Estratégias para ajuste do ciclo vigília-sono de adolescentes aos horários escolares matutinos: a educação sobre o sono e a exposição a luz solar

In adolescents, who tend to sleep and wake-up later, the school schedule in the morning is associated with sleep advancement and shortening besides bedtime and wake-up time irregularity between week and weekend days. As a result, there is an increase in daytime sleepiness and a drop in cognitive performance that interfer in students performance in classroom. These consequences reinforce the need to evaluate alternatives that help the adolescent to adapt their sleep needs to the time of start of classes in the morning. Accordingly, the general aim of this study was to evaluate the effects of a sleep program education and sunlight exposure in early morning on sleep-wake cycle (SWC) and daytime sleepiness of adolescents. The students chronotype were evaluated by the Horne-Ostberg questionnaire and the health and usual sleep habits by "the health and the sleep questionnaire. The SWC patterns were assessed by sleep log, the daytime sleepiness by Karolinska Sleepiness Scale (KSS) and the alertness by the Psychomotor Vigilance Test (PVT). These parameters were compared before and after a sleep education program and before and during the sunlight exposure. The sleep program was effective in increasing sleep knowledge of adolescents, in promoting a reduction of bedtime and wake-up time irregularity and increasing the sleep duration in school days. The sunlight exposure effect was evaluated in the return to classes after vacation due to the difference in sleep patterns between school and vacation days. During the intervention week it was observed an advance of sleep schedules, an increase on sleep duration and alertness at the end of the morning. Assessed separately, sleep education and sunlight exposure should contribute to minimize adolescents partial sleep deprivation, but daytime sleepiness effect must be better investigated. These strategies should be used jointly by school members to improve health and performance of their students

Efeito do exercício físico matinal realizado sob luz solar no ciclo vigília-sono de adolescentes

The sleep onset and offset delay at adolescence in relation to childhood. Besides biological causes, some external factors as academic obligations and socialization contributes, increasing the burden of school and socialization. However, morning school schedules reduce sleep duration. Besides light strong effect, studies in humans have indicated that exercise influence circadian synchronization. To evaluate the effect of the morning exercise under sunlight on sleep-wake cycle (SWC) of adolescents, 160 high school students (11th year) were exposed to the following conditions: lesson in usual classroom (Group C), lesson in swimming pool exposed to sunlight (Group E), half of them carrying through physical activity (EE) and the other resting (EL). Each experimental group met two stages: assessment of SWC 1 week before and 1 week during the intervention, which was held in Monday and Wednesday between 7:45 and 8:30 am. In the baseline, there were applied the questionnaires "Health and Sleep" and cronotype evaluation (H & O). In addition, students were evaluated before and during the intervention by "Sleep Diary", "Karolinska Sleepiness Scale" (KSS), Psychomotor Vigilance Test (PVT) and actimetry. During the intervention, there was a delay in wake-up time on the weekend and a trend to greater sleep duration on week for the three groups. At the weekend, only the groups EE and EL increased sleep duration. There was no difference in bedtime, irregularity of sleep schedules and nap variables. The sleepiness showed a circadian pattern characterized by higher alertness levels at 11:30 am and sleepiness levels at bedtime and wake-up time on week. On weekends there were higher levels of alertness in these times. In the days of intervention, there was an increase of sleepiness at 11:30 am for groups EL and EE, which may have been caused by a relaxing effect of contact with the water of the pool. In addition, the group EE showed higher alert levels at 14:30 pm on Monday and at 8:30 am in the Wednesday, possibly caused by exercise arousal effect. The reaction time assessed through the TPV did not vary between the stages. The sleep quality improved in the three groups in the second stage, making impossible the evaluation of intervention effect. However, the sleep quality increased on Monday and Tuesday only on the group EE. From the results, it is suggested that the intervention promoted effects on the sleepiness at some day hours. In other SWC variables there were no effects, possibly due to a large SWC irregularity on weekends. Thus, the evaluation of higher weekly frequency EF is necessary, since only two days were insufficient to promote greater effect on adolescents SWC

