<p>Uzroci gubitka svesti su različiti i te&scaron;ko ih je diferencirati. Razlikovanja epileptičkih od neepileptičkih gubitaka svesti je od krucijalnog značaja za ispitivanje, lečenja i prognoze ovih poremećaja. Elektroencefalografija (EEG) je standardna, neinvazivna metoda koja se koristi u ispitivanju nakon gubitka svesti. Inicijalni EEG nalaz nakon prvog gubitka svesti može biti normalan, specifičan ili nespecifičan. Procenat patolo&scaron;kog EEG nalaza je veći kod rano urađenog EEG pregleda. Kod dece rani EEG pregled u roku od 48h ne pokazuje statistički značajne abnormalnosti. Spontanim spavanjem ili EEG pregledom nakon deprivacije spavanja se beleži značajno veća prisutnost epileptiformnih promena kod dece starije od 3 godine, čak i kada je prvi EEG u budnom stanju normalan. Kombinacijama pregleda u budnom stanju i spavanju povećava prisutnost patolo&scaron;kih promena u EEG zapisu. Materijal metode: Istraživanje je obuhvatilo 198 dece uzrasta od 3-12 godine života nakon prvog gubitka svesti. Ispitanici su klasifikovani u dve grupe na osnovu otpusne dijagnoze: na grupu dece kod kojih dijagnoza epilepsije nije postavljena i na grupu dece kod kojih je dijagnoza epilepsije potvrđena. Korelirani su nalazi EEG-a u budnom stanju i spavanju (spontanom ili nakon deprivacije spavanja) sa anamnestičkim i kliničkim podacima o gubitku svesti, podacima o dužini trajanja gubitka svesti i vremena oporavka, vremenom kada je urađen prvi EEG u odnosu na gubitak svesti kao i sa podacima o ličnoj i porodičnoj anamnezi, a koji su navedeni u protokolu istraživanja. Ispitanici su potom podeljeni prema uzrastu u pet grupa u intervalima od 2 godine (3-4; 5-6; 7-8; 9-10; 11-12). Rezultati: Nakon prvog gubitka svesti specifičan (epileptiformni) nalaz EEG u budnom stanju imalo je 41,97% ispitanika, a 58,03% je imalo nespecifičan ili uredan EEG nalaz u budnom stanju, dok je specifičan nalaz EEG u spavanju imalo je 73,57% ispitanika, a 26,43% je imalo nespecifičan ili uredan EEG nalaz u spavanju. Ispitanici koji su imali specifičan EEG nalaz u budnom stanju imali su i specifičan nalaz u spavanju, a 45,07%, nakon deprivacije sna. Ispitanici koji su u budnom stanju imali nespecifičan ili uredan EEG nalaz u budnom stanju su u 35,92% nakon deprvacije spavanja imali specifičan EEG nalaz u spavanju, za razliku od 1,41% dece koji su imali specifičan EEG nalaz u spontanom spavanju. Sumarno gledano bolesnici koji su &ldquo;aktivirani&rdquo; odnosno oni kod kojih je deprivacija spavanja uticala na dobijanje specifičnog nalaza (epileptiformnih pormena) u spavanju čine 37.32% od svih ispitanika sa specifičnim (epileptiformnim) promenama u EEG-u u spavanju Zaključak: Kod većine pacijenata nakon prvog gubitka svesti EEG nalaz u budnom stanju je bio nespecifičan ili uredan. Procenat specifičnih EEG nalaza (epileptiformnih promena) se značajno povećao prilikom snimanja EEG u spavanju. Naročito velika korist od deprivacije spavanja kao metode aktivacije potvrđena kod onih pacijenata koji su imali inicijalni EEG u budnom stanju uredan ili nespecifičan. Dobijeni rezultati nesumljivo ukazuju na efikasnost deprivacije spavanja kao provokacione metode i povećanja procenta interiktalnihepileptiformnih EEG promena. Neprovociranih prvi gubitci svesti su se če&scaron;će javljali u grupi dece kod kojih je dijagnoza epilepsije potvrđena, dok su se provocirani gubitci svesti javljali če&scaron;će u grupi dece kod kojih dijagnoza epilepsije nije postavljena. Uzrast dece nije uticao na postavljanje dijagnoze epilepsije kao ni na inicijalne nalaze EEGa u budnom stanju i spavanju ali se registrovalo povećanje specifičnih nalaza (epileptiformnih promena) EEG-a, nakon deprivacije spavanja , sa porastom godina života.</p> / <p>The reasons for the loss of consciousness are various and difficult to be differentiated. It is of utmost importance to differentiate between epileptic and non-epileptic losses of consciousness for the purpose of testing, treating and giving prognosis related to this disorder. Electroencephalography (EEG) is a standard, non-invasive method used in testing after the loss of consciousness. The initial EEG after the first loss of consciousness can be normal, specific and non-specific. The percentage of pathological EEG findings is higher in EEG exams performed at an earlier stage. In children, an early EEG exam within 48 hours does not reveal any statistically relevant abnormalities. Spontaneous sleeping or an EEG examination after sleep deprivation leads to a significantly higher number of epileptiform changes in children above the age of 3, even in cases when the first EEG in the awake state was normal. Combinations of examinations in the awake state and during sleep lead to an increased presence of pathological changes in the EEG recording. Material and methods: The research included 198 children aged 3-12 who have experienced their first loss of consciousness. The subjects were classified into two groups, based on their discharge diagnosis: children who have not been diagnosed with epilepsy and children who have had epilepsy confirmed. A correlation was established between EEG findings in the awake state and sleep (spontaneous or following sleep deprivation) and medical history and clinical data related to the loss of consciousness, the information about the length of the loss of consciousness and recovery time, the time when the first EEG examination was performed in relation to the loss of consciousness, as well as the data from the personal and family history. The subjects were further divided into five groups, depending on their age, with each