Transtornos do sono em pacientes ambulatoriais com depressão

BACKGROUND: Sleep disorders are a characteristic feature of depressive disorder and can occur in the first stages of depression, anticipate it or act as a residual symptom. OBJECTIVE: To evaluate sleep disorder complaints in outpatients with depressive disorder from a general hospital. METHODS: An observational, cross-sectional study was carried out with a test group of 70 patients (44 women and 26 men) with diagnosis of depressive disorder, according to the DSM-IV criteria. The patients were interviewed and evaluated by the Identification Questionnaire, the Sleep Habits Questionnaire and the Beck Depression Inventory (BDI). RESULTS: In this study, 50 (71.3%) patients had recurrence of sleep disorder complaints. Mean BDI score was 35.83+8.85, with significant differences between patients with (38.50+8.70) and without (29.60+7.80) recurrence (p ; 3 episodes (p ; 3 episódios (p < 0,05) de transtornos do sono. Neste estudo, 49 (70%) pacientes apresentaram insônia e 21 (30%), sonolência excessiva subjetiva. Houve diferença significativa entre a duração média em meses dos transtornos do sono (7,16±2,10) e do transtorno depressivo (6,12±1,90) (p < 0,05). DISCUSSÃO: Na amostra estudada, à recorrência das queixas de transtornos do sono foi elevada e associada significativamente a depressão mais grave. Houve prevalência de insônia, e a duração média dos transtornos do sono foi maior em relação à do transtorno depressivo

O sono e os transtornos do sono na depressão

CONTEXTO: Os transtornos do sono são freqüentemente associados a um leque de transtornos psiquiátricos, sendo considerados uma característica inerente do transtorno depressivo. OBJETIVOS: Discorrer a cerca das atuais evidências sobre as investigações do sono e das alterações deste na depressão, além de alguns dos principais modelos teóricos propostos para explicar essas alterações. MÉTODOS: O levantamento da literatura médica foi feito nos seguintes bancos de dados: ISI e Medline. RESULTADOS: Diversos estudos constataram alterações no padrão eletroencefalográfico do sono em pacientes com depressão. Dentre os principais achados, estão alterações na continuidade e na duração do sono, diminuição das fases 3 e 4 do sono, menor latência do sono REM (rapid eye movements) e maior duração e densidade do primeiro período REM. Essa técnica tem atualmente uma utilidade limitada como ferramenta de diagnóstico na depressão. CONCLUSÕES: Embora os mecanismos fisiopatológicos das alterações do sono na depressão sejam complexos e de natureza multifacetada, os estudos do sono têm um importante papel na investigação da depressão, particularmente nas áreas de predição de resposta a tratamentos, prognóstico de recaídas e na investigação de modelos etiológicos.BACKGROUND: Sleep disorders are usually associated with a wide range of psychiatric disorders, and are regarded as acharacteristic feature of depression. OBJECTIVES:To reportthe current state-of-the-artin sleep research in depression and to present some of the principal theoretical models that explain these sleep disturbances. METHODS: Literature review was carried out in the ISI and Medline databases. RESULTS: Several studies have indicated alterations in sleep electroencephalographic patterns in subjects with depression. Some of the most frequent findings are disorders affecting the continuity and duration of sleep, reduction of phases 3 and 4 of sleep, decreased REM (rapid eye movements) sleep latency, and prolonged and intense first period of REM sleep. This technique is currently of limited use as a diagnostic tool in depression. CONCLUSIONS: AAlthough the pathophysiological mechanisms of sleep disorders in depression are complex, sleep studies play a key role in investigative research in depression, particularly in areas regarding prediction of responses to treatment, prognosis of relapses, and etiological models regarding depression

Relevância clínica de pesadelos em pacientes com transtorno depressivo

INTRODUCTION: Several studies have suggested a strong association between nightmares and depressive disorder. The aim of this study was to detect the prevalence of nightmares among patients with depressive disorders and to observe its relationship with age, sex, duration of disease, severity of depression and suicidal ideation. METHODS: Sixty patients were interviewed and assessed by means of the Beck Depression Inventory (BDI) and the Beck Scale for Suicidal Ideation (SSI). Nightmares were assessed according to the DSM-IV criteria for Nightmare Disorder. Data analyses were performed by Descriptive analyses and Students t-test with statistical significance at pINTRODUÇÃO: Diversos estudos sugerem uma estreita relação entre pesadelos e o transtorno depressivo. O objetivo deste estudo foi detectar a prevalência de pesadelos em pacientes com transtorno depressivo e observar sua relação com idade, sexo, tempo de doença, gravidade do quadro depressivo e ideação suicida. MÉTODOS: Sessenta pacientes foram entrevistados e avaliados por meio da escala de depressão de Beck (EDB) e da escala de ideação suicida de Beck (EIS). Os pesadelos foram avaliados segundo os critérios da DSM-IV para transtorno de pesadelos. A análise dos dados foi realizada mediante a análise descritiva e o teste-t de Student, com nível de significância de 5%. RESULTADOS: Nesta amostra, houve prevalência de 60% de pesadelos nos pacientes, com predominância entre mulheres. Os pacientes deprimidos com pesadelos apresentaram significativamente (p < 0,05) maior tempo de doença depressiva, média de pontuações mais elevadas nas duas escalas e nos itens sobre sensação de fracasso, alterações de sono e ideação suicida da EDB. DISCUSSÃO: Na amostra de pacientes deprimidos estudada, a presença de pesadelos foi relacionada com a gravidade do quadro depressivo e a presença de ideação suicida clinicamente marcante. Assim, os pesadelos devem ser considerados na avaliação de pacientes com transtorno depressivo

