Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Previamente, alteraÃÃes circadianas na doenÃa pulmonar obstrutiva crÃnica (DPOC) foram insuficientemente investigadas. Neste trabalho, que consiste em trÃs estudos, foram avaliadas as alteraÃÃes no ritmo vigÃlia-sono; a variaÃÃo circadiana da temperatura oral; a secreÃÃo noturna de melatonina e a concentraÃÃo de cortisol matinal na DPOC estÃvel. Inicialmente, 26 pacientes com DPOC moderada a muito grave (idade mÃdiaÂDP=66,9Â8,5 anos) e 15 controles (idade=63,0Â10,7 anos) foram avaliados por actimetria durante 5-7 dias. Dispneia, funÃÃo pulmonar (espirometria), qualidade do sono (Ãndice de Qualidade do Sono de Pittsburgh, IQSP) e sonolÃncia diurna (Escala de SonolÃncia de Epworth, ESE) foram mensurados. IndivÃduos com DPOC apresentaram maior latÃncia para o sono (p=0.003), atividade noturna (p=0.003) e tempo acordado apÃs inÃcio do sono (p=0.003) e menor tempo total de sono (TTS; p=0.024) e eficiÃncia do sono (p=0.001). Nos pacientes, a dispneia correlacionou-se com atividade no sono (r=0,41; p=0.04) e TTS (r=-0,46; p=0.02). A qualidade do sono foi pior na DPOC (p=0.043). No segundo estudo, a temperatura oral foi medida a cada duas horas, das 4 Ãs 22 horas, em 31 pacientes com DPOC moderada a muito grave (idade=66,3Â6,5anos) e 19 controles (idade=63,6Â5,4anos). Dispneia, qualidade do sono (IQSP), sonolÃncia diurna (ESE), sintomas depressivos (InventÃrio DepressÃo de Beck, BDI-II), fadiga (Escala de Gravidade de Fadiga, EGF), cronotipo (QuestionÃrio de Matutinidade-Vespertinidade, MEQ) e risco de apneia obstrutiva do sono (QuestionÃrio de Berlim) foram avaliados. Pacientes com DPOC apresentaram pior escore do IQSP (p<0.001), do BDI-II (p=0.02) e do EGF (p<0.001). Os valores de temperatura Ãs 4 e 6 horas foram maiores nos pacientes do que nos controles (p=0.001 e p=0.02, respectivamente). Na DPOC, a temperatura Ãs 6 horas correlacionou-se com o IQSP global (p=0.015). No terceiro estudo, 11 pacientes com DPOC moderada a grave (idade=64,4Â8,8 anos) foram avaliados com polissonografia e determinaÃÃo do grau de dispneia, funÃÃo pulmonar, comorbidades (Indice de Comorbidades de Charlson, ICC) e dosagem de cortisol matinal (6 horas). Em sete casos, foi medida a concentraÃÃo de melatonina Ãs 18, 19, 20, 21, 22, 23, 00, 2, 4 e 6 horas. Observou-se prolongamento da latÃncia para o sono REM (118,1Â86,3 min), baixa eficiÃncia do sono (82,9Â11,6%) e elevado Ãndice de despertares (16,3Â8,5/hora). As curvas de secreÃÃo de melatonina mostraram grande variabilidade. Em mÃdia, o pico de melatonina (82,28Â49,4pg/mL) ocorreu Ãs 22 horas. A eficiÃncia do sono correlacionou-se com a concentraÃÃo de melatonina Ãs 20 (p=0.05) e 23 horas (p=0.04) e o TTS com a concentraÃÃo de melatonina Ãs 22 horas (p=0.05). A concentraÃÃo de cortisol Ãs 6 horas (22,08Â5,8 mg /dl)
correlacionou-se inversamente com o Ãndice de despertares (p=0.04). Em conclusÃo, pacientes com DPOC estÃvel apresentam alteraÃÃes do sono avaliados por actimetria, associada ao grau de dispneia. O ritmo da temperatura oral na DPOC està alterado, com temperaturas mais elevadas no inÃcio da manhÃ, o que pode estar relacionado a alteraÃÃes do sono. O padrÃo de secreÃÃo de melatonina na DPOC à bastante variÃvel. Os nÃveis de cortisol matinal e a concentraÃÃo de melatonina Ãs 20, 22 e 23 horas associam-se a alteraÃÃes do sono nestes pacientes. / Previously, circadian alterations in chronic obstructive pulmonary disease (COPD) have been insufficiently investigated. In this work, consisting of three studies, we evaluated the impairments in sleep-wake rhythm, the circadian variation of oral