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1.
J Consult Clin Psychol ; 89(6): 537-550, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34264701

RESUMO

OBJECTIVE: To determine if the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) improves functional impairment, psychiatric symptoms, and sleep and circadian functioning. METHOD: Adults diagnosed with serious mental illness (SMI) and sleep and circadian dysfunction (N = 121) were randomly allocated to TranS-C plus usual care (TranS-C + UC; n = 61; 8 individual weekly sessions) or 6 months of Usual Care followed by Delayed Treatment with TranS-C (UC-DT; n = 60). Schizophrenia (45%) and anxiety disorders (47%) were common. Blind assessments were conducted pre-treatment, post-treatment, and 6 months later (6FU). The latter two were the post-randomization points of interest. The location was Alameda County Behavioral Health Care Services (ACBHCS), a Community Mental Health Center (CMHC) in California. RESULTS: For the primary outcomes, relative to UC-DT, TranS-C + UC was associated with reduction in functional impairment (b = -3.18, p = 0.025, d = -0.58), general psychiatric symptoms (b = -5.88, p = 0.001, d = -0.64), sleep disturbance (b = -5.55, p < .0001, d = -0.96), and sleep-related impairment (b = -9.14, p < .0001, d = -0.81) from pre-treatment to post-treatment. These effects were maintained to 6-month follow-up (6FU; d = -0.42 to -0.82), except functional impairment (d = -0.37). For the secondary outcomes, relative to UC-DT, TranS-C + UC was associated with improvement in sleep efficiency and on the Sleep Health Composite score from pre-treatment to 6FU. TranS-C + UC was also associated with reduced total wake time and wake time variability from pre-treatment to post-treatment, as well as reduced hallucinations and delusions, bedtime variability, and actigraphy measured waking activity count variability from pre-treatment to 6FU. CONCLUSIONS: A novel transdiagnostic treatment, delivered within a CMHC setting, improves selected measures of functioning, symptoms of comorbid disorders, and sleep and circadian outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Centros Comunitários de Saúde Mental , Transtornos Mentais/terapia , Psicoterapia/métodos , Transtornos do Sono do Ritmo Circadiano/terapia , Transtornos do Sono-Vigília/terapia , Adulto , Ansiedade/terapia , Transtornos de Ansiedade/terapia , California , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Esquizofrenia/terapia , Sono , Transtornos do Sono do Ritmo Circadiano/complicações , Transtornos do Sono-Vigília/complicações , Resultado do Tratamento
2.
J Parkinsons Dis ; 11(3): 971-992, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33896849

RESUMO

Sleep disturbances are among the common nonmotor symptoms in patients with Parkinson's disease (PD). Sleep can be disrupted by nocturnal motor and nonmotor symptoms and other comorbid sleep disorders. Rapid eye movement sleep behavior disorder (RBD) causes sleep-related injury, has important clinical implications as a harbinger of PD and predicts a progressive clinical phenotype. Restless legs syndrome (RLS) and its related symptoms can impair sleep initiation. Excessive daytime sleepiness (EDS) is a refractory problem affecting patients' daytime activities. In particular, during the COVID-19 era, special attention should be paid to monitoring sleep problems, as infection-prevention procedures for COVID-19 can affect patients' motor symptoms, psychiatric symptoms and sleep. Therefore, screening for and managing sleep problems is important in clinical practice, and the maintenance of good sleep conditions may improve the quality of life of PD patients. This narrative review focused on the literature published in the past 10 years, providing a current update of various sleep disturbances in PD patients and their management, including RBD, RLS, EDS, sleep apnea and circadian abnormalities.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Doença de Parkinson , Transtorno do Comportamento do Sono REM , Síndrome das Pernas Inquietas , Síndromes da Apneia do Sono , Transtornos do Sono do Ritmo Circadiano , COVID-19 , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/etiologia , Distúrbios do Sono por Sonolência Excessiva/terapia , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Transtorno do Comportamento do Sono REM/diagnóstico , Transtorno do Comportamento do Sono REM/etiologia , Transtorno do Comportamento do Sono REM/terapia , Síndrome das Pernas Inquietas/diagnóstico , Síndrome das Pernas Inquietas/etiologia , Síndrome das Pernas Inquietas/terapia , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/etiologia , Síndromes da Apneia do Sono/terapia , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/etiologia , Transtornos do Sono do Ritmo Circadiano/terapia
3.
J Clin Sleep Med ; 17(7): 1503-1506, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33792535

