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To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. The exposures of interest were the behavioral risk factors for non-communicable diseases NCDs : screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future. Sleep is an essential biological process for survival and is important for the physical, mental, and social well-being of individuals 1 1. Past, present, and future: trends in sleep duration and implications for public health. Sleep Health. Since it is essential for healthy development, the American Academy of Sleep Medicine recommends that adolescents should regularly sleep 8 to 10 hours a day, an amount associated with better health outcomes and quality of life 2 2. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med. Adolescence is a period marked by changes in sleep patterns due to biological, environmental, and psychosocial factors, such as pubertal maturation, circadian rhythm regulation, and less regular schedules 3 3. Functional consequences of inadequate sleep in adolescents: a systematic review. Sleep Med Rev. These changes are characterized by diurnal sleep dysfunctions, which, in turn, are risk factors for excessive daytime sleepiness in this age group 4 4. Rev Bras Epidemiol. Adolescents are not getting enough sleep, and this is a chronic problem worldwide. Insufficient sleep in adolescents and young adults: an update on causes and consequences. Sleep duration and consumption of sugar-sweetened beverages and energy drinks among adolescents. Factors associated with sleep duration across life stages: results from the Canadian Health Measures Survey. Less screen time and more physical activity is associated with more stable sleep patterns among Icelandic adolescents. Rev Paul Pediatr. Loss of sleep and its disorders can have their effects accumulated over time, being associated with several harmful health consequences, such as non-communicable diseases NCDs 10 Prevalence of poor sleep quality and its associated factors among hypertensive patients on follow up at Jimma University Medical Center. J Hum Hypertens. Some of the factors that lead to changes in sleep are considered as risks for major NCDs. World Health Organization. Noncommunicable diseases country profiles Geneva: World Health Organization; The obesity epidemic is a reality in all age groups and has been considered one of the main causes of the NCDs numbers in the world 12 Poor quality sleep has been linked to higher rates of being overweight, just as obesity can trigger comorbidities that affect sleep quality. In this bidirectional relationship 13 The epidemiology of sleep and obesity. The most frequent behavioral health risks in adolescence act together as part of an unhealthy style and increase the risk of obesity. Therefore, better understanding the complex association between these risk factors and sleep in an adolescent population becomes necessary, since this combination can impact health throughout life. In addition, no study to our knowledge of has used overweight as a mediator of these associations. This study, therefore, aims to estimate, by structural equation modeling, the association between modifiable behavioral risk factors for NCDs and sleep quality and excessive daytime sleepiness in adolescents, considering overweight as a mediator of these pathways. Cad Saude Publica. In this study, we used data collected in the second follow-up of the cohort, obtained in Those identified were invited to attend the follow-up, totaling participants. To increase the power of the sample and to prevent future losses, the cohort was opened to include other individuals born in In a second stage, volunteers identified in schools and universities were included, totaling 1, participants. The final sample consisted of 2, adolescents. Data were collected by health students and professionals duly trained, on the premises of UFMA, who conducted interviews to apply structured questionnaires answered by the participants themselves. The following information was used: schooling of the head of the family and the adolescent, monthly family income, economic class, alcohol consumption, smoking, use of illicit drugs, time of exposure to screens, food consumption, level of physical activity, quality of sleep, and daytime sleepiness. The frequency of daily consumption of sugar-sweetened beverages and caffeine were obtained with a food frequency questionnaire validated for adolescents 17 The questionnaire contained food items, which assess the frequency and portion of consumption of these foods in the last 12 months. The consumption of sugar-sweetened beverages was estimated by the intake of soft drinks, industrialized juices, chocolates, and energy drinks. The percentage of energy from these beverages in relation to the daily energy intake of the adolescent was calculated by the sum of energy from all sugar-sweetened beverages, multiplied by and divided by the sum of total daily energy intake. Guideline: