Frequent Nocturnal Awakenings Research Articles

Correlation Between Maternal Anxiety During Mid-Pregnancy and Subsequent Infant Sleep Issues: A Cross-Sectional Study from 2015 to 2016.

To explore the correlation between maternal anxiety during mid-pregnancy and infant sleep issues based on the anxiety status of mothers in mid-pregnancy. A cohort of 2122 primigravida women from Ma'anshan City, Anhui Province, was followed from pregnancy until 6 months postpartum. The study analyzed the impact of maternal anxiety on infant sleep patterns, including primary caregivers, encompassing insufficient sleep duration, frequent nocturnal awakenings, prolonged nocturnal awakening durations, and elongated sleep latency. A total of 1891 mother-infant pairs were included in this analysis. After adjusting for confounding factors, a positive correlation was found between maternal anxiety during mid-pregnancy and insufficient sleep duration (OR=1.69, 95% CI:1.13-2.52), and elongated sleep latency (OR=2.26, 95% CI:1.61-3.18). Maternal anxiety during mid-pregnancy is associated with sleep issues in infants. Addressing maternal mental health during pregnancy may enhance sleep quality for mothers and infants, promoting overall maternal-infant health.

Sundowning in Patients with Dementia: Identification, Prevalence, and Clinical Correlates.

The term sundowning is used to describe the emergence or worsening of neuropsychiatric symptoms in late afternoon or early evening in people with dementia. Our aim was to evaluate sundowning's prevalence and clinical manifestations among patients attending a tertiary memory clinic and to investigate its clinical and neuropsychological correlates. Patients with dementia attending our memory clinic were enrolled in the study. Sundowning was identified through a specifically designed questionnaire. Sociodemographic and clinical features of sundowners and non-sundowners were compared, and a logistic regression was performed to identify the variables associated with the phenomenon. A subgroup of patients underwent a complete neuropsychological assessment. Among 184 recruited patients, 39 (21.2%) exhibited sundowning, mostly expressed as agitation (56.4%), irritability (53.8%), and anxiety (46.2%). Sundowners were significantly older, had a later dementia onset, exhibited more severe cognitive and functional impairment, more frequent nocturnal awakenings, and hearing loss relative to non-sundowners. They were also more likely to use anticholinergic medications and antipsychotics, and less likely to use memantine. In a multi-adjusted model, the factors significantly associated with sundowning were the Clinical Dementia Rating score (OR 3.88; 95% CI 1.39-10.90) and the use of memantine (OR 0.20; 95% CI 0.05-0.74). Participants with and without sundowning obtained similar results in single domain neuropsychological tests. Sundowning is commonly experienced by patients with dementia and appears as a multiply determined condition. Its presence should always be evaluated in clinical practice and a multidimensional approach should be adopted to identify its predictors.

1039 The Progression of Sleep-Related Breathing Disorders in a Patient with Joubert syndrome

Abstract Introduction Joubert syndrome (JS) is a rare autosomal recessive disease characterized by malformations of the cerebellar vermis, hypotonia, developmental delay, and respiratory variability. Among the potential health challenges that children with congenital malformations of the central nervous system including JS, may face, sleep concerns are frequent and may include sleep-related breathing disorders (SRBDs). Report of case(s) A 17-month-old female with JS was referred to the pediatric pulmonary clinic due to disrupted and fragmented sleep. She had frequent nocturnal awakenings, snoring, mouth breathing, and witnessed apneas. There was no family history of SRBDs. Physical exam was notable for high-arched palate, diffuse hypotonia, and intermittent periods of tachypnea followed by apneas, even when awake. Her polysomnography (PSG) demonstrated an apnea-hypopnea index (AHI) of 27.1/hour, with the obstructive apnea-hypopnea index (oAHI) of 18/hr with central apnea index (CAI) of 9.1/hr and nadir oxygen saturation (SpO2) of 87%. An attempt was made to initiate supplemental oxygen; however, the patient did not tolerate the cannula. At that time, neither adenoid nor tonsillar hypertrophy were noted and surgical intervention was not indicated. The repeat PSG one year later demonstrated AHI of 9.1/hour, oAHI of 4.7/hr with CAI of 4.4/hr and nadir SpO2 of 84%. At this time, she did demonstrate enlarged adenoids and tonsils and underwent adenotonsillectomy with some clinical improvement in snoring. Her mother noted continued pauses in breathing and post operative PSG demonstrated AHI of 12.8/hour, oAHI of 1.4/hr and CAI of 11.4/hr and nadir SpO2 of 79%. The patient had demonstrated worsening episodic tachypnea and central apneas and the decision was made to attempt initiation of a respiratory assist device to regulate breathing and ventilation. Due to the patient’s age, intensive therapy desensitization is required to allow her to tolerate positive airway pressure therapy. Conclusion Patients with JS are at high risk for complex SRBDs as part of their clinical presentation. It is therefore important to carefully monitor the character of sleep-disordered breathing, offering appropriate treatments where indicated. It is important to note the added challenges of young pediatric patients who often require deliberate desensitization interventions to proceed with successful treatment. Support (if any)

