Changes In Sleep Parameters Research Articles

The association of changes of sleep architecture related to donepezil: A systematic review and meta-analysis

Donepezil had been recognized to have impact on sleep quality in demented patients. However, there was insufficient evidences about the actual effect of donepezil in the sleep architectures. Our meta-analysis aimed to evaluate the changes of sleep architectures related to donepezil use. Followed the PRISMA2020 and AMSTAR2 guidelines, electronic search had been performed on the databases of PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane CENTRAL, ProQuest, Web of Science, and ClinicalTrials.gov. The outcome measurement was changes of sleep parameters detected by polysomnography. A random-effects meta-analysis was conducted. Total twelve studies had been involved. The percentage of REM sleep would significantly increase after donepezil treatment (Hedges' g=0.694, p<0.001). Compared to placebo/controls, subjects with donepezil would had significantly increased percentage of REM sleep stage (Hedges' g=0.556, p=0.018). Furthermore, donepezil was also associated with the decreased stage 2 sleep percentage, sleep efficiency, or total sleep time in different analysis conditions. Our meta-analysis provided detailed changes of sleep architectures related to donepezil treatment. Further larger sample size studies with stricter control of potential moderators are needed to clarify these issues.

FLUID study: study protocol for an open-label, single-centre pilot study to investigate the efFect of Lemborexant on sleep management in Japanese sUbjects aged 50 years and older with Insomnia Disorder

IntroductionBidirectional associations have been reported between sleep disturbance and both cognitive impairment, including Alzheimer’s disease and amyloid beta-peptide (Aβ) accumulation. These relationships can be explained by the glymphatic system, which...

The Effect of Adenotonsillectomy on Children's Behavior and Cognitive Performance with Obstructive Sleep Apnea Syndrome: State of the Art.

(1) Background: This systematic review was designed to analyze adenotonsillectomy’s role in treating behavioural disorders and sleep-related quality of life in pediatric OSAS. (2) Methods: Papers that report pre-operative and post-operative outcomes by using the Epworth sleepiness scale, OSA-18, NEPSY, Conners’ rating scale, BRIEF, PSQ-SRBD, PedsQL and CBCL. We performed a comprehensive review of English papers published during the last 20 years regarding behavioural disorders in OSAS patients and adenotonsillectomy. (3) Results: We included 11 studies reporting behavioral outcomes and sleep related quality of life after surgery. We investigated changes in behavior and cognitive outcomes after AT, and we found significant improvements of the scores post-AT in almost all studies. After comparing the AT group and control group, only one study had no difference that reached significance at one year post-AT. In another study, it did not show any significant improvement in terms of all behavioural and cognitive outcomes. The questionnaires on sleep-related quality of life after AT (PSQ-SRBD or ESS or OSA-18 or KOSA) may improve with positive changes in sleep parameters (AHI, ODI and SpO2). Furthermore, there is a significantly higher decrease in OSAS symptoms than the pre-AT baseline score. (4) Conclusion: Future studies should pay more attention to characterizing patient populations as well as rapid surgical treatments through existing criteria.

O018 Changes in sleep parameters in children with Down Syndrome following treatment

Abstract Introduction There is limited evidence about how sleep changes in children with Down syndrome (DS) following sleep interventions. This study evaluated changes in sleep over time in children receiving treatment comparing to a control group who did not. Methods Children with DS, 3-16yrs, attending the sleep clinic were followed for 24-months. Sleep parameters including parent completed child sleep habits questionnaire (CSHQ), PSG and home sleep diary were obtained pre and post sleep interventions for children undergoing treatment. Data was obtained at similar intervals for the control group who were followed over the same time period. Results Data was obtained for 41 participants, 16 children received an intervention and 25 did not. Interventions included ENT surgery (7), CPAP (4), melatonin (3) or a combination (2). The intervention group had a significantly higher average total CSHQ score overall than those in the control group (0.01). Scores decreased over time but remained higher than in controls throughout, and were clinically significant in both groups (&amp;gt;41). Sleep diary estimated average total sleep duration did not differ between groups and was 10hrs/night. PSG showed improvement in OAHI in those children undergoing pre and post intervention studies. Discussion Evaluation of sleep parameters in this referred cohort of children with Down syndrome demonstrates total sleep duration in keeping with national recommendations and improvement in obstruction with treatment. However, CSHQ results indicate ongoing sleep difficulties reported by parents, despite standard sleep interventions. This may reflect persisting non-respiratory sleep disorders, which are not being adequately addressed at present.

