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Los estudiantes universitarios están propensos a sufrir alteraciones en el sueño como la somnolencia diurna, lo cual tiene repercusión directa en su calidad de vida y desempeño diario. Objetivo. Determinar la relación entre la calidad de sueño y somnolencia diurna en estudiantes de la Universidad nombre, en Perú. Materiales y Métodos. Se consideró el enfoque cuantitativo, de diseño no experimental, con la aplicación de los instrumentos de calidad del sueño de Pittsburgh y la escala de somnolencia Epworth. La población fue de 446 estudiantes y se obtuvo una muestra de 220 estudiantes universitarios, mediante un muestreo no probabilístico. Resultados. Se presentan severos problemas en relación a la calidad del sueño en un 60,9 %; así como en la calidad subjetiva del sueño en un 49,5 %, duración del sueño en un 54,5 %, uso de medicación hipnótica en un 56,8 %, disfunción diurna 50,5 %; y la latencia del sueño, eficiencia de sueño habitual y alteraciones del sueño en un 57,7 %. Entre tanto, la somnolencia diurna fue alta en un 58,6 %. Conclusiones. Existe relación positiva y significativa entre la calidad del sueño y la somnolencia diurna en los alumnos de la Universidad nombre, alcanzando una ρ = 0.000 (ρ < 0.05); del mismo modo se encontró relación significativa en cada una de las dimensiones de la calidad del sueño y la somnolencia diurna; de lo que se interpreta que la calidad del sueño de problemas de nivel leve, la somnolencia diurna se encuentra en niveles bajos en los universitarios.

University students are prone to sleep disturbances such as daytime sleepiness, which has a direct impact on their quality of life and daily performance. Objective. Determine the relationship between sleep quality and daytime sleepiness in students at the Universidad Nombre, in Peru. Materials and methods. The quantitative approach was considered, with a non-experimental design, with the application of the Pittsburgh sleep quality instruments and the Epworth sleepiness scale. The population was 446 students and a sample of 220 university students was obtained, through non-probabilistic sampling. Results. There are severe problems in relation to sleep quality in 60.9 %; as well as in the subjective quality of sleep in 49.5 %, duration of sleep in 54.5 %, use of hypnotic medication in 56.8 %, daytime dysfunction 50.5 %; and sleep latency, habitual sleep efficiency and sleep disturbances by 57.7 %. Meanwhile, daytime sleepiness was high at 58.6 %. Conclusions. There is a positive and significant relationship between sleep quality and daytime sleepiness in the students of the Name University, reaching ρ = 0.000 (ρ < 0.05); Likewise, a significant relationship was found in each of the dimensions of sleep quality and daytime sleepiness; from which it is interpreted that the quality of sleep has mild problems, daytime sleepiness is at low levels in university students.

Os estudantes universitários são propensos a distúrbios do sono, como a sonolência diurna, o que tem impacto direto na sua qualidade de vida e no desempenho diário. Objetivo. Determinar a relação entre qualidade do sono e sonolência diurna em estudantes da Universidad Nombre, no Peru. Materiais e métodos. Considerou-se a abordagem quantitativa, com desenho não experimental, com aplicação dos instrumentos de qualidade do sono de Pittsburgh e da escala de sonolência de Epworth. A população foi de 446 estudantes e obteve-se uma amostra de 220 estudantes universitários, através de amostragem não probabilística. Resultados. Existem problemas graves em relação à qualidade do sono em 60,9 %; bem como na qualidade subjetiva do sono em 49,5 %, duração do sono em 54,5 %, uso de medicação hipnótica em 56,8 %, disfunção diurna 50,5 %; e latência do sono, eficiência habitual do sono e distúrbios do sono em 57,7 %. Enquanto isso, a sonolência diurna foi elevada, 58,6 %. Conclusões. Existe uma relação positiva e significativa entre a qualidade do sono e a sonolência diurna nos estudantes da Universidade do Nome, atingindo ρ = 0,000 (ρ < 0,05); Da mesma forma, foi encontrada relação significativa em cada uma das dimensões da qualidade do sono e da sonolência diurna; a partir do qual se interpreta que a qualidade do sono apresenta problemas leves, a sonolência diurna é baixa em estudantes universitários.

RESUMO

Los estudiantes universitarios están propensos a sufrir alteraciones en el sueño como la somnolencia diurna, lo cual tiene repercusión directa en su calidad de vida y desempeño diario. Objetivo. Determinar la relación entre la calidad de sueño y somnolencia diurna en estudiantes de la Universidad nombre, en Perú. Materiales y Métodos. Se consideró el enfoque cuantitativo, de diseño no experimental, con la aplicación de los instrumentos de calidad del sueño de Pittsburgh y la escala de somnolencia Epworth. La población fue de 446 estudiantes y se obtuvo una muestra de 220 estudiantes universitarios, mediante un muestreo no probabilístico. Resultados. Se presentan severos problemas en relación a la calidad del sueño en un 60,9 %; así como en la calidad subjetiva del sueño en un 49,5 %, duración del sueño en un 54,5 %, uso de medicación hipnótica en un 56,8 %, disfunción diurna 50,5 %; y la latencia del sueño, eficiencia de sueño habitual y alteraciones del sueño en un 57,7 %. Entre tanto, la somnolencia diurna fue alta en un 58,6 %. Conclusiones. Existe relación positiva y significativa entre la calidad del sueño y la somnolencia diurna en los alumnos de la Universidad nombre, alcanzando una ρ = 0.000 (ρ < 0.05); del mismo modo se encontró relación significativa en cada una de las dimensiones de la calidad del sueño y la somnolencia diurna; de lo que se interpreta que la calidad del sueño de problemas de nivel leve, la somnolencia diurna se encuentra en niveles bajos en los universitarios.

