Validation of the NoSAS score for screening sleep-disordered breathing: A sleep clinic- based study in Turkey

Background/aim: The NoSAS score is a new tool for the identification of high-risk patients for sleep-disordered breathing (SDB). The aim of this study was to validate the NoSAS score in a sleep clinical population in Turkey and compare its performance with the Epworth Sleepiness Scale (ESS), STOP-Bang, and Berlin questionnaires for high-risk SDB. Materials and methods: This was a retrospective study. Patients who had a full-night PSG examination between 01.03.2017 and 01.01.2018 at the sleep center of our hospital were included in the study. Demographic characteristics, anthropometrics measurements, ESS, STOP-Bang, and Berlin scores were collected from the existing data of the patients. The NoSAS score was subsequently calculated based on available data. Predictive parameters for each screening questionnaires were calculated to compare the discriminative power of those for high-risk SDB. Results: A total of 450 patients were included in the study. The sensitivity, specificity, PPV, and NPV of the NoSAS score were 81%, 51.2%, 88.2%, and 37.5% for an AHI (apnea­hypopnea index) ≥ 5 event/h and 84.5%, 38.2%, 66%, and 63.4% for an AHI ≥ 15 event/h, respectively. AUC percentages for the NoSAS score, STOP-Bang questionnaire, Berlin questionnaire, and ESS were 0.740, 0.737, 0.626, and 0.571 for an AHI ≥ 5 events/h and 0.715, 0.704, 0.574, and 0.621 for an AHI ≥ 30 events/h. The NoSAS score had a false negative rate of 2.9% for severe SDB. Conclusion: The NoSAS score had a good degree of differentiation for SDB and can be used as an easily applicable, subjective, and effective screening tool in a sleep clinical population in Turkey. Not only in moderate to severe SDB but also in mild SDB, the NoSAS score performed better than the other 3 screening tools.

Elaboração e validação da cartilha "Higiene do Sono para Crianças" / Elaboración y validación de la cartilla "Higiene del sueño para niños" / Development and validation of the "Sleep Hygiene for Children" booklet

Resumo Objetivo Elaborar e validar cartilha sobre higiene do sono para crianças escolares. Métodos Estudo de abordagem metodológica, realizado no período de setembro de 2018 a outubro de 2019, seguindo as etapas de levantamento bibliográfico, elaboração e validação de conteúdo da cartilha por especialistas. O instrumento para validação, encaminhado a três profissionais da área da saúde, foi composto por sete itens, divididos em subitens, com respostas dispostas em escala tipo Likert. Os dados obtidos foram tabulados em planilha do Excel. Considerou-se adequado os valores da proporção de concordância dos subitens entre os examinadores (índice de validade do conteúdo) acima de 80%. Resultados A cartilha foi validada após a segunda rodada de avaliação, atingindo índice de validade de 85,7% do conteúdo total e sendo composta por quatro temas: "O que é higiene do sono?", "Importância do sono", "Como realizar a higiene do sono?" e "Guia rápido de recomendações de higiene do sono". Conclusão A cartilha de higiene do sono para crianças, validada por especialistas na segunda rodada, poderá auxiliar a criança a entender a importância do sono para seu desenvolvimento e obter hábitos adequados de sono e de autocuidado.

Resumen Objetivo Elaborar y validar una cartilla sobre higiene del sueño para niños escolares. Métodos Estudio de enfoque metodológico, realizado en el período de septiembre de 2018 a octubre de 2019, que siguió las etapas de recopilación bibliográfica, elaboración y validación del contenido de la cartilla por especialistas. El instrumento para la validación, que fue enviado a tres profesionales del área de la salud, estaba compuesto por siete ítems, divididos en subítems, con respuestas dispuestas en escala tipo Likert. Los datos obtenidos fueron tabulados en planilla de Excel. Los valores de la proporción de concordancia de los subítems entre los examinadores (índice de validez de contenido) superiores a 80 % se consideraron adecuados. Resultados La cartilla fue validada después de la segunda ronda de evaluación, con un índice de validez del contenido total del 85,7 %. El material está compuesto por cuatro temas: "¿Qué es la higiene del sueño?", "Importancia del sueño", "¿Cómo realizar la higiene del sueño?" y "Guía rápida de recomendaciones de higiene del sueño". Conclusión La cartilla de higiene del sueño para niños, validada por especialistas en la segunda ronda, podrá ayudar a los niños a entender la importancia del sueño para el desarrollo y a obtener hábitos adecuados de sueño y de autocuidado.

