Excessive Sleepiness Research Articles

Microstructural brain abnormalities, fatigue, and cognitive dysfunction after mild COVID-19

Although some studies have shown neuroimaging and neuropsychological alterations in post-COVID-19 patients, fewer combined neuroimaging and neuropsychology evaluations of individuals who presented a mild acute infection. Here we investigated cognitive dysfunction and brain changes in a group of mildly infected individuals. We conducted a cross-sectional study of 97 consecutive subjects (median age of 41 years) without current or history of psychiatric symptoms (including anxiety and depression) after a mild infection, with a median of 79 days (and mean of 97 days) after diagnosis of COVID-19. We performed semi-structured interviews, neurological examinations, 3T-MRI scans, and neuropsychological assessments. For MRI analyses, we included a group of non-infected 77 controls. The MRI study included white matter (WM) investigation with diffusion tensor images (DTI) and functional connectivity with resting-state functional MRI (RS-fMRI). The patients reported memory loss (36%), fatigue (31%) and headache (29%). The quantitative analyses confirmed symptoms of fatigue (83% of participants), excessive somnolence (35%), impaired phonemic verbal fluency (21%), impaired verbal categorical fluency (13%) and impaired logical memory immediate recall (16%). The WM analyses with DTI revealed higher axial diffusivity values in post-infected patients compared to controls. Compared to controls, there were no significant differences in the functional connectivity of the posterior cingulum cortex. There were no significant correlations between neuropsychological scores and neuroimaging features (including DTI and RS-fMRI). Our results suggest persistent cognitive impairment and subtle white matter abnormalities in individuals mildly infected without anxiety or depression symptoms. The longitudinal analyses will clarify whether these alterations are temporary or permanent.

Risk of sleep problems in a clinical sample of children who stutter

PurposePrevious studies have shown increased prevalence of sleep problems among people who stutter. However, there is a lack of knowledge about what these sleep problems may specifically be. MethodFifty children who stutter (CWS) from 6;0 to 12;9 years of age and 50 age- and gender-matched controls participated in this study. Parents did not report coexisting conditions, excepting stuttering and/or sleep problems. Sleep problems were investigated using a standardized questionnaire answered by parents. The questionnaire shows cut-off scores to identify the risk of sleep problems as a whole and on each one of the six subscales (i.e., disorders of initiating and maintaining sleep; sleep breathing disorders; disorders of arousal; sleep-wake transition disorders; disorders of excessive somnolence; and sleep hyperhidrosis). Scores above the cut-off are suggestive of sleep problems. ResultsTwenty-one CWS scored higher than the cut-off on the sleep questionnaire compared to only two controls (p < 0.00001). Specifically, CWS scored higher than controls in disorders of initiating and maintaining sleep, sleep-wake transition disorders (especially jerking, sleep talking, and bruxism), and disorders of excessive somnolence (p < 0.0083, corrected for multiple comparisons). DiscussionCompared to controls, CWS are at greater risk for sleep problems, which are not consequences of coexisting disorders. Present findings confirm and expand current knowledge about sleep problems in CWS. Directionality possibilities and clinical implications are discussed.

