Impaired Sleep Quality Research Articles

Sleep, eating and psychopathologies: Which one(s) may be associated with the development of metabolic syndrome in psoriasis patients through psoriasis quality of life?

Background: Psoriasis (PS) has many comorbidities including metabolic-syndrome (MetS) sleep and eating disorders and psychopathologies. Objectives: Investigating the relationship between the presence of MetS and sleep, eating and psychological pathologies in PS-patients through psoriasis quality of life (PSQoL). Methods: In this cross-sectional and descriptive correlation study, besides demographics, MetS-parameters and comorbidities, PS-severity, PS related quality of life (PSQoL), sleep-quality (SQ), depression, anxiety, body image-related QoL (BIQoL), perceived stress, flourishing, social appearance anxiety and eating attitudes of subjects were examined with related scales. Data analyzed using SPSS software, according to two PS groups with and without MetS. Results: Of 107 PS-patients, 68 were diagnosed with MetS. Mean-age and PS-duration were significantly higher in MetS (+) group. PS- severity was correlated with poor PSQoL, anxiety, depression, impairing flourishing, poor overall SQ and impairing in two sleep-subcomponents in MetS (+) group, whereas it was correlated with only poor PSQoL and poor overal SQ in MetS (-) group. Poor PSQoL was correlated with anxiety, depression, poor BIQoL, poor overal SQ and impairing in three sleep-subcomponents in MetS (+) group, whereas no correlation was found between these parameters and PSQoL in MetS(-) group. Conclusions: MetS is seen at high-rate in patients with long-term PS. PS-severity is especially correlated with anxiety, impaired-flourishing, and impaired-SQ in PS-patients with Mets (+). PSQoL appear to be correlated with depression, anxiety, distorted-BI and impaired SQ in these patients. It should be kept in mind that neuropsychological factors may facilitate the development of dysmetabolic events in PS-patients, by impairing PSQoL.

Impact of Hemodialysis on Sleep Disorders in Patients With End-Stage Renal Disease in a Tertiary Care Academic Hospital.

Although hemodialysis (HD) has prolonged the survival of patients with end-stage renal disease (ESRD), it has also adversely affected the sleep and emotional state of these patients. We evaluated the impact of HD on sleep duration, quality, and other sleep-related disorders. We recruited consecutive adult patients visiting our tertiary care dialysis unit. We included only ESRD patients who had an estimated glomerular filtration rate (eGFR) of <15 mL/min/1.73m2. We excluded patients with unrelated comorbidities or on medications that could affect sleep. Basic demographic information, anthropometric data, and appropriate lab investigations were obtained. Objective information related to their sleep duration and quality was asked using a predefined proforma. Subjective sleep scores were obtained by using the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), and insomnia severity index (ISI). For comparison, the patients were divided into HD and conservative treatment (CT) groups based on their treatment modality. The baseline characteristics of the patients were noted. The Shapiro-Wilk test was used to test normality. Correlations were obtained by using Student's t-test for parameters that were normally distributed and the Mann-Whitney-Wilcoxon test for those that were not. Of the 56 patients we studied, 59% were males. The average age and body mass index (BMI) were 45.7 years and 20.98 kg/m2, respectively. Overall, 41% of patients were assigned to the HD group, and the remaining to the CT group. The CT group had fewer comorbidities compared to the HD group. The average sleep duration was similar in both groups (HD: 6.64 hours, CT: 6.49 hours). There was a weak-to-moderate positive correlation between the sleep scores. Overall, one-half of the patients had excessive daytime sleepiness (EDS) (46.43%) and insomnia (48.21%), and two-thirds of them were poor sleepers (66.07%). Symptoms suggestive of sleep-disordered breathing (SDB) were seen in 25% of patients, restless legs syndrome (RLS) in 19.64% of patients, and periodic limb movement disorder (PLMD) in 44.64% of patients. Patients undergoing HD had poorer sleep quality compared to the CT group (p=0.038). The odds of developing poor sleep were 3.6 times higher in the HD group. This cross-sectional study focuses on the quantification of objective and subjective deterioration of sleep quality in ESRD patients on HD. The prevalence of EDS (63.64%), insomnia (51.52%), and poor sleep quality (84.84%) in the HD group was more than the previously reported values. The PSQI, ESS, and ISI scores were higher in HD patients, indicating poorer sleep quality. Our study highlights the underestimation of sleep disorders in HD patients in underserved areas. Theresults warrant a meticulous evaluation of the same by a keen nephrologist, followed byreferral to sleep providers where necessary.