sugars intake for adults and children. To estimate caffeine intake in milligrams per day, we calculated the daily consumption of foods coffee and energy drinks , in grams or milliliters, from multiplying the daily frequency and the size of the portion recorded for each food. The calculation of caffeine intake was obtained from the knowledge of caffeine values in grams or milliliters of each food from the USDA Nutrient Database for Standard Reference 19 US Department of Agriculture. Nutrient database for standard reference - SR Validation of interviewer- and self-administered physical activity checklists for fifth grade students. Med Sci Sports Exerc. For participants aged 19 years, the WHO classification 22 Physical status: the use of and interpretation of anthropometry. WHO technical report series; The adolescents were categorized as overweight overweight and obese or not. To assess sleep, two self-administered instruments were used separately, which use subjective measures in scales validated in Brazil: Pittsburgh Sleep Quality Index PSQI 23 Reliability and validity of the Brazilian version of the Pittsburgh Sleep Quality Index in adolescents. J Pediatr Rio J. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol. The PSQI is a questionnaire with 19 questions regarding sleep quality and disorders in the last month, and evaluates seven sleep components subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disorders, use of sleeping medications, and daytime dysfunction with scores ranging from 0 to 3, totaling a maximum of 21 points. Scores greater than 5 indicate poor sleep quality. Other scores were categorized as good sleep quality 23 The ESS 24 Two theoretical models were constructed to estimate the association between the main modifiable risk factors for NCDs and sleep in adolescents, differing only in the variable used to assess the outcome: sleep quality Model 1 or excessive daytime sleepiness Model 2. The SES latent variable was the most distal determinant exogenous variable associated with all variables of the model. The variables considered behavioral risk factors were the exposures of interest: substance use tobacco, alcohol, and illicit drugs , unhealthy food consumption intake of beverages sweetened with sugar and caffeine , screen time, and physical inactivity. Overweight was considered a mediator in the analysis Figure. To investigate the effect of behavioral and metabolic risk factors for NCDs on adolescent sleep, structural equation modeling SEM was used. The advantage of this technique is that it allows analyzing the dependency relationships between multiple exposure variables and outcomes, estimating direct and indirect effects, in addition to being able to represent unobserved concepts latent variables in these relationships, modeling the measurement error in the estimation process 25 Porto Alegre: Bookman; Statistical analysis was performed using Mplus software version 7. When the proposed modification suggestions were considered plausible from the theoretical point of view, a new model was elaborated and analyzed, if the modification index value was higher than Direct and indirect effects of the observed and latent variables on sleep quality and excessive daytime sleepiness were estimated with standardized coefficients SC. In the sample of 2, adolescents, Regarding economic class, Among the adolescents, The percentage of According to the PSQI, In this study, risk factors for NCDs, such as physical inactivity, increased consumption of alcohol and sugar-sweetened beverages were associated with excessive daytime sleepiness in adolescents. More distally, higher socioeconomic status was also associated with excessive daytime sleepiness in adolescents. Physical inactivity and higher consumption of sugar-sweetened beverages were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness in our sample. Physical inactivity was associated with worse sleep parameters analyzed in our study: poor sleep quality and excessive daytime sleepiness. A study with a representative sample of the population of Canada showed that sedentary young men were more likely to have short-term sleep 7 7. Physical exercise has been pointed out as an important behavioral treatment to improve sleep quality, in addition to preventing sleep disorders 26 Sleep and exercise: a reciprocal issue? The beneficial effects of physical activity on sleep can be explained by multiple pathways, for example by the interaction of circadian rhythm and metabolic, vascular, thermoregulatory, immunological, endocrine, and mood effects 26 Higher consumption of sugar-sweetened beverages was also associated with worse sleep parameters: poor sleep quality and excessive daytime sleepiness. The consumption of sugar-sweetened beverages has been associated with poor sleep quality 27 Association between the degree of processing of consumed foods and sleep quality in adolescents. The consumption of sugar-sweetened beverages can lead to a short duration