- Email: [email protected]
159 QUALITY OF SLEEP AND SLEEP PATTERNS IN COPD
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Abstracts of 3rd International Congress of the Association of Sleep Medicine (WASM) / Sleep Medicine 10, Suppl. 2 (2009) S1–S83
had poorer quality of sleep (p=0.002), as well as higher scores on the Beck Depression Inventory Scale (p=0.000) and on the Epworth Sleepiness Scale (p=0.001). They were also at higher risk of having obstructive sleep apnea (OSA) (p=0.01) and showed a higher Charlson Comorbidity Index (p=0.01). Hypertension was associated with the presence of moderate/severe RLS and remained so after controlling for the risk of OSA [p=0.02, OR=0.29, CI: 0.100.82]. Conclusion: Approximately one-fifth of ESRD patients on hemodialysis are affected by RLS and they show lower hemoglobin values, worse sleep quality, more excessive daytime sleepiness, depressive symptoms and higher risk of OSA. Hypertension is associated with moderate/severe RLS in hemodialysis patients.
159
QUALITY OF SLEEP AND SLEEP PATTERNS IN COPD
P.F.C. de Bruin. Universidade Federal do Ceará Introduction: Sleep problems are common in COPD and may have a negative impact on the daytime functionality and quality of life in these patients. Previous studies with respect to sleep in COPD have relied on subjective information that has been gathered from questionnaires or on objective measures from lab-based sleep studies. The technique of actigraphy allows the sleep-wake cycle to be monitored for a prolonged period, and is less expensive and time-consuming than polysomnography. Although actigraphy has been successfully used for the assessment of sleep in several medical conditions, there are no previous reports of its use in ambulatory patients with COPD. Objective: The main purpose of this study was to investigate the quality of sleep and sleep patterns in patients with COPD in their home environment. Methods: The study population included 21 patients with moderate to very severe COPD and 11 healthy controls. Sleep was objectively assessed by wrist actigraphy. The subjective assessments of the quality of sleep and daytime sleepiness were evaluated by the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, respectively. Lung function was assessed by spirometry. Results: COPD patients had impaired sleep efficiency (p=0.04), earlier sleep onset (p=0.03) and a trend towards earlier sleep offset (p=0.06) than did the controls. There was a positive correlation between body mass index (BMI) and sleep efficiency in COPD (r=0.49; p=0.02). Patients had lower subjective quality of sleep (p=0.01) and more daytime sleepiness (p=0.02) than the controls. Conclusions: Patients with moderate to very severe COPD have poor sleep quality, as determined by both objective and subjective measures. Sleep efficiency is impaired in COPD patients, particularly in combination with a low BMI, which has been shown to be an independent predictor of mortality. The early sleep onset and tendency towards an early offset suggest an advanced sleep-phase in COPD. These results demonstrate that actigraphy can become a useful tool for the assessment of sleep in COPD patients.
160
TRAZODONE FOR THE TREATMENT OF SLEEP DISORDERS IN DEMENTED PATIENTS
E.F. Camargos 1 , M.B. Pandolfi 1 , M.P.D. Freitas 2 , J.O. Lima 1 , L.C. Miranda 1 , L.W. Pimentel 1 , J.L. Quintas 1 , P.M. Souza 1 . 1 Universidade de Brasília - UnB; 2 Public Health and Aging Research Group, Oswaldo Cruz Foundation René Rachou Institute Sleep disorders in patients with dementia are very common in clinical practice. The use of antidepressants with hypnotic actions, such as trazodone and mirtazapine, plays an important role in these cases in addition to the use of other medications that, while avoided in the elderly, are used off label. The aim of this study is to present a profile of the use of hypnosedative drugs, including antidepressants (trazodone, mirtazapine and mianserin), antipsychotics (haloperidol, levomepromazine) and benzodiazepines (clonazepam) in demented patients with sleep disorders, as well as a review of trazodone hydrochloride. We evaluated 178 elderly patients followed in a reference center for the treatment of Alzheimer’s disease and other dementias who clinically presented sleep disorders and were treated with hypnosedative medications. In the one-year period of the study, 68 (38.2%) of the 178 subjects experienced sleep disorders. Most patients (114; 64.0%) had a diagnosis of Alzheimer’s disease. Approximately 85% of patients with sleep disorders used hypnosedative drugs; 15% used only sleep hygiene. Trazodone was the
drug most commonly used to treat sleep disorders (N=35) and had an effectiveness of 65.7%, followed by clonazepam (N=23), with an effectiveness of 69.5%, mirtazapine (N=20), with effectiveness of 85%, mianserin (N=16), with effectiveness of 62.5% and haloperidol (N=14), with an effectiveness efficiency of 71.4%. In clinical practice, antidepressants (trazodone, mirtazapine and mianserin) are the most widely used drug class in the treatment of sleep disorders in patients with dementia. Trazodone has been shown to be safe and effective and is a good option for treatment of the elderly with dementia and associated sleep disorders.
