The effect of caffeine supplementation on exercise performance evaluated by a novel animal model

Introduction: Caffeinated drinks are used for improve performance. Animal models represent investigational strategy that circumvents most of the drawbacks of research in humans, including motivational factors and the placebo effect. No animal model that could test whether different forms of administering caffeine affect exercise propensity was found in the literature. Methods: An animal model of grouped voluntary exercise was tested. Two-month-old male C57/bl mice were housed in a cage fitted with one running wheel and a monitoring system. Six animals per cage were introduced individually. To assess the sensitivity of the model, the effect of different caffeinated drinks was observed in mice exercising ad libitum. During 2 days, the mice received: 1) pure anhydrous caffeine 0.125 mg/mL (PC), 2) cola drink (CC), and 3) caffeine-taurine-glucuronolactone drink (CTG), intercalating wash-out periods of 2 days, receiving pure water. Results: The distance run during the periods of water ingestion was significantly lower than during the periods of stimulant drinks ingestion: PC (5.6 ± 1.3 km; p = 0.02), of CC ingestion (7.6 ± 0.6 km; p = 0.001), and of CTG ingestion (8.3 ± 1.6 km; p = 0.009). The performances when ingesting the three caffeinated drinks do not follow a dose-response curve. Conclusions: The model described here was able to measure the effect of caffeine intake on voluntary exercise of mice. The sensitivity of the model to the effect of caffeine needs to be further validated. The action of each component of the drinks on exercise performance needs to be clarified in future research. The present model is adequate for such investigation (AU)

Craniocervical Posture in Patients with Obstructive Sleep Apnea

Abstract Introduction Obstructive Sleep Apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep. Objective The objective of this study is to verify the craniofacial characteristics and craniocervical posture of OSA and healthy subjects, determining possible relationships with the apnea/hypopnea index (AHI). Methods This case-control study evaluated 21 subjects with OSA, who comprised the OSA group (OSAG), and 21 healthy subjects, who constituted the control group (CG). Cephalometry analyzed head posture measurements, craniofacial measurements, and air space. Head posture was also assessed by means of photogrammetry. Results The groups were homogeneous regarding gender (12 men and 9 women in each group), age (OSAG = 41.86 11.26 years; GC = 41.19 11.20 years), and body mass index (OSAG = 25.65 2.46 kg/m2; CG = 24.72 3.01 kg/m2). We found significant differences between the groups, with lower average pharyngeal space and greater distance between the hyoid bone and the mandibular plane in OSAG, when compared with CG. A positive correlation was found between higher head hyperextension and head anteriorization, with greater severity of OSA as assessed by AHI. Conclusion OSAG subjects showed changes in craniofacial morphology, with lower average pharyngeal space and greater distance from the hyoid bone to the mandibular plane, as compared with healthy subjects. Moreover, in OSA subjects, the greater the severity of OSA, the greater the head hyperextension and anteriorization.

Craniocervical Posture in Patients with Obstructive Sleep Apnea.

INTRODUCTION: Obstructive Sleep Apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep. OBJECTIVE: The objective of this study is to verify the craniofacial characteristics and craniocervical posture of OSA and healthy subjects, determining possible relationships with the apnea/hypopnea index (AHI). METHODS: This case-control study evaluated 21 subjects with OSA, who comprised the OSA group (OSAG), and 21 healthy subjects, who constituted the control group (CG). Cephalometry analyzed head posture measurements, craniofacial measurements, and air space. Head posture was also assessed by means of photogrammetry. RESULTS: The groups were homogeneous regarding gender (12 men and 9 women in each group), age (OSAG = 41.86 ± 11.26 years; GC = 41.19 ± 11.20 years), and body mass index (OSAG = 25.65 ± 2.46 kg/m2; CG = 24.72 ± 3.01 kg/m2). We found significant differences between the groups, with lower average pharyngeal space and greater distance between the hyoid bone and the mandibular plane in OSAG, when compared with CG. A positive correlation was found between higher head hyperextension and head anteriorization, with greater severity of OSA as assessed by AHI. CONCLUSION: OSAG subjects showed changes in craniofacial morphology, with lower average pharyngeal space and greater distance from the hyoid bone to the mandibular plane, as compared with healthy subjects. Moreover, in OSA subjects, the greater the severity of OSA, the greater the head hyperextension and anteriorization.

