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1.
PLoS One ; 19(9): e0309984, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39231170

RESUMO

BACKGROUND: Benzodiazepines are frequently prescribed to treat anxiety and insomnia, but long-term use has been associated with the development of dependence, tolerance, and cognitive decline, especially among older adults. This study aimed to investigate the pattern of consumption and factors associated with inappropriate prescribing of benzodiazepines in primary health care. METHODS: This is a cross-sectional analytical study, using dispensing records of diazepam, clonazepam, and nitrazepam from public pharmacies in a Brazilian municipality between 2018 and 2022. Metrics for benzodiazepine consumption were DDD (Defined Daily Dose) and DDD/1000PD (per 1000 population per day). Long-term/prolonged benzodiazepine use was defined as consuming at least 90 DDD and at least 2 dispensations per year. To ascertain associations between long-term use and predictor variables, a multivariate logistic regression model was utilized. FINDINGS: A total of 40402 participants were included, with an average age of 55 years (SD = 0.30), 38.5% were older aged. Diazepam and nitrazepam exceeded the daily dose recommended. There was a reduction in diazepam consumption during the study period, as calculated by DDD/1.000PD, while the consumption of other benzodiazepines remained stable. However, a significant increase in diazepam consumption is noted when considering the last decade. Prolonged use was observed in 29.1% of participants, with a significant prevalence among the older people (34.8% of them were long-term users) and advancing age was identified as a risk factor for long-term use. Higher PDDs were also associated with long-term use and aging. Participants who used different benzodiazepines during the period had a higher risk of prolonged use. CONCLUSIONS: These results provide insights into the prevalence of problematic utilization of benzodiazepines in primary health care. Authorities and health care providers must take steps to encourage gradual cessation of prolonged benzodiazepine prescriptions and the embrace of suitable strategies for addressing anxiety and insomnia within primary health care settings.


Assuntos
Benzodiazepinas , Prescrição Inadequada , Atenção Primária à Saúde , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Benzodiazepinas/uso terapêutico , Benzodiazepinas/efeitos adversos , Benzodiazepinas/administração & dosagem , Prescrição Inadequada/estatística & dados numéricos , Estudos Transversais , Idoso , Brasil , Adulto , Diazepam/uso terapêutico , Diazepam/efeitos adversos , Diazepam/administração & dosagem , Nitrazepam/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Clonazepam/uso terapêutico , Clonazepam/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/epidemiologia
2.
J Clin Psychiatry ; 85(4)2024 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-39265056

RESUMO

Background: Insomnia is a common sleep disorder, associated with multiple health concerns. Current medications for insomnia are associated with higher safety risks if clinical practice guidelines or monograph recommendations are not followed. This study aims to understand real-world prescribing practices among patients with insomnia in Canada, including medication utilization, potentially inappropriate medication use, cost incurred, and lines of treatment.Methods: This retrospective observational study utilized longitudinal drug claims data from 2018 to 2020 from the Canadian IQVIA National Private Drug Plan and Ontario Drug Benefit databases. Patients with any claims for medications approved for insomnia in Canada were identified. Four types of inappropriate medication usage were defined: (1) elevated daily dose; (2) extended duration of use for benzodiazepines (BZD) and/or Z-drugs; (3) combination use; and (4) opioid overlap with BZD and/or Z-drugs.Results: In 2019, 597,222 patients with insomnia were identified; 64% were female, with an average age of 55 years. Inappropriate medication use was noted in 52.5% of adult patients (aged 18-65 years) and 69.5% of senior patients (aged >65 years). Extended duration was the most common inappropriate medication usage category. The annual cost of medications for insomnia was $54.8 million, and $30.3 million (55.2%) met inappropriate medication use criteria.Conclusion: High prevalence of inappropriate medications usage in insomnia raises serious safety concerns for patients suffering from insomnia, particularly seniors, while also placing a substantial burden on the Canadian public and private health systems. This highlights an unmet need for better education regarding current guidelines and more effective and safer treatment options.


Assuntos
Prescrição Inadequada , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto , Idoso , Adolescente , Adulto Jovem , Prescrição Inadequada/estatística & dados numéricos , Canadá , Benzodiazepinas/uso terapêutico , Benzodiazepinas/economia , Uso de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Hipnóticos e Sedativos/uso terapêutico , Hipnóticos e Sedativos/economia
3.
Sleep Med ; 123: 42-48, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39236464