Manifestações neurológicas da Síndrome de Ogden: relato de caso

INTRODUCTION: The syndrome related to a mutation in the N-alpha-acetyltransferase 10 (NAA10) gene, an X-linked recessive disorder, Ogden Syndrome, presents in boys with severe developmental delay, central hypotonia, dysmorphic features, cardiac malformations, and early death in the first months of life. CASE REPORT: Male infant with hypotonia and craniofacial dysmorphisms: prominent forehead, triangular facies, bilateral microphthalmia, superior oblique palpebral fissure and epicanthus, increased nasolabial filter, tapered upper lip, sparse blond hair, long and light eyelashes. Delay in neuropsychomotor development, brief episodes of oromasticatory movements, sialorrhea, horizontal nystagmus, excessive sleepiness, and hypo-responsiveness, with oxygen saturation drop and bradycardia. Electroencephalogram: bursts of diffuse slow waves. Echocardiogram and electrocardiogram without alterations. Cranial resonance: cortical thickening in the right frontal lobe, small encephalomalacic area; signs of previous ischemic insult in the territory of the right posterior cerebral artery; areas of signal alteration in the central and deep white matter adjacent to the lateral ventricles with mild compensatory dilation of the same; and diffuse thinning of the corpus callosum of undetermined nature, treatment initiated. Genome identified a likely pathogenic variant in the NAA10 gene. Under treatment with phenobarbital and oxcarbazepine, and multiprofessional follow-up. DISCUSSION/CONCLUSION: Many patients present neuroimaging alterations, mainly: corpus callosum hypoplasia and microcephaly. Epilepsy around 69%, generalized, described eyelid myoclonias or spasms, or as identified in this patient: oromasticatory automatism. There is a need to include Ogden Syndrome in differential diagnoses and investigate the NAA10 gene in epilepsy and intellectual disability panels, even without multisystemic manifestations.

Excessive Drowsiness among Truck Drivers in Benin in 2023: Associated Factors and Risk of Crashes Occurrence

Excessive Drowsiness among Truck Drivers in Benin in 2023: Associated Factors and Risk of Crashes Occurrence

Acute Toxicity of Aqueous Extract from Bredemeyera floribunda Root Bark in an Animal Model

The medicinal plant Bredemeyera floribunda Willd. is used to treat cardiovascular disease, chronic fatigue, low libido, as well as increased diuresis. However, studies considering the toxicity of this plant are scarce. Develop an aqueous extract of B. floribunda considering traditional use and determine the average lethality (LD50), signs, and symptoms of toxicity. The B. floribunda extract was obtained by immersing the root bark in ultrapure water for 18 hours at 4°C, under constant stirring. The test extract was administered in a single dose of 2.000 mg/kg by gavage to rats. Signs and symptoms of toxicity were determined according to the Hippocratic screening test and compared with the control group. In addition, a necropsy was performed for macroscopic evaluation of the organs in the abdominal cavity. A powder was obtained from aqueous extracts that showed the same organoleptic characteristics and emulsification capacity as those presented by the fresh root when prepared according to popular tradition. The LD50 was greater than the test dose with three animals surviving. On the other hand, necropsy of dead rats showed necrosis and reduction in lung mass, in addition to the presence of foam and excessive distension of the stomach and intestines. The main symptoms of toxicity were anesthesia, ataxia, sedation, loss of muscle strength, and excessive drowsiness in the first 24 hours. There was no difference between the control and extract groups with regard to body mass, food, and water intake, as well as in macroscopy of the heart, liver, lungs, intestines, spleen, pancreas, and kidneys. The aqueous extract of the B. floribunda was considered nontoxic or of very low toxicity. However, it is capable of altering the activity of the central nervous system and causing disorders in the respiratory and digestive systems.

Ab. No. 94 Efficacy of Transcranial Direct Current Stimulation (TDCS) on the Quality of Sleep for Management of Sleep APNEA: A Review Study

Introduction: The purpose of the study was to evaluate the therapeutic efficacy of tDCS on quality of sleep for the conservative management of sleep apnea. Sleep Apnea is characterized by excessive diurnal sleepiness and neuropsychiatric changes (mood swings), affecting quality of life. Hence, this study explores the efficacy of tDCS on sleep quality to widen the spectrum of management for sleep apnea. Methods: Randomized clinical trials and cross over trials published within 2016 to 2023. The research was performed on various databases including PubMed, SCOPUS, and search engines including Research Gate and Google scholar. The data was limited to last 8 years (2016 to 2023). 20 Articles were identified out of which 7 articles full filled the inclusion criteria were selected. PRISMA methodology guidelines were used for data extraction. Qualitative analysis of study was done using PEDro scale. According to PEDro analysis, majority of articles included were good quality (score 4 to 6). Result: Total of 7 studies on efficacy of tDCS on sleep were reviewed, the data showed significant results on improving sleep quality. It was identified that tDCS uses cortico-thalamo-cortical feedback loop initiating slow wave activity which increases stage 3 and 4 (deep sleep) in Non Rapid eye Movement (NREM) sleep. Hence, improving the sleep quality and thereby quality of life. Conclusion: The use of tDCS in the treatment of sleep disorders such as sleep apnea is effective as an auxiliary source in the treatment, ensuring the resumption of patients’ quality of life by improving the quality and time of sleep. Thus, tDCS can be implemented as a choice of modality for management of individuals with sleep apnea. Implications: tDCS has found to be portable, feasible and relatively safe, thus can be used in management of sleep apnea patients.