Abstract Objective To develop and validate a booklet on sleep hygiene for school children. Methods Methodological study conducted from September 2018 to October 2019, following the steps of bibliographic survey, development and content validation of the booklet by experts. The instrument for validation, sent to three health professionals, was composed of seven items, divided into sub-items with responses arranged on a Likert-type scale. Data obtained were tabulated in an Excel spreadsheet. Values of the proportion of agreement of sub-items between experts (content validity index) above 80% were considered appropriate. Results The booklet was validated after the second evaluation round, reaching a validity rate of 85.7% of the total content. It comprised the following four themes: "What is sleep hygiene?", "Importance of sleep", "How to practice sleep hygiene?" and "Sleep hygiene recommendations quick guide". Conclusion The sleep hygiene booklet for children, validated by experts in the second round, can help children understand the importance of sleep for their development and obtain appropriate sleep and self-care habits.

Adherence to the mediterranean diet in elementary school children (1st cycle) / Adesão à dieta mediterrânica em crianças do 1º ciclo de escolaridade

ABSTRACT Objective: To characterize the adherence to the Mediterranean diet (MD) in students from elementary schools in Porto and Maia and analyze its association with sleep hygiene, physical activity, cardiometabolic risk, and school performance. Methods: This is a cross-sectional study with 891 Portuguese students: 455 boys (51%) and 436 girls (49%), aged between 9 and 11 years old (mean [M]=9.2, standard deviation [SD]=0.4), with an average weight of 35.9 kg (SD=8.1), average height of 1.4 m (SD=0.1), average body mass index (standardized BMI Z score for the pediatric age group) of 0.76 (SD=1.21); 59.5% of them had normal weight and 15.9% were obese. The students filled a questionnaire on the adherence to the Mediterranean Diet (Mediterranean Diet Quality Index in Children and Adolescents [KIDMED]), participated in a socio-demographic interview, and had their anthropometric data collected after their parents signed the informed consent form. Results: The results suggest high levels of adherence to the MD (77.6%) both in males and females. Using Pearson's correlation coefficient, we found that the Z score was positively associated to cardiometabolic risk and the starting age of an extracurricular physical activity, and negatively associated to the average hours of sleep on a typical day both in males and females. We also identified a negative relation between KIDMED and the starting age of physical activity. Conclusions: This study has contributed to the knowledge of adherence to the MD among Portuguese elementary students and correlations with variables associated to a healthier lifestyle (MD, hours of sleep, and physical activity). Future studies should focus their attention on other countries and more heterogeneous samples.

RESUMO Objetivo: Caracterizar a adesão à dieta mediterrânica de alunos de escolas primárias do Porto e Maia e analisar a sua associação com a higiene do sono, a atividade física, o risco cardiometabólico e o desempenho escolar. Métodos: Estudo transversal com 891 alunos portugueses: 455 meninos (51%) e 436 meninas (49%), entre 9 e 11 anos (média [M]= 9,2; desvio padrão [DP]= 0,4), peso médio 35,9 kg (DP= 8,1), estatura média 1,4 cm (DP= 0,1), índice de massa corporal médio (IMC padronizado por escore Z para a faixa etária pediátrica) 0,76 (DP= 1,2), 59,5% de pessoas com peso adequado e 15,9% de obesos. Os alunos completaram o Índice de Qualidade de Adesão à Dieta Mediterrânica em Crianças e Adolescentes (Mediterranean Diet Quality Index in Children and Adolescents [KIDMED]) e uma entrevista sociodemográfica e dados antropométricos, após obtenção do consentimento informado dos pais. Resultados: Os resultados sugerem altos níveis de adesão ao padrão alimentar mediterrânico (77,6%), tanto nos meninos como nas meninas. Recorrendo ao coeficiente de correlação de Pearson, encontramos associação positiva entre o escore Z e o risco cardiometabólico, associação negativa entre o escore Z e a média de horas de sono em um dia típico nos meninos e nas meninas, associação positiva entre o escore Z e a idade de início de uma atividade física extracurricular e associação negativa entre o KIDMED e a idade de início da atividade física. Conclusões: Este estudo contribuiu para o conhecimento da adesão ao padrão alimentar mediterrânico de alunos do 1º ciclo de escolaridade do Porto e da Maia e correlações com variáveis associadas a um estilo de vida mais saudável (adesão à dieta mediterrânica, horas de sono e atividade física). Estudos futuros deverão focar a sua atenção em outros países e com amostras mais heterogêneas.

Unveiling sleep mysteries: functions / Revelando mistérios do sono: funções

Sleep occupies roughly one-third of human lives, yet it is still not entirely scientifically clear about its purpose or function. However, the latest research achievement concluded that sleeping has much more effect on the brain than formerly believed. Much of these studies are about the effects of sleep deprivation, and the glymphatic pathway initially identified in the rodent brain. In this paper, it is presented some of the theories about sleep functions, besides a review of some physiologic function of sleep. Now, it is accepted that sleep is involved with cleaning the brain toxins, physical restoration, information processing and recall, regulation, besides strengthening the immune system. Sleep implies in a neuronal activity markedly different along with its phases. It is regulated by two parallel mechanisms, homeostatic and circadian. Besides, the sleep-waking cycle involves diverse brain circuits and neurotransmitters and their interaction is explained using a flip-flop model. Several theories may help clarify the reasons human beings spend an important part of their lives sleeping such as those of Inactivity, Energy Conservation, Restorative, and Brain Plasticity. Recently, it was emphasized the importance of the glymphatic system that is a waste clearence system that acts mainly during sleep support efficient removal of soluble proteins and metabolites from the central nervous system. Indeed, sleep meet the needs of higher brain functions along with basic vital processes.

