[Insomnia in the menopause]

During the menopause transition, pathogenetic changes begin to occur in the reproductive system and they affect the quality of sleep and contribute to the development of insomnia. Given the multifactorial nature of insomnia and the special characteristics of its pathogenesis, it is necessary to adhere to an integrated approach in the treatment of patients of the older age group. In our opinion, if we have indications, a promising direction for the treatment of sleep disorders during period of menopausal syndrome is the use of hormone replacement therapy in addition to traditional methods of the treatment of insomnia.

The Interplay Between Poor Sleep and Work-Related Health

Objectives

Sleep disorders can arise from work. Employees who experience work overload are more likely to develop sleep problems. Poor sleep leads to decreased performance, sick leave, and accidents. Therefore, sleep disorders may be linked to workplace hazards as well as decreased occupational health, however, the relationship remains unknown.

Methods

This relationship was examined using secondary data analysis of aggregated survey data from 97 companies based in Germany between 2003 and 2020 as part of Workplace Health Management project. Two extreme groups with respect to sleep problems were analyzed (N = 4,865 + 9,795). The survey “Diagnosis of corporate health” contained 137 individual questions which recorded all relevant working conditions, aspects of health, and one question relating to insomnia traits. A one-way analysis of variance was used to examine whether and to what extent the potentials, hazards, and health aspects differed between employees depending on their perceived sleep problems. In addition, multiple linear regressions were used to determine whether and to what extent work characteristics affect various health aspects for both good and poor sleepers.

Results

In total, 49.7% of staff reported moderate difficulty falling and/or remaining asleep. These poor sleepers perceived all health potentials worse than good sleepers, especially on scales such as fair assessment, work climate, and learning at work. Furthermore, poor sleepers perceived health hazards (physical environmental stress, job insecurity, and time pressure) more whilst positive health indicators (joy of work and confidence) were perceived less.

Conclusion

Overall, the determination of sleep difficulties could be used as a substantial health indicator. Also, these sleep problems are reported more frequently in certain occupations compared to others, which could mean that the perception of sleep health varies between professions. Therefore, it is important to implement specific recommendations for each industry in order to improve working conditions for poor sleepers which in turn, improves their health.

[Features of emotional status and autonomic regulation in patients with ischemic heart disease with sleep disorders]

OBJECTIVE

To study the features of the emotional status and autonomic regulation in patients with coronary heart disease and sleep disorders.

MATERIAL AND METHODS

Patients with angina pectoris of II-IV functional class (n=244), aged 36 to 72 years (average age 56.9±0.5 years), were examined. Emotional status was assessed by the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory, the State-Trait Anxiety Inventory. The vegetative status was studied by heart rate variability based on 5-minute recordings of cardiointervalogram and D.J. Ewing cardiovascular tests and a vegetative disorders questionnaire. Patients were divided into 2 groups depending on the severity of sleep disorders.

RESULTS

Sixty-two patients (25.4%) had no sleep disorders (≥22 points on the sleep quality questionnaire), they were included in the 2^nd group; 113 patients (46.3%) had severe sleep disorders (≤18 points on the sleep quality questionnaire), these patients were included in the 1^st group, 69 patients (28.3%) had sleep disorders assessed as insignificant (from 19 to 21 points on the sleep quality questionnaire). The HADS scores for anxiety and depression were 9.2±0.4 and 7.7±0.4, respectively, in the 1^st group; in the 2^nd group the levels of anxiety and depression were 5.9±0.4 and 3.9±0.4 points (p<0.001). Clinically expressed autonomic disorders were observed in 100% of patients in the 1^st group and in 75.8% in the 2^nd group (p<0.001). The average score on the questionnaire of autonomic disorders was 41.8±1.2 in the 1^st group, and 25.6±1.6 points in the 2^nd group (p<0.001).

CONCLUSION

In patients with sleep disorders, a higher level of anxiety, depression, autonomic disorders and lower heart rate variability were detected, which is an unfavourable prognostic sign that should be considered in treatment and rehabilitation of these patients.

[Psychosocial factors and coronary heart disease]

Article is devoted to a research of interrelation of psychosocial factors and courses of coronary heart disease (CHD). The anxiety, a depression, social isolation of patients with CHD is considered. Need of identification of psychosocial factors at patients with CHD for the purpose of their correction and improvement of the forecast of sick CHD and quality of their life is shown.

