Navegando por Palavras-chave "insomnia"

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    Can valerian improve the sleep of insomniacs after benzodiazepine withdrawal?
    (Elsevier B.V., 2002-04-01) Poyares, Dalva R. [UNIFESP]; Guilleminault, C.; Ohayon, M. M.; Tufik, Sergio [UNIFESP]; Stanford Univ; Universidade Federal de São Paulo (UNIFESP)
    Purpose: the authors studied the sleep of patients with insomnia who complained of poor sleep despite chronic use of benzodiazepines (BZDs). the sample consisted of 19 patients (mean age 43.3 +/- 10.6 years) with primary insomnia (DSM-IV), who had taken BZDs nightly, for 7.1 +/- 5.4 years. the control group was composed of 18 healthy individuals (mean age 37:E 8 years). Sleep electroencephalogram (EEG) of the patients was analyzed with period amplitude analysis (PAA) and associated algorithms, during chronic BZD use (Night 1), and after 15 days of a valerian placebo trial (initiated after washout of BZD, Night 2). Sleep of control subjects was monitored in parallel. Results: Valerian subjects reported significantly better subjective sleep quality than placebo ones, after BZD withdrawal, despite the presence of a few side effects. However, some of the differences found in sleep structure between Night I and Night 2 in both the valerian and placebo groups may be due to the sleep recovery process after BZD washout. Example of this are: the decrease in Sleep Stage 2 and in sigma count; the increase in slow-wave sleep (SWS), and delta count, which were found to be altered by BZD ingestion. There was a significant decrease in wake time after sleep onset (WASO) in valerian subjects when compared to placebo subjects; results were similar to normal controls. Nonetheless, valerian-treated patients also presented longer sleep latency and increased alpha count in SWS than control subjects. Conclusions: the decrease in WASO associated with the mild anxiolytic effect of valerian appeared to be the major contributor to subjective sleep quality improvement found after 2-week of treatment in insomniacs who had withdrawn from BDZs. Despite subjective improvement, sleep data showed that valerian did not produce faster sleep onset; the increase in alpha count compared with normal controls may point to residual hyperarousabilty, which is known to play a role in insomnia. Nonetheless, we lack data on the extent to which a sedative drug can improve alpha sleep EEG. Thus, the authors suggest that valerian had a positive effect on withdrawal from BDZ use. (C) 2001 Elsevier Science Inc. All rights reserved.
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    Chronic benzodiazepine usage and withdrawal in insomnia patients
    (Elsevier B.V., 2004-05-01) Poyares, D.; Guilleminault, C.; Ohayon, M. M.; Tufik, S.; Stanford Sleep Epidemiol Res Ctr; Stanford Univ; Universidade Federal de São Paulo (UNIFESP)
    We studied the sleep of patients with insomnia during continuous and very long-term use of benzodiazepines (BZDs), and after withdrawal. A group of 25 patients (mean age 44.3 +/- 11.8 years) with persistent insomnia, who had been taking BZDs nightly for 6.8 +/- 5.4 years was selected. the control group was comprised of 18 age-matched healthy individuals. Sleep stage parameters were analyzed during Night 1 (while taking BZDs), Night 2 (first night after completing BZD withdrawal), and Night 3 (15 days after gradual BZD withdrawal). Sleep data for control subjects was monitored in parallel. Sleep EEGs of the patients were analyzed using Period Amplitude Analysis (PAA), during Nights I and 3 only. During BZD use, a significant reduction of Total Sleep Time (TST) and increased sleep latency were found in the insomniac group when compared to controls. We found an increase in stage 2 non-REM (NREM) sleep, and a reduction in Slow Wave Sleep (SWS) when comparing to night 3 (after withdrawal). Sleep EEGs analysis showed an increase in sigma band and decrease in delta count in stages 2, 3, 4 NREM and REM sleep in the BZD group when comparing to night 3 (after withdrawal). During the BZD withdrawal period, six out of nine subjects taking lorazepam failed withdrawal. in the remaining 19 subjects, gradual withdrawal of BZDs was associated with immediate worsening of nocturnal sleep, as indicated by sleep parameters. However, 15 days after withdrawal (Night 3), some of the sleep structure parameters of patients were not significantly different from baseline (while taking BZDs), except for a significant increase in SWS and in delta count throughout most sleep stages, and a decrease in stage 2 NREM sleep. These values were not different from those shown by control subjects. REM sleep parameters showed no significant variation across the experimental conditions. Subjective sleep quality was significantly improved on Night 3 compared with Night 1. Conclusions: Chronic intake of BZDs may be associated with poor sleep in this population. A progressive 15-day withdrawal did not avoid an immediate worsening of sleep parameters. But at the end of the protocol, SWS, delta count, and sleep quality were improved compared to those recorded during the chronic BZD intake, despite the lack of change in sleep efficiency. (C) 2003 Elsevier B.V. All rights reserved.