O sono ocupa cerca de um terço da vida humana, mas ainda não é totalmente claro cientificamente o seu propósito ou função. No entanto, a mais recente pesquisa concluiu que dormir tem muito mais efeito no cérebro do que se pensava anteriormente. Muitos desses estudos são sobre os efeitos da privação do sono e o sistema glinfático inicialmente identificada no cérebro de roedores. Neste artigo, são apresentadas algumas das teorias sobre as funções do sono, além de uma revisão de algumas funções fisiológicas do sono. Agora, aceita-se que o sono esteja envolvido com a limpeza de toxinas cerebrais, restauração física, processamento e memorização de informações, regulação do humor, além de fortalecer o sistema imunológico. O sono implica em uma atividade neuronal marcadamente diferente ao longo de suas fases. É regulado por dois mecanismos paralelos, homeostático e circadiano. Além disso, o ciclo de vigília envolve diversos circuitos cerebrais e neurotransmissores e sua interação é explicada por meio de um modelo de flip-flop. Várias teorias podem ajudar a esclarecer as razões pelas quais o ser humano passa uma parte importante de suas vidas dormindo, como as de inatividade, conservação de energia, restauração e plasticidade cerebral. Recentemente, enfatizou-se a importância do sistema glinfático agir principalmente durante o sono, que é um sistema de eliminação de resíduos para apoiar a remoção eficiente de proteínas e metabólitos solúveis do sistema nervoso central. De fato, o sono atende às necessidades de funções cerebrais superiores, juntamente com processos vitais básicos.

The Effects of the COMMASH-E Intervention on the Fatigue, Sleep Quality and Functional Status of Children with Cancer in Indonesia.

This study aimed to investigate the effects of the combined music and sleep hygiene education (COMMASH-E) intervention on the fatigue, sleep quality and functional status of children with cancer residing in temporary lodges in Indonesia. The design of this study was a quasi-experimental pre-post test with a control group. We recruited children with cancer aged 7-18 years (n = 58) using a consecutive sampling method and assigned them to intervention and control groups (n = 29 in each group). The intervention group had the COMMASH-E intervention while the control group received routine care. Fatigue, sleep quality and functional status were measured on days 1 and 4 using Allen's Fatigue in Childhood Cancer Scale, the Sleep Problem in Children Scale and the Barthel Index, respectively. T-dependent and independent tests and Multivariate Analysis of Covariance (MANCOVA) tests were performed for the data analysis. There were significant differences in fatigue, sleep quality and functional status between the intervention and control groups after the COMMASH-E intervention. Nonetheless, chemotherapy drugs contributed to the children's sleep quality. COMMASH-E was found to be more effective than routine care in the reducing fatigue and increasing the sleep quality and functional status of children with cancer.

El sueño del niño con trastornos del neurodesarrollo / The sleep in children with neurodevelopmental disorders

El sueño adecuado es necesario para el desarrollo sináptico y la maduración cerebral, un sueño de mala calidad tiene efectos perjudiciales en las funciones cognitivas, de atención, memoria y conducta de los niños. La preocupación sobre la alta prevalencia de los problemas del sueño es amplia en todo el mundo; las consecuencias de estos problemas son incluso más importantes en los niños portadores de trastornos del neurodesarrollo; estos niños a menudo tienen dificultades de inicio y mantenimiento del sueño y despertares nocturnos frecuentes que afectan a sus problemas de conducta. El propósito de este escrito es revisar el estado del arte de los problemas del sueño en los niños con trastornos del neurodesarrollo. En este punto, es importante tener en cuenta el ritmo circadiano, un reloj que genéticamente dirige los ritmos celulares de transcripción, traslación y metabolismos. Este reloj se combina con el ambiente diurno y nocturno coordinando estos mecanismos durante los ciclos luz/oscuridad, sueño/vigilia, frío/calor, ingesta/ayuno, tanto diariamente como en las diferentes estaciones. En conclusión, los problemas del sueño son un factor condicionante de la evolución y calidad de vida de los niños con trastornos del neurodesarrollo, que debe ser tenido en cuenta en todos los casos y ocupar un lugar preferente tanto en la etapa diagnóstica como en la terapéutica.

