V minulosti sa predpokladalo, že hormonálne zmeny po pôrode spojené s dojčením sú rizikovým faktorom pre psychické zdravie žien a že dojčenie zhoršuje, či je priamo príčinou popôrodnej depresie či popôrodnej psychózy (dôkazom je napríklad zastaraný pojem "laktačná psychóza"). V súčasnosti však existuje veľa poznatkov v oblasti neuroendokrinológie, psychiatrie a psychológie, ktoré tento predpoklad nepodporujú, či dokonca priamo vyvracajú. Cieľom nášho článku bolo priniesť prehľad súčasných poznatkov k popôrodnej depresii a dojčeniu a porovnať odporúčania k liečbe dojčiacich žien na Slovensku a v zahraničí. Náš článok obsahuje súhrn aktuálnych výskumov v oblasti popôrodnej depresie a dojčenia v súvislosti so spánkom a s fungovaním hormonálneho systému a osi HPA žien po pôrode. Autori výskumov uvádzajú, že hormóny, ktoré sú po pôrode vylučované vďaka dojčeniu, majú stabilizačný účinok na psychiku žien a os HPA, čo naznačuje, že dojčenie môže mať ochranný účinok pred rozvojom popôrodnej depresie, či ju zmierňovať, ak sa napriek dojčeniu rozvinie. Nedojčenie je podľa našich zistení aj rizikovým faktorom pre kvalitu spánku žien po pôrode, čo môže ovplyvňovať ich psychické zdravie, a teda zvyšovať riziko, že sa popôrodná depresia rozvinie, či zhoršovať jej symptómy. V záverečnej kapitole článku sme zhrnuli slovenské a české odporúčania pri liečbe popôrodnej depresie a porovnali ich so zahraničnými, konkrétne v Spojených štátoch amerických. Zistili sme, že kým v zahraničí sa neodporúča ukončenie dojčenia a zastavenie tvorby mlieka v prípade diagnózy popôrodnej depresie, na Slovensku je to stále bežnou, odporúčanou praxou, ktorá v článkoch nebola podporená žiadnymi relevantnými výskumami či argumentmi.
In the past, postpartum hormonal changes associated with breastfeeding were thought to be a risk factor for women ́s mental health. It was assumed that breastfeeding either worsened or was the direct cause for postpartum depression or postpartum psychosis (as evidenced, for example, by the outdated term "lactation psychosis"). However, there is currently much knowledge in the field of neuroendocrinology, psychiatry and psychology that does not support or even refutes this assumption. The aim of this article is to provide an overview of current knowledge on postpartum depression and breastfeeding and to compare recommendations for the treatment of breastfeeding women in Slovakia and abroad. Our article contains a summary of current research in the field of postpartum depression and breastfeeding in connection with sleep and the functioning of the hormonal system and the HPA axis of women after childbirth. Researchers report that hormones secreted due to breastfeeding have a stabilizing effect on women ́s mental health and HPA axis, suggesting that breastfeeding may have a protective effect against the development of postpartum depression or alleviate it if it develops despite breastfeeding. According to our findings, bottle feeding is also a risk factor for the quality of women ́s sleep after childbirth, which can affect their mental health and thus increase the risk that postpartum depression will develop or worsen its symptoms afterwards. In the final chapter of the article, we summarize the Slovak and Czech recommendations for the treatment of postpartum depression and compare them with those from abroad, specifically from the United States. We found that while breastfeeding cessation and lactation suppression in the case of a diagnosis of postpartum depression is not recommended abroad, it is still a common, recommended practice in Slovakia. Though recommended, this practice isn ́t supported in Slovak articles by any relevant research or arguments.
Aging and chronic sleep deprivation (SD) are well-recognized risk factors for Alzheimer's disease (AD), with N-methyl-D-aspartate receptor (NMDA) and downstream nitric oxide (NO) signalling implicated in the process. Herein, we investigate the impact of the age- and acute or chronic SD-dependent changes on the expression of NMDA receptor subunits (NR1, NR2A, and NR2B) and on the activities of NO synthase (NOS) isoforms in the cortex of Wistar rats, with reference to cerebral lateralization. In young adult controls, somewhat lateralized seasonal variations in neuronal and endothelial NOS have been observed. In aged rats, overall decreases in NR1, NR2A, and NR2B expression and reduction in neuronal and endothelial NOS activities were found. The age-dependent changes in NR1 and NR2B significantly correlated with neuronal NOS in both hemispheres. Changes evoked by chronic SD (dysfunction of endothelial NOS and the increasing role of NR2A) differed from those evoked by acute SD (increase in inducible NOS in the right side). Collectively, these results demonstrate age-dependent regulation of the level of NMDA receptor subunits and downstream NOS isoforms throughout the rat brain, which could be partly mimicked by SD. As described herein, age and SD alterations in the prevalence of NMDA receptors and NOS could contribute towards cognitive decline in the elderly, as well as in the pathobiology of AD and the neurodegenerative process.
