Increasing trends of sleep complaints in the city of Sao Paulo, Brazil

The effects of social jetlag and sleep variability on sleepiness in a population-based study: The mediating role of sleep debt

Sleepiness is a multicausal condition, and previous research has highlighted associations between this symptom and the circadian timing system, specifically concerning social jetlag and sleep variability. Recent inquiries have shown that the effects of social jetlag on sleepiness can be confounded with the consequences of sleep debt. In light of the current evidence, we aimed to assess the effects of social jetlag and sleep variability on sleepiness and the potential mediating role of sleep debt. We used data from the EPISONO study, a cross-sectional population-based study with a sample size of 1042 participants, representative of the city of Sao Paulo, Brazil. Participants completed the UNIFESP Sleep Questionnaire (self-reported bedtime and get-up time) and the Epworth Sleepiness Scale (subjective daytime sleepiness). Subsequently, sleep-corrected mid-sleep time (chronotype), total sleep time, social jetlag (absolute difference between the mid-sleep time on workdays and mid-sleep time on free days), sleep variability (standard deviation of mid-sleep time), and sleep debt (difference between total sleep time on workdays and free days) were calculated. Generalised linear models were used to test whether social jetlag and sleep variability affected sleepiness. Mediation models were used to determine if any observed significant effects were mediated by sleep debt. The prevalence of social jetlag was 23% for >1 h and 12% for >2 h. The mean sleep variability was 41 ± 30 min. Social jetlag had a significant effect on the Epworth Sleepiness Scale scores. This association was no longer statistically significant after controlling for age, sex, body mass index, work schedule, and chronotype. A significant indirect effect of social jetlag on sleep debt and subsequently on the Epworth Sleepiness Scale scores was found. No effect of sleep variability on sleepiness could be identified. In conclusion, the association between social jetlag and sleepiness was mediated by sleep debt but was not independent of demographic, work, and chronotype variables. This study provides new evidence on the importance of circadian misalignment and sleep debt for sleep health on a population level.

Evolution of Sleep Complaints in Myotonic Dystrophy Type 1: A 9-Year Longitudinal Study

The objective was to characterize the progression of sleep complaints in 115 dystrophy type 1 (DM1) patients who filled out a sleep questionnaire twice at a 9-year interval. Daytime napping (22.1% vs. 34.5%, p < 0.05), early awakenings (11.4% vs 21.1%, p < 0.05), nonrestorative sleep (39.5% vs 51.8%, p < 0.05), stimulant use (7.0% vs 19.3%, p < 0.01), breathing cessation (10.7% vs 23.2%, p < 0.01), and nighttime urination (42.5% vs 54.9%, p < 0.05) increased between Time 1 and Time 2. Sleep-related complaints are prominent and augment rapidly in DM1 patients. Physicians need to better identify and treat them to help alleviate the burden they impose on patients and their caregivers.

Exploring the potential relationships among obstructive sleep apnea, erectile dysfunction, and gut microbiota: a narrative review

INTRODUCTION

Poor sleep quality is closely associated with comorbidities affecting a multitude of organ systems. Among the sleep disorders in the population, there has recently been an increase in the prevalence of obstructive sleep apnea (OSA), which has particularly affected men. The intermittent hypoxia and sleep fragmentation associated with OSA can result in the manifestation or aggravation of a number of pathophysiologic conditions, including the impairment of reproductive function in men and women. In this context, erectile dysfunction (ED) is of particular concern. Other consequences of OSA are changes in the gastrointestinal microbiota, with the resultant dysbiosis having potentially harmful consequences that promote downstream exacerbation of various comorbidities.

OBJECTIVES

This narrative review aims to explore the potential relationships among ED, gut microbiota, and OSA.

METHODS

A search of the relevant literature was performed in the PubMed, Embase, Medline, and Web of Science databases.

RESULTS

Sleep is important for regulating the body's functions, and sleep deprivation can negatively affect health. OSA can damage organic functions, including reproductive function, and can lead to ED. Restoring the microbiota and improving sleep can help to improve sexual function or reverse ED and enhance other associated conditions mediated through the gut-brain axis relationship. Probiotics and prebiotics can be used as supportive strategies in the prevention and treatment of OSA, as they help to reduce systemic inflammation and improve intestinal barrier function.

CONCLUSION

A good diet, a healthy lifestyle, and proper bowel function are essential in controlling depression and several other pathologies. Modulating the gut microbiota through probiotics and prebiotics can provide a viable strategy for developing new therapeutic options in treating many conditions. A better understanding of these a priori unrelated phenomena would foster our understanding of the effects of OSA on human fertility and how changes in gut microbiota may play a role.

Emergence of different dimensions of sleepiness in a general population sample: An EPISONO study

INTRODUCTION

Recent evidence supports the idea that sleepiness has several dimensions, comprising psychophysiological phenomena, such as sleep propensity and sleepiness perception. The Epworth Sleepiness Scale (ESS) is among one of the most used sleepiness assessment tools, but recent data suggest that it might not detect problematic impairments in sleep health. More research is warranted investigating sleepiness dimensions with large sample sizes, using both objective and subjective methods of analyzing sleep.

METHODS

We used data from the Epidemiological Sleep Study (EPISONO), a major study carried out in Brazil using a representative sample of 1042 participants of the general population of Sao Paulo city, who completed questionnaires and underwent type I polysomnography. Sleepiness was measured by the ESS (sleep propensity) and the UNIFESP Sleep Questionnaire, which asked about the frequency of feeling sleepy during the day (sleepiness perception). The participants were distributed into 4 groups in respect of excessive daytime sleepiness (EDS) according to the following criteria: 1) having an ESS score >10 (ESS group). 2) feeling sleepy ≥3 times per week (Frequent EDS group). 3) the combined criteria (Combined EDS group). 4) having no evidence of EDS (no EDS group). The UNIFESP Sleep Questionnaire was used to obtain self-reported sleep duration, sleep debt, and sleep duration variability. Participants also completed the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and a pre-polysomnography sleep questionnaire.

RESULTS

After removing participants with missing data, there were 620 participants with no EDS, 255 individuals in the ESS group, 68 in the Frequent EDS group, and 73 in the Combined EDS group. Compared to the no EDS group, the ESS and Combined EDS groups had significantly increased sleep efficiency, diminished sleep latency, wake after sleep onset, and self-reported weekly sleep duration. The Frequent and Combined EDS groups had significantly higher scores in the Insomnia Severity Index and Pittsburgh Sleep Quality Index. All EDS groups had an increased likelihood of nonrestorative sleep. EDS frequency and the ESS scores were significantly correlated.

CONCLUSIONS

Participants with a high sleep propensity had a profile suggesting prior sleep deprivation, while high sleepiness perception was associated with impaired sleep quality. These findings indicated that, in the general population, these instruments evaluated separate sleepiness dimensions with different associations, highlighting that screening using a combination of instruments might be more effective in detecting impairments in sleep health.

The bidirectional association between chronic musculoskeletal pain and sleep-related problems: a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis synthesizes the evidence on prospective bidirectional associations between sleep-related problems (SRP) and chronic musculoskeletal pain (CMP).

METHODS

A literature search for cohort studies available in the PubMed, Scopus, Web of Science, PsycINFO and Cochrane Library databases as of 19 July 2022 was performed. Pooled odds ratios and effect sizes were calculated through random effects meta-analysis. Subgroup and meta-regression analyses were performed to explore differences by follow-up time, proportion of each sex and mean age. The Meta-analysis Of Observational Studies in Epidemiology guidelines were strictly followed.

