"Life" beyond classical test theory: some considerations on using complementary psychometric approaches in sleep medicine

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A hipótese da hiperativação na insónia psicofisiológica: estudo da default-mode network e sua modificação após TCC

Doutoramento em PsicologiaA insónia primária é a perturbação do comportamento de sono mais prevalente quer na população clínica quer na comunidade. Uma das formas mais comuns é a insónia psicofisiológica (IP). A hiperativação neuropsicofisiológica, afetiva, cognitiva e comportamental assim como o condicionamento mal-adaptativo entre estímulos associados ao sono e à cama com estímulos indutores de ativação são duas das características mais diferenciadoras desta patologia. Tendo por base a importância que esta perturbação assume em termos de saúde pública, levou-se a cabo 4 estudos empíricos com recurso a ressonância magnética funcional: No primeiro estudo comparou-se a ativação neurobiológica entre um grupo de doentes com IP (n=5) e um grupo de indivíduos saudáveis (n=5) emparelhado quanto ao sexo e à idade quando eram confrontados com palavras que remetiam para preocupações do passado/presente, preocupações do futuro e palavras neutras; no segundo estudo, explorou-se as diferenças na ativação referente à default-mode network (DMN) e outras resting-states nos mesmos grupos do estudo 1; no terceiro e quarto estudos, repetiram-se os mesmos procedimentos para um grupo clínico (N=2) após estes terem sido submetidos a terapia cognitivo-comportamental para a insónia (TCC-I). No geral, verificou-se que os doentes com IP exibiram um padrão generalizado de hiperativação em áreas associadas à DMN quer quando confrontados com estímulos ativadores quer em repouso; em termos de ativação nas resting-states, constatou-se que, em repouso, o grupo clínico apresentou disfunções significativas. Após TCC-I, observou-se que os indicadores disfuncionais verificados nos estudos anteriores se esbateram tendendo a aproximar-se do perfil de ativação dos indivíduos saudáveis. Os resultados obtidos reforçam assim a ideia da hiperativação na insónia ao longo das 24 horas do dia assim como do papel fundamental que a ativação cognitiva parece ter na etiopatogenia e no tratamento da insónia. Para além disso, este trabalho contribui para um melhor entendimento da neurobiologia da insónia e sugere que se podem identificar mecanismos neuronais subjacentes às modificações operadas pela TCC-I.Primary Insomnia is the more prevalent sleep disorder both in clinical and community samples. One of the most frequent subtypes is psychophysiological insomnia (PI). The hyperarousal at different levels – biological, affective, cognitive, and behavioral – and the maladaptive conditioning between sleep-related stimuli and arousal are two major features of PI. Since this is a disorder which assumes an important role in public health, we performed 4 empirical studies recurring to fMRI: In the first study, we compared neurobiological activation between a group of PI patients (n=5) and a sex- and age-matched control group (n=5) when they were exposed to words concerning to past/present worries, future worries and neutral words; in the second study, we explored the activity of default-mode network (DMN) and other brain resting-states in the same groups as study 1; in the third and fourth studies, we repeated both experiments in a clinical group of patients with PI (N=2) after they underwent cognitive-behavioral therapy for insomnia (CBT-I). In general, it was observed that PI patients exhibited a generalized pattern of hyperarousal in several brain areas associated with DMN when they were confronted with affective stimuli and when they were resting in the fMRI scanner. In terms of activation of brain resting networks, we observed that the clinical group presented significant dysfunctions. After CBT-I, it was detected that the dysfunctional indicators observed in previous studies normalize, approaching the activation patterns typical of healthy individuals. The obtained results enhance the idea that the hyperarousal in PI is present during the 24-hours of the day; besides, the key role that cognitive arousal may be in the etiology and therapy of insomnia is also highlighted. In conclusion, this work contributes to a better understanding of neurobiology of insomnia and suggests that it might be possible to identify neural mechanisms underlying modifications accounted by CBT-I