Avaliação da função pulmonar em obesos mórbidos com sonolência diurna excessiva

Background: Obesity impairment to the pulmonary function related to the magnitude of adiposity and is associated with excessive daytime sleepiness (EDS) and snoring, among others symptoms of respiratory disorders related to sleep. It is possible that obese individuals with excessive daytime sleepiness may make changes in lung function on spirometry monitored during the day as a consequence of fragmented sleep or episodes of nocturnal hypoventilation that cause respiratory and changes that can persist throughout the day. The combination of these findings alone sleepiness observed by subjective scales with pulmonary function in obese patients is unknown. Objective: To assess the influence of EDS and snoring on pulmonary function in morbidly obese and distinguish between different anthropometric markers, the snoring and sleepiness which the best predictors of spirometric function and respiratory muscle strength and endurance of these patients. Methods: We evaluated 40 morbidly obese markers on the anthropometric, spirometric respiratory variables, maximal inspiratory and expiratory pressures (MIP and MEP) and maximal voluntary ventilation (MVV) and the measured excessive daytime sleepiness (the Epworth sleepiness scale) and snoring (snoring scale of Stanford). The data were treated when the differences between the groups of obese patients with and without sleepiness, whereas the anthropometric variables, respiratory and snoring. Pearson's correlation was performed, and multiple regression analysis assessed the predictors of pulmonary function. For this we used the software SPSS 15.0 for windows and p <0.05. Results: 39 obese patients were included (28 women), age 36.92+11.97y, body mass index (BMI) 49.3+5.1kg/m², waist-hip ratio (WHR) 0.96+0.07 and neck circumference (NC) 44.1+4.2 cm. Spirometric values and respiratory pressures were up 80% of predicted values, except for endurance (MVV <80%). Obese with EDS have lower tidal volume. Positive correlation was observed between BMI and EDS, EDS and NC and between snoring and BMI, and negative correlation between EDS and tidal volume (TV), and between snoring and snoring FVC and FEV1. In linear regression the best predictor of pulmonary function was snoring, followed by NC. NC has more obese with higher strength (MEP, p = 0.031) and endurance (MVV p = 0.018) respiratory muscle. Conclusion: Obese with EDS tend to have lower TV. In addition, snoring and NC can better predict pulmonary function in obese when compared with other anthropometric markers or EDS. Obese patients with higher NC tend to have greater capacity for overall strength of respiratory muscles, but may have low muscle endurance

Funcionalidade em pacientes após acidente vascular encefálico: relação com o sono e ritmo de atividade-repouso

It is known that sleep plays an important role in the process of motor learning. Recent studies have shown that the presence of sleep between training a motor task and retention test promotes a learning task so than the presence of only awake between training and testing. These findings also have been reported in stroke patients, however, there are few studies that investigate the results of this relationship on the functionality itself in this population. The objective of this study was to evaluate the relationship between functionality and sleep in patients in the chronic stage of stroke. A cross-sectional observational study was conducted. The sample was composed of 30 stroke individuals in chronic phase, between 6 and 60 months after injury and aged between 55 and 75 years. The volunteers were initially evaluated for clinical data of disease and personal history, severity of stroke, through the National Institute of Health Stroke Scale, and mental status, the Mini-Mental State Examination. Sleep assessment tools were Pittsburgh Sleep Quality Index, the Questionnaire of Horne and Ostberg, Epworth Sleepiness Scale, the Berlin questionnaire and actigraphy, which measures were: real time of sleep, waking after sleep onset, percentage of waking after sleep onset, sleep efficiency, sleep latency, sleep fragmentation index, mean activity score. Other actigraphy measures were intraday variability, stability interdiária, a 5-hour period with minimum level of activity (L5) and 10-hour period with maximum activity (M10), obtained to evaluate the activity-rest rhythm. The Functional Independence Measure (FIM) and the Berg Balance Scale (BBS) were the instruments used to evaluate the functional status of participants. The Spearman correlation coefficient and comparison tests (Student's t and Mann-Whitney) were used to analyze the relationship of sleep assessment tools and rest-activity rhythm to measures of functional assessment. The SPSS 16.0 was used for analysis, adopting a significance level of 5%. The main results observed were a negative correlation between sleepiness and balance and a negative correlation between the level of activity (M10) and sleep fragmentation. No measurement of sleep or rhythm was associated with functional independence measure. These findings suggest that there may be an association between sleepiness and xii balance in patients in the chronic stage of stroke, and that obtaining a higher level of activity may be associated with a better sleep pattern and rhythm more stable and less fragmented. Future studies should evaluate the cause-effect relationship between these parameters

