Arousal Time Research Articles

Winter Roosting by Eastern Red Bats in Ozark Mountain Forests of Missouri

The eastern red bat (Lasiurus borealis Müller, 1776) is a widespread species that roosts in evergreen or dead foliage suspended in trees during winter but retreats to leaf litter during colder periods. Roosting in leaf litter by eastern red bats makes them vulnerable to prescribed fires in winter. Using radio telemetry, we tracked 33 male eastern red bats to 101 winter (November–February) roosts and quantified roost locations, habitat surrounding roosts, and landscape attributes of roost locations. When roosting in trees, bats preferred oaks but generally avoided other tree species; they used pines in proportion to their availability. During colder periods, bats retreated to roosts in leaf litter where 21% suffered mortality either from predation/scavenging or unknown causes while roosting on the ground. Models of roost selection indicated that southerly aspect was the most important factor determining roost selection, and both tree- and leaf-litter roosts were predominately (≥94%) on upper south-facing slopes. Prescribed burning in late morning/early afternoon on clear days when temperatures under leaf litter are warmest in winter could reduce potential mortality by allowing faster arousal time for hibernating bats.

Nonverbal pre-performance expressions of professional darts players distinguish between good and poor performance

The present research attempted to extend prior research that showed that thin-slices of pre-performance nonverbal behavior (NVB) of professional darts players gives valid information to observers about subsequent performance tendencies. Specifically, we investigated what kind of nonverbal cues were associated with success and informed thin-slice ratings. Participants (N = 61) were first asked to estimate the performance of a random sample of videos showing the preparatory NVB of professional darts players (N = 47) either performing well (470 clips) or poorly (470 clips). Preparatory NVB was assessed via preparation times and Active Appearance Modeling using Noldus FaceReader. Results showed that observers could distinguish between good and poor performance based on thin-slices of preparatory NVB (p = 0.001, d = 0.87). Further analyses showed that facial expressions prior to poor performance showed more arousal (p = 0.011, ƞ2p = 0.10), sadness (p = 0.040, ƞ2p = 0.04), and anxiety (p = 0.009, ƞ2p = 0.09) and preparation times were shorter (p = 0.001, ƞ2p = 0.36) prior to poor performance than good performance. Lens model analyses showed preparation times (p = 0.001, rho = 0.18), neutral (p = 0.001, rho = 0.13), sad (rho = 0.12), and facial expressions of arousal (p = 0.001, rho = 0.11) to be correlated with observers’ performance ratings. Hence, preparation times and facial cues associated with a player’s level of arousal, neutrality, and sadness seem to be valid nonverbal cues that observers utilize to infer information about subsequent perceptual-motor performance.

Effects of Transcutaneous Electrical Acupoint Stimulation on Stress Response during Intubation and Extubation in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Prospective, Randomized Controlled Trial.

Objective The study aimed to evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on the stress response during intubation and extubation in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods 122 patients undergoing VATS lobectomy were randomly divided into two groups: the TEAS group (n = 62) and the control group (n = 60). Patients in the TEAS group underwent electroacupuncture stimulation of bilateral Neiguan (PC6), Hegu (L14), Lieque (LU7), and Chize (LU5) acupoints from 30 min before anesthesia to the end of surgery. The patients in the control group did not undergo stimulation. The primary endpoints were the hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol. The secondary endpoints were the consumption of remifentanil and propofol, Ramsay sedation score and arousal time, extubation quality score, and postoperative complications. Results The hemodynamic variables and plasma concentrations of epinephrine, norepinephrine, and cortisol during intubation and extubation were lower in the TEAS group at T1, T3, and T4 compared with the control group. TEAS led to a reduction in the consumption of remifentanil (P < 0.01), as well as a reduction in the incidence of postoperative complications. The extubation quality score was lower (P < 0.01) while the Ramsay sedation score was higher (P < 0.01) in the TEAS group than in the control group. However, the arousal time and consumption of propofol were not significantly different between the two groups. Conclusion TEAS can maintain hemodynamic stability, reduce the stress response during intubation and extubation, improve the quality of anesthesia recovery, and decrease the incidence of postoperative complications in patients undergoing VATS.

