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[PMID]:28460138
[Au] Autor:Tucker MA; Morris CJ; Morgan A; Yang J; Myers S; Pierce JG; Stickgold R; Scheer FAJL
[Ad] Endereço:Center for Sleep and Cognition, Beth Israel Deaconess Medical Center, Boston, MA.
[Ti] Título:The Relative Impact of Sleep and Circadian Drive on Motor Skill Acquisition and Memory Consolidation.
[So] Source:Sleep;40(4), 2017 04 01.
[Is] ISSN:1550-9109
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Study Objectives: Sleep during the biological night facilitates memory consolidation. Here we determined the impact of sleep and wake on motor skill learning (acquisition) and subsequent off-line skill improvement (memory consolidation), independent of circadian phase, and compared this to the impact of the endogenous circadian system, independent of whether sleep occurred during the biological night or day. Methods: Participants completed two 8-day sleep laboratory visits, adhering on one visit to a circadian aligned ("normal") sleep schedule for the full duration of the protocol, and on the other to a circadian misaligned (12-hour inverted) schedule, with alignment during the first 3 days, a 12-hour 'slam shift' on Day 4, followed by circadian misalignment during the last 4 days of the protocol. Participants were repeatedly trained and tested on different versions of the finger-tapping motor sequence task across each visit. Results: Sleep facilitated offline memory consolidation regardless of whether it occurred during the biological day or night, while circadian phase had no significant impact. These sleep-related benefits remained after accounting for general motor speed, measured in the absence of learning. In addition, motor skill acquisition was facilitated when the training session followed shortly after sleep, without significant impact of circadian phase (biological morning vs. evening). This effect was largely driven by heightened acquisition in participants who slept during the day and were trained shortly thereafter, that is, when acquisition occurred during the biological evening. These benefits were also retained after controlling for general motor speed. Conclusions: Sleep benefits both the acquisition and consolidation of motor skill regardless of whether they occur during the biological day or night. After controlling for general motor speed, a critical adjustment that few studies perform, these sleep benefits remain intact. Our findings have clear implications for night shift workers who obtain their sleep during the day.
[Mh] Termos MeSH primário: Ritmo Circadiano/fisiologia
Consolidação da Memória/fisiologia
Destreza Motora/fisiologia
Sono/fisiologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Jornada de Trabalho em Turnos
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1093/sleep/zsx036


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[PMID]:29377925
[Au] Autor:Thurman SM; Wasylyshyn N; Roy H; Lieberman G; Garcia JO; Asturias A; Okafor GN; Elliott JC; Giesbrecht B; Grafton ST; Mednick SC; Vettel JM
[Ad] Endereço:U.S. Army Research Laboratory, Human Research & Engineering Directorate, Aberdeen Proving Ground, Maryland, United States of America.
[Ti] Título:Individual differences in compliance and agreement for sleep logs and wrist actigraphy: A longitudinal study of naturalistic sleep in healthy adults.
[So] Source:PLoS One;13(1):e0191883, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:There is extensive laboratory research studying the effects of acute sleep deprivation on biological and cognitive functions, yet much less is known about naturalistic patterns of sleep loss and the potential impact on daily or weekly functioning of an individual. Longitudinal studies are needed to advance our understanding of relationships between naturalistic sleep and fluctuations in human health and performance, but it is first necessary to understand the efficacy of current tools for long-term sleep monitoring. The present study used wrist actigraphy and sleep log diaries to obtain daily measurements of sleep from 30 healthy adults for up to 16 consecutive weeks. We used non-parametric Bland-Altman analysis and correlation coefficients to calculate agreement between subjectively and objectively measured variables including sleep onset time, sleep offset time, sleep onset latency, number of awakenings, the amount of wake time after sleep onset, and total sleep time. We also examined compliance data on the submission of daily sleep logs according to the experimental protocol. Overall, we found strong agreement for sleep onset and sleep offset times, but relatively poor agreement for variables related to wakefulness including sleep onset latency, awakenings, and wake after sleep onset. Compliance tended to decrease significantly over time according to a linear function, but there were substantial individual differences in overall compliance rates. There were also individual differences in agreement that could be explained, in part, by differences in compliance. Individuals who were consistently more compliant over time also tended to show the best agreement and lower scores on behavioral avoidance scale (BIS). Our results provide evidence for convergent validity in measuring sleep onset and sleep offset with wrist actigraphy and sleep logs, and we conclude by proposing an analysis method to mitigate the impact of non-compliance and measurement errors when the two methods provide discrepant estimates.