RESULTS

Twenty studies with a total of 208 190 adults (aged 34.4-71.7 years) were included, with 17 of them being used in the meta-analysis. Individuals with SRP at baseline had a 1.79-fold higher incidence (odds ratio [OR] = 1.79; 95% CI: 1.55, 2.08; I2 = 84.7%; P < 0.001) and a 2.04-fold higher persistence (OR = 2.04; 95% CI: 1.42, 2.94; I2 = 88.5%; P < 0.005) of CMP than those without SRP. In the subgroup analysis of the association between SRP and CMP, the longer the follow-up time of the studies, the higher the heterogeneity between them. In the corresponding meta-regression, no significant effect was observed for follow-up time, sex proportion or age. Individuals with CMP at baseline had a 2.02-fold higher incidence of SRP (OR = 2.02; 95% CI: 1.62, 2.53; I2 = 90.0%; P < 0.001) than those without CMP.

CONCLUSION

This study provides robust evidence concerning the longitudinal association between SRP and incidence-persistence of CMP in adults. In addition, the available prospective studies support the existence of a bidirectional relationship between CMP and SRP.

PROSPERO REGISTRATION NUMBER

CRD42020212360.

Association between night pain and quality of life in women: A general population sleep study

BACKGROUND

Women with pain present decreased sleep duration and quality of life, but little is known about the consequences of nighttime pain on overall health. Our goal was to compare levels of anxiety, depression and fatigue in women with pain during the night with those without pain. We hypothesized that pain perception is associated with the worsening of fatigue and mood.

METHODS

In total, 244 women aged 20-80 years who took part in the Epidemiologic Sleep Study (EPISONO) met the inclusion criteria, 85 in the self-reported pain group and 171 in the control group. Participants were assigned to the pain group if they both responded (i) they generally had pain, according to Pre-Sleep Questionnaire (PSQ) and (ii) their pain generally interfered with their sleep 3 or more times a week, according to Pittsburg Sleep Quality Index (PSQI). Those who answered negatively to both questions were allocated to the control group. All participants underwent a full night laboratory polysomnography, and completed questionnaires related to fatigue, depression, anxiety and quality of life.

RESULTS

Pain group participants had a significantly lower perception of quality of life, and significantly higher levels of fatigue (5.4 times), anxiety and depression. Pain perception was also correlated to levels of anxiety and depression in the psychological (r_s  = -0.463, -0.607, respectively) and social (r_s  = -0.423, -0.438, respectively) quality of life domains.

CONCLUSIONS

Nighttime pain in women was associated with decreased quality of life, worsening mood and fatigue. Our data shows the importance of investigating pain and its deleterious effects on women's health.

SIGNIFICANCE

Our study highlights that women experiencing nighttime pain also reported worse mood outcomes and decreased quality of life, regardless of the level and type of pain. Our data, based on association analysis and not investigating causality, suggest it is important to consider nighttime pain in clinical care to improve quality of life and general health.

Trends and socioeconomic inequities in insomnia-related symptoms among Japanese adults from 1995 to 2013

BACKGROUND

Although insomnia prevalence is increasing in developed countries, little is known about trends in sleep problems among Japanese adults according to socioeconomic status. Therefore, we aimed to determine trends and socioeconomic inequalities in insomnia-related symptom (IRS) in Japan using nationally representative data.

METHODS

The IRSs were based on past subjective sleeping difficulty. Using data from the Comprehensive Survey of Living Conditions for every 3 years from 1995 to 2013, we built multivariable Poisson regression models, with IRS as an outcome and survey year and socioeconomic status variables as explanatory variables.

RESULTS

Data from 513,223 Japanese adults were analyzed. Age- and sex-adjusted IRS prevalence was the lowest in 1995, highest in 2007, and decreased from 2007 to 2013. The IRSs were more frequently reported in unemployed or self-employed individuals aged 20-64 years; those with the lowest household expenditure level, except among women aged ≥65 years; and those divorced, separated, or single, especially among women aged 20-64 years.

LIMITATIONS

First, the repeated cross-sectional study design prevented the exclusion of the possibility of reversal of causality between factors. Second, data on insomnia-related lifestyle behaviors were unavailable. Third, the IRSs examined did not meet established clinical criteria for clinical insomnia. Fourth and fifth, information and selection biases could exist because of self-reported data and a small sample size, respectively.

CONCLUSIONS

These results could aid in developing more effective prevention strategies for sleep problems and provide benchmarks for monitoring sleep health trends in Japan and other East Asian countries.

Effect of chronic sleep deprivation on acrosomal integrity and functional parameters of murine sperm

OBJECTIVE

To evaluate the effect of chronic sleep deprivation on sperm function quality in mice.

DESIGN

Experimental study.

SETTING

Not applicable.

ANIMALS

Spermatozoa from twenty-four 10-week-old C57BL/6J male mice.

INTERVENTION(S)

The sleep deprivation group underwent gentle handling for 6 hours for 5 consecutive days. The mice in the sleep recovery group were allowed to sleep during the 24-hour period after the sleep deprivation protocol.

MAIN OUTCOME MEASURE(S)

After euthanasia, the spermatozoa were collected for analysis. Sperm motility was evaluated using computer-assisted sperm analyzer. Intracellular superoxide anion (O₂^-) activity, acrosome integrity, mitochondrial activity, and DNA fragmentation assays were conducted afterward.

RESULT(S)

Sleep deprivation and sleep recovery groups presented a lower percentage of spermatozoa with an intact acrosome, compared with the respective control groups. Regarding DNA fragmentation, a decreased proportion of spermatozoa with Comet I class intact DNA was observed in the sleep recovery group, compared with the recovery control group. Beat cross frequency was increased in the sleep recovery group.

CONCLUSION(S)

Sleep deprivation can reduce sperm quality, impairing acrosome integrity. Sleep recovery decreased DNA integrity and increased beat cross frequency.

Habitual Sleep Patterns and Chronic Sleep Problems in Relation to Sex, Age, and Circadian Preference in a Population-Based Sample of Norwegian Adults

Sleep patterns and problems vary in relation to internal (e.g., sex, age, circadian preference) and external (e.g., social structures) factors. The main aim of the present study was to describe habitual sleep patterns and chronic sleep problems in a population-based sample of Norwegian adults. During spring 2022, a sample of 1028 adults completed an online survey on sleep habits and problems. Response rate was 33.5%. The survey included the Munich ChronoType Questionnaire and items on circadian preference and chronic sleep problems. Mean workday sleep duration was 7:19 h (±199 min), and shorter in males (p = 0.035) and evening persons (p = 0.003). Short workday sleep duration (<6 h) was reported by 3.1% and was associated with evening preference (p = 0.001). Mean social jetlag was 0:51 h (±75 min), and longer in males (p = 0.036), younger adults (p < 0.001) and evening persons (p < 0.001). Long social jetlag (≥2 h) was reported by 11.2% and associated with younger age (p < 0.001) and evening preference (p < 0.001). Chronic sleep problems (≥3 months) were reported by 44.1%, and associated with female sex (p < 0.001) and evening preference (p = 0.002). Results underscore the importance of considering evening circadian preference as a risk factor for short workday sleep duration, long social jetlag and self-reported chronic sleep problems.

Association between discrimination and poor sleep health outcomes among 2192 South Korean gay, lesbian, and bisexual adults: A nationwide cross-sectional survey

OBJECTIVE

The study aimed to assess the prevalence of poor sleep health outcomes and examine the associations between experiences of discrimination and the sleep health outcomes among lesbian, gay, and bisexual (LGB) adults in Korea.

DESIGN & SETTING

The study used data from Rainbow Connection Project I, a nationwide cross-sectional survey of Korean LGB adults, conducted via online in 2016.

