Sleep History Research Articles

Novel and reappraised wide-band EEG findings in migraineurs: its correlation with several clinical variables

ObjectiveCortical spreading depolarization is one possible pathogenesis of migraine, of which slow neurophysiological change is barely recorded in conventional EEG settings. Using wide-band EEG conditions, we reappraised the features of EEG in migraineurs, including subdelta-band EEG changes. MethodsThis retrospective study included 144 patients with migraine. We delineated EEG of focal delta slow (FDS) (1-4 Hz) by time constant (TC) 0.3 s and focal subdelta slow (FSDS) (< 1 Hz) by TC 2 s. Relationships between clinical variables and EEG findings were evaluated. ResultsOf 144 patients, 39 had aura and 105 did not. FSDS and FDS were observed in 38 and 58 patients, respectively. No EEG was recorded during the aura. In multivariate analysis with the phase of migraine, family history, age, and percentage of sleep during EEG recording, the phase of migraine was related to the occurrence of FSDS (postdrome vs interictal, prodrome, and headache respectively (OR = 49.00 [95% CI = 3.89-616.66], 46.28 [2.99-715.78], 32.79 [2.23-481.96], p = 0.0026, 0.0061, 0.011). FDS was clinically unremarkable for differential evaluation. ConclusionsWide-band EEG abnormality in migraineurs, i.e., FSDS, can be affected by migraine phase. SignificanceWide-band EEG finding could be a biomarker related to clinical variables in migraines.

The Natural History of Unnatural Sleep: Surviving, But Not Thriving, After Critical Illness.

The Natural History of Unnatural Sleep: Surviving, But Not Thriving, After Critical Illness.

Association between sleep microarchitecture and cognition in obstructive sleep apnea

Abstract Study Objectives Obstructive sleep apnea (OSA) increases the risk of cognitive impairment. Measures of sleep microarchitecture from EEG may help identify patients at risk of this complication. Methods Participants with suspected OSA (n = 1142) underwent in-laboratory polysomnography and completed sleep and medical history questionnaires, and tests of global cognition (Montreal Cognitive Assessment, MoCA), memory (Rey Auditory Verbal Learning Test, RAVLT) and information processing speed (Digit–Symbol Coding, DSC). Associations between cognitive scores and stage 2 non-rapid eye movement (NREM) sleep spindle density, power, frequency and %-fast (12–16Hz), odds-ratio product (ORP), normalized EEG power (EEGNP), and the delta:alpha ratio were assessed using multivariable linear regression (MLR) adjusted for age, sex, education, and total sleep time. Mediation analyses were performed to determine if sleep microarchitecture indices mediate the negative effect of OSA on cognition. Results All spindle characteristics were lower in participants with moderate and severe OSA (p ≤ .001, vs. no/mild OSA) and positively associated with MoCA, RAVLT, and DSC scores (false discovery rate corrected p-value, q ≤ 0.026), except spindle power which was not associated with RAVLT (q = 0.185). ORP during NREM sleep (ORPNREM) was highest in severe OSA participants (p ≤ .001) but neither ORPNREM (q ≥ 0.230) nor the delta:alpha ratio were associated with cognitive scores in MLR analyses (q ≥ 0.166). In mediation analyses, spindle density and EEGNP (p ≥ .048) mediated moderate-to-severe OSA’s negative effect on MoCA scores while ORPNREM, spindle power, and %-fast spindles mediated OSA’s negative effect on DSC scores (p ≤ .018). Conclusions Altered spindle activity, ORP and normalized EEG power may be important contributors to cognitive deficits in patients with OSA.

Self-reported prevalence of sleep and mental health disorders in current and former athletes: a preliminary cross-sectional investigation of help-seeking behaviours