group covering a 2-year period (3-4; 5-6; 7-8; 9-10; 11-12). Results: Following the first loss of consciousness, specific (epileptiform) EEG findings were noticed in 41.97% subjects, while 58.03% of them had non-specific, i.e. regular findings in the awake state. When it comes to the findings during sleep, 73,57% were specific, while 26,43% were non-specific, i.e. regular. The subjects who had specific EEG findings in the awake state also had specific findings during sleep, while that percentage was 45,07% after sleep deprivation. The subjects who had non-specific, i.e. regular EEG findings in the awake state had specific EEG findings during sleep in 35.92% of the cases following sleep deprivation, while 1.41% of the children had specific EEG findings during spontaneous sleep. In total, the patients who were &ldquo;activated&rdquo;, i.e. those whose sleep deprivation contributed to specific findings (epileptiform changes) during sleep comprise 37.32% of all subjects with specific (epileptiform) changes in the EEG findings during sleep. Conclusion: In most patients suffering from the first loss of consciousness the EEG findings were non-specific, i.e. regular. The percentage of specific EEG findings (epileptiform changes) was significantly increased when the EEG examination was performed during sleep. Sleep deprivation, as an activation method, was particularly useful in patients whose initial EEG findings in the awake state were regular, i.e. non-specific. The results obtained undoubtedly confirm the efficiency of sleep deprivation as a provoking method and the increase of the percentage of interictal epileptiform EEG changes. Unprovoked first losses of consciousness were more common in the group of children who have had the diagnosis of epilepsy confirmed, while provoked losses of consciousness were more common in the group of children who have not been diagnosed with epilepsy. The age of children did not affect the process of establishing a diagnosis of epilepsy, nor did it affect the initial EEG findings in the awake state or during sleep, but it was observed that the number of specific EEG findings (epileptiform changes) following sleep deprivation increased with the increase of the age of the patients.</p>

L’objectif de la présente étude visait à évaluer les effets différentiels de la privation de sommeil (PS) sur le fonctionnement cognitif sous-tendu par les substrats cérébraux distincts, impliqués dans le réseau fronto-pariétal attentionnel, lors de l’administration d’une tâche simple et de courte durée. Les potentiels évoqués cognitifs, avec sites d’enregistrement multiples, ont été prévilégiés afin d’apprécier les effets de la PS sur l’activité cognitive rapide et ses corrélats topographiques. Le matin suivant une PS totale d’une durée de 24 heures et suivant une nuit de sommeil normale, vingt participants ont exécuté une tâche oddball visuelle à 3 stimuli. L’amplitude et la latence ont été analysées pour la P200 et la N200 à titre d’indices frontaux, tandis que la P300 a été analysée, à titre de composante à contribution à la fois frontale et pariétale. Suite à la PS, une augmentation non spécifique de l’amplitude de la P200 frontale à l’hémisphère gauche, ainsi qu’une perte de latéralisation spécifique à la présentation des stimuli cibles, ont été observées. À l’opposé, l’amplitude de la P300 était réduite de façon prédominante dans la région pariétale pour les stimuli cibles. Enfin, un délai de latence non spécifique pour la N200 et la P300, ainsi qu’une atteinte de la performance (temps de réaction ralentis et nombre d’erreurs plus élevé) ont également été objectivées. Les résultats confirment qu’une PS de durée modérée entraîne une altération des processus attentionnels pouvant être objectivée à la fois par les mesures comportementales et électrophysiologiques. Ces modifications sont présentes à toutes les étapes de traitement, tel que démontré par les effets touchant la P200, la N200 et la P300. Qui plus est, la PS affecte différemment les composantes à prédominance frontale et pariétale. / The objective of the present study was to assess the differential effects of sleep deprivation (SD) on cognitive functions relying on distinct cerebral networks, involved in the fronto-parietal attentional network, during a relatively simple and short cognitive task. Multi-sites recording event-related-potentials (ERP) were used in order to evaluate the effect of SD on rapid cognitive activity and its topographical correlates. The morning following a night of total SD and a night of sleep, 20 participants were administered a 3-stimuli visual oddball paradigm. Amplitudes and latencies of the P200 and N200 ERP components were analyzed as frontal indexes, whereas P300 was analyzed as a mixed frontal and parietal component. Following TSD, a non specific increase in P200 amplitude for the left hemisphere, as well as a loss of lateralisation in response to target stimuli, were observed. Contrarily, P300 amplitude was predominantly reduced in the parietal region in response to target stimuli. Moreover, N200 and P300 latencies were delayed non specific to the type of stimuli and performance (reaction time and accuracy) was altered. These results confirm the deleterious effect of a moderate duration SD on attention processes that can be objectified by means of behavioural and electrophysiological measures. Each stages of information processing was altered by SD, as shown by its effect on P2, N2 and P3 components. Moreover, SD affected differently components caracterized by a predominant frontal or parietal distribution.

