Sleep Evaluation Research Articles

Improve sleep in critically ill patients: Study protocol for a randomized controlled trial for a multi-component intervention of environment control in the ICU.

In critically ill patients, sleep and circadian rhythms are greatly altered. These disturbances have been associated with adverse consequences, including increased mortality. Factors associated with the ICU environment, such as exposure to inadequate light and noise levels during the day and night or inflexible schedules of daily care activities, have been described as playing an essential role in sleep disturbances. The main objective of this study is to evaluate the impact of the use of a multifaceted environmental control intervention in the ICU on the quantity and quality of sleep, delirium, and post-intensive care neuropsychological impairment in critically ill patients. This is a prospective, parallel-group, randomized trial in 56 critically ill patients once they are starting to recover from their acute illness. Patients will be randomized to receive a multifaceted intervention of environmental control in the ICU (dynamic light therapy, auditory masking, and rationalization of ICU nocturnal patient care activities) or standard care. The protocol will be applied from enrollment until ICU discharge. Baseline parameters, light and noise levels, polysomnography and actigraphy, daily oscillation of plasma concentrations of Melatonin and Cortisol, and questionnaires for the qualitative evaluation of sleep, will be assessed during the study. In addition, all patients will undergo standardized follow-up before hospital discharge and at 6 months to evaluate neuropsychological impairment. This study is the first randomized clinical trial in critically ill patients to evaluate the effect of a multicomponent, non-pharmacological environmental control intervention on sleep improvement in ICU patients. The results will provide data about the potential synergistic effects of a combined multi-component environmental intervention in ICU on outcomes in the ICU and long term, and the mechanism of action. ClinicalTrials.gov, NCT. Registered on January 10, 2023. Last updated on 24 Jan 2023.

Changes in Functional Connectivity of Hippocampal Subregions in Patients with Obstructive Sleep Apnea after Six Months of Continuous Positive Airway Pressure Treatment.

Previous studies have shown that the structural and functional impairments of hippocampal subregions in patients with obstructive sleep apnea (OSA) are related to cognitive impairment. Continuous positive airway pressure (CPAP) treatment can improve the clinical symptoms of OSA. Therefore, this study aimed to investigate functional connectivity (FC) changes in hippocampal subregions of patients with OSA after six months of CPAP treatment (post-CPAP) and its relationship with neurocognitive function. We collected and analyzed baseline (pre-CPAP) and post-CPAP data from 20 patients with OSA, including sleep monitoring, clinical evaluation, and resting-state functional magnetic resonance imaging. The results showed that compared with pre-CPAP OSA patients, the FC between the right anterior hippocampal gyrus and multiple brain regions, and between the left anterior hippocampal gyrus and posterior central gyrus were reduced in post-CPAP OSA patients. By contrast, the FC between the left middle hippocampus and the left precentral gyrus was increased. The changes in FC in these brain regions were closely related to cognitive dysfunction. Therefore, our findings suggest that CPAP treatment can effectively change the FC patterns of hippocampal subregions in patients with OSA, facilitating a better understanding of the neural mechanisms of cognitive function improvement, and emphasizing the importance of early diagnosis and timely treatment of OSA.

Sleep in Gerstmann-Straüssler-Scheinker disease

BackgroundGerstmann-Sträussler-Scheinker (GSS) is a rare prion disease with heterogeneous clinical presentation. Although sleep-related abnormalities are prominent and well-known in other prion diseases such as fatal familial insomnia and Creutzfeldt-Jakob disease, information on sleep is limited in GSS. MethodsWe evaluated sleep in three genetically confirmed GSS cases using clinical history, sleep scales and video-polysomnography. In addition, patients underwent neurological assessment, neurological scales, neuropsychological testing, lumbar puncture, brain MRI and brain 18F-FDG-PET. ResultsTwo patients reported sleep maintenance insomnia attributed to leg stiffness and back pain while the remaining patient did not report sleep problems. Video-polysomnography showed normal sleep staging in all of them. Findings such as reduced sleep efficiency in two patients, a confusional arousal in one patient, obstructive apneas in one patient, and periodic legs movements in sleep in two patients were observed. ConclusionsIn contrast to fatal familial insomnia, the normal sleep staging in GSS may suggest dissimilar involvement of the neuronal structures that regulate sleep. We found non-specific sleep alterations in GSS such as obstructive apneas and periodic leg movements in sleep which are of unknown origin and of uncertain clinical relevance. Studies including a larger number of patients, serial sleep evaluations and incorporating neuropathological assessment will further help to understand sleep in GSS.

