- Email: [email protected]
013 THE SLEEP-WAKE CYCLE AMONG NURSES USING MEDICATIONS TO SLEEP
S4
012
Abstracts of 3rd International Congress of the Association of Sleep Medicine (WASM) / Sleep Medicine 10, Suppl. 2 (2009) S1–S83
CHRONIC RESPONSES OF GLUCOSE METABOLISM AND ADIPOKINES IN SHIFT WORKERS
H.G. Padilha, A.P. Crispim, I.Z. Zimberg, S. Tufik, M.T. de Mello. Department of Psychobiology, Universidade Federal de Sao Paulo - UNIFESP, Sao Paulo, Sao Paulo, Brazil Introduction: Shift work has been associated with a higher propensity for the development of problems in glucose metabolism and a higher risk for the development of insulin resistance and diabetes. The aim of this study was to evaluate the levels of cortisol, homeostasis model assessment (HOMA), adiponectin, tumor necroses factor-alpha (TNF-α) and interleukin-6 (IL-6) in different fixed-shift work schedules. Methods: Concentrations of glucose, insulin, cortisol, adiponectin, TNF-α and IL-6 were measured in 3 groups: fixed night shift work (n=9), fixed early morning shift work (n=6) and a fixed day-active group (n=7). Blood samples were collected every 4 hours within the 24 hours of the study, totaling 6 samples per individual. The results are expressed as the mean ± SE. A repeatedmeasures ANOVA and a Tukey post hoc test were used for statistical analyses where p ? 0.05 was considered statistically significant. Results: A significant circadian variation was found for cortisol and HOMA in all of the groups. The 24 hour mean plasma cortisol levels were statistically higher in early morning than day-active subjects (p=0.047). No significant variation was found for the 24 hour HOMA levels. For adiponectin, TNF-α and IL-6 there was no significant circadian variation between groups. Conclusion: The present study shows that shift workers, especially early morning subjects, present different levels of cortisol. Meanwhile the adipokines failed to show a difference between groups. In light of these results, it may be possible that fixed shift workers are more adjustable than rotative ones. Further studies are necessary to understand these results.
013
THE SLEEP-WAKE CYCLE AMONG NURSES USING MEDICATIONS TO SLEEP
M.C. Pires da Rocha, M.M.F. De Martino. Nursery Department of the Faculty of Medical Sciences of the State University of Campinas (UNICAMP) - SP - Brazil Background: The system of organization of nurses’ work necessitates that human rhythms be modified, with direct consequences for organic systems and cycle vigil-sleep. The resulting changes in sleep-wake cycle may damage workers’ quality of life; furthermore, the ease with which members of the nursing profession may obtain and use medications to aid in sleep becomes a concern. The aims of the present work are: to describe sleep-wake cycle characteristics and alterations, analyze the use of medications to aid in sleep and correlate sleep quality in individuals who uses medications to sleep. Procedure: this was a comparative, descriptive, cross-sectional and quantitative study performed in a hospital in Campinas city, Brazil. Data were obtained through a social-demographic identification chart and Pittsburgh Sleep Quality Index (PSQI). Results: A total of 203 subjects from morning, afternoon and night shifts were studied. Most of the interviewed subjects were females (88.2%); their mean age was 39 years and 17.7% of them used medications to sleep (benzodiazepines). Nurses from morning shifts and those working from 07:00 to 17:00 slept a mean of 6 to 7 hours per night (mean, 1.12, SD, 0.99), while nurses from afternoon and night shifts slept more than 7 hours per night (Chi-Square Test; p=0.008). In the present study, there was no significant statistical correlation between age and PSQI score. Male subjects showed more sleeping disturbance during the day (mean, 1.75, SD, 0.90) than female subjects (mean, 1.36, SD, 0.87) according to the Chi-Square Test (p=0.0402). Nurses who used medications to sleep showed an average PSQI score of 12.33 and those who did not had an average PSQI score of 5.56 (Chi-Square Test; p<0.0001). With respect to sleep quality, RNs who used medications to sleep showed, in their totality (100%), poor sleep quality compared to those who did not use medications to sleep, of whom 54% reported good sleep quality (Fisher Exact Test; p<0.0001). Conclusions: The inquiry carried out an analysis of sleep-wake cycles in individuals who used medicines to sleep and demonstrated various negative repercussions of the use of such medicines. It was found that nurses who used medications to sleep showed damage that intensely compromised sleep quality. The occurrence of changes of sleep-wake cycle in subjects who used medications to sleep suggests that the use of medications to sleep is an inefficacious therapy for the treatment of sleep disturbances.