Confiabilidade e reprodutibilidade do Questionário de Hábitos do Sono em pacientes depressivos ambulatoriais

BACKGROUND: Recent studies suggest that, together with clinical assessment, sleep questionnaires can adequately characterize sleep complaints in depressed patients. OBJECTIVE: To determine reability and reproducibility of the Sleep Habits Questionnaire in the identification of sleep disorder complaints, such as insomnia and excessive sleepiness, in depressed outpatients. METHODS: A cross-sectional study with a study sample of 70 depressed patients was conducted in the psychiatry outpatient unit of a general hospital. Patients were interviewed and evaluated by the Sleep Habits in two moments and the study design included a test-retest reliability of the answers, which were analyzed and estimated by means of Kappa coefficient. RESULTS: In the reliability and reproducibility analysis, the Kappa coefficient showed high levels of concordance (0.73 a 0.80) for most questions, and in most of the items coefficients were above 0.75. CONCLUSIONS: The Sleep Habits Questionnaire proved to be reliable for the evaluation of insomnia and excessive sleepiness complaints in depressed outpatients.CONTEXTO: Estudos recentes sugerem que, em concomitância com a avaliação clínica, a utilização de questionários do sono permite melhor caracterizar as queixas de sono alterado em pacientes depressivos. OBJETIVO: Determinar a confiabilidade e a reprodutibilidade do Questionário de Hábitos do Sono na identificação das queixas de transtornos do sono, como a insônia e a sonolência excessiva, em pacientes ambulatoriais com transtorno depressivo. MÉTODOS: Realizou-se um estudo transversal com uma amostra de 70 pacientes depressivos no ambulatório de psiquiatria de um hospital geral. Os pacientes foram entrevistados e avaliados por meio do Questionário de Hábitos do Sono em dois momentos, sendo utilizado um desenho de estudo de confiabilidade teste-reteste das respostas que foram analisadas e estimadas pelo coeficiente Kappa. RESULTADOS: Na análise de confiabilidade e de reprodutibilidade, o coeficiente Kappa obteve um nível de concordância forte (0,73 a 0,80) em grande parte das questões, com a maioria dos coeficientes acima de 0,75. CONCLUSÕES: O Questionário de Hábitos do Sono mostrou ser confiável na avaliação das queixas de insônia e de sonolência excessiva em pacientes depressivos ambulatoriais

Short-term complexity of cardiac autonomic control during sleep: REM as a potential risk factor for cardiovascular system in aging.

peer reviewedINTRODUCTION: Sleep is a complex phenomenon characterized by important modifications throughout life and by changes of autonomic cardiovascular control. Aging is associated with a reduction of the overall heart rate variability (HRV) and a decrease of complexity of autonomic cardiac regulation. The aim of our study was to evaluate the HRV complexity using two entropy-derived measures, Shannon Entropy (SE) and Corrected Conditional Entropy (CCE), during sleep in young and older subjects. METHODS: A polysomnographic study was performed in 12 healthy young (21.1+/-0.8 years) and 12 healthy older subjects (64.9+/-1.9 years). After the sleep scoring, heart period time series were divided into wake (W), Stage 1-2 (S1-2), Stage 3-4 (S3-4) and REM. Two complexity indexes were assessed: SE(3) measuring the complexity of a distribution of 3-beat patterns (SE(3) is higher when all the patterns are identically distributed and it is lower when some patterns are more likely) and CCE(min) measuring the minimum amount of information that cannot be derived from the knowledge of previous values. RESULTS: Across the different sleep stages, young subjects had similar RR interval, total variance, SE(3) and CCE(min). In the older group, SE(3) and CCE(min) were reduced during REM sleep compared to S1-2, S3-4 and W. Compared to young subjects, during W and sleep the older subjects showed a lower RR interval and reduced total variance as well as a significant reduction of SE(3) and CCE(min). This decrease of entropy measures was more evident during REM sleep. CONCLUSION: Our study indicates that aging is characterized by a reduction of entropy indices of cardiovascular variability during wake/sleep cycle, more evident during REM sleep. We conclude that during aging REM sleep is associated with a simplification of cardiac control mechanisms that could lead to an impaired ability of the cardiovascular system to react to cardiovascular adverse events

Neuronal excitation/inhibition balance is set by the need for sleep and the biological clock

peer reviewe

Non-Visual Effects of Light on Melatonin, Alertness and Cognitive Performance: Can Blue-Enriched Light Keep Us Alert?

