Análisis de movimientos periódicos de piernas durante el sueño, presión arterial de 24 horas y frecuencia cardíaca.

Los Movimientos Periódicos de las Piernas durante el Sueño (PLMS), diagnosticados por polisomnografía, se caracterizan por movimientos estereotipados de las piernas que aparecen de forma repetitiva durante la noche. Cada PLMS se asocia a un microdespertar e incrementos de la frecuencia cardiaca, presión arterial y actividad simpática. Objetivos: Analizar asociación entre el índice patológico de PLMS y la PA de 24 horas, en pacientes normotensos. Evaluar la asociación entre índice patológico de PLMS, con alteraciones en la velocidad de onda de pulso y frecuencia cardíaca. Métodos Estudio observacional de casos y controles. Se estudiaron 19 sujetos normotensos mediante Polisomnografía Nocturna y Monitoreo Ambulatorio de la Presión Arterial. Se determinaron las variables: Edad, sexo, peso, índice de masa corporal. La presión arterial y frecuencia cardíaca de 24 hs, diurna y nocturna se evaluaron con monitoreo ambulatorio de presión arterial de 24 h. Se excluyeron pacientes con índice de apneas/hipopneas ≥ 5 e/h. Se describieron las variables y compararon sujetos con y sin PLMS, considerando significativo una p<0,05, además análisis de correlación.   Resultados Se estudiaron a 11 pacientes con PLMS patológico y 7 controles (Índice PLMS 35,6±15 versus 7,9±5 respectivamente). Los pacientes con PLMS fueron más jóvenes 57 ±14 versus 64±6; p=0,284 años. La presión arterial de 24 h, fue menor en el grupo PLMS que en los controles (sistólica 114,2±11 versus 123±11; p=0,095; y diastólica 65,7±5 versus 74,4±11, p=0,027).   Conclusión Encontramos una relación estadísticamente significativa, inversa, no esperada, al correlacionar los movimientos periódicos de piernas durante el sueño, de grado patológico, con la presión arterial sistólica y media de 24 h, la presión arterial sistólica diurna y nocturna, y la presión arterial media nocturna, como así también hallazgos similares en la presión de pulso de 24 horas y la presión de pulso diurna y nocturna que fueron inferiores al grupo control. No encontramos cambios en la frecuencia cardíaca.

Is Being a Lark Healthier for Patients with Type 1 Diabetes Mellitus?

Background Sleep quality and mood have been evaluated in type 1 diabetic (T1DM) patients, but chronotypes were not studied. Our objectives were to analyze chronotypes, sleep and mood variables and to describe their association with some metabolic variables in this population. Methods An observational, cross-sectional study was performed. Adults with a diagnosis of T1DM were included. We evaluated chronotypes by the Morningness-Eveningness Questionnaires, sleep quality by Pittsburgh Sleep Quality Index (PSQI), excessive daytime sleepiness by Epworth Sleepiness Scale (ESS), symptoms of depression by Patient Health Questionnaire - 9 (PHQ-9) and emotional well-being by Emotional Well Being Index (IWHO-5). A few metabolic variables were included. Results Ninety-five patients participated. The mean age was 38 years old (range 18-70). The average body mass index (BMI) was 24.4 Kg/m 2 (standard deviation [SD]: 4.6). Out of the total sample, 52.6% were males. The Intermediate chronotype was predominant: n = 56 (55%). We found poor quality of sleep in 67.4% of the sample, excessive daytime sleepiness in 14.7%, depressive symptoms in 6.3% by PHQ9 and low perception of well-being by IWHO-5 in 16.8%. Evening chronotype scored worse in sleep quality ( p = 0.05) and had lower well-being ( p = 0.03) compared with the other chronotypes. Higher MEQ values (morningness) correlated with lower height ( p = 0.043), lower values in the PSQI ( p = 0.021); and higher values in emotional well-being ( p = 0.040). Conclusions We found that the predominant chronotype in T1DM was the intermediate. Two-thirds reported poor quality of sleep and 14,7% excessive daytime sleepiness. Possible diagnosis of a depressive disorder in 6.3% and poor self-perception of emotional well-being in 16. 8% were observed. The morning chronotype had significant correlation with better sleep quality and higher scores in emotional well-being.

