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Summary: Sleep bruxism (SB) has been associated with biological and psychosocial factors. The assessment of SB includes self‐report, clinical evaluation, and polysomnography. This study aimed to investigate the associations of self‐reported SB with other sleep disorders and demographic, psychological, and lifestyle factors in the adult general population, and to investigate whether self‐reported SB and polysomnographically (PSG) confirmed SB provide similar outcomes in terms of their associated factors. We recruited 915 adults from the general population in Sao Paulo, Brazil. All participants underwent a one‐night PSG recording and answered questions about sex, age, BMI, insomnia, OSA risk, anxiety, depression, average caffeine consumption, smoking frequency, and alcohol consumption frequency. We investigated the link between SB and the other variables in univariate, multivariate, and network models, and we repeated each model once with self‐reported SB and once with PSG‐confirmed SB. Self‐reported SB was only significantly associated with sex (p = 0.042), anxiety (p = 0.002), and depression (p = 0.03) in the univariate analysis, and was associated with insomnia in the univariate (p < 0.001) and multivariate (β = 1.054, 95%CI 1.018–1.092, p = 0.003) analyses. Network analysis showed that self‐reported SB had a direct positive edge to insomnia, while PSG‐confirmed SB was not significantly associated with any of the other variables. Thus, sleep bruxism was positively associated with insomnia only when self‐reported, while PSG‐confirmed SB was not associated with any of the included factors. [ABSTRACT FROM AUTHOR]

Aging is accompanied by changes in the quantity and quality of sleep. Obstructive sleep apnea (OSA) is also more prevalent in the older population. Although severe OSA has been linked to a higher risk of cardiovascular disease regardless of adult age, clinical consequences of mild-to-moderate OSA in the older adults are still uncertain. Objectives: To investigate the relationships between severity and metabolic, cognitive, and functional characteristics in community-dwelling older adults from a representative sample of the city of São Paulo. Methods: In total, 199 participants of the first follow-up of the São Paulo Epidemiologic Sleep Study (EPISONO, São Paulo, Brazil) >60 years were cross-sectionally assessed through questionnaires, physical evaluations, laboratory tests, and full in-lab polysomnography (PSG). Three groups according to the OSA severity were compared according to sociodemographic characteristics, anthropometric measures, PSG parameters, the frequency of comorbidities, and the use of medications. Results: Participants' age ranged from 60 to 87 years with a mean of 70.02 ± 7.31, 59.8% female. In the univariate analysis, body mass index (BMI, kg/m2) (p = 0.049) and waist circumference (p = 0.005) were significantly higher in the participants with moderate OSA, but not among those with severe OSA. Participants with severe OSA had a higher arousal index (p = 0.007). Multivariate analysis showed that severe OSA was significantly associated with hypertension (p = 0.005), heart diseases (p = 0.025), and the use of two or more medications (p = 0.035). Conclusion: In a population-based study, severe, but not mild-to-moderate, OSA in older adults was associated with hypertension and the use of more medications. As age advances, anthropometric indicators of obesity may not increase the risk of severe OSA. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the effects of the phases of the menstrual cycle and the use of hormonal contraception on sleep patterns in a population-based study. Methods: In a prospective study carried out among premenopausal women between July and December 2007, a 3-stage cluster sampling was used to ensure accurate representation of the general population of São Paulo, Brazil. Questionnaires were administered, hormonal assays were performed, and full-night polysomnography was recorded. Results: The study sample included 297 premenopausal women. Women in the follicular phase complained of fatigue more than those in the luteal phase and those using hormonal contraceptive treatment. Premenopausal women using hormonal contraceptives had a significantly lower apnea–hypopnea index (1.1±2.0) compared with women in both the follicular (2.2±4.5) and the luteal (2.9±5.4) phases (P =0.01). Women taking hormonal contraceptives tended to have increased sleep efficiency compared with women in either the follicular or luteal phases. Conclusion: The use of hormonal contraceptives was associated with a lower apnea–hypopnea index and a trend toward improved sleep efficiency. The current findings suggest that the use of hormonal contraceptives has a stronger association with sleep duration compared with menstrual cycle phase. [Copyright &y& Elsevier]