Relationship among perceived stress, anxiety, depression and craniocervical pain in nursing professionals under stress at work / Relação entre o estresse percebido, ansiedade, depressão e a dor craniocervical em profissionais de enfermagem sob estresse no trabalho

Abstract Introduction: The appearance and evolution of some clinical pain conditions may be influenced by stress and other psychosocial factors. Face, head and cervical muscles may increase their activity and tension in the presence of stress, leading to craniocervicomandibular pain in individuals exposed to stress. Objective: To assess the relationship among perceived stress, anxiety, depression and craniocervicomandibular pain in nursing professionals under stress at work. Materials and Methods: Forty-three women under stress at work, according to the Job Stress Scale (JSS), were assessed by the Perceived Stress Scale (PSS), the Hospital Anxiety and Depression Scale (HADS), pressure pain threshold, measured by algometry, and muscle sensitivity to hand palpation of the masticatory and cervical muscles. Results: A low moderate level of perceived stress was found in 62.79% of the sample, anxiety in 11.63% and depression in 9.30%. The psychosocial scales correlated with each other. No correlation was found between pressure pain threshold and perceived stress, anxiety and depression. The level of pain to hand palpation correlated with the perceived stress scores. Conclusion: Pressure pain threshold was not influenced by the psychosocial factors assessed. Pain intensity to hand palpation, however, was higher as the perception of stress increased.

Resumo Introdução: O aparecimento e evolução de algumas condições clínicas de dor podem ser influenciados pelo estresse e outros fatores psicossociais. A musculatura da face, cabeça e cervical podem aumentar sua atividade e tensão na presença do estresse, podendo provocar dor craniocervicomandibular nos indivíduos a ele expostos. Objetivo: Avaliar a relação entre estresse percebido, ansiedade, depressão e a dor craniocervicomandibular em profissionais da enfermagem sob estresse no trabalho. Materiais e Métodos: 43 mulheres sob estresse no trabalho, de acordo com a Escala de Estresse no Trabalho (JSS), foram avaliadas pelas Escalas de Estresse Percebido (PSS), Escala Hospitalar de Ansiedade e Depressão (HADS), limiar de dor à pressão, por algometria, e a sensibilidade muscular por palpação manual dos músculos mastigatórios e cervicais. Resultados: Nível moderado baixo de estresse percebido foi encontrado em 62,79% da amostra, ansiedade em 11,63% e depressão em 9,30%. As escalas psicossociais se correlacionaram entre si. Não houve correlação entre limiar de dor à pressão e estresse percebido, ansiedade e depressão. O nível de dor à palpação manual se correlacionou com os escores de estresse percebido. Conclusão: Os fatores psicossociais avaliados não influenciaram o limiar de dor à pressão. Entretanto, a intensidade da dor à palpação manual foi mais alta à medida que aumentou a percepção do estresse.

Disfunção temporomandibular e dor craniocervical em profissionais da área da enfermagem sob estresse no trabalho / Temporomandibular dysfunction and craniocervical pain in professionals of the nursing area under work stress

RESUMO Objetivo: verificar a presença e severidade de Disfunção Temporomandibular, presença de cefaleia e cervicalgia e o limiar de dor muscular de músculos cervicais em profissionais de enfermagem sob estresse no trabalho. Métodos: 43 mulheres foram avaliadas quanto à presença e severidade de Disfunção Temporomandibular pelo instrumento Critérios de Diagnóstico para Pesquisa de Desordem Temporomandibular e pelo Índice Temporomandibular, respectivamente. Além disso, foram avaliadas quanto ao limiar de dor à pressão nos músculos cervicais por algometria e quanto à presença de cefaleia e cervicalgia. Resultados: disfunção Temporomandibular foi encontrada em 30,23% da amostra, com valor médio de escore de gravidade de 0,52. Entre as participantes com Disfunção Temporomandibular, 69,23% apresentavam depressão, 61,64% graduação I de dor crônica e Sintomas Físicos não Específicos incluindo e excluindo itens de dor em 46,15% e 61,64%, respectivamente. Cefaleia foi referida por 55,81% e cervicalgia por 60,47%. Não houve associação entre Disfunção Temporomandibular, cefaleia e cervicalgia. Os limiares de dor dos músculos cervicais apresentaram-se baixos tanto nos indivíduos com diagnóstico de Disfunção Temporomandibular quanto nos sem este diagnóstico, sem diferença significativa. O músculo esternocleidomastóideo apresentou-se com os menores limiares de dor à pressão. Conclusão: alta incidência de Disfunção Temporomandibular, cefaleia e cervicalgia foram detectadas nesta amostra. Disfunção Temporomandibular não influenciou a presença de cefaleia e/ou cervicalgia. A alta frequência de dor cervical e os baixos limiares de dor no músculo esternocleidomastóideo em todas as participantes demonstram o comprometimento dos músculos cervicais, resultante de possíveis posturas inadequadas e tensão muscular relacionadas ao estresse.

