Quality of sleep and excessive daytime sleepiness among medical students in a Brazilian private university

SUMMARY OBJECTIVE: The aim of this study was to assess medical students' quality of sleep and excessive daytime sleepiness in different graduation cycles. METHODS: A cross-sectional study was carried out at a private university in Maceió, Brazil, from August 2021 to March 2022. The sample was composed of medical students aged 18 years and above from years 1-2 (basic cycle), 3-4 (clinical cycle), and 5-6 (internship) of Medical School who were invited to answer two validated questionnaires: the Pittsburgh Sleeping Quality Index and the Epworth Sleepiness Scale. RESULTS: A total of 179 students participated; most of them were female (78.2%), aged 19-25 years (73.7%), and with a body mass index<25 kg/m2 (73.7%), with smaller participation from students from the basic cycle (21.2%). Analyzing the Pittsburgh Sleeping Quality Index, 55.9% of the students were classified as having poor sleep quality, with no difference in sleep category between gender, age, body mass index, and graduation cycle. Students with a body mass index of ≥25 kg/m2 had longer sleep latency (p=0.016) and shorter sleep duration (p=0.027). The Epworth Sleepiness Scale assessment showed that 44.1% of the students exhibit daytime sleepiness. Women had more daytime sleepiness than men (p=0.017), with no difference between age, body mass index, and graduation cycle. CONCLUSION: About half of the medical students experience poor sleep quality and daytime sleepiness, regardless of the graduation cycle. This should trigger a targeted institutional intervention to promote better mental and physical health, as well as sleep hygiene, to reduce future health issues.

Quality of sleep in individuals with systemic sclerosis and its correlation with functional disability and quality of life: a cross-sectional study

SUMMARY OBJECTIVE: This study aimed to evaluate the quality of sleep in individuals with systemic sclerosis and its correlation with the quality of life and disability. METHODS: This is a cross-sectional study, carried out in a tertiary service of a university hospital. Inclusion criteria were diagnosis of systemic sclerosis according to the criteria of the American College of Rheumatology/European League Against Rheumatism 2013 or the preliminary criteria of the American College of Rheumatology 1980, age ≥ 18 years; regularly monitored at the outpatient clinic of rheumatology. Clinical and demographic data of the patients were obtained through a structured interview and evaluation of the medical records. Sleep quality was assessed using the Pittsburgh Sleep Quality Index questionnaire, daytime sleepiness using the Epworth Sleepiness Scale, quality of life using 12-item short-form health survey, and disability using the scleroderma health assessment questionnaire. RESULTS: A total of 50 patients with systemic sclerosis were included, with 92% female, mean age 48.9 years, mean disease duration 8.9 years, and 60% limited cutaneous form. Most systemic sclerosis patients (84%) have poor sleep quality and 20% have excessive daytime sleepiness. There was a significant negative correlation between Pittsburgh Sleep Quality Index and the physical and mental components of the 12-item short-form health survey (r=-0.42, p=0.003 and r=-0.43, p=0.002, respectively) and a positive correlation with the scleroderma health assessment questionnaire (r=0.52, p=<0.001). CONCLUSION: This study showed that poor sleep quality is a very common finding among systemic sclerosis patients, and it negatively affects both the quality of life and the degree of disability.

Associação entre parâmetros do sono e atividade física em corredores durante a pandemia de COVID-19 / Association between sleep parameters and physical activity in runners during the COVID-19 pandemic

Determinar associação entre qualidade do sono (QS), sonolência diurna excessiva (SDE) e a atividade física (AF) em corredores de rua durante a pandemia deCOVID-19. Em86 voluntários, as seguintes variáveis foram avaliadas: QS (pelo Índice de Qualidade do Sono de Pittsburgh, ESE (pelaEscala de Sonolência de Epworth) e a AF (pelo aplicativo Google Fit®).Utilizou-se o teste de correlação de Pearson ou teste de correlação de Spearman. A análise de regressão linear simples foi realizada entre as variáveis que apresentaram correlação. Consideraram-se significantes os valores de p<0,05. Houve correlação entre a SDE e a contagem de passos, bem como entre a SDE e a AF. Verificou-se associação entre a SDE e a AF, mas não entre a QS e a AF.

To determine the association between sleep quality (SQ), excessive daytime sleepiness (EDS) and physical activity (PA) in amateur street runners during the COVID-19pandemic. Eighty-six volunteers were evaluated, and the analyzed variables were: SQ (By Pittsburgh Sleep Quality Index), EDS (By Epworth Sleepiness Scale), and PA (By the Google Fit® app). The data was collected remotely, via email, using Google Forms. Pearson correlation test or Spearman correlation test was used for data correlation. Simple linear regression analysis was performed between variables that showed correlation. P values < 0.05 were considered significant. There was a correlation between EDS and step count [r (p) = 0.219 (0.042)], and only an association between PA and EDS was observed. Based on the results, an association was found between EDS and PA. However, no association was found between SQ and PA.

Desenvolvimento de aplicativo para higiene do sono em adultos / Development of an application for sleep hygiene in adults / Desarrollo de una aplicación para la higiene del sueño en adultos

Introdução: Diferentes condições clínicas podem afetar a quantidade e a qualidade do sono. As medidas de higiene do sono interferem diretamente na qualidade deste. Elas podem ser propagadas à população por meio de aplicativos. Objetivo: Desenvolver, avaliar e disponibilizar um aplicativo que contemple as medidas de higiene do sono e que seja capaz de gerar mudança e verificar a ocorrência de sonolência diurna excessiva. Metodologia: O aplicativo "Somnum" foi desenvolvido e 26 fonoaudiólogos certificados em Sono pela Associação Brasileira do Sono foram convidados a avaliar usando o questionário Emory e outro questionário elaborado pelas autoras. Após, 38 estudantes usaram o aplicativo e responderam antes e depois do uso o Índice de Qualidade do Sono de Pittsburgh e a Escala de Epworth. Resultados: Após seu desenvolvimento, o aplicativo foi avaliado por 4 fonoaudiólogas que contribuíram com suas sugestões e 38 universitários participaram respondendo os questionários, sendo que 6 deles participaram antes e após o uso do aplicativo. Sobre o Índice de qualidade de sono de Pittsburgh, foi observado na análise estatística, comparando o antes e após o uso do aplicativo, melhora da qualidade de sono (p=0,04). No que se refere ao questionário Epworth, foi verificado na situação após o uso do aplicativo "Somnum", que não houve diferença significativa. Conclusão: Após o uso do aplicativo, verificou-se possível melhora na qualidade de sono. Houve ocorrência de sonolência diurna excessiva. (AU)