1037 Central sleep apnea due to high altitude periodic breathing

Abstract Introduction Many popular tourist destinations are at high-altitude. Visitors commonly report poor sleep quality during the first few nights after arriving, but some do not resolve over time and daytime symptoms may develop that require medical attention. Report of case(s) A previously healthy 76-year-old American man presented with progressive fatigue and frequent nocturnal awakenings to a clinic in Bogota, Columbia (altitude 2640 meters), where he had been living for eighteen months during the COVID-19 pandemic lockdown due to limited ability to travel. An arterial blood gas on room air revealed hypocapnia with a partial pressure of CO2 of 25 mmHg. A polysomnography (PSG) performed in Bogota demonstrated an apnea-hypopnea index (AHI) of 98 events/hour consisting of predominately central as well as obstructive respiratory disturbances (Figure 1). After a titration study, he was placed on treatment with continuous positive airway pressure (CPAP) at 10 cmH2O along with oxygen 1 L/min, but he had difficulty acclimating to treatment. The patient presented to our institution two months after returning to the USA with significantly improved symptoms despite remaining off CPAP. Repeat PSG revealed a substantial reduction in the AHI at 15 events/hour consisting of only central respiratory disturbances in the supine position during transitional N1/N2 sleep (Figure 2). Positional therapy was recommended. A repeat home sleep study performed three months later to reassess disease severity during non-supine sleep showed resolution of respiratory disturbances (Figure 3). High-altitude periodic breathing is a common phenomenon, characterized by alternating periods of absent respiratory efforts with periods of hyperventilation without another etiology (1, 2). It occurs due to the interaction of hypocapnia and increased loop-gain (2). Central sleep apnea (CSA) is considered a disorder only when associated with symptoms, not simply due to an elevated central apnea index (3). The more rapid ascent and the higher the altitude, the greater risk of developing periodic breathing. Descending to a lower altitude will often resolve apnea after few days but the phenomenon can persist for up to months (2, 4) as our patient. Conclusion CSA develops commonly upon ascent to high altitude. When feasible, symptomatic patients should be encouraged to descend to a lower altitude. Support (if any)

Жалобы на нарушения сна у детей 5—13 лет: распространенность и содержание. Часть 1

<p>Sleep-related complaints are common in children and affect their daytime sleepiness, success and quality of life. However, often parents are unaware of or do not consider them as a problem demanding treatment. <strong>Aim.</strong> To identify the parental appraisals of the patterns and difficulties with sleep in children aged 5—13 years and parental subjective qualification of them as a problem. <strong>Methods.</strong> In 147 pairs of «parent-child 5—13 years old without diagnosed sleep disorders» (47 pairs with a child 5—6 years old, 49 with a child 7—9 years old, 51 with a child 10—13 years old), parents answered questions about the pattern children’s sleep habits and completed the Children’s Sleep Habits Questionnaire. Children replied to Sleep Self-Report. <strong>Results.</strong> Difficulties with sleeping are common in children 5—13 years of age: irregular bedtimes, prolonged time falling asleep, falling asleep in someone else’s bed, night terrors, insufficient sleep time, frequent nocturnal awakenings, sleep-talking, early morning awakenings, long time to get up in the morning, fatigue in the afternoon 3 times a week or more are typical for every third child, while protests against going to bed, the impossibility of waking up on their own in the morning, difficulties in getting up in the morning — for every second child. For children 10—13 years old, lack of sleep was also wide-spread. Parents frequently do not consider sleep difficulties in children as a problem. The pattern of going to bed, sleeping, and waking up didn’t not differ between boys and girls, but girls rated their sleepiness higher, and rated sleep quality lower. With age, daytime and nighttime sleep was reduced, bedtime became later, while breathing problems during sleep, parasomnia symptoms and night terrors became rarer. <strong>Conclusion.</strong> Given the prevalence of complaints about various difficulties associated with sleep in children aged 5—13 years, the acute question is why parents do not qualify these difficulties as problems and do not seek help is relevant.</p>

Depressive symptoms and sleep disturbances in late pregnancy: Associations with experience of induction of labor with a catheter

