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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.

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Introduction: Although the diurnal fluctuation of motor dysfunction, reversible with small doses of dopamine, is a cornerstone for the phenotype of the autosomal dominant Segawa syndrome, the non-motor symptoms of this neurotransmitter deficiency have still received limited attention. Objective: This study aims to evaluate non-motor symptoms of this dopa-responsive dystonia through an intrafamilial comparative cross-sectional study. Methods: Seventeen individuals with a c.IVS5 + 3insT (c.626 + 3insT) variation in the GTP cyclohydrolase-1 gene (GCH1, HGNC: 4193) and 34 intrafamilial controls were studied using the Beck Depression Inventory-II, the Wiener Matrizen Test 2, the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, the MINI/MINI PLUS Questionnaires, the World Health Organization Quality of Life - BREF Instrument and a drug use assessment questionnaire. Results: No significant difference was found between the groups in the prevalence of sleep disorders and in cognitive function. Nevertheless, generalized anxiety disorder (p = 0.050) and attention-deficit/hyperactivity disorder in childhood (p = 0.011) were observed only in individuals without the molecular variation. The group with the GCH1 variation presented a worse perception about how safe they feel in their daily lives (p = 0.034), less satisfaction with themselves (p = 0.049) and with their relationships (p = 0.029), and a higher prevalence of past major depressive episodes before use of L-Dopa (p = 0.046). Conclusion: Low dopamine could have been protective against generalized anxiety disorder and attention-deficit/hyperactivity disorder in childhood in Segawa group individuals. The prevalence of depression was higher in individuals with the molecular variant prior to the L-Dopa treatment. Considering it, the penetrance estimates for the variant carriers increased from 58.8% to up to 88% in this large studied family. Additionally, neuropsychiatric tests of all individuals with a molecular diagnosis in an affected family are a valuable instrument for its clinical management.

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This study aimed to examine the prevalence rates of poor quality sleep and daytime sleepiness in health professionals and their association with socioeconomic, lifestyle, and anthropometric factors and psychosocial work conditions. This cross-sectional study was performed with health professionals from various public and private hospitals in Rio Verde, Goiás, Brazil. Daytime sleepiness and sleep quality were assessed using the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index, respectively. The variables were analyzed using multiple hierarchical Poisson regression in the statistical package Stata version 13.0. A total of 244 health professionals participated in this study (women, 78.28%). The rates of abnormal daytime sleepiness and poor sleep quality were 50.41% (n = 123) and 55.74% (n = 136), respectively. Reduced physical activity was associated with poor sleep quality (prevalence ratio (PR) = 1.32; 95% confidence interval (CI) 1.02-1.70, p = 0.035). Age between 20 and 29 years (PR = 2.59; 95% CI 1.37-4.91, p = 0.021) and 30 and 49 years (PR = 2.09; 95% CI 1.12-3.91, p = 0.021), as well as excessive alcohol consumption (PR = 1.29; 95% CI 1.01-1.66, p = 0.048), were risk factors for daytime sleepiness. Conversely, adequate bodyweight (PR = 0.52; 95% CI 0.33-0.82, p = 0.005) was considered a protective factor. The present findings suggest high rates of abnormal daytime sleepiness and poor sleep quality among healthcare professionals. We emphasize the importance of physical activity, adequate weight, and healthy habits for better quality sleep and reduced daytime sleepiness.

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Resumen Introducción: La somnolencia diurna excesiva se asocia a distintos desórdenes del sueño y determina un deterioro significativo de la calidad de vida. La escala de somnolencia de Epworth (ESE) es un instrumento frecuentemente utilizado en la práctica clínica para cuantificar somnolencia diurna, pero no ha sido validada en Chile. Objetivo: Validación transcultural y psicométrica de la ESE en Chile (ESE-CL), y evaluación de su sensibilidad y especificidad en el contexto de pacientes con apneas del sueño (SAHOS). Material y Método: Se realizó una adaptación transcultural y validación inicial en un grupo piloto (58 personas), aplicando en dos ocasiones separadas el mismo instrumento (ESE-CL). Se analizó el nivel de confiabilidad con alfa de Cronbach y con test retest. Para evaluar su sensibilidad se aplicó la ESE-CL a 94 pacientes con SAHOS y 100 controles. Resultados: Los valores de confiabilidad alfa de Cronbach y test re-test fue de 0,732 y 0,837, respectivamente. La capacidad de discriminación de SAHOS de la escala de somnolencia de Epworth versión chilena fue de 67%. Conclusión: La ESE-CL es un instrumento válido y confiable. Un puntaje mayor a 11 se asocia a tener mayor riesgo de padecer SAHOS y constituye una herramienta útil y de fácil aplicación clínica ante pacientes con sospecha de SAHOS.

