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Previous issue date: 2009-07-10 === The cerebral vascular accident is a neurological dysfunction of vascular origin that
leds to development of motor sensibility, cognitive, perceptive and language deficits.
Despite the fact that the main sleep disorders in stroke patients are well known, it is
still necessary to analyze which mechanisms of regulation of sleep and wakefulness
are affected. The objective of this study was to evaluate the changes in the circadian
and homeostatic control of sleep-wakefulness in stroke patients and the correlations
with quality of life and level of physical activity. The study analyzed 22 stroke patients
(55? 12 years old) and 24 healthy subjects (57 ?11 years old). The instruments used
in this study were questionnaires on sleep quality, daytime sleepiness, quality of life,
physical activity level and the actigraphy. The data were analyzed using the Student
`t test, Mann-Whitney test, ANOVA and Spearman's correlation tests. The results
showed stability in the sleep-wake circadian expression with changes in the
amplitude of the rhythm. However, significant changes were found related to the
homeostatic component characterized by increased sleep duration, increased
latency, fragmented sleep and lower sleep efficiency. Additional data showed
decreased quality of sleep and increased daytime sleepiness, as well as decreased
quality of life and level of physical activity. The results indicate that the interaction of
circadian and homeostatic control of sleep-wake is compromised and the main
reason might be because of the homeostatic component and the lower activity level
resulting from the brain damage. Thus, further studies may be developed to evaluate
whether behavioral interventions such as increased daytime activity and restriction of
sleep during the day can influence the homeostatic process and its relation to
circadian component, resulting in improved quality of nocturnal sleep in stroke
patients === O Acidente Vascular Encef?lico (AVE) ? uma disfun??o neurol?gica de origem
vascular com desenvolvimento de d?ficits sens?riomotores, cognitivo, perceptivo e
da linguagem. Apesar de serem conhecidas as principais altera??es do sono nos
pacientes com AVE, ainda ? necess?rio analisar quais mecanismos da regula??o do
sono e vig?lia est?o afetados. O objetivo deste estudo foi avaliar as altera??es do
controle circadiano e homeost?tico do sono-vig?lia em pacientes com AVE e as
correla??es com a qualidade de vida e o n?vel de atividade f?sica. Participaram do
estudo 22 pacientes (55?12 anos) e 24 sujeitos saud?veis (57?11 anos). Os
instrumentos utilizados neste estudo foram os question?rios sobre a qualidade do
sono, sonol?ncia diurna, qualidade de vida, n?vel de atividade f?sica e a actimetria.
Os dados foram analisados atrav?s do teste t`Student, teste de Mann-Whitney,
ANOVA e teste de correla??o de Spearman. Os resultados encontrados no estudo
apontaram estabilidade da express?o circadiana do sono-vil?gia com altera??o na
amplitude do ritmo. Entretanto, foram encontradas altera??es homeost?ticas
significativas relacionadas com maior dura??o do sono, lat?ncia e fragmenta??o do
sono, assim como menor efic?ncia. Dados adicionais mostraram comprometimento
da qualidade do sono e aumento da sonol?ncia diurna, assim como diminui??o da
qualidade de vida e do n?vel de atividade f?sica. Os resultados observados indicam
comprometimento da intera??o do controle circadiano e homeost?tico do sono-vig?lia
desencadeado principalmente pelo homeost?tico e diminui??o do n?vel de atividade
consequentes da les?o cerebral ocorrida. Dessa forma, estudos posteriores podem
ser desenvolvidos a fim avaliar se interven??es comportamentais, como aumento da
atividade diurna e restri??o do sono durante o dia, podem influenciar o processo
homeost?tico e sua rela??o com o circadiano resultando em melhoria da qualidade
do sono noturno em pacientes com AVE
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