Actual Sleep Conditions from the Last Trimester of Pregnancy to Three Months Postpartum and the Associated Minor Problems

Objective: To investigate the actual sleep conditions at four time points from the last trimester of pregnancy to 3 months postpartum, and to examine the relationship between sleep and minor problems affecting sleep. Methods: A cross-sectional survey on the frequency of minor problems, Pittsburgh Sleep Quality Index (PSQI), and observations in a sleep diary was carried out on women at the end of pregnancy, 2 weeks postpartum, 1 month postpartum, and 3 months postpartum. The questionnaires were distributed to 165 participants. Correlation coefficients were obtained for each item and each scale, and the associations were analyzed. Results: The number of valid responses was 127. In the evaluation of sleep, sleep duration was the shortest and sleep quality was the lowest in the first month after delivery based on the PSQI score. In the correlation between “psychiatric symptoms” and sleep, women with anxiety and nervousness at the end of pregnancy were associated with poorer sleep quality. At all time-points, there was a significant association between “psychiatric symptoms” and poor sleep quality. Conclusion: An association exists between “psychiatric symptoms” and poor sleep quality in women from the last trimester of pregnancy to 3 months postpartum.

Sleep Patterns of Pilots: An Objective Assessment.

Objectives Circadian dysregulation (jetlag), sleep loss (extended wakefulness), sleep deprivation (acute or chronic), fatigue (exhaustion), preexisting medical and mental conditions, and medication use can all affect the cognitive and behavioral performance of commercial aircraft pilots. This study evaluated the sleep habits of pilots and copilots flying short-haul flights in the Gulf region. Methods This cross-sectional study examined Airbus A320 pilots and copilots for one of Saudi Arabia's commercial airlines. Data such as age, sex, body mass index (BMI), employment position, work experience, flight hours, and rest time were collected. Each participant completed the Epworth Sleepiness Scale (ESS) for daytime sleepiness, the Pittsburgh Sleep Quality Index (PSQI), and the Fatigue Severity Index (FSI). Actigraphy equipment was used to perform objective sleep evaluations. Results Twenty-four participants were included. Actigraphy showed that 66.7% had an irregular sleep pattern and that 41.7% had poor sleep efficiency. We found that 12.5% had daytime sleepiness, 33% had poor sleep quality, and 29.2% had fatigue. We found a significant negative correlation between years of experience and time in bed; however, there was no significant difference in sleep time or sleep efficiency between pilots with different levels of experience. Conclusions We found that pilots and copilots are at risk of irregular sleep patterns, poor sleep efficiency, poor sleep quality, daytime sleepiness, and fatigue. This study emphasizes the need to instigate measures to minimize these risks.

Exploration of sleep disturbances in children and adolescents with and without autism in a paediatric sample referred for polysomnography.

The purpose of the study was to increase the body of knowledge related to sleep in children with autism. The specific aims were to (i) identify the subgroup of children with autism, ages 3-17 years, referred for polysomnography and (ii) describe types and frequency of clinical encounters for sleep problems in a sample of children ages 3-17 with and without the diagnosis of autism. The authors performed a secondary data analysis of the de-identified Nationwide Children's Hospital Sleep DataBank, a collection of encounters with children referred for polysomnography. The data were filtered for ages 3-17 years at the time of the participant's first sleep study, and further filtered for the presence of an autism diagnosis. In the sample, there were 2838 unique participants (M = 10.5 years) with a total of 172 167 encounters between 2017 and 2019. Of these, 198 (7%) were diagnosed with Autism Spectrum Disorder, Asperger's Syndrome, or Pervasive Developmental Disorder. Among all participants, the most common sleep problems were apnea, snoring, non-specified sleep disorders (including restless sleeper), circadian rhythm disorder (CRD), and insomnia. The subgroup of patients diagnosed with autism was noted to have higher frequency of several types of sleep problems, especially restless sleep, CRD and insomnia, compared to those without an autism diagnosis. Findings elucidate the increased presence of sleep problems in paediatric patients with autism, and the need for purposeful sleep evaluation and research given the potential impact on daytime function for these individuals and their families.

