Andréia Gomes Bezerra

The effect of menopause on objective sleep parameters: Data from an epidemiologic study in São Paulo, Brazil

OBJECTIVE Our objective was to investigate the influence of menopausal status on sleep patterns in a representative sample of women from São Paulo, Brazil. STUDY DESIGN A population-based survey with a probabilistic three-stage cluster sample of the city of São Paulo was used to represent the local population according to gender, age (20-80 years) and socioeconomic status. MAIN OUTCOME MEASURES The female participants answered a sleep questionnaire, underwent polysomnographic recording and allowed their hormone levels to be measured. They also completed a gynecological questionnaire for classification of the reproductive aging stages: premenopausal or reproductive, perimenopausal or menopausal transition, and postmenopausal, defined as being after 12 months of amenorrhea. Women were allocated into early (the first 5 years after menopause) and late (after the first 5 years) stages. RESULTS A total of 535 women were included in this study: 339 were premenopausal, 53 were early postmenopausal, 118 were late postmenopausal and 25 were using hormone therapy or isoflavone compounds. Our main findings were that women in postmenopause spent more time in N3 sleep, had a higher apnea-hypopnea index (AHI) and lower SaO2 compared with premenopausal women after an analysis adjusted for confounding factors. We found no significant differences between early and late postmenopausal women in the adjusted analysis. CONCLUSION Our results indicate menopause itself exerts a modest, but important influence on objective sleep patterns, independent of age, in particular on AHI and SaO2.

Effects of acute sleep deprivation on state anxiety levels: a systematic review and meta-analysis

Increased anxiety levels have been widely recognized as one of the most important consequences of sleep deprivation. However, despite this general consensus, there are still aspects of this relationship, such as the extent of the anxiogenic potential and the specific effects of different types of sleep deprivation, which remain unclear. As no broad review has been undertaken to evaluate this relationship, we performed a systematic review and meta-analysis regarding the effects of sleep deprivation on state anxiety. Our search strategy encompassed two databases - Pubmed/Medline and Scopus - through which we were able to identify 756 articles. After the selection process, 18 articles, encompassing 34 experiments, composed our final sample. Our analyses indicate that sleep deprivation, whether total or not, leads to a significant increase in state anxiety levels, but sleep restriction does not. Regarding the effect of the length of the period of sleep deprivation, no significant results were observed, but there was a notable tendency for an increase in anxiety in longer sleep deprivations. With regard to tools, the State-Trait Anxiety Inventory (STAI) seems to be the best one to measure sleep-induced anxiogenesis, while the Profile of Mood States (POMS) presented inconclusive results. In conclusion, it can be affirmed that sleep deprivation induces a state of increased anxiety, with similar results also in the case of total sleep deprivation; however, results in more specific experimental conditions are not definitive.

Effects of a hydroalcoholic extract of Turnera diffusa Willd. ex Schult., Turneraceae, in tests for adaptogenic activity

The objective of the present study was to assess whether Turnera diffusa Willd. ex Schult., Turneraceae, (TD), plant known in popular medicine as tonic and aphrodisiac, has other effects that are characteristic of an adaptogen substance, such as improvement of the memory and reduction of the damage caused by stress. We carried out an initial screening to detect a possible toxicity of the plant. In that phase of the study we used tests of observational screening; evaluation of acute toxicity; measurement of motor activity and motor coordination, and sleeping time induced by pentobarbital, and observed that the extract presented low toxicity and no stimulant or depressant effect on the animals. We then performed specific tests for the evaluation of an adaptogen effect. TD did not protect the stomach of the animals from the formation of ulcers, neither did it alter the plasmatic levels of adrenocorticotropic hormone (ACTH) and corticosterone of the animals submitted to immobilization and cold. As regards the evaluation of memory in passive avoidance, TD did not inhibit scopolamine-induced amnesia. Additionally, the hydroalcoholic extract presented low antioxidant activity in vitro. In the models used, TD produced no changes in relation to a possible adaptogen effect.

