OBJECTIVES: Aging is associated with morphological, functional, biochemical, and psychological alterations. The aim of this study was to verify whether basal metabolic rate (BMR) is associated with body composition and sleep in elderly men with or without obstructive sleep apnea (OSA).
METHODS: We evaluated 95 elderly men (69.1 ± 3.4 years old) divided into OSA and non-OSA groups. The protocol included polysomnography, BMR (performed the morning after polysomnography) and body composition evaluations.
RESULTS: The results showed that body mass index (BMI) and REM sleep percentage were positively correlated with BMR and negatively related to stage 1 sleep percentage. This model can explain 40% of the BMR variation observed. BMR was positively correlated with morphologic variables and sleep efficiency. In addition, we observed negative correlations of BMR with sleep latency and wake after sleep onset. When comparing the groups, the OSA group had higher values for weight, fat mass, arousals, and apnea-hypopnea index. The OSA group had lower percentage of REM sleep and levels of fat-free mass.
CONCLUSION: This study identified significant associations among BMR, BMI and some sleep variables (stage 1 and REM). Despite the differences between groups in AHI, arousals some sleep parameters, weight and fat mass, BMR was not different between the OSA and non-OSA group.
Keywords: aging, body composition, obstructive, sleep apnea, sleep disorders.
Achyrocline satureioides (As) (known as Marcela) is a plant belonging to the family Asteraceae, with a high content of flavonoids, which justifies its antioxidant and anti-inflammatory properties. Previous clinical studies confirm that compounds with these actions have beneficial effects on patients with Obstructive Sleep Apnea Syndrome (OSAS). This double-blind pilot study investigates the influence of chronic oral treatment (3 months duration) with a preparation of As on some sleep parameters. Eight patients selected as do not possess of other pathologies were diagnosed with OSAS by standard polysomnography (PSG) (5 treated with As and 3 with placebo). As extract used containing 3 mg/ml of the flavonoid quercetin, measured by HPLC, and a prepared without As was used as placebo. Another PSG was performed at the end of the study. The results showed a statistically significant increase of REM sleep (Stage R, 125% increase) and an increasing trend in N2 and N3 stages (slow wave sleep) in patients treated with As. Untreated patients showed random results. The Epworth Sleepiness Scale decreased significantly, which means better quality of life and waking. There were no changes in rates of apnea/hypopnea or oximetry. Improving the quality of sleep and wakefulness, but not a direct influence on the parameters of OSAS, could be justified by the antioxidant and anti-inflammatory actions described for polyphenols, contents in preparations of As.
Keywords: achyrocline, flavonoids, obstructive sleep apnea.
Arylalkylamine N-Acetyltransferase (AANAT) is a rate-limiting enzyme of the melatonin synthesis pathway. Polymorphisms in the AANAT gene are likely to alter the rate of melatonin synthesis and thus lead particular variations on the circadian rhythms of individuals. The purpose of this study was to perform a screening of the AANAT gene in order to identify the polymorphisms presents in a Brazilian sample and seek associations with diurnal preferences. Individuals that scored extreme diurnal preference according to the Horne-Ostberg questionnaire were selected. The search for SNPs was done using Denaturing High Performance Liquid Chromatography (DHPLC). Segregated association tests were performed for each SNP and for the haplotype blocks. A total of six polymorphisms were found, including two that are still not reported in DNA data banks or in the literature. All polymorphisms in the AANAT gene found in this sample, except for one, appeared with very low frequencies, of which the rarer alleles show a maximum frequency 0.06. The most frequent SNP, located in the promoter region (C-263G), showed a borderline association with extreme diurnal preference. It was more frequent in volunteers with an evening preference. The haplotype analysis revealed an association of one haplotype (CACTAC) with diurnal preference. The morning group showed more individuals with the CACTAC haplotype. Thus, it is a very interesting possibility that the C-263G polymorphism, in the context of the other SNPs in the gene, can modulate AANAT gene expression and change the speed of enzyme synthesis, with possible consequences for the temporality of the melatonin secretion curve.
Keywords: AANAT, circadian rhythms, genetics, melatonin, polymorphisms.
INTRODUCTION/OBJECTIVES: Inadequate sleep habits can affect the physical and mental well-being of the individual; therefore, the aim of this study was to assess the sleep habits of patients with chronic stroke and the necessity of sleep hygiene measures.