MEASUREMENTS

Participants were asked about experiences of anti-LGB discrimination and discrimination based on other characteristics (ie, gender, age, place of origin, nationality/race, religion, appearance including height and weight, disability status, and other) in the past 12 months. Using the responses, the participants were categorized into 4 groups: those who experienced (1) none, (2) only anti-LGB discrimination, (3) only other types of discrimination, and (4) both anti-LGB and other types of discrimination. Past-week sleep quality, unrestful sleep, and long sleep latency were included as sleep health outcomes.

RESULTS

Of the 2192 participants, 740 (33.8%) had poor sleep quality, 1211 (55.2%) had unrestful sleep, and 681 (31.1%) had long sleep latency in the past week. Participants who experienced both anti-LGB and other types of discrimination had 1.65 times (95% confidence interval [CI] = 1.38-1.98), 1.30 times (95% CI = 1.16-1.45), and 1.58 times (95% CI = 1.31-1.90) higher prevalence of poor sleep quality, unrestful sleep, and long sleep latency, respectively, compared to those without any experiences of discrimination.

CONCLUSIONS

Experiencing discrimination may deprive Korean LGB adults of good quality sleep. Interventions that seek to prevent discrimination are needed to promote sleep health among Korean LGB individuals.

Sound reasons for unsound sleep: Comparative support for the sentinel hypothesis in industrial and nonindustrial groups

Background and objectives

Sleep is a vulnerable state in which individuals are more susceptible to threat, which may have led to evolved mechanisms for increasing safety. The sentinel hypothesis proposes that brief awakenings during sleep may be a strategy for detecting and responding to environmental threats. Observations of sleep segmentation and group sentinelization in hunter-gatherer and small-scale communities support this hypothesis, but to date it has not been tested in comparisons with industrial populations characterized by more secure sleep environments.

Methodology

Here, we compare wake after sleep onset (WASO), a quantitative measure of nighttime awakenings, between two nonindustrial and two industrial populations: Hadza hunter-gatherers (n = 33), Malagasy small-scale agriculturalists (n = 38), and Hispanic (n = 1,531) and non-Hispanic White (NHW) (n = 347) Americans. We compared nighttime awakenings between these groups using actigraphically-measured sleep data. We fit linear models to assess whether WASO varies across groups, controlling for sex and age.

Results

We found that WASO varies significantly by group membership and is highest in Hadza (2.44 h) and Malagasy (1.93 h) and lowest in non-Hispanic Whites (0.69 h). Hispanics demonstrate intermediate WASO (0.86 h), which is significantly more than NHW participants. After performing supplementary analysis within the Hispanic sample, we found that WASO is significantly and positively associated with increased perception of neighborhood violence.

Conclusions and implications

Consistent with principles central to evolutionary medicine, we propose that evolved mechanisms to increase vigilance during sleep may now be mismatched with relatively safer environments, and in part responsible for driving poor sleep health.

Technological infrastructure, sleep, and rest-activity patterns in a Kaqchikel Maya community

Sleep duration, quality, and rest-activity pattern-a measure for inferring circadian rhythm-are influenced by multiple factors including access to electricity. Recent findings suggest that the safety and comfort afforded by technology may improve sleep but negatively impact rest-activity stability. According to the circadian entrainment hypothesis, increased access to electric lighting should lead to weaker and less uniform circadian rhythms, measured by stability of rest-activity patterns. Here, we investigate sleep in a Maya community in Guatemala who are in a transitional stage of industrialization. We predicted that (i) sleep will be shorter and less efficient in this population than in industrial settings, and that (ii) rest-activity patterns will be weaker and less stable than in contexts with greater exposure to the natural environment and stronger and more stable than in settings more buffered by technologic infrastructure. Our results were mixed. Compared to more industrialized settings, in our study population sleep was 4.87% less efficient (78.39% vs 83.26%). We found no significant difference in sleep duration. Rest-activity patterns were more uniform and less variable than in industrial settings (interdaily stability = 0.58 vs 0.43; intradaily variability = 0.53 vs 0.60). Our results suggest that industrialization does not inherently reduce characteristics of sleep quality; instead, the safety and comfort afforded by technological development may improve sleep, and an intermediate degree of environmental exposure and technological buffering may support circadian rhythm strength and stability.

Prevalence and predictors of bruxism in two university clinic patient populations with dental implants: A cross-sectional analysis

OBJECTIVE

To analyze the prevalence, predictors, and prosthetic complications of bruxing patients with dental implants in two tertiary clinics in Istanbul, Turkey.

METHODS

Patients with at least one dental implant and with a fixed prosthesis were examined for the evidence of probable bruxism. Factors that could be related to bruxism were analyzed in relation to patient-specific variables. Technical and mechanical complications were investigated.

RESULTS

A total of 1688 patients were analyzed. The overall rate of probable bruxism was 19.72%. Besides self-reported bruxism (p < 0.022), antidepressant use (p < 0.002), frequent headaches (p < 0.014), and observation of linea alba (p < 0.028) were the predictors for probable bruxism. Technical and mechanical complications were frequent in the probable bruxers (p < 0.05).

CONCLUSION

Overall prevalence of bruxism was 19.72%, and bruxism was associated with general and gender-specific predictors.

Sleep disorders and prostate cancer prognosis: biology, epidemiology, and association with cancer development risk

Sleep is crucial for the maintenance of health and well-being. Sleep disorders can result in physiological consequences and are associated with several health issues, including cancer. Cancer is one of the most significant health problems in the world. In Western countries, prostate cancer is the most prevalent noncutaneous cancer among men. Epidemiological studies showed that one in nine men will have this disease during their life. Many factors influence prostate cancer and the tumor niche, including endogenous hormones, family history, diet, and gene mutations. Disruption of the circadian cycle by sleep disorders or other factors has been suggested as a novel and important risk factor for prostate cancer and its tumorigenesis. This review presents information regarding the epidemiological and biological aspects of prostate cancer, and discusses the impact of sleep physiology and sleep disorders on this type of cancer, highlighting possible associations with risk of cancer development.

Sleep duration as an independent factor associated with vitamin D levels in the EPISONO cohort

STUDY OBJECTIVES

Obstructive sleep apnea and short sleep duration have been separately associated with inadequate serum 25-hydroxyvitamin D [25(OH)D] levels. However, whether these 2 factors may concurrently influence 25(OH)D in the general population is unknown. We hypothesized that both obstructive sleep apnea and short sleep duration would be independently associated with lower concentrations of 25(OH)D in a sex-dependent manner.

METHODS

In this cross-sectional study, 712 individuals, part of the prospective EPISONO cohort (Brazil), underwent polysomnography, answered sleep questionnaires, and had their blood collected for serum 25(OH)D quantification.

RESULTS

Individuals with a sleep duration of < 6 hours had 2-fold increased odds of 25(OH)D < 20 ng/mL compared with those who reported 6 or more hours of sleep, even after adjusting for confounding factors. Subset sex analysis revealed that men with a sleep duration of < 6 hours had 4-fold increased odds of 25(OH)D < 20 ng/mL. In women, short sleep duration was not associated with lower 25(OH)D levels. The presence of obstructive sleep apnea (as classified according to the individual's apnea-hypopnea index) was not independently related to 25(OH)D concentrations in men or women. Sleep parameters, including sleep latency and sleep efficiency, had no association with 25(OH)D < 20 ng/mL.

CONCLUSIONS

Short sleep, but not apnea-hypopnea index, was an independent factor associated with low 25(OH)D serum levels in men, but not in women. Apnea-hypopnea index scores were not associated with 25(OH)D levels in either sex. These results raise the possibility of investigating sex-specific characteristics, such as gonadal hormone regulation, and re-evaluating obstructive events by classifying them in mild, moderate, and severe obstructive sleep apnea.