ABSTRACT Objective Athletes typically report a high prevalence of mental health issues and face significant barriers within the sporting environment that prevent help seeking. However, little is known about how retired or non-elite athletes engage with support; this lack of empirical data is even more pronounced in the case of sleep disorders. Method A cross-sectional online survey was completed by current and former athletes (n = 946; 495 women, 444 men, 7 non-binary) from all sports and competition levels in seven countries. Self-disclosed diagnosis history, help-seeking behaviours, and functional impact of sleep and mental health disorders were assessed. Results Comparable rates of mental health disorders were observed between current athletes (39.3%) and former athletes (42.0%), OR = 1.17, p = .337. Similarly, comparable rates of sleep disorders were observed between current athletes (25.4%) and former athletes (30.9%), OR = 1.20, p = .298. Men reported lower mental health disorder prevalence than women (32.9% vs. 46.3%), OR = 1.82, p < .001. Gender differences were also evident in the types of disorders reported. For sleep disorders, men were less likely to seek assistance from a psychologist than women (8.4% vs. 26.2%), p < .001,φ = 0.23. No differences in help seeking avenues for mental health were observed. Comorbid disorders had more frequent functional impairment than individual sleep or mental health disorders. Conclusions These self-reported prevalence estimates have significance for practitioners and clinicians. Data indicates the most prevalent types of disorders in these populations and where athletes typically engage in support. Evaluating the time course of these disorders can inform health promotion strategies and treatment methods for practitioners and support staff.

Sleep education for medical students: A study exploring gaps and opportunities

PurposeTo explore final-year medical students’ perceptions of sleep education during medical school to inform the development of a sleep curriculum. MethodsYear 6 medical students on their final general practice placement in 2020 were invited to complete an online survey including questions regarding sleep education recalled during the medical programme. ResultsResponses were received from 51/71 (72 %) students. Main learning topics recalled by participants were sleep apnoea (83 %), sleep physiology (71 %), and snoring (69 %). Education in other topics was reported by <65 % of students. Priority topics for students were treating common sleep disorders, taking a sleep history, and navigating shift work. ConclusionsWhilst the majority of students recalled education on specific topics, many had little awareness of education relating to sleep assessment, insomnia, or shift work. Sleep education in the curriculum needs more emphasis and reinforcement given sleep's relevance across many domains of health and morbidity. We propose that an identifiable sleep curriculum is required to ensure medical students have the necessary core education regarding sleep and sleep disorders both for patients and themselves. Further, we believe this is possible to achieve in a short timeframe within the constraints of an existing curriculum and propose some creative solutions.

Improving sleep outcomes in patients with cancer with chronic insomnia using cognitive behavioral therapy: A retrospective study.

e13555 Background: Cancer patients experience a threefold higher rate of insomnia (23-54%) than the general population. Cognitive behavioral therapy for Insomnia (CBT- i) is the gold standard treatment of chronic insomnia. Few studies, however, have demonstrated CBT- i efficacy for chronic insomnia in cancer patients. To address the needs of cancer patients with insomnia, a psycho-oncology physician trained to provide CBT- i therapy established an insomnia clinic in an ambulatory oncology center tailored for oncology patients. The objective of this study is to assess the efficacy of CBT- i for chronic insomnia among cancer patients. Methods: A retrospective review of electronic medical records was performed on consecutive referrals to an insomnia clinic in an ambulatory oncology center. All patients with ICD-10 confirmed chronic insomnia diagnosis who received at least 2 sessions up to a maximum of 7 sessions of CBT- i were included in the analysis. Demographic variables, cancer-related disease and treatment variables, and sleep parameters at initial session (T1) and last session (T2) were collected. Sleep parameters included sleep efficiency, total sleep time, sleep onset latency, number of nightly awakenings, and sleep quality. Semi-structured psychiatric clinical interviews, past medical and sleep history, and patient-rated Pittsburgh Sleep Quality Index (PSQI) scores at T1 were collected. Data analysis utilized SPSS descriptive statistics and T-test to compare differences between the baseline (T1) and post-CBT- i treatment (T2) sleep variable outcome measures. Results: The sample included 18 cancer patients (mean age 59 years; 12 Hispanics, 6 non-Hispanics; 16 females, 2 males) with ICD-10-confirmed chronic insomnia treated with CBT- i. Cancer-related variables among the sample included a mean duration of 18 months since cancer diagnosis, disease staging ranging from 0-IV, and 16 patients completed curative treatment. The sample included 13 breast cancer patients. Mean duration of insomnia was 6 years. PSQI score was 14 (PSQI score ranges from 0 to 21, scores above 5 are indicative of poor sleep quality). The mean number of sessions delivered was 5. Sleep parameters at T2 showed a significant improvement compared to those at T1 (Table). The number of nightly awakenings decreased from 3 at T1 to 2 at T2 (p=0.01), and 78% (14/18) of patients reported an improvement in their sleep quality at T2. Conclusions: Cognitive Behavioral Therapy for Insomnia demonstrates efficacy in the treatment of chronic insomnia in cancer patients and is easily administered within an ambulatory oncology center. [Table: see text]