Pressure-Sensor-Based Sleep Status and Quality Evaluation System

Sleep quality evaluation is a major approach to clinical diagnosis of different types of sleep andmental disturbances.How to render it possible for test subjects to complete sleep status detection and quality assessment in a natural environment is what this paper mainly highlights. Clinically, sleep disturbances are analyzed by the so-called Polysomnography (PSG). However, due to limitations in space and high cost, as well as the fact that test subjects must wear various physiological detection equipment during the test, the collected signal is susceptible to interference due to uncomfortable sensations. As such it usually does not reflect the realistic situation of the subject. For this reason,we propose in this paper a pressure-sensor-based smart mattress to realize sleep status detection and quality evaluation. Regarding sleep posture recognition, a proposed convolutional neural network (CNN) model in conjunction with a pressure distribution image formed by the pressure sensing matrix are applied. With respect to assessing the subjects’ time in bed, a support vectormachine (SVM) is used to determine sitting or lying postures, and further recognize the actual time in bed. As for sleep quality assessment, Fuzzy inference is adopted in this paper base on a set of four predefined sleep parameters. Compared with some of prior arts, the proposed systemdoes not require the test subjects to wear any equipment, and as such the subjects can complete the test in a natural environment. Experimental results show that the accuracy of the proposed SVM classifier for differentiating sitting and lying posture and that of CNN model for the recognition of four different sleep postures can be up to 99.986% and 96.987%, respectively. With the proposed model, precise sleep parameters, including time in bed, number of times of bed-leaving, number of times of body movements all night, standard deviation of time interval between body movements, and sleep posture can be provided. Moreover, the system does not use devices such as microphones or surveillance cameras to collect the data of the test subjects; thus, there is no concern about infringing the privacy of the subjects. It is believed that the system will be of considerable help and serve as an aid to clinical diagnosis of sleep disturbance.

A Longitudinal evaluation of early Sleep and Respiratory Impairment in ALS patients (S6.005)

<h3>Objective:</h3> To evaluate early impairment of sleep and breath in patients affected by amyotrophic lateral sclerosis (ALS) in order to do early treatments, for a longer survival and a better quality of life (QoL). <h3>Background:</h3> ALS is a fatal neurodegenerative disease characterised by skeletal muscles wasting and weakness. 30% present a bulbar onset, while 70% a spinal one. Extra-motor systems involved in ALS include circuits regulating sleep; the early identification of sleep impairment and his better definition could improve ALS patient’s QoL. One of the most important prognostic factors in ALS is respiratory impairment. It’s early recognition and an early starting of non-invasive ventilation (NIV) allow a prolongation of survival. <h3>Design/Methods:</h3> Between August 2021 and January 2022 we enrolled, until 2 months from diagnosis, 37 ALS patients and 37 healthy controls (HC). At baseline and at month six, patients underwent neurological examination, polysomnography (PSG), arterial blood gases (ABG), spirometry and filled sleep and respiratory questionnaire (RLSRS, STOP-BANG, ISI, ESS, PSQI, PIRS, MEQ, STAI, BDI). Mann-Whitney U test, Friedman test, and Cox regression analysis were applied. <h3>Results:</h3> At baseline, ALS patients without respiratory symptoms showed an increase of AHI index and of ODI index, contrary to HC (respectively, p=0.001 and p=0.04). Contrarily, spirometry and ABG resulted normal in this sub-group of patients. Longitudinally we observed a significant worsening of PSG parameters (p&lt;0.05). Patients who started nocturnal-NIV (10 out of 37) showed a significant improvement of PSG parameters. At baseline we also observed an excess of periodic limb movement in ALS vs HC (p=0.01). Direct correlation between progression rate of disease and both AHI and ODI (r=0.546 and r=0.442 p&lt;0.05). <h3>Conclusions:</h3> This preliminary study showed the presence of respiratory impairment and of sleep disorders in ALS patients since the beginning of the disease. Their identification is fundamental for an early treatment, and for an improvement of QoL. <b>Disclosure:</b> Dr. Bombaci has nothing to disclose. Dr. Iadarola has nothing to disclose. Dr. Fattori has nothing to disclose. Dr. Gojani has nothing to disclose. Dr. Manera has nothing to disclose. Dr. Calvo has nothing to disclose. Dr. Chio has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cytokinetics. Dr. Chio has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubishi. Dr. Chio has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Alessandro Cicolin has nothing to disclose.

