OBJECTIVE: To investigate the gender differences in relationship between body composition and sleep pattern in healthy subjects.
METHODS: Fifty-two healthy volunteers (27 women) participated in this study. Subjects underwent overnight polysomnography and measurements of body composition were taken in the following morning after a 12-hour fast. Validated protocols were used to evaluate sleep (polysomnography) and anthropometry (body mass, height, skinfolds and body circumferences).
RESULTS: A positive correlation between percentage of slow-wave sleep and percentage of lean body mass (r=0.46, p=0.016) was found in women. In men, awakenings during sleep were correlated positively with indices such as body mass index (r=0.62, p<0.01), fat mass (kg) (r=0.61, p<0.01), fat percentage (r=0.56, p<0.01), waist circumference (r=0.58, p<0.01), hip circumference (r=0.45, p<0.01), and waist-to-hip ratio (r=0.50, p=0.01). Body mass index, body fat percentage, waist circumference, and waist-to-hip ratio were correlated with apnea-hypopnea index (r=0.40, p=0.03; r=0.46, p<0.01; r=0.49, p<0.01; and r=0.56, p<0.01) in both genders.
CONCLUSION: This study showed important statistical associations between different sleep variables and anthropometric characteristics in healthy subjects, suggesting a possible relationship between greater body fat deposition and impairment of sleep quality. In addition, it was noticed that these associations differ between genders and deserve further exploration.
Keywords: sleep/physiology; sleep disorders/diagnosis; body mass index; body composition; body fat distribution; polysomnography; human; female.
OBJECTIVE: Therapeutic approaches to the Restless Legs Syndrome and Periodic Limb Movement sleep disorders are often implemented concomitantly. The objective of this study was to assess the effect of aerobic physical exercise on the symptoms of Restless Legs Syndrome.
METHODS: The study included 11 patients who were diagnosed with RLS and with on the severity scale established by the International Restless Legs Syndrome Scale (IRLSS), which was translated and validated into Brazilian Portuguese. The patients completed 72 sessions of aerobic exercises prescribed at Anaerobic Ventilatory Threshold Intensity on an ergometric cycle. Patients performed 3 50-minute sessions per week for approximately 6 months. Each patient completed a severity scale questionnaire of Restless Legs Syndrome prior to the first training session and after sessions 1, 36 and 72.
RESULTS: In response to aerobic physical exercise, the patients demonstrated a significant reduction in symptoms of Restless Legs Syndrome after 36 sessions (score: 24 to 15). This reduction was maintained even after 72 sessions (score: 7) of aerobic exercises (p<0.001).
CONCLUSIONS: The aerobic exercise proved to be efficient in diminishing Restless Legs Syndrome symptoms.
Keywords: restless leg syndrome/therapy; exercice; sleep disorders; exercise therapy.
This study aimed to verify the correlation between job satisfaction and sleep quality among nursing technicians and assistants who worked 12-hour night shifts at a philanthropic hospital in Tubarão (SC), Brazil. The participants of this study were 81 professionals, average age 31.9 years old (SD=8.18). Spearman correlation test showed a correlation between sleep quality and job satisfaction (r=-0.41; p<0.00). Some aspects were reported as very satisfactory by these workers such as work content and motivation towards the work as well as the extension in which they identify themselves with the hospital image.
Keywords: job satisfaction; nursing staff, hospital; personnel staffing and scheduling; occupational health nursing; occupational health; shift work; occupational diseases; workload.
In this review, the authors highlight the main findings on the neural mechanisms of the sleep-wake cycle, emphasizing the importance of hypothalamic control of the sleep and wake cycle. The anterior, posterior, and lateral hypothalamic regions are the three divisions involved in this anatomical-functional control. The galaninergic and inhibitory GABAergic systems of the ventrolateral preoptic nucleus of the anterior hypothalamus and the neurons producing melanin concentrating hormone of the lateral hypothalamus are responsible for the inhibition of the waking system and they are, therefore, responsible for the initiation and maintenance of non-rapid-eye-movement and rapid-eye-movement sleep. The neurons of the suprachiasmatic nucleus of the anterior hypothalamus are responsible for the circadian rhythm of the sleep-wake cycle. The histaminergic nuclei of the posterior hypothalamus and hypocretinergic ones of the lateral hypothalamus are active during wakefulness, stimulating the aminergic system of the brainstem and inhibiting both the ventrolateral preoptic nucleus and also the melanin concentrating hormone systems and, thus, establishing a stable waking state. The inhibition-stimulation interaction between the posterior and lateral hypothalamic system of wakefulness and the GABAergic sleep system of the anterior hypothalamus is the base model of the reciprocal interaction, which results in the stability of the wake or sleep states. Changes in these nuclei or pathways result in the instability of the sleep-wake cycle and in sleep disorders.