Diverses études se sont penchées sur les paramètres EEG du sommeil en ondes lentes, y compris l’activité en ondes lentes en lien avec le somnambulisme, mais les résultats se révèlent inconsistants et contradictoires. Le premier objectif de la présente étude était d’analyser quantitativement l’EEG en sommeil en mesurant les fluctuations de puissance spectrale en delta (1-4 Hz) et delta lent (0.5-1 Hz) avant des épisodes de somnambulisme. Le second était de détecter les oscillations lentes (> 75 μV, fréquence d'environ 0.7-0.8 Hz) et très lentes (> 140 μV, fréquence d'environ 0.7-0.8 Hz) afin d'examiner leur changement d'amplitude et de densité avant de tels épisodes. Suite à une privation de sommeil de 25 heures, les enregistrements polysomnographiques de 22 adultes atteints de somnambulisme ont été scrutés. L’analyse des 200 secondes avant les épisodes révèle que ceux-ci ne sont pas précédés d’une augmentation graduelle de puissance spectrale en delta ni en delta lent, tant sur les dérivations frontale, centrale que pariétale. Toutefois, une hausse statistiquement significative de la densité des oscillations lentes et des oscillations très lentes a été observée au cours des 20 sec immédiatement avant le début des épisodes. Reste à déterminer le rôle exact de ces paramètres de l’EEG en sommeil par rapport à la manifestation et au diagnostic des parasomnies en sommeil lent. / Several studies have investigated slow-wave sleep EEG parameters, including slow-wave activity (SWA) in relation to somnambulism, but results have been both inconsistent and contradictory. The first goal of the present study was to conduct a quantitative analysis of sleepwalkers’ sleep EEG by studying fluctuations in spectral power for delta (1-4 Hz) and slow delta (0.5-1 Hz) before the onset of somnambulistic episodes. A secondary aim was to detect slow wave oscillations to examine their changes in amplitude and density prior to behavioral episodes of somnambulism. Twenty-two adult sleepwalkers were investigated polysomnographically following 25 h of sleep deprivation. Analysis of patients’ sleep EEG over the 200 sec prior to the episodes’ onset revealed that the episodes were not preceded by a gradual increase in spectral power for either delta or slow delta over frontal, central, or parietal leads. However, time course comparisons revealed significant changes in the density of slow and very slow wave oscillations, with significant increases occurring during the final 20 sec immediately preceding episode onset. The specificity of these sleep EEG parameters for the occurrence and diagnosis of NREM parasomnias remains to be determined.

Nous avons étudié les effets de la baisse de la vigilance sur les mécanismes de contrôle de l'erreur lors d'une tâche de temps de réaction de choix (TR). Lors de la première expérience, la baisse de vigilance a été obtenue par un éveil prolongé de 26 heures. Dans les expériences deux et trois, on a diminué le niveau de vigilance par voie pharmacologique en choisissant de n'affecter qu'une des voies neurochimiques impliquées dans l'éveil (voie histaminergique puis voie dopaminergique) pour déterminer si les indices du contrôle de l'erreur seraient ou non affectés de la même façon qu'après un éveil prolongé. Si oui, cela supposerait un effet redondant des systèmes neurochimiques impliqués dans l'éveil sur le contrôle de l'erreur, dans le cas contraire, cela supposerait une influence spécifique de ces différents systèmes sur le contrôle de l'erreur. Le contrôle de l'erreur peut être décomposé en contrôle proactif et contrôle réactif. Ce contrôle de l'erreur est dit en ligne s'il opère au cours d'un essai, hors-ligne s'il s'opère d'un essai sur l'autre.La privation de sommeil affecte le contrôle de l'erreur proactif en ligne et le contrôle de l'erreur réactif. La baisse de l'activité histaminergique n'affecte que le contrôle de l'erreur réactif et on n'a pas mis en évidence d'effets de la déplétion dopaminergique sur le contrôle de l'erreur. Les effets observés sur le contrôle de l'erreur par la baisse de vigilance induite par la privation de sommeil n'étaient pas reproduits par la baisse de vigilance induite par les déplétions des activités dopaminergiques et histaminergiques, suggérant des influences spécifiques de ces deux voies sur le contrôle de l'erreur. / To study the impact of a vigilance decrease on error monitoring mechanisms in healthy participants, electromyogram and electroencephalogram were recorded during a choice reaction time task. The aim of experiment one was to decipher which indices of error monitoring at the behavioral and electrophysiological levels, were altered by sleep deprivation. In experiments two and three, decreases in vigilance were obtained through pharmacological treatments. We attempted to selectively inhibit one arousal system (either by acting on the histaminergic or on the dopaminergic pathway), so as to determine whether indices of error monitoring would be affected in the same way than after extended wakefulness. Proactive (implemented before an error execution) and reactive modes (implemented after an error execution) of error monitoring were distinguished. Within each mode, we further distinguished on-line (implemented within-trial) and off-line (between-trials) processes.Proactive off-line monitoring was unaffected by the decrease in vigilance, whether this caused by extended wakefulness, histaminergic depeltion or dopaminergic depletion). Sleep deprivation affected proactive on-line and off-line monitoring and reactive control. Histaminergic depletion affected only reactive control and reactive control seemed insensitive to dopaminergic depletion.As sleep deprivation, both histaminergic and dopaminergic depletion induced decrease in vigilance. However, effects of sleep deprivation on error monitoring were entirely reproduced neither by histaminergic nor by dopaminergic depletion, suggesting specific influences of the corresponding systems on error monitoring.