Effects of experimental sleep deprivation on anxiety-like behavior in animal research: Systematic review and meta-analysis

Increased acute anxiety is a commonly reported behavioral consequence of sleep deprivation in humans. However, rodent studies conducted so far produced inconsistent results, failing to reproduce the same sleep deprivation induced-anxiety observed in clinical experiments. While some presented anxiogenesis as result of sleep deprivation, others reported anxiolysis. In face of such inconsistencies, this article explores the effects of experimental sleep deprivation on anxiety-like behavior in animal research through a systematic review and a series of meta-analyses. A total of 50 of articles met our inclusion criteria, 30 on mice, 19 on rats and one on Zebrafish. Our review shows that sleep deprivation induces a decrease in anxiety-like behavior in preclinical models, which is opposite to results observed in human settings. These results were corroborated in stratified analyses according to species, sleep deprivation method and anxiety measurement technique. In conclusion, the use of animal models for the evaluation of the relationship between sleep deprivation lacks translational applicability and new experimental tools are needed to properly evaluate sleep deprivation-induced anxiogenesis in rodents.

Effects of Panax ginseng, Turnera diffusa and Heteropterys tomentosa extracts on hippocampal apoptosis of aged rats

ABSTRACT Objective: To verify if the medicinal plants Panax ginseng C.A. Mey, Turnera diffusa Willd. ex Schult., and Heteropterys tomentosa O. Mach., which are amply used by the population as tonics and cognition enhancers, could have a protective effect on cell death by apoptosis, since this could be one of the mechanisms of action of these substances. Methods: Aged male Wistar rats (n=24) were divided into four groups. Over 30 days, three groups received treatments with hydroalcoholic extracts of the plants, and one group received saline solution. A fifth group with young adult male Wistar rats (n=4) received saline solution during the same period. Using the TUNEL technique, the percentage of apoptosis in the hippocampus of these animals was evaluated. Results: No differences were observed between the percentage of apoptotic cells in the hippocampus of aged animals and of young control animals. The percentage of apoptosis in the hippocampus of aged animals treated chronically with the extracts from the three plants also did not differ from the percentage of apoptosis in the hippocampus of the control group of aged animals. Conclusion: Treatment with the hydroalcoholic extracts of Panax ginseng, Turnera diffusa, and Heteropterys tomentosa did not influence the apoptosis of the hippocampal cells of aged rats.

PHYTOCHEMICAL ANALYSIS OF HYDROETHANOLIC EXTRACTS FROM POWDERED ROOTS OF Panax ginseng C. A. Meyer AND Heteropterys tomentosa A. Juss AND EVALUATION OF THEIR EFFECTS ON ASTROCYTE CELL DEATH

The medicinal plants Panax ginseng C. A. Meyer (Araliaceae) and Heteropterys tomentosa A. Juss (Malpighiaceae) are widely and separately used by the Brazilian population as phytotherapeutics for the same medicinal purposes as tonics and to improve cognition. A chemical analysis was carried out on hydroethanolic extracts of powdered roots from P. ginseng and H. tomentosa using HPLC-DAD-ESI-MS/MS (High Performance Liquid Chromatography coupled to Diode-Array Detector and Electrospray Ionization - Mass Spectrum/Mass Spectrum). The ginsenosides Rg1, Rf, mRg and mRf were the main constituents in a hydroethanolic extract from P. ginseng, while in the hydroethanolic extract from H. tomentosa, caffeoylquinic acid derivatives and astilbin isomers were the main constituents. Concentration-time-effect curves were generated in cultures of astrocytes that were incubated with hydroethanolic extracts of these species to elucidate their toxicities. The P. ginseng extract was nontoxic at all of the tested times and concentrations. The hydroethanolic extract from H. tomentosa demonstrated toxicity at a concentration of 1000 µg/mL. P. ginseng extract had no protective effect against staurosporine. Many studies have demonstrated the neuroprotective effect of ginsenosides, caffeoylquinic derivatives and flavonoids.