CITATION

de Oliveira DL, Dokkedal-Silva V, Fernandes GL, Kim LJ, Tufik S, Andersen ML. Sleep duration as an independent factor associated with vitamin D levels in the EPISONO cohort. J Clin Sleep Med. 2021;17(12):2439-2449.

Sleep deficit in COVID-19 health-care workers may increase the infection risk

The COVID-19 pandemic has had negative effects on health-care workers. The rapid growth of the disease has led to overwhelmed health-care systems, overcrowded hospitals, an insufficient number of health-care professionals and shortages of medical equipment. The potential exposure of front-line health-care workers during the COVID-19 outbreak has led to self-isolation and the appearance of adverse feelings such as stress, anxiety and fear. All these factors, combined with an increased workload and extra and changed shifts, are determinants of a sleep-loss process that may result in insomnia. The exacerbated pro-inflammatory milieu caused by insomnia and sleep deprivation present in health professionals may therefore make them more prone to developing severe COVID-19 if infected and/or aggravate the symptoms of the disease. Keeping these professionals healthy and doing everything possible to prevent them from being infected with COVID-19 should be a top priority. As part of this effort, we must be aware of the important effects of insomnia on the immune systems of these professionals and take all possible measures to counter these effects.

Depressive symptoms are associated with impaired sleep, fatigue, and disease activity in women with rheumatoid arthritis

OBJECTIVES

To investigate the associations between sleep quality, fatigue, disease activity and depressive symptoms in women with rheumatoid arthritis (RA).

METHODS

Female patients with previous diagnosis of RA from a Rheumatology Outpatient Clinic at a tertiary referral centre, in Fortaleza, Brazil, were consecutively recruited into the study. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI); fatigue by the Fatigue Severity Scale (FSS); daytime sleepiness by the Epworth Sleepiness Scale (ESS); and depressive symptoms by the Beck Depression Inventory II (BDI-II). RA activity was measured by the disease activity score (DAS28).

RESULTS

One hundred ten women (mean age ± SD = 51.1 ± 13.0 y) were included in the study. On average, patients with depressive symptoms (BDI-II > 13), as compared to those without, showed poorer sleep quality (PSQI: 10.09 ± 4.1 vs 7.33 ± 3.55; p = 0.001 respectively), more fatigue (FSS: 4.69 ± 1.89 vs 3.34 ± 1.8; p = 0.001) and higher disease activity level (DAS28: 4.36 ± 1.53 vs 3.7 ± 1.39; p = 0,047). The logistic regression analysis showed that sleep quality is an independent predictor of depressive symptom severity.

CONCLUSION

Depressive symptoms, impaired sleep and fatigue are common in women with RA. Poor sleep is associated with greater frequency and severity of depressive symptoms in these patients, suggesting that screening for sleep and mood problems may be relevant both in clinical research and routine patient care. Future studies investigating the impact of measures to promote healthy sleep on depressive symptom control in this patient population are warranted.

Self-reported sleep bruxism is associated with vitamin D deficiency and low dietary calcium intake: a case-control study

Background

Sleep bruxism may result in deleterious effects including loss of tooth enamel, fracture of teeth or restorations, teeth hypersensitivity or pain, and headache. The aim was to study the link between sleep bruxism, low serum vitamin D, low consumption of dietary calcium, psychological symptoms, and frequent headache.

Methods

This case-controlled study included 50 individuals with sleep bruxism and 50 age and gender matched controls. 25-hydroxyvitamin D was measured in serum. Hospital Anxiety and Depression Scale was used to measure anxiety and depression. Data about dietary calcium and frequent headache were self-reported.

Results

Participants with sleep bruxism had lower 25-hydroxyvitamin D and higher scores of anxiety and depression compared to controls (p < 0.05). Vitamin D deficiency, abnormal scores of anxiety and depression, low calcium consumption (< 323 mg/day), and frequent headache were reported in higher % of individuals with sleep bruxism compared to controls (p < 0.05). Binary logistic regression showed that sleep bruxism was significantly associated with vitamin D deficiency (OR = 6.66, p = 0.02), low consumption of dietary calcium (OR = 5.94, p = 0.01), and frequent headache (OR = 9.24, p < 0.001). Multiple linear regression showed that anxiety was significantly associated with decreased 25-hydroxyvitamin D (p = 0.03), increased scores of depression (p < 0.001) and female sex (p = 0.01). Binary logistic regression also showed that frequent headache was significantly associated with sleep bruxism (OR = 5.51, p < 0.01).

Conclusions

Sleep bruxism was associated with vitamin D deficiency and low consumption of calcium and was also associated with increased scores of anxiety and depression. Further investigations should be performed to check if vitamin D and calcium supplementation could relieve sleep bruxism.

Qualidade do sono e fatores associados entre docentes de educação superior

Resumo Introdução: a baixa qualidade do sono pode comprometer tanto a saúde como a qualidade de vida. Objetivo: estimar a prevalência e os fatores associados à qualidade do sono ruim entre docentes de educação superior de uma universidade pública na Bahia. Métodos: estudo exploratório, transversal, realizado de novembro de 2015 a abril de 2016 com 423 docentes aleatoriamente selecionados. A qualidade do sono foi mensurada pela escala Mini-Sleep Questionnaire (MSQ). Resultados: a prevalência de qualidade do sono ruim foi de 61,3%. As queixas mais frequentes foram: dificuldade de adormecer, acordar cansado, acordar com dor de cabeça e não ter tempo para dormir durante o dia. Apresentaram-se estatisticamente associadas com a qualidade do sono ruim: manter mais de um vínculo empregatício, tempo irregular e/ou insuficiente para a prática de atividades de lazer, seis horas ou menos de sono, queixas de dor musculoesquelética e de cabeça, e alta exigência psicológica com baixo controle sobre o trabalho. Conclusão: condições de trabalho que propiciam os fatores associados à elevada prevalência de qualidade do sono ruim entre docentes devem ser repensadas em prol da saúde desses trabalhadores e da importância do seu trabalho para a sociedade.

Association of self-reported sleep disturbances with ideal cardiovascular health in Brazilian adults: A cross-sectional population-based study

OBJECTIVE

To examine the association between sleep disturbances and cardiovascular health in Brazilian adults.

METHODS

We analyzed cross-sectional data from a nationally representative sample of 36,480 Brazilian adults ages 18 and over. Multivariate Poisson regression models were used to assess the association between sleep disturbances (difficulty falling asleep, frequent interruptions in sleep, or sleeping more than usual) and Life's Simple 7 (LS7) cardiovascular health (CVH) scores through consideration of four behaviors (smoking, physical activity, body mass index, and diet) and three biological factors (hypercholesterolemia, hypertension, and diabetes).

RESULTS

Adults with no sleep disturbances had better CVH, with higher mean LS7 CVH scores (4.2, 95% confidence interval [CI]: 4.1; 4.2) when compared to those experiencing some level of sleep disturbance within a 2-week timespan (3.8, 95% CI: 3.7; 3.8). Specifically, compared to those with no sleep disturbance, adults reporting sleep disturbances for half of the weekdays had significantly lower LS7 CVH mean scores (β = -0.02, 95% CI: -0.04; 0.01). Adults who had disturbances more than half of the weekdays had even lower scores (β = -0.06, 95% CI: -0.09; -0.02), followed by those who reported disturbances almost every day (β = -0.08, 95% CI: -0.11; -0.04), even after adjusting for age, sex, education status, depressive symptoms, and night shift work.