P191 Efficacy and improvement in patient-reported outcomes at weeks 16 and 52 in ixekizumab treated biological naïve patients with radiographic axial spondyloarthritis achieving clinically important pain at night reduction at week 16: results from COAST-V trial

Abstract Background/Aims Ixekizumab (IXE), a monoclonal antibody that selectively targets interleukin IL-17A, has shown efficacy in patients with radiographic axial spondyloarthritis (r-axSpA). Spinal pain, in particular spinal pain at night (SP-N), is a major contributor to the patient burden of r-axSpA.To assess SP-N improvement in patients up to week (W) 52 and to determine the association of SP-N improvement in patients treated with IXE with other patient-reported outcomes (PROs) at W16 and with reaching ASDAS LDA at W52. Methods The Phase III COAST-V (NCT02696785) trial investigated the efficacy of IXE in 341 patients with r-axSpA and were biological disease-modifying anti-rheumatic drug (bDMARD)-naïve. Patients were randomised to IXE every 2W (IXEQ2W), IXE every 4W (IXEQ4W), adalimumab (ADA) or placebo (PBO) up to W16. Only approved dose IXEQ4W data are presented here. SP-N was measured at each visit using a numeric rating scale (NRS) (0-10). A clinically relevant improvement in SP-N was defined as &amp;gt; 2 point improvement from baseline. Differences in baseline variables between those achieving versus not achieving &amp;gt;2 improvement in SP-N were tested using Fisher’s exact test (binary variables) and analysis of variance (ANOVA; continuous variables). Associations of SP-N improvement with PROs (BASFI, Fatigue Severity NRS, Jenkins Sleep Evaluation Questionnaire (JSEQ), SF-36 PCS) at W16, and ASDAS LDA at W52 were tested using analysis of covariance (ANCOVA; continuous variables) and logistic regression (binary variables). Missing values were imputed using non-responder imputation (NRI), and modified baseline observation carried forward. Results A greater proportion of patients achieved &amp;gt;2 improvement in SP-N with IXE treatment compared to PBO at W16 (63.0% vs. 32.2%, p &amp;lt; 0.001) and improvement was sustained up to W52. Of the 81 patients originally randomised to IXE, those achieving &amp;gt;2 improvement in SP-N (63%) at W16 were younger, more frequently positive for HLA-B27 and had higher disease activity at baseline compared to those that did not achieve &amp;gt;2 improvement. Achieving &amp;gt;2 improvement in SP-N was associated with improvement in PROs including BASFI, Fatigue Severity, JSEQ and SF-36 PCS at W16 and with achieving ASDAS&amp;lt;2.1 at W52 compared to those not achieving &amp;gt;2 improvement in SP-N. Conclusion IXE improved SP-N for patients with r-axSpA not previously treated with bDMARDs. Improvements in SP-N were associated with improvements in disease activity, function, fatigue, and quality of life. Disclosure S. Ramiro: Consultancies; S. Ramiro has served as a speaker and/or consultant for: AbbVie, Eli Lilly and Company, Merck Sharp &amp; Dohme, Novartis, Pfizer, Sanofi, and UCB Pharma. Grants/research support; S. Ramiro has received grant and/or research support from: AbbVie, Galapagos NV, Novartis, Pfizer, and UCB Pharma. C. Lukas: Consultancies; C. Lukas has served as a speaker and/or consultant for: AbbVie, Amgen, Bristol Myers Squibb, Chugai Pharmaceutical, Eli Lilly and Company, Galapagos NV, Merck Sharp &amp; Dohme, Novartis, Pfizer, Roche. Grants/research support; C. Lukas has received grant and/or research support from: Eli Lilly and Company, Novartis, Pfizer, and Roche. M. Nissen: Consultancies; M. J. Nissen has served as a speaker and/or consultant for: AbbVie, Celgene, Eli Lilly and Company, Janssen, Novartis, and Pfizer. Y. Schymura: Shareholder/stock ownership; Y. Schymura is a shareholder and employee of: Eli Lilly and Company. K. Ng: Shareholder/stock ownership; K. Ng is a shareholder and employee of: Eli Lilly and Company. A. Bradley: Shareholder/stock ownership; A. Bradley was an employee of: Eli Lilly and Company at the time of the study. G. Doridot: Shareholder/stock ownership; G. Doridot is a shareholder and employee of: Eli Lilly and Company. S. Liu-Leage: Shareholder/stock ownership; S. Liu-Leage is a shareholder and employee of: Eli Lilly and Company. A. Chan: Consultancies; A. Chan has served as a speaker and/or consultant for: AbbVie, Amgen, Biogen, Celgene, Eli Lilly and Company, Janssen, Novartis, and UCB Pharma. C. Wei: Grants/research support; J. C.-C. Wei has received consulting fees and/or grant and/or research support from: AbbVie, Bristol Myers Squibb, Celgene, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen, Novartis, Pfizer, Sanofi-Aventis, TSH Biopharm, and UCB Pharma.