Adequate sleep is of critical need for a typical synaptic development and brain maturation, a poor quality sleep can have detrimental effects on children's' cognitive attention, memory, mood regulation, and behavior functions. Great concern has been voiced out regarding the high prevalence of poor sleep in children worldwide, the effects of poor sleep may be even more pronounced in children with neurodevelopmental disorders; these children often have difficulties with falling and staying asleep and with night awakenings, this has a strong association with daytime behavior problems. The purpose of this article is to provide an overview of the state of the science of sleep in children with a neurodevelopmental disorder. In this context, it is important to take the circadian cycle into account, a genetically encoded clock that drives cellular rhythms of transcription, translation and metabolism. The circadian clock interacts with the diurnal and nocturnal environment that also drives transcription and metabolism during light/dark, sleep/wake, hot/cold and feast/fast daily and seasonal cycles In conclusion, the sleep problems are a conditioning factor in the evolution and quality of life of children with neurodevelopmental disorders that must be taken into account in all cases and occupy a preferential place in both the diagnostic and the therapeutic stages.

Subjective sleep need and daytime sleepiness in adolescents / Necessidade subjetiva de sono e sonolência diurna em adolescentes

ABSTRACT Objective: To analyze the contribution of subjective sleep need for daytime sleepiness in adolescents, and to compare questions about sleep, age and body mass index between adolescents who considered to sleep enough and those who reported the need for more sleep. Methods: This is a descriptive, epidemiological and cross-sectional study. Data collection was performed in August 2016, with 773 adolescents aged 14-19 years old, from Paranaguá, Paraná, Southern Brazil. The analysis included the following variables: time in bed, half-sleep phase, sleep need, social jetlag, daytime sleepiness, body mass index and physical activity. Results: The prevalence of adolescents with subjective need for sleep was 73.0%, with an average need of 1.7 extra hours of sleep. These adolescents woke up earlier (p<0.001) and slept less on school days (p<0.001). The need for more sleep was associated with higher daytime sleepiness scores (rho=0.480; p<0.001) and with later half-sleep phase (rho=0.200; p<0.001). No correlation was identified between the sleep need and time in bed (rho=-0.044; p=0.225). The subjective sleep need was the variable with the greatest explanatory power for daytime sleepiness (24.8%; p<0.001). In addition, the less adolescents practiced physical activity, the higher their daytime sleepiness scores (rho=-0.117; p<0.001). Conclusions: The subjective sleep need has an important role in explaining daytime sleepiness among adolescents. Adolescents who needed to sleep more reported waking up early and experienced sleep deprivation during class days; they also woke up later on the weekends and experienced more daytime sleepiness, compared to those who believed they had enough sleep.

RESUMO Objetivo: Analisar a contribuição da necessidade subjetiva de sono para a sonolência diurna em adolescentes e comparar questões sobre sono, idade e índice de massa corporal entre os adolescentes que consideram dormir o suficiente e os que julgam necessitar dormir mais. Métodos: Estudo descritivo, epidemiológico e transversal, cuja coleta de dados ocorreu em agosto de 2016 em 773 adolescentes de 14 a 19 anos de Paranaguá, PR, Brasil. As variáveis de análise foram tempo de cama, meia fase do sono e necessidade de mais horas de sono, além do jetlag social, sonolência diurna, índice de massa corpórea (IMC) e atividade física. Resultados: A prevalência de adolescentes com necessidade subjetiva de sono foi 73,0%, sugerindo precisar, em média, de 1,7 hora a mais de sono. Estes acordavam mais cedo (p<0,001) e dormiam menos nos dias de aula (p<0,001). A necessidade de dormir mais associou-se a maiores pontuações de sonolência diurna (rho=0,480; p<0,001) e com meia fase do sono mais tardia (rho=0,200; p<0,001). Não foi identificada correlação entre necessidade de sono e tempo de cama (rho=-0,044; p=0,225). A necessidade subjetiva de sono foi a variável com maior poder explicativo da sonolência diurna (24,8%; p<0,001). Além disso, quanto menos os adolescentes praticavam atividade física, maiores as pontuações de sonolência diurna (rho=-0,117; p<0,001). Conclusões: A percepção subjetiva de sono teve papel importante para explicar a sonolência diurna dos adolescentes. Os jovens que precisavam dormir mais relataram acordar mais cedo e apresentavam privação de sono durante os dias de aula, acordaram mais tarde no final de semana e apresentaram maior sonolência diurna, comparando-se aos que acreditavam dormir o suficiente.

Management of perinatal depression with non-drug interventions.

Perinatal depression is a common disorder that has been associated with serious risks to mother and child. Recently, screening for depression in pregnant and postpartum women has increased, as has the development of new psychotherapy and non-drug treatment modalities. Matching patients to treatments can be challenging, and although research into personalized treatment of major depression in the general population has increased, no published guidelines focus on personalized treatment approaches to perinatal depression. In particular, guidelines on non-drug treatments are lacking. This review summarizes the evidence on personalized non-drug treatment of perinatal depression, how to incorporate patients' preferences, novel treatments under investigation, and the potential role of biomarkers in matching patients to treatment. The review provides recommendations for future research in personalized care of perinatal depression.