Changes in Sleep Parameters in Different Age Groups between Genders

Aim: To examine the changes in sleep parameters related to sex between the patients over 65 years old and younger group. Method:A total of 293 patients who applied to the sleep clinic with complaints such as snoring, cessation of breathing during sleep, and excessive daytime sleepiness (GAUH) and whose Polysomnography (PSG) were taken were included in the study. Of these patients, 71 people were in the group over 65 (Male: 43, Female: 28) and 222 people (Male: 139, Female: 83) were in the group between the ages of 45-60. The medical histories of the patients were retrospectively scanned from the patient files. Among the PSG parameters, Total Sleep Time, Sleep Efficiency (%), REM sleep rate (%), NREM sleep rate (%), AHI (Apnea Hypopnea index), REM AHI, NREM AHI, minimum oxygen saturation (min O2 hours), mean oxygen saturation (mean O2 hours), oxygen desaturation time (min) and oxygen desaturation index (ODI) were recorded. Results: When sleep parameter changes between age groups were examined, regardless of gender, it was observed that sleep efficiency (the ratio of total sleep time to length of stay in bed) was significantly decreased in the 65+ age group compared to the younger group (73.69±17.49 and 79.44±14.65 p: 0.014). When the total sleep duration (244.38±97.44 and 284.51±93.40) and sleep efficiency data (73.55±16.16 and 82.19±14.13 p:0.002 ) of PSG parameters in male patients were examined, it was seen that the data of the over 65 age group were lower than the young group. When the minimum and mean oxygen saturation in female patients was examined, it was observed that the group over 65 years had lower levels (minimum oxygen saturation: 71.14±13.52 and 77.97±11.01 p:0.021, mean oxygen saturation: 89.78±4.52 and 91.93±3.70 p:0.030). Desaturation (%) was found to be lower in the elderly group also.(30.52±33.71 and 12.22±18.97 p:0.012) Conclusion: In this study, decreases in total sleep duration, sleep efficiency, minimum oxygen saturation, average oxygen saturation and desaturation (%) were detected in sleep parameters in advanced age compared to younger ages. Further studies with larger participation and younger patients are needed to support the results and for the new results.

Longitudinal changes in sleep patterns and circadian rhythm metrics in preschool-age children from Northern Mexico

ObjectivesTo assess changes in sleep parameters and circadian rhythm metrics measured by actigraphy in preschool-aged children. DesignLongitudinal analysis over 1 year. ParticipantsNinety-four children living in Tijuana and Ensenada, Mexico. MeasurementsChildren wore accelerometers on the right hip for one continuous week at baseline and 1-year follow-up. Parents recorded child bedtime, waketime, and naps in sleep diaries. We used cosinor and nonparametric approaches to calculate circadian rhythm metrics. ResultsAt baseline, children had a mean age of 4.2 years, and 51.1% were girls. In multivariable models adjusted for age, gender, BMI category, parental education, household income and city, at follow-up children had significantly earlier waketimes (β = -7.99 minutes, p < .001) compared to baseline. Children also had lower sleep onset latency (β = -2.32 minutes, p = .057), and longer nighttime sleep (β = 9.38 minutes, p = .079), but these changes were not significant at the α < 0.05 level. We found significant increases in log relative amplitude (β = 0.017, p = .009), and decreases in log midline estimated statistic of rhythm (β = -0.084, p = .017) and log of the least active 5-hour period (β = -0.057, p = .010). When we adjusted for co-sleeping, we found significant decreases in the number of nighttime awakenings (β = -1.29, p = .011) but otherwise similar results. There were no other changes in sleep parameters or circadian rhythm metrics. ConclusionsMean increases in nighttime sleep and earlier wake times over one year were concomitant with decreases in overall activity levels and increases in circadian rhythm robustness. Co-sleeping was a predictor of sleep disturbances. This study provides longitudinal evidence regarding changes in sleep and circadian metrics in a sample of children from an under-researched sociodemographic group during an important, early life period.