Représentations et pratiques nocturnes dans la société roumaine (XVIIIe – XXe siècles)

Folklorists, ethnographers and anthropologists have dedicated few studies to the night, and they especially emphasized its negative representations: an interval of darkness, of anxiety and fear, a time of intensified activities of evil supernatural forces. By favoring imaginary and mythical components, night was taken into consideration as an exceptional and extraordinary time, as a negative counterpart to the day, and not as a natural reverse of it. For a long time, the night did not draw the attention of historians, being perceived as a time when nothing happens, a time for rest and sleep. Starting with Jean Verdon’s pioneering book (“La Nuit au Moyen Âge”, 1994), historians have become increasingly interested in night habits, and explored the nightlife of people in ancient societies, bedtimes and waking times, sleep duration. The history of sleep has become a new field of research, opened by the American historian Roger Ekirch (2001, 2005), who advanced the theory that people in pre-industrial societies used to sleep differently. During the night, the sleep was biphasic (or segmented), divided into two moments and separated by a period of wakefulness (watch) at around midnight (between the first sleep and the second one). In our study we intend to verify if the results of Ekirch’s research are also applicable to the realities of the Romanian society in the 18th-20th centuries. We must recognize the difficulties of a history of nocturnal time, the fragmentary nature of the sources, the lack of direct and explicit testimonies (few people have been able to subjectivize their experience of sleep and transmit written testimonies). Therefore, we investigated sources such as chronicles, judiciary documents and literary texts, in search of the segmented sleep pattern. We have identified direct or indirect references to the two periods of sleep, and the intervening period of wakefulness. These references allow us to cautiously advance the hypothesis that this sleep pattern also existed in pre-modern Romanian society, in rural and urban environments. The future researches, based on teamwork, will more accurately determine the validity of this hypothesis.

Prevalence and pattern of sleep problems among older persons attending a tertiary hospital in Nigeria

Background: Sleep disturbances are common symptoms in adults and are related to various factors, but they are not an inherent part of the ageing process. Objective: To determine the prevalence and pattern of sleep problems among older persons attending the General Out-patient Clinics in a tertiary health-care facility in Uyo, Nigeria. Materials and Methods: This was a hospital-based cross-sectional descriptive study on older persons attending the GOP clinics of the University of Uyo Teaching Hospital. Using a semi-structured interviewer administered questionnaire, information on the sociodemographic characteristics and the sleep history of the respondents were obtained. Data entry and analysis were done using Epi info® version 3.5.1. Results: The prevalence of sleep problems was 64.5% with early awakening being the commonest sleep problem (50.5%) experienced by the respondents. Conclusion: The prevalence of sleep problems is high in this study, and there is need for counselling of older persons on how to improve their sleeping habits.

The Interplay of Sleep Quality, Mental Health, and Sociodemographic and Clinical Factors among Italian College Freshmen.

Background/Objectives: Sleep and mental health are closely linked, with sleep deprivation increasing the risk of mental health problems in college students. This study aimed to analyze the role of sleep in the mental health status of a sample of Italian freshmen, considering various mental health outcomes and potential interactions between sleep and other relevant factors, such as sociodemographic characteristics, academic experiences, and mental health history. Methods: All freshmen from a medium-sized Italian university were invited to participate in a multidimensional online survey (n = 3756). Sleep quality was assessed through questions on average hours of sleep per night and on satisfaction of perceived sleep quality. Mental health outcomes included psychophysical well-being, psychological distress, substance use, and problematic internet use. Statistical analysis involved multivariate analysis of variance, followed by pairwise comparisons. Results: The sample (n = 721) exhibited low levels of well-being and a high prevalence of psychological distress (52.1%). Approximately one-third of students (n = 258) were dissatisfied with their sleep quality, and one-fourth (n = 186) reported inadequate sleep (less than 7 h per night). More specifically, 24.4% of students slept on average six hours per night, and 1.4% slept five hours or less. Satisfaction with perceived sleep quality significantly influenced well-being, psychological distress, and cannabis use (ηp2 = 0.02). Interaction effects were observed between satisfaction with sleep quality and drop-out intentions (ηp2 = 0.01), as well as between satisfaction with sleep quality and history of mental health diagnosis (ηp2 = 0.02), both of which were significant for psychological distress and cannabis use. Conclusions: This study highlights the influence of perceived sleep quality on academic distress among college freshmen, particularly those with higher intentions of leaving university and with a history of mental health diagnosis.

