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1.
Crit Care ; 24(1): 597, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023669

RESUMO

BACKGROUND: Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. METHODS: Prospective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. RESULTS: A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53-1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0-2.5) vs 2 IQR 1.0-3.0] days (p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40-2.72), p = 0.92]. CONCLUSION: In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.


Assuntos
Infecções por Coronavirus/terapia , Intubação Intratraqueal/efeitos adversos , Oxigenoterapia/métodos , Pneumonia Viral/terapia , Decúbito Ventral , Vigília , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Medição de Risco
3.
Psychiatr Danub ; 32(Suppl 1): 33-35, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890359

RESUMO

BACKGROUND: Bruxism is excessive teeth grinding or jaw clenching. Several symptoms are commonly associated with bruxism, including hypersensitive teeth, aching jaw muscles, headaches, tooth wear, and damage to dental restorations. There are two types of bruxism, awake bruxism and sleep bruxism. Awake bruxism is generally treated by dentists and maxilla-facial surgeons through several treatment modalities such as, counselling about triggers, relaxation, occlusal splints and botulinum toxin type A injections. METHODS: We will present the case of a 21-year-old woman presenting mood swings with a high level of anxiety and concentration difficulties since childhood. She also complained of awake bruxism. Intelligence was evaluated using The Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV). Attention-deficit hyperactivity disorder (ADHD) was investigated through a neuropsychology test. RESULTS: Intelligence evaluation showed normal intellectual function. Neuropsychology test showed a profile corresponding to ADHD. Bupropion XR 300 mg was initiated for ADHD. Pregabalin was prescribed for general anxiety syndrome. The patient reported a complete disappearance of awake bruxism at a daily dose of 375 mg, with no occlusal appliances. Following the improvement of the anxiety symptoms, the attempt to reduce the dose twice leading to the recurrence of bruxism. CONCLUSIONS: A 21 years old female treated with 375 mg daily doses of pregabalin for generalized anxiety disorder experienced a significant reduction of daytime bruxism. More studies are needed to determine whether pregabalin has a long term effect against awake bruxism.


Assuntos
Ansiolíticos , Bruxismo , Vigília , Ansiolíticos/uso terapêutico , Ansiedade , Transtornos de Ansiedade , Bruxismo/tratamento farmacológico , Feminino , Humanos , Pregabalina/uso terapêutico , Adulto Jovem
4.
J Oral Facial Pain Headache ; 34(3): 273-280, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870956

RESUMO

AIMS: To examine if the existence of an association between self-reported awake oral behaviors and orofacial pain depends on the belief of patients that these behaviors are harmful to the jaw and to investigate if an additional variable (ie, somatic symptoms, depression, and/or anxiety) indirectly affects the association between the causal attribution belief and the report of awake oral behaviors. METHODS: Prior to the first clinical visit, patients referred to a specialized clinic for complaints of orofacial pain and dysfunction completed a digital questionnaire. Data of 329 patients diagnosed with myalgia according to the Diagnostic Criteria for Temporomandibular Disorders (82.4% women; mean ± SD age = 41.9 ± 14.7 years) were analyzed. RESULTS: Causal attribution belief moderated the association between awake oral behaviors and orofacial pain intensity. In addition, the relationship between causal attribution belief and self-reported oral behaviors was partially mediated by the presence of somatic symptoms (8%), depression (9%), and anxiety (16%). CONCLUSION: Awake oral behaviors were positively associated with orofacial pain, but only under the condition of a strong belief of the patients in causal attribution of these behaviors to the jaw pain complaint. No such association was present in case of a low causal attribution belief. It appeared that, within this patient cohort, the relationship between causal attribution belief and self-reported oral behaviors was (in part) the result of shared psychologic risk factors.


Assuntos
Transtornos da Articulação Temporomandibular , Vigília , Dor Facial , Feminino , Humanos , Masculino , Autorrelato , Inquéritos e Questionários
5.
Nat Commun ; 11(1): 4523, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32908125

RESUMO

Thousands of functional magnetic resonance imaging (fMRI) studies have provided important insight into the human brain. However, only a handful of these studies tested infants while they were awake, because of the significant and unique methodological challenges involved. We report our efforts to address these challenges, with the goal of creating methods for awake infant fMRI that can reveal the inner workings of the developing, preverbal mind. We use these methods to collect and analyze two fMRI datasets obtained from infants during cognitive tasks, released publicly with this paper. In these datasets, we explore and evaluate data quantity and quality, task-evoked activity, and preprocessing decisions. We disseminate these methods by sharing two software packages that integrate infant-friendly cognitive tasks and eye-gaze monitoring with fMRI acquisition and analysis. These resources make fMRI a feasible and accessible technique for cognitive neuroscience in awake and behaving human infants.