Medidas de autorresposta como exames complementares no diagnóstico de insónia

[This paper has no abstract. First 111 words are shown] Chronic insomnia disorder (CID) is a highly prevalent sleep disorder and a public health problem (Riemann et al., 2017). It is well recognized as a subjective disorder. Subjective because the diagnosis is fundamentally based on the self-report/complaints of the patients and in the clinical assessment of the sleep expert through a systematic clinical interview – which is the standard method (gold standard) for establishing a diagnosis of CID (Marques et al., 2018). On the contrary, the diagnosis of other sleep disorders demands the so-called objective measures such as polysomnography (PSG) (Riemann et al., 2017). We cannot forget that being CID a subjective disorder, it is important to be exhaustive in clinical assessment.[Este artigo não tem resumo. Apresentam-se as primeiras 112 palavras] A insónia crónica é um distúrbio de sono muito prevalente constituindo um problema de saúde pública (Riemann et al., 2017). É caracterizada por ser um distúrbio subjetivo. Subjetivo, uma vez que o diagnóstico é baseado essencialmente no auto-relato/nas queixas dos doentes e na avaliação do especialista de sono através de uma entrevista clínica sistemática que, na prática, constitui o método de eleição para o diagnóstico (gold standard) (Marques et al., 2018). Por sua vez, o diagnóstico de outros distúrbios do sono requerem a utilização das chamadas "medidas objetivas" como a polissonografia (Riemann et al., 2017). Sendo a insónia crónica um distúrbio subjetivo, é importante proceder a uma avaliação clínica exaustiva

The Role of Sleep Effort as a Mediator Between Anxiety and Depression

Depression, anxiety, and insomnia are all conditions that share a complex bidirectional relationship. Sleep effort is a construct with cognitive and behavioral components that perpetuates insomnia. Although many studies have examined the associations between these three variables, no studies have yet examined sleep effort as a mediating variable between anxiety and depression and vice versa. Online versions of the Hospital Anxiety and Depression Scale and the Glasgow Sleep Effort Scale were administered to a sample of 1927 higher education students aged 18–40 years (75.9% women and 76% from 18 to 23 years old). As part of the survey, participants also completed a sociodemographic questionnaire. Mediation analysis indicated that sleep effort mediates the relationship between depression and anxiety, when the former was the predictor and the latter was the criterion. Moreover, sleep effort also mediated the relationship between anxiety and depression when the former was the predictor and the latter was the criterion, albeit in a lesser extent. Sleep effort appears to play a bidirectional mediational role between depression and anxiety, being a potential target for intervention

Circadian preferences in young adults: Psychometric properties and factor structure of the Portuguese version of the Preferences Scale (PS-6)

Morningness is a trait-like variable which has been extensively studied within chronobiology. Despite the number of existing measures to assess morningness, there is a need for brief instruments that are psychometrically sound to be used in applied settings. Accordingly, the modified version of the Preferences Scale (PS-6) comprises six items and was reported to have adequate reliability and satisfactory validity indicators. In this article, the psychometric properties of the Portuguese version of the PS-6 are reported. A total of 700 students attending medical school were recruited, and this sample was randomly divided into two groups. In the first group (n = 352), we assessed the internal consistency calculations and conducted a principal component analysis of the posited structure. In the second group (n = 348), we conducted a confirmatory factor analysis (CFA) using structural equation modeling. Overall, the results indicated that the PS-6 has adequate reliability (α = .75) and is constituted by two components: (I) preferred cognitive activities timings and (II) preferred sleeping-eating timings, respectively. In conclusion, the Portuguese version of the PS seems suitable for use in research and applied settings such as shift work schedules management. However, the applicability of the PS-6 in other samples and further validity indicators should be both investigated. The use of actigraphy and biological measures should also be collected to enhance the robustness of the PS-6

Postural stability in pre-pubertal school children: sex and maturity-associated variation

Prepubescent children experience a dynamic developmental period marked by rapid changes in body size, shape and composition, whose magnitude depends on sex and maturity status. The purpose of this study was to analyze sex and maturity- associated variation on the postural stability at a time of rapid changes such as the pre-pubertal growth spurt. This was a cross-sectional study involving 312 children (10.8 ± 0.4 years), 152 boys and 160 girls, who were self-assessed as belonging to Tanner stages I (n= 209) and II (n=103). Postural balance control was evaluated using the single-legged flamingo balance test. Anthropometric and morphological measurements were also carried out. The more biologically mature prepubescent children expressed higher weight, body mass index, body fat percentage and endomorphic component than the less mature. However, no advantage of biologically mature children in postural stability was found compared with their less mature peers. Interestingly, girls outperformed boys in the postural stability test, but no interaction between sex and maturity status was observed. The particularity of anthropometric and morphological changes in the pre-pubertal growth spurt, together with sensorial (i.e., vestibular system) and environmental influences, may have influenced the impact of maturity status on postural stability. This could be considered important to teachers and coaches to adapt practical tasks related to maturity status and sex