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    Clinical co-morbidities in obstructive sleep apnea syndrome treated with mandibular repositioning appliance
    (W B Saunders Co Ltd, 2006-06-01) Machado, Marco Antonio Cardoso [UNIFESP]; Carvalho, Luciane Bizari Coin de [UNIFESP]; Juliano, Maria Ligia [UNIFESP]; Taga, Marcel Frederico de Lima [UNIFESP]; Prado, Lucila Bizari Fernandes do [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Intraoral mandibular repositioner appliances (IOMRAs) are designed to enlarge pharyngeal airway space advancing the mandible and increasing genioglossus tone during sleep. Obstructive sleep apnea syndrome (OSAS) treatment with IOMRAs is beneficial, but there is a lack of studies in the literature defining the target population more inclined to respond to this treatment.Methods: We contacted by telephone 188 previously treated patients with IOMRA, detecting 20 not improved patients (Study Group). Twenty improved patients of the remaining 168 were randomly paired according to gender, age, apnea, and hypopnea index as Control Group. Both groups answered questionnaires for diagnosis of sleep disorders, depression, anxiety, and the Epworth sleepiness scale. We did a descriptive and inferential statistical analysis. the inferential analysis was divided into two steps: univariate analysis using Fischer exact test and a multiple inferential analysis using a stepwise regression model.Results: Although the final model included only insomnia, we concluded that the presence of gastric, neurological and rheumatic diseases also tended to be associated with the self-perception of non-improvement. the association between the accumulation of gastric, neurological, and rheumatic diseases and insomnia and improvement demonstrated that an increase in one of these diseases correspond to a two-fold increase in the chance of non-improvement.Conclusions: Insomnia was the most important factor compromising the, success of OSAS treatment with IOMRAs, and the isolated presence of gastric, neurological and rheumatic diseases, but especially their combination, reduces the perception rate of welt-succeeded treatment with IOMRAs. (c) 2005 Elsevier B.V. All rights reserved.
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    Clinical profile of menopausal insomniac women referred to sleep laboratory
    (Taylor & Francis As, 2009-01-01) Hachul, Helena [UNIFESP]; Brandao, Leticia de C. [UNIFESP]; Bittencourt, Lia R. A. [UNIFESP]; D'Almeida, Vania [UNIFESP]; Andersen, Monica L. [UNIFESP]; Baracat, Edmund C. [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective. the primary purpose of this study was to assess the overall clinical profile of menopausal women complaining of insomnia who were referred to a sleep laboratory. Methods. A total of 206 menopausal women who had complaints related to insomnia were interviewed. Each participant completed a questionnaire in order to obtain data on general health, menopausal status, medications, and sleep patterns. Results. the mean age of the participants was 55.9 years. Clinical profiles revealed that the most prevalent health problems were systemic arterial hypertension (33.9%) and osteoporosis (19%), though there was no association between insomnia and incidence of chronic disease. Our data demonstrate an overall prevalence of insomnia of 4-5 times a week in 62% of the women, with 68.9% complaining of hot flashes. However, there was no association between hot flashes and frequency of insomnia across the menopausal transition period. Only 7% of women had already undergone polysomnography. Less than 5% of the participants were undergoing treatment for menopause, while 8% were taking benzodiazepines for sleep problems. Conclusions. This study provides evidence that insomnia in postmenopausal women was not associated with incidence of chronic disease. in addition, the majority of the participants were not undergoing treatment for menopause or for sleep disturbance.
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    Effects of isoflavone on oxidative stress parameters and homocysteine in postmenopausal women complaining of insomnia
    (Soc Biolgia Chile, 2009-01-01) Brandao, Leticia de Campos [UNIFESP]; Hachul, Helena [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Tufik, Sergio [UNIFESP]; D'Almeida, Vania [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Sleep disorders have an increased incidence after menopause. The objective of this work was to evaluate the effects of isoflavone on some oxidative stress markers in postmenopausal women complaining of insomnia. Women aged between 50-65 years (n=38) were recruited and assigned to a double-blind placebo controlled study for 4 months. The treated group received 100 mg/day of isoflavones. Blood collections were conducted on three different occasions to assess total gluthathione; superoxide dismutase and catalase in erythrocytes; lipid peroxidation; and homocysteine plasma concentrations. No differences between the groups were observed. However, all the patients seem to improve their oxidative stress Status and homocysteine concentration after treatment. Superoxide dismutase activity was correlated with age and time of menopause at the beginning of the treatment, but these correlations were no longer observed by the end of the study. Soy isoflavones were not able to overcome the placebo effect for either oxidative stress parameters or homocysteine concentrations.