161
PROFILE LEVEL OF PHYSICAL ACTIVITY AND QUALITY OF SLEEP IN PATIENTS WITH FIBROMYALGIA
R.M.S. Campos, A. Silva, M. Mônico Neto, S. Queiroz, H.K. Antunes, S. Tufik, M. de Mello. Universidade Federal de São Paulo - UNIFESP Introduction: Fibromyalgia is a chronic, non-inflammatory pain syndrome, which is characterized by the presence of diffuse pain throughout the body for a minimal period of three months. This chronic pain leads to a reduction in the level of physical activity, which consequently increases the complaints of sleep disturbances. Objective: The aim of this study was to describe and correlate the level of physical activity and the quality of sleep in patients with fibromyalgia. Methods: The study cohort included 15 female patients, with a mean age of 58.47±7.0 years, who were diagnosed with fibromyalgia. This crosssectional study utilized several self-administered questionnaires: the International Physical Activity Questionnaire (IPAQ,), which assessed the level of physical activity; the chronotype morning-afternoon questionnaire, which assessed the chronotype; the Pittsburgh Questionnaire, which assessed the quality of sleep; and the Epworth Sleepiness Scale, which assessed daytime sleepiness. All data were analyzed using the statistical program SPSS Statistics Version 17. The “student’s t” test was used to test the homogeneity of the sample. The test for equality of variance and the Levene X2 Fischer test were used to establish the relationship between the IPAQ and the Pittsburgh questionnaires and between the IPAQ questionnaire and the Epworth scale. Results: The level of physical activity of patients revealed that 67% were minimally active and the remaining 33% were inactive. With respect to the quality of sleep, 94% had complaints of sleep, and 53% have daytime sleepiness. Conclusions: The chronic, overall pain that is caused by fibromyalgia leads to a reduction of elimination of physical activity and a subsequent association of sleep disorders. Given that physical exercise is now considered a form of treatment for complaints related to sleep, an alternative treatment for patients with fibromyalgia would be the implementation of a physical exercise routine on a gradual and progressive basis. Support: Research supported by AFIP and FAPESP (CEPID #98/14303-3 to S.T. and #07/56620-6 to A.S. and #09/05442-6 to R.M.S.C.). Sergio Tufik and Marco Túlio de Mello are recipients of fellowships from CNPq, FADA – UNIFESP, CEPE.
162
PREVALÊNCIA DE SINTOMAS ASSOCIADOS A DISTÚRBIOS RESPIRATÓRIOS DO SONO EM PACIENTES SUBMETIDOS À HEMODIÁLISE
P.G.S. Cettolin, C. Daltro, Q.C. Cettolin, L.G.C. Riccio, P.B.P. Batista. EBMSP Introduction: Obstructive Sleep Apnea (OSA) is the most important sleep respiratory disturbance, with respect to prevalence and mortality. Many patients with end stage renal disease (ESRD) undergoing dialysis therapy suffer from sleep disturbances. The interest in this syndrome is continuously increasing in the renal community, but many nephrologists do not fully appreciate its potential clinical implications. In addition, OSA has been found to be associated with obesity, inflammation, metabolic dysregulation and cardiovascular morbidity. Objective: The aim of this study was to estimate the risk of sleep apnea in hemodialysed patients in Salvador-Bahia, Brazil. Study design: This was conducted as a cross-sectional study. Methods: Seventy-one patients from four of twelve hemodialysis reference centers in Salvador-Bahia were included in the study. The risk of OSA was based on the Berlin Sleep Questionnaire. Demographic and anthropometric characteristics were assessed. Other variables that were recorded included etiology of ERSD, duration of dialysis, comorbidities, kt/V, hemoglobin levels and blood pressure before and after the last dialysis session.