Introduction: Different clinical conditions can affect the quantity and quality of sleep. Sleep hygiene measures directly affect the quality of sleep. They can be disseminated to the population by means of applications. Objective: To develop, evaluate and make available an application that approach sleep hygiene and that is able to generate changes and verify the occurrence of excessive daytime sleepiness. Methodology: The application "Somnum" was developed and 26 speech therapists certified in sleep by the Brazilian Sleep Association were invited to evaluate it using the Emory questionnaire and another questionnaire developed by the authors. Afterwards, 38 students used the application and answered before and after the use the Pittsburgh Sleep Quality Index and the Epworth Scale. Results: After its development, the app was evaluated by 4 speech therapists who contributed with their suggestions, and 38 university students participated by answering the questionnaires, 6 of them before and after the use of the application. In the Pittsburgh Sleep Quality Index, it was observed in the statistical analysis, comparing before and after using the application, improvement in sleep quality (p=0.04). In the Epworth questionnaire, it was verified in the situation after using the "Somnum" application, that there was not significant difference. Conclusion: After using the application, there was a possible improvement in sleep quality. There was occurrence of excessive daytime sleepiness. (AU)

Introducción: Diferentes condiciones clínicas pueden afectar a la cantidad y calidad del sueño. Las medidas de higiene del sueño afectan directamente a la calidad del mismo. Pueden propagarse a la población mediante aplicaciones. Objetivo: Desarrollar, evaluar y poner a disposición una aplicación que incluya medidas de higiene del sueño y que sea capaz de generar cambios y verificar la aparición de somnolencia diurna excesiva. Metodología: Se desarrolló la aplicación "Somnum" y se invitó a 26 fonoaudiólogos certificados en soeño por la Asociación Brasileña del Sonido a evaluarla utilizando el cuestionario Emory y otro cuestionario elaborado por los autores. Posteriormente, 38 estudiantes utilizaron la aplicación y respondieron antes y después del uso de la misma al Índice de Calidad del Sueño de Pittsburgh y a la Escala de Epworth. Resultados: Tras su desarrollo, la aplicación fue evaluada por 4 fonoaudiólogos que aportaron sus sugerencias y 38 estudiantes universitarios participaron respondiendo a los cuestionarios, 6 de ellos antes y después del uso de la aplicación. Sobre el Índice de Calidad del Sueño de Pittsburgh, se observó en el análisis estadístico, comparando antes y después del uso de la aplicación, mejoría en la calidad del sueño (p=0,04). Con respecto al cuestionario de Epworth, se verificó en la situación posterior al uso de la aplicación "Somnum", que no hubo diferencia significativa. Conclusión:Después de usar la aplicación, hubo uma posible mejora em la calidad del sueño. Hubo ocurrencia de somnolencia diurna excesiva. (AU)

Dependence on the use of technologies and daytime sleepiness in adolescent students

INTRODUCTION: Over the past 50 years, there has been a decline in average sleep duration and quality, with adverse consequences for overall health. Growing evidence from countries around the world shows the negative impact of using internet access technologies on sleep due to the short wavelength enriched light emitted by these electronic devices. OBJECTIVE: To analyze the exposure to modern technologies/internet and its relationship with the state of daytime sleepiness in teenage high school students. METHODS: a survey was conducted in six public schools located in the northeast of Brazil. The sample consisted of 1,130 students (mean age 16.6 years ± 1.1). The data collection instrument used was an objective criterion. The characteristic analytical study and quantitative interpretation. Quantitative variables were expressed as mean and standard deviation. For association analyses, the chi-square test or Student's t-test was used. It was considered significant p<0.05. RESULTS: We found that 7% and 31.6% of the participants reported a state of sleepiness during and after classes, respectively. 59.3% report using the internet excessively, 39.9% have a feeling of dependence, 32.6% report sleep deprivation due to excessive internet use, and 26.7% are unsuccessful in trying to reduce the use of cell phones. CONCLUSION: The relationships between the variables in this study will allow us, the younger students use internet access equipment, the more they are exposed to the risk of sleep impairment.

A nationwide study on sleep complaints and associated factors in older adults: ELSI-Brazil / Estudo nacional sobre queixas de sono e fatores associados em idosos: ELSI-Brasil / Estudio nacional sobre quejas de sueño y factores asociados en adultos mayores: ELSI-Brasil

Abstract: Sleep problems, such as difficulty falling asleep, staying asleep, early awakening with failure to continue sleep, and altered sleep-wake cycle, are common in the general population. This cross-sectional study with 6,929 older adults (≥ 60 years) aimed to estimate the prevalence of different types of sleep problems, their associated factors, and the population-attributable fraction of associated factors among older adults. The outcome variables consisted of self-reported sleep problems: insomnia (initial, intermediate, late, and any type of insomnia), poor sleep quality, and daytime sleepiness. The independent variables were sociodemographic and behavioral characteristics and health conditions. The prevalence proportions were initial insomnia (49.1%), intermediate insomnia (49.2%), late insomnia (45.9%), any type of insomnia (58.6%), poor sleep quality (15.6%), and daytime sleepiness (38.4%). Female sex, presence of two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health were positively associated with the sleep problems investigated. Consuming alcohol once a month or more was inversely associated with initial insomnia. Population attributable fraction estimates ranged from 3% to 19% considering two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health. High prevalence of self-reported sleep problems was evinced in older adults. These results can be useful to guide public health services in the creation of informational, evaluative, and screening strategies for sleep problems in older Brazilian adults.