Sleep quality burden in chronic rhinosinusitis with nasal polyps and its modulation by dupilumab

BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is associated with a substantial burden on patients’ quality of life and impaired sleep quality. The most common CRSwNP endotype is characterized by type 2 inflammation, with enhanced production of interleukin (IL)-4, IL-5, and IL-13. Dupilumab is a monoclonal antibody against IL-4 receptor-α, which inhibits both IL-4 and IL-13 signaling, and was recently approved for treatment of CRSwNP. ObjectiveWe investigated the effect of dupilumab on the sleep quality of patients with CRSwNP in a real-life setting. MethodsPatients were evaluated at baseline and after 1 and 3 months of dupilumab treatment by means of the Epworth sleepiness scale (ESS), insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), and sinonasal outcome test 22 (SNOT-22) sleep domain. ResultsA total of 29 consecutive patients were enrolled, and their baseline sleep quality assessment were as follows: ESS of 7.9 (± 4.5); ISI of 13.1 (± 6.2); PSQI of 9.2 (± 3.7); and SNOT-22 sleep domain of 12.1 (± 4.2). Excessive daily sleepiness, insomnia, and globally impaired sleep quality were present in 24.1%, 79.3%, and 93.1% respectively. Treatment with dupilumab was associated with significant improvement in ESS, ISI, PSQI, and SNOT-22 sleep domain with concomitant reduction of the proportion of patients with insomnia and globally impaired sleep quality. ConclusionCRSwNP was associated with a significant impact on global sleep quality, in particular, insomnia, and treatment with dupilumab induced a rapid improvement (after 1 single month of treatment) in all the sleep quality parameters, suggesting that sleep disturbances should be more carefully evaluated as an additional outcome in these patients.

Associations of Positive and Negative Perceptions of Outdoor Artificial Light at Night with Nighttime Outdoor Behaviors and Health: Self-Reported Data Analyses on Urban and Suburban Residents in Japan

Nighttime light guarantees outdoor work, leisure, and other activities, and its convenience and security greatly improve the quality of human life. However, the negative effects of outdoor artificial light at night (ALAN) on humans are also being proven. This study aimed to examine the relationships between outdoor nighttime lighting and human behaviors (i.e., outdoor nighttime behaviors such as jogging and meeting friends) and health (i.e., physical and mental health, including sleep quality and stress) through how individuals feel about outdoor ALAN (i.e., ALAN perceptions) in their living environment. Two online questionnaire surveys were conducted among residents of Tokyo (Survey 1, N = 2000) and Tsukuba City (Survey 2, N = 500), Japan. Structural equation modeling results show that both positive and negative ALAN perceptions increase nighttime outdoor behavior in both surveys. In Survey 1, this association led to a deterioration in sleep quality and physical and mental health. The current findings contribute to understanding the controversial relationships between the pros and cons of nighttime light perceptions and behaviors and health. They also contribute to designing better nighttime lighting in outdoor public and private spaces with relevant restrictions by balancing the benefits and harms of outdoor ALAN.

Difficulties experienced by patients with benign prostatic hyperplasia regarding their physical symptoms

AbstractBenign prostatic hyperplasia (BPH) is a significant health concern for all ageing men and is characterized by clinical symptoms resulting from the growth of benign tissues in the prostate gland. Living with a chronic disease like BPH undoubtedly affects different aspects of a person's life. This study was conducted to examine in‐depth the difficulties experienced by BPH patients who have no other option but to undergo surgery due to their symptoms. The study is qualitative research with a phenomenological design. A total of 18 patients were included in the study. Research data were obtained using the interview method, which is one of the qualitative data collection methods, and the content analysis method was used to analyse the data obtained from the interviews. Eighteen patients with ages ranging from 57 to 75 years and experiencing BPH‐related symptoms for 2–11 years participated in the study. The reactions of patients to living with BPH‐related symptoms were presented under the themes of social anxiety, social disconnection, impaired quality of sleep, and decreased sexual self‐confidence. The themes mentioned by BPH patients regarding the duration of their illness are the result of a combination of many factors. In this context, it is recommended that urology nurses provide psychological support, medical information, self‐care skills, and self‐monitoring skills to BPH patients to develop individual coping mechanisms. BPH is a significant health concern for all ageing men and is characterized by clinical symptoms resulting from the growth of benign tissues in the prostate gland. Living with a chronic disease like BPH undoubtedly affects different aspects of a person's life. It is not impossible to find solutions to patients by understanding them deeply.