Analysis of periodic leg movements during sleep, 24-hour blood pressure and heart rate / [Análisis de movimientos periódicos de piernas durante el sueño, presión arterial de 24 horas y frecuencia cardíaca.]

Los Movimientos Periódicos de las Piernas durante el Sueño (PLMS), diagnosticados por polisomnografía, se caracterizan por movimientos estereotipados de las piernas que aparecen de forma repetitiva durante la noche. Cada PLMS se asocia a un microdespertar e incrementos de la frecuencia cardiaca, presión arterial y actividad simpática. Objetivos: Analizar asociación entre el índice patológico de PLMS y la PA de 24 horas, en pacientes normotensos. Evaluar la asociación entre índice patológico de PLMS, con alteraciones en la velocidad de onda de pulso y frecuencia cardíaca. Métodos: Estudio observacional de casos y controles. Se estudiaron 19 sujetos normotensos mediante Polisomnografía Nocturna y Monitoreo Ambulatorio de la Presión Arterial. Se determinaron las variables: Edad, sexo, peso, índice de masa corporal. La presión arterial y frecuencia cardíaca de 24 hs, diurna y nocturna se evaluaron con monitoreo ambulatorio de presión arterial de 24 h. Se excluyeron pacientes con índice de apneas/hipopneas ≥ 5 e/h. Se describieron las variables y compararon sujetos con y sin PLMS, considerando significativo una p<0,05, además análisis de correlación. Resultados: Se estudiaron a 11 pacientes con PLMS patológico y 7 controles (Índice PLMS 35,6±15 versus 7,9±5 respectivamente). Los pacientes con PLMS fueron más jóvenes 57 ±14 versus 64±6; p=0,284 años. La presión arterial de 24 h, fue menor en el grupo PLMS que en los controles (sistólica 114,2±11 versus 123±11; p=0,095; y diastólica 65,7±5 versus 74,4±11, p=0,027). Conclusión: Encontramos una relación estadísticamente significativa, inversa, no esperada, al correlacionar los movimientos periódicos de piernas durante el sueño, de grado patológico, con la presión arterial sistólica y media de 24 h, la presión arterial sistólica diurna y nocturna, y la presión arterial media nocturna, como así también hallazgos similares en la presión de pulso de 24 horas y la presión de pulso diurna y nocturna que fueron inferiores al grupo control. No encontramos cambios en la frecuencia cardíaca.

Periodic Leg Movements During Sleep (PLMS), diagnosed by polysomnography, is characterized by stereotyped leg movements that appear repetitively at night. Each PLMS is associated with microarousal and increases in heart rate, blood pressure, and sympathetic activity. Objectives: To analyze the association between the pathological index of PLMS and 24-hour BP in normotensive patients.To evaluate the association between the pathological index of PLMS, with alterations in pulse wave velocity and heart rate. Methods: Observational study of cases and controls. 19 normotensive subjects were studied by Nocturnal Polysomnography and Ambulatory Blood Pressure Monitoring. The variables were determined: Age, sex, weight, body mass index. 24-h, diurnal, and nocturnal blood pressure and heart rate were assessed with 24-h ambulatory blood pressure monitoring. Patients with apnea/hypopnea index ≥ 5 e/h were excluded. The variables were described and subjects with and without PLMS were compared, considering significant a p<0.05, in addition to correlation analysis. Results: Eleven patients with pathological PLMS and 7 controls were studied.PLMS Index 35.6±15 versus 7.9±5 respectively. PLMS patients were younger 57±14 versus 64±6; p=0.284. The 24-h blood pressure was lower in the PLMS group than the controls (systolic 114.2±11 versus 123±11; p=0.095; and diastolic 65.7±5 versus 74.4±11, p=0.027). Discussion: We found an unexpected, inverse, statistically significant relationship when correlating pathological-grade periodic leg movements during sleep with 24-hour mean and systolic blood pressure, daytime and nighttime systolic blood pressure, and mean blood pressure. nocturnal, as well as similar findings in the 24-hour pulse pressure and the diurnal and nocturnal pulse pressure that were lower than the control group. We found no changes in heart rate.