Acute Dystonia Associated with Low-Dose Aripiprazole in a Male Child: A Case Report

Aripiprazole is a newer anti-psychotic agent with low liability for Extrapyramidal Symptoms (EPS). Acute dystonia develops due to a lack of dopamine, resulting in a relative overactivity of cholinergic neurons. In the past, cases of Aripiprazole-induced acute dystonia have been reported more frequently among adults than children. Here, the authors present a case in which acute dystonia developed at a very low dose (2 mg) of Aripiprazole. The case involves a 10-year-old boy diagnosed with Oppositional Defiant Disorder (ODD) who exhibited aggressive behaviour and irritability. Aripiprazole (2 mg) was initiated for treatment, but after five days, the patient developed excessive sleepiness, slurred speech, oculogyric crisis, and torticollis, indicative of acute dystonia. To rule out any organic causes, a detailed assessment and investigations were conducted, including complete blood counts, liver and kidney function tests, serum calcium, electrolytes, ceruloplasmin, blood copper levels, slit-lamp examination for Kayser-Fleischer ring, and electroencephalography, which did not reveal any significant organic conditions. Aripiprazole was discontinued, and Promethazine was administered. The dystonia score on the Unified Dystonia Rating Scale (UDRS) decreased from 10 to 0 in 5 days, indicating complete resolution of dystonia. Naranjo’s causality assessment score was seven, reflecting the probable association of aripiprazole with acute dystonia. This case emphasises the importance of monitoring for adverse reactions to anti-psychotic medications, particularly in paediatric patients, and the need for prompt recognition and management of adverse effects to ensure patient safety and treatment efficacy. To the best of our knowledge, this is the first case report of acute dystonia in a child at such a low dose of Aripiprazole. Clinicians should be vigilant for the emergence of such significant adverse effects of commonly used drugs.

Effects of sleep quality in early pregnancy on pregnancy outcomes and mood state.

To clarify the relationship between quality of sleep and pregnancy outcomes and to explore how sleep quality affects mood state in the first trimester of pregnancy. This prospective cohort study enrolled pregnant women from June 2020 to June 2021. Maternal sleep conditions, daytime sleepiness, and mood state in the first trimester were assessed using four Chinese self-rating scales, namely, the Pittsburgh Sleep Quality Index (PSQI), the Sleep Hygiene Practice Scale (SHPS), Epworth Sleepiness Scale (ESS), and the abbreviated version of the Profile of Mood States (a-POMS). Participants were divided into an exposed group (PSQI score > 5, poor sleep quality group) and a non-exposed group (PSQI score ≤ 5, good sleep quality group). Maternal characteristics, pregnancy outcomes, and the relationship among sleep quality, sleepiness, and mood state were analyzed. Comparisons of sleep hygiene behavior variables between the two subgroups were also analyzed. A total of 2703 pregnantwomen were enrolled in the study. Poor sleep quality increased the probability of gestational diabetes mellitus (GDM) (1.573, 1.315-1.863), liver function damage (1.467, 1.021-2.107), preterm delivery (1.468, 1.077-2.002), mild sleepiness (1.612, 1.357-1.915), and excessive sleepiness (2.134, 1.686-2.701). Poor maternal sleep quality was significantly associated with the occurrence of preterm premature rupture of membranes (1.947, 1.168-3.243) and perinatal death (1.003, 1.000-1.006). Additionally, a significant positive correlation between the PSQI score and the total mood disturbance (TMD) score was revealed by Spearman's correlation analysis (r = 0.378, P < 0.01). Enter Regression analysis demonstrated that sleep quality (R2 = 0.390, P < 0.01) and sleepiness (R2 = 0.234, P < 0.01) exerted significant direct effects on mood state during pregnancy. Furthermore, Spearman's correlation analysis indicated a positive association between the PSQI score and the SHPS total score (r = 0.227, P < 0.01). Poor sleep quality is significantly associated with elevated rates of maternal mood disturbances, obstetric complications, and adverse outcomes in infants. The findings suggest that it may be useful toprovide comprehensive sleep assessment and education on sleep hygiene during the early stages of pregnancy.