Objective: To evaluate sleep quality among women using 2 different types of sanitary pad.Methods: Seventeen women (18-40 years) with menstrual cycles of 28-30 days and self-reported moderate-to-intense menstrual flow were enrolled in a crossover study from March to August 2009 in Sao Paulo, Brazil. Sleep assessments were made by polysomnography and by means of validated questionnaires. The first evaluation of sleep (control condition) was performed during the follicular phase (7-10th day of cycle). There were subsequent evaluations during the 2nd and 3rd day of the menstrual period, and a different type of absorbent pad (A or B) was used on each day. The participants were randomly assigned to an order of pad use (AB or BA).Results: The use of absorbent pad A or B did not affect the parameters of sleep or the quality of sleep. The results obtained with use of either absorbent pad did not differ significantly from the control condition and were within the normal limits.Conclusion: There was no significant difference in sleep quality between the follicular phase and the menstrual period; in addition, the use of different absorbent pads over consecutive nights during the same menstrual cycle was not associated with changes in sleep. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The aims of this study were to estimate the prevalence of erectile dysfunction (ED) complaints in a population-based sample from Sao Paulo and to determine the associations of ED prevalence with sleep disturbances, testosterone levels, age, body mass index (BMI), socioeconomic factors and selected medical history indicators. Methods: The Epidemiologic Sleep Study (EPISONO) is a population-based study of sleep and risk factors for sleep disturbances in Brazil’s largest city, Sao Paolo. This study adopted a probabilistic three-stage cluster sampling approach for the city of Sao Paulo. Questionnaires that covered medical conditions and sexual and erection complaints were administered and polysomnographies and fasting blood samples were collected. The patient cohort of the current study of ED consisted of 467 men, aged 20–80years at the time of their enrollment in EPISONO. The percentage of men who participated in EPISONO but refused to participate in our study was 2.3%. Results: The prevalence of ED complaints in the study cohort was 17.08% overall. ED complaints ranged from 7.3% in younger men (20–29years old) to 63.25% in older men (>50years old) (adjusted odds ratio [OR]=21.65). The logistic regression model showed that both reduced time spent in REM sleep and fragmented sleep had significant effects as risk factors for ED complaints. Obesity (OR=1.8), low testosterone levels (OR=4.28), low quality of life (OR=4.4), an apnea–hypopnea index over 15 (OR=2.75), and obstructive sleep apnea syndrome (OR=2.13) were also significantly associated with a higher risk of ED complaints. Conclusion: EPISONO study indicates that ED complaints are relatively common phenomena, especially among older men. Adequate sleep patterns and normal or high levels of testosterone, which serve as markers for sexual motivation, may be protective against ED. The prevalence of sleep apnea showed a strong impact on erectile function and subsequently negatively affects sexual activity. [Copyright &y& Elsevier]

Introduction. Angiotensin-converting enzyme (ACE) is the major regulator of circulatory homeostasis. An insertion/deletion (I/D) polymorphism in the ACE gene has been associated with marked differences in serum ACE levels and with various cardiovascular diseases. Limited and conflicting data have been published on the influence of this genetic variant on the pathophysiology of erectile dysfunction (ED). Aim. To evaluate a potential association between ACE gene polymorphism and ED complaints in a population-based sample in São Paulo, Brazil. Main Outcome Measures. The prevalence of ED complaints was estimated according to previously validated 8 item questionnaire. Methods. A total of 449 men were enrolled in the Epidemiologic Sleep Study and answered an 8-item questionnaire to ascertain sexual performance/ED and satisfaction. ACE gene polymorphism were genotyped using a standard polymerase chain reaction method. Results. No significant case–control difference was observed for the ACE gene I/D polymorphism either by genotype or allele-wise. Because age is a significant risk factor for ED complaints in our sample, we carried out analyses stratifying the sample by age group. The ID and II genotypes were significantly more frequent in ED complaint cases (88.9%) compared with controls (57.1%) in the men between 40 and 55 years of age. The frequency of the I allele was also significantly higher in individuals complaining of ED (66.7%) compared with men with no complaints (39.0%) (odds ratio = 3.12; 95% confidence interval = 1.48–6.59). Correction for potential confounding variables, including genetic ancestry, did not affect the strength of the association. Conclusions. The findings of the present study suggest that the I/D polymorphism or another variant in close linkage disequilibrium with it may play a role in the development of ED in a specific age group and provides progress towards the understanding of the interaction between genetic factors and the risk of ED. Andersen ML, Guindalini C, Santos-Silva R, Bittencourt LRA, and Tufik S. Angiotensin converting enzyme polymorphism and erectile dysfunction complaints in the Brazilian population. J Sex Med 2010;7:2791–2797. [ABSTRACT FROM AUTHOR]

