Yogic meditation improves objective and subjective sleep quality of healthcare professionals.

OBJECTIVE: Our aim was to evaluate the impact of yogic meditation in sleep quality of healthy pediatric healthcare professionals. METHOD: Subjects were randomized into a meditation group (MG, n = 32), who attended a yogic meditation class held for eight weeks, or a control group (CG, n = 32). Polysomnography (PSG) and Pittsburgh Sleep Quality Index (PSQI) scores were determined at baseline and after eight weeks. RESULTS: The PSQI overall score was lower (p = 0.024) in the MG. Reported sleep latency (p = 0.046) and MG sleep latency (p = 0.028) were lower in the MG at eight weeks. PSG showed a time effect (p = 0.020) on decreasing minutes of wake after sleep onset in the MG. There were strong and significant correlations between PSG and PSQI variables. There was a significant time effect on heart rate (p = 0.001) in the MG. CONCLUSION: Yogic meditation may be used as an integrative health tool to foster improvements in the health-related aspects of healthcare professionals' lives. TRIAL REGISTRATION: CinicalTrials.gov identifier: NCT02947074; trial registry name: Meditation Practice in Pediatric Healthcare Professionals: A Randomized Controlled Clinical Trial.

Patients With OSA Are Perceived as Younger Following Treatment With CPAP.

BACKGROUND: The aim of this study was to compare the effects of CPAP treatment and placebo intervention on the facial appearance of patients with OSA. METHODS: Patients with severe OSA were randomized to receive either CPAP treatment or nasal dilator (placebo) intervention for 1 month. The sequence was interposed by 15 days of washout with no treatment. Patients were evaluated by using questionnaires, polysomnography, and facial photographs at baseline and at the end of both interventions. In an electronic survey, the photographs were presented in a randomized order to 704 observers who rated the perceived age, health, attractiveness, and tiredness of the patients. Observers were unaware of the patients' conditions. RESULTS: Thirty patients (age, 46 ± 9 years; 21 men; apnea-hypopnea index, 61.8 ± 26.2) were evaluated. During each intervention period, patients used CPAP 6.0 ± 1.7 h per night on 94% of the nights and the placebo intervention on 98% of the nights. After CPAP treatment, patients were rated younger (47.9 ± 3.5 years) than they appeared at baseline (53.9 ± 4.0 years) and following the placebo treatment (49.8 ± 3.7 years) (P < .001). Linear regression analysis identified that CPAP adherence, total sleep time, and percentage of total sleep time with oxyhemoglobin saturation < 90% were predictors of a decreased age rating following CPAP treatment. CONCLUSIONS: Patients with severe OSA had a younger appearance following 1 month of CPAP treatment. This benefit can serve as an additional source of motivation for patients with OSA to comply with CPAP treatment and may facilitate OSA management. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02117271; URL: www.clinicaltrials.gov.

Nasal Dilator Strip is an Effective Placebo Intervention for Severe Obstructive Sleep Apnea.

STUDY OBJECTIVES: The aim of this study was to evaluate the effects of nasal dilator strip (NDS) as a placebo intervention compared with continuous positive airway pressure (CPAP) treatment in patients with severe obstructive sleep apnea (OSA). METHODS: Patients were treated with both NDS and nasal CPAP. The sequence was randomized and interposed by 15 days of washout. Polysomnography was performed at baseline and on the first night of intervention with NDS and CPAP (titration). The Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), and Beck Depression Inventory (BDI) were completed at baseline and at the end of both interventions. A questionnaire on the comfort and satisfaction (0 = no to 10 = total) was completed at the end of each intervention. RESULTS: Twenty-six patients with OSA were evaluated (19 male; age 46.3 ± 9.3 y; body mass index 33.2 ± 5.1 kg/m2; ESS 15.8 ± 4.1; apnea-hypopnea index 60.7 ± 25.2). Adherence was high in both NDS (98%) and CPAP interventions (94%; 5.8 ± 1.7 h/night). In contrast to the baseline values, NDS intervention had no significant effect on all polysomnographic parameters, but NDS improved somnolence (ESS 13.0 ± 5.4, p = 0.001) and depressive symptoms (BDI 7.7 ± 6.9, p = 0.005). Reported satisfaction was significantly higher for CPAP than for NDS (sleep quality 9.2 ± 0.8 vs. 6.1 ± 2.1; wake up at morning: 8.6 ± 1.2 vs. 6.0 ± 2.2; daily activities: 8.9 ± 1.4 vs. 5.8 ± 1.5; quality of life: 8.3 ± 2.1 vs. 3.8 ± 3.5, p < 0.001), but similar low levels of difficulty for both interventions were observed (1.3 ± 2.2 vs. 0.3 ± 1.3, p = 0.098). CONCLUSIONS: Our data indicate that NDS is an attractive placebo intervention for randomized controlled trials evaluating the effects of CPAP in sleepy patients with OSA.