- MeSH
- Alzheimerova nemoc epidemiologie etiologie MeSH
- krysa rodu rattus MeSH
- membránové glykoproteiny genetika metabolismus MeSH
- mozková kůra metabolismus MeSH
- oxid dusnatý metabolismus MeSH
- potkani Wistar MeSH
- receptory N-methyl-D-aspartátu genetika metabolismus MeSH
- regulace genové exprese MeSH
- rizikové faktory MeSH
- signální transdukce * MeSH
- spánková deprivace metabolismus patofyziologie MeSH
- stárnutí metabolismus MeSH
- synthasa oxidu dusnatého metabolismus MeSH
- věkové faktory MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Intensive care unit (ICU) environment has a very strong and unavoidable negative impact on patients' sleep. Sleep deprivation in ICU patients has been already studied and negative effects on their outcome (prolonged ICU stay, decreased recovery) and complication rates (incidence of delirium, neuropsychological sequels of critical illness) discussed. Several interventions potentially improving the sleep disturbance in ICU (sleep-promotion strategies) have been assumed and tested for clinical practice. We present a review of recent literature focused on chosen types of non-pharmacological interventions (earplugs and eye mask) analysing their effect on sleep quality/quantity. From the total amount of 82 papers found in biomedical databases (CINAHL, PubMed and SCOPUS) we included the 19 most eligible studies meeting defined inclusion/exclusion criteria involving 1 379 participants. Both experimental and clinical trials, either ICU and non-ICU patient populations were analysed in the review. Most of the reviewed studies showed a significant improvement of subjective sleep quality when using described non-pharmacological interventions (objective parameters were not significantly validated). Measuring the sleep quality is a major concern limiting the objective comparison of the studies' results since non-standardised (and mainly individual) tools for sleep quality assessment were used. Despite the heterogeneity of analysed studies and some common methodological issues (sample size, design, outcome parameters choice and comparison) earplugs and eye mask showed potential positive effects on sleep quality and the incidence of delirium in ICU patients.
- MeSH
- chrániče sluchu * trendy MeSH
- delirium epidemiologie patofyziologie terapie MeSH
- jednotky intenzivní péče * trendy MeSH
- lidé MeSH
- ochranné prostředky očí * trendy MeSH
- péče o pacienty v kritickém stavu metody trendy MeSH
- poruchy spánku a bdění epidemiologie patofyziologie prevence a kontrola MeSH
- randomizované kontrolované studie jako téma metody MeSH
- spánek fyziologie MeSH
- spánková deprivace epidemiologie patofyziologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
In this study we set out to understand is sleep fragmentation affects the cardiovascular regulation and circadian variability of core body temperature more or less than sleep deprivation. 50 healthy men (age 29.0+/-3.1 years; BMI 24.3+/-2.1 kg/m(2)) participated in a 3-day study that included one adaptative night and one experimental night involving randomization to: sleep deprivation (SD) and sleep fragmentation (SF). The evaluation included hemodynamic parameters, measures of the spectral analysis of heart rate and blood pressure variability, and the sensitivity of arterial baroreflex function. Core body temperature (CBT) was measured with a telemetric system. SF affects heart rate (61.9+/-5.6 vs. 56.2+/-7.6, p<0.01) and stroke index (52.7+/-11.1 vs. 59.8+/-12.2, p<0.05) with significant changes in the activity of the ANS (LF-sBP: 6.0+/-5.3 vs. 3.4+/-3.7, p<0.05; HF-sBP: 1.8+/-1.8 vs. 1.0+/-0.7, p<0.05; LF-dBP: 5.9+/-4.7 vs. 3.5+/-3.2, p<0.05) more than SD. Post hoc analysis revealed that after SD mean value of CBT from 21:30 to 06:30 was significantly higher compared to normal night's sleep and SF. In healthy men SF affects the hemodynamic and autonomic changes more than SD. Sympathetic overactivity is the proposed underlying mechanism.
