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Previous issue date: 2017-07-27 / Os dist?rbios do sono s?o caracterizados por altera??es no ciclo sono-vig?lia. Os estudos relativos ?s condi??es do sono e suas repercuss?es na popula??o brasileira s?o em sua grande maioria de contexto cl?nico, reduzindo a representatividade dos achados. O objetivo do estudo foi identificar fatores biol?gicos/sa?de, comportamentais e sociais associados com as queixas de redu??o da fun??o reparadora do sono (FRS), ins?nia e sonol?ncia excessiva diurna (SED) na popula??o brasileira assim como os efeitos destas queixas na ocorr?ncia de morte e eventos cardio-cerebrovasculares em idosos. O estudo foi desenvolvido em dois delineamentos. O primeiro foi uma an?lise de dados transversais oriundos da Pesquisa Nacional de Sa?de de 2013. Neste delineamento visava-se estimar a ocorr?ncia da redu??o da FRS, queixas de ins?nia e sonol?ncia excessiva e suas associa??es. O segundo desenho trata-se de uma coorte prospectiva de idosos comunit?rios com linha base em 2009, dividida em grupo de expostos ?s queixas de ins?nia e sonol?ncia e n?o expostos, para estimar seus efeitos sobre a mortalidade e eventos cardiovasculares, em oito anos de seguimento. As an?lises dos dados transversais ocorreram atrav?s de modelagem de Cox com a inclus?o dos pesos amostrais no c?lculo das estimativas e para os dados prospectivos aplicou-se modelagem de Poisson. Adotou-se um ??0,05. O estudo foi submetido ao Comit? de ?tica em Pesquisa do Hospital Onofre Lopes, recebendo o parecer 2.048.708. Os resultados do primeiro estudo indicam que aproximadamente 28,2% (IC95%:27,4%-29,0%) dos adultos e 34,1% (IC95%:32,6%-35,7%) em idosos relatam queixas de ins?nia e sonol?ncia. A FRS estava reduzida em 34,1% (IC95%:32,6%-35,7%) em adultos e 29,2% (IC95%:27,2%-30,6%) nos idosos. As queixas de ins?nia/SED foram relatadas em 28,2% (IC95%: 27,4%-29,0%) nos adultos e 34,1% (32,6%-35,7%) no idosos. Nos adultos, a redu??o da FRS associa-se com as mulheres (RPaj1=1,12; IC95%: 1,05-1,20/ RPajus2=1,22; IC95%:1,09-1,37), baixos estratos sociais DE (RPaj1=1,21;1,07-1,35, RPaj2=1,42;1,18-1,71) e C (RPaj1=1,30;1,12-1,50), sintomas depressivos (RPaj1=3,22;2,94-3,52/RPaj=3,29;2,83-3,83), oscila??o comportamental (RPaj1=1,51;1,41-1,63/ RPaj2=1,66;1,46-1,89), m? percep??o de sa?de geral (RPaj=1,32;1,20-1,38/ RPaj2=2,30;1,92-2,75), m? percep??o de sa?de bucal (RPaj=1,11;1,04-1,19), ter condi??o cr?nica de sa?de (RPaj1=1,23;1,15-1,31/ RPaj2=1,42;1,26-1,61), ter queixas de ins?nia/SED (RPaj1=2,47;2,28-2,67/ RPaj2=3,03;2,66-3,47), possuir atividade laboral (RPaj1=1,32;1,23-1,42/ RPaj2=1,27;1,13-1,44)e morar em zona urbana (RPaj2=1,31;1,10-1,55). Baixo peso (RPaj1=0,82;0,69-0,98), estilo de vida saud?vel (RPaj1=0,91;0,83-0,99/ RPaj2=0,74;0,64-0,87) e reduzido apoio social (RPaj1=0,88;0,80-0,96) s?o inversamente associados a redu??o da FRS em adultos. Em idosos, a redu??o da FRS associa-se com a ra?a/cor branca (RPaj2=1,18;1,01-1,39), dificuldade em atividades di?rias (RPaj1=1,13;1,01-1,27/ RPaj2=1,36;1,12-1,65), usar computador/internet (RPaj1=1,14;1,01-1,30) e, assim como nos adultos, sintomas depressivos (RPaj1=3,37;2,87-3,97/ RPaj2=3,77;2,88-4,96), oscila??o comportamental (RPaj1=1,75;1,53-1,99/ RPaj2=1,81;1,46-2,24), m? percep??o de sa?de geral (RPaj1=1,50;1,23-1,82/ RPaj2=3,12;2,31-4,21), regular percep??o de sa?de bucal (RPaj=1,21;1,08-1,37), ter condi??o cr?nica de sa?de (RPaj2=1,58;1,11-2,40), ter queixas de ins?nia/SED (RPaj1=2,45;2,14-2,79/ RPaj2=3,46;2,77-4,33), ter apoio social (RPaj1=1,14;1,01-1,30) e morar em zona urbana (RPaj2=1,32;1,02-1,72). O delineamento prospectivo revelou 40 (25,97%:19,04-32,89) mortes no per?odo e 48 (30,76%:23,52-38,01) eventos cardio-cerebrovasculares. Os homens apresentaram maior risco (RR=1,88; 1,01-3,50) de morte. A depress?o (RR=2,04;1,06-3,89), gravidade da ins?nia (RR=2,39;1,52-4,56) e lat?ncia do sono entre 16-30 minutos (RR=3,54;1,26-9,94) e 31-60 minutos (RR=2,23;1,12-4,47) aumentam o risco de morte independentemente em idosos comunit?rios. Os eventos cardio-cerebrovasculares foram preditos apenas por idosos hipertensos e/ou diab?ticos (RR=8,30;1,98-34,82). As queixas de redu??o da FRS, ins?nia e sonol?ncia atingem quase um ter?o da popula??o brasileira e est? intimamente relacionada ?s condi??es emocionais, cronicidade e urbaniza??o. As queixas de gravidade da ins?nia e a dificuldade de iniciar o sono parecem aumentar a mortalidade em idosos, juntamente com sintomas depressivos. / Sleep disturbances are characterized by changes in the sleep-wake cycle. Studies on sleep conditions and their repercussions on the