BACKGROUND AND OBJECTIVE: Continuous Positive Airway Pressure (CPAP) is the treatment of choice for moderate to severe obstructive sleep apnea (OSA). However, the compliance to CPAP is variable. We evaluated the impact of a simple educational program administered by one nurse.
METHODS: We evaluated CPAP compliance in 95 OSA patients that participated in the educational program and in 93 patients that did not. The program provided information and training, supported by video sessions and outpatient visits with the nurse at 7, 15, 30, 60 and 90 days at after CPAP initiation. The control group did not receive any information or training. Both groups were evaluated at each visit, using the general sleep and Epworth Sleepiness Scale (ESS) questionnaire, for adherence and side effects of CPAP.
RESULTS: Control and experimental groups had similar age (53±11 vs. 53±11 y), body mass index (32±6 vs. 33±7 kg/m2), apneahypopnea index (43±25 vs. 46±28), and CPAP pressure (17±5 vs. 16±6 cmH2O). CPAP compliance was significantly higher in the educational program group compared with the control group (71 vs. 56%, p=0.02; and 6.3±1.9 vs. 5.1±1.7 hrs/night, respectively, p=0.01) at the 90th day. In the educational program group, regular CPAP users had lower ESS scores after 90 days of CPAP therapy compared with irregular users (7.1±4.9 vs. 10.2±5.3, respectively; p=0.007).
CONCLUSIONS: Our study supports the concept that an orientation program is effective in improving CPAP compliance.
Keywords: CPAP, compliance, educational program, OSAS.
BACKGROUND AND OBJECTIVE: Sleep deprivation promotes an increase in aggressiveness; however, this effect has not been investigated in humans. Since high alcohol intake promotes desynchronized sleep deprivation and alcoholism is directly associated with domestic violence (DV), this study aimed to collect information on sleep characteristics, anxiety, and alcohol consumption by DV perpetrators.
METHODS: Having this purpose in mind, 53 female victims of physical violence perpetrated by their intimate partners (DV group) were interviewed after providing free informed consent. The interviews took place on the occasion that the abused women registered a formal accusation at the Specialized Police Station for Women. The interviews were structured in a previously tested questionnaire.
RESULTS: Thirty women from the general population without any complaint of DV composed the control group. The DV group showed prevalent insomnia, high sleep fragmentation, intense daily snoring, a tendency to disregard sleep hygiene rules and thus feel sleepy during the day, sleep complaints, high alcohol intake, and high anxiety levels. Increased aggressiveness from their partners after a poor night's sleep was reported by 58% of DV victims, and half of them reported having been battered on those days.
CONCLUSIONS: Data obtained support the possible involvement of sleep-deprivation-induced aggressiveness in DV etiology; this fact requires confirmation by further studies using other reliable methods.
Keywords: sleep deprivation, aggressiveness, alcoholism, anxiety, domestic violence.
BACKGROUND AND OBJECTIVE: Hypocretins (orexins) are recently discovered neuropeptides that are produced in a very restricted area of the lateral hypothalamus. These peptides were originally associated with feeding behavior, but have come to be viewed as essential in causing narcolepsy and regulating sleep. Narcolepsy is a sleep disorder associated with REM sleep abnormalities, and it is likely that hypocretins play a major role in regulation of this sleep stage.
METHODS: To verify the potential effects of REM sleep deprivation on the levels of hypocretins in the brain, we deprived mice of REM sleep for 96 h and measured the levels of hypocretins in whole brain preparations using an enzyme immunoassay.
RESULTS: Our results showed no difference in the levels of hypocretin 1 and 2 (orexin A and B) in REM sleep-deprived animals or in animals that had a sleep rebound after sleep deprivation.
CONCLUSIONS: These results corroborate data in the literature that show that sleep deprivation does not produce significant alteration in hypocretin levels in the mouse brain just after an active period.
Keywords: Hypocretin, Orexin, Sleep, Sleep Deprivation, REM Sleep, Enzyme immunoassay
BACKGROUND AND OBJECTIVE: The purpose of the present study was to evaluate the effects of a nap at work on the sleepiness of 12-hour, night-shift (registered and assistant) nursing personnel.
METHODS: Twelve nurses filled out daily logs, the Karolinska Sleepiness Scale (KS), and wore wrist actigraphs for two periods of four continuous days.
RESULTS: Mean nap duration during the night shifts was 138.3 (SD+39.8) minutes. The mean sleepiness level assessed by the KS score was lower, 3.3 (SD±1.6), when the nap was taken during the first span (00:01 - 03:00h) of the night shift, compared with 6.6 (SD±1.0) when there was no nap. The mean sleepiness level assessed by the KS score was also lower, 3.6 (SD±0.9), when the nap was taken during the second span (03:01 - 06:00h) of the night shift, compared with 7.0 (SD±1.1) when there was no nap. Thus, napping either during the first or second part of the night shift reduces sleepiness of 12-hour, night-shift nursing personnel. Moreover, the mean duration of the first sleep episode after night work was longer in those who did not nap than in those who did.
CONCLUSIONS: The results of this study show that napping during the 12-hour, night-shift results in less sleepiness at work and less need for recovery sleep after work.
Keywords: naps, sleepiness, sleep, night work, nursing personnel.