RESUMO

NONE: Non-24-hour sleep-wake disorder is 1 of several chronic circadian rhythm sleep-wake disorders. It is defined as progressive daily shifts in sleep onset and wake times. It mainly affects patients who are sight-impaired, is relatively rare in sighted patients, and is difficult to treat, with no guidelines. This case report discusses non-24-hour sleep-wake disorder in a sighted young man who complained of alternating severe insomnia and excessive sleepiness, with a sleep agenda and actigraphic data showing a daily delay of approximately 2 hours. A novel therapy by total sleep deprivation followed by a combination of morning light therapy and nocturnal melatonin administration was efficient in stopping his free-running sleep-wake pattern both immediately and in the long term. The treatment combination for 6 months resulted in stable circadian entrainment to a 24-hour cycle. Compliance with chronotherapy was maintained over the course of follow-up.


Assuntos
Melatonina , Marca-Passo Artificial , Transtornos do Sono do Ritmo Circadiano , Ritmo Circadiano , Humanos , Masculino , Melatonina/uso terapêutico , Sono , Privação do Sono/complicações , Privação do Sono/terapia , Transtornos do Sono do Ritmo Circadiano/complicações , Transtornos do Sono do Ritmo Circadiano/terapia
4.
Sleep ; 44(5)2021 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-33582815

RESUMO

This White Paper presents the results from a workshop cosponsored by the Sleep Research Society (SRS) and the Society for Research on Biological Rhythms (SRBR) whose goals were to bring together sleep clinicians and sleep and circadian rhythm researchers to identify existing gaps in diagnosis and treatment and areas of high-priority research in circadian rhythm sleep-wake disorders (CRSWD). CRSWD are a distinct class of sleep disorders caused by alterations of the circadian time-keeping system, its entrainment mechanisms, or a misalignment of the endogenous circadian rhythm and the external environment. In these disorders, the timing of the primary sleep episode is either earlier or later than desired, irregular from day-to-day, and/or sleep occurs at the wrong circadian time. While there are incomplete and insufficient prevalence data, CRSWD likely affect at least 800,000 and perhaps as many as 3 million individuals in the United States, and if Shift Work Disorder and Jet Lag are included, then many millions more are impacted. The SRS Advocacy Taskforce has identified CRSWD as a class of sleep disorders for which additional high-quality research could have a significant impact to improve patient care. Participants were selected for their expertise and were assigned to one of three working groups: Phase Disorders, Entrainment Disorders, and Other. Each working group presented a summary of the current state of the science for their specific CRSWD area, followed by discussion from all participants. The outcome of those presentations and discussions are presented here.


Assuntos
Melatonina , Transtornos do Sono do Ritmo Circadiano , Transtornos do Sono-Vigília , Ritmo Circadiano , Humanos , Síndrome do Jet Lag , Sono , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/epidemiologia , Transtornos do Sono do Ritmo Circadiano/terapia , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/terapia
5.
Sleep Med ; 78: 8-14, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33383396

RESUMO

OBJECTIVES: Recent studies have demonstrated that first-line nurses involved in the coronavirus disease-2019 (COVID-19) crisis may experience sleep disturbances. As breathing relaxation techniques can improve sleep quality, anxiety, and depression, the current study aimed to evaluate the effectiveness of diaphragmatic breathing relaxation training (DBRT) for improving sleep quality among nurses in Wuhan, China during the COVID-19 outbreak. METHODS: This study used a quasi-experimental (before and after) intervention strategy, with 151 first-line nurses from four wards in Leishenshan hospital. The Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) to evaluate the effectiveness of DBRT before and after the intervention. Data were examined using the Shapiro-Wilk test, Levene's test, and paired t-test. RESULTS: A total of 140 nurses completed the DBRT sessions. First-line nurses achieved significant reductions in global sleep quality (p < 0.01), subjective sleep quality (p < 0.001), sleep latency (p < 0.01), sleep duration (p < 0.001), sleep disturbances (p < 0.001), habitual sleep efficiency (p = 0.015), daytime dysfunction (p = 0.001), and anxiety (p = 0.001). There were no significant reductions in the use of sleeping medication (p = 0.134) and depression (p = 0.359). CONCLUSION: DBRT is a useful non-pharmacological treatment for improving sleep quality and reducing anxiety among first-line nurses involved in the COVID-19 outbreak. The study protocol was clinically registered by the Chinese Clinical Trial Registry. CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR2000032743.