Sleep is a behavior expressed differently for each individual. However, studies have shown that some ethnic groups express common sleep patterns, which can be observed in different ethnic groups. Previous studies have shown the existence of sleep disparities in populations of different ethnicities. Most of these studies have considered self-reported ethnicity and assessed sleep subjectively. Therefore, the aim of this study was to evaluate sleep disparities in different ethnic groups based on an analysis of genetic ancestry and the use of objective sleep evaluation. To do this, we used data from the São Paulo Epidemiologic Sleep Study (EPISONO), which was undertaken in Brazil, a country that is known for its ethnic/racial diversity. All individuals completed a series of questionnaires, underwent full polysomnography and had their blood collected for DNA extraction. After genotyping and identifying samples with high-quality DNA suitable for genetic analysis, 31 ancestry-informative markers (AIMs) were selected. These markers exhibited substantial allelic frequency differences, enabling the characterization of the three primary founding populations of modern Brazil - Europeans, West-Africans, and Native Americans. Through this analysis, the genetic contribution of each of these ancestral groups was identified in respect of each participant. Based on this, a latent class cluster analysis (LCCA) was performed to define the three clusters that best classified the sample according to ethnic group: African (n = 255), Caucasian (n = 668) and Native American (n = 83). Applying the adjusted model for the confounding variables (age, socio-economic class and sex), statistically significant differences in sleep variables between ethnicities were found. Africans had higher sleep latency compared to the other groups (β = 4.46, CI = 1.18 to 7.74 and β = 7.83, CI = 3.50 to 12.15), while Caucasians had longer total sleep time (β = −16.47, CI = −29.94 to −2.99) and better sleep efficiency (β = −2.19, CI = −4.35 to −0.02) compared to Africans. Regarding the respiratory arousals index (β = −1.11, IC = −2.07 to −0.16) and periodic leg movements index (β = −7.48, CI = −12.08 to −2.88), both were higher among Caucasians compared to Africans. We were able to conclude that genetic ancestry might modulate sleep structure and the occurrence of sleep disorders. • Studies have shown that some ethnic groups express common sleep patterns. • Most of these studies have considered self-reported ethnicity and assessed sleep subjectively. • This study was based on a genetic analysis combined with objective sleep evaluation. • We have identified differences in sleep parameters according to ethnicity. [ABSTRACT FROM AUTHOR]

Multiple elements modulate drug use, including sleep, which is increasingly being considered as an important contributor to substance use and abuse. The present study aimed to evaluate the association between sleep, psychiatric and socioeconomic/demographic factors and substance use in a large-scale representative sample from the city of São Paulo, Brazil. Data from the 2007 São Paulo Epidemiological Sleep Study (EPISONO) database were used. In the EPISONO study, volunteers underwent a polysomnographic exam and completed a series of questionnaires to assess objective and subjective sleep quality and associated comorbidities. Drug use was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Linear (univariate and multivariate) and logistic regressions were performed to identify factors associated with the use of the 4 most commonly used substances in the sample (tobacco, alcohol, cannabis and cocaine/crack). Structural equation models were used to establish theoretical networks to explain the relationship between sleep, psychiatric and socioeconomic factors and use of these substances. The logistic regression results showed that psychiatric symptoms, lower income, and poorer subjective sleep were the main factors associated with tobacco consumption; gender and occupational status with alcohol intake; age and occupation with cannabis use; and education with cocaine/crack use. The structural equation models partially supported these findings and identified significant effects of psychiatric symptoms on tobacco consumption, both directly and mediated by sleep. Our results reinforce previous findings concerning factors associated with generally misused substances and suggest that sleep should be considered as an important element in future substance use disorder studies. • Psychiatric symptoms, low income and poor sleep were associated with tobacco use. • Being male and unemployed was associated with alcohol use. • Younger age and being unemployed/not studying were associated with cannabis use. • Lower education levels were associated with cocaine/crack use. • Sleep was identified as a mediator between psychiatric symptoms and tobacco use. [ABSTRACT FROM AUTHOR]