376 dCBT-I with Chatbot and Artificial Intelligence: a feasibility study in Brazil

Abstract Introduction Digital cognitive-behavioral therapies for insomnia (dCBT-I) provide low-cost, evidence-based technology, effective in improving mental health and reducing healthcare costs. However, dropout rates still challenge dCBT-I scalability. Moreover, few solutions are available in middle-and-low-income economies where they are most needed. Our goal was to investigate feasibility, describing real-world data and preliminary findings of a novel, fully automated program, developed by Vigilantes do Sono (Sleep Watchers) using Chatbot and Artificial Intelligence (AI). Methods A digital coach interacts with users daily for 5–10 minutes, asking them to complete tailored diaries and delivering CBT-I knowledge pills in ~50 sessions, during ~7 weeks. The Insomnia Severity Index (ISI) is used before and after sleep restriction cycles, weekly revised by an algorithm. Participants (18+ years) were recruited (Jan-Oct/2020) through advertisements on social media, organic search, or were referred by health-care professionals, without face-to-face evaluation. All electronically signed an informed consent. We estimated engagement dividing number of complete diaries by number of days in the program. Generalized Estimating Equations (GEE) evaluated changes in sleep parameters, adjusting for baseline characteristics. Results Of 3,887 individuals who completed initial assessment, 3,139 (81%) had insomnia (ISI ≥11) and 1,489 (42±11 years, 91% women) fulfilled 7+ diaries, commenced sleep restriction, and were included in analysis. Of them, 604 (41%) completed a second ISI and 326 (22%) finished the program. GEE analyzing 42,802 diaries showed sleep duration increased 16.8 (11.9–21.6) minutes from first to second week and 67.3 (52.8–81.8) after week seven; parallel to a relative increase of 34% in sleep efficiency among women and 26% among men. Of 296 participants who reached therapeutic response (ISI reduction ≥8), 66% completed all sessions and 34% crossed half-way. Insomnia remission (ISI≤7) was seen for 55% and 33% of those with subthreshold (n=171) or clinical (n=419) baseline insomnia, respectively. Median (interquartile) engagement was 86% (65–98) and 90% of users recommend the program. Conclusion Chatbot and AI provide a framework to customize dCBT-I and personalize insomnia therapy, potentially favoring engagement and effectiveness. Our findings demonstrate feasibility of the program and support moving forward to continued development and testing the effects in clinical trials. Support (if any):

Are elite track and field athletes on track? The impact of COVID-19 outbreak on sleep behavior and training characteristics.

The Covid-19 outbreak forced many governments to enter a nationwide lockdown. The aim of this study was to evaluate, by means of a survey, changes in sleep parameters and physical activity characteristics of elite track and field athletes in three periods: before the lockdown (T0), during the lockdown (09th March – 03rd May 2020, T1) and the first month after the lockdown (T2). This study was conducted from May 2020 to June 2020 and data were collected using an offline survey with 89 elite track and field athletes (mean age: 24.7 ± 5.4; n = 43 males; n = 46 females). The survey consisted of demographic data and questions on physical activity and sleep behavior at T0, T1 and T2. Athletes reported lower sleep quality scores at T1 compared to T0 and T2 (p < 0.0001) and registered delayed bedtime, wake-up time and longer sleep latency during the lockdown compared to pre-lockdown and post-lockdown whereas no changes in total sleep time were reported. No inter-group differences were detected in sleep characteristics between short- and long-term disciplines and between genders. The weekly training volume decreased from 16.1 ± 5.7 hours at T0 to 10.7 ± 5.7 hours at T1 (p < 0.0001) whereas no significant differences were detected in training volume during the lockdown in relation to the square footage of the house (p = 0.309). Alcohol (p = 0.136) and caffeine intake (p = 0.990) and use of electronic devices (p = 0.317) were similar pre-, during, and post-lockdown. The unprecedented circumstances of the Covid-19 pandemic had negative impacts on the Italian track and field athletes’ sleep and training volumes.

Sleep alterations as a predictor of bipolar disorder among offspring of parents with bipolar disorder: a systematic review and meta-analysis.