ObjectiveDepressive symptoms and sleep disturbances have been found to be associated with negative labor experiences, particularly an increased level of pain. However, the associations between maternal depressive symptoms and sleep disturbances and the experience of induction of labor (IOL) remain unknown. In this study, we evaluated these associations with balloon catheter IOL. Study designA prospective study was conducted on 106 women with planned IOL. Depressive symptoms were evaluated with The Edinburg Postnatal Depression Scale (EPDS) and sleep disturbances with the Basic Nordic Sleep Questionnaire (BNSQ) at the beginning of IOL. The IOL experience was investigated both during the IOL and postpartum with the same nine visual analogue scale (VAS) questions. ResultsRegarding sleep disturbances, during the IOL, women with worse general sleep quality were less satisfied (P = 0.019), less relaxed (P = 0.008), experienced more pain in general (P = 0.002) and reported higher contraction frequency (P = 0.003). Furthermore, women who experienced difficulties falling asleep were less relaxed (P = 0.009), reported more general pain (P < 0.001) and contraction pain (P = 0.005), while those with more daytime sleepiness reported less contraction pain (P = 0.033). In postpartum, women with worse general sleep quality reported more general pain (P = 0.003), while women with longer sleep duration and those with higher sleep loss reported more anxiety (P = 0.009 and P = 0.024, respectively). Additionally, women who woke up too early in the morning were less satisfied (P = 0.042), less relaxed (P = 0.004) and reported more general pain (P = 0.018). However, those who experienced more frequent nocturnal awakenings reported being more relaxed (P = 0.014) and having less general pain (P = 0.033). Higher depressive symptoms were associated with a higher frequency of contractions during IOL (P = 0.030), but with less general pain in postpartum (P = 0.027). ConclusionsWomen with sleep disturbances during pregnancy were more likely to report more negative experiences during the IOL. Specifically, they reported more pain, feeling less relaxed and they were less satisfied with IOL. Conversely, the association between depressive symptoms and the experience of IOL seemed weaker. Thus, the quality of sleep of pregnant women is important for a better experience of IOL.

Periodic leg movements during sleep and iron status in infants with prematurity, Down syndrome and Prader-Willi syndrome.

Sleep disturbances including bedtime problems and night awakenings are common during infancy. Polysomnography during the first years of life is performed mainly to rule out sleep-disordered breathing; however, sleep-related movement disorders can constitute a significant contributor to sleep disruption in this age group. Almost no studies have investigated the presence of periodic limb movements during sleep and underlying iron deficiency in infants, especially in those born preterm or with an underlying genetic syndrome. In this retrospective study we included infants 3-24 months referred for polysomnography for snoring or frequent nocturnal awakenings. All children had bloodwork (ferritin and haemoglobin) conducted within 3months of the overnight sleep study. We studied 79 infants, including 31 (39.2%) full-term without diagnosis, 10 (12.7%) born premature, 16 (20.3%) with Down syndrome, 15 (19.0%) with Prader-Willi syndrome, and the remaining seven (8.9%) had various disorders. Compared with those with Down syndrome, Prader-Willi syndrome and full-term infants, those with prematurity showed a statistically significant elevated periodic limb movement index and lower ferritin levels than the other groups. Both ferritin (r= -0.18) and haemoglobin (r= -0.30) were negatively correlated with periodic limb movement index; however, this correlation reached statistical significance only for haemoglobin. Iron deficiency is associated with increased periodic leg movements during sleep in infants. Infants with prematurity had higher periodic limb movement index and lower ferritin levels than infants with Down syndrome, Prader-Willi syndrome or without diagnosis.

Linking chronic stress to insomnia symptoms in older adults: The role of stress co-occurrence during the pandemic.

Studies examining the associations of chronic stressors with sleep health in older adults have shown conflicting results. While the COVID-19 pandemic increased perceived stress at the population level, less is known about chronic stressors experienced by older adults in the context of the COVID-19 pandemic and its impact on sleep health in an aging population. This study aims to examine the association of older adults' chronic stress with insomnia symptoms during the first year of the COVID-19 pandemic. A cross-sectional analysis was performed using early-release COVID-19 data from the Health and Retirement Study. Data on chronic stressors and insomnia symptoms in older adults (N = 2021; mean age = 68.8) were examined. Co-occurrence network analysis, latent class analysis, Rao-Scott χ2 tests, and multivariable logistic regression were used to characterize the co-occurrence of chronic stressors and associations with insomnia symptoms. The most common co-occurring chronic stressors during the first year of the COVID-19 pandemic were self-health issues, family-health issues, and financial stress. Older adults experiencing frequent stress co-occurrence had 91% higher odds of difficulty initiating sleep (p < 0.001), 40% higher odds of frequent nocturnal awakening (p = 0.028), and 83% higher odds of nonrestorative sleep (p < 0.001). However, adjustment for health risk factors and COVID-19 concerns attenuated the effects, leaving strongest association for difficulty initiating sleep (odds ratio = 1.51, p = 0.010). Frequent stress co-occurrence plays an important role linking chronic stress to insomnia symptoms in an aging population. Ongoing research is needed to examine the lingering effects of frequent stress co-occurrence on older adults' sleep health in the post COVID-19era.