L’objectif majeur de cette thèse a été d’appréhender les conséquences de la comparaison sociale sur l’auto-évaluation implicite et explicite en termes de prudence, les affects et les comportements à risque. Les participants ont été exposés à un standard de comparaison prudent (standard haut) ou imprudent (standard bas) en matière d’alcool. Les résultats montrent que les sujets confrontés au standard haut se perçoivent implicitement plus imprudents et ressentent plus d’anxiété que les sujets exposés au standard bas. En revanche, le standard de comparaison n’influence pas l’auto-évaluation explicite et les comportements contrôlés. Ces résultats témoignent en faveur d’une dissociation entre les processus automatiques (implicites) et contrôlés (explicites) en jeu dans la comparaison sociale. Au niveau appliqué, nos données suggèrent que dans une campagne de prévention il serait potentiellement plus efficace de mettre en scène un standard prudent plutôt que de montrer un preneur de risque. / The main goal of this PhD research was to study the consequences of social comparison on implicit and explicit self-evaluation in terms of cautiousness, on affect and on risk-taking behavior. In a series of studies, participants were exposed to a comparison standard who displayed either cautious (high standard) or reckless (low standard) drinking behavior. Results show that participants confronted with the high standard implicitly perceive themselves as more reckless and experience higher levels of anxiety than participants exposed to the low standard. On the other hand, the comparison standard does not influence explicit self-evaluation and controlled behaviors. These results indicate that there might be a dissociation between automatic (implicit) and controlled (explicit) processes involved in social comparison. On an applied level, regarding alcohol prevention campaigns, our findings suggest that it could be more effective to show a cautious standard rather than a reckless one.

L’objectif de la présente étude visait à évaluer les effets différentiels de la privation de sommeil (PS) sur le fonctionnement cognitif sous-tendu par les substrats cérébraux distincts, impliqués dans le réseau fronto-pariétal attentionnel, lors de l’administration d’une tâche simple et de courte durée. Les potentiels évoqués cognitifs, avec sites d’enregistrement multiples, ont été prévilégiés afin d’apprécier les effets de la PS sur l’activité cognitive rapide et ses corrélats topographiques. Le matin suivant une PS totale d’une durée de 24 heures et suivant une nuit de sommeil normale, vingt participants ont exécuté une tâche oddball visuelle à 3 stimuli. L’amplitude et la latence ont été analysées pour la P200 et la N200 à titre d’indices frontaux, tandis que la P300 a été analysée, à titre de composante à contribution à la fois frontale et pariétale. Suite à la PS, une augmentation non spécifique de l’amplitude de la P200 frontale à l’hémisphère gauche, ainsi qu’une perte de latéralisation spécifique à la présentation des stimuli cibles, ont été observées. À l’opposé, l’amplitude de la P300 était réduite de façon prédominante dans la région pariétale pour les stimuli cibles. Enfin, un délai de latence non spécifique pour la N200 et la P300, ainsi qu’une atteinte de la performance (temps de réaction ralentis et nombre d’erreurs plus élevé) ont également été objectivées. Les résultats confirment qu’une PS de durée modérée entraîne une altération des processus attentionnels pouvant être objectivée à la fois par les mesures comportementales et électrophysiologiques. Ces modifications sont présentes à toutes les étapes de traitement, tel que démontré par les effets touchant la P200, la N200 et la P300. Qui plus est, la PS affecte différemment les composantes à prédominance frontale et pariétale. / The objective of the present study was to assess the differential effects of sleep deprivation (SD) on cognitive functions relying on distinct cerebral networks, involved in the fronto-parietal attentional network, during a relatively simple and short cognitive task. Multi-sites recording event-related-potentials (ERP) were used in order to evaluate the effect of SD on rapid cognitive activity and its topographical correlates. The morning following a night of total SD and a night of sleep, 20 participants were administered a 3-stimuli visual oddball paradigm. Amplitudes and latencies of the P200 and N200 ERP components were analyzed as frontal indexes, whereas P300 was analyzed as a mixed frontal and parietal component. Following TSD, a non specific increase in P200 amplitude for the left hemisphere, as well as a loss of lateralisation in response to target stimuli, were observed. Contrarily, P300 amplitude was predominantly reduced in the parietal region in response to target stimuli. Moreover, N200 and P300 latencies were delayed non specific to the type of stimuli and performance (reaction time and accuracy) was altered. These results confirm the deleterious effect of a moderate duration SD on attention processes that can be objectified by means of behavioural and electrophysiological measures. Each stages of information processing was altered by SD, as shown by its effect on P2, N2 and P3 components. Moreover, SD affected differently components caracterized by a predominant frontal or parietal distribution.