Introduction Bipolar disorder (BD) has a high heritability rate. Current studies have been dedicated to identifying prodromes of BD in the offspring of parents with BD (BO) and the sleep patterns of these individuals have been considered important factors.Objective To describe changes in sleep parameters among offspring of parents with BD when compared to offspring of controls and to identify if changes in parameters and quality of sleep predict the onset of BD among these individuals.Methods PubMed, PsycINFO, and Embase were systematically searched with no year or language restrictions, up to August 18, 2020. We searched for a combination of the following search items (“sleep*”) AND (“bipolar disorder*” OR “mania” OR “hypomania” OR “bipolar depression”) AND (“ultra-high risk” OR “high risk” OR “offspring” OR “first degree relatives”).Results A total of 10 studies were included in the systematic review and 4 studies were included in the meta-analysis. Our meta-analysis showed that the BO had greater daytime sleepiness as compared to the offspring of control parents. The systematic review indicated that shorter sleep duration, sleep disorders, and other related features can differentiate the two groups. Finally, some sleep patterns such as decreased sleep, difficulty falling asleep, and overall sleep problems might be predictors for the development of BD.Conclusion Results from the meta-analysis indicated that BO had greater daytime sleepiness. Qualitative results showed that the offspring of parents with BD have an increased likelihood of experiencing an adverse sleep pattern.

A quantitative analysis of the effect of bilateral subthalamic nucleus-deep brain stimulation on subjective and objective sleep parameters in Parkinson's disease

ObjectiveTo explore how subjective and objective sleep parameters respond to bilateral subthalamic nucleus-deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). MethodsThirty DBS sleep studies were included by searching PubMed, Embase, and the Cochrane Library, and only 21 prospectively designed studies, including 541 patients, were eligible for the main analysis. We evaluated sleep disturbance using 1 objective measurement, polysomnography (PSG), and 4 subjective scales, including PD Sleep Scale (PDSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and restless legs syndrome (RLS). We pooled data using the standard mean difference (SMD). The primary outcome was a change in sleep parameters 6 months postoperatively. Outcomes from <12 months to ≥12 months follow-up were compared in the subgroup analysis. Meta-regression was further conducted. ResultsSTN-DBS significantly improved all 4 subjective sleep scales in the 6-month follow-up: ESS (SMD = 0.234), PDSS (SMD = 0.724), PSQI (SMD = 1.374) and RLS (SMD = 1.086), while most PSG parameters remained unchanged, except for shortened rapid eye movement sleep latency (RSL) (SMD = 0.520). In the over-12-month follow-up, improvement persisted in PDSS but not in ESS. Dopamine drug reduction (p = 0.009) and motor improvement (p = 0.036) were correlated with ESS improvement and PDSS improvement, respectively. ConclusionsBilateral STN-DBS continuously improved subjective nocturnal sleep, while its effect on ESS lasted for only 1 year. Medication reduction and motor improvement may contribute to improved daytime sleepiness and better subjective nocturnal sleep, respectively. Except for a shortened RSL, STN-DBS did not change PSG parameters, including sleep efficiency and sleep architecture. RegistrationOpen Science Framework: DOI 10.17605/OSF.IO/3EGRC.

Changes in Physical Activity and Sleep Among Veterans Using a Service Dog as a Rehabilitation Modality for Post-traumatic Stress Disorder: An Open-Label Single-Arm Exploratory Trial Using Actigraphy-Based Measures

