Mediation analysis of circadian preferences and other behavioral and sociodemographic factors associated with subjective well-being in undergraduate students.

Undergraduate students are usually subjected to a routine with constant pressure, stress, circadian misalignment, and sleep irregularity that impairs their subjective well-being. Recent evidence suggests that circadian preference is also a risk factor for impaired mental health and factors related to subjective well-being. This study aimed to identify the sociodemographic factors associated with subjective well-being and describe the mediating behavioral variables. Between September 2018 and March 2021, 615 Brazilian students enrolled in higher educational institutions completed an electronic form containing questionnaires on subjective well-being, sociodemographic, and behavioral-related factors (convenience sample). A statistical mediation model was applied to describe how these variables influence subjective well-being. We observed that Morningness (p < .001), identification with the male gender (p = .010), not working while studying (p = .048), and the practice of Pilates/yoga (p = .028) were associated with greater subjective well-being. Except for employment status, no direct effects were observed, which reinforces the need to consider a multidimensional approach. The relationship between subjective well-being and sociodemographic factors exists only in the presence of behavioral mediators, specifically perceived stress, daytime sleepiness, symptoms of depression, sleep quality, and positive and negative affects. Future work should investigate in more detail the impact of sleep, stress, and circadian preferences on this relationship.

An Overview of the Methods Used to Measure the Impact of Mindfulness-Based Interventions in Sleep-Related Outcomes.

Introduction Systematic reviews and metanalyses have shown that mindfulness-based interventions can have positive effects on health, such as reducing anxiety, depression, and chronic pain. However, their effect on sleep-related outcomes is not yet well established. Sleep can be assessed subjectively (questionnaires, sleep logs, self-reporting) and/or objectively (actigraphy, polysomnography, biological markers), and outcomes may differ depending on which type of assessment is used. Objective In this study, we present a literature overview on mindfulness and sleep, innovatively presenting and discussing studies that address sleep subjectively and objectively. Methods The search was undertaken using four databases (Pubmed Medline, Scopus, Web of Science, Psychinfo) in September 2019, and repeated in May 2021. Studies were analyzed through a two-step process: (1) reading titles and abstracts, and (2) full text analysis that met the review's eligibility criteria, with the final sample comprising 193 articles. We observed a growth in the number of studies published, particularly since 2005. However, this was mostly due to an increase in studies based on subjective research. There is a moderate to nonexistent agreement between objective and subjective sleep measures, with results of subjective measures having higher variability and uncertainty.We identified 151 articles (78%) using an exclusively subjective sleep evaluation, which can cause a misperception about mindfulness effects on sleep. Conclusion Future studies should place greater emphasis on objective measurements to accurately investigate the effects of mindfulness practices on sleep, although subjective measures also have a role to play in respect of some aspects of this relationship.

Effectiveness of a specific physical therapy program for Charcot-Marie-Tooth on sleep quality, pain perception, and nocturnal cramps: a pilot study.

Introduction: Chronic pain, nocturnal cramps, and sleep alterations are prevalent symptoms and signals in Charcot-Marie-Tooth disease patients. Sleep and pain are bidirectionally related and physical therapy can improve the binomial sleep and pain/nocturnal cramps. Therefore, we hypothesized that the application of a specific physical therapy program for Charcot-Marie-Tooth disease would improve sleep quality, pain perception, and nocturnal cramps. Material and Methods: A non-randomized controlled study that included 9 Charcot-Marie-Tooth disease patients (intervention group - physical therapy program) and 8 controls (active control group - booklet on sleep hygiene). The intervention lasted 8 weeks, three sessions per week. The effects were evaluated ten days before (baseline) and ten days after the intervention (post). Our primary outcome was sleep quality (subjective and objective, assessed by Pittsburgh sleep quality index and actigraphy, respectively); and secondary outcomes were pain perception (brief pain inventory) and nocturnal cramps (self-report). Results: The program was able to improve the subjective sleep quality (p=0.005) and nocturnal cramps (p<0.001) but had no effect on actigraphy data (p>0.05) neither on pain perception (p>0.05). Conclusion: Our initial hypothesis was partially corroborated: the improvement in subjective quality of sleep and nocturnal cramps is already beneficial for the health promotion of the volunteers in this study affected by the disease. Our findings may serve as a basis for future research to develop a program focused on the treatment of analgesia, which can improve pain perception and alter the objective quality of sleep.

The impact of pain and nocturnal cramps on sleep quality in Charcot Marie Tooth disease: a case-control study.