[About Development of Programs of Struggle with Tobacco Smoking in Medical Workers]

The article presents a review of prevalence of smoking among physicians and medical nurses suffering from nicotine dependence. The most of smoking medical workers began to smoke already during student years. they don't relate their diseases with smoking. The incomplete awareness of true causes of one's own diseases is manifested in ignoring preventive activities and healthy life-style. The actuality of necessity of development of program of prevention tobacco dependence in medical workers suffering from tobacco dependence is demonstrated.

[The course of coronary heart disease and quality of life in patients with anxiety of different degree]

AIM

To study an emotional status and quality of life (QL) in patients with coronary heart disease (CHD) and anxiety, to evaluate efficacy of anxiolytic drug lorazepam (lorafen) in such patients.

MATERIAL AND METHODS

Anxiety in 277 CHD patients was assessed by hospital scale of anxiety and depression, depression--by Beck's questionnaire, QL--by Seattle questionnaire.

RESULTS

CHD patients with clinically significant anxiety had more serious vegetative disorders, worse QL and prognosis. Lorazepam treatment improved both emotional state of the patients and QL.

CONCLUSION

High prevalence of anxious disorders in CHD patients deteriorating QL and prognosis dictates the necessity of detecting and treating anxiety in CHD patients.

[Effect of Lorazepam on emotional status and quality of life of patients with ischemic heart disease]

AIM

To investigate emotional status and quality of life of patients with ischemic heart disease (IHD) with various anxiety and effect of therapy with benzodiazepine anxiolytic lorazepam on these parameters.

MATERIAL AND METHODS

Hospital scale of anxiety and depression, Beck Depression Inventory, and Seattle Questionnaire were used for assessment of anxiety, depression, and quality of life, respectively, in 277 patients with IHD.

RESULTS

Patients with clinically evident level of depression had higher level of vegetative disturbances, worse quality of life and prognosis. Improvement of not only emotional state (lowering of anxiety and depression level) but also of quality of life occurred in patients with clinically pronounced level of depression at the background of treatment with lorazepam.

CONCLUSION

Lorazepam is effective and safe preparation for the treatment of anxiety disorders in patients with IHD. Lorazepam improves not only emotional status of these patients but their quality of life as well.

[Automatic regulation and central hemodynamics in patients with postinfarct cardiosclerosis and heart failure]

The study was undertaken to examine the specific features of autonomic regulation and the parameters of central hemodynamics in patients with postinfarct cardiosclerosis (PICS) and circulatory insufficiency who had different types of left ventricular remodelling (LVR). Thirty-two patients with PICS and heart failure (HF) were examined. The autonomic status was studied, by analyzing cardiac rhythm variability (CRV) from 5-min resting cardiointervalograms and by the cardiovascular tests described by D. Y. Ewing; integral rheography was also performed. The patients were divided into 2 groups according to the type of LVR. Patients with PICS + HF and concentric LVR were found to have a more balanced autonomic circulatory regulation and a hemodynamic type that was more energetically efficient for the myocardium. Those with PICS + HF and eccentric LVR had a hemodynamic type that was less efficient for the myocardium, which was accompanied by the enhanced activity of the sympathetic nervous system (SNS) even at resting. Patients with PICS + HF, particularly in the presence of the latter's higher functional class and eccentric LVR, seemed to have desensitized adrenoceptors and impaired baroreflex activity, as appeared as no rise in peripheral vascular resistance with the enhanced sympathetic activity. The findings support the expediency of using beta-adrenoblockers in HF in patients with PICS, particularly with eccentric LVR. Analysis of cardiac rhythm variability is sufficiently informative in evaluating autonomic regulation and autonomic balance, SNS tone in particular, in patients with HF.

[A course of coronary heart disease and quality of life in patients with varying depressive states]

AIM

To study a course of coronary heart disease (CHD) in patients with depressive disorders.

MATERIAL AND METHODS

The trial included 77 CHD patients aged 39 to 68 years (mean age 54.9 +/- 0.9 years), 40 (51.9%) of them had myocardial infarction. All the examinees had effort angina of functional class II-IV by criteria of the Canadian Cardiology Association. All the patients have undergone standard clinical examination, stress tests, coronaroangiography (n = 30), assessment of the degree of vegetative dystonia and quality of life. The patients were divided into two groups depending on the depression degree.

