Frequent Nighttime Awakenings Research Articles

Impact of Breakfast Consumption and Sleep Habits on Morning Attention and Concentration Among Health Professional Students.

Background Breakfast consumption and sleep habits are known to affect cognitive performance, yet their specific impact on health professional students' morning attention is underresearched. Objective The study's objective was to assess the influence of sleeping habits and breakfast eating habits on health professional students' morning attention span. Methodology A cross-sectional study was conducted with 323 undergraduate health professional students from medical colleges in Lahore, Pakistan. Participants completed an online questionnaire that gathered data on demographic characteristics, breakfast consumption patterns, sleep habits, and morning attention levels. Morning attention was measured using a self-reported scale where students rated their ability to concentrate during morning lectures on a five-point Likert scale ranging from "very poor" to "very good." Additional questions assessed the frequency and quality of breakfast consumption, sleep duration, sleep quality (using the Pittsburgh Sleep Quality Index), and daytime napping habits. Statistical analyses, including descriptive statistics and multiple regression analysis, were conducted using the IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States) to explore the relationships between breakfast and sleep habits and their effects on self-reported attention during morning lectures. Results Of the 323 participants, 78 (24.14%) never skipped breakfast, while 71 (22.93%) skipped breakfast regularly. Breakfast skippers exhibited poorer attention, with a coefficient of -0.45 (p = 0.0002). Students consuming a more nutritious breakfast demonstrated improved attention, with a coefficient of 0.32 (p < 0.0001). Regarding sleep, 196 students (60.68%) slept four to six hours; those with longer sleep durations had better attention (coefficient = 0.21, p = 0.020). Conversely, 271 participants (83.90%) reported that frequent daytime napping and poor sleep quality, including frequent nighttime awakenings, had a negative impact on attention, with coefficients of -0.30 (p = 0.007) and -0.28 (p = 0.005), respectively. Additionally, 161 students (49.84%) reported difficulty concentrating during morning lectures. Conclusion Regular consumption of a nutritious breakfast and sufficient sleep are crucial for maintaining optimal morning attention and cognitive performance among health professional students.

Sleep disturbance associated with the menopause.

Sleep disturbance is one of the most common and debilitating symptoms experienced by women during the menopause transition. However, there are currently no therapies specifically approved for sleep disturbance associated with the menopause. Here, we consider how to characterize sleep disturbance associated with the menopause and discuss its etiology, including the latest advances in our understanding of the neuronal circuits that regulate reproduction, body temperature, sleep, and mood; and reflect on its impact on women's health and well-being. We also examine the current treatment landscape and look to the future of treatment for this condition. We conducted a review of the literature and combined this with discussion with experts in the fields of sleep and menopause as well as experiences from our own clinical practices. Sleep disturbance associated with the menopause is characterized by frequent night-time awakenings and increased awake time after sleep onset. Its impacts are wide-ranging, negatively affecting health as well as personal and social relationships, productivity, and work performance. There is currently an unmet need for effective, safe, and well-tolerated treatments to address this important symptom, and wider recognition of the association between sleep disturbances and the menopause is needed. Sleep disturbances associated with the menopause can result from hormone changes as well as vasomotor and mood symptoms. Growing research has contributed to our knowledge of the role of hypothalamic estrogen-sensitive kisspeptin/neurokinin B/dynorphin neurons. These neurons are thought to integrate the gonadotropin-releasing hormone pathway and the pathways responsible for the homeostatic control of body temperature and the circadian regulation of sleep-wake cycles. Understanding these neurons offers the potential to create treatments that target a key cause of sleep disturbance associated with the menopause. Further research to understand their etiology and characterize the neuronal circuits responsible could benefit the development of these targeted treatment approaches.

Association between Sleep and Language Development in Children with Congenital Zika Syndrome.

Congenital Zika Virus Syndrome (CZS) presents notable hurdles to neurodevelopment, with language development emerging as a crucial aspect. This study investigates sleep patterns and language skills in children with CZS, aiming to explore the potential synchronization of sleep development with their neurodevelopment. We studied cross-sectionally 135 children with CZS aged 0 to 48 months, investigating sleep using the BISQ Questionnaire. Language development was assessed using the Early Language Milestone Scale, while motor development and cognitive and social ability were assessed using the Bayley Scales of Infant and Young Child Development 3rd edition. We also studied longitudinally a cohort of 16 children (initially aged 0 to 12 months) whom we followed for four years, assessing at one-year intervals. Sleep disturbances and language deficits were highly frequent in this population. In the 0-12 months group, a late bedtime and frequent nighttime awakenings were associated with poorer auditory expressive skills. At 13-24 months, nighttime awakenings were associated with poorer auditory expressive skills, while among 25-36-month-olds decreased auditory receptive skills were associated with longer sleep onset latency and reduced nighttime sleep duration. The brain alterations caused by Zika virus infection affect both sleep disturbances and delays in language development. It is possible that sleep disturbance may be a mediating factor in the pathway between CZS and delayed language development, as the three analyzed language skills showed a correlation with sleep parameters.