Abstract P198: Short Sleep Duration, Greater Cognitive Arousal, And Eveningness Are Associated With Reduced Left Ventricular Function In Insomnia Disorder

Aim: Insomnia is associated with cardiovascular disease (CVD), particularly the phenotype with objective short sleep duration and associated physiological arousal. However, what objective sleep and arousal characteristics among patients with insomnia are related to markers of cardiovascular structure and function remains unknown. The present study examined the association of objective sleep metrics and self-reported arousability with arterial stiffness, endothelial function, and left ventricular function among patients with insomnia disorder. Methods: Sixteen young, healthy adults (age: M [ SD ]=30[7]; 56.3% women) meeting diagnostic criteria for insomnia disorder and reporting no history of CVD, underwent fasting vascular testing including carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL TM ), brachial-artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300 TM ). Left ventricular function was assessed by ejection fraction (EF), global longitudinal strain (GLS), mitral valve E/e’ (MVE/e’), and lateral e’ using standardized methods. Ten participants wore a portable sleep monitor for 1 night (WatchPat200, Itamar Medical) and an actigraph for 8 nights (Actiwatch Spectrum Plus, Philips Respironics). All participants completed the Pre Sleep Arousal Scale (PSAS; somatic &amp; cognitive subscales), and the Arousal Predisposition Scale (APS). Bivariate correlations and curvilinear regressions (total sleep time [TST] only) were conducted for the associations between actigraphy-assessed TST and WatchPat (WP) TST, actigraphy-assessed mean bedtime, and PSAS and APS scores with cardiovascular markers. Each set of one sleep metric with all six cardiovascular markers were Bonferroni corrected (α level: p &lt;0.007). Results: On average, participants obtained 7h,9min of TST (range: 6h,26min - 8h,41min) and went to bed at 23:40 (range:21:47-2:13) via actigraphy, and slept 6h,51min via WP. Mean PSAS Somatic, PSAS Cognitive, and APS scores were 13.7(SD=4.5), 24.5(SD=7.5), and 27.9(SD=7.6), respectively. cfPWV (range:4.6-8.0), EF% (range:55.0-70.9), GLS% (range:-25- -19), and MVE/e’ (range:3.6-13.3) were all within age and sex normative ranges. Mean FMD was 7.8% (SD=2.6, range:4.4-14.6), and lateral e’ was 15 cm/s (SD=4.5, range:9-22). Correlations indicated that greater PSAS cognitive scores were related to worsening (less negative) GLS% ( r =0.77, p =0.001), later bedtimes were associated with lower lateral e’ ( r =-0.84, p =0.004), and shorter WPTST was associated with lower EF% (r=0.84, p=0 . 002). Conclusion: Among young adults with insomnia disorder, greater cognitive arousal, later bedtimes, and shorter objective total sleep time were associated with subclinical worsening of left ventricular strain, diastolic and systolic function.

Analysis of the characteristics of sleep in patients with patent foramen ovale complicated with obstructive sleep apnea.

Analyzing sleep quality and sleep structure in patients with patent foramen ovale (PFO) complicated with obstructive sleep apnea (OSA) and the interaction between OSA and PFO in sleep. We compared patients with PFO complicated with OSA, patients with simple PFO, and controls. Pittsburgh Sleep Quality Index was used to compare sleep quality and polysomnography was used to compare sleep structure of the three groups. Compared with the control group(n = 62), PFO with OSA (n = 48) and simple PFO (n = 61) groups had more frequent occurrence of poor sleep quality (χ2 = 89.901; p < 0.001). These two groups also showed decreased sleep efficiency (p < 0.010),lower percentages of REM sleep, and reducedN3 sleep (p < 0.050). The N2 sleep was prolonged (p < 0.010). The nocturnal lowest SpO2 was lower and the oxygen desaturation index was higher (p < 0.50). Compared with the simple PFO group, the poor sleep quality was more frequent in the PFO with OSA group; sleep latency (p < 0.001) was prolonged; wake after sleep onset (p < 0.001) and arousal times (p = 0.031) were increased; and sleep micro-arousal index (p = 0.037), periodic leg movement index (p = 0.024), and apnea hypopnea index (p < 0.001) were higher in the PFO with OSA group. Patients withPFO and OSA have poor sleep quality with changes in sleep stage and high occurrence rate of sleep disorders. OSA further deteriorates sleep quality and alters sleep structure in patients with PFO.

