Trastornos del sueño en niños con epilepsia / Sleep disorders in children with epilepsy

Introducción: Los niños con epilepsia tienen más trastornos del sueño (TS) que la población sana. Es fundamental su diagnóstico, ya que la epilepsia y los TS tienen una relación bidireccional. Objetivo: Determinar la incidencia de TS y malos hábitos de sueño en niños con epilepsia. Método: Estudio transversal de pacientes menores de 18 años con epilepsia sobre TS, mediante la versión española de Sleep Disturbance Scale for Children (SDSC), y sobre hábitos de sueño, mediante cuestionario de elaboración propia. Resultados: La muestra incluyó 153 pacientes. El 84% de la población estudiada presentaba alterado algún aspecto del sueño. Lo más frecuente fueron las alteraciones en la transición sueño-vigilia (53%), en el inicio-mantenimiento del sueño (47,7%) y la somnolencia diurna (44,4%). Un 70% de los padres de los pacientes referían que su hijo «dormía bien», pero en este grupo se detectaron TS hasta en el 75,7%. Muchos de los pacientes tenían hábitos de sueño poco saludables, como dormirse con dispositivos electrónicos (16,3%), precisar presencia familiar para dormirse (39%) o dormir en colecho o cohabitación (23,5 y 30,5%, respectivamente). Aquellos con epilepsias generalizadas, refractarias, crisis nocturnas y discapacidad intelectual presentaron mayor probabilidad de presentar TS. En cambio, los malos hábitos de sueño fueron frecuentes independientemente de las características de la epilepsia. Conclusiones: Los TS y los malos hábitos de sueño son frecuentes en niños con epilepsia. Su tratamiento puede conllevar una mejoría en la calidad de vida del paciente y su familia, así como una mejoría en el pronóstico de la epilepsia.(AU)

Introduction: Children with epilepsy present greater prevalence of sleep disorders than the general population. Their diagnosis is essential, since epilepsy and sleep disorders have a bidirectional relationship. Objective: Determine the incidence of sleep disorders and poor sleep habits in children with epilepsy. Methods: We conducted a cross-sectional study of patients under 18 years of age with epilepsy, assessing sleep disorders using the Spanish-language version of the Sleep Disturbance Scale for Children (SDSC), and sleep habits using an original questionnaire. Results: The sample included 153 patients. Eighty-four percent of our sample presented some type of sleep alteration. The most frequent alterations were sleep-wake transition disorders (53%), sleep initiation and maintenance disorders (47.7%), and daytime sleepiness (44.4%). In 70% of cases, the patients’ parents reported that their child “slept well,” although sleep disorders were detected in up to 75.7% of these patients. Many patients had poor sleep habits, such as using electronic devices in bed (16.3%), requiring the presence of a family member to fall asleep (39%), or co-sleeping or sharing a room (23.5% and 30.5%, respectively). Those with generalised epilepsy, refractory epilepsy, nocturnal seizures, and intellectual disability were more likely to present sleep disorders. In contrast, poor sleep habits were frequent regardless of seizure characteristics. Conclusions: Sleep disorders and poor sleep habits are common in children with epilepsy. Their treatment can lead to an improvement in the quality of life of the patient and his/her family, as well as an improvement in the prognosis of epilepsy.(AU)

Sleep disorders in children with epilepsy.

INTRODUCTION: Children with epilepsy present greater prevalence of sleep disorders than the general population. Their diagnosis is essential, since epilepsy and sleep disorders have a bidirectional relationship. OBJECTIVE: Determine the incidence of sleep disorders and poor sleep habits in children with epilepsy. METHODS: We conducted a cross-sectional study of patients under 18 years of age with epilepsy, assessing sleep disorders using the Spanish-language version of the Sleep Disturbance Scale for Children (SDSC), and sleep habits using an original questionnaire. RESULTS: The sample included 153 patients. Eighty-four percent of our sample presented some type of sleep alteration. The most frequent alterations were sleep-wake transition disorders (53%), sleep initiation and maintenance disorders (47.7%), and daytime sleepiness (44.4%). In 70% of cases, the patients' parents reported that their child "slept well," although sleep disorders were detected in up to 75.7% of these patients. Many patients had poor sleep habits, such as using electronic devices in bed (16.3%), requiring the presence of a family member to fall asleep (39%), or co-sleeping or sharing a room (23.5% and 30.5%, respectively). Those with generalised epilepsy, refractory epilepsy, nocturnal seizures, and intellectual disability were more likely to present sleep disorders. In contrast, poor sleep habits were frequent regardless of seizure characteristics. CONCLUSIONS: Sleep disorders and poor sleep habits are common in children with epilepsy. Their treatment can lead to an improvement in the quality of life of the patient and his/her family, as well as an improvement in the prognosis of epilepsy.

Condiciones laborales e indicadores de salud mental en profesionales de la medicina y enfermería en Chile durante la pandemia por COVID-19 / Working conditions and mental health indicators in medical and nursing professionals in Chile during the COVID-19 pandemic

Antecedentes: La salud mental del personal sanitario fue afectada por la pandemia de SARS-CoV-2 y sus consecuencias asociadas, entre ellas, el cambio en las condiciones laborales. Objetivos: Analizar la relación entre indicadores de salud mental y factores socio-laborales. Materiales y métodos: Los instrumentos PHQ-9, GAD-7 e ISI-3 fueron aplicados a 90 trabajadores sanitarios. Resultados: El personal de enfermería reportó mayor sintomatología depresiva, ansiosa y de insomnio. A su vez, manifestaron mayores indicadores de depresión en interacción con el cambio en la jornada laboral (F (1,86) = 3.83, p= 0.05, η² parcial= 0.04) y turno de trabajo (F (1,86) = 6.80, p= 0.01, η² parcial = 0.07); mayor sintomatología ansiosa en interacción con cambio de jornada (F (1,86) = 5.83, p= 0.02, η² parcial= 0.06) y turno de trabajo (F (1,86) = 9.26, p= 0.003, η² parcial = 0.10). Asimismo, más indicadores de insomnio en interacción con pertenecer a la primera línea (F (1,86) = 4.96, p = 0.04, η² parcial= 0.05) y cambios en la jornada laboral (F (1,86) = 3.88, p = 0.05, η² parcial= 0.04). Conclusión: El personal de enfermería resultó más afectado por los cambios en las condiciones laborales, teniendo mayor sintomatología ansiosa, depresiva e insomnio (AU)

