Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines.

This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.

Residência Multiprofissional: fomentando o Ensino Centrado no Residente ­ um relato de experiência com o corpo docente-assistencial e gestores

Objetivo: Este artigo teve como objetivo descrever a experiência de uma oficina ministrada aos preceptores, tutores e coordenação de uma Residência Multiprofissional em Terapia Intensiva do Adulto abrangendo as áreas de Enfermagem, Fisioterapia e Psicologia. O foco da oficina foi destacar a importância e os impactos de intervenções rápidas no Ensino Centrado no Residente. Descrição da experiência: Durante a oficina, foram empregadas diversas ferramentas de ensino, incluindo dinâmicas em grupo, a utilização da ferramenta Mentimeter® e a Revisão por pares. A avaliação do evento foi conduzida através de revisões realizadas pelos pares de cada participante (preceptor, tutor e coordenação) ao término da atividade, bem como por meio de autoavaliações. Os resultados obtidos refletem a eficácia do planejamento pedagógico, evidenciada pelos depoimentos positivos dos participantes. No entanto, a análise da experiência educacional também revelou que a metodologia demanda um maior período de tempo para ser completamente absorvida e que seria benéfico incluir um espaço dedicado ao feedback crítico, visando proporcionar críticas construtivas para aprimorar a dinâmica do processo. Em conclusão, este relato de experiência demonstra a eficácia de atividades pedagógicas rápidas, baseadas em metodologias ativas, ao envolver preceptores, tutores e coordenação de residências multiprofissionais na compreensão da relevância de estabelecer uma relação sólida com os residentes. Essa conexão desempenha um papel fundamental na concepção de planos de aprendizado personalizados que levam em conta as características individuais de cada residente.

Reference Values for the 6-min Walk Distance in Healthy Children Age 7 to 12 Years in Brazil: Main Results of the TC6minBrasil Multi-Center Study.

INTRODUCTION: Brazil is a country with great climatic, socioeconomic, and cultural differences that does not yet have a reference value for the 6-min walk test (6MWT) in healthy children. To avoid misinterpretation, the use of equations to predict the maximum walk distance should be established in each country. OBJECTIVES: We sought to establish reference values and to develop an equation to predict the 6-min walk distance for healthy children in Brazil. METHODS: This is a cross-sectional multi-center study that included 1,496 healthy children, aged 7 to 12 y, assessed across 11 research sites in all regions of Brazil, and recruited from public and private schools in their respective regions. Each child was assessed for weight and height. Walk distance was our main outcome. An open-source software environment for statistical computing was used for statistical analysis. RESULTS: We observed a higher average distance walked by boys (531.1 m) than by girls (506.2 m), with a difference of 24.9 m (P < .001). We established 6MWT reference values for boys with the following equation: Distance = (16.86 × age) + (1.89 × Δ heart rate) - (0.80 × weight) + (336.91 × R1) + (360.91 × R2). For girls the equation is as follows: Distance = (13.54 × age) + (1.62 × Δ heart rate) - (1.28 × weight) + (352.33 × R1) + (394.81 × R2). CONCLUSION: Reference values were established for the 6MWT in healthy children aged 7-12 y in Brazil.

Estudo comparativo da qualidade do sono e insônia entre mulheres no climatério e com ciclo menstrual regular / Comparative study of sleep quality and insomnia among women in the climax and with regular menstrual cycle

Climatério é a passagem entre o período reprodutivo e não reprodutivo da mulher, caracterizado pelos fogachos e sudorese que geram alterações em sua qualidade de vida, podendo interferir no sono e nas atividades rotineiras. OBJETIVO: Avaliar a qualidade do sono e nível de insônia de mulheres no climatério e comparar com mulheres de ciclo menstrual regular. MÉTODO: A coleta de dados foi realizada de janeiro a abril de 2018. Foram coletados pessoais, data da última menstruação, uso de medicações, se pratica atividade física, uso de bebida alcoólica ou cigarro, além de dados antropométricos. Aplicou-se 3 questionários: o Índice Menopausal de Kupperman (IMK), aplicado nas mulheres que estavam no climatério; Índice de Qualidade do Sono de Pittsburgh (PSQI-BR) e o Índice de gravidade da insônia. RESULTADOS: A amostra foi constituída por 53 mulheres sendo 30 com ciclo menstrual regular e 23 no período do climatério. A média de idade foi de 45±9 anos, peso de 70±7 kg e altura de 158 ±4 cm. Observou-se que em relação à gravidade da sintomatologia climatérica, 61% das mulheres obtinham sintomas moderados e apresentavam qualidade do sono ruim onde apenas as mulheres no climatério foram avaliadas com presença de distúrbio do sono e 67% das mulheres que estavam no climatério obtinham insônia leve a moderada. Houve diferença significativa entre a qualidade do sono (p=0,001) e a gravidade da insônia (p=0,014) entre os grupos. CONCLUSÕES: Mulheres climatéricas possuem pior qualidade do sono e insônia leve a moderada em comparação com mulheres que menstruam regularmente.