[Mh] Termos MeSH primário: Actigrafia/métodos
Documentação
Fidelidade a Diretrizes
Sono
Punho
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Voluntários Saudáveis
Seres Humanos
Estudos Longitudinais
Masculino
Personalidade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180130
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191883


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[PMID]:28460124
[Au] Autor:Mantua J; Henry OS; Garskovas NF; Spencer RMC
[Ad] Endereço:Department of Psychological and Brain Sciences, Neuroscienceand Behavior Program, Amherst, MA.
[Ti] Título:Mild Traumatic Brain Injury Chronically Impairs Sleep- and Wake-Dependent Emotional Processing.
[So] Source:Sleep;40(6), 2017 Jun 01.
[Is] ISSN:1550-9109
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Study Objectives : A single traumatic brain injury (TBI), even when mild (ie, concussion), can cause lasting consequences. Individuals with a history of chronic (>1-year prior) mild TBI have an increased risk of mood disturbances (eg, depression, suicide). This population also has lingering sleep alterations, including poor sleep quality and changes in sleep stage proportions. Given these sleep deficits, we aimed to test whether sleep-dependent emotional memory consolidation is reduced in this population. We utilized a mild TBI group (3.7 ± 2.9 years post injury) and an uninjured (non-TBI) population. Methods : Participants viewed negative and neutral images both before and after a 12-hour period containing sleep ("Sleep" group) or an equivalent period of time spent awake ("Wake" group). Participants rated images for valence/arousal at both sessions, and memory recognition was tested at session two. Results : The TBI group had less rapid eye movement (REM), longer REM latency, and more sleep complaints. Sleep-dependent memory consolidation of nonemotional images was present in all participants. However, consolidation of negative images was only present in the non-TBI group. A lack of differentiation between the TBI Sleep and Wake groups was due to poor performance in the sleep group and, unexpectedly, enhanced performance in the wake group. Additionally, although the non-TBI participants habituated to negative images over a waking period, the TBI participants did not. Conclusions : We propose disrupted sleep- and wake-dependent emotional processing contributes to poor emotional outcomes following chronic, mild TBI. This work has broad implications, as roughly one-third of the US population will sustain a mild TBI during their lifetime.
[Mh] Termos MeSH primário: Lesões Encefálicas Traumáticas/fisiopatologia
Lesões Encefálicas Traumáticas/psicologia
Emoções
Sono
Vigília
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Casos e Controles
Doença Crônica/psicologia
Feminino
Seres Humanos
Masculino
Consolidação da Memória
Distúrbios do Início e da Manutenção do Sono
Sono REM
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1093/sleep/zsx062


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[PMID]:29302035
[Au] Autor:Rijo-Ferreira F; Carvalho T; Afonso C; Sanches-Vaz M; Costa RM; Figueiredo LM; Takahashi JS
[Ad] Endereço:Graduate Program in Areas of Basic and Applied Biology, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4099-002, Porto, Portugal.
[Ti] Título:Sleeping sickness is a circadian disorder.
[So] Source:Nat Commun;9(1):62, 2018 01 04.