Background: The mental health of health personnel was affected by the SARS-CoV-2 pandemic and its associated consequences, including the change in working conditions. Aims: To analyze the relationship between mental health indicators and socio-occupational factors. Materials and methods: The PHQ-9, GAD-7, and ISI-3 were applied to 90 health workers. Results: Nursing staff reported greater depressive, anxiety, and insomnia symptomatology. In turn, they manifested greater indicators of depression in interaction with the change in workday (F (1,86) = 3.83, p= 0.05, partial η² = 0.04) and work shift (F (1,86) = 6.80, p= 0. 01, partial η² = 0.07); greater anxious symptomatology in interaction with change in workday (F (1,86) = 5.83, p= 0.02, partial η² = 0.06) and work shift (F (1,86) = 9.26, p= 0.003, partial η² = 0.10). Additionally, more indicators of insomnia in interaction with being on the front line (F (1,86) = 4.96, p = 0.04, partial η²= 0.05) and changes in working hours (F (1,86) = 3.88, p = 0.05, partial η²= 0.04). Conclusion: The nursing staff was more affected by changes in working conditions, having more symptoms of anxiety, depression, and insomnia (AU)

Somatic symptoms and insomnia among bereaved parents and siblings eight years after the Utøya terror attack.

Background: Levels of prolonged grief symptoms (PGS) and post-traumatic stress symptoms (PTSS) can be high, many years following bereavement after terror, but knowledge concerning somatic health is scarce. Terrorism is a serious public health challenge, and increased knowledge about long-term somatic symptoms and insomnia is essential for establishing follow-up interventions after terrorism bereavement.Objective: To study the prevalence of somatic symptoms and insomnia and their association with PGS, PTSS, and functional impairment among terrorism-bereaved parents and siblings.Methods: A cross-sectional quantitative study included 122 bereaved individuals from the Utøya terror attack in Norway in 2011. The sample comprised 88 parents and 34 siblings aged 19 years and above (Mage = 49.7 years, SDage = 13.8 years, 59.8% females). The participants completed questionnaires 8 years after the attack assessing somatic symptoms (Children's Somatic Symptoms Inventory) and insomnia (Bergen Insomnia Scale) along with measures of PGS (Inventory of Complicated Grief), PTSS (Impact of Event Scale-Revised), and functional impairment (Work and Social Adjustment Scale).Results: Fatigue was the most frequently reported somatic symptom (88% of females and 65% of males). Females reported statistically significantly more somatic symptoms than males. In total, 68% of the bereaved individuals scored above the cut-off for insomnia. There were no statistically significant gender differences for insomnia. Female gender, intrusion, and arousal were associated with somatic symptoms. Intrusion and somatic symptoms were associated with insomnia. Somatic symptoms, avoidance, and hyperarousal were associated with functional impairment.Conclusion: Many bereaved parents and siblings report somatic symptoms and insomnia eight years after the terror attack. Somatic symptoms are associated with functional impairment. Long-term follow-up and support after traumatic bereavement should focus on somatic symptoms and insomnia.

Many bereaved individuals, especially females, reported insomnia and somatic symptoms, including fatigue, pain, and other related symptoms.Somatic symptoms, avoidance, and hyperarousal were identified as being associated with functional impairment among the bereaved.Post-traumatic stress symptoms played a more significant role than prolonged grief symptoms in explaining the reduced physical health experienced by the bereaved.

Síndrome de apnea del sueño en población colombiana con epilepsia empleando la escala de apnea del sueño del cuestionario de trastornos del sueño / Sleep apnea syndrome in a Colombian population with epilepsy using the Sleep Apnea Scale of the Sleep Disorders Questionnaire

Introducción: La epilepsia es un desorden caracterizado por la predisposición a generar crisis epilépticas, mientras que el síndrome de apnea del sueño (SAOS) ha sido reconocido como un desorden crónico de colapso intermitente de la vía aérea que genera hipoxia recurrente. En este trabajo se aplicó la escala de trastornos del sueño (Sleep Apnea Scale of the Sleep Disorders Questionnaire SA-SDQ), previamente validada en inglés para pacientes con epilepsia, a fin de determinar su capacidad para detectar apnea de sueño en nuestra población. Materiales y métodos: En una primera etapa se realizó la adaptación transcultural de la escala SA-SDQ en castellano, provista por los autores, al español colombiano. Luego se recopiló la información de los pacientes en quienes se realizó polisomnografía entre mayo y agosto del 2022 y se determinó el valor de corte para diagnosticar SAOS con la escala SA-SDQ. Resultados: Cuarenta pacientes pudieron realizarse la polisomnografía, de los cuales 30 (75 %) tuvieron índices de apnea-hipopnea superiores a 5, lo que indica SAOS. El área bajo la curva fue 0,790 y la puntuación SA-SDQ de 21 proporcionó una sensibilidad del 73,3 % (IC 53,83-87,02 %) y una especificidad del 80 % (IC 44,2-96,5 %). La consistencia interna fue aceptable (α = 0,713). Conclusiones: La escala SA-SDQ es un instrumento útil para tamizar SAOS en la población colombiana que padece epilepsia. Nuestros resultados indican que los puntos de corte sugeridos anteriormente (2936 para hombres y 26-32 para mujeres) pueden ser demasiado altos para nuestra población. Sugerimos un punto de corte de 21 para ambos.

