Navegando por Palavras-chave "Insomnia"

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    Análise do comprimento médio de telômeros de leucócitos em indivíduos com apneia obstrutiva do sono, insônia e ambos os distúrbios associados: um estudo de base populacional
    (Universidade Federal de São Paulo (UNIFESP), 2017-06-30) Tempaku, Priscila Farias [UNIFESP]; Tufik, Sergio [UNIFESP]; Hirotsu, Camila [UNIFESP]; http://lattes.cnpq.br/0254842686561012; Lattes http://lattes.cnpq.br/1375290481822767; http://lattes.cnpq.br/1848763194021358; Universidade Federal de São Paulo (UNIFESP)
    Analysis of mean leukocyte telomere length in individuals obstructive sleep apnea, insomnia and both disorders associated: a population-based study. 2017. 129p. MSc Dissertation - Department of Psychobiology. Universidade Federal de Sao Paulo, Sao Paulo, Brazil. Throughout life, there is significant alterations in quantity and quality of sleep, characterized by reduction in its duration and higher prevalence of sleep disorders such as insomnia and obstructive sleep apnea (OSA). Although the sleep pattern of the elderly is well-known, the relationship between sleep and the aging-related mechanisms is not clarified. Thus, the present study aimed to determine the relationship between the mean leukocyte telomere length (LTL) with sleep parameters and the presence of OSA, insomnia, insomnia associated with sleep duration and both associated sleep disorders in an adult population. For this, we used DNA collected and extracted from peripheral blood of 928 individuals from the EPISONO. All individuals were subjected to one full-night polysomnography. OSA was determined according to apnea-hypopnea index (AHI). Iindividuals with an AHI≥15 were classified as OSA, while those with AHI<15 were considered as controls. Insomnia was evaluated following the 4th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and when associated with sleep duration, it was additionally evaluated through weighted self-reported total sleep time. For the measurement of LTL, we used the quantitative real-time polymerase chain reaction method in a multiplex format. The results showed negative correlations between LTL and the following variables: apnea-hypopnea index, desaturation index and wake after sleep onset. LTL was also positively correlated with sleep efficiency, total sleep time and basal, lowest and mean oxygen saturation. LTL was significantly shorter in OSA (1.27 ± 0.1) compared to controls (1.38 ± 0.1) (p=0.047). However we did not find a significant association between OSA severity and LTL (p=0.437). Insomnia was not statistically associated with LTL (p=0.823). However, among the long sleepers, insomnia individuals presented shorter LTL (1.28 ± 0.1) compared to controls (1.45 ± 0.1) (p=0.021). Moreover, we did not observe a significant association of both sleep disorders (insomnia+OSA) (1.32 ± 0.1) on LTL (p=0.466). Our data indicates that, differently from insomnia, OSA by itself may have a significant role in the shortening of telomeres. Added to this, when associated with sleep duration, the present study suggests that insomnia may be associated with cellular aging. Thus, we conclude that there is a relationship between the pathophysiological mechanisms of sleep and the molecular pathways of cellular aging related to telomere length maintenance.
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    Análises sobre a relação do uso de contraceptivos hormonais e padrão de sono em mulheres em idade fértil
    (Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Bezerra, Andréia Gomes [UNIFESP]; Hachul de Campos, Helena [UNIFESP]; Andersen, Monica Levy [UNIFESP]; http://lattes.cnpq.br/4951931552005515; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4791144E7; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4702853P7; Universidade Federal de São Paulo (UNIFESP)
    Female sexual hormones have known hypnogenic effects and the use of hormonal replacement therapy in postmenopausal women leads to improvement in sleep quality. However, the effects of hormonal contraceptives in premenopausal women is still scarcely understood. The present thesis consisted of two studies addressing the theme. The first one sought to evaluate the impact of hormonal contraceptive use on subjective sleep self-reports among premenopausal women through a web-based cross-sectional trial. A total of 2,055 premenopausal women between 18 and 40 years-old participated answering an online questionnaire evaluating hormonal contraceptive use, sleeprelated characteristics and related features. In addition to questions about the self-perception of sleep parameters, the sleep assessment tools comprised the Epworth Sleepiness Scale (ESS) and the Insomnia Severity Index (ISI). A first level of analysis assessed differences between hormonal contraceptive users and non-users. In a second level of analysis, we compared whether there was a significant difference in sleep parameters between combined contraceptive users and progestagen-only contraceptive users. Generations of contraceptives were evaluated at a third level of analysis and, finally, we assessed possible sleep effects between oral progestagen-only contraceptives and levonorgestrelreleasing intrauterine system type. Of the total sample, only 1286 participants met the inclusion criteria, of which 918 were using hormonal contraceptives (Combined: 848; Progestagen-only: 70). Hormonal contraceptive users reported more sleep complaints and higher scores on ESS and IGI, which means they had excessive daytime sleepiness and more insomnia symptoms. Women using progestagen-only contraceptives reported a shorter total sleep time compared to those using the combined contraceptive. Users of 3rd generation contraceptives presented lower total sleep time and higher IGI scores when compared with nonusers. Comparisons between users of levonorgestrel intrauterine devices and users of other progestagen-only hormonal contraceptives demonstrated a lower sleepiness score, as measured by ESS, among levonorgestrel intrauterine device users in both raw and corrected analysis (intrauterine device users: 9.12±4.57; other progestagens-only: 11.58±4.59). The second study addressed a systematic review and meta-analyses aiming at synthesizing the evidences about the effects of hormonal contraceptives in sleep among premenopausal women. The databases for the bibliographic research were Pubmed, Scopus and Web of Science. The Bibliographic search retrieved 2402 articles, which were reduced to a sample of ten articles after an articles selection process. In total 13 parameters related to sleep were meta-analyzed. It was only possible to include studies of before and after, transversal and cohort design. The only significant result was observed in the total time in the bed, however this data isolated from other sleep parameters does not allow robust conclusions. These data showed a lack of studies in this area and the need to promote research on the possible effects of hormonal contraceptives on sleep in women of reproductive age.