Resumo: Problemas de sono, como dificuldade para adormecer, permanecer dormindo, despertar precoce com falha na continuidade do sono e alteração do ciclo vigília-sono, são comuns na população em geral. Este estudo transversal com 6.929 idosos (≥ 60 anos) buscou estimar a prevalência de diferentes tipos de problemas de sono, seus fatores associados e a fração atribuível populacional de fatores associados a problemas de sono nessa população. As variáveis de desfecho foram problemas de sono autorreferidos: insônia (inicial, intermediária, tardia e qualquer tipo de insônia), má qualidade do sono e sonolência diurna. As variáveis independentes incluíram características sociodemográficas, comportamentais e condições de saúde. As proporções de prevalência foram: insônia inicial (49,1%), insônia intermediária (49,2%), insônia tardia (45,9%), qualquer tipo de insônia (58,6%), má qualidade do sono (15,6%) e sonolência diurna (38,4%). Sexo feminino, presença de duas ou mais doenças crônicas, não consumir a quantidade recomendada de frutas e hortaliças e autoavaliação da saúde como regular e ruim/muito ruim mostraram associação positiva aos problemas de sono investigados. Consumo de álcool uma vez por mês ou mais associou-se inversamente à insônia inicial. As estimativas da fração atribuível populacional variaram de 3% a 19% considerando duas ou mais doenças crônicas, consumo insuficiente de frutas e vegetais e saúde autorrelatada regular/ruim/muito ruim. Evidenciou-se alta prevalência de problemas de sono autorreferidos em idosos. Esses resultados podem orientar os serviços públicos de saúde na criação de estratégias informativas, avaliativas e de rastreamento de problemas de sono em idosos brasileiros.

Resumen: Problemas del sueño, como la dificultad para conciliar el sueño, permanecer dormido, despertarse temprano sin poder seguir durmiendo y cambios en el ciclo de sueño y vigilia, son comunes en la población en general. Este estudio transversal con 6.929 personas mayores (≥ 60 años) buscó estimar la prevalencia de diferentes tipos de problemas de sueño, sus factores asociados y la fracción atribuible a la población de factores asociados con problemas de sueño en esta población. Las variables de desenlace fueron problemas de sueño autoinformados: insomnio (inicial, intermedio, tardío y cualquier tipo de insomnio), mala calidad del sueño y somnolencia diurna. Las variables independientes incluyeron características sociodemográficos y conductuales y condiciones de salud. Estas fueron las proporciones de prevalencia: insomnio inicial (49,1%), insomnio intermedio (49,2%), insomnio tardío (45,9%), cualquier tipo de insomnio (58,6%), mala calidad del sueño (15,6%) y somnolencia diurna (38,4%). El sexo femenino, la presencia de dos o más enfermedades crónicas, no consumir la cantidad recomendada de frutas y hortalizas y la autoevaluación de la salud como regular y mala/muy mala mostraron una asociación positiva con los problemas de sueño investigados. El consumo de alcohol una vez al mes o más se asoció inversamente con el insomnio inicial. Las estimaciones de la fracción atribuible de la población oscilaron entre el 3% y el 19% considerando dos o más enfermedades crónicas, un consumo insuficiente de frutas y verduras y una salud autoinformada regular/mala/muy mala. Se evidenció una alta prevalencia de problemas de sueño autoinformados en las personas mayores. Estos resultados pueden orientar los servicios públicos de salud en la creación de estrategias informativas, evaluativas y de seguimiento de los problemas de sueño en las personas mayores brasileñas.

Condições de saúde, qualidade do sono e concentração sérica de interleucinas e metabólitos em trabalhadores de enfermagem hospitalar / Health conditions, sleep quality and serum concentration of interleukins and metabolites in hospital nursing workers

Introdução: O trabalho em turnos expõe os profissionais de enfermagem hospitalar à privação do sono podendo levar a Sonolência Diurna Excessiva (SDE), estar associada à resposta imunológica e metabólica e ao adoecimento físico, mental e emocional dos trabalhadores. As interleucinas pró-inflamatórias e os metabólitos podem ser potenciais biomarcadores para a avaliar a qualidade do sono e as alterações de saúde. Objetivo: Verificar a ocorrência de SDE nos trabalhadores de enfermagem que atuam com pacientes adultos em estado crítico e possíveis associações com as condições de saúde, com a concentração sérica de interleucinas e metabólitos expressos conforme o turno de trabalho. Método: é um estudo de corte transversal, correlacional, com abordagem quantitativa, realizado em um hospital federal de ensino do interior de Minas Gerais, Brasil. A população foi constituída pelos trabalhadores de enfermagem das Unidades de Terapia Intensiva de adultos. Entre 172 profissionais, 124 cumpriram os critérios de inclusão e participaram da pesquisa divididos em três grupos: diurno, noturno e duplo ou triplo vínculos. Foram utilizados três instrumentos para coleta dos dados: questionário de características sociodemográficas, questionário de condições de saúde e a Escala de Sonolência Diurna de Epworth e, além disso, procedeu-se a coleta de sangue venoso para a dosagem de interleucinas e metabólitos. Os dados foram tabulados e analisados no StatisticalPackage for the Social Sciences-SPSS 22.0. Entre os testes utilizados estão: Fator de Inflação da Variância (VIF), Critério de Informação de Akaike (AIC), multicolinearidade, regressão linear múltipla, regressão logística, qui-quadrado, Mann-Whitney, Shapiro-Wilk e Kruskal-Wallis, além do softwere GraphPadPrism 7.0 e Mass Hunter Qualitative v. 10.0. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da EERP-USP, conforme parecer nº 3.950.501/2020. Resultados: 81,5% dos participantes eram mulheres que trabalhavam em média 49h59min. semanais e dormiam a média de 5h50min. 37,1 % referiram doenças pré-existentes com destaque para cardiovasculares, endócrino metabólicas e neuropsiquiátricas. 70,2% apresentaram SDE associada a nove variáveis com destaque para o "sono não restaurador", "episódios de choro e vontade chorar", "alterações de memória e concentração" e "diminuição dos reflexos". Foram testadas IL-6, TNF?- e IL-10, contudo estatisticamente inexpressivas. Quanto à metabolômica, esta apresentou 6 metabólicos diferencialmente expressos entre os turnos com destaque para a C-16 esfinganina e o PI (0-20:0/21:0) mais concentrados no noturno e duplo ou triplo vínculos associados ao "sono não restaurador", "alteração da memória e da concentração" e "diminuição dos reflexos". O metabólito PC(2:0/O-16:0)[U], predominante no diurno, apresentou associação com "alteração da memória e da concentração" e "episódios de choro e vontade chorar". Conclusões: Os resultados comprovaram a associação da SDE com os sinais e sintomas de privação do sono e com metabólitos diferencialmente expressos conforme o turno de trabalho.

