Movement disorders or disturbances (MD) comprise an important subset of sleep medicine. Among the known types of MDs, two are considered to be of great importance: disorders related to periodic limb movements in sleep (PLMS) and restless leg syndrome (RLS), which usually occur during sleep or at the transition between waking and sleep. These two problems tend to be associated and are frequently referred to by the common acronym RLS/PLMS. In addition to these, sleep related cramps, sleep bruxism and rhythmic movements make up the range of sleep-related movement disorders listed in the International Classification of Sleep Disorders. The present paper reviews the epidemiological, etiological, diagnostic and therapeutic aspects of these diseases.
Keywords: sleep; sleep disorders; movement disorders; restless legs syndrome; periodic limb movements.
Diabetes, which has been declared a major global health issue, involves the central nervous system and balancing vital functions such as cardiovascular and circadian rhythms. There is increasing evidence that the alarming prevalence of diabetes may be aggravated by endemic voluntary sleep loss. In an attempt to understand the underlying mechanisms involved in the genesis and progression of diabetes, animal models have been developed to mimic the physiological responses involved. These models have greatly assisted research in this field. Major advancements have been made in diabetes research in animal models that have significantly contributed to the understanding of the etiopathology of this disease and its dreaded chronic complications. This review summarizes rodent models used in studying diabetes, focusing on its manifestations in sleep patterns.
Keywords: Diabetes; Sleep; Sleep deprivation; Obesity; Animal models; Rats.
Shift work is a reality in many sectors of industrial societies. Unfortunately, it is associated with several problems. Within this context, we highlight fatigue caused by extended working hours and the resulting increase in the risk of accidents. This is also a reality on Brazilian roads, with increasingly alarming rates of accidents involving intercity drivers. A significant number of such accidents is related to sleepiness caused by disruptions in the circadian rhythm. The necessity to drive for many consecutive hours without a pause, extended working hours, and mainly driving in the early hours of the morning may affect the driver's wakefulness state and performance. This may be due to a lack of synchrony with the temperature curve, as well as melatonin levels. To minimize the risk of accidents, work schedules should include regular pauses during the work journey. Moreover, such schedules should prevent professional drivers from working for more than 10 consecutive hours, as the risk of accidents increases significantly after the 8th hour at the wheel.
Keywords: Shift work; Accidents; Intercity drivers; Circadian rhythm; Fatigue.
OBJECTIVE: The objective of this study was to evaluate sleep disorders and their relationship to clinical variables in schizophrenia.
SUBJECTS AND METHODS: In this cross-sectional study with ambulatory patients suffering from schizophrenia, sleep quality was evaluated with the Pittsburgh Sleep Quality Index (PSQI), and excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS).
RESULTS: Eighty-two patients (42 male and 40 female) aged 17 to 59 years (mean age 32.2±9.8) were studied. Poor sleep quality (PSQI>6), exhibited by 41 patients (51.3%), was independently associated with the female gender (OR=2.98; CI=1.13-7.83). Excessive daytime sleepiness (ESS>10) was found in 20 patients (24.7%), and ESS scores tended to correlate with treatment duration (P=0.07).
CONCLUSION: In schizophrenia, poor sleep quality, present in 50% of the patients studied, is associated with the female gender. We suggest that physical and cognitive-behavior therapy to improve sleep quality should be initiated intensively in women with schizophrenia.
Keywords: Sleep; Schizophrenia; Epworth Sleepiness Scale.
In several treatment regimens, the recognition of chronobiology contributes to the therapeutic process through the effective use of temporization protocols. The purpose of the present study was to evaluate the relationship between the response to physiotherapeutic treatment and the time of day when such treatment was performed, as well as the chronotype of orthopedic and rheumatologic patients in a clinical physiotherapy school. The population studied was treated in the morning and evening periods. The patients were divided into three groups of pathologies with similar treatments, which were as follows: syndrome of shoulder impact (n=33), knee artrosis (n=17), and lombalgia (n=23). At the end of ten treatment sessions, data concerning pain, percentage of subjective improvement, chronotype, and age were compared. At the end of the study, it was observed that the time of day when treatment was performed influenced the results of individuals treated in the evenings but had no influence on the individuals treated in the morning. In addition, the evening schedule was the most well suited for intermediate individuals.
Keywords: Physiotherapy, Chronobiology, Chronotype, Chronotherapy.
OBJECTIVES: Comparing the sleep-wake cycle, sleep quality, and sleep-related complaints of patients in a private general hospital to those patients in a public general hospital
METHODS: Transversal study conducted with a sample comprising 50 patients in a public hospital and 42 patients in a private hospital. Protocols: Pittsburgh Sleep Quality Index, Questionnaire on Sleep Habits and medical records. The Student's t-Test was utilized for independent samples and for Person's correlation.