Physical activity, sleep, and mental health during the COVID-19 pandemic: A one-year longitudinal study of Spanish university students

The objective of this longitudinal study was to analyze changes in physical activity, sedentary time, sleep, anxiety, mood, and perceived health as a result of COVID-19 pandemic in a cohort of Spanish university students, both during the home confinement and one year after. Additionally, we analyzed the associations between physical activity, sedentary time, and other measured parameters. Data were collected through two online questionnaires that included the International Physical Activity Questionnaire-Short Form, the Pittsburgh Sleep Quality Index, and self-reported anxiety, mood, and perceived health levels before, during and one year after home confinement. Participants reported decreased physical activity, increased sedentary time, and deterioration in sleep quality and perceived health during confinement. Most parameters had improved one year later; however, the participants still reported less physical activity, more sedentary time, and deterioration in sleep quality and perceived health compared to before confinement. Men reported greater reduction of physical activity during home confinement than women. In contrast, women reported reduced physical activity one year after confinement, whereas men reported increased activity. Participants reported higher anxiety and worse mood both during and one year post-confinement compared to pre-confinement, with women reporting higher levels of anxiety than men. Sports science students were closer to regaining pre-pandemic levels of physical activity one year post-confinement than students in other disciplines. Sleep, anxiety, and mood were worse among students with obesity compared to students in other BMI categories. Overall, increased physical activity and decreased sedentary time were associated with less anxiety and better sleep, mood, and perceived health during and one year post-confinement. In conclusion, our results demonstrate that physical activity, sedentary behavior, sleep, anxiety, mood, and perceived health were disrupted one year after home confinement. Higher levels of physical activity and lower sedentary time were associated with preserved sleep and mental health during the pandemic.

Psychosocial and health stressors during the COVID-19 pandemic and their association with sleep quality

Objective We investigated how psychosocial and health stressors and related cognitive-affective factors were differentially associated with sleep quality during the early months of the COVID-19 pandemic Methods and Measures Adults living in Florida (n = 2,152) completed a Qualtrics survey in April-May 2020 (Wave 1). Participants (n = 831) were reassessed one month later (Wave 2; May-June 2020). At Wave 1, participants reported their level of physical contact with someone they care about, presence of a pre-existing chronic disease, employment status, loneliness, health worry, and financial distress. At Wave 2, participants rated their quality of sleep and insomnia symptoms. Results Loneliness, but not health worry or financial distress, directly predicted worse sleep quality. Lack of physical contact was indirectly associated with worse sleep quality via greater levels of loneliness. Further, results showed the presence of a pre-existing chronic disease was associated with both greater health worry and worse sleep quality. Conclusion Loneliness was the sole cognitive-affective predictor of worse sleep quality when controlling for other psychosocial factors. As expected, adults living with a chronic disease reported impaired sleep quality. Understanding the processes influencing sleep quality during a significant time of stress is important for identifying risk factors, informing treatment, and improving sleep health beyond the pandemic.

The Relationship between Knowledge, Dietary Supplementation, and Sleep Quality in Young Adults after the COVID-19 Pandemic.