Sleep disturbances in children and adolescents after kidney transplantation.

Disturbances of sleep are prevalent among children with chronic kidney disease. However, the aetiology of sleep disorders in children particularly after kidney transplantation is not clear. We sought to ascertain the prevalence and type of sleep disturbances in paediatric kidney transplant recipients and to identify predictors of sleep disturbances in this population. Caregivers of kidney transplant recipients completed online questionnaires about their child's sleep. The questionnaires utilised were the Sleep Disturbance Scale for Children (SDSC), the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), questions about sleep hygiene, and questions about restless leg syndrome. Demographic and clinical details were collected from medical records. Thirty-five children were included in the study, with a median (IQR) age of 14.1years (9.5-16.1) and median years (IQR) since transplant of 3.7 (0.7-8.7) years, and 72.0% were identified to have at least one category of sleep disturbance according to scores on the SDSC. The most common sleep disturbances reported were disorders of initiating and maintaining sleep (DIMS) (40.0%) and disorders of excessive somnolence (DOES) (31.4%). Statistically significant predictors of sleep disturbances include low estimated glomerular filtration rate and increased age. Among children who screened positive for DIMS and DOES, the majority indicated use of electronic devices in 1h before bed. A high prevalence of sleep disturbances has been identified in children after kidney transplants, and some risk factors may be modifiable. Further studies are required to understand whether there are other readily modifiable predictors of sleep disturbances.

Monitoring Daytime Napping in Community Dwelling Older Adults Using Contactless Sleep Technologies

AbstractBackgroundIncreased daytime napping and excessive sleepiness are associated with cognitive decline in older adults, especially in people living with dementia (PLWD) [1]. Subjective assessments of naps are burdensome and maybe unreliable in PLWD and hence there is a need for technologies that provide objective longitudinal assessment of the incidence and duration of naps. Here we compare two contactless sleep technologies (CSTs) against sleep diary and actigraphy for monitoring daytime napping in community dwelling non‐demented older adults.MethodTwo under‐mattress CSTs (Withings Sleep Analyser [WSA] and Emfit QS [Emfit]) along with actigraphy (Actiwatch Spectrum [AWS]) were deployed in the home of 17 older adults for a period of 14 days ( = 65 years; Mean Age ± SD = 72 ± 4.49; 6 Women). The ground truth nap information was collected using an extended consensus sleep diary that included additional information about naps (timing, duration, and location). We analyzed the agreement of the napping events and duration estimated by WSA, Emfit and AWS against the sleep diary reported events.ResultThe CSTs only detected in‐bed naps whilst the AWS detected both in‐bed and not‐in‐bed naps. Although all the compared devices detected spurious naps unreported in the sleep diary, it was highest in AWS (81% of total naps detected) followed by Emfit (63%) and WSA (16%) as shown in Figure 1. Among the CSTs, WSA accurately detected more in bed naps while registering less spurious naps compared to Emfit but had lower duration agreement to sleep diary (Figure 2). Further, when the contribution of daytime naps to 24‐h total sleep time was computed, the WSA estimate (12.8±6.1%) was closest to the sleep diary estimate (12.9±9.1%) followed by AWS (15.6±9.9%) and Emfit (17.2±11.1%).ConclusionCSTs, with their ability to provide both contextual location information and objective measures of napping, such as timing and duration, offer a reliable and unobtrusive alternative to traditional methods such as sleep diary and actigraphy for long‐term round‐the‐clock monitoring of sleep in older adults.