- MeSH
- dospělí MeSH
- krevní tlak fyziologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- spánková deprivace diagnóza patofyziologie MeSH
- srdeční frekvence fyziologie MeSH
- stadia spánku fyziologie MeSH
- tělesná teplota fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
Cíl studie: Ověřit, zda nedostatek spánku jako stresor navozený noční směnou/službou u zdravotníků pracujících na resuscitačním oddělení prodlouží QT interval a změní hodnotu indexu kardio-elektrofyziologické rovnováhy (ICEB), ukazatelů náchylnosti k arytmiím. Typ studie: Observační. Typ pracoviště: Lůžkové resuscitační oddělení fakultní nemocnice. Materiál a metoda: Sestry/lékaři v nočních směnách/službách. Standardní dvanáctisvodové EKG před noční směnou/službou, po ní. Automatizovanou analýzou byly zjištěny hodnoty srdeční frekvence, QRS, QT, výpočtem korigovaný QTc (Hodges), ICEB = QT/QRS. Dotazník o zdravotním stavu, spánkových zvyklostech. Výsledky: 59 lidí, 18 mužů (30,5 %), 41 žen (69,5 %), 45 sester (76,3 %, 35 žen, 10 mužů), 13 lékařů (22 %, 7 mužů, 6 žen), 1 sanitář (1,7 %), stáří 35,3 ? 5,6 roku, všichni podle preventivní prohlídky schopni noční práce, cítili se zdrávi. Průměrná obvyklá doba spánku 6,7 ? 0,6 hod, průměrná doba spánku před směnou/službou 6,3 ? 1,9 hodiny, sestry v noční směně nespaly, lékaři spali 4,3 ? 1,0 hod s 0–3 přerušeními. Srdeční frekvence před 68 ? 10, po 64 ? 10, QRS 90,9 ? 12,3 ms, respektive 92,6 ? 12,8 ms, QT 387,6 ? 28 ms, respektive 402,9 ? 31,3 ms, korigovaný QT interval podle Hodgese 400,2 ? 19,3 ms, respektive 409,2 ? 21,5 ms, ICEB stoupl ze 4,32 ? 0,57 na 4,43 ? 0,66. Nebyly významné arytmie. Závěr: Prokázali jsme, že jedna noc nedostatečného spánku v důsledku noční směny/služby na velkém resuscitačním oddělení prodlužuje QT, QTc, zvyšuje ICEB. Tyto změny mohou přispívat k negativním účinkům práce ve směnách na zdraví zdravotnického personálu i v dlouhodobé perspektivě.
Objective: To determine the impact of sleep deprivation due to night shift/duty in ITU nurses and doctors on the QT interval and the index of cardio-electrophysiological balance (ICEB), predictors of arrhythmias. Design: Observational trial. Setting: University Hospital ITU. Materials and methods: Nurses/doctors on night shift/duty. Standard 12-lead ECG before and after the shift was recorded. Heart rate, QRS, QT from automated analysis, corrected QTc using Hodges formula and ICEB = QT/QRS were calculated. A questionnaire on the health status and sleep behaviour was filled in. Results: Total 59 participants, 18 men (30.5%), 41 women (69.5%), 45 nurses (76.3%, 35 women, 10 men), 13 doctors (22 %, 7 men, 6 women), 1 hospital attendant (1.7%), age 35.3 ? 5.6 years, all fit for night shift/duty. Mean usual sleep duration was 6.7 ? 0.6 hours, mean sleep duration before the shift was 6.3 ? 1.9 hours, nurses did not sleep during the shift, doctors slept for 4.3 ? 1.0 hour with 0-3 interruptions per night. Heart rate before the shift was 68 ? 10, after the shift 64 ? 10, QRS 90.9 ? 12.3 ms and 92.6 ? 12,8 ms respectively, QT 387.6 ? 28 ms and 402.9 ? 31.3 ms respectively, corrected QT interval (Hodges) 400.2 ? 19.3 ms and 409.2 ? 21.5 ms respectively, ICEB increased from 4.32 ? 0.57 to 4.43 ? 0.66. Conclusion: One night of insufficient sleep due to a night shift on the ITU prolongs the QT and QTc intervals, and increases ICEB. These changes might contribute to the negative impact of shift work on the health status of healthcare workers in the short and long-term perspective.