Introdução: A privação de sono (PdS) tem sido utilizada como um estratégia alternativa para o tratamento do Transtorno Depressivo Maior (TDM), contudo sua eficácia e efetividade carecem de estudos homogêneos e de bom delinemento para dar um grau de evidência científica para seu uso na prática diária. Assim sendo, desde a primeira publicação, em 1971, num relato de caso de um paciente com TDM grave tipo melancólico, por Plug e Tölle, o mesmo estava assintomático no dia seguinte à privação total de sono. Contudo, na noite seguinte de sono seus sintomas depressivos retornaram. Nestes quase 40 anos desde esta publicação houve dezenas de estudos em sua maioria relatos de caso, série de casos ou até estudos abertos só que misturando pacientes com TDM com Depressão Bipolar sem mesmo distinguir se tipo I ou II. A cafeína com seu efeito estimulador poderia ser uma alternativa para facilitar a privação de sono. No entanto, não há dados sobre o sua potencial influência no efeito antidepressivo da PdS. O objetivo deste estudo é avaliar o efeito da cafeína na PdS em pacientes deprimidos unipolares moderados a graves não psicóticos. Métodos: Ensaio Clínico randomizado, duplo cego, cruzado, comparando cafeína contra placebo em pacientes deprimidos moderados a graves submetidos à privação total de sono (PdS). Os pacientes foram avaliados por itens da escala de Lader, HAMD- 6 itens, CGI Severidade e Melhora Global. Resultados: Foram avaliados 20 pacientes. Os pacientes que usaram cafeína mantiveram o mesmo escore de energia pré e pós-privação de sono (item energético-letárgico da escala de Lader) enquanto os do grupo placebo diminuíram o escore de energia pós-privação de sono. (p = 0,0045). Não houve diferença entre o grupo cafeína e placebo nos demais itens da escala de Lader. Conclusão: O uso combinado de cafeína e PdS pode ser uma estratégia útil para manter os pacientes mais acordados sem o prejuízo do cansaço da PdS em pacientes ambulatoriais deprimidos. Contudo, mais estudos envolvendo pacientes que tenham 10 respondido à PdS são necessários para verificar se a cafeína também não interfere nos resultados deste grupo. / Introduction: Sleep deprivation (SD) has been used as an alternative approach to treat major depressive disorder (MDD), however the efficacy and the effectiveness needs studies with homogeneity and better delineament to strengthen the evidence based medicine to the use in the practical daily use. Besides, since the 1° puplication in 1971 of a case report, by Plug and Tölle, in that one patient with severe melancholic depressive disorder achieved remission in the next day after a total sleep deprivation. However his depressive sintomtology was back after the next night of sleep. Since this almost 40 years, a lot of papers were puplished, and the majority where case report, case reports and open trials with patients with MDD, bipolar depression without make difference between tipe I or II. Caffeine, due to its stimulating effect, could be an alternative to promote sleep deprivation. However, there are no data about its potential influence on the antidepressive effect of SD. The objective of this study is to assess the effect of caffeine on SD in non-psychotic patients with moderate to severe unipolar depression. Methods: Randomized, double-blind, crossover clinical trial comparing caffeine and placebo in moderate to severe depressed patients who underwent total sleep deprivation (SD). The patients were assessed with items of the Bond-Lader Scale, the 6-item Hamilton Depression Rating Scale (HAMD-6), and the Clinical Global Impression (CGI)-Severity/Improvement. Results: Twenty patients participated in this study. The patients who consumed caffeine presented the same score of energy before and after sleep deprivation (lethargicenergetic item of the Bond-Lader scale), while the patients in the placebo group had a reduced score of energy after sleep deprivation (p = 0.0045). There was no difference between the caffeine and placebo groups in the other items of the Bond-Lader scale. Conclusion: The combined use of caffeine and SD can be a useful strategy to keep the 12 patient awake without impairing the effect of SD on depressed outpatients. However, further studies involving patients who have responded to SD are needed in order to verify if caffeine also does not interfere with the results in this group.