Sleep architecture and emotional inhibition processing in adolescents hospitalized during a suicidal crisis.

BackgroundSuicide is the second leading cause of death in adolescents. Sleep disturbances could alter inhibitory processes and contribute to dangerous behaviors in this critical developmental period. Adolescents in suicidal crisis have been shown to have lighter sleep compared to healthy controls. Additionally, suicidal adolescents have lower neural resources mobilized by emotionally charged inhibition processing. The present exploratory study aimed to determine how sleep architecture in suicidal adolescents may relate to inhibition processing in response to emotional stimuli.MethodsTen adolescents between 12 and 17 years of age with a diagnosis of major depressive disorder and who attempted suicide were recruited while hospitalized for a suicidal crisis in a psychiatric inpatient unit. Event-related potentials (ERPs) were recorded prior to bedtime during a Go/NoGo task involving pictures of sad, happy, and neutral faces. Polysomnography was then recorded throughout the night. Pearson correlations were conducted to investigate how inhibition performance and ERP parameters reflecting inhibition processing (i.e., P3d and N2d derived from difference waveform calculated as NoGo minus Go trials) relate to sleep architecture.ResultsPoorer inhibition accuracy in response to emotional stimuli was significantly correlated with shorter REM sleep latency, higher REM sleep, and more frequent nocturnal awakenings. The P3d in response to sad faces was negatively correlated with NREM2 sleep and positively correlated with NREM3 sleep. No such association with the P3d was found for happy or neutral stimuli. There were no significant correlations for the N2d.ConclusionAltered sleep in adolescents with depression who are in a suicidal crisisis associated with behavioral inhibition difficulties and fewer neural resources mobilized by inhibitory processes in emotionally charged contexts. This highlights the importance of addressing sleep disturbances while managing suicidal crises in adolescents.

0830 A Pediatric Case of Myoclonic Seizures Precipitating Central Sleep Apnea And Sequences of Periodic Breathing During Sleep

Abstract Introduction Myoclonic seizures are known to be influenced by the sleep-wake cycle. Although myoclonic seizures have been shown to alter sleep architecture, little is known about their influence on sleep-disordered breathing. Report of Cases: A 7-year-old male with a history of generalized epilepsy of unknown etiology with absence as well as myoclonic seizures, poor impulse control, and fine motor delay was referred for restless sleep and frequent nocturnal awakenings. A routine electroencephalography (EEG) performed 33 months prior to presentation, at an outside institution, reportedly showed 3.0 Hz generalized frontally dominant spike and wave discharges lasting less than two seconds. Video EEG (vEEG) revealed diffuse bilateral poly-spike and slow wave discharges, predominantly during sleep, and myoclonic seizures with abrupt whole-body jerks. Polysomnography, at this time, was characterized by mild central sleep apnea (AHI: 3.7; OAHI: 0.0; CAI: 2.8; REM AHI: 14.4). His lamotrigine dosing was increased to from 1.8 mg/kg/day to 3.6 mg/kg/day, at presentation, with seizure control for three months but he developed a recurrence of myoclonic seizures in the setting of sleep deprivation. A repeat vEEG was similar to previous findings and his lamotrigine was increased further and clobazam was added. Due to worsening behaviors, clobazam was discontinued and a weaning plan for lamotrigine was formulated. Repeat polysomnography demonstrated worsening central sleep apnea (AHI: 18.3, OAHI: 2.3), without hypoventilation, characterized by sequences of periodic breathing that occurred in conjunction with myoclonic seizures. The majority of seizure-induced periodic breathing episodes were observed during a one-hour period of NREM sleep near the end of the study. Stereotyped epileptiform activity occurred in conjunction with a resumption of hyperventilatory respirations following apneic events. The increased respiratory drive, however, did not appear to be clinically epileptic in nature as the epileptiform activity either preceded or trailed the respirations. A variable REM and then NREM predominance of central events on successive polysomnograms further suggests that his central events are not intrinsic but that they are precipitated by epileptiform activity. Zonisamide, an anticonvulsant with carbonic anhydrase inhibitory properties was initiated and is being titrated to therapeutic goal. Conclusion This case illustrates an unusual presentation of myoclonic seizure-induced periodic breathing during sleep. Support (If Any) Cincinnati Children’s Research Foundation.