- Klíčová slova
- noční směny, studie EQUINDOC,
- MeSH
- dospělí MeSH
- elektrokardiografie využití MeSH
- kardiovaskulární fyziologické jevy MeSH
- lékaři MeSH
- lidé středního věku MeSH
- lidé MeSH
- noční péče o pacienty * pracovní síly MeSH
- pozorovací studie jako téma MeSH
- průzkumy a dotazníky MeSH
- resuscitační péče pracovní síly MeSH
- senioři MeSH
- spánková deprivace * patofyziologie MeSH
- syndrom dlouhého QT * MeSH
- vliv směnného provozu na zdraví * fyziologie MeSH
- zdravotní sestry MeSH
- zdravotnický personál MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- diabetes mellitus 2. typu * etiologie metabolismus prevence a kontrola MeSH
- energetický metabolismus MeSH
- hmotnostní přírůstek MeSH
- inzulinová rezistence MeSH
- lidé MeSH
- obezita * etiologie metabolismus prevence a kontrola MeSH
- přijímání potravy MeSH
- rizikové faktory MeSH
- spánková deprivace * komplikace metabolismus patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
It is well established that the incidence and infarct size in acute myocardial infarction (AMI) is subject to circadian variations. At the molecular level, circadian clocks in distinct cells, including cardiomyocytes, generate 24-h cycles of biochemical processes. Possible imbalance or impairment in the cell clock mechanism may alter the cardiac metabolism and function and increase the susceptibility of cardiovascular diseases. One of the key components of the human clock system PERIOD3 (PER3) has been recently demonstrated to affect circadian expression of various genes in different tissues, including the heart. The variable number tandem repeat (VNTR) polymorphism (rs57875989) in gene Period3 (Per3) is related to multiple phenotypic parameters, including diurnal preference, sleep homeostasis, infection and cancer. The aim of our study was to investigate the effect of this polymorphism in AMI with ST elevation (STEMI). The study subjects (314 patients of Caucasian origin with STEMI, and 332 healthy controls) were genotyped for Per3 VNTR polymorphism using an allele-specific polymerase chain reaction. A gender difference in circadian rhythmicity of pain onset was observed with significant circadian pattern in men. Furthermore, the Per3(5/5) variant carriers were associated with higher levels of interleukin-6, B-type natriuretic peptide and lower vitamin A levels. By using cosinor analysis we observed different circadian distribution patterns of AMI onset at the level of genotype and allelic frequencies. Genotypes with at least one 4-repeat allele (Per3(4/5) and Per3(4/4)) (N = 264) showed remarkable circadian activity in comparison with Per3(5/5) (N = 50), especially in men. No significant differences in genotype and/or allele frequencies of Per3 VNTR polymorphism were observed when comparing STEMI cases and controls. Our results indicate that the Per3 VNTR may contribute to modulation of cardiac functions and interindividual differences in development and progression of myocardial infarction.
- MeSH
- alely MeSH
- cirkadiánní proteiny Period genetika metabolismus MeSH
- cirkadiánní rytmus genetika MeSH
- elektrokardiografie MeSH
- frekvence genu MeSH
- genotyp MeSH
- incidence MeSH
- infarkt myokardu genetika MeSH
- interleukin-6 krev MeSH
- kohortové studie MeSH
- krevní tlak MeSH
- lidé středního věku MeSH
- lidé MeSH
- minisatelitní repetice * MeSH
- polymorfismus genetický * MeSH
- regulace genové exprese * MeSH
- senioři MeSH
- spánek genetika MeSH
- spánková deprivace patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- cévní mozková příhoda * komplikace MeSH
- lidé MeSH
- polysomnografie metody přístrojové vybavení MeSH
- poruchy spánku a bdění * diagnóza etiologie patofyziologie MeSH
- spánek * fyziologie MeSH
- spánková deprivace diagnóza etiologie patofyziologie MeSH
- stadia spánku fyziologie MeSH
- statistické modely MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- chronobiologické jevy MeSH
- chuť k jídlu MeSH
- cirkadiánní rytmus MeSH
- diabetes mellitus 2. typu * etiologie MeSH
- inzulinová rezistence MeSH
- krevní glukóza metabolismus MeSH
- lidé MeSH
- metabolický syndrom etiologie metabolismus MeSH
- obezita etiologie metabolismus MeSH
- poruchy metabolismu glukózy etiologie MeSH
- rizikové faktory MeSH
- spánek fyziologie MeSH
- spánková deprivace * metabolismus patofyziologie MeSH
- vliv směnného provozu na zdraví fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Sleep is a fundamental physiological process, characterized by the activation of several cortical and subcortical neural networks. The relation between sleep and cardiovascular system is complex and bidirectional: sleep disorders may alter cardiovascular system, leading to an increased cardiovascular risk, while, on the contrary, cardio- vascular diseases are characterized by an alteration of physiological sleep. Autonomic nervous system (ANS) plays a key role in the regulation of cardiovascular functions during different sleep stages, with sympatho-vagal balance dynamically shifting towards sympathetic or vagal predominance across different sleep stages. Sleep deprivation (SD) has becoming one of the most relevant health problem in modern societies. SD can be related to aging, which is associated with increased sleep fragmentation, and to sleep disorders, such as sleep disordered breathing and neurological disorders. Experimental studies in animals showed that SD significantly affects cardiovascular functions, altering heart rate and blood pressure responses, and increasing sympathetic activity and neuroendocrine response to stressor stimuli. Clinical studies in humans have shown that SD, either due to experimental sleep loss and to sleep disorders, can affect different biological pathways, such as cardiovascular autonomic control, inflammation, immunity responses and metabolism. All these alterations may predispose subjects with SD to an increased cardiovascular risk. Hence, it is fundamental to identify the presence of a sleep disorder, which could be per se responsible for sleep loss, or the presence of sleep deprivation due to other factors, such as social life, habits etc., in order to identify subjects at high risk for cardiovascular events.