Analysis of Sleep Quality, Mood Alterations and modifications of some Habits/Behavior during two different Periods of the COVID-19 Pandemic in Argentina / Análisis de la calidad del sueño, alteraciones del humor y modificaciones de algunos hábitos y conductas durante dos diferentes períodos de la pandemia por COVID-19 en Argentina.

The pandemic caused by COVID-19 in the world, in its different periods, produced many changes in sleep and in various areas of mental health. Objectives: To evaluate and to compare sleep quality and aspects of mental health during two different periods of the COVID-19 pandemic, as well as to analyze some changes in habits/behaviors. Subjects and methods: A cross-sectional study was carried out, through an anonymous survey. Demographic information, sleep quality, depressive and anxiety symptoms were analyzed. Of the total, 998 surveys were selected. The survey focused on 2 time periods, from March to July 2020 and from March to July 2021. Results: When sleep quality was compared during the 2020 versus 2021 periods, the percentage of poor sleepers went from 51% to 59% in the second period. Regarding depressive symptoms, it went from 21.1 to 16.3% and the percentage of anxiety symptoms went from 59.5 to 47.6%. Poor sleep quality affected more people in 2021 compared to 2020. The percentage of participants with symptoms of anxiety and depression decreased in 2021. People changed some habits/behaviors, such as: changing routine schedules, acquiring pets, sharing their dreams more, and remembering them more frequently. This article contributes to knowing various aspects of sleep, mood swings and changes in habits/behaviors that occurred during the pandemic in Argentina.

La pandemia provocada por COVID-19 en el mundo, en sus diferentes períodos, produjo muchos cambios en el sueño y en diversas áreas de la salud mental. Objetivos: Evaluar y comparar calidad de sueño y aspectos de la salud mental durante dos períodos diferentes de la pandemia por COVID-19, como así también analizar algunos cambios en hábitos/conductas. Materiales y métodos: Se realizó un estudio de corte transversal, a través de una encuesta anónima de la que participaron 998 personas. La misma se realizó en dos períodos de tiempo. El primer período comprendió de marzo a julio de 2020, el segundo período abarcó de marzo a julio 2021. El análisis consideró: información demográfica, calidad del sueño, síntomas depresivos y de ansiedad. Resultados: Al comparar la calidad de sueño durante los períodos 2020 versus el 2021, el porcentaje de malos dormidores pasó del el 51% al 59% en el segundo período. En cuanto a los síntomas depresivos pasó del 21,1 al 16,3% y el porcentaje de síntomas de ansiedad pasó del 59,5 al 47,6%. La mala calidad del sueño afectó a un número mayor de personas en el 2021 que en el 2020 mientras que el porcentaje de participantes con síntomas de ansiedad y de depresión disminuyó en el año 2021. En la segunda fase de la encuesta las personas modificaron algunos hábitos/conductas como ser: cambiaron horarios de rutina, adquirieron mascotas, compartieron más sus sueños y recordaban con mayor frecuencia los mismos. Este artículo contribuye a conocer diversos aspectos del sueño, los cambios de humor y modificaciones de hábitos/conductas que ocurrieron durante la pandemia en Argentina.

[Pre-pandemic melatonin treatment for sleep disorders and COVID-19 infection. A retrospective cross-sectional study]. / Tratamiento con melatonina pre-pandemia por trastornos del sueño e infección por COVID-19. Estudio de corte transversal, retrospectivo.