Myofunctional therapy improves adherence to continuous positive airway pressure treatment.

PURPOSE: Few studies have investigated myofunctional therapy in patients with obstructive sleep apnea syndrome (OSAS). The objective of this study was to evaluate the effect of myofunctional therapy on continuous positive airway pressure (CPAP) adherence. METHODS: The study was registered at ClinicalTrials.gov (NCT01289405). Male patients with OSAS were randomly divided into four treatment groups: placebo, patients undergoing placebo myofunctional therapy (N = 24); myofunctional therapy, undergoing myofunctional therapy (N = 27); CPAP, undergoing treatment with CPAP (N = 27); and combined, undergoing CPAP therapy and myofunctional therapy (N = 22). All patients underwent evaluations before and after 3 months of treatment evaluation and after 3 weeks of washout. Evaluations included Epworth sleepiness scale (ESS), polysomnography, and myofunctional evaluation. RESULTS: The 100 men had a mean age of 48.1 ± 11.2 years, body mass index of 27.4 ± 4.9 kg/m2, ESS score of 12.7 ± 3.0, and apnea-hypopnea index (AHI) of 30.9 ± 20.6. All treated groups (myofunctional therapy, CPAP, and combined myofunctional therapy with CPAP) showed decreased ESS and snoring, and the myofunctional therapy group maintained this improvement after the "washout" period. AHI reduction occurred in all treated groups and was more significant in CPAP group. The myofunctional therapy and combined groups showed improvement in tongue and soft palate muscle strength when compared with the placebo group. The association of myofunctional therapy to CPAP (combined group) showed an increased adherence to CPAP compared with the CPAP group. CONCLUSIONS: Our results suggest that in patients with OSAS, myofunctional therapy may be considered as an adjuvant treatment and an intervention strategy to support adherence to CPAP.

The experience of a Power Nap Center in the largest city of Brazil.

We evaluated the frequency of naps and features of nappers who took a nap in a Power Nap Center located in downtown area of São Paulo. Company database was retrospectively analyzed and 4.625 naps were evaluated (January-December 2014). Most naps (57%) lasted 30 min. 33% of subjects took a nap more than once a week (73% male). Progressive growth in the number of naps across the months was observed (January=110 to December=505). Results suggest that the society is sleep deprived and taking a nap during the day could be an important strategy to improve quality of life and increase productivity.

Systematic Evaluation of the Upper Airway in a Sample Population: Factors Associated with Obstructive Sleep Apnea Syndrome.