Evaluation of weekend catch-up sleep and weekday sleep duration in relation to metabolic syndrome in Korean adults.

This study aimed to evaluate whether or notthe relationship between weekday sleep duration and prevalence of metabolic syndrome (MetS) differs according to weekend catch-up sleep (CUS) in Korean adults. Data from the Korea National Health and Nutrition Examination Survey 2016-2020, including that regarding weekday sleep duration, weekend CUS, MetS components, and confounding factors such as sociodemographic factors, health behaviors, and illness-related factors, were evaluated in Korean adults aged 19 to 80years. Complex-sample logistic regression was applied after adjusting for confounding factors. Among 24,313 adults, the prevalence of MetS was lowest in individuals with 6-7h of sleep on weekdays and CUS ≥ 2h (17.7%, reference group). The interaction between weekday sleep duration and weekend CUS for MetS was significant. Compared to the reference group, the prevalence of MetS was higher in those who slept < 7h and had a maximum CUS of 1h (aORs, 1.42-1.66), and in those who slept ≥ 9h and had a maximum CUS of 2h (aORs, 1.28-1.82). In subjects with no CUS or CUS ≥ 2h, the prevalence of MetS was greater even in those with adequate weekday sleep duration (7- 9h) than in the reference group (aORs, 1.37 and 1.64, respectively). Weekend CUS may help individuals with short weekday sleep duration reduce their odds of developing MetS, but it may worsen the condition in individuals with a long weekday sleep length.

Sleep disturbances associated with DPPX autoantibodies: a case series.

To describe a case series of patients with prominent sleep disturbances and their polysomnography findings in six patients with dipeptidyl-peptidase-like protein-6 (DPPX) autoimmunity syndrome. Of 13 patients with DPPX autoimmunity evaluated at Mayo Clinic, 6 were seen by Sleep Medicine with polysomnography and were assessed with blood and cerebrospinal fluid, neuroimaging, neuropsychological testing, and evaluation tailored to clinical presentation. Median age of our six DPPX autoimmunity patients was 57 (range 27-70) years, with one woman. All patients had prominent gastrointestinal disturbances, most with prominent and early weight loss, and a spectrum of neuropsychiatric disturbances including cognitive impairment, myoclonus, exaggerated startle, and dysautonomia. Sleep disturbances included insomnia and obstructive sleep apnea in six patients, periodic leg movements of sleep in four, and REM sleep behavior disorder in two. Polysomnography demonstrated REM sleep-atonia loss in four patients, and ambiguous sleep with status dissociatus (mixed features of wakefulness, non-rapid eye movement [NREM], and REM sleep) appeared in one patient. Five of six patients showed neurological improvement with immunotherapy, including three with at least partial improvement in sleep disturbances. Our patients with DPPX autoimmunity syndrome had prominent sleep disturbances including sleep-disordered breathing, REM sleep behavior disorder, and abnormal NREM sleep architecture with highly variable clinical presentations. DPPX autoimmunity should be considered in cases with a triad of sleep disturbance, neurological features of hyperexcitability, and systemic symptoms of gastrointestinal disturbance and weight loss. Future prospective studies of DPPX autoimmunity syndrome including detailed sleep evaluation and follow-up are necessary.

Association of Plasma Biomarkers with Sleep Outcomes and Treatment Response After Mild Traumatic Brain Injury.

