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Antecedentes: La calidad de vida relacionada con la salud (CVRS) se encuentra disminuida en la enfermedad renal en etapa avanzada (EREA) pero se conoce poco acerca del impacto de los trastornos del sueño, la modalidad de diálisis y los factores demográficos sobre la CVRS de pacientes mexicanos con EREA. Métodos: Se incluyeron 121 adultos con EREA pertenecientes a 4 unidades de diálisis del estado de Guanajuato, México, estratificados por unidad y modalidad de diálisis (Hemodiálisis [HD], diálisis peritoneal continua ambulatoria [DPCA] y diálisis peritoneal automatizada [DPA]). Se realizó un análisis de la información clínica y los datos obtenidos del Sleep Hart Health Study Sleep Habits Questionnaire, del cuestionario corto del Medical Outcomes Study (MOS; SF-36) y de la Escala de Somnolencia Epworth. Resultados: En general, los síntomas y los trastornos del sueño fueron frecuentes (ej. insomnio 37.2%). Los puntajes de SF-36 resultaron más bajos comparados con las normas de México y Estados Unidos. En la subescala de Vitalidad, los pacientes de HD reportaron mejor CVRS y los pacientes de DPCA la peor CVRS. En el modelo de análisis multivariado, la modalidad de diálisis y los trastornos del sueño en grupo y el ingreso bajo, resultaron asociados significativamente con una pobre calidad de vida total (SF-36) y una pobre salud mental (CVRS). Los modelos de calidad de vida total y del componente mental mostraron una CVRS significativamente mejor tanto para DPA como para la HD con tamaños del efecto de pequeño a moderado. El análisis de costo-efectividad mostró ventaja para la DPA. Conclusiones: Los pacientes mexicanos de EREA tienen una CVRS reducida, y los trastornos del sueño pueden ser importantes para conducir a este hallazgo. La DPA debe ser la modalidad de diálisis de preferencia en México.

Background Health-related quality of life (HR-QOL) is reduced with end-stage renal disease (ESRD) but little is known about the impact of sleep disorders, dialysis modality and demographic factors on HR-QOL of Mexican patients with ESRD. Methods 121 adults with ESRD were enrolled from 4 dialysis units in the state of Guanajuato, Mexico, stratified by unit and dialysis modality (hemodialysis [HD], continuous ambulatory peritoneal dialysis [CAPD] and automated peritoneal dialysis [APD]). Analysis included clinical information and data from the Sleep Heart Health Study Sleep Habits Questionnaire, the Medical Outcomes Study (MOS) short form (SF-36) HR-QOL measure and Epworth Sleepiness Scale. Results Overall, sleep symptoms and disorders were common (e.g., 37.2% insomnia). SF-36 scores were worse versus US and Mexican norms. HD patients reported better, while CAPD patients poorer HR-QOL for Vitality. With multivariate modelling dialysis modality, sleep disorders as a group and lower income were significantly associated with poorer overall SF-36 and mental health HR-QOL. Overall and Mental Composite Summary models showed HR-QOL was significantly better for both APD and HD with small to moderate effect sizes. Cost-effectiveness analysis demonstrated an advantage for APD. Conclusions Mexican ESRD patients have reduced HR-QOL, and sleep disorders may be an important driver of this finding. APD should be the preferred mode of dialysis in Mexico.

Objective The purpose of this study was to examine the association between self-reported sleep duration and markers of kidney function. Design A cross-sectional survey from the 2009-2012 National Health and Nutrition Examination Survey. Setting and Participants The participants were 8690 adults (≥ 20 years) without a previous sleep disorder diagnosis, end-stage kidney failure, or other kidney or liver problems. Subsamples with pre-diabetes and pre-hypertension were examined. Measurements Participants reported habitual sleep duration, coded as ≤ 5, 6, 7, 8, and ≥ 9 hours per night. Biomarkers of kidney function were determined, including glomerular filtration rate (eGFR) estimated from the Chronic Kidney Disease Epidemiology Collaboration equation, urine albumin-to-creatinine ratio (ACR), microalbuminuria status, and glomerular hyperfiltration status. Weighted and adjusted general linear models assessed associations between sleep duration with eGFR and ACR. Logistic regression analyses evaluated the associations of microalbuminuria and glomerular hyperfiltration status with sleep duration. Results Greater eGFR was related to short sleep duration in the total sample and among participants with pre-diabetes. Greater ACR was associated with short and long sleep duration. Short sleep duration (≤ 5 hours) was associated with an increased odds for glomerular hyperfiltration (OR, 1.41; 95% CI, 0.97-2.06) and microalbuminuria (OR, 1.31; 95% CI, 0.96-1.79). Conclusions In a US representative sample of adults, self-reported short and long sleep duration were related to higher ACR. Short sleep duration was associated with higher eGFR and microalbuminuria. Research is needed to understand whether these associations indicate increased risk for kidney damage and cardiovascular risk.