Sleep-related painful erections: a survey-based analysis of patient-reported experiences with diagnosis and management.

Sleep-related painful erection (SRPE) is a condition characterized by painful nocturnal erections and frequent nighttime awakenings; however, the pathophysiology is not well understood and existing literature consists mainly of case reports. We aimed to investigate the causes, treatments, and impact on quality of life among individuals affected by SRPE. An e-questionnaire comprising of 30 items was administered to a group of men with SRPE identified through social media in October of 2021. The survey collected information on demographics, clinical and social history, symptomatology, interventions and quality of life. 44 patients with SRPE completed surveys (70.9% response rate), with a mean age ± SD of 43.3 ± 12.8 years. Most respondents had no relevant medical history related to erectile function disorders. 43.2% of subjects reported sleep apnea, and 27.1% reported a mental health disorder or psychiatric medication use. Baclofen was the most common medication, but only 25% of patients found it beneficial. Sleep repositioning, oxygen device use and pelvic floor therapy were interventions that provided the most relief. Most patients did not require emergency department visits (93.2%); only a small number needed penile aspiration (n = 2). As reported by most respondents, SRPE significantly impacted patients' quality of life.

From co-regulation to self-regulation: Maternal soothing strategies and self-efficacy in relation to maternal reports of infant regulation at 3 and 7 months.

This study, conducted in Germany, examines the role of maternal soothing strategies to explain the association of maternal self-efficacy with infant regulation (crying and sleeping behavior). Questionnaire data of 150 mothers, living in Germany, with mixed ethnic and educational backgrounds were collected when infants were 3 and 7 months old. Two types of maternal soothing strategies were distinguished: close soothing, involving close physical and emotional contact, and distant soothing, involving physical and emotional distancing from the infant. A cross-sectional SEM at 3 months indicated that maternal self-efficacy is associated with reported infant regulation through distant soothing strategies. Low maternal self-efficacy was associated with frequent maternal use of distant soothing, which in turn was related to reported infant regulation problems, that is, non-soothability and greater crying frequency. Frequent use of close soothing was associated with reported infant sleeping behavior, that is, frequent night-time awakenings. A longitudinal SEM further indicated that the effects of close soothing persisted at least until the infants' age of 7 months. The study showed how low maternal self-efficacy, increased use of distant soothing, and reported early infant regulation problems are intertwined and that, due to their persisting positive effect on infant soothability, close soothing better supports infant development.

Role of Evidence based Management of Ayurveda Medicines in Insomnia: A Critical Review

Abstract A person with insomnia has trouble falling asleep or gets insufficient, poor-quality sleep. They might experience frequent nighttime awakenings with difficulty going back asleep and early morning wakefulness. It is common in older adults, females, students, and people with medical illness. The aim is to analyze and review the published clinical studies conducted on insomnia to assess the effectiveness of Ayurvedic remedies for the management of insomnia. For this review, the literature has been searched using databases such as Medline, PubMed, NLM, Ayush Research Portal, and many others. All randomized controlled trials involving individuals with insomnia, utilizing Ayurvedic herbs either alone or in combination and Panchakarma procedures (processes of detoxifying and purifying the body) with an exposure period of ≥7 days, and with the primary outcome being the improvement in sleep quality, were included. This review includes 16 clinical trials, among them Mansyadi Kwath (decoction made up of Jatamamsi (Nardostachys jatamansi DC), Ashwagandha (Withania somnifera Linn.) and Parsik Yvani (Hyoscyamus niger Linn.), Aswagandha (W. somnifera Linn.), Jatamansi (N. jatamansi DC), Tagar (Valeriana wallichii DC.), Brahmi (Bacopa monnieri Linn.), Gud Pippali Churna (powder of jaggery and root of Piper longum Linn.), Jatipatri Ksheerpaka (milk decoction of Myristica fragrans Houtt.), Insomrid tablet (tablet made up of 5 drugs named Jatamamsi, Ashwagandha, Parsik Yvani (H. niger Linn.), Tagar (Valeriana wallichii DC.), and Sarpagandha (Rauwolfia serpentina Benth.) and Shirodhara (~slowly and steadily dripping medicated liquids on the forehead) are found effective in the treatments of insomnia according to these studies. This research serves as secondary data for further studies and the medication are described here have the ability to manage insomnia with very minimal or no side effects. These drugs are also cost-effective and nonaddictive.