Sleep is one of the most important factors affecting the quality of life. More than 50% of Polish adults have sleeping disorders, and young adults are the ones particularly vulnerable to this. This is why the analysis of the predictors of sleep quality, such as sleep hygiene knowledge and dietary knowledge, in young adults is a very important topic, especially after the COVID-19 pandemic, which may have affected sleeping habits. 402 young adults (mean age 28.12 ± 6.08 years old) were enrolled in the study during the COVID-19 pandemic. Sleep quality was assessed with the Pittsburgh Sleep Quality Questionnaire, while dietary knowledge and sleep hygiene knowledge were assessed with dedicated questionnaires. The participants were also asked about the use of specific dietary supplements. The analysis showed that sleep hygiene knowledge was significantly associated with sleep length (R = -0.17, p = 0.003) and overall sleep quality (R = -0.17, p = 0.005), while dietary knowledge significantly correlated with time to fall asleep (R = -0.12, p = 0.026). The regression analysis revealed that sleep hygiene knowledge was a significant negative predictor of sleep quality impairment (β = -0.13, p = 0.028). Significant results were also obtained for the use of supplements (β = -0.20; p = 0.001) and the use of medications (β = -0.32, p = 0.001), which were negative predictors of sleep quality impairment. This study showed that increased sleep hygiene knowledge promoted improved sleep length and overall sleep quality. In addition, dietary knowledge significantly correlated with time to fall asleep. On the other hand, decreased sleep quality was observed in participants who used medications or dietary supplements.

Assessment of daily blood pressure parameters in patients after injury

ABSTRACT. Many studies have highlighted the impact of various significant risk factors on the occurrence of arterial hypertension. However, few papers have examined the effect of psychoemotional factors as important contributors to the risk of arterial hypertension for such a specific population group as contracted servicemen performing military service under conditions of performing special tasks. Furthermore, there is a lack of data on the daily profile of blood pressure in this particular group of individuals. This thesis aims to substantiate the claim that injury, as a risk factor, greatly influences changes in the daily profile of blood pressure. The study examined 118 patients, divided into an experimental group (65 people) and a control group (53 people). The daily profile of blood pressure was assessed using continuous ambulatory blood pressure monitoring. Questionnaires were used to evaluate the quality of sleep, anxiety, and depression. The findings indicated that the patients of the experimental group, following trauma, exhibited a higher index of systolic and diastolic blood pressure duration, while the mean values remained within the normal range. Additionally, these patients more frequently exhibited a blood pressure profile characterized by an insufficient nocturnal decrease in blood pressure, known as non-dipping. This could be attributed to impaired sleep quality, as well as subclinically significant manifestations of anxiety and depression caused by stress. The early detection of changes in the index of systolic and diastolic blood pressure duration, along with deviations in the daily blood pressure profile observed through continuous ambulatory blood pressure monitoring, would enable specialists to promptly address alterations in the hemodynamics of these patients and prescribe appropriate therapy. Therefore, psychoemotional stress in people who have experienced trauma is one of the trigger mechanisms for increased blood pressure. If left unaddressed, this can progress to persistent arterial hypertension.

Sleep Quality Aspects in Post-COVID-19 Patients.

In this observational cohort study, sleep quality in post-COVID-19 patients was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. This study aimed to examine aspects of sleep quality in patients who have undergone SARS-CoV-2 infection and if there is a pattern of progression or regression over time (6 months). We also observed and analyzed the results in order to identify any possible links between the severity of COVID-19 and sleep quality as measured by the PSQI questionnaire. The study group consisted of 65 adult patients with confirmed SARS-CoV-2 infection who were referred to a pulmonologist for evaluation. Sleep quality was impacted at a high rate in post-COVID-19 patients, quantified by a PSQI score ≥5. Out of 65 patients, 51% of them had scores greater than or equal to 5. Sleep was subjectively reported as unsatisfactory predominantly in mild and moderate COVID-19 patients. According to the PSQI score and a 6-month follow-up, many patients presented persistency in poor sleep quality. Investigation and individualized treatment of sleep disorders in post-COVID-19 patients should be part of the routine pneumological control, as improvement in sleep quality has an impact not only on the health but also on the psychological state of patients. Educating patients about the importance of sleep and sleep quality impairment should be a primary concern.

The emotional component of insomnia disorder: A focus on emotion regulation and affect dynamics in relation to sleep quality and insomnia.