Brazilian population are mostly in the clinical context, reducing the impact of the findings. The aim was to identify biological/health, behavioral and social factors associated with complaints of reduction of sleep repair function (SRF), insomnia and excessive daytime sleepiness (EDS) in the Brazilian population, as well as the effects of these complaints on the occurrence of death and cardio-cerebrovascular events in the elderly. The study was developed in two designs. The first was an analysis of cross-sectional data from the National Health Survey of 2013. This study aimed to estimate the occurrence of reduced SRF, complaints of insomnia and excessive sleepiness and their associations. The second design is a prospective cohort of community-based older adults in 2009, divided into a group of exposed to insomnia and EDS and unexposed complaints, to estimate their effects on mortality and cardiovascular events at eight years follow-up. The cross-sectional data analyzes were performed using Cox modeling with inclusion of sample weights in the estimation of the estimates and for the prospective data, Poisson modeling was applied. It was adopted ??0.05. The study was submitted to the Research Ethics Committee of Hospital Onofre Lopes, receiving opinion 2,048,708. The results of the first study indicate that approximately 28.2% (95% CI: 27.4% -29.0%) of adults and 34.1% (95% CI: 32.6% -35.7%) in the elderly report complaints of insomnia and drowsiness. Sleep RF was reduced by 34.1% (95% CI: 32.6% -35.7%) in adults and 29.2% (95% CI: 27.2% -30.6%) in the elderly. Complaints of insomnia/EDS were reported in 28.2% (95% CI: 27.4% -29.0%) in adults and 34.1% (95% CI: 32.6% -35.7%) in the elderly. In adults, the reduction of RF stands out in relation to women (PRadj1=1.12; 95%CI:1.05-1.20/PRadj2=1.22; 95%CI:1.09-1,37), low social strata DE (PRadj1=1.21; 1.07-1.35/PRadj2=1.42;1.18-1.71) and C (PRadj1=1.30;1.12-1.50), depressive symptoms (PRadj1=3.22;2.94-3.52/PRadj2=3.29;2.83-383), emotional behavioral oscillation (PRadj1=1.51;1.41-1.63 /PRadj2=1.66;1.46-1.89), bad general health perception (PRadj1= 1.32;1.20-1.38 / PRadj2=2.30;2.05-2.90), bad perception of oral health (PRadj1=1.11;1.04-1.19), chronic health condition (PRadj1=1.23;1.15-1.31/PRadj2=1.42;1.26-1.61), insomnia/EDS complaints (PRadj1=2.47:2.28-2.67/PRadj2=3.03;1.23-1.42), livening urban areas (PRadj2=1.31;1.101.5). Low weight (PRadj1=0.82;0.690.98), healthy life style (PRadj1=0.91:0.830.99/PRadj2=0.74;0,64-0,87) and low social support (PRadj1=0.88;0.80-0.96) are inversely associated with reduction of RF in adults. In the elderly, the reduction in RF is associated with white (PRadj2=1.18;1.01-1.39), daily activities difficulty (PRadj1=1.13;1.01-1,27/PRadj2=1.36;1,12-1,65), use computer/internet (PRadj1=1.14;1.01-1.30) and, as well as in adults, depressive symptoms(PRadj1=3.37;2.87-3.97/PRadj2=3.77;2.88-4.96), behavioral oscillation (PRadj1=1.75;1.46-2.24), bad general health perception (PRadj1=1.50;1.23-1.82/PRadj2=3,12;2,31-4,21), regular oral health perception (PRadj=1.21;1.08-1.37), chronic health condition (PRadj1=1.58;1.11-2.40), insomnia/EDS complaints (PRadj1=2.45;2.14-2.79/PRadj2=3.46;2.77-4.33), social support (PRadj1=1.14;1.01-1.30) and living in urban areas (PRadj2=1.32;1.02- 1.72). The prospective design revealed 40 (25.97%;19.04-32.89) deaths in the period and 48 (30.76%;23.52-38.01) cardio-cerebrovascular events. Men presented higher risk (RR=1.88;1.01-3.50) of death. Depression (RR=2.04; 1.06-3.89), insomnia severity (RR=2.39;1.52-4.56) and sleep latency between 16-30 minutes (RR=3.54;1.26-9.94) and 31-60 minutes (RR=2.23;1.12-4.47) increase the risk of death independently in community-dwelling elderly. Cardiovascular events were predicted only by hypertensive and/or diabetic elderly (RR=8.30;1.98-34.82). The complaints of RFS reduction, insomnia/EDS affect almost a third of the Brazilian population and are closely related to emotional conditions, chronicity and urbanization. Complaints of insomnia severity and difficulty in initiating sleep seem to increase mortality in the elderly along with depressive symptoms.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/24804 |
| Date | 27 July 2017 |
| Creators | Lopes, Johnnatas Mikael |
| Contributors | 42313384420, Maciel, ?lvaro Campos Cavalcanti, 93261438487, Dantas, F?bio Galv?o, 49737252420, Piuvezam, Grasiela, 02371412481, Ata?de J?nior, Luiz, 19218664468, Oliveira, Angelo Giuseppe Roncalli da Costa |
| Publisher | PROGRAMA DE P?S-GRADUA??O EM SA?DE COLETIVA, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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