Introduction: Epilepsy is a disorder characterized by a predisposition to have epileptic seizures, while sleep apnea syndrome (OSAS) has been recognized as a chronic disorder of intermittent collapse of the airway that generates recurrent hypoxia. In this work, the sleep disorders scale (SA-SDQ) previously validated in English for patients with epilepsy was applied to determine its ability to detect sleep apnea in our population. Materials and methods: In the first stage, the cross-cultural adaptation of the SA-SDQ scale in Spanish provided by the authors was carried out into Colombian Spanish. then the information of the patients in whom polysomnography was performed between May and August 2022 was collected and the cut-off value was determined to diagnose OSAS with the SA-SDQ scale. Results: 40 patients were able to undergo polysomnography, of which 30 (75 %) had apnea-hypopnea indices greater than five, indicating OSAS. The area under the curve was 0.790 and the SA-SDQ score of 21 provided a sensitivity of 73.3 % (CI 53.83-87.02 %) and a specificity of 80 % (CI 44.2-96, 5 %). The internal consistency was acceptable (α = 0.713). Conclusions: The SA-SDQ scale is a useful instrument for screening OSAS in the Colombian population suffering from epilepsy. Our results indicate that the previously suggested cut-off points (29-36 for men and 26-32 for women) may be too high in our population. We suggest a cutoff of 21 for both.

Las manifestaciones primordiales de la fibromialgia, dolor generalizado e insomnio, en la pintura de Remedios Varo / Fibromyalgia's main features, widespread pain, and insomnia in the paintings of Remedios Varo

La sensibilidad de las artistas plásticas ante el sufrimiento humano ha quedado plasmada de diversas maneras. Este artículo relata las circunstancias que llevaron a la pintora surrealista hispano-mexicana, Remedios Varo, a representar en forma original las 2 manifestaciones cardinales de la fibromialgia: dolor generalizado e insomnio. (AU)

The sensitivity of plastic artists to human suffering has been expressed in different ways. This article recounts the circumstances that led the Spanish-Mexican surrealist painter, Remedios Varo, to depict in an original way the 2 cardinal manifestations of fibromyalgia; widespread pain and insomnia. (AU)

Fibromyalgia's main features, widespread pain, and insomnia in the paintings of Remedios Varo.

The sensitivity of plastic artists to human suffering has been expressed in different ways. This article recounts the circumstances that led the Spanish-Mexican surrealist painter, Remedios Varo, to depict in an original way the two cardinal manifestations of fibromyalgia; widespread pain and insomnia.

Trastornos en la calidad del sueñoasociados a los inhibidores dela integrasa en el tratamiento del VIH / Sleep disorders related to HIV treatment

FUNDAMENTOS: Los inhibidores de la integrasa se han posicionado recientemente en todas las Guías Clínicas de VIH como tratamiento antirretroviral de primera línea para el VIH. Sin embargo, dos de estos fármacos se han asociado también a efectos adversos a nivel del sistema nervioso central, concretamente con alteraciones del sueño. El objetivo del trabajo fue analizar la influencia de bictegravir y dolutegravir en la calidad del sueño en personas que viven con VIH (PVIH). MÉTODOS: Se realizó un estudio observacional y transversal entre los meses de diciembre de 2020 y enero de 2021 en las PVIH de las consultas de atención farmacéutica del hospital. Se recogieron variables demográficas y de adherencia. La calidad del sueño se midió mediante el Cuestionario de Pittsburgh o PSQI. Las PVIH se clasificaron en 2 grupos: el grupo estudio, constituido por participantes con bictegravir o dolutegravir en su tratamiento, y el grupo control, integrado por el resto de PVIH. Se analizó la influencia de las variables recogidas sobre el resultado del PSQI mediante la prueba de chi cuadrado/odds ratio para variables categóricas y el de t de Student o U de Mann Whitney para variables continuas. RESULTADOS: Se incluyeron 119 PVIH, de las cuales un 64% en el grupo estudio y un 67% en el grupo control sufrían trastornos del sueño según el PSQI (p=0,788). Tampoco hubo diferencias estadísticamente significativas cuando se compararon los diferentes componentes del sueño entre los dos grupos. CONCLUSIONES: Un elevado porcentaje de PVIH, independientemente de si el TAR incluye bictegravir o dolutegravir, tienen problemas relacionados con la calidad del sueño. No se encuentra correlación entre la calidad del sueño y el tratamiento con bictegravir o dolutegravir comparado con el resto de tratamientos.(AU)

BACKGROUND: HIV Clinical Guidelines have positioned integrase inhibitors recently as first-line treatment. However, two of these drugs have also been associated with adverse side effects on the central nervous system, especially with sleep disturbances. The objective was to analyse the influence of bictegravir and dolutegravir on the sleep quality in HIV patients. METHODS: An observational, cross-sectional study was carried out between December 2020 and January 2021 in HIV patients attended in a pharmacy care clinic. Demographic and adherence variables were collected. Sleep quality was measured using the Pittsburgh questionnaire or PSQI. We classified patients into two groups: patients with bictegravir or dolutegravir in their treatment (study group) and the rest (control group). The influence of the variables collected on the PSQI result was analysed using the Chi-Square test for categorical variables and the student t-test or Mann-Whitney U test for continuous variables. RESULTS: One hundred and nineteen patients were included. 64% in the study group and 67% in the control group suffered from sleep disorders according to the PSQI questionnaire (p=0.788). Neither were statistical differences found when the different components of sleep were analysed between the two groups. CONCLUSIONS: A high percentage of patients, regardless of whether their treatment includes bictegravir or dolutegravir, have problems with their sleep quality. We didn’t find a correlation between sleep quality and treatment with bictegravir or dolutegravir compared to the other treatments.(AU)

Enfermedades por priones humanas. Una revisión general / Human prion diseases: An overview