RESUMO

BACKGROUND: Chronic insomnia disorder (CID) is commonly associated with mood disorders. The cingulate gyrus (CG) plays a critical role in the pathophysiology of CID and anxiety. However, the specific characteristics of altered brain networks in the CG in CID with anxiety remain unclear. This study aimed to investigate the characteristics of CG functional connectivity (FC) in CID with and without anxiety. METHODS: Resting-state functional magnetic resonance imaging was conducted on 92 CID and 36 healthy controls (HC). CID was divided into CID with anxiety (CID-A, N = 37) and CID without anxiety (CID-NA, N = 55) groups based on anxiety scores. Using the Human Brainnetome Atlas, the subregion CG FC network was constructed. RESULTS: Compared with HC, CID showed significantly decreased CG FC with the precuneus, middle frontal gyrus (MFG), and hippocampus, while showing significantly increased CG FC with the middle temporal gyrus (MTG)/superior temporal gyrus (STG). In contrast, CID-A showed significantly decreased CG FC with the salience network (insular, putamen) and default mode network (MTG/STG and inferior parietal lobule), while showing significantly increased CG FC with the thalamus and MFG compared to CID-NA. Further, CID-A and CID-NA could be classified with 84.21 % accuracy by using the CG FCs as features. Among these features, the CG FC with MFG, thalamus, and putamen had the highest contribution weights. CONCLUSION: This study revealed specific changes in the brain network of the CG subregion in CID-A. Understanding these CG FC alterations can help identify potential biomarkers specific to CID-A, which may be valuable for early detection and differentiation from other CID subtypes.


Assuntos
Giro do Cíngulo , Imageamento por Ressonância Magnética , Distúrbios do Início e da Manutenção do Sono , Humanos , Masculino , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/diagnóstico por imagem , Feminino , Giro do Cíngulo/fisiopatologia , Giro do Cíngulo/diagnóstico por imagem , Adulto , Ansiedade/fisiopatologia , Pessoa de Meia-Idade , Vias Neurais/fisiopatologia , Mapeamento Encefálico/métodos , Rede Nervosa/fisiopatologia , Rede Nervosa/diagnóstico por imagem
4.
Sleep Med ; 123: 37-41, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39236463

RESUMO

INTRODUCTION: COVID-19 infection has resulted in a high prevalence of a post-infectious syndrome, known as post-acute sequelae of SARS-CoV-2 (PASC) or "Long COVID". PASC is a heterogeneous disease with a high prevalence of sleep disturbances, varying from an insomnia disorder to excessive daytime sleepiness. METHODS: Patients seen in the Covid Survivorship Program at the Beth Israel Deaconess Medical Center Boston, USA, were screened for sleep disorders as part of a comprehensive multi-system evaluation. Those who screened positive were referred for a comprehensive sleep evaluation in a dedicated COVID-19-Sleep clinic, followed by diagnostic sleep testing and treatment. This report summarizes patients who completed an American Academy of Sleep Medicine (AASM) accredited facility-based diagnostic evaluation. International Classification of Sleep Disorders 3rd Edition-Revised criteria were met for all diagnoses. RESULTS: In 42 patients with PASC, five categories of sleep disorder syndromes were observed following a sleep clinic evaluation, including obstructive sleep apnea, chronic insomnia disorder, primary hypersomnia, REM behavior disorder (RBD), and new onset circadian phase delay. Seven patients met criteria for idiopathic hypersomnia, and two had narcolepsy type 2. RBD patients were infected in three different waves; circadian disturbance patients were all infected in the winter wave of 2020/21, and the primary hypersomnolence group occurred during all waves, predominantly the initial wave of 2020. A peculiar form of insomnia was a persistent loss of sleep regularity. CONCLUSIONS: Specific sleep symptoms/syndromes are reported in this select group of patients with PASC/Long Covid. As new onset sleep complaints are prevalent in PASC, we recommend a complete clinical and investigative sleep evaluation for persistent severe sleep symptoms following COVID-19 infection.


Assuntos
COVID-19 , Síndrome de COVID-19 Pós-Aguda , Transtornos do Sono-Vigília , Humanos , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/diagnóstico , Adulto , Idoso , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , SARS-CoV-2 , Distúrbios do Sono por Sonolência Excessiva/etiologia , Distúrbios do Sono por Sonolência Excessiva/diagnóstico
5.
Sleep Med ; 123: 49-53, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39241463

RESUMO

OBJECTIVE/BACKGROUND: Insomnia is common in children with autism spectrum disorder (ASD). We recently developed and validated the 21-item Pediatric Autism Insomnia Rating Scale (PAIRS). This report explores the associations and agreements between actigraphy and PAIRS. PARTICIPANTS METHODS: Children with ASD, with and without sleep problems, were assessed with a battery of parent-rated and clinician measures (N = 134). In a subset (n = 70), a wrist-worn actigraph measured sleep for five consecutive nights. Parents completed logs for scoring sleep intervals. Spearman correlations evaluated associations with the PAIRS and actigraphy indices (sleep onset latency = SOL, wake after sleep onset = WASO, total sleep time = TST, sleep efficiency = SE%). Agreements on "poor sleepers" based on PAIRS total score (≥33) and conventional thresholds for TST and SE% were evaluated with Cohen's Kappa and McNemar's test. RESULTS: Actigraphy data were averaged over 4.64 ± 0.68 nights in 70 children (mean age = 7.3 ± 2.9, 74.3 % male). There were no significant correlations between PAIRS and any actigraphy indices. On TST, 48.6 % (n = 34) and on SE% 52.9 % (n = 37) were classified as "poor sleepers" compared to 32.9 % (n = 23) on PAIRS (kappa = 0.11 for TST and 0.27 for SE%). P-values on McNemar's Chi square test for PAIRS with TST and with SE% were 0.072 and 0.011, respectfully. CONCLUSIONS: These results suggest that actigraphy and PAIRS do not agree. Actigraphy TST captures movement and an estimate of specific sleep parameters. PAIRS is a broader measure that incorporates sleep disturbance and sleep-related impairment.