[Is] ISSN:2041-1723
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Sleeping sickness is a fatal disease caused by Trypanosoma brucei, a unicellular parasite that lives in the bloodstream and interstitial spaces of peripheral tissues and the brain. Patients have altered sleep/wake cycles, body temperature, and endocrine profiles, but the underlying causes are unknown. Here, we show that the robust circadian rhythms of mice become phase advanced upon infection, with abnormal activity occurring during the rest phase. This advanced phase is caused by shortening of the circadian period both at the behavioral level as well as at the tissue and cell level. Period shortening is T. brucei specific and independent of the host immune response, as co-culturing parasites with explants or fibroblasts also shortens the clock period, whereas malaria infection does not. We propose that T. brucei causes an advanced circadian rhythm disorder, previously associated only with mutations in clock genes, which leads to changes in the timing of sleep.
[Mh] Termos MeSH primário: Transtornos do Sono do Ritmo Circadiano/fisiopatologia
Sono/fisiologia
Trypanosoma brucei brucei/fisiologia
Tripanossomíase Africana/parasitologia
[Mh] Termos MeSH secundário: Animais
Temperatura Corporal/fisiologia
Ritmo Circadiano/fisiologia
Fibroblastos/metabolismo
Fibroblastos/parasitologia
Expressão Gênica
Interações Hospedeiro-Parasita
Seres Humanos
Masculino
Camundongos Endogâmicos C57BL
Camundongos Transgênicos
Proteínas Circadianas Period/genética
Transtornos do Sono do Ritmo Circadiano/complicações
Fatores de Tempo
Tripanossomíase Africana/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Period Circadian Proteins)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1038/s41467-017-02484-2


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[PMID]:28455315
[Au] Autor:Lundholm MD; Rooney M; Maas MB; Attarian H; Prabhakaran S
[Ad] Endereço:From the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
[Ti] Título:Wake-Up Stroke Is Associated With Greater Nocturnal Mean Arterial Pressure Variability.
[So] Source:Stroke;48(6):1668-1670, 2017 06.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Wake-up strokes (WUS) account for ≈20% to 30% of ischemic strokes. Studies have shown that increased autonomic instability as measured by blood pressure variability (BPV) is greater in stroke patients than nonstroke patients, but no studies have compared BPV in WUS versus non-WUS patients. METHODS: From a single-center prospective registry, we identified consecutive ischemic stroke patients. BPV was calculated as the coefficient of variation of the mean arterial pressure during the first 24 hours after hospitalization. We assessed 24-hour BPV as a continuous measure and in quartiles in WUS versus non-WUS patients using univariable and multivariable statistics. RESULTS: Among 369 patients (64.9±16.5 years; 50.1% male; 64.7% white), 78 were WUS (21.1%). Clinical characteristics and medical history were not different between WUS and non-WUS patients except WUS patients were older (69.0 versus 63.8 years; =0.015) and more frequently had previous ischemic stroke (29.5% versus 17.2%; =0.012). Initial 24-hour BPV (11.77 versus 10.76; =0.098) was similar between groups. However, WUS patients had greater nocturnal BPV (10.50 versus 8.95; =0.030), whereas daytime BPV was similar between groups (10.96 versus 10.47, =0.459). In multivariate analysis, the highest quartile (≥11.48 mm Hg) of nocturnal BPV was independently associated with WUS (adjusted odds ratio, 1.95; confidence interval, 1.13-3.39; =0.017). CONCLUSIONS: In this single-center study, we observed that greater nocturnal BPV during the first 24 hours after hospitalization occurred in WUS than non-WUS patients. Nocturnal autonomic instability warrants further study as a potential mechanism of WUS.
[Mh] Termos MeSH primário: Pressão Arterial/fisiologia
Doenças do Sistema Nervoso Autônomo/fisiopatologia
Isquemia Encefálica/fisiopatologia
Sono/fisiologia
Acidente Vascular Cerebral/fisiopatologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Doenças do Sistema Nervoso Autônomo/complicações
Isquemia Encefálica/etiologia
Feminino
Hospitalização
Seres Humanos
Masculino
Meia-Idade
Sistema de Registros
Acidente Vascular Cerebral/etiologia
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.016202


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[PMID]:29465549
[Au] Autor:Marques NDSF; Abreu LC; Santos BVD; Neto CFR; Silva JRCD; Braga KKS; Uchôa KDS; Moraes LMS; Ferreira LCP; Ribeiro NG; Santos SLD; Silva TAD; Andrade PE; Raimundo RD
[Ad] Endereço:Laboratory of Study Design and Scientific Writing of the Faculty of Medicine of ABC, Prince of Wales, Santo André/SP-CEP, Brazil.