Monitoring Daytime Napping in Community Dwelling Older Adults Using Contactless Sleep Technologies

AbstractBackgroundIncreased daytime napping and excessive sleepiness are associated with cognitive decline in older adults, especially in people living with dementia (PLWD) [1]. Subjective assessments of naps are burdensome and maybe unreliable in PLWD and hence there is a need for technologies that provide objective longitudinal assessment of the incidence and duration of naps. Here we compare two contactless sleep technologies (CSTs) against sleep diary and actigraphy for monitoring daytime napping in community dwelling non‐demented older adults.MethodTwo under‐mattress CSTs (Withings Sleep Analyser [WSA] and Emfit QS [Emfit]) along with actigraphy (Actiwatch Spectrum [AWS]) were deployed in the home of 17 older adults for a period of 14 days (≥65 years; Mean Age ± SD = 72 ± 4.49; 6 Women). The ground truth nap information was collected using an extended consensus sleep diary that included additional information about naps (timing, duration, and location). We analyzed the agreement of the napping events and duration estimated by WSA, Emfit and AWS against the sleep diary reported events.ResultThe CSTs only detected in‐bed naps whilst the AWS detected both in‐bed and not‐in‐bed naps. Although all the compared devices detected spurious naps unreported in the sleep diary, it was highest in AWS (81% of total naps detected) followed by Emfit (63%) and WSA (16%) as shown in Figure 1. Among the CSTs, WSA accurately detected more in bed naps while registering less spurious naps compared to Emfit but had lower duration agreement to sleep diary (Figure 2). Further, when the contribution of daytime naps to 24‐h total sleep time was computed, the WSA estimate (12.8±6.1%) was closest to the sleep diary estimate (12.9±9.1%) followed by AWS (15.6±9.9%) and Emfit (17.2±11.1%).ConclusionCSTs, with their ability to provide both contextual location information and objective measures of napping, such as timing and duration, offer a reliable and unobtrusive alternative to traditional methods such as sleep diary and actigraphy for long‐term round‐the‐clock monitoring of sleep in older adults.

Comparison of the clinical and electrophysiological characteristics between type 1 and type 2 narcolepsy: a cross-sectional study

IntroductionNarcolepsy is a chronic brain disease characterized by excessive sleepiness and classified into two types based on the presence of cataplexy or reduced level of cerebrospinal fluid orexin-A (hypocretine-1): narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2). These two types differ in symptoms other than cataplexy, as well as in certain examination findings. The present study aimed to investigate the clinical and electrophysiological characteristics of NT1 by comparing its features with those of NT2.MethodsSubjects were 118 first diagnosed and untreated patients with narcolepsy. They underwent both polysomnography (PSG) and multiple sleep latency test (MSLT) as a sleep test. Diagnosis was established in accordance with International Classification of Sleep Disorders, Third Edition, and the type of narcolepsy was determined by the presence or absence of cataplexy, patients with cataplexy were diagnosed with NT1, and without cataplexy were diagnosed with NT2. We investigated characteristics of the patients, PSG and MSLT outcomes, and applied a suite of duly statistical analysis to account for each parameter.ResultsAmong the 118 subjects, 35 patients (29.7%) were NT1, and 83 patients (70.3%) were NT2. Excessive daytime sleepiness which was measured by Japanese version of Epworth sleepiness scale (JESS) was significantly higher in NT1 than NT2. Furthermore, the presence of sleep hallucination (n = 29, 82.9%), sleep paralysis (n = 18, 51.4%), difficult maintaining sleep (n = 22, 62.9%), and sleep related movement and behavior disorders (n = 7, 20.0%) were significantly higher in NT1 than those in NT2. Additionally, parameters indicative of sleep fragmentation, such as the arousal index and wake time after sleep onset measured in PSG, exhibited a statistically significant increase in NT1 when contrasted with NT2.ConclusionsFragmentation of nocturnal sleep which is explained by the high arousal index and the long wake time after sleep onset on PSG was considered a characteristic finding of NT1 compared with NT2, and the patients with NT1 experienced greater difficulty of maintaining sleep. Concomitantly, the prevalence of NT1 in this study may be a representative value of the prevalence of NT1 among the patients with narcolepsy in Japan.