Abstract Introduction: Excessive daytime sleepiness (EDS) is associated with different sleep disorders, which in turn causes a significant decline quality of life. Epworth sleepiness scale (ESS) is a frequently used instrument to quantify EDS, but it has not been validated in Chile. Aim: Transcultural and psychometric validation of ESS Chilean version. Material and Method: ESS-CL was initially adapted and applied to a pilot group on two separate occasions. Reliability was assessed via Cronbach's alpha and test-retest. ESS-CL was applied to 94 patients with diagnosis of obstructive sleep apnea (OSA) and 100 control to assess its sensitivity. Results: Reliability values (Cronbach's alpha and test-retest) were 0.732 y 0.837 respectively. The ability to discriminate OSA was 67%. Conclusion: The ESS-CL is a valid and reliable instrument. A score higher than 11 points is associated with a greater risk of OSA. It is a useful and accessible tool for patients in whom OSA is suspected.

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OBJETIVO: el objetivo primario es determinar si los estudiantes de medicina de la Universidad Mayor de San Simón (UMSS) sufren de somnolencia diurna excesiva mediante el uso de la Escala de somnolencia de Epworth (ESE). MÉTODOS: Se trata de un estudio transversal, descriptivo. Estudiantes de medicina de la UMSS completaron una encuesta la cual incluía datos demográficos, escala del sueño de Epworth traducida al español, número de horas nocturnas de sueño, siestas y uso de estimulantes del SNC durante el mes anterior a la realización de la encuesta. RESULTADOS: el universo consistió en 1923 estudiantes y la muestra en 324 estudiantes del primer al quinto curso de carrera de medicina (5% margen de error, 95% nivel de confianza); 57% del sexo femenino, media de edad de 21 años (±2,1), la media de la escala de Epworth fue de 9 (±3,3) (95% IC 8,46-9,54); 23,6% presentó algún grado de somnolencia diurna excesiva; 67% de los estudiantes indican dormir 4-6 hrs diarias; 79% goza entre 5 ­ 90 minutos de siesta cada día durante el mes anterior a la encuesta; 76% reporta usar algún tipo de estimulante del sistema nervioso central. CONCLUSIONES: un porcentaje menor pero relevante de estudiantes de medicina de la UMSS tiene algún grado de somnolencia diurna excesiva. Este menor porcentaje puede deberse al uso de siestas; habito comúnmente practicado en nuestro país.

OBJECTIVES: the primary objective is to determine if medical students of San Simon University (UMSS) suffer from excessive daytime sleepiness using the Epworth Sleeping Scale (ESS). METHODS: It was a cross-sectional, descriptive study. Medical students of San Simon University responded to a survey which included demographics, Epworth Sleepiness Scale translated to Spanish, number of nighttime hours of sleep, presence of naps and use of any stimulant of the central nervous system during the month prior to the survey. RESULTS: The universe consisted of 1923 students and the sample was 324 students from the first to the fifth course of the medical school of University of San Simon (5% margin of error, 95% level of confidence); 57% female, mean age was 21 years (±2.1), the average Epworth Sleepiness scale was 9 (±3.3) (95% CI 8.46-9.54); 23.6% presented some degree of excessive daytime sleepiness; 67% of students indicated sleep 4-6 hours daily; 79% enjoy 5 - 90 minute daily naps during the month prior to survey; 76% reported using some type of stimulant of the central nervous system. CONCLUSIONS: A small but relevant number of medical students have some degree of excessive daytime sleepiness. This is maybe due to use of naps; a habit commonly used in our country.

