Gabriel Natan Pires

Sleep impairment during pregnancy: Possible implications on mother–infant relationship

The modern living standard has imposed upon society a situation of chronic sleep deprivation. This chronic loss of sleep affects women more than it does men. As a result, the postponement of pregnancy has become a common choice due to the priority given to social and domestic activities. For women, pregnancy represents a condition of intense physical and physiological changes that subject the pregnant woman to a number of potentially stressful situations, ultimately interfering with their quality of sleep. Chronic sleep deprivation, along with the changes imposed on women through pregnancy, can lead to several harmful consequences for the pregnant woman and the child, and can potentially undermine the mother-infant relationship. This article discusses circumstances under which sleep deprivation and poor sleep quality during pregnancy could result in damage to the mother-infant relationship, specifically through maternal fatigue, postpartum depression and changes in pregnancy-related hormonal secretions and activity.

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.

Modafinil ameliorates cognitive deficits induced by maternal separation and sleep deprivation

Animals exposed to an early adverse event may be more susceptible to a second source of stress later in life, and these stressors may have additive deleterious effects. Sleep deprivation is known to be a stressor, affecting multiple body functions such as the cognition. Modafinil enhances working memory and attention in healthy non-sleep deprived subjects and in animal models of sleep deprivation. The first aim of the present study was to investigate the effects of maternal separation (MS) combined with paradoxical sleep deprivation (PSD) in adulthood on recognition memory in rats. Second, we aimed to evaluate whether the administration of modafinil would be able to ameliorate memory deficits induced by MS and PSD. Wistar rat pups were initially distributed into MS and handling (H) groups, with their litters standardized in 4 females and 4 males. In adulthood, the male rats were submitted to PSD or control condition, being redistributed afterwards in modafinil- or vehicle-treatment immediately after the training session of object recognition task. PSD did not potentiate the cognitive deficit due to MS. However, modafinil was able to recover memory impairments associated to PSD and also to MS in the neonatal period. This study demonstrates for the first time that modafinil ameliorates cognitive deficits associated to MS and to PSD in adulthood, independent from MS in the neonatal period.

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.

Sleep quality of mother-caregivers of Duchenne muscular dystrophy patients

BackgroundSleep disturbance is a common problem for caregivers. In general, patients with Duchenne muscular dystrophy (DMD) use noninvasive ventilation to maintain quality of life and improve survival.ObjectiveThe aim of this study was to evaluate the sleep quality of caregiver-mothers of sons with DMD and factors that are associated with their sleep quality.MethodsWe evaluated 32 caregiver-mothers of sons with DMD and 32 mothers of sons without any neuromuscular or chronic disease (control—CTRL group). The evaluation of quality of sleep was made using the Pittsburgh Sleep Quality Index (PSQI).ResultsCaregiver-mothers had poor sleep quality, specifically longer sleep latency and reduced sleep efficiency. The impaired sleep quality of the caregiver-mothers was associated with the length of time of noninvasive ventilation used by their sons. ConclusionsOur results suggest that caregiver-mothers of sons with DMD have poor quality of sleep, and the length of use of noninvasive ventilation of their sons is associated with better sleep of caregiver-mothers.

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.

Grooming analysis algorithm: Use in the relationship between sleep deprivation and anxiety-like behavior

Increased anxiety is a classic effect of sleep deprivation. However, results regarding sleep deprivation-induced anxiety-like behavior are contradictory in rodent models. The grooming analysis algorithm is a method developed to examine anxiety-like behavior and stress in rodents, based on grooming characteristics and microstructure. This study evaluated the applicability of the grooming analysis algorithm to distinguish sleep-deprived and control rats in comparison to traditional grooming analysis. Forty-six animals were distributed into three groups: control (n=22), paradoxical sleep-deprived (96 h, n=10) and total sleep deprived (6 h, n=14). Immediately after the sleep deprivation protocol, grooming was evaluated using both the grooming analysis algorithm and traditional measures (grooming latency, frequency and duration). Results showed that both paradoxical sleep-deprived and total sleep-deprived groups displayed grooming in a fragmented framework when compared to control animals. Variables from the grooming analysis algorithm were successful in distinguishing sleep-deprived and normal sleep animals regarding anxiety-like behavior. The grooming analysis algorithm and traditional measures were strongly correlated. In conclusion, the grooming analysis algorithm is a reliable method to assess the relationship between anxiety-like behavior and sleep deprivation.

Sleep deprivation and anxiety in humans and rodents--translational considerations and hypotheses.

The effects of acute sleep deprivation on anxiety are the focus of controversy in the literature. While clinical research studies on the effects of sleep deprivation seem to show a consistent increase in acute anxiety, rodent studies have produced inconsistent results, with some experiments pointing to anxiogenesis and others to anxiolysis. Such observations impair the translational applicability of rodent models on the paradigm between sleep deprivation and anxiety. Current studies fail in the very basic principle of biomedical translational research: to provide relevant and reliable knowledge from basic experimental science that can be applied in clinical environments. Possible explanations for the disparity between human and animal studies include the accuracy of both human and rodent research, the ability of current behavioral protocols to truly reflect the anxiety response of rodents to sleep deprivation, and the nature of sleep deprivation-induced anxiety in rodents. Based on these hypotheses, we performed a brief overview of the literature on the relationship between sleep deprivation and anxiety and propose a research agenda that could lead to a better understanding of the reasons for the discrepancies found in the literature and provide more reliable data on the translational relationship between sleep deprivation and anxiety.

Wound-healing and benzodiazepines: does sleep play a role in this relationship?

Patients who have suffered burns frequently experience psychological consequences, among which anxiety disorders are prominent. Benzodiazepines are commonly administered to treat these symptoms. The effects of benzodiazepines on healing may not be direct but rather are modulated by alterations of the sleep architecture. This hypothesis is supported by studies that demonstrate the effects of benzodiazepines on the immune system and the inflammatory profile under both normal sleep conditions and during sleep deprivation, particularly rapid eye movement sleep deprivation.

Effects of REM sleep restriction during pregnancy on rodent maternal behavior

OBJECTIVE To evaluate the effects of sleep restriction during pregnancy on maternal care and maternal aggression in a rodent model. METHODS Twenty-three female Wistar rats were assigned to one of two groups: control (n=12) or sleep restriction (n=11) during the entire pregnancy. At the fifth postpartum day, the animals were subjected to the resident-intruder paradigm and to the pup retrieval test. RESULTS Sleep restriction during pregnancy had no direct effects on maternal care. Regarding aggressive behavior, defensive aggression was increased by sleep loss, with a lower responsiveness threshold to hostile environmental stimuli. Sleep deprivation during gestation also reduced self-grooming behavior. CONCLUSION Taking increased self-grooming as a behavioral correlate of anxiety in rodents, this study provides evidence that lactating dams were in a condition of reduced anxiety. From an adaptive perspective, this pattern of stress response may function to ensure proper maternal behavior, thereby guaranteeing the survival and viability of the litter. Under a translational perspective, the present article confronts the importance of biological and adaptive features to rodent maternal behavior with the relevance of sociocultural factors to the human mother-infant relationship and to the onset of postpartum depression.