RESUMO
Sleep disorders are frequent and can have serious consequences on patients' health and quality of life. While some sleep disorders are more challenging to treat, most can be easily managed with adequate interventions. We review the main diagnostic features of 6 major sleep disorders (insomnia, circadian rhythm disorders, sleep-disordered breathing, hypersomnia/narcolepsy, parasomnias, and restless legs syndrome/periodic limb movement disorder) to aid medical practitioners in screening and treating sleep disorders as part of clinical practice.
Assuntos
Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/terapia , Depressores do Sistema Nervoso Central/uso terapêutico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtornos Cronobiológicos/diagnóstico , Transtornos Cronobiológicos/terapia , Terapia Cognitivo-Comportamental , Pressão Positiva Contínua nas Vias Aéreas , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/terapia , Humanos , Programas de Rastreamento , Melatonina/uso terapêutico , Narcolepsia/diagnóstico , Narcolepsia/terapia , Síndrome da Mioclonia Noturna/diagnóstico , Síndrome da Mioclonia Noturna/terapia , Parassonias/diagnóstico , Parassonias/terapia , Fototerapia , Polissonografia , Síndrome das Pernas Inquietas/diagnóstico , Síndrome das Pernas Inquietas/terapia , Medicamentos Indutores do Sono/uso terapêutico , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/terapia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia , Latência do SonoRESUMO
BACKGROUND: Disturbed circadian rhythm is a potentially modifiable cause of delirium among patients in intensive-care units (ICUs). Bright-light therapy in the daytime can realign circadian rhythm and reduce the incidence of delirium. We investigated whether a high-intensity dynamic light application (DLA) would reduce ICU-acquired delirium. METHODS: This was a randomised, controlled, single-centre trial of medical and surgical patients admitted to the ICU of a teaching hospital in the Netherlands. Patients older than 18 years, expected to stay in the ICU longer than 24 h and who could be assessed for delirium were randomised to DLA or normal lighting (control), according to a computer-generated schedule. The DLA was administered through ceiling-mounted fluorescent tubes that delivered bluish-white light up to 1700 lux between 0900 h and 1600 h, except for 1130-1330 h, when the light was dimmed to 300 lux. The light could only be turned off centrally by investigators. Control light levels were 300 lux and lights could be turned on and off from inside the room. The primary endpoint was the cumulative incidence of ICU-acquired delirium. Analyses were by intention to treat and per protocol. The study was terminated prematurely after an interim analysis for futility. This study is registered with Clinicaltrials.gov, number NCT01274819. FINDINGS: Between July 1, 2011, and Sept 9, 2013, 734 patients were enrolled, 361 in the DLA group and 373 in the control group. Delirium occurred in 137 (38%) of 361 DLA patients and 123 (33%) of 373 control patients (odds ratio 1·24, 95% CI 0·92-1·68, p=0·16). No adverse events were noted in patients or staff. INTERPRETATION: DLA as a single intervention does not reduce the cumulative incidence of delirium. Bright-light therapy should be assessed as part of a multicomponent strategy. FUNDING: None.
Assuntos
Transtornos Cronobiológicos/prevenção & controle , Cuidados Críticos , Delírio/prevenção & controle , Fototerapia/métodos , Idoso , Transtornos Cronobiológicos/complicações , Transtornos Cronobiológicos/diagnóstico , Delírio/diagnóstico , Delírio/etiologia , Término Precoce de Ensaios Clínicos , Feminino , Humanos , Unidades de Terapia Intensiva , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Falha de TratamentoAssuntos
Lesões Encefálicas/complicações , Transtornos Cronobiológicos/etiologia , Hipotálamo , Narcolepsia/etiologia , Adulto , Temperatura Corporal/fisiologia , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/fisiopatologia , Transtornos Cronobiológicos/diagnóstico , Transtornos Cronobiológicos/fisiopatologia , Ritmo Circadiano/fisiologia , Humanos , Hipotálamo/lesões , Hipotálamo/patologia , Hipotálamo/fisiopatologia , Masculino , Narcolepsia/diagnóstico , Narcolepsia/fisiopatologiaRESUMO
Las alteraciones de la presión arterial nocturna, tanto absolutas (hipertensión arterial nocturna) como relativas (patrón circadiano no dipper), son un hallazgo frecuente entre los pacientes con hipertensión arterial. Estas anomalías se relacionan con un riesgo aumentado de daño vascular subclínico y de complicaciones cardiovasculares. La monitorización ambulatoria de la presión arterial es una herramienta básica en la evaluación de la presión arterial nocturna. En la presente revisión se tratan tanto aspectos descriptivos y epidemiológicos de la presión arterial nocturna como posibles abordajes terapéuticos. Éstos incluyen desde el tratamiento antihipertensivo clásico hasta alternativas recientes, como la cronoterapia o el bloqueo óptimo del sistema renina-angiotensina (AU)
Nocturnal blood pressure alterations, both absolute (nocturnal hypertension) and relative (non-dipper pattern) are a common finding in hypertensive patients. These alterations are associated with increased subclinical target-organ damage and adverse cardiovascular outcomes. Ambulatory blood pressure monitoring constitutes a key tool for evaluating nocturnal blood pressure. The present article discusses several descriptive and epidemiological features of nocturnal hypertension, as well as possible therapeutic approaches, including conventional antihypertensive treatment, chronotherapy, and optimal renin-angiotensin system blockade (AU)
Assuntos
Humanos , Hipertensão/epidemiologia , Cronoterapia/métodos , /uso terapêutico , Modalidades Horárias , Sistema Renina-Angiotensina , Monitorização Ambulatorial da Pressão Arterial/métodos , Transtornos Cronobiológicos/diagnósticoRESUMO
Detection of individual body time (BT) via a single-time-point assay has been a longstanding unfulfilled dream in medicine, because BT information can be exploited to maximize potency and minimize toxicity during drug administration and thus will enable highly optimized medication. To achieve this dream, we created a "molecular timetable" composed of >100 "time-indicating genes," whose gene expression levels can represent internal BT. Here we describe a robust method called the "molecular-timetable method" for BT detection from a single-time-point expression profile. The power of this method is demonstrated by the sensitive and accurate detection of BT and the sensitive diagnosis of rhythm disorders. These results demonstrate the feasibility of BT detection based on single-time-point sampling, suggest the potential for expression-based diagnosis of rhythm disorders, and may translate functional genomics into chronotherapy and personalized medicine.