1153 Many Reasons for Restless Legs, Not to Rest

Abstract Introduction Restless leg syndrome (RLS) involves an urge to move the legs that is exacerbated by rest, relieved by movement, and most prominent in the evening. While RLS is commonly associated with low ferritin, here we present a complex case in a patient requiring phlebotomy for symptom control related to elevated ferritin levels. Report of case(s) A 52 year-old male presented with uncontrolled RLS diagnosed 12 years prior. Sleep history included obstructive sleep apnea (OSA) on CPAP and hypersomnolence. Diagnostic polysomnogram was notable for an AHI 36.4 events/hr with associated hypoxia. Ferritin was 374ng/mL. He presented to our clinic on melatonin and wearing socks with bars of soap atop his feet. On exam, he was obese and plethoric with significant hypersomnolence despite excellent CPAP compliance. He was previously treated unsuccessfully with a combination of phenobarbital, trazodone, and ropinirole, which exacerbated his hypersomnia. He drank 4-5 liters (L) of soda daily. In the 5 years after initial presentation, he went through periods of total cessation to drinking up to 12L a day. He eventually developed uncontrolled diabetes, hypertension, hyperlipidemia, and NASH with advanced fibrosis. He was referred to Hematology and underwent therapeutic phlebotomy every 2-4 months. He was found to have HFE-C282Y Heterozygous mutation and NASH fibrosis without iron overload on MRI. His RLS was eventually controlled with a combination of pramipexole 1.5 mg, gabapentin 1800 mg, alprazolam 0.5 mg along with therapeutic phlebotomy to maintain a ferritin level less than 250 ng/mL. His hypersomnia was managed with amphetamine-dextroamphetamine. Conclusion RLS has been associated with high serum ferritin, iron, and saturation transferrin index levels with a low transferrin level due to impaired mobilization of stored iron. Iron deposits can be seen on MRI in the globus pallidus, dentate, red nuclei and substantia nigra. In this patient, soda cessation would help improve his diabetes, thereby decreasing chronic inflammation and lowering ferritin levels. Chronic liver disease, HFE C282Y mutations, and hypoxia from OSA can also contribute to increased ferritin levels. Abstaining from caffeine can likewise improve symptoms of RLS as caffeine is known to heighten proprioceptive awareness and increase neuromuscular reactivity which may include myoclonus. Support (if any)

Sleeping Problems or Emerging Psychosis? A Review of Emerging Literature

IntroductionSleep disturbance, particularly insomnia, is prevalent across various mental health disorders. While it is a common sign in mood disorders, emerging evidence suggests that insomnia might act as a precursor or an early sign of psychosis. Our case report and literature review emphasize the importance of evaluating sleep disturbances in the diagnosis and management of mental disorders.Objectives-To explore potential neurobiological underpinnings linking sleep disturbances to psychosis onset.-To advocate for the importance of early identification and intervention for sleep disturbances in the broader context of preventing or managing psychotic disorders. Methods We present a case describing a young patient’s first episode of psychosis, which was masked by an initial presentation of insomnia. Additionally, we conducted a review of the relationship between sleep disturbances and psychosis, with a comprehensive literature search from Pubmed, Scopus and psychINFO.Results A 20-year-old African-American male with a history of poor sleep was initially diagnosed with Major Depressive Disorder. He was treated with Bupropion, Quetiapine, and Trazodone. However, he later presented with worsening depression, odd behavior, and signs of disorganization, suggestive of a psychotic episode. After switching his medication to Risperidone 4mg twice daily, the patient’s sleep and other symptoms markedly improved. Through our literature review, we identified that sleep disturbances, especially insomnia, can be a risk factor for developing psychosis. While a cross-sectional study recorded one-fourth of their study population experiencing First Episode Psychosis (FEP) with clinical insomnia, another study reported close to 80% of their study sample with early psychosis suffering from a minimum of one sleep disorder; insomnia and nightmare disorder being the most frequent. A large sample longitudinal analysis lasting one year also observed patients with sleep disorders to be twice at risk of onset and persistence of psychotic episodes. A growing body of evidence also suggests that structural brain abnormalities and neural development alterations in the early stages of psychosis may lead to sleep disturbances and subsequent psychotic symptoms. Findings suggest that thalamic dysfunction may in particular contribute to sleep spindle deficits and altered EEG microstate dynamics. These deficits are unrelated to antipsychotic medication exposure, and are also not observed in patients with other psychiatric illnesses.Conclusions While the correlation between sleep disorders and psychosis has been well-established for decades, very limited literature is available on the role of sleep in FEP. Recognizing and treating sleep disturbances is pivotal in managing psychiatric disorders, including psychosis. Thus, a comprehensive evaluation of sleep issues in patients presenting with psychiatric symptoms is imperative for accurate diagnosis and management.Disclosure of InterestNone Declared