Assuntos
Mapeamento Encefálico/métodos , Encéfalo/diagnóstico por imagem , Desenvolvimento Infantil/fisiologia , Imagem por Ressonância Magnética/métodos , Vigília/fisiologia , Técnicas de Observação do Comportamento , Encéfalo/crescimento & desenvolvimento , Pré-Escolar , Cognição/fisiologia , Estudos de Coortes , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino
6.
Nat Commun ; 11(1): 4715, 2020 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-32948772

RESUMO

Animal-fMRI is a powerful method to understand neural mechanisms of cognition, but it remains a major challenge to scan actively participating small animals under low-stress conditions. Here, we present an event-related functional MRI platform in awake pigeons using single-shot RARE fMRI to investigate the neural fundaments for visually-guided decision making. We established a head-fixated Go/NoGo paradigm, which the animals quickly learned under low-stress conditions. The animals were motivated by water reward and behavior was assessed by logging mandibulations during the fMRI experiment with close to zero motion artifacts over hundreds of repeats. To achieve optimal results, we characterized the species-specific hemodynamic response function. As a proof-of-principle, we run a color discrimination task and discovered differential neural networks for Go-, NoGo-, and response execution-phases. Our findings open the door to visualize the neural fundaments of perceptual and cognitive functions in birds-a vertebrate class of which some clades are cognitively on par with primates.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Cognição/fisiologia , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/veterinária , Vigília , Animais , Artefatos , Comportamento Animal/fisiologia , Mapeamento Encefálico , Columbidae , Humanos , Inibição Psicológica , Aprendizagem , Movimento (Física) , Redes Neurais de Computação , Recompensa
7.
BMJ Open Respir Res ; 7(1)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32928787

RESUMO

The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Infecções por Coronavirus/terapia , Oxigenoterapia/métodos , Posicionamento do Paciente/métodos , Pneumonia Viral/terapia , Decúbito Ventral , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/mortalidade , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/métodos , Razão de Chances , Pandemias , Pneumonia Viral/mortalidade , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido , Vigília
8.
BMJ Open Respir Res ; 7(1)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32895247

RESUMO

The global pandemic of COVID-19 has challenged the management of hypoxaemic respiratory failure and strained intensive care unit resources. While prone positioning (PP) is an established therapy in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), its role in conscious patients is less well defined. We retrospectively reviewed our experience of implementing early PP in a cohort of 24 patients with acute hypoxaemic respiratory failure due to COVID-19 who required support with continuous positive airway pressure (CPAP). The use of PP alongside CPAP significantly increased both the ROX index and arterial oxygen pressure:fractional inspired oxygen (PaO2:FiO2) ratio from baseline values (ROX index: 7.0±2.5 baseline vs 11.4±3.7 CPAP+PP, p<0.0001; PaO2:FiO2 ratio: 143±73 mm Hg baseline vs 252±87 mm Hg CPAP+PP, p<0.01), and the changes to both the ROX index and PaO2:FiO2 ratio remained significant 1 hour after cessation of proning. The mean duration of PP in the first 24 hours was 8±5 hours. Few complications were observed and PP was continued for a mean of 10±5 days. From our experience in a dedicated COVID-19 respiratory high care unit, PP alongside CPAP therapy was feasible, tolerated, safe and improved oxygenation. The use of conscious PP in ARDS warrants further investigation in randomised controlled trials.


Assuntos
Betacoronavirus , Pressão Positiva Contínua nas Vias Aéreas/métodos , Infecções por Coronavirus/terapia , Posicionamento do Paciente/métodos , Pneumonia Viral/terapia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Decúbito Ventral , Estudos Retrospectivos , Tempo , Resultado do Tratamento , Vigília
9.
Artigo em Chinês | MEDLINE | ID: mdl-32842204