Las enfermedades por priones constituyen un grupo de enfermedades neurodegenerativas, cuyo agente causal es una proteína normal del cerebro (PrP) que se agrega en una conformación anómala. La proteína anormal, conocida como prion (PrPSc), tiene la propiedad de autopropagarse, induciendo la plegadura anómala de la proteína normal PrP. Estas enfermedades se presentan de manera esporádica, por transmisión genética, o de forma adquirida por ingesta de carne contaminada con priones o por exposición iatrógena. Su diagnóstico resulta difícil. La utilización de exploraciones complementarias de alta sensibilidad y especificidad, como la resonancia magnética o la RT-QuIC, facilitan su diagnóstico. El diagnóstico definitivo se establece por el estudio histopatológico de muestras de tejidos. Actualmente, no se dispone de ningún tratamiento que modifique el curso de la enfermedad, pero su diagnóstico precoz es fundamental para planificar los cuidados del enfermo, adoptar las medidas de prevención necesarias y el consejo genético (AU)

Prion diseases are a group of neurodegenerative diseases. The disease-causing agent is a protein (PrP), that is normally produced in the nervous system, aggregated in an abnormal form. The abnormal protein, known as prion (PrPSc), is capable of self-propagation promoting the misfolding of the normal protein (PrP). These conditions can be acquired sporadically, genetically, or infectiously either by eating meat contaminated with prions or from iatrogenic exposure. The diagnosis of these diseases is often challenging. The use of highly sensitive and specific diagnostic tools, such as MRI and RT-QuIC, may aid in the diagnosis. Neuropathological examination of brain tissue ensures a definite diagnosis. At present, no treatment significantly improves the course of prion diseases; however, an early diagnosis is of paramount importance for patient care decision planning, infection control purposes, and genetic counseling (AU)

Impacto del Programa de Rehabilitación Interdisciplinario de Dolor Crónico en pacientes sin y con trastornos del sueño / Impact of the Interdisciplinary Chronic Pain Rehabilitation Programme in patients with and without sleep disorders

Introducción: Los trastornos del sueño y el dolor crónico están relacionados bidireccionalmente. Ambos están relacionados con trastornos afectivos, fatiga, depresión, ansiedad y abuso de fármacos, y afectan significativamente a la calidad de vida. El objetivo del Programa Interdisciplinario de Dolor (PRID) es aliviar el dolor del paciente y mejorar su funcionalidad a través de la incorporación de hábitos posturales, del sueño y nutricionales saludables, técnicas de relajación, ejercicio físico y mecanismos cognitivoconductuales. Pacientes y métodos: Se realizó un estudio retrospectivo, observacional y transversal. Se examinó a 323 pacientes con dolor crónico que completaron el PRID. Se les evaluó al principio y al final del programa con escalas de dolor, depresión, calidad de vida e insomnio, y se les comparó entre grupos con y sin insomnio –índice de gravedad del insomnio (ISI) menor de 15 frente a mayor o igual a 15–. Se estudió a 58 pacientes con polisomnografía. Resultados: Se observó una mejoría significativa (p < 0,0001) del dolor, la depresión y la calidad de vida evaluados mediante la escala analógica visual (EVA), el inventario de Beck y el cuestionario Short Form-36 (SF-36), tanto en pacientes con dolor crónico con ISI menor de 15 como ISI mayor o igual a 15. Los resultados fueron superiores en el grupo de pacientes con insomnio. La presencia de un índice de apneas e hipopneas elevado y movimientos periódicos de los miembros inferiores en los pacientes no se relacionó con la mejoría de las escalas de Beck, SF-36, ISI y EVA. Conclusiones: En conclusión, el PRID beneficia a los pacientes con dolor crónico no oncológico en varias esferas afectadas, además del dolor, mediante un tratamiento integral. La polisomnografía puede ayudar a diagnosticar patologías específicas e individualizar el tratamiento farmacológico.(AU)

Introduction: Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients’ pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms. Patients and methods: A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography. Results: A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales. Conclusions: In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.(AU)

[Human prion diseases: An overview]. / Enfermedades por priones humanas. Una revisión general.

Prion diseases are a group of neurodegenerative diseases. The disease-causing agent is a protein (PrP), that is normally produced in the nervous system, aggregated in an abnormal form. The abnormal protein, known as prion (PrPSc), is capable of self-propagation promoting the misfolding of the normal protein (PrP). These conditions can be acquired sporadically, genetically, or infectiously either by eating meat contaminated with prions or from iatrogenic exposure. The diagnosis of these diseases is often challenging. The use of highly sensitive and specific diagnostic tools, such as MRI and RT-QuIC, may aid in the diagnosis. Neuropathological examination of brain tissue ensures a definite diagnosis. At present, no treatment significantly improves the course of prion diseases; however, an early diagnosis is of paramount importance for patient care decision planning, infection control purposes, and genetic counseling.

Trastornos circadianos del sueño / Circadian Sleep Disorders

Resumen El sistema circadiano está sincronizado al ciclo luz-oscuridad que es generado por la rotación de la tierra, asegurando que la vigilia sea durante el día y que el sueño ocurra durante la noche. Sin embargo, el ritmo de sueño-vigilia puede estar desincronizado del ciclo luz-oscuridad o desincronizado de manera endógena, dando como resultado: insomnio, fatiga y bajo rendimiento en las actividades cotidianas. Mientras que los trastornos del sueño están clasificados por la Asociación Americana de Trastornos del Sueño como: disomnias intrínsecas, disomnias extrínsecas, parasomnias o trastornos del sueño médicos/psiquiátricos. Los trastornos circadianos del sueño se han categorizado por separado, en parte para reconocer que en la mayoría de los casos la etiología de los trastornos circadianos es una mezcla de factores internos y ambientales, o por un desajuste temporal entre ambos. Los síntomas generalmente son insomnio o hipersomnia, síntomas comunes en pacientes con trastornos circadianos del sueño, aunque hay otras causas a las que pueden atribuirse y que deben excluirse antes de realizar el diagnóstico de un trastorno circadiano del sueño. En el paciente sin otra patología del sueño, un registro diario de actividades, comidas, ejercicio, siestas y la hora de acostarse es una herramienta esencial para evaluar los trastornos circadianos del sueño. Estos registros deben mantenerse durante 2 semanas o más, ya que una perturbación debida a cambios de trabajo o viajes a través de zonas horarias puede tener efectos sobre el sueño y el estado de alerta durante el día, semanas después del evento.