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    Assessment of sleep satisfaction in patients with dementia due to Alzheimer's disease
    (Elsevier B.V., 2014-12-01) Oliveira, Fabricio Ferreira de [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Chen, Elizabeth Suchi [UNIFESP]; Smith, Marilia de Arruda Cardoso [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Sleep length and architecture are potential markers of progressive cognitive impairment, while neuropsychiatric symptoms and APOE4- haplotypes have been associated with more sleep complaints in patients with dementia due to Alzheimer's disease (AD). in this cross-sectional study, we sought to investigate which factors might be related to sleep satisfaction in patients with AD. A total of 217 consecutive patients with AD were assessed for demographic features, neuropsychiatric symptoms, cognitive decline, functional impairment for activities of daily living, caregiver burden, APOE haplotypes, self-reported sleep satisfaction and length of sleep. Statistical comparisons were conducted with significance at p < 0.05. Concerning sleep complaints, 179 patients (82.5%) reported satisfactory sleep, while 38 (17.5%) were Unsatisfied, with no relation to age, sex, APOE haplotypes, obesity, education, marital status, alcohol consumption or smoking found. Length of sleep (p = 0.011) and behavioural symptoms (p = 0.009) had significant associations with sleep satisfaction. Length of sleep was positively correlated with apathy (p = 0.014) and scores on the Clock Drawing Test (p = 0.015), and inversely correlated with anxiety (p = 0.015) and independence for instrumental activities of daily living (p = 0.003). Patients who were treated with memantine (p = 0.02) or anti-psychotics (p < 0.01) had longer duration of sleep. in conclusion, behavioural symptoms had strong associations with sleep satisfaction, which is highly correlated with length of sleep in patients with AD. Functional independence, apathy, anxiety, use of memantine or anti-psychotics, and scores on the Clock Drawing Test were significantly associated with length of sleep in this sample. (C) 2014 Elsevier B.V. All rights reserved.
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    Association between obesity and sleep disorders in postmenopausal women
    (Lippincott Williams & Wilkins, 2018) Naufel, Maria Fernanda [UNIFESP]; Frange, Cristina [UNIFESP]; Andersen, Monica Levy [UNIFESP]; Batista Castello Girao, Manoel Joao [UNIFESP]; Tufik, Sergio [UNIFESP]; Ribeiro, Eliane Beraldi [UNIFESP]; Hachul, Helena [UNIFESP]
    Objective:To investigate the relationship between obesity and sleep architecture in postmenopausal women.Methods:One hundred seven postmenopausal women from the Ambulatory of Integrative Treatment for Female Sleep Disorders were invited by telephone to participate in this study. Fifty-three completed the study. We included women aged 50 to 70 years, and excluded women on hormone therapy or missing data. The study consisted of two meetings, including a full-night polysomnography. Menopause status was confirmed by amenorrhea for at least 1 year. Anthropometric measurements included: body mass, height, body mass index (BMI), waist circumference, hip circumference, waist-to-hip ratio (WHR), and neck circumference. Participants were allocated into two groups according to BMI: nonobese group (BMI <30kg/m(2)) and obese group (BMI 30kg/m(2)).Results:The obese group had significantly (P<0.01) increased values of BMI, neck circumference, waist circumference, and hip circumference. WHR was similar between the groups (P=0.77). Obese participants had significantly increased values of respiratory disturbance index (16.4 vs 9.3n degrees/h) and apnea-hypopnea index (14.2 vs 5.6n degrees/h). Rapid eye movement sleep latency was positively correlated to body mass (r=P<0.01), BMI (P<0.01), and hip circumference (P=0.01). WHR was negatively correlated to sleep efficiency (P=0.03). The linear regression model showed that BMI (P<0.01) and WHR (P<0.01) were positive predictors of rapid eye movement sleep latency.Conclusion:In postmenopausal women, high BMI and abdominal obesity are sources of sleep disturbances, decreasing deep sleep, and sleep efficiency, while increasing the risk of obstructive sleep apnea.
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    Chiropractic intervention in the treatment of postmenopausal climacteric symptoms and insomnia: A review
    (Elsevier B.V., 2014-05-01) Goto, Viviane [UNIFESP]; Frange, Cristina [UNIFESP]; Andersen, Monica L. [UNIFESP]; Junior, Jose M. S. [UNIFESP]; Tufik, Sergio [UNIFESP]; Hachul, Helena [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Insomnia is a frequent postmenopausal symptom and may be due to hormonal changes, depressive states related to this period of life, hot flashes or nocturia. Chiropractic care has been demonstrated to be effective in the treatment of these symptoms.Objectives: the aim of this study was to review chiropractic interventions in postmenopausal women as a possible management approach to menopausal symptoms and insomnia.Methods: A PubMed search was conducted by cross-referencing the key words insomnia, sleep, and menopause with chiropractic. the search used an end date of January 2014 and retrieved 17 articles.Results: Three articles were eligible for the study. All epidemiological data from large surveys demonstrated a lack of evidence for chiropractic intervention as a complementary and alternative therapeutic method in the management of menopausal symptoms and insomnia.Conclusions: There is no evidence for the effectiveness of chiropractic intervention as a complementary and alternative therapy for menopausal symptoms and insomnia. Further studies with proper methodological designs are warranted. (C) 2014 Published by Elsevier Ireland Ltd.