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    Heart rate variability in normal and pathological sleep
    (Frontiers Research Foundation, 2013-01-01) Tobaldini, Eleonora; Nobili, Lino; Strada, Silvia; Casali, Karina Rabello [UNIFESP]; Braghiroli, Alberto; Montano, Nicola; Univ Milan; Osped Niguarda Ca Granda; Universidade Federal de São Paulo (UNIFESP); Univ Fdn Cardiol; Fdn S Maugeri; St Annes Univ Hosp
    Sleep is a physiological process involving different biological systems, from molecular to organ level; its integrity is essential for maintaining health and homeostasis in human beings. Although in the past sleep has been considered a state of quiet, experimental and clinical evidences suggest a noteworthy activation of different biological systems during sleep. A key role is played by the autonomic nervous system (ANS), whose modulation regulates cardiovascular functions during sleep onset and different sleep stages. Therefore, an interest on the evaluation of autonomic cardiovascular control in health and disease is growing by means of linear and non-linear heart rate variability (HRV) analyses. the application of classical tools for ANS analysis, such as HRV during physiological sleep, showed that the rapid eye movement (REM) stage is characterized by a likely sympathetic predominance associated with a vagal withdrawal, while the opposite trend is observed during non-REM sleep. More recently, the use of non-linear tools, such as entropy-derived indices, have provided new insight on the cardiac autonomic regulation, revealing for instance changes in the cardiovascular complexity during REM sleep, supporting the hypothesis of a reduced capability of the cardiovascular system to deal with stress challenges. Interestingly, different HRV tools have been applied to characterize autonomic cardiac control in different pathological conditions, from neurological sleep disorders to sleep disordered breathing (SDB). in summary, linear and non-linear analysis of HRV are reliable approaches to assess changes of autonomic cardiac modulation during sleep both in health and diseases. the use of these tools could provide important information of clinical and prognostic relevance.
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    Impact of insomnia on pain in postmenopausal women
    (Taylor & Francis Ltd, 2017) Frange, Cristina [UNIFESP]; Naufel, Maria Fernanda Soares [UNIFESP]; Andersen, Monica Levy [UNIFESP]; Ribeiro, Eliane Beraldi [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Tufik, Sergio [UNIFESP]; Hachul, Helena [UNIFESP]
    Background: Sleep disturbances and pain are assumed to be reciprocally linked. Insomnia and pain are central symptoms of the postmenopausal period and are closely related. Insomnia affects quality of life, increases pain sensitivity, the risk of pain-related disability, and other health problems.Objective: To investigate whether insomnia influences aspects of pain (pain intensity and the effect of pain on daily function) in postmenopausal women, and to evaluate the objective sleep pattern of insomniacs with pain.Methods: Fifty-seven women completed questionnaires about insomnia, climacteric symptoms, and pain. Polysomnography data were collected as well as their medical history. Patients were allocated into three groups: control, subthreshold insomnia, and insomnia. Pain intensity, climacteric symptoms and objective sleep pattern were compared between groups.Results: Postmenopausal women with insomnia had statistically significant higher pain interference in their activities (e.g. relationships with other people, enjoyment of life and sleep) than controls, and had more severe climacteric symptoms. There were no statistically significant differences in pain intensity and objective sleep pattern between groups.Conclusions: Insomnia status affected climacteric symptoms and pain interference, but not pain intensity in postmenopausal women. Women with insomnia had higher rates of climacteric symptoms than those without insomnia or those with subthreshold insomnia. No changes in objective sleep pattern were found.