Durante el embarazo, los cambios orgánicos pueden alterar la percepción de la calidad de vida (CV) de la adolescente. En este trabajo se determinaron las diferencias en la CV por trimestre del embarazo en adolescentes argentinas mediante un estudio comparativo trasversal. La CV se determinó con el cuestionario SF-36 y el análisis de resultados mediante Statistical Package for the Social Sciences (SPSS) versión 21. Cincuenta y seis adolescentes de 18 ± 2 años reportaron su CV en escala de 0-100 (a mayor puntaje, mejor CV percibida), resultando un promedio de 37.7 ± 8.4 en la puntuación del componente físico (PCF) y de 44.1 ± 12.2 en la puntuación del componente mental (PCM). Se encontraron diferencias en el PCF comparando los grupos del primer y tercer trimestres (43.7 ± 10 vs. 33.8 ± 6; p < 0.01) y los grupos del segundo y tercer trimestres (39.7 ± 8 vs. 33.8 ± 6; p < 0.01). Las adolescentes reportaron una menor CV en el PCF (mayor limitación física y dolor corporal) a medida que progresa la gestación.

Introduction As a result of exposure to toxic substances, different human and animals cells have displayed either global DNA hypomethylation or gene-specific hypermethylation. Specifically in occupational volatile organic compound (VOC) exposure, we previously found hypermethylation in TOP2A, SOD1 and TNF-α promoter area in leukocytes from people exposed to a complex VOC mixture, while participants exposed to a single VOC did not show any differences compared to controls. The aim of this study was to analyse the methylation pattern in the 5’-UTR region, considered for some authors as an “internal/alternative promoter area” in people occupationally exposed to a single VOC (n = 19) compared to VOC mixtures exposure (n = 20) as well as a reference, non-exposed group (n = 20). Methods PCR-pyrosequencing was performed in order to analyse methylation status in CpG’s located at the 5’-UTR region of the TOP2A, SOD1, IL6, TNF-α and CYP2E1 genes in leukocytes from Mexican workers labouring at three different scenarios with VOC exposure compared to a reference group. Results 5’-UTR region from IL6 and TOP2A genes showed hypomethylation for two populations exposed to a VOC mixture, while TNF-α showed hypermethylation; methylation in the SOD1 gene did not show differences between groups. DNA obtained from the reference group showed hypermethylation in the 5’-UTR region from the CYP2E1 gene compared to all exposed subgroups. Conclusions 5’-UTR region in certain genes is more prone to undergo epigenetic modifications compared to promoter area as a result of VOC exposure. 5’-UTR methylation status must be considered in a near future as an early biomarker of effect in human chemical toxicity.

Latinos are the fastest growing minority group in the United States. Factors such as sleep quality and sleep disorders that may impact the health of this segment of the U.S. population are important now, and will be increasingly meaningful in the future. This overview of sleep disorders among Latino youth and adults identifies gaps in the literature and serves as a springboard for future sleep promotion, prevention, and intervention studies for Latino populations in the United States. Language, culture care, and access to care issues that need to be addressed in research and in clinical practice for Latinos are also described. La poblacion latina es el grupo minoritario de crecimiento mas rapido en los Estados Unidos. Existen factores como la calidad del sueno y los trastornos del sueno que pueden afectar la salud de este segmento de rapido crecimiento de la poblacion de los Estados Unidos que son importantes ahora, y seran cada vez mas significativos en el futuro. Esta vision general de los trastornos del sueno entre los jovenes latinos y adultos senala las deficiencias en la literatura y sirve como un trampolin para futuros estudios de promocion, prevencion e intervencion del sueno en poblaciones latinas en los Estados Unidos. Asimismos se describen temas como el lenguaje, el cuidado cultural y el acceso a la atencion medica de los latinos que necesitan ser abordados en la investigacion y en la practica clinica.

The conceptual domains of health-related quality of life (HR-QoL) examine the complex nature and interactions of overall physical or mental health. HR-QoL data are being used increasingly as outcome indicators in clinical trials, effectiveness research, and quality of care via the generation of health utilities profiles that can inform patient management and policy decisions regarding disease states, patient groups, or areas of function. In the past decade, measures of HR-QoL have been incorporated in sleep research to examine associations between a wide spectrum of sleep disorders and health outcomes in various populations. This chapter provides a snapshot of HR-QoL in sleep research in the USA, France, Japan, Turkey, and China, primarily from large national or international population-based studies. The chapter also incorporates overviews of HR-QoL in special populations: restless legs syndrome, end-stage renal disease, and children with Autism Spectrum Disorders, their parents and caregivers. The summary addresses the need for incorporating measures of HR-QoL in sleep research and interventions to enhance outcomes, reduce healthcare costs, and inform policy.