Abstract The circadian system is synchronized to the light-dark cycle generated by the rotation of the earth, ensuring that wakefulness is during the day and sleep occurs at night. However, the sleep-wake rhythm may be out of sync with the light-dark cycle or endogenously out of sync, resulting in insomnia, fatigue, and poor performance in activities of daily living. Sleep disorders are classified by the American Sleep Disorders Association, as intrinsic dyssomnias, extrinsic dyssomnias, parasomnias, or medical/psychiatric sleep disorders. Circadian sleep disorders have been categorized separately to recognize that in most cases the etiology of circadian disturbances is a mix of internal and environmental factors or a temporary mismatch between the two. Symptoms are usually insomnia or hypersomnia, common symptoms in patients with circadian sleep disorders although other causes can be attributed and must be excluded before a diagnosis of a circadian sleep disorder is made. In the patient without other sleep pathology, a daily record of activities, meals, exercise, naps, and bedtime is an essential tool in assessing circadian sleep disorders. These records should be kept for 2 weeks or more, as a disturbance due to job changes or travel across time zones can have effects on sleep and daytime alertness weeks after the event.

Psychometric properties of the Diurnal Insomnia Symptoms Response Scale (DISRS) in a Mexican population sample APPENDIX / Propiedades psicométricas de la Escala de Respuestas a los Síntomas Diurnos del Insomnio (DISRS) en una muestra de población mexicana

Abstract Introduction Increased rumination is associated with longer night-time sleep onset latency and poorer sleep quality and efficiency in people with insomnia symptoms. Objective To validate the Diurnal Insomnia Symptoms Response Scale (DISRS) in a general population sample. Method 102 participants (women = 67 and men = 35) comprising patients and relatives who attended an outpatient consultation at a health center in Mexico City were evaluated. The English-Spanish-English translation system was used by two Spanish-speaking experts on the subject, an independent bilingual expert translated the new version of the scale into English, which was then compared with the original. The following self-administered questionnaires were used to evaluate the convergent, discriminant validity of this tool: the Ruminative Response Scale (RRS), the Insomnia Severity Index (ISI), and Penn State Worry Questionnaire (PSWQ). Results The internal consistency of the scale items was α = .93. Principal components factor analysis yielded three factors with an eigenvalue of greater than one, which together explain 59.5% of the variance. Correlations between the total DISRS score and the cognitive-motivational dimensions (r = .938, p < .01), negative state (r = .898, p < .01) and tiredness (r = .853, p < .01) were statistically significant. Insomnia symptoms (SCC = .89) outweighed worries (SCC = .33) and ruminant responses (SCC = .33) when discriminating between cases with low and high levels of rumination associated with insomnia symptoms. Discussion and conclusion Our results suggest that the DISRS scale has adequate psychometric properties that make it valid and reliable for use with the Mexican population.

Resumen Introducción Los pensamientos rumiativos se asocian con mayor latencia del sueño, peor calidad y eficiencia de sueño en personas con insomnio. Objetivo Realizar la validación de la escala de respuestas a los síntomas diurnos del insomnio (DISRS) en una muestra de población general en México. Método Se evaluaron a 102 participantes (mujeres = 67 y hombres = 35) que acudieron a consulta externa de un centro de salud de la Ciudad de México. Se utilizó el sistema de traducción inglés-español-inglés, un experto bilingüe independiente tradujo al inglés la nueva versión de la escala y se verificó con el original. Para evaluar la validez convergente y discriminante del DISRS, se aplicó la Escala de Respuestas Rumiativas (RRS), el Índice de Severidad del Insomnio (ISI) y el Cuestionario de Preocupaciones de Pensilvania (PSWQ). Resultados La consistencia interna de los ítems fue α = .93. El análisis factorial de componentes principales determinó tres factores con valor propio superior a uno, que explican 59.5% de la varianza. Las correlaciones del puntaje del DISRS con las dimensiones cognitivo-motivacional (r = .938, p < .01), estado negativo (r = .898, p < .01) y cansancio (r = .853, p < .01) resultaron significativas. Los síntomas de insomnio (CCE =.89) tuvieron más peso que las preocupaciones (CCE = .33) y las respuestas rumiativas (CCE = .33) al discriminar a los casos con bajos y altos niveles de rumiación asociada al insomnio. Discusión y conclusión La escala DISRS en español tiene adecuadas propiedades psicométricas que la hacen válida y confiable para ser utilizada en población mexicana.

Psychometric properties of the Insomnia Severity Index (ISI) in Mexican adults / Propiedades psicométricas del Índice de Severidad de Insomnio (ISI) en adultos mexicanos

Background: Insomnia is the sleep disorder with the highest incidence worldwide. It is estimated that this condition increases the risk of developing psychiatric, neurological, and cardiovascular problems. Due to this, it is important to have brief, reliable and valid psychometric instruments that allow health personnel their timely detection in first level health centers. Objectives: Analyze the psychometric properties of the Insomnia Severity Index (ISI) in its version adapted to Spanish in a sample of Mexican adults. Methods: The sample consisted of 310 adults, 223 (71.9%) women and 87 (28.1%) men. The comparison of four ISI measurement models of one, two and three factors and a bifactor model was carried out, its internal consistency was analyzed, an analysis of invariance by sex and correlation analysis with the Athens and Epworth scales. Results: The ISI bifactor model with a general factor (G) and a specific factor for insomnia impact (I) showed the best fit indices (χ2= 29.48, gl = 11, SRMR= 0.03, CFI= 0.98, TLI= 0.96, RMSEA= 0.07), and demonstrated configural, metric, and scalar invariance by sex. Adequate reliability was demonstrated by Omega coefficients (General: ωG= 0.86, Impact: ωI= 0.86) showed adequate reliability; the scale showed very strong correlations with the Athens scale (rAGoverall= 0.84; rAImpact=0.75) and weak to moderate correlations with the Epworth scale (rEGeneral= 0.39; rEImpact=0.44). Conclusions: The ISI bifactor version in Spanish presents adequate psychometric properties for the measurement of insomnia and, as it is a brief tool, it can be used at different levels of health care.

