Backgrounds and aims. Insomnia is a common sleep problem with significant health burden to individuals, families and society. Several risk factors contributed to the development of insomnia with significant familial aggregation phenomenon. According to this prospective study, we aimed to (1) explore the longitudinal course and outcomes of insomnia in both children and their parents; (2) confirm the familial aggregation and heritability of insomnia by detailed clinical interviews; (3) explore the potential biological markers of insomnia in terms of heart rate variability, 24-hour urinary cortisol and serial salivary cortisol. / Conclusions. Insomnia is commonly found in both adolescents and adults with moderate persistence rate after 5 years in Hong Kong Chinese. Our findings of increased risk of chronic medical burdens and various upper airway inflammatory diseases in both adolescent and adult subjects with insomnia suggested that insomnia requires comprehensive medical attention. Insomnia is a highly heritable disorder with robust familial aggregations, with a heritability of 0.67 for lifetime insomnia. We found gene-environment interaction on the pathogenesis of insomnia. Our findings strongly suggested the necessity of further molecular genetic analysis on insomnia. Daytime HRV, 24-hour urinary cortisol and serial salivary cortisol might not be the reliable biological markers for insomnia. (Abstract shortened by UMI.) / Results. Phase 1. The prevalences of insomnia were 4.5%, 10.8% and 13.9% at baseline and 6.6%, 8.1% and 11.6% at follow-up for children, fathers and mothers respectively. Similar incidence rate of insomnia was found across adolescents, fathers and mothers (6.2%, 5.4% and 6.8% respectively, p>0.05), while highest persistence rate of insomnia was found in mothers (43.8%), followed by fathers (26.9%) and adolescents (14.9%) (mothers vs adolescents OR(95%CI)=4.43(2.22--8.86); mothers vs fathers OR(95%CI) = 2.11(1.31--3.42); fathers vs adolescents OR(95%CI) = 2.17(0.98--4.52)). Insomnia at baseline was significantly associated with frequent episodes of allergic rhinitis, asthma, and laryngopharyngitis and chronic use of medicine at follow-up in adolescents (p<0.05). Insomnia at baseline was also significantly associated with poor medical outcomes in adults, including frequent allergic rhinitis, otitis media, hypertension, arthritis, psychiatric disorders, chronic pain and gastroesophageal reflux disease at follow-up in middle-aged adults (p<0.05). Phase 2 study . The first degree relatives' recurrent rate was higher in those adolescents with insomnia than those adolescents without insomnia (43.9% vs 22.9% for current insomnia and 51.1% vs 28.0% for lifetime insomnia, respectively p<0.001). Genetic analysis showed that the heritabilities were 0.57 +/- 0.19 for current insomnia and 0.67 +/- 0.13 for lifetime insomnia after adjusted for age and gender. There was significant synergistic interaction between parental history of insomnia and life stress on the development of insomnia of offsprings (p=0.002). Insomnia disorder and its severity were also found to correlate with neuroticism personality, psychological distress and poor quality of life. The phenotypic correlations of insomnia with these factors could be mainly explained by genetic component in bivariate genetic analysis. Phase 3 study. (1) Subjective sleep quantity and quality was consistently and negatively correlated with 24-hour urinary cortisol and salivary cortisol levels in adolescents. However, there was no such association in adults. (2) Adolescents with insomnia diagnosis had lower salivary cortisol at 0 minute after waking up (T1) but less decrease in AUCi3 than non-insomniac adolescents. Although there was no difference in serial salivary cortisol between insomniacs and non-insomniacs in adult, insomnia diagnosis interacted with gender on the effects of AC1Ji and salivary cortisol level at 10:00 pm. (3) There was no difference in 24-hour urinary