Assuntos
Actigrafia , Transtorno do Espectro Autista , Distúrbios do Início e da Manutenção do Sono , Humanos , Actigrafia/métodos , Masculino , Feminino , Criança , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/diagnóstico , Pré-Escolar , Reprodutibilidade dos Testes
6.
BMC Public Health ; 24(1): 2385, 2024 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-39223477

RESUMO

AIMS: Insomnia is a common complaint among older adults. However, the comparative prevalence between older adults living in urban versus rural areas remains under-researched. This study aims to validate the overall prevalence of insomnia among older adults in Indonesia and investigate the comparative prevalence between older adults living in urban and rural areas. METHODS: The data were derived from the 2018 Indonesian Basic Health Research Study. We included a total of 93,830 older participants aged > 60 years old who completed the insomnia questions. The prevalence and regression models were analyzed using the SPSS software. RESULTS: The insomnia group has a higher age compared to the non-insomnia group (P < 0.05). Insomnia is more prevalent in females compared to males (P < 0.05). When classified by age groups (60-64, 65-69, 70-74, and > 75 years old), the prevalence of insomnia was 20%, 21%, 23%, and 24%, respectively. The prevalence of insomnia among older individuals living in rural areas was higher compared to those living in urban areas. In addition, increasing age, being female, unemployed, having comorbidities, being less active, and drinking alcohol are associated with insomnia symptoms. CONCLUSION: The findings of this study indicated that the prevalence of insomnia is high among older adults in Indonesia, with older adults living in rural areas exhibiting a higher prevalence compared to those living in urban areas. Our findings strengthen the importance of sleep management in clinical or community settings.


Assuntos
População Rural , Distúrbios do Início e da Manutenção do Sono , População Urbana , Humanos , Feminino , Masculino , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Idoso , Indonésia/epidemiologia , Prevalência , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Idoso de 80 Anos ou mais , Estudos Transversais
7.
Front Public Health ; 12: 1423216, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39267639

RESUMO

Introduction: Insomnia symptoms are prevalent among healthcare workers and represent a potential public health problem. However, there is currently insufficient evidence on insomnia symptoms among doctors and nurses under the context of high prevalence of multiple infectious diseases after the pandemic in China. The purpose of this study was to analyze the prevalence of insomnia symptoms among doctors and nurses in third-grade class-A general hospitals under the context of high prevalence of multiple infectious diseases, and to explore the influence of demographic characteristics, work-related factors, health and lifestyle-related factors on insomnia symptoms. Methods: An institution-based cross-sectional survey was conducted among doctors and nurses in two third-grade class-A general hospitals. A structured questionnaire was used to collect information on demographic characteristics, work-related factors, health and lifestyle-related factors, and insomnia symptoms among doctors and nurses. Multivariate logistics regression analysis was applied to identify factors significantly associated with insomnia symptoms among doctors and nurses, respectively. Results: A total of 1,004 participants were included in this study, including 503 doctors and 501 nurses. The prevalence of insomnia symptoms in doctors and nurses was 47.7 and 51.3%, respectively. Multivariate logistics regression analysis showed that workplace violence (OR: 1.631, 95% CI: 1.050-2.532), doctor-patient relationship (OR: 1.603, 95% CI: 1.049-2.450), chronic pain (OR: 4.134, 95% CI: 2.579-6.625), chronic disease (OR: 1.825, 95% CI: 1.164-2.861), and anxiety symptoms (OR: 2.273, 95% CI: 1.357-3.807) were associated factors with insomnia symptoms in doctors. Education (OR: 0.301, 95% CI: 0.106-0.851), service years (OR: 1.978, 95% CI: 1.304-3.002), weekly working hours (OR: 1.694, 95% CI: 1.061-2.705), chronic pain (OR: 5.359, 95% CI: 3.241-8.860), and anxiety symptoms (OR: 2.472, 95% CI: 1.478-4.136) were associated factors with insomnia symptoms in nurses. Conclusion: The prevalence of insomnia symptoms among doctors and nurses was high, and affected by many factors. This information can inform tailored interventions to insomnia symptoms by doctors and nurses who play an important role in public health.