RESUMO

Objective:Drug induced sleep endoscopy(DISE) is a useful tool to locate the upper airway obstructions in patients with obstructive sleep apnea syndrome(OSAS). The goal of our research was to compare the sites, degree and patterns of upper airway obstruction detected by DISE versus endoscopy in awake children. The benefit of DISE-mediated upper airway surgery in pediatric OSAS was evaluated. Method:This is a retrospective case series of children with OSAS who had adenoid hypertrophy(the area where adenoids block the postnaris ≥2/3) and tonsils ≤2 degrees(Friedman classification method) . All children underwent sleep monitoring by pulse oximeter before and after operation. DISE was performed before adenoidectomy in DISE group. If obstruction of oropharynx caused by tonsils was found, tonsillectomy was performed at the same time with adenoidectomy. The children who did not undergo DISE before operation were enrolled in the control group. Differences in the degrees and patterns of upper airway obstruction in the DISE group under wakefulness and drug induction were analyzed. Result:The study included 126 children in DISE group, and 200 children in control group. In the DISE group, 56 cases(44.4%) had grade 2 tonsils, and 70 cases(55.6%) had grade 1 tonsils. The patterns of obstruction at velum, tongue base and epiglottis were significantly different in DISE compared with awake endoscopy(P<0.05); the patterns of obstruction at adenoid and oropharynx were the same in both techniques. There were significant differences in endoscopy scores between the lateral wall of oropharynx and the tongue base(P<0.05). DISE revealed 57 (45.2%) cases had grade 2 obstruction in the oropharyngeal level. Among them, 44 cases (34.9%) had tonsils at 2 degrees and 13 cases (10.3%) had tonsils at 1 degrees.. There was an improvement in respiratory disturbance index(RDI) and oxygen saturation nadir in the DISE and control groups 1 year after surgery(P<0.05), and the RDI improvement was better in the DISE group compared with controls(P=0.04). Conclusion:DISE is an effective method to evaluate the sites and severity of upper airway obstruction in children with OSAS, which was conductive to make the upper airway personalized surgical plan for patients.


Assuntos
Obstrução das Vias Respiratórias , Apneia Obstrutiva do Sono , Criança , Endoscopia , Humanos , Polissonografia , Estudos Retrospectivos , Vigília
10.
Arq Neuropsiquiatr ; 78(7): 397-402, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32756859

RESUMO

BACKGROUND: The relationship of bidirectional comorbidity between chronic migraine and pain in the cephalic segment led us to evaluate the improvement in reducing the pain in patients diagnosed with chronic migraine headache and awake bruxism, when undergoing treatment with a partial posterior interocclusal device designed for the management and control of awake bruxism through biofeedback. METHODS: Seventy-four patients were evaluated during the following periods: pretreatment, seven, thirty, ninety, one hundred and eighty days, and one year. The evaluation was carried out by measuring the pain in the pretreatment period and pain reduction after awake bruxism treatment, using clinical evaluation and numerical scales for pain. RESULTS: Most of the patients who complained of headache migraine pain, masticatory myofascial pain, temporomandibular joint and neck pain experienced a significant reduction in overall pain, including headaches, between t0 and t30 (p<0.0001). After 30 days of using the device, it was observed that the improvement remained at the same level without any recurrence of pain up to t90. At t180 and t360, it was observed that even with the device withdrawal (at t90) the improvement remained at the same level. CONCLUSION: The utilization of a posterior interocclusal device designed for the management and control of awake bruxism through biofeedback seems to contribute to the reduction of pain (including migraine headache) in the majority of patients, and, even with the device withdrawal (at t90), the improvement remained at the same level, suggesting the patients succeeded in controlling their awake bruxism and consequently the pains.


Assuntos
Bruxismo/complicações , Dor Facial/complicações , Transtornos de Enxaqueca/complicações , Transtornos da Articulação Temporomandibular/complicações , Vigília/fisiologia , Biorretroalimentação Psicológica , Bruxismo/diagnóstico , Humanos , Transtornos da Articulação Temporomandibular/diagnóstico
11.
Chronobiol Int ; 37(8): 1181-1190, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32757673

RESUMO

The Chinese Government quarantined Wuhan on 23 January 2020 and thereafter the Hubei province, affecting a total of 59 million citizens, to cease the spread of the coronavirus disease in 2019 (COVID-19). The effects of this lockdown on the psychological and mental health of both the affected and unaffected Chinese are largely unknown currently. We utilized one of the largest crowdsourced databases (Sleep as Android) that consisted of 15,681 sleep records from 563 users in China to estimate the change in the sleep pattern of Chinese users during the span of 30 December 2019 to 8 March 2020 with reference to 64,378 sleep records of 1,628 users for the same calendar period of years 2011-2019. The sleep pattern in China changed drastically after 23 January 2020 when the law of quarantine and suspension of Wuhan became effective. The two major findings are: (1) Chinese people increased their sleep duration by an average of 20 min and delayed their sleep onset by an average of 30 min at weekdays, while they maintained a similar sleep duration at weekends, and (2) larger changes were found in several subgroups, including those in Wuhan (80 sleep records from 3 users), female subjects, and those aged ≤ 24 years. Overall, Chinese people slept later and longer than usual during the COVID-19 pandemic quarantine.


