Avaliação de mediadores inflamatórios e o padrão de sono em mulheres com dismenorreia participantes do projeto EPISONO
Data
2023-09-04
Autores
Ishikura, Isabela Antunes 
Orientadores
Andersen, Monica Levy
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Analisar o padrão de sono e os mediadores inflamatórios de mulheres no período reprodutivo com e sem dismenorreia participantes de um estudo de corte transversal em uma amostra epidemiológica da cidade de São Paulo (Projeto Episono 2007). Métodos: Foram incluídas 328 mulheres em idade reprodutiva pertencentes ao Projeto Episono 2007. As informações sobre queixas de dismenorreia e fase do ciclo menstrual das participantes foram obtidas a partir das respostas ao Questionário Institucional da Mulher e níveis dos hormônios sexuais. Essas mulheres foram distribuídas em grupos de acordo com presença ou ausência de queixas de dismenorreia (Etapa 1) ou fase do ciclo menstrual (Etapa 2), de forma que esta 2a etapa constituiu de mulheres sem queixas de dismenorreia. Nas 2 etapas do projeto, as variáveis comparadas entre os grupos incluíram dados da polissonografia (PSG) tipo I de noite inteira, dosagens de IL-6, TNF-alfa e proteína C-reativa e aplicação de questionários específicos para sintomas de insônia, ansiedade e depressão, qualidade de sono, sonolência excessiva diurna, fadiga e qualidade de vida. A avaliação estatística das variáveis na Etapa 1 foi realizada com o Generalized Linear Model, com post hoc Bonferroni, enquanto na Etapa 2 foi utilizado o teste de Kruskal-Wallis e post hoc de Dunn. Em ambas as etapas consideramos p<0,05. Resultados: Os nossos achados da Etapa 1 revelam que as mulheres com sintomas de dismenorreia apresentaram menor eficiência de sono (82,5%±13,8) e acordaram mais tarde (7:12h) quando comparadas às mulheres sem sintomas de dismenorreia (86,2%±10,9; 6:52h, respectivamente). A condição de dismenorreia demonstrou estar associada à maior fadiga e sonolência e menor qualidade de vida no aspecto físico. Não foi detectada diferença significativa entre os grupos quanto aos níveis de mediadores inflamatórios, outros questionários e demais parâmetros da PSG. Os resultados da Etapa 2, em que a condição de dismenorreia estava ausente, mostraram que as mulheres na fase folicular tiveram melhor eficiência de sono (89,9%±9,63) e menor latência de sono (7,19min±7,19) quando comparadas às mulheres na fase menstrual (83,08%±10,84; 22,33min±32,42) e fase lútea (83,78%±12,72; 15,94min±14,74). Os outros parâmetros da PSG, mediadores inflamatórios e questionários não apresentaram diferenças significativas entre os grupos. Em ambas as etapas do projeto, a pontuação do questionário de Pittsburgh de qualidade de sono foi >5 em todos os grupos, indicando baixa qualidade de sono na amostra do estudo. Conclusões: A condição de dismenorreia foi associada à uma pior qualidade de sono em mulheres, com repercussões diurnas que podem afetar o bem-estar e a qualidade de vida desses indivíduos. Observamos que, quando não consideramos a dismenorreia, a fase folicular foi o período do ciclo menstrual relacionado a melhor qualidade de sono, com maiores índices de eficiência de sono e menor tempo para iniciar o sono. A menstruação demonstrou ser o período mais deletério para o sono, com menor eficiência de sono e um aumento em até 3 vezes do tempo para início de sono em comparação à fase folicular.