University students are prone to sleep disturbances such as daytime sleepiness, which has a direct impact on their quality of life and daily performance. Objective. Determine the relationship between sleep quality and daytime sleepiness in students at the Universidad Nombre, in Peru. Materials and methods. The quantitative approach was considered, with a non-experimental design, with the application of the Pittsburgh sleep quality instruments and the Epworth sleepiness scale. The population was 446 students and a sample of 220 university students was obtained, through non-probabilistic sampling. Results. There are severe problems in relation to sleep quality in 60.9 %; as well as in the subjective quality of sleep in 49.5 %, duration of sleep in 54.5 %, use of hypnotic medication in 56.8 %, daytime dysfunction 50.5 %; and sleep latency, habitual sleep efficiency and sleep disturbances by 57.7 %. Meanwhile, daytime sleepiness was high at 58.6 %. Conclusions. There is a positive and significant relationship between sleep quality and daytime sleepiness in the students of the Name University, reaching ρ = 0.000 (ρ < 0.05); Likewise, a significant relationship was found in each of the dimensions of sleep quality and daytime sleepiness; from which it is interpreted that the quality of sleep has mild problems, daytime sleepiness is at low levels in university students.

Os estudantes universitários são propensos a distúrbios do sono, como a sonolência diurna, o que tem impacto direto na sua qualidade de vida e no desempenho diário. Objetivo. Determinar a relação entre qualidade do sono e sonolência diurna em estudantes da Universidad Nombre, no Peru. Materiais e métodos. Considerou-se a abordagem quantitativa, com desenho não experimental, com aplicação dos instrumentos de qualidade do sono de Pittsburgh e da escala de sonolência de Epworth. A população foi de 446 estudantes e obteve-se uma amostra de 220 estudantes universitários, através de amostragem não probabilística. Resultados. Existem problemas graves em relação à qualidade do sono em 60,9 %; bem como na qualidade subjetiva do sono em 49,5 %, duração do sono em 54,5 %, uso de medicação hipnótica em 56,8 %, disfunção diurna 50,5 %; e latência do sono, eficiência habitual do sono e distúrbios do sono em 57,7 %. Enquanto isso, a sonolência diurna foi elevada, 58,6 %. Conclusões. Existe uma relação positiva e significativa entre a qualidade do sono e a sonolência diurna nos estudantes da Universidade do Nome, atingindo ρ = 0,000 (ρ <, 05); Da mesma forma, foi encontrada relação significativa em cada uma das dimensões da qualidade do sono e da sonolência diurna; a partir do qual se interpreta que a qualidade do sono apresenta problemas leves, a sonolência diurna é baixa em estudantes universitários.

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In adults, nightmare disorder is related to sleep deprivation, drug consumption or abuse, or other comorbid sleep disorders such as insomnia or insufficient sleep syndrome. Behavioral treatment has solid scientific evidence in disorders such as insomnia and, more recently, parasomnias. The aim of the present study was to investigate the clinical effectiveness of a Brief Behavioral Telemedicine Therapy in Nightmare Disorder in a 23-year-old female patient. The procedure consisted of the case study, with pre and posttreatment measures as well as follow-up after 1 month; and the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Paris Arousal Disorders Severity Scale, and a sleep diary were applied. In parallel with changes recorded in the sleep diary, a decrease in nightmares, sleepiness, and insomnia symptoms was observed when the intervention was finished. The behavioral intervention was clinically effective; therefore, the present case report provides information on behavioral treatments for nightmare disorder.

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The bimodal preference is a fourth diurnal preference proposed by re-scoring the Morningness-Eveningness Questionnaire. The present work aimed to describe the prevalence of the bimodal preference in a sample of undergraduate students and to characterize the bimodal type in terms of their health and sleep-related outcomes. A web-based cross-sectional study conducted between September 2018 and March 2021 (convenience sampling method). The sample was composed of undergraduate students who completed an electronic form that included the Morningness and Eveningness Questionnaire, the Pittsburgh Sleep Quality Index, the Self-Compassion Scale, the Epworth Sleepiness Scale, the Hospital Anxiety and Depression Scale, and the World Health Organization Subjective Well-Being Index. The final sample consisted of 615 students (82% female, mean age: 23.4 ± 6.5 years), of whom 108 (18%) had positive bimodality indexes. Bimodal subjects comprised 48 students, 8% of the total sample. Bimodal subjects had poorer subjective sleep quality, more daytime sleepiness, lower subjective well-being, greater anxiety and depression symptoms, and lower self-compassion than morning and/or intermediate types; they did not differ from evening types. The description of bimodal diurnal preference in this population may be of interest for the design of academic policies more in line with the circadian reality of students.