Introduction: Shift work exposes hospital nursing professionals to sleep deprivation, which can lead to Excessive Daytime Sleepiness (EDS) and is associated with the immunological response, metabolism and physical, mental and emotional illness of workers. Pro-inflammatory interleukins and metabolites can be potential biomarkers for assessing sleep quality and health changes. Objective: To verify the occurrence of EDS in nursing workers who work with critically ill adult patients and possible associations with the conditions of health, with the serum concentration of interleukins and metabolites expressed according to the work shift. Method: it is a cross-sectional, correlational study, with a quantitative approach, carried out in a federal teaching hospital in the interior of Minas Gerais, Brazil. The population consisted of nursing workers from adult Intensive Care Units. Among 172 professionals, 124 met the inclusion criteria and participated in the research divided into three groups: daytime, nighttime and double or triple bonds. Three instruments were used to collect data: sociodemographic characteristics questionnaire, health conditions questionnaire and the Epworth Daytime Sleepiness Scale and, in addition, venous blood was collected to measure interleukins and metabolites. The data were tabulated and analyzed using the Statistical Package for the Social Sciences-SPSS 22.0. Among the tests used are: Variance Inflation Factor (VIF), Akaike Information Criterion (AIC), multicollinearity, multiple linear regression, logistic regression, chi-square, Mann-Whitney, Shapiro-Wilk and Kruskal-Wallis, in addition of Graph Pad Prism 7.0 software and Mass Hunter Qualitative v. 10.0. The study was approved by the EERP-USP Research Ethics Committee, according to opinion no. 3,950,501/2020. Results: 81.5% of participants were women who worked an average of 49h59min per week and slept an average of 5h50min. 37.1% reported pre-existing diseases, especially cardiovascular, endocrine, metabolic and neuropsychiatric diseases. 70.2% had EDS associated with nine variables, highlighting "non-restorative sleep", "episodes of crying and wanting to cry", "changes in memory and concentration" and "decreased reflexes". IL-6, TNF?- and IL-10 were tested, but they were statistically insignificant. As for metabolomics, this presented 6 metabolic variables differentially expressed between shifts, with emphasis on C-16 sphinganine and PI (0-20:0/21:0) more concentrated at night and double or triple bonds and associated with "sleep not restorative", "change in memory and concentration" and "decrease in reflexes". The metabolite PC (2:0/O-16:0)[U], predominant in the daytime, was associated with "change in memory and concentration" and "episodes of crying and wanting to cry". Conclusions: The results confirmed the association of EDS with the signs and symptoms of sleep deprivation and with metabolites differentially expressed according to the work shift.

Correlation of sleep disorders with emotional apathy and executive function in Parkinson disease / 中风与神经疾病杂志

@#Objective To investigate the relationship of sleep disorders with emotional apathy and cognitive executive function in patients with Parkinson's disease （PD）. Methods Ninety-two patients with PD （41 males and 51 females） who visited the Department of Neurology，The Affiliated Hospital of Southwest Medical University from January to December 2022 were included. All patients were scored using the Pittsburgh Sleep Quality Index （PSQI） and divided into sleep disorders group （PSQI≥8） and non-sleep disorders group （PSQI<8）. To investigate the clinical characteristics of PD patients with sleep disorders，we employed the UPDRS-Ⅱ，UPDRS-Ⅲ，UPDRS-V （H-Y staging），Epworth Sleepiness Scale （ESS），Montreal Cognitive Assessment （MOCA） scale，Mini-Mental State Examination （MMSE） scale，Stroop Color-Word Test （SCWT），Trail Making Test （TMT），and Modified Apathy Evaluation Scale （MAES） to measure the severity of PD，daytime sleepiness，emotional apathy，and cognitive executive function in all subjects. Results The PD patients with sleep disorders （64，69.6%） showed significantly higher values in age （71.88±8.77），duration of illness ［3 （1，7）］，UPDRS-Ⅱ score ［14 （9，19.5）］，UPDRS-Ⅲ score ［30.5 （19，44）］，and H-Y stage ［2.5 （2，3）］，as compared with patients without sleep disorders ｛（64.96±10.47），［1 （0.5，3.5）］，［5 （2，8）］，［9.5 （6，18）］，［1.75（1.5，2）］｝ （P<0.01）. Patients with sleep disorders also showed significantly higher values in the response time of SCWT A （84±29），B （78±30），and C ［124 （97，146）］，the time spent on TMT a ［118 （95，165）］ and b ［126 （100，168）］，and the MAES score ［16 （11，22）］，as compared with patients without sleep disorder｛（67±23），（59±22），［86 （75.5，103.5）］，［94 （76.5，115）］，［103 （83，139）］，［9.5 （7，11）］｝ （P<0.05）. The MMSE score and MoCA score were significantly lower in the sleep disorders group ｛［23 （19，27）］，［21 （16，26）］｝ than in the non-sleep disorders group ｛［28 （26，30）］，［25 （22，29）］｝ （P<0.01）. Sleep disorders in PD patients were positively correlated with age （r=0.307，P=0.003），disease duration （r=0.273，P=0.008），UPDRS-Ⅱ （r=0.558，P<0.001），UPDRS-Ⅲ （r=0.603，P<0.001），H-Y stage （r=0.463，P<0.001），response time of SCWT A （r=0.266，P=0.011），B （r=0.318，P=0.002），and C （r=0.436，P<0.001），time spent on TMT a （r=0.329，P=0.001） and b （r=0.216，P=0.038），MAES score （r=0.447，P<0.001），and ESS score （r=0.259，P=0.013），and negatively correlated with MMSE （r=-0.451，P<0.001） and MoCA score （r=-0.368，P<0.001）. Conclusion PD patients have a high incidence of sleep disorders. PD patients with sleep disorders are older and have longer disease duration and more significant impairment in daily living ability and motor ability compared with those without sleep disorders. Severe sleep disorders are associated with severe cognitive executive dysfunction，emotional apathy，and daytime sleepiness.