Theoretical models of insomnia disorder recognise an emotional component in the maintenance of the disorder. Nonetheless, the field of emotions is vast and different processes are involved in psychological well-being. The present narrative review focusses on emotion regulation and affect dynamics, synthesising some of the most recent and relevant evidence on emotions in relation to the quality of sleep and to insomnia disorder. The literature underlines the close association between impaired sleep quality and difficulties in regulating emotions. Impaired sleep quality is also associated with reduced positive affect and increased negative affect, but little evidence supports a bi-directional association between affective states and sleep. Affect variability in relation to sleep has been less investigated. Initial evidence suggests that high variability in positive affect has a negative impact on sleep. Neurobiological and behavioural evidence indicates that insomnia disorder is associated with emotion dysregulation, negative affect, and a distinct daily profile of affective states. More research is needed on the affective experience of patients with insomnia disorder, adopting multiple sampling of affect across the day and the week. Understanding how the unfolding of emotions over time interact with sleep alterations may help to improve the tailoring and monitoring of treatments addressing disturbed emotional processes in insomnia disorder.

Порушення сну внаслідок дистресу війни

Topicality. With the start of the full-scale invasion of russia in Ukraine, sleeping disorders are becoming more and more widespread among the civil population – frequent air alarms at night, shelling of the civil areas, everyday loud sounds that are now perceived in a different way - these all cause sleeping disorders. Studies of the US researchers [1] prove that sleeping disorders, such as insomnia, short-term sleep, and nightmares in particular, are common at the time of military actions. This has an impact on people’s health and well-being by reducing muscular strength and impairing the nervous and cardiovascular systems. For many people involved in armed conflicts (servicemen, civilians living within the area of active combat actions, people under constant threat of air attacks, etc.) sleeping disorders last for many more years after and can have a considerable impact on their ability to reintegrate in society and have a normal life after war. As of today, there is little research in Ukraine which would describe sleeping disorders and sleep quality deterioration in the civilian population in wartime, features of sleep in wartime, and their correlation with psychopathological phenomena, such as anxiety and depression. Also, there is insufficient research of projected functional changes in the population emerging as a result of sleep-wake cycle disorders. All these define the topicality of this research. Aim of the research. The research aims to explore sleep quality deterioration in the civilian population living in Ukraine in wartime and identify correlation between sleep quality deterioration and symptoms of anxiety and depression. Methodology of the research. The clinical objects of the research are 103 respondents. In addition to the social demography method of study, the research made use of the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Quality of Life Scale (© by O. Chaban), as well as the methods of statistical data processing using the CORREL function in Excel tables. Results. In the course of the research it has been discovered that ⅔ of the respondents living in Ukraine in wartime show sleeping disorders of different severity. Positive direct medium-degree correlation has been established between sleep quality deterioration and elevated anxiety levels. The given research contains optimized recommendations for medical and psychological consultations aimed at improving sleep quality at the time of crisis and dealing with negative consequences of sleeping disorders.

Psychological states and needs among post-allogeneic hematopoietic stem cell transplantation survivors.

To analyze psychological states and needs of patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Questionnaires were sent to 101 allo-HSCT survivors and 96 questionnaires were returned. The questionnaire covered several categories: (1) demographics and general information, (2) physical conditions, (3) psychologic status and sleep quality, (4) survivor's comments on transplantation, (5) demands and needs, (6) preferred forms and channels of information. Depression and poor sleep quality were major concerns troubling allo-HSCT survivors. A notable discrepancy exists between clinically diagnosed depression (4.2%) and self- reported depression based on BDI-13 (55.2%). Young adults (18-49 years old), chronic graft-versus-host disease, the ECOG performance score of 2-4, surviving within 5 years since HSCT, no or low dose of ATG used and being single were significantly associated with self-reported depression. Based on the PSQI score, 75% of survivors experienced varying degrees of sleep quality impairment. Young adults, chronic GVHD and the ECOG score of 2-4 were significantly associated with worse sleep quality. The majority of patients reported unmet needs on physical and psychosocial aspects. Nutrition information was the most important topic, followed by disease treatments and fatigue. Differences in informational needs were found in the survivors according to age, time since HSCT and gender. WeChat public account and WeChat applet, mobile interactive platform and one-to-one conversation were the favorite channel for information. Clinicians should establish more appropriate survivorship care plans focusing on survivors' psychologic states, demands and needs.