Sleep disturbances occur in up to 70% of patients with mild traumatic brain injury (mTBI). Modern mTBI management recommends targeted treatment for the patient's unique clinical manifestations (i.e., obstructive sleep apnea, insomnia). The purpose of this study was to evaluate the association of plasma biomarkers with symptom reports, overnight sleep evaluations, and response to treatment for sleep disturbances secondary to mTBI. This study is a secondary analysis of a prospective multiple interventional trial of patients with chronic issues related to mTBI. Pre- and post-intervention assessments were conducted, including overnight sleep apnea evaluation, the Pittsburgh Sleep Quality Index (PSQI), and blinded analysis of blood biomarkers. Bivariate Spearman correlations were conducted for pre-intervention plasma biomarker concentrations and 1) PSQI change scores and 2) pre-intervention sleep apnea outcomes (i.e., oxygen saturation measures). A backward logistic regression model was built to evaluate the association of pre-intervention plasma biomarkers with improvement in PSQI over the treatment period (p < 0.05). Participants were 36.3 ± 8.6 years old and 6.1 ± 3.8 years from their index mTBI. Participants reported subjective improvements (PSQI = -3.7 ± 3.8), whereas 39.3% (n = 11) had improved PSQI scores beyond the minimum clinically important difference (MCID). PSQI change scores correlated with von Willebrand factor (vWF; ρ = -0.50; p = 0.02) and tau (ρ = -0.53; p = 0.01). Hyperphosphorylated tau correlated with average saturation (ρ = -0.29; p = 0.03), lowest desaturation (ρ = -0.27; p = 0.048), and baseline saturation (ρ = -0.31; p = 0.02). The multi-variate model (R 2 = 0.33; p = 0.001) retained only pre-intervention vWF as a predictor (odds ratio = 3.41; 95% confidence interval, 1.44-8.08; p = 0.005) of improving PSQI scores beyond the MCID. vWF had good discrimination (area under the curve = 0.83; p = 0.01), with an overall accuracy of 77%, sensitivity of 46.2%, and specificity of 90.0%. Validation of vWF as a potential predictive biomarker of sleep improvement post-mTBI could optimize personalized management and healthcare utilization.

International Consensus Statement on Obstructive Sleep Apnea.

Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Biopsychosocial factors should be considered when evaluating central sensitization in axial spondyloarthritis.

To identify the determinants of central sensitization (CS) in patients with axial spondyloarthritis (axSpA). Central Sensitization Inventory (CSI) was used to determine CS frequency. Disease-related variables including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP/-ESR), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and Numeric Rating Scale (NRS)GLOBAL were assessed. Biopsychosocial variables were evaluated by the Multidimensional Scale of Perceived Social Support (MSPSS), Brief Illness Perception Questionnaire (B-IPQ), Hospital Anxiety and Depression Scale (HADS) and subscales for Anxiety (HADS-A) and Depression (HADS-D), and Jenkins Sleep Evaluation Scale (JSS). To determine the predictors of the development and severity of CS, multiple linear and logistic regression analyses were performed. The frequency of CS was 57.4% in the study population (n = 108). CSI score was correlated with the duration of morning stiffness, BASDAI, ASDAS-CRP, ASDAS-ESR, NRSGLOBAL, BASFI, MASES, ASOoL, JSS, HADS, and B-IPQ total scores (ρ ranged from 0.510 to 0.853). Multiple regression analysis indicated that BASDAI (OR: 10.44, 95% CI: 2.65-41.09), MASES (OR: 2.47, 95% CI: 1.09-5.56) and HADS-A (OR: 1.62, 95% CI: 1.11-2.37) were independent predictors of the development of CS. Additionally, higher NRSGLOBAL, JSS, HADS-D, and HADS-A scores appeared to determine the severity of CS. This study confirms that worse disease activity, more enthesal involvement, and anxiety independently predict the development of CS. Additionally, higher patient-perceived disease activity, sleep impairment and poor mental health significantly contribute to the severity of CS.

The past, present, and future of sleep quality assessment and monitoring

Sleep quality is considered to be an individual's self-satisfaction with all aspects of the sleep experience. Good sleep not only improves a person's physical, mental and daily functional health, but also improves the quality-of-life level to some extent. In contrast, chronic sleep deprivation can increase the risk of diseases such as cardiovascular diseases, metabolic dysfunction and cognitive and emotional dysfunction, and can even lead to increased mortality. The scientific evaluation and monitoring of sleep quality is an important prerequisite for safeguarding and promoting the physiological health of the body. Therefore, we have compiled and reviewed the existing methods and emerging technologies commonly used for subjective and objective evaluation and monitoring of sleep quality, and found that subjective sleep evaluation is suitable for clinical screening and large-scale studies, while objective evaluation results are more intuitive and scientific, and in the comprehensive evaluation of sleep, if we want to get more scientific monitoring results, we should combine subjective and objective monitoring and dynamic monitoring.