Assuntos
Enfermeiras e Enfermeiros , Médicos , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Estudos Transversais , Masculino , Feminino , Adulto , Prevalência , China/epidemiologia , Inquéritos e Questionários , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Médicos/estatística & dados numéricos , Fatores de Risco , Doenças Transmissíveis/epidemiologia
8.
Transl Psychiatry ; 14(1): 374, 2024 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-39277609

RESUMO

Insomnia is highly comorbid in patients with psychiatric disorders, including depression, bipolar disorder, and substance use disorders, and should be treated as an independent condition. Dual orexin receptor antagonists (DORAs) have been investigated as a treatment for chronic insomnia. The objective of this systematic review was to examine evidence for two DORAs, lemborexant and suvorexant, as treatments for insomnia comorbid with a psychiatric disorder. We searched PubMed, Cochrane, and Embase from their inception until January and April 2023, and included studies examining suvorexant and lemborexant for treating insomnia comorbid with psychiatric disorders. We also manually searched clinical trial registries ( https://clinicaltrials.gov and https://www.umin.ac.jp/ctr ). Randomized clinical trials and observational/cohort studies were included. We identified 18 studies from PubMed, Cochrane, and Embase and three studies from clinicaltrials.gov and UMIN. Of the 21 reports, four were completed/terminated randomized clinical trials, eight were ongoing clinical trials, and nine were observational studies. We identified evidence for switching from benzodiazepine receptor agonists to a DORA, or using a DORA as add-on therapy and, therefore, discuss this topic as well. Two studies examined switching to or adding on a DORA in patients being treated with a benzodiazepine receptor agonist. DORAs may be as effective and safe for treating psychiatric comorbid insomnia (for most psychiatric conditions) as they are for treating primary insomnia. However, the evidence is limited to a few small studies. Further investigation of DORAs for the treatment of comorbid insomnia in those with coexisting psychiatric conditions is warranted.


Assuntos
Antagonistas dos Receptores de Orexina , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/complicações , Antagonistas dos Receptores de Orexina/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/complicações , Azepinas/uso terapêutico , Comorbidade , Triazóis/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Sci Data ; 11(1): 990, 2024 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-39261517

RESUMO

This data resource provides evidence concerning the prevalence of perceptual alterations of emotional faces amongst individuals experiencing symptoms of insomnia, anxiety, depression, mania, psychotic experiences, and schizotypal tendencies. More specifically, we explored the categorisation accuracy (whether the displayed emotion was correctly identified), misperception (which emotion an incorrect judgment was perceived to be), intensity (extent of the emotion signal strength) and emotional valence (the extent and direction of perceived affect) of six facial expressions of emotion from the Karolinska Directed Emotional Faces database. Complete data from N = 572 respondents are included. The dataset is available to other researchers and is provided on Figshare. Information concerning the data records, usage notes, code availability and technical validation are presented. Finally, we present demographic and correlational data concerning psychiatric symptoms and alterations in the perception of emotional faces.


Assuntos
Ansiedade , Depressão , Emoções , Expressão Facial , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/psicologia , Depressão/psicologia , Transtornos Psicóticos/psicologia , Mania/psicologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade
10.
JAMA Netw Open ; 7(9): e2434354, 2024 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-39292455

RESUMO

Importance: Cannabis is increasingly being used to treat medical symptoms, but the effects on brain function in those using cannabis for these symptoms are not known. Objective: To test whether 1 year of cannabis use for medical symptoms after obtaining a medical cannabis card was associated with increased brain activation during working memory, reward, and inhibitory control tasks, areas of cognition affected by cannabis. Design, Setting, and Participants: This cohort study was conducted from July 2017 to July 2020 among participants from the greater Boston area who were recruited as part of a clinical trial of individuals seeking medical cannabis cards for anxiety, depression, pain, or insomnia symptoms. Participants were aged between 18 and 65 years. Exclusion criteria were daily cannabis use and cannabis use disorder at baseline. Data analysis was conducted from August 2021 to April 2024. Main Outcomes and Measures: Outcomes were whole brain functional activation during tasks involving working memory, reward, and inhibitory control at baseline and after 1 year of medical cannabis card ownership. Results: Imaging was collected from participants before and 1 year after obtaining medical cannabis cards, with 57 participants at baseline (38 female [66.7%]; 6 [10.5%] Black and 45 [78.9%] White participants; 1 [1.8%] Hispanic participant; median [IQR] age, 34.0 [24.0-51.0] years) and 54 participants at 1 year (37 female [68.5%]; 4 [7.4%] Black and 48 [88.9%] White participants; 1 [1.9%] Hispanic participant, median [IQR] age, 36.5 [25.0-51.0] years). Imaging was also collected in 32 healthy control participants at baseline (22 female [68.8%]; 2 [6.2%] Black and 27 [84.4%] White participants; 3 [9.4%] Hispanic participants; median [IQR] age, 33.0 [24.8-38.2] years). In all groups and at both time points, functional imaging revealed canonical activations of the probed cognitive processes. No statistically significant difference in brain activation between the 2 time points (baseline and 1 year) in those with medical cannabis cards and no associations between changes in cannabis use frequency and brain activation after 1 year were found. Conclusions and Relevance: In this cohort study of adults obtaining medical cannabis cards for medical symptoms, no significant association between brain activation in the areas of cognition of working memory, reward, and inhibitory control and 1 year of cannabis use was observed. The results warrant further studies that probe the association of cannabis at higher doses, with greater frequency, in younger age groups, and with larger, more diverse cohorts.