Automatic Sleep Staging Based on EEG-EOG Signals for Depression Detection

In this paper, an automatic sleep scoring system based on electroencephalogram (EEG) and electrooculogram (EOG) signals was proposed for sleep stage classification and depression detection. Our automatic sleep stage classification method contained preprocessing based on independent component analysis, feature extraction including spectral features, spectral edge frequency features, absolute spectral power, statistical features, Hjorth features, maximum-minimum distance and energy features, and a modified ReliefF feature selection. Finally, a support vector machine was employed to classify four states (awake, light sleep [LS], slow-wave sleep [SWS] and rapid eye movement [REM]). The overall accuracy of the Sleep-EDF database reached 90.10 ± 2.68% with a kappa coefficient of 0.87 ± 0.04. Furthermore, a depression recognition method was developed to distinguish the patients with depression from healthy subjects. Specifically, according to the differences in sleep patterns between the two groups, REM latency, sleep latency, LS proportion, SWS proportion, sleep maintenance and arousal times were employed in this study. Sleep data from 12 healthy individuals and 19 patients with depression were applied to the system. The accuracy of the recognition results reached 95.24%, thus verifying the feasibility of our approach.

Reversal of epidural xylazine in Egyptian water buffalo (Bubalus bubalis) with atipamezole

The reversal of epidural xylazine, induced with IV atipamezole was evaluated in 15 buffaloes. Atipamezole at different dose rates (5, 10 and 15 µg/kg) injected 30 minutes after epidural xylazine provoked visible signs of arousal shortly after inection in all buffaloes without any side effects. The mean arousal times were 4.8±0.84 min, 2.4±0.24 min and 2.0±0.00 min while the mean total recovery times were 61.0±2.6 min, 33.0±3.7 min and 32.0±4.3 min following doses of 5, 10 and 15 µg/kg atipamezole respectively. The heart, respiratory and ruminal rates were mildly influenced. Overall, the IV atipamezole at a dose rate of 10 µg/kg was found effective and satisfactory for reversing the analgesic, sedative and cardiopulmonary depression effects induced by epidural xylazine administration in buffaloes.

ROS and hypoxia signaling regulate periodic metabolic arousal during insect dormancy to coordinate glucose, amino acid, and lipid metabolism

Metabolic suppression is a hallmark of animal dormancy that promotes overall energy savings. Some diapausing insects and some mammalian hibernators have regular cyclic patterns of substantial metabolic depression alternating with periodic arousal where metabolic rates increase dramatically. Previous studies, largely in mammalian hibernators, have shown that periodic arousal is driven by an increase in aerobic mitochondrial metabolism and that many molecules related to energy metabolism fluctuate predictably across periodic arousal cycles. However, it is still not clear how these rapid metabolic shifts are regulated. We first found that diapausing flesh fly pupae primarily use anaerobic glycolysis during metabolic depression but engage in aerobic respiration through the tricarboxylic acid cycle during periodic arousal. Diapausing pupae also clear anaerobic by-products and regenerate many metabolic intermediates depleted in metabolic depression during arousal, consistent with patterns in mammalian hibernators. We found that decreased levels of reactive oxygen species (ROS) induced metabolic arousal and elevated ROS extended the duration of metabolic depression. Our data suggest ROS regulates the timing of metabolic arousal by changing the activity of two critical metabolic enzymes, pyruvate dehydrogenase and carnitine palmitoyltransferase I by modulating the levels of hypoxia inducible transcription factor (HIF) and phosphorylation of adenosine 5'-monophosphate-activated protein kinase (AMPK). Our study shows that ROS signaling regulates periodic arousal in our insect diapasue system, suggesting the possible importance ROS for regulating other types of of metabolic cycles in dormancy as well.