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OBJECTIVES:: Tinnitus is an auditory sensation in the absence of any external stimulus. It has a negative impact on quality of life and interferes with concentration, sleep, social activities, and even emotional stability. The aim of this study was to compare sleep architecture in patients with and without chronic subjective tinnitus. METHODS:: This was an observational, noninterventional, and prospective study. The sample consisted of 50 individuals of both sexes aged 20 to 60 years. Twenty-five patients with tinnitus constituted the study group, and for comparison, a control group consisting of 25 patients without reported tinnitus was formed. The patients underwent polysomnography and were administered the Epworth Sleepiness Scale, Tinnitus Handicap Inventory, and visual analog scales. RESULTS:: The group with tinnitus had higher mean values in sleep stages 1 and 2, and lower mean values in stage 3 and in rapid eye movement (REM) sleep, compared with the control group, and this difference was significant only for REM sleep ( P = .031). This demonstrates that patients with tinnitus remained longer in shallow sleep and spent less time in deep sleep (stage 3) and REM sleep. CONCLUSIONS:: This study shows that patients with tinnitus have significant alterations in REM sleep latency as well as the REM sleep phase.

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Introdução: A apneia obstrutiva do sono (AOS) é caracterizada por obstrução das vias aéreas superiores durante o sono e provoca uma série de consequências para o sistema cardiovascular. Estudos mostram associação de apneia obstrutiva do sono com um mau prognóstico em longo prazo após intervenção coronariana e elevação do índice de infarto agudo do miocárdio. Objetivo: Analisar a prevalência de apneia obstrutiva do sono em pacientes no pré-operátorio de cirurgia cardíaca. Métodos: Estudo transversal no qual foi avaliado prevalência de apneia obstrutiva do sono através do Questionário de Berlin e da Escala de Sonolência de Epworth (ESE). Foram incluídos pacientes no período de julho a outubro de 2017, com idade igual ou superior a 18 anos. Resultados: Foram avaliados 40 pacientes, com idade média de 62,35 ± 7,9 anos e a maioria do sexo masculino (72,5%). O procedimento mais prevalente foi à Cirurgia de Revascularização do Miocárdio (CRM) (80%). Foi identificado alto índice de prevalência de AOS em 62,5% dos participantes; 65% dos pacientes não apresentaram índices significativos de sonolência. Conclusão: Com este estudo vimos que pacientes que realizam cirurgia cardíaca, apresentam alta prevalência de AOS, mas não apresentam necessariamente altos índices de sonolência. Percebe-se que entre os pacientes com maior prevalência de AOS existe uma maior prevalência da realização de Cirurgia de Revascularização do Miocárdio (CRM), mostrando a relação direta de doença cardiovascular com AOS.(AU)

Introduction: Obstructive sleep apnea (OSA) is characterized by obstruction of the upper airways during sleep and causes a number of consequences for the cardiovascular system. Studies show an association of obstructive sleep apnea with a poor long-term prognosis after coronary intervention and elevation of the acute myocardial infarction index. Objective: To analyze the prevalence of OSA in patients in the preoperative period of cardiac surgery. Methods: A cross-sectional study evaluating the prevalence of OSA using the Berlin Questionnaire and the Epworth Sleepiness Scale. Patients were included in the period from July to October 2017, aged 18 years or over. Results: A total of 40 patients were evaluated, with a mean age of 62.35 ± 7.9 years and the majority males (72.5%). The most prevalent procedure was coronary artery bypass grafting (80%). A high prevalence rate of OSA was identified in 62.5% of the participants; 65% of the patients did not present significant drowsiness indexes. Conclusion: With this study, we observed that patients who undergo cardiac surgery have a high prevalence of OSA, but do not necessarily present high rates of sleepiness. Among patients with a higher prevalence of OSA, there is a higher prevalence of coronary artery bypass grafting, showing a direct relationship between cardiovascular disease and OSA. (AU)

