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1.
Zhonghua Yi Xue Za Zhi ; 104(27): 2471-2476, 2024 Jul 16.
Artigo em Chinês | MEDLINE | ID: mdl-38978371

RESUMO

Idiopathic hypersomnia(IH) is a chronic central disorders of hypersomnolence that manifests as excessive daytime sleepiness occurring despite normal or prolonged sleep time. Due to the individual heterogeneity of disease, the high overlap of clinical, poor repeatability of polysomnography monitoring results and the lack of clear disease biomarkers, clinical diagnosis and differential diagnosis are still difficult. This article summarizes the update of diagnostic criteria, clinical manifestations, diagnosis and treatment strategies of IH, in order to receive attention, increase the recognition rate of clinical diagnosis, reduce the misdiagnosis rate and missed diagnosis rate.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Hipersonia Idiopática , Polissonografia , Humanos , Diagnóstico Diferencial , Hipersonia Idiopática/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Transtornos do Sono-Vigília/diagnóstico
2.
Sleep Med ; 120: 10-14, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38824847

RESUMO

The effects of exercise on daytime sleepiness remain unclear, with conflicting findings in the literature. We reviewed the existing literature on the relationship between exercise and daytime sleepiness in healthy individuals. We conducted a systematic search of PubMed and Google Scholar (1991 to present) for interventional studies that used the Epworth Sleepiness Scale (ESS) to measure change in self-reported degree of sleepiness before and after an exercise regimen. Seven studies were included in the review. Exercise significantly improved self-reported sleepiness after the intervention, as measured by ESS, in 4 of the 7 studies; the other studies indicated no significant difference. Additionally, exercise interventions enhanced sleep quality, evident in lower Pittsburgh Sleep Quality Index scores in 4 of 5 studies, thus indirectly alleviating daytime sleepiness. Results were variable and influenced by exercise type, intensity, and timing, as well as participant adherence. Factors that may contribute to the effect of exercise on daytime sleepiness include improved sleep quality, regulation of circadian rhythms, neurotransmitter release, stress reduction, increased energy levels, and weight reduction. This review suggests benefits of exercise for reducing daytime sleepiness and improving sleep quality. Future research is essential for assessing the mechanisms of these effects.


Assuntos
Exercício Físico , Qualidade do Sono , Humanos , Exercício Físico/fisiologia , Sonolência , Distúrbios do Sono por Sonolência Excessiva , Ritmo Circadiano/fisiologia
3.
Sleep Med ; 119: 192-200, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38701718

RESUMO

BACKGROUND AND OBJECTIVES: Nonconvulsive status epilepticus (NCSE) manifests as a change in mental status without a coma (NCSE proper) or comatose NCSE. Hypocretin-1/orexin-A (H/O) is involved in alertness and sleep maintenance. Sleep impairment and excessive daytime sleepiness (EDS) have a negative impact on cognitive functions and activities of daily living (ADL). METHODS: Patients meeting the NCSE criteria underwent cerebrospinal fluid and brain magnetic resonance imaging examinations, polysomnographies (PSG), multiple latency sleep tests (MSLT), and completed Epworth Sleepiness Scale (ESS). Montreal Cognitive Assessment was used to evaluate cognitive functions, and the Barthel Index was used to assess ADL in the acute phase (V1) and three months follow-up (V2). RESULTS: From May 2020 to May 2023, we enrolled 15 patients, eight (53.3 %) women, with a median age of 69 (14) years. The median H/O CSF concentration was 250 (63.6) pg/ml; however, only three CSF samples (20 %) decreased below the borderline concentration of 200 pg/ml. Fourteen out of 15 patients (93.3 %) completed the PSG study. The median of wakefulness after sleep onset was 167 (173.5) min, sleep efficiency (SE) was 62.9 (63) %, sleep latency (SL) was 6 (32) min, REM sleep was 2.85 (7.2) %, and REM first episode latency was 210.5 (196.5) minutes. The medians of the stages N1 NREM were 4.65 (15) %, N2 NREM 68.4 (29.9) %, and N3 NREM 21.8 (35.5) %. MSLT mean latency was 7.7 (12.6) minutes. A significant negative correlation exists between H/O CSF concentrations and the stage N1 NREM (rs = -0.612, p = 0.02), and the proportion of cumulative sleep time with oxygen saturation below 90 % in total sleep time (TST) t90 (rs = -0.57, p = 0.03). MSLT had significant negative correlation with TST (rs = -0.5369, p = 0.0478), with SE (rs = -0.5897, p = 0.0265), with apnea-hypopnea index (rs = -0.7631, p = 0.0002) and with deoxygenation index (rs = -0.8009, p = 0.0006). A positive correlation exists between MSLT and SL (rs = 0.6284, p = 0.0161) and between ESS and t90 (rs = 0.9014, p = 0.0004). The correlation between H/O CSF concentrations and EDS, cognitive performance, and ADL was not proved. CONCLUSIONS: Patients after NCSE exhibited sleep impairment and excessive daytime sleepiness. Hypocretin-1/orexin-A concentrations decreased only in 20 % of these cases.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Orexinas , Polissonografia , Estado Epiléptico , Humanos , Feminino , Orexinas/líquido cefalorraquidiano , Masculino , Estado Epiléptico/líquido cefalorraquidiano , Idoso , Distúrbios do Sono por Sonolência Excessiva/líquido cefalorraquidiano , Estudos Transversais , Sono/fisiologia , Estudos de Coortes , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética
4.
Sleep Med ; 119: 488-498, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38796978