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    Insomnia: psychological and neurobiological aspects and non-pharmacological treatments
    (Academia Brasileira de Neurologia - ABNEURO, 2014-01-01) Molen, Yara Fleury; Carvalho, Luciane Bizari Coin de [UNIFESP]; Prado, Lucila Bizari Fernandes do [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Insomnia involves difficulty in falling asleep, maintaining sleep or having refreshing sleep. This review gathers the existing informations seeking to explain insomnia, including those that focus on psychological aspects and those considered neurobiological. Insomnia has been defined in psychological (cognitive components, such as worries and rumination, and behavioral aspects, such as classic conditioning) and physiological terms (increased metabolic rate, with increased muscle tone, heart rate and temperature). From the neurobiological point of view, there are two perspectives: one which proposes that insomnia occurs in association with a failure to inhibit wakefulness and another that considers hyperarousal as having an important role in the physiology of sleep. The non-pharmacological interventions developed to face different aspects of insomnia are presented.
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    New guidelines for diagnosis and treatment of insomnia
    (Assoc Arquivos Neuro- Psiquiatria, 2010-08-01) Pinto, Luciano Ribeiro [UNIFESP]; Alves, Rosana Cardoso; Caixeta, Eliazor; Fontenelle, John Araujo; Bacellar, Andrea; Poyares, Dalva [UNIFESP]; Aloe, Flavio; Rizzo, Geraldo; Minhoto, Gisele; Bittencourt, Lia Rita [UNIFESP]; Ataide, Luiz; Assis, Marcia; Pradella-Hallinan, Marcia [UNIFESP]; Ribeiro Pinto, Maria Christina [UNIFESP]; Rodrigues, Raimundo Nonato D.; Hasan, Rosa; Fonseca, Ronaldo; Tavares, Stella [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Sch Med Sci; Fed Univ; Carlos Bacelar Clin; Moinhos de Vento Hosp; Catolic Univ; Universidade Federal de Pernambuco (UFPE); Sao Lucas Hosp; Universidade de Brasília (UnB); State Univ
    The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. the following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. for diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. for non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.
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    Polysomnographic Study of the Prevalence of Sleep Bruxism in a Population Sample
    (Sage Publications Inc, 2013-07-01) Maluly, M. [UNIFESP]; Andersen, M. L. [UNIFESP]; Dal-Fabbro, C. [UNIFESP]; Garbuio, S. [UNIFESP]; Bittencourt, L. [UNIFESP]; Siqueira, J. T. T. de [UNIFESP]; Tufik, S. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The goal of the current study was to estimate the prevalence of sleep bruxism (SB) in the general population using a representative sample of 1,042 individuals who answered questionnaires and underwent polysomnography (PSG) examinations. After PSG, the individuals were classified into 3 groups: absence of SB, low-frequency SB, and high-frequency SB. the results indicated that the prevalence of SB, indicated by questionnaires and confirmed by PSG, was 5.5%. With PSG used exclusively as the criterion for diagnosis, the prevalence was 7.4% regardless of SB self-reported complaints. With questionnaires alone, the prevalence was 12.5%. of the 5.5% (n = 56) with confirmed SB, 26 were classified as low-frequency SB, and 30 as high-frequency. the episodes of SB were more frequent in stage 2 sleep, and the phasic bruxism events were more frequent than tonic or mixed events in all sleep stages in individuals with SB. A positive association was observed between SB and insomnia, higher degree of schooling, and a normal/overweight body mass index (BMI). These findings demonstrate the prevalence of SB in a population sampled by PSG, the gold standard methodology in the investigation of sleep disorders, combined with validated questionnaires (ClinicalTrials.gov, NCT00596713).
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    Prevalence of self-reported sleep disturbance among older adults and the association of disturbed sleep with service demand and medical conditions
    (Cambridge Univ Press, 2008-06-01) Blay, Sergio Luis [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]; Gastal, Fabio Leite; Universidade Federal de São Paulo (UNIFESP)
    Objective: This cross-sectional study investigated the prevalence of disturbed sleep and the association of disturbed sleep with medical conditions and service use among older adults.Methods: A sample of 6961 household residents aged 60 and over was recruited from a population-based random sample. Each subject was examined in a face-to-face interview.Results: the overall prevalence of disturbed sleep was 33.7%, with the condition being more prevalent in women (37.2%) than in men (27.4%). the overall rate of medical consultations was 78%, and higher in those with sleep disturbance (males 73% vs 27%; females 80% vs 20%) compared to persons without disturbed sleep. the overall rate of hospitalizations was 20.2%. in logistic regression analyses, being female, of low income, low education, younger age, with psychiatric morbidity, pneumonia, urinary infection, dermatological problems and/or hypertension were significantly associated with self-reported sleep disturbance. Ethnicity, civil status or outpatient visits in the previous six months and hospitalizations in the previous year were not associated with self-reported sleep disturbance.Conclusion: Self-reported sleep disturbance was a frequent problem in the study population and was associated with gender, income, education, lower age and medical conditions. There was no association between sleep problems and use of medical services in the surveyed population.