Assuntos
Encéfalo , Cognição , Maconha Medicinal , Memória de Curto Prazo , Humanos , Feminino , Masculino , Adulto , Maconha Medicinal/uso terapêutico , Pessoa de Meia-Idade , Cognição/efeitos dos fármacos , Cognição/fisiologia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Encéfalo/efeitos dos fármacos , Memória de Curto Prazo/efeitos dos fármacos , Memória de Curto Prazo/fisiologia , Estudos de Coortes , Adulto Jovem , Ansiedade , Distúrbios do Início e da Manutenção do Sono , Depressão , Dor/fisiopatologia , Boston/epidemiologia , Recompensa , Adolescente
11.
Brain Behav ; 14(9): e70046, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39295101

RESUMO

OBJECTIVE: Some correlations between thyroid disorders and insomnia have been found in previous studies; however, the causal relationship between them is unclear. The aim of this study was to investigate the causal relationship between insomnia and five thyroid disorders (hyperthyroidism, hypothyroidism, thyroiditis, thyroid nodules, and thyroid cancer). METHODS: We assessed the causal relationship between insomnia and thyroid disorders using inverse variance weighted, weighted median, and Mendelian randomization (MR)-Egger analyses in MR analyses and then used inverse MR analyses to assess the causal relationship between thyroid disorders and insomnia. RESULTS: MR analysis showed that insomnia did not increase the risk of hyperthyroidism, hypothyroidism, thyroiditis, thyroid nodules, and thyroid cancer. However, reverse MR analysis showed that thyroid cancer increased the risk of insomnia (OR = 1.01, 95%CI: 1.00-1.02, p = .01), and the other four thyroid disorders had no direct causal relationship with insomnia. Sensitivity analyses indicated that the results were robust and no pleiotropy or heterogeneity was detected. CONCLUSION: This study did not find evidence of a bidirectional causal relationship between genetically predicted insomnia and hyperthyroidism, hypothyroidism, thyroiditis, and thyroid nodules. However, we found that although insomnia does not increase the risk of thyroid cancer, thyroid cancer does increase the risk of insomnia.


Assuntos
Análise da Randomização Mendeliana , Distúrbios do Início e da Manutenção do Sono , Doenças da Glândula Tireoide , Humanos , Distúrbios do Início e da Manutenção do Sono/genética , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Doenças da Glândula Tireoide/genética , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/complicações , Hipertireoidismo/genética , Hipertireoidismo/complicações , Hipertireoidismo/epidemiologia , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/epidemiologia , Hipotireoidismo/genética , Hipotireoidismo/epidemiologia , Nódulo da Glândula Tireoide/genética , Nódulo da Glândula Tireoide/epidemiologia
12.
Sci Rep ; 14(1): 21352, 2024 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-39266657

RESUMO

Poststroke aphasia hinders patients' emotional processing and social adaptation. This study estimated the risks of depression and related symptoms in patients developing or not developing aphasia after various types of stroke. Using data from the US Collaborative Network within the TriNetX Diamond Network, we conducted a retrospective cohort study of adults experiencing their first stroke between 2013 and 2022. Diagnoses were confirmed using corresponding International Classification of Diseases, Tenth Revision, Clinical Modification codes. Patients were stratified by poststroke aphasia status and stroke type, with propensity score matching performed to control for confounders. The primary outcome was depression within one year post-stroke; secondary outcomes included anxiety, fatigue, agitation, emotional impact, and insomnia. Each matched group comprised 12,333 patients. The risk of depression was significantly higher in patients with poststroke aphasia (hazard ratio: 1.728; 95% CI 1.464-2.038; p < 0.001), especially those with post-hemorrhagic-stroke aphasia (hazard ratio: 2.321; 95% CI 1.814-2.970; p < 0.001). Patients with poststroke aphasia also had higher risks of fatigue, agitation, and emotional impact. Anxiety and insomnia risks were higher in those with post-hemorrhagic-stroke aphasia. Poststroke aphasia, particularly post-hemorrhagic-stroke aphasia, may increase the risks of depression and associated symptoms, indicating the need for comprehensive psychiatric assessments.


Assuntos
Afasia , Depressão , Acidente Vascular Cerebral , Humanos , Feminino , Masculino , Afasia/etiologia , Depressão/etiologia , Depressão/complicações , Acidente Vascular Cerebral/complicações , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Ansiedade/etiologia , Fadiga/etiologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/complicações , Idoso de 80 Anos ou mais
13.
Nutrients ; 16(17)2024 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-39275260