CONCLUSION

Brazilian adults with sleep disturbances are less likely to achieve ideal CVH. Given that sleep disturbances seem to be increasingly common in Brazil, recent gains in CVH mortality may be affected.

Evaluation of jaw bone density and morphology in bruxers using panoramic radiography

Background/purpose

Bruxism affects the stomatognathic system and causes tissue damage by the excessive jaw movements. The purpose of this study was to evaluate the effects of sleep bruxism on jaw bone density, mineralisation and morphology by comparing bruxers and non-bruxers.

Materials and methods

60 bruxers and 60 non-bruxers (control) patients were included in the analysis. Cortical width at the gonion (GI), at the mental foramen (MI), at the antegonion (AI), the panoramic mandibular index (PMI), the mandibular cortical index (MCI) and antegonial notch depth (AND) were measured bilaterally on 120 panoramic radiographs. The measurements were evaluated for repeatability, correlation with age, gender and correlation between the variables.

Results

A significant association was observed between cortical shape (MCI) and bruxism status (p = 0.012). The MI was significantly different between the bruxers and non-bruxers (p = 0.006). There was a significant but weak correlation between the MI value and age in bruxers and the control (p = 0.003, p = 0.04). The AI was not associated with bruxism status and did not vary by age or gender (p > 0.05). The AND was higher in bruxers than non-bruxers (p = 0.001). Male bruxers had a significantly higher AND value than female bruxers (p = 0.001). The GI was higher in male bruxers (p = 0.001).

Conclusion

Defects in the endosteal margin of the cortex and cortical thickening in the mental region were detected in bruxer patients. Furthermore, AND was increased in bruxers. Tiny bone peaks accompanied the cortical thickening seen in the gonial region. Male bruxer patients had higher GI and AND values than female bruxers.

The Brazilian-Portuguese version of the Sleep Hygiene Index (SHI): validity, reliability and association with depressive symptoms and sleep-related outcomes

Objective

To translate the Sleep Hygiene Index (SHI) to Brazilian Portuguese, to describe its psychometric properties and to show its association with sleep quality, daytime sleepiness, risk for sleep apnea and depressive symptoms.

Methods

Thirty subjects participated in the cultural adaptation and the item clarity evaluation. Twenty subjects answered the instrument in three different time-points for test-retest reliability. Eighty adult workers completed the SHI, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Beck Depression Inventory (BDI) and the STOP-BANG (S-B).

Results

SHI shows an acceptable internal consistency (Cronbach's α=0.75), as well as a high reproducibility (intraclass correlation=0.972, p<0.01). The three final factors of confirmatory factor analysis extract an average of 48.22% of the total sample variance. Worse sleep hygiene (higher SHI score) correlated with poor sleep quality (r=0.398, p<0.001), excessive daytime sleepiness (r=0.406, p<0.001) and depressive symptoms (r=0.324, p=0.003). No correlations with S-B were found.

Conclusions

SHI presents satisfactory-to-optimal psychometric properties. This instrument is useful for treatment planning and management of sleep hygiene practices. Thus, it represents a reliable way of assessing sleep hygiene quantitatively in both research and clinical settings.

Effect of endoscopic endonasal skull base surgery on snoring

BACKGROUND

As the number of endoscopic skull base surgeries has increased, postoperative changes in quality of life require attention, including evaluation of whether snoring symptoms change.

OBJECTIVE

To investigate the effect of endoscopic endonasal skull base surgery on snoring and nasal symptom scores.

METHODS

Between February 2009 and September 2018, 510 patients underwent skull base tumor resection via an endoscopic endonasal approach and were included in this study. Nasal symptoms were scored using the Nasal Obstruction Symptoms Evaluation (NOSE) scale and snoring symptoms were subjectively scored from 0 to 10 by partners using a visual analog scale (VAS). Computational fluid dynamics (CFD) was employed for pilot patient analysis.

RESULTS

A pituitary adenoma was the most common surgical pathology encountered over the past 10 years (81.6% of all tumors). The NOSE scores increased significantly after surgery (pre-surgery, 3.28 ± 3.18; post-surgery, 4.09 ± 3.61; P < .001). The snoring VAS score decreased significantly postoperatively (pre-surgery, 2.91 ± 2.74; post-surgery, 2.43 ± 2.45; P < .001). A positive correlation was apparent between the NOSE and snoring score changes (r = 0.374; P < .001).

CONCLUSIONS

Snoring improved after endoscopic endonasal skull base surgery, associated with changes in nasal symptoms.

LEVEL OF EVIDENCE

4.

Sleep quality in women who use different contraceptive methods

BACKGROUND

Both menstrual cycle and hormone alterations influence sleep pattern. The aim of this study was to evaluate sleep quality in women who use different contraceptive methods.

MATERIAL AND METHODS

This study was a descriptive, cross-sectional survey. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, and a questionnaire was used to obtain sociodemographic, clinical, lifestyle, and contraceptive use data.

RESULTS

The study population comprised 235 women in reproductive age. Regarding lifestyle, 25.5% of the women were physically active, 12.3% were tobacco-smoking, and 70.6% drank coffee daily. Sleep quality was good in 34% of the studied population and poor in 66% of the population. The population was divided into two groups: hormonal (57.1%) and non-hormonal (42.9%) contraceptive users. Sleep quality in the users of non-hormonal contraceptive methods was similar to that in the users of hormonal methods (6.1±3.2 versus 5.9±2.9; p=0.5). Sleep efficiency was statistically higher among the users of non-hormonal contraceptive methods (94.7±17.7) than among the users of hormonal methods (90.0±15.3; p=0.03). The patients who had irregular or altered menstrual cycles reported poorer sleep quality. The absence of routine physical activity negatively influenced sleep quality (p=0.05). The women who snored reported worse sleep quality (p=0.002).

CONCLUSIONS

Nearly half of the studied population was users of hormonal contraception, and most of these women reported poor sleep quality. Sleep efficiency was higher among the users of non-hormonal contraceptives. No differences in subgroups (hormonal contraceptive users) were observed.

Chronotypes and its association with psychological morbidity and childhood parasomnias

BACKGROUND

The relationship between chronotypes and sleeping problems is not clear. The objective of the study was to identify the relative occurrence of chronotypes among college students and to explore adult psychological morbidity and childhood sleeping problems across chronotypes.

MATERIALS AND METHODS

One hundred and fifty undergraduate medical students were assigned into different chronotypes by Morningness-Eveningness Questionnaire and they were further assessed using Self-Reporting Questionnaire, Parasomnia Questionnaire (adapted from the Adult Sleep Disorders Questionnaire), and Pittsburgh Sleep Quality Index.

RESULTS

Intermediate chronotype was the most common, seen in 87 (58%) students, followed by evening type in 34 (22.7%). Evening types have more difficulties in making a decision, becoming exhausted more easily and feeling worthless than other chronotypes. Evening-oriented students showed a significantly higher frequency of initial insomnia and poorer overall sleep quality than the other groups. The current bedwetting was more in evening types; there was no difference in any other current and childhood parasomnias.

CONCLUSIONS

Evening chronotypes had greater difficulty in decision-making, and they were more vulnerable to feel worthless. No significant association was found between childhood parasomnias and chronotypes except persistent bedwetting during adulthood in evening types.

Psychosocial Predictors of Bruxism

OBJECTIVES

The study aimed to investigate the psychosocial predictors of bruxism. The association of various psychosocial factors such as alexithymia, emotional processing, state and trait anxiety, and stress with awake bruxism was analysed.

METHODS

The study involved 52 volunteers diagnosed with awake bruxism. The toolkit that was used included the Toronto Alexithymia Scale (TAS-20), the Emotional Processing Scale (EPS), the Cohen Perceived Stress Scale (PSS-10), and the State- and Trait-Anxiety Inventory (STAI), with independent individual psychological diagnoses being made for every patient. The results were statistically analysed using IBM SPSS Statistics 24.