RESUMO

Idiopathic hypersomnia typically is a chronic and potentially debilitating neurologic sleep disorder, and is characterized by excessive daytime sleepiness. In addition to excessive daytime sleepiness, idiopathic hypersomnia symptoms can include severe sleep inertia; long, unrefreshing naps; long sleep time; and cognitive dysfunction. Patients with idiopathic hypersomnia may experience a significant impact on their quality of life, work or school performance, earnings, employment, and overall health. Given the complex range of symptoms associated with idiopathic hypersomnia and the array of treatments available, there is a need to provide guidance on the treatment of idiopathic hypersomnia and the clinically relevant recommendations that enhance effective disease management. Identifying appropriate treatment options for idiopathic hypersomnia requires timely and accurate diagnosis, consideration of individual patient factors, and frequent reassessment of symptom severity. In 2021, low-sodium oxybate was the first treatment to receive approval by the US Food and Drug Administration for the treatment of idiopathic hypersomnia in adults. However, many off-label treatments continue to be used. Adjunct nonpharmacologic therapies, including good sleep hygiene, patient education and counseling, and use of support groups, should be recognized and recommended when appropriate. This narrative review describes optimal treatment strategies that take into account patient-specific factors, as well as the unique characteristics of each medication and the evolution of a patient's response to treatment. Perspectives on appropriate symptom measurement and management, and potential future therapies, are also offered.


Assuntos
Hipersonia Idiopática , Humanos , Hipersonia Idiopática/terapia , Hipersonia Idiopática/diagnóstico , Hipersonia Idiopática/tratamento farmacológico , Qualidade de Vida , Distúrbios do Sono por Sonolência Excessiva/terapia , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Oxibato de Sódio/uso terapêutico
5.
Ann Med ; 56(1): 2352028, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38803075

RESUMO

BACKGROUND: Daytime sleepiness is an important health problem. However, the dimensionality of the Epworth Sleepiness Scale (ESS) in older adults remains unclear. This study aimed to determine the prevalence of ESS-defined excessive daytime sleepiness in older adults. Furthermore, the dimensionality of ESS and its respective correlates were also compared. MATERIALS AND METHODS: This is a community-based survey in which community-dwelling older adults aged ≥ 65 years participated. Excessive daytime sleepiness was assessed using the ESS and was defined as an ESS score of > 10. Exploratory factor analysis was performed to identify the ESS factors. Multiple logistic regression analysis was used to examine the independent correlates of the ESS-defined and factor-specific correlates of excessive daytime sleepiness. RESULTS: In total, 3978 older adults participated in this study. The mean age was 76.6 ± 6.7 years, with 53.8% ≥ 75 years, and 57.1% were female. The prevalence of ESS-defined excessive daytime sleepiness was 16.0%. An exploratory factor analysis revealed two factors in the ESS, which were designated as 'passive' and 'active' according to the soporific levels of ESS items loaded in each factor. Multiple logistic regression showed that male, illiteracy, depression, disability, short sleep duration and no exposure to hypnotics were risk indicators for ESS-defined excessive daytime sleepiness. However, the correlates for passive and active factor-defined excessive daytime sleepiness differ in pattern, especially in variables related to education, exercise, mental health, and sleep. CONCLUSIONS: The prevalence of ESS-defined excessive daytime sleepiness is high, and its correlates vary among older adults. This study also suggests a dual ESS structure in community-dwelling older adults.


Daytime sleepiness is prevalent in older adults.The Epworth Sleepiness Scale (ESS) has dual constructs in older adults.Correlates for excessive daytime sleepiness vary by constructs of the ESS.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Vida Independente , Humanos , Masculino , Feminino , Idoso , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Taiwan/epidemiologia , Prevalência , Vida Independente/estatística & dados numéricos , Idoso de 80 Anos ou mais , Inquéritos e Questionários , Fatores de Risco , Análise Fatorial , Modelos Logísticos , Estudos Transversais
6.
Sleep Med ; 119: 35-43, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38636214