Assuntos
Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Terapia de Relaxamento/métodos , Transtornos do Sono do Ritmo Circadiano/terapia , Latência do Sono , Adulto , Ansiedade/terapia , COVID-19/epidemiologia , China , Feminino , Humanos , Masculino , Recursos Humanos de Enfermagem no Hospital/psicologia , Autoeficácia , Transtornos do Sono do Ritmo Circadiano/prevenção & controle , Estresse Psicológico/prevenção & controle , Inquéritos e Questionários
6.
Sleep Med Clin ; 15(3S): e1-e7, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33008491

RESUMO

Prior to the COVID-19 pandemic, few pediatric sleep medicine clinicians routinely engaged in telemedicine visits because thorough examinations were difficult to perform; there was lack of consistent reimbursement; and many clinicians were busy with their in-office practices. This article reviews how telemedicine has been explored in pediatric sleep medicine prior to the pandemic, current applications of telemedicine, challenges, and reimagining pediatric sleep within the realm of telemedicine.


Assuntos
Pediatria , Medicina do Sono , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/terapia , Telemedicina/métodos , Betacoronavirus , COVID-19 , Criança , Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus , Humanos , Otolaringologia , Pandemias , Pneumonia Viral , Polissonografia , Encaminhamento e Consulta , Síndrome das Pernas Inquietas/diagnóstico , Síndrome das Pernas Inquietas/terapia , SARS-CoV-2 , Sono , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/terapia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia
7.
Medicine (Baltimore) ; 99(36): e22068, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899073

RESUMO

INTRODUCTION: Nearly 20% of night shift nurses will cause shift work disorder (SWD) due to the disruption of sleep-wake cycle, which not only affects the daily work efficiency, but also brings a huge burden on physical and mental health. Acupuncture is a safe and effective intervention on SWD. This trial will combine with functional magnetic resonance imaging (fMRI) to study the clinical effects and potential mechanism of acupuncture in the treatment of SWD. METHODS AND ANALYSIS: This is a randomized controlled neuroimaging trial, with enrolled participants, outcome assessors, and data statisticians blinded. 60 patients with SWD and 30 healthy controls who sleep regularly will be recruited and divided into divided into a control group, a true acupoints treatment group (TATG) and a sham acupoints treatment group (SATG) by the ratio of 1:1:1. The TATG and SATG will receive 8 sessions of acupuncture treatment in 4 weeks. Cognitive function scales and MRI scanning will be performed before and after 4-week acupuncture treatment. The control group will receive no intervention. Functional connectivity of intra-network and inter-network will be the primary outcome and effect indicator. The secondary outcomes included Repeatable Battery for the Assessment of Neuropsychological Status, Attentional Network Test, Pittsburgh Sleep Quality Index scale and needle sensation assessment scale. Neuroimage indicators will be correlated with clinical data and scores of cognitive function assessment to explore the possible mechanisms underlying the changes of brain activity caused by acupuncture treatment. DISCUSSION: The results of this study will enable us to verify the therapeutic effect of acupuncture on SWD and explore the potential central mechanism of acupuncture on SWD from the change of brain activity.


Assuntos
Terapia por Acupuntura/métodos , Encéfalo/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Transtornos do Sono do Ritmo Circadiano/terapia , Pontos de Acupuntura , Terapia por Acupuntura/efeitos adversos , Adulto , Encéfalo/irrigação sanguínea , Encéfalo/fisiopatologia , Estudos de Casos e Controles , China/epidemiologia , Cognição/fisiologia , Feminino , Humanos , Testes Neuropsicológicos , Enfermeiras e Enfermeiros/psicologia , Avaliação de Resultados em Cuidados de Saúde , Transtornos do Sono do Ritmo Circadiano/psicologia
8.
Rev Med Suisse ; 16(698): 1237-1242, 2020 Jun 17.
Artigo em Francês | MEDLINE | ID: mdl-32558452