OBJECTIVES: To investigate the anatomy of the upper airway (UA) of a representative sample of the adult population of São Paulo city, Brazil, and to identify factors associated with the presence of obstructive sleep apnea syndrome (OSAS), as confirmed using full-night polysomnography (PSG). STUDY DESIGN: Cross-sectional study. SETTING: Population-based sample. METHODS: A 3-stage sampling procedure was used to proportionally recruit adult residents of São Paulo city according to gender, age, and socioeconomic status. A complete evaluation was performed, including a systematic evaluation of the UA prior to conducting PSG. RESULTS: Nine-hundred ninety-three (90.2%) of the participants were seen by an ear, nose, and throat (ENT) specialist. Individuals who were diagnosed with OSAS (32.9%) presented a higher frequency of nasal symptoms and structural abnormalities (both nasal and oropharyngeal) compared with those without OSAS. No anatomical differences were observed in the facial skeleton. An abnormal nasal structure visible via anterior rhinoscopy was the only UA factor predicting OSAS after adjustments for the other common OSAS risk factors (male sex, aging, obesity, and increased neck circumference). CONCLUSION: This is the first study in which a systematic evaluation of the UA was followed by a sleep study in a population-based sample. In a sample of the general population that had not previously been screened for OSAS, having an abnormal nasal structure was found to be a risk factor for OSAS, in conjunction with other well-established clinical and demographic factors, such as male gender, increased age, increased neck circumference, and body mass index.

Assessment of interobserver concordance in polysomnography scoring of sleep bruxism.

INTRODUCTION: Objective evaluation of sleep bruxism (SB) using whole-night polysomnography (PSG) is relevant for diagnostic confirmation. Nevertheless, the PSG electromyogram (EMG) scoring may give rise to controversy, particularly when audiovisual monitoring is not performed. Therefore, the present study assessed the concordance between two independent scorers to visual SB on a PSG performed without audiovisual monitoring. METHODS: Fifty-six PSG tests were scored from individuals with clinical history and polysomnography criteria of SB. In addition to the protocol of conventional whole-night PSG, electrodes were also placed bilaterally on the masseter and temporal muscles. Visual EMG scoring without audio video monitoring was scored by two independent scorers (Dentist 1 and Dentist 2) according the recommendations formulated in the AASM manual (2007). Kendall Tau correlation was used to assess interobserver concordance relative to variables "total duration of events (seconds), "shortest events", "longest events" and index in each phasic, tonic or mixed event. RESULTS: The correlation was positive and significant relative to all the investigated variables, being T>0.54. CONCLUSION: It was found a good inter-examiner concordance rate in SB scoring in absence of audio video monitoring.

Effects of aging on sleep structure throughout adulthood: a population-based study.

OBJECTIVE: Although many studies have shown the evolution of sleep parameters across the lifespan, not many have included a representative sample of the general population. The objective of this study was to describe age-related changes in sleep structure, sleep respiratory parameters and periodic limb movements of the adult population of São Paulo. METHODS: We selected a representative sample of the city of São Paulo, Brazil that included both genders and an age range of 20-80 years. Pregnant and lactating women, people with physical or mental impairments that prevent self-care and people who work every night were not included. This sample included 1024 individuals who were submitted to polysomnography and structured interviews. We subdivided our sample into five-year age groups. One-way analysis of variance was used to compare age groups. Pearson product-moment was used to evaluate correlation between age and sleep parameters. RESULTS: Total sleep time, sleep efficiency, percentage of rapid eye movement (REM) sleep and slow wave sleep showed a significant age-related decrease (P<0.05). WASO (night-time spent awake after sleep onset), arousal index, sleep latency, REM sleep latency, and the percentage of stages 1 and 2 showed a significant increase (P<0.05). Furthermore, apnea-hypopnea index increased and oxygen saturation decreased with age. The reduction in the percentage of REM sleep significantly correlated with age in women, whereas the reduction in the percentage of slow wave sleep correlated with age in men. The periodic limb movement (PLM) index increased with age in men and women. CONCLUSIONS: Sleep structure and duration underwent significant alterations throughout the aging process in the general population. There was an important correlation between age, sleep respiratory parameters and PLM index. In addition, men and women showed similar trends but with different effect sizes.

Temporal sleep patterns in adults using actigraph.