RESUMO

OBJECTIVE: This study aimed to investigate the prevalence, clinical correlates and the relationship between hypersomnolence and clinical outcomes in a cohort of MDD patients. METHODS: This is a cross-sectional study of a MDD cohort in an university-affiliated adult psychiatric outpatient clinic. The diagnosis of MDD and severity of depression were ascertained by the clinician with structured clinical interviews. Each participant completed the Epworth Sleepiness Scale (ESS), 1-week sleep diary, and a battery of questionnaires that assessed usual sleep pattern, insomnia, anxiety, depression, fatigue and circadian preference. Hypersomnolence was defined as ESS score ≥14 among those reported ≥7 h of nighttime sleep. Univariate analysis and multiple logistic regression were used to analyze the relationships between the variables. RESULTS: Among 252 recruited subjects, 11 % met the criteria of hypersomnolence as defined by a ESS score ≥14 despite ≥7 h of nighttime sleep. Patients with hypersomnolence had greater depression ratings, higher rates of suicidal ideations over the past week, and more likely to meet a diagnosis of atypical depression (p < 0.05) than those without hypersomnolence. Step-wise logistic regression demonstrated that hypersomnolence was an independent risk factor associated with a 3-fold increase in the risk of depression non-remission (adjusted OR 3.13; 95 % CI 1.10-8.95; p = 0.034). CONCLUSION: Patients with hypersomnolence despite seemingly adequate sleep represent a subgroup of MDD patients who have a more severe illness profile with higher non-remission rate and suicidality. The findings highlight the importance of addressing both sleep and mood symptoms in the management of MDD.


Assuntos
Transtorno Depressivo Maior , Distúrbios do Sono por Sonolência Excessiva , Humanos , Masculino , Feminino , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Ideação Suicida , Fatores de Risco , Prevalência
7.
Sleep Med ; 119: 53-57, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38643516

RESUMO

BACKGROUND: Sleep disorders and psychiatric disorders stand in a bidirectional relationship. Sleep complaints are prominent in populations with psychiatric disorders, especially amongst people with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Consultations at sleep clinics offer opportunities to screen psychiatric disorders and to propose primary psychiatric care. METHODS: This descriptive study was conducted on 755 patients making their first visit to sleep clinic, with 574 seeking consultation for suspected obstructive sleep apnoea-hypopnoea syndrome (OSAHS), 139 for complaints of insomnia, and 42 for complaints of hypersomnia. The results of 387 screening scales for MDD (BDI-II) and 403 for TSPT (PCL-5) were compared according to the reason given for the consultation. RESULTS: In the whole group, 12.1 % of patients presented a positive MDD screening and 4.9 % for PTSD. Among patients presenting with insomnia, 19.8 % had a positive screening for MDD, as compared to 9.3 % in patients presenting with suspected OSAHS (p = 0.02). Regarding PTSD, 9.7 % of patients seeking consultation because of insomnia had a positive screening, compared to 2.9 % among patients with suspected OSAHS (p = 0.03). Among patients with a positive screening for MDD, 40.5 % were not receiving antidepressant or mood stabilizer treatment. CONCLUSION: Positive screening for MDD and PTSD are frequent in patients who attend sleep centers, especially amongst those presenting with insomnia. Nearly half of the patients with positive screening for MDD or PTSD were not receiving a dedicated pharmacological treatment. These figures emphasize systematic screening for psychiatric disorders in sleep clinics.


Assuntos
Transtorno Depressivo Maior , Distúrbios do Início e da Manutenção do Sono , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtorno Depressivo Maior/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Prevalência , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Distúrbios do Sono por Sonolência Excessiva/diagnóstico
8.
Rev Assoc Med Bras (1992) ; 70(3): e20231141, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38656002

RESUMO

OBJECTIVE: The aim of this study was to assess medical students' quality of sleep and excessive daytime sleepiness in different graduation cycles. METHODS: A cross-sectional study was carried out at a private university in Maceió, Brazil, from August 2021 to March 2022. The sample was composed of medical students aged 18 years and above from years 1-2 (basic cycle), 3-4 (clinical cycle), and 5-6 (internship) of Medical School who were invited to answer two validated questionnaires: the Pittsburgh Sleeping Quality Index and the Epworth Sleepiness Scale. RESULTS: A total of 179 students participated; most of them were female (78.2%), aged 19-25 years (73.7%), and with a body mass index<25 kg/m2 (73.7%), with smaller participation from students from the basic cycle (21.2%). Analyzing the Pittsburgh Sleeping Quality Index, 55.9% of the students were classified as having poor sleep quality, with no difference in sleep category between gender, age, body mass index, and graduation cycle. Students with a body mass index of ≥25 kg/m2 had longer sleep latency (p=0.016) and shorter sleep duration (p=0.027). The Epworth Sleepiness Scale assessment showed that 44.1% of the students exhibit daytime sleepiness. Women had more daytime sleepiness than men (p=0.017), with no difference between age, body mass index, and graduation cycle. CONCLUSION: About half of the medical students experience poor sleep quality and daytime sleepiness, regardless of the graduation cycle. This should trigger a targeted institutional intervention to promote better mental and physical health, as well as sleep hygiene, to reduce future health issues.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Qualidade do Sono , Estudantes de Medicina , Humanos , Feminino , Estudantes de Medicina/estatística & dados numéricos , Masculino , Estudos Transversais , Brasil/epidemiologia , Adulto Jovem , Adulto , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Inquéritos e Questionários , Universidades , Índice de Massa Corporal , Adolescente
9.
Sleep Med ; 118: 93-100, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38657350