cortisol between insomniacs and non-insomniacs. (4) There were some inconsistent associations of salivary cortisol with objective and subjective sleep parameters between continuous and dichotomized approaches. Fox example, there was no correlation between salivary cortisol and objective sleep measures in adults when using continuous variables, but, short sleepers as defined by objective TIB≤400 minutes had higher cortisol levels at T1 (13.5+/-7.9 nmol/L vs 11.2+/-5.0 nmol/L) and T2 (14.0+/-6.0 vs 11.5+/-6.2 nmol/L) than their counterparts (TIB>400 minutes). In brief, cortisol (both salivary and urinary samples) level was more likely to be correlated with subjective measures of sleep than objective measures or insomnia diagnosis. In particular, the association predominantly occurred in adolescent group. / Zhang, Jihui. / Adviser: Yun-bwote Wing. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 245-249). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

研究背景與目的：2008年美國睡眠醫學會(American Academy of Sleep Medicine)對於失眠患者在助眠劑的臨床使用原則中(clinical guideline)，建議初次藥物治療的時間以2至4週較為適宜，後續是否繼續用藥則須專業醫師的重新評估，以降低身體對於藥物的依賴性及副作用的風險，但實際上許多失眠患者因擔心停用助眠劑就無法入眠，因此仍長期使用助眠劑。目前臨床上大都採用逐步減藥的方式協助患者降低助眠劑的使用，除了藥物因素會影響減藥成效之外，從心理因素來看，在過去研究指出自我效能會影響健康行為的改變，因此本研究將比較逐步減藥計畫加上提升減藥自我效能策略與單獨逐步減藥計畫對於原發性失眠患者在減藥上的成效。 研究方法：本研究的原發型失眠患者共48人(男17人，女31人，平均年齡46.8歲，平均使用助眠劑66.7個月)，被分為兩組進行10週的減藥介入計畫，一組為自我效能提升組(n=24)，受試者減藥前先接受為期兩週的提升減藥自我效能策略，再進行8週的逐步減藥計畫，另一組為單純減藥組(n=24)，受試者只進行8週的逐步減藥計畫。受試者每週均需填寫睡眠日誌、單題減藥自我效能量尺，以瞭解睡眠參數、減藥自我效能及助眠劑使用之情況。 研究結果：減藥成效方面，自我效能提升組在減少劑量的百分比顯著高於單純減藥組(自我效能提升組=78.62%；單純減藥組=64.10%)，且自我效能提升組在減藥前後劑量的改變也顯著高於單純減藥組(自我效能提升組=4.35顆/週；單純減藥組=3.22顆/週)，自我效能提升組在停藥人數的百分比上雖未顯著高於單純停藥組(自我效能提升組=29.2%；單純減藥組=16.7%)，但就整體結果來看均較為支持自我效能提升組在減藥的成效上是優於單純減藥組。減藥自我效能方面，在控制住第1週的減藥自我效能後，提升減藥自我效能策略造成的減藥自我效能改變量仍可以有效解釋21.9%的減藥百分比。 研究結論：自我效能提升組增加的提升減藥自我效能策略能有助於個案在執行逐步減藥計畫的成效，另外，提升減藥自我效能策略造成的減藥自我效能改變量是減藥百分比有效的預測因子。因此，減藥自我效能對於減藥成效來說，確實是一個可以著力的部分。 / Introduction：According to the 2008 clinical guidelines for insomnia by the American Academy of Sleep Medicine proposed, hypnotic use is recommended for short-term use for 2 to 4 weeks. However, many insomnia patients have difficulty to stop hypnotic use. In clinic practices, gradual tapering is usually applied in helping patients to reduce the hypnotic use. Previous studies have shown that self-efficacy of the patients are associated with medication tapering. The present study examine the effect of the institution of a self-efficacy enhancement strategy prior to gradual tapering plan on hypnotic tapering in patients with primary insomnia. Methods：Forty-eight patients with primary insomnia (17 men, 31 women；mean age of 46.8 years；mean duration of hypnotics use of 66.7 months) were assigned to two groups: a self-efficacy enhancement group and a tapering group. Patients in the self-efficacy enhancement group (n=24) underwent a two-week self-efficacy enhancement strategy prior to an eight-week gradual tapering plan. Patients in the tapering group (n=24) participated in the eight-week gradual tapering plan only. The main outcome measures were sleep parameters from sleep diary, a single-item tapering self-efficacy rating scale, number of pills taken per week, and percentage of dosage reduction. Results：The percentage of dosage reduction of patients in the self-efficacy enhancement group was significantly more than those in the tapering group (the self-efficacy enhancement group = 78.62%；the tapering group = 64.10%). The number of pills taken per week also showed significantly more reduction for patients in the self-efficacy enhancement group than those in the tapering group (the self-efficacy enhancement group = 4.35 pills per week；the tapering group = 3.22 pills per week). However, the percentage of drug-free patients at the end of the programs in the self-efficacy enhancement group was not significant different from those in the tapering group (the self-efficacy enhancement group = 29.2%；the tapering group = 16.7%). Overall, the effect of hypnotic tapering in the