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    Chronotype and anxiety are associated in patients with chronic primary insomnia
    (Assoc Brasileira Psiquiatria, 2017) Passos, Giselle Soares [UNIFESP]; Santana, Marcos Gonçalves de [UNIFESP]; Poyares, Dalva [UNIFESP]; D'Aurea, Carolina Vicaria Rodrigues [UNIFESP]; Teixeira, Alexandre Abílio de Souza [UNIFESP]; Tufik, Sergio [UNIFESP]; Mello, Marco Tulio de [UNIFESP]
    Objective: To assess the interaction of chronotype with anxiety in patients with chronic primary insomnia. Methods: Sixty-four patients (50 women) with mean age 43.9 +/- 8.1 years were investigated with the Horne and Ostberg Morningness-Eveningness Questionnaire (MEQ) and State-Trait Anxiety Inventory (STAI). Results: Significant negative correlations of chronotype-MEQ score with STAI state-anxiety (r = -0.40, p < 0.05), STAI trait-anxiety (r = -0.40, p < 0.05), and STAI pre-sleep state anxiety (r = -0.30, p < 0.05) were observed. Eveningness preference was associated with higher trait, state, and pre-sleep state anxiety. Conclusions: These results suggest that chronotype may be an important parameter to identifying the origin and significance of a vicious anxiety-insomnia-depression cycle in patients with chronic primary insomnia.
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    Depressive symptoms and sleep: A population-based polysomnographic study
    (Elsevier B.V., 2013-12-30) Castro, Laura Siqueira [UNIFESP]; Castro, Juliana [UNIFESP]; Hoexter, Marcelo Queiroz [UNIFESP]; Quarantini, Lucas Castro; Kauati, Adriana [UNIFESP]; Mello, Luiz Eugenio [UNIFESP]; Santos-Silva, Rogerio [UNIFESP]; Tufik, Sergio [UNIFESP]; Bittencourt, Lia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia (UFBA)
    The goals of the present study were to determine the prevalence of depression in the adult population of São Paulo, Brazil and to explore the relationship among sociodemographic, physical and psychological factors, sleep-related symptoms and polysomnography parameters. Participants of a cross-sectional study (N=1101) were administered questionnaires and submitted to polysomnography. A score >20 in the Beck Depression Inventory was used to describe depression. Results revealed that the prevalence of depression was 10.9%. Estimates were higher in women and were significantly higher among housewives, non-workers and individuals with lower education and income. A combination of sleep-related symptoms and impaired quality of life was 2.5 times more frequent among depressed than nondepressed. Co-morbid insomnia and anxiety were positively associated to depressive symptomatology. There were no alterations in the polysomnography parameters, in either group. the occurrence of sleep apnea with values on the apnea-hypopnea index >= 5 was similar and frequent in both groups (around 30%). the findings suggest that depressive symptoms were associated with low education, low income, severe comorbid symptomatology, and impaired quality of life. Considering the high prevalence of sleep apnea, these results point to potential social and financial burdens associated with the depressive symptomatology and various sleep diagnoses. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
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    Does menopause influence nocturnal awakening with headache?
    (Informa Healthcare, 2013-06-01) Lucchesi, Ligia Mendonça [UNIFESP]; Hachul, Helena [UNIFESP]; Yagihara, Fabiana Tokie [UNIFESP]; Santos-Silva, Rogerio [UNIFESP]; Tufik, Sergio [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective the aim of the present study was to assess whether menopausal status influences the occurrence of nocturnal awakening with headache (NAH) in the female population of São Paulo, Brazil. We also examined the relationship of this complaint to sociodemographic determinants, hot flushes, sleep quality and parameters, anxiety and depressive symptoms, somnolence and fatigue according to menopausal status.Methods the female population of the São Paulo Epidemiologic Sleep Study (EPISONO) (n = 576) was divided according to menopausal status (pre-, peri-, early and late menopause) based on questionnaires and hormonal blood measures. the complaint of waking up because of a headache at least once a week was assessed by the UNIFESP Sleep questionnaire. Additionally, hot flushes, sleep complaints, anxiety and depressive symptoms, somnolence and fatigue were assessed by specific questionnaires. A full-night polysomnography assessed sleep parameters.Results the prevalence of NAH in women in the São Paulo population was 13.3%. Perimenopause was associated with a higher risk of having NAH (odds ratio 13.9; 95% confidence interval 4.3-45.2). More complaints of NAH were observed in obese women. All the groups with NAH showed more hot flushes, worse subjective sleep quality, more complaints of insomnia, anxiety symptoms and fatigue.Conclusions We observed a constellation of symptoms in women according to menopausal status and NAH that included hot flushes, sleep complaints, more anxiety symptoms and fatigue. Moreover, some of these symptoms were more frequent in perimenopausal women with NAH. Therefore, we concluded that menopausal status influences NAH and the women in perimenopause presented a high risk of having this complaint.
