Influence of sleep on motor skill acquisition in children: a systematic review.

Effects of sleep on procedural (implicit) memory consolidation in children remain controversial. The aim of this systematic review was to synthesise the evidence on the influence of sleep on motor skills acquisition in children. Four electronic databases were searched: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medica Database (Embase), and Biblioteca Virtual em Saúde (BVS). Original studies, published until October 17, 2023, on motor skill acquisition in children aged ≤12 years, in which the intervention group slept after motor skill training, while the control group remained awake, were considered for inclusion. Risk of bias was evaluated using the Cochrane's Risk of Bias 2 tool. The review protocol was pre-registered at the International Prospective Register of Systematic Reviews (PROSPERO protocol number: CRD42022363868) and all reported items followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Of the 7241 articles initially retrieved, nine met the primary criteria and were included in this review. Of these, six studies reported that daytime or night-time sleep intervention improved motor skill acquisition, as compared to wakefulness. All studies presented a high risk of bias. In conclusion, the evidence summarised suggests that sleep may enhance motor skills acquisition and could be important for motor development in childhood. However, due to the high risk of bias in the included studies, future randomised controlled trials with high methodological quality are necessary to better clarify this topic.

Pharmacological and non-pharmacological interventions to promote sleep in intensive care units: a critical review.

PURPOSE: Although it is generally recognized that poor sleep is common in the intensive care unit (ICU), it is still unclear which interventions can effectively improve sleep in this setting. In this review, we critically analyze the various pharmacological and non-pharmacological measures that have been proposed to tackle this problem. METHODS: A search of MEDLINE/PubMed, SciELO, and the Brazilian Virtual Library in Health (LILACS and BNDEF) databases was performed. Results were reviewed and 41 articles on pharmacological and non-pharmacological interventions to promote sleep in ICU were analyzed. RESULTS: Non-pharmacological interventions including eye mask and earplugs, bundles to reduce noise and lighting, and organization of patient care were shown to improve subjective and objective sleep quality, although the level of evidence was considered low. Assist-control ventilation was associated with a greater objective sleep quality than spontaneous modes, such as pressure support ventilation and proportional assist ventilation. Among pharmacological interventions, a moderate level of evidence was found for oral melatonin, with increases in both objective and subjective sleep quality. Continuous nocturnal infusion of dexmedetomidine was reported to increase sleep efficiency and favorably modify the sleep pattern, although evidence level was moderate to low. CONCLUSIONS: Several non-pharmacological and pharmacological measures can be helpful to improve sleep in critical patients. Further high-quality studies are needed to strengthen the evidence base.

Obstructive Sleep Apnea and Wake-up Stroke - A 12 Months Prospective Longitudinal Study.

BACKGROUND: Wake-up stroke (WUS) are strokes that are noted upon awakening in patients previously going to bed in a normal state of health. The role of sleep abnormalities in WUS is uncertain. The objective was to determine clinical characteristics, respiratory abnormalities during sleep and outcomes in patients with WUS versus non-WUS. METHODS: At baseline, patients with ischemic stroke were examined clinically and with a portable sleep recorder. Apnea-Hypopnea Index greater than or equal to 20 defined a cut-off severity index. At follow-up (3 and 12-months), patients were re-evaluated clinically and with questionnaires: Epworth Sleepiness Scale, Modified Rankin (MR) and Modified Barthel Index Results: Among all (N = 102, 64% male), hypertension (73%), Type 2 diabetes (29.4), heart disease (16.7%), physical inactivity (69.6%), smoking (32.4%) and alcohol consumption (17.6) were found. Apnea-Hypopnea Index (AHI) greater than 5 (92.9%), AHI greater than 15 (44.7%), AHI greater than or equal to 20 (35.3%) and AHI greater than 30 (11.8%) were registered. Cases with and without WUS did not differ regarding polygraphic findings. Long apneas (apnea duration > 20 s) was equally found in patients with WUS (23.1%) and non-WUS (23.7%). Type 2 diabetes mellitus (T2D) was independently associated with WUS (OR = 2.76; CI: 1.10-6.05; P = .03). Prospectively, symptom severity was not different between WUS and non-WUS. Overall, patients with OSA (IAH≥20) evolved with worse functional performance (MR, P = .02). CONCLUSIONS: Wake-up stroke occurred in approximately 1 of 3 of cases. Irrespective of WUS, half of the patients had moderate to severe sleep apnea; those with OSA (AHI≥ 20) evolved with worse functional performance after 1 year. WUS was associated with TDM reinforcing a relationship with cerebral small vessel disease.