Caracterização do ciclo sono/vigília de professores do ensino médio em natal/rn

In the school environment is fundamental the knowledge about the sleep-wake cycle (SWC), because we find children and adolescents with excessive sleepiness and learning difficulties. Furthermore, teachers with high demand and with different work schedule, which may contribute to changes in SWC. The aim of this study was to describe the SWC of high school teachers in Natal/RN. Habits and knowledge about sleep, chronotype, SWC, daytime sleepiness, sleep quality and job satisfaction were described in 98 high school teachers from public and private school. These parameters were compared according to the characteristics of work, family structure and gender. Data collection was performed with the use of questionnaires in two stages: 1) "health and sleep" (general characterization of sleep habits), Horne & Ostberg questionnaire (characterization of chronotype), Epworth Sleepiness Scale and the Index of Pittsburg Sleep Quality, 2) The sleep diary for 14 days. From the results, we observe that the teachers woke up and went to bed earlier in the week and showed a reduction of time in bed around 42min comparing to weekend. This reduction in time in bed during the week was accompanied by an increase in nap duration on weekend. In addition the teachers woke up earlier on Saturdays than on Sundays, probably due to housework and leisure. The teachers' knowledge about sleep was low in relation to individual differences and effect of alcoholic beverages on sleep, and high in the consequences of sleep deprivation. The differences found in comparisons on the characteristics of work, family structure and gender were punctual, except concerning the work schedule. The teacher who started work in the morning and finished in the night, woke up earlier, went to bed later and had less time in bed, when compared to teachers who work only in two shifts. In addition, teachers with late chronotypes who begin the work in the morning had a greater irregularity in the wake up time compared to teachers with earlier and intermediate chronotypes. Half of teachers have excessive sleepiness, which was positive correlated with work dissatisfaction. In general, teachers showed IPSQ averages equivalent to poor sleep quality and the women showed worst averages. From the results, it is suggested that the SWC of teachers varies according to work schedule, leading to irregularity and partial sleep deprivation in the week, although these responses vary according to chronotype. These changes are accompanied by excessive daytime sleepiness and poor sleep quality. However, it is necessary to expand the sample to clarify the influence of variables related to work, family structure and gender together

Influência do horário de trabalho, do gênero e de um programa de educação sobre o sono no ciclo sono/vigília de professores do ensino fundamental e médio

The teaching profession is often associated with extensive workload inside and outside the classroom, poor teaching conditions, among other challenges that can cause sleep problems. These problems may be even greater in women, due to the professional and domestic work hours and to the major sleep necessity. Considering that sleeping problems may result from the practice of poor sleep habits, sleep education programs are conducted with the aim to reduce sleep deprivation, irregularity on sleep schedules, daytime sleepiness and improve sleep quality. In this sense, the objective of this study is to evaluate the influence of working hours, gender and a sleep education program on sleeping habits, quality of sleep, daytime sleepiness and the level of stress in teachers of elementary and secondary education. For that, teachers filled the questionnaires that assessed: 1. Sleeping habits (Sleep & Health), 2. Chronotype (Horne & Ostberg), 3. Daytime sleepiness (Epworth Sleepiness Scale), 4. Sleep Quality (Pittsburgh Sleep Quality Index), 5. Level of stress (The Inventory of Stress for Adults of Lipp) and 6. Daily pattern of sleep/wake cycle (Sleep Diary). The questionnaires 1, 4, 5 and 6 were repeated 3 weeks after the sleep education program. Teachers who begin work in the morning (7:11 ± 0:11 h) wake up earlier in the week and often have poor sleep quality compared to those who start in the afternoon (13:04 ± 00:12 h). Among those who begin work in the morning, the intermediate types and those with an evening tendency were more irregular in the wake up time than morning types and increased sleep duration on weekend. In relation to gender, women had longer sleep duration than men, although the majority presented excessive daytime sleepiness and poor sleep quality. However, when work schedule and age are similar between genders, the difference in sleep duration becomes a tendency and the difference in the percentage of excessive daytime sleepiness disappears, but the poor sleep quality persists in women. With respect to teachers who have gone through the sleep education program, there was an increase in knowledge about the subject, which may have contributed to the reduction in the frequency of coffee consumption close to bedtime and to the sleep quality improved in 18 % of participants. In the control group, there were random differences in knowledge in 3rd stage, and sleep quality improved in only 9% of teachers. The participation in the sleep education program was not enough to change the hours of sleep and decrease stress of teachers. Therefore, the start time school in the morning was preponderant in determining the wake up time of teachers, especially for intermediates types and those with an evening tendency. Furthermore, the poor quality of sleep was more common in women, and the sleep education program contributed to increase knowledge on the subject and to improve sleep quality.