ABSTRACT Purpose : to investigate the presence of Temporomandibular Disorder, headache and neck pain and muscle pain threshold of cervical muscles in nursing professionals exposed to occupational stress. Methods: 43 women were evaluated for the presence and severity of Temporomandibular Disorder using the Diagnostic Criteria for Temporomandibular Disorder instrument and Temporomandibular Dysfunction Index, respectively. Furthermore, they were evaluated for the pain threshold to pressure on the cervical muscles by algometry and for the presence of headache and neck pain. Results: temporomandibular Disorder was found in sample 30.23% and 0.52 was the mean score of dysfunction severity. Of the participants with Temporomandibular Disorder, there presence of depression was found in 69.23%; 61.64% Grade I in Graded Chronic Pain and Specific Physical Symptoms including pain and excluding pain were 46.15% and 61.64%, respectively. Headache was reported by 55.81% and neck pain by 60.47%. There was no association between the presence of Temporomandibular Disorder, headache and neck pain. Pain pressure thresholds of cervical muscles were low in subjects with and without Temporomandibular Disorder, without statistical difference. The sternocleidomastoid muscle it´s the lowest value of pain pressure threshold. Conclusion: high incidence of Temporomandibular Disorder, headache and neck pain were detected in the studied sample. Temporomandibular Disorder was not associated with the presence of headache and / or neck pain. The high frequency of cervical pain and low pain pressure thresholds in the sternocleidomastoid muscle in all subjects demonstrate the involvement of the cervical spine and muscles in these professionals, resulting of possible improper postures and stress-related muscle tension.

Aspectos clínicos e psicossociais avaliados por critérios de diagnóstico para disfunção temporomandibular / Clinical and psychosocial aspects assessed by the research diagnostic criteria for temporomandibular disorder

RESUMO Objetivo: analisar a associação entre a classificação de diagnósticos clínicos (dor miofascial, desordem discal e articular) e a graduação de dor crônica, depressão e sintomas físicos não específicos em sujeitos com disfunção temporomandibular. Métodos: foram incluídos 32 pacientes, com média de idade de 28,71±4,66 anos. Como instrumento de avaliação, foi utilizado o Critério de Diagnóstico para Pesquisa das Desordens Temporomandibulares - Eixo I e II. Quanto ao grupo diagnóstico, 88,13% dos indivíduos apresentaram diagnóstico misto, sendo 43,75% dos grupos I e III (distúrbios musculares e articulares) e 34,38% dos grupos I, II e III (distúrbios musculares, articulares e deslocamento de disco). Resultados: de acordo com o eixo II, 96,88% dos participantes foram classificados com dor crônica grau I e II (baixa incapacidade e baixa intensidade; baixa incapacidade e alta intensidade). Graus moderado e grave de depressão foram observados em 84,38% dos participantes. Na avaliação de sintomas físicos não específicos incluindo e excluindo dor, respectivamente, 59,38% apresentaram sintomas severos e 71,88% apresentaram sintomas moderados e severos. Verificou-se relação significante dos diagnósticos clínicos de disfunção temporomandibular com o grau de sintomas físicos não específicos incluindo dor. Conclusão: alguns aspectos clínicos e psicossociais estão associados em pacientes com disfunção temporomandibular, observando uma multiplicidade de diagnósticos clínicos com a presença de uma relação significante entre os diagnósticos clínicos encontrados e a presença de sintomas físicos inespecíficos com dor. Queixa de maior gravidade de sintomas físicos foi encontrada em pacientes com diagnóstico clínico múltiplo.