Depressive symptoms, quality of sleep, and disease control in women with asthma.

PURPOSE: A large number of asthmatic patients, particularly females, present inadequate disease control. Depressive symptoms are reportedly common in asthma and have been related to poor disease control, but the mechanism of this association is still unclear. Poor quality sleep, frequently observed in asthmatics, is also a manifestation of depression and has been related to uncontrolled asthma. This study aimed to investigate the relationship between depressive symptoms, sleep quality, and asthma control. METHODS: This was a cross-sectional study of 123 women with previous diagnosis of asthma from a reference center in Fortaleza, Brazil. Depressive symptoms were assessed by the Beck Depression Inventory (BDI); quality of sleep was evaluated by the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness by the Epworth Sleepiness Scale (ESS), and asthma control by the Asthma Control Test (ACT). RESULTS: Inadequate asthma control (ACT <20) was found in 94 (76.4 %) subjects, depressive symptoms in 92 (74.8 %), poor quality sleep (PSQI >5) in 99 (80.49 %), and excessive daytime sleepiness (ESS ≥10) in 34 (27.64 %). Depressive symptoms were associated with both poor quality sleep (R = 0.326) and inadequate asthma control (R = -0.299). Regression analysis showed that depressive symptoms and sleep quality were independent predictors of the level of asthma control. CONCLUSION: Asthma control in women is independently associated with depressive symptoms and quality of sleep, suggesting that these patients might benefit from simple measures to promote healthy sleep behavior and sleep hygiene and also that routine screening for depression can be relevant, particularly, in poorly controlled cases.

Health of Psychiatry Residents: Nutritional Status, Physical Activity, and Mental Health.

OBJECTIVE: This study aims to analyze mental health, nutritional status, and physical activity in psychiatry residents. METHODS: Sixty-two residents were invited and 59 participated (95.2% response). Depressive, anxious, and social phobic symptoms; alcohol use; and nicotine dependence were measured. Body mass index and lifestyle were also evaluated. RESULTS: Almost half of psychiatry residents were overweight or obese, and 61% reported a sedentary lifestyle. Furthermore, 33.9% of residents had high scores for anxiety; 30.5% for social phobia; and 19% for depression. In addition, 81.4% reported alcohol use, and 22% had harmful alcohol use. High scores for anxiety were associated with lower attention and worse relationship with preceptors, and high scores of depressive symptoms were related to a worse relationship with patients and preceptors. Anxiety was associated with depressive symptoms (p < 0.001) and social phobia (p = 0.006). CONCLUSION: The findings of this study highlight high rates of overweight/obesity, physical inactivity, and depressive and anxiety symptoms in psychiatric residents.

What can blood biomarkers tell us about cardiovascular risk in obstructive sleep apnea?

