Search

Obesity is commonly associated with depressive symptoms, disturbed sleep and changes in eating pattern, as observed in patients with the Night Eating Syndrome (NES). However, the impact of bariatric surgery (BS) on these conditions has been insufficiently investigated. This thesis seeks to improve current knowledge in this area and comprises three studies. The first study is a critical review of the existing literature on the treatment of NES. A systematic search was performed in PubMed for original clincial studies investigating pharmacological and/or non-pharmacological treatment modalities, from 1955 to 2015. Only 17articles met the selection criteria, highlighting the need for more well-controlled randomized clinical trials. Promising results were reported with the use of serotonergic agents, psychological interventions, and chronobiologic interventions, which deserve further investigation. The second study evaluated the effects of BS on night eating and depressive symptoms in 60 consecutive patients undergoing BS at the Hospital Geral Dr. César Cals (HGCC)in Fortaleza, Brazil. Presence and severity of the NES were evaluated by the night eating questionnaire (NEQ), and a score ≥25 was considered positive for NES. Depressive symptoms were assessed by the Beck Depression Inventory – Short Form (BDI), and a score>4 was indicative of depressive symptoms. A postoperative improvement in the BDI scores (9.77±7.01 vs 4.70±4.60, p=0.001) as well as a trend for an increase in overall NEQ scores (14.18±7.69 vs 12.32±7.66, p=0.05) were observed. Patients with preoperative depressive symptoms showed a greater reduction in NEQ scores compared with those without these symptoms (16.03±7.73 vs 12.80±7.76,respectively; p=0.01), raising the possibility of a causal relationship. In the third study, the course of excessive daytime sleepiness (EDS) and sleep impairment was investigated in 60 patients following BS, at the HGCC. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) and a score>5 indicated poor quality sleep. Daytime sleepiness was evaluated by the Epworth Sleepiness Scale (ESS)and a score ≥10 indicated EDS. The Berlin questionnaire was used to measure the risk for obstructive sleep apnea (OSA). The BDI analyzed the presence and severity of depressive symptoms. Results demonstrated that BS improves PSQI (6.4±3.8 vs 4.1±2.8; p4 foi indicativa de sintomas depressivos. Observou-se melhora pós-operatória nos escores do IDB (9,77±7,01 vs 4,70± 4,60; p=0,001) e uma tendência de melhora dos escores globais do QAN (14,18±7,69 vs 12,32±7,66; p=0,05). Verificou-se também que o grupo com sintomas depressivos basais apresentou maior redução do QAN comparado ao grupo sem esses sintomas (respectivamente, 16,03±7,73 vs 12,80±7,76; p = 0,01). Além da redução dos sintomas depressivos pós-CB confirmada pelo estudo, a melhora da alimentação noturna observada predominantemente nos pacientes com sintomas depressivos basais sugere uma relação de causalidade entre as duas condições. No terceiro estudo, foram investigados prospectivamente o curso da sonolência diurna excessiva (SDE) e do comprometimento do sono em 60 pacientes submetidos a CB, consecutivamente recrutados no ambulatório de CB do HGCC. A qualidade subjetiva do sono foi avaliada pelo Índice de Qualidade do Sono de Pittsburgh (IQSP) e uma pontuação >5 foi indicativa de sono de má qualidade. A SDE foi avaliada pela Escala de Sonolência de Epworth (ESE) e uma pontuação ≥10 foi indicativa de SDE. O risco de síndrome da apneia obstrutiva do sono (SAOS) foi avaliado pelo questionário de Berlim (QB). A presença e a gravidade dos sintomas depressivos foram investigadas pelo IDB. Os resultados obtidos demonstram que a CB melhora o IQSP (6,4 ±3,8 vs 4,1 ±2,8; p

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

Night eating syndrome (NES) is an eating disorder characterized by a delay in the circadian time of food intake, with more than 25% of daily caloric intake after the evening meal or at least 3 nocturnal awakenings with ingestion per week. The Night Eating Questionnaire (NEQ) has 14 items with a 5 point scale and has been used as a tool for NES evaluation. The main objective of this study was to translate the current English version of the NEQ into Portuguese and adapting to cultural differences to allow for its use in Brazilian patients. The first part of the study consisted of translation; back-translation to English; review of the translations and evaluation of semantic equivalence. After this initial phase, intra and inter-observer reproducibility was assessed in a group of 37 individuals. The reliability of the questionnaire was evaluated by the Cronbach coefficient in 90 individuals. The translated and adapted version showed excellent internal consistency, with an alfa coefficient slightly below 0.9. This new version also had adequate reproducibility both intra-observer, with coefficients between 0.95 and 1.0, and inter-observer, with coefficients between 0.92 and 1.0. These results show that the translated questionnaire is clear, and the answers elicited are consistent and remain stable over time. Therefore, equivalence of the concepts in each item and operational equivalence of the English and Portuguese versions are established. Future studies evaluating the applicability of the Brazilian version using samples stratified by schooling, income and social status are necessary for a more precise evaluation of this tool. A síndrome alimentar noturna (SAN) é um distúrbio alimentar caracterizada por um atraso no ritmo circadiano de apetite-saciedade, com ingestão calórica ≥ 25% do total diário após a refeição da noite e / ou pelo menos três despertares noturnos acompanhados de alimentação por semana. O Night Eating é um instrumento, que contém 14 itens com cinco pontos, usado como triagem para o diagnóstico da SAN. O principal objetivo deste estudo foi traduzir para o português a versão em inglês, atualizada, do Night Eating Questionnaire e adaptá-la culturalmente para uso em pacientes brasileiros. Na primeira etapa do estudo, foi realizada tradução; retrotradução para o Inglês; revisão das traduções e avaliação da equivalência semântica. Em seguida, avaliou-se a reprodutibilidade intra e interobservador num grupo de 37 indivíduos. A confiabilidade do questionário foi avaliada pelo coeficiente de Cronbach em 90 indivíduos. A escala brasileira apresentou excelente consistência interna, com coeficiente alfa ligeiramente inferior a 0,9. A escala traduzida e adaptada apresentou ainda adequada reprodutibilidade intra-observador com coeficientes entre 0,95 e 1,0 e interobservador com coeficientes entre 0,92 e 1,0. Estes resultados mostram que o instrumento traduzido tem clareza e que conduz a respostas consistentes, que não se confundem com o passar do tempo. Desse modo, ficam estabelecidas a equivalência conceitual dos itens e a equivalência operacional das versões em português e inglês. Novos estudos da aplicabilidade da versão brasileira utilizando amostras estratificadas por escolaridade, faixa de renda e classe social deverão ser realizados para avaliar este instrumento de forma mais precisa.