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Abstract Currently, the percentage of traffic accidents has increased, and according to statistics, this percentage will continue to increase every year, so it is necessary to develop new technologies to prevent this kind of accidents. This paper presents a drowsiness detection system based on electroencephalogram (EEG) signals using a pair of channels (Fp1 and Fp2) applied to drivers before entering their vehicles. First, this model detects the relationship between the area under the curve (AUC) of alpha brain waves, an effective parameter for detecting drowsiness. Then, the extracted information is passed to a fuzzy expert system (FES) that classifies the subject's state as "alert" or "sleepy"; the criterion used was a threshold and training with subjective levels. The proposed system was compared with neural network models, such as support vector machine (SVM), K nearest neighbors (KNN), and random forest (RF). Measurements of one hundred and twenty minutes were performed on each of the ten drivers for two days to test the system. The tests confirm that this system is suitable for preventive measures and that the fuzzy system is superior to traditional neural network methods.

Resumen Actualmente, el porcentaje de accidentes de tráfico ha aumentado, y según las estadísticas, este porcentaje seguirá aumentando cada año, por lo que es necesario desarrollar nuevas tecnologías para prevenir este tipo de accidentes. Este trabajo presenta un sistema de detección de somnolencia basado en señales de electroencefalograma (EEG) utilizando un par de canales (Fp1 y Fp2) aplicado a los conductores antes de entrar en sus vehículos. En primer lugar, este modelo detecta la relación entre el área bajo la curva (AUC) de las ondas cerebrales alfa, un parámetro eficaz para detectar la somnolencia. A continuación, la información extraída se pasa a un sistema experto difuso (FES) que clasifica el estado del sujeto como "alerta" o "somnoliento"; el criterio utilizado fue un umbral y el entrenamiento con niveles subjetivos. El sistema propuesto se comparó con modelos de redes neuronales, como la máquina de vectores de soporte (SVM), K vecinos más cercanos (KNN) y el bosque aleatorio (RF). Se realizaron mediciones de ciento veinte minutos en cada uno de los diez conductores durante dos días para probar el sistema. Las pruebas confirman que este sistema es adecuado para las medidas preventivas y que el sistema difuso es superior a los métodos tradicionales de redes neuronales.

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STUDY OBJECTIVES: Low-sodium oxybate (LXB; calcium, magnesium, potassium, and sodium oxybates; Xywav) contains the same active moiety as high-sodium oxybates (SXBs; SXB [Xyrem] and fixed-dose SXB [Lumryz]), with 92% less sodium, and is approved in the United States for treatment of cataplexy or excessive daytime sleepiness in patients 7 years of age and older with narcolepsy, and idiopathic hypersomnia in adults. Patients with narcolepsy have increased cardiovascular risk relative to people without narcolepsy. LXB's lower sodium content is recognized by the United States Food and Drug Administration in the narcolepsy population as clinically meaningful in reducing cardiovascular morbidity compared with SXBs. The Substitution of Equal Grams of Uninterrupted Xyrem to Xywav study (NCT04794491) examined the transition experience of patients with narcolepsy switching from SXB to LXB. METHODS: Eligible participants were aged 18-80 years with narcolepsy type 1 or 2 on a stable SXB dose/regimen. After 2 weeks, participants transitioned gram-per-gram to LXB for 6 weeks, with opportunity for subsequent titration. Assessments included the Epworth Sleepiness Scale, Patient Global Impression of change, Ease of Switching Medication Scale, and Forced Preference Questionnaire. RESULTS: The study enrolled 62 participants at baseline; 60 transitioned to LXB and 54 completed the study. At baseline and end of the LXB intervention/early discontinuation, respectively, mean total doses were 8.0 and 8.0 g/night; mean Epworth Sleepiness Scale scores were 9.4 and 8.8. Most participants reported improvement (45%) or no change (48%) in narcolepsy symptoms on the Patient Global Impression of change, reported the transition to LXB was "easy" (easy, extremely easy, not difficult at all; 93%) on the Ease of Switching Medication Scale, and preferred LXB compared with SXB (79%) on the Forced Preference Questionnaire, most commonly due to the lower sodium content. CONCLUSIONS: Most participants switched from SXB to LXB with minimal modifications of dose/regimen and reported the transition process was easy. Effectiveness of oxybate treatment was maintained on LXB, and most participants preferred LXB to SXB. No new safety or tolerability issues were identified. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: An Interventional Safety Switch Study (Segue Study) of XYWAV in Narcolepsy; URL: https://classic.clinicaltrials.gov/ct2/show/NCT04794491; Identifier: NCT04794491. CITATION: Macfadden W, Leary EB, Fuller DS, Kirby MT, Roy A. Effectiveness and optimization of low-sodium oxybate in participants with narcolepsy switching from a high-sodium oxybate: data from the Substitution of Equal Grams of Uninterrupted Xyrem to Xywav study. J Clin Sleep Med. 2024;20(9):1467-1477.