Construction and validation of a sleep hygiene booklet for the elderly / Construcción y validación de un manual para ancianos acerca de la higiene del sueño / Construção e validação de cartilha para idoso acerca da higiene do sono

ABSTRACT Objective: to construct and validate an educational booklet for the elderly, with guidelines on sleep hygiene. Method: a methodological research with booklet construction; validation by 22 judges and evaluation by 22 elderly people. The content was extracted from the guidelines of the Brazilian Sleep Association and the elderly health manual of the Human Rights Office. The item with Content Validity Index (CVI) greater than 0.8 or whose concordance ratio verified with the Binomial Test was valid and statistically equal to or greater than 80%. Results: the booklet presented 14 guidelines for the elderly about sleep hygiene distributed over 25 pages. All items were evaluated as relevant. The CVI had an average of 0.95 by the judges and 0.95 by the elderly. Conclusion: the booklet was constructed and validated as to its content and appearance. It can be used by health professionals in the various services with the elderly.

RESUMEN Objetivo: construir y validar un manual educativo para ancianos, con orientaciones sobre higiene del sueño. Método: investigación metodológica con construcción de lo manual, validación por 22 jueces y evaluación por 22 ancianos. El contenido fue extraído de las orientaciones de la asociación brasileña del sueño y del manual de salud del anciano de la Secretaría de Derechos Humanos. Se consideró válido el ítem con Índice de Validez de Contenido (IVC) mayor que 0,8 o cuya proporción de concordancia, verificada con el Test Binomial, fue estadísticamente igual o superior al 80%. Resultados: lo manual presentó 14 orientaciones para ancianos sobre higiene del sueño, distribuidas en 25 páginas. Todos los ítems fueron evaluados como pertinentes y el IVC tuvo promedio de 0,95 por los jueces y 0,95 por los ancianos. Conclusión: lo manual fue construida y validada en cuanto a su contenido y apariencia, pudiendo ser utilizada por los profesionales de salud en los diversos servicios con el público anciano.

RESUMO Objetivo: construir e validar cartilha educativa para idosos, com orientações sobre higiene do sono. Método: pesquisa metodológica com construção da cartilha, validação por 22 juízes e avaliação por 22 idosos. O conteúdo foi extraído das orientações da associação brasileira do sono e do manual de saúde do idoso da Secretaria de Direitos Humanos. Foi considerado válido o item com Índice de Validade de Conteúdo (IVC) maior que 0,8 ou cuja proporção de concordância, verificada com o teste binomial, foi estatisticamente igual ou superior a 80%. Resultados: a cartilha apresentou 14 orientações para idosos sobre higiene do sono, distribuídas em 25 páginas. Todos os itens foram avaliados como pertinentes e o IVC teve média de 0,95 pelos juízes e 0,95 pelos idosos. Conclusão: a cartilha foi construída e validada quanto seu conteúdo e aparência e pode ser utilizada pelos profissionais de saúde nos diversos serviços com o público idoso.

Validating the Persian Adolescent Sleep Hygiene Scale-Revised (ASHSr) using comprehensive psychometric testing methods.

BACKGROUND: This study translated the Adolescent Sleep Hygiene Scale-revised (ASHSr) into Persian and aimed to validate its psychometric properties using classical test theory and Rasch analyses. METHODS: Adolescents aged 14-18 (n = 389; 199 males) and their parents in Iran participated in the study. Each adolescent wore a wrist actigraphy device during sleep time and completed the ASHSr, the Depression Anxiety Stress Scale (DASS), the General Health Questionnaire (GHQ), the Pediatric Daytime Sleepiness Scale (PDSS), and the Pittsburgh Sleep Quality Index (PSQI). A parent of each adolescent completed the Sleep Disturbance Scale for Children (SDSC). RESULTS: The construct validity of the ASHSr was supported by both classical test theory (factor loadings from confirmatory factor analysis [CFA] = 0.64 to 0.88; corrected item-total correlations = 0.70 to 0.92; test-retest reliability = 0.72 to 0.90) and Rasch analyses (infit mean square = 0.73 to 1.30; outfit mean square = 0.74 to 1.32). ASHSr had significantly negative associations with DASS subscales (ß = -0.15 to -0.42, ps < 0.001) and GHQ (ß = -0.663, p < 0.001). Known-group validity was demonstrated by the significant differences between poor and good sleep hygiene based on ASHSr in the actigraphy measure and scores of PDSS, PSQI, and SDSC. The multigroup CFA and differential item functioning in Rasch analyses suggested that all the participants interpreted the ASHSr similarly, regardless of their gender or living in a private room. CONCLUSIONS: The Persian ASHSr demonstrated good reliability and validity in assessing sleep hygiene among Iranian adolescents. Healthcare providers may use it to assess the effectiveness of sleep hygiene programs.