The aim of the present study was to characterize the temporal patterns of sleep and wakefulness in a sample of the adult subjects from São Paulo city. All subjects filled the Morningness/Eveningness Questionnaire (MEQ) and wore an actigraph for at least three consecutive days. A total of 359 subjects were considered for the analyses. The mean age was 43±14 years, the mean body mass index was 26.7±5.7 kg/m(2), and 60% were female. The mean MEQ score was 58.0±10.7. The sleep pattern evaluated by the actigraphic analyses showed that 92% had a monophasic sleep pattern, 7% biphasic, and 1% polyphasic sleep pattern. Cluster analysis, based on time to sleep onset, sleep efficiency, sleep latency, and total sleep time, was able to identify three different groups denominated: morning type, evening type, and undefined type. Morning type subjects were more frequent, older, and had higher MEQ scores than evening type subjects. Our results showed that the actigraph objectively assessed the sleep-wake cycle and was able to discriminate between morning and evening type individuals. These findings suggest that the actigraph could be a valuable tool for assessing temporal sleep patterns, including the circadian preferences.

Depressive symptoms and sleep: a population-based polysomnographic study.

The goals of the present study were to determine the prevalence of depression in the adult population of Sao Paulo, Brazil and to explore the relationship among sociodemographic, physical and psychological factors, sleep-related symptoms and polysomnography parameters. Participants of a cross-sectional study (N = 1101) were administered questionnaires and submitted to polysomnography. A score > 20 in the Beck Depression Inventory was used to describe depression. Results revealed that the prevalence of depression was 10.9%. Estimates were higher in women and were significantly higher among housewives, non-workers and individuals with lower education and income. A combination of sleep-related symptoms and impaired quality of life was 2.5 times more frequent among depressed than non-depressed. Co-morbid insomnia and anxiety were positively associated to depressive symptomatology. There were no alterations in the polysomnography parameters, in either group. The occurrence of sleep apnea with values on the apnea-hypopnea index ≥ 5 was similar and frequent in both groups (around 30%). The findings suggest that depressive symptoms were associated with low education, low income, severe comorbid symptomatology, and impaired quality of life. Considering the high prevalence of sleep apnea, these results point to potential social and financial burdens associated with the depressive symptomatology and various sleep diagnoses.

Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea.

BACKGROUND: Patients with obstructive sleep apnea (OSA) exhibit reduced quality of life (QoL) due to their daytime symptoms that restricted their social activities. The available data for QoL after treatment with continuous positive airway pressure (CPAP) are inconclusive, and few studies have assessed QoL after treatment with speech therapy or other methods that increase the tonus of the upper airway muscles or with a combination of these therapies. The aim of our study was to assess the effect of speech therapy alone or combined with CPAP on QoL in patients with OSA using three different questionnaires. METHODS: Men with OSA were randomly allocated to four treatment groups: placebo, 24 patients had sham speech therapy; speech therapy, 27 patients had speech therapy; CPAP, 27 patients had treatment with CPAP; and combination, 22 patients had treatment with CPAP and speech therapy. All patients were treated for 3 months. Participants were assessed before and after treatment and after 3 weeks of a washout period using QoL questionnaires (Functional Outcomes of Sleep Questionnaire [FOSQ], World Health Organization Quality of Life [WHOQoL-Bref], and Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]). Additional testing measures included an excessive sleepiness scale (Epworth sleepiness scale [ESS]), polysomnography (PSG), and speech therapy assessment. RESULTS: A total of 100 men aged 48.1±11.2 (mean±standard deviation) years had a body mass index (BMI) of 27.4±4.9 kg/m(2), an ESS score of 12.7±3.0, and apnea-hypopnea index (AHI) of 30.9±20.6. After treatment, speech therapy and combination groups showed improvement in the physical domain score of the WHOQoL-Bref and in the functional capacity domain score of the SF-36. CONCLUSIONS: Our results suggest that speech therapy alone as well as in association with CPAP might be an alternative treatment for the improvement of QoL in patients with OSA.

Consequences of obstructive sleep apnea on metabolic profile: a Population-Based Survey.