Effects of hormonal contraceptives on sleep - A possible treatmentfor insomnia in premenopausal women

Due to the changes that took place since the 1970s, women have achieved important socioeconomic positions. Many tasks, including domestic and familiar ones, continue to be under women’s responsibility, which leads to an overload work. Additionally, the female organism has its peculiarities due to hormonal changes. Adding all these factors up, women seem to be more vulnerable to stressing factors and consequently, might be prone to present several health problems. Within this scenario, one can point out insomnia as a highly prevalent disease among women, directly affecting performance and quality of life. Progesterone has an important effect over sleep, acting both as a hypnogenic and as a respiratory stimulant. Hormonal contraceptives are largely recognized among the modern society women; however, little is known about the effects of these drugs on sleep. This proposal hypothesizes that the use of hormonal contraceptives, mainly those based on progestagens could be a new therapeutic element for the treatment of insomnia and one more tool to be used to improve women´s sleep pattern and quality of life.

Women’s Sleep Disorders: Integrative Care

The integrative care model is rooted in a biopsychosocial approach. Integrative is a term which refers to increasing the harmony and coherence of your whole being, and integrative care is therefore focused on the person, not on either the disease or a therapy. It is provided collaboratively by a health team comprising physicians, psychologists, physiotherapists, acupuncturists, and meditation, nutrition, and floral therapy. Previous studies have demonstrated that interventions based on the integrative care model improved womens lifestyle and quality of life. Our aim was to describe the use of complementary and alternative medicine (CAM) alongside traditional medicine among women with sleep conditions in our Womens Sleep Disorders Integrative Treatment Outpatient Clinic. We are sharing our experiences and clinical practice as the model we developed seems to have both physical and psychological benefits for women with sleep problems. We discuss the wide range of benefits that result from this type of complex intervention, and the contextual factors that may influence these benefits. This will inform future practitioners and we hope to contribute to quantitative research in the clinical setting. The study highlights the importance of treating sleep complaints with a caring relationship and a CAM approach, alongside conventional medicine. Exploration of the lived experience of CAM and its meaning enables healthcare professionals to gain insights into the patients needs, preferences, and values. Gynecologists, clinicians, and health care providers should support and guide patients in their decision to use CAM by providing evidence-based and comprehensive advice on the potential benefits, risks and related safety issues of this approach.

Plasma Leptin and Premenstrual Syndrome: A Review

Importance Premenstrual syndrome (PMS) is characterized by physical and psychological symptoms in the luteal phase. Leptin can influence PMS as it acts on the hypothalamic-pituitary-gonadal axis. Objective The aim of this study was to evaluate data in the literature about the profile of plasma leptin in women with PMS. Evidence Acquisition We performed a search of databases using both descriptors. Three studies were identified. They included 181 participants. Two of these studies found higher leptin levels in women with PMS. Results Conflicting results were found regarding the leptin levels in the luteal phase and the correlation between leptin, estradiol, and progesterone levels. Conclusions and Relevance Leptin could have a role in the pathophysiology of PMS and indicate degree of severity of PMS. Future studies on the role of leptin in PMS are needed.

Insomnia and Menopause

Global life expectancy has increased substantially over the last century. For women, this means that they now live nearly one-third of their lives in the climacteric period with the undesirable effects of hypoestrogenism. The consequences of this decrease in estrogen may occur in the short or long term. Among the early manifestations, the most important are vasomotor symptoms, insomnia, increased irritability, anxiety, depression, and loss of memory. Hormonal changes can be responsible for insomnia in the menopause transition and postmenopause, but it can also be caused by biopsychological changes that often happen in women’s lives. Many women retire during this time, and may pass through social and health changes. Women can develop “empty nest syndrome,” when their children leave home. These changes can lead to depression, a factor which is closely linked to insomnia. In addition, other consequences of hypoestrogenism, such as genital atrophy, nocturia, body pain, and other changes, can lead to sleep fragmentation. The aim of this chapter is not only to review the current literature on the subject but also to describe the pathophysiology of insomnia in postmenopause and the care that can be given by a multidisciplinary team. We highlight the importance of evaluating the patient as a whole, in an individualized and personalized manner. In our view, looking at both the body and the mind, from a hormonal to a biopsychosocial context, is the best approach to effective treatment.