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    Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis
    (Oxford Univ Press Inc, 2018) Keenan, Brendan T.; Kim, Jinyoung; Singh, Bhajan; Bittencourt, Lia [UNIFESP]; Chen, Ning-Hung; Cistulli, Peter A.; Magalang, Ulysses J.; McArdle, Nigel; Mindel, Jesse W.; Benediktsdottir, Bryndis; Arnardottir, Erna Sif; Prochnow, Lisa Kristin; Penzel, Thomas; Sanner, Bernd; Schwab, Richard J.; Shin, Chol; Sutherland, Kate; Tufik, Sergio [UNIFESP]; Maislin, Greg; Gislason, Thorarinn; Pack, Allan I.
    Study Objectives: A recent study of patients with moderate-severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. Methods: Using data on 972 patients with moderate-severe OSA (apnea-hypopnea index [AHI] >= 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes. Results: The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity
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    Sleep disorders in pregnancy
    (Academia Brasileira de Neurologia - ABNEURO, 2004-06-01) Lopes, Eliane Aversa [UNIFESP]; Carvalho, Luciane Bizari Coin de [UNIFESP]; Seguro, Priscila Bernal da Costa [UNIFESP]; Mattar, Rosiane [UNIFESP]; Silva, Ademir Baptista [UNIFESP]; Prado, Lucila Bizari Fernandes do [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    CONTEXT: The precise function of sleep in animals and human beings is still unknown, and any sort of physical, social or psychological variation may change the normal sleep-wake cycle. PURPOSE: This research aims is to determine the sleep disorders (SD) for each of the three trimesters of the pregnancy comparing them to the pre-pregnancy state (PG). METHOD: SD were investigated in three hundred pregnant women 11- to 40-years-old through with a brief clinical interview based on directed questions. One hundred pregnant women were considered for each trimester. RESULTS: The rate of pregnant women with insomnia increased by 23% in the 2nd trimester (p< 0.005); the rate for excessive daytime sleepiness (EDS) by 15% in the 1st trimester (p<0.003), 55% in the 2nd trimester (p<0.001) and by 14% in the 3rd trimester (p<0.002); the rate for mild sleepiness increased by 33% in the 2nd trimester (p<0.002) and by 48% in the 3rd trimester (p<0.001); the rate for specific awakenings increased by 63% in the 1st trimester, by 80% in the 2nd trimester and by 84% in the 3rd trimester (p<0.001). CONCLUSION: SD were more frequent during pregnancy comparatively to PG state, mostly at the expenses of EDS and specific awakenings.
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    Sleep disturbances, oxidative stress and cardiovascular risk parameters in postmenopausal women complaining of insomnia
    (Taylor & Francis Ltd, 2006-08-01) Campos, H. Hachul de; Brandao, L. C.; D'Almeida, V.; Grego, B. H. C.; Bittencourt, L. R.; Tufik, S.; Baracat, E. C.; Universidade Federal de São Paulo (UNIFESP)
    Objective the aim of this work was to investigate cardiovascular risk factors and oxidative stress parameters as well as sleep disturbances in polysomnography recordings of 38 postmenopausal women with insomnia.Methods Polysomnography recordings were performed on subjects for sleep analysis. Oxidative stress parameters were analyzed by measuring blood concentration of catalase, superoxide dismutase (SOD), thiobarbituric acid reactive substances (TBARS) and glutathione. for cardiovascular risk factors, we measured plasma levels of homocysteine, folic acid and vitamin B6.Results Findings of polysomnography recordings revealed: 68% experienced decreased sleep efficiency, 50% had apnea, 7.8% had periodic leg movements and 2.6% had bruxism (involuntary gnashing and grinding of the teeth during sleep). Our results showed that the majority of our subjects presented normal concentrations of the parameters studied according to standards reached in our laboratory. the only notable exception was TBARS. in this case, only 21% displayed normal values. We also found inverse correlations between SOD activity and both age and time of menopause.Conclusions Although all women complained of insomnia, 50% of them demonstrated apnea during polysomnography recordings. of the parameters measuring oxidative stress, only TBARS levels were increased in our sample. Some clinical data, such as time of onset of menopause, may be associated with the oxidative stress status of these women, probably due to the lack of estrogen and to sleep disturbances, such as apnea.