RESULTS

CHD patients with manifest depression vs those with subclinical depression had a higher level of personality and reactive anxiety. They had neurotic and psychopathological personality alterations associated with more pronounced vegetative disorders. These patients suffered from more severe coronary atherosclerosis, more hospitalizations for the previous year, more myocardial infarctions, lower physical activity and quality of life.

CONCLUSION

CHD patients with manifest depression have lower physical performance and quality of life though this is not confirmed at exercise tests.

[Characteristics of psycho-autonomic correlations and clinical course of ischemic heart disease in men and women]

AIM

To study psychovegetative correlations and clinical course of ischemic heart disease (IHD) in men and women.

MATERIAL AND METHODS

Personality characteristics (MMPI test), reactive and personal anxiety (Spilberger's questionnaire), severity of depression (Back's questionnaire), vegetative status (vegetative disorders questionnaire), variability of cardiac rhythm (cardiovascular tests) were studied in 60 females and 62 males with IHD.

RESULTS

IHD females vs males were characterized by higher neurotization, personal accentuation, more serious anxiety, depression and vegetative disturbances, lower variability of heart rate. IHD in females is more frequent in postmenopause, is characterized by less severe hemodynamically significant coronary stenoses.

CONCLUSION

Emotional disorders make a great contribution to a course of ischemic heart disease.

[Autonomic regulation and emotional status in patients with ischemic heart disease having pain syndrome of various severity]

To study vegetative regulation and emotional status of ischemic heart disease (IHD) patients with various pain severity, 81 patients with IHD were examined. Personality characteristics were studied by the data of MMPI questionnaire, reactive and personal anxiety--of Spilberger questionnaire, depressive changes--of Beck's questionnaire, vegetative status--by vegetative discharge, Seattle angina questionnaire of life quality, heart rhythm variability and cardiovascular tests. All the patients have undergone clinical examination, exercise stress tests, echocardiography. Selective coronary angiography was made in some examinees. The patients were divided into two groups by anginal pain severity. The patients with more severe anginal pain had higher reactive and personal anxiety, neurotization. This was not associated with changes in the vegetative status and hemodynamics at rest. The detected emotional disorders in IHD patients may cause higher sensitivity of these patients to pain, on the one side, and changes in vegetative regulation of cardiovascular system and hemodynamics, on the other.

[Experimental model of atherosclerosis induced by administration of acetylcholine into the reticular formation of the midbrain]

Acetylcholine injections into the mesencephalon reticular system of rabbits every second day during a month induced atherosclerosis of the aorta. The microscopic examination of aortic intima showed lipomatosis, liposclerosis, atheromatosis, atherocalcinosis.

[Changes in the hormone content of the blood during chronic electrical stimulation of the midbrain]

The levels of hormones of the hypophysis (ACTH, TTH, CTH), thyroid gland (T3, T4), adrenal glands (epinephrine, norepinephrine, cortisol) and pancreas (insulin, glucagon) increased during a prolonged electrostimulation of the reticular nucleus of mesencephalon in rabbits. Administration of the substance P returned the hormonal levels to normal.

[Changes in the fraction composition of collagen from the aorta and left ventricle wall during electric stimulation of the reticular formation of the brain]

Concentration of catecholamines, II-hydroxycorticosteroids, free and bound hydroxyproline in blood, free and total hydroxyproline, fractions of collagen were studied in left heart ventricular wall and aorta of rabbits after long term electrostimulation of the mesencephalon reticular system. Alterations of collagen metabolism in left heart ventricular wall and aorta caused by electrostimulation of reticular system occurred due to hypertension and to change in content of adrenal hormones in peripheral blood stream.

[Changes in collagen metabolism during the chronic electrical stimulation of the midbrain reticular formation]

The content of 11-hydroxycorticosteroids, free and bound hydroxyproline in the peripheral blood, as well as the level of free and net hydroxyproline in the aortic wall and myocardium of rabbits were studied in chronic prolonged electrical stimulation of the mesencephalon reticular system. The experiments have shown that electrical stimulation leads to the activation of adrenal cortex function and is accompanied by alterations in collagen metabolism, accumulation of collagen in the aorta and decreased collagen level in the myocardium.