability and feasibility. The findings demonstrated the reliability of the measure (Cronbach's alpha 0.74). The instrument presented a sensitivity of 81.3%, 86.2%, and 93.8%, and specificity of 82.5%, 54.7% and 50.0% for the risk stratification of obstructive sleep apnea according to the AHI ≥5, ≥15 and ≥ 30 events per hour, respectively. It should be emphasized that the BQ is a screening instrument for obstructive sleep apnea (OSA) and should be combined with a clinical evaluation and later confirmed with PSG. CONCLUSION: The Brazilian version of the Berlin Questionnaire was reliable and valid in the study population.

Napping, functional capacity and satisfaction with life in older adults: A population-based study.

AIM AND OBJECTIVE: To analyse the association between napping, functional capacity and satisfaction with life in older adult residing in the community. METHOD: A cross-sectional population-based study using data from a health survey conducted in a city of the state of São Paulo. Information on sociodemographic and clinical variables was collected through a questionnaire, as well as the occurrence or not of napping and satisfaction with life. Functional capacity was assessed using the Katz Index and Lawton-Brody Scale. Statistical analysis was performed using the Rao-Scott chi-square test and a hierarchical analysis using stepwise backward multiple Poisson regression. p-Values <0.05 were considered significant. In this paper, we adhere to STrengthening the Reporting of OBservational studies in Epidemiology guidelines. RESULTS: There was predominance of the 60-69 years age group (51.3%) and of females (60.8%). The majority of the older adults (57.5%), of both sexes, reported napping. A higher prevalence of napping was found in the older subjects, the male sex, the subjects without children, those with health problems and those that were partially dependent in instrumental activities of daily living. CONCLUSIONS: The study showed that naps are prevalent in older adults. The need to identify the issues that permeate napping is emphasised, in order to promote health in individuals of this age group, before classifying the practice as beneficial or harmful. RELEVANCE TO CLINICAL PRACTICE: It is essential that health professionals, in their practices, consider the complaints and reports of naps in the elderly, in an attempt to detect and reduce possible consequences in activities of daily living.

Sleep quality and adverse outcomes for patients with acute myocardial infarction.

AIMS AND OBJECTIVES: This study aimed to analyse the relationship between the worsening of clinical outcomes (cardiovascular death, recurrent cardiovascular ischaemic events and stroke) and sleep quality, daytime sleepiness and risk for obstructive sleep apnoea syndrome in patients admitted to cardiac care units due to an acute myocardial infarction. BACKGROUND: There is evidence that sleep disorders can contribute to the worsening of cardiovascular diseases. DESIGN: This is a descriptive study with follow-up. METHODS: Data collection was conducted in a large university hospital in Brazil from October 2013 to March 2014. Patients admitted with acute myocardial infarction provided data about sleep quality, daytime sleepiness and risk factors for obstructive sleep apnoea syndrome by answering specific questionnaires. Clinical data were obtained from medical charts. Data were analysed with descriptive statistics and multiple logistic regression models. RESULTS: The worsening of clinical outcome occurred in 12·4% of patients and was independently associated to poor sleep quality. CONCLUSION: Poor sleep quality, excessive daytime sleepiness and high risk for obstructive sleep apnoea syndrome were frequent in hospitalised patients with acute myocardial infarction and affect negatively the process of recovery. RELEVANCE TO CLINICAL PRACTICE: It is important to evaluate sleep quality and sleep disorders, aiming at preventing and reducing unfavourable outcomes of cardiovascular disease, particularly for acute myocardial infarction patients.

SLEEP QUALITY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION / CALIDAD DEL SUEÑO EN PACIENTES CON INFARTO AGUDO DE MIOCARDIO / QUALIDADE DO SONO EM PACIENTES COM INFARTO AGUDO DO MIOCÁRDIO

ABSTRACT The aim of this study was to describe sleep quality and to identify associated factors in patients hospitalized with acute myocardial infarction. A descriptive and cross-sectional study was conducted with 113 patients (70.8% men, mean age 59.7 years). An instrument was used for sociodemographic and clinical characterization and the Pittsburgh Sleep Quality Index. Results showed that 71.7% of participants had poor sleep quality and over 64% slept six hours or less per night. The presence of diabetes mellitus, depression, and absence of physical activity contributed to increase the final score of the Pittsburgh Sleep Quality Index in about 2.5 points for each variable. The identification of sleep quality and proposals of interventions to improve sleep quality must be included in the actions of nurses in order to reduce harm to patients' health before and after the acute myocardial infarction episode.