The correlation between excessive daytime sleepiness and sleep disordered breathing in patients after stroke / 天津医药

Objective To explore the correlation between excessive daytime sleepiness(EDS)and sleep disordered breathing after stroke.Methods A total of 148 patients with stroke were divided into the EDS group(ESS＞7,n=69)and the non-EDS group(ESS≤7,n=79)according to Epworth Sleepiness Scale(ESS).The general data,blood biochemistry and polysomnography(PSG)parameters were compared between the two groups of patients.The correlation between EDS and SDB incidence rate after stroke was analyzed by spearman test.Multivariate Logistic regression analysis was applied for influencing factors of EDS after stroke.Results There were higher proportion of males,hypoventilation index(AHI),oxygen reduction index(ODI),proportion of N1 sleep period and average nighttime diastolic blood pressure in the EDS group than those of the non-EDS group(P＜0.05).There was a positive correlation between the incidence rate of EDS and SDB in stroke patients(rs=0.225,P＜0.05).Multivariate Logistic regression analysis revealed that gender(OR=2.768,95%CI:1.133-6.765),high AHI(OR=1.048,95%CI:1.023-1.074)and high average nighttime diastolic blood pressure(OR=1.035,95%CI:1.001-1.071)were the independent risk factors for EDS after stroke.Conclusion Male,higher AHI and high average nighttime diastolic blood pressure are independent risk factors for EDS after stroke.

Relationship among daytime sleepiness,bedtime procrastination and sleep quality in college students / 中国心理卫生杂志

Objective:To investigate the relationship between bedtime procrastination and daytime sleepiness in college students,and to explore the mediating effect of sleep quality and the moderating effect of gender in the a-bove-mentioned relationship.Methods:A total of 2 823 college students(808 males,2 015 females)from two uni-versities were selected.They were assessed with the Bedtime Procrastination Scale(BPS),Epworth Sleeping Scale(ESS,ESS score≥11 indicated daytime sleepiness)and Pittsburgh Sleep Quality Index(PSQI).Process model 4 was used to test the mediating effect of sleep quality and model 14 was used to test the moderating effect of gender.Results:There were 1 214(43.0％)college students suffering from daytime sleepiness.The scores of ESS in college students were positively associated with the BPS scores(β=0.16).The total scores of PSQI partially mediated the effect of BPS scores on college students'ESS scores,and the value of mediating effect was 39.9％.The association between PSQI scores and ESS scores was moderated by gender(β=-0.13).Conclusion:Daytime sleepiness is associated with bedtime procrastination and sleep quality in college students,and the association be-tween sleep quality and daytime sleepiness is moderated by gender.

Serum proteomics of different symptom subtypes of obstructive sleep apnea / 中风与神经疾病杂志

@#Objective Patients with obstructive sleep apnea (OSA) can present with excessive daytime sleepiness (EDS),insomnia,and other symptom subtypes. It remains unclear whether proteomics differs in patients with OSA with EDS and insomnia. Therefore,we examined the serum proteomics of patients with OSA with different clinical subtypes,in order to identify potential biomarkers for the classification of clinical subtypes of OSA,and provide insights into the molecular biological mechanisms underlying different subtypes of the disease. Methods We included six patients with OSA (three with EDS and three with insomnia) at the Second Affiliated Hospital of Air Force Medical University. All the patients underwent overnight polysomnography (PSG) and sleep scale evaluation,followed by blood sample collection on the next morning after PSG. Differentially expressed proteins were selected by label-free quantification,and bioinformatics analysis was performed. Results We identified a subset of 34 proteins that were differentially expressed between OSA with EDS and with insomnia. Compared with the OSA with insomnia group,the OSA with EDS group showed 20 up-regulated and 14 down-regulated serum proteins. The bioinformatics analysis revealed that the main functions of these proteins focused on DNA damage,reactive oxygen species elimination,immune regulation,and inflammatory response,and they were mainly involved in intracellular transport,secretion,and vesicle transport and other biological processes. The differentially expressed proteins were mainly localized in the cytoplasm,which might be secretory proteins. The APRT-AK1 interaction pathway might play an important role in different clinical subtypes of OSA. Conclusion We determined 34 differentially expressed proteins between OSA with EDS and OSA with insomnia,such as significantly up-regulated DDI2 and PRDX6 in the serum of patients with OSA with EDS,which can identify different clinical subtypes of OSA. In addition,the APRT-AK1 interaction pathway might play an important role in different subtypes of OSA.

A cross-sectional study on the sleep quality and excessive daytime sleepiness of Filipino medical students in a state-run university during the coronavirus disease (COVID-19) pandemic

Introduction@#Movement restrictions and changes in medical education around the world due to the Coronavirus 2019 pandemic have been sources of stress, which affect sleep and compound the demands of medical education. In the Philippines, stay-at-home orders were implemented in the National Capital Region on 15 March 2020, and despite various readjustments and re-definitions, remain in effect to date, March 2022. Objectives. This cross-sectional study aims to determine the sleep quality and daytime sleepiness of Filipino medical students during prolonged stay-at-home orders, to compare them with pre-pandemic evaluations, and to explore associations between scores and participant characteristics.@*Methods@#The medical student population of a state-run university in the City of Manila was included, while those on a leave of absence were excluded. The Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index which measure excessive daytime sleepiness and sleep quality, respectively, were disseminated via Google Forms from April to May 2021. @*Results@#Response rate was 87.75% (n=709) with a mean age of 22.9 ± 2.0 years and a 1:1.09 male-to-female ratio. Among the respondents, 41.18% had excessive daytime sleepiness, and was significantly higher for first-year premedicine students. Compared to pre-pandemic scores, daytime sleepiness decreased during the pandemic. On the other hand, 62.34% of the respondents had poor sleep quality, with global scores being significantly higher for the first-year pre-medicine students. Relationships between participants' characteristics and their scores were extremely weak, while a moderately significant correlation existed between global daytime sleepiness and sleep quality scores.@*Conclusion@#Both excessive daytime sleepiness and poor sleep quality remain prevalent during prolonged stay-athome orders. These reflect the effect of the pandemic on stress inherent to medical education, and may be additional facets to be regarded in evaluating the general well-being of medical students.