self-efficacy enhancement group was better than those in the tapering group. In addition, linear regression showed that the tapering self-efficacy data showed that, after controlling baseline tapering self-efficacy, the change of tapering self-efficacy following the first two weeks of self-efficacy enhancement strategy can explain the variation of percentage of dosage reduction up to 21.9%. Conclusions：The institution of self-efficacy enhancement strategy can increase the efficacy of gradual tapering plan for hypnotics. In addition, the level of tapering self-efficacy enhanced by the self-efficacy enhancement strategy is a good predictor for dosage reduction. This is a useful strategy that can be applied in clinical settings.

Uppmärksamhet/övervakning (monitoring) är en viktig komponent vid utvecklandet och vidmakthållandet av insomni. Genom medveten närvaro (MN) kan förmågan att rikta uppmärksamheten tränas upp. Syftet med studien var att undersöka effekten av MN och beteendeterapi (BT) vid behandling av primär insomni hos personer med hög uppmärksamhet/övervakning av sömnrelaterade stimuli. Behandlingens effekt på sömn och uppmärksamhet samt en eventuell sekundär effekt på oro och ruminering undersöktes. En single-subject design med en konstruktiv strategi användes och två behandlingar gavs, där hälften av deltagarna fick BT och hälften fick BT+MN. Resultaten visade att sömn, uppmärksamhet/övervakning och oro förbättrades av behandlingarna men obreoende av MN. För framtida forskning rekomenderas en utökad design för att undersöka effekten av MN vid behandling av insomni. / People with insomnia attend to sleep-related stimuli during the day and night. The activity is called monitoring. In mindfulness (MN) attention plays a central part, and by practicing MN the ability to direct attention can be improved. The aim of this study was to explore the effect of MN and behavioral therapy (BT) when treating people with primary insomnia who tend to monitor sleep-related cues. The effect on sleep and monitoring was examined, as well as the secondary effect on worry and rumination. A single-subject design with a constructive strategy was used. Two different treatments were implemented and half of the participants were given BT and the other half BT+MN. Together the results showed that sleep, monitoring and worry improved, but independent of MN. A suggestion for future research is to extend the current design to further explore the effect of MN within the treatment of insomnia.

The frequently studied concept of social capital has often been related to health, but theconceptualisationand measurement of the conceptisanon-goingdebate. The main aim of this thesis is to study the relationship of four different indicators of social capital; informal social capital, formal social capital, trust towards institutions and trust towards others, with self-rated physical health and self-rated mental health in Iceland in 2009, shortly after a harsh economic crash. Insomnia symptoms will be studied as a possible mediator or moderator in the relationship. Furthermore, longitudinal data on informal social capital will be used to see the causal effect of social capital on health and to see if informal social capital decreased after the economic collapse. Population-based panel data from Iceland in 2007 and 2009 will be used to perform both cross-sectional analysis (n = 3,243) and longitudinal analysis (n = 3,131). The main results are that the four indicators of social capital all relate differently to physical and mental self-rated health, and insomnia symptoms seem to mediate the relationship between social capital and health, especially physical health. Surprisingly, informal social capital did increase during the economic collapse. The panel analysis further suggests that having poor informal social capital has causal effects on poor self-rated mental health when adjusted for symptoms of insomnia, age, gender, family status, education and smoking.