Unlocking the Secret to a Restful Night's Sleep: Understanding Insomnia (Anidra) and Overcoming it with Ayurveda

Sleep is a naturally occurring state of both mind and body. The challenge of insomnia disorder arise when an individual subjectively perceives or subpar sleep quality. This can manifest in various ways, including difficulty initiating sleep, frequent nighttime awakenings with subsequent struggles to return to slumber, premature morning awakenings. Insomnia is intimately linked to various medical and psychiatric conditions and can have profound repercussions on an individual's overall quality of life and emotional well-being. Regrettably, in our contemporary world, a growing number of individuals have become reliant on sleep-inducing medications, forming habitual dependencies on them. Within the framework of holistic well-being, three essential pillars support a healthy life: Aahar (nutrition), Nidra (sleep), and Brahmcharya (celibacy or responsible sexual conduct). Nidra, plays a crucial role in nourishing the living body. Anidra, the absence of sound sleep, has been meticulously described by ancient scholars in various contexts, such as its connection to Vata Nanatmaja Vikara and Vataja Jwara. Traditional Ayurvedic therapies, known as Panchkarma, offer effective approaches to address Anidra. These therapies include Shirodhara (a continuous stream of warm oil on the forehead), Shirobasti (retaining oil on the head), Shiroabhyang (head massage), Shiropicchu (warm oil application in the ear canal), and Padaabhyang (foot massage). These techniques have proven to be valuable in the treatment of insomnia. In light of recent research findings, it is our aim to delve into the underlying causes, consequences, and potential management strategies for insomnia, all through the unique lens of Ayurvedic wisdom.

Prevalence of Sleep Disorders Among the General Population of the Jazan Region of Southwest Saudi Arabia.

Sleep disorders impose a substantial burden on the global population, leading to an array of health complications. Understanding their prevalence and associated risk factors is crucial to formulating effective interventions. This study aimed to determine the prevalence and associated risk factors of sleep disorders among residents of the Jazan region of Saudi Arabia. This cross-sectional study conducted an online survey from December 2022 to March 2023. The sample comprised 670 respondents aged 18 years and older residing in Jazan. Demographic data, lifestyle habits, sleep patterns, and sleep disorder symptoms were assessed. The participants were predominantly women (62.2%), with an average age of 30.99 years and a normal body mass index. The analyses revealed that 28.8% of the respondents reported experiencing sleep disorders, and 13.4% particularly had obstructive sleep apnea. Nearly half of the participants reported having primary insomnia, excessive daytime sleepiness, and restless leg syndrome. Significant associations were found between sleep disorders and older age (p = 0.012), obesity (p = 0.043), short or thin neck (p = 0.034), smoking (p = 0.003), caffeine use (p = 0.001), existing health conditions (p = 0.001), medication use (p = 0.013), lack of daytime naps (p = 0.043), and frequent nighttime awakenings to urinate (p = 0.001). The most common self-reported reasons for nightly awakenings were urination, anxiety or stress, discomfort or noise, and health conditions. The findings suggest a high prevalence of sleep disorders among adults in Jazan, Saudi Arabia. Various demographic, lifestyle, and health-related factors are linked to these disorders. Therefore, targeted sleep health education and interventions could be instrumental in tackling this significant public health issue.

Ketogenic Diet Affects Sleep Architecture in C57BL/6J Wild Type and Fragile X Mice.

Nearly half of children with fragile X syndrome experience sleep problems including trouble falling asleep and frequent nighttime awakenings. The goals here were to assess sleep-wake cycles in mice in response to Fmr1 genotype and a dietary intervention that reduces hyperactivity. Electroencephalography (EEG) results were compared with published rest-activity patterns to determine if actigraphy is a viable surrogate for sleep EEG. Specifically, sleep-wake patterns in adult wild type and Fmr1KO littermate mice were recorded after EEG electrode implantation and the recordings manually scored for vigilance states. The data indicated that Fmr1KO mice exhibited sleep-wake patterns similar to wild type littermates when maintained on a control purified ingredient diet. Treatment with a high-fat, low-carbohydrate ketogenic diet increased the percentage of non-rapid eye movement (NREM) sleep in both wild type and Fmr1KO mice during the dark cycle, which corresponded to decreased activity levels. Treatment with a ketogenic diet flattened diurnal sleep periodicity in both wild type and Fmr1KO mice. Differences in several sleep microstructure outcomes (number and length of sleep and wake bouts) supported the altered sleep states in response to a ketogenic diet and were correlated with altered rest-activity cycles. While actigraphy may be a less expensive, reduced labor surrogate for sleep EEG during the dark cycle, daytime resting in mice did not correlate with EEG sleep states.