RESUMO

Circadian rhythm sleep disorders (CRSD) represent sleep-wake disturbances due to a disruption of endogenous circadian system or to a desynchronization between internal sleep-wake rhythms and the external environment. They comprise seven diagnostic entities grouped in two main categories: endogenous and exogenous. The patients typically describe chronic excessive daytime sleepiness and/or insomnia symptoms, impacting their daytime functioning. The exact prevalence of CRSD is probably underestimated. The diagnosis is based on sleep diary coupled with actigraphy. Several therapeutic options are validated to allow the realignment between endogenous circadian rhythm and the external environment. The correct diagnostic of CRSD is important to improve the patient's quality of life and to propose them appropriate treatment.


Assuntos
Ritmo Circadiano , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/terapia , Sono , Actigrafia , Ritmo Circadiano/fisiologia , Humanos , Qualidade de Vida , Sono/fisiologia , Transtornos do Sono do Ritmo Circadiano/fisiopatologia , Transtornos do Sono do Ritmo Circadiano/psicologia , Sonolência
9.
Sleep Health ; 6(5): 690-701, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32173374

RESUMO

Sleep problems and circadian misalignment affect health and well-being and are highly prevalent in those with co-morbid neuropsychiatric disorders. Interventions altering light exposure patterns of affected individuals are a promising non-pharmacological treatment option, shown by previous meta-analyses to improve sleep, and often described as minimally invasive. To best translate laboratory-based mechanistic research into effective treatments, acceptability and barriers to adherence should be understood, but these have not yet been systematically evaluated. Here, we examined evidence regarding adherence and acceptability in studies of light or dark interventions using various delivery devices and protocols to improve sleep in intrinsic circadian rhythm sleep-wake disorders and neuropsychiatric illness. Attrition during intervention was low, and reported experiences were largely positive, but measurement and reporting of self-reported experiences, expectations, and adverse effects were poor. Approaches to management and measurement of adherence were varied, and available light monitoring technology appeared under-exploited, as did mobile technology to prompt or track adherence. Based on these findings we suggest recommended reporting items on acceptability and adherence for future investigations. Few studies assessed baseline light exposure patterns, and few personalised interventions. Overall, many applied studies exhibited an approach to light schedule interventions still reminiscent of laboratory protocols; this is unlikely to maximise acceptability and clinical effectiveness. For the next phase of translational research, user acceptability and adherence should receive increased attention during intervention design and study design. We suggest framing light therapies as complex interventions, and emphasise the occupationally embedded (daily activity routine embedded) context in which they occur.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fototerapia , Transtornos Psicóticos/terapia , Transtornos do Sono do Ritmo Circadiano/terapia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Humanos
10.
J Am Osteopath Assoc ; 120(2): 107-117, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31985761

RESUMO

In this highly digitalized era, sleep disorders are becoming more common and are associated with an increased burden of chronic disease. Shift workers are at an increased risk for both sleep disorders and metabolic syndrome. In this article, the authors outline the connection between circadian discordance, hormonal imbalance, and the development of metabolic syndrome in shift workers. Based on a literature review of animal model studies, observational studies, and clinical trials conducted between August and October of 2018, the authors offer several clinical interventions, including work schedules, light therapy, medications, and dietary habits to improve the circadian synchronicity of shift workers and reduce their risk of morbidity and mortality. It is important for physicians to be familiar with the consequences of shift work and ways to mitigate the risks for this patient population.


Assuntos
Síndrome Metabólica/etiologia , Síndrome Metabólica/terapia , Jornada de Trabalho em Turnos/efeitos adversos , Transtornos do Sono do Ritmo Circadiano/etiologia , Transtornos do Sono do Ritmo Circadiano/terapia , Comportamento Alimentar , Humanos , Manipulação Osteopática , Fototerapia
11.
Eur J Sport Sci ; 20(10): 1368-1377, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31939334