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Study Objective: To examine the association between adherence to a Mediterranean diet (MD) and changes in sleep duration and sleep quality in older adults. Methods: We used data from 1596 participants in the Seniors-ENRICA cohort aged ≥ 60 years. MD was evaluated in 2012 with the Mediterranean Diet Adherence Screener (MEDAS) score. Sleep duration (h) and indicators of poor sleep quality were assessed both in 2012 and 2015. Analyses were adjusted for sociodemographic, lifestyle and morbidity variables, and for sleep duration and the number of poor sleep indicators at baseline. Results: Over a median follow-up of 2.8 years, 12.2% of individuals increased and 8.8% decreased their sleep duration by ≥2 h/night. Compared with those in the lowest tertile of adherence to the MD in 2012, those in the highest tertile showed both a lower risk of a ≥2 h/night increase in sleep duration (odds ratio [OR]: 0.54, 95% confidence interval [CI] 0.34-0.85, p-trend = .01) and of a ≥2 h/night decrease (OR: 0.58, 95% CI 0.35-0.95, p-trend = 0.02) from 2012 to 2015. Being in the highest tertile of MD in 2012 was also associated with lower risk of poor sleep quality at follow-up, the OR (95% CI) for having 2-3 indicators of poor sleep was 0.70 (0.51-0.97) and for ≥4 indicators was 0.68 (0.47-0.99, p-trend = .04). High adherence to the MD was also associated with 56% lower odds of having large changes in sleep duration and ≥2 indicators of poor sleep quality simultaneously (OR: 0.44, 95% CI 0.29-0.68, p trend < .001). Conclusions: Adherence to a MD pattern was associated with lower risk of changes in sleep duration and with better sleep quality in older adults.

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Introdução: A sonolência excessiva diurna (SED) é um importante transtorno do sono e frequentemente é associado à síndrome da apneia-hipopneia obstrutiva do sono (SAHOS). É conhecido como um fator predisponente comum para acidentes, redução da produtividade, comprometimento neurocognitivo e interpessoal e/ou problemas sociais. Portanto, a detecção precoce da SED é fundamental. Objetivo: Avaliar a correlação da escala de sonolência de Epworth (ESE) com parâmetros polissonográficos nos pacientes com SAHOS. Métodos: O estudo avaliou 1264 laudos de exames de polissonografia de pacientes com SAHOS admitidos de janeiro de 2009 até dezembro de 2013 no Instituto do Sono dos Campos Gerais. Os laudos foram divididos inicialmente em grupos de acordo com a gravidade da SAHOS e em seguida de acordo com a pontuação obtida na ESE e avaliados de acordo com os resultados dos parâmetros polissonográficos. Resultados: Dos laudos analisados, 822 (65,03%) eram de pacientes do sexo masculino e 442 (34,97%) do sexo feminino. A análise da pontuação da ESE evidenciou uma relação com a SAHOS (r = 0,175, p < 0,00001). Quando analisado os subgrupos de gravidade, apenas a SAHOS grave apresentou correlação significativa com a ESE (r = 0,136, p = 0,0004). Conclusões: A escala possui correlação com a SAHOS grave. Devido à importância da detecção precoce da sonolência, a ESE pode ser utilizada como método de avaliação rápida em pacientes com a SAHOS, estimando sua gravidade e a existência de SED (AU)

Introduction: Excessive daytime sleepiness (EDS) is an important sleep disorder, frequently associated to the obstructive sleep apnea hypopnea syndrome (OSAHS). It is known to be an important predisposing factor to accidents, decreased productivity, neurocognitive disorders and social issues. Thus, early detection of EDS is crucial. Objective: To evaluate the correlation of the Epworth Sleepiness Scale (ESS) with polysomnographic parameters in patients with OSAHS. Method: The study evaluated 1264 reports of polysomnography of patients with OSAHS admitted from January 2009 to December 2013 at the Instituto do Sono dos Campos Gerais. The reports were initially divided into groups according to the severity of OSAHS and then according to the score obtained in ESE and evaluated according to the results of the polysomnographic parameters. Results: From the analyzed reports, 822 (65.03%) were male patients, and 442 (34.87%) were female patients. According to the ESS scores analysis, a relation was observed between the scale and OSAHS (r = 0.175, p < 0.,00001). However, when divided into subgroups only severe OSAHS presented a significant correlation (r = 0.136, p = 0.0004). Conclusion: The scale is more strongly related with severe OSAHS, which is also more likely to develop EDS. Due to the importance of early detection of sleepiness, the ESS can be used as a method of rapid assessment in patients with OSAHS, to estimate its severity and the presence of SED. (AU)

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Here our goal was to determine the magnitude of sleep-related motor skill enhancement. Performance on the finger tapping task (FTT) was evaluated after a 90 min daytime nap (n=15) or after quiet wakefulness (n=15). By introducing a slight modification in the formula used to calculate the offline gains we were able to refine the estimated magnitude of sleep׳s effect on motor skills. The raw value of improvement after a nap decreased after this correction (from ~15% to ~5%), but remained significantly higher than the control. These results suggest that sleep does indeed play a role in motor skill consolidation.