Порівняльний аналіз поширеності та структури порушень нічного сну в дітей з розладами нейророзвитку під час воєнного і мирного часу

The problem of sleep disorders in children is one of the most urgent in the practice of a pediatrician and has become especially acute during wartime, given the chronic effects of a significant number of stressors. The need to develop practical recommendations for improving the quality of sleep in children during wartime necessitated a comparative study of the frequency and structure of sleep disorders in children during wartime and peacetime. Purpose - to determine the frequency and structure of nighttime sleep disorders in children with neurodevelopmental disorders and healthy children in wartime and peacetime. Materials and methods. An online survey of parents of 529 children aged 1-7 years (26.8% of healthy children and 73.2% of children with neurodevelopmental disorders) was conducted in 2022 during wartime. A survey of parents of 1352 children under the age of 7 was conducted in 2002 in peacetime (as part of the Family and Children of Ukraine project), with a case-control comparison. Results. The overall prevalence of nighttime sleep disorders among all children in wartime was 93.6% in healthy children and 94.8% in children with neurodevelopmental disorders. Difficulties falling asleep were noted in 51.4% of healthy children and 56.8% of children with neurodevelopmental disorders; frequent nighttime awakenings - in 35.9% and 39.0% of children, respectively. Sleep disorders: snoring - in 16.2% and 18.9% of children; apnoea - in 9.9% and 14.9% of children. Parasomnias: night terrors - in 19.7% and 18.6% of children; sleepwalking - in 2.8% and 4.4% of children. Comparison of the frequency of nighttime sleep disorders in healthy children in peacetime (2002) and wartime (2022): half of healthy children had difficulty going to bed (51.4% vs. 47.2%); early waking (49.8% vs. 12.7%); frequent waking at night (47.3% vs. 35.9%); snoring (33.6% vs. 16.2%); increased daytime sleepiness - 5 times more often in 2002 (30.3% vs. 6.3%); every fourth child has nightmares (25.6% vs. 26.8%); prolonged falling asleep (23.5% vs. 51.4% in 2022). Conclusions. The overall prevalence of nighttime sleep disorders among all children in wartime was 94.5%. In children with neurodevelopmental disorders, early awakenings (29.2% vs. 12.7%), sleep apnoea (14.9% vs. 9.9%), increased daytime sleepiness (14.9% vs. 6.3%), and catalepsy (8.3% vs. 4.2%) were more common compared to healthy children. In wartime, the incidence of early wake-ups (49.8% vs. 12.7% in 2022), snoring (33.6% vs. 16.2% in 2022), and increased daytime sleepiness (30.3% vs. 6.3% in 2022) decreased among healthy children, but the incidence of falling asleep problems increased by 2 times (51.4% vs. 23.5% in the 2002). Children with neurodevelopmental disorders are a more vulnerable group that reacts negatively to the stressful conditions of martial law by increasing the frequency of nighttime sleep disorders. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.

Prolonged experimental sleep disturbance affects the inflammatory resolution pathways in healthy humans

BackgroundSleep disturbances, as manifested in insomnia symptoms of difficulties falling asleep or frequent nighttime awakenings, are a strong risk factor for a diverse range of diseases involving immunopathology. Low-grade systemic inflammation has been frequently found associated with sleep disturbances and may mechanistically contribute to increased disease risk. Effects of sleep disturbances on inflammation have been observed to be long lasting and remain after recovery sleep has been obtained, suggesting that sleep disturbances may not only affect inflammatory mediators, but also the so-called specialized pro-resolving mediators (SPMs) that actively resolve inflammation. The goal of this investigation was to test for the first time whether the omega-3 fatty acid-derived D- (RvD) and E-series (RvE) resolvins are impacted by prolonged experimental sleep disturbance (ESD). MethodsTwenty-four healthy participants (12 F, age 20–42 years) underwent two 19-day in-hospital protocols (ESD/control), separated by > 2 months. The ESD protocol consisted of repeated nights of short and disrupted sleep with intermittent nights of undisturbed sleep, followed by three nights of recovery sleep at the end of the protocol. Under the control sleep condition, participants had an undisturbed sleep opportunity of 8 h/night throughout the protocol. The D- and E-series resolvins were measured in plasma using liquid chromatography-tandem mass spectrometry (LC-MS/MS). ResultsThe precursor of the D-series resolvins, 17-HDHA, was downregulated in the ESD compared to the control sleep condition (p <.001 for condition), and this effect remained after the third night of recovery sleep has been obtained. This effect was also observed for the resolvins RvD3, RvD4, and RvD5 (p <.001 for condition), while RvD1 was higher in the ESD compared to the control sleep condition (p <.01 for condition) and RvD2 showed a mixed effect of a decrease during disturbed sleep followed by an increase during recovery sleep in the ESD condition (p <.001 for condition*day interaction). The precursor of E-series resolvins, 18-HEPE, was downregulated in the ESD compared to the control sleep condition (p <.01 for condition) and remained low after recovery sleep has been obtained. This effect of downregulation was also observed for RvE2 (p <.01 for condition), while there was no effect for RvE1 (p >.05 for condition or condition*day interaction). Sex-differential effects were found for two of the D-series resolvins, i.e., RvD2 and RvD4. ConclusionThis first investigation on the effects of experimental sleep disturbance on inflammatory resolution processes shows that SPMs, particularly resolvins of the D-series, are profoundly downregulated by sleep disturbances and remain downregulated after recovery sleep has been obtained, suggesting a longer lasting impact of sleep disturbances on these mediators. These findings also suggest that sleep disturbances contribute to the development and progression of a wide range of diseases characterized by immunopathology by interfering with processes that actively resolve inflammation. Pharmacological interventions aimed at promoting inflammatory resolution physiology may help to prevent future disease risk as a common consequence of sleep disturbances. Trial Registration: ClinicalTrials.gov NCT02484742.