BACKGROUND AND OBJECTIVE: Comparing the sleep-wake cycle (SWC) and daytime sleepiness in adolescents when they attend morning classes and during school vacations.
METHODS: The sleep-wake cycle was evaluated based on the student's sleep log, and daytime sleepiness was evaluated by the Karolinska Sleepiness Scale (KS). Comparison between these variables was performed with 42 Brazilian adolescent students (14-19 years old) based on a one-week period on schooldays and a one-week period on vacation days. SWC irregularity was evaluated through standard deviation in bedtime and wake-up time on weekdays and on weekends. For statistical analysis, dependent T-test and Repeated Measures Anova were applied (p <0.05).
RESULTS: During the vacation period, sleep irregularity is maintained, but in contrast to the schoolday period, adolescents have a more extended sleep period on weekdays than on weekends. Bedtime and wake-up time are delayed, and sleep duration increases along the week. Sleepiness shows a daily pattern characterized by higher sleepiness levels at wake-up time and bedtime, and during vacations, such levels decrease at wake-up time and at 2:00pm. Moreover, during vacations frequency of naps decreases both on weekdays and on weekends.
CONCLUSION: The morning school schedule is not the sole cause for the adolescent's sleep irregularity. Sleep habits associated with other factors involving the adolescent's socio-cultural context may influence such behavior. It is important to investigate the extent at which sleep schedule irregularity starts to be detrimental to the individual's sleep quality.
Keywords: Sleep-wake cycle, adolescent, vacation, school schedules, partial sleep deprivation
BACKGROUND AND OBJECTIVE: Patients with Parkinson's disease (PD) often suffer from sleep disorders that impair their quality of life. The purpose of this study was to investigate how dietary supplementation with fish oil, which is rich in the omega -3 family fatty acids Docosahexaenoic acid (DHA) and Eicosapentaenoic (EPA), may affect sleep quality and excessive daytime sleepiness (EDS) in Parkinson patients lacking comorbidity or depression.
METHODS: Thirty-seven patients from the Parana Association of Parkinson Carriers were divided into two groups; patients in one group (n=19, average age 66.6±11.6 years) were administered fish oil capsules while patients in the other group were given mineral oil (n=18, average age 62.1±13.3 years) for eight consecutive weeks. The two groups were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ES).
RESULTS: We found that supplementation with fish did not affect daytime sleepiness in patients (F= 2.18; p = 0.15); both groups showed a reduction in daytime sleepiness (F= 4.26; p<0.05). We also did not observe an effect of supplementation on patients sleep quality (F=0, 27; p<0.61); both groups had an improvement in sleep quality (F= 5.46; p<0.05).
CONCLUSION: We found that polyunsaturated fatty acids, which ameliorate psychiatric disorders like depression, do not affect sleep alterations in Parkinson patients under the clinical conditions evaluated, although our conclusions are limited by a reduced sample size.
Keywords: Parkinson's Disease; fish oil, omega-3 fatty acids; daytime sleepiness.
Primary SB pathophysiology has been associated with mild dysfunction of the basal ganglia, psychological social factors, tooth interference, genetic influences and a combination of these factors that lead to increased motoneural excitability during sleep. In primary SB, arousals trigger autonomic nervous system and chewing muscle activity, which lead to teeth grinding. The main signs and symptoms of SB include grinding noises, dental wear, masseter and temporal muscle hypertrophy, local pain, temporomandibular joint disorders, and unrefreshing nocturnal sleep. Primary SB manifestations are highly variable over time. A primary SB clinical diagnosis is made by evaluation of a patient's history and a dental examination. Sleep studies are indicated to rule out anassociated sleep pathology, such as sleep-disordered breathing, and to evaluate sleep-state teeth grinding and arousals. Therapeutic approaches to secondary SB consist of managing the underlying medical, psychiatric or substance-related conditions. Primary SB therapeutic treatment includes several approaches which are customized to the subject's clinical characteristics. Dental treatment with mouth guards primarily aims to prevent orofacial damage and pain. Pharmacologic therapy with muscle relaxers, benzodiazepines, antidepressants other than Selective Seratonin Reupatake Inhibitor (SSRIs), or anti-epileptic drugs can be employed. Botulin toxin type A IM applications into masticatory muscles might be considered as an alternative for unresponsive cases of primary and secondary SB.
Keywords: teeth grinding, sleep bruxism, physiopathology, treatment.
SB treatment is based on a combination of behavioral treatment, pharmacological treatment, and dental treatment according to the carrier's profile. Secondary SB treatment should be tailored to the specific cause, in addition to any necessary procedures described below.
Behavioral treatment encompasses drugs suppression, sleep hygiene measures, relaxation techniques, and behavioral treatment for anxiety.
Primary and secondary SB pharmacology employs dopaminergic agonistic drugs, anxyolitic benzodiazepinics, clonidine, buspirone, non-benzodiazepinic hypnotics (zolpiden), muscle relaxers, antidepressants, such as mirtazapine, trazodone, and antiepileptic drugs, such as gabapentine. Local application of botulinic toxin to the masseter and temporal muscles may be used in cases of secondary bruxism or severe SB.
Association of behavioral strategies and dental protection appliances seem to be the most adequate therapeutic measures for mid-and long-term bruxism treatment.
Keywords: sleep bruxism, behavioral treatment, pharmacological treatment, dental treatment