RESULTS: The sleep quality averages for patients in the private hospital and in the public hospital were 5.3 ± 2.9 and 7.04 ± 4.2, respectively, with a significant difference between them (t = 2.2; p < 0.05). Overall, 74% of patients in the public hospital and 69% of patients in the private hospital showed excessive daily sleepiness. Disturbed sleep during the night for medication was the most frequent complaint in relation to the hospital environment. Only a few complaints were made by patients, and the ones that were reported were seldom acted on by the health care professionals.
CONCLUSIONS: Environmental and individual factors should be considered in the etiology, predisposition and maintenance of sleep disturbances in patients treated in general hospitals.
Keywords: Inpatients, Sleep, Sleep disorders, Hospitals, Behavioral Medicine, Health.
OBJECTIVE: Several clinical and experimental studies have shown an association between hyperhomocysteinemia and cardiovascular diseases (CVD). Long-term exposure to a hyperlipidic diet induces tissue fatty acid accumulation and increases circulating lipid concentrations, which raises the risk for CVD. Sleep debt is also considered to be an important factor enhancing cardiovascular risk. Since no information concerning homocysteine (Hcy) levels resulting from a hyperlipidic diet is currently available, our objective was to investigate changes in Hcy concentrations in sleep deprived rats fed a hyperlipidic diet.
SUBJECTS AND METHODS: Rats were maintained for 65 days on a high-fat diet, whereas control animals received regular food ad libitum. After this period, a sub-group of these animals was submitted to sleep deprivation (SD). Homocysteine, thiobarbituric acid reactive substances (TBARS), vitamin B6, folate, and the lipid profile were measured.
RESULTS: Hcy concentrations were significantly higher in hyperlipidic fed rats. Sleep deprivation reduces high levels of this amino acid as well as triacylglicerols and TBARS levels.
CONCLUSIONS: The present study shows for the first time that plasma Hcy concentrations in rats increase as a result of a hyperlipidic diet consumption. Metabolic changes induced by SD interfered in CVD-related factors even after the use of a hyperlipidic diet.
Keywords: hyperhomocysteinemia; hyperlipidic diet; rats; sleep deprivation.
OBJECTIVE: To carry out a retrospective evaluation on the characteristics of dental occlusion in children and adolescents who were referred for polysomnography due to complaints about snoring and sleep disorders.
SUBJECTS AND METHODS: In the present descriptive study, out of the 101 patients who were referred for polysomnographic evaluation (PSG), 60 patients (45 male and 15 female) were consecutively evaluated. The instruments used in the evaluation were clinical data, medical records, and PSG.
RESULTS: The sample average age was 9.2±4.7 years, and the BMI was 21.0 ± 7.7 kg/m2. According to the PSG, the population evaluated showed the following sleep abnormalities: OSAS was detected in 65% (n=39) of the subjects, snoring in 18.33% (n=11), and contractions of the mentonian region muscles in 26.66% (n=16). According to the clinical evaluation, 49 of the patients showed oral breathing; Class I occurred in 21.66% (n=13) of the patients, Class II in 68.33% (n=41), and Class III in 10% (n=6). A significant correlation was observed between OSAS, and Class II (p=0.05) and between OSAS and Class III (p=0.009).
CONCLUSION: According to the methodology applied, it was found that, in children and adolescents evaluated in the present study, a significant correlation between OSAS and dental occlusion type Class II could be observed. Considering the limited number of subjects included in the sample, prospective studies with larger samples should be conducted.
Keywords: Oral breathing; Malocclusion; Sleep disorders; OSAS; Disordered breath during sleep.
Adolescence is marked by, among other things, an increase in daily sleepiness as a consequence of insufficient sleep, more intense during school days. Partial sleep deprivation results from the tendency of adolescents to delay their sleeping and waking times. This behavior is known as the phase delay, and is in conflict with the students' morning school schedules. Excessive sleepiness during the day impairs their concentration and their capacity to learn. The purpose of this article was to discuss the role of sleep in consolidating learning. In addition, it also shows that the phase delay, in contrast to what was believed some decades ago, is caused not just by changes in the adolescent's habits but also by physiological changes that occur during puberal development. Lastly, this article presents strategies for intervention that aim to reduce excessive daily sleepiness. Such interventions involve increasing awareness in the school community of the importance of sleep habits, introducing educational programs on sleep in elementary school, and discussing the adequacy of school schedules.
Keywords: Adolescents; Phase delay; Excessive daily sleepiness; School performance.