0997 Severe mixed sleep apnea in a patient with epilepsy and gene mutation EEFIA2

Abstract Introduction EEFIA2 gene mutation has been linked with epilepsy and intellectual disability. There have been case series and case reports in the past that have linked the gene mutation with both epilepsy and possible phenotypes of broad nasal bridge and tented upper lip. In previous cases, there has been no description of work up of sleep disordered breathing. Here, we present a case of sleep apnea in a patient with intractable epilepsy and gene mutation. Report of case(s) Patient is a toddler-aged female with epilepsy. She was diagnosed with infantile epileptic encephalopathy with a pathogenic mutation in EEF1A2 gene with intractable generalized myoclonic epilepsy, hypotonia, and developmental delay. She has been on several seizure medications in an effort to obtain seizure control. With medications she has been undergoing side effects of swallowing difficulties and increased sedation. During her neurology epilepsy follow up, she was noted to have frequent nighttime awakenings. She was scheduled to have a combined polysomnography and 24-hour electroencephalogram. Polysomnography performed which showed evidence of severe mixed central and obstructive sleep apnea-hypopnea syndrome with AHI of 100/h, CAI 42/H, OAHI - 57/h, and REM AHI of 106/h. Video Electroencephalogram performed at the same time and showed multiple atonic and myoclonic seizures with multifocal discharges. Patient was evaluated by otolaryngology and was not a candidate for surgical interventions. She was titrated on bilevel positive airway pressure during a split titration sleep study. Conclusion Genetic mutations and their phenotypes are becoming more widely addressed and researched. In this case we present a rare genetic mutation EEFIA2 which has presented as intellectual disability, hypotonia, and intractable epilepsy in this patient. Given some daytime somnolence and nighttime awakenings, a polysomnography was pursued and showed severe obstructive sleep apnea. In cases where phenotypes are not widely known, it is important to screen for sleep disorders. Support (if any)

(193) Sleep Related Painful Erections: A Survey Based Analysis of Patient Reported Experiences with Diagnosis and Management

Abstract Introduction Sleep related painful erection disorder (SRPE) is a debilitating condition which is currently not well understood. It is characterized by frequent nighttime awakenings due to painful nocturnal erections. Various theories surrounding the pathophysiology of this condition include increased testosterone levels, obstructive sleep apnea, altered autonomic function and psychosomatic factors, amongst others. To our knowledge, there have been no controlled studies investigating this, with literature consisting mostly of case reports. We sought to survey those affected to determine a unifying cause, treatment, and assess the impact on their quality of life Objective Understand the collective experience and unifying themes in the presentation, diagnosis and treatment of patients with SRPE. Methods A group of 63 men diagnosed with SRPE were administered a 30 item questionnaire consisting of both multiple choice, short and long answers from January 2021 to July 2021. Question items were generated based on existing literature. Survey items were reviewed by two academic Urologists specializing in treatment of sexual dysfunction. Information about demographics, clinical history, social history, symptomatology, and both surgical and medical interventions were captured. Quality of life was captured on a 5 point likert scale. Results Overall, 40 patients diagnosed with SRPE responded to the survey. The median age of those surveyed was 43.5 (range 21-69). Majority of respondents (66%, n=21) had no pertinent past medical history related to disorders of erectile function, while 50% (n=20) of subjects reported definitely or possibly having sleep apnea, and 38% (n=12) reported a mental health disorder. The most common current medication among subjects was baclofen (55%, n=22), followed by clonazepam (10%, n=4). However, baclofen proved to be beneficial in only 36% (n=8) of responders who had trialed it. The interventions which were most commonly reported as helpful by those who attempted were sleep repositioning (50%, n=4) and oxygen device use (43%, n=3). Majority of patients have not required intervention in the emergency department 92.5%, n=37), and only 7.5% (n=3) patients have required penile aspiration. Responders described their quality of life as being severely impacted by SRPE, with 14 choosing a severity of 5 (35%). The median score for this response category was 4. Conclusions SRPE is a poorly described condition which should be distinguished from other erectile pathologies such as priapism. The majority of our patients reported OSA, and previous studies have suggested a sleep-cycle association. Sleep reposition and oxygen use appear to provide the most relief for the majority of our patients, although this was not a reliable treatment option. From a medication perspective, there was no consistent class of medication that provides symptom relief. Majority of patients appear to manage their erections without requiring a visit to ED. An overwhelming majority of our patients identified with a mental health disorder, and similarly the average response was that this had a severe impact on their quality of life. Based on these responses and the impact on quality of life, further studies must be done to better elucidate this condition. Disclosure No