RESUMO

Insomnia is a common sleep disorder that significantly impacts individuals' sleep quality and daily life. Recent studies have suggested that gut microbiota may influence sleep through various metabolic pathways. This study aims to explore the causal relationships between the abundance of gut microbiota metabolic pathways and insomnia using Mendelian randomization (MR) analysis. This two-sample MR study used genetic data from the OpenGWAS database (205 gut bacterial pathway abundance) and the FinnGen database (insomnia-related data). We identified single nucleotide polymorphisms (SNPs) associated with gut bacterial pathway abundance as instrumental variables (IVs) and ensured their validity through stringent selection criteria and quality control measures. The primary analysis employed the inverse variance-weighted (IVW) method, supplemented by other MR methods, to estimate causal effects. The MR analysis revealed significant positive causal effects of specific carbohydrate, amino acid, and nucleotide metabolism pathways on insomnia. Key pathways, such as gluconeogenesis pathway (GLUCONEO.PWY) and TCA cycle VII acetate producers (PWY.7254), showed positive associations with insomnia (B > 0, p < 0.05). Conversely, pathways like hexitol fermentation to lactate, formate, ethanol and acetate pathway (P461.PWY) exhibited negative causal effects (B < 0, p < 0.05). Multivariable MR analysis confirmed the independent causal effects of these pathways (p < 0.05). Sensitivity analyses indicated no significant pleiotropy or heterogeneity, ensuring the robustness of the results. This study identifies specific gut microbiota metabolic pathways that play critical roles in the development of insomnia. These findings provide new insights into the biological mechanisms underlying insomnia and suggest potential targets for therapeutic interventions. Future research should further validate these causal relationships and explore how modulating gut microbiota or its metabolic products can effectively improve insomnia symptoms, leading to more personalized and precise treatment strategies.


Assuntos
Microbioma Gastrointestinal , Análise da Randomização Mendeliana , Polimorfismo de Nucleotídeo Único , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/microbiologia , Distúrbios do Início e da Manutenção do Sono/metabolismo , Distúrbios do Início e da Manutenção do Sono/genética , Redes e Vias Metabólicas/genética
14.
Rev Assoc Med Bras (1992) ; 70(9): e20240180, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39292081

RESUMO

OBJECTIVE: The aim of the study was to determine the factors affecting poor sleep quality in the last trimester pregnant women. METHODS: A cross-sectional study was conducted at a tertiary care maternity hospital in Ankara, Turkey. The research was conducted between May and September 2019 with 570 pregnant women in the last trimester. The data were collected through the Personal Information Form, Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire Short Form, Restless Legs Syndrome Form, Brief Fatigue Inventory, and Perceived Stress Scale. RESULTS: The mean Pittsburgh Sleep Quality Index score of the pregnant women was 5.98±3.31, and 48.9% of them were found to have over five Pittsburgh Sleep Quality Index scores. Hemoglobin levels, income perceptions, smoking habits, attending pregnant schools, experiencing leg pains or cramping, experiencing back, waist, or neck pains, Restless Legs Syndrome, fatigue levels, and perceived stress levels of the pregnant women were found to be important determinants of sleep quality (p<0.05). CONCLUSION: According to the findings, increasing hemogram levels, attending antenatal education programs, and improving the ability of pregnant women to manage stress are opportunities to improve sleep quality during pregnancy. Careful evaluation of pregnant women in terms of insomnia and affecting factors can be suggested during antenatal follow-up.


Assuntos
Complicações na Gravidez , Terceiro Trimestre da Gravidez , Qualidade do Sono , Humanos , Feminino , Estudos Transversais , Gravidez , Turquia/epidemiologia , Adulto , Inquéritos e Questionários , Adulto Jovem , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília/epidemiologia , Fatores Socioeconômicos
15.
PLoS One ; 19(9): e0310849, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39298402

RESUMO

BACKGROUND: Older people are vulnerable to various psycho-social problems such as depression, anxiety, insomnia, dementia, and loneliness that have profound impact on overall health and their quality of life and higher use of health services. Prevention and treatment of psychological problems in this risk group is critical for improving their quality of life. OBJECTIVE: This study aimed to find out the psycho-social problems among older people residing in community. METHODS: The study was a cross-sectional study design and 388 older people aged 65 years and above residing in different wards of Bharatpur Metropolitan city were selected using probability simple random sampling technique. Data were collected using interview schedule containing geriatric depression scale-15; Geriatric anxiety scale-10, University of California Loss Angels Loneliness Scale (UCLA-20), Anthens Insomnia Scale and Mini-Cog Test. Obtained data were analyzed in SPSS version 20 for windows. Chi-square test was applied to measure the association between psychosocial problems and selected variables. RESULT: Findings of the study revealed that the mean age (± SD) of respondents was 72.92 (±7.12) years. Almost all (93.6%) older people had full functioning of activity of daily living and two third (66.5%) had other co-morbid conditions. More than two third (67.0%) of older adults had depression, 60.3% had anxiety, 53.6% had moderate to high level loneliness, 47.2% had insomnia, and 33.3% had dementia. Age, functional dependency, sex, co-morbidity, financial dependence, education and occupation were significantly associated with the psychosocial problems among older people. CONCLUSION AND RECOMMENDATION: Psychosocial problems are common among older people residing in community of Chitwan. Hence, there is need to develop and implement health care strategy by local health care planner to prevent, treat and manage the psychosocial problems among this risk groups. Further, health care providers working in geriatric problems or psychosocial health need to conduct regular screening programs for the early diagnosis and treatment of these problems.