Comparison between Effects of Fentanyl and Ketofol as Sedative in Elective Caesarean Section under Subarachnoid Anaesthesia

Background: Regional anaesthesia has become an important anaesthetic technique now a days. The use of spinal (subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Pharmacologically induced tranquility improves acceptance of regional technique.&#x0D; Objective: This study compares Fentanyl and Ketofol (Ketamine+Propofol) in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia.&#x0D; Materials and method: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I patients between age 20-40 years undergoing elective Caesarean sections under subarachnoid anaesthesia during the period January 2022 to June 2022. Patients were randomly allocated to one of two groups: Fentanyl group (Group F, n=30), who received Fentanyl in a single dose of 0.5mcg/kg and Ketofol group (Group KP, n=30), who received Ketofol in a single dose of 0.5mg/kg (Ketamine-0.5mg/kg+ Propofol-0.5mg/kg). Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (intravenous) injection of Fentanyl or Ketofol to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 ( patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale.&#x0D; Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (p&gt;0.05). Time of onset of sedation was significantly less with Ketofol than Fentanyl (p&lt;0.05). The arousal time i.e. duration of sedation was significantly longer with Ketofol than Fentanyl (p&lt;0.05). Fentanyl was associated with high incidence of some adverse effects like nausea, vomiting than Ketofol (46.66% vs 16.70%, p&lt;0.05). Pain in arm during drug administration was significantly more with Ketofol (33.33% vs 6.66%, p&lt;0.05). Significant percentage of patients was satisfied with Ketofol than Fentanyl (66.66% vs 20%, p&lt;0.001).&#x0D; Conclusion: The study showed that the time to reach effective sedation was less with Ketofol than Fentanyl and the arousal time i.e. duration of sedation was significantly longer with Ketofol which is beneficial for the patient in single dose technique for sedation. Although incidence of pain in arm was more with Ketofol, Fentanyl was associated with high incidence of some adverse effects like nausea and vomiting. Thus it is recommended that Ketofol is a better choice than Fentanyl for sedation in single dose technique during subarachnoid block for Caesarean section.&#x0D; Delta Med Col J. Jul 2020;8(2): 67-74

0700 Prediction Of Surgical Outcome Using Respiratory Pattern Clafification

Abstract Introduction: Introduction A diagnosis of the surgical indication is important in Sleep surgery. In otolaryngology regions, it is usually considered that a site of occlusion diagnosis by DISE. However, for OSA patients with aging, heart failure and neurologic disease, the effect with the surgical treatment is still low. In these OSA patients, it is a reason that a functional factor is associated as well as an anatomical factor. Similarly, without clear complications including Aging etc, there are a lot of the OSA patients whom a functional factor is associated with. OSA is multi-factorial disease according to Wellman model, OSA is associated with the functional factor including loop gain and the ability of the upper airway to dilate associated with ventilatory drive, arousal threshold only other than the anatomical factor of the upper airway. By normal PSG, the respiratory event is classified as obstructive, mixed and central. However, there are a lot of events that a functional factor is associated with, even if it is a respiratory event to be diagnosed as an obstructive respiratory event. An effect of sleep surgery is expected only for an anatomical factor. Therefore, in the case of sleep surgery, we must diagnose a pure obstructive respiratory event precisely. Purpose of this study: To clarify a respiratory pattern to influence surgical success. Methods: Methods 26 surgical patients with Pharyngeal surgeries diagnosed as OSA by PSG + Pes measurements were enrolled. We distinguish respiratory event as Pure obstructive event or not, using Pes signal pattern and EEG arousal timing. Results: Results Rate of pure obstructive event of all respiratory event varied by an individual patient. Mean rate of pure obstructive event is 57.3%. We find significant difference of AHI improvement rate between two groups which Rate of pure obstructive event shows more than 55% or less than 55%. Conclusion: Conclusion Breathing pattern is variety and pure obstructive event is few than ever considered. Respiratory pattern influence surgical success. Support Non

Decoding dynamic affective responses to naturalistic videos with shared neural patterns