[Ti] Título:Cardiorespiratory parameters and glycated hemoglobin of patients with type 2 diabetes after a rehabilitation program.
[So] Source:Medicine (Baltimore);97(8):e9321, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Cardiovascular autonomic dysfunction reflex of the pathophysiology of diabetes mellitus (DM) favors an increase in morbidity and mortality related to cardiovascular events, and for this reason has been one of the most studied clinical entities. METHOD: An experimental study of a randomized clinical trial type was therefore proposed to analyze the hemodynamic and glycemic response after the practice of a rehabilitation program in patients with type 2 diabetes mellitus (T2DM). In this clinical trial the patients will initially be submitted to an evaluation protocol that consists of assessing blood pressure, heart rate, Borg scale, respiratory rate, oxygen saturation, distance traveled through the 6-minute walk test, quality of life questionnaire, Pittsburgh sleep quality questionnaire, and still glycated hemoglobin and heart rate variability through the cardiofrequency meter. After careful evaluation of the patients, they will be submitted to a metabolic rehabilitation program composed of aerobic and resisted exercises, performed for 12 weeks, in 3 weekly meetings of 60 minutes each. With such evaluations, it will be possible to construct with evidence that it is possible to work safer metabolic rehabilitation programs in patients with T2DM or other diseases that generate cardiovascular risks, guaranteeing them an improvement in cardiorespiratory fitness, hemodynamic and glycemic variables, allowing improvement of the quality of life. ETHICS AND DISSEMINATION: The protocol is approved by the host institution's ethics committee under the number 1.616.721. Results will be disseminated via peer-reviewed journal articles and conferences. This clinical trial is registered at ClinicalTrials.gov identifier: NCT3094767.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 2
Exercício/fisiologia
Hemoglobina A Glicada/análise
Treinamento de Resistência/métodos
[Mh] Termos MeSH secundário: Adulto
Glicemia/análise
Pressão Sanguínea
Protocolos Clínicos
Diabetes Mellitus Tipo 2/sangue
Diabetes Mellitus Tipo 2/fisiopatologia
Diabetes Mellitus Tipo 2/reabilitação
Feminino
Frequência Cardíaca
Seres Humanos
Masculino
Consumo de Oxigênio
Qualidade de Vida
Sono
Inquéritos e Questionários
Resultado do Tratamento
Teste de Caminhada
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Glycated Hemoglobin A); 0 (hemoglobin A1c protein, human)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009321


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[PMID]:28452285
[Au] Autor:Woelders T; Beersma DGM; Gordijn MCM; Hut RA; Wams EJ
[Ad] Endereço:Chronobiology Unit, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands.
[Ti] Título:Daily Light Exposure Patterns Reveal Phase and Period of the Human Circadian Clock.
[So] Source:J Biol Rhythms;32(3):274-286, 2017 Jun.
[Is] ISSN:1552-4531
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Light is the most potent time cue that synchronizes (entrains) the circadian pacemaker to the 24-h solar cycle. This entrainment process is an interplay between an individual's daily light perception and intrinsic pacemaker period under free-running conditions. Establishing individual estimates of circadian phase and period can be time-consuming. We show that circadian phase can be accurately predicted (SD = 1.1 h for dim light melatonin onset, DLMO) using 9 days of ambulatory light and activity data as an input to Kronauer's limit-cycle model for the human circadian system. This approach also yields an estimated circadian period of 24.2 h (SD = 0.2 h), with longer periods resulting in later DLMOs. A larger amount of daylight exposure resulted in an earlier DLMO. Individuals with a long circadian period also showed shorter intervals between DLMO and sleep timing. When a field-based estimation of tau can be validated under laboratory studies in a wide variety of individuals, the proposed methods may prove to be essential tools for individualized chronotherapy and light treatment for shift work and jetlag applications. These methods may improve our understanding of fundamental properties of human circadian rhythms under daily living conditions.