Associations of sleep problems with asthma and allergic rhinitis among Chinese preschoolers

The aim of this study was to examine the associations of sleep problems with asthma and allergic rhinitis among Chinese preschoolers. This cross-sectional survey was conducted in Guangzhou, China. Children aged 3–6 years were recruited from 32 kindergartens in 7 administrative districts. Asthma, allergic rhinitis and sleep problems were evaluated using a valid questionnaire. Binary logistic regression models were employed to estimate the odds ratios (OR) and 95% confidence intervals (CI) for the associations of asthma and allergic rhinitis with short sleep duration, late bedtime and frequent nocturnal awakening. We included 4876 preschool children in the current analysis. Of these, 182 (3.7%) diagnosed as asthma, and 511 (10.5%) diagnosed as allergic rhinitis. Frequent nocturnal awakening was associated with asthma and allergic rhinitis, with adjusted OR were 1.49 (95% CI 1.05–2.13) and 1.59 (95% CI 1.27–1.99), respectively. Subgroup analysis showed the OR for frequent nocturnal awakening with asthma was higher in girls (1.68; 95% CI 1.02–2.78) than in boys (1.35; 95% CI 0.81–2.24), but the OR for frequent nocturnal awakening with allergic rhinitis were similar in girls (1.73; 95% CI 1.15–2.30) and boys (1.57; 95% CI 1.17–2.12). No significant associations of short sleep duration and late bedtime with asthma or allergic rhinitis were identified. Our data suggested that frequent nocturnal awakening was associated with asthma and allergic rhinitis among preschoolers, and the association of frequent nocturnal awakening with asthma differed by gender. Further studies are warranted to address the causal relationship between nocturnal awakening and asthma and allergic rhinitis.

Sleep Disturbance and Sympathetic Reactivity in Menopausal Women

IntroductionCardiovascular disease (CVD) is the leading cause of death in women. Sleep disturbances (DS), such as insomnia or frequent nocturnal awakenings, may increase the risk of CVD. Prior work suggests that autonomic blood pressure (BP) dysregulation in postmenopausal women may exaggerate risk of hypertension (HTN) and CVD. In addition, individuals with greater BP and sympathetic neural responses to stressors, such as a cold pressor test (CPT), demonstrate future risk for HTN development. Further, when exposed to 24‐hour sleep deprivation, older women, but not older men, demonstrate greater sympathetic activity. It is unknown, however, if women who experience DS demonstrate a greater sympathetic reactivity to a CPT. The purpose of this study was to determine if postmenopausal women with DS exhibit sympathetic reactivity to a CPT compared to women without DS.MethodsEighteen women (62±1yrs old; mean±SE) participated in two study visits. Visit 1: Informed consent and medical and health questionnaires. Visit 2: DS was assessed by the Menopause‐Specific Quality of Life questionnaire. Participants were classified as having disturbed sleep (DS; n=10) or non‐disturbed sleep (NDS; n=8) based on a scale of 1 indicating ‘none’ and 2‐8 being how bothersome it is. The study was conducted in the morning after overnight fast and abstinence of alcohol, caffeine, and exercise. Muscle sympathetic nerve activity (MSNA) was measured from the peroneal nerve using microneurography. Heart rate (HR) via 3‐lead electrocardiography, MSNA, and beat‐to‐beat BP using a non‐invasive finger cuff were measured during a 10‐min quiet rest and a two‐min CPT of the left hand.ResultsMenopause onset ranged from 40‐57yrs (50±1yrs). Body mass index was similar between groups (DS=25±1kg/m2, NDS=24±2kg/m2, p=0.53). MSNA burst incidence (bursts/100 heart beats, hb) increased throughout the CPT (time effect, p&lt;0.01), but increases were not significantly different between DS (Δ19±6b/100hb; 95% CI [7,31]) and NDS (Δ11±6b/100hb; 95% CI [‐2,24]) (time*group, p=0.36) groups. Systolic BP, Diastolic BP and HR increased similarly (p&gt;0.05) during the CPT for both groups. Sleep difficulty score was correlated with resting diastolic BP (r=0.43, p=0.03) and trended to correlate with the age of menopause (r= ‐0.37, p=0.05).ConclusionThese findings suggest that women with DS do not demonstrate greater sympathetic reactivity to a CPT, however, we did observe that DS was linked to greater diastolic BP at rest and appeared to be more bothersome for women who completed menopause at an earlier age. These findings suggest a pathway by which disrupted sleep may contribute to the future development of HTN and CVD in postmenopausal women.