OBJECTIVE: Epidemiologic studies that control for potential confounders are needed to assess the independent associations of obstructive sleep apnea (OSA) with metabolic abnormalities. The aim of our study was to evaluate the associations of OSA with metabolic abnormalities among the adult population of Sao Paulo, Brazil. DESIGN AND METHODS: Questionnaires were applied face-to-face, full night polysomnography (PSG) was performed, and blood samples were collected in a population-based survey in Sao Paulo, Brazil, adopting a probabilistic three-stage cluster sample method. The metabolic profile included fasting glucose, insulin, and lipid levels. The hepatic insulin resistance index was assessed by the homeostasis model assessment-estimated insulin resistance (HOMAIR ). RESULTS: A total of 1,042 volunteers underwent PSG. Mild OSA and moderate to severe OSA comprised 21.2% and 16.7% of the population, respectively. Subjects with severe to moderate OSA were older, more obese, had higher fasting glucose, HOMAIR , and triglycerides (TG) levels than did the mild and non-OSA group (P < 0.001). Multivariate regression analyses showed that an apnea-hypopnea index (AHI) ≥ 15 and a time of oxy-hemoglobin saturation <90% were independently associated with impaired fasting glucose, elevated TG, and HOMAIR . CONCLUSIONS: The results of this large cross-sectional epidemiological study showed that the associations of OSA and metabolic abnormalities were independent of other risk factors.

Relationship between physical activity and depression and anxiety symptoms: a population study.

BACKGROUND: There are few studies evaluating the association between practice of physical activity and mood in a population sample. This study evaluated the frequency of symptoms of depression and anxiety in the population of the city of Sao Paulo and their association with the report of practice of regular physical activity. METHODS: This survey was conducted with the adult population of Sao Paulo between July and December of 2007. The sample was composed of 1042 volunteers (both genders) with a mean age of 41.9±14.4 years. The volunteers were evaluated using the Beck Depression Inventory, the Beck Anxiety Inventory, and two simple questions designed to evaluate and classify physical activity. Socioeconomic status was also determined according to Brazil's Economic Classification Criterion. RESULTS: People who do not engage in physical activity are two times more likely to exhibit symptoms of depression (PR: 2.1) and anxiety (PR: 2.5) compared with those who regularly practice physical activity and a higher prevalence of symptoms for anxiety (9.8%) and depression (10.9%) was observed among those claiming to not practice regular physical activity and 63.2% related did not practice any physical activity regularly. CONCLUSION: Altogether, these results suggest that people who do not practice physical activity have a higher chance of exhibiting symptoms of depression and anxiety when compared to those who perform physical activity regularly. In this sense, regular physical activity must be encouraged, and this incentive should be routine in both current and future public health policies. Although the methodology in the present study does not allow assigning a relation of cause and effect, we observed associations between symptoms of depression, anxiety and physical activity.

A population-based survey on the influence of the menstrual cycle and the use of hormonal contraceptives on sleep patterns in São Paulo, Brazil.

OBJECTIVE: To investigate the effects of the phases of the menstrual cycle and the use of hormonal contraception on sleep patterns in a population-based study. METHODS: In a prospective study carried out among premenopausal women between July and December 2007, a 3-stage cluster sampling was used to ensure accurate representation of the general population of São Paulo, Brazil. Questionnaires were administered, hormonal assays were performed, and full-night polysomnography was recorded. RESULTS: The study sample included 297 premenopausal women. Women in the follicular phase complained of fatigue more than those in the luteal phase and those using hormonal contraceptive treatment. Premenopausal women using hormonal contraceptives had a significantly lower apnea-hypopnea index (1.1 ± 2.0) compared with women in both the follicular (2.2 ± 4.5) and the luteal (2.9 ± 5.4) phases (P=0.01). Women taking hormonal contraceptives tended to have increased sleep efficiency compared with women in either the follicular or luteal phases. CONCLUSION: The use of hormonal contraceptives was associated with a lower apnea-hypopnea index and a trend toward improved sleep efficiency. The current findings suggest that the use of hormonal contraceptives has a stronger association with sleep duration compared with menstrual cycle phase.