Little is known about the changes occurring after acquiring a service dog (SDPTSD) trained for the management of post-traumatic stress disorder (PTSD) symptoms on physical activity and sleep among veterans. To quantify, using actigraphy measures, changes in physical activity and sleep before and after acquiring a SDPTSD. A total of 18 veterans with chronic PTSD wore an actigraph wGT3X-BT during 7 days, 3 months before (T−3) and 9 months after (T+9) acquiring their SDPTSD. They also completed online questionnaires at both measuring times: Life Space Assessment, Pittsburgh Sleep Quality Index, Post-traumatic Stress Disorder Checklist-Military version and Beck Depression Inventory II. Non-parametric statistics compared results between T−3 and T+9 and Cohen’s d effect sizes (E.S.) determined the magnitude of changes. Veterans remained sedentary during most of their awake time at T+9 (p = 0.173; E.S. = 0.249), whereas the percentage of time dedicated to moderate physical activity (p = 0.038, E.S. = 0.38) and the number of steps/day (p = 0.008; E.S. = 0.49) increased. These changes were accompanied by expanded mobility patterns into their neighborhood (p = 0.002; E.S. = 0.52) and outside of town (p = 0.03, E.S. = 0.36). Actigraphy measures showed no change in sleep parameters despite reported improvements in sleep efficiency (p = 0.006; E.S. = 0.45), quality (p = 0.04, E.S. = 0.35), and disturbances (p = 0.001; E.S. = 0.55). Decreased PTSD (p ≤ 0.001; E.S. = 0.60) and depressive (p ≤ 0.001; E.S. = 0.60) symptoms were reported. Acquiring a SDPTSD represents a promising rehabilitation intervention for veterans with PTSD that improves moderate physical activity and the number of steps/day while reportedly triggering positive changes on mobility patterns, sleep quality, and psychiatric symptoms. The present exploratory trial provides the rationale for studying larger groups of participants in controlled studies over longer periods of time.

Prospective associations of sleep apnea, periodic limb movements, and plasma fibrinogen level.

Our previous cross-sectional study showed that periodic limb movements during sleep (PLMS) were frequently found in patients with obstructive sleep apnea (OSA) and that both OSA and PLMS were associated with higher plasma fibrinogen levels. We explored the longitudinal relationships among these factors. Plasma fibrinogen levels were measured in 333 consecutive patients who underwent polysomnography to diagnose OSA. Patients who initiated continuous positive airway pressure (CPAP) underwent follow-up polysomnography after 3months of CPAP use. They were categorized into groups with good or poor adherence (% days with ≥ 4h/night of CPAP use ≥ 70% or < 70%, respectively). Changes in sleep parameters and plasma fibrinogen levels during the treatment period were compared between these groups. The cross-sectional analysis of all reviewed 333 patients indicated that fibrinogen levels were associated with the severities of OSA and PLMS. The 60 patients (27 good and 33 poor adherence) who underwent follow-up polysomnography were included in the longitudinal analysis. The median (interquartile range) periodic limb movement index did not change significantly from CPAP titration to the 3-month follow-up (good adherence: 10.5 (0-23.8) to 10.8 (0-70.2) events/h, p = 0.21; poor adherence: 1.2 (0-14.3) to 0.8 (0-15.7) events/h, p = 0.67). However, the plasma fibrinogen level significantly decreased only in the good adherence group (good adherence: baseline 275 ± 46 to follow-up 255 ± 47mg/dl, p < 0.01; poor adherence: 277 ± 52 to 284 ± 70mg/dl, p = 0.48). These results did not support a longitudinal association between PLMS and OSA. However, good adherence to CPAP could reduce plasma fibrinogen levels, thus ameliorating elevations in plasma fibrinogen as a risk factor for future cardiovascular events.

Associations Of Sleep, Physical Activity, And Sedentary Behavior Across Pregnancy Trimesters

PURPOSE: Sleep and physical activity are altered in pregnancy and may affect pregnancy health; however, whether these behaviors influence each other is not well understood. In this study, we describe self-reported sleep parameters across pregnancy trimesters and examine associations with objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB). METHODS: Women were recruited from Iowa City, IA and Pittsburgh, PA to assess sleep, MVPA, and SB in each trimester of pregnancy. Sleep was measured using the Pittsburgh Sleep Quality Index. MVPA and SB were estimated using a waist-worn ActiGraph GT3X and thigh-worn activPAL3 micro, respectively; data were considered valid with ≥4 days of ≥10 hours of wear. Mixed effects models were used to examine changes in sleep parameters (global sleep score, poor sleep quality, sleep efficiency, sleep duration) across trimesters. Associations of MVPA and SB trajectories with sleep parameters were also examined using mixed effects models. RESULTS: Women (n=120) averaged 31.1 ± 4.7 years of age with a pre-pregnancy BMI of 26.8 ± 6.7 kg/m2. As seen in the Table, differences were found for all sleep parameters across pregnancy trimesters, with adverse changes occurring in the third trimester compared to the first and second trimesters. MVPA trajectory was not associated with any of the sleep parameters. Women in the high SB trajectory had greater sleep efficiency (β=4.78%, 95% CI: 0.07, 9.49) and women in the moderate and high SB trajectories also had longer sleep duration (β=0.79 hours, 95% CI: 0.23, 1.35; β=0.80 hours, 95% CI: 0.26, 1.33, respectively), compared to those in the low SB trajectory. CONCLUSIONS: Few studies have examined self-reported sleep measures across pregnancy trimesters. Findings indicate that sleep quality, efficiency, and duration are adversely affected in the third trimester. Contrary to our hypotheses, high SB but not MVPA was favorably associated with sleep parameters.