METHODS: A descriptive study was conducted, which involved 154 patients (90 men and 64 women): 55.2% ≥ 60 years of age and 44.8% < 60 years of age; 81 right brain-damaged and 73 left brain-damaged. The patients completed a Sleep Habits Questionnaire, validated in Brazil, with 47 questions related to family, housing, health, sleep and daily activities. The data were analyzed by the chi-square test.
RESULTS: The results showed that 63.6% of the patients had an additional person sleeping in their bedroom, 12.3% complained about too much noise in the room and 35% complained about too much light. Of these patients, 5.8% were smokers, and 7.8% were alcohol consumers and 70.1% were coffee drinkers. Regarding the sleep quality, 28.6% had difficulty initiating sleep, and 37.6% awoke in the middle of the night. In addition, 95% were unemployed, 80.5% did not perform physical activities, and 95.4% did not perform mental activities.
CONCLUSION: These results indicate that many patients do not follow sleep hygiene measures, suggesting a requirement for sleep medicine measures so that these patients can learn lifestyle habits that ensure good quality of sleep.
Keywords: sleep hygiene, sleep medicine, sleep quality, stroke.
This study provides validation of the Children Sleep Habits Questionnaire (CSHQ) and the Sleep Self Report (SSR) for Portuguese children, using community and clinical samples. The community sample included 574 parents, who fulfilled the CSHQ-PT, and 306 children (Age: M = 8.26; SD = 0.92) who answered the SSR-PT. The clinical sample included 60 parents, who filled the CSHQ-PT, and 30 children (Age: M = 8.73; SD = 1.14) who answered the SSR-PT. Concerning the CSHQ-PT, the community sample showed a total mean score of 43.83 (SD = 6.12), an internal consistency of 0.77, a test-retest reliability of 0.80, and the clinical sample showed a total mean score of 53.99 (SD = 10.43), and an internal consistency of 0.86. Comparisons between the community and clinical samples indicate statistical significant differences (z = -7.91, p = .000). A Receiver Operator Characteristic Curve (ROC) indicated a cut-off total score of 44 (sensitivity of 81%; specificity of 64%). Concerning the SSR-PT, the community sample showed a total mean score of 34.93 (SD = 5.71), internal consistency of 0.70, and the test-retest reliability of 0.75, and the clinical sample showed a total mean score of 39.87 (SD = 7.81), and internal consistency of 0.81. Comparisons between samples indicate statistical significant differences (z = -3.34, p = 0.001). Correlations between parents and children were statistically significant in 14 items of the community sample, and in 12 items of the clinical sample (in a total of 16 items). These results demonstrate that both questionnaires have good psychometric properties, and consistently differentiate the community and clinical samples. In accordance, they can be useful in screening sleep disturbances and habits in Portuguese school-aged children.
Keywords: child, questionnaires, sleep, validation studies.
The Brazilian physiotherapists are working in Sleep field in Brazil, both in clinical practice and research. There are only a few professionals in light of the huge demand of sleep disorder's patients. This text aims to gather evidence and propose protocols to produce guidelines of clinical practice in the performance of physiotherapists in Brazil. It addresses Obstructive Sleep Apnea Syndrome, Neuromuscular Disorders, Restless Legs Syndrome, Periodic Leg Movements, Fibromyalgia and Sleep Bruxism.
Keywords: fibromyalgia, neuromuscular diseases, nocturnal myoclonus syndrome, obstructive, physical therapy specialty, sleep apnea.
Frailty results from decreased physiological and functional reserves during pathologic aging processes and leads to vulnerability to minor stress, increasing morbidity and mortality. The majority of older persons more than 85 years are frail or pre-frail. Sleep disturbances are also more prevalent in the elderly and possible associations between frailty and sleep problems have been studied. This article aims to summarize clinical and biological data favoring this hypothesis and discuss future research implications. Keywords related to frailty and sleep were searched by means of a non-systematic search in the National Library of Medicine's MedLine database's PubMed system. Observational studies found associations between frailty parameters and subjective and objective measurements indicating poor sleep, circadian rhythm disruption and sleep disorders in aged persons. Unbalances between catabolic and anabolic hormones, enhanced inflammatory response and reduced energy expenditure are shared pathways that can explain a bidirectional correlation between frailty states and poor sleep in advanced ages. Interventions over circadian rhythm or sleep disorders have potential clinical implications in the frail elderly. As a complex entity with sparse and still emergent therapeutic options, frailty can benefit from sleep quality improvement along advanced ages.
Keywords: aging, frail elderly, sleep disorders.