[Mh] Termos MeSH primário: Relógios Circadianos
Luz
Fotoperíodo
[Mh] Termos MeSH secundário: Adulto
Temperatura Corporal
Ritmo Circadiano
Feminino
Seres Humanos
Síndrome do Jet Lag
Masculino
Melatonina
Sono
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
JL5DK93RCL (Melatonin)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1177/0748730417696787


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[PMID]:29406659
[Au] Autor:Rollins JA
[Ti] Título:Sharing a Room: Updated Recommendations for a Safe Infant Sleeping Environment.
[So] Source:Pediatr Nurs;43(1):7, 14, 2017 Jan-Feb.
[Is] ISSN:0097-9805
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Leitos
Promoção da Saúde
Gestão da Segurança/métodos
Sono
Morte Súbita do Lactente/prevenção & controle
[Mh] Termos MeSH secundário: Aleitamento Materno
Meio Ambiente
Seres Humanos
Lactente
Recém-Nascido
Prevenção Primária
Fatores de Risco
Sociedades Médicas
Estados Unidos
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:180207
[St] Status:MEDLINE


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[PMID]:29394482
[Au] Autor:Zundo K; Richards EA; Ahmed AH; Codington JA
[Ti] Título:Factors Associated with Parental Compliance with Supine Infant Sleep: An Integrative Review.
[So] Source:Pediatr Nurs;43(2):83-91, 2017 Mar-Apr.
[Is] ISSN:0097-9805
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Despite educational programs, sudden infant death syndrome (SIDS) rates remain unacceptably high, especially among low-income and African-American populations. The purpose of this review is to examine reasons for parental noncompliance with supine sleep recommendations. A database search in Cochrane Database of Systematic Reviews, PubMed, EBSCOhost, and CINAHL was conducted using keywords SIDS, prevention and control, parental compliance, nursing, supine position, Back to Sleep campaign, and Safe to Sleep campaign. Literature was included from 2002 to 2014. Types of studies included randomized control trials, literature reviews, and descriptive studies. Literature from academic journals was also included. Included literature discussed parental knowledge, the Back to Sleep and the Safe to Sleep campaigns, compliance with recommendations from the American Academy of Pediatrics (AAP), and interventions and education. Seventeen studies were included that used data collection methods, including surveys, focus groups, face-to-face interviews, and questionnaires. Major trends identified as being associated with noncompliance included parent knowledge, sources of advice, infant comfort and quality of infant sleep, safety concerns (i.e., choking), race/ethnicity, education level, and income. Noncompliance was highest among single, less-educated, low-income, or African-American parents.
[Mh] Termos MeSH primário: Pais/psicologia
Sono
Morte Súbita do Lactente/prevenção & controle
Decúbito Dorsal
[Mh] Termos MeSH secundário: Seres Humanos
Lactente
Recém-Nascido
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


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[PMID]:29308828
[Au] Autor:Lewis SR; Schofield-Robinson OJ; Alderson P; Smith AF
[Ad] Endereço:Patient Safety Research Department, Royal Lancaster Infirmary, Pointer Court 1, Ashton Road, Lancaster, UK, LA1 4RP.
[Ti] Título:Propofol for the promotion of sleep in adults in the intensive care unit.