RESUMO

OBJECTIVE: Excessive daytime sleepiness (EDS) persists in some patients with obstructive sleep apnea (OSA) despite continuous positive airway pressure (CPAP) treatment. This study characterized response to CPAP and factors associated with residual EDS. METHODS: Danish National Patient Registry data were analyzed. Patients with OSA diagnosis (1994-2016), Epworth Sleepiness Scale (ESS) scores and apnea-hypopnea index recorded before beginning CPAP (baseline) and after 1-13 months of CPAP use, and CPAP adherence were included. Odds ratios (OR) for residual EDS after CPAP treatment were estimated using multivariate logistic regression. RESULTS: Of 1174 patients (mean age, 57 years; 75.5% male), 41.1% had baseline EDS (mild, 13.2%; moderate, 14.0%; severe, 13.9%); 58.9% did not. After CPAP treatment, follow-up mean ESS scores were normal (≤10) for all baseline EDS subgroups; however, 15.6% (n = 183) of patients had residual EDS (mild, 6.7%; moderate, 5.5%; severe, 3.4%). Odds of residual EDS were higher for patients with mild (OR, 5.2; 95% confidence interval [CI], 3.2-8.6), moderate (OR, 4.5; 95% CI, 2.7-7.4), and severe (OR, 13.0; 95% CI, 8.0-21.2) EDS at baseline compared with those with normal daytime sleepiness at baseline. Patients adherent with CPAP use were 38.2% less likely to have residual EDS compared with nonadherent patients (OR, 0.62; 95% CI, 0.43-0.88). CONCLUSIONS: EDS was common in this cohort of Danish patients with OSA. Baseline EDS severity predicted higher odds of residual EDS. After CPAP treatment, adherence was associated with reduced odds of residual EDS, but EDS persisted in a subgroup of patients.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Distúrbios do Sono por Sonolência Excessiva , Sistema de Registros , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Dinamarca/epidemiologia , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Cooperação do Paciente/estatística & dados numéricos , Idoso
10.
Rev. Ciênc. Plur ; 10 (1) 2024;10(1): 34483, 2024 abr. 30. tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1553344

RESUMO

Objetivo:Avaliar a correlação entre a ansiedade com qualidade do sono e sonolência diurna dos estudantes universitários em curso de graduação em enfermagem, assim como caracterizar o perfil sociodemográfico dos estudantes. Metodologia:Estudodescritivo transversalcom abordagem quantitativa envolvendo 255 acadêmicos do curso de Enfermagem de uma instituição privada. A coleta dos dados ocorreu em Outubro de 2022 em salas de aula. Os instrumentos utilizados na coleta dos dados foram o Inventário de Ansiedade de Beck,Índice de Qualidade do Sono de Pittsburgh, Escala de Sonolência de Epwort-th e um questionário sociodemográfico. Utilizou-se o software estatístico R versão 4.0.2 e foram feitas suas correlações. Resultados: Foram encontrados padrões de ansiedade grave, com níveis de sonolência diurna anormal. A correlação entre o Inventário de Ansiedade de Beckcom a Escala de Sonolência de Epworth e o Índice de Qualidade de sono de Pittsburgh, que embora tenha sido considerada fraca a moderada, por sua vez mostrou-se significativa (r=0,29; p=0,01). Ademais, temos que, a relação entre oinventário de Becke o Índice de qualidade de sono de Pittsburgh mostrou-se também com valor de significância (r=0,35; p=0,01). Conclusões:Foi possível compreender que a ansiedade pode interferir na qualidade do sono e sonolência diurna do público de estudantes de Enfermagem (AU).


Objective: To evaluate the correlation between anxiety and sleep quality and daytime sleepiness among undergraduate nursing students, as well as to characterize the students' sociodemographic profile. Methodology: A cross-sectional descriptive study with a quantitative approach involving 255 nursing students from a private institution. Data collection took place in October 2022 in classrooms. The instruments used to collect the data were the Beck Anxiety Inventory, the Pittsburgh Sleep Quality Index, the Epwort-Th Sleepiness Scale and a sociodemographic questionnaire. Statistical software R version 4.0.2 was used and correlations were made. Results:Patterns of severe anxiety were found, with abnormal levels of daytime sleepiness. The correlation between the Beck Anxiety Inventory, the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index, although considered weak to moderate, was significant (r=0.29; p=0.01). Furthermore, the relationship between the Beck Inventory and the Pittsburgh Sleep Quality Index was also found to be significant (r=0.35; p=0.01). Conclusions:It was possible to understand that anxiety can interfere with the quality of sleep and daytime sleepiness among nursing students (AU).