BACKGROUND: Despite its high prevalence and frequent association with multiple comorbidities, including hypertension, heart disease, and stroke, obstructive sleep apnea (OSA) still lacks appropriate tools for cardiovascular risk assessment and stratification. Circulating biomarkers represent a safe, convenient, and inexpensive possibility, and several studies have been performed to define an ideal marker in this context. Additionally, biomarkers can provide insight into the pathological mechanisms of the disease and suggest new therapeutic approaches. METHODS: In the present review, the authors critically analyze the biomarkers of cardiovascular risk currently available and other potential markers, including brain natriuretic peptide, C-reactive protein, tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), cysteine, homocysteine, free fatty acids, 8-isoprostane, gamma-glutamyl transferase, glycated hemoglobin, adipokines, and adhesion molecules. CONCLUSION: The results clearly demonstrate that the relationship between specific biomarkers and OSA is often influenced by age, gender or ethnicity, which has hindered the identification of a unique marker for the evaluation of all patients with OSA. Moreover, given the frequency of comorbidities in OSA, which, by themselves, increase the cardiovascular risk, all confounding factors must be considered in the evaluation of these biomarkers.

Structural brain abnormalities in patients with Parkinson's disease with visual hallucinations: a comparative voxel-based analysis.

The objective is to evaluate clinical characteristics and cerebral alterations in Parkinson's disease (PD) patients with diurnal visual hallucinations (VHs). Assessment was performed using magnetic resonance image (MRI) and voxel-based morphometry (VBM). Thirty-nine patients with PD (53.8%) and ten controls were studied. Voxel based morphology analysis was performed. Eleven patients presented diurnal VHs and among these, six had cognitive dysfunction. Patients with VHs performed worse in the mentation-related UPDRS I (p=0.005) and motor-related UPDRS III (p=0.02). Patients with VHs showed significant clusters of reduced grey matter volume compared to controls in the left opercula frontal gyrus and left superior frontal gyrus. PD without hallucinations demonstrated reduced grey matter volume in the left superior frontal gyrus compared to controls. Comparisons between patients with VHs regarding the presence of cognitive dysfunction showed that cases with cognitive dysfunction as compared to those without cognitive dysfunction showed significant clusters of reduced grey matter volume in the left opercular frontal gyrus. Cases without cognitive dysfunction had reduced grey matter substance in the left insula and left trigonal frontal gyrus. Judging from our findings, an abnormal frontal cortex, particularly left sided insula, frontal opercular, trigonal frontal gyrus and orbital frontal would make PD patients vulnerable to hallucinations. Compromise of the left operculum distinguished cases with VHs and cognitive dysfunction. Our findings reinforce the theoretical concept of a top-down visual processing in the genesis of VHs in PD.

Syndecan-1 levels predict septic shock in critically ill patients with COVID-19.

BACKGROUND: The clinical picture of coronavirus disease 2019 (COVID-19)-associated sepsis is similar to that of sepsis of other aetiologies. The present study aims to analyse the role of syndecan-1 (SDC-1) as a potential predictor of septic shock in critically ill patients with COVID-19. METHODS: This is a prospective study of 86 critically ill patients due to COVID-19 infection. Patients were followed until day 28 of hospitalization. Vascular biomarkers, such as vascular cell adhesion protein-1, SDC-1, angiopoietin-1 and angiopoietin-2, were quantified upon admission and associated with the need for vasopressors in the first 7 d of hospitalization. RESULTS: A total of 86 patients with COVID-19 (mean age 60±16 y; 51 men [59%]) were evaluated. Thirty-six (42%) patients died during hospitalization and 50 (58%) survived. The group receiving vasopressors had higher levels of D-dimer (2.46 ng/ml [interquartile range {IQR} 0.6-6.1] vs 1.01 ng/ml [IQR 0.62-2.6], p=0.019) and lactate dehydrogenase (929±382 U/l vs 766±312 U/l, p=0.048). The frequency of deaths during hospitalization was higher in the group that received vasoactive amines in the first 24 h in the intensive care unit (70% vs 30%, p=0.002). SDC-1 levels were independently associated with the need for vasoactive amines, and admission values >269 ng/ml (95% CI 0.524 to 0.758, p=0.024) were able to predict the need for vasopressors during the 7 d following admission. CONCLUSIONS: Syndecan-1 levels predict septic shock in critically ill patients with COVID-19.

Restless legs syndrome and quality of sleep in patients with glomerulopathy.