INTRODUCTION: Melatonin is a safe medication with multiple uses in sleep medicine for the treatment of circadian rhythm disorders, insomnia, and REM sleep behavior disorder. In view that melatonin has been recommended as an adjuvant treatment in COVID-19 pandemic mainly due to its anti-inflammatory properties, the objective of the present study was to evaluate the history of COVID-19 infection and the requirement of hospitalization in a group of adult patients previously treated with melatonin for various sleep disorders. MATERIAL AND METHODS: This is a retrospective cross-sectional study of data from a closed population of 110 adult patients at a University Hospital treated with melatonin for various sleep disorders, analyzed until the onset of COVID-19 pandemic. Demographic and melatonin-related variables (dose, treatment time) were analyzed and were reevaluated during the pandemic period, by scheduled tele-consultation regarding diagnosis, hospitalization requirements, variables related to COVID-19 infection prior to specific vaccination. Categorical variables were described as relative and absolute frequencies. RESULTS: N = 110 patients. Age range = 40- 96 years (mean = 71 years ± 9.9), older adults > 65 years: N =87 (79,1%). COVID-19 infection was recorded in 15 patients (13.5%) requiring hospitalization in 5 of those infected, only one of them with severe pneumonia. There were no deaths due to COVID-19. There were no differences between infected vs. uninfected in age (p = 0.74), body mass index (p = 0.65) or melatonin dose (p = 0.10).The melatonin dose range was 3-150 mg / day (mean = 46.33 ± 34.1), older adults receiving a mean dose of 50,3 ± 35,6.The 75.5% of the patients were treated for at least 12 months with melatonin. CONCLUSION: We found that 13.5% of patients previously treated with melatonin for various sleep disorders were infected by COVID-19, requiring hospitalization with subsequent medical discharge one third of them. According to national records the lethality rate in older adults in August 2020 was 10.5%. No patient treated with melatonin died for this cause in this sample. We did not find statistically significant differences in terms of indicated melatonin dose, age or body mass index, when comparing those infected with those not infected. The patients in general were mostly older adults, treated with a mean dose greater than 40 mg / day of melatonin for various sleep disorders, mainly for complaints of insomnia, for more than 12 months. The results are consistent with a possible preventive effect of melatonin in the COVID-19 pandemic.

Early impact on sleep and mental health during the mandatory social isolation of COVID-19 outbreak: an obser vational cross-sectional study carried out in Argentina.

Introduction: The mandatory social isolation (MSI) due to the pandemic caused by COVID-19 in the world produced many changes in sleep and different areas of mental health. Objectives: To evaluate the early effects of MSI on sleep, anxiety, and depression in Argentina. Material and Methods: An anonymous observational cross-sectional web-based study was distributed throughout the country and was completed by 2,594 respondents to analyze demographic information, quality of sleep, REM sleep-related events, depressive, and anxiety symptoms. Results: The study revealed that 53, 21, 22, 23, and 16% of people surveyed were poor sleepers, had dream-related behaviors, nightmares, depression, and anxiety symptoms, respectively. Multivariate logistic regression showed a positive correlation between anxiety, being a poor sleeper, and having nightmares. Conclusion: We identified the early effects of MSI on sleep quality, dreaming activity, anxiety, and depression in Argentina during the COVID-19 outbreak. Our findings can be used to formulate sleep and psychological interventions to improve mental health during the pandemic and post-pandemic times.

[Sleep quality, depressive symptoms and generalized anxiety disorders during confinement by COVID-19]. / Calidad de sueño, síntomas depresivos y de ansiedad durante el confinamiento por COVID-19 en Argentina.

The confinement due to the pandemic caused by COVID-19 in Argentina produced many changes. OBJECTIVE: To assess sleep, anxiety disorders, and depression in adults. SUBJECTS AND METHODS: Through an anonymous survey distributed in the country through the web that was completed by 2,594 people (69% women, 32% men). 30% reported working in the health field. Demographic information, quality and other sleep variables, depressive symptoms and anxiety were analyzed. RESULTS: The general prevalence of bad sleepers, depressive symptoms, and anxiety were 53%, 21.1%, and 43.8%, respectively. Those over 65 years of age showed a significantly higher prevalence of going to bed earlier and having a lower sleep onset latency. Multivariate logistic regression showed that age <55 years and being a woman were associated with anxiety and with being a poor sleeper. Sleeping more than 10 hours, going to bed later, being a poor sleeper and anxiety, were associated with depressive symptoms. Being a healthcare worker was associated with more anxiety. CONCLUSIONS: We identified poor sleep quality and alteration mental health in times of confinement. We found that more than half of the evaluated population turned out to be poor sleepers and presented high scores of symptoms related to anxiety and depression. Additionally, health workers presented more anxiety than the rest.

[Sleep Disorders and depression in Parkinson's Disease]. / Trastornos del sueno y Depresión en la enfermedad de Parkinson.