Objetivo:Evaluar la correlación entre la ansiedad y la calidad del sueño y la somnolencia diurna en estudiantes universitarios de enfermería, así como caracterizar el perfil sociodemográfico de los estudiantes. Metodología:Estudio descriptivo transversal con enfoque cuantitativo en el que participaron 255 estudiantes universitarios de enfermería de una institución privada. La recogida de datos tuvo lugar en octubre de 2022 en las aulas. Los instrumentos utilizados para la recogida de datos fueron el Inventario de Ansiedad de Beck, el Índice de Calidad del Sueño de Pittsburgh, la Escala de Somnolencia de Epwort-Th y un cuestionario sociodemográfico. Se utilizó el software estadístico R versión 4.0.2 y se realizaron correlaciones. Resultados:Se encontraron patrones de ansiedad severa, con niveles anormales de somnolencia diurna. La correlación entre el Inventario de Ansiedad de Beck con la Escala de Somnolencia de Epworth y el Índice de Calidad del Sueño de Pittsburgh, aunque se consideró de débil a moderada, fue significativa (r=0,29; p=0,01). Además, la relación entre el Inventario de Beck y el Índice de Calidad del Sueño de Pittsburgh también resultó significativa (r=0,35; p=0,01). Conclusiones: Se pudo comprender que la ansiedad puede interferir en la calidad del sueño y en la somnolencia diurna de los estudiantes de enfermería (AU).


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Transtornos de Ansiedade/psicologia , Estudantes de Enfermagem , Qualidade do Sono , Distúrbios do Sono por Sonolência Excessiva/psicologia , Transtornos do Sono-Vigília , Estudos Transversais/métodos , Inquéritos e Questionários , Interpretação Estatística de Dados , Determinantes Sociais da Saúde , Fatores Sociodemográficos
11.
CPT Pharmacometrics Syst Pharmacol ; 13(5): 880-890, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38468601

RESUMO

Obstructive sleep apnea (OSA) is a sleep disorder which is linked to many health risks. The gold standard to evaluate OSA in clinical trials is the Apnea-Hypopnea Index (AHI). However, it is time-consuming, costly, and disregards aspects such as quality of life. Therefore, it is of interest to use patient-reported outcomes like the Epworth Sleepiness Scale (ESS), which measures daytime sleepiness, as surrogate end points. We investigate the link between AHI and ESS, via item response theory (IRT) modeling. Through the developed IRT model it was identified that AHI and ESS are not correlated to any high degree and probably not measuring the same sleepiness construct. No covariate relationships of clinical relevance were found. This suggests that ESS is a poor choice as an end point for clinical development if treatment is targeted at improving AHI, and especially so in a mild OSA patient group.


Assuntos
Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Sonolência , Qualidade de Vida , Medidas de Resultados Relatados pelo Paciente , Índice de Gravidade de Doença , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Adulto , Idoso
12.
Neurol India ; 72(1): 83-89, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38443007

RESUMO

BACKGROUND: DM1 is a multisystem disorder caused by expansion of a CTG triplet repeat in the 3' non-coding region of DMPK. Neuropsychological consequences and sleep abnormalities are important associations in DM1. OBJECTIVE: To describe the clinical phenotype, disease progression and characterize the sleep alterations and cognitive abnormalities in a sub-set of patients. MATERIALS AND METHODS: A retrospective study on 120 genetically confirmed DM1 cases. Findings in neuropsychological assessment and multiple sleep questionnaires were compared with 14 age and sex matched healthy individuals. All 120 patients were contacted through letters/telephonic consultation/hospital visits to record their latest physical and functional disabilities. RESULTS: The mean age at symptom onset was 23.1 ± 11.4 years, M: F = 3.8:1, mean duration of illness = 14.3 ± 9.5 years. Clinically 54.2% had adult onset form, juvenile = 27.5%, infantile = 10.8%, late adult onset = 7.5%. Paternal transmission occurred more frequently. The predominant initial symptoms were myotonia (37.5%), hand weakness (21.7%), lower limb weakness (23.3%) and bulbar (10%). Twenty patients completed sleep questionnaires (SQ). Abnormal scores were noted in Epworth sleepiness scale (55%); Pittsburgh sleep quality index (45%); Berlin SQ (30%); Rapid eye movement sleep Behaviour Disorder SQ (15%); Restless leg syndrome rating scale (10%). Neuropsychological assessment of 20 patients revealed frontal executive dysfunction, attention impairment and visuospatial dysfunction. Frontal lobe was most affected (72%) followed by parietal (16%) and temporal lobe (12%). CONCLUSIONS: The current study provides a comprehensive account of the clinical characteristics in Indian patients with DM1. Hypersomnolence was most commonly seen. Excessive daytime sleepiness and Sleep disordered breathing were the most common sleep related abnormality. Cognitive impairment comprised predominantly of frontal lobe dysfunction.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Miotonia , Distrofia Miotônica , Adulto , Humanos , Criança , Adolescente , Adulto Jovem , Distrofia Miotônica/complicações , Estudos Retrospectivos , Progressão da Doença
13.
Sleep ; 47(6)2024 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-38531670