Aims: To investigate the sleep and inflammatory mediators of women during the reproductive phase of life with or without dysmenorrhea enrolled in Episono 2007, a cross-sectional study of an epidemiological sample from the city of São Paulo, Brazil. Methods: A total of 328 women under reproductive phase of life were investigated. Dysmenorrhea symptoms and phases of the menstrual cycle were obtained by the answers from the Institutional Women’s Questionnaire and dosages of sexual hormones’ levels. Women were distributed according to the presence or absence of dysmenorrhea (Stage 1) or phases of the menstrual cycle (Stage 2), this latter stage did not comprise women with dysmenorrhea. Both stages of the study included data from full-night polysomnography (PSG) type I, levels of IL-6, TNF-alpha and C-reactive protein, and responses to specific questionnaires related to symptoms of insomnia, depression and anxiety, sleep quality, excessive daytime sleepiness, fatigue and quality of life. Generalized Linear Model with Bonferroni post hoc were used for the statistical analysis of the Stage 1 while the Kruskall-Wallis with Dunn post hoc were used in the Stage 2 of the study. In both analysis we considered p<0.05. Results: Stage 1’s findings revealed that women with dysmenorrhea symptoms presented with reduced sleep efficiency (82.5%±13.8) and later wake up time (7:12am) when compared to women without dysmenorrhea symptoms (86.2%±10.9; 6:52am, respectively). Dysmenorrhea condition was statistically associated with higher fatigue and sleepiness and lower physical quality of life. No statistical differences were observed between the 2 groups in respect of inflammatory mediators’ levels, other questionnaires and PSG parameters. Stage 2’s results demonstrated that women in follicular phase of the menstrual cycle presented significantly higher sleep efficiency (89.9%±9.63) and shorter sleep latency (7.19min±7.19) when compared to women in menstrual phase (83.08%±10.84; 22.33min±32.42) and luteal phase (83.78%±12.72; 15.94min±14.74). Other PSG parameters, inflammatory mediators’ levels and questionnaires did not show statistical differences between the groups. In both stages of the study, quality of sleep scores from Pittsburgh Sleep Quality Index was >5, which indicates that our study sample presented poor sleep quality. Conclusions: Dysmenorrhea condition was associated to worsened sleep with daytime repercussions and reduced quality of life. Follicular phase of the menstrual cycle was related to better sleep, with higher sleep efficiency and shorter sleep latency, while women menstruating presented lower sleep efficiency and took more time to fall asleep.
Aims: To investigate the sleep and inflammatory mediators of women during the reproductive phase of life with or without dysmenorrhea enrolled in Episono 2007, a cross-sectional study of an epidemiological sample from the city of São Paulo, Brazil. Methods: A total of 328 women under reproductive phase of life were investigated. Dysmenorrhea symptoms and phases of the menstrual cycle were obtained by the answers from the Institutional Women’s Questionnaire and dosages of sexual hormones’ levels. Women were distributed according to the presence or absence of dysmenorrhea (Stage 1) or phases of the menstrual cycle (Stage 2), this latter stage did not comprise women with dysmenorrhea. Both stages of the study included data from full-night polysomnography (PSG) type I, levels of IL-6, TNF-alpha and C-reactive protein, and responses to specific questionnaires related to symptoms of insomnia, depression and anxiety, sleep quality, excessive daytime sleepiness, fatigue and quality of life. Generalized Linear Model with Bonferroni post hoc were used for the statistical analysis of the Stage 1 while the Kruskall-Wallis with Dunn post hoc were used in the Stage 2 of the study. In both analysis we considered p<0.05. Results: Stage 1’s findings revealed that women with dysmenorrhea symptoms presented with reduced sleep efficiency (82.5%±13.8) and later wake up time (7:12am) when compared to women without dysmenorrhea symptoms (86.2%±10.9; 6:52am, respectively). Dysmenorrhea condition was statistically associated with higher fatigue and sleepiness and lower physical quality of life. No statistical differences were observed between the 2 groups in respect of inflammatory mediators’ levels, other questionnaires and PSG parameters. Stage 2’s results demonstrated that women in follicular phase of the menstrual cycle presented significantly higher sleep efficiency (89.9%±9.63) and shorter sleep latency (7.19min±7.19) when compared to women in menstrual phase (83.08%±10.84; 22.33min±32.42) and luteal phase (83.78%±12.72; 15.94min±14.74). Other PSG parameters, inflammatory mediators’ levels and questionnaires did not show statistical differences between the groups. In both stages of the study, quality of sleep scores from Pittsburgh Sleep Quality Index was >5, which indicates that our study sample presented poor sleep quality. Conclusions: Dysmenorrhea condition was associated to worsened sleep with daytime repercussions and reduced quality of life. Follicular phase of the menstrual cycle was related to better sleep, with higher sleep efficiency and shorter sleep latency, while women menstruating presented lower sleep efficiency and took more time to fall asleep.