Keywords: sleep-wake transition disorders; ventromedial hypothalamic nucleus; gamma-aminobutyric acid; melatonin/metabolism; GABA modulators; hypothalamic hormones; sleep/physiology; sleep, REM/physiology; histamine.
Out of the many sleep disorders, obstructive sleep apnea-hypopnea syndrome is one of the most harmful. This syndrome is an important risk factor for the development of cardiovascular disease and patient mortality. Exercise is a way to reduce cardiovascular mortality, which also results in improved sleep quality and may act on the pathogenesis of obstructive sleep apnea-hypopnea syndrome. However, evidence about the actual role of exercise in this syndrome is still scarce. We reviewed the existing literature about the possible benefits of exercise in patients with obstructive sleep apnea-hypopnea syndrome. We performed a search in the PubMed database using MESH Terms related to physical exercise and sleep apnea. Out of the 149 references identified, we selected randomized controlled trials or case studies in English or Portuguese that included patients with OSAHS. After searching titles, abstracts and full texts, we located only three studies that investigated the effects of exercise on the diagnostic and severity indices of obstructive sleep apnea-hypopnea syndrome. In these three papers, groups that exercised showed a reduction in the severity of the syndrome. Despite the insufficient level of evidence in the literature, the agreeing positive results of the studies suggest a potential benefit of exercise on obstructive sleep apnea-hypopnea syndrome.
Keywords: exercise; sleep apnea syndromes; cardiovascular diseases; sleep apnea, obstructive.
Obstructive sleep apnea syndrome and primary snoring are associated with the presence of neurogenic lesions and impaired sensory function in the upper airway, which are presumably caused by low-frequency vibrations produced by snoring or intermittent hypoxia. The clinical impact of this peripheral neuropathy on the pharynx has not been thoroughly investigated with respect to the management of patients with obstructive sleep apnea syndrome. Several authors have shown changes in swallowing associated with this syndrome, such as early bolus escape, the presence of pharyngeal residue, laryngeal penetration, and increased latency before triggering of the swallowing reflex. In this article, we review the main features of swallowing that may be altered in obstructive sleep apnea syndrome and the mechanisms involved in its pathophysiology as well as the results of studies that have evaluated swallowing in patients after treatment for this syndrome.
Keywords: deglutition; deglutition disorders; sleep apnea, obstructive; snoring.
The upper airway resistance syndrome (UARS) is a sleep breathing disorder described by Guilleminault et al., in 1993, to identify patients that present increased respiratory effort and airflow limitation during sleep associated with an increase in the upper airway resistance. Patients usually complain of daytime sleepiness, fatigue, snoring, and difficulty to maintain sleep. Complains related to cognitive impairment, headache, anxiety, and irritability are also frequent. The physical examination shows nasal obstruction, increase in soft tissue and craniofacial abnormalities associated with decrease in the upper airway space. Nocturnal polysomnography does not show apneas or hyponeas for diagnostic criteria of obstructive sleep apnea syndrome (OSAS), and respiratory abnormalities consist on periods of increase in respiratory effort, sleep fragmentation, presence of respiratory event related arousal (RERAs) and presence of flattening of respiratory curve, which indicates airflow limitation. Controversies exist regarding the characterization of upper airway resistance syndrome as part of a continuum with other sleep breathing disorders, or as a separate entity that may not progress to obstructive sleep apnea syndrome. Treatment of upper airway resistance syndrome is more challenging than obstructive sleep apnea syndrome, since patients have lower tolerance for continuous positive airway pressure (CPAP) use. Other treatment modalities have been investigated, but they are still not established for clinical practice. Recognition of upper airway resistance syndrome is important, since it may prevent long-term consequences or progression to more severe forms of sleep-related breathing disorders.
Keywords: airway resistance; polysomnography; electroencephalography; sleep apnea, obstructive; sleepiness; arousal; respiration.