Introduction: Charcot-Marie-Tooth disease is an inherited neuropathy that presents two main forms - type 1 and type 2 -, differentiated by the speed of the nervous conduction. Our goal was to assess sleep in Charcot-Marie-Tooth disease and its relationship with pain perception and nocturnal cramps. Material and Methods: This was a case-control study. The case group was composed of 10 volunteers diagnosed with the type 1 and 23 with the type 2. The control group was composed of 22 individuals from the same family matched by age and gender. Volunteers underwent clinical screening to assess the presence of nocturnal cramps and filled the brief pain inventory, the Chalder fatigue scale, the Epworth sleepiness scale, and the Pittsburgh sleep quality index. Sleep was evaluated by actigraphy. Results: Type 2 patients presented a more severe perception of pain and fatigue, more time spend awake after sleep onset, and had lower sleep efficiency. The individuals who reported nocturnal cramps also had worse perception of pain, reduced sleep latency, and increased sleep fragmentation. Conclusion: The Charcot-Marie-Tooth type 2 was related with worse sleep quality, perception of pain, and fatigue and these parameters were negatively related.

Sleep parameters assessed by actigraphy in Fabry's disease patients: a proof-of-concept.

BACKGROUND: In a previous study developed by our group, we identified a phase inversion in 6-sulfatoxymelatonin - melatonin metabolite in urine - daily profile in Fabry's disease patients. Since melatonin is an endogenous marker, it could also be accompanied by behavioral changes in sleep-wake cycle, which impairs the overall patient's life quality. OBJECTIVE: In this study, we evaluated sleep-wake cycle in Fabry disease patients. We hypothesized that patients would have increased daytime naps, given our previous results for urinary 6-sulfatoxymelatonin. PATIENTS/METHODS: This was a cross-sectional and case-control study, performed between October 2016 and May 2017. Volunteers recorded activity and rest rhythm by actigraphy and answered Pittsburgh Sleep Quality Index (PSQI). From actigraphy data, we calculated sleep parameters: sleep latency, wake after sleep onset, sleep (WASO) efficiency, awakenings index (PSQI), and the amount and duration of daytime naps. We included 16 Fabry disease patients with biochemical and molecular diagnosis and 10 control individuals matched by age and gender. RESULTS: We did not observe significant differences for any of the parameters analyzed (p > 0.05). However, evaluating the magnitude of the effect, we found that patients dozed, on average, about 42 min longer (d = 0.9 - large effect size) than control group. CONCLUSIONS: This is a preliminary study, a proof-of-concept, and our results indicate that changes in melatonin secretion phase may have behavioral consequences in sleep-wake cycle, with longer duration of daytime naps.

Rhythmic changes in Fabry disease: Inversion and non-oscillatory pattern in 6-sulfatoxymelatonin daily profile.

Fabry disease is a progressive disease characterized by an enzymatic deficiency of acid alpha-galactosidase and glycosphingolipids storage within the lysosomes. The disease has two phenotypes: classic and nonclassic. Excessive daytime sleepiness is a common sign reported by patients and can be caused by a circadian rhythm sleep disorder. Activity and rest cycle, variation of body temperature and melatonin biosynthesis are known rhythmicity markers. In the face of these evidences, our goal was to evaluate the rhythmic profile in Fabry's disease patients using rhythmicity markers. For this purpose, we recruited 17 patients diagnosed with Fabry disease (11 classic and 6 nonclassic variant) that answered the Epworth Sleepiness Scale and the Morningness-Eveningness questionnaire adapted from Horne and Ostberg; recorded activity and body temperature rhythms by an actigraphy during at least 10 days and collected urine to assess 6-sulfatoxymelatonin excretion load during the day (from the second urine in the morning until 7 p.m.) and night (starting from 7 p.m. until the first urine in the morning of the following day). We observed that control subjects presented higher excretion load of 6-sulfatoxymelatonin during the night (p < 0.05, d = 7.8), as expected. Patients with the nonclassic variant presented an inversion on 6-sulfatoxymelatonin daily profile (p < 0.05, d = 3.8) and there was no difference between the day and night profile of classic variant patients when compared to the other two groups. Patients with the classic variant also presented temperature period greater than 24 hours (p < 0.05, d = 2.0). Therefore, we came to the conclusion that there is an alteration in the circadian rhythms in Fabry disease patients, evidenced by modifications in the 6-sulfatoxymelatonin daily profile and in the body temperature rhythm period.