RESULTS

The obtained data clearly show that psychological traits-both permanent dispositions (e.g., state anxiety and alexithymia) and temporary states (e.g., trait anxiety, emotional processing deficits, and psychological stress)-are significant determinants of awake bruxism. The percentage of explained variance indicates the presence of other factors as well.

CONCLUSIONS

Psychosocial factors such as state anxiety and trait anxiety, alexithymia, and perceived stress are as important as somatic causes in the occurrence and maintenance of awake bruxism. The profile of the obtained data suggests the possibility of preventing or minimizing the symptoms of awake bruxism through properly constructed psychoprophylactic interactions.

Quality of sleep, health and well-being in a population-based study

OBJECTIVE

To estimate the prevalence of poor self-rated sleep and to identify the population subgroups most susceptible to the problem.

METHODS

This is a cross-sectional, population-based study developed with data from the Health Survey conducted in the city of Campinas (ISACamp 2014/2015). Data from a sample of 1,998 individuals aged 20 years or older were analyzed. The self-rated quality of sleep was analyzed according to socio-demographic characteristics, morbidities, health behaviors and feeling of well-being. The association of sleep quality with different complaints and characteristics of sleep was also analyzed. Adjusted prevalence ratios were estimed using Poisson multiple regression model allowing for the sample weights.

RESULTS

Prevalence of poor self-rated sleep was 29.1% and showed to be significantly higher in women, in individuals aged from 40 to 50 years, migrants, without occupation, physically inactive in leisure context, with common mental disorder (PR = 1.59), with greater number of health problems (PR = 2.33), poor self-rated health (PR = 1.61), and life dissatisfaction. Poor sleep was strongly associated with reports of difficulty in initiating sleep (PR = 4.17), in maintaining sleep (PR = 4.40) and with never or almost never feeling well when waking up (PR = 4.52).

CONCLUSIONS

The results identify the population subgroups with poor quality of sleep that deserve greater attention. It also highlight the need to consider, in addition to the presence of comorbidities, mental health and the feeling of well-being in the care of patients with sleep problems and in the interventions planed for promoting healthy sleep.

Sleep disturbances and daytime fatigue: data from the Brazilian National Health Survey, 2013

This study aims to describe the prevalence of sleep disturbances and daytime fatigue and their association with socio-demographic and behavioral factors. Data from the Brazilian National Health Survey conducted in 2013 with 60,202 adults (≥ 18 years old) were used. The outcomes evaluated were self-reported sleep disturbances and daytime fatigue in the last two weeks. Sleep disturbance was defined as the presence of difficulty to fall asleep, frequently waking up during the night or sleeping more than usual; daytime fatigue was defined as the presence of not feeling rested and motivated during the day, feeling tired and lacking energy. Sociodemographic, lifestyle and chronic health aspects were explored as exposures for both outcomes. Prevalence of sleep disturbances and daytime fatigue were 14.9% (14.4-15.4) and 11.9% (11.4-12.3), respectively. Both outcomes were more common in women, older people, people with no formal education, smokers and among physically inactive individuals. The association with education was inverse (the highest the level of education the lower the prevalence ratio - PR - of sleep disturbances and daytime fatigue; adjusted p-value for trend < 0.001). Prevalence of sleep disturbances combined with daytime fatigue was 6.7% (6.4-7.1) and was about 6 times higher among those with three or more chronic health disturbances (PR = 6.2; 95%CI: 5.3-7.2). Strategies to decrease the prevalence of sleep disturbances and daytime fatigue should be encouraged and focused on chronically ill individuals that share other modifiable risk factors.

Sleep differences in the UK between 1974 and 2015: Insights from detailed time diaries

It is often stated that sleep deprivation is on the rise, with work suggested as a main cause. However, the evidence for increasing sleep deprivation comes from surveys using habitual sleep questions. An alternative source of information regarding sleep behaviour is time-use studies. This paper investigates changes in sleep time in the UK using the two British time-use studies that allow measuring "time in bed not asleep" separately from "actual sleep time". Based upon the studies presented here, people in the UK sleep today 43 min more than they did in the 1970s because they go to bed earlier (~30 min) and they wake up later (~15 min). The change in sleep duration is driven by night sleep and it is homogeneously distributed across the week. The former results apply to men and women alike, and to individuals of all ages and employment status, including employed individuals, the presumed major victims of the sleep deprivation epidemic and the 24/7 society. In fact, employed individuals have experienced a reduction in short sleeping of almost 4 percentage points, from 14.9% to 11.0%. There has also been a reduction of 15 percentage points in the amount of conflict between workers work time and their sleep time, as measured by the proportion of workers that do some work within their "ideal sleep window" (as defined by their own chronotype).

High-Intensity Interval Training Attenuates Insulin Resistance Induced by Sleep Deprivation in Healthy Males

Introduction: Sleep deprivation can impair several physiological systems and recently, new evidence has pointed to the relationship between a lack of sleep and carbohydrate metabolism, consequently resulting in insulin resistance. To minimize this effect, High-Intensity Interval Training (HIIT) is emerging as a potential strategy.

Objective: The aim of this study was to investigate the effects of HIIT on insulin resistance induced by sleep deprivation.

Method: Eleven healthy male volunteers were recruited, aged 18–35 years, who declared taking 7–8 h sleep per night. All volunteers were submitted to four different conditions: a single night of regular sleep (RS condition), 24 h of total sleep deprivation (SD condition), HIIT training followed by regular sleep (HIIT+RS condition), and HIIT training followed by 24 h of total sleep deprivation (HIIT+SD condition). They performed six training sessions over 2 weeks and each session consisted of 8–12 × 60 s intervals at 100% of peak power output. In each experimental condition, tests for glucose, insulin, cortisol, free fatty acids, and insulin sensitivity, measured by oral glucose tolerance test (OGTT), were performed.

Results: Sleep deprivation increased glycaemia and insulin levels, as well as the area under the curve. Furthermore, an increase in free fatty acids concentrations and basal metabolism was observed. There were no differences in the concentrations of cortisol. However, HIIT before 24 h of sleep deprivation attenuated the increase of glucose, insulin, and free fatty acids.

Conclusion: Twenty-four hours of sleep deprivation resulted in acute insulin resistance. However, HIIT is an effective strategy to minimize the deleterious effects promoted by this condition.

Comparison between an African town and a neighbouring village shows delayed, but not decreased, sleep during the early stages of urbanisation

The well-established negative health outcomes of sleep deprivation, and the suggestion that availability of electricity may enable later bed times without compensating sleep extension in the morning, have stimulated interest in studying communities whose sleep pattern may resemble a pre-industrial state. Here, we describe sleep and activity in two neighbouring communities, one urban (Milange) and one rural (Tengua), in a region of Mozambique where urbanisation is an ongoing process. The two communities differ in the amount and timing of daily activity and of light exposure, with later bedtimes (≈1 h) associated with more evening and less daytime light exposure seen in the town of Milange. In contrast to previous reports comparing communities with and without electricity, sleep duration did not differ between Milange (7.28 h) and Tengua (7.23 h). Notably, calculated sleep quality was significantly poorer in rural Tengua than in Milange, and poor sleep quality was associated with a number of attributes more characteristic of rural areas, including more intense physical labour and less comfortable sleeping arrangements. Thus, whilst our data support the hypothesis that access to electricity delays sleep timing, the higher sleep quality in the urban population also suggests that some aspects of industrialisation are beneficial to sleep.

