Daytime Symptoms Research Articles

0600 Subjective reporting of Disrupted Nighttime Sleep and Associated Functional Outcomes in NT1 Youth

Abstract Introduction In people with NT1, Disrupted Nighttime sleep (DNS) can be measured using the Wake/N1 Index, the number of transitions from sleep to wake or N1 sleep per hour of sleep. However, it remains unknown if this DNS measure correlates with sleep quality and daytime symptom burden. We compared the Wake/N1 Index with perceptions of sleep quality in young NT1 patients and healthy controls (HC) and determined its relationships with subjective sleep quality, daytime behavior, and cognition across groups. Methods 25 HC (mean age 13.4 years) and 23 NT1 participants (mean age 15.8 years) completed a 15-item survey after sleeping a minimum of 6 hours during an in-lab polysomnogram. The survey included questions from validated surveys on habitual sleep quality, fatigue, sleepiness and cognitive function. We dichotomized survey responses into frequent or infrequent concerns. We compared responses using Fisher Exact tests and logistic regression to determine associations with the Wake/N1 Index. NT1 participants could take SSRI/SNRI medication for cataplexy but were weaned off wake-promoting medications and excluded if on an oxybate. Results Compared to HC, NT1 participants reported more frequent restless sleep, nighttime moaning/groaning/talking, tossing and turning, and waking more than once during the night (p’s < 0.02) and showed a trend for more leg kicking during sleep (p=0.06). NT1 and HC groups did not differ in falling asleep quickly and returning back to sleep quickly after waking. NT1 subjects reported more frequent fatigue, difficulty keeping thoughts focused, difficulty thinking clearly and making decisions, problems remembering things, and dozing/napping inadvertently. Across groups and controlling for age, the Wake/N1 Index was associated with subjective reporting of waking more than once (OR=3.2) as well as problems with daytime alertness (OR 1.5) and fatigue (OR 1.4). Conclusion Young NT1 patients describe DNS as a multi-factorial complaint comprising problems with sleep maintenance, restless sleep, parasomnia-like behaviors, and periodic limb movements. The Wake/N1 Index is associated with perceptions of waking at night as well as daytime alertness and fatigue across groups. This work suggests that Wake/N1 Index could be a useful measure of sleep instability and inform future research on DNS impact on daytime function. Support (if any) NIH 5K23NS104267-2, Jazz Pharmaceuticals

Summary of Research: Development and Validation of the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ).

This is a summary of the original article 'Development and Validation of the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ)'. Individuals with insomnia are best positioned to assess the impact of insomnia on their quality of life. Patient reported outcomes (PROs) are self-reported health measures created to allow people to record their experience of their disease. Chronic insomnia has a major impact on daytime functioning for patients, and on their quality of life. This summary of research provides an overview of a previously published article detailing the development and evaluation of the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ), as a tool to allow people with insomnia to report their experience of the impact on their daytime functioning.

Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults

ABSTRACT Background: Disrupted sleep and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a day-to-day basis. However, most of the previous research has focused on subjective measures of sleep only. Objective: Here, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective measures of sleep (actigraphy). Methods: Forty-one non-treatment seeking, trauma exposed young adults (age M = 24.68, SD = 8.15) with a range of PTSD symptom severities (PTSS, 0–53 on PCL-5) were recruited. Participants completed two surveys per day over four weeks to measure day-time PTSD symptoms (i.e. PTSS and number of intrusions) and night-time sleep subjectively, while wearing an actigraphy watch to measure sleep objectively. Results: Linear mixed models revealed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and increasing number of intrusive memories both within and between participants. Similar results were found for daytime PTSD symptoms on night-time sleep. However, these associations were not found using objective sleep data. Exploratory moderator analyses including sex (male vs. female) found that these associations differed in strength between sexes but were generally in the same direction. Discussion: These results were in line with our hypothesis with regards to the sleep diary (subjective sleep), but not actigraphy (objective sleep). Several factors which have implications on both PTSD and sleep, such as the COVID-19 pandemic and/ or sleep-state misperception, may be potential reasons behind those discrepancies. However, this study had limited power and needs to be replicated in larger samples. Nonetheless, these results add to the current literature about the bi-directional relationship between sleep and PTSD and have clinical implications for treatment strategies.