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BACKGROUND: The aging population in Mexico, particularly those aged 60 and above, faces challenges in healthcare, including potentially inappropriate prescriptions of benzodiazepines. Physiological changes in older adults make precise drug prescriptions crucial. OBJECTIVE: This study aims to evaluate and compare functionality, cognition, and daytime somnolence in older adults using benzodiazepines versus non-users. Additionally, it outlines the demographic and clinical characteristics of both groups. METHODS: A cross-sectional study enrolled 162 participants aged 60 and above, categorized as benzodiazepine consumers or non-consumers. Assessment tools included Lawton's Index, Montreal Cognitive Assessment, Epworth Sleepiness Scale, and Benzodiazepine Dependence Questionnaire. Statistical analysis employed t-tests and chi-square tests. RESULTS: Benzodiazepine users (n=81) exhibited lower cognitive scores, increased sleepiness, and reduced daily living activities compared to non-users (n=81). Demographically, BZD users had lower education levels. CONCLUSION: Benzodiazepine use in older adults is associated with cognitive decline, daytime somnolence, and functional limitations, emphasizing the need for cautious prescription practices and continual monitoring. This study contributes insights into the impact of benzodiazepines on the cognitive health of older adults in Mexico.

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BACKGROUND: Situational awareness is the acquisition of information from elements present in the work environment, the perception of the meaning of this information, and the prediction of future working conditions. Sleepiness and fatigue can influence an individual's ability to reach situation awareness, decision-making, and performance on a task. OBJECTIVE: This scoping review examines methods used to assess situational awareness, fatigue, sleepiness, and their interrelationships. METHODS: A systematic search of online databases was conducted to identify experimental, peer-reviewed articles published in English between 2017 and 2022. A total of 29 publications were selected for analysis. RESULTS: The selected studies originated from various countries, primarily in the northern hemisphere. Health and automotive engineering were the academic categories with the highest publications. The studies employed objective and subjective methods to assess situational awareness, fatigue, and sleepiness. CONCLUSIONS: Most studies reported a decline in situational awareness during fatigue and sleepiness conditions, although one study did not find this association. Future research should focus on employing objective methods to analyze cognitive factors, increasing sample sizes, and conducting testing in real-world situations.

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BACKGROUND: Uncertainty exists about the impact of OSA and its phenotypes on cardiovascular disease. RESEARCH QUESTION: Are OSA and clinical features such as daytime sleepiness associated with incident subclinical coronary atherosclerosis? STUDY DESIGN AND METHODS: In this prospective community-based cohort study, we administered a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. Coronary artery calcium (CAC; 64-slice multidetector CT scan imaging) was measured at two different time points throughout the study (baseline, between 2010 and 2014, and follow-up, between 2016 and 2018). Incidence of subclinical atherosclerosis was defined as baseline CAC of 0 followed by CAC of > 0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed. RESULTS: We analyzed 1,956 participants with available CAC scores at baseline (mean age, 49 ± 8 years; 57.9% female; 32.4% with OSA). In covariate-adjusted analyses (n = 1,247; mean follow-up, 5.1 ± 0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis (OR, 1.26; 95% CI, 1.06-1.48), with stronger effects among those reporting EDS (OR, 1.66; 95% CI, 1.30-2.12; P = .028 for interaction). Interestingly, EDS per se was not associated with any CAC outcome. An exploratory analysis of the square root of CAC progression (baseline CAC > 0 followed by a numerical increase in scores at follow-up; n = 319) showed a positive association for both OSA (ß = 1.084; 95% CI, 0.032-2.136; P = .043) and OSA with EDS (ß = 1.651; 95% CI, 0.208-3.094; P = .025). INTERPRETATION: OSA, particularly with EDS, predicts the incidence and progression of CAC. These results support biological plausibility for the increased cardiovascular risk observed among patients with OSA with excessive sleepiness.

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Sleepiness is a multicausal condition, and previous research has highlighted associations between this symptom and the circadian timing system, specifically concerning social jetlag and sleep variability. Recent inquiries have shown that the effects of social jetlag on sleepiness can be confounded with the consequences of sleep debt. In light of the current evidence, we aimed to assess the effects of social jetlag and sleep variability on sleepiness and the potential mediating role of sleep debt. We used data from the EPISONO study, a cross-sectional population-based study with a sample size of 1042 participants, representative of the city of Sao Paulo, Brazil. Participants completed the UNIFESP Sleep Questionnaire (self-reported bedtime and get-up time) and the Epworth Sleepiness Scale (subjective daytime sleepiness). Subsequently, sleep-corrected mid-sleep time (chronotype), total sleep time, social jetlag (absolute difference between the mid-sleep time on workdays and mid-sleep time on free days), sleep variability (standard deviation of mid-sleep time), and sleep debt (difference between total sleep time on workdays and free days) were calculated. Generalised linear models were used to test whether social jetlag and sleep variability affected sleepiness. Mediation models were used to determine if any observed significant effects were mediated by sleep debt. The prevalence of social jetlag was 23% for >1 h and 12% for >2 h. The mean sleep variability was 41 ± 30 min. Social jetlag had a significant effect on the Epworth Sleepiness Scale scores. This association was no longer statistically significant after controlling for age, sex, body mass index, work schedule, and chronotype. A significant indirect effect of social jetlag on sleep debt and subsequently on the Epworth Sleepiness Scale scores was found. No effect of sleep variability on sleepiness could be identified. In conclusion, the association between social jetlag and sleepiness was mediated by sleep debt but was not independent of demographic, work, and chronotype variables. This study provides new evidence on the importance of circadian misalignment and sleep debt for sleep health on a population level.

