Association between sleep and awake bruxism in patients with migraine

IntroductionWhen migraine undergoes transformation from episodic to chronic form it becomes more disabling due to the refractoriness in treatment and the emergence of comorbidities, with the establishment of a bidirectional relationship between sleep bruxism and chronic migraine. This study aimed to assess whether sleep and awake bruxism are more prevalent in chronic migraine when compared to episodic migraine and also to establish possible clinical correlations with the process of chronification.Methods210 patients were allocated to the study, 97 with episodic migraine and 113 with chronic migraine, who underwent face-to-face interviews with the completion of the scales: specific questionnaire for the diagnosis of sleep and awake bruxism, PHQ-9 (depression), GAD-7 (anxiety), Epworth Scale (daytime sleepiness), MIDAS (migraine incapacity) and HIT-6 (impact of headache). ResultsThe prevalence of sleep and awake bruxism was similar in patients with episodic versus chronic migraine (p = 0.300 and p = 0.238). The correlation of patients with concomitant awake and sleep bruxism and with high scores on the migraine incapacity (MIDAS) and headache impact (HIT-6) scales was higher among patients with chronic migraine than in patients with episodic migraine. (p <0.001 and p <0.001). ConclusionSleep and awake bruxism alone are not more prevalent in chronic migraine when compared to episodic migraine, although bruxism causes greater impact and disability on individuals with chronic migraine.

Optimization of Complex Sanatorium-resort Treatment for Patients with Chronic Insomnia by Including Transcranial Magnetic Therapy

Aim. To determine the effectiveness of the transcranial magnetic therapy course inclusion in the sanatorium-resort treatment complex for patients with chronic insomnia. Material and methods. 122 patients with a verified diagnosis of chronic insomnia were examined, the average age was 54.0±0.92 years, of which 68.9% were women and 31.1% were men. The patients were divided into 2 randomized groups: 62 in the main group (who received health resort treatment complex and transcranial magnetic therapy) and 60 in the comparison group (an identical complex without transcranial magnetic therapy). All patients were evaluated for the index of insomnia severity, symptoms of impaired daytime functioning, daytime sleepiness on the Epworth scale, anxiety and depression on the HADS scale, vegetative tone, polysomnography data, and quality of life (SF-36). Results. As a result of the course of treatment, the average index of insomnia severity in the main group decreased from 20.3±0.32 to 13.0±0.38 (p<0.001), in the comparison group from 19.9±0.32 to 15.3±0.29 (p<0.001). Clinically, in addition to improving sleep quality, patients reported improved daytime functioning significantly more pronounced in the main group for most of the analyzed symptoms (p<0.05). A comparative analysis of the daytime sleepiness results assessment on the Epworth scale, anxiety and depression on the HADS scale before and after treatment showed a statistically significant positive trend more pronounced in the main group (p<0.05). The change in the indicators of vegetative tone in patients with chronic insomnia after treatment was expressed in a statistically significant decrease in the number of patients with sympathicotonia by 15.7% (p<0.05) and an increase in the number of patients with normotonic vegetative support by 17.4% (p<0.05). In the comparison group, the results were significantly worse (p<0.05). After the use of therapeutic complexes, there was a favorable reliable dynamic in the change in polysomnography indicators in patients of both groups, however, the positive result in the main group was more pronounced (p<0.05). the resulting positive assessment of the transcranial magnetotherapy application was a statistically significant improvement in the quality of life of patients in the main group (p<0.05). Conclusion. The inclusion of transcranial magnetotherapy in complex health resort treatment treatment can significantly improve the effectiveness of sleep disorders treatment and improve the quality of life of patients with chronic insomnia.