Enchanced preoperative rehabilitation as part of the complex perioperative rehabilitation of patients with super-obesity and obstructive sleep apnea syndrome (clinical outlook)

Obesity is a global social and economic problem. The bariatric surgery is a most effective treatment for obesity. The presented clinical case demonstrates the usage of principles of enchanced perioperative rehabilitation for the preoperative preparation of a patient with super obesity and with severe obstructive sleep apnea and alveolar hypoventilation syndrome.A 54-year-old patient was hospitalized with complaints of obesity, impossibility of persistent weight loss conservatively, severe daytime sleepiness, frequent nocturnal awakenings (up to 8 times per night). The patient’s weight was 230 kg with a height of 157 cm (BMI 93.5 kg / m2). The examination revealed a syndrome of sleep apnea of mixed genesis of extremely severe degree, chronic night hypoxemia of an extremely severe degree. Preoperative preparation was performed in accordance with the program of enchanced perioperative rehabilitation. The duration of preoperative preparation was 19 days; weight loss — 40 kg (%WL -17,4), compensation of comorbidities was achieved as well. After that the patient underwent a laparoscopic sleeve gastrectomy. There were no complications in the postoperative period. Length of postoperative hospital stay was 6 days. At follow-up examination one year after surgery, body weight dropped from 230 to 153 kg (% WL-33.5), a significant improvement of the quality of life was achieved.The enchanced perioperative rehabilitation program can be successfully used as an effective method for preoperartive preparation of the patients with morbid obesity in combination with severe obstructive sleep apnea syndrome.and obesity hypoventilation. It can be a reasonable alternative to the standard program with preoperative intragastric balloon treatment. The use of this technique allows to increase the effectiveness of treatment of these high-risk patients, as well as to reduce the risk of perioperative complications.

Relationships between locus coeruleus structural integrity and nocturnal awakenings in the context of AD biomarkers: A 7T MRI study

AbstractBackgroundThe brainstem locus coeruleus (LC) may constitute the intersection of the initial pathophysiological and clinical phenotypes of Alzheimer’s disease (AD). Tau protein accumulation starts early in the LC and sleep‐wake disruption occurs in early stages of AD, potentially reflecting arousal dysregulation in wake‐promoting neurons of the LC. Here, we sought to investigate whether LC structural integrity could be related to subjective sleep‐wake measures in the context of AD biomarkers.MethodWe used an in‐house developed LC‐specific MRI sequence at 7T in 72 cognitively normal older participants (mean age = 65.2 ± 8.2y; 37 women), and we identified sub‐portions of the LC using intensity‐based cluster analyses. Participants’ reports on habitual sleep quality and nocturnal awakenings were collected. In addition, blood‐based biomarker of total tau was measured, and APOE genotype was determined.ResultTwo distinct LC segments were identified, with one covering the middle‐to‐caudal LC and displaying lower intensity compared to the middle‐to‐rostral cluster (t(70) = ‐4.40, p &lt; .0001). Generalized linear mixed models adjusted for age, sex, depression, and APOE status showed that subjective sleep quality was not related to any LC integrity measures. However, we found that lower MRI signal intensity within the middle‐to‐caudal LC, but not in the middle‐to‐rostral LC, was associated with a higher number of self‐reported nocturnal awakenings (F1,63 = 4.89, p = 0.03). Furthermore, this association was mostly evident in individuals with elevated levels of total tau (F1,61 = 4.23, p = 0.04).ConclusionOur findings provide in vivo evidence that worse LC structural integrity is associated with more frequent nocturnal awakenings in the context of neurodegeneration, in cognitively normal older individuals. In addition, they further emphasize the role of the LC in the arousal‐ascending system as an important neurobiological correlate of sleep‐wake regulation, and hold promise for the identification of at‐risk populations for preventive interventions.

Clinical, laboratory and psychological aspects of moderate COVID-19 in cardiovascular patients one month after discharge from the hospital