BACKGROUND: Despite a confirmed association between restless legs syndrome (RLS) and end-stage renal disease (ESRD), there is no study on patients presenting with nephrotic syndrome (NS). To investigate the frequency of RLS and poor quality sleep in NS-patients secondary to primary glomerulopathy with nearly normal glomerular filtration rate (GFR) and its associated factors. METHODS: Patients with NS, defined as 24 h-urine protein greater than 3.5 g/1.73 m2 and hypoalbuminemia, (n = 99, 53 women) and a mean age of 36±11 years were studied. Age and sex-matched controls were used to compare RLS and poor sleep quality prevalence. Standardized RLS questionnaire formulated by the International Restless Legs Syndrome and Pittsburgh Sleep Quality Index (PSQI) were used. RESULTS: RLS was more frequent in NS-patients than in controls (22.8 vs. 4.0%, p = 0.01). Mean time since diagnosis (52.2±34.1 vs. 28.6±22.5 months, p < 0.01) and 24 h-proteinuria (3.7±1.3 vs. 2.6±0.6 g/1.73 m2, p = 0.001) were greater in NS-patients with RLS those not presenting RLS. Association between RLS with 24 h-proteinuria [OR = 2.31; p = 0.007; 95% CI 1.87-2.89] and time since diagnosis [OR = 1.10; p = 0.003; CI = 1.02-1.39] were identified even after controlling for age, GFR and diabetes. Sleep quality was poor in NS-patients than in controls (mean PSQI score 7.35±3.7 vs. 5.2±3.0, p = 0.003). In NS-patients, only RLS was associated with poor sleep quality (OR = 1.20; p = 0.004). CONCLUSION: Poor quality sleep and RLS are frequent in NS-patients without ESRD. Pathophysiology of this association must be further investigated.

Melatonin supplementation enhances pulmonary rehabilitation outcomes in COPD: a randomized, double-blind, placebo-controlled study.

Melatonin (MLT), the main product of the pineal gland, is involved in muscle tissue repair and regeneration, besides several other important physiologic functions. In COPD, MLT administration can improve lung oxidative stress and sleep quality, but its potential effects on the outcomes of pulmonary rehabilitation (PR) have not been previously investigated. A randomized controlled trial was undertaken to test the hypothesis that a combined approach of rehabilitative exercise training and MLT supplementation could maximize functional performance, health status and quality of life in patients with COPD. Thirty-nine individuals with COPD referred to a supervised PR program at the Federal University of Ceara, Brazil, were randomized to receive MLT (3 mg/day; n = 18) or placebo (n = 21). Exercise capacity (6-min walk test - 6MWT), health status (COPD assessment test), and quality of life (airways questionnaire 20) were investigated as primary outcomes. No differences were observed at baseline in demographic, anthropometric and clinical characteristics between MLT and placebo groups. At the end of PR, superiority of the MLT group was demonstrated in improvement in the distance covered in the 6MWT (71 ± 26 vs. 25 ± 36 m; p < 0.01), health status (-11 ± 6 vs. -3 ± 5; p < 0.01), and quality of life (-6.9 ± 3.0 vs. -1.9 ± 2.4; p < 0.01), compared to the placebo group. In conclusion, MLT supplementation during the course of 12 weeks of PR can improve functional capacity, health status and quality of life in patients with COPD. These findings may have significant implications for the management of this condition.

Morningness/eveningness in gestational diabetes mellitus: clinical characteristics and maternal-neonatal outcomes.