Introducción: El insomnio es el trastorno de sueño de mayor incidencia a nivel mundial. Se estima que este padecimiento eleva el riesgo de desarrollar problemas psiquiátricos, neurológicos y cardiovasculares. Debido a ello es importante tener instrumentos psicométricos breves, confiables y válidos que permitan al personal de salud su oportuna detección en los centros de salud de primer nivel. Objetivo: Analizar las propiedades psicométricas del Índice de Severidad de Insomnio (ISI) en su versión adaptada al español en una muestra de adultos mexicanos. Método: Participaron 310 adultos, 223 (71.9%) mujeres y 87 (28.1%) hombres. Se realizó la comparación de cuatro modelos de medida del ISI de uno, dos y tres factores y un modelo bifactor, se analizó su consistencia interna, un análisis de invarianza por sexo y análisis de correlación con las escalas de Atenas y de Epworth. Resultados: Se encontró que el modelo ISI bifactor con un factor general (G) y uno específico de Impacto del insomnio (I) fue el que mostró los mejores índices de ajuste (χ2=29.48, gl= 11, SRMR= 0.03, CFI= 0.98, TLI= 0.96, RMSEA= 0.07), y que presenta invarianza configuracional, métrica y escalar por sexo. El coeficiente Omega (General: ωG =0.86, Impacto: ωI=0.86 ) mostraron una confiabilidad adecuada; la escala mostró correlaciones muy fuertes con la escala Atenas (rAGeneral= 0.84; rAImpacto=0.75) y débiles a moderadas con la escala Epworth (rEGeneral= 0.39; rEImpacto=0.44). Conclusiones: La versión ISI bifactor en español presenta adecuadas propiedades psicométricas para la medición del insomnio y al ser una herramienta breve puede emplearse en diferentes niveles de atención a la salud.

El tratamiento psicológico del insomnio durante la infancia: Una revisión paraguas / The psychological treatment of insomnia during childhood: An umbrella review

El insomnio es un problema muy frecuente en niños y adolescentes y está relacionado con numerosos resultados negativos. La evidencia sobre lasintervenciones psicológicas efectivas en el tratamiento del insomnio infantil ha ido en aumento, pero carece de una síntesis exhaustiva de los hallazgos. Por ello, realizamos una revisión sistemática de revisiones sistemáticas y meta-análisis sobre la efectividad de las intervenciones psicológicasen el tratamiento del insomnio infantil. Se realizaron búsquedas en la base de datos PsycINFO, hasta julio de 2022, mediante una combinaciónde palabras clave. Los datos fueron extraídos de forma independiente por las dos autoras y se presentó una síntesis de los resultados. La calidadmetodológica fue evaluada de forma independiente por las dos autoras, utilizando AMSTAR-2. Se incluyeron cuatro artículos que informaron, engeneral, sobre la efectividad de las intervenciones psicológicas para disminuir los síntomas de insomnio durante la infancia y adolescencia, tanto acorto como a largo plazo. Las revisiones incluidas fueron calificadas con una calidad metodológica baja, lo que debilita la evidencia de los resultados reportados. Se encontró que actualmente la Terapia Cognitivo Conductual es la intervención psicológica más basada en la evidencia y la másefectiva, independientemente del formato de tratamiento. Se necesitan realizar más ensayos clínicos aleatorios de alta calidad. (AU)

Insomnia is a very common problem in children and adolescents andis associated with numerous negative outcomes. Evidence for effective psychological interventions in the treatment of childhood insomnia has beenincreasing, but lacks a comprehensive synthesis of findings. Therefore, we conducted a systematic review of systematic reviews and meta-analyseson the effectiveness of psychological interventions in the treatment of childhood insomnia. We searched the PsycINFO database, until July 2022, using a combination of keywords. Data were extracted independently by the two authors and a synthesis of the results was presented. Methodologicalquality was assessed independently by the two authors using AMSTAR-2. Four articles were included that reported, in general, on the effectivenessof psychological interventions to decrease insomnia symptoms during childhood and adolescence, both in the short and long term. The includedreviews were rated with low methodological quality, which weakens the evidence for the reported results. CBT was currently found to be the mostevidence-based and effective psychological intervention, regardless of treatment format. More high-quality randomized clinical trials are needed. (AU)

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.

Calidad de sueño en Uruguay al inicio de la pandemia / Sleep quality in Uruguay at the beginning of the pandemic / Qualidade do sono no Uruguai no início da pandemia

El año 2020 será recordado por el comienzo de la pandemia de COVID-19, la que ha generado trágicas consecuencias para la salud personal y social. Además de los fallecimientos, contagios y el temor a estos, se redujo considerablemente la interacción social debido al confinamiento. Trabajos realizados en distintos países demostraron que la pandemia ha generado importantes trastornos del sueño. Con el objetivo de explorar si la pandemia afectó el sueño de los uruguayos, del 16 al 20 mayo del 2020 se realizó una encuesta anónima vía Web, a mayores de 18 años residentes en Uruguay (n =1137). Esta consistió en el Índice de Calidad de Sueño de Pittsburgh (ICSP), que es el cuestionario auto administrado más utilizado para este fin. El ICSP explora 7 dimensiones de sueño (calidad subjetiva, latencia, duración, eficiencia, perturbaciones, medicación y disfunción diurna), con un rango de puntaje de 0 a 21 (mayor puntuación, menor calidad de sueño), donde un ICSP mayor a 5 se considera una mala calidad de sueño. Los resultados mostraron que el ICSP promedio fue de 7,4 ± 4,0, presentando 63% de los encuestados un ICSP > 5. El ICSP fue mayor en mujeres (8,2 ± 4,0) que en hombres (6,4 ± 3,8; P < 0.001). El ICSP junto con otros parámetros relevados, sugieren que los residentes en Uruguay presentaron una mala calidad de sueño al comienzo de la pandemia.