Clinical prediction of opioid use disorder in chronic pain patients: a cohort-retrospective study with a pharmacogenetic approach.

Opioids are widely used in chronic non-cancer pain (CNCP) management. However, they remain controversial due to serious risk of causing opioid use disorder (OUD). Our main aim was to develop a predictive model for future clinical translation that include pharmacogenetic markers. An observational study was conducted in 806 pre-screened Spanish CNCP patients, under long-term use of opioids, to compare cases (with OUD, N.=137) with controls (without OUD, N.=669). Mu-opioid receptor 1 (OPRM1, A118G, rs1799971) and catechol-O-methyltransferase (COMT, G472A, rs4680) genetic variants plus cytochrome P450 2D6 (CYP2D6) liver enzyme phenotypes were analyzed. Socio-demographic, clinical and pharmacological outcomes were also registered. A logistic regression model was performed. The model performance and diagnostic accuracy were calculated. OPRM1-AA genotype and CYP2D6 poor and ultrarapid metabolizers together with three other potential predictors: 1) age; 2) work disability; 3) oral morphine equivalent daily dose (MEDD), were selected with a satisfactory diagnostic accuracy (sensitivity: 0.82 and specificity: 0.85), goodness of fit (P=0.87) and discrimination (0.89). Cases were ten-year younger with lower incomes, more sleep disturbances, benzodiazepines use, and history of substance use disorder in front of controls. Functional polymorphisms related to OPRM1 variant and CYP2D6 phenotypes may predict a higher OUD risk. Established risk factors such as young age, elevated MEDD and lower incomes were identified. A predictive model is expected to be implemented in clinical setting among CNCP patients under long-term opioids use.

Initial validation of the new browser-based application DREEP for diagnosis of common chronic sleep disorders

Abstract Background Traditionally, individuals with chronically disordered sleep are referred to a sleep specialist, who would usually arrange diagnostic investigations including polygraphy and/or polysomnography (PSG). Dr. Sleep (DREEP) is a browser-based application developed for diagnosing common chronic sleep disorders such as obstructive sleep apnea (OSA), periodic leg movements (PLMD), and insomnia in adults. The DREEP algorithm is based on disease-specific questions adapted from validated sleep questionnaires. This study evaluated the preliminary performance of DREEP for the diagnosis and severity assessment of sleep disorders in adults with chronically disordered sleep. Methods Sixty-four individuals admitted to the sleep laboratory of the Department of Sleep Medicine at the University of Essen, Germany, were recruited. Medical sleep history was taken by a sleep specialist. Each participant underwent full-night PSG and used the DREEP application on a tablet in the evening of admission or the morning after diagnostic sleep testing. Results DREEP predicted OSA with a sensitivity of 97%, but specificity was low at 25% (it had a tendency to overestimate OSA). DREEP had sensitivity of 79.2% and specificity of 80% for detecting PLMD/restless legs syndrome (RLS). The application showed the best performance for detection of insomnia (sensitivity 90%, specificity 83%), and successfully detected one individual with clinically confirmed narcolepsy. Conclusion This initial validation study has shown that the browser-based application DREEP is adequately able to assess risk and improve the pre-test probability for prescribing further tests in individuals with common chronic sleep disorders, including OSA, PLMD/RLS, and insomnia. In addition, DREEP was able to correctly identify most individuals without these conditions despite a tendency to overestimate. In a follow-up study, the promising clinical accuracy of DREEP needs to be substantiated by adding a healthy control group.