[So] Source:Cochrane Database Syst Rev;1:CD012454, 2018 Jan 08.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: People in the intensive care unit (ICU) experience sleep deprivation caused by environmental disruption, such as high noise levels and 24-hour lighting, as well as increased patient care activities and invasive monitoring as part of their care. Sleep deprivation affects physical and psychological health, and people perceive the quality of their sleep to be poor whilst in the ICU. Propofol is an anaesthetic agent which can be used in the ICU to maintain patient sedation and some studies suggest it may be a suitable agent to replicate normal sleep. OBJECTIVES: To assess whether the quantity and quality of sleep may be improved by administration of propofol to adults in the ICU and to assess whether propofol given for sleep promotion improves both physical and psychological patient outcomes. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 10), MEDLINE (1946 to October 2017), Embase (1974 to October 2017), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 to October 2017) and PsycINFO (1806 to October 2017). We searched clinical trials registers for ongoing studies, and conducted backward and forward citation searching of relevant articles. SELECTION CRITERIA: We included randomized and quasi-randomized controlled trials with adults, over the age of 16 years, admitted to the ICU with any diagnoses, given propofol versus a comparator to promote overnight sleep. We included participants who were and were not mechanically ventilated. We included studies that compared the use of propofol, given at an appropriate clinical dose with the intention of promoting night-time sleep, against: no agent; propofol at a different rate or dose; or another agent, administered specifically to promote sleep. We included only studies in which propofol was given during 'normal' sleeping hours (i.e. between 10 pm and 7 am) to promote a sleep-like state with a diurnal rhythm. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias and synthesized findings. MAIN RESULTS: We included four studies with 149 randomized participants. We identified two studies awaiting classification for which we were unable to assess eligibility and one ongoing study.Participants differed in severity of illness as assessed by APACHE II scores in three studies and further differences existed between comparisons and methods. One study compared propofol versus no agent, one study compared different doses of propofol and two studies compared propofol versus a benzodiazepine (flunitrazepam, one study; midazolam, one study). All studies reported randomization and allocation concealment inadequately. We judged all studies to have high risk of performance bias from personnel who were unblinded. We noted that some study authors had blinded study outcome assessors and participants for relevant outcomes.It was not appropriate to combine data owing to high levels of methodological heterogeneity.One study comparing propofol with no agent (13 participants) measured quantity and quality of sleep using polysomnography; study authors reported no evidence of a difference in duration of sleep or sleep efficiency, and reported disruption to usual REM (rapid eye movement sleep) with propofol.One study comparing different doses of propofol (30 participants) measured quantity and quality of sleep by personnel using the Ramsay Sedation Scale; study authors reported that more participants who were given a higher dose of propofol had a successful diurnal rhythm, and achieved a greater sedation rhythmicity.Two studies comparing propofol with a different agent (106 participants) measured quantity and quality of sleep using the Pittsburgh Sleep Diary and the Hospital Anxiety and Depression Scale; one study reported fewer awakenings of reduced duration with propofol, and similar total sleep time between groups, and one study reported no evidence of a difference in sleep quality. One study comparing propofol with another agent (66 participants) measured quantity and quality of sleep with the Bispectral Index and reported longer time in deep sleep, with fewer arousals. One study comparing propofol with another agent (40 participants) reported higher levels of anxiety and depression in both groups, and no evidence of a difference when participants were given propofol.No studies reported adverse events.We used the GRADE approach to downgrade the certainty of the evidence for each outcome to very low. We identified sparse data with few participants, and methodological differences in study designs and comparative agents introduced inconsistency, and we noted that measurement tools were imprecise or not valid for purpose. AUTHORS' CONCLUSIONS: We found insufficient evidence to determine whether administration of propofol would improve the quality and quantity of sleep in adults in the ICU. We noted differences in study designs, methodology, comparative agents and illness severity amongst study participants. We did not pool data and we used the GRADE approach to downgrade the certainty of our evidence to very low.
[Mh] Termos MeSH primário: Dissonias/tratamento farmacológico
Hipnóticos e Sedativos/uso terapêutico
Unidades de Terapia Intensiva
Propofol/uso terapêutico
Sono/efeitos dos fármacos
[Mh] Termos MeSH secundário: Adulto
Flunitrazepam/uso terapêutico
Seres Humanos
Midazolam/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Hypnotics and Sedatives); 620X0222FQ (Flunitrazepam); R60L0SM5BC (Midazolam); YI7VU623SF (Propofol)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180109
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012454.pub2



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