Assuntos
Betacoronavirus/metabolismo , Ritmo Circadiano/fisiologia , Infecções por Coronavirus/fisiopatologia , Crowdsourcing , Pneumonia Viral/fisiopatologia , Sono/fisiologia , Vigília , China/epidemiologia , Infecções por Coronavirus/virologia , Surtos de Doenças , Humanos , Saúde Mental , Pandemias , Pneumonia Viral/virologia , Quarentena/psicologia , Transtornos do Sono-Vigília/epidemiologia , Smartphone
12.
J Oral Rehabil ; 47(9): 1110-1119, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32613647

RESUMO

BACKGROUND: Sleep bruxism (SB) and awake bruxism (AB) have been considered different entities, although co-occurrence between them has been shown. While genetic factors have a marked influence on phenotypic variance in liability to SB, this remains unclear for AB. AIM: To examine the degree of co-occurrence of SB and AB, and whether they have common correlates and also twin similarity of SB and AB bruxism traits by zygosity and sex. METHODS: A questionnaire was mailed to all twins born 1945-1957 in Finland in 2012 (n = 11 766). Age and sex adjusted logistic regression models were used. Twin similarity was assessed using polychoric correlations, and crosstwin-crosstrait correlations were computed. RESULTS: The response rate was 72% (n = 8410). Any SB was reported by 14.8% and ≥ 3 nights weekly by 5.0%. Percentages for any AB were 18.4% and 6.3%, respectively. There was substantial co-occurrence (29.5%) between SB and AB, and several shared correlates were found. For SB, the polychoric intra-class correlation was 0.366 in monozygotic (MZ) and 0.200 in dizygotic (DZ) pairs, without gender difference. A twofold crosstwin-crosstrait correlation was observed in MZ twins compared to DZ twins. CONCLUSIONS: The risk factor profiles of SB and AB were largely but not entirely similar. The higher correlation in MZ than in DZ pairs suggests the influence of genetic factors on both SB and AB. The higher crosstwin-crosstrait correlation in MZ than in DZ pairs suggests some degree of genetic influences shared by SB and AB.


Assuntos
Gêmeos Dizigóticos , Vigília , Finlândia , Humanos , Autorrelato , Gêmeos Monozigóticos
13.
Zhongguo Gu Shang ; 33(7): 659-61, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32700491

RESUMO

OBJECTIVE: To explore the application and clinical effect of wide awake local anesthesia no tourniquet technique in the surgery of bilateral carpal tunnel syndrome. METHODS: From March 2016 to August 2018, 20 patients (40 sides) with bilateral carpal tunnel syndrome were treated by wide awake technique. All patients were female, aged from 32 to 56 (50.8±6.4) years old. The anesthetic, intraoperative and postoperative pain and anxiety were evaluated, operative field bleeding in operation were assessed, postoperative skin healing of surgical area and anesthetic complications were observed, and Kelly grading were used to evaluate recovery of function. RESULTS: Twenty patients were followed up from 6 to 9 months with an average of 7.8 months. There was light anxiety before injection (NRS score rangedfrom 1 to 3), slight pain occurred during injection on the first poke (NRS ranged from 2 to 3);no pain and anxiety during operation (NRS score was 0);mild or moderate pain (NRS score ranged from 1 to 6) without anxiety(NRS score was 0) after operation was occurred. Surgical skin healed well at the stageⅠwithout side effect of anesthetic. At final follow-up, according to Kelly grading, 30 sides got excellent results, 8 sides good and 2 sides fair. CONCLUSION: Wide awake technique is safe and effective in treating neurolysis of bilateral carpal tunnel syndrome, and could receive good clinical effects.