Daytime sleepiness in depression—underestimated in psychiatric inpatients

Abstract Background Sleep disorders are among the most common symptoms of depression. Both the ICD-10/11 and DSM‑5 list sleep disorders of all types as diagnostic criteria for depression, but these are not defined in detail. Objective This study focused on the prevalence of daytime sleepiness and associated sleep disorders in patients diagnosed with a severe depressive episode. Materials and methods In total, 192 inpatients with a moderate/severe depressive episode from an open acute psychiatric ward were included. Sleep history immediately after admission and sleep-related questionnaires, such as the Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Regensburg Insomnia Scale (RIS), were collected. Polysomnographic assessment was performed in 82 patients with suspected sleep disorders. Patient groups (e.g., with and without sleepiness or apnea) were compared. Results The prevalence of daytime sleepiness (ESS &gt; 10) was 25.3%. Fatigue and insomnia were reported in 66.7 and 75.7% of patients, respectively. Polysomnography revealed a prevalence of sleep apnea of 18.2%, and sleep apnea was newly diagnosed in 80% of these patients. Daytime sleepiness was more common in patients with undiagnosed sleep apnea. Patients with daytime sleepiness had more fatigue but did not have more severe depression. Conclusion The present results highlight the importance of assessing sleep history in psychiatric patients, especially those with depression. The ESS may be a useful tool to specifically assess daytime sleepiness as opposed to depression-related fatigue. A systematic assessment of sleepiness and specific sleep disorders, in particular sleep apnea, might contribute to improved treatment of inpatients with depression.

Impact of COVID-19 outbreak on subjective sleep during lockdown: relation with resilience characteristics.

The SARS-CoV-2 pandemic had a considerable impact on both the physical and mental health of people. Resilience is a psychological characteristic reflecting the ability to overcome or adapt to difficulties such as adversity, trauma, or extremely stressful situations. People with high resilience have been shown to exhibit lower levels of anxiety, stress and depression when faced with a stressful event. Sleep is particularly sensitive to anxiety and stress. The aim of this study was to investigate the impact of COVID-19 pandemic on sleep quantity, quality, and habits, while considering resilience as a factor. A total of 1260 individuals were recruited through an online survey. The variables that were assessed were socio-demographic, sleep habits and sleep disorders history, the Athens Insomnia Scale (AIS), the 25-item version of the Connor-Davidson Resilience Scale (CD-RISC), and any work/financial consequences during the first COVID-19 lockdown. The results showed that sleep habits during the lockdown changed for many of the participants. Their sleep schedule moving towards earlier or later for 9% and 67% of them, respectively; 38% of the participants were found to suffer from insomnia, based on the AIS score. A higher score on the CD-RISC was associated with better sleep. In conclusion, our study confirmed previous studies identifying quantitative and qualitative changes in sleep during the COVID-19 lockdown. It also expanded on the previous findings by identifying the correlation between sleep and resilience during the stressful period of the COVID-19 lockdown.

Common Childhood Sleep Problems and Disorders.

Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children. To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents. A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with the keywords "sleep problem" or "sleep disorder" and "child" or "adolescent". Findings in the relevant articles and cross-references were compiled. Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in initiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. Comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm the history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders, such as obstructive sleep apnea and narcolepsy, needs timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical features, indications for evaluation, and treatment options summarized. Screening for sleep problems shall be an integral part of each child's health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disorders for early intervention to prevent long-term adverse outcomes.

The Phenomenon of Sleeping in Sand Based On Culture In Elderly With Osteoarthritis

Background: Pain in the elderly with osteoarthritis requires alternative therapy to fulfill their comfort. The purpose of this study was to explore the culture of sleeping on the sand among the coastal elderly with osteoarthritis pain. Methods: This research method used a qualitative research approach with phenomenological research design and data collection techniques using in-depth interviews, participant observation, and documentation. The time of the research is from April to May 2023, located in Legung Village, Batang-Batang District, Sumenep Regency. The technique was judgment sampling, with nurses as key informants, the elderly as main informants, and traditional and community leaders as supporting informants, so the informants in this study were 18 participants. Data analysis uses athematic analysis based on values, activities, and artifacts. Results: 1. Cultural elements in the form of values and ideas in the culture of sleeping on the sand include sleep history, belief in sleeping on the sand, and concepts or values in society. 2. The form of activity can be seen in several sand extraction activities or the implementation procedure of preparing sand to be used as the basic material for bedding. 3. The form of the artifacts is related to the tools and materials used in this case, which are related to sleep culture. Conclusion: The culture of sleeping on the sand has a comforting effect on older people based on three forms of culture, including ideas and values, activities, and artifacts. The culture of sleeping on the sand can be used as a daily activity to overcome the problem of osteoarthritis in older people. This research can be developed regarding the implementation of culture-based transcultural nursing care.