The impact of fibromyalgia syndrome on obstructive sleep apnea syndrome in terms of pain threshold, daytime symptoms, anxiety, depression, disease severity, and sleep quality: a polysomnographic study.

Current studies have focused on the association of fibromyalgia syndrome (FMS) and obsctructive sleep apnea syndrome (OSAS). Results of these studies on the effect of this association have been inconsistent. The current study aimed to investigate the effect of FMS on OSAS regarding sleep quality, pressure pain threshold, fatigue, daytime symptoms, anxiety, and depression, and also to determine the relationship between OSAS severity and FMS. In a cross-sectional design, patients diagnosed with OSAS were evaluated in two groups comparing those with and those without FMS. Data on demographics, headache, morning fatigue, and chronic pain duration were collected. Questionnaires including the Fatigue Severity Scale (FSS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were completed. Pressure pain threshold, tender points, and polysomnographic data were recorded. Of 69 patients, 27 were diagnosed with FMS + OSAS and 42 were diagnosed as OSAS only. Statistically significant differences were found between the two groups in VAS, pain duration, morning fatigue, headache, BAI, tender point count, FIQ and FSS scores, and algometer measurements. All polysomnografic data were compared, and no statistically significant differences were found between the two groups. There were no statistically significant differences in the algometer, BDI, BAI, FIQ, and FSS scores when analyzed according to the severity of OSAS. The findings suggest that FMS has no effect on polysomnographic parameters of OSAS. Headache, daytime fatigue, anxiety, depression, pain duration, and pain intensity are higher while the pressure pain threshold is lower when FMS is present. No correlation was found between OSAS severity and FMS, fatigue, pressure pain threshold, depression, and anxiety. NCT05367167/date: April 8, 2022.

Nicotine, alcohol, and caffeine use among individuals with untreated obstructive sleep apnea.

Psychoactive substance use (i.e., nicotine, alcohol, and caffeine) has substantial effects on sleep architecture in healthy individuals, but their effects in those with obstructive sleep apnea (OSA) have not been well described. We aimed to describe the association between psychoactive substance use and sleep characteristics and daytime symptoms in individuals with untreated OSA. We performed a secondary, cross-sectional analysis of The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Exposures included current smoking, alcohol and caffeine use in individuals with untreated OSA. Outcome domains included subjective and objective sleep characteristics, daytime symptoms, and comorbid conditions. Linear or logistic regression assessed the association between substance use and each domain (e.g., self-reported sleep duration, total polysomnographic sleep time, sleepiness, and anxiety). Of the 919 individuals with untreated OSA, 116 (12.6%) were current cigarette smokers, 585 (63.7%) were moderate or heavy alcohol users, and 769 (83.7%) were moderate or heavy caffeine users. Participants were on average 52.2±11.9years old, 65.2% were male with a median BMI of 30.6 (IQR: 27.2, 35.9, kg/m2). Current smokers exhibited lower sleep duration (0.3h), longer sleep latency (5min) compared with non-smokers (all p-values < 0.05). People with heavy or moderate alcohol use exhibited more REM sleep (2.5 and 5% of total sleep time respectively), as did those with moderate caffeine use (2%, p-values < 0.05). The combined smoker plus caffeine group exhibited shorter sleep duration (0.4h, p-value < 0.05) and higher risk for chronic pain [Odds Ratio (95%CI) = 4.83 (1.57, 14.9) compared with non-users. Psychoactive substance use is associated with sleep characteristics and clinically relevant correlates in people with untreated OSA. Further investigation into the effects that various substances have on this population may present opportunities to understand disease mechanisms more fullyand increase the effectiveness of treatment in OSA.

Exposures to Organophosphate Esters and Respiratory Morbidity among School-Aged Children with Asthma.