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    O efeito da massagem terapêutica nos sintomas climatéricos em mulheres pós-menopausadas com insônia: um estudo clínico randomizado
    (Universidade Federal de São Paulo (UNIFESP), 2011-06-29) Oliveira, Denise de Souza [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    In the climacteric period, approximately 80% of women are affected by consequences of hypoestrogenism: physiological and psychological alterations, hot flashes, nycturia, mood alterations. These changes contribute to the increase of insomnia prevalence in this phase, which affects approximately 28% to 63% of postmenopausal women. The presence of such symptoms associated with socio-cultural conditions, such as retirement, appreciation of youth, aging, reflect directly on quality of life of this population. As hormone therapy is indicated in certain cases and is not indicated for some patients, there has been an increase in the demand for complementary or alternative therapies, including therapeutic massage, which may relieve insomnia symptoms in the climacteric period. The present study is presented in two studies. The first one, a pilot study with seven individuals, evaluated the effects of therapeutic massage on post-menopausal insomniac women and demonstrated subjective and objective sleep improvement. The results of this study led us to conduct a second one, now a randomized and controlled trial, including 44 women, distributed into 3 groups (control, passive movement and therapeutic massage). The results of the questionnaires demonstrated improvement in sleep, climacteric symptoms and quality of life.
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    Efeitos da sonolência excessiva diurna ou da insônia associadas á apneia obstrutiva do sono no risco cardiovascular: um estudo longitudinal prospectivo de base populacional.
    (Universidade Federal de São Paulo (UNIFESP), 2018-03-29) Kim, Lenise Jihe [UNIFESP]; Andersen, Monica Levy [UNIFESP]; http://lattes.cnpq.br/4951931552005515; http://lattes.cnpq.br/9426936592794461; Universidade Federal de São Paulo (UNIFESP)
    Introdução: Diversas são as apresentações clínicas da apneia obstrutiva do sono (AOS), as quais possuem associações distintas com comorbidades. Sonolência excessiva diurna (SED) e insônia são sintomas comuns da AOS. Uma susceptibilidade distinta à mortalidade e a doenças cardiovasculares entre pacientes com AOS sintomática e assintomática ainda é incerta. Objetivos: Investigar os efeitos das apresentações clínicas da AOS com sintomas de SED e insônia na mortalidade, incidência de doenças cardiovasculares e níveis de marcadores metabólicos e inflamatórios. Avaliamos também os possíveis fatores sociodemográficos associados aos efeitos da AOS nos desfechos cardiovasculares. Métodos: Nós conduzidos uma análise prospectiva em uma amostra de base populacional de 1.061 participantes provenientes do Estudo Epidemiológico do Sono (EPISONO) com um tempo médio de seguimento de 8 anos. AOS foi definida como um índice de apneia-hipopneia >5, SED por escores >10 na Escala de Sonolência de Epworth e a insônia pelo auto-relato de 1 ou mais queixas de dificuldade de iniciar o sono (DIS), dificuldade de manter o sono (DMS) ou despertar precoce (DP) por pelo menos 3 vezes/semana. Desfechos primários consistiram na mortalidade por todas as causas e por doenças cardiovasculares. Desfechos secundários incluíram a incidência de eventos cardiovasculares não-fatais e combinados, além dos níveis de marcadores metabólicos e inflamatórios. Resultados: Nos modelos ajustados, AOS foi um fator preditor de riscos 3,02 e 5,85 vezes maiores de eventos cardiovasculares combinados independentemente da SED e insônia, respectivamente. O risco cardiovascular aumentado na AOS foi ainda mais proeminente somente em mulheres (OR: 6,19; IC95%: 1,52-25,28; P=0,01). A insônia foi também um fator de risco de eventos cardiovasculares não-fatais (OR: 5,52; IC95%: 1,12-27,12; P=0,04) e combinados (OR: 6,74; IC95%: 1,39-32,63; P=0,02), com o subtipo da DMS apresentando as únicas associações positivas. A mortalidade e os níveis de marcadores metabólicos e inflamatórios não diferiram entre as apresentações clínicas da AOS. Conclusões: Nossos achados de um seguimento de 8 anos indicaram que a AOS assintomática para SED e insônia é uma apresentação de maior risco de desfechos cardiovasculares. Um risco cardiovascular aumentado foi também observado em pacientes com insônia, especificamente o subtipo de DMS, e em mulheres com AOS.