Assuntos
Transtornos Cronobiológicos/diagnóstico , Transtornos Cronobiológicos/genética , Ritmo Circadiano/genética , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Animais , Genômica , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Análise de Sequência com Séries de Oligonucleotídeos/normas , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Humans spend approximately one third of their lives asleep. Although the same medical disorders that occur during wakefulness persist into sleep, there are many disorders that occur exclusively during sleep or are manifestations of a disturbance of normal sleep-wake physiology. The most common reason for referral to a sleep laboratory is OSA, whereas the most common sleep disorder is insomnia. Effective treatments now exist for many sleep disorders, such as OSA and RLS, and a major breakthrough in the treatment of narcolepsy seems imminent. Because all disease processes are adversely affected by insufficient sleep, it is essential that the practicing physician understand the causes and treatments of the common sleep disorders.
Assuntos
Transtornos do Sono-Vigília/fisiopatologia , Sono REM/fisiologia , Adulto , Idoso , Antioxidantes/uso terapêutico , Respiração de Cheyne-Stokes/diagnóstico , Transtornos Cronobiológicos/diagnóstico , Transtornos Cronobiológicos/tratamento farmacológico , Cronoterapia , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Feminino , Humanos , Masculino , Melatonina/uso terapêutico , Pessoa de Meia-Idade , Narcolepsia/diagnóstico , Síndrome da Mioclonia Noturna/diagnóstico , Polissonografia/instrumentação , Respiração com Pressão Positiva/métodos , Síndrome das Pernas Inquietas/diagnóstico , Síndromes da Apneia do Sono/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Transtornos do Sono-Vigília/classificação , Transtornos do Sono-Vigília/diagnósticoRESUMO
In healthy subjects, both the duration of wakefulness and the circadian pacemaker have been demonstrated to be involved in the regulation of mood. Some features of affective disorders suggest that these two factors also play a role in the dysregulation of mood. In particular, disturbances of the circadian pacemaker have been proposed to be a pathogenetic factor in Seasonal Affective Disorder, winter type (SAD). This report presents a test of this proposition. To this end seven SAD patients and matched controls were subjected to a 120-h forced desynchrony protocol, in which they were exposed to six 20-h days. This protocol enables us to discriminate the extent to which the course of mood is determined by the imposed 20-h sleep-wake cycle from the influence of the circadian pacemaker on that course. Patients participated during a depressive episode, after recovery upon light therapy and in summer. Controls were studied in winter and in summer. Between SAD patients and controls no significant differences were observed in the period length nor in the timing of the endogenous circadian temperature minimum. In both groups, sleep-wake cycle- and pacemaker-related components were observed in the variations of mood, which were not significantly different between conditions.
Assuntos
Afeto/fisiologia , Transtornos Cronobiológicos/fisiopatologia , Ritmo Circadiano/fisiologia , Transtorno Afetivo Sazonal/fisiopatologia , Adulto , Temperatura Corporal/fisiologia , Transtornos Cronobiológicos/diagnóstico , Transtornos Cronobiológicos/psicologia , Feminino , Humanos , Masculino , Melatonina/sangue , Pessoa de Meia-Idade , Inventário de Personalidade , Polissonografia , Transtorno Afetivo Sazonal/diagnóstico , Transtorno Afetivo Sazonal/psicologia , Transtorno Afetivo Sazonal/terapia , Estações do Ano , Privação do Sono/fisiopatologia , Privação do Sono/psicologia , Vigília/fisiologiaRESUMO
A clinically applicable review of circadian rhythm physiology is presented, including a detailed examination of the interaction of circadian and homeostatic systems and the maturation of the circadian system from preconception through adolescence. Emphasis is placed on the clinical evaluation gathering information through the history, sleep log, and if necessary, actigraphy and polysomnography. Circadian disorders, including advanced sleep phase syndrome, circadian disorders seen in blind children, delayed sleep phase syndrome, and non-24-hour sleep phase are described. Case descriptions of each are provided. Treatment and interventions for these disorders are described, including the importance of education, light therapy, sleep-wake schedule adjustments, and the occasional use of medications, such as sedative hypnotics and melatonin.