Organophosphate esters (OPEs) are an emerging class of chemicals used in a variety of consumer products as flame retardants, plasticizers, and additives. While prior epidemiologic studies suggest that OPEs may impact respiratory health, results remain inconclusive. We examined associations between urinary biomarkers of OPEs and symptoms of respiratory morbidity in a panel study of 147 predominantly Black school-aged children with asthma living in Baltimore City, Maryland. The study consisted of up to four seasonal, week-long, in-home visits where urine samples and self-reported asthma symptoms were collected on days 4 and 7 (nsamples = 438). We quantified concentrations of nine urinary OPE biomarkers: bis(2-chloroethyl) phosphate (BCEtp), bis(1-chloro-2-propyl) phosphate (BCPP), bis(1,3-dichloro-2-propyl) phosphate (BDCIPP), di-n-butyl phosphate (DBuP), di-benzyl phosphate (DBzP), di-o-cresylphosphate (DOCP), di-p-cresylphosphate (DPCP), di-(2-propylheptyl) phthalate (DPHP), and 2,3,4,5-tetrabromo benzoic acid (TBBA). We estimated prevalence odds ratios (POR) of respiratory morbidity symptoms using logistic regression with generalized estimating equations to account for our repeated measure design. We assessed BDCIPP and DPHP as continuous (log2) concentrations and dichotomized exposure of BCEtP, DBuP, and DPCP (detect vs non-detect) based on their lower detection frequencies. We adjusted models for season, visit day, age, gender, caregiver education, health insurance type, exposure to household smoking, atopy, and PM2.5. Higher DPHP concentrations were significantly associated with odds of daytime symptoms (POR: 1.26; 95% CI: 1.04-1.53; p = 0.02) where daytime symptoms consisted of trouble breathing due to asthma, reporting bother caused by asthma, and/or limitation in activities due to asthma. DBuP detection was associated with use of rescue medication on the day of sample collection (POR: 2.36; 95% CI: 1.05-5.29; p = 0.04). We also observed several consistent, albeit non-significant (p > 0.05), positive associations for BCEtP and DPCP and respiratory morbidity measures. This is the first study to evaluate the relationship between OPE biomarkers and respiratory morbidity symptoms in children with asthma, and findings suggest that further studies are warranted to confirm whether these associations are causal.

Asthma in pregnant woman and its management : a review

Asthma is the most common comorbidity in pregnant women and gives 30% of exacerbation experience. The other 30% will see improvement of their symptoms, and the rest will not see the changes. Exacerbations have become a major clinical concern in pregnant women. Medical concerns for the mother and the childbirth included low birth weight, preeclampsia, and preterm delivery. The major goal is to keep asthma under control to ensure mother's health and well-being, as well as fetal growth. Controlling asthma and preventing exacerbations are the main goals of asthma treatment during pregnancy. Treatment for asthma should ideally begin before conception. This is to avoid day-time and night-time symptoms, as well as to keep lung function. Furthermore, fetal oxygenation is a crucial factor during the pregnancy. With a few exceptions, asthma drugs are basically the same in pregnancy as they are in non-pregnant people. Inhaled corticosteroids (ICS) are often used as a controlling treatment. Budesonide is the recommended ICS. Short-acting β-agonist (SABA) preferable as reliever in acute asthma and to relieve exacerbation. As an add-on therapy for medium to high dose ICS, long-acting β-gonists (LABA) is often used. Virus infections and ICS nonadherence are the two most common causes of asthma exacerbations during pregnancy.

Bergen Insomnia Scale for Adults: The Psychometric Features of the Turkish Version

Objective: Insomnia is an important health problem affecting physical, spiritual and social well-being of individuals negatively and it should be early diagnosed as well. The purpose is to appraise the psychometric features of the Turkish version of the Bergen Insomnia Scale (BIS) for adults.&#x0D; Methods: A total of 495 adults were included in the methodological study in Turkey. Turkish form of BIS was designed within the scope of study conducted in adolescent sample. Construct validity was appraised with exploratory, confirmatory factor analysis, convergent and discriminant validity. Internal-consistency and test-retest analysis were used for reliability.&#x0D; Results: According to results of explanatory, confirmatory factor analysis; it was identified that BIS showed a two-factor structure as daytime symptoms (α=.85) and nocturnal symptoms (α=.80). Item-total correlations were found as ≥.59 and test-retest correlation as .83.&#x0D; Conclusions: The Turkish version of the Bergen Insomnia Scale for adults was assessed as valid and reliable.

Trends in the Use of Complementary and Alternative Therapies among US Adults with Current Asthma.