0987 Asking the Right Questions: A Case of Restless Legs Syndrome and Spinal Muscular Atrophy

Abstract Introduction The association between iron deficiency and restless legs syndrome (RLS) is well established. However, there is limited data on the association between motor neuron diseases such as spinal muscular atrophy (SMA) and RLS. A forty-three-year-old with Type 2 SMA presented to clinic for management of chronic respiratory failure. She had recently undergone surgery and chemotherapy for newly diagnosed anal cancer. However, she reported persistent abdominal pain, anorexia, weight loss, and rectal bleeding. She reported “muscle twitching” and bilateral lower extremity pain and tingling that was worse at night. Her husband would awaken every 2 hours to massage her legs. She assumed these symptoms had emerged as a result of an increase in motor function due to risdiplam, a survival motor neuron 2 splicing modifier drug. Further questioning led to the diagnosis of RLS. Bloodwork revealed severe iron deficiency anemia (hemoglobin of 6.0 g/dL, iron 13 mcg/dL, and ferritin 3 ng/ml). She received a blood transfusion and underwent sigmoidoscopy for evaluation of cancer recurrence given the report of bleeding. Fortunately, her cancer remained in remission. Her symptoms of RLS significantly improved after blood transfusions and iron supplementation. Report of case(s) n/a Conclusion RLS is a complex sensorimotor syndrome. The diagnosis of RLS is clinical, relying on diagnostic criteria that requires lower extremity movement. The case is a reminder of the variable presentation of RLS in individuals with neuromuscular disorders, including SMA. How are symptoms of restless legs disclosed in patients with the inability to move and with potentially altered sensorium? The focus of the patient encounter could have anchored on the common and expected sequalae of SMA, chronic respiratory failure. Unfortunately, anchoring bias would have delayed the diagnosis and treatment of what could have been a potentially fatal disease – metastatic cancer. Ironically, the patient’s longing for motor function repressed her ability to lament. To the patient, symptoms of frequent nighttime awakenings and limb discomfort were perceived as a desired side effect of a medication that would increase movement. This case emphasizes the importance of the patient interview and its value of uncovering subtle complaints that may broaden the differential diagnosis and guide further work-up. Support (if any)

Self-reported sleep characteristics are linked to type 2 diabetes in middle-aged and elderly individuals: a cross-sectional study based on NHANES.

This study was aimed to evaluate the link between sleep characteristics and type 2 diabetes of middle-aged and elderly individuals. Twenty thousand four hundred ninety-seven individuals enrolled in National Health and Nutritional Examination Survey (NHANES) form periods of 2005-2008 were included in this study, and 3965 individuals aged 45years and older with complete data were detected. Variables related to sleep characteristics were analyzed by univariate analysis to identify the risk factors of type 2 diabetes, the logistic regression model was used to test for the tendency across the sections of sleep duration, and the link between sleep duration and risk of type 2 diabetes was manifested as odds ratio (OR) and 95% confidence interval (CI). Six hundred ninety-four individuals with type 2 diabetes were identified and enrolled in the type 2 diabetes group, while the remaining individuals (n = 3271) were enrolled in the non-type 2 diabetes group. Individuals in the type 2 diabetes group (63.9 ± 10.2) were older than those in the non-type 2 diabetes group (61.2 ± 11.5, P < 0.001). Factors of taking longer time to fall asleep (P < 0.001), sleeping less (≤ 4h) or more (≥ 9h) (P < 0.001), having trouble in falling asleep (P = 0.001), frequent snoring (P < 0.001), frequent sleep apnea (P < 0.001), frequent nighttime awakenings (P = 0.004), and frequent excessive daytime sleepiness (P < 0.001) were linked to the risk of type 2 diabetes. Our study revealed that sleep characteristics were closely linked to type 2 diabetes in middle-aged and elderly individuals, and a longer sleep duration might have protective effects against type 2 diabetes, but it should be constrained within 9h/night.