Sleep characteristics and excessive daytime sleepiness in adolescents and adults: results from the birth cohorts of three Brazilian cities — RPS Consortium / Características do sono e sonolência diurna excessiva em adolescentes e adultos: resultados das coortes de nascimento de três cidades brasileiras - Consórcio RPS

ABSTRACT Objective: To describe the prevalence of insufficient sleep duration, long sleep latency, terminal or maintenance insomnia, subjective sleep quality, and excessive daytime sleepiness among participants of birth cohorts conducted in three Brazilian cities, and to evaluate differences in prevalence rates within cohorts according to sociodemographic characteristics. Methods: Cross-sectional analyses involving adolescents and adults participating in four birth cohorts conducted in Ribeirão Preto (RP78 and RP94), Pelotas (PEL93) and São Luís (SL97/98). Sleep duration, latency, terminal or maintenance insomnia, and subjective sleep quality were obtained through the Pittsburgh Sleep Quality Index; and excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale. Differences in the prevalence of the outcomes were analyzed in each cohort according to sociodemographic characteristics (skin color, marital status, socioeconomic status, study and working at the time of the interview) stratified by sex. Results: Insufficient sleep duration was the most common outcome at the four cohorts, with higher frequency among men. Long latency was more frequently reported by young adult women in RP94 and PEL93 cohorts, and insomnia by women of the four cohorts, when compared to men of the same age. Women generally suffered more from excessive daytime sleepiness and evaluated the quality of their sleep more negatively than men. In addition to sex, being a student and working were associated with the largest number of outcomes in both sexes. Conclusion: Sleep disorders are more prevalent in women, reinforcing the need for greater investment in sleep health in Brazil, without disregarding gender and socioeconomic determinants.

RESUMO Objetivo: Descrever a prevalência de duração do sono, latência, insônia terminal, qualidade subjetiva do sono e sonolência diurna excessiva entre participantes de coortes de nascimentos realizadas em três cidades brasileiras, bem como avaliar as diferenças nas taxas de prevalência das coortes de acordo com características sociodemográficas. Métodos: Análises transversais envolvendo participantes de quatro coortes de nascimento realizadas em Ribeirão Preto (RP78 e RP94), Pelotas (PEL93) e São Luís (SL97). A duração, a latência, a insônia terminal e a qualidade subjetiva do sono foram obtidas por meio do Índice de Qualidade do Sono de Pittsburgh; e a sonolência diurna excessiva foi avaliada pela Escala de Sonolência de Epworth. As diferenças na prevalência dos desfechos foram analisadas em cada coorte segundo características sociodemográficas estratificadas por sexo. Resultados: A duração insuficiente do sono foi o desfecho mais comum nas quatro coortes, com maior frequência entre os homens. Latência longa foi mais frequentemente relatada por mulheres adultas jovens nas coortes RP94 e PEL93, e insônia por mulheres das quatro coortes, quando comparadas a homens da mesma idade. As mulheres geralmente sofriam mais com sonolência diurna excessiva e avaliavam a qualidade do sono de forma mais negativa do que os homens. Além do sexo, ser estudante e trabalhar estiveram associados ao maior número de desfechos em ambos os sexos. Conclusão: Os distúrbios do sono são mais prevalentes em mulheres, reforçando a necessidade de maior investimento na saúde do sono no Brasil, sem desconsiderar gênero e determinantes socioeconômicos.

Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents / Fatores de risco comportamentais modificáveis para DNT e sono em adolescentes brasileiros

ABSTRACT OBJECTIVE To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. METHODS This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18-19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale - ESS) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. RESULTS Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. CONCLUSIONS The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

RESUMO OBJETIVO Analisar a associação entre fatores de risco comportamentais modificáveis para doenças não transmissíveis e parâmetros do sono em adolescentes brasileiros. MÉTODOS Estudo transversal que utilizou dados do Consórcio de Coortes RPS, São Luís, Brasil para o seguimento de adolescentes de 18-19 anos (n = 2.515). Os desfechos foram a sonolência diurna excessiva (Escala de Sonolência de Epworth - ESE) e a qualidade do sono (Índice de Qualidade do Sono de Pittsburgh - IQSP). As exposições de interesse foram os fatores de risco comportamentais para doenças não transmissíveis (DNT): tempo de tela, inatividade física, álcool, cigarro, drogas ilícitas, consumo de cafeína, consumo de bebidas adoçadas com açúcar. O excesso de peso foi considerado um possível mediador dessa associação entre as exposições de interesse e os desfechos. Os modelos foram analisados por modelagem com equações estruturais. RESULTADOS A inatividade física (Coeficiente padronizado, CP = 0,112; p = 0,001), maior consumo de álcool (CP = 0,168; p = 0,019) e de bebidas adoçadas com açúcar (CP = 0,128; p < 0,001) foram associados a sonolência diurna excessiva nos adolescentes; a melhor situação socioeconômica também foi associada a este desfecho (CP = 0,128; p < 0,001). A inatividade física (CP = 0,147; p < 0,001) e o maior consumo de bebidas adoçadas com açúcar (CP = 0,089; p = 0,003) também se associaram com a qualidade do sono ruim. O excesso de peso não foi mediador e nem associado à qualidade do sono ou à sonolência diurna excessiva. CONCLUSÕES Os principais fatores de risco comportamentais modificáveis para DNT estão associados a piores parâmetros do sono já na adolescência; alertando para um quadro de acúmulos de riscos para distúrbios de sono no futuro.