This study explored the feasibility of using shared neural patterns from brief affective episodes (viewing affective pictures) to decode extended, dynamic affective sequences in a naturalistic experience (watching movie-trailers). Twenty-eight participants viewed pictures from the International Affective Picture System (IAPS) and, in a separate session, watched various movie-trailers. We first located voxels at bilateral occipital cortex (LOC) responsive to affective picture categories by GLM analysis, then performed between-subject hyperalignment on the LOC voxels based on their responses during movie-trailer watching. After hyperalignment, we trained between-subject machine learning classifiers on the affective pictures, and used the classifiers to decode affective states of an out-of-sample participant both during picture viewing and during movie-trailer watching. Within participants, neural classifiers identified valence and arousal categories of pictures, and tracked self-reported valence and arousal during video watching. In aggregate, neural classifiers produced valence and arousal time series that tracked the dynamic ratings of the movie-trailers obtained from a separate sample. Our findings provide further support for the possibility of using pre-trained neural representations to decode dynamic affective responses during a naturalistic experience.

Optogenetic/Chemogenetic Activation of GABAergic Neurons in the Ventral Tegmental Area Facilitates General Anesthesia via Projections to the Lateral Hypothalamus in Mice.

The ventral tegmental area (VTA) reportedly regulates sleep and wakefulness through communication with the lateral hypothalamus (LH). It has also been suggested that adequate anesthesia produced by administration of chloral hydrate, ketamine, or halothane significantly reduces the GABAergic neuronal firing rate within the VTA. However, the exact effects on GABAergic neurons in the VTA and the mechanisms through which these neurons modulate anesthesia through associated neural circuits is still unclear. Here, we used optogenetic and chemogenetic methods to specifically activate or inhibit GABAergic neuronal perikarya in the VTA or their projections to the LH in Vgat-Cre mice. Electroencephalogram (EEG) spectral analyses and burst suppression ratio (BSR) calculations were conducted following administration of 0.8 or 1.0% isoflurane, respectively; and loss of righting reflex (LORR), recovery of righting reflex (RORR), and anesthesia sensitivity were assessed under 1.4% isoflurane anesthesia. The results showed that activation of GABAergic neurons in the VTA increased delta wave power from 40.0 to 46.4% (P = 0.006) and decreased gamma wave power from 15.2 to 11.5% (P = 0.017) during anesthesia maintenance. BSR was increased from 51.8 to 68.3% (P = 0.017). Induction time (LORR) was reduced from 333 to 290 s (P = 0.019), whereas arousal time (RORR) was prolonged from 498 to 661 s (P = 0.007). Conversely, inhibition of VTA GABAergic neurons led to opposite effects. In contrast, optical activation of VTA–LH GABAergic projection neurons increased power of slow delta waves from 44.2 to 48.8% (P = 0.014) and decreased that of gamma oscillations from 10.2 to 8.0%. BSR was increased from 39.9 to 60.2% (P = 0.0002). LORR was reduced from 330 to 232 s (P = 0.002), and RORR increased from 396 to 565 s (P = 0.007). Optical inhibition of the projection neurons caused opposite effects in terms of both the EEG spectrum and the BSR, except that inhibition of this projection did not accelerate arousal time. These results indicate that VTA GABAergic neurons could facilitate the anesthetic effects of isoflurane during induction and maintenance while postponing anesthetic recovery, at least partially, through modulation of their projections to the LH.

Circadian Rhythms and Physiological Synchrony

Circadian rhythms determine daily sleep cycles, mood, and cognition. Depending on an individual's circadian preference, or chronotype (i.e.,"early birds" and "night owls"), the rhythms shift earlier or later in the day. Early birds experience circadian arousal peaks earlier in the morning than night owls. Prior work has shown that individuals are more effective at analytic tasks during their peak arousal times but are more creative during their off-peak times. We investigate if these findings hold true for small groups. We find that time of day and a group's majority chronotype impact performance on analytic and creative tasks. Physiological synchrony among group members positively predicts group satisfaction. Specifically, homogeneous groups perform worse on all tasks regardless of time of day, but they achieve greater physiological synchrony and feel more satisfied as a group. Based on these findings, we present and advocate for a temporal dimension of group diversity.

Combination of Alprazolam and Bailemian Capsule Improves the Sleep Quality in Patients With Post-Stroke Insomnia: A Retrospective Study.