Is portable monitoring for diagnosing obstructive sleep apnea syndrome suitable in elderly population?

PURPOSE: Obstructive sleep apnea syndrome (OSAS) is highly prevalent in the elderly. Unattended, at-home portable monitoring (PM) is a diagnostic alternative to polysomnography in adults with high clinical probability of OSAS. However, no studies have evaluated the diagnostic accuracy of PM in elderly population. The aim of our study was to evaluate the effectiveness of PM in elderly patients. METHODS: We selected patients aged over 65 years with suspected OSAS. Two-order randomized evaluations were performed: one night of at-home PM (PMhome) and one night of simultaneous PM and polysomnography (PSG) in the sleep lab (PSG+PM). We obtained three different apnea-hypopnea index (AHI): AHI from PSG (AHI PSG), AHI from at-home PM (AHI PMhome), and AHI from PM+PSG (AHI PM+PSG). Two technicians, blinded to the recording order, scored each sleep study. RESULTS: We studied a total of 43 patients. No difference between the AHI values for each of the different recordings was found (p > 0.05). There was good correlation between AHI PSG and AHI PMhome (r = 0.67) and AHI PSG+PM (r = 0.84). The area under the receiver operator curve was above 0.83, indicating good sensitivity and a positive predictive value for AHI with cutoffs of 5, 15, and 30 and good specificity and negative predictive value for AHI values above 15. Correlation, accuracy, and agreement were greater when the recordings were made simultaneously. CONCLUSIONS: PM was effective for diagnosing OSAS in the elderly and can be used as an alternative to PSG in elderly patients with a high clinical probability of OSAS.

Adenosine deaminase polymorphism affects sleep EEG spectral power in a large epidemiological sample.

Slow wave oscillations in the electroencephalogram (EEG) during sleep may reflect both sleep need and intensity, which are implied in homeostatic regulation. Adenosine is strongly implicated in sleep homeostasis, and a single nucleotide polymorphism in the adenosine deaminase gene (ADA G22A) has been associated with deeper and more efficient sleep. The present study verified the association between the ADA G22A polymorphism and changes in sleep EEG spectral power (from C3-A2, C4-A1, O1-A2, and O2-A1 derivations) in the Epidemiologic Sleep Study (EPISONO) sample from São Paulo, Brazil. Eight-hundred individuals were subjected to full-night polysomnography and ADA G22A genotyping. Spectral analysis of the EEG was carried out in all individuals using fast Fourier transformation of the signals from each EEG electrode. The genotype groups were compared in the whole sample and in a subsample of 120 individuals matched according to ADA genotype for age, gender, body mass index, caffeine intake status, presence of sleep disturbance, and sleep-disturbing medication. When compared with homozygous GG genotype carriers, A allele carriers showed higher delta spectral power in Stage 1 and Stages 3+4 of sleep, and increased theta spectral power in Stages 1, 2 and REM sleep. These changes were seen both in the whole sample and in the matched subset. The higher EEG spectral power indicates that the sleep of individuals carrying the A allele may be more intense. Therefore, this polymorphism may be an important source of variation in sleep homeostasis in humans, through modulation of specific components of the sleep EEG.

Is portable monitoring accurate in the diagnosis of obstructive sleep apnea syndrome in chronic pulmonary obstructive disease?

BACKGROUND: No scientific evidence supports the use of portable devices to diagnose obstructive sleep apnea syndrome (OSAS) in patients with co-morbities. Our aim was to evaluate the accuracy of a portable monitoring device (Stardust - STD) in the detection of patients with chronic obstructive pulmonary disease (COPD). METHODS: Patients with COPD and clinical suspicion of OSAS were recruited for a prospective randomized study. The STD was used on two different nights: (1) at home (STDHome) and (2) at the sleep laboratory simultaneous with polysomnography (PSG-STDLab). RESULTS: A total of 72 patients underwent the proposed recordings. Forty-six volunteers were excluded due to recording problems, and data from 26 subjects were analyzed. The mean age was (mean±SD) 62.8±8.5 years, 50% were male, and the mean forced expiratory volume in the first second was 55±11%. Significant intraclass correlation was observed between apnea-hypopnea index (AHI)-PSG vs. AHI-STDLab (r=0.61, p<0.0001) and AHI-STDHome (r=0.47, p<0.007). Kappa analysis also showed a significant agreement for severe group. CONCLUSION: Despite the agreement found in a small number of patients between AHI, a large number of failures in the recording limits the use of this portable device for the diagnosis of OSAS in patients with COPD.