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    Efeitos de mindfulness no padrão de uso crônico de hipnóticos e na insônia entre mulheres insones que buscam por tratamento
    (Universidade Federal de São Paulo (UNIFESP), 2017-10-26) Barros, Viviam Vargas de [UNIFESP]; Noto, Ana Regina [UNIFESP]; Opaleye, Emérita Sátiro [UNIFESP]; Demarzo, Marcelo Marcos Piva [UNIFESP]; Emérita Sátiro Opaleye : http://lattes.cnpq.br/6255799029544793; Marcelo Marcos Piva Demarzo : http://lattes.cnpq.br/9242996936416312; http://lattes.cnpq.br/1146514655934224; http://lattes.cnpq.br/1656095676195242; Universidade Federal de São Paulo (UNIFESP)
    Objectives: 1) To evaluate the profile of women who chronically use hypnotics and seek for treatment, and the association between hypnotics dependence and dispositional mindfulness in this population. 2) To evaluate the impact of the Mindfulness-Based Relapse Prevention program on the insomnia and hypnotics reduction in this population, over six months postintervention, in a clinical setting. Methods: The research was composed by two studies. The Study 1 was a cross-sectional study and comprised a sample of 76 women in chronic use of hypnotics who lived in São Paulo and voluntarily sought the MBRP program for the reduction or cessation of hypnotics use after disclosure of the project in the media. They answered questionnaires about demographics, dispositional mindfulness (FFMQ-BR), hypnotics dependence (BENDEP-SRQ-PV), insomnia severity (ISI) and anxiety trait (STAI-T). Study 2 was a randomized controlled trial and its sampla was composed by the participants of Study 1. After 6 dropouts, 70 participants were randomized to intervention group – IG (36), which received the MBRP program; and control group- CG (34), that was in the waitlist, having received phone monitoring about the hypnotics use during the 8 weeks, while the IG received the intervention. Every participant received a psychiatric consultation for instruction about the hypnotics tapering and a psychoeducational group session based on the Motivational Interviewing about the chronic use of hypnotics, previously to the intervention. We repeated the measures every two months after the intervention, totaling 8 months of follow-up. Twenty eight participants from the CG and 23 participants of the IG concluded the study. Results: Study 1 – Most of the sample (85.3%) was under medical prescription of hypnotics, from those, in 55.6% of the cases, the doctor frequently evaluated the side effects or effects of the medicine on the patients sleep. Although most of them were using under medical prescription, the dependence indices ranged from high to very high in all dependence subscales. The most used medicine was the Zolpidem (41.3%) and the median of the time of hypnotic’s use was 30 months (IQR=51). In the baseline, the level of dispositional mindfulness, especially in the “observe” and “non-reactivity to inner experience” dimensions, was inversely associated to the hypnotic’s dependence in every dimension, except to the “problematic use” dimension. Study 2 – in the clinical trial we observed that the IG reduced the dosage significantly more than the CG in the T1 [b=2,22; CI (0,26;4,19) p=0,027]. This difference was no longer significant on the next follow-ups, once the CG also continued to reduce the use. Regarding the insomnia, there was a significant reduction of its severity in the IG, but not in the CG, on the 3rd [b=4,33; IC (1,75;6,91) p=0,0001] and 4th follow-ups [b=3,65; IC (1,07;6,22) p=0,005], even when the analyses were adjusted by time, group, interaction between time and grou, insomnia severity in the baseline, anxiety (trait), menopause and depression symptoms. Conclusion: The mindfulness abilities, specially “observe” and “non-react” were potential protective factors to hypnotic’s dependence in the cross-sectional study. These data were corroborated by the clinical trial, once the intervention favored the hypnotic’s tapering, also contributing to the reduction of the insomnia severity on the long-term. These data show preliminary evidence on the mindfulness-based interventions for the chronic hypnotic’s use, paving the way for a new therapeutic possibility to the reduction of inappropriate consumption of these medicines. ClinicalTrials.gov Identifier: NCT02127411
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    Efeitos de um treinamento de mindfulness e relaxamento para insônia (TMRI) em mulheres na pós menopausa : um ensaio clínico randomizado
    (Universidade Federal de São Paulo (UNIFESP), 2017-08-31) Garcia, Marcelo Csermak [UNIFESP]; Campos, Helena Hachul de [UNIFESP]; Kozasa, Elisa Harumi ; Mello, Luiz Eugenio Araujo de Moraes [UNIFESP]; Elisa Harumi Kozasa : http://lattes.cnpq.br/9887789366520035; Luiz Eugenio Araujo de Moraes Mello : http://lattes.cnpq.br/4462750801249231; http://lattes.cnpq.br/0292346083994904; http://lattes.cnpq.br/6012839930467648; Universidade Federal de São Paulo (UNIFESP)
    É na menopausa que há o cessamento da produção hormonal ovariana, que pode ser de forma natural ou cirúrgica, acarretando uma importante diminuição de estrogênio e progesterona no organismo. O hipoestrogenismo decorrente da pós-menopausa acarreta diversos efeitos no organismo, sendo a insônia e os sintomas vasomotores muito prevalentes nesta fase, onde há razoável prejuízo e diminuição na qualidade de vida desta mulher. A insônia é uma das queixas mais comuns e prevalentes na transição menopáusica e pós menopáusica e causa repercussões como dores de cabeça, dificuldade de atenção e memória, irritabilidade, entre outros sintomas com algum prejuízo na vida e no comportamento desde indivíduo. Assim, em razão das repercussões importantes deste distúrbio, o presente trabalho, baseado nestas premissas, avaliou o impacto de técnicas do uso de meditação denomidas de mindfulness na insônia, sintomas vasomotores, atentividade e qualidade geral de vida destas mulheres. Este estudo avaliou a intervenção desta técnica nesta população por um período de 8 semanas de treinamento seguido, com instruções presenciais semanais e a continuidade da prática em 3 x ao dia. Foram avaliadas 30 mulheres, sendo 19 que praticaram a técnica e 11 foram um grupo de espera participando de encontros informais semanais realizando palavras cruzadas nível fácil em casa, sendo que este grupo após as 8 semanas também recebeu instruções com a prática da mesma forma que o grupo intervenção. As voluntárias foram avaliadas por questionários de sono, sintomas menopausais, atenção e qualidade de vida geral na menopausa e também passaram por 2 exames de polissonografia ambulatorial antes e depois da interveção em ambos os grupos. Foram encontradas diferenças significantes para o grupo que recebeu treinamento em mindfulness em relação ao grupo controle, indicando a melhora na qualidade do sono e na severidade da insônia, na qualidade de vida, nos níveis atencionais e diminuição dos sintomas menopausais e vasomotores. Não encontramos diferenças entre os grupos e entre as noites pela avaliação da polissonografia. O treinamento de 8 semanas em meditação mindfulness melhorou a qualidade de sono, a qualidade de vida geral, o nível de atenção e diminuiu os sintomas vasomotores neste grupo. Este estudo mostra a eficácia da aplicação da técnica de meditação mindfulness para esta população insone menopsausada. Nossos achados sugerem que esta prática pode ser aplicada de forma complementar aos tratamentos já existentes para insônia e fogachos e sintomas menopausais, contribuindo para a aquisição de qualidade de vida para esta população.