Insomnia is often ignored in the diagnosis and treatment of patients of stroke. The present study aimed to evaluate the efficacy of alprazolam (ALP) combined with Bailemian capsule (BC, a traditional Chinese patent medicine) in the treatment of post-stroke insomnia (PSI). A total of 231 stroke patients involved in this retrospective study were treated with ALP, BC, or ALP + BC for 3 weeks. The quality of sleep was evaluated by the Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG), while self-care ability was monitored by the modified Rankin Scale (mRS) before and after treatment. Compared with the baseline, the self-care ability of patients in each group was significantly improved after treatment (P < 0.01). The PSQI data showed a significant improvement in all patients in all of the subjective PSQI items and global score (P < 0.05). Notably, ALP + BC administration had a significantly greater effect on sleep latency, quality, disturbance, and efficiency, as well as daytime dysfunction and global PSQI than the use of ALP or BC alone (P < 0.05). The PSG data showed that ALP significantly improved the sleep efficiency and decreased the arousal times, rapid eye movement (REM) sleep, and sleep latency (P < 0.05), while BC significantly improved the sleep efficiency, total sleep time, and the duration of N3 (P < 0.05). Strikingly, ALP + BC achieved the effect of both ALP and BC (P < 0.05). Importantly, the effect of the combination of ALP and BC was greater than the use of ALP or BC alone, which was consistent with the result of PSQI. In conclusion, the sleep quality and self-care ability of patients with PSI were improved by ALP and BC, thereby supporting the potential advantages of ALP combined with BC in the treatment of patients with PSI.

Head cooling during sleep improves sleep quality in the luteal phase in female university students: A randomized crossover-controlled pilot study.

Although selective head-cooling has been reported to decrease scalp and tympanic temperature and improve sleep quality, whether head-cooling during sleep can improve sleep quality in women during the luteal phase has not been elucidated. This randomized, controlled crossover open trial aimed to investigate the effect of head cooling during sleep on sleep quality in women during the luteal phase. Female university students aged 19–25 years with increased daytime sleepiness during the luteal phase were recruited by poster advertisement at their university from May to June 2016 and from May to June 2017. Fourteen women aged 19–22 years participated in this study. The temperature-controllable cooling sheet containing tubes filled with circulating water was used for head-cooling, and the head-cooling and the controlled temperature were set at 25°C and 35°C, respectively. Electroencephalogram data were obtained using a single-channel portable electroencephalogram device. The difference in sleep-related variables and tympanic temperature between head-cooling and control were analyzed using a linear mixed model. The proportion of arousal was lower with head cooling than with the control. In contrast, the proportion of non-REM3 and the delta power were higher with head cooling than with the control. The proportion of non-REM2 and non-REM3 among sleep EEG stages were positively and negatively correlated with the mean tympanic temperature during sleep, respectively. However, arousal and REM were not correlated with tympanic temperature. We considered the reduction of arousal time by head-cooling might be related to scalp temperature rather than tympanic temperature. Further, our results suggested that head-cooling also improved subjective sleep comfort. In conclusion, head-cooling during sleep could improve sleep quality in young women during the luteal phase.

Association between weekend catch-up sleep and health-related quality of life of Korean adults.