Assessment of serum level of melatonin in migraine: a case control study

BackgroundMigraine attacks are reported to be severe enough to affect daily living events and can affect different age groups including early childhood. Chronic migraine is usually associated with several comorbidities such as anxiety, depression, sleep disorders, fibromyalgia, and fatigue. The existence of a bidirectional relationship between sleep and migraine is documented. This study aims at assessing the relationship between serum melatonin, sleep quality, and both migraine and migraine severity. This case–control study was executed on 70 patients and 70 healthy controls. Serum melatonin was assessed in morning and evening blood samples. Patients underwent a thorough clinical examination, assessing migraine severity using the Migraine Disability Assessment Scale and the sleep quality of both groups was evaluated using the sleep quality scale.ResultsSerum melatonin levels were significantly reduced among migraine patients in both morning and evening samples. Sleep quality was significantly impaired in migraine patients. There is a statistically significant negative correlation between melatonin in both samples and both of frequency of attack and migraine disability. Positive family history, presence of aura and chronic migraine had significantly lower melatonin in both samples compared to those without aura was associated with significantly lower melatonin. Sleep quality was negatively correlated with serum melatonin, and positively correlated with migraine severity and frequency.ConclusionSerum melatonin is significantly reduced among migraineurs, and linked to migraine severity; they also had impaired sleep quality so melatonin administration may represent a chance for improving headache characteristics.

0948 End-to-End utility of the Cardiopulmonary Coupling Sleep Spectrogram in Sleep Medicine

Abstract Introduction Technology has improved the diagnosis and therapeutic tracking of sleep disorders, but remains fragmented. For example, the laboratory polysomnogram and home sleep apnea test is disconnected from the data available from therapy devices. Remote patient monitoring has focused more on apnea metrics rather than sleep quality. There is some value to a device or system which can be used for diagnosis, risk stratification, and tracking of clinical outcomes across different sleep disorders. Methods A method which offers the potential of end-to-end utility in sleep medicine is the cardiopulmonary coupling (CPC) spectrogram. Originally an ECG-base device, the current form is that of a Ring oximeter (finger) with an integrated activity monitor. The oximeter data is processed via Bluetooth in a smartphone, and then transferred to a Cloud-based analysis (www.sleepimage.com). The CPC analysis integrates heart rate variability and ECG or photoplethysmography-derived respiration. Outputs include a Sleep Quality Index and percentage of stable sleep (high frequency coupling which covaries with delta power on the electroencephalogram and is associated with blood pressure dipping), unstable sleep (low frequency coupling), an apnea-hypopnea index, oxygen desaturation index, heart rate profile across the night (dipping or non-dipping heart rate), total sleep time and sleep efficiency. Data from two clinical systems were used: Empower Sleep (an Internet-based “digital sleep clinic”) and Sleep Continuum (a sleep tracking service offered by Neurocare, Inc, in the Boston area). Results Data from over 500 patients across a range of sleep disorders show end-to-end utility of the SleepImage system. These include diagnosis of sleep apnea including multi-night recording, sleep apnea phenotyping (high loop gain and sleep fragmentation), remote patient monitoring during CPAP or oral appliance use, supportive information for diagnosis of hypersomnia, tracking medication effects (sodium oxybate, sedative-hypnotics, acetazolamide), sleep-wake instability in mood disorders and Long-Covid, impaired sleep quality in chronic fatigue syndrome and restless legs syndrome, off-label therapies for central sleep apnea (oxygen, acetazolamide, buspirone), and sleep fragmentation in Long-Covid and parasomnia. Examples from each of these clinical use cases will be shown. Conclusion The CPC-based SleepImage Ring system can provide complete diagnostic, phenotyping, and tracking functions. Support (if any) The Institute for Personalized Sleep Health, BIDMC, Empower Sleep

