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OBJECTIVE: Sleep problems are common in patients with psychotic disorders, especially schizophrenia. Although pharmacological methods are at the forefront of treatment, this method has some drawbacks. Cognitive behavioral therapy for insomnia (CBT-I) is an option for the treatment of individuals with insomnia. In recent years, there has been an increasing interest in its use in patients with psychotic disorders. This meta-analysis aims to evaluate the effectiveness of CBT-I on sleep problems in patients with psychotic disorders. METHODS: A systematic search was conducted using PubMed, Scopus, and EBSCO (MEDLINE) databases to identify relevant studies. The study included RCTs and uncontrolled studies that focused on participants diagnosed with schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorders not otherwise specified, bipolar disorders, or unipolar depression with psychotic features, who had sleep problems for at least one month, and who were receiving treatment. The initial search yielded 246 studies, and eight studies were selected for the meta-analysis after screening and applying inclusion and exclusion criteria.The statistical analysis was conducted using the R software. RESULTS: CBT-I significantly ameliorates insomnia and sleep quality in patients with psychotic disorders during short and long-term periods. In addition to this, CBT-I leads to a significant improvement in psychotic symptoms in the short-term period and contributes significantly to the improvement in mental well-being in both short and long-term periods. CONCLUSIONS: CBT-I is an effective and valuable method for sleep problems in patients with psychotic disorders and its use is recommended to be widespread.
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Integrase strand transfer inhibitors (INSTI) are associated with neuropsychiatric adverse events (NPAEs). The aim of this study was to evaluate improvements in NPAEs after switching an INSTI-based regimen to darunavir/cobicistat (DRV/c) or doravirine (DOR). Methods: A prospective cohort study was conducted to evaluate the reversibility of NPAEs via the Patient Health Questionnaire (PHQ-9), the Insomnia Severity Index (ISI), and the Hospital Anxiety and Depression Scale (HADS-A and D) in patients who started antiretroviral therapy with dolutegravir (DTG) or bictegravir (BIC). These patients were switched to DRV/c or DOR. Scales were compared at the moment of the switch and 12 weeks later. Results: We included 1153 treatment-naïve men, 676 (58.7%) with BIC and 477 (41.3%) with DTG. A total of 32 (2.7%) experienced NPAEs that led to discontinuation. Insomnia was found in 20 patients; depression via PHQ-9 in 21 patients, via HADS-D in 5 patients, and anxiety via HADS-A in 12 patients. All of them were evaluated by a psychiatrist at the moment of the symptoms; 7 (21.8%) started psychotropic drugs. After 12 weeks of follow-up, PHQ-9, ISI, HADS-A, and HADS-D decreased, with a p-value ≤ 0.05. Conclusions: NPAEs seem to improve after switching to a DRV/c- or DOR-based regimen after the first 4 and 12 weeks.
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Cobicistat , Darunavir , Infecções por HIV , Piridonas , Humanos , Masculino , Darunavir/efeitos adversos , Darunavir/uso terapêutico , Darunavir/administração & dosagem , Infecções por HIV/tratamento farmacológico , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto , Cobicistat/efeitos adversos , Cobicistat/uso terapêutico , Cobicistat/administração & dosagem , Piridonas/efeitos adversos , Inibidores de Integrase de HIV/efeitos adversos , Inibidores de Integrase de HIV/uso terapêutico , Inibidores de Integrase de HIV/administração & dosagem , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Substituição de Medicamentos/efeitos adversos , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Piperazinas/efeitos adversos , TriazóisRESUMO
As the chronological age increases, there is a decrease in the telomere length (TL). Associations between TL and age-related diseases have been described. Since the major pathophysiological factors related to inadequate sleep (including sleep complaints and sleep disorders) contribute to the exacerbation of inflammation and oxidative stress, an association of sleep and TL has been proposed. The aim of this study was to evaluate the association between sleep-related variables with TL in a longitudinal framework. We used data derived from the EPISONO cohort, which was followed over 8 years. All individuals answered sleep-related questionnaires, underwent a full-night polysomnography (PSG), and had their blood collected for DNA extraction. The TL was measured through a quantitative real time polymerase chain reaction. Age, sex, body mass index (BMI), smoking, physical activity status, and the 10 principal components (ancestry estimate) were considered covariables. Of the 1042 individuals in the EPISONO cohort, 68.3% agreed to participate in the follow-up study (n = 712). Baseline SpO2 (ß = 0.008, p = 0.007), medium SpO2 (ß = 0.013, p = 0.013), and total sleep time <90% (ß = -0.122, p = 0.012) had an effect on TL from the follow-up. The 8 year TL attrition was inversely associated with total sleep time, sleep efficiency, sleep architecture variables, wake after sleep onset, arousal index, oxygen-related variables baseline, and the presence of obstructive sleep apnea (OSA). We conclude that individuals with worse sleep quality, alterations in sleep architecture, and OSA had greater TL attrition over the 8 years. Using a longitudinal approach, these findings confirm previous cross-sectional evidence linking sleep with accelerated biological ageing.