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SUMMARY OBJECTIVE: The aim of this study was to assess medical students' quality of sleep and excessive daytime sleepiness in different graduation cycles. METHODS: A cross-sectional study was carried out at a private university in Maceió, Brazil, from August 2021 to March 2022. The sample was composed of medical students aged 18 years and above from years 1-2 (basic cycle), 3-4 (clinical cycle), and 5-6 (internship) of Medical School who were invited to answer two validated questionnaires: the Pittsburgh Sleeping Quality Index and the Epworth Sleepiness Scale. RESULTS: A total of 179 students participated; most of them were female (78.2%), aged 19-25 years (73.7%), and with a body mass index<25 kg/m2 (73.7%), with smaller participation from students from the basic cycle (21.2%). Analyzing the Pittsburgh Sleeping Quality Index, 55.9% of the students were classified as having poor sleep quality, with no difference in sleep category between gender, age, body mass index, and graduation cycle. Students with a body mass index of ≥25 kg/m2 had longer sleep latency (p=0.016) and shorter sleep duration (p=0.027). The Epworth Sleepiness Scale assessment showed that 44.1% of the students exhibit daytime sleepiness. Women had more daytime sleepiness than men (p=0.017), with no difference between age, body mass index, and graduation cycle. CONCLUSION: About half of the medical students experience poor sleep quality and daytime sleepiness, regardless of the graduation cycle. This should trigger a targeted institutional intervention to promote better mental and physical health, as well as sleep hygiene, to reduce future health issues.

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SUMMARY OBJECTIVE: This study aimed to evaluate the quality of sleep in individuals with systemic sclerosis and its correlation with the quality of life and disability. METHODS: This is a cross-sectional study, carried out in a tertiary service of a university hospital. Inclusion criteria were diagnosis of systemic sclerosis according to the criteria of the American College of Rheumatology/European League Against Rheumatism 2013 or the preliminary criteria of the American College of Rheumatology 1980, age ≥ 18 years; regularly monitored at the outpatient clinic of rheumatology. Clinical and demographic data of the patients were obtained through a structured interview and evaluation of the medical records. Sleep quality was assessed using the Pittsburgh Sleep Quality Index questionnaire, daytime sleepiness using the Epworth Sleepiness Scale, quality of life using 12-item short-form health survey, and disability using the scleroderma health assessment questionnaire. RESULTS: A total of 50 patients with systemic sclerosis were included, with 92% female, mean age 48.9 years, mean disease duration 8.9 years, and 60% limited cutaneous form. Most systemic sclerosis patients (84%) have poor sleep quality and 20% have excessive daytime sleepiness. There was a significant negative correlation between Pittsburgh Sleep Quality Index and the physical and mental components of the 12-item short-form health survey (r=-0.42, p=0.003 and r=-0.43, p=0.002, respectively) and a positive correlation with the scleroderma health assessment questionnaire (r=0.52, p=<0.001). CONCLUSION: This study showed that poor sleep quality is a very common finding among systemic sclerosis patients, and it negatively affects both the quality of life and the degree of disability.

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Purpose: The aim of the present study is to analyze the association between physical activity and sleep indicators among adolescents. Methods: Cross-sectional study involving 647 adolescents (53.0% female). Leisure time physical activity at low and at moderate to vigorous intensities (420 min/week) were the independent variables and the outcomes were daytime sleepiness, classroom sleepiness, poor sleep perception, sleep duration, bedtime, and wake up time. The multivariate association was performed by Poisson regression to estimate Prevalence Ratios (PR). Results: Not achieving 420 min/week of physical activity at light and at moderate to vigorous intensities was associated with a higher prevalence ratio for classroom sleepiness (PR=1.79 and 1.64), daytime sleepiness (PR=1.25 and 1.17), and poor sleep perception (PR=1.52 and 1.27), all P<0.05. However, not achieving 420 min/week showed the opposite association and decreased the prevalence ratio for having a sleep duration <8h (PR=0.74 and 0.72), P<0.05. No association was found between physical activity and bedtime or wake up time. Mediation analysis revealed that the association between physical activity and daytime sleepiness was fully mediated by a poor perception of sleep quality, while classroom sleepiness showed a partial mediation. Conclusion: Physical activity seems to have a positive effect on daytime sleepiness, classroom sleepiness, and perceived sleep quality. Poor sleep perception was the pathway through which physical activity was associated to sleepiness in the present sample. Conversely, physical activity reduced the likelihood of students achieving 8h of sleep.