RESUMO

STUDY OBJECTIVES: Recent studies suggest that sleepy patients with obstructive sleep apnea (OSA) are at higher risk for incident cardiovascular disease. This study assessed cardiac autonomic function in sleepy versus non-sleepy patients with OSA using heart rate variability (HRV) analysis. We hypothesized that HRV profiles of sleepy patients would indicate higher cardiovascular risk. METHODS: Electrocardiograms (ECG) derived from polysomnograms (PSG) collected by the Sydney Sleep Biobank were used to study HRV in groups of sleepy (ESS ≥ 10) and non-sleepy OSA patients (ESS < 10). HRV parameters were averaged across available ECG signals during N2 sleep. RESULTS: A total of 421 patients were evaluated, with a mean age of 54 (14) years, body mass index of 33 (9) kg/m2, apnea-hypopnea index of 21 (28) events/h, and 66% male. The sleepy group consisted of 119 patients and the non-sleepy group 302 patients. Sleepy patients exhibited lower HRV values for: root mean square successive difference (RMSSD, p = 0.028), total power (TP, p = 0.031), absolute low frequency (LF, p = 0.045), and high-frequency (HF, p = 0.010) power compared to non-sleepy patients. Sleepy patients with moderate-to-severe OSA exhibited lower HRV values for: (RMSSD, p = 0.045; TP, p = 0.052), absolute LF (p = 0.051), and HF power (p = 0.025). There were no differences in other time and frequency domain HRV markers. CONCLUSIONS: This study shows a trend toward parasympathetic withdrawal in sleepy OSA patients, particularly in moderate-to-severe cases, lending mechanistic support to the link between the sleepy phenotype and CVD risk in OSA.


Assuntos
Eletrocardiografia , Frequência Cardíaca , Polissonografia , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/complicações , Masculino , Frequência Cardíaca/fisiologia , Feminino , Pessoa de Meia-Idade , Adulto , Sistema Nervoso Autônomo/fisiopatologia , Distúrbios do Sono por Sonolência Excessiva/fisiopatologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-38526870

RESUMO

BACKGROUND: Excessive daytime sleepiness (EDS) is one of the most frequent nonmotor symptoms in Parkinson's disease (PD); however, the pathogenesis of EDS is unclear, and there is a lack of information on plasma biomarkers for EDS in PD. We aimed to investigate the plasma biomarkers of EDS in a large PD cohort. METHODS: A total of 159 PD patients were included in the prospective cohort study and followed up annually for 3 years. Plasma biomarkers including glial fibrillary acidic protein, amyloid-beta, p-tau181, and neurofilament light chain (NfL), were measured using an ultrasensitive single-molecule array (Simoa) technology at each visit. EDS was evaluated using the Epworth Sleepiness Scale (ESS). RESULTS: The frequency of EDS in PD increased from 15.1% at baseline to 25.0% after 3 years. The mean ESS scores increased from 5.1 (standard deviation [SD]: 4.8) at baseline to 6.1 (SD: 5.5) at the third year of follow-up. At baseline, compared with patients with PD without EDS, those with EDS were more likely to be male, had poorer cognitive performance, and more severe motor and nonmotor symptoms. The adjusted generalized estimating equations models showed that higher plasma NfL levels (OR: 1.047 [1.002-1.094], p = .042) were associated with EDS during follow-ups. The adjusted linear mixed-effects model showed that higher plasma NfL levels (ß 0.097 [0.012-0.183], p = .026) were associated with ESS scores during follow-ups. CONCLUSIONS: Higher plasma NfL levels were associated with EDS in PD, indicating an association between neuro-axonal degeneration and EDS in PD.


Assuntos
Biomarcadores , Distúrbios do Sono por Sonolência Excessiva , Doença de Parkinson , Humanos , Doença de Parkinson/sangue , Doença de Parkinson/complicações , Masculino , Feminino , Biomarcadores/sangue , Idoso , Estudos Prospectivos , Distúrbios do Sono por Sonolência Excessiva/sangue , Distúrbios do Sono por Sonolência Excessiva/etiologia , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Proteínas de Neurofilamentos/sangue , Pessoa de Meia-Idade , Peptídeos beta-Amiloides/sangue , Proteínas tau/sangue , Estudos Longitudinais
15.
BMJ Open ; 14(3): e067197, 2024 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-38531588