Evaluation of sleep and therapeutic education needs of military with PTSD

Sleep disorders in post-traumatic stress disorder (PTSD) are both diagnostic (nocturnal reliving) and prognostic. Poor sleep worsens the daytime symptomatology of PTSD and makes it resistant to treatment. However, no specific treatment is codified in France to treat these sleep disorders although sleep therapies (cognitive behavioural therapy for insomnia, psychoeducation and relaxation) have proven for years to be effective in treating insomnia. Therapeutic sessions can be part of a therapeutic patient education program, which is a model for the management of chronic pathologies. It allows for an improvement in a patient's quality of life and enhanced medication compliance. We therefore carried out an inventory of sleep disorders of patients with PTSD. First, we collected data by means of sleep diaries concerning the population's sleep disorders at home. Then we assessed the population's expectations and needs regarding its management of sleep, thanks to a semi-qualitative interview. The data from sleep diaries, which was consistent with the literature, showed that our patients suffered from severe sleep disorders that strongly impact their daily lives, with 87% of patients having an increased sleep onset latency, and 88% having nightmares. We observed a strong demand from patients for specific support for these symptoms, 91% expressing an interest in a TPE program targeting sleep disorders. Thanks to the data collected, the emerging themes for a future therapeutic patient education program targeting sleep disorders of soldiers with PTSD are: sleep hygiene; management of nocturnal awakenings, including nightmares; and psychotropic drugs.

Impact of COVID 19 on sleep quality: a study of 154 patients

IntroductionIn addition to psychological distress, neurological and neurocognitive manifestations, the COVID19 pandemic and its medium- and long-term consequences combine other risk factors to alter sleep.ObjectivesTo screen for COVID19 sleep disorders and to identify epidemiological and clinical factors correlated with this disorder in post COVID19 patients.MethodsThis is a descriptive and analytical cross-sectional study that took place during the period from the 1rst of March to the 15th of May 2021 with 154 patients who were hospitalized at the COVID unit19 at the Hedi Chaker Hospital in Sfax Tunisia.The sleep evaluation, made by telephone, was performed using the “Insomnia Severity Index” scale.ResultsThe mean age was 66.62 ± 13.34 years. Male patients represented 60.4% of the study population.In our study, the prevalence of anxiety, depression and post-traumatic stress disorder was 24.7%, 11% and 13.6% respectively.The mean score of the sleep disorder severity index was 3.94 with extremes of score ranging from zero to 24. Thirty-six patients (23.4%) had insomnia, which was severe in 2.6% of patients.We found a significant association between gender and sleep disorders. Thus, women were more likely to have insomnia.A significant association was found between insomnia, anxiety-depressive disorders and post-traumatic stress disorder.No significant association was found between disease characteristics and sleep disorders.ConclusionsIn post COVID, patients suffer from an important sleep disorder. Indeed, the management of these sleep disorders in post Covid-19 is essential to improve the quality of life of these people.Disclosure of InterestNone Declared

Subjective memory disorders and psychological distress in post COVID 19

IntroductionIn addition to psychological distress in patients with COVID 19, neurological and neurocognitive manifestations, such as memory impairment, are increasingly reported. Screening for cognitive impairment is therefore crucial.ObjectivesIdentify cognitive impairment inpost COVID19.MethodsThis is a descriptive and analytical cross-sectional study that took place during the period from 1 st March 15 th May 2021 with 154 patients who were hospitalized at the COVID19 unit at Hedi Chaker Hospital Sfax. The psychometric evaluation, done by telephone, was performed using the &amp;quot;Hospital Anxiety and Depression Scale&amp;quot; for the screening of anxiety-depressive disorders, the &amp;quot;Impact of Event Scale-Revised&amp;quot; for the screening of post-traumatic stress disorder, the Insomnia Severity Index for the evaluation of sleep, the &amp;quot;The Prospective and Retrospective Memory Questionnaire&amp;quot; scale and the Mac Nair questionnaire for the evaluation of subjective memory.ResultsThe mean age was 66.62 ± 13.34 years. Male patients represented 60.4% of the population. The prevalence of anxiety, depression and post-traumatic stress disorder was 24.7%, 11% and 13.6% respectively. For the assessment of subjective memory, the mean total score of the PRMQ was 27.72 ± 7.71, with that of prospective and retrospective memory 15.41 ± 4.44 and 12.16 ± 3.73 respectively. According to the Mac Nair scale, 18.8% of patients had memory impairment (Mac Nair score &amp;gt;15). Anxious patients showed more memory impairment. Depressed patients had the most impaired scores for total memory (p= 0.03) and retrospective memory (p= 0.022). Patients with post-traumatic stress disorder had more memory impairment (p=0.021).ConclusionsPsychological distress is multifactorial in its etiology. The medium and long term management of COVID+ patients must therefore be multidisciplinary.Disclosure of InterestNone Declared

Effects of bilateral erector spinae plane block for posterior lumbar spine surgery in elderly patients.