Climacteric is the passage between the reproductive and non-reproductive period of women, characterized by hot flushes and sweating that generate changes in their quality of life, which may interfere with sleep and routine activities. OBJECTIVE: To evaluate the sleep quality and insomnia level of climacteric women and compare with women of regular menstrual cycle. METHODS: Data were collected from January to April 2018. Personal data, date of last menstruation, use of medication, physical activity, alcohol or cigarette use, and anthropometric data were collected. Three questionnaires were applied: the Kupperman Menopausal Index (IMK), applied to women who were in the climacteric; Pittsburgh Sleep Quality Index (PSQI-BR) and Insomnia Severity Index. RESULTS: The sample consisted of 53 women, 30 with regular menstrual cycle and 23 during climacteric. The average age was 45 ± 9 years, weight 70 ± 7 kg and height 158 ± 4 cm. Regarding the severity of climacteric symptoms, 61% of women had moderate symptoms and had poor sleep quality where only women in the climacteric were evaluated with the presence of sleep disorder and 67% of women in the climacteric had insomnia. mild to moderate. There was a significant difference between sleep quality (p = 0.001) and insomnia severity (p = 0.014) between groups. CONCLUSIONS: Climacteric women have worse sleep quality and mild to moderate insomnia compared to women who regularly menstruate.

Effects of massage therapy on sleep quality after coronary artery bypass graft surgery.

INTRODUCTION: Having poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and poor sleep quality may be improved by massage therapy. OBJECTIVE: This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery. METHOD: Participants included cardiopulmonary artery bypass graft surgery patients who were randomized into a control group and a massage therapy group following discharge from the intensive care unit (Day 0), during the postoperative period. The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy, respectively. The patients were evaluated on the following mornings (i.e., Day 1 to Day 3) using a visual analogue scale for pain in the chest, back and shoulders, in addition to fatigue and sleep. Participants kept a sleep diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period, 17 of whom were excluded due to postoperative complications. The remaining 40 participants (male: 67.5%, age: 61.9 years ± 8.9 years, body mass index: 27.2 kg/m² ± 3.7 kg/m²) were randomized into control (n = 20) and massage therapy (n = 20) groups. Pain in the chest, shoulders, and back decreased significantly in both groups from Day 1 to Day 3. The participants in the massage therapy group had fewer complaints of fatigue on Day 1 (p=0.006) and Day 2 (p=0.028) in addition, they reported a more effective sleep during all three days (p=0.019) when compared with the participants in the control group. CONCLUSION: Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep.

Sleep in infants with congenital heart disease.

OBJECTIVES: To investigate hypoxia and sleep disordered breathing in infants with congenital heart disease. METHODS: Prospective study. In-hospital full polysomnography was performed on 14 infants with congenital heart disease, age 7 +/-1 months, and in 7 normal infants, age 10 +/-2 months. Congenital heart disease infants were classified as acyanotic (n=7) or cyanotic (n=7). RESULTS: Nutritional status, assessed by the Gomez classification and expressed as % weight for age, was 70 +/-7, 59 +/-11 and 94 +/-16 in the acyanotic, cyanotic congenital heart disease and control infants, respectively (p<0.001). The respiratory disturbance index (AHI, events per hour) was [median (25-75%)]: 2.5 (1.0-3.4), 2.4 (1.5-3.1) and 0.7 (0.7-0.9) in acyanotic, cyanotic CHD infants and controls, respectively (p=0.013). Almost all congenital heart disease infants (11 out of 14) and only one control infant had an AHI >1 event/hour. The minimum oxygen saturation was 79% (74-82), 73% (57-74) and 90% (90-91) in the acyanotic, cyanotic congenital heart disease infants and controls, respectively (p <0.001). The arousal index (events/hour) was similar among the three groups at 8.4 +/-2.4, 10.3 +/-8.7 and 6.5 +/-3, respectively (p=0.451). CONCLUSIONS: Infants with congenital heart disease frequently present with sleep-disordered breathing associated with oxygen desaturations but not arousals. Therefore, sleep may represent a significant burden to infants with congenital heart disease.