Sleep Apnea and Dental Implications -A Review

Obstructive sleep apnea (OSA) is an increasingly common, chronic, sleep-related breathing disorder.The prevalence of obstructive sleep apnea (OSA) continues to rise due to change in life patterns.The most common presenting symptom of OSA is excessive sleepiness and is associated with a 2- to 3-fold increased risk of cardiovascular and metabolic disease. The key contributors to OSA pathogenesis include a narrow, crowded, or collapsible upper airway “anatomical compromise” and “non-anatomical” contributors such as ineffective pharyngeal dilator muscle function during sleep, a low threshold for arousal to airway narrowing during sleep, and unstable control of breathing. Effective treatments include weight loss and exercise, positive airway pressure, oral appliances that hold the jaw forward during sleep, and surgical modification of the pharyngeal soft tissues or facial skeleton to enlarge the upper airway. This review summarizes the latest knowledge ondifferent contributors to OSA with a focus on emerging clinical tools.

Excessive day time sleepiness and its associated factors among adult population in an urban area of southern Rajasthan

Background: Sleep problems have been considered as an unmet public health problem. Sleep problems are mostly under reported and neglected by the Indian population. Very limited studies have been conducted in India on this aspect. Aims and Objectives: The aim of the study was to estimate the prevalence of excessive day time sleepiness (EDS) and its associated factors among urban adult population. Materials and Methods: A community based cross-sectional study was conducted among 409 adults of 20–60 years age group in urban Udaipur. Socio-demographic and other details were obtained using a semi structured questionnaire. Using Epworth Sleepiness Scale, assessment of EDS was assessed. Results: In the present study, mean age of the participants was 40.8 ± 11.3 years. Considering the ESS score of 10 or more, EDS was observed in 60.2% subjects. EDS was associated with age, gender, milk consumption, and mobile use. No significant association was found between EDS with central obesity, body mass index, marital status, literacy, occupation, exercise, smoking, and consumption of alcohol. Conclusion: In the present study, the prevalence of EDS was high. Therefore, early identification of excessive sleep problems and appropriate intervention that address the various determinants of the sleep problems is of prime importance.

A practical guide to improve sleep and performance in athletes

Sleep is vital for optimal mental and physical health. For athletes, optimizing sleep is becoming a popular strategy to enhance athletic performance. Athletes often complain of sleep problems including insufficient sleep and insomnia symptoms and are also at a higher risk for sleep disordered breathing. Sleep disorders and insufficient sleep can contribute to excessive sleepiness, daytime dysfunction, and performance problems. In contrast, better sleep provides benefits for physical health and athletic performance. For athletes, multiple factors can contribute to insufficient sleep. Sport-specific factors include frequent travel across time zones, competition and training schedules, high training loads, and sleeping in an unfamiliar environment. Non-sport-related factors include work, social, and family commitments; attitudes and sleeping beliefs; individual characteristics, such as chronotype or preference for morning or evening; and lifestyle choices. Fortunately, there are strategies that can be implemented to improve sleep in athletes including (a) education and emphasis on the importance of sleep; (b) sleep screening; providing extra sleep opportunities like (c) banking sleep and (d) napping; improving sleep hygiene like (e) proper light exposure; (f) a good pre-sleep routine; (g) a conducive sleep environment; (h) a strategy for supplementation; (i) utilizing circadian timing adjustments; and (j) jet lag management. Increased recognition of the importance of sleep from sport professionals and screening for sleep disorders and disturbances will be key for future athlete health, well-being, and performance.