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    Efeitos do exercício aeróbio na insônia crônica primária: uma comparação entre dois horários do dia
    (Universidade Federal de São Paulo (UNIFESP), 2010-10-27) Passos, Giselle Soares [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    O objetivo do presente estudo foi avaliar os efeitos do exercício aeróbio moderado no padrão do sono, na qualidade de vida e no perfil de humor de pacientes com insônia crônica primária, bem como verificar se esses efeitos são dependentes do horário da prática do exercício. Dezenove pacientes com insônia crônica primária (45 anos [EP  1,9]) foram distribuídos aleatoriamente entre os grupos MANHÃ (10:00  1 h) e TARDE (18:00  1 h). Todos os voluntários participaram de um protocolo de exercícios aeróbios, realizados em intensidade moderada (caminhada), durante 50 minutos, 3 vezes/semana, durante 6 meses. Para avaliar o sono foram utilizados a polissonografia e o diário do sono, a qualidade de vida foi medida pelo questionário Medical Outcome Study Short Form - 36 (MOS SF-36) e o humor pelo questionário Profile of Mood States (POMS). Na polissonografia, os resultados demonstraram, nos dois grupos (MANHÃ e TARDE), reduções na latência do sono, no tempo acordado após o início do sono, além de aumento na eficiência do sono, após a intervenção. No diário do sono, significantes melhoras foram observadas na latência do sono, na qualidade do sono e na sensação de descanso ao acordar, nos dois grupos. Além disto, a qualidade de vida (atividades sociais e limitação por aspectos emocionais) e o perfil de humor (tensão-ansiedade, depressão e distúrbio total de humor) melhoraram após a intervenção. Estes efeitos não diferiram quanto ao horário do dia. Podemos concluir que o exercício aeróbio crônico, realizado em intensidade moderada, produz significantes melhoras no padrão do sono, na qualidade de vida e no perfil de humor de pacientes com insônia crônica primária. De forma geral, estes efeitos parecem não diferir quando o exercício físico é realizado pela manhã ou ao final da tarde.
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    Efeitos do óleo essencial de lavanda na qualidade de sono em mulheres na pós-menopausa com insônia
    (Universidade Federal de São Paulo (UNIFESP), 2020-04-30) Lucena, Leandro dos Reis [UNIFESP]; Hachul de Campos, Helena [UNIFESP]; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4791144E7; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K8484267P6; Universidade Federal de São Paulo (UNIFESP)
    Objective: This study aimed to evaluate the effect of Lavandula angustifolia essential oil inhalation on sleep and menopausal symptoms in postmenopausal women with insomnia. Methods: In this double-blind, randomized controlled trial, 35 women (aged 48-65) with a clinical diagnosis of insomnia were divided into two groups: Placebo, which inhaled sunflower oil before bed and Aroma, which inhaled Lavandula angustifolia essential oil before bed, for 29 days. Both groups received sleep hygiene guidelines before the intervention and weekly follow-up during it. Polysomnography and validated questionnaires, such as Epworth Sleepiness Scale, Insomnia Severity Index, and Pittsburgh Sleep Quality Index were used to evaluate sleep. In addition, the effect of the intervention on quality of life, anxiety and depression symptoms, and postmenopausal symptoms were assessed. Evaluations were performed before and after intervention in both groups. Statistical analyses were performed with SPSS 22 using the Generalized Estimated Equations test and intention-to-treat to impute missing data. Results: There were no significant differences between groups after intervention in the primary outcome; however, a tendency of improvement in wake after sleep onset (WASO) was observed. Both groups presented better sleep quality over time. Aroma group participants showed a significant decrease in sleep onset latency, depression levels, hot flashes, postmenopausal symptoms and, in polysomnography data, increased sleep efficiency (P=0.002) compared to baseline. Conclusion: Although no significant differences were observed between groups, our data presented a tendency of improvement in WASO. Moreover, Aroma group participants had enhanced overall sleep pattern, quality and sleep efficiency. Weekly follow-up and sleep hygiene instructions were essential for both groups to show improvement in almost all outcomes.
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    Effects of different sleep deprivation protocols on sleep perception in healthy volunteers
    (Elsevier B.V., 2014-10-01) Goulart, Leonardo I.; Pinto, Luciano R. [UNIFESP]; Perlis, Michael L.; Martins, Raquel [UNIFESP]; Caboclo, Luis Otavio; Tufik, Sergio [UNIFESP]; Andersen, Monica L. [UNIFESP]; Hosp Israelita Albert Einstein; Univ Penn; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To investigate whether different protocols of sleep deprivation modify sleep perception.Methods: the effects of total sleep deprivation (TD) and selective rapid eye movement (REM) sleep deprivation (RD) on sleep perception were analyzed in normal volunteers. Thirty- one healthy males with normal sleep were randomized to one of three conditions: (i) normal uninterrupted sleep; (ii) four nights of RD; or (iii) two nights of TD. Morning perception of total sleep time was evaluated for each condition. Sleep perception was estimated using total sleep time (in hours) as perceived by the volunteer divided by the total sleep time (in hours) measured by polysomnography (PSG). the final value of this calculation was defined as the perception index (PI).Results: There were no significant differences among the three groups of volunteers in the total sleep time measured by PSG or in the perception of total sleep time at baseline condition. Volunteers submitted to RD exhibited lower sleep PI scores as compared with controls during the sleep deprivation period (P < 0.05). Both RD and TD groups showed PI similar to controls during the recovery period.Conclusion: Selective REM sleep deprivation reduced the ability of healthy young volunteers to perceive their total sleep time when compared with time measured by PSG. the data reinforce the influence of sleep deprivation on sleep perception. (C) 2014 Elsevier B. V. All rights reserved.