Complementary and Alternative Medicines/Therapies (CAM) are commonly used by US asthma adults, yet little is known about recent trends in their use. Our aim was to report trends in CAM use among US adults with current asthma. We conducted a serial cross-sectional study using nationally representative data from the BRFSS Asthma Call-Back Survey (ACBS) collected between 2008 and 2019 (sample size per cycle, 8222 to 14,227). The exposure was calendar time, as represented by ACBS cycle, while the main outcomes were use of at least one CAM and eleven alternative therapies. We analyzed CAM use overall and by population subgroups based on age, gender, race/ethnicity, income, and daytime and night-time asthma symptoms. Our findings show that there was an increase in the use of at least one CAM from 41.3% in 2008 to 47.9% in 2019 (p-trend < 0.001) and an upward trend in the use of herbs, aromatherapy, yoga, breathing exercises, homeopathy, and naturopathy (p-trend < 0.05). However, the use of vitamins, acupuncture, acupressure, reflexology, and other CAM therapies remained stable (p-trend > 0.05). These trends varied according to population characteristics (age, sex, race, income) and asthma symptoms. In conclusion, our study suggests that CAM use among US adults with current asthma is either increasing or stable, and further studies are needed to explore the factors influencing these trends.

Should testing for obstructive sleep apnea be offered routinely to older family medicine patients? A prospective cohort study

ABSTRACT In our previous studies, we offered older family medicine patients testing for obstructive sleep apnea (OSA) and discovered that 80% of patients who accepted, were later diagnosed with unsuspected OSA. In the present study, we followed such patients for 3 years of usual treatment. The goals were to (1) observe whether wider testing for OSA would increase case recognition and treatment uptake; (2) identify symptom and health characteristics associated with diagnosis and treatment efficacy. 101 women and 75 men (>45 years) recruited from family medicine clinics completed questionnaires, polysomnography and consented to chart review (Time 1). Participants with OSA were offered treatment and follow-up with a sleep medicine specialist. All were re-evaluated after 3 years (Time 2). At Time 1, 93% of participants received a diagnosis of OSA. Of these, 53 initiated treatment (46 PAP therapy); at Time 2, 24 PAP users met criteria for adherence. PAP-adherent participants had worse OSA and worse reported symptoms at Time 1 than non-adherent participants. At Time 2, PAP-adherent participants improved on insomnia and daytime symptoms compared to non-adherent participants who showed no change. Adherent and non-adherent participants showed no difference in health indices at Time 1 and no change at three-year follow-up. Benefits of treatment included improvements in co-morbid insomnia and daytime functioning; however, offering wider testing for OSA to older, family medicine patients yielded a high rate of diagnosis but low treatment adoption and adherence. Therefore, a cost-effective strategy would identify and support those likely to adopt and adhere to treatment.

Cognitive behavioral therapy and acceptance and commitment therapy for insomnia: Exploring the potential benefit of psychological flexibility and self-compassion combined with behavioral strategies

Chronic insomnia is a prevalent sleep disorder with serious consequences on wellbeing and health that largely extend into daily functioning. Cognitive-Behavioral Therapy for Insomnia (CBT-I), an efficacious intervention for insomnia with solid empirical support, is the recommended first-line treatment. Given the complexity of factors and mechanisms involved in its aetiology and maintenance, advances in treatment protocols and modules are important. We will review the current knowledge on insomnia and examine how advancements in behavioral sleep medicine and third-wave therapies may apply to treatment. Specifically, we will outline how a treatment protocol based on Acceptance and Commitment Therapy (ACT), adapted to include insomnia-specific behavioral strategies and with an explicit focus on self-compassion, could be a potentially effective treatment. We believe that broadening treatment focus to target hyperarousal, metacognitions, dysfunctional though control strategies and provide self-compassion training may benefit treatment outcomes, increase sleep quality, reduce daytime symptoms, and improve quality of life.

A feasibility study of pre-sleep audio and visual alpha brain entrainment for people with chronic pain and sleep disturbance.