Veterans suffering from posttraumatic stress (PTSD), compared to relative trauma-exposed veterans without PTSD, have more serious relationship problems. Research in the area of combat trauma-related symptoms and intimate partner relationships have to-date, mostly focused on identifying the negative outcomes of trauma but have not elaborated on how the symptoms themselves act as agents in negative relationship functioning. The purpose of this study was to identify a relationship between combat-related PTSD symptoms of insomnia/sleep dysfunction, avoidance/emotional numbing, and intimate partner distress - specifically the mechanisms by which symptoms and distress are maintained or exacerbated. A review of combat trauma and relationship theories indicated that a newly applied theory, Conservation of Resources (COR) could account for specific combat trauma symptomology, the effects of non-PTSD intimate partners’ distress, and the course of these aspects. This study predominately utilized quantitative data for exploratory correlational research. One hundred and fifteen Canadian combat veterans completed self-administered questionnaires that included demographic characteristics, supplementary questions and the study variables: PTSD assessment, dyadic adjustment, and sleep issues. Results indicated that PTSD overall is negatively related to dyadic adjustment, and that avoidance symptoms represent the most detrimental cluster of PTSD in terms of relationship functioning. Although insomnia/sleep dysfunction was not correlated to dyadic adjustment for those with PTSD, it was identified as a contributor to negative relationship functioning through supplementary responses. The study suggests a revised Canadian PTSD prevalence rate of 29%, which is noteworthy when compared to the previous PTSD prevalence rate estimation of 10%. The application of COR theory to combat veterans and relationship functioning is supported by the results of this study. Findings of this study can aid clinicians in the enhancement of couple therapies, draw attention to the need for improved deployment screening and care provisions for military members, and contribute to the breadth of empirical literature.

Depression och insomni är två vanliga former av psykisk ohälsa. I den här studien undersöktes om en bevisat effektiv behandling för insomni, (KBT-I), påverkade grad av depressiva symtom hos personer med konstaterade symtom på såväl depression som insomni. I studien kontrollerades för en minskning av nedstämdhet kunde tillskrivas en ökad fysisk aktivitetsnivå. En single case experimental design användes för ändamålet, med dagliga skattningar av sömn, nedstämdhet och fysisk aktivitetsnivå. Symtom på såväl insomi som nedstämdhet minskade signifikant hos tre av sex deltagare. Minskad nedstämdhet kunde inte förklaras av ökad fysisk aktivitetsnivå. Samvariation observerades mellan depression och insomni. Resultaten visar att insomni och depression kan påverkas av samma behandling, vilket antyder förekomst av gemensamma vidmakthållande mekanismer. / Insomnia and depression are two common mental health problems. This study investigated whether a proven effective treatment for insomnia CBT-I, would change the severity of depressive symptoms, for participants with comorbid insomnia and depression. It was controlled for, whether a reduction in depressive symptoms could be the result of increased physical activity. A single case experimental design, including daily measurements of sleep, depression and physical activity, was used as a means to answer the research questions. Symptoms of both depression and insomnia were significantly reduced for three out of six participants. Increased physical activity was not able to explain the decrease in depression scores. A correlation was observed, between depression and insomnia. The results shows that insomnia and depression can be affected by the same treatment, which implies existence of common perpetual mechanisms.