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    Effects of moderate aerobic exercise training on chronic primary insomnia
    (Elsevier B.V., 2011-12-01) Passos, Giselle Soares [UNIFESP]; Poyares, Dalva [UNIFESP]; Santana, Marcos Gonçalves de; D'Aurea, Carolina Vicaria Rodrigues [UNIFESP]; Youngstedt, Shawn D.; Tufik, Sergio [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Goiás (UFG); Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq); Univ S Carolina
    Objective: To evaluate the effect of long-term moderate aerobic exercise on sleep, quality of life, and mood of individuals with chronic primary insomnia, and to examine whether these effects differed between exercise in the morning and exercise in the late afternoon.Methods: Nineteen sedentary individuals with chronic primary insomnia, mean age 45.0 (standard error [SE] 1.9) years, completed a 6-month exercise training protocol, randomized to morning and late-afternoon exercise groups.Results: Combining polysomnographic data across both time points, this study found a significant decrease in sleep onset latency (from 17.1 [SE 2.6] min to 8.7 [SE 1.4] min; P < 0.01) and wake time after sleep onset (from 63.2 [SE 12.8] min to 40.1 [SE 6.0] min), and a significant increase in sleep efficiency (from 79.8 [SE 3.0]% to 87.2 [SE 1.6]%) following exercise. Data from sleep diaries revealed significant improvement in sleep onset latency (from 76.2 [SE 21.5] min to 80.3 [SE 7.4] min) sleep quality (from 41.5 [SE 5.2]% to 59.4 [SE 6.6]%) and feeling rested in the morning (from 50.8 [SE 5.3] to 65.1 [SE 5.0]). There were generally no significant differences in response between morning and late-afternoon exercise. Following exercise, some quality-of-life measures improved significantly, and a significant decrease was seen in the following Profile of Mood State measures: tension-anxiety (from 7.2 [SE 1.0] to 3.5 [SE 1.0]), depression (from 5.9 [SE 1.2] to 3.3 [SE 1.1]) and total mood disturbance (from 9.2 [SE 4.8] to -1.7 [SE 4.8]). These effects did not vary between morning and late-afternoon exercise.Conclusion: Long-term moderate aerobic exercise elicited significant improvements in sleep, quality of life and mood in individuals with chronic primary insomnia. (C) 2011 Elsevier B.V. All rights reserved.
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    Estudo do binômio insônia-dor musculoesquelética crônica na pós-menopausa
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Frange, Cristina Mattos Pereira [UNIFESP]; Andersen, Monica Levy [UNIFESP]; Hachul, Helena [UNIFESP]; http://lattes.cnpq.br/0292346083994904; http://lattes.cnpq.br/4951931552005515; http://lattes.cnpq.br/5507825991578153; Universidade Federal de São Paulo (UNIFESP)
    Sleep and pain are assumed to share a reciprocal relationship. Chronic musculoskeletal pain, and sleep disorders such as insomnia are two central symptoms of menopause symptomatology. Although postmenopausal women often suffer from both, there is a lack of studies addressing these two factors and their interaction. The objectives of this study were therefore to investigate the relationship between these two factors and their effect on sleep quality and pattern; chronic musculoskeletal pain severity, intensity and interference in daily function, the number of pain sites; menopausal and mood symptoms; and quality of life. We examined this relationship between sleep and chronic musculoskeletal pain, through a 10-day temporal analysis. Our sample was composed of 4 groups: CTRL - control group, absence of diagnosis of insomnia and musculoskeletal pain; CMP Group - absence of insomnia and complaint of chronic musculoskeletal pain; INS Group - clinical diagnosis of insomnia and absence of chronic musculoskeletal pain and CMP+INS Group - clinical diagnosis of insomnia and presence of complaint of chronic musculoskeletal pain. We performed two analyzes: coss sectional and microlongitudinal. All volunteers answered questionnaires about pain, quality of sleep and life, climacteric, anxiety and depression symptoms, and blood samples were collected for confirmation of postmenopausal status, and we performed polysomnography and actigraphy exams. Our results indicate that insomnia by itself was associated with more self-reported pain. The presence of chronic musculoskeletal pain alone does not modify sleep, either subjectively or objectively. However, the association of both comorbidities was related to worsening menopausal and anxiety symptoms, higher sleep fragmentation, worse severity of chronic musculoskeletal pain, as well as more interference in daily activities and more pain sites, and also lower quality of life. Our findings indicated that the higher the sleep duration, the higher the pain intensity upon waking, while increased pain at bedtime predicted longer sleep duration and also time in bed in postmenopausal women. These results strongly suggest that sleep and pain conditions should both be targeted in the treatment of postmenopausal women in order to improve quality of life and reduce the possible development of comorbidities, such as anxiety and depression.