Chronic pain and sleep disturbance are bi-directionally related. Cortical electrical activity in the alpha frequency band can be enhanced with sensory stimulation via the phenomenon of entrainment, and may reduce pain perception. A smartphone based programme which delivers 10 Hz stimulation through flickering light or binaural beats was developed for use at night, pre-sleep, with the aim of improving night time pain and sleep and thereby subsequent pain and related daytime symptoms. The aim of this study was to assess the feasibility and give an indication of effect of this programme for individuals with chronic pain and sleep disturbance. In a non-controlled feasibility study participants used audio or visual alpha entrainment for 30 min pre-sleep each night for 4 weeks, following a 1 week baseline period. The study was pre-registered at ClinicalTrials.gov with the ID NCT04176861. 28 participants (79% female, mean age 45 years) completed the study with high levels of data completeness (86%) and intervention adherence (92%). Daily sleep diaries showed an increase compared to baseline in total sleep time of 29 min (p = 0.0033), reduction in sleep onset latency of 13 min (p = 0.0043), and increase in sleep efficiency of 4.7% (p = 0.0009). Daily 0-10 numerical rating scale of average pain at night improved by 0.5 points compared to baseline (p = 0.027). Standardised questionnaires showed significant within-participant improvements in sleep quality (change in median Global PSQI from 16 to 12.5), pain interference (change in median BPI Pain Interference from 7.5 to 6.8), fatigue (change in median MFI total score from 82.5 to 77), and depression and anxiety (change in median HADS depression score from 12 to 10.5 and anxiety from 13.5 to 11). Pre-sleep use of a smartphone programme for alpha entrainment by audio or visual stimulation was feasible for individuals with chronic pain and sleep disturbance. The effect on symptoms requires further exploration in controlled studies.

Daridorexant for the treatment of insomnia disorder: A systematic review and meta-analysis of randomized controlled trials.

Daridorexant is a novel dual orexin receptor antagonist that has shown efficacy as a treatment for insomnia in multiple randomized clinical trials. However, the efficacy and safety of daridorexant for treatment of insomnia disorder has not been characterized comprehensively in the literature. Therefore, we performed a meta-analysis of available studies. We performed a meta-analysis to systematically evaluate the efficacy and safety of daridorexant for treatment of insomnia disorder. MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov for randomized controlled trials were systematically searched up to February 2022. Relative risk and standard mean difference were used to evaluate clinical outcomes. We pooled 2271 patients from 4 randomized clinical trials, and evaluated efficacy endpoints. We found that 50 mg of daridorexant was superior to placebo for 4 efficacy outcomes including wake time after sleep onset, latency to persistent sleep, subjective total sleep time, and Insomnia Daytime Symptoms and Impacts Questionnaire domain score (P < .05). In addition, there were no significant differences (P > .05) in adverse events between daridorexant and placebo. Different dosages of daridorexant were tested for treatment of insomnia; however, 5 and 10 mg are not available because of issues of suboptimal effectiveness. Daridorexant showed better efficacy and safety for treatment of insomnia disorder at doses of 25 and 50 mg.

Selection of patients with symptomatic vagal-induced sinus node dysfunction: Who will be the best candidate for cardioneuroablation?

Sinus node dysfunction is a multifaceted disorder with variable manifestations, the prevalence of which increases with age. In a specific group of patients, excessive vagal activity may be the sole cause for this condition. These patients are characterized as having recurrent daytime symptoms attributed to bradyarrhythmia, no evidence of organic sinus node lesions, cardiac vagal overactivation, and are non-elderly. For sinus node dysfunction patients, a permanent pacemaker implantation appears to be the ultimate solution, although it is not an etiological treatment. Cardioneuroablation is a promising emerging therapy that can fundamentally eliminate symptoms in a highly selective sub-set of sinus node dysfunction patients by cardiac vagal nerve denervation. Denervation with ablation for vagal-induced sinus node dysfunction can effectively improve sinus bradycardia and reduce syncope. To date, guidelines for selection of suitable candidates for cardioneuroablation remain lacking. The primary objective of this study was to distinguish the nature of abnormal sinus node function and to find methods for quantifying vagal tone. Clear selection criteria could help physicians in identification of patients with autonomic imbalance, thereby maximizing patient benefits and the success rate of cardioneuroablations.