Strength training adaptations associated with an 8-week suspension training program in prepubecent boys

The effectiveness of suspension training (ST) on strength has not been investigated in prepubescent children yet. Thirty-eight boys (10.87±0.50 years) were randomly assigned into an experimental group (ST: n=20) to train twice a week for 8 weeks, and a control group (C: n=18; no training program). In the post-training, it was observed a significant difference and large effect size of group on training-induced explosive strength (F(1,36)=15.30, p<0.001, =0.74). Explosive strength measures significantly increased only on the ST group. Differences were observed in the 1 and 3 kg medicine ball throws (5.8 and 8.8%, respectively, p<0.001), in the counter movement vertical jump (7.2%, p<0.001), in the standing long jump (7.4%, p<0.001) and in the time-at-20m (1.2%, p<0.001). This could be considered an alternative methodology to optimize explosive strength training in school-based programs.O objetivo do estudo foi analisar os efeitos de treino de força (ST) com TRX® na força explosiva em rapazes pré-púberes. Trinta e oito rapazes (10.87±0.50 anos) foram distribuídos aleatoriamente num grupo experimental (ST: n=20) para treinar duas vezes por semana, durante 8 semanas, e um grupo de controlo (C: n=18; sem programa de treino). No pós-treino, foi observado um efeito estatisticamente significativo e de elevada dimensão do fator grupo na força explosiva induzida pelo treino (F(1,36)=15.30, p<0.001, =0.74). As medidas de força explosiva melhoraram significativamente apenas no grupo ST. Observaram-se diferenças nos lançamentos de bolas medicinais de 1 e 3 kg (5.8 e 8.8%, respetivamente, p<0.001), no salto vertical com contramovimento (7.2%, p<0.001), no salto longitudinal (7.4%, p<0.001) e no tempo de corrida de 20m (1.2%, p<0.001). O treino de força com TRX® poderá ser considerado como alternativa para otimizar o treino da força explosiva na escola

Body fat in prepubertal boys: different training program`s designs

This project was supported by the National Funds through FCT - Portuguese Foundation for Science and Technology (UID/DTP/04045/2013) - and the European Fund for regional development (FEDER) allocated by European Union through the COMPETE 2020 Programme (POCI-01-0145-FEDER-006969), and it was supported by the Project NanoSTIMA: Macro-toNano Human Sensing, Towards Integrated Multimodal Health Monitoring and Analytics, NORTE-01-0145-FEDER-000016, co-financed by European Fund for Regional Development (FEDER) - NORTE 2020Research studies agreed that strength and aerobic training either combined or performed separately promote bone density, aerobic capacity, and explosive strength improvements in childhood. Nevertheless, there still is uncertainty regarding to the best training program to be implemented that efficiently improve body fat percentage. The current study aimed to compare different training program’s designs on body fat percentage in prepubertal boys.One hundred twenty-three boys (10.93 ± 0.57 years) were randomly assigned into five experimental groups to perform different training protocols for 8 weeks: strength-only (SG), aerobic-only (AG), inter-session concurrent aerobic-strength training (ASG_2), intra-session concurrent aerobic-strength training (ASG), intra-session concurrent strength-aerobic training (SAG), and a control group, no training (CG). SG, AG, ASG and SAG groups performed single sessions two days per week. ASG_2 group performed on different days each week (two and two days per week). The strength training program comprised plyometric exercises (medicine ball throws and jumps) and sprint running. The aerobic training program comprised the 20m shuttle run exercise. Body fat percentage was assessed using a body composition analyzer (Tanita TBF-300A) before and after the 8-weeks of the training program.Body fat percentage showed significant decrements from pre- to the post-training in the ASG_2 (17.6%, p=0.004), SG (16.1%, p=0.000), and SAG (17.7%, p=0.000) groups. There was an impairment in the ASG (4.2%, p=0.492) and control group CG (16.8%, p=0.000). No differences were presented in the AG (p=0.053).The order of intra-session concurrent training influenced body fat percentage changes. Moreover, performing intra-session concurrent strength and aerobic training is more useful than strength or aerobic training only and concurrent training in different sessions to decrease body fat percentage in prepubertal boys. These results have a meaningful interest to optimized school-based fat loss exercise programs in childhood