Made available in DSpace on 2015-07-22T20:49:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-06-29 / A redução no tempo de sono caracteriza a sociedade moderna. A associação recíproca entre a duração do sono e o ganho de peso tem sido atualmente explorada. Contudo, as conseqüências desses fatores no sistema cardiovascular permanecem não completamente elucidadas, principalmente quando verificadas ao longo da vida. Além disso, as conseqüências da privação de sono ainda podem sofrer a influência do fator sexo. Assim, o objetivo do presente estudo foi verificar o impacto da privação de sono aguda associada à obesidade em ratas Zucker de diferentes idades (Artigo 1) e comparar os efeitos da privação de sono paradoxal (PSP) e restrição de sono (RS) crônica em ratos eutróficos machos e fêmeas (Artigo 2) nos parâmetros cardiovasculares (Artigos 1 e 2) e hormonal (Artigo 2). Para a realização do Artigo 1, ratas Zucker fêmeas magras e obesas de 3, 6 e 15 meses de idade foram distribuídas em grupos controle (CTRL, gaiolas-moradia) ou privação de sono (PS). Para o Artigo 2, ratos adultos machos e fêmeas da linhagem Wistar foram distribuídos nos grupos: controle (CTRL, gaiolas-moradia), PSP (ratos submetidos a PSP por 96 horas) ou RS (ratos submetidos à RS por 21 dias). Para ambos os artigos, os animais foram anestesiados após respectivo protocolo de PS ou tempo equivalente nos grupos CTRL, para cateterização da artéria e veia femorais. Em seguida, o índice de sensibilidade baroreflexa foi mensurado por infusões de fenilefrina (resposta bradicárdica) e nitroprussiato de sódio (resposta taquicárdica). No caso do Artigo 2, outro grupo de animais foi utilizado para a coleta sanguínea a fim de avaliar as concentrações de hormônio adrenocorticotrófico (ACTH). No Artigo 1, observamos que a obesidade resultou em disfunção da resposta taquicárdica nos animais desde os 3 meses de idade. Aos 6 e 15 meses de idade, a resposta bradicárdica e taquicárdica foram significativamente menores em animais obesos comparados aos respectivos grupos magros. Aos 15 meses de idade, a interação entre obesidade, PS e idade provocou as maiores conseqüências no sistema cardiovascular, uma vez que aumentou a pressão arterial, a freqüência cardíaca e reduziu a sensibilidade baroreflexa. No Artigo 2, os resultados mostraram que a pressão arterial média foi significativamente maior no grupo RS comparada ao grupo CTRL em ambos os sexos. Em fêmeas, a freqüência cardíaca foi significativamente maior após a PSP comparada ao respectivo grupo CTRL. O protocolo de RS atenuou a resposta baroreflexa vagal similarmente em ratos machos e fêmeas. A resposta baroreflexa simpática foi atenuada nos grupos PSP e RS, contudo, em fêmeas este parâmetro foi afetado apenas após o procedimento de PSP. Nenhuma diferença significativa em relação ao sexo foi observada para qualquer parâmetro cardiovascular em ratos da linhagem Wistar, apenas a PSP aumentou significativamente as concentrações de ACTH comparado ao grupo CTRL em ambos os sexos. Em conjunto, esses resultados sugerem que diferentes durações de perda de sono levam a conseqüências específicas nos parâmetros cardiovasculares e hormonais e estes efeitos foram similares entre ratos machos e fêmeas no caso de ratos eutróficos. Em animais obesos, a associação entre os fatores de risco (obesidade, PS e idade) exerceram as piores consequências nos parâmetros cardiovasculares analisados. / Curtailment of sleep time is a characteristic of modern society, and the reciprocal association between duration of sleep and weight gain has been under scrutiny as of late. The consequences of such factors upon the cardiovascular system remain to be fully elucidated, particularly along a full life span. Moreover, the consequences of sleep deprivation may also be influenced by the gender. The current study thus purported to examine the impact of acute sleep deprivation associated to obesity in female Zucker rats of different ages (Paper 1) and to compare the effects of paradoxical sleep deprivation (PSD) and chronic sleep restriction (SR) in male and female eutrophic rats (Paper 2) upon the cardiovascular (Papers 1 and 2) and hormonal (Paper 2 ) parameters. For the experiments described in Paper 1 lean and obese female Zucker rats 3, 6, and 15 months old were distributed into either control groups (CTRL, homecage) or sleep deprived (SD). For the experiments of Paper 2 adult female and male Wistar rats were distributed in either control groups (CTRL, home-cage) or in Paradoxical Sleep Deprivation for 96h groups (PSD-96h) or Sleep Restriction for 21 days groups (SR 21 days). In both experiments the subjects were anesthetized according to respective SD protocol or equivalent time in the CTRL groups, after which a catheter was placed in their femoral artery and vein. The baroreflex sensibility index was measured by means of phenilephrine (bradicardiac response) and sodium nitroprussiate (taquicardiac response). For the experiments conducted for Paper 2 a different group of subjects was used for blood harvesting to assess the concentrations of adrenocorticotrophic hormone (ACTH). In Paper 1 we observed that obesity resulted in dysfunctional taquicardia in subjects from 3 months of age and on. At 6 and 15 months of age the bradicardiac and taquicardiac response were significantly smaller in obese subjects when compared to respective lean groups. At 15 