Sleep disorders as primary and secondary factors in relation with daily functioning in medical students.

BACKGROUND: College students experience various types of sleep disorders that impact daily functioning. Previous studies have focused on the effect of one sleep disorder. OBJECTIVE: Examine factors that might relate to several sleep disorders and the impacts of sleep disorders on the daily functioning in medical students. DESIGN: Cross-sectional study. SETTING: Medical college. SUBJECTS AND METHODS: A random sample of medical students from a public university was invited to participate in a cross-sectional study using the structured SLEEP-50 self-reported questionnaire. The sleep disorders covered by the questionnaire were insomnia, sleep apnea, restless legs syndrome, sleep walking, circadian rhythm sleep disorder, nightmares, narcolepsy, and factors impacting sleep, effects of sleep complaints on daily functioning, and sleeping duration. MAIN OUTCOME MEASURE: Sleep duration, sleep disorders. RESULTS: Of 317 participants, 165 (50.2%) reported having less than 7 hours sleep and apart from hyper-somnia, had various kinds of sleep disorders. Various factors such as having no pleasure and entertainment, feeling sadness, alcohol drinking, amount of sleeping hours, smoking, age, a noisy or light bedroom, and substance abuse were related to different sleep disorders. Moreover, students with sleep disorders felt tired arising, felt sleepy during the day, were easily irritated, had difficulty in concentration, had concerns about amount of sleep, and slept badly at college. CONCLUSIONS: Insufficient sleep is a common issue in medical students and a number of sleep disorders were found. The results suggest that sleep disorders could have negative impacts on the daily functioning of students. LIMITATIONS: The study findings may not be generalizable because sociocultural characteristics of the sample may differ from the general population.

Non-pharmacological interventions for sleep and quality of life: a randomized pilot study / Intervenções não farmacológicas no sono e qualidade de vida: estudo piloto aleatorizado / Intervenciones no farmacológicas en el sueño y calidad de vida: estudio piloto aleatorizado

ABSTRACT Objective: to estimate the effects of non-pharmacological interventions to improve the quality of sleep and quality of life of patients with heart failure. Method: pilot study of a randomized controlled trial with 32 individuals assigned to four groups. Sleep was assessed using the Pittsburgh Sleep Quality Inventory, while health-related quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, at the baseline and at the 12th and 24th weeks. The means of the outcomes according to intervention groups were compared using analysis of covariance; effect sizes were calculated per group. Results: all groups experienced improved quality of sleep and health-related quality of life at the end of the intervention (week 12) and at follow-up (week 24), though differences were not statistically significant (p between 0.22 and 0.40). The effects of the interventions at the 12th week ranged between -2.1 and -3.8 for the quality of sleep and between -0.8 and -1.7 for quality of life, with similar values at the 24th week. Conclusion: the effects found in this study provide information for sample size calculations and statistical power for confirmatory studies. Brazilian Clinical Trials Registry - RBR 7jd2mm

RESUMO Objetivo: estimar os efeitos de intervenções não farmacológicas para melhora da qualidade de sono e de vida de pacientes com insuficiência cardíaca. Método: estudo piloto de um ensaio controlado aleatorizado com 32 indivíduos alocados em quatro grupos. Sono foi avaliado pelo Pittsburgh Sleep Quality Inventory e qualidade de vida relacionada à saúde avaliada pelo Minnessota Living with Heart Failure Questionnaire, no início e nas semanas 12 e 24 do estudo. As médias dos desfechos por grupo de intervenção foram comparadas por análise de covariância, e os tamanhos dos efeitos calculados para cada grupo. Resultados: todos os grupos apresentaram melhora na qualidade de sono e de vida relacionada à saúde no final do período de intervenção (12 semanas) e no seguimento de 24 semanas, mas as diferenças não foram estatisticamente significantes (p entre 0,22 e 0,40). Em 12 semanas, os efeitos das intervenções variaram entre -2,1 e -3,8 na qualidade de sono e de -0,8 e -1,7 na qualidade de vida, com valores similares em 24 semanas. Conclusão: os efeitos obtidos neste estudo podem servir de base para cálculos de tamanho amostral e poder estatístico em estudos confirmatórios. Registro Brasileiro de Ensaios Clínicos - RBR 7jd2mm