研究目的 本研究的目的是要藉由線索暴露的實驗典範,探索長期使用安眠藥物 之患者對於安眠藥物相關刺激的注意力偏誤現象,並根據 Baker 及其同事們 (2004)與其他學者所提出的「藥物動機理論的情感模型」,強調負向情感在長 期使用安眠藥物的失眠患者所扮演的角色,本研究另欲探討長期使用失眠藥物的 患者是否在負向的情緒下能引發其對安眠藥物有更多的注意力及反應偏誤,並以 oddball 實驗典範來引發測量大腦皮質 ERP 波的注意力偏誤現象,並試圖以主觀 渴求問卷來測量個案是否在負向情感下有較強烈的主觀渴求反應。 方法 研究之有效樣本為 13 人。其中男性 5 人,女性 8 人,年齡介於 23-54 歲 (34.15 ± 11.07),參與研究之受試者會進行兩晚之實驗及多頻道睡眠生理檢查, 實驗情境分成基礎情境及挫折情境,在挫折情境中,受試者在進行較困難之認知 作業的同時,研究者會給予負向之指導語以進行情緒之操弄;而在基礎情境則給 予中性之指導語。在認知作業進行之後,開始進行線索暴露之 ERP 測量,受試 者須判斷圖片是否含有動物(目標刺激),另包含中性圖片刺激(96 張)、睡眠 相關刺激(32 張)及藥物相關刺激(32 張)。另外在認知測驗及線索暴露的前後 也會測量受試者之情緒狀態及主觀渴求狀態。研究分析以多變量變異數分析進行 檢驗。 結果 長期使用安眠藥物的患者相較於中性刺激,其對於藥物圖片刺激及睡眠相 關刺激皆有較大之 P300 及 SPW 腦波振幅。未在研究中驗證 Baker 等人提出之負 增強處理模式之因果關係,但發現,在基礎情境中,當受試者的正向情緒減少愈 多,受試者在單一題項渴求程度減少愈少;而負向情緒與其他的渴求指標較具有 相關性,研究發現當負向情緒增加愈多,單一題項渴求程度增加愈多,對藥物效 果的期待也愈高,對藥物的欲求與所帶來欣快感也會愈高,顯示情緒的改變於主 觀渴求狀態的相關性。此外本研究結果顯示客觀的腦波指標與部分主觀感受顯著 相關,其中 P300 與其對藥物的渴求程度呈正相關。 結論 無論是在基礎情境或挫折情境,長期使用安眠藥物之患者對安眠藥刺激及 睡眠相關刺激皆有注意力偏誤之現象,且此注意力偏誤現象與其對藥物的渴求程 度具有一定程度之相關性。在挫折情境中,受試者對藥物之主觀渴求有較大的傾向。 / Introduction The major goal of this study is to examine the phenomenon of craving in hypnotic use. The Affective Processing Model of Negative Reinforcement (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004) suggests that negative affect would influence drug use through the change of cognitive process to a “hot information processing” and therefore increase the craving for drug use. The study explores the effects of negative affect on attentional bias and subjective craving associated with hypnotic use to test this model. Method Thirteen long-term hypnotic users were included in this study. They came to the sleep laboratory for two nights for an experimental night in which negative affect was induced by giving negative comments on their performance on a cognitive task and a control night with exactly the same procedure except that the negative comments was replaced by neutral comments. For both nights, craving was assessed with subjective ratings and measure of attentional bias with recording of event-related potentials (ERPs) induced by pictures related to hypnotic use, sleep and neutral pictures. Result The amplitude of P300 and SPW for sleep related pictures and hypnotic related pictures are significant larger than the amplitude for neutral pictures in both conditions. Also, results show that the picture of P300 are positively correlated with subjective craving for hypnotic drugs. Moreover, the data shows the tendency of condition difference in subjective craving. Conclusion The hypnotic long-term users do show attentional bias for sleep related and hypnotic related pictures. However, the result does not show more attentional bias for hypnotic related pictures in stressful situation. On the other hand, the data shows a tendency that the subjective craving is stronger in stressful situation than in baseline situation. The findings show only partial support for the Affective Processing Model of Negative Reinforcement.