The year 2020 will be remembered for the beginning of the COVID-19 pandemic, which has generated tragic consequences for personal and social health. In addition to deaths, infections and the fear of these, social interaction was considerably reduced due to confinement. Studies carried out in different countries showed that the pandemic has generated significant sleep disorders. With the aim of exploring whether the pandemic affected the sleep of Uruguayans, from May 16 to 20, 2020, an anonymous survey was carried out via the Web, to residents over 18 years of age in Uruguay (n = 1137). This consisted of the Pittsburgh Sleep Quality Index (PSQI), which is the most widely used self-administered questionnaire for this purpose. The PSQI explores 7 dimensions of sleep (subjective quality, latency, duration, efficiency, disturbances, medication, and daytime dysfunction), with a score range from 0 to 21 (higher score, lower sleep quality), where an ICSP greater than 5 it is considered a poor quality of sleep. The results showed that the average ICSP was 7.4 ± 4.0, with 63% of the respondents presenting an ICSP > 5. The ICSP was higher in women (8.2 ± 4.0) than in men (6.4 ± 3.8, P < 0.001). The ICSP, together with other parameters collected, suggest that residents of Uruguay had poor sleep quality at the beginning of the pandemic.

O ano de 2020 será lembrado pelo início da pandemia do COVID-19, que gerou consequências trágicas para a saúde pessoal e social. Além das mortes, das infecções e do medo destas, o convívio social foi consideravelmente reduzido devido ao confinamento. Trabalhos realizados em diferentes países mostraram que a pandemia gerou distúrbios significativos do sono. Com o objetivo de explorar se a pandemia afetou o sono dos uruguaios, de 16 a 20 de maio de 2020, foi realizada uma pesquisa anônima via Web, para maiores de 18 anos residentes no Uruguai (n = 1137). Este consistiu no Índice de Qualidade do Sono de Pittsburgh (ICSP), que é o questionário autoaplicável mais utilizado para esse fim. O ICSP explora 7 dimensões do sono (qualidade subjetiva, latência, duração, eficiência, distúrbios, medicação e disfunção diurna), com uma escala de pontuação de 0 a 21 (maior pontuação, menor qualidade do sono), onde um ICSP maior que 5 é considerado uma má qualidade de sono. Os resultados mostraram que o ICSP médio foi de 7,4 ± 4,0, com 63% dos entrevistados apresentando ICSP > 5. O ICSP foi maior nas mulheres (8,2 ± 4,0) do que nos homens (6,4 ± 3,8, P < 0,001). O ICSP, juntamente com outros parâmetros coletados, sugere que os residentes do Uruguai tinham má qualidade de sono no início da pandemia.

Alterações de sono em pacientes depressivos adultos: uma revisão integrativa / Sleep changes in adult depressive patients: an integrative review / Cambios del sueño en pacientes depresivos adultos: una revisión integradora

Esta é uma revisão da literatura que tem como objetivo elucidar as alterações do sono em pacientes adultos com depressão, principalmente sem outras comorbidades ou condições especiais, e estabelecer a relação entre distúrbios do sono e depressão, com foco no Transtorno Depressivo Maior. A metodologia envolve uma revisão integrativa da literatura dos últimos 15 anos (2009-2023) nas bases de dados Biblioteca Virtual em Saúde (BVS) e Pubmed, utilizando as palavras-chave "distúrbios do sono", "depressão" e "adultos". Os resultados mostram um total de 240 artigos, dos quais 26 foram selecionados e 12 foram incluídos na análise. A discussão destaca o interesse recente em estudar as associações entre distúrbios do sono e transtornos depressivos, bem como a natureza global da pesquisa. A relação entre sono e saúde mental, bem como a classificação e relação entre distúrbios do sono, também são discutidos. Os achados indicam que distúrbios do sono são prevalentes em pacientes com depressão, sendo a insônia um fator de risco significativo para o desenvolvimento da depressão. A relação bidirecional entre sono e depressão é destacada, com a depressão afetando o sono e o sono afetando a depressão. A importância de estudar os mecanismos por trás dessa relação é enfatizada, pois pode ajudar os psiquiatras a gerenciar de forma mais eficaz a comorbidade de depressão e distúrbios do sono. O tratamento adequado dos distúrbios do sono também pode desempenhar um papel vital na melhoria do prognóstico e na prevenção da recorrência da depressão.

This is a literature review that aims to elucidate the sleep alterations in adult patients with depression, primarily without other comorbidities or special conditions, and establish the relationship between sleep disturbances and depression, with a focus on Major Depressive Disorder. The methodology involves an integrative review of the literature from the last 15 years (2009-2023) on the databases Biblioteca Virtual em Saúde (BVS) and Pubmed, using the keywords "sleep disorders," "depression," and "adults." The results show a total of 240 articles, 26 of which were selected and 12 of which were included in the analysis. The discussion highlights the recent interest in studying the associations between sleep disturbances and depressive disorders, as well as the global nature of the research. The relationship between sleep and mental health, as well as the classification and relationship between sleep disturbances, are also discussed. The findings indicate that sleep disturbances are prevalent in patients with depression, with insomnia being a significant risk factor for the development of depression. The bidirectional relationship between sleep and depression is highlighted, with depression affecting sleep and sleep affecting depression. The importance of studying the mechanisms behind this relationship is emphasized, as it can help psychiatrists manage the comorbidity of depression and sleep disturbances more effectively. Adequate treatment of sleep disturbances may also play a vital role in improving the prognosis and preventing the recurrence of depression.