RESUMEN Objetivo: estimar los efectos de intervenciones no farmacológicas para mejoría de la calidad de sueño y de vida de pacientes con insuficiencia cardíaca. Método: estudio piloto de un ensayo controlado aleatorizado con 32 individuos asignados a cuatro grupos. El sueño fue evaluado por el Pittsburgh Sleep Quality Inventory y la calidad de vida relacionada a la salud fue evaluada por el Minnessota Living with Heart Failure Questionnaire, en el inicio y en las semanas 12 y 24 del estudio. Las medias de los resultados por grupo de intervención fueron comparadas con análisis de covariancia y los tamaños de los efectos fueron calculados para cada grupo. Resultados: todos los grupos presentaron mejoría en la calidad de sueño y de vida relacionada a la salud al final del período de intervención (12 semanas) y en el seguimiento de 24 semanas; sin embargo, las diferencias no fueron estadísticamente significativas (p entre 0,22 y 0,40). En 12 semanas, los efectos de las intervenciones variaron entre -2,1 y -3,8 en la calidad de sueño y de -0,8 a -1,7 en la calidad de vida, con valores similares en 24 semanas. Conclusión: los efectos obtenidos en este estudio pueden servir de base para calcular el tamaño de la muestra y del poder estadístico en estudios confirmatorios. Registro Brasileño de Ensayos Clínicos - RBR 7jd2mm.

School start time effects on adolescent learning and academic performance, emotional health and behaviour.

PURPOSE OF REVIEW: The investigation of the relationship between the time of day that school begins and the effects it could have on students began in the mid-1990s. Since that time, many articles have been written either for the medical literature or the educational literature. This review is intended to bridge that gap by examining together the findings for both academic and health outcomes, exploring what we know and what is needed in further investigation. RECENT FINDINGS: Teens who are sleep deficient (defined as obtaining less than 8 h per night) because of early starting time for their school are much more likely to engage in risky behaviours, such as drug, cigarette and alcohol use, have significant feelings of depression, get lower grades and are at greater risk for car crashes. Many studies of academic performance and later school start time indicate benefits, although further research is needed to understand the related mechanisms that contribute to improvements in achievement. Recent research in adolescent sleep and outcomes is being shaped by not only measuring sleep duration, but also examining the timing in which sleep occurs. SUMMARY: Early school starting time for middle and high students has a clear, deleterious effect on their health and well being. Most recently, sleep deficit in teens is being viewed as a public health issue that needs a wider discussion about its impact and it necessitates improved public education about the sleep phase shift that occurs during adolescence.

What keeps children with cystic fibrosis awake at night?

BACKGROUND: Sleep disturbance is common in children with cystic fibrosis (CF) however there are limited studies investigating the causes for poor sleep quality. In a cross sectional observational study we aimed to evaluate the clinical correlates of sleep disturbance in this population. METHODS: Children with CF (7-18years) free from pulmonary exacerbation completed medical review, overnight oximetry, the OSA-18 and 14days of actigraphy recordings with a sleep diary. RESULTS: In addition to FEV1 <80% and low baseline SpO2, CF-related diabetes, PEG feeding and co-morbid behaviour disorder were associated with lower objective sleep quantity. Paternal smoking and a family member with a mood disorder were also associated with sleep disturbance. The use of electronic devices before bedtime was associated with lower sleep quantity and quality. FEV1, nocturnal cough, age and a behaviour disorder predicted sleep duration. FEV1, nocturnal cough, SpO2 nadir and asthma predicted sleep efficiency. Conversely, sleep efficiency independently predicted FEV1. CONCLUSIONS: Reduced sleep quality in children with CF is related to lung health and co-morbidities. However, family characteristics and poor sleep hygiene in the child were also associated with sleep disturbance. Optimal management of CF would seem to be the primary intervention to alleviate children's sleep disturbance, however our data raises additional targets for attempts to improve sleep.

A Sleep Hygiene and Relaxation Intervention for Children With Acute Lymphoblastic Leukemia: A Pilot Randomized Controlled Trial.

BACKGROUND: Sleep disturbance and fatigue are common and distressing pediatric cancer-related outcomes. Sleep hygiene education and relaxation techniques are recommended to improve sleep in healthy children and adult cancer survivors. No studies have tested these interventions to improve sleep and fatigue for children with acute lymphoblastic leukemia (ALL) in the home setting. OBJECTIVES: The aim of this study is to establish the feasibility and acceptability of a sleep hygiene and relaxation intervention to improve sleep and fatigue for children receiving maintenance chemotherapy for ALL. The child's fatigue and sleep data were collected to inform sample size calculations for a future trial. METHODS: In this pilot randomized controlled trial, 20 children were allocated randomly to the sleep intervention or control group. The sleep intervention group received a 60-minute educational session to discuss sleep and fatigue in children with cancer and strategies to improve sleep, including use of 2 storybooks to teach deep breathing and progressive muscle relaxation. Objective sleep data were collected using actigraphy and fatigue was measured using the Childhood Cancer Fatigue Scale. RESULTS: The intervention was acceptable to families, and feasibility of the intervention and data collection was clearly established. Although not statistically significant, increases in mean nighttime sleep and decreases in mean wake time after sleep onset in the sleep intervention group represented clinically important improvements. CONCLUSIONS: This pilot study demonstrated the feasibility and acceptability of a sleep hygiene and relaxation intervention for children undergoing maintenance chemotherapy for ALL. IMPLICATIONS FOR PRACTICE: Given the clinically important improvements in sleep observed, replication in a larger, adequately powered randomized controlled trial is merited.