Sleep influences the immune response and the rejection process alters sleep pattern: Evidence from a skin allograft model in mice

INTRODUCTION

Sleep generally regulates immune functions in a supportive manner and can affect parameters that are directly involved in the rejection process.

STUDY OBJECTIVES

The first objective was to assess whether sleep deprivation (SD) or sleep restriction (SR) affects the allograft rejection process in mice. The second objective was to investigate whether the rejection process itself modulates the sleep pattern of allografted mice.

DESIGN

Adult BALB/c and C57BL/6J male mice were used as the donors and recipients, respectively, except for the syngeneic group (ISOTX), which received skin from mice of the same strain (C57BL/6J). The recipients were randomly assigned to either one of two control groups - TX (allogenic) or ISOTX (syngeneic) - which underwent stereotaxic surgery to enable sleep recording prior to the allograft but were not sleep deprived; one of two paradoxical sleep deprived groups - SDTX and TXSD - which underwent 72h of continuous SD either before or after the allograft respectively, and one of two sleep restricted groups - SRTX and TXSR - which underwent 21h of SD and 3h of sleep for 15days either before or after the allograft respectively.

INTERVENTIONS

The skin allograft was inspected daily to determine the survival time, expected as 8.0±0.4days in this transplant model under no treatment. The sleep pattern was controlled throughout the rejection process in the SD and SR groups. Draining lymph nodes, spleen, blood and skin grafts were harvested on the 5th day after transplantation for evaluation of the immune parameters related to allograft rejection.

MEASUREMENTS AND RESULTS

In the control groups, we observed a reduction in paradoxical sleep throughout the entire allograft rejection process. Acute and chronic experimental sleep loss in the SD and SR groups produced marked alterations in the immune response. Both SD and SR prolonged allograft survival compared to the non-sleep-deprived group. There were reductions in the following parameters involved in the allograft rejection under sleep loss: CD4⁺ and CD8⁺ T cell subpopulations in the peripheral lymph organs and spleen, circulating sIL-2R levels, graft-infiltrating CD4⁺ T cells and skin allograft global gene expression.

CONCLUSIONS

We provide, as far as we are aware, the first evidence in vivo that the immune response can alter the normal sleep pattern, and that sleep loss can conversely affect the immune response related to graft rejection.

Timing and quality of sleep in a rural Brazilian family-based cohort, the Baependi Heart Study

Sleep is modulated by several factors, including sex, age, and chronotype. It has been hypothesised that contemporary urban populations are under pressure towards shorter sleep duration and poorer sleep quality. Baependi is a small town in Brazil that provides a window of opportunity to study the influence of sleep patterns in a highly admixed rural population with a conservative lifestyle. We evaluated sleep characteristics, excessive daytime sleepiness, and chronotype using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Morningness-Eveningness Questionnaire questionnaires, respectively. The sample consisted of 1,334 subjects from the Baependi Heart study (41.5% male; age: 46.5 ± 16.2 y, range: 18-89 years). Average self-reported sleep duration was 07:07 ± 01:31 (bedtime 22:32 ± 01:27, wake up time: 06:17 ± 01:25 hh:min), sleep quality score was 4.9 + 3.2, chronotype was 63.6 ± 10.8 and daytime sleepiness was 7.4 ± 4.8. Despite a shift towards morningness in the population, chronotype remained associated with reported actual sleep timing. Age and sex modulated the ontogeny of sleep and chronotype, increasing age was associated with earlier sleep time and shorter sleep duration. Women slept longer and later, and reported poorer sleep quality than men (p < 0.0001). This study provides indirect evidence in support of the hypothesis that sleep timing was earlier prior to full urbanisation.

Effects of physical activity at work and life-style on sleep in workers from an Amazonian Extractivist Reserve

Physical activity has been recommended as a strategy for improving sleep. Nevertheless, physical effort at work might not be not the ideal type of activity to promote sleep quality. The aim of this study was to evaluate the effects of type of job (low vs. high physical effort) and life-style on sleep of workers from an Amazonian Extractivist Reserve, Brazil. A cross-sectional study of 148 low physical activity (factory workers) and 340 high physical activity (rubber tappers) was conducted between September and November 2011. The workers filled out questionnaires collecting data on demographics (sex, age, occupation, marital status and children), health (reported morbidities, sleep disturbances, musculoskeletal pain and body mass index) and life-style (smoking, alcohol use and practice of leisure-time physical activity). Logistic regression models were applied with the presence of sleep disturbances as the primary outcome variable. The prevalence of sleep disturbances among factory workers and rubber tappers was 15.5% and 27.9%, respectively. The following independent variables of the analysis were selected based on a univariate model (p<0.20): sex, age, marital status, work type, smoking, morbidities and musculoskeletal pain. The predictors for sleep disturbances were type of job (high physical effort); sex (female); age (>40 years), and having musculoskeletal pain (≥5 symptoms). Rubber tapper work, owing to greater physical effort, pain and musculoskeletal fatigue, was associated with sleep disturbances. Being female and older than 40 years were also predictors of poor sleep. In short, these findings suggest that demanding physical exertion at work may not improve sleep quality.

•

Sleep data from workers with low and high physical effort at work were analyzed.

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Sleep disturbances were prevalent in 28% of workers with high physical effort at work.

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Being female and older than 40 years were predictors of poor sleep.

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Musculoskeletal pain was associated with sleep disturbances.

•

Physical exertion at work may not improve sleep quality.

Polysomnography findings in spinocerebellar ataxia type 6

Spinocerebellar ataxia type 6 (SCA6) is usually described as a pure ataxia syndrome. However, SCA6 patients may have sleep complaints. In this paper, sleep disorders were investigated in patients with SCA6. Twelve SCA6 patients and 12 subjects matched by gender, age and body mass index (control group) underwent polysomnography and clinical investigation for sleep disorders. SCA6 had a higher frequency of snoring (P = 0.01), a higher index of awakening due to respiratory events (P = 0.003) and central apnea events during sleep (P = 0.024), a longer sleep Stage N1 (P = 0.02) and a lower sleep Stage N3 (P = 0.05) in SCA6 patients than in control subjects. SCA6 patients had a reduction in slow wave sleep and a higher frequency of snoring and respiratory disorders during sleep when compared to the control group.

Mediator Effect of Sleep Hygiene Practices on Relationships Between Sleep Quality and Other Sleep-Related Factors in Chinese Mainland University Students

This study examined the mediator effect of sleep hygiene practices (SHP) on relationships between sleep quality and other sleep-related factors in Chinese mainland university students using structural equation modeling analysis. Of the 413 students, 41.4% had poor sleep quality. Gender, academic stress, relaxed psychological status, good physical status, and SHP had significant direct effects on sleep quality; relaxed psychological status had significant direct effect on SHP and indirect effect on sleep quality via SHP. The direct, indirect, and total effects of gender, academic stress, relaxed psychological status, good physical status, and SHP explained 25% of the variance in sleep quality. The Chinese mainland university students had relative poor sleep quality. SHP was a mediator between sleep quality and relaxed psychological status.

Prospective study of predictors and consequences of insomnia: personality, lifestyle, mental health, and work-related stressors

OBJECTIVE

To prospectively investigate the reciprocal relationships between personality traits, lifestyle factors, mental health, sleepiness, and work-related stressors against insomnia.

METHODS

A total of 799 Norwegian shift-working nurses (mean age 33.2 years, 90% female) participated in this prospective cohort study. They were assessed on self-report instruments (Bergen Insomnia Scale, Diurnal Type Scale, Hospital Anxiety and Depression Scale, Negative Acts Questionnaire-Revised, Work-Family Interface Scale, among others) in 2008/2009 (wave 1) and 2011 (wave 3). Structural equation modeling was employed to investigate the bidirectional relationship between a wide range of individual and work-related variables and insomnia.