1032 Auricular Point Acupressure for Sleep Disturbance in Women With Breast Cancer: A Pilot Randomized Controlled Trial

Abstract Introduction Sleep disturbance is reported in up to 60% of cancer patient. In traditional Chinese medicine, evidence suggests that auricular point acupressure (APA) improves sleep. However, little is known about APA’s effect on sleep disturbance in patients with breast cancer (BC). We tested the preliminary efficacy of APA on sleep in BC women undergoing chemotherapy. Methods A pilot randomized controlled trial was conducted in 41 BC patients (mean age=50±14) with self-reported poor sleep [Pittsburgh Sleep Quality Index (PSQI)≥7]. Participants were randomly assigned to an APA group (n=22) and a control group (n=19). All patients received sleep hygiene education. Additionally, for the APA group, magnetic pellets were attached to selected auricular points once a week for 3 weeks at the clinic, and the participants were instructed to self-press the pellets 4 times a day. Sleep were objectively measured by Actiwatch Spectrum and subjectively using PSQI at baseline and post-intervention. Paired t-tests and analyses of covariance using the variable baseline values were used to examine changes in sleep parameters. Results Twenty-one participants from the APA and sixteen from the control groups completed the study. Within the APA group, PSQI [mean difference (MD)=3.85, 95% Confidence Interval (C)=3.12~4.60] and sleep onset latency (MD=18.02, 95%CI=5.96~30.09) were significantly decreased, and the sleep duration (MD=-0.53, 95%CI=-0.99~-2.35) and sleep efficacy (MD=-5.00, 95%CI=-8.72~-1.28) were significant increased at post-intervention. Compared to the control group, participants in the APA group had significantly lower PSQI (F=30.77, p&amp;lt;0.001) and greater sleep efficacy (F=5.25, p=0.028) at post-intervention. Conclusion APA may be an inexpensive and effective approach to improve sleep in patients with BC. More rigorous research with larger samples is needed to further test the efficacy of APA on promoting sleep in BC patients. Support None

The Course of Obstructive Sleep Apnea Syndrome in Patients With Acromegaly During Treatment.

BackgroundObstructive sleep apnea syndrome (OSAS) is common in active acromegaly and negatively influences quality of life, morbidity, and mortality. This prospective study with 3 predetermined timepoints and a standardized treatment protocol investigates changes in sleep parameters during the first 2.5 years of acromegaly treatment.MethodsBefore initiation of acromegaly treatment (medical pretreatment followed by surgery), polysomnography (PSG) was performed in 27 consecutive patients with treatment-naive acromegaly. PSG was repeated after 1 year (N = 24) and 2.5 years (N = 23), and anthropometric and biochemical parameters were obtained.ResultsAt baseline, 74.1% of the patients was diagnosed with OSAS. The respiratory disturbance index (RDI; P = 0.001), oxygen desaturation index (ODI; P = 0.001), lowest oxygen saturation (LSaO2; P = 0.007) and the Epworth Sleepiness Scale (ESS; P < 0.001) improved significantly during treatment, with the greatest improvement in the first year. After 2.5 years of treatment, all patients had controlled acromegaly. Of the 16 patients with repeated PSG and OSAS at baseline, 11 (68.8%) were cured of OSAS. Changes in RDI, ODI, LSaO2, and ESS correlated with insulin-like growth factor 1 levels.ConclusionOSAS has a high prevalence in active acromegaly. There is a substantial decrease in prevalence and severity of OSAS following acromegaly treatment, with the largest improvement during the first year. Most patients recover from OSAS following surgical or biochemical control of the acromegaly. Therefore, a PSG is advised after diagnosis of acromegaly. When OSAS is present, it should be treated and PSG should be repeated during acromegaly treatment.