Objetivo: O objetivo do presente estudo é analisar a associação entre atividade física e indicadores de sono em adolescentes. Metodologia: Estudo transversal envolvendo 647 adolescentes. A atividade física no tempo livre nas intensidades leve e moderada a vigorosa (420 min/semana) foram as variáveis independentes e os desfechos foram: sonolência diurna, sonolência em sala de aula, percepção de sono ruim, duração do sono, hora em que se deita e acorda. A associação multivariada foi realizada por meio da regressão de Poisson para estimar as Razões de prevalência (PR). Resultados: Não atingir 420 min/semana de atividade física leve e moderada a vigorosa se associou com a maior razão de prevalência de sonolência em sala de aula (PR=1,79 e 1,64), sonolência diurna (PR=1,25 e 1,17) e percepção de sono ruim (PR=1,52 e 1,27), P<0,05. No entanto, não atingir 420 min/semana demonstrou associação oposta e reduziu a razão de prevalência para duração de sono <8h (PR=0,74 e 0,72), P<0,05. Nenhuma associação foi encontrada entre atividade física e hora de deitar ou acordar. A associação entre atividade física e sonolência diurna foi mediada de forma completa pela percepção de sono ruim, enquanto que a sonolência em sala de aula foi mediada parcialmente. Conclusão: A atividade física parece ter efeito positivo na sonolência diurna, em sala de aula e na percepção de sono. A percepção de sono foi a via pela qual a atividade física associou-se à sonolência na amostra estudada. Por outro lado, a atividade física reduziu a probabilidade de estudantes atingirem 8h de sono.

Objetivos: El objetivo del presente estudio es analizar la asociación entre actividad física e indicadores de sueño en adolescentes. Metodología: Estudio transversal en el que participaron 647 adolescentes. La actividad física en el tiempo libre a intensidades ligera y moderada a vigorosa (420 min/semana) fueron las variables independientes y las dependientes fueron: somnolencia diurna, somnolencia en el aula, mala percepción del sueño, duración del sueño, hora de acostarse y despertarse. La asociación multivariada se realizó mediante regresión de Poisson para estimar las razones de prevalencia (RP). Resultados: No alcanzar 420 min/semana de actividad física ligera y moderada a vigorosa se asoció con una mayor razón de prevalencia de somnolencia en el aula (RP=1,79 y 1,64), somnolencia diurna (RP=1,25 y 1,17) y mala percepción del sueño. (RP=1,52 y 1,27), P<0,05. No alcanzar los 420 min/semana demostró la asociación opuesta y redujo la razón de prevalencia para la duración del sueño <8 h (RP = 0,74 y 0,72), P <0,05. No se encontró asociación entre la actividad física y la hora de acostarse o despertarse. La asociación entre actividad física y somnolencia diurna fue completamente mediada por la mala percepción del sueño, mientras que la somnolencia en el aula fue parcialmente mediada. Conclusión: La actividad física parece tener un efecto positivo sobre la somnolencia diurna, en el aula y sobre la percepción del sueño. La percepción del sueño es la forma en que la actividad física redujo la somnolencia en la muestra estudiada. Por otro lado, la actividad física redujo la probabilidad de que los estudiantes alcanzaran las 8 horas de sueño.

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OBJECTIVE: To investigate the subjective risk for obstructive sleep apnea (OSA) in adolescents and young adults with isolated Robin sequence (IRS). Additionally, to investigate the association of OSA risk with respiratory signs/symptoms, and retrognathia. DESIGN: Prospective, observational, and cross-sectional study. SETTING: Tertiary reference hospital for the rehabilitation of craniofacial anomalies. PARTICIPANTS: Adolescents and adults (n = 30) with IRS were clinically evaluated and screened through the Berlin Questionnaire (BQ) and Respiratory Symptoms Questionnaire. The maxillomandibular relationship was assessed on lateral cephalograms of those that reached skeletal maturity (n = 13). Polysomnography (PSG) was performed in a subgroup of 4 individuals. RESULTS: The mean age of the sample was 18.2 (±3.4) years, 17 (56.7%) were adolescents (14-19 years), and 16 were (53.3%) female, all presented a repaired cleft palate. CLINICAL PARAMETERS: Systemic arterial pressure (118.0 ± 4.1/76.3 ± 4.9 mmHg), body mass index (BMI) (20.9 ± 2.8 kg/m2), neck (33.2 ± 2.3 cm), and waist circumferences (72.0 ± 5.8 cm) were within normal ranges. A skeletal class I pattern was observed in 61.5% of the participants while a class II was seen in 15.4% of them. A high risk for OSA was detected in 16.7%, and it was associated with nasal obstruction, snoring and drowsiness, and a skeletal class II pattern (P ≤ .05). One patient presented with mild OSA (apnea-hypopnea index [AHI] = 10.1 events/hour) at the PSG exam. CONCLUSIONS: A high risk for OSA can be observed with a moderate frequency among adolescents and young adults with IRS, especially among those who are concurrently suffering from nasal obstruction, snoring and retrognathia.