ABSTRACT Purpose: to analyze the association between the classification of clinical diagnoses (myofascial pain, disk displacement and joint disorder) and chronic pain grade, depression and non-specific physical symptoms in subjects with temporomandibular disorder. Methods: 32 patients, mean age 28.71±4.66 years, were included. The assessment tool used was the Research Diagnostic Criteria for Temporomandibular Disorders - Axis I and II. Regarding the diagnostic group, 88.13% of patients showed mixed conditions, with 43.75% from groups I and III (muscle and joint disorders) and 34.38% from groups I, II and III (muscle and joint disorders, and disk displacement). Results: according to Axis II, 96.88% the participants were classified as having chronic pain, grade I and II (low disability and low intensity; low disability and high intensity). Moderate and severe degrees of depression were observed in 84.38% of the participants. In the assessment of non-specific physical symptoms including and excluding pain, respectively, 59.38% showed severe symptoms and 71.88% had moderate and severe symptoms. There was a significant relationship between the clinical diagnosis of temporomandibular disorder and the degree of non-specific physical symptoms including pain. Conclusion: some clinical and psychosocial factors are associated in patients with temporomandibular disorder, observing a variety of clinical diagnoses with a significant relationship between clinical diagnoses and the presence of non-specific physical symptoms with pain. Complaints of greater severity of physical symptoms were found in patients with multiple clinical diagnoses.

Obesidade e variáveis polissonográficas empacientes com apneia obstrutiva do sono / Obesity and polysomnographic variables on patients with obstructivesleep apnea

Apneia Obstrutiva do Sono (AOS) e a obesidade, são condições que vem ganhando importância devido à alta prevalênciae influência na saúde dos indivíduos. Dessa forma, o objetivo do estudo foi comparar variáveis polissonográficas entrepacientes com apneia obstrutiva do sono (AOS) classificados como eutróficos, com sobrepeso ou obesos. Foram avaliados88 pacientes divididos em grupo eutrófico (GE; n=21; IMC=23,4±1,3kg/m2), sobrepeso (GS; n=34; IMC=27,5±1,4kg/ m2)e obeso (GO; n=33; IMC=33,6±2,9kg/m2) que realizaram polissonografia basal de noite inteira para diagnóstico da AOS.Foram analisadas as seguintes variáveis: estágios 1, 2 e 3 do sono (N1, N2 e N3), sono REM, índice de movimentos periódicosde membros inferiores (MPMI), índice de apneia e hipopneia (IAH), IAH no sono REM (IAHREM) e índice demicrodespertares (IMD). O GO apresentou elevação do N2 (p=0,036), do IAHREM (p=0,001) e do IMD (p=0,004) emcomparação ao GE. O IAH foi maior no GO do que no GE (p<0,001) e no GS (p=0,014). O GO apresentou redução doN3 em relação ao GE (p=0,016) e ao GS (p=0,003). Houve correlação significativa do IMC com o N2 (r=0,30), com oIAH (r=0,49), com o IAHREM (r=0,37), com o IMD (r=0,37) e com o N3 (r=-0,38). A obesidade esteve associada à elevaçãono número de apneias e hipopneias, microdespertares e tempo do estágio N2, assim como à redução no tempo doestágio N3 do sono. A combinação destas alterações demonstra baixa qualidade do sono em sujeitos obesos, em relaçãoaos eutróficos ou com sobrepeso.