Effects of Medical Therapy on Mild Obstructive Sleep Apnea in Adult Patients.

Patients with obstructive sleep apnea (OSA) have been shown to have high levels of inflammatory markers. Anti-inflammatory treatment with montelukast and intranasal steroids have demonstrated efficacy for mild OSA in children; this has not been fully evaluated in adults. This study investigated the response of mild OSA in adults to anti-inflammatory medical therapy. Adults aged ≥ 21 years with an apnea-hypopnea index (AHI) ≤ 15 events/h on polysomnography (PSG) were recruited to a prospective double-blind, randomized control trial. Patients were treated for 12 weeks with montelukast and fluticasone or placebo. All underwent a pretreatment and posttreatment PSG. Epworth Sleepiness Scale (ESS) score was obtained pretreatment and at 6 and 12 weeks posttreatment. A total of 26 patients completed the study with 13 in each group. Mean age in the treatment and placebo groups were 58.3 ± 10.3 and 54.8 ± 14 years, respectively. There was no significant difference between groups reporting nasal congestion (P = .186), rhinitis (P = .666), or snoring (P = .177). There was no difference in the pretreatment ESS score (P = .077), body mass index (P = .173), or AHI (P = .535). The posttreatment PSG in the treatment group demonstrated a significant increase in total sleep time (P = .02) and percent of stage R sleep (P = .05). Neither group showed significant change in AHI. In patients in the treatment group, the 6- and 12-week follow-up ESS scores were not significantly different from pretreatment scores (P = .37-.46). Intranasal steroids and montelukast did not decrease AHI; however, total sleep time and percent of stage R sleep significantly increased. Self-reported improvement could be explained by observed changes in sleep parameters. Larger prospective studies could help elucidate the effects of medical therapy on adult patients with OSA. Registry: ClinicalTrials.gov; Title: Montelukast and Nasa ICS for Treatment of Mild Obstructive Sleep Apnea in Adults; Identifier: NCT01089647; URL: https://clinicaltrials.gov/ct2/show/record/NCT01089647.

Sleep patterns deteriorate over time in chronic corticosterone-treated rats

Repeated corticosterone (CORT) injections reliably produce depressive-like behavior in rodents. Our previous study showed that sleep parameters were altered in rats after daily injections of CORT for 7 days, and sleep disturbances appeared to be correlated with depressive-like behavior. The aim of the present study was to investigate time-dependent correlations between changes in sleep parameters and the formation of depressive-like behavior in rats after more prolonged treatment with CORT. Rats received daily injections of CORT (40 mg/kg, s.c.) for 7, 14, or 21 days. Electroencephalographic recordings were performed to study sleep parameters. The sucrose preference test and forced swim test were performed to evaluate depressive-like behavior. Western blot was used to detect protein levels. Our results showed that 7-day CORT treatment resulted in no significant depressive-like behavior or changes in rapid-eye-movement (REM) sleep. However, the duration of non-REM sleep significantly decreased, tyrosine hydroxylase (TH) levels significantly increased, and glucocorticoid receptor (GR) expression decreased in the locus coeruleus. Treatment with CORT for 14 and 21 days increased depressive-like behavior, enhanced REM sleep, shortened REM sleep latency, decreased TH and GR levels, and increased the levels of the chaperone FK506 binding protein 51 (FKBP51) in the locus coeruleus. These results indicate that the development of depression after chronic CORT treatment may be related to the formation of sleep disorders. Abnormalities of REM sleep may be a characteristic of sleep in models of depression that is induced by chronic CORT administration in rats. The noradrenergic system and GR pathway in the locus coeruleus may be involved in the formation of depression concomitant with sleep disturbances.

Heterozygosity for the Mood Disorder-Associated Variant Gln460Arg Alters P2X7 Receptor Function and Sleep Quality.