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Previous studies have noted the crucial role of excessive daytime sleepiness (EDS) in the course of depressive illness, and more recently, a few studies documented its strong associations with an increased risk of suicide. While insomnia is associated with heightened emotional reactivity, suicidal behaviors, and increased relapses and recurrence. Our main hypothesis is that major depressive episodes (MDE) with insomnia and EDS are associated with more severe manifestations of depression. However, to date, no study has directly compared MDE with insomnia without EDS (Ins), and MDE with insomnia with EDS (InsEDS) using both subjective biomarkers (administration of self-assessment questionnaires for psychiatric evaluation and sleep complaints) and objective biomarkers (of sleep and circadian rhythms (using actigraphy). The InsEDS group, compared to the Ins group, exhibited significantly increased suicidal ideation, larger seasonal impacts on mood, alterations in sleep duration, weight, appetite, energy levels, and social activities throughout the year. Furthermore, they had significant delayed onset of daily activity measured with actigraphy. These findings provided new insights into the link between suicide, sleep, alertness, and biological clock. They also hold significant implications for identifying individuals with more severe depressive manifestations and for developing tailored and personalized therapeutic strategies.

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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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Determinar associação entre qualidade do sono (QS), sonolência diurna excessiva (SDE) e a atividade física (AF) em corredores de rua durante a pandemia deCOVID-19. Em86 voluntários, as seguintes variáveis foram avaliadas: QS (pelo Índice de Qualidade do Sono de Pittsburgh, ESE (pelaEscala de Sonolência de Epworth) e a AF (pelo aplicativo Google Fit®).Utilizou-se o teste de correlação de Pearson ou teste de correlação de Spearman. A análise de regressão linear simples foi realizada entre as variáveis que apresentaram correlação. Consideraram-se significantes os valores de p<0,05. Houve correlação entre a SDE e a contagem de passos, bem como entre a SDE e a AF. Verificou-se associação entre a SDE e a AF, mas não entre a QS e a AF.

To determine the association between sleep quality (SQ), excessive daytime sleepiness (EDS) and physical activity (PA) in amateur street runners during the COVID-19pandemic. Eighty-six volunteers were evaluated, and the analyzed variables were: SQ (By Pittsburgh Sleep Quality Index), EDS (By Epworth Sleepiness Scale), and PA (By the Google Fit® app). The data was collected remotely, via email, using Google Forms. Pearson correlation test or Spearman correlation test was used for data correlation. Simple linear regression analysis was performed between variables that showed correlation. P values < 0.05 were considered significant. There was a correlation between EDS and step count [r (p) = 0.219 (0.042)], and only an association between PA and EDS was observed. Based on the results, an association was found between EDS and PA. However, no association was found between SQ and PA.

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Introdução: Diferentes condições clínicas podem afetar a quantidade e a qualidade do sono. As medidas de higiene do sono interferem diretamente na qualidade deste. Elas podem ser propagadas à população por meio de aplicativos. Objetivo: Desenvolver, avaliar e disponibilizar um aplicativo que contemple as medidas de higiene do sono e que seja capaz de gerar mudança e verificar a ocorrência de sonolência diurna excessiva. Metodologia: O aplicativo "Somnum" foi desenvolvido e 26 fonoaudiólogos certificados em Sono pela Associação Brasileira do Sono foram convidados a avaliar usando o questionário Emory e outro questionário elaborado pelas autoras. Após, 38 estudantes usaram o aplicativo e responderam antes e depois do uso o Índice de Qualidade do Sono de Pittsburgh e a Escala de Epworth. Resultados: Após seu desenvolvimento, o aplicativo foi avaliado por 4 fonoaudiólogas que contribuíram com suas sugestões e 38 universitários participaram respondendo os questionários, sendo que 6 deles participaram antes e após o uso do aplicativo. Sobre o Índice de qualidade de sono de Pittsburgh, foi observado na análise estatística, comparando o antes e após o uso do aplicativo, melhora da qualidade de sono (p=0,04). No que se refere ao questionário Epworth, foi verificado na situação após o uso do aplicativo "Somnum", que não houve diferença significativa. Conclusão: Após o uso do aplicativo, verificou-se possível melhora na qualidade de sono. Houve ocorrência de sonolência diurna excessiva. (AU)

Introduction: Different clinical conditions can affect the quantity and quality of sleep. Sleep hygiene measures directly affect the quality of sleep. They can be disseminated to the population by means of applications. Objective: To develop, evaluate and make available an application that approach sleep hygiene and that is able to generate changes and verify the occurrence of excessive daytime sleepiness. Methodology: The application "Somnum" was developed and 26 speech therapists certified in sleep by the Brazilian Sleep Association were invited to evaluate it using the Emory questionnaire and another questionnaire developed by the authors. Afterwards, 38 students used the application and answered before and after the use the Pittsburgh Sleep Quality Index and the Epworth Scale. Results: After its development, the app was evaluated by 4 speech therapists who contributed with their suggestions, and 38 university students participated by answering the questionnaires, 6 of them before and after the use of the application. In the Pittsburgh Sleep Quality Index, it was observed in the statistical analysis, comparing before and after using the application, improvement in sleep quality (p=0.04). In the Epworth questionnaire, it was verified in the situation after using the "Somnum" application, that there was not significant difference. Conclusion: After using the application, there was a possible improvement in sleep quality. There was occurrence of excessive daytime sleepiness. (AU)