temperature, the nocturnal melatonin secretion and morning cortisol concentration in patients with stable COPD. Initially, 26 patients with moderate to very severe COPD (mean age  SD = 66.9  8.5 years) and 15 controls (age = 63.0  10.7 years) were evaluated by actigraphy for 5-7 days. Dyspnea, lung function (spirometry), sleep quality (Pittsburgh Sleep Quality Index, PSQI) and daytime sleepiness (Epworth Sleepiness Scale, ESS) were measured. Individuals with COPD showed increased sleep latency (p = 0.003), mean nocturnal activity (p = 0.003), and wake after sleep onset (p = 0.003). Furthermore, they presented reduced total sleep time (TST, p = 0.024) and lower sleep efficiency (p = 0.001). In patients, severity of dyspnea was correlated with activity levels during sleep (r = 0.41, p = 0.04) and with TST (r = -0.46, p = 0.02). Subjective sleep quality was poorer in patients than controls (p = 0.043). In the second study, oral temperature was measured every two hours, from 4:00 a.m to 10:00 p.m, in 31 patients with moderate to very severe COPD (age = 66.3  6.5 years) as well as in 19 controls (age = 63.6  5.4 years). Dyspnea, sleep quality (PSQI), daytime sleepiness (ESS), depressive symptoms (Beck Depression Inventory, BDI-II), fatigue (Fatigue Severity Scale, FSS), chronotype (morningness-eveningness Questionnaire, MEQ) and risk of sleep apnea (Berlin Questionnaire) were evaluated. COPD patients showed worse PSQI global score (p<0.001), BDI-II (p = 0.02) and FSS (p <0.001). Mean temperature at 4:00 a.m and 6:00 a.m were higher in patients than in controls (p = 0.001 and p = 0.02, respectively). In the COPD group, the temperature at 6:00 a.m was correlated with the PSQI global score (p = 0.015). In the third study, 11 patients with moderate or severe COPD (age = 64.4  8.8 years) were evaluated with polysomnography, dyspnea, pulmonary function and comorbidities (Charlson Comorbidity Index, CCI) and they had the cortisol levels measured in the morning at 6:00 a.m. The concentration of melatonin was measured at 6:00, 7:00, 8:00, 9:00, 10:00, 11:00 p.m and, 0:00, 2:00, 4:00 and 6:00 a.m in seven cases. It was observed prolongation of REM sleep latency (118.1  86.3 min), lower sleep efficiency (82.9  11.6%) and elevated arousal index (16.3  8.5 / h). The curves of melatonin secretion showed great variability. On average, the peak of melatonin (82.28  49.4 pg / ml) occurred at 10:00 p.m. Sleep efficiency was correlated with the concentration of melatonin at 8:00 p.m (p = 0.05) and 11:00 p.m (p = 0.04) and the TST with melatonin concentration at 10:00 p.m (p = 0.05). The cortisol concentration
at 6:00 a.m (22.08 Â 5.8 mg /dl) were correlated inversely with the arousal index (p = 0.04). In conclusion, clinically stable COPD patients presented sleep alterations assessed by actigraphy, associated with the degree of dyspnea. The rhythm of oral temperature was altered in COPD, with higher temperatures in the early morning, and this may be related to sleep disturbances. The pattern of melatonin secretion in COPD is variable. Cortisol morning levels and melatonin concentration measured at 8:00, 10:00 and 11:00 p.m are associated with changes in the sleep pattern of these patients.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:6201 |
| Date | 21 October 2012 |
| Creators | Deuzilane Muniz Nunes |
| Contributors | Pedro Felipe Carvalhedo de Bruin, Veralice Meireles Sales de Bruin, Eanes Delgado Barros Pereira |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em CiÃncias MÃdicas, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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