OBJECTIVES: Sleep disorders are common in Parkinson's disease (PD). To diagnose sleep disturbances analyzing the sleep macrostructure and other variables in PD. METHOD: The cross-sectional, retrospective study in PD patients. Sociodemographic, clinical/pharmacological variables, Epworth sleepiness scale (ESS), Beck depression index (BDI) and polysomnography of patients with Parkinson's disease. Frequency, mean, standard deviation analysis were obtained. The variables were compared using t test student, univariate ANOVA and chi-square. A p<0.05 was considered significant. SPSS (Chicago SPSS Inc.) 18 was used. The n were 44 patients, 33 men, mean age 71 (range 52-90), ESS 7.7±6 (normal), BDI 13±8 points (pathological). CONCLUSIONS: At older age, the time awake after sleep began (p=0.03) was greater and lower sleep efficiency (p=0.02).The average percentage of stage of N3 sleep was 37.2% in women vs 24.7% in men (p=0.02). Hypopnea apnea index was pathological grade at 79.5% (n=35).We diagnose apnea hypopnea syndrome in the majority, insomnia and REM parasomnias. The increase in the percentage of stage N3 was rarely reported in the literature. At older age were more changes in the macroestructure and more sleep disturbances.

Respiratory disorders during sleep in patients with acute ischemic stroke. / [Trastornos respiratorios durante el sueño en pacientes con accidente cerebrovascular isquémico.]

Introduction: Sleep breathing disorders (SBD) especially obstructive hypopnea apnea syndrome (OSA) in patients with stroke are common and can complicate their evolution. The objective was analyzing the different sleep breathing disorders in patients with stroke. Methods: Descriptive, cross-sectional and retrospective study of acute ischemic stroke patients, using nightly polysomnography with oximetry (PSG). Results: It was a descriptive, cross-sectional, retrospective study during 19 months; 53 patients with stroke were included, with a men age of 67 ±12 years and 62% were men. SBD was evaluated by nocturnal polysomnography with oximetry within 10 days of installing the stroke. The Apnea hypopnea index (AHI) was 24.5±20, of mild grade in 21%, moderate in 31%, severe grade in 34%. The average oxygen saturation time less than 90% was 38 ±51 minutes. The minimum oxygen saturation was marked in infratentorial lesions. Conclusion: We found a high percentage of OSA, which was associated with older patients and a higher body mass index. There was a marked decrease in the minimum oxygen saturation and greater tendency to present central apneas in infratentorial lesion. Early diagnosis and treatment could minimize neuronal damage and improve prognosis.

Introducción: Los trastornos respiratorios durante el sueño (TRDS), sobre todo el síndrome de apneas hipopneas obstructivas (SAHOS) en pacientes con accidente cerebrovascular o ACV, son frecuentes y pueden complicar su evolución. El objetivo fue analizar diversos TRDS en pacientes con ACV. Métodos: Estudio descriptivo, de corte transversal y retrospectivo de 19 meses, en pacientes con ACV, mediante polisomnografía nocturna con oximetría (PSG). Resultados: Se incluyó a 53 pacientes, con edad media de 67 ± 12 años, y 62% pertenecían al sexo masculino. Se evaluó los TRDS mediante polisomnografía nocturna con oximetría dentro de los 10 días de instalado el ACV. Se detectó un índice de apneas hipopneas durante el sueño (IAH) de grado leve en 21%, grado moderado en 31% y severo en 34%. La media de tiempo de saturación de oxígeno < a 90% fue de 38 ±51 minutos. La saturación mínima de oxígeno fue marcada en lesiones infratentoriales. Conclusión: Nosotros hemos encontrado en nuestro estudio, un alto porcentaje de SAHOS, que se asoció a pacientes de mayor edad y mayor índice de masa corporal. Se constató descenso marcado de la saturación mínima y mayor tendencia a presentar apneas centrales en lesiones infratentoriales. El diagnóstico y tratamiento precoz podría minimizar el daño neuronal y mejorar el pronóstico.

Coping with Antarctic demands: Psychological implications of isolation and confinement.

Working in extreme environments requires a wide range of cognitive, psychological and social competences. Antarctica represents one of the most challenging habitats to work in due to its aridity, extremely cold weather, and isolated conditions. This study aimed to assess mood variations and coping strategies, as well as their possible modulation by group dynamics in a crew at the Belgrano II Argentine Antarctic Station throughout 1 year of confinement. Thirteen members of the Argentine Army completed emotional, coping and social dynamics questionnaires bimonthly in March, May, July, September and November. Results showed a significant decline in social dynamics scales, evidenced by decreases in perceived peer and hierarchical support. Additionally, coping strategies displayed a drop in mature defence throughout the expedition. A positive correlation was found between social support and recovery from stress. Our results highlight the importance of interpersonal relationships in psychological adjustment to isolation and extreme environments.

