OBJECTIVE: Polygraphy (PG) is an attractive alternative for diagnosing obstructive sleep
apnea (OSA) in patients with high pre-test probability. However, several
patients may not present typical symptoms. In this scenario, it is unclear
the performance of PG for diagnosing OSA in non-referred populations to
METHODS: Data from participants of the ELSA-Brasil cohort were used for this analysis. We performed an overnight home PG (Embletta GoldTM) synchronized with a wrist actigraphy (Actiwatch model 2TM). The validation strategy comprised three scorings from each participant: 1) Original scoring (PG): Routine scoring using data from the exclamation button mark to define “analysis start” and “analysis stop”; 2) Scoring using actigraphy data (PG+actigraphy): total sleep time defined by the actigraphy data; 3) Scoring using diaries (PG+diary): “analysis start” and “analysis stop” based on the diaries. Bland-Altman plots were generated to assess the agreements (Kappa) between each scoring strategy.
RESULTS: A total of 300 participants were included in the final analysis (45% males, mean age: 48±8 years). The frequency of OSA using the PG score was 27.3%. Despite small differences in the OSA severity index, we obtained a high concordance of AHI comparing the PG vs. PG+actigraphy (Kappa: 0.95) as well as PG+diary vs. PG+actigraphy (Kappa: 0.96). No significant changes in the OSA classification (mild, moderate and severe) were observed in the 3 protocols.
CONCLUSION: Using a pragmatic approach to address OSA at home, our results suggest that PG is a useful tool for OSA diagnosis even in subjects not referred to sleep studies.
Keywords: Sleep Apnea; Diagnosis; Polysomnography; Wrist
STUDY OBJECTIVES: Night-to-night variability in the apnea-hypopnea index (AHI) may affect the
accuracy of the diagnosis of obstructive sleep apnea (OSA) and treatment
selection. This study was conducted to assess the utility of the standard
error of measurement (SEM) in predicting the night-to-night variability in
METHODS: Ninety nine patients underwent a 3-consecutive nights of sleep monitoring with a validated home portable monitoring devise (BTI-APNiA, BTI Biotechnology Institute, Vitoria, Spain). The night-to-night variability in apnea- and hypopnea-related measures and blood desaturation were assessed. The agreement between the three nights was also assessed. The SEM and the AHI of the first night were used to calculate a range for the severity of the OSA. This range was then challenged to predict the most frequent OSA severity, the OSA severity in nights 2 and 3, and the OSA severity in the three nights.
RESULTS: Ninety nine patients (mean age: 56±14 years) participated in the study. The mean body mass index was 25.4±4.0 Kg/m2 and the mean score of Epworth questionnaire was 8±5. The AHI of the first, second and third nights were 13.96±13.46, 13.76±12.76 and 13.52±12.91 events/h, respectively. The night-to-night variability in the AHI and the sleep time in supine position over the three nights were not statistically significant. However, the differences in the severity of the OSA was statistically significant (range of agreement in the diagnosis: 41.7%-83.3%). The standard error of measurement (SEM) considering the AHI was 4.64 events/h.. The SEM was efficient in predicting the most frequent OSA severity (among the three nights) in more than 96% of the cases.
CONCLUSIONS: The night-to-night variability in the AHI might affect the diagnosis of OSA. The use of standard error of measurement and the AHI of one single night would be of interest to predict the night-to-night variability in the severity of OSA.
Keywords: Sleep; Sleep Apnea, Obstructive; Polysomnography; Respiratory Rate.
OBJECTIVES: Musculoskeletal (MSK) pain and hypersomnolence (HPS) are very disabling
conditions that may share some pathophysiological factors. This study aimed
to evaluate the interaction between MSK pain and HPS and its association
with mood symptoms, fatigue, quality of life, and both objective and
subjective sleep quality.
DESIGN: Cross-sectional study.
SETTING: General population based sample.
PARTICIPANTS: 510 individuals from EPISONO cohort, São Paulo (Brazil).
MEASUREMENTS: All participants completed questionnaires, had clinical assessment and underwent a full-night polysomnography. HPS was defined according to Epworth Sleepiness Scale while the presence of MSK pain was defined by structured questionnaire. The sample was allocated into 4 groups: control (CTRL, n=281), HPS (n=141), MSK (n=50), and both conditions (HPS+MSK, n=38).