Objective: This study aims to evaluate the impact of morning-evening preference in pregnancy outcomes in gestational diabetes mellitus (GDM). Methods: This is a prospective cohort study of 2nd-3rd trimester GDM outpatient care in Fortaleza, Brazil (2018-2020). Eveningness was defined by the Horne-Östberg Morningness-Eveningness-Questionnaire (MEQ ≤ 41). Furthermore, we obtained a 7-day actigraphic register. Subjective sleep quality, daytime somnolence, insomnia, fatigue and depressive symptoms were also evaluated. Associations with pregnancy outcomes were investigated. Results: Among 305 patients with GDM, evening preference was found in 21 (6.9%). Patients with evening preference had worse sleep quality (p < 0.01), greater severity of insomnia (p < 0.005), fatigue (p < 0.005) and depressive symptoms (<0.009). Evening chronotype was associated with preeclampsia [p = 0.01; OR = 0.27; CI 0.09-0.79] and a greater need for admission to a neonatal intensive care unit (NICU) [p = 0.02; OR = 0.23; CI .0.06-0.80]. A lower MEQ score confirmed an association with preeclampsia [p = 0.002; OR = 0.94; CI 0.90-0.97] and this was maintained after controlling for age, arterial hypertension, sleep quality, fatigue and depressive symptoms [p < 005; OR = 0.91; CI 0.87-0.95]. Conclusion: In GDM, patients with evening preference had worse sleep quality, more insomnia, fatigue, and depressive symptoms. Furthermore, eveningness was independently associated with preeclampsia. These results indicate the important role of eveningness in adverse pregnancy outcomes.

Melatonin reduces lung oxidative stress in patients with chronic obstructive pulmonary disease: a randomized, double-blind, placebo-controlled study.

Chronic obstructive pulmonary disease (COPD), a major cause of death and disability, is attributed to an abnormal inflammatory response by the lungs to noxious substances, primarily from cigarette smoke. Although oxidative stress is regarded as central to the pathogenesis of COPD, very few studies have examined the effects of antioxidants in this condition. This was a randomized, double-blind, placebo-controlled study on the effects of melatonin in COPD. Thirty-six consecutive patients with clinically stable moderate to very severe COPD (30 men; mean±S.D.=66.6±7.8yr) were randomized to receive 3mg melatonin (N=18) or placebo for 3 months. Oxidative stress was evaluated by 8-isoprostane levels in exhaled breath condensate at baseline (T0) and after one (T1), two (T2), and three months (T3) of treatment. Additionally, exhaled breath condensate levels of IL-8, dyspnea severity (Medical Research Council scale), lung function (spirometry), and functional exercise capacity (six min walk test) were compared at baseline and after treatment. Patients receiving melatonin showed a decrease in 8-isoprostane (T0: mean±S.E.M.=20.41±2.92pg/mL; T1: 18.56±2.68pg/mL; T2: 12.68±2.04pg/mL; T3: 12.70±2.18pg/mL; P=0.04; repeated measures ANOVA) with significant differences from baseline after 2 (P=0.03) and 3months (P=0.01). Dyspnea was improved by melatonin (P=0.01), despite no significant changes in lung function or exercise capacity. Placebo-treated patients, but not those who were given melatonin, showed an increase in IL-8 (P=0.03). In summary, melatonin administration reduced oxidative stress and improved dyspnea in COPD. Further studies are necessary to determine the potential role for melatonin in the long-term management of these patients.

Sleep-wake disturbances in Parkinson's disease: current evidence regarding diagnostic and therapeutic decisions.

Sleep disorders have been frequently reported in patients with Parkinson's disease (PD). However, there is insufficient evidence to guide precise recommendations on some diagnostic and treatment strategies. Here, we review clinical studies dealing with sleep abnormalities in PD and present clinical recommendations. Previous studies describing insomnia, excessive daytime sleepiness, narcolepsy-like episodes, circadian changes, sleep-disordered breathing, rapid eye movement sleep behavior disorder, vivid dreams and restless legs syndrome are evaluated. Longitudinal studies associating sleep disorders with PD onset or clinical deterioration are rare: only one longitudinal study associated daytime sleepiness with PD onset. Evidence suggests that clinical investigations must include direct questioning about depressive symptoms, nocturnal cramps, pain, nocturia and nighttime off periods. A patient interview must be conducted regarding sleep symptoms, including nightmares, abnormal behavior during sleep, snoring, restless legs syndrome and daytime sleepiness. Initial evidence indicates that light therapy improves motor function and depression. Advice on sleep hygiene, the treatment of concomitant depression and the careful use of dopaminergic drugs and hypnosedative agents should be considered. To date, very few controlled studies are available to make a recommendation for the management of sleep-wake disturbances in PD.