Internetbaserad KBT är en behandlingsform som har visat god effekt vid insomni. Vården av personer med insomni skulle dock kunna förbättras av mer kunskap om faktorer som påverkar utfall på lång sikt. Föreliggande studie hade en explorativ ansats och syftet var att identifiera faktorer som kunde predicera behandlingsutfall vid 36-månadersuppföljning (FU36). Därutöver ämnade studien undersöka hur väl data insamlad innan behandlingen kunde predicera behandlingsutfall vid FU36 i jämförelse med data insamlad både innan och efter behandling. Behandlingsutfall definierades som förändring av insomnisymtom och grad av insomnisymtom vid FU36. Totalt inkluderades 203 deltagare från två olika behandlingsstudier, vilka genomgått 9–12 veckors insomnibehandling med eller utan kombinerad depressionsbehandling. Initiala korrelationer undersökte samband mellan prediktorer och utfallsmått, därefter genomfördes regressionsanalyser med de prediktorer som visade signifikanta samband. Resultaten påvisade att det var möjligt att predicera förändring och grad av insomnisymtom vid FU36. Prediktorer från data insamlad innan och efter behandling kunde predicera behandlingsutfall bäst och förklarade 33% av den totala variansen gällande förändring av insomnisymtom tre år efter avslutad behandling. Allvarligare grad av insomni vid behandlingsstart, förändring av insomnisymtom under behandlingen, hög ålder och missnöje vid utvärderingen kunde predicera insomnisymtom tre år efter avslutad behandling. Kliniskt kan detta innebära att patienter som riskerar sämre behandlingseffekt på lång sikt kan få bättre stöd. / Internet-based CBT is a treatment-form that has proved to be effective against insomnia. Treatment of patients with insomnia could benefit from more knowledge about factors that affect long-term outcomes. The present study had an explorative design and the aim was to identify factors that could predict treatment outcomes at 36-month-follow-up (FU36). The study also made a comparison of predictive power regarding treatment outcomes between data gathered before treatment and data gathered both before and after treatment. Treatment outcomes were defined as change in insomnia symtoms and degree of insomnia symtoms at FU36. In total 203 participants were included from two different treatment studies, whom had received 9-12 weeks of insomnia treatment with or without combined treatment for depression. Initial correlations explored relationships between predictors and outcome measures, thereafter multiple regression analyses were done with the predictors that showed significant relationships. The results showed that it was possible to predict change and degree of insomnia symtoms at FU36. Predictors taken from data gathered before and after treatment had the most predictive power and explained 33% of the total variance of the change of insomnia symtoms at FU36. More insomnia symtoms at the beginning of treatment, change of insomnia symtoms during treatment, high age and a dissatisfaction of treatment were factors that were able to predict insomnia symtoms at FU36. / ClinicalTrials.gov Identifier: NCT01663844 New Clinical Applications for Internet-based Cognitive Behavior Therapy for Insomnia and Depression

Inledning: Sömnlöshet (insomni) är ett stort och växande folkhälsoproblem för den vuxna befolkningen. I dagsläget rekommenderas läkemedel och kognitiv beteendeterapi som behandling för diagnosen, men inga särskilda vetenskapliga rekommendationer finns i syfte att förebygga insomni. Forskning visar att individers levnadsvanor verkar som bestämningsfaktorer för deras sömnkvalitet, men ännu bedöms området vara relativt outforskat. Syfte: Denna studie syftade till att undersöka om fysisk aktivitet kan förebygga kronisk sömnlöshet och sömnlöshetssymtom hos den vuxna befolkningen. Metod: Systematiskt litteraturstudie i PubMed. Resultat: Fysisk aktivitet visade sig vara associerat med kronisk insomni och sömnlöshetssymtom, och föreningen påverkades emellertid av individens body mass indiex. Skillnader beträffande intensitetsnivåer och form av fysisk aktivitet observerades både mellan könen och i olika åldersgrupper. Diskussion: Förskrivning av fysisk aktivitet på recept i förebyggande syfte för individer i riskgrupp för sömnlöshet, eller i behandlingssyfte för lidande patienter, utgör en potentiell framtida folkhälsosatsning av sömnlöshet, men kostnadseffektivitet måste utvärderas. / Introduction: Insomnia is a major and growing public health problem for the adult population. Currently recommend medication and cognitive behavior therapy as treatment for the diagnosis, but no special recommendations are available for the purpose of preventing chronic insomnia och insomnia symptoms. Research shows that peoples living habits appear to be determining factors for their sleep quality, but it is still estimated that the area is relatively unexplored. Aim: This study investigate whether physical activity can prevent chronic insomnia and symptoms of insomnia in adults. Method: Systematic literature study in PubMed. Result: Physical activity was found to be associated with chronic insomnia and insomnia symptoms, and the association was affected by the body mass index (BMI) of the individual. Differences in intensity levels and physical activity were observed between the sexes and in different age groups. Discussion: The prescription of physical activity to individuals at risk for insomnia, or for treatment of those suffering from insomnia, represents a potential future public health strategy for the management and prevention of insomnia, however, cost-effectiveness of these strategies must be evaluated.