Sleep debt is known to have harmful effects on health. Weekend catch-up sleep (CUS) is a behavior to cope with weekday sleep debt. However, it is unclear whether weekend CUS has advantageous effects on health because sleep hygiene guidelines recommend regularizing bed time and arousal time. The aim of this study was to identify whether weekend CUS behavior has an association with better health-related quality of life (HRQoL)According to the inclusion criteria, 4871 participants were selected from the 2016 Korea National Health and Nutrition Examination Survey. Sleep questionnaires and European quality of life scale-5 dimensions (EQ-5D) questionnaire were used to collect data about the participants’ sleep patterns and HRQoL. Odds ratios (ORs) with 95% confidence intervals (95% CIs) for each dimensional problem of EQ-5D were derived by logistic regression. Mean EQ-5D index scores were compared between weekend CUS and non-CUS groups based on their weekday sleep durations and quintile of chronotype.The ORs of dimensional problems of HRQoL of non-CUS group versus weekend CUS group were 1.63 (95% CI 1.07, 2.47) for usual activities, and 1.45 (95% CI 1.11, 1.90) for anxiety/depression. Mean EQ-5D scores of the weekend CUS group were significantly higher than those of the non-CUS group for sleeping less than 6 hours (0.953 ± 0.004 vs 0.936 ± 0.007, P = .036) and sleeping 6 to 7 hours (0.965 ± 0.003 vs 0.955 ± .0.004, P = .045). These findings were similar in the fourth quintile (Q4) of chronotype (0.965 ± 0.007 vs 0.951 ± 0.008, P = .008) and fifth quintile (Q5) (0.952 ± 0.006 vs 0.941 ± 0.007, P = .022).Weekend CUS behavior was associated with better HRQoL than non-CUS among Korean adults. Especially, it was significant in participants who slept for less than 7 hours or participants whose chronotype was the fourth or fifth quintile. Attention may be needed for subjects with sleep short time and later chronotype who do not have weekend-CUS behaviors, because there is a risk that their HRQoL might be compromised.

Antagonistic Effect of Flumazenil on Isoflurane in the Emersion of General Anesthesia

Introduction and Objectives: Isoflurane, an inhalational general anesthetic widely used in medical practice, belonging to the group of volatile liquids together with desflurane and sevoflurane. Volatile inhalational anesthetics (halogenated) as mechanism of action, has the property of increasing inhibitory synaptic transmission at postsynaptic level by potentiating ion channels regulated by ligand activated by alpha-aminobutyric acid (GABA). Flumazenil is a benzodiazepine. It is currently known that there is no specific drug capable of antagonizing the effects of halogenates that allow the rapid and complete recovery of general anesthesia, for this reason this work focuses its efforts on demonstrating whether flumazenil has the ability to reverse the actions of the patient. isoflurane and allow an early restoration of the level of consciousness. Materials and Methods: The study to be performed is a clinical type of longitudinal, prospective, unicentric and double blind. The sample will be formed by patients who are going to be subjected to a balanced general anesthesia. The sample will be divided into 2 large groups: group C (control) and group F (Flumazenil). At the end of the surgery, the mixture will be administered according to the selected group in a random manner (Flumazenil 0.25mg or 0.9% solution in a 20cc syringe) and the time of extubation, recovery time of the level of consciousness, time of discharge UCPA and hemodynamic state (FC, TAM and SO2 ). Results: The flumazenil group showed a significantly shorter time from injection to extubation than the placebo group (p= 0.007). Differences in terms of shorter times needed to achieve Aldrete of 9 points in the flumazenil group (P = 0.04) were observed as were shorter anesthetic arousal times represented by a Ramsey 2. Heart rate, mean arterial pressure and saturation they had similar values between the 2 groups. Conclusion: The study showed that a single dose of 0.25 mg of flumazenil administered at the end of the surgical act, just after completing all surgical stimulation was beneficial (P= 0.007) in the context of extubation times and shorter anesthetic arousal times.

Antagonistic Effect of Flumazenil on Isoflurane in the Emersion of General Anesthesia

Introduction and Objectives: Isoflurane, an inhalational general anesthetic widely used in medical practice, belonging to the group of volatile liquids together with desflurane and sevoflurane. Volatile inhalational anesthetics (halogenated) as mechanism of action, has the property of increasing inhibitory synaptic transmission at postsynaptic level by potentiating ion channels regulated by ligand activated by alpha-amino butyric acid (GABA). Flumazenil is a benzodiazepine. It is currently known that there is no specific drug capable of antagonizing the effects of halogenates that allow the rapid and complete recovery of general anesthesia, for this reason this work focuses its efforts on demonstrating whether flumazenil has the ability to reverse the actions of the patient. Isoflurane and allow an early restoration of the level of consciousness. Materials and Methods: The study to be performed is a clinical type of longitudinal, prospective, unicentric and double blind. The sample will be formed by patients who are going to be subjected to a balanced general anesthesia. The sample will be divided into 2 large groups: group C (control) and group F (Flumazenil). At the end of the surgery, the mixture will be administered according to the selected group in a random manner (Flumazenil 0.25mg or 0.9% solution in a 20cc syringe) and the time of extubation, recovery time of the level of consciousness, time of discharge UCPA and hemodynamic state (FC, TAM and SO2). Results: The flumazenil group showed a significantly shorter time from injection to extubation than the placebo group (p = 0.007). Differences in terms of shorter times needed to achieve Aldrete of 9 points in the flumazenil group (P = 0.04) were observed as were shorter anesthetic arousal times represented by a Ramsey 2. Heart rate, mean arterial pressure and saturation they had similar values between the 2 groups. Conclusion: The study showed that a single dose of 0.25 mg of flumazenil administered at the end of the surgical act, just after completing all surgical stimulation was beneficial (P = 0.007) in the context of extubation times and shorter anesthetic arousal times.