of sleep, especially when consumed close to bedtime 6 6. The results of this study add knowledge by showing that caffeine consumption was not associated with poor sleep quality or excessive daytime sleepiness in adolescents, which suggests that the association may stem from the effect of sugar. A higher consumption of sugar-sweetened beverages was also associated with excessive daytime sleepiness, which may be explained by the high-sugar intake resulting in less restorative sleep and more nocturnal awakenings 28 Fiber and saturated fat are associated with sleep arousals and slow wave sleep. The best socioeconomic status was directly associated with excessive daytime sleepiness. These findings are contrary to those of a systematic review, which included 12 articles, showing that lower socioeconomic status was associated with shorter sleep duration, worse subjective perception of sleep quality assessed with questionnaires , and greater daytime sleepiness in adolescents 9 9. J Bras Psiquiatr. Prevalence and correlates of screen time among Brazilian adolescents: findings from a country-wide survey. Appl Physiol Nutr Metab. Screen time showed no association with sleep among adolescents in this study. Screen time did not even mediate associations in the analysis, even with most adolescents A systematic review, conducted with 42 articles, aiming to analyze the evidence on the sleep of adolescents, concluded that screen time is an increasingly frequent factor and that it has affected the onset and duration of sleep, with consequent daytime sleepiness, tiredness, and decreased academic performance of adolescents 31 Association between screen viewing duration and sleep duration, sleep quality, and excessive daytime sleepiness among adolescents in Hong Kong. In our study, the variable screen time included joint exposure to television, video games, cell phones, tablets, and computers, which may possibly explain the different findings. Alcohol consumption presented the highest standardized coefficient associated with excessive daytime sleepiness. This effect happens as the body adjusts to the presence of alcohol during the first half of sleep in an effort to maintain the normal sleep pattern 33 Roehrs T, Roth T. Sleep, sleepiness, and alcohol use. Alcohol Res Health. The authors highlight that both the pattern and duration of sleep and substance use among young people are interconnected by bidirectional associations 34 Longitudinal bi-directional relationships between sleep and youth substance use. J Youth Adolesc. Despite the known effect of being overweight on increased sleep problems 35 Sleep in overweight adolescents: shorter sleep, poorer sleep quality, sleepiness, and sleep-disordered breathing. J Pediatr Psychol. In addition, excess weight did not act as a mediator of associations in the studied models. Prevalence of overweight and obesity among Brazilian adolescents over time: a systematic review and meta-analysis. Public Health Nutr. This study has some limitations. The use of different scales in the literature, for assessing both sleep and other variables used, such as socioeconomic status, hinders the comparison of results. The study has a cross-sectional design, thus establishing a causal relationship between the risk factors for NCDs and sleep is impossible due to the possibility of reverse causality and the bidirectional relationship between exposures and outcome. However, this is one of the few studies that evaluated the effect of multiple risk factors for NCDs in association with sleep quality and excessive daytime sleepiness in adolescents. Strengths include the sample size and the method of analysis used to evaluate the effect of the associations. The modeling with structural equations allowed to observe the paths of the effects from mediating variables in sleep, estimating several separate and interdependent multiple regression equations. The main modifiable behavioral risk factors for NCDs are associated with worse sleep indicators in adolescents, such as poor sleep quality and excessive daytime sleepiness, and are independent of overweight. These findings contribute to emphasize the importance of coordinated surveillance and prevention actions against NCDs and altered sleep, focusing on behavioral risk factors, which begin in adolescence and can trigger health problems throughout life. Open menu Brazil. Open menu. Abstract Resumo English Resumo Portuguese. Caffeine consumption To estimate caffeine intake in milligrams per day, we calculated the daily consumption of foods coffee and energy drinks , in grams or milliliters, from multiplying the daily frequency and the size of the portion recorded for each food. Proposed Theoretical Models Two theoretical models were constructed to estimate the association between the main modifiable risk factors for NCDs and sleep in adolescents, differing only in the variable used to assess the outcome: sleep quality Model 1 or excessive daytime sleepiness Model 2. Publication