RESUMO

OBJECTIVES: To explore the relationship between physical activity over a 10-year period and current symptoms of insomnia, daytime sleepiness and estimated sleep duration in adults aged 39-67. DESIGN: Population-based, multicentre cohort study. SETTING: 21 centres in nine European countries. METHODS: Included were 4339 participants in the third follow-up to the European Community Respiratory Health Survey (ECRHS III), who answered questions on physical activity at baseline (ECRHS II) and questions on physical activity, insomnia symptoms, sleep duration and daytime sleepiness at 10-year follow-up (ECRHS III). Participants who reported that they exercised with a frequency of at least two or more times a week, for 1 hour/week or more, were classified as being physically active. Changes in activity status were categorised into four groups: persistently non-active; became inactive; became active; and persistently active. MAIN OUTCOME MEASURES: Insomnia, sleep time and daytime sleepiness in relation to physical activity. RESULTS: Altogether, 37% of participants were persistently non-active, 25% were persistently active, 20% became inactive and 18% became active from baseline to follow-up. Participants who were persistently active were less likely to report difficulties initiating sleep (OR 0.60, 95% CI 0.45-0.78), a short sleep duration of ≤6 hours/night (OR 0.71, 95% CI 0.59-0.85) and a long sleep of ≥9 hours/night (OR 0.53, 95% CI 0.33-0.84) than persistently non-active subjects after adjusting for age, sex, body mass index, smoking history and study centre. Daytime sleepiness and difficulties maintaining sleep were not related to physical activity status. CONCLUSION: Physically active people have a lower risk of some insomnia symptoms and extreme sleep durations, both long and short.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Distúrbios do Início e da Manutenção do Sono , Adulto , Humanos , Duração do Sono , Estudos de Coortes , Exercício Físico
17.
Sci Rep ; 14(1): 5637, 2024 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-38454070

RESUMO

Physical activity has been found to alter sleep architecture, but these effects have been studied predominantly in the laboratory and the generalizability of these findings to naturalistic environments and longer time intervals, as well as their psychological effects, have not been evaluated. Recent technological advancements in wearable devices have made it possible to capture detailed measures of sleep outside the lab, including timing of specific sleep stages. In the current study, we utilized photoplethysmography coupled with accelerometers and smartphone ambulatory assessment to collect daily measurements of sleep, physical activity and mood in a sample of N = 82 over multi-month data collection intervals. We found a robust inverse relationship between sedentary behavior and physical activity and sleep architecture: both low-intensity and moderate-to-vigorous physical activity were associated with increased NREM sleep and decreased REM sleep, as well as a longer REM latency, while higher levels of sedentary behavior showed the opposite pattern. A decreased REM/NREM ratio and increased REM latency were in turn associated with improved wellbeing, including increased energy, reduced stress and enhanced perceived restfulness of sleep. Our results suggest that physical activity and sleep account for unique variance in a person's mood, suggesting that these effects are at least partially independent.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Sono , Humanos , Polissonografia , Sono REM , Fases do Sono , Exercício Físico
18.
Aging Clin Exp Res ; 36(1): 66, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38472505

RESUMO

BACKGROUND: This study aims to compare frequency and coexistence of geriatric syndromes in older patients with dementia to those without dementia. METHODS: 1392 patients admitted to geriatric outpatient clinics were evaluated. Evaluations for eleven geriatric syndromes including polypharmacy, malnutrition, fraility, sarcopenia, dysphagia, urinary incontinence, fear of falling, falls, insomnia, excessive daytime sleepiness, and orthostatic hypotension (OH) were carried out in consultation with the patient and the caregiver. Two groups with and without dementia were matched according to age and gender using the propensity score matching method. RESULTS: A total of 738 patients, 369 with dementia and 369 without dementia were included, of whom 70.1% were female and the mean age was 80.5 ± 6.8. Polypharmacy, malnutrition, frailty, sarcopenia, dysphagia, fear of falling, and excessive daytime sleepiness were significantly higher in patients with dementia (p < 0.05). There was no difference between OH, urinary incontinence and insomnia between groups (p > 0.05). The co-existence of 0, 1, 2, 3, 4 and ≥ 5 geriatric syndromes in the same patient was 4.3%, 10.2%, 11.8%, 16.8%, 13.4% and 43.7% in non-dementia patients, respectively; 2.4%, 7.2%, 9.6%, 8.3%, 10.4% and 62.1% in those with dementia, respectively (p < 0.05). CONCLUSION: The presence and co-existence of geriatric syndromes is common in patients with dementia. These geriatric syndromes should be examined by clinicians and healthcare professionals who work with the demented population, so that more successful management of dementia patients may be achieved.