Aim. To study clinical, laboratory and psychological aspects of moderate coronavirus disease 2019 (COVID-19) in cardiovascular patients one month after discharge from the hospital.Material and methods. The study included 88 patients with cardiovascular diseases hospitalized for COVID-19. After 1 month, 72 respondents continued the participation in the study. Medical history collection, physical examination, and diagnostic investigations were performed. We used the Hospital Anxiety and Depression Scale (HADS) by Zigmond A. S., Snaith R. P., Beck Anxiety Inventory scale, Mini-mental State Examination (MMSE) scale for assessing mental status.Results. One month after discharge, there was a decrease in the number of patients with signs of impaired respiratory system, such as cough, shortness of breath, chest congestion, while a decrease in exercise tolerance persists was revealed in 80,5% (out of 95,5% during hospiatalization), generalized weakness and increased sweating — in 69,5%. In addition, 38,9% of patients noted a noticeable, newly reported, hair loss. Attention is drawn to the high prevalence of neurological symptoms during hospiatalization, including dizziness, severe headaches not relieved by analgesics and non-steroidal anti-inflammatory drugs, lethargy, disorientation of place and time, and in some cases even hallucinations. Some of the symptoms persist after 1 month: 55,5% note a decrease in memory, 36% — feelings of fear and anxiety, 63,9% — sleep disorders in the form of frequent nocturnal awakenings (19,4%), insomnia (16,6%), long falling asleep (11,1%). Some of the respondents revealed unfavorable events over the past month as follows: blood pressure (BP) destabilization in the form of episodes of BP increase and decrease during the day — 36,0%, hypertensive crisis — 14,0%. There was an increase in the number of patients with subclinical and clinical depression (p&lt;0,05). There was also an increase in the number of patients with hypercholesterolemia compared with inhospital data by 15,5%.Conclusion. One month after discharge, the respiratory symptoms naturally decrease, but new symptoms appear, such as shortness of breath during exercise, fatigue, unsteady gait, hair loss, and increased sweating. There was an increase in the number of patients with subclinical and clinical depression on the HADS scale. Among laboratory parameters, an increase in the number of patients with increased level of total cholesterol and low-density lipoproteins was revealed.

Associations between locus coeruleus integrity and nocturnal awakenings in the context of Alzheimer\u2019s disease plasma biomarkers: a 7T MRI study

BackgroundThe brainstem locus coeruleus (LC) constitutes the intersection of the initial pathophysiological processes of Alzheimer’s disease (AD) and sleep-wake dysregulation in the preclinical stages of the disease. However, the interplay between in vivo assessment of LC degeneration and AD-related sleep alterations remains unknown. Here, we sought to investigate whether MRI-assessed LC structural integrity relates to subjective sleep-wake measures in the context of AD plasma biomarkers, in cognitively unimpaired older individuals.MethodsSeventy-two cognitively unimpaired older individuals aged 50–85 years (mean age = 65.2 ± 8.2 years, 37 women, 21 APOE ε4 carriers) underwent high-resolution imaging of the LC at 7 Tesla, and LC structural integrity was quantified using a data-driven approach. Reports on habitual sleep quality and nocturnal awakenings were collected using sleep questionnaires. Plasma levels of total tau, p-tau181, Aβ40, and Aβ42 were measured using single-molecule array technology.ResultsIntensity-based cluster analyses indicated two distinct LC segments, with one covering the middle-to-caudal LC and displaying lower intensity compared to the middle-to-rostral cluster (t70 = −5.12, p < 0.0001). After correction for age, sex, depression, and APOE status, lower MRI signal intensity within the middle-to-caudal LC was associated with a higher number of self-reported nocturnal awakenings (F1,63 = 6.73, pFDR = 0.03). Furthermore, this association was mostly evident in individuals with elevated levels of total tau in the plasma (F1,61 = 4.26, p = 0.04).ConclusionOur findings provide in vivo evidence that worse LC structural integrity is associated with more frequent nocturnal awakenings in the context of neurodegeneration, in cognitively unimpaired older individuals. These results support the critical role of the LC for sleep-wake regulation in the preclinical stages of AD and hold promises for the identification of at-risk populations for preventive interventions.

Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system.

Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system.

823 Apparent seizure activity in a 9 year old female presenting as hypnopompic hallucinations

Abstract Introduction The presence of hypnopompic hallucinations raises concerns for narcolepsy. However, sleep-related hallucinations may occur in other settings. Dreams at sleep-wake transitions may be difficult for patients to differentiate from sleep-related hallucinations. Sleep-related hallucinations are predominantly visual, although they can be auditory, tactile and/or kinetic. However, they are generally not olfactory in nature. Report of case(s) Here we present a case of a 9-year-old female with a history of tonsillectomy and adenoidectomy, ADHD, ODD, nocturnal enuresis, nocturia, aggressive behaviors and emotional outbursts who presented with EDS, frequent nocturnal awakenings, involuntary dozing, prolonged naps and a one year duration of hypnopompic hallucinations. Initially, the hallucinations occurred 2–3 times per week, but then decreased in frequency to 2–3 times per month. The frequency of episodes apparently decreased after tonsillectomy. She states that she wakes up and sees dots, and “she looks scary” when she looks at herself. She describes a variety of hallucinations including: seeing dots (including her mother being covered in dots), a cupcake, a strange woman walking, her hands looking strange--they had enlarged or hearing noises (a single loud bang). Pertinent physical exam findings included: BMI 66th percentile, Mallampati score 2/4, and a mildly enlarged tongue. The polysomnogram demonstrated mild obstructive sleep apnea by pediatric criteria, and, most notably, demonstrated an EEG with spike and wave formations in the central and frontal leads bilaterally. These were seen during NREM sleep and most prominently during sleep-wake transitions. There was also a more focal brief run of a regular 2 Hz rhythm in the central and frontal leads bilaterally. A referral was placed to Pediatric Neurology who ordered a full EEG which is pending at this time. Conclusion Sleep-related hallucinations may occur in narcolepsy, other sleep disorders, a mental disorder, a medical disorder, a medication effect or secondary to substance use. This case suggests that seizure activity may present as hypnopompic hallucinations as well. Support (if any):