A single nucleotide polymorphism substitution from glutamine (Gln, Q) to arginine (Arg, R) at codon 460 of the purinergic P2X7 receptor (P2X7R) has repeatedly been associated with mood disorders. The P2X7R-Gln460Arg variant per se is not compromised in its function. However, heterologous expression of P2X7R-Gln460Arg together with wild-type P2X7R has recently been demonstrated to impair receptor function. Here we show that this also applies to humanized mice coexpressing both human P2X7R variants. Primary hippocampal cells derived from heterozygous mice showed an attenuated calcium uptake upon agonist stimulation. While humanized mice were unaffected in their behavioral repertoire under basal housing conditions, mice that harbor both P2X7R variants showed alterations in their sleep quality resembling signs of a prodromal disease stage. Also healthy heterozygous human subjects showed mild changes in sleep parameters. These results indicate that heterozygosity for the wild-type P2X7R and its mood disorder-associated variant P2X7R-Gln460Arg represents a genetic risk factor, which is potentially able to convey susceptibility to mood disorders.SIGNIFICANCE STATEMENT Depression and bipolar disorder are the most common mood disorders. The P2X7 receptor (P2X7R) regulates many cellular functions. Its polymorphic variant Gln460Arg has repeatedly been associated with mood disorders. Genetically engineered mice, with human P2X7R, revealed that heterozygous mice (i.e., they coexpress the disease-associated Gln460Arg variant together with its normal version) have impaired receptor function and showed sleep disturbances. Human participants with the heterozygote genotype also had subtle alterations in their sleep profile. Our findings suggest that altered P2X7R function in heterozygote individuals disturbs sleep and might increase the risk for developing mood disorders.

Sleep quality and cytokine expression after an exhaustive exercise: influence of ACE polymorphism I/D

Strenuous exercise affects immune system and stimulates the synthesis of pro-inflammatory cytokines, including interleukin 6 (IL-6) and the anti-inflammatory cytokines, mainly interleukin 10 (IL-10). IL-6 and IL-10 fluctuations can influence sleep quality. Many genetic tracts influence the immune system response to exercise. The angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism (rs1799752) is one of the most investigated genetic variants correlated to the physical performance and immune system. The aim of this study was to evaluate: (a) the response to an exhaustive strength exercise in terms of IL-6 and IL-10 expression in relation to ACE polymorphisms; and (b) the sleep behavior in response to an exhaustive strength exercise in relation to ACE polymorphisms. All participants were subjected to the following procedures: (a) genotyping of ACE polymorphism, (b) assay cytokine expression (IL-6 and IL-10) pre- and post-exhaustive exercise, and (c) evaluation of sleep parameters pre- and post-exhaustive exercise by actigraphy. We showed that after the exhaustive exercise: (a) the ACE I/I, I/D, and D/D genotypes underwent an increase in IL-6 expression (p < 0.05); (b) only I/I and I/D genotypes increased significantly the IL-10 expression (p < 0.05); and (c) D/D genotypes showed a deterioration of sleep parameters: Sleep Efficiency and Immobile Time decreased (p < 0.05) while Moving Time increased (p < 0.01); the I/I and I/D genotypes showed no changes in sleep parameters. The increase of IL-10 observed in I/I and I/D genotypes could play a protective role on sleep. The ACE D/D genotype seems to be more exposed to sleep disturbance after exercise.

Changes in Sleep Duration and Sleep Timing Associated with Retirement Transitions

Investigate whether retirement transitions are associated with changes in sleep duration and sleep timing, and whether these associations are modified by age, sex, mental health, or circadian preference. The Retirement and Sleep Trajectories (REST) study is a longitudinal study consisting of four annual mailed surveys that collected information about employment, sleep, and health. Differences in reported sleep duration, bedtime and wake time between successive surveys were calculated to estimate change over 1, 2, and 3 y. Linear regression models were used to estimate changes in these sleep parameters associated with retirement 1, 2, and 3 y posttransition. Retiring from full-time work was associated with bedtimes that were 30, 31, and 36 min later 1, 2, and 3 y postretirement; wake times that were 63, 69, and 78 min later; and sleep durations that were 15, 16, and 22 min longer 1, 2, and 3 y postretirement. These associations did not differ by sex or mental health status. Age and circadian preference modified the associations between retirement and change in sleep parameters; the increase in sleep duration was shorter and the wake time extension was lesser with advancing retirement age; those with evening preference had longer wake time extensions than those with morning preference. Transitioning to retirement is associated with longer sleep duration, later bedtimes, and later wake times. These changes were detectable about 1 y postwork transition and were persistent up to 3 y later.