RESULTS

Languidity (β = 0.18***), anxiety (β = 0.11**), depression (β = 0.14***), exposure to bullying behavior (β = 0.08*), and negative spillover between work and family life (work to family, β = 0.08*; family to work, β = 0.07*) predicted increased symptoms of insomnia over time. Morningness (β = -0.09*) and positive spillover from work to family (β = -0.11**) predicted less symptoms of insomnia over time. No support was found for night work as a predictor of increased insomnia. Insomnia was a precursor for anxiety (β = 0.11**), but not for depression (*p <0.05, **p <0.01, ***p <0.001).

CONCLUSION

The data suggested that insomnia more often emerges as a consequence of individual and work-related factors than as a precursor to them. The scope of factors causing insomnia, and factors protecting against it, should be further investigated. Insomnia should be considered in prediction models for mental illnesses and as an outcome of adverse work-related experiences.

Effects of Oropharyngeal Exercises on Snoring: A Randomized Trial

BACKGROUND

Snoring is extremely common in the general population and may indicate OSA. However, snoring is not objectively measured during polysomnography, and no standard treatment is available for primary snoring or when snoring is associated with mild forms of OSA. This study determined the effects of oropharyngeal exercises on snoring in minimally symptomatic patients with a primary complaint of snoring and diagnosis of primary snoring or mild to moderate OSA.

METHODS

Patients were randomized for 3 months of treatment with nasal dilator strips plus respiratory exercises (control) or daily oropharyngeal exercises (therapy). Patients were evaluated at study entry and end by sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and full polysomnography with objective measurements of snoring.

RESULTS

We studied 39 patients (age, 46 ± 13 years; BMI, 28.2 ± 3.1 kg/m2; apnea-hypopnea index (AHI), 15.3 ± 9.3 events/h; Epworth Sleepiness Scale, 9.2 ± 4.9; Pittsburgh Sleep Quality Index, 6.4 ± 3.3). Control (n = 20) and therapy (n = 19) groups were similar at study entry. One patient from each group dropped out. Intention-to-treat analysis was used. No significant changes occurred in the control group. In contrast, patients randomized to therapy experienced a significant decrease in the snore index (snores > 36 dB/h), 99.5 (49.6-221.3) vs 48.2 (25.5-219.2); P = .017 and total snore index (total power of snore/h), 60.4 (21.8-220.6) vs 31.0 (10.1-146.5); P = .033.

CONCLUSIONS

Oropharyngeal exercises are effective in reducing objectively measured snoring and are a possible treatment of a large population suffering from snoring.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT01636856; URL: www.clinicaltrials.gov.

Musculoskeletal Pain as a Marker of Health Quality. Findings from the Epidemiological Sleep Study among the Adult Population of São Paulo City

Background

We are witnessing the growth of urban populations, particularly in the developing world. São Paulo, the largest city in South America, continues to grow, and this growth is dramatically effecting the environment and human health. The aim of this study was to estimate the point prevalence of chronic pain in São Paulo city dwellers and to explore the influence of aspects related to urbanicity.

Methods

A two-stage cluster randomized sample included 1100 individuals of the city of Sao Paulo, representing the population proportionally in terms of gender, age and social classes in 2007. For this observational cross-sectional study, the household sample was interviewed using validated questionnaires for sociodemographic aspects, the Beck inventories for anxiety and depression, the WHOQoL-REF for quality of life, the Chalder Fatigue Scale. Musculoskeletal pain was defined as diffuse pain or pain located in the back, joints or limbs. Data regarding sleep complaints and polysomnography were obtained from the Epidemiologic Sleep Study conducted in São Paulo city in 2007.

Results

The prevalence estimate of chronic musculoskeletal pain was approximately 27%, with a female/male ratio of approximately 2.6/1. The predictors were being in the age-range of 30–39 years, low socioeconomic and schooling levels, obesity, sedentarism, fatigue, non-restorative sleep, daytime sleepiness, poor sleep quality, poor life quality, anxiety and depression symptoms. Psychological wellbeing was the main discriminator between responders with chronic musculoskeletal pain and the controls, followed by depression for the participants with poor psychological wellbeing, and fatigue, for the remaining ones. Insomnia syndrome was the third-level discriminator for those with fatigue, whereas sleep quality for those without fatigue.

Conclusions

Musculoskeletal pain was frequently reported by São Paulo city dwellers and its correlates with psychological and sleep aspects are suggestive of a response to urbanicity.

Trial Registration

ClinicalTrials.gov NCT00596713

Sleep disturbances in adults in a city of Sao Paulo state

OBJECTIVE

To analyze the occurrence of sleep-related disorders among adults from Presidente Prudente, Brazil, as well as to identify associations with behavioral, socio-demographic and nutritional status variables.

METHODS

After random selection of the sample, interviews were performed with 743 adults of both genders, living in Presidente Prudente, Brazil. Sleep-related disorders, demographic variables (sex, age, ethnicity and schooling), behavioral variables (leisure physical activity, alcohol consumption, and smoking) and nutritional status were analyzed by questionnaires.

RESULTS

The prevalence of sleep-related disorders was 46.7%, with 95% confidence interval (95%CI) 43.1 - 50.2. In the multivariate analysis, female sex, with odds ratio (OR) 1.74 (95%CI 1.26 - 2.40), schooling (OR = 0.49; 95%CI 0.28 - 0.82), overweight (OR = 1.99; 95%CI 1.39 - 2.85) and obesity (OR = 2.90; 95%CI 1.94 - 4.35) were associated with sleep-related disorders.

CONCLUSION

There is high occurrence of sleep-related disorders in this sample, which was associated with female sex, lower schooling, overweight and obesity.

Chronic conditions and sleep problems among adults aged 50 years or over in nine countries: a multi-country study

Background

Data on the association between chronic conditions or the number of chronic conditions and sleep problems in low- or middle-income countries is scarce, and global comparisons of these associations with high-income countries have not been conducted.

Methods

Data on 42116 individuals 50 years and older from nationally-representative samples of the Collaborative Research on Ageing in Europe (Finland, Poland, Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) conducted between 2011–2012 and 2007–2010 respectively were analyzed.

Results

The association between nine chronic conditions (angina, arthritis, asthma, chronic lung disease, depression, diabetes, hypertension, obesity, and stroke) and self-reported severe/extreme sleep problems in the past 30 days was estimated by logistic regression with multiple variables. The age-adjusted prevalence of sleep problems ranged from 2.8% (China) to 17.0% (Poland). After adjustment for confounders, angina (OR 1.75–2.78), arthritis (OR 1.39–2.46), and depression (OR 1.75–5.12) were significantly associated with sleep problems in the majority or all of the countries. Sleep problems were also significantly associated with: asthma in Finland, Spain, and India; chronic lung disease in Poland, Spain, Ghana, and South Africa; diabetes in India; and stroke in China, Ghana, and India. A linear dose-dependent relationship between the number of chronic conditions and sleep problems was observed in all countries. Compared to no chronic conditions, the OR (95%CI) for 1,2,3, and≥4 chronic conditions was 1.41 (1.09–1.82), 2.55 (1.99–3.27), 3.22 (2.52–4.11), and 7.62 (5.88–9.87) respectively in the overall sample.

Conclusions

Identifying co-existing sleep problems among patients with chronic conditions and treating them simultaneously may lead to better treatment outcome. Clinicians should be aware of the high risk for sleep problems among patients with multimorbidity. Future studies are needed to elucidate the best treatment options for comorbid sleep problems especially in developing country settings.