Dates Publication in this collection 20 Oct Date of issue History Received 14 July Accepted 9 Nov This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Departamento de Ensino. Departamento de Odontologia II. Pedro Martins Lima Neto Data collection, analysis, and interpretation. Imperatriz, MA, Brasil. Conflict of Interest: The authors declare no conflict of interest. Figures 1 Tables 4. Notes: SCHAD: level of education of the adolescent; SCHE: level of education of the head of the family; income: monthly family income; CCEB: Brazilian Economic Classification Criterion; SES: socioeconomic status; alco: alcohol consumption; toba: smoking; drug: use of illicit drugs; SSBEV: consumption of sugar-sweetened beverages; coffee: caffeine consumption; screen: screen time; innat: physical inactivity; weight: overweight; sleep: sleep. Latent variable Model 1 Model 2 Socioeconomic status Factor loading Standard error p-value Factor loading Standard error p-value Education level of the head of the family 0. Stay informed of issues for this journal through your RSS reader. PDF English Portuguese. Google Google Scholar. Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents.

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Official websites use. Share sensitive information only on official, secure websites. E-mail: diretrizes cardiol. Membros: Leda A. Daud Lotaif, Madson Q. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Fonte: Carey et al. Fonte: Nilson et al. Em , ocorreu um total de 1. A abordagem adequada dos fatores de risco para o desenvolvimento da HA deve ser o grande foco do SUS. Fonte: Adaptado de Carey et al. A obesidade geral e a obesidade abdominal foram associadas ao aumento do risco de HA. Neste estudo, os autores encontraram um aumento no risco absoluto para eventos cardiovasculares CV. Diversos outros estudos foram publicados desde o estudo inicial de Vasan et al. Mais recentemente, foram publicados diversos estudos de coorte, muitos com grandes amostras. Os estudos demonstraram que a rigidez arterial poderia preceder a HA, estabelecendo a teoria da rigidez como causa. Humphey et al. Fonte: Malachias et al. Os Quadros 3. A MDPAC melhora a reprodutibilidade da medida da PA, e o efeito do avental branco pode ser substancialmente reduzido ou mesmo eliminado. Caso seja utilizado o de punho, o que deve ser desestimulado, preferem-se aqueles validados, com sensor de altura e movimento. O Quadro 4. Na Figura 4. Na maioria dos pacientes hipertensos, coexistem ou agregam-se outros fatores reconhecidos como capazes, per se, determinar ou incrementar o aparecimento e desenvolvimento da DCV, independentemente dos valores da PA. Conforme exposto no Quadro 5. No Qaudro 5. O Quadro 5. Assim, a meta atingida equivale a valores entre mmHg, se comparada com a medida realizada nos estudos anteriores. Para tanto, o MS publicou a Portaria 2. Nesse sentido, o profissional deve:. Adaptado de Fuchs, Foi bem registrado o efeito hipertensor do ganho de peso. O Quadro 8. Pode ser considerada como um conjunto de valores morais, mentais e emocionais que norteiam pensamentos, comportamentos e atitudes 3 , GR: I, NE: B. A Quadro 9. Apresentam boa tolerabilidade. O Quadro 9. A Figura 9. Adaptado de ESC, Estudo em 9. O Quadro Assim, devemos priorizar os anti-hipertensivos que passam em quantidade menor pelo leite materno. Adaptado de Flynn et al. Adaptado de Flynn et al, Adaptado de Dionne et al. IV: intravenoso; IM: intramuscular; min. Nesse contexto, o Quadro HELPP: hemolysis, elevated liver enzymes, low platelets. Adaptado de Malachias et al. O tratamento da UH Figura Para o tratamento agudo, indicam-se a captoprila e a clonidina. Adaptada de Whelton et al. Destacamos aqui as peculiaridades para o idoso. O risco de quedas em idosos pode aumentar nas primeiras semanas de tratamento com o uso dos DIU e, no primeiro dia, com as demais classes. Aboyans et al. No entanto, muitos desses sintomas e sinais podem ser menos destacados na HA. Outros sintomas podem ser visualizados no Quadro Adaptado de: Malachias et al. Fonte: Ji H et al. Fonte: Feitosa et al. As a library, NLM provides access to scientific literature. Arq Bras Cardiol. View full-text in English. Find articles by Weimar Kunz Sebba Barroso. Find articles by Cibele Isaac Saad Rodrigues. Find articles by Luiz Aparecido Bortolotto. Find articles by Carlos Alberto Machado. Find articles by Carlos Eduardo Poli-de-Figueiredo. Find articles by Celso Amodeo. Find articles by Eduardo Costa Duarte Barbosa. Find articles by Fernando Nobre. Find articles by Juan Carlos Yugar-Toledo. Find articles by Roberto Dischinger Miranda. Find articles by Sandra C Fuchs. Find articles by Alexandre Alessi. Find articles by Alexandre Jorge Gomes de Lucena. Find articles by Alvaro Avezum. Find articles by Ana Luiza Lima Sousa. Find articles by Andrea Pio-Abreu. Find articles by Andrei Carvalho Sposito. Find articles by Angela Maria Geraldo Pierin. 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