Obstructive Sleep Apnea (OSA) and obesity are conditions that are gaining importance due to the high prevalence andinfluence on individuals’ health. Therefore, the aim of the study was to compare polysomnographic variables among ObstructiveSleep Apnea (OSA) patients classified as eutrophic, overweight or obese. Eighty eight patients were evaluateddivided in eutrophic (EG; n=21; BMI=23.4±1.3kg/m2), overweight (OWG; n=34; BMI=27.5±1.4kg/m2) and obese group(OG; n=33; BMI=33.6±2.9kg/m2) that carried out all-night basal polysomnography for the diagnosis of Obstructive SleepApnea (OSA). The following variables were analyzed: stages 1, 2 and 3 of sleep (N1, N2 and N3), REM sleep, index periodicmovements of the lower limbs (PLMS), apnea and hypopnea (AHI), AHI in REM sleep (AHIREM) and micro-arousalrates (MAR). The OG presented an increase of the N2 (p=0,036), of the AHIREM (p=0.001) and of the MAR (p=0.004), incomparison to EG. The AHI was larger in the OG than in the EG (p<0.001) and in the SG (p=0.014). The OG presentedreduction in the N3 in relation to the EG (p=0.016) and SG (p=0.003). There was a significant correlation of the BMI withthe N2 (r=0.30), with the AHI (r=0.49), with the AHIREM (r=0.37), with the MAR (r=0.37) and with the N3 (r=-0.38). Theobesity has been associated with the increase in the number of apneas and hypopneas, micro-arousals, and time of stage 2,and the reduction in time of stage 3 of sleeping. The combination of these changes demonstrates low quality of sleep onobese individuals, in relation to eutrophic or overweight individuals.

Obstructive sleep apnea: acute effects of CPAP on polyssonographic variables / Apneia obstrutiva do sono: efeitos agudos do CPAP sobre variáveis polissonográficas

Introduction The use of non-invasive ventilation in the form of continuous positive airway pressure (CPAP) is among the main therapeutic options for patients with obstructive sleep apnea (OSA). Yet the effects of CPAP obtained on the first night of use are underreported. Objective To evaluate the acute effects of CPAP on polysomnographic variables in patients with OSA. Materials and methods This study is a case series with 31 patients (55.8 ± 11.4 years; 22 men) in the initial phase of CPAP treatment. The subjects were evaluated by means of polysomnography with and without CPAP (10.2 ± 3.1 cmH2O) and without CPAP, on different days, by means of the following variables: sleep stages 1, 2 and 3 (N1, N2 and N3), rapid eye movement (REM) sleep, apnea and hypopnea index (AHI), AHI in REM sleep (AHIREM) and the micro-arousal index (MAI). Results The use of CPAP resulted in a reduction of N2 (p < 0.001), AHI (p < 0.001), AHIREM (p < 0.001) and MAI (p = 0.001). There was an increase in N3 (p = 0.006) and REM sleep (p < 0.001) during the night with use of CPAP. Conclusion This study demonstrated that, from the first night of use by patients with OSA, CPAP promotes greater balance between sleep phases, and improves sleep quality. These results should be presented to patients and their families in order to encourage greater adherence in the initial phase of treatment with CPAP. .

Introdução O uso de ventilação não invasiva sob a forma de Continuous Positive Airway Pressure (CPAP) está entre as principais opções terapêuticas no manejo de pacientes com apneia obstrutiva do sono (AOS). No entanto, os efeitos obtidos logo na primeira noite de uso do CPAP ainda são pouco relatados. Objetivo Avaliar os efeitos agudos do CPAP sobre variáveis polissonográficas em pacientes com AOS. Materiais e métodos Trata-se de uma série de casos, com um total de 31 pacientes (55,8 ± 11,4 anos; 22 homens) em fase inicial de tratamento com o CPAP no Instituto do Sono de Santa Maria (RS). Os sujeitos foram avaliados pela polissonografia sem e com CPAP (10,2 ± 3,1 cmH2O), em dias diferentes, por meio das seguintes variáveis: estágios do sono 1, 2 e 3 (N1, N2 e N3), sono REM (rapid eyes moviment), índice de apneia e hipopneia (IAH), IAH no sono REM (IAHREM) e índice de microdespertares (IMD). Resultados Houve diminuição com o uso do CPAP no N2 (p < 0,001), IAH (p < 0,001), IAHREM (p < 0,001) e IMD (p = 0,001). O N3 (p = 0,006) e o sono REM (p < 0,001) aumentaram durante a noite com o CPAP. Conclusão Este estudo demonstrou que o CPAP, logo na primeira noite de sua utilização, promove um maior equilíbrio entre as fases e melhora na qualidade do sono de pacientes com AOS. Esses resultados devem ser apresentados aos pacientes e aos seus familiares, visando estimular maior adesão na fase inicial do tratamento com o CPAP. .