Light exposure can cascade numerous effects on the human circadian process via the non-imaging forming system, whose spectral relevance is highest in the short-wavelength range. Here we investigated if commercially available compact fluorescent lamps with different colour temperatures can impact on alertness and cognitive performance

Circadian and ultradian NREM-REM sleep modulation of dream recall : effects of age and spectral activity

This thesis deals with the electrophysiological correlates of sleep prior to dream recall and the age-related effects on dream processing. The dual NREM/REM sleep cycle and the circadian modulation of REM sleep sum to generate dream processing. However, little is known about the age-related effects on dream recall during both NREM and REM sleep, which comprises the first aim of this thesis. To address this question, seventeen young (20-31 years) and 15 older (57-74 years) healthy volunteers underwent continuous polysomnography recording and hormonal assessments during a 40-h multiple nap protocol (150 minutes of wakefulness and 75 minutes of sleep; 10 naps in total) under constant routine conditions. The analysis of NREM/REM sleep prior to dream recall focused on the last 15 minutes of each nap prior to dream recall. Number of dreams, dream recall and the emotional aspect of dreaming was investigated using the sleep mentation questionnaire. The results indicate that older participants had less dream recall after both NREM and REM sleep, although no differences were observed between the age-groups with respect to the emotional domain of dreaming. Interestingly, older volunteers had fewer dreams after naps scheduled during the biological day (outside the time window of melatonin secretion), which was closely associated with the circadian rhythm of REM sleep. This implies that aging can be associated to decreased amplitude in the circadian modulation of REM sleep, with repercussions on dream recall. Since dreaming crucially relies on the ultradian NREM/REM sleep, it is very likely that differences in the spectral composition of sleep prior to dreaming may pinpoint the cortical networks associated to dream generation. Surprisingly, frequency and regional specific differences in EEG activity prior to dreaming remains both controversial and with mixed results, due to the use of different sleep recordings and dream assessments. To answer this issue, NREM/REM sleep EEG power density associated with and without dream recall was investigated in young participants. NREM sleep was associated with lower EEG power density for dream recall in frontal delta and centro-parietal sigma activity, while REM sleep was associated with low frontal alpha activity, and with high occipital alpha and beta activity. Thus, specific EEG frequency- and topography changes can modulate differences between dream recall and no recall after NREM and REM sleep awakening. In the next logical step, we investigated how age-related changes in sleep structure can impact on dream processing, an issue that remains largely unknown. During NREM sleep prior to dream recall, older participants had higher frontal EEG delta activity and higher centro-parietal sigma activity than the young volunteers. Contrariwise, before no recall, older participants had less frontal-central delta activity and less sigma activity in frontal, central and parietal derivations than the young participants. REM sleep was associated to age-related changes, such that older participants had less frontal-central alpha and beta activity, irrespective of dream recall and no recall. Taken together, age-related differences in dream recall seem to be directly associated to specific frequency and topography EEG activity patterns, particularly during NREM sleep. Thus, aging can result in specific changes for dream processing, most likely through its effects on sleep. The results in this thesis indicate that the circadian and ultradian NREM/REM sleep modulation on dream recall can help to better understand the mechanistic framework of this complex cognitive process

Sleep disorders and suicidal ideation in patients with depressive disorder.

An intrinsic association between suicidal ideation and sleep disorders in patients with depressive disorder has been observed in recent studies. This study was conducted in order to examine the relationship between suicidal ideation and sleep disorders, such as insomnia and excessive sleepiness, in outpatients with major depressive disorder. Seventy patients with diagnoses of major depressive disorder were interviewed and assessed with the Sleep Habits Questionnaire and the Beck Scale for Suicidal Ideation (SSI). Data analyses were performed through descriptive analysis, Students t-test, Chi-square test and logistic regression model, with a statistical significance of 5%. In this study, depressed patients had high SSI scores (6.12+/-2.67), particularly for active suicidal ideation (1.61+/-0.39) and specific plans for suicide components (1.51+/-0.40). Depressed patients with insomnia had significantly higher SSI scores (7.39+/-2.84), in relation to patients with excessive sleepiness (3.68+/-1.73). Furthermore it was observed that insomniac patients had significantly higher scores on the following components: active suicide ideation, specific plans for suicide and previous suicide attempts. The results of multivariate analysis showed that only insomnia had a significant association with suicidal ideation. Thus, sleep disturbances, particularly insomnia, should be considered in the assessment of suicidal risk in outpatients with depressive disorder