Lipid-focused dietary education intervention in pregnant women: study protocol for an open-label, parallel, randomised, intervention study addressing adverse pregnancy outcomes in China

IntroductionThe incidence of infants who are large-for-gestational-age (LGA) is on the rise in China, and its detrimental effects on health have received increasing attention. Diet-based interventions have the potential to...

Assessment of oropharyngeal respiratory volume and sleep apnoea scores using peripheral arterial tonometry may improve diagnosis and treatment planning of combined dysgnathia therapy approaches.

Increased daytime sleepiness is a frequently reported symptom in patients with pronounced dysgnathia. This study investigated possible correlations using home peripheral arterial tonometry (PAT) and oropharyngeal airway volume determination in patients with dysgnathia and daytime sleepiness. Twenty patients (13 male, median age 27.6 ± 6.8 years) with abnormal sleep history and 10 skeletal neutral configured controls (6 male, median age 29.5 ± 4.2 years) with normal sleep history were examined. Patients and controls were evaluated for apnoea-hypopnoea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), snoring volume (dB), total sleep time (TST) and REM-percentage (REM). Airway volumetry was measured via CBCT. Individual user experience for PAT was assessed using the User Experience Questionnaire (UEQ). Patients had significantly higher respiratory scores than controls. AHI increased 4.6-fold (p = .006), RDI 2.5-fold (p = .008) and ODI 6.4-fold (p < .001). Oropharyngeal volumes showed a 30% decrease (p = .003). dB, TST and REM showed no significant differences. AHI (r = -.51; p = .005), ODI (r = -.60; p < .001) and RDI (r = -.45; p = .016) correlated negatively with pharyngeal volume. Wits appraisal correlated negatively with oropharyngeal volume (r = -.47; p = .010) and positively with AHI (r = .41; p = .03) and ODI (r = .49; p = .007). dB and TST (r = -.49; p = .008) and REM and RDI (r = -.43; p = .02) correlated negatively. UEQ-KPI (2.17 ± 0.24) confirmed excellent usability of PAT. Patients with mandibular retrognathia and abnormal sleep history showed significantly higher respiratory indices and smaller oropharyngeal volumes than neutrally configured controls. The dygnathia severity directly influenced the risk of obstructive sleep apnoea.

ReeBundle: A Method for Topological Modeling of White Matter Pathways Using Diffusion MRI.

Tractography can generate millions of complex curvilinear fibers (streamlines) in 3D that exhibit the geometry of white matter pathways in the brain. Common approaches to analyzing white matter connectivity are based on adjacency matrices that quantify connection strength but do not account for any topological information. A critical element in neurological and developmental disorders is the topological deterioration and irregularities in streamlines. In this paper, we propose a novel Reeb graph-based method "ReeBundle" that efficiently encodes the topology and geometry of white matter fibers. Given the trajectories of neuronal fiber pathways (neuroanatomical bundle), we re-bundle the streamlines by modeling their spatial evolution to capture geometrically significant events (akin to a fingerprint). ReeBundle parameters control the granularity of the model and handle the presence of improbable streamlines commonly produced by tractography. Further, we propose a new Reeb graph-based distance metric that quantifies topological differences for automated quality control and bundle comparison. We show the practical usage of our method using two datasets: (1) For International Society for Magnetic Resonance in Medicine (ISMRM) dataset, ReeBundle handles the morphology of the white matter tract configurations due to branching and local ambiguities in complicated bundle tracts like anterior and posterior commissures; (2) For the longitudinal repeated measures in the Cognitive Resilience and Sleep History (CRASH) dataset, repeated scans of a given subject acquired weeks apart lead to provably similar Reeb graphs that differ significantly from other subjects, thus highlighting ReeBundle's potential for clinical fingerprinting of brain regions.