014
EFFECTS OF 40H PROLONGED WAKEFULNESS ON AUDITORY PROCESSING
K. Pusch, J. Rosenberg, R. Dietrich. HU Berlin The rationale for the present study was based on two primary research results. First, the “central slowing” hypothesis (Bratzke et al., 2007) posits that cognitive performance decreases during the night. Secondly, recent studies indicate the important role of body temperature for cognitive processing (Schmidt et al., 2007). Our study investigated changes in cognitive efficiency related to auditory processing during 40-hr prolonged wakefulness which cannot be explained solely by a variation of vigilance or sleepiness. A 40hr Quasi-Constant Routine protocol (QCR) was conducted which started in the morning at 8:00. According to a cyclic schedule, eleven subjects (mean age 24.9) performed an auditory discrimination task as part of a cognitive test battery every 3 hours during 40 hr of constant wakefulness. External environmental conditions were constant with dim light (∼10 lux), room temperature (21-22 °C) and no time information. At the beginning of each hour, subjects received iso-caloric meals (∼100 kcal). To identify variations in alertness, the Karolinska Sleepiness Scale and different Visual Analogue Scales were conducted hourly. Status of vigilance was tested by the Psychomotor Vigilance Test every three hours. The circadian phase was estimated over the diurnal course of salivary melatonin and body temperature. The mean dim light melatonin onset (melatonin concentration >3 pg/ml) was measured at 22:30 (SD 96 min). A significant circadian modulation of auditory performance was found for acoustic as well as for phonetic performance with a peak in the early evening. During the night, performance and body temperature decreased significantly with a nadir in the early morning. Cross-correlation analysis showed a significant relationship with a 1hr delay between melatonin concentration and body temperature. Furthermore, cross-correlation analysis revealed a significant relationship without time delay between body temperature and auditory discrimination performance, which was slightly more distinctive in phonetic than in acoustic discrimination. These data suggest that changes in auditory discrimination performance could be derived from variations in body temperature and indicate an association between better performance and higher body temperature.
015
EVALUATION OF THE QUALITY OF SLEEP AND CHRONOTYPE OF BRAZILIAN ATHLETES: PARALYMPIC GAMES IN BEIJING 2008
S.S. de Queiroz 1 , A. Silva 1 , C. Winckler 2 , R. Vital 3 , R. Peterson 4 , S. Tufik 5 , M.T. de Mello 5 . 1 Universidade Federal de São Paulo - UNIFESP, Centro de Estudos em Psicobiologia e Exercício; 2 Universidade Federal de São Paulo UNIFESP; 3 Universidade Federal do Rio Grande do Norte, Comitê Paraolímpico Brasileiro, Departamento Médico, Brasília, DF; 4 Comitê Paraolímpico Brasileiro, Departamento Médico, Brasília, DF; 5 Universidade Federal de São Paulo UNIFESP, Centro de Estudos em Psicobiologia e Exercício, CNPq Introduction: Sleep is an activity that occupies about a third of our lives and it is fundamental for good mental and emotional health, aside from being essential in the maintenance of a healthy life. Still, there are few studies on the sleep of Paralympics athletes. It will be important to elucidate the conditions of the deficiency, in an effort to potentiate the athlete’s best characteristics. Objective: The objective of this study was to evaluate sleep quality and sleepiness in the Brazilian athletes before the Paralympics Games of Beijing in 2008. Methodology: We studied 32 Paralympics athletes (18 men and 14 women, with mean age 28±6 years old), engaged in track-and-field competition. The sleep quality was evaluated through the Scale of Pittsburgh and the Scale of Sleepiness of Epworth was used to evaluate sleepiness. Chronotype was determined by the Questionnaire of Horne and Östberg. The evaluations were accomplished in Brazil, three days before athletes were scheduled to travel to the competition. Results: Our results demonstrated that 88,9% of athletes presented bad sleep quality; 43,7% presented excessive daytime sleepiness. As for the chronotype, 51,6% of the athletes were classified as moderately morning, 29% as definitely morning and 19,4% classified as indifferent. Conclusions: On the eve of the competition most of the athletes presented bad sleep quality, perhaps related to pre-competitive stress. As for chronotype, most of the athletes in our sample were classified as moderately morning. This information, whenever possible, can be considered in relation to the schedules for rest (sleep), training and competitions.