Assuntos
Ansiedade , Depressão , Solidão , Qualidade de Vida , Humanos , Idoso , Masculino , Feminino , Estudos Transversais , Nepal/epidemiologia , Solidão/psicologia , Depressão/epidemiologia , Depressão/psicologia , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/psicologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Demência/epidemiologia , Demência/psicologia , Atividades Cotidianas
16.
BMJ Open ; 14(9): e079531, 2024 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-39260839

RESUMO

OBJECTIVES: This study explored the mechanisms by which physical activity was associated with depressive symptoms in multi-ethnic (Han, Yi and Tibetan) adolescents in southwest China. The mediating role of insomnia in the association of physical activity with depressive symptoms, the moderating role of resilience in this mediation model and the moderating role of parental absence in the moderated mediation model were also examined. DESIGN: A cross-sectional survey. SETTING: In southwest China (Sichuan Province and Tibet Autonomous Region). PARTICIPANTS: 3195 adolescents from a school-based survey conducted between April and October 2020. METHODS: There were 3143 valid samples in this study (47.2% males with mean age=12.88±1.68 years). Structural equation models were developed to estimate the direct and mediating effect, and the moderating effect. Multigroup comparison was performed to examine the differences and similarities of the moderated mediation model across three parental absence subgroups: (1) both parents present, (2) one parent absent and (3) both parents absent. RESULTS: As hypothesised, physical activity was significantly and positively associated with the reduction of depressive symptoms in adolescents. Insomnia partially mediated the effect of physical activity on depressive symptoms. In addition, resilience moderated the direct and indirect effects of physical activity (through insomnia) on depressive symptoms. Finally, the multigroup comparison indicated the moderating effect of parental absence on the moderated mediation model. CONCLUSIONS: Physical activity was associated with alleviating insomnia symptoms among adolescents, thus correlating with the improvement of their depressive symptoms. Resilience was associated with enhancing the beneficial effects of physical activity, further improving depressive symptoms among adolescents, especially those with both absent parents. It is evident that physical activity interventions should be further incorporated into public health programmes to foster the physical and mental health of left-behind adolescents in southwest China.


Assuntos
Depressão , Exercício Físico , Pais , Resiliência Psicológica , Distúrbios do Início e da Manutenção do Sono , Humanos , Masculino , Adolescente , Feminino , Distúrbios do Início e da Manutenção do Sono/psicologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , China/epidemiologia , Exercício Físico/psicologia , Pais/psicologia , Criança
17.
Medicine (Baltimore) ; 103(37): e39741, 2024 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-39287226

RESUMO

To investigate the causal relationship between sleep duration and heart failure (HF) in a European population. We focused on the continuous sleep duration of 460,099 European individuals as our primary exposure. Genome-wide significant single nucleotide polymorphisms (SNPs, n = 9851,867) linked to continuous sleep duration were adopted as instrumental variables. The outcome of interest was based on HF events in a European cohort (n = 977,323; with 930,014 controls and 47,309 cases). We employed a two-sample Mendelian randomization (MR) approach to infer causality between sleep duration and the incidence of HF. For validation purposes, an additional cohort of 336,965 European individuals diagnosed with insomnia was selected as a secondary exposure group. Using its SNPs, a subsequent two-sample MR analysis was conducted with the HF cohort to further corroborate our initial findings. Employing the MR methodology, we selected 57 SNPs that are associated with sleep duration, and 24 SNPs that are associated with insomnia as instrumental variables. We discerned a substantial association between genetically inferred sleep duration and HF risk (odds ratio: 0.61; 95% confidence interval: 0.47-0.78, P < .0001). Our subsequent analysis highlighted a pronounced increased HF risk associated with insomnia (odds ratio: 1.54; 95% confidence interval: 1.08-2.17, P < .02). These conclusions were further bolstered by consistent results from sensitivity analyses. Our study suggests a causal linkage between sleep duration and the onset risk of HF in the European population. Notably, shorter sleep durations were associated with a heightened risk of HF.


Assuntos
Insuficiência Cardíaca , Análise da Randomização Mendeliana , Polimorfismo de Nucleotídeo Único , Sono , Humanos , Insuficiência Cardíaca/genética , Insuficiência Cardíaca/epidemiologia , Sono/genética , Masculino , Feminino , Distúrbios do Início e da Manutenção do Sono/genética , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Pessoa de Meia-Idade , Europa (Continente)/epidemiologia , Fatores de Risco , Estudo de Associação Genômica Ampla , Fatores de Tempo , Duração do Sono
18.
Int Ophthalmol ; 44(1): 381, 2024 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-39299944