Asthma control, social jetlag, and sleep impairment in high school adolescents.

INTRODUCTION: Social jetlag is associated with several negative health outcomes, but its impact on asthma control has not been previously investigated. Although impaired sleep is common in asthma, studies on the relationship between sleep quality, social jetlag and asthma control in adolescents are scarce. OBJECTIVE: To investigate the relationship between asthma control and sleep quality, sleep-wake pattern and excessive daytime sleepiness in adolescents. METHODS: This was a cross-sectional study of 1457 Brazilian high-school adolescents. Asthma was identified using the International Study of Asthma and Allergies in Childhood questionnaire, and disease control was measured by the Asthma Control Test. Sleep-wake pattern and social jetlag were assessed by the Munich Chrono-Type Questionnaire; sleep quality, by the Pittsburgh Sleep Quality Index; and daytime sleepiness, by the Epworth Sleepiness Scale. RESULTS: Asthma was present in 250 (17.2%) participants and was classified as uncontrolled in 120 (47.9%). Both uncontrolled and controlled asthma groups, compared with non-asthmatics, had worse sleep quality (81.7% vs 77.4% vs 56.5%; p < 0.001) and excessive daytime sleepiness (EDS: 56.2% vs 56.5% vs 39.2%; p < 0.001). On average, adolescents with uncontrolled asthma, compared to non-asthmatics, showed later sleep onset (mean ± SD: 23:54pm ± 1 h:45min vs 23:20pm ± 1 h:27min; p = 0.002) and shorter sleep duration (5.7 h ± 1.8 h vs 6.3 h ± 1.4 h; p = 0.002) on school days. No significant difference in social jetlag was found among the three groups. CONCLUSIONS: Asthma is associated with EDS and poor-quality sleep in adolescents. Social jetlag is common in these subjects and is not related to the presence and control of asthma.

Exercise modifies lipid and glucose metabolism alterations induced by sleep deprivation in mice.

Insufficient sleep compromises lipid/glucose homeostasis. In opposition, exercise increases energy expenditure and has positive effects on glucose and fatty acid metabolism. Presently, it is hypothesized that exercise ameliorates metabolic dysfunction associated with sleep deprivation (SD). The effects of exercise (EX), SD and EX before SD. (EX+SD) on lipid and glucose metabolism were evaluated. Swiss mice were assigned to 4 groups (N=12, each) control, exercise (EX, 8 weeks, 1-hour of treadmill/9cm/s, 5x/week, from noon to 1:00 p.m.), SD (SD-72h, multiple platforms method), and exercise before SD (EX+SD). Exercise increased blood glucose, lactate and triglycerides (p<0.05). Both, SD and EX+SD reduced blood triglycerides (p<0.05). EX increased VLDL and reduced LDL; conversely, SD and EX+SD reduced VLDL and increased LDL. Hepatic triglycerides were markedly reduced by SD (p<0.05) and this was prevented by previous exercise (EX+SD). In summary, exercise improved essential cholesterol fractions and exercise before SD increased hepatic cholesterol and prevented hepatic triglycerides depletion.

Depressive symptoms are associated with impaired sleep, fatigue, and disease activity in women with rheumatoid arthritis.