Smart Phone/Ecological Momentary Assessment of Sleep and Daytime Symptoms Among Older Adults With Insomnia

ObjectivesTo employ smart phone/ecological momentary assessment (EMA) methods to evaluate the impact of insomnia on daytime symptoms among older adults. DesignProspective cohort study SettingAcademic medical center ParticipantsTwenty-nine older adults with insomnia (M age = 67.5 ± 6.6 years, 69% women) and 34 healthy sleepers (M age = 70.4 ± 5.6 years, 65% women). MeasurementsParticipants wore an actigraph, completed daily sleep diaries, and completed the Daytime Insomnia Symptoms Scale (DISS) via smart phone 4x/day for 2 weeks (i.e., 56 survey administrations across 14 days). ResultsRelative to healthy sleepers, older adults with insomnia demonstrated more severe insomnia symptoms in all DISS domains (alert cognition, positive mood, negative mood, and fatigue/sleepiness). A series of mixed model analyses were performed using the Benjamini-Hochberg procedure for correcting false discovery rate (BH-FDR) and an adjusted p-value <0.05. Among older adults with insomnia, all five prior-night sleep diary variables (sleep onset latency, wake after sleep onset, sleep efficiency, total sleep time, and sleep quality) were significantly associated with next-day insomnia symptoms (i.e., all four DISS domains). The median, first and third quintiles of the effect sizes (R2) of the association analyses were 0.031 (95% confidence interval (CI: [0.011,0.432]), 0.042(CI: [0.014,0.270]), 0.091 (CI:[0.014,0.324]). ConclusionResults support the utility of smart phone/EMA assessment among older adults with insomnia. Clinical trials incorporating smart phone/EMA methods, including EMA as an outcome measure, are warranted.

Nocturnal continuous positive airway pressure offers symptomatic benefit in excessive dynamic airway collapse despite normal sleep study.

Excessive dynamic airway collapse (EDAC) and tracheobronchomalacia (TBM) cause debilitating symptoms yet are often misdiagnosed as asthma or chronic obstructive pulmonary disease (COPD). EDAC/TBM should be considered in all cases of obstructive ventilatory defect refractory to medical management. Diagnosis is made with flexible bronchoscopy and/or inspiratory and expiratory phase computed tomography (CT) scans. Treatment should be individualised and "pneumatic stenting" with the use of continuous positive airway pressure (CPAP) may lead to symptomatic relief, and in some cases regardless of the degree of collapse or absence of sleep disordered breathing in overnight oximetry. The case of a 63-year-old female referred to a tertiary respiratory department for a trial of CPAP due to EDAC is presented. Over the course of a few months, she had presented frequently to hospital with cough and shortness of breath which had been attributed to asthma. As she had not responded to treatment, an inpatient flexible bronchoscopy was performed which identified EDAC of the right main bronchus and she was referred to a tertiary ventilation department. Despite a normal sleep study whilst self-ventilating, nocturnal CPAP therapy significantly improved quality and duration of sleep, daytime symptoms and therefore quality of life. She was discharged with nocturnal CPAP and remains adherent to treatment.

Effects of electrostatic therapy on nighttime sleep and daytime symptoms in patients with chronic insomnia: Evidences from an open label study.

Transcranial electric stimulation (TES) is a neuromodulation approach that applies low-intensity electrical current to the brain and has been proposed as a treatment for insomnia. Electrostatic therapy is a kind of TES and people do not have a feeling of electrical stimuli when the voltage of static electricity is lower than 2,000 volts. However, no studies have examined the effects of electrostatic therapy on objective sleep and daytime symptoms in patients with insomnia. Thirty chronic insomnia patients were included. All patients received a 6 week electrostatic therapy and three comprehensive assessments including two consecutive polysomnography (PSG) and daytime symptoms assessments, at pre-treatment, 3 week and 6 week of treatment. Insomnia Severity Index (ISI) was used to assess the severity of insomnia. Multiple sleep latency test (MSLT), Epworth Sleepiness Scale (ESS), and Flinders Fatigue Scale (FFS) were used to assess objective and self-reported daytime sleepiness and fatigue, respectively. Attention network test (ANT) was used to assess attention levels. Total ISI scores decreased significantly at 3 weeks (p < 0.001) and 6 weeks (p < 0.001) after initiation of treatment. Furthermore, objective total sleep time (TST, p = 0.020) and sleep efficiency (SE, p = 0.009) increased and wake time after sleep onset (p = 0.012) decreased significantly after 6 weeks electrostatic therapy. Regarding daytime symptoms, ESS and FFS scores decreased significantly at 3 weeks (ESS, p = 0.047; FFS, p = 0.017) and 6 weeks (ESS, p = 0.008; FFS, p = 0.003) after initiation of treatment. Moreover, executive control improved significantly from pre-treatment to 3 weeks (p = 0.006) and 6 weeks (p = 0.013) and altering network improved significantly at 6 weeks (p = 0.003) after initiation of treatment. Secondary analyses showed that TST and SE improved significantly after electrostatic therapy in insomnia patients who slept < 390 min (all p-value < 0.05). However, no significant changes regarding TST and SE were observed in insomnia patients who slept ≥ 390 min. Electrostatic therapy improves both nighttime sleep and daytime symptoms in patients with chronic insomnia. The effect on objective sleep appears to be stronger in patient with objective short sleep duration. Electrostatic therapy might be a therapeutic choice for insomnia patients with difficulty maintaining sleep and not responding to behavioral treatments. [www.clinicaltrials.gov], identifier [ChiCTR2100051590].