Early detection of changes in lung mechanics with oscillometry following bariatric surgery in severe obesity.

Obesity is associated with respiratory symptoms that are reported to improve with weight loss, but this is poorly reflected in spirometry, and few studies have measured respiratory mechanics with oscillometry. We investigated whether early changes in lung mechanics following weight loss are detectable with oscillometry. Furthermore, we investigated whether the changes in lung mechanics measured in the supine position following weight loss are associated with changes in sleep quality. Nineteen severely obese female subjects (mean body mass index, 47.2 ± 6.6 kg/m(2)) were evaluated using spirometry, oscillometry, plethysmography, and the Pittsburgh Sleep Quality Index before and 5 weeks after bariatric surgery. These tests were conducted in both the upright and the supine position, and pre- and postbronchodilation with 200 µg of salbutamol. Five weeks after surgery, weight loss of 11.5 ± 2.5 kg was not associated with changes in spirometry and plethysmography, with the exception of functional residual capacity. There were also no changes in upright respiratory system resistance (Rrs) or reactance following weight loss. Importantly, however, in the supine position, weight loss caused a substantial reduction in Rrs. In addition, sleep quality improved significantly and was highly correlated with the reduction in supine Rrs. Prior to weight loss, subjects did not respond to the bronchodilator when assessed in the upright position with either spirometry or oscillometry; however, with modest weight loss, bronchodilator responsiveness returned to the normal range. Improvements in lung mechanics occur very early after weight loss, mostly in the supine position, resulting in improved sleep quality. These improvements are detectable with oscillometry but not with spirometry.

Validação para língua portuguesa de duas escalas para avaliação de hábitos e qualidade de sono em crianças / Language validation of two scales to evaluate sleep quality in children

OBJETIVO: Apresentar a validação para língua portuguesa das escalas de avaliação do sono: "Inventário dos hábitos de sono para crianças pré-escolares" e "Questionário sobre o comportamento do sono". MÉTODOS: Inicialmente as escalas foram traduzidas para português, após receberam tradução reversa, em reunião de consenso foi avaliada a melhor versão. As escalas foram aplicadas em dois grupos de crianças (controle e com epilepsia). Os pacientes com epilepsia foram estratificados pela gravidade através da classificação de Engel. Os escores obtidos foram comparados entre si e relacionados com a gravidade da epilepsia. RESULTADOS: A escala "Inventário dos hábitos de sono para crianças pré-escolares" evidenciou maior incidência de alterações na rotina da hora de dormir, na ritmicidade do sono e de separação dos pais no grupo com epilepsia refratária. Crianças com epilepsia controlada apresentaram hábitos do sono mais saudáveis (p < 0,05). A aplicação do "Questionário sobre o comportamento do sono" evidenciou alterações na qualidade do sono no grupo com epilepsia (p < 0,001). Quanto maior a refratariedade da epilepsia pior a qualidade do sono (p < 0,001). CONCLUSÃO: Disponibilizamos através da validação para língua portuguesa questionários para avaliação de distúrbios do sono na infância. A aplicação destes questionários demonstrou a influência exercida pela epilepsia com crises não controladas na qualidade do sono.

OBJECTIVE: Validation to Portuguese of the questionaries: Sleep Habits Inventory for Preschool Children and Sleep Behavior Questionaire. METHODS: The English version of the questionnaires was translated and back translated independently by two professionals, after that the best version was choose. The Portuguese version was applied in two groups of children: patients with epilepsy and a control group. Patients with epilepsy were classified according to Engel score. Results obtained on both groups were related to epilepsy refractoriness. RESULTS: Sleep Habits Inventory for Preschool Children applied in children between 2-6 years of age showed that patients with refractory epilepsy have a major incidence of disorders in the sleep rhythm and routines. Furthermore, they also have more problems to be separated from parents. Children with well controlled epilepsy have more incidence of health sleep habits (p < 0,05). The score of Sleep Behavior Questionnaire applied in children between 7-14 years of age showed significant difference among children with epilepsy (47,52 ± 10,9) and controls (30,52 ± 3,75) (p < 0,001). Refractory epilepsies related with worse sleep quality (p < 0.001). CONCLUSION: Two questionnaires that evaluate sleep habits were translated and validated to be used in Portuguese. Application of these questionnaires in controls and in children with epilepsy showed that uncontrolled epilepsy influences quality of sleep.