0918 Elevated stress during the first-year of medical school negatively impacts sleep quality

Abstract Introduction Poor sleep health is widespread within healthcare and is notoriously neglected during residency; however, little is known about sleep quality during the pre-clinical years of medical school. Stress contributes to poor sleep quality and is commonplace in medical education. This study sought to understand how stress impacts sleep among first-year medical students. Methods A one-time, 130-item survey was distributed to the first-year medical school class three months into the first semester. Quantitative and open-text questions sought to understand student demographics, mental health, sleep quality, and sleep-related behaviors, beliefs, and knowledge. Highly prevalent anxiety was defined as feeling nervous/anxious/on edge for more than half of the days during the previous two weeks. Odds ratios (OR) include 95% confidence intervals and were determined using binary logistic regression. Statistical significance was considered a p-value ≤0.05. Results 138 of the 209 students (66%) in the first-year medical school class completed the survey. Demographics mirrored those of the whole class: 46% male, 54% female, and average age 23.5. Short sleep was prevalent with a mean (standard deviation) sleep time of 6.85 (0.86) hours. Additionally, more than three-quarters reported suboptimal sleep: 56% rated quality as average, and 21% rated quality as poor/very poor. 33% of respondents reported difficulty falling asleep at least once per week. A lack of restorative sleep was also common: 38% felt that sleep was rarely or never refreshing. Over half of respondents (51%) attributed poor sleep to either stress or school, and 29% of students reported elevated or highly prevalent anxiety. Elevated anxiety predicted suboptimal sleep quality (OR 14.67, 1.70-126.76, p=0.015) and a lack of restorative sleep (OR 6.00, 1.52-23.71, p=0.011). Similarly, suboptimal sleep quality was associated with highly prevalent anxiety (OR 44.0, 4.62-418.93, p&amp;lt; 0.001) and difficulty falling asleep (OR 4.14, 1.76-9.75, p=0.001). Conclusion Poor sleep and stress are both prevalent during the first year of medical school, with students directly linking stress from their academic workload to impaired sleep quality and insufficient sleep duration. Due to the pervasiveness of stress within medical education, future interventions should help students improve their sleep during both low and high stress time periods. Support (if any)

The Effects of COVID-19 Lockdown on the Sleep Quality of Children

Introduction: The COVID-19 lockdown has caused important changes in children’s routines, especially in terms of nutrition, physical activity, screen time, social activity, and school time. Regarding these changes, recent studies show that the COVID-19 lockdown is associated with higher levels of anxiety and depression in children. The objective of this study was to assess changes in sleep quality in Spanish children during the lockdown decreed by the Spanish government between March and June 2020. Methodology: We compared the BEAR (bedtime, excessive daytime sleepiness, awakening during the night, and regularity and duration of sleep) scores of 478 participants (median age = 7.5 years; 48% girls) in the SENDO project during the periods before, during, and after lockdown. The questionnaires were filled out by one of the parents. We used hierarchical models with two levels of clustering to account for the intra-cluster correlation between siblings. The interaction of time with a set of a priori selected variables was assessed by introducing the interaction term into the model and calculating the likelihood ratio test. Results: The mean scores in the BEAR questionnaire referred to the periods before, during, and after lockdown were 0.52 (sd 1.25), 1.43 (sd 1.99), and 1.07 (sd 1.55), respectively. These findings indicate a deterioration in sleep quality during the period of confinement. Parental level of education was found to be an effect modifier (p for interaction = 0.004). Children whose parents had higher education (university graduates or higher) showed a smaller worsening than those without. Conclusion: Our study shows that the COVID-19 lockdown was associated with a significant worsening of sleep quality. Moreover, although the end of the lockdown brought about a slight improvement, mean scores on the BEAR scale remained significantly higher than before the lockdown, suggesting that the consequences for sleep quality could persist over time. This worsening was higher in children whose parents had lower educational degrees. Helping children maintain healthy sleeping habits despite the circumstances and providing early psychological support when needed is important to prevent negative psycho-physical symptoms due to lockdown that could persist over the years.

Upadacitinib for moderate to severe atopic dermatitis.

Atopic dermatitis is an inflammatory skin disease, theprevalence of which has increased in the last decade. It affects all age groups, with adult involvement being a major focus of interest in recent years. The unmet needs of the disease, such as pruritus, sleep quality impairment and eczematous skin lesions, have undergone a therapeutic revolution following the commercialization of drugs such as JAK inhibitors. Upadacitinib, a selective JAK1 inhibitor, has been positioned by both clinical trial results and those observed in clinical practice as the fastest and most effective drug in reducing both pruritus and Eczema Area and Severity Index and validated Investigator Global Assessment. Although the safety profile may be initially alarming, it is advisable to update the actual data in this regard for proper management. New perspectives for upadacitinib in nonatopic comorbidities such as psoriasis and alopecia areata are beginning to be described, and interest in learning more about its peculiarities is growing.