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    Eszopiclone versus zopiclone in the treatment of insomnia
    (Hospital clinicas, univ sao paulo, 2016) Pinto Júnior, Luciano Ribeiro [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Treptow, Erika Cristine [UNIFESP]; Braga, Luciano Rotella [UNIFESP]; Tufik, Sergio [UNIFESP]
    OBJECTIVE: To determine the therapeutic effects of two selective GABA-A agonists, zopiclone and eszopiclone, in the treatment of insomnia. METHODS: This study comprised a phase III, single-center, randomized, double-blind, double-dummy, parallel-group, non-inferiority trial. Patients were randomized to receive zopiclone 7.5 mg or eszopiclone 3 mg, both orally, for four weeks. In total, 199 patients were evaluated during two visits and then followed for at least six weeks. The primary endpoint was the Insomnia Severity Index after four weeks of treatment. Secondary endpoints were obtained through polysomnography data, including total sleep time, sleep latency and sleep efficiency. The frequency of adverse events was also analyzed. ClinicalTrials.gov: NCT01100164. RESULTS: The primary efficacy analysis demonstrated the non-inferiority of eszopiclone over zopiclone. Analysis of objective parameters assessed by polysomnography showed that eszopiclone increased total sleep time and also improved sleep efficiency. The safety profile of both study treatments was similar and the most common events reported in both groups were dysgeusia, headache, dizziness, irritability and nausea. Adverse events were observed in 223 patients, 109 (85.2%) in the eszopiclone group and 114 (87.7%) in the zopiclone group. CONCLUSION: Based on the Insomnia Severity Index at the end of four weeks of treatment, eszopiclone demonstrated efficacy comparable to that of zopiclone in the treatment of insomnia, increasing total sleep time as well as sleep efficiency according to polysomnography.
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    Frequencia dos disturbios de sono em mulheres na pos-menopausa com sobrepeso/obesidade
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2014-02-01) Correa, Karin Mitiyo; Bittencourt, Lia Rita Azeredo [UNIFESP]; Tufik, Sergio [UNIFESP]; Hachul, Helena; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE:To evaluate the frequency of sleep disorders, such as obstructive sleep apnea, restless leg syndrome and insomnia in overweight/obese postmenopausal women seen in a climacteric sleep disorders clinic.METHODS:Thirty-four postmenopausal women were selected using the following inclusion criteria: age between 50 and 70 years; at least 12 months of amenorrhea; body mass index (BMI) greater than or equal to 25 kg/m2; and sleep-related complaints with at least one previous polysomnography. Patients provided responses to 6 questionnaires related to sleep characteristics and menopausal symptoms. Weight and height were measured using standardized scales, and abdomen and hip circumferences were also measured. The statistical analyses were performed using the χ2 test for qualitative variables and using Student's t-test for quantitative variables.RESULTS:Patients' characteristics were as follows: mean age of 60.35 years; mean BMI of 31.62; an average of 11.61 postmenopausal years and an average Kupperman Index of 19. A total of 85.2% of the patients had a waist/hip ratio of less than 0.8. The Epworth Scale score was greater than or equal to 9 in 50% of patients; 68% had sleep disturbances according to the Pittsburgh Index, and 68% were classified as high-risk for sleep apnea by the Berlin Questionnaire. On polysomnography, 70.58% of the patients had a sleep efficiency lower than 85%; 79.41% had a sleep latency of less than 30 min; 58.82% had a REM sleep latency of less than 90 min, and 44.11% had mild apnea. When the groups were compared, a linear association was identified between BMI and the AHI average, and a relationship between high BMI and use of drugs for thyroid treatment was found.CONCLUSION:There was a high prevalence of sleep-disordered breathing, initial insomnia, fragmented sleep, and thyroid disorders in the group with higher BMI.
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    Gender and age differences in polysomnography findings and sleep complaints of patients referred to a sleep laboratory
    (Associação Brasileira de Divulgação Científica, 2008-12-01) Silva, Andressa [UNIFESP]; Andersen, Monica Levy [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Peruzzo, Daiane; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)
    Our objective was to examine the effet of gender on the sleep pattern of patients referred to a sleep laboratory. The data (questionnaires and polysomnographic recordings) were collected from a total of 2365 patients (1550 men and 815 women). The polysomnography permits an objective assessment of the sleep pattern. We included only polysomnography exams obtained with no more than one recording system in order to permit normalization of the data. Men had a significantly higher body mass index than women (28.5 ± 4.8 vs 27.7 ± 6.35 kg/m²) and had a significantly higher score on the Epworth Sleepiness Scale (10.8 ± 5.3 vs 9.5 ± 6.0), suggesting daytime sleepiness. Women had a significantly higher sleep latency than men, as well as a higher rapid eye movement (REM) latency. Men spent more time in stages 1 (4.6 ± 4.1 vs 3.9 ± 3.8) and 2 (57.0 ± 10.5 vs 55.2 ± 10.1) of non-REM sleep than women, whereas women spent significantly more time in deep sleep stages (3 and 4) than men (22.6 ± 9.0 vs 19.9 ± 9.0). The apnea/hypopnea and arousal indexes were significantly higher and more frequent in men than in women (31.0 ± 31.5 vs 17.3 ± 19.7). Also, periodic leg movement index did not differ significantly between genders, but rather differed among age groups. We did not find significant differences between genders in the percentage of REM sleep and sleep efficiency. The results of the current study suggest that there are specific gender differences in sleep pattern.