RESUMEN Este estudio tuvo como objetivo describir la calidad del sueño e identificar los factores asociados en pacientes hospitalizados por infarto agudo de miocardio. Estudio descriptivo transversal con 113 pacientes (hombres=70,8%; edad media=59,7 años). Se utilizó un instrumento para caracterización sociodemográfica y clínica y el Índice de Calidad de Sueño de Pittsburgh. El 71,7% de los participantes tenía sueño de mala calidad y más del 64% dormía seis horas o menos por noche. La presencia de diabetes mellitus y depresión y la ausencia de actividad física contribuyeron a aumentar el marcador final del Índice de Calidad de Sueño de Pittsburgh en aproximadamente 2,5 puntos en cada variable. La identificación de la calidad del sueño y propuestas de intervenciones para su mejora deben integrar las acciones de enfermeros para reducir el daño a la salud de los pacientes antes y después del episodio de infarto agudo de miocardio.

RESUMO Este estudo objetivou descrever a qualidade do sono e identificar fatores associados à mesma em pacientes hospitalizados devido a infarto agudo do miocárdio. Estudo descritivo e transversal em que participaram 113 pacientes (70,8% homens, média de idade 59,7). Utilizou-se um instrumento para caracterização sociodemográfica e clínica e o Índice de Qualidade do Sono de Pittsburgh. Verificou-se que 71,7% dos participantes tinham sono de má qualidade e que mais de 64% dormiam seis horas ou menos por noite. A presença de diabete melito, depressão e a ausência da prática de atividade física contribuíram para aumentar o escore final do Índice de Qualidade do Sono de Pittsburgh em cerca de 2,5 pontos para cada uma destas variáveis. Identificar a qualidade do sono e propor intervenções para sua melhora devem integrar as ações do enfermeiro visando à redução de prejuízos à saúde dos pacientes antes e após episódio de infarto agudo do miocárdio.

High risk for obstructive sleep apnea in patients with acute myocardial infarction.

OBJECTIVES: to stratify the risk for obstructive sleep apnea in patients with acute myocardial infarction, treated at a public, tertiary, teaching hospital of the state of São Paulo, Brazil, and to identify related sociodemographic and clinical factors. METHOD: cross-sectional analytical study with 113 patients (mean age 59.57 years, 70.8% male). A specific questionnaire was used for the sociodemographic and clinical characterization and the Berlin Questionnaire for the stratification of the risk of obstructive sleep apnea syndrome. RESULTS: the prevalence of high risk was 60.2% and the outcome of clinical worsening during hospitalization was more frequent among these patients. The factors related to high risk were body mass index over 30 kg/m2, arterial hypertension and waist circumference indicative of cardiovascular risk, while older age (60 years and over) constituted a protective factor. CONCLUSION: considering the high prevalence of obstructive sleep apnea and its relation to clinical worsening, it is suggested that nurses should monitor, in their clinical practice, people at high risk for this syndrome, guiding control measures of modifiable factors and aiming to prevent the associated complications, including worsening of cardiovascular diseases.

High risk for obstructive sleep apnea in patients with acute myocardial infarction / Alto risco para síndrome da apneia obstrutiva do sono em pacientes com infarto agudo do miocárdio / Alto riesgo para el síndrome de apnea obstructiva del sueño en pacientes con infarto agudo del miocardio

Objectives: to stratify the risk for obstructive sleep apnea in patients with acute myocardial infarction, treated at a public, tertiary, teaching hospital of the state of São Paulo, Brazil, and to identify related sociodemographic and clinical factors.Method: cross-sectional analytical study with 113 patients (mean age 59.57 years, 70.8% male). A specific questionnaire was used for the sociodemographic and clinical characterization and the Berlin Questionnaire for the stratification of the risk of obstructive sleep apnea syndrome.Results: the prevalence of high risk was 60.2% and the outcome of clinical worsening during hospitalization was more frequent among these patients. The factors related to high risk were body mass index over 30 kg/m2, arterial hypertension and waist circumference indicative of cardiovascular risk, while older age (60 years and over) constituted a protective factor.Conclusion: considering the high prevalence of obstructive sleep apnea and its relation to clinical worsening, it is suggested that nurses should monitor, in their clinical practice, people at high risk for this syndrome, guiding control measures of modifiable factors and aiming to prevent the associated complications, including worsening of cardiovascular diseases.

