Impacto da insônia na qualidade de vida de mulheres em uma amostra representativa da população da cidade de São Paulo entre os anos de 2007 e 2015 (EPISONO)
Data
2024-08-08
Orientadores
Hachul , Helena 
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A insônia é uma das queixas de sono mais comumente observadas na população adulta, principalmente em mulheres, que apresentam risco maior para esta condição. Com o avanço da idade, essas queixas podem aumentar e vir acompanhadas de sintomas psicológicos e dores musculares. Além disso, sabe-se que a insônia está associada a uma série de comorbidades, como aumento de ansiedade e depressão, o que leva a piora na qualidade de vida. O presente projeto constituiu-se de dois estudos abordando temas relacionados com queixas de dor durante a noite, presença ou ausência de sintomas de insônia e qualidade de vida na população feminina. O primeiro estudo foi uma análise transversal em que se analisou a associação entre a presença ou ausência de dor durante o período da noite com a qualidade de vida em mulheres adultas. Nossa hipótese era que as participantes com queixas de dor apresentariam índices prejudicados considerando o nível de ansiedade, depressão, fadiga e na qualidade de vida, em comparação ao grupo sem queixas de dor. Para isso, utilizamos dados do Estudo Epidemiológico do Sono da cidade de São Paulo (EPISONO), conduzido em 2007. Participantes do sexo feminino foram incluídas, sendo então distribuídas em um grupo com queixas de dor e o outro como controle. Para definição dos grupos, foi utilizado a resposta de dois instrumentos, no caso: o Índice de Qualidade de Sono de Pittsburgh (IQSP) e o questionário pré-sono (instrumento que mensura o padrão de sono nos últimos meses). Como método de comparação, foram empregados o Índice de Ansiedade de Beck (IAB), Índice de Depressão de Beck (IDB), Questionário de Fadiga de Chalder (QFC), o questionário de Qualidade de Vida da Organização Mundial da Saúde, versão abreviada (WHOQOL-Bref) e dados provenientes do exame de polissonografia (PSG). Nossos resultados mostraram que houve associação entre a piora no nível de ansiedade, depressão, fadiga e na qualidade de vida nas participantes com queixas de dor. Além disso, as participantes com queixas de dor tinham mais chance de se sentirem fatigadas. Nossa segunda avaliação foi um estudo coorte e teve como objetivo avaliar o impacto dos sintomas de insônia e suas consequências na qualidade de vida e no humor de mulheres ao longo do tempo. Para isso, dados do EPISONO de 2007 e seu acompanhamento realizado com a mesma população em 2015, foram utilizados. Mulheres adultas de todas as faixas etárias foram incluídas e classificadas de acordo com um critério subjetivo para avaliação da presença ou ausência de sintomas de insônia em ambos os momentos. Neste contexto, três instrumentos validados foram utilizados para este fim: o IQSP, Índice de Gravidade de Insônia e o Questionário de Sono UNIFESP. Apenas dados das participantes que foram classificadas com ou sem sintomas de insônia em 2007 e permaneceram no mesmo grupo em 2015, foram incluídas na análise final. O histórico clínico e os dados sociodemográficos serviram como mensuração para observar a diferença ou semelhança dos grupos no período basal (2007) e com passar do tempo (2007 x 2015). Em relação a análise longitudinal, o IAB, IDB, QFC, WHOQOL-Bref e dos dados provenientes dos exames PSG, nos forneceram informações relevantes para avaliar o efeito do grupo, do tempo e a interação entre grupo e tempo. Este estudo levantou a hipótese de que a manutenção das queixas de insônia teria um impacto negativa na percepção de qualidade de vida e humor das participantes. No entanto, considerando a interação entre grupo e tempo, não houve diferença significativas. Apesar disso, nossos resultados evidenciam que as participantes com sintomas de insônia mantiveram índices similares e prejudicados em relação ao humor, qualidade de vida e fadiga, em comparação ao grupo controle. Por fim, o passar do tempo piorou o nível de depressão e fadiga em todas as participantes, independente do grupo.