RESUMO

Epidemiological studies suggest that cardiorespiratory fitness (CRfitness) is associated with reduced risk of depression and anxiety in women, however, the mechanisms by which CRfitness may be protective against the development of these disorders are less clear. Because sleep problems are associated with both a higher risk for mental illness and altered physiological responses to stress, this study investigated whether sleep quality might influence the relationship between CRfitness and physiological stress responses in women. Thirty healthy women (18-45 y) who were medication-free, with regular menstrual cycles completed: (1) enrolment visit [including the assessment of CRfitness via maximal oxygen consumption during exercise]; (2) one-week sleep monitoring period including subjective (daily sleep diaries) and objective (wrist actigraphy) sleep measures; and (3) psychosocial stressor protocol (the Trier Social Stress Test; TSST) for the collection of heart rate (HR), blood pressure (BP), and salivary cortisol stress responses. Higher CRfitness was associated with reduced wake after sleep onset (WASO) duration (r = -.38, p = 0.04), higher self-reported sleep quality (higher scores reflect poorer sleep quality; r = -.37, p = 0.05), and lower HR (r = -.43, p = 0.02) during the stressor. Higher sleep quality was associated with a lower HR during the stressor (r = .44, p = 0.01). Increased WASO duration and WASO number were associated with blunted cortisol output during the stressor (r = -.44, p = 0.02, and r = -.46, p = 0.02, respectively). Results suggest that, in women, CRfitness may be protective against the deleterious effects of stress via improved sleep quality.


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Exercício Físico/fisiologia , Consumo de Oxigênio/fisiologia , Sono/fisiologia , Estresse Fisiológico/fisiologia , Actigrafia , Adolescente , Adulto , Ansiedade/etiologia , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Depressão/etiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hidrocortisona/análise , Hidrocortisona/metabolismo , Ciclo Menstrual , Pessoa de Meia-Idade , Projetos Piloto , Saliva/química , Autorrelato , Transtornos do Sono do Ritmo Circadiano/terapia , Estresse Psicológico/fisiopatologia , Adulto Jovem
12.
Artigo em Alemão | MEDLINE | ID: mdl-31393214

RESUMO

Effect of light therapy on the night sleep of children with sleep problems Abstract. Studies on the effect of light therapy on the nighttime sleep of adolescents revealed earlier sleep onset and longer sleep periods. The present study examines the corresponding effects in children. A group of 28 children (M = 10.0; SD = 1.65 years) with difficulties falling asleep and sleeping through the night received a light therapy device for home application. The effect was investigated by an A-B-A-B design with four measurement points. We detected significant, small- to medium-sized effects on the children's sleep-onset problems and ability to sleep through the night as well as mood. Sleep onset was reduced by approximately 10 minutes. The representativeness of the sample is limited, but the results largely correspond to the findings in adolescents. Because of the weekly switch between application and nonapplication, the true circadian effects might be underestimated. In principle, however, the effects found in adolescents appear to be transferable to children, though further research is necessary.


Assuntos
Ritmo Circadiano/efeitos da radiação , Fototerapia , Transtornos do Sono do Ritmo Circadiano/terapia , Sono/efeitos da radiação , Afeto/efeitos da radiação , Criança , Ritmo Circadiano/fisiologia , Humanos , Sono/fisiologia , Fatores de Tempo
13.
Int Arch Occup Environ Health ; 93(5): 535-550, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31853633

RESUMO

INTRODUCTION: The aim of the study was to compare the effectiveness of cognitive behavioural therapy interventions for insomnia (CBT-I) to that of a sleep hygiene intervention in a randomized controlled design among shift workers. We also studied whether the features of shift work disorder (SWD) affected the results. METHODS: A total of 83 shift workers with insomnia disorder were partially randomized into a group-based CBT-I, self-help CBT-I, or sleep hygiene control intervention. The outcomes were assessed before and after the interventions and at 6-month follow-up using questionnaires, a sleep diary, and actigraphy. RESULTS: Perceived severity of insomnia, sleep-related dysfunctional beliefs, burnout symptoms, restedness, recovery after a shift, and actigraphy-based total sleep time improved after the interventions, but we found no significant differences between the interventions. Mood symptoms improved only among the group-based CBT-I intervention participants. Non-SWD participants had more mental diseases and symptoms, used more sleep-promoting medication, and had pronounced insomnia severity and more dysfunctional beliefs than those with SWD. After the interventions, non-SWD participants showed more prominent improvements than those with SWD. CONCLUSIONS: Our results showed no significant differences between the sleep improvements of the shift workers in the CBT-I interventions and of those in the sleep hygiene control intervention. Alleviation of mood symptoms seemed to be the main added value of the group-based CBT-I intervention compared to the control intervention. The clinical condition of the non-SWD participants was more severe and these participants benefitted more from the interventions than the SWD participants did. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02523079.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Distúrbios do Início e da Manutenção do Sono/terapia , Actigrafia , Adulto , Esgotamento Profissional/psicologia , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Serviços de Saúde do Trabalhador/métodos , Psicoterapia de Grupo/métodos , Transtornos do Sono do Ritmo Circadiano/psicologia , Transtornos do Sono do Ritmo Circadiano/terapia , Higiene do Sono , Distúrbios do Início e da Manutenção do Sono/psicologia , Resultado do Tratamento
14.
Sleep Breath ; 24(1): 253-258, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31853836