With the rapid development of aging population, the number of elderly patients undergoing posterior lumbar spine surgery continues to increase. Lumbar spine surgery could cause moderate to severe postoperative pain, and the conventional opioid-based analgesia techniques have many side effects, which are barriers to the recovery after surgery of the elderly. Previous studies have demonstrated that erector spinae plane block (ESPB) could bring about favorable analgesia in spinal surgery. As far as the elderly are concerned, the analgesic and recovery effects of ESPB on posterior lumbar spine surgery are not completely clear. This study aims to observe the effects of bilateral ESPB on elderly patients undergoing posterior lumbar spine surgery, and to improve the anesthesia techniques. A total of 70 elderly patients of both sex, who were selected from May 2020 to November 2021, scheduled for elective posterior lumbar spine surgery, and in the age of 60-79 years, with American Society of Anesthesiologists class Ⅱ-Ⅲ, were divided into a ESPB group and a control (C) group using a random number table method, with 35 patients each. Before general anesthesia induction, 20 mL 0.4% ropivacaine was injected to the transverse process of L3 or L4 bilaterally in the ESPB group and only saline in the C group. The score of Numerical Rating Scale (NRS) indicating pain at rest and on movement within 48 h after operation, time of first patient control analgesia (PCA), cumulative consumptions of sufentanil within 48 hours, Leeds Sleep Evaluation Questionnaire (LSEQ) scores on the morning of day 1 and day 2 after operation, Quality of Recovery-15 (QoR-15) scores at 24 and 48 h after operation, full diet intake times, perioperative adverse reactions such as intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation were compared between the 2 groups. A total of 70 patients were enrolled and 62 subjects completed the study, including 32 in the ESPB group and 30 in the C group. Compared with the C group, the postoperative NRS scores at rest at 2, 4, 6, and 12 h and on movementat at 2, 4, and 6 h were lower, time of first PCA was later, sufentanil consumptions were significantly decreased during 0-12 h and 12-24 h after operation, LSEQ scores on the morning of day 1 and QoR-15 scores at 24 and 48 h after operation were higher, full diet intakes achieved earlier in the ESPB group (all P<0.05). There were no significant differences in the incidences of intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation between the 2 groups (all P>0.05). Providing favorable analgesic effects with reduced opioids consumption, bilateral ESPB for posterior lumbar spine surgery in the elderly patients could also improve postoperative sleep quality, promote gastrointestinal functional restoration, and enhance recovery with few adverse reactions.

Acute and long-term sleep measurements produce opposing results on sleep quality in 8 and 12 hour shift patterns in law enforcement officers.

The occupational demands of law enforcement increase the risk of poor-quality sleep, putting officers at risk of adverse physical and mental health. This cross-sectional study aimed to characterise sleep quality in day workers, 8 and 12 h rotating shift pattern workers. One hundred eighty-six officers volunteered for the study (37 female, age: 41 ± 7). Sleep quality was assessed using the Pittsburgh sleep quality index, actigraphy and the Leeds sleep evaluation questionnaire. The maximal aerobic capacity (VO2max ) was measured on a treadmill via breath-by-breath analysis. There was a 70% overall prevalence of poor sleepers based on Pittsburgh sleep quality index scores, where 8h shifts exhibited the worst prevalence (92%, p=0.029), however, there was no difference between age, gender, or role. In contrast, 12 h shifts exhibited the poorest short-term measures, including awakening from sleep (p=0.039) and behaviour following wakefulness (p=0.033) from subjective measures, and poorer total sleep time (p=0.024) and sleep efficiency (p=0.024) from the actigraphy. High VO2max predicted poorer wake after sleep onset (Rsq=0.07, p=0.05) and poorer sleep latency (p=0.028). There was no relationship between the Pittsburgh sleep quality index scores and any of the short-term measures. The prevalence of poor sleepers in this cohort was substantially higher than in the general population, regardless of shift pattern. The results obtained from the long- and short-term measures of sleep quality yielded opposing results, where long-term perceptions favoured the 12 h pattern, but short-term subjective and objective measures both favoured the 8h pattern.