Association of sleep and wake bruxism in patients with migraine

Introduction: When migraine evolves from episodic to chronic form, it becomes more disabling, due to refractory treatment and the arising of comorbidities. Bruxism has already been associated with migraine in adults, with a bidirectional relationship between sleep bruxism and chronic migraine. This study aimed to assess whether sleep and wake bruxism are more prevalent in chronic migraine when compared to episodic migraine and also to establish possible clinical correlations with chronification. Methods: 210 patients were allocated to the study, 97 with episodic migraine (EM) and 113 with chronic migraine (CM). The patients were submitted to face-to-face interviews with a neurologist to confirm the diagnosis and fill in the scales: specific questionnaire for the diagnosis of sleep and wake bruxism, PHQ-9 (depression), GAD-7 (anxiety), Epworth Scale (sleepness), MIDAS and HIT-6 scales to assess the migraine disability and the headache impact on patients. Results: The prevalence of sleep and wake bruxism was similar in patients with EM versus CM (p=0.300 and p=0.238). The correlation of patients with both bruxism forms at the same time with the high scores on the migraine disability and the headache impact, was higher among patients with chronic migraine than in patients with chronic migraine. episodic migraine (p <0.001). Conclusion: Sleep and wake bruxism alone aren’t more prevalent in chronic migraine when compared to episodic migraine. In patients affected with both bruxism forms, bruxism only causes a greater impact and disability on individuals with chronic migraine.

Association of Obstructive Sleep Apnea and severity of COVID-19: A hospital based observational study

IntroductionOSA has been postulated to be associated with mortality in COVID19, but studies are lacking thereof. This study was done to estimate prevalence of OSA in patients with COVID-19 using various screening questionnaires and to assess effect of OSA on outcome of disease.MethodologyIn this prospective observational study, consecutive patients with RTPCR confirmed COVID 19 patients were screened for OSA by different questionnaires (STOPBANG, Berlin Questionnaire, NoSAS and Epworth Scale). Association between OSA and outcome (mortality) and requirement for respiratory support was assessed.ResultsIn study of 213 patients; screening questionnaires for OSA {STOPBANG, Berlin Questionnaire (BQ), NoSAS} were more likely to be positive in patients who died compared to patients who survived. On binary logistic yregression analysis, age≥55 and STOPBANG score ≥5 were found to have small positive but independent effect on mortality even after adjusting for other variables. Proportion of patients who were classified as high risk for OSA by various OSA screening tools significantly increased with increasing respiratory support (p<0.001 for STOPBANG, BQ, ESS and p=0.004 for NoSAS).ConclusionThis is one of the first prospective studies of sequentially hospitalized patients with confirmed COVID 19 status who were screened for possible OSA. This study shows that OSA could be an independent risk factor for poor outcome in patients with COVID19.

Ansiedade Versus Alterações do Padrão de Sono-Vigília em Estudantes de Medicina

O Curso de Medicina está associado com níveis elevados de ansiedade e de qualidade do sono ruim, refletindo nos profissionais da área daSaúde, que ocupam o terceiro lugar da classificação com maior intensidade de estresse. Estudos relatam que estudantes de medicina dormem menos durante a semana, e por consequência, há diminuição no desempenho acadêmico. Este estudo teve como objetivo avaliar a qualidade do sono e sonolência/insônia relacionadas com a ansiedade entre os estudantes de Medicina das Universidades Anhanguera Uniderp e Federal de Mato Grosso do Sul, em Campo Grande/MS, em 2016. Após a aprovação do CEP, iniciou-se a coleta de dados através de questionários, entre maio a junho de 2016. Foram avaliados 558 alunos da Uniderp e da UFMS do 1º ao 4º ano e se evidenciou que entre os alunos da Uniderp, cursando o quarto período, de acordo com as escalas de Hamilton (Ansiedade) e Epworth (Sonolência), foi significantemente menor do que os alunos que cursavam o primeiro período (teste do qui-quadrado, escala de Hamilton (Ansiedade): p=0,025; escala Epworth (Sonolência): p=0,019, com correção de Bonferroni, p<0,05). O mesmo não foi observado entre os alunos da UFMS (p=0,444 e p=0,392, respectivamente). Em relação ao percentual de alunos com alteração na escala de Pittsburgh (Sonolência), não ocorreu significativamente diferença entre os períodos, em ambas as IES (UFMS: p=0,948; Uniderp, p=0,705). Concluiu-se que, preponderantemente, os acadêmicos das duas instituições apresentam alterações tanto de sono quanto de ansiedade e sonolência excessiva diurna, devendo haver um olhar mais atento a estes quesitos. Palavras-chave: Qualidade de Sono. Sonolência. Aprendizado Baseado em Problemas.AbstractThe Medical school is associated with high levels of anxiety and poor sleeping quality, reflecting in the health professionals’ health, whooccupy the third place of the classification with greater intensity of stress. Studies reported that medical students sleep less during the week, and consequently decreases their academic performance. The purpose of this study was to evaluate the quality of sleeping and anxiety related to sleepiness/insomnia among medical students of Uniderp and the Federal of Mato Grosso do Sul Universities, in Campo Grande-MS, in 2016. The data collection was started through questionnaires between May and June of 2016. The study evaluated a total of 558 students from theboth universities from the 1st to the 4th period. It was evidenced that among the Uniderp students, those in the fourth period obtained resultsof the Hamilton (Anxiety) and Epworth (Sleepiness) scales significantly lower than the students who attended the first period (chi-square test,Hamilton’s scale (Anxiety): p = 0.025; Epworth scale (Sleepiness): p = 0.019, with Bonferroni correction, p <0.05). The same was not observedamong UFMS students (p = 0.444 and p = 0.392, respectively). In relation to the percentage of students with changes in the Pittsburgh scale (Sleepiness), there was no significant difference between the periods in both universities (UFMS: p = 0.948; Uniderp: p = 0.705). It was concluded that the academics of both institutions present alterations in sleeping , anxiety and excessive daytime sleepiness, and there should be a closer look at these questions.Keywords: Sleeping Quality. Somnolence. Problem-Based Learning.