Assuntos
Transtornos de Deglutição , Demência , Distúrbios do Sono por Sonolência Excessiva , Desnutrição , Sarcopenia , Distúrbios do Início e da Manutenção do Sono , Incontinência Urinária , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Masculino , Avaliação Geriátrica/métodos , Prevalência , Sarcopenia/epidemiologia , Medo , Demência/epidemiologia , Incontinência Urinária/epidemiologia
19.
Orphanet J Rare Dis ; 19(1): 103, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38454488

RESUMO

BACKGROUND: As the most common subtype of adult muscular dystrophy worldwide, large cohort reports on myotonic dystrophy type I (DM1) in China are still lacking. This study aims to analyze the genetic and clinical characteristics of Chinese Han DM1 patients. METHODS: Based on the multicenter collaborating effort of the Pan-Yangtze River Delta Alliance for Neuromuscular Disorders, patients with suspected clinical diagnoses of DM1 were genetically confirmed from January 2020 to April 2023. Peak CTG repeats in the DMPK gene were analyzed using triplet repeat-primed PCR (TP-PCR) and flanking PCR. Time-to-event analysis of onset age in females and males was performed. Additionally, detailed clinical features and longitudinal changes from the disease onset in 64 DM1 patients were retrospectively collected and analyzed. The Epworth Sleepiness Scale and Fatigue Severity Scale were used to quantify the severity of daytime sleepiness and fatigue. RESULTS: Among the 211 genetically confirmed DM1 patients, the mean age at diagnosis was 40.9 ± 12.2 (range: 12-74) with a male-to-female ratio of 124:87. The average size of CTG repeats was 511.3 (range: 92-1945). Among the DM1 patients with comprehensive clinical data (n = 64, mean age 41.0 ± 12.0), the age at onset was significantly earlier in males than in females (4.8 years earlier, p = 0.026). Muscle weakness (92.2%), myotonia (85.9%), and fatigue (73.4%) were the most prevalent clinical features. The predominant involved muscles at onset are hands (weakness or myotonia) (52.6%) and legs (walking disability) (42.1%). Of them, 70.3% of patients had daytime sleepiness, 14.1% had cataract surgery, 7.8% used wheelchairs, 4.7% required ventilatory support, and 1.6% required gastric tubes. Regarding the comorbidities, 4.7% of patients had tumors, 17.2% had diabetes, 23.4% had dyspnea, 28.1% had intermittent insomnia, 43.8% experienced dysphagia, and 25% exhibited cognitive impairment. Chinese patients exhibited smaller size of CTG repeats (468 ± 139) than those reported in Italy (613 ± 623), the US (629 ± 386), and Japan (625 [302, 1047]), and milder phenotypes with less multisystem involvement. CONCLUSION: The Chinese Han DM1 patients presented milder phenotypes compared to their Caucasian and Japanese counterparts. A male predominance and an early age of onset were identified in male Chinese Han DM1 patients.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Miotonia , Distrofia Miotônica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Fadiga , Distrofia Miotônica/genética , Distrofia Miotônica/diagnóstico , Estudos Retrospectivos , Criança , Adolescente , Adulto Jovem , Idoso , Estudos Multicêntricos como Assunto , Estudos de Coortes
20.
J Affect Disord ; 355: 131-135, 2024 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-38554878

RESUMO

BACKGROUND: Physical activity was suggested to be related to sleep health, while the gardening-sleep association among the community population remained unrevealed. Therefore, this study aimed to explore whether gardening was associated with sleep complaints. METHODS: A total of 62,098 adults from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) were included in this study and further categorized as non-exercisers, gardeners, and other exercisers, based on their self-reported exercise status. Sleep complaints including short/prolonged sleep duration, probable insomnia, daytime sleepiness, and sleep apnea were surveyed via a questionnaire. Primary outcome was multiple sleep complaints (coexistence of ≥2 sleep complaints) and secondary outcomes referred to individual sleep complaints. The adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated to assess the associations between gardening or tertiles of gardening duration and the outcomes using multivariable logistic regression models. RESULTS: The sample included 16,707 non-exercisers, 4243 gardeners, and 41,148 other exercisers. Relative to non-exercisers, gardeners (OR 0.58, 95%CI 0.49-0.67) and other exercisers (OR 0.67, 95%CI 0.61-0.72) had a lower likelihood of experiencing multiple sleep complaints. The adjusted OR comparing the highest gardening duration tertile to non-exercise was 0.45 (95%CI 0.33-0.63) for multiple sleep complaints (P for trend <0.001). Similar patterns persisted in several individual sleep complaints, such as short sleep duration, probable insomnia, daytime sleepiness, and sleep apnea. LIMITATIONS: Cross-sectional study design and use of self-reported variables. CONCLUSIONS: This nationwide study observed an inverse association of gardening with multiple sleep complaints and several individual sleep complaints, in a dose-response manner.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Síndromes da Apneia do Sono , Distúrbios do Início e da Manutenção do Sono , Adulto , Humanos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Jardinagem , Estudos Transversais , Sono , Distúrbios do Sono por Sonolência Excessiva/epidemiologia
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