012
Abstracts of 3rd International Congress of the Association of Sleep Medicine (WASM) / Sleep Medicine 10, Suppl. 2 (2009) S1–S83
CHRONIC RESPONSES OF GLUCOSE METABOLISM AND ADIPOKINES IN SHIFT WORKERS
H.G. Padilha, A.P. Crispim, I.Z. Zimberg, S. Tufik, M.T. de Mello. Department of Psychobiology, Universidade Federal de Sao Paulo - UNIFESP, Sao Paulo, Sao Paulo, Brazil Introduction: Shift work has been associated with a higher propensity for the development of problems in glucose metabolism and a higher risk for the development of insulin resistance and diabetes. The aim of this study was to evaluate the levels of cortisol, homeostasis model assessment (HOMA), adiponectin, tumor necroses factor-alpha (TNF-α) and interleukin-6 (IL-6) in different fixed-shift work schedules. Methods: Concentrations of glucose, insulin, cortisol, adiponectin, TNF-α and IL-6 were measured in 3 groups: fixed night shift work (n=9), fixed early morning shift work (n=6) and a fixed day-active group (n=7). Blood samples were collected every 4 hours within the 24 hours of the study, totaling 6 samples per individual. The results are expressed as the mean ± SE. A repeatedmeasures ANOVA and a Tukey post hoc test were used for statistical analyses where p ? 0.05 was considered statistically significant. Results: A significant circadian variation was found for cortisol and HOMA in all of the groups. The 24 hour mean plasma cortisol levels were statistically higher in early morning than day-active subjects (p=0.047). No significant variation was found for the 24 hour HOMA levels. For adiponectin, TNF-α and IL-6 there was no significant circadian variation between groups. Conclusion: The present study shows that shift workers, especially early morning subjects, present different levels of cortisol. Meanwhile the adipokines failed to show a difference between groups. In light of these results, it may be possible that fixed shift workers are more adjustable than rotative ones. Further studies are necessary to understand these results.
013
THE SLEEP-WAKE CYCLE AMONG NURSES USING MEDICATIONS TO SLEEP
M.C. Pires da Rocha, M.M.F. De Martino. Nursery Department of the Faculty of Medical Sciences of the State University of Campinas (UNICAMP) - SP - Brazil Background: The system of organization of nurses’ work necessitates that human rhythms be modified, with direct consequences for organic systems and cycle vigil-sleep. The resulting changes in sleep-wake cycle may damage workers’ quality of life; furthermore, the ease with which members of the nursing profession may obtain and use medications to aid in sleep becomes a concern. The aims of the present work are: to describe sleep-wake cycle characteristics and alterations, analyze the use of medications to aid in sleep and correlate sleep quality in individuals who uses medications to sleep. Procedure: this was a comparative, descriptive, cross-sectional and quantitative study performed in a hospital in Campinas city, Brazil. Data were obtained through a social-demographic identification chart and Pittsburgh Sleep Quality Index (PSQI). Results: A total of 203 subjects from morning, afternoon and night shifts were studied. Most of the interviewed subjects were females (88.2%); their mean age was 39 years and 17.7% of them used medications to sleep (benzodiazepines). Nurses from morning shifts and those working from 07:00 to 17:00 slept a mean of 6 to 7 hours per night (mean, 1.12, SD, 0.99), while nurses from afternoon and night shifts slept more than 7 hours per night (Chi-Square Test; p=0.008). In the present study, there was no significant statistical correlation between age and PSQI score. Male subjects showed more sleeping disturbance during the day (mean, 1.75, SD, 0.90) than female subjects (mean, 1.36, SD, 0.87) according to the Chi-Square Test (p=0.0402). Nurses who used medications to sleep showed an average PSQI score of 12.33 and those who did not had an average PSQI score of 5.56 (Chi-Square Test; p<0.0001). With respect to sleep quality, RNs who used medications to sleep showed, in their totality (100%), poor sleep quality compared to those who did not use medications to sleep, of whom 54% reported good sleep quality (Fisher Exact Test; p<0.0001). Conclusions: The inquiry carried out an analysis of sleep-wake cycles in individuals who used medicines to sleep and demonstrated various negative repercussions of the use of such medicines. It was found that nurses who used medications to sleep showed damage that intensely compromised sleep quality. The occurrence of changes of sleep-wake cycle in subjects who used medications to sleep suggests that the use of medications to sleep is an inefficacious therapy for the treatment of sleep disturbances.