The association between the Framingham risk score and sleep: a São Paulo epidemiological sleep study.

BACKGROUND: Sleep is an important factor in the maintenance of cardiovascular integrity. It seems that cardiovascular injury and sleep impairment is another chicken or egg puzzle and we hypothesized that the higher the cardiovascular risk factors the higher the sleep impairment. Therefore, the goal of this study is to analyze the sleep profile of a general population based on cardiovascular risk stratification. METHODS: This population-based survey used a probabilistic three-stage cluster sample of Sao Paulo inhabitants to represent the population. A sample size of 1056 volunteers was defined in order to allow for prevalence estimates with 3% precision. From the 1101 selected and interviewed participants, a complete full-night polysomnogram (PSG) was performed in 1042 participants as well as clinical evaluation and blood samples analyses to assess Framingham risk score. RESULTS: Nine hundred four subjects were classified according the Framingham score and were included in the analyses. A total of 91.7% were classified as a low risk, 5.8% in the intermediate, and 2.4% in the high risk groups according to Framingham score. All polisomnographic parameters were different between groups, except those related to REM sleep parameters. AHI were greater in the high risk compared to the intermediate and low risk groups (23.9 ± 2.8; 17.7 ± 1.8; 7.2 ± 0.5, respectively, p<0.001), as well as a lower total sleep time in minutes (295.3 ± 16.2; 338.4 ± 10.2; 347.4 ± 2.6, respectively, p=0.01). Sleep efficiency in percentage also exhibits a reduction between groups (67.6 ± 2.5; 78.4 ± 1.6; 82.9 ± 0.4, respectively, p<0.001). After adjustment for confounder factors age (p<0.001) and sleep efficiency (p=0.06) remained strongly associated with high risk population. CONCLUSION: High Framingham risk score was associated with poor sleep efficiency and aging.

Sleep disorders and demand for medical services: evidence from a population-based longitudinal study.

BACKGROUND: The aim of this study was to investigate whether insomnia and obstructive sleep apnea (OSA) were predictors of hospitalizations or emergency department visits during two years following the Sao Paulo Epidemiologic Sleep Study (EPISONO) sample. METHODS AND FINDINGS: All participants (n = 1,101) who underwent a baseline evaluation between July and December 2007 were contacted in December 2009 and asked to fill out a questionnaire about body weight changes, number of hospitalizations and visits to the emergency department. Participants lost during the follow-up period represented 3.2% (n = 35) and 7 subjects had died. Hospitalizations were reported by 116 volunteers (10.5%) and emergency department visits were reported by 136 participants (12.4%). The average body mass index (BMI) did not vary significantly between the first and the second assessment [26.7(95%CI:26.3-27.1) vs. 26.9(26.5-27.4) kg/m2]. After adjusting for confounders, a multiple logistic regression model revealed that female gender [1.4(1.0-1.9)], age ≥ 40 years, insomnia diagnosed according to the DSM-IV criteria [1.6(1.0-2.6)], and apnea-hypopnea index ≥ 15 [1.5(1.0-2.2)] were predictors of hospitalizations and/or demand for emergency services. CONCLUSION: Our study of a probabilistic sample of the Sao Paulo inhabitants shows that over a period of two years, insomnia and OSA were both associated with health impairment. Considering the high prevalence and public health burden of sleep disorders, the consequences of untreated disease for both the individual and society are undeniable and should be addressed.