Esta es una revisión de la literatura que tiene como objetivo dilucidar las alteraciones del sueño en pacientes adultos con depresión, principalmente sin otras comorbilidades o condiciones especiales, y establecer la relación entre las alteraciones del sueño y la depresión, con un enfoque en el Trastorno Depresivo Mayor. La metodología consiste en una revisión integradora de la literatura de los últimos 15 años (2009-2023) en las bases de datos Biblioteca Virtual em Saúde (BVS) y Pubmed, utilizando las palabras clave "sleep disorders," "depression," y "adults." Los resultados muestran un total de 240 artículos, de los cuales 26 fueron seleccionados y 12 incluidos en el análisis. La discusión destaca el reciente interés por estudiar las asociaciones entre las alteraciones del sueño y los trastornos depresivos, así como el carácter global de la investigación. También se analiza la relación entre el sueño y la salud mental, así como la clasificación y la relación entre los trastornos del sueño. Los resultados indican que las alteraciones del sueño son prevalentes en pacientes con depresión, siendo el insomnio un factor de riesgo significativo para el desarrollo de la depresión. Se destaca la relación bidireccional entre sueño y depresión, en la que la depresión afecta al sueño y el sueño a la depresión. Se subraya la importancia de estudiar los mecanismos que subyacen a esta relación, ya que puede ayudar a los psiquiatras a gestionar la comorbilidad de la depresión y los trastornos del sueño de forma más eficaz. El tratamiento adecuado de los trastornos del sueño también puede desempeñar un papel vital en la mejora del pronóstico y la prevención de la recurrencia de la depresión.

El insomnio y la pobre calidad de sueño se asocian a un mal control de crisis en pacientes con epilepsia / Insomnia and poor sleep quality are associated with poor seizure control in patients with epilepsy

Objetivos: Evaluamos la presencia de trastornos del sueño en pacientes con epilepsia y analizamos su asociación con el control de las crisis.MétodosSe realizó un estudio transversal de pacientes con epilepsia reclutados consecutivamente entre septiembre de 2017 y diciembre de 2018. Los pacientes se clasificaron en 2 grupos según el control de crisis (buen control: pacientes sin crisis en las últimas 4 semanas) o mal control (pacientes con una crisis o más en las últimas 4 semanas). Se compararon variables demográficas y clínicas; insomnio, medido por el Índice de Severidad del Insomnio (ISI); somnolencia diurna excesiva, medida por la Escala de Somnolencia de Epworth (ESS); calidad del sueño, medida por el Índice de Calidad del Sueño de Pittsburgh (PSQI); depresión, medida por el Inventario de Depresión de Beck-II (BDI-II); y calidad de vida, medida por el test de Calidad de Vida en Epilepsia (QOLIE-10).ResultadosSe incluyeron 123 pacientes. El 31,7% tenía somnolencia diurna excesiva (ESS ≥ 10), el 50,4% insomnio (ISI ≥ 10) y el 53,6% mala calidad del sueño (PSQI ≥ 5). Los factores asociados con la presencia de crisis fueron el desempleo (odds ratio [OR] = 4,7; intervalo de confianza del 95% [IC 95%]: 1,36-19,2; p = 0,02), un mayor número de fármacos antiepilépticos (OR = 5,87; IC 95%: 1,81-27,1; p < 0,001), insomnio (OR = 1,9; IC 95%: 1,1-9,3; p = 0,04) y mala calidad del sueño (OR = 2,8; IC 95%: 1,9-10,32; p = 0,01).ConclusionesLos trastornos del sueño son frecuentes en pacientes con epilepsia. El insomnio y la mala calidad del sueño se asociaron con un peor control de crisis. Estos hallazgos apoyan que los trastornos del sueño son una comorbilidad frecuente en epilepsia, especialmente en pacientes con peor control de crisis. (AU)

Objectives: This study aimed to assess the presence of sleep disorders in patients with epilepsy and to analyse their association with seizure control.MethodsWe performed a cross-sectional study of patients with epilepsy, recruited consecutively between September 2017 and December 2018. Patients were classified as having good seizure control (no seizures in the last 4 weeks) or poor seizure control (at least one seizure in the last 4 weeks). We performed intergroup comparisons for demographic and clinical data, insomnia (Insomnia Severity Index [ISI]), excessive daytime sleepiness (Epworth Sleepiness Scale [ESS]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), depression (Beck Depression Inventory-II [BDI-II]), and quality of life (Quality of Life in Epilepsy Inventory-10 [QOLIE-10]).ResultsThe sample included a total of 123 patients, of whom 31.7% had excessive daytime sleepiness (ESS ≥ 10), 50.4% had insomnia (ISI ≥ 10), and 53.6% had poor sleep quality (PSQI ≥ 5). According to our multivariate analysis, presence of seizures was associated with unemployment (odds ratio [OR] = 4.7; 95% confidence interval [CI], 1.36-19.2; P = .02), a higher number of antiepileptic drugs (OR = 5.87; 95% CI, 1.81-27.1; P < .001), insomnia (OR = 1.9; 95% CI, 1.1-9.3; P = .04), and poor sleep quality (OR = 2.8; 95% CI, 1.9-10.32; P = .01).ConclusionsSleep disorders are common in patients with epilepsy. Insomnia and poor sleep quality were associated with poor seizure control. These findings support the hypothesis that sleep disorders constitute a significant comorbidity of epilepsy, especially in patients with poor seizure control. (AU)

Melatonin in sleep disorders.

Melatonin is the main hormone involved in the control of the sleep-wake cycle. It is easily synthesisable and can be administered orally, which has led to interest in its use as a treatment for insomnia. Moreover, as production of the hormone decreases with age, in inverse correlation with the frequency of poor sleep quality, it has been suggested that melatonin deficit is at least partly responsible for sleep disorders. Treating this age-related deficit would therefore appear to be a natural way of restoring sleep quality, which is lost as patients age. However, despite the undeniable theoretical appeal of this approach to insomnia, little scientific evidence is available that supports any benefit of this substitutive therapy. Furthermore, the most suitable dose ranges and pharmaceutical preparations for melatonin administration are yet to be clearly defined. This review addresses the physiology of melatonin, the different pharmaceutical preparations, and data on its clinical usefulness.