Improving Children's Sleep Habits Using an Interactive Smartphone App: Community-Based Intervention Study.

Sleep problems are quite common among young children and are often a challenge for parents and a hinderance to children's development. Although behavioral therapy has proven effective in reducing sleep problems in children, a lack of access to professionals who can provide effective support is a major barrier for many caregivers. Therefore, pediatric sleep experts have begun developing apps and web-based services for caregivers. Despite the substantial influence of cultural and familial factors on children's sleep, little effort has gone into developing cultural or family-tailored interventions. This study aimed to examine the effectiveness of the interactive smartphone app "Nenne Navi," which provides culturally and family-tailored suggestions for improving sleep habits in young Japanese children through community-based long-term trials. The study also aimed to investigate the association between app-driven improvements in sleep and mental development in children. This study adopted a community-based approach to recruit individuals from the Higashi-Osaka city (Japan) who met ≥1 of the following eligibility criteria for sleep problems: sleeping after 10 PM, getting <9 hours of nighttime sleep, and experiencing frequent nighttime awakenings. A total of 87 Japanese caregivers with young children (mean 19.50, SD 0.70 months) were recruited and assigned to the app use group (intervention group) or the video-only group (control group). Both groups received educational video content regarding sleep health literacy. The caregivers in the intervention group used the app, which provides family-tailored suggestions, once per month for 1 year. A total of 92% (33/36) of the caregivers in the app use group completed 1 year of the intervention. The participants' overall evaluation of the app was positive. The wake-up time was advanced (base mean 8:06 AM; post mean 7:48 AM; F1,65=6.769; P=.01 and sleep onset latency was decreased (base mean 34.45 minutes; post mean 20.05 minutes; F1,65=23.219; P<.001) significantly in the app use group at the 13th month compared with the video-only group. Moreover, multiple regression analysis showed that decreased social jetlag (β=-0.302; P=.03) and increased sleep onset latency SD (β=.426; P=.02) in children predicted a significant enhancement in the development of social relationships with adults. At 6 months after the completion of the app use, all the caregivers reported continuation of the new lifestyle. The present findings suggest that the app "Nenne Navi" has high continuity in community use and can improve sleep habits in young Japanese children and that interventions for sleep habits of young children may lead to the enhancement of children's social development. Future studies must focus on the effectiveness of the app in other regions with different regional characteristics and neuroscientific investigations on how changes in sleep impact brain development.

Sleep and Rest-Activity Rhythms in Recovering Patients with Severe Concurrent Mental and Substance Use Disorder: A Pilot Study

Objective: Mental health and substance use disorders are commonly associated with disrupted sleep and circadian rest-activity rhythms. How these disorders in combination relate to sleep and circadian organization is not well studied. We provide here the first quantitative assessment of sleep and rest-activity rhythms in inpatients with complex concurrent disorders, taking into account categories of substance use (stimulant vs. stimulant and opioid use) and psychiatric diagnosis (psychotic disorder and mood disorder). We also explore how sleep and rest-activity rhythms relate to psychiatric functioning. Methods: A total of 44 participants (10 female) between the age of 20–60 years (median = 29 years) wore wrist accelerometers over 5–70 days and completed standardized questionnaires assessing chronotype and psychiatric functioning (fatigue, psychiatric symptom severity, and impulsiveness). To examine potential influences from treatment, we computed (1) length of stay; (2) days of abstinence from stimulants and opioids as a measure of withdrawal; and (3) a sedative load based on prescribed medications. Results: Participants exhibited a sustained excessive sleep duration, frequent nighttime awakenings, and advanced rest-activity phase related to sedative load. Sleep disruptions were elevated in participants with a history of opioid use. Patients with a psychotic disorder showed the longest sleep and most fragmented and irregular rest-activity patterns. Non-parametric circadian rhythm analysis revealed a high rhythm amplitude by comparison with population norms, and this was associated with greater psychiatric symptom severity. Psychiatric symptom severity was also associated with greater fatigue and later MCTQ chronotype. Conclusions: This pilot study provides initial information on the prevalence and severity of sleep and circadian rhythm disturbances in individuals with severe concurrent disorders. The results underline the need for further studies to start to understand the role of sleep in the disease and recovery process in this understudied population.

Associations between demographic and parental factors and infant sleep characteristics.