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INTRODUCTION: Individuals with insomnia disorder often exhibit differences between reported experiences of sleep and objectively measured sleep parameters; however, the implications of this subjective-objective sleep discrepancy during treatment remains unclear. OBJECTIVE: The aim of this study was to investigate the impact of cognitive behavioural therapy for insomnia (CBT-I) on the discrepancy between objective and subjective measures of sleep, and to assess whether changes in clinical variables such as depression, anxiety, fatigue, and beliefs about sleep, were related to changes in discrepancy. METHODS: Twenty-five participants with insomnia disorder were enrolled in group CBT-I. Sleep measures were continually sampled from baseline until 2 weeks post-treatment with both objective (i.e., actigraphy) and subjective (i.e., sleep diary) methods. RESULTS: The subjective-objective discrepancy significantly decreased from baseline early on in treatment (following the second session) and were maintained at post-treatment for sleep onset latency, wake after sleep onset (WASO) and sleep efficiency (SE). Total sleep time (TST) discrepancy and misperception decreased from baseline to post-treatment. Improvement in depression symptoms, fatigue symptoms, and negative beliefs about sleep were significantly correlated with the decrease in the discrepancy for WASO and SE. CONCLUSION: These findings suggest that CBT-I resolves the mismatch between objective and subjective sleep parameters early in treatment for adults with insomnia. Sleep misperception improved from underestimating to accurately estimating TST. Improvement of psychological symptoms were related to decrease in sleep discrepancies across treatment. Future research is needed to explore how feedback on objective and subjective sleep discrepancy may impact sleep perception across treatment with CBT-I.
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AIM: To evaluate the prevalence and types of sleep problems and their correlations with melatonin content and behavior in Attention-Deficit Hyperactivity Disorder (ADHD) children. METHOD: Sleep in ADHD children and typically developing children (TD) aged 6-14 was assessed by the Sleep Disorders Scale for Children (SDSC) and actigraphy, salivary melatonin quantified by ELISA, and behavior was analyzed using the Strengths and Difficulties Questionnaire. RESULTS: ADHD children showed a higher frequency of sleep disturbances, higher sleep latency, and lower sleep efficiency than in the TD group. The ADHD group presented lower melatonin nocturnal content compared to the TD group. Disorders of Initiating and Maintaining Sleep (DIMS) was moderately associated with nocturnal melatonin. The total behavior difficulties were correlated with Disorders of Initiating and Maintaining Sleep (DIMS), Sleep/Wake Transition Disorders (SWTD), Disorders of Excessive Somnolence (DES), Sleep Hyperhidrosis (SHY) and Total SDSC Score. The behavior was the only determinant of the total SDSC score (R2 = 0.499; p < 0.002). CONCLUSION: This study provides, for the first time, evidence that among the frequent sleep disturbances in ADHD, the disorders in initiating and maintaining sleep are associated with the low levels of melatonin found in this population. Additionally, these, along with other sleep disturbances, are linked to behavioral problems in ADHD.
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Actigrafia , Transtorno do Deficit de Atenção com Hiperatividade , Melatonina , Transtornos do Sono-Vigília , Humanos , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Melatonina/metabolismo , Criança , Masculino , Feminino , Transtornos do Sono-Vigília/epidemiologia , Adolescente , Saliva/metabolismo , Saliva/química , Inquéritos e QuestionáriosRESUMO
Introduction Insomnia is highly prevalent among individuals with Attention-Deficit/Hyperactivity Disorder (ADHD). However, the biological mechanisms shared between both conditions is still elusive. We aimed to investigate whether insomnia's genomic component is able to predict ADHD in childhood and adolescence. Methods A Brazilian sample of 259 ADHD probands and their biological parents were included in the study. Their genomic DNA genotypes were used to construct the polygenic risk score for insomnia (Insomnia PRS), using the largest GWAS summary statistics as a discovery sample. The association was tested using logistic regression, under a case-pseudocontrol design. Results Insomnia PRS was nominally associated with ADHD (OR = 1.228, p = 0.022), showing that the alleles that increase the risk for insomnia also increase the risk for ADHD. Discussion Our results suggest that genetic factors associated with insomnia may play a role in the ADHD genetic etiology, with both phenotypes likely to have a shared genetic mechanism.
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Psychological flexibility has recently attracted the attention of researchers in the field of sleep disorders; therefore, in the study, psychological flexibility was evaluated as a predictor or factor related to the presence/severity of insomnia. We included 2218 individuals selected from the randomized-control trial for behavioural therapy for insomnia and cross-sectional studies, including 1797 individuals with insomnia and 421 controls without insomnia. All participants completed the DSM-5-based insomnia diagnosis interview, Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Acceptance Action Questionnaire-II. Linear regression and multinomial logistic regression models were used. Sex, education, occupation, marital status, anxiety, depression and psychological inflexibility were possible predictors or factors associated with the severity of insomnia. Multivariate linear regression analysis demonstrated that sex (ð½ = 0.88; t = 2.80; p = 0.005), depression (ð½ = 0.41; t = 10.7; p < 0.001), anxiety (ð½ = 0.58; t = 14.1; p < 0.001) and psychological inflexibility (ð½ = 0.09; t = 5.07; p < 0.001) were predictors of insomnia. The results of the multinomial logistic regression demonstrate that, in comparison to the absence of insomnia, insomnia at all levels (mild, moderate and severe) was associated with sex, anxiety and depression. Psychological inflexibility was only associated with severe insomnia (odds ratio = 1.04). These findings are important from a public health perspective because behavioural strategies designed to treat insomnia with a focus on psychological flexibility are low-cost and may help improve sleep quality in adults with insomnia, which also influences mental health.
