Improvement In Sleep Disturbance Research Articles

Investigating the Comparative Effectiveness of Yoga and Relaxation Therapy on Restlessness, Fatigue and Difficulty Concentrating in Multiple Sclerosis Patients

Background: Multiple sclerosis (MS) is a long-term autoimmune disorder affecting the central nervous system, leading to reduced quality of life and impaired physical and psychological functions. Objectives: This study aims to examine the relative efficacy of yoga and relaxation therapy in improving sleep disturbances, fatigue, and cognitive impairment among individuals diagnosed with MS. Methods: This study employed a semi-experimental research design, including a pre-test, post-test, and follow-up over three months. The target population comprised all MS patients referred to the Iranian MS Association in Tehran between July and November 2023. Sixty participants were selected using purposive sampling and randomly assigned to research groups: Two yoga therapy groups with 17 participants each, a relaxation therapy group with 16 participants, and a control group with 18 participants. The yoga therapy group participated in twelve 90-minute sessions twice a week, while the control group received no intervention and was placed on a waiting list. Various tools, including the Multidimensional Fatigue Inventory (MFI), Cohen-Mansfield Agitation Inventory (CMAI-O), and a concentration skills questionnaire, were used to collect data. The data were analyzed using ANOVA, Bonferroni post hoc test, MANCOVA, and Kruskal-Wallis H tests with a significance level of 0.05, utilizing SPSS 27 software. Results: The study found a significant difference (P < 0.001) in the restlessness factor in both the post-test and follow-up phases. Additionally, there was a significant difference (P < 0.001) in the levels of physical fatigue, mental fatigue, decreased activity, and decreased motivation in both the post-test and follow-up phases, indicating significant changes in the fatigue factor among the research groups. However, there was no significant difference in the general fatigue component between the research groups. A significant difference (P < 0.001) was also found in the concentration factor, particularly in the components of voluntary and involuntary concentration, during both the post-test and follow-up stages. Conclusions: The results of this study indicate that both yoga and relaxation therapy techniques significantly reduce restlessness, physical tiredness, mental fatigue, decreased activity, and decreased motivation. Furthermore, the findings validate that both yoga and relaxation therapy techniques effectively enhance voluntary and involuntary concentration.

Exploring the Relationship between Sleep Pattern and Quality of Life in the Middle-aged Population Based on Fuzzy-set Qualitative Comparative Analysis.

This study aims to investigate the effects of 7 factors (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction), as measured by the Pittsburgh Sleep Quality Index, on the quality of life (QOL) in middle-aged individuals. A total of 194 middle-aged individuals aged 45 to 59 years participated in this study. The Chinese version of the medical outcomes study 36-item short-form health survey and the Pittsburgh Sleep Quality Index were used to assess the QOL and sleep quality, respectively. The relationship between sleep patterns and QOL was analyzed using fuzzy-set qualitative comparative analysis. Improvement in sleep disturbances and reduction in the use of sleeping medications are necessary conditions for enhancing QOL. Two configurations of sleep patterns positively influence QOL: the "sufficiency type" with high level of sleep duration, non-sleep disturbances, and non-daytime dysfunction as core conditions; and the "efficiency type" with high habitual sleep efficiency and non-daytime dysfunction as core conditions. Three configurations of sleep patterns negatively influence QOL: the "low-quality type" with non-high-level subjective sleep quality, sleep duration, and habitual sleep efficiency as core conditions; the "barrier type" with high level of sleep disturbances, non-high-level sleep latency, and non-high-level subjective sleep quality/sleep duration as core conditions; and the "drug-based type" with high level of use of sleeping medications and subjective sleep quality as core conditions. Using the fuzzy-set qualitative comparative analysis method, this study initially reveals that the influence of sleep patterns on QOL in middle-aged individuals is a holistic effect combining multiple elements. This deepens and enriches the understanding of the relationship between sleep patterns and QOL and expands new perspectives for more in-depth research on how to improve the QOL of middle-aged individuals through sleep interventions.

The clinical value of nonpharmacological interventions for preventing postoperative delirium: a narrative review.

Postoperative delirium (POD) is a prevalent perioperative complication among elderly individuals and is a cause of significant detrimental consequences for both individuals and society. Pharmacological and nonpharmacological prevention methods/therapies have been proposed to mitigate the risk of POD. Nevertheless, the efficacy of pharmacological interventions is controversial, and some of them cause side effects. Therefore, numerous studies have explored the effectiveness of nonpharmacological interventions in mitigating POD and have recommended the use of nonpharmacological multicomponent interventions by an interdisciplinary team as primary interventions. However, dedicated units aimed at promoting comanagement are rare and are only present in academic hospitals. Therefore, there is increasing interest in nonpharmacological mono-component interventions for preventing POD, which offer advantages such as easy application, cost-effectiveness, patient acceptability and noninvasiveness. These interventions are divided into cognitive training and noncognitive interventions. The former is aimed at increasing cognitive reserve, thus decreasing the incidence rate of POD. Noncognitive interventions, including sensory stimuli (music therapy, odor enrichment), improving sleep disturbances, physical activity, acupuncture and transcranial magnetic/direct current stimulation, are aimed at decreasing the risk factors for POD. This review provides a comprehensive overview of recently reported nonpharmacological mono-component interventions for preventing POD and briefly describes their clinical value.

Association between yogurt and dietary supplements containing probiotic consumption with sleep disturbance in US adults: Results from NHANES, 2009–2018

PurposeSleep disorders are common globally. Probiotics may improve human microbial diversity, offering potential benefits for sleep disturbances by enhancing sleep quality and reducing disorders. We aimed to use a population-based study to investigate the association between yogurt (a probiotic food) and probiotic consumption with sleep disturbances in US adults. MethodsA total of 49,693 adults from the 2009–2018 National Health and Nutrition Examination Survey (NHANES) were included in the analyses. Sleep disorders and sleep duration were assessed according to the Sleep Disorders Questionnaire. The Dietary Questionnaire evaluated yogurt and dietary supplements containing probiotic consumption. After adjusting for confounding factors, weighted multivariable logistic regression and subgroup analyses were used to assess the association between yogurt and probiotic consumption and sleep status. ResultsOf the study cohort, 3535 (14.24 %) participants consumed yogurt and/or dietary supplements containing probiotics. The prevalence of sleep disorders was 16.22 %. Only 53.51 % of the participants achieved the recommended amount of sleep (7–9 h), with 6.10 % and 33.48 % having excessive and insufficient sleep duration, respectively. Weighted Logistic regression models indicated a significant association of probiotic intake with a decreased risk of sleep disturbances compared with those without yogurt or probiotic consumption after adjustments. (For sleep disorders: OR: 0.96, 95 % CI 0.94–0.98, P < 0.001; for sleep duration: OR: 0.98, 95 % CI 0.96–1.00, P = 0.081) Moreover, the effect size of the probiotic intake on sleep was especially significant in sex, race, and BMI subgroups. ConclusionThe present study first indicated that yogurt and probiotic consumption were associated with a reduced risk of sleep disturbances in US adults, particularly among males, whites, and those with a normal BMI. Incorporating yogurt or probiotics into the diet could serve as a public health strategy for improving sleep disturbances, though further investigation into the underlying mechanisms is needed.

Improvement in sleep disturbance following arthroscopic rotator cuff repair

Approximately 90% of patients express concerns with sleep shortly after developing shoulder-related symptoms. Previous small cohort studies have demonstrated the impact of rotator cuff