014
EFFECTS OF 40H PROLONGED WAKEFULNESS ON AUDITORY PROCESSING
K. Pusch, J. Rosenberg, R. Dietrich. HU Berlin The rationale for the present study was based on two primary research results. First, the “central slowing” hypothesis (Bratzke et al., 2007) posits that cognitive performance decreases during the night. Secondly, recent studies indicate the important role of body temperature for cognitive processing (Schmidt et al., 2007). Our study investigated changes in cognitive efficiency related to auditory processing during 40-hr prolonged wakefulness which cannot be explained solely by a variation of vigilance or sleepiness. A 40hr Quasi-Constant Routine protocol (QCR) was conducted which started in the morning at 8:00. According to a cyclic schedule, eleven subjects (mean age 24.9) performed an auditory discrimination task as part of a cognitive test battery every 3 hours during 40 hr of constant wakefulness. External environmental conditions were constant with dim light (∼10 lux), room temperature (21-22 °C) and no time information. At the beginning of each hour, subjects received iso-caloric meals (∼100 kcal). To identify variations in alertness, the Karolinska Sleepiness Scale and different Visual Analogue Scales were conducted hourly. Status of vigilance was tested by the Psychomotor Vigilance Test every three hours. The circadian phase was estimated over the diurnal course of salivary melatonin and body temperature. The mean dim light melatonin onset (melatonin concentration >3 pg/ml) was measured at 22:30 (SD 96 min). A significant circadian modulation of auditory performance was found for acoustic as well as for phonetic performance with a peak in the early evening. During the night, performance and body temperature decreased significantly with a nadir in the early morning. Cross-correlation analysis showed a significant relationship with a 1hr delay between melatonin concentration and body temperature. Furthermore, cross-correlation analysis revealed a significant relationship without time delay between body temperature and auditory discrimination performance, which was slightly more distinctive in phonetic than in acoustic discrimination. These data suggest that changes in auditory discrimination performance could be derived from variations in body temperature and indicate an association between better performance and higher body temperature.
015
EVALUATION OF THE QUALITY OF SLEEP AND CHRONOTYPE OF BRAZILIAN ATHLETES: PARALYMPIC GAMES IN BEIJING 2008
S.S. de Queiroz 1 , A. Silva 1 , C. Winckler 2 , R. Vital 3 , R. Peterson 4 , S. Tufik 5 , M.T. de Mello 5 . 1 Universidade Federal de São Paulo - UNIFESP, Centro de Estudos em Psicobiologia e Exercício; 2 Universidade Federal de São Paulo UNIFESP; 3 Universidade Federal do Rio Grande do Norte, Comitê Paraolímpico Brasileiro, Departamento Médico, Brasília, DF; 4 Comitê Paraolímpico Brasileiro, Departamento Médico, Brasília, DF; 5 Universidade Federal de São Paulo UNIFESP, Centro de Estudos em Psicobiologia e Exercício, CNPq Introduction: Sleep is an activity that occupies about a third of our lives and it is fundamental for good mental and emotional health, aside from being essential in the maintenance of a healthy life. Still, there are few studies on the sleep of Paralympics athletes. It will be important to elucidate the conditions of the deficiency, in an effort to potentiate the athlete’s best characteristics. Objective: The objective of this study was to evaluate sleep quality and sleepiness in the Brazilian athletes before the Paralympics Games of Beijing in 2008. Methodology: We studied 32 Paralympics athletes (18 men and 14 women, with mean age 28±6 years old), engaged in track-and-field competition. The sleep quality was evaluated through the Scale of Pittsburgh and the Scale of Sleepiness of Epworth was used to evaluate sleepiness. Chronotype was determined by the Questionnaire of Horne and Östberg. The evaluations were accomplished in Brazil, three days before athletes were scheduled to travel to the competition. Results: Our results demonstrated that 88,9% of athletes presented bad sleep quality; 43,7% presented excessive daytime sleepiness. As for the chronotype, 51,6% of the athletes were classified as moderately morning, 29% as definitely morning and 19,4% classified as indifferent. Conclusions: On the eve of the competition most of the athletes presented bad sleep quality, perhaps related to pre-competitive stress. As for chronotype, most of the athletes in our sample were classified as moderately morning. This information, whenever possible, can be considered in relation to the schedules for rest (sleep), training and competitions.