Although sleep problems are highly prevalent in infants, the intrinsic and extrinsic factors that influence sleep consolidation and regulation in this age group are not well understood. This study aimed to examine the cross-sectional associations of demographic and parental factors with infant sleep characteristics. Participants were 97 Canadian mother-infant dyads primarily from Edmonton, Alberta. Demographic factors (e.g., infant age), parenting practices (e.g., sleep position, sleep initiation methods), and infants sleep characteristics (e.g., the frequency of nighttime awakenings) were assessed using the Brief Infant Sleep Questionnaire. Maternal sleep characteristics (e.g., nighttime sleep duration) were assessed using Actigraph accelerometers. Infant age (mean = 4.24 ± 2.90) was associated with most infant sleep characteristics. In multiple regression models for infant nighttime sleep duration, after removing influential observations, a negative association for side (vs. prone) sleep position was, respectively, observed. In multiple regression models for the frequency of nighttime awakenings in infants, positive associations for infants falling asleep while feeding (vs. in bed alone) and side (vs. prone) sleep position were consistently observed after removing influential observations. Lower nighttime sleep efficiency (B = - 0.08, 95%CI: -0.13, -0.02) and longer nighttime wake after sleep onset (B = 1.03, 95%CI: 0.41, 1.65) in mothers were associated with more frequent nighttime awakenings in infants. After removing influential observations, more frequent nighttime awakenings (B = 0.35; 95%CI: 0.09, 0.61) and longer total sleep duration (B = 0.33, 95%CI: 0.11, 0.55) in mothers were also associated with more frequent nighttime awakenings in infants. Sleep initiation methods with less parental involvement, and more continuous and efficient maternal nighttime sleep, tended to be associated with less interrupted infant sleep.

Sleep and Phelan-McDermid Syndrome: Lessons from the International Registry and the scientific literature.

BackgroundSleep is essential to maintaining a healthy life. Sleep disturbances among individuals with neurodevelopmental disorders are not well studied, affecting their early detection and treatment. Sleep disturbances in individuals with Phelan–McDermid Syndrome (PMS) are among the primary concerns reported by parents. However, little research has been aimed at addressing their concern.MethodsThe purpose of this investigation was to identify and quantify specific sleep disturbances in people with PMS by analyzing data collected by the PMS Foundation International Registry.ResultsThe registry shows that 284 out of 384 (73.4%) individuals with confirmed chromosome 22q13 deletions or SHANK3 pathogenic variants have a sleep disturbance. The prevalence of sleep disturbances increases with age with 56% reporting a sleep disturbance in the 0–3 year age group and 90% reporting these disturbances in those over age 18 years old. The primary sleep disturbances were circadian rhythm sleep disorders that included difficulty falling asleep, frequent nighttime awakenings, difficulty returning to sleep after a nighttime awakening event, and hypersomnia and parasomnias including enuresis, night terrors, sleepwalking, and sleep apnea. Sleep disturbances were similarly frequent among individuals with SHANK3 pathogenic variants (84.8%) and those with deletions (71.9%), supporting the role of haploinsufficiency of SHANK3 in sleep.ConclusionSleep disturbances are a common feature of PMS and should be considered in clinical evaluation and management because of the effect they have on the quality of life of the patients and their families.

Sleep disturbance among breast cancer survivors and controls from midlife to early older adulthood: Pink SWAN.

To compare sleep disturbance from 5years pre- to 5years post-diagnosis between breast cancer survivors (BCS) and women without cancer over the same period and to identify BCS subgroups exhibiting different sleep trajectories. Analyses included data from 152 BCS and 2163 controls from 20years of follow-up in the longitudinal Study of Women's Health Across the Nation (SWAN), a multi-racial/ethnic cohort study. SWAN participants were assessed approximately annually from 1995 to 2015 using a standardized protocol. Pink SWAN focused on women who reported no cancer at SWAN enrollment and developed incident breast cancer after enrollment or did not develop breast cancer. Nonparametric locally weighted scatterplot smoothing plots and linear mixed models were used to compare the prevalence of the most frequently reported sleep problem, frequently waking several times a night (a sleep maintenance problem) during the previous 2weeks, between BCS and controls in the 5years pre- to 5years post-diagnosis. We characterized heterogeneity among BCS on this sleep problem using group-based trajectories and examined pre-diagnosis variables as predictors of group membership. No differences were found between BCS and controls in prevalence of frequent nighttime awakenings either before or after diagnosis. Among BCS, three trajectory groups were identified. Thirty-seven percent of BCS had consistently low prevalence of waking several times per night, 30% had high prevalence, and 33% had increasing prevalence which started 2years pre-diagnosis. Prevalence of pre-diagnosis vasomotor symptoms, anxiety, depressive symptoms, and smoking differed among these groups. Among mid-aged women diagnosed with breast cancer, this diagnosis did not trigger/amplify a sleep maintenance problem. The majority of BCS had similar levels of this sleep problem from pre- to post-diagnosis. Although sleep maintenance problems were not amplified by a cancer diagnosis, a subset of BCS may have sleep issues that should be monitored and treated, as indicated.