P027 Insights from a 10-year Australasian consumer data registry study.

Abstract Introduction Idiopathic hypersomnia (IH) is a disorder of central hypersomnolence that results in excessive daytime sleepiness in the absence of another identifying cause. Case studies from sleep clinic patients have guided current knowledge but may not be a fair representation of the wider population of IH diagnoses. This study aims to better characterize patients diagnosed with IH in Australasia using online survey data. Methods A retrospective analysis of 686 participants from the Hypersomnolence Australia Consumer Data Registry sleep physician diagnosed with either IH (n = 554) or narcolepsy (NC) (n = 132) between January 2013 and January 2023 was performed. Results IH participants (98.9% had MSLT) reported additional sleep disorders such as OSA (16.4%) and restless leg syndrome (7.9%) and notable comorbidities included depression (46.2%) and anxiety (50%). Forty-two percent of IH participants were diagnosed after turning 33 years of age (compared to NC participants, 31.8%). The IH group reported more unrefreshing sleep, sleep drunkenness and the NC group reported more excessive sleepiness, hallucinations, sleep paralysis and automatic behaviour (all p values &amp;lt; 0.001). The most frequently used medication in both groups was dexamphetamine (IH = 44.2%, NC = 47.7%) but participants from the IH group were prescribed more modafinil and less armodafinil and sodium oxybate (p values &amp;lt; 0.001) than patients with NC. Further analyses are in preparation. Discussion This study demonstrates the value of consumer registries to better characterize symptomatology and co-morbidities in IH and NC and further research in these conditions.

Obstructive sleep apnea induced bilateral tonic- clonic seizure of unknown origin: A case series of a novel association

BackgroundObstructive sleep apnea is a highly prevalent disorder, characterized by recurrent events of upper airway obstruction during sleep and associated with recurrent cycles of desaturation and re-oxygenation, sympathetic hyperactivity, and intra-thoracic pressure fluctuations, resulting in fragmentation of sleep and subsequent daytime fatigue with excessive sleepiness. Obstructive sleep apnea-induced bilateral tonic–clonic seizures are unheard of. We aimed to report 3 patients with previously undiagnosed obstructive sleep apnea who presented to the emergency department with new onset bilateral tonic–clonic seizure without any evidential neurological or metabolic cause. MethodsPatient data were obtained from medical records from the Department of Internal Medicine, IPGMER and SSKM Hospital, Kolkata, and Belle Vue Clinic, Kolkata, India. ResultsThree male patients (67, 58, and 44 years old) presented with bilateral tonic–clonic seizure disorder without any underlying cause of seizures after rigorous investigations except for moderate to severe obstructive sleep apnea on polysomnography. All 2 patients were seizure-free after being treated with levetiracetam, chronic continuous positive airway pressure therapy in 2, and only continuous positive airway pressure in the other. The patients remained seizure-free on continuous positive airway pressure, even when levetiracetam was withdrawn, suggesting obstructive sleep apnea's causality in their new-onset acute seizures. ConclusionAlthough further investigation is required to clarify this association, underlying obstructive sleep apnea should be ruled out in patients with a first-ever bilateral tonic–clonic seizure. Whether or not continuous positive airway pressure alone could effectively treat hypoxia and deranged cortical excitability, which may lead to seizures in cases with long-standing obstructive sleep apnea, is yet to be explored.