OBJECTIVES: To investigate the associations between sleep quality, fatigue, disease activity and depressive symptoms in women with rheumatoid arthritis (RA). METHODS: Female patients with previous diagnosis of RA from a Rheumatology Outpatient Clinic at a tertiary referral centre, in Fortaleza, Brazil, were consecutively recruited into the study. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI); fatigue by the Fatigue Severity Scale (FSS); daytime sleepiness by the Epworth Sleepiness Scale (ESS); and depressive symptoms by the Beck Depression Inventory II (BDI-II). RA activity was measured by the disease activity score (DAS28). RESULTS: One hundred ten women (mean age ± SD = 51.1 ± 13.0 y) were included in the study. On average, patients with depressive symptoms (BDI-II > 13), as compared to those without, showed poorer sleep quality (PSQI: 10.09 ± 4.1 vs 7.33 ± 3.55; p = 0.001 respectively), more fatigue (FSS: 4.69 ± 1.89 vs 3.34 ± 1.8; p = 0.001) and higher disease activity level (DAS28: 4.36 ± 1.53 vs 3.7 ± 1.39; p = 0,047). The logistic regression analysis showed that sleep quality is an independent predictor of depressive symptom severity. CONCLUSION: Depressive symptoms, impaired sleep and fatigue are common in women with RA. Poor sleep is associated with greater frequency and severity of depressive symptoms in these patients, suggesting that screening for sleep and mood problems may be relevant both in clinical research and routine patient care. Future studies investigating the impact of measures to promote healthy sleep on depressive symptom control in this patient population are warranted.

A retrospective study of the influence of obesity on polysomnography and cephalometric parameters in males with obstructive sleep apnea.

OBJECTIVE: Evaluate the influence of obesity on the polysomnographic and cephalometric parameters in obstructive sleep apnea (OSA). METHODS: Fifty records of male patients with OSA, containing information on dental, medical, polysomnographic, and cephalometric exams were selected. The degree of obesity was based on Body Mass Index (BMI). Group I comprised normal or overweight individuals (BMI ≤ 29.9 kg/m2), whereas Group II consisted of obese individuals (BMI ≥ 29.9 kg/m2). RESULTS: BMI significantly correlated with apnea and hypopnea index (p < 0.0005), minimal oxyhemoglobin saturation (p < 0.0005), and two cephalometric variables (soft palate length, p = 0.01 and width, p = 0.01). Group II showed a significant correlation with the position of the hyoid bone (p = 0.02). Soft palate length and width significantly differed between groups (p = 0.014; 0.016). CONCLUSION: Obese males present wider and longer soft palate dimensions, and patients with a greater BMI present a more inferiorly positioned hyoid bone.

Melatonin improves sleep and reduces nitrite in the exhaled breath condensate in cystic fibrosis--a randomized, double-blind placebo-controlled study.

Cystic fibrosis (CF) is a chronic progressive disorder characterized by repeated episodes of respiratory infection. Impaired sleep is common in CF leading to reduced quality of life. Melatonin, a secretory product of the pineal gland, has an important function in the synchronization of circadian rhythms, including the sleep-wake cycle, and has been shown to possess significant anti-oxidant properties. To evaluate the effects of exogenous melatonin on sleep and inflammation and oxidative stress markers in CF, a randomized double-blind, placebo-controlled study initially involving 20 patients with CF was conducted. One individual failed to conclude the study. All subjects were clinically stable when studied and without recent infectious exacerbation or hospitalization in the last 30 days. Groups were randomized for placebo (n = 10; mean age 12.1 +/- 6.0) or 3 mg melatonin (n = 9; mean age 16.6 +/- 8.26) for 21 days. Actigraphy was performed for 6 days before the start of medication and in the third week (days 14-20) of treatment. Isoprostane and nitrite levels were determined in exhaled breath condensate (EBC) at baseline (day 0) and after treatment (day 21). Melatonin improved sleep efficiency (P = 0.01) and tended to improve sleep latency (P = 0.08). Melatonin reduced EBC nitrite (P = 0.01) but not isoprostane. In summary, melatonin administration reduces nitrite levels in EBC and improves sleep measures in clinically stable CF patients. The failure of melatonin to reduce isoprostane levels may have been a result of the low dose of melatonin used as a treatment.