Objetivos: estratificar o risco para a síndrome da apneia obstrutiva do sono em pacientes com infarto agudo do miocárdio, atendidos em um hospital público, terciário e de ensino do Estado de São Paulo, Brasil, bem como identificar fatores sociodemográficos e clínicos relacionados.Método: estudo analítico transversal com 113 pacientes (média de idade 59,57 anos, 70,8% pertencentes ao sexo masculino). Utilizou-se questionário específico para caracterização sociodemográfica e clínica e o Questionário de Berlim para estratificação do risco da síndrome da apneia obstrutiva do sono.Resultados: a prevalência do alto risco foi de 60,2% e o desfecho de piora clínica na hospitalização foi mais frequente entre esses pacientes. Os fatores relacionados ao alto risco foram índice de massa corporal superior a 30kg/m2, hipertensão arterial e circunferência da cintura indicativa de risco cardiovascular, enquanto a idade mais avançada (60 anos ou mais) constituiu fator de proteção.Conclusão: considerando a elevada prevalência da síndrome da apneia obstrutiva do sono e a sua relação com piora clínica, sugere-se que o enfermeiro deve rastrear, na sua prática clínica, as pessoas com alto risco para essa síndrome, orientando medidas de controle dos fatores modificáveis e visando prevenir complicações associadas à mesma, entre elas o agravamento de doenças cardiovasculares.

Objetivos: estratificar el riesgo para el síndrome de apnea obstructiva del sueño, en pacientes con infarto agudo del miocardio, atendidos en un hospital público, terciario y de enseñanza del Estado de Sao Paulo, en Brasil, así como identificar factores sociodemográficos y clínicos relacionados.Método: estudio analítico transversal con 113 pacientes (promedio de edad 59,57 años, 70,8% pertenecientes al género masculino). Se utilizó un cuestionario específico para caracterización sociodemográfica y para la estratificación del riesgo del síndrome de apnea obstructiva del sueño clínica el Cuestionario de Berlín.Resultados: la prevalencia del alto riesgo fue de 60,2% y el resultado de empeoramiento clínico en la hospitalización fue más frecuente entre esos pacientes. Los factores relacionados al alto riesgo fueron: índice de masa corporal superior a 30kg/m2, hipertensión arterial y circunferencia de la cintura indicativa de riesgo cardiovascular; la edad más avanzada (60 años o más) constituyó un factor de protección.Conclusión: considerando la elevada prevalencia del síndrome de apnea obstructiva del sueño y su relación con el empeoramiento clínico, se sugiere que el enfermero debe rastrear, en su práctica clínica, a las personas con alto riesgo para ese síndrome, orientándolos a tomar medidas de control de los factores modificables y objetivando prevenir complicaciones asociadas a este síntoma, entre ellas el agravamiento de enfermedades cardiovasculares.

Excessive daytime sleepiness in patients with acute myocardial infarction / Sonolência diurna excessiva nos pacientes com infarto agudo do miocárdio

Objective:To characterize daytime sleepiness in patients with acute myocardial infarction and identify the sociodemographic and clinical characteristics associated with excessive daytime sleepiness in these patients.Methods:A cross-sectional study with 113 patients (mean age of 59.7 years; 70.8% male), in which were used an instrument for the sociodemographic and clinical characterization, and the Epworth Sleepiness Scale.Results:Excessive daytime sleepiness was identified in 33 patients (29.2%). Those with a body mass index above 30 kg/m2 and those who progressed to clinical worsening obtained a higher score in the Epworth Sleepiness Scale, compared to those with a body mass index less than 30 kg/m2 and clinical improvement. The patients aged 60 years or more, those separated, and with body mass index greater than 30 kg/m2 were more likely to mention excessive daytime sleepiness.Conclusion:Identifying individuals with excessive daytime sleepiness should be part of the routine work of nurses for the prevention of cardiovascular diseases.

Objetivos: Caracterizar a sonolência diurna em pacientes com infarto agudo do miocárdio e identificar as características sociodemográficas e clínicas associadas à sonolência diurna excessiva nesses pacientes. Métodos: Estudo transversal com 113 pacientes (média de idade 59,7; 70,8% sexo masculino). Utilizou-se um instrumento para caracterização sociodemográfica e clínica e a Escala de Sonolência de Epworth. Resultados: A sonolência diurna excessiva foi identificada em 33 pacientes (29,2%). Aqueles com índice de massa corporal acima de 30kg/m2 e aqueles que evoluíram com piora clínica obtiveram escore superior na Escala de Sonolência Epworth, comparados àqueles com índice de massa corporal inferior a 30kg/m2 e melhora clínica. Os pacientes com 60 anos ou mais, os separados e aqueles com índice de massa corporal superior a 30kg/m2 apresentaram chances maiores de referir sonolência diurna excessiva. Conclusão: Identificar indivíduos com sonolência diurna excessiva deve constituir parte da atuação rotineira do enfermeiro visando à prevenção das doenças cardiovasculares.