Abstracts of 3rd International Congress of the Association of Sleep Medicine (WASM) / Sleep Medicine 10, Suppl. 2 (2009) S1–S83
had poorer quality of sleep (p=0.002), as well as higher scores on the Beck Depression Inventory Scale (p=0.000) and on the Epworth Sleepiness Scale (p=0.001). They were also at higher risk of having obstructive sleep apnea (OSA) (p=0.01) and showed a higher Charlson Comorbidity Index (p=0.01). Hypertension was associated with the presence of moderate/severe RLS and remained so after controlling for the risk of OSA [p=0.02, OR=0.29, CI: 0.100.82]. Conclusion: Approximately one-fifth of ESRD patients on hemodialysis are affected by RLS and they show lower hemoglobin values, worse sleep quality, more excessive daytime sleepiness, depressive symptoms and higher risk of OSA. Hypertension is associated with moderate/severe RLS in hemodialysis patients.
159
QUALITY OF SLEEP AND SLEEP PATTERNS IN COPD
P.F.C. de Bruin. Universidade Federal do Ceará Introduction: Sleep problems are common in COPD and may have a negative impact on the daytime functionality and quality of life in these patients. Previous studies with respect to sleep in COPD have relied on subjective information that has been gathered from questionnaires or on objective measures from lab-based sleep studies. The technique of actigraphy allows the sleep-wake cycle to be monitored for a prolonged period, and is less expensive and time-consuming than polysomnography. Although actigraphy has been successfully used for the assessment of sleep in several medical conditions, there are no previous reports of its use in ambulatory patients with COPD. Objective: The main purpose of this study was to investigate the quality of sleep and sleep patterns in patients with COPD in their home environment. Methods: The study population included 21 patients with moderate to very severe COPD and 11 healthy controls. Sleep was objectively assessed by wrist actigraphy. The subjective assessments of the quality of sleep and daytime sleepiness were evaluated by the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, respectively. Lung function was assessed by spirometry. Results: COPD patients had impaired sleep efficiency (p=0.04), earlier sleep onset (p=0.03) and a trend towards earlier sleep offset (p=0.06) than did the controls. There was a positive correlation between body mass index (BMI) and sleep efficiency in COPD (r=0.49; p=0.02). Patients had lower subjective quality of sleep (p=0.01) and more daytime sleepiness (p=0.02) than the controls. Conclusions: Patients with moderate to very severe COPD have poor sleep quality, as determined by both objective and subjective measures. Sleep efficiency is impaired in COPD patients, particularly in combination with a low BMI, which has been shown to be an independent predictor of mortality. The early sleep onset and tendency towards an early offset suggest an advanced sleep-phase in COPD. These results demonstrate that actigraphy can become a useful tool for the assessment of sleep in COPD patients.
160
TRAZODONE FOR THE TREATMENT OF SLEEP DISORDERS IN DEMENTED PATIENTS
E.F. Camargos 1 , M.B. Pandolfi 1 , M.P.D. Freitas 2 , J.O. Lima 1 , L.C. Miranda 1 , L.W. Pimentel 1 , J.L. Quintas 1 , P.M. Souza 1 . 1 Universidade de Brasília - UnB; 2 Public Health and Aging Research Group, Oswaldo Cruz Foundation René Rachou Institute Sleep disorders in patients with dementia are very common in clinical practice. The use of antidepressants with hypnotic actions, such as trazodone and mirtazapine, plays an important role in these cases in addition to the use of other medications that, while avoided in the elderly, are used off label. The aim of this study is to present a profile of the use of hypnosedative drugs, including antidepressants (trazodone, mirtazapine and mianserin), antipsychotics (haloperidol, levomepromazine) and benzodiazepines (clonazepam) in demented patients with sleep disorders, as well as a review of trazodone hydrochloride. We evaluated 178 elderly patients followed in a reference center for the treatment of Alzheimer’s disease and other dementias who clinically presented sleep disorders and were treated with hypnosedative medications. In the one-year period of the study, 68 (38.2%) of the 178 subjects experienced sleep disorders. Most patients (114; 64.0%) had a diagnosis of Alzheimer’s disease. Approximately 85% of patients with sleep disorders used hypnosedative drugs; 15% used only sleep hygiene. Trazodone was the
drug most commonly used to treat sleep disorders (N=35) and had an effectiveness of 65.7%, followed by clonazepam (N=23), with an effectiveness of 69.5%, mirtazapine (N=20), with effectiveness of 85%, mianserin (N=16), with effectiveness of 62.5% and haloperidol (N=14), with an effectiveness efficiency of 71.4%. In clinical practice, antidepressants (trazodone, mirtazapine and mianserin) are the most widely used drug class in the treatment of sleep disorders in patients with dementia. Trazodone has been shown to be safe and effective and is a good option for treatment of the elderly with dementia and associated sleep disorders.