Assuntos
Síndrome do Túnel Carpal , Adulto , Anestesia Local , Feminino , Humanos , Pessoa de Meia-Idade , Dor Pós-Operatória , Vigília
14.
Nat Commun ; 11(1): 3240, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32632168

RESUMO

Astrocytic Ca2+ signaling has been intensively studied in health and disease but has not been quantified during natural sleep. Here, we employ an activity-based algorithm to assess astrocytic Ca2+ signals in the neocortex of awake and naturally sleeping mice while monitoring neuronal Ca2+ activity, brain rhythms and behavior. We show that astrocytic Ca2+ signals exhibit distinct features across the sleep-wake cycle and are reduced during sleep compared to wakefulness. Moreover, an increase in astrocytic Ca2+ signaling precedes transitions from slow wave sleep to wakefulness, with a peak upon awakening exceeding the levels during whisking and locomotion. Finally, genetic ablation of an important astrocytic Ca2+ signaling pathway impairs slow wave sleep and results in an increased number of microarousals, abnormal brain rhythms, and an increased frequency of slow wave sleep state transitions and sleep spindles. Our findings demonstrate an essential role for astrocytic Ca2+ signaling in regulating slow wave sleep.


Assuntos
Astrócitos/metabolismo , Sinalização do Cálcio , Sono de Ondas Lentas/fisiologia , Animais , Camundongos , Vigília/fisiologia
15.
Sr Care Pharm ; 35(8): 336-337, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32718388

RESUMO

As the number of people taking multiple medications increases, differing approaches to address drug-drug interactions and adverse drug reactions have been debated-but not solved-despite excellent criteria to stop the use of potentially inappropriate medications.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Interações Medicamentosas , Humanos , Farmacêuticos , Lista de Medicamentos Potencialmente Inapropriados , Vigília
16.
Clin Ter ; 171(4): e335-e339, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614368

RESUMO

Awake fiberoptic intubation (AFOI) is mandatory to manage difficult airways. Superior laryngeal nerve block (SLNB) could reduce risks and improve patient comfort. The aim of this study is to assess the procedural comfort of SLNB during AFOI in a population of patients undergoing upper airway oncological surgery. Forty patients were randomized into two groups and were treated with continuous infusion of remifentanil, topic anesthesia and intercricoid block. In the study group (=20), SLNB was performed with lidocaine (L-SLNB); in the control group (n=20) SLNB was performed using saline (S-SLNB). AFOI was more comfortable in the L-SLNB group compared to S-SLNB patients [FOICS ≤ 1 in 18 patients (90%) L-SLNB; 2 (10%) S-SLNB (P <0.001)]. Intubation was faster in L-SLNB (47.45 ±15.38 sec) than S-SLNB (80.15 ±37.91 sec) (p <0.001). The SLNB procedure during AFOI is a safe and comfortable procedure in a population of patients undergoing upper airways surgery. Time to intubation was shorter in L-SLNB than in S-SLNB.


Assuntos
Obstrução das Vias Respiratórias/terapia , Intubação Intratraqueal , Nervos Laríngeos , Bloqueio Nervoso , Obstrução das Vias Respiratórias/cirurgia , Anestesia Local , Constrição Patológica , Feminino , Tecnologia de Fibra Óptica/métodos , Humanos , Intubação Intratraqueal/métodos , Lidocaína , Masculino , Pessoa de Meia-Idade , Vigília
17.
PLoS One ; 15(7): e0236404, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716956

RESUMO

Driving accidents due to hypovigilance are common but the role of hypnotics is unclear in patients suffering from sleep disorders. Our study examined factors influencing accidents and near miss accidents attributed to sleepiness at the wheel (ANMAS). Using data from an online questionnaire aimed at patients with sleep disorders, we analysed the associations between ANMAS, sociodemographic data, symptoms of sleep disorders, severity of insomnia (Insomnia Severity Index (ISI)) symptoms of anxiety and depression (Hospital Anxiety and Depression scale with depression (HADD) and anxiety (HADA) subscales), chronic sleepiness (Epworth sleepiness scale ESS), hypnotic use and information about sleep habits. Hypnotics were hierarchically grouped into Z-drugs, sedative medication, melatonin and over the counter (OTC) alternative treatments. Of 10802 participants; 9.1% reported ANMAS (Men 11.1% women 8.3%) and 24.4% took hypnotics (Z-drugs 8.5%, sedative medication 8%, melatonin 5.6% and alternative treatments 2.5%). Logistic regression analysis identified the following risk factors for ANMAS: moderate (OR 2.4; CI: 2.10-2.79) and severe sleepiness (ESS OR 5.66; CI: 4.74-6.77), depression (HADD OR 1.2; CI: 1.03-1.47), anxiety (HADA OR 1.2;CI: 1.01-1.47), and insufficient sleep (OR1.4; CI: 1.2-1.7). Hypnotics were not associated with an increased risk of ANMAS in patients suffering from insomnia. Risk factors varied according to sex: in females, sex (OR 0.; CI: 0.55-0.74), mild insomnia (OR 0.5; CI: 0.3-0.8) and use of alternative treatments (OR 0.455, CI:0.23-0.89) were protective factors and risk was increased by sleepiness, sleep debt, social jetlag, caffeine use, anxiety and depression. In men no protective factors were identified: sleepiness, sleep debt, and severe insomnia were associated with an increased risk of ANMAS. In clinical practice, all patients with daytime sleepiness and men with severe insomnia should be counselled concerning driving risk and encouraged to avoid sleep debt.