RESUMO

PURPOSE: Insomnia is a common psychiatric disorder that has oxidative and degenerative effects on the brain. It is thought that the brain's processes affect the retina through their synaptic connections. However, the effects of sleep disorders on the retina and choroid are not fully understood. We aimed to investigate the impact of insomnia on retinal nerve fiber layer (RNFL), central foveal thickness, retinal layers, and choroidal thickness. METHODS: The right eye of 16 healthy controls and 15 patients with insomnia complaints for 3 months, no history of psychiatric drug use, and an Insomnia Severity Index (ISI) score of 15 or higher were included in the study. The retinal layers and RNFL analyses were performed using optical coherence tomography (OCT), and choroidal layers were analyzed using enhanced depth imaging OCT. RESULTS: Nasal and temporal ganglion cell complex thicknesses were significantly lower in patients with insomnia compared to the controls (97 µm vs. 111 µm P = 0.004; 94 µm vs. 105 µm P = 0.012, respectively). A significant negative correlation was detected between the ISI score and global RNFL thickness (rho, P = 0.03) Additionally, pachychoroid-like vascular structures were observed in choroidal images. CONCLUSION: These changes in the retina and the choroid layers due to insomnia may be precursors to retinal degenerative conditions, such as age-related macular degeneration that may occur in the future. Multicenter studies including more patients are needed to demonstrate the importance of quality sleep for eye health.


Assuntos
Corioide , Fibras Nervosas , Células Ganglionares da Retina , Distúrbios do Início e da Manutenção do Sono , Tomografia de Coerência Óptica , Humanos , Feminino , Masculino , Tomografia de Coerência Óptica/métodos , Células Ganglionares da Retina/patologia , Corioide/patologia , Corioide/diagnóstico por imagem , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Pessoa de Meia-Idade , Adulto , Fibras Nervosas/patologia , Retina/patologia , Retina/diagnóstico por imagem
19.
Medicine (Baltimore) ; 103(36): e39611, 2024 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-39252292

RESUMO

This study investigates the association between insomnia and depression severity, exploring sleep disturbances in individuals with depression. The aim is to establish a new foundation for managing patients with co-occurring depression and insomnia, using 2015 to 2016 National Health and Nutrition Examination Survey (NHANES) data. We employed a cross-sectional design, using NHANES data from 2015 to 2018. The study included 11,261 participants after excluding incomplete data. Depression severity, assessed using Patient Health Questionnaire-9 (PHQ-9) scores, served as the exposure variable. We considered various demographic and lifestyle factors as covariates in the multivariate adjustment model. Statistical analyses adhered to CDC recommendations, with sample weights incorporated to account for NHANES' complex sample design. Our study, encompassing 19,225 participants, revealed that higher PHQ-9 scores correlated with an increased likelihood of sleep disorders. In the fully adjusted model, a positive association emerged between PHQ-9 scores and trouble sleeping (OR = 3.95, 95% CI: 3.35-4.66, P < .0001). This relationship displayed an inverted U-shaped curve, with an inflection point at 28. Subgroup analysis and interaction tests indicated no reliance on factors such as gender, age, marital status, or BMI for the connection between depression severity and trouble sleeping (all P for interaction > .05). We identified a significant inverted U-shaped correlation between sleep disturbances and depression severity. This underscores the crucial importance of assessing sleep disorder risks in individuals with varying degrees of depression severity, facilitating personalized therapeutic interventions.


Assuntos
Depressão , Inquéritos Nutricionais , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono , Humanos , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Adulto , Depressão/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Idoso , Adulto Jovem , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/psicologia
20.
Medicine (Baltimore) ; 103(38): e39784, 2024 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-39312364

RESUMO

The Kingdom of Saudi Arabia is the second largest country in the Arabian Peninsula and ranks 61st out of 150 countries in terms of coffee consumption. Excessive coffee consumption is associated with the risk of adverse health outcomes. This study aimed to assess awareness of the effects of coffee consumption and its relationship with insomnia among the adult population in Jazan, Saudi Arabia. A cross-sectional study was conducted with 431 adults in the Jazan region. A self-administered questionnaire was distributed to the participants using an online survey. Data were analyzed using Statistical Program for the Social Sciences, Version 24.0. Of 431 participants, 377 (87.5%) consumed coffee. Females and married women consumed more coffee than their counterparts (91.3%, P < .01; 92.8%, P < .05; respectively), while students consumed coffee (85.2%) less than both the employed and unemployed (P < .05). The proportion of consumption increased from underweight (79.7%) to normal weight (88.5%), and as high as 91.3% among overweight/obese (P < .05). More than one-third of the participants (35.5%) preferred drinking coffee at coffee shops. The most preferred coffee was Arabic coffee (40%), and the major reason for drinking coffee was to change their mood (29.7%). More than half of the participants (54.5%) reported that coffee caused insomnia (P < .01). Awareness-raising initiatives for the negative effects of excessive coffee consumption are important. Longitudinal studies are required in the next stage of research to identify trends such as the motivations and profiles of Saudi coffee drinkers.


Assuntos
Café , Distúrbios do Início e da Manutenção do Sono , Humanos , Arábia Saudita/epidemiologia , Café/efeitos adversos , Feminino , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Masculino , Adulto , Estudos Transversais , Adulto Jovem , Pessoa de Meia-Idade , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários
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