Sleep quality and psychobiological aspects of Brazilian Paralympic athletes in the London 2012 pre-Paralympics period

The objective of the study was to evaluate the psychobiological aspects of the Paralympic athletes athletics mode, before the London Paralympic Games 2012. We evaluated 40 athletes without 31 men and 9 women who were selected by the Brazilian Paralympic Committee to be part of the Brazilian delegation. For the evaluation of psychobiological aspects used questionnaires: Trait Anxiety Inventory-State, POMS, the Beck Depression questionnaire Pittsburgh Epworth Scale to assess, respectively, anxiety, mood, depression, sleep and sleepiness. For trait anxiety and state anxiety, athletes exhibited a mean level of anxiety in relation to the profile of mood states and higher intensity values than any other dimensions. The lower total sleep time was in athletes with bad sleep, sleep deficiency was lower in athletes with poor sleep and total sleep time was lower for those who had efficiency < 85%. All psychobiological variables evaluated in pre-competition period were normal for the athletes of the Brazilian Paralympic athletics team that took part in the London 2012 Paralympic Games.

An evaluation study of the Epworth sleepiness scale adapted for children and adolescents: a tool for case finding of pediatric excessive daytime sleepiness (EDS)

Child and adolescent sleepiness is an important public health issue with potentially serious consequences on attention, learning, behaviour, and quality of life. For some individuals, sleepiness may be due to a sleep disorder which requires clinical investigation and subsequent treatment. A reliable measure of child and adolescent sleepiness is needed and a version of the Epworth Sleepiness Scale has been adapted for use in child and adolescent populations.The adapted Epworth Scale is a questionnaire which aims to identify the chance of falling asleep in 10 different situtations. This questionnaire is normally used in a clinical context as a diagnostic tool. The objective of this study was to investigate whether the adapted Epworth Scale could be used to screen for sleep disorders in a similar manner to the adult scale. This presentation describes a validation study of the adapted Epworth Scale in a population of college students. 9,005 Parisian college students (50.4% female) completed an on-line questionnaire. The mean age was 12.7 years (sd = 1.35). The response rate was greater than 95% for each item of the adapted Epworth score. The mean score was 8.6 / 30 (sd = 4.62).We suggest that the adapted Epworth Scale could be used as a tool for case finding of excessive daytime sleepiness in schools. If the adapted scale is to be used for this purpose, subjects with high scores should be offered investigation to exclude underlying sleep disorders such as narcolepsy, primary hypersomnia or ADHD.