The effect of circadian preference and sleep disturbances on depression in children 6 to 12 years of age

ABSTRACT Circadian rhythm and sleep disruption have been associated with depressive symptoms in children. This study was conducted to determine sleep disturbances and circadian preferences and their possible associations with depression in healthy children 6 to 12 years of age. A total of 111 healthy children (mean age 7.5 years; 62.2% male) were included. Sleep disturbances and depression were determined by the Sleep Disturbance Scale for Children (SDSC) and the Children’s Depression Inventory (CDI), respectively. Circadian preference was evaluated by the Morningness – Eveningness Stability Scale improved (MESSi). SDSC was correlated with CDI (r = 0.396, p < 0.001). Morning affect was inversely correlated with CDI (r = −0.405, p < 0.001), SDSC (r = −0.348, p < 0.001), and three subdimensions of SDSC, i.e. disorders of initiating and maintaining sleep (DIMS, r = −0.317, p = 0.001), disorders of arousal (DA, r = −0.375, p < 0.001) and disorders of excessive somnolence (DOES, r = −0.303, p = 0.001). Distinctness was inversely correlated with CDI (r = −0.402, p < 0.001) and SDSC (r = −0.274, p < 0.001). Increased use of electronic devices was associated with higher CDI (p = 0.003), while decreased duration of physical activity with higher SDSC (p = 0.017). Our findings support the recommendations addressing sleep and circadian preferences as lifestyle modifications in reducing depression in children.

Evaluation of selected factors influencing sleep disorders in paramedics during the COVID-19 pandemic.

Sleep disorders can develop as a result of exposure to stressors. The outbreak of the COVID-19 pandemic was an additional source of stress for paramedics, due to the fear of the unknown nature of the new pathogen. The main aim of this study was to identify factors influencing the development of sleep disorders among paramedics working during the COVID-19 pandemic. This was a cross-sectional, anonymous, voluntary, online survey conducted on social networks among paramedics working during the COVID-19 pandemic in Poland from 10/11/2020 to 14/01/2021. The survey included 387 participants, the majority of whom were men (72.35%). A proprietary questionnaire and standardized scales were used to identify risk factors: Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale. Among all participants, there were 107 (27.65%) women and 280 (72.35%) men. Significantly higher scores of the analyzed scales were observed in the female gender. Based on the AIS scale, mild sleep disorders were found in 3.6% of women and 2.9% of men. Excessive sleepiness on the Epworth scale was assessed in more than 70% of women and 58.8% of men working in Emergency Medical Teams (EMTs). The main factors influencing the development of sleep disorders were female gender, use of sleep aids and not having a life partner. In contrast, older age and longer job tenure, being married, and having good relationships with family members had a protective effect.

Sleep analysis of hospital and out-of-hospital emergency professionals

IntroductionSleep deprivation is associated with poorer cognitive functioning and a greater risk of serious diseases. Herein, we analyzed differences in the quality of sleep and excessive daytime sleepiness between hospital emergency services and out-of-hospital emergencies services, and investigated its association with sociodemographic and labor variables. MethodThis is a cross-sectional observational study carried out between April 2019 and February 2020, including healthcare professionals from different emergency departments, who were evaluated through the following instruments: “Pittsburgh Sleep Quality Index“ and “Epworth Sleepiness Scale”. ResultsFour-hundred and four healthcare professionals were included (mean age 40.4 ± 11.1 years), predominantly women (61.4%) from hospital emergency departments (62.6%). A total of 65.3% of the workers had poor sleep quality and 27.7% had excessive sleepiness. Women had poorer sleep quality (p = 0.022) and higher sleepiness (p = 0.010) than men. Hospital emergency workers presented 2-fold increased risk of poor sleep quality (OR = 1.93, p = 0.003) and sleepiness (OR = 1.93, p = 0.009) than out-of-hospital emergency workers. The more optimistic were less likely to have poor sleep quality (OR = 0.73, p = 0.01) or sleepiness (OR = 0.70, p = 0.002). Nurses, emergency medical technicians and nursing assistants also had a higher risk of poor sleep quality compared to physicians (OR = 1.60; p = 0.043). ConclusionsEmergency healthcare professionals working in hospital emergency departments had a two-times higher risk of poor sleep quality and sleepiness than out-of-hospital emergency healthcare professionals.