Terapia miofuncional en síndrome de apnea obstructiva del sueño (AOS): revisión de la literatura / Myofunctional therapy in obstructive sleep apnea syndrome (OSA): a literature review

La terapia miofuncional orofacial (TMO) ha tenido un creciente desarrollo durante la última década, presentándose como una opción terapéutica en pacientes con AOS. Sin embargo, la evidencia es limitada y en Chile no hay mucho conocimiento al respecto. Se desarrolló una revisión sistemática en PubMed, MEDLINE, Embase, Web of Science, Lilacs y Scielo, que incluyó estudios primarios publicados en los últimos 10 años en idioma inglés, español o portugués y que utilizaran la TMO en pacientes adultos con AOS. Se excluyeron estudios que combinaran otras estrategias, con alteraciones miofuncionales secundarias a patologías concomitantes y con otro tipo de trastorno del sueño. La revisión consideró 9 artículos en su análisis; los resultados mostraron beneficios significativos a favor de la TMO en relación a disminución del índice de apnea-hipopnea, mejor calidad del sueño, nivel de somnolencia de Epworth, menor intensidad y frecuencia de los ronquidos, menor circunferencia del cuello, entre otros. Se concluye que la TMO genera beneficios en los pacientes con AOS, siendo una opción no invasiva y accesible.

Orofacial myofunctional therapy (OMT) has had a growing development during the last decade, presenting itself as a therapeutic option in patients with OSA. However, the evidence is limited and in Chile there is not much knowledge about it. A systematic review was developed in PubMed, MEDLINE, Embase, Web of Science, Lilacs and Scielo, which included primary studies published in the last 10 years in English, Spanish or Portuguese that used OMT in adult patients with OSA. Studies that combined other strategies, with myofunctional alterations secondary to concomitant pathologies and with another type of sleep disorder were excluded. The review considered 9 articles in its analysis; The results showed significant benefits in favor of OMT in relation to a decrease in the apnea-hypopnea index, better sleep quality, Epworth sleepiness level, less intensity and frequency of snoring, less neck circumference, among others. It is concluded that OMT generates benefits in patients with OSA, being a non-invasive and accessible option.

Prevalence of Overlap Syndrome in Patients with Obstructive Sleep Apnea in a Quaternary Care Center of Kerala

Background: The coexistence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is termed “Overlap syndrome (OS).” Objectives: The present study aimed at estimating the prevalence of OS among patients diagnosed with OSA. Methods: It was a prospective observational study conducted on patients presenting to respiratory medicine outpatient department (sleep clinic) with symptoms of sleep-disordered breathing and was found to have OSA by overnight polysomnography. These patients were then subjected to spirometry to diagnose COPD. Results: The prevalence of OS in the study population was found to be 41.3%. Excessive daytime sleepiness was found to be higher in overlap group patients (P = 0.033), the difference was statistically significant. The mean age (59.9 ± 9.6 years) was found to be high in the OS group compared to those without the same. The mean forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC (pre? and postbronchodilator) spirometry parameters were found to be lower in patients with OS. Conclusion: The study showed that the prevalence of OS in the present study was 41.3%. Excessive daytime sleepiness and age >60 years were risk factors for OS in a patient with OSA. OS patients had lower pulmonary function values.

Fatigue and primary sarcopenia in geriatric patients

SUMMARY OBJECTIVE: This study aimed to investigate the frequency of fatigue in geriatric patients with primary sarcopenia and to evaluate the relationship between fatigue and symptoms such as depression and sleepiness. METHODS: This case-control study was conducted between December 2020 and August 2021 in the geriatrics outpatient clinic of Istanbul University-Cerrahpasa. The European Working Group on Sarcopenia in Older People 2 criteria were considered for the diagnosis of sarcopenia. Demographic data, accompanying chronic diseases, comprehensive geriatric assessments, and laboratory values of the patients were noted. Scales used to assess fatigue in all participants include Fatigue Assessment Scale, Fatigue Severity Scale, and Fatigue Impact Scale and associated symptoms include Geriatric Depression Scale and Epworth Sleepiness Scale. RESULTS: The mean (standard deviation) age was 75.3 (7.1) for 51 primary sarcopenia (38 female) patients and 73.5 (5.8) for 51 control (37 female) patients. There was no significant difference between the two groups in terms of gender and age (p=0.822, p=0.171). The prevalence of hypertension was higher, and the level of education was lower in the sarcopenic group than in the nonsarcopenic group (p=0.017, p=0.013). Fatigue Assessment Scale, Fatigue Severity Scale, Fatigue Impact Scale total, Fatigue Impact Scale cognitive, Fatigue Impact Scale physical, and Fatigue Impact Scale social questionnaire scores were significantly higher in the sarcopenic group (all p<0.001). The Geriatric Depression Scale score was statistically higher in the sarcopenic group; however, there was no significant difference in the Epworth Sleepiness Scale score between the two groups (p=0.014, p=0.072). Multivariate analysis was performed on education level, hypertension, fatigue questionnaires, and Geriatric Depression Scale, which were found to be significant in the univariate logistic regression analysis. In the multivariate logistic regression analysis, only the Fatigue Impact Scale total was determined to be associated with sarcopenia [odds ratio 1.161, 95% confidence interval (1.084-1.242)]. CONCLUSION: In primary sarcopenia, there is mental and social fatigue as well as physical fatigue. Therefore, the prevention and treatment of sarcopenia in geriatric patients is important.