Clinical and functional characteristics of OSA in children with comorbid asthma treated by leukotriene receptor antagonist: A descriptive study.

Obstructive sleep apnea (OSA) is the most common form of respiratory disorders during sleep in children, especially those with severe asthma. However, optimal treatment of asthma might significantly improve OSA severity. It was a cohort study including children aged >5 years old and diagnosed with asthma according to GINA (Global Initiative for Asthma). The data related to age, gender, height, weight, body mass index (BMI), clinical symptoms and medical history of asthma, spirometry (FEV1: forced expiratory in 1 s), and exhaled nitric oxide (FENO) were recorded for analysis. Respiratory polygraphy (RPG) was done for each study subject to diagnose OSA and its severity. Among 139 asthmatic children, 99 patients with OSA (71.2%) were included in the present study (9.3 ± 0.2 years): 58.6% with uncontrolled asthma and 32.3% with partial controlled asthma. The mean ACT (asthma control testing) score was 19.0 ± 3.4. The most frequent night-time symptoms were restless sleep (76.8%), snoring (61.6%), sweating (52.5%), and trouble breathing during sleep (48.5%). The common daytime symptoms were irritable status (46.5%) and abnormal behavior (30.3%). The mean AHI (apnea-hypopnea index) was 3.5 ± 4.0 events/h. There was a significant correlation between BMI and snoring index (R = 0.189 and P = 0.027), bronchial and nasal FENO with AHI (R = 0.046 and P < 0.001; R = 0.037 and P < 0.001; respectively). There was no significant correlation between asthma level, FEV1 and AHI. The severity of asthma and respiratory function were improved significantly after 3 months and 6 months of asthma treatment in combination with leukotriene receptor antagonist (LRA) treatment. The symptoms related to OSA were significantly improved after treatment with LRA. The severity of OSA was decreased significantly after 3 months and 6 months of treatment. The treatment of asthmatic children with comorbid OSA by LRA in combination with standard therapy for asthma could improve the control of asthma and the symptoms and severity of OSA.

PS-C32-5: GENDER DIFFERENCE IN HYPERTENSIVE PATIENTS ASSOCIATED WITH PROBABLE OSA

Objectives: Obstructive Sleep Apnea (OSA) has high association with hypertension and cardiovascular disease. OSA has been widely proven to be more common in men than women possibly due to pathophysiological difference and clinical presentations. However, there are limited studies on assessing the gender difference in correlation between OSA and hypertensive patients. This study aimed to examine the determinants of probable OSA according to gender among hypertensive patients in primary care clinics. Design and Methods: A cross-sectional study was carried out using systematic random sampling method in hypertensive patients who attended two government primary care clinics in Sarawak, Malaysia. A validated STOP-Bang questionnaire was used in this study and socio-demographic data was captured with questionnaire. Probable OSA was defined as STOP BANG score of 3 and above. SPSS version 23 was used to do the analysis and multivariate logistic regressions were used to determine the determinants of probable OSA according to gender. Results: 440 hypertensive patients were enrolled into this study, 60.7% of them were female. There was a higher proportion of male patients (92.5%) found to have probable OSA as compared to female patients (30%) (p &lt; 0.001). Looking into criteria of STOP BANG, between female and male patients, there were significant differences in daytime symptoms (p = 0.020) and BMI categories (p = 0.001). As for demographic data, the determinant of probable OSA in men were low income (&lt;RM3,000) (AOR = 4.320, P = 0.022, 95% confidence interval [CI] 1.23,15.15), longer duration of hypertension (AOR = 1.269, P = 0.029, 95% CI 1.03,1.57) and being married (AOR = 5.612, P = 0.021, 95% CI 1.30,24.22). For female, the determinant of probable OSA were neck circumference (AOR = 1.613, P = 0.002, 95% CI 1.19,2.81) and Chinese ethnicity (AOR = 11.711, P = 0.013, 95% CI 1.67,81.95). Conclusion: In conclusion, this study reported that among hypertensive patients, OSA is more prevalent in men than women, and criteria of STOP BANG and clinical characteristics are significantly different between gender. Primary care clinicians should be aware of these difference and screen for probable OSA accordingly for further early intervention.