Effects of massage therapy on sleep quality after coronary artery bypass graft surgery

INTRODUCTION: Having poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and poor sleep quality may be improved by massage therapy. OBJECTIVE: This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery. METHOD: Participants included cardiopulmonary artery bypass graft surgery patients who were randomized into a control group and a massage therapy group following discharge from the intensive care unit (Day 0), during the postoperative period. The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy, respectively. The patients were evaluated on the following mornings (i.e., Day 1 to Day 3) using a visual analogue scale for pain in the chest, back and shoulders, in addition to fatigue and sleep. Participants kept a sleep diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period, 17 of whom were excluded due to postoperative complications. The remaining 40 participants (male: 67.5 percent, age: 61.9 years ± 8.9 years, body mass index: 27.2 kg/m² ± 3.7 kg/m²) were randomized into control (n = 20) and massage therapy (n = 20) groups. Pain in the chest, shoulders, and back decreased significantly in both groups from Day 1 to Day 3. The participants in the massage therapy group had fewer complaints of fatigue on Day 1 (p=0.006) and Day 2 (p=0.028) in addition, they reported a more effective sleep during all three days (p=0.019) when compared with the participants in the control group. CONCLUSION: Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep.

Sleep in infants with congenital heart disease

OBJECTIVES: To investigate hypoxia and sleep disordered breathing in infants with congenital heart disease. METHODS: Prospective study. In-hospital full polysomnography was performed on 14 infants with congenital heart disease, age 7 ±1 months, and in 7 normal infants, age 10 ±2 months. Congenital heart disease infants were classified as acyanotic (n=7) or cyanotic (n=7). RESULTS: Nutritional status, assessed by the Gomez classification and expressed as percent weight for age, was 70 ±7, 59 ±11 and 94 ±16 in the acyanotic, cyanotic congenital heart disease and control infants, respectively (p<0.001). The respiratory disturbance index (AHI, events per hour) was [median (25-75 percent)]: 2.5 (1.0-3.4), 2.4 (1.5-3.1) and 0.7 (0.7-0.9) in acyanotic, cyanotic CHD infants and controls, respectively (p=0.013). Almost all congenital heart disease infants (11 out of 14) and only one control infant had an AHI >1 event/hour. The minimum oxygen saturation was 79 percent (74-82), 73 percent (57-74) and 90 percent (90-91) in the acyanotic, cyanotic congenital heart disease infants and controls, respectively (p <0.001). The arousal index (events/hour) was similar among the three groups at 8.4 ±2.4, 10.3 ±8.7 and 6.5 ±3, respectively (p=0.451). CONCLUSIONS: Infants with congenital heart disease frequently present with sleep-disordered breathing associated with oxygen desaturations but not arousals. Therefore, sleep may represent a significant burden to infants with congenital heart disease.

Estudo do sono em crianças portadoras de doenças cardíacas / Sleep study in infants with congenital cardiac

Avaliou-se a arquitetura do sono e distúrbios respiratórios do sono (DRS) em crianças (6 a 12 meses) portadoras de doenças cardíacas congênitas (DCC) sem (DCC-NH) e com presença hipoxemia (DCC-H) durante a vigília. Foram estudadas 21 crianças através de polissonografia noturna (7 DCC-NH, 7 DCC-H e 7 controles). O índice de distúrbios respiratórios (eventos/hora de sono) foi de 2,2, 2,5 e 0,7 nos grupos DCC-NH, DCC-H e controle, respectivamente, p < 0,05. A saturação de oxigênio mínima foi de 79%, 73% e 90% nos grupos DCC-NH, DCC-H e controle, respetivamente, p < 0,05. Apesar do alto índice de DRS nas crianças com DCC, a arquitetura do sono mostrou-se preservada.

This study has investigated the sleep architecture and sleep breathing disorders (SBD) in infants (6 to 12 months) with congenital cardiac disease (CCD). Nocturnal polysomnography was performed in 21 infants: 7 non-hypoxemic, 7 hypoxemic and 7 healthy infants (control group). The respiratory disturbance index (events/hour) was 2.2, 2.5 and 0.7 in the non-hypoxemic, hypoxemic and control group (p < 0.05). The minimum oxygen saturation was 79% for the non-hypoxemic group, 73% for the hypoxemic group and 90% for the control group. Despite the high respiratory disturbance index the sleep architecture was preserved in infants with CCD.