months of age the interaction between obesity, SD and age caused the greatest consequences in the cardiovascular system as arterial. Results of Paper 2 show that the average arterial pressure was significantly higher in the SR group when compared to the CTRL group in both genders. In females, cardiac frequency was significantly higher after PSD when compared to respective controls. The SR protocol attenuated the vagal baroreflex response similarly in males and females. The sympathetic baroreflex response was attenuated in the PSD and SR groups, but in females this parameter was affected only after PSD. No significant difference in relation to gender was observed in any of the cardiovascular parameters. PSD did increase ACTH concentrations significantly when compared to controls of both genders. The body of results yielded by both studies suggests that different periods of lost sleep lead to specific consequences in cardiovascular and hormonal parameters, and such effects were similar in male and female rat subjects. / TEDE

Introdução: A privação de sono (PdS) tem sido utilizada como um estratégia alternativa para o tratamento do Transtorno Depressivo Maior (TDM), contudo sua eficácia e efetividade carecem de estudos homogêneos e de bom delinemento para dar um grau de evidência científica para seu uso na prática diária. Assim sendo, desde a primeira publicação, em 1971, num relato de caso de um paciente com TDM grave tipo melancólico, por Plug e Tölle, o mesmo estava assintomático no dia seguinte à privação total de sono. Contudo, na noite seguinte de sono seus sintomas depressivos retornaram. Nestes quase 40 anos desde esta publicação houve dezenas de estudos em sua maioria relatos de caso, série de casos ou até estudos abertos só que misturando pacientes com TDM com Depressão Bipolar sem mesmo distinguir se tipo I ou II. A cafeína com seu efeito estimulador poderia ser uma alternativa para facilitar a privação de sono. No entanto, não há dados sobre o sua potencial influência no efeito antidepressivo da PdS. O objetivo deste estudo é avaliar o efeito da cafeína na PdS em pacientes deprimidos unipolares moderados a graves não psicóticos. Métodos: Ensaio Clínico randomizado, duplo cego, cruzado, comparando cafeína contra placebo em pacientes deprimidos moderados a graves submetidos à privação total de sono (PdS). Os pacientes foram avaliados por itens da escala de Lader, HAMD- 6 itens, CGI Severidade e Melhora Global. Resultados: Foram avaliados 20 pacientes. Os pacientes que usaram cafeína mantiveram o mesmo escore de energia pré e pós-privação de sono (item energético-letárgico da escala de Lader) enquanto os do grupo placebo diminuíram o escore de energia pós-privação de sono. (p = 0,0045). Não houve diferença entre o grupo cafeína e placebo nos demais itens da escala de Lader. Conclusão: O uso combinado de cafeína e PdS pode ser uma estratégia útil para manter os pacientes mais acordados sem o prejuízo do cansaço da PdS em pacientes ambulatoriais deprimidos. Contudo, mais estudos envolvendo pacientes que tenham 10 respondido à PdS são necessários para verificar se a cafeína também não interfere nos resultados deste grupo. / Introduction: Sleep deprivation (SD) has been used as an alternative approach to treat major depressive disorder (MDD), however the efficacy and the effectiveness needs studies with homogeneity and better delineament to strengthen the evidence based medicine to the use in the practical daily use. Besides, since the 1° puplication in 1971 of a case report, by Plug and Tölle, in that one patient with severe melancholic depressive disorder achieved remission in the next day after a total sleep deprivation. However his depressive sintomtology was back after the next night of sleep. Since this almost 40 years, a lot of papers were puplished, and the majority where case report, case reports and open trials with patients with MDD, bipolar depression without make difference between tipe I or II. Caffeine, due to its stimulating effect, could be an alternative to promote sleep deprivation. However, there are no data about its potential influence on the antidepressive effect of SD. The objective of this study is to assess the effect of caffeine on SD in non-psychotic patients with moderate to severe unipolar depression. Methods: Randomized, double-blind, crossover clinical trial comparing caffeine and placebo in moderate to severe depressed patients who underwent total sleep deprivation (SD). The patients were assessed with items of the Bond-Lader Scale, the 6-item Hamilton Depression Rating Scale (HAMD-6), and the Clinical Global Impression (CGI)-Severity/Improvement. Results: Twenty patients participated in this study. The patients who consumed caffeine presented the same score of energy before and after sleep deprivation (lethargicenergetic item of the Bond-Lader scale), while the patients in the placebo group had a reduced score of energy after sleep deprivation (p = 0.0045). There was no difference between the caffeine and placebo groups in the other items of the Bond-Lader scale. Conclusion: The combined use of caffeine and SD can be a useful strategy to keep the 12 patient awake without impairing the effect of SD on depressed outpatients. However, further studies involving patients who have responded to SD are needed in order to verify if caffeine also does not interfere with the results in this group.