RESUMO

PURPOSE: To measure the effect of a 2-day sleepcoaching seminar on daytime sleepiness and sleep-related variables of shift workers employed in an Austrian railway company (ÖBB: Österreichische Bundesbahnen). METHOD: Participants filled in pre- and post-intervention questionnaires, containing items of the PSQI and the ESS, questions about chronotype, personality factors and possible burnout risk factors. About 30 shift workers, working in shifts for more than 300 months on average (28 male; mean age = 24 ± 45.90, age range 24-56 years) voluntarily took part in the investigation twice. Sleep coaching by Holzinger and Kloesch™ (SC) is a new holistic approach for non-pharmacological treatment of non-restorative sleep and is based on Gestalt therapy. It includes psychotherapeutic aspects, which enable clients to improve their sleep quality by developing one's own coping strategies which can be implemented in daily routine. Dream work and relaxation techniques are also part of the programme. RESULTS: The 2-day SC seminar was beneficial by focusing on the sleep problems related to shift work. A significant improvement of the global PSQI score and the PSQI variables subjective sleep quality, diurnal fatigue, and sleep latency was achieved, with a medium effect size. However, the programme did not result in the reduction of daytime sleepiness (ESS). Six more variables did not change significantly. CONCLUSION: While some sleep problems related to shift work were successfully addressed by SC, daytime sleepiness (ESS) could not be reduced contrary to our expectations. More research with a greater sample and a longitudinal design is needed to examine the long-term effects of SC.


Assuntos
Distúrbios do Sono por Sonolência Excessiva/terapia , Tutoria/métodos , Transtornos do Sono do Ritmo Circadiano/terapia , Adulto , Áustria , Terapia Combinada , Sonhos , Feminino , Terapia Gestalt , Humanos , Masculino , Pessoa de Meia-Idade , Terapia de Relaxamento , Inquéritos e Questionários , Falha de Tratamento
15.
J Clin Sleep Med ; 15(12): 1863-1865, 2019 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-31855173

RESUMO

None: The prevalence of shift work in the United States is nearly 20%, but recognition of shift work disorder (SWD) among shift workers is still a challenge. The health care sector is no exception. While a substantial portion of shift workers are physicians and nurses, expertise in identifying SWD is lacking. Shift work adjustment occurs spontaneously in some individuals, but for others, it poses difficulties, including both sleep disturbance and insufficient sleep, leading to chronic excessive sleepiness and other long-term morbidities. Treatment is multifaceted and often requires pharmacologic therapy to address acute sleep-wake symptoms, as well as circadian interventions to realign intrinsic biological rhythms to the externally imposed shift-work schedule. The complexity and myriad obstacles of treating maladjustment to shift work after its manifestation, including determination of circadian phase, risk-benefit considerations in pharmacologic treatment, and behavioral/health risks associated with delaying intervention, suggest that prevention of SWD should be a priority. This article presents the personal experience of one author (Amit Gupta), identifies some of the issues faced by shift workers, especially medical trainees, and suggests a preventive approach to this complex problem that should be considered for future research and practical implementation in the clinic.