Pressão de sono e perfil acadêmico de estudante de medicina do 1º período da UFRN

Academic demands, new social context, new routines and decrease of the parental control, are factors that may influence the sleep pattern of freshman students at the University. Medical students from the Federal University of Rio Grande do Norte (UFRN) have a full-time course, subjects with high-level content, and, at the first semester, classes begin at 7 a.m. This group composed by young adults who still suffering with delayed sleep phase, common in adolescence, indicating that this class schedule can be inappropriate at this age. The reduction of nocturnal sleep during school days, and the attempt to recover sleep on free days – social jet lag (JLS), suggests that in the first semester, students suffer from high sleep pressure. High sleep pressure may reflect on cognitive tasks and performance. Therefore, the aim of this study was to investigate the relationship between sleep pressure and the academic profile of medical students from the first semester of UFRN, characterizing this population socio-demographically and investigating possible impacts on therestactivity rhytm and academic performance. A sample of 88 students, healthy men and women awswered the following questionnaires: Pittsburgh Sleep Quality (PSQI), Epworth Sleepiness Scale (ESS), Horne & Ostberg Chronotype (HO), Munich Chronotype (MCTQ) and “Health and Sleep” adapted. Actigraphy was used during 14 days to make actogramas and obtain non-parametric variables of the rest-activity rhythm and the grades of the morning schedule were used as academic performance. The JLS was used as a measure of sleep pressure. Statistics significance level was 95%. The population was sociodemographic homogeneous. Most students have healthy lifestyle, practice physical activity, use car to go to the university and take between 15 and 30 minutes for this route. Regarding CSV, most were classify as intermediate (38.6%) and evening (32%) chronotypes, needs to nap during the week, suffer daytime sleepiness and have poor sleep quality. 83% of the sample has at least 1h JLS, which led us to divide into two groups: Group <2h JLS (N = 44) and Group ≥ 2h JLS (N = 44). The groups have differences only in chronotype, showing that most evening individuals have more JLS, however, no differences were found in relation to sociodemographic aspect, rest-activity rhythm or academic performance. The homogeneity of the sample was limited to compare the groups, however, is alarming that students already present in the first half: JLG, poor sleep quality and excessive daytime sleepiness, which can be accentuated through the university years, with the emergence of night shifts and increased academic demand. Interventionsaddressingthe importance of good sleep habits and the change of the class start time are strategies aimed to improve student’s health.

Influência do jet lag social em marcadores circadianos de atividade - repouso e cardíaco em estudantes de medicina

Studies reveal that in recent decades a decrease in sleep duration has occurred. Social commitments, such as work and school are often not aligned to the "biological time" of individuals. Added to this, there is a reduced force of zeitgeber caused by less exposure to daylight and larger exposure to evenings. This causes a chronic sleep debt that is offset in a free days. Indeed, a restriction and extent of sleep called "social Jet lag" occurs weekly. Sleep deprivation has been associated to obesity, cancer, and cardiovascular risk. It is suggested that the autonomic nervous system is a pathway that connects sleep problems to cardiovascular diseases. However, beyond the evidence demonstrated by studies using models of acute and controlled sleep deprivation, studies are needed to investigate the effects of chronic sleep deprivation as it occurs in the social jet lag. The aim of this study was to investigate the influence of social jet lag in circadian rest-activity markers and heart function in medical students. It is a cross-sectional, observational study conducted in the Laboratory of Neurobiology and Biological Rhythmicity (LNRB) at the Department of Physiology UFRN. Participated in the survey medical students enrolled in the 1st semester of their course at UFRN. Instruments for data collection: Munich Chronotype Questionnaire, Morningness Eveningness Questionnaire of Horne and Östberg, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Actimeter; Heart rate monitor. Analysed were descriptive variables of sleep, nonparametric (IV60, IS60, L5 and M10) and cardiac indexes of time domain, frequency (LF, HF LF / HF) and nonlinear (SD1, SD2, SD1 / SD2). Descriptive, comparative and correlative statistical analysis was performed with SPSS software version 20. 41 students participated in the study, 48.8% (20) females and 51.2% (21) males, 19.63 ± 2.07 years. The social jet lag had an average of 02: 39h ± 00:55h, 82.9% (34) with social jet lag ≥ 1h and there was a negative correlation with the Munich chronotype score indicating greater sleep deprivation in subjects prone to eveningness. Poor sleep quality was detected in 90.2% (37) (X2 = 26.56, p <0.001) and 56.1% (23) excessive daytime sleepiness (X2 = 0.61, p = 0.435). Significant differences were observed in the values of LFnu, HFnu and LF / HF between the groups of social jet lag <2h and ≥ 2h and correlation of the social jet lag with LFnu (rs = 0.354, p = 0.023), HFnu (rs = - 0.354 , p = 0.023) and LF / HF (r = 0.355, p = 0.023). There was also a negative association between IV60 and indexes in the time domain and non-linear. It is suggested that chronic sleep deprivation may be associated with increased sympathetic activation promoting greater cardiovascular risk.