Subjective time estimation in Antarctica: The impact of extreme environments and isolation on a time production task.

Interval timing measures time estimation in the seconds-to-minutes range. Antarctica provides a real-world context to study the effect of extreme photoperiods and isolation on time perception. The aim of this study was to explore interval timing as a cognitive measure in the crew of Belgrano II Argentine Antarctic Station. A total of 13 subjects were assessed for interval timing in short (3 s), intermediate (6 s) and long (12 s) duration stimuli. Measures were taken during the morning and evening, five times along the year. Significant variations were found for 3 s and 6 s during the morning and 6 s during the evening. Results suggest an impact of isolation on morning performances and an effect of the polar night on evening measures. These findings shed some light on the use of interval timing as a cognitive test to assess performance in extreme environments.

[Sleep quality, depressive symptoms and other menopause things]. / Calidad de sueño, síntomas depresivos y las otras cosas de la menopausia.

Sleep disorders (insomnia, hypersomnia, parasomnias and breathing disturbances), hormonal changes and vasomotor symptoms are highly prevalent in peri and postmenopausal women. The aim of our study was to assess sleep quality, some sleep disturbances, depression and suffocation during postmenopausal. Data come from a cross-sectional study of 195 women, which was conducted at a University Hospital. Data related to sleep were assessed with the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Oviedo Sleep Questionnaire (OSQ) and Beck´s Inventory of Depression (BDIII). The hospital Ethical Committee granted their approval of this study. The mean PSQI score was 6.90½ 4.43. Up to 46.7% of participants had a PSQI > 5 (poor sleep quality). Snoring was reported by 13% of the patients (PSQI # 10 A). COS score was 17.57± 7. According to COS #1 all the subjects (100%) reported some degree of sleep dissatisfaction. Media of BDIII´s inventory of depression was 9.8 (½7.14), 41% of women reported depression. Correlation BDIII and PSQI was 0.00. We found that the level of dissatisfaction was elevated. One out of two women referred poor quality of sleep, requiring medical assistance. Poor sleep quality was associated with depression.

Sleep, napping and alertness during an overwintering mission at Belgrano II Argentine Antarctic station.

During Antarctic isolation personnel are exposed to extreme photoperiods. A frequent observation is a sleep onset phase delay during winter. It is not known if, as a result, daytime sleeping in the form of naps increases. We sought to assess sleep patterns - with focus on daytime sleeping - and alertness in a Latin American crew overwintering in Argentine Antarctic station Belgrano II. Measurements were collected in 13 males during March, May, July, September and November, and included actigraphy and psychomotor vigilance tasks. Sleep duration significantly decreased during winter. A total of eight participants took at least one weekly nap across all measurement points. During winter, the nap onset was delayed, its duration increased and its efficiency improved. We observed a significant effect of seasonality in the association of evening alertness with sleep onset. Our results replicate previous findings regarding sleep during overwintering in Antarctica, adding the description of the role of napping and the report of a possible modulatory effect of seasonality in the relation between sleep and alertness. Napping should be considered as an important factor in the scheduling of activities of multicultural crews that participate in Antarctica.

Aspectos históricos de los nervios craneales / Historical aspects of cranial nerves

Este trabajo revisa la perspectiva histórica en la descripción de los 12 nervios craneanos hecha por los anatomistas clásicos, utilizando textos tradicionales y traducciones modernas. La historia de la enumeración de los nervios se remonta a Galeno con su clasificación en 7 pares, pasando por los 9 pares de Willis (1664) y los 12 pares de Soemmerring (1778). Hubo contribuciones de anatomistas medievales como Achillini, Berengario de Carpi y Massa, a pesar de las prohibiciones que pesaron sobre los estudios anatómicos hasta el siglo XVI. La clasificación de los nervios craneanos en 9 pares se siguió utilizando hasta fines del siglo XIX, a pesar de que ya había sido aceptada su clasificación en 12 pares hacia 1778. Se recuerda también a aquellos autores que describieron estructuras individuales y las nombraron por primera vez.