Is NREM-predominant obstructive sleep apnea syndrome a different clinical entity?

Background/aim: This study aimed to evaluate whether NREM-predominant obstructive sleep apnea syndrome (OSAS) patients (NREM AHI < REM AHI) have distinct clinical and polysomnographic features compared to REM-predominant OSAS patients (REM AHI > NREM AHI). Materials and methods: A total of 342 patients (93 females and 249 males) who were admitted to the Sleep Disorders Unit at the Gazi University Faculty of Medicine and underwent polysomnography between January 2011 and April 2016 were retrospectively reviewed. Patient data, symptoms related to OSAS, Epworth Sleepiness Scale (ESS) scores, and polysomnographic findings were recorded. The patients were divided into two groups according to the apnea-hypopnea index (AHI) as patients with NREM-predominant OSAS and patients with REM-predominant OSAS. Results: The total AHI in the NREM-predominant group was significantly higher than in the REM-predominant group (P < 0.001). The patients with severe OSAS constituted the majority in both groups, and the rate of patients with severe OSAS was significantly higher in the NREM-predominant group than in the REM-predominant group (P < 0.001). Arousal index and sleep time spent under 90% SaO2 was higher in the NREM-predominant group (P = 0.005, P = 0.001), whereas nocturnal mean and minimum O2 saturation values were lower in the NREM-predominant group compared to patients with REM-predominant OSAS (P < 0.001, P = 0.013). In evaluating systemic disorders, the prevalence of coronary artery disease was significantly higher in the NREM-predominant OSAS group (P < 0.001). Conclusion: Our results showed that patients with NREM-predominant OSAS had a more severe course than patients with REMpredominant OSAS. However, we found no significant difference in sleep-specific symptoms, suggesting that the two groups represented distinct entities.

Original Research: Aerosolized Lidocaine: Effective for Safer Arousal After Suspension Laryngoscopy

To examine the systemic and local effects of the lidocaine on the larynx and trachea which is applied after the end of the surgery and through various application methods. Randomized controlled prospective study. The study is composed of patients who underwent suspension laryngoscopy (SL) for benign laryngeal diseases (cysts, polyp, granuloma, etc) and American Society of Anesthesiologists (ASA) I, between January 2017 and January 2018. The patients were randomly divided into 3 groups. In the first group nothing is applied at the end of the surgery and called as control group, second group received 7 pufs of aerosolized 10% lidocaine solution (70 mg) over larynx and trachea and third group received cotton swaps that impregnated in 1 ml of 20 mg lidocaine solution over surgical area for 1 minutes. Operation and arousal times, heart rate and mean arterial blood pressure levels were noted and compared. Also laryngospasm, cough, and agitation scores were obtained during arousal. 64 patients were included in the study. Laryngospasm was not observed in any of the patients. In group 2 (aerosolized lidocaine group), patients' blood pressure remained similar while increased in other groups (P < 0.05). Agitation scores were significantly lower in group 2 compared to the other groups (P = 0.012). Cough reflex is observed less in group 2 but result was not statistically significant (P = 0.13) CONCLUSION: The usage of aerosolized lidocaine after suspension laryngoscopy is very effective in blocking the stimulation of superior laryngeal nerve and sympathetic nerves which were responsible for the pressor reflexes. The inhibition of these reflexes before or during arousal could secure a safer arousal.