Impact du confinement sur la santé mentale des doctorants, une étude de cohorte dans une université française

IntroductionFew studies are available on the health status of doctoral students. This position at the border between university studies and a professional activity presents specific risk factors, especially in terms of psychosocial constraints. The lockdowns implemented worldwide to control the COVID-19 pandemic are potentially worsening factors. MethodsAt Lyon 1 University, a systematic medical follow-up of first year PhD students had been set up by the occupational health service in 2019. In the context of the lockdown during the COVID-19 pandemic, a telephonic interview was proposed to the same PhD students in order to assess the impact of the lockdown on working conditions and health and to provide possible assistance. During this interview, a standardized questionnaire was used to collect information about the conditions during the lockdown, doctoral work during this period and the consequences on research progress, as well as possible financial difficulties due to the lockdown. In addition, questions were asked about the perceived general health conditions and consultation with a health practitioner during this period. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) were used to assess depression and anxiety. Questions on lifestyle during lockdown, changes in diet during the period, weight change, and changes in the quantity and quality of their sleep were also asked. Comparisons of perceived health status, the prevalence of anxiety and depression symptoms at baseline and during the follow-up survey were made by MacNemar Chi2 tests, as the data were repeated ones. The students were informed orally and in writing that their data would be entered anonymously into a computer and that they could have access to their data in accordance with the General Data Protection Regulation (GDPR). They were all informed by e-mail about the study results at the end of the study. The data collection process was registered with the National Institute for Health Data (INDS) and with the university's register under reference no. 2020/002 by the university's data protection officer in compliance with the French data protection laws (CNIL). The protocol was approved by the ethics committee of the Lyon University College of General Medicine (notification number: 2020-10-29-02). ResultsOf the 161 PhD students initially interviewed, 149 underwent a second interview. In total, 89.2% of the students assessed their health as good or very good. Regarding the answers to the GAD-7 questionnaire, 8.1% had a score equal to or higher than 10, corresponding to moderate to severe anxiety. Regarding the answers to PHQ-9, 19.6% of the PhD students had a score equal to or higher than 9 corresponding to moderate to severe depressive syndromes. The prevalence of an anxiety disorder was significantly associated with the absence of an outside private access in the place of residence during lockdown (75% vs. 37%), an increase in coffee consumption (33% vs. 5%), an increase in the quantity of food consumed (50% vs. 12%), weight gain (50% vs. 19%) and a deterioration in sleep quality (75% vs. 28%). The prevalence of a depressive symptom was significantly associated with lockdown in an urban area (89% vs. 70%), the occurrence of financial difficulties (7% vs. 1%), the consultation of a health professional during the period (34% vs. 15%), smoking cessation (14% vs. 1%), changes in the quantity (31% vs. 9%) and deterioration (59% vs. 25%) of the quality of sleep, and diet changes (66% vs. 43%). GAD-7 scores were unchanged for 90% of participants between the two surveys, but they were higher for 6.8% of doctoral students and lower for 2.7 % (P=0.1). A deterioration of the PHQ-9 scores, i.e. higher scores in the second survey compared to the first, was observed for 15.5% of the PhD students while an improvement of the scores was observed for 1.4% (P=0.0001). DiscussionA number of studies have been published on the impact of lockdown on mental health, but few of them focused specifically on PhD students and even fewer were prospective studies. Their results are therefore difficult to compare with ours; they generally show GAD-7 and PHQ-9 scores that are similar to those of our population, or even higher. The impact of lockdown on the mental health of doctoral students highlighted in our study therefore justifies an appropriate follow-up of this population, particularly in the case of former psychiatric disorders.

Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study

Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea. CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2-7 months after hospital discharge and a later time point 10-14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107). 2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4-6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5-8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (-19%; 95% CI -20 to -16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18-39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27-41% of this effect. Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition. UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council.