Insomnia is one of the most common sleep complaints observed in the adult population, especially in women, who are at greater risk for this condition. With advancing age, these complaints may increase and be accompanied by pain and psychological symptoms. Furthermore, it is known that insomnia is associated with a series of comorbidities, such as increased levels of anxiety and depression, which leads to a worsening of quality of life. The present project consisted of two studies addressing topics related to complaints of pain at night, the presence or absence of insomnia symptoms, and the perception of quality of life in the female population. Therefore, our first study was structured as a cross-sectional analysis, analyzing the association between the presence or absence of pain during the night and quality of life in adult women. Our hypothesis was that participants with pain complaints would have an impaired index considering the level of anxiety, depression, fatigue, and quality of life, compared to the control group. For this, we used data from the Sleep Epidemiological Study of the city of São Paulo (EPISONO), conducted in 2007. Female participants were included, being distributed into one group with pain complaints and the other as a control. To define the groups, the response from two instruments was used, in this case: the Pittsburgh Sleep Quality Index (PSQI) and the pre-sleep questionnaire (an instrument that measures the sleep pattern in recent months). As a comparison method, the Beck Anxiety Index (BAI), Beck Depression Index (BDI), Chalder Fatigue Questionnaire (CFQ), the World Health Organization Quality of Life questionnaire, abbreviated version (WHOQOL-Bref), and data from the polysomnography exam (PSG). Our results corroborate our hypothesis, so there was an association between the worsening of anxiety, depression, fatigue and quality of life in participants with pain complaints. Furthermore, there was an increase in the chance of participants with pain complaints feeling fatigued. Our second study was designed as a longitudinal evaluation and aimed to assess the impact of insomnia symptoms and their consequences on women's quality of life and mood over time. For this, data from EPISONO from 2007 and its monitoring carried out with the same population in 2015 were used. Adult women of all age groups were included and classified according to a subjective criterion to assess the presence or absence of insomnia symptoms at both moments. In this context, three validated instruments were used for this purpose: the PSQI, Insomnia Severity Index and the UNIFESP Sleep Questionnaire. Only data from participants who were classified with or without insomnia symptoms in 2007 and remained in the same group in 2015 were included in the final analysis. The clinical history and sociodemographic data served as measurements to observe the difference or similarity of the groups at baseline (2007) and over time (2007 x 2015). Regarding longitudinal analysis, the BAI, BDI, CFQ, WHOQOL-Bref, and data from PSG exams provided us with relevant information to evaluate the effect of group, time and the interaction between group and time. This study raised the hypothesis that the maintenance of insomnia complaints would have a negative impact on the participants' perception of quality of life and mood. However, when considering the interaction between group and time, there was no significant difference. Despite this, our results show that participants with insomnia symptoms maintained similar and impaired levels of mood, quality of life and fatigue, compared to the control group. Finally, the passage of time worsened the level of depression and fatigue in all participants, regardless of the group.
Insomnia is one of the most common sleep complaints observed in the adult population, especially in women, who are at greater risk for this condition. With advancing age, these complaints may increase and be accompanied by pain and psychological symptoms. Furthermore, it is known that insomnia is associated with a series of comorbidities, such as increased levels of anxiety and depression, which leads to a worsening of quality of life. The present project consisted of two studies addressing topics related to complaints of pain at night, the presence or absence of insomnia symptoms, and the perception of quality of life in the female population. Therefore, our first study was structured as a cross-sectional analysis, analyzing the association between the presence or absence of pain during the night and quality of life in adult women. Our hypothesis was that participants with pain complaints would have an impaired index considering the level of anxiety, depression, fatigue, and quality of life, compared to the control group. For this, we used data from the Sleep Epidemiological Study of the city of São Paulo (EPISONO), conducted in 2007. Female participants were included, being distributed into one group with pain complaints and the other as a control. To define the groups, the response from two instruments was used, in this case: the Pittsburgh Sleep Quality Index (PSQI) and the pre-sleep questionnaire (an instrument that measures the sleep pattern in recent months). As a comparison method, the Beck Anxiety Index (BAI), Beck Depression Index (BDI), Chalder Fatigue Questionnaire (CFQ), the World Health Organization Quality of Life questionnaire, abbreviated version (WHOQOL-Bref), and data from the polysomnography exam (PSG). Our results corroborate our hypothesis, so there was an association between the worsening of anxiety, depression, fatigue and quality of life in participants with pain complaints. Furthermore, there was an increase in the chance of participants with pain complaints feeling fatigued. Our second study was designed as a longitudinal evaluation and aimed to assess the impact of insomnia symptoms and their consequences on women's quality of life and mood over time. For this, data from EPISONO from 2007 and its monitoring carried out with the same population in 2015 were used. Adult women of all age groups were included and classified according to a subjective criterion to assess the presence or absence of insomnia symptoms at both moments. In this context, three validated instruments were used for this purpose: the PSQI, Insomnia Severity Index and the UNIFESP Sleep Questionnaire. Only data from participants who were classified with or without insomnia symptoms in 2007 and remained in the same group in 2015 were included in the final analysis. The clinical history and sociodemographic data served as measurements to observe the difference or similarity of the groups at baseline (2007) and over time (2007 x 2015). Regarding longitudinal analysis, the BAI, BDI, CFQ, WHOQOL-Bref, and data from PSG exams provided us with relevant information to evaluate the effect of group, time and the interaction between group and time. This study raised the hypothesis that the maintenance of insomnia complaints would have a negative impact on the participants' perception of quality of life and mood. However, when considering the interaction between group and time, there was no significant difference. Despite this, our results show that participants with insomnia symptoms maintained similar and impaired levels of mood, quality of life and fatigue, compared to the control group. Finally, the passage of time worsened the level of depression and fatigue in all participants, regardless of the group.
Descrição
Citação
LUCENA, Leandro dos Reis. Impacto da insônia na qualidade de vida de mulheres em uma amostra representativa da população da cidade de São Paulo entre os anos de 2007 e 2015 (EPISONO) . 2024. 167 f. Tese (Doutorado em Psicobiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.