Introducción: Diferentes condiciones clínicas pueden afectar a la cantidad y calidad del sueño. Las medidas de higiene del sueño afectan directamente a la calidad del mismo. Pueden propagarse a la población mediante aplicaciones. Objetivo: Desarrollar, evaluar y poner a disposición una aplicación que incluya medidas de higiene del sueño y que sea capaz de generar cambios y verificar la aparición de somnolencia diurna excesiva. Metodología: Se desarrolló la aplicación "Somnum" y se invitó a 26 fonoaudiólogos certificados en soeño por la Asociación Brasileña del Sonido a evaluarla utilizando el cuestionario Emory y otro cuestionario elaborado por los autores. Posteriormente, 38 estudiantes utilizaron la aplicación y respondieron antes y después del uso de la misma al Índice de Calidad del Sueño de Pittsburgh y a la Escala de Epworth. Resultados: Tras su desarrollo, la aplicación fue evaluada por 4 fonoaudiólogos que aportaron sus sugerencias y 38 estudiantes universitarios participaron respondiendo a los cuestionarios, 6 de ellos antes y después del uso de la aplicación. Sobre el Índice de Calidad del Sueño de Pittsburgh, se observó en el análisis estadístico, comparando antes y después del uso de la aplicación, mejoría en la calidad del sueño (p=0,04). Con respecto al cuestionario de Epworth, se verificó en la situación posterior al uso de la aplicación "Somnum", que no hubo diferencia significativa. Conclusión:Después de usar la aplicación, hubo uma posible mejora em la calidad del sueño. Hubo ocurrencia de somnolencia diurna excesiva. (AU)

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Background Sleep quality and mood have been evaluated in type 1 diabetic (T1DM) patients, but chronotypes were not studied. Our objectives were to analyze chronotypes, sleep and mood variables and to describe their association with some metabolic variables in this population. Methods An observational, cross-sectional study was performed. Adults with a diagnosis of T1DM were included. We evaluated chronotypes by the Morningness-Eveningness Questionnaires, sleep quality by Pittsburgh Sleep Quality Index (PSQI), excessive daytime sleepiness by Epworth Sleepiness Scale (ESS), symptoms of depression by Patient Health Questionnaire - 9 (PHQ-9) and emotional well-being by Emotional Well Being Index (IWHO-5). A few metabolic variables were included. Results Ninety-five patients participated. The mean age was 38 years old (range 18-70). The average body mass index (BMI) was 24.4 Kg/m 2 (standard deviation [SD]: 4.6). Out of the total sample, 52.6% were males. The Intermediate chronotype was predominant: n = 56 (55%). We found poor quality of sleep in 67.4% of the sample, excessive daytime sleepiness in 14.7%, depressive symptoms in 6.3% by PHQ9 and low perception of well-being by IWHO-5 in 16.8%. Evening chronotype scored worse in sleep quality ( p = 0.05) and had lower well-being ( p = 0.03) compared with the other chronotypes. Higher MEQ values (morningness) correlated with lower height ( p = 0.043), lower values in the PSQI ( p = 0.021); and higher values in emotional well-being ( p = 0.040). Conclusions We found that the predominant chronotype in T1DM was the intermediate. Two-thirds reported poor quality of sleep and 14,7% excessive daytime sleepiness. Possible diagnosis of a depressive disorder in 6.3% and poor self-perception of emotional well-being in 16. 8% were observed. The morning chronotype had significant correlation with better sleep quality and higher scores in emotional well-being.

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OBJECTIVES: To conduct cost-utility and budget impact analysis of providing Continuous Positive Airway Pressure (CPAP) therapy versus no treatment for moderate to severe obstructive sleep apnea (OSA) in Colombia from a third-party payer perspective. METHODS: We used a Markov model to assess the cost-utility and budget impact analysis of CPAP in patients over 40 years old with moderate to severe OSA. Data on effectiveness and utility values were obtained from published literature. A discount rate of 5% was applied for outcomes and costs. ICER was calculated and compared against the threshold estimated for Colombia, which is 86% of the GDP per capita. RESULTS: Over a lifetime horizon, the base case analysis showed the incremental cost per quality-adjusted life-years (QALYs) gained with CPAP therapy was COP$3,503,804 (USD$1,011 in 2020 prices). The budget impact analysis showed that the adoption of CPAP therapy in the target population would lead to a cumulative net budget impact of COP$411,722 million (USD$118,784,412 in, 2020 prices) over five years of time horizon. CONCLUSIONS: CPAP was cost-effective compared to no-treatment in OSA. According to the budget impact analysis, adopting this technology would require a budget allocation that is partially offset by reduced number of strokes and traffic accident events.

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