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Introduction Appropriate quality and quantity of sleep are critical for good mental health, optimal body functioning, memory consolidation, and other cognitive processes. Objectives To evaluate the sleeping patterns of medical students in Saudi Arabia and their relationships with psychological distress. Methods This was a cross-sectional, self-administered, questionnaire-based study. The study included medical students from a university in Jeddah, Saudi Arabia. The Pittsburgh Sleep Quality Index (PSQI) and the Athens Insomnia Scale (AIS) were used to evaluate the prevalence and burden of inadequate sleep quality and insomnia in the participants. Results The majority of the participants was women (76.6%). Furthermore, most participants (96.2%) were aged between 18 and 24 years old, while 54.4% of the participants were in their senior year. According to the AIS scores (mean: 15.85 ± 4.52), 98.7% of the participants exhibited insomnia symptoms. The PSQI scores (mean: 9.53 ± 5.67) revealed that 70.5% of the participants had poor sleep quality. Students in their fundamental and junior years had significantly higher percentages of insomnia symptoms and poor sleep quality compared with students in their senior years. Conclusion The prevalence of insomnia and poor sleep quality is high among medical students. Therefore, appropriate strategies for early detection and intervention are warranted.
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OBJECTIVE: To examine whether objective sleep parameters are associated with cognitive function (CF) in patients with major depressive disorder (MDD) with chronic insomnia (CI) and whether the severity of these disorders is related to CF. METHOD: Thirty patients with MDD with CI attending a tertiary care institution underwent two consecutive nights of polysomnographic (PSG) recording and a battery of neuropsychological tests, which included episodic memory, sustained attention, working memory, and executive function. The severity of MDD and CI was assessed by clinical scales. We examined the relationship between PSG parameters and CF, as well as whether the severity of the disorders is related to CF. RESULTS: Linear regression analysis revealed that total sleep time (TST) was positively associated with higher learning and recall of episodic memory, as well as better attention. Slow-wave sleep (SWS) showed a positive association with better working memory. Furthermore, wake after sleep onset (WASO) was negatively associated with episodic memory and lower attention. No significant relationships were found between the severity of MDD or CI with CF. CONCLUSION: Both sleep duration and depth are positively associated with several aspects of CF in patients with MDD with CI. Conversely, a lack of sleep maintenance is negatively related to CF in these patients. These findings could help identify modifiable therapeutic targets to reduce CF impairment.
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Cognição , Transtorno Depressivo Maior , Polissonografia , Distúrbios do Início e da Manutenção do Sono , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Atenção , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/psicologia , Memória Episódica , Memória de Curto Prazo , Gravidade do Paciente , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Testes NeuropsicológicosRESUMO
OBJECTIVES: Polygenic scores (PGS) for sleep disturbances and depressive symptoms in an epidemiological cohort were contrasted. The overlap between genes assigned to variants that compose the PGS predictions was tested to explore the shared genetic bases of sleep problems and depressive symptoms. METHODS: PGS analysis was performed on the São Paulo Epidemiologic Sleep Study (EPISONO, N = 1042), an adult epidemiological sample. A genome wide association study (GWAS) for depression grounded the PGS calculations for Beck Depression Index (BDI), while insomnia GWAS based the PGS for Insomnia Severity Index (ISI) and Pittsburg Sleep Quality Index (PSQI). Pearson's correlation was applied to contrast PGS and clinical scores. Fisher's Exact and Benjamin-Hochberg tests were used to verify the overlaps between PGS-associated genes and the pathways enriched among their intersections. RESULTS: All PGS models were significant when individuals were divided as cases or controls according to BDI (R2 = 1.2%, p = 0.00026), PSQI (R2 = 3.3%, p = 0.007) and ISI (R2 = 3.4%, p = 0.021) scales. When clinical scales were used as continuous variables, the PGS models for BDI (R2 = 1.5%, p = 0.0004) and PSQI scores (R2 = 3.3%, p = 0.0057) reached statistical significance. PSQI and BDI scores were correlated, and the same observation was applied to their PGS. Genes assigned to variants that compose the best-fit PGS predictions for sleep quality and depressive symptoms were significantly overlapped. Pathways enriched among the intersect genes are related to synapse function. CONCLUSIONS: The genetic bases of sleep quality and depressive symptoms are correlated; their implicated genes are significantly overlapped and converge on neural pathways. This data suggests that sleep complaints accompanying depressive symptoms are not secondary issues, but part of the core mental illness.