Assuntos
Acidentes de Trânsito , Condução de Veículo , Hipnóticos e Sedativos/efeitos adversos , Near Miss , Caracteres Sexuais , Sonolência , Vigília , Acidentes de Trânsito/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Condução de Veículo/psicologia , Comportamento , Doença Crônica , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
19.
Proc Natl Acad Sci U S A ; 117(29): 17359-17368, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32636265

RESUMO

Sleep disorders are among the most debilitating comorbidities of Parkinson's disease (PD) and affect the majority of patients. Of these, the most common is insomnia, the difficulty to initiate and maintain sleep. The degree of insomnia correlates with PD severity and it responds to treatments that decrease pathological basal ganglia (BG) beta oscillations (10-17 Hz in primates), suggesting that beta activity in the BG may contribute to insomnia. We used multiple electrodes to record BG spiking and field potentials during normal sleep and in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinsonism in nonhuman primates. MPTP intoxication resulted in severe insomnia with delayed sleep onset, sleep fragmentation, and increased wakefulness. Insomnia was accompanied by the onset of nonrapid eye movement (NREM) sleep beta oscillations that were synchronized across the BG and cerebral cortex. The BG beta oscillatory activity was associated with a decrease in slow oscillations (0.1-2 Hz) throughout the cortex, and spontaneous awakenings were preceded by an increase in BG beta activity and cortico-BG beta coherence. Finally, the increase in beta oscillations in the basal ganglia during sleep paralleled decreased NREM sleep, increased wakefulness, and more frequent awakenings. These results identify NREM sleep beta oscillation in the BG as a neural correlate of PD insomnia and suggest a mechanism by which this disorder could emerge.


Assuntos
Gânglios da Base/fisiopatologia , Doença de Parkinson/complicações , Distúrbios do Início e da Manutenção do Sono/complicações , Sono/fisiologia , 1-Metil-4-Fenil-1,2,3,6-Tetra-Hidropiridina/efeitos adversos , Animais , Ritmo beta/fisiologia , Córtex Cerebral/patologia , Haplorrinos , Humanos , Doença de Parkinson/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Vigília
20.
Nat Commun ; 11(1): 3661, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32694504

RESUMO

The relationship between orexin/hypocretin and rapid eye movement (REM) sleep remains elusive. Here, we find that a proportion of orexin neurons project to the sublaterodorsal tegmental nucleus (SLD) and exhibit REM sleep-related activation. In SLD, orexin directly excites orexin receptor-positive neurons (occupying ~3/4 of total-population) and increases gap junction conductance among neurons. Their interaction spreads the orexin-elicited partial-excitation to activate SLD network globally. Besides, the activated SLD network exhibits increased probability of synchronized firings. This synchronized excitation promotes the correspondence between SLD and its downstream target to enhance SLD output. Using optogenetics and fiber-photometry, we consequently find that orexin-enhanced SLD output prolongs REM sleep episodes through consolidating brain state activation/muscle tone inhibition. After chemogenetic silencing of SLD orexin signaling, a ~17% reduction of REM sleep amounts and disruptions of REM sleep muscle atonia are observed. These findings reveal a stabilization role of orexin in REM sleep.


Assuntos
Tronco Encefálico/fisiologia , Orexinas/metabolismo , Privação do Sono/fisiopatologia , Sono REM/fisiologia , Potenciais de Ação/fisiologia , Animais , Comportamento Animal , Tronco Encefálico/citologia , Modelos Animais de Doenças , Eletrodos Implantados , Eletroencefalografia , Eletromiografia , Humanos , Masculino , Camundongos , Camundongos Transgênicos , Tono Muscular/fisiologia , Neurônios/metabolismo , Optogenética , Receptores de Orexina/metabolismo , Orexinas/genética , Técnicas de Patch-Clamp , Ratos , Ratos Sprague-Dawley , Vigília/fisiologia
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