Impact of pulmonary rehabilitation in sleep in COPD patients measured by actigraphy.

Chronic obstructive pulmonary disease (COPD) patients have poor sleep quality, longer time to sleep onset and frequent nocturnal awakenings. Poor sleep quality in COPD is associated with poor quality of life (QoL), increased exacerbations and increased mortality. Pulmonary rehabilitation (PR) improves functional status and QoL in COPD but effects on sleep are unclear. PR improves subjective sleep quality but there is paucity of objective actigraphy data. We hypothesized that actigraphy would demonstrate subjective and objective improvement in sleep following PR. Paired comparisons (t-test or Wilcoxon-signed-rank test) were performed before and after PR data on all variables. This retrospective study of COPD patients undergoing PR utilized actigraphy watch recordings before and after 8-weeks of PR to assess changes in sleep variables including total time in bed (TBT), total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE), wakefulness after sleep onset (WASO) and total nocturnal awakenings. A change in Pittsburg Sleep Quality Index (PSQI) was a secondary outcome. PSQI was performed before and after PR. Sixty-nine patients were included in the final analysis. Most participants were male (97%), non-obese (median BMI 27.5, IQR 24.3 to 32.4 kg/m2) with an average age of 69 ± 8 years and 71% had severe COPD (GOLD stage 3 or 4). Prevalence of poor sleep quality (PSQI ≥5) was 86%. Paired comparisons did not show improvement in actigraphic sleep parameters following 8-weeks PR despite improvements in 6-min-walk distance (6MWD, mean improvement 54 m, 95% CI 34 m to 74 m, p<0.0001) and St. George's Respiratory Questionnaire scores (SGRQ, mean improvement 7.7 points, 95% CI 5.2 to 10.2, p<0.0001). Stratified analysis of all sleep variables by severity of COPD, BMI, mood, mental status, 6-MWD and SGRQ did not show significant improvement after PR. In Veterans with poor sleep quality (PSQI ≥ 5), PR improved subjective sleep quality (PSQI, mean difference 0.79, 95% CI 0.07 to 1.40, p = 0.03). Pulmonary rehabilitation improved subjective sleep quality in Veterans who had poor sleep quality at the beginning of the PR but did not improve objective sleep parameters by actigraphy. Our findings highlight the complex interactions among COPD, sleep and exercise.

Impact of pre-sleep habits on adolescent sleep: an Italian population-based study

ObjectiveSeveral evidences demonstrate that pre-sleep habits may negatively impact adolescent sleep, yet few data exist on Italian population. This study aimed to investigate the relationship between pre-sleep habits, use of technology/activity and sleep in Italian adolescents. MethodsSelf-report questionnaires including Italian version of School Sleep Habits Survey and use of technology/activity (eg smartphone, PC) at bedtime were administered to 972 adolescents (13–19 years) from Lombardia. We stratified the sample in five groups according to the age: Group I (13–14 years), Group II (15 years), Group III (16 years), Group IV (17 years), Group V (18–19 years). ResultsOur descriptive analysis reveals a different sleep profile across age-groups: Group III showed highest percentage of bad sleep (26.7%) and frequent nocturnal awakenings (24.1%), Group V had the highest percentage of insufficient sleep (40,4%) and difficulty falling asleep (42.7%) and Group IV presented an elevated difficulty in waking up in the morning (70.1%). A significant negative correlation was found in total group between use of smartphone, internet and studying/doing homework and total sleep time. The use of smartphone, internet videogames, listening to music and studying/doing homework was positively associated with delayed bedtime. ConclusionsThis study confirms the great impact of pre-sleep habits, and in particular the use of technology on adolescent sleep. Our results demonstrate that sleep is strongly altered among Italian adolescents using electronic devices in evening. The type of technology may be related to specific sleep profile, emphasizing the importance of stratification analyses to identify associated factors to sleep problems.