Assuntos
Jornada de Trabalho em Turnos/efeitos adversos , Transtornos do Sono do Ritmo Circadiano/terapia , Humanos , Transtornos do Sono do Ritmo Circadiano/etiologia , Tolerância ao Trabalho Programado
16.
Curr Opin Endocrinol Diabetes Obes ; 26(6): 313-316, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31633567

RESUMO

PURPOSE OF REVIEW: To integrate evidence on the role of circadian rhythm in male reproduction. Several studies report on various aspects of the association between the circadian system and male reproductive function in animals and humans both in physiological condition as well as in the case of subfertility. RECENT FINDINGS: Epidemiological data demonstrate diurnal and seasonal changes as well as the effect of sleep/wake cycles on the quality of semen. Rare and common genetic variation in circadian clock genes in humans and animal models support the role of circadian rhythms in male fertility in humans. SUMMARY: Current data support the modest effect of the circadian clock on male reproductive potential; however, the evidence available is still fragmented and inconclusive. Additional well designed and sufficiently powered studies are needed to delineate the role of the circadian clock both in cause and potential interventional and preventive approaches in male subfertility.


Assuntos
Ritmo Circadiano/fisiologia , Reprodução/fisiologia , Animais , Proteínas CLOCK/genética , Relógios Circadianos/genética , Humanos , Infertilidade Masculina/epidemiologia , Infertilidade Masculina/etiologia , Infertilidade Masculina/genética , Infertilidade Masculina/prevenção & controle , Masculino , Medicina Preventiva/métodos , Reprodução/genética , Estações do Ano , Análise do Sêmen , Transtornos do Sono do Ritmo Circadiano/complicações , Transtornos do Sono do Ritmo Circadiano/epidemiologia , Transtornos do Sono do Ritmo Circadiano/genética , Transtornos do Sono do Ritmo Circadiano/terapia
17.
Curr Opin Endocrinol Diabetes Obes ; 26(6): 317-321, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31644470

RESUMO

PURPOSE OF REVIEW: In recent years, new studies have investigated the role and influence of sleep on female fertility and early pregnancy outcomes, providing a growing body of knowledge demonstrating how regulation by sleep of hormones are important to reproduction, and how disruptions in sleep, circadian rhythms, and genes regulating circadian rhythmicity can negatively impact fertility and early pregnancy outcomes. This review aims to summarize the most recent research on the relationship among circadian rhythms, fertility, and early pregnancy outcomes in women, and to explore possible fertility interventions. RECENT FINDINGS: Recent studies have found altered levels of FSH, LH, and prolactin with sleep disturbance or circadian dysrhythmia. Disruption of circadian rhythms in the form of shift work, jet lag, and daylight savings time changes have been associated with poorer fertility and early pregnancy outcomes. Alterations in the expression of circadian rhythm-regulating circadian locomotor output cycles kaput (CLOCK) genes have been associated with decreased fertility and increased rates of miscarriage. SUMMARY: Overall, undisrupted sleep and circadian rhythmicity appear to optimize fertility and early pregnancy outcomes and may play an important role in the success of fertility treatment.


Assuntos
Ritmo Circadiano/fisiologia , Infertilidade Feminina/etiologia , Infertilidade Feminina/terapia , Reprodução/fisiologia , Animais , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Infertilidade Feminina/sangue , Hormônio Luteinizante/sangue , Gravidez , Resultado da Gravidez , Prolactina/sangue , Técnicas de Reprodução Assistida , Sono/fisiologia , Transtornos do Sono do Ritmo Circadiano/sangue , Transtornos do Sono do Ritmo Circadiano/complicações , Transtornos do Sono do Ritmo Circadiano/terapia , Resultado do Tratamento
19.
JAMA Netw Open ; 2(9): e1911944, 2019 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-31553469