Impact of CPAP treatment for a short period in moderate-to-severe OSAS patients: a randomized double-blind clinical trial / Impacto do tratamento com CPAP por um curto período em pacientes com SAOS moderada a grave: um estudo clínico duplo-cego randomizado

Abstract Introduction: Obesity is the most frequent reversible agravating factor of obstructive sleep apnea syndrome, with physical activity very important for its control. Continuous positive air pressure during sleep is the ‟gold standard" treatment for obstructive sleep apnea syndrome. Objective: we aimed to investigate if the use of continuous positive air pressure for a short period (7 days), would improve sleep quality, daytime sleepiness, and the disposition for physical activity. Methods: Eighty obstructive sleep apnea syndrome patients were randomly assigned as follows: group I - continuous positive air pressure with a steady pressure of 4cm H2O; group II - ideal therapeutic pressure. After filling out the questionnaires related to the studied variables (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index), patients underwent a baseline pulmonary function test and continuous positive air pressure titration. After continuous positive air pressure therapy for 4> hours a night for 7 consecutive days, patients returned and filled out new (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index) forms. New spirometry was carried out. Results: 39 patients completed the study. The mean age was 52 ±11 years old and 28 patients (71.79%) were obese. Both groups were similar for all variables studied at baseline. After Continuous positive air pressure use, patients of group II presented more significant improvements (p< 0.05) for sleep quality and diurnal sleepiness. Time spent with physical activities did not change. Spirometric data were at normal range at baseline. Solely the variable FEF 25%-75% was significantly enhanced (p< 0.05) in group II. Conclusion: Continuous positive air pressure therapy for 1 week, with ideal pressure, improves daytime sleepiness and sleep quality, enhances pulmonary function, but does not change the mean time spent with physical activities.

Resumo Introdução: A obesidade é o fator causal reversível mais frequente da síndrome da apneia obstrutiva do sono, a atividade física é muito importante para o seu controle. A pressão positiva contínua na via aérea, CPAP, durante o sono é o tratamento padrão ouro para essa condição clínica. Objetivo: Avaliar se o uso do CPAP na síndrome da apneia obstrutiva do sono por um curto período (7 dias) melhoraria a qualidade do sono, a sonolência diurna e a disposição para a prática de atividades físicas, além da função pulmonar. Método: Oitenta pacientes com síndrome da apneia obstrutiva do sono foram distribuídos aleatoriamente da seguinte forma: grupo I - CPAP com pressão constante de 4cm H2O; grupo II - pressão terapêutica ideal. Após o preenchimento dos questionários relacionados ao estudo das variáveis (PSQI, ESS e IPAQ-L), os pacientes foram submetidos a teste de função pulmonar basal e titulação da CPAP. Após terapia com CPAP por ≥ 4 horas por noite durante sete dias consecutivos, os pacientes retornaram e preencheram novos questionários PSQI, ESS e IPAQ-L. Nova espirometria foi feita. Resultados: Apenas 39 pacientes completaram o estudo. A média de idade foi de 52 ± 11 anos e 28 pacientes (71,79%) eram obesos. Ambos os grupos eram semelhantes quanto às variáveis avaliadas no início do estudo. Após o uso de CPAP, os pacientes do grupo II apresentaram melhorias mais significantes (p < 0,05) para qualidade do sono e sonolência diurna. O tempo gasto com atividades físicas não mudou. Os dados espirométricos estavam na faixa normal no início do estudo. Apenas a variável FEF 25%-75% aumentou significantemente (p < 0,05) no grupo II. Conclusão: A terapia com CPAP por uma semana, com pressão ideal, melhora a sonolência diurna e a qualidade do sono, melhora a função pulmonar, mas não altera o tempo médio despendido com atividades físicas.

Sleep Quality among Healthcare Professionals in a Tertiary Care Hospital

Introduction: A person spends one third life in sleep, so the quality and quantity of sleep is of utmost importance. Health Care Professionals (HCPs) are more prone to inconsistency in sleep both in quality and quantity, which leads to deflection from health and well-being of themselves and care of others. This study aims to assess the various factors influencing sleep quality and daytime sleepiness among medical and nursing healthcare professionals. Methodology: A cross sectional study was conducted using a structured questionnaire to collect socio-demographic and work-related information, co-morbidity and quality of Sleep using ESS (Epworth Sleepiness Scale) and PSQI (Pittsburgh Sleep Quality Index) scale. Results: Among the 150 HCPs, 64.7% were medical and 35.3% were nursing professionals. 53.6% of medical and 66% of nursing professionals reported poor sleep quality. Increased coffee consumption influences sleep quality and it was found to be statistically significant. Nursing professionals had more excessive daytime sleepiness (58.5%) with significant p-value (p=0.01). Conclusion: According to our study results, sleep quality was poor among nursing professionals which highlights the need for measures to improve their quality of sleep.

Mental disorders among pregnant women during the COVID-19 pandemic. A cross-sectional study

ABSTRACT BACKGROUND: Pregnancy is the most important event in women's lives and can lead to psychological lability. Several risk factors (such as disasters, events and pandemics) have been correlated with greater prevalence of mental disorders during pregnancy. OBJECTIVES: To research how pregnant women have been affected by the coronavirus disease-19 (COVID-19) pandemic process, in order to contribute to the limited literature. DESIGN AND SETTING: Cross-sectional survey study conducted at the Training and Research Hospital of the Faculty of Medicine, University of Ordu, Ordu, Turkey, from February 1 to March 1, 2021. METHODS: In total, 356 pregnant women were enrolled and completed the survey. Intention of going to hospital and the Beck anxiety, Beck depression, Beck hopelessness and Epworth sleepiness scales were applied to detect mental disorders. RESULTS: Among the participants, the anxiety, depression, hopelessness and sleepiness scores were 29.2%, 36.2%, 58.1% and 11.8%, respectively. The pregnant women stated that they avoided going to hospital in unnecessary situations by obeying the 'stay at home' calls, but also stated that they were afraid of the potential harmful effects of inadequate physician control. However, most of them stated that they would go to the hospital in emergencies. CONCLUSIONS: This paper illustrated the effect of the COVID-19 pandemic on the mental health of pregnant women and emphasized their high rates of anxiety, depression, hopelessness and sleepiness. Since presence of mental disorders is indirectly related to poor pregnancy outcomes, preventive strategies should be developed, especially during this pandemic process.