RESULTS: MSK pain and HPS by themselves were associated with worse mood symptoms and quality of life. However, individuals with both associated conditions (HPS+MSK) presented higher frequencies of moderate to severe depression (44.1%) and anxiety symptoms (45.7%), as well as an additional decrease in quality of life compared to the other groups. There were no differences between HPS+MSK and MSK groups in objective sleep pattern. With regard to subjective sleep, HPS+MSK presented a higher prevalence of sleep attacks and cataplexy compared to all other groups.
CONCLUSIONS: The combination of MSK pain and HPS was associated with worse mood symptoms, quality of life and HPS-related features. This study suggests that sleepiness may be an important symptom to be investigated and treated in MSK pain-related conditions for a better quality of life.
Keywords: Sleep; Musculoskeletal Pain; Disorders of Excessive Somnolence; Mood Disorders; Quality of Life.
BACKGROUND AND AIM: Given the ever-increasing of the older adults population and in order to
achieve healthy and active ageing goals and improvement in the cognitive
function and sleep quality in older adult, this study aimed to evaluate the
effect of cognitive training program on improving cognitive function and
ageing-related sleep quality in community-dwelling elderly in Iran, in
METHODS: This was an experimental study. The sample comprised 420 older adults who were a member of the comprehensive health center in one of the southern cities of Iran. 164 had a cognitive problem and sleep disorder, of whom 108 were selected by the available method and based on inclusion criteria. Participants were randomly allocated to an experimental group (n=54) and a control group (n=54). Experimental group samples were undergoing the intervention for two months. Data were collected using MMSE questionnaire, Pittsburgh sleep quality, insomnia severity index and Clinical Dementia Rating Scale (CDR). Data were collected one month before-and-after the intervention. Data were analyzed using SPSS software.
RESULTS: There was no significant difference between the mean score of cognitive function and sleep quality in both the intervention group and the control group before the intervention (p>0.05). At the post-test, the mean (SD) of elderly adults’ cognitive function in the intervention and control groups were 2.7 (1.3) and 3.44 (1.7), respectively (p=0.017). Moreover, the mean (SD) of sleep quality in older adults in the intervention and the control group was 6.76 (2.3) and 9.25 (2.36), respectively (p<0.001).
CONCLUSION: Given the obtained results in the current study the cognitive training promotes cognitive function and sleep quality in older adults. Therefore, since this program is effective, low-cost and applicable, it can be used to improve cognitive function and sleep disorder in the older adult population.
Keywords: Cognitive Therapy; Memory; Cognitive Dysfunction; Sleep; Health of the Elderly; Iran
OBJECTIVES: Sleep is one of the basic elements which affects the growth and development
and mental health of the child. The aim of this study was to determine the
relationship between sleep habits and mental health in elementary school
children in Nahavand/Iran.
METHODS: In this correlation study, 240 children aged 6-11 years old were selected by cluster random sampling from schools of Nahavand city in Iran, 2017. Data were collected through questionnaires included demographic information, children’s sleep habits (CSHQ) and children sickness indications (CSI-4). Questionnaires were completed by one of parents as self-report. The data were analyzed using Pearson’s correlation and regression analysis.
RESULTS: Based on results, Trouble in sleeping was reported by 36% and mental health disorders by 24.5% of elementary schools children. The regression analysis showed sleep habits had significant associations with the mental health score. In other words, improper sleep habits were associated with higher scores of illness symptoms of mental health that are indicative of poor mental health.
DISCUSSION: Sleep disorder is one of the problems of elementary schools children, which related to their mental health. Sleep health training for parents and trainers in schools can help to improve the mental health of children by reforming proper sleep habits.
Keywords: Sleep Habits; Mental Health; Children
OBJECTIVE: The aim of this study was evaluated effects of an intervention with the
serious game “Perfect Bedroom: learn to sleep well” on the sleep habits of
METHODS: Two groups were composed, experimental (EG) (n=8) and control (CG) (n=5), with health children. This study presented four stages: pre-intervention, intervention, post-intervention and follow-up. Parents responded questionnaires about sociodemographic data and sleep habits measured by UNESP Sleep Habits and Hygiene Scale Child version (USHS). Children responded strategies developed by researchers: “Set up your bedroom” and “Mapping activities before bedtime”. The intervention was performed with “Perfect Bedroom” twice a week and for three weeks in a row. Inferential analysis was accomplished for comparisons between groups (Mann-Whitney test) and intragroups (Wilcoxon signed-rank test and Friedman test for repeated measures).