RESUMO

Importance: Owing to biological, behavioral, and societal factors, sleep duration in teenagers is often severely truncated, leading to pervasive sleep deprivation. Objective: To determine whether a novel intervention, using both light exposure during sleep and cognitive behavioral therapy (CBT), would increase total sleep time in teenagers by enabling them to go to sleep earlier than usual. Design, Setting, and Participants: This double-blind, placebo-controlled, randomized clinical trial, conducted between November 1, 2013, and May 31, 2016, among 102 adolescents enrolled full-time in grades 9 to 12, who expressed difficulty going to bed earlier and waking up early enough, was composed of 2 phases. In phase 1, participants were assigned to receive either 3 weeks of light or sham therapy and were asked to try to go to sleep earlier. In phase 2, participants received 4 brief CBT sessions in addition to a modified light or sham therapy. All analyses were performed on an intent-to-treat basis. Interventions: Light therapy consisted of receiving a 3-millisecond light flash every 20 seconds during the final 3 hours of sleep (phase 1) or final 2 hours of sleep (phase 2). Sham therapy used an identical device, but delivered 1 minute of light pulses (appearing in 20-second intervals, for a total of 3 pulses) per hour during the final 3 hours of sleep (phase 1) or 2 hours of sleep (phase 2). Light therapy occurred every night during the 4-week intervention. Cognitive behavioral therapy consisted of four 50-minute in-person sessions once per week. Main Outcomes and Measures: Primary outcome measures included diary-based sleep times, momentary ratings of evening sleepiness, and subjective measures of sleepiness and sleep quality. Results: Among the 102 participants (54 female [52.9%]; mean [SD] age, 15.6 [1.1] years), 72 were enrolled in phase 1 and 30 were enrolled in phase 2. Mixed-effects models revealed that light therapy alone was inadequate in changing the timing of sleep. However, compared with sham therapy plus CBT alone, light therapy plus CBT significantly moved sleep onset a mean (SD) of 50.1 (27.5) minutes earlier and increased nightly total sleep time by a mean (SD) of 43.3 (35.0) minutes. Light therapy plus CBT also resulted in a 7-fold greater increase in bedtime compliance than that observed among participants receiving sham plus CBT (mean [SD], 2.21 [3.91] vs 0.29 [0.76]), as well as a mean 0.55-point increase in subjective evening sleepiness as compared with a mean 0.48-point decrease in participants receiving sham plus CBT as measured on a 7-point sleepiness scale. Conclusions and Relevance: This study found that light exposure during sleep, in combination with a brief, motivation-focused CBT intervention, was able to consistently move bedtimes earlier and increase total sleep time in teenagers. This type of passive light intervention in teenagers may lead to novel therapeutic applications. Trial Registration: ClinicalTrials.gov identifier: NCT01406691.


Assuntos
Terapia Cognitivo-Comportamental , Terapia Combinada/métodos , Fototerapia , Transtornos do Sono do Ritmo Circadiano/terapia , Adolescente , Método Duplo-Cego , Feminino , Humanos , Masculino , Transtornos do Sono do Ritmo Circadiano/fisiopatologia , Resultado do Tratamento
20.
Acta Oncol ; 58(12): 1692-1698, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31524020

RESUMO

Background: Fatigue is one of the most common and distressing long-term effects of cancer treatment. Cognitive behavioral therapy (CBT) is an evidence-based intervention for patients with severe post-cancer fatigue. CBT for fatigue is a complex intervention consisting of multiple elements like a graded activity program, regulation of the sleep-wake rhythm and reformulation of fatigue-related cognitions. The contribution of the separate elements to the positive effect of CBT on fatigue is unclear. The main objective of this pragmatic crossover trial was comparing the efficacy of graded activity with the other elements of CBT in reducing post-cancer fatigue.Material and methods: Severely fatigued cancer survivors were randomized to (i) graded activity followed by the other elements of CBT after crossover (n = 41), or (ii) the two components in reverse order (n = 48). Fatigue severity was measured at baseline, before crossover and after CBT (Checklist Individual Strength (CIS), Fatigue Severity subscale). Differences in effects on fatigue were examined with a linear regression analysis. Objective physical activity, perceived activity and self-efficacy were explored as mediators of the effect of graded activity.Results: Before crossover, the reduction in fatigue was significantly larger after graded activity than after the other elements (ß = 4.75, 95% confidence interval (95% CI) = -9.19; -0.32). An increase in perceived activity mediated this effect (ß = -4.17, 95% CI = -7.37; -1.37).Conclusions: Graded activity is an important component of CBT for post-cancer fatigue as it resulted in a larger reduction in fatigue compared with the other elements, mediated by an increased level of perceived activity. Results indicated that the other elements of CBT are of added value in reducing fatigue.


Assuntos
Sobreviventes de Câncer , Terapia Cognitivo-Comportamental/métodos , Exercício Físico , Fadiga/terapia , Lista de Checagem , Intervalos de Confiança , Estudos Cross-Over , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/terapia , Descanso , Índice de Gravidade de Doença , Transtornos do Sono do Ritmo Circadiano/terapia , Fatores de Tempo , Resultado do Tratamento
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