Sleep duration and daytime sleepiness in a large sample of Brazilian high school adolescents.

OBJECTIVE: To investigate the prevalence and main factors associated with short and long sleep duration and excessive daytime sleepiness in Brazilian adolescents. METHODS: This was a cross-sectional study of 11.525 students of both genders, aged 14-17 years, from the public high-school system. Sleep duration was assessed by self-report and <8 h of sleep per day was considered short sleep and >10 h, long sleep. Socio-demographic and behavioral factors were investigated through a purpose-built questionnaire and daytime somnolence was assessed by the Epworth sleepiness scale (ESS). RESULTS: The overall prevalence of short and long sleep was 54.7% and 3.3%, respectively. Frequency of short sleep was lowest in the afternoon shift (38.2%) and highest in the morning shift (62.9%) and full-day students (70.0%). Insufficient sleep was more frequent in working (63.0%) than non-working adolescents (53.1%; p = 0.001) and among those who used their cell phone before bedtime (56.3%) compared to non-users (49.7%, p = 0.001). On average, ESS score was higher in subjects with short and long sleep (respectively, 9.7 ± 4.4 and 10.0 ± 4.5) compared to those with normal sleep duration (8.9 ± 4.2; p = 0.001). CONCLUSION: Insufficient sleep and excessive daytime sleepiness are very common among urban high-school Brazilian adolescents. Full day and morning school shifts are associated with short sleep and daytime somnolence, suggesting later start times may have a role in reducing sleep loss in these subjects. Older age, work activity, and cell phone use before bedtime, are also risk factors for of short sleep in adolescents. Although less common, long sleep can also be associated with excessive daytime sleepiness.

Exercise effects on brain and behavior in healthy mice, Alzheimer's disease and Parkinson's disease model-A systematic review and meta-analysis.

This systematic review and meta-analysis examines how exercise modifies brain and behavior in healthy mice, dementia (D) and Parkinson disease (PD) models. A search was performed on the Medline and Scopus electronic databases (2008-2019). Search terms were "mice", "brain", "treadmill", "exercise", "physical exercise". In the total, 430 were found but only 103 were included. Animals n = 1,172; exercised 4-8 weeks (Range 24 h to 32 weeks), 60 min/day (Range 8-120 min per day), and 10/12 m/min (Range 0.2 m/min to 36 m/min). Hippocampus, cerebral cortex, striatum and whole brain were more frequently investigated. Exercise improved learning and memory. Meta-analysis showed that exercise increased: cerebral BDNF in health (n = 150; z = 5.8, CI 3.43-12.05; p < 0.001 I2 = 94.3 %), D (n = 124; z = 4.18, CI = 2.22-9.12; p < 0.001; I2 = 93.7 %) and PD (n = 16 z = 4.26, CI 5.03-48.73 p < 0.001 I2 = 94.8 %). TrkB improved in health (n = 84 z = 5.49, CI 3.8-17.73 p < 0.001, I2 = 0.000) and PD (n = 22; z = 3.1, CI = 2.58-67.3, p < 0.002 I2 = 93.8 %). Neurogenesis increased in health (n = 68; z = 7.08, CI 5.65-21.25 p < 0.001; I2 17.58) and D model (n = 116; z = 4.18, CI 2.22-9.12 p < 0.001 I2 93.7 %). Exercise augmented amyloid clearance (n = 166; z = 7.51 CI = 4.86-14.85, p < 0.001 I2 = 58.72) and reduced amyloid plaques in D models (n = 49; z = 4.65, CI = 3.94-15.3 p < 0.001 I2 = 0.000). In conclusion, exercise improved brain and behavior, neurogenesis in healthy and dementia models, reduced toxicity and cerebral amyloid. Evidence regarding inflammation, oxidative stress and energy metabolism were scarce. Studies examining acute vs chronic exercise, extreme training and the durability of exercise benefit were rare. Vascular or glucose metabolism changes were seldom reported.