RESULTS: Preliminary results indicated non-significant differences on the sleep habits reported by parents. Children’s responses indicated a reduction in the number of electronic objects in bedroom and actions with these devices to EG.
DISCUSSION: As far as we know, this is the first study that used a serious game to promote healthy sleep habits in children. In addition, they are actively included in the change process. Preliminary findings contribute to indicate the potential of this approach as an effective tool to promote healthy sleep habits in children.
Keywords: Children; Sleep Hygiene; Sleep; Interactive Learning; Games, Experimental
The cone beam computed tomography (CBCT) image provides clear differentiation of soft tissues from empty spaces. This paper presents a literature review to evaluate the effects of orthopedic and surgical treatment on the pharyngeal dimension by CBCT. It was concluded that treatments involving dentofacial orthopedics and orthognathic surgery have been related with an increase in the upper airway volume. Standardized capturing of tomographic images and more controlled and randomized studies are necessary.
Keywords: Cone Beam Computed Tomography; Pharynx; Orthognathic Surgery; Orthodontics
INTRODUCTION: Obstructive sleep apnea (OSA) is a respiratory sleep disorder. Many of these
patients also exhibit autonomic alterations which can be observed through
heart rate variability (HRV). Currently, one of the treatments for apnea is
continuous positive airway pressure (CPAP).
OBJECTIVE: To observe OSA patients treated with CPAP exhibit HRV changes at medium and long treatment period.
METHODS: This is an integrative literature review conducted in May of 2018. The databases used for this research were PubMed, Scopus, Scielo and Pedro, the keywords used were “heart rate variability”, “obstructive sleep apnea” and “CPAP”. In this review was included original, published, randomized and non-randomized articles, released in the English language, before and up to April 2018, which specified the effects of CPAP therapy in autonomic dysfunction through the analysis of the HRV of patients diagnosed with OSA after at least one month of therapy.
RESULTS: The research of the literature produced 113 articles. After excluding duplicates and applying the inclusion and exclusion criteria, 8 articles were selected for this review.
CONCLUSION: It was concluded that CPAP therapy is related to change in heart rate variability in patients with obstructive sleep apnea.
Keywords: Obstructive Sleep Apnea; Heart Rate; Continuous Positive Airway Pressure; Autonomic Nervous System
Non-pharmacologic treatments of Sleep-Related Movement Disorders (SRMD) are already well described in the literature. The physical activity has been presented as a factor to improve quality of life and in several aspects related to sleep disorders. Thus, the purpose of this review was to analyze the benefits of physical exercise and your indication to improve to SRMD. In the research, 19 studies were found that evaluate the efficacy of physical exercise on SRMD in both human and animal models. The results demonstrate that both acute and chronic physical exercises are effective in reducing symptoms of SRMD. However, most studies were performed with aerobic exercise. Three studies evaluated the efficacy of combined exercise, and no studies have investigated the relationship of resistance exercise. Regarding the mechanisms involved, a study discusses the relationship between the release of beta-endorphin and the exercise practice, and two studies with animal models show the changes of the dopaminergic system after physical exercise. From this evidences, we suggested that physical exercise is a favorable non-pharmacological treatment for SRMD. However, more studies should be available for a better understanding of the molecular mechanisms involved, as well of the type, duration and better time of the day to practice.
Keywords: Restless Legs Syndrome; Movement Disorders; Physical Exercise; Sleep Wake Disorders
This review concerns the first systematic work on REM Behavior Disorder (RBD) etiology, physiopathology, diagnosis, clinical management, as well as new trends on genetic research. It represents massive expert cooperation involving multinational specialists and provides a valuable tool for further comprehension of this sleep condition.
Keywords: Sleep; Sleep, REM; REM Sleep Behavior Disorder; REM Sleep Parasomnias