����� ���������� ����������� ����� � ������ �� ���������� ������㳺� ������ ���������

Abstract. The goal of modern treatment of patients with bronchial asthma (BA) is to achieve and maintain full control over the disease: good control of clinical symptoms, minimization of fixed bronchial obstruction and unwanted side effects of treatment, as well as reducing the risks of future exacerbations. The controllability of the course of BA with comorbid pathology of the digestive system is currently uncertain according to the literature. The aim of the study: to learn the clinical features of the course of BA with comorbid pathology of the gastrointestinal tract. Materials and methods. The object of the study: 480 patients with asthma, including 194 men and 286 women, with a controlled, uncontrolled and partially controlled course of asthma, who were treated in the department of broncho-obstructive lung diseases in tuberculosis patients of the State Organization (SO) �Yanovsky National Institute of Phthisiology and Pulmonology NAMS of Ukraine�. In order to identify the possible causes of the uncontrolled course of the disease, a questionnaire was conducted using a questionnaire for patients with broncho-obstructive lung disease, developed at the SO �Yanovsky National Institute of Phthisiology and Pulmonology NAMS of Ukraine�. All patients kept a self-observation diary, which recorded: nocturnal asthma (number of awakenings during the night due to respiratory symptoms) � in points, morning chest tightness (in points), daytime symptoms (in points), cough during the day (in points), average dyspnea score (in points). All the symptoms listed above were included in the total asthma score (in points), and the number of inhalations of short-acting ?2 -agonists per day was also noted. The results. It has been established that the loss of asthma controllability always leads to an increase in the number and combination of dysfunction of various organs of the digestive system and vice versa: the appearance and increase of comorbid pathology of the digestive system aggravates the course and worsens the controllability of BA. The most common comorbid pathology of the gastrointestinal tract with a controlled course of BA is an irritable bowel syndrome � in 44.4 % of patients, with a partially controlled course: chronic gastritis 34.5 %, chronic cholecystitis � 22.0 %, and chronic pancreatitis � 67.4 %, with an uncontrolled course, with a high percentage of patients with chronic gastritis, cholecystitis and irritable bowel syndrome, the percentage of patients with calculous cholecystitis increased � 25.0 %. With the controlled course of BA there was no difference in the clinical manifestations of BA either in the group of patients with or without comorbid gastrointestinal pathology. With a partially controlled course of BA with comorbid pathology of the digestive system, exacerbation of BA due to respiratory factors, allergens and pronounced seasonality was determined in 53.5 % of patients with moderate severity, in 28.0 % with severe, of which 67.4 % of patients underwent inpatient treatment up to two times a year, a quarter of patients � more than three or four times a year, 30.2 % with a duration of hospitalization up to 30 days. In the uncontrolled course of BA with comorbid gastrointestinal pathology, 56.1 % of patients noted seasonality of symptoms, 47.8 % � a connection with allergens, physical exertion � 38.0 %, respiratory infections � 51.2 %. Only 46.3 % of patients had exacerbations up to twice a year, 43.9 % up to four times, and 9.8 % more than four times a year. Exacerbations of moderate severity in 53.5 % of patients, severe in 27.9 %, and with a duration of hospitalization for more than thirty days in 92.7 % of patients. Conclusions. The controllability of both affects and depends on the comorbid pathology of the digestive system: the progression of the dysfunction of the digestive system limits the possibilities of drug therapy for BA, nullifying the expected result from the received treatment, not leading to full and long-term control of the disease, forcing to repeat the course of systemic glucocorticosteroids again and again. which again deepens the dysfunction of the digestive system, forming a vicious circle of mutual burden and leads to an increase in the terms of hospitalization, causes disability, and prevents the implementation of rehabilitation measures. Key words: bronchial asthma, controllability, comorbid pathology, digestive system.