Made available in DSpace on 2015-07-22T20:50:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-10-27 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Associação Fundo de Incentivo à Psicofarmacologia (AFIP) / O objetivo do presente estudo foi avaliar os efeitos do exercício aeróbio moderado no padrão do sono, na qualidade de vida e no perfil de humor de pacientes com insônia crônica primária, bem como verificar se esses efeitos são dependentes do horário da prática do exercício. Dezenove pacientes com insônia crônica primária (45 anos [EP  1,9]) foram distribuídos aleatoriamente entre os grupos MANHÃ (10:00  1 h) e TARDE (18:00  1 h). Todos os voluntários participaram de um protocolo de exercícios aeróbios, realizados em intensidade moderada (caminhada), durante 50 minutos, 3 vezes/semana, durante 6 meses. Para avaliar o sono foram utilizados a polissonografia e o diário do sono, a qualidade de vida foi medida pelo questionário Medical Outcome Study Short Form - 36 (MOS SF-36) e o humor pelo questionário Profile of Mood States (POMS). Na polissonografia, os resultados demonstraram, nos dois grupos (MANHÃ e TARDE), reduções na latência do sono, no tempo acordado após o início do sono, além de aumento na eficiência do sono, após a intervenção. No diário do sono, significantes melhoras foram observadas na latência do sono, na qualidade do sono e na sensação de descanso ao acordar, nos dois grupos. Além disto, a qualidade de vida (atividades sociais e limitação por aspectos emocionais) e o perfil de humor (tensão-ansiedade, depressão e distúrbio total de humor) melhoraram após a intervenção. Estes efeitos não diferiram quanto ao horário do dia. Podemos concluir que o exercício aeróbio crônico, realizado em intensidade moderada, produz significantes melhoras no padrão do sono, na qualidade de vida e no perfil de humor de pacientes com insônia crônica primária. De forma geral, estes efeitos parecem não diferir quando o exercício físico é realizado pela manhã ou ao final da tarde. / To evaluate the effect of chronic moderate aerobic exercise on sleep, quality of life and mood of individuals with chronic primary insomnia, and to examine whether these effects differed for morning vs. late-afternoon exercise. Nineteen sedentary individuals with chronic primary insomnia (mean age 45.0 [SE  1.9] years) completed 6-month moderate aerobic exercise training (3 days/week), randomized to the morning (10:00  1 h) or late-afternoon (18:00  1 h). Across both time points, polysomnographic data demonstrated significant reductions in sleep onset latency and wake time after sleep onset, and a significant increase in sleep efficiency following exercise. Sleep diary data revealed significant improvements in sleep onset latency, sleep quality and feeling rested in the morning. There was generally no significant difference in response to morning vs. late-afternoon exercise. Following exercise, significant increases in some quality of life measures, and significant reductions in Profile of Mood State measures of tension-anxiety, depression and total mood disturbance were found. These effects did not vary by time of day. In conclusion, chronic moderate aerobic exercise elicited significant improvements in sleep, quality of life and mood in individuals with chronic primary insomnia; these effects generally did not differ for morning vs. late-afternoon exercise. / FAPESP: 2008/02862 - 1 / FAPESP: 98/14303 - 3 / TEDE / BV UNIFESP: Teses e dissertações