161
PROFILE LEVEL OF PHYSICAL ACTIVITY AND QUALITY OF SLEEP IN PATIENTS WITH FIBROMYALGIA
R.M.S. Campos, A. Silva, M. Mônico Neto, S. Queiroz, H.K. Antunes, S. Tufik, M. de Mello. Universidade Federal de São Paulo - UNIFESP Introduction: Fibromyalgia is a chronic, non-inflammatory pain syndrome, which is characterized by the presence of diffuse pain throughout the body for a minimal period of three months. This chronic pain leads to a reduction in the level of physical activity, which consequently increases the complaints of sleep disturbances. Objective: The aim of this study was to describe and correlate the level of physical activity and the quality of sleep in patients with fibromyalgia. Methods: The study cohort included 15 female patients, with a mean age of 58.47±7.0 years, who were diagnosed with fibromyalgia. This crosssectional study utilized several self-administered questionnaires: the International Physical Activity Questionnaire (IPAQ,), which assessed the level of physical activity; the chronotype morning-afternoon questionnaire, which assessed the chronotype; the Pittsburgh Questionnaire, which assessed the quality of sleep; and the Epworth Sleepiness Scale, which assessed daytime sleepiness. All data were analyzed using the statistical program SPSS Statistics Version 17. The “student’s t” test was used to test the homogeneity of the sample. The test for equality of variance and the Levene X2 Fischer test were used to establish the relationship between the IPAQ and the Pittsburgh questionnaires and between the IPAQ questionnaire and the Epworth scale. Results: The level of physical activity of patients revealed that 67% were minimally active and the remaining 33% were inactive. With respect to the quality of sleep, 94% had complaints of sleep, and 53% have daytime sleepiness. Conclusions: The chronic, overall pain that is caused by fibromyalgia leads to a reduction of elimination of physical activity and a subsequent association of sleep disorders. Given that physical exercise is now considered a form of treatment for complaints related to sleep, an alternative treatment for patients with fibromyalgia would be the implementation of a physical exercise routine on a gradual and progressive basis. Support: Research supported by AFIP and FAPESP (CEPID #98/14303-3 to S.T. and #07/56620-6 to A.S. and #09/05442-6 to R.M.S.C.). Sergio Tufik and Marco Túlio de Mello are recipients of fellowships from CNPq, FADA – UNIFESP, CEPE.
162
PREVALÊNCIA DE SINTOMAS ASSOCIADOS A DISTÚRBIOS RESPIRATÓRIOS DO SONO EM PACIENTES SUBMETIDOS À HEMODIÁLISE
P.G.S. Cettolin, C. Daltro, Q.C. Cettolin, L.G.C. Riccio, P.B.P. Batista. EBMSP Introduction: Obstructive Sleep Apnea (OSA) is the most important sleep respiratory disturbance, with respect to prevalence and mortality. Many patients with end stage renal disease (ESRD) undergoing dialysis therapy suffer from sleep disturbances. The interest in this syndrome is continuously increasing in the renal community, but many nephrologists do not fully appreciate its potential clinical implications. In addition, OSA has been found to be associated with obesity, inflammation, metabolic dysregulation and cardiovascular morbidity. Objective: The aim of this study was to estimate the risk of sleep apnea in hemodialysed patients in Salvador-Bahia, Brazil. Study design: This was conducted as a cross-sectional study. Methods: Seventy-one patients from four of twelve hemodialysis reference centers in Salvador-Bahia were included in the study. The risk of OSA was based on the Berlin Sleep Questionnaire. Demographic and anthropometric characteristics were assessed. Other variables that were recorded included etiology of ERSD, duration of dialysis, comorbidities, kt/V, hemoglobin levels and blood pressure before and after the last dialysis session.