Made available in DSpace on 2014-12-17T15:36:53Z (GMT). No. of bitstreams: 1 AnaPLM.pdf: 607381 bytes, checksum: 38ed8ff61bb80d4aa7e083e73b98e3f8 (MD5) Previous issue date: 2008-06-04 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The sleep onset and offset delay at adolescence in relation to childhood. Besides biological causes, some external factors as academic obligations and socialization contributes, increasing the burden of school and socialization. However, morning school schedules reduce sleep duration. Besides light strong effect, studies in humans have indicated that exercise influence circadian synchronization. To evaluate the effect of the morning exercise under sunlight on sleep-wake cycle (SWC) of adolescents, 160 high school students (11th year) were exposed to the following conditions: lesson in usual classroom (Group C), lesson in swimming pool exposed to sunlight (Group E), half of them carrying through physical activity (EE) and the other resting (EL). Each experimental group met two stages: assessment of SWC 1 week before and 1 week during the intervention, which was held in Monday and Wednesday between 7:45 and 8:30 am. In the baseline, there were applied the questionnaires "Health and Sleep" and cronotype evaluation (H & O). In addition, students were evaluated before and during the intervention by "Sleep Diary", "Karolinska Sleepiness Scale" (KSS), Psychomotor Vigilance Test (PVT) and actimetry. During the intervention, there was a delay in wake-up time on the weekend and a trend to greater sleep duration on week for the three groups. At the weekend, only the groups EE and EL increased sleep duration. There was no difference in bedtime, irregularity of sleep schedules and nap variables. The sleepiness showed a circadian pattern characterized by higher alertness levels at 11:30 am and sleepiness levels at bedtime and wake-up time on week. On weekends there were higher levels of alertness in these times. In the days of intervention, there was an increase of sleepiness at 11:30 am for groups EL and EE, which may have been caused by a relaxing effect of contact with the water of the pool. In addition, the group EE showed higher alert levels at 14:30 pm on Monday and at 8:30 am in the Wednesday, possibly caused by exercise arousal effect. The reaction time assessed through the TPV did not vary between the stages. The sleep quality improved in the three groups in the second stage, making impossible the evaluation of intervention effect. However, the sleep quality increased on Monday and Tuesday only on the group EE. From the results, it is suggested that the intervention promoted effects on the sleepiness at some day hours. In other SWC variables there were no effects, possibly due to a large SWC irregularity on weekends. Thus, the evaluation of higher weekly frequency EF is necessary, since only two days were insufficient to promote greater effect on adolescents SWC / Na adolesc?ncia h? uma tend?ncia a dormir e acordar mais tarde em rela??o ? inf?ncia. Embora esta caracter?stica tenha causas biol?gicas, alguns fatores externos podem favorec?-la: como o aumento da carga escolar e da socializa??o. No sentido contr?rio os hor?rios escolares matutinos representam um dos grandes fatores respons?veis pela priva??o parcial de sono. Ainda que a exposi??o ? luz seja considerada o regulador mais importante do sistema circadiano em mam?feros, estudos em seres humanos indicaram que o exerc?cio f?sico influencia a sincroniza??o circadiana. Por isso, o objetivo do nosso trabalho ? avaliar o efeito do exerc?cio f?sico matinal sob luz solar no ciclo vig?lia-sono (CVS) de adolescentes. O estudo contou com a participa??o de 160 alunos do ensino m?dio (1? e 2? ano), expostos ?s seguintes condi??es: aula na sala habitual (Grupo C), aula na piscina exposto ? luz solar (Grupo E), metade em exerc?cio f?sico (EE) e outra em repouso (EL). Cada grupo experimental cumpriu duas etapas: avalia??o do CVS 1 semana antes e 1 semana durante a interven??o, que foi realizada na 2? e 4? feira entre 7:45 e 8:30 h. Na linha de base foram aplicados os question?rios Sa?de e Sono e de avalia??o do cronotipo (H&O). Al?m disso, os alunos foram avaliados antes e durante a interven??o pelo Di?rio de sono , Escala de Sonol?ncia de Karolinska (ESK), Teste de vigil?ncia psicomotora (TPV) e actimetria. Durante a interven??o, houve atraso no hor?rio de acordar no fim de semana e tend?ncia a maior dura??o do sono na semana nos tr?s grupos. No fim de semana, apenas os grupos EE e EL passaram a dormir mais. N?o houve diferen?a no hor?rio de dormir, na irregularidade dos hor?rios de sono e nas vari?veis do cochilo. A sonol?ncia apresentou um padr?o circadiano caracterizado por maior alerta ?s 11:30 h e maior sonol?ncia nos hor?rios de acordar e dormir na semana, e menor sonol?ncia nos finais de semana. Nos dias de interven??o, houve um aumento da sonol?ncia ?s 11:30 h para os grupos EE e EL, que pode ter sido decorrente de um efeito relaxante do contato com a ?gua da piscina. Al?m disso, o grupo EE apresentou maiores n?veis de alerta ?s 14:30 h na 2? feira e ?s 8:30 h na 4? feira, possivelmente decorrentes de um efeito ativacional do exerc?cio. O tempo de rea??o avaliado por meio do TPV n?o variou entre as etapas. A qualidade do sono melhorou nos tr?s grupos na 2? etapa, impossibilitando avaliar o efeito da interven??o. Entretanto, houve melhora na qualidade do sono na 2? e 3? feira apenas para o grupo EE. A partir dos resultados, sugere-se que a interven??o promoveu efeitos sobre a sonol?ncia em alguns hor?rios. Nas outras vari?veis n?o foram observados efeitos, possivelmente devido a uma grande irregularidade no CVS nos finais de semana. Faz- se necess?rio ampliar o estudo com a realiza??o de exerc?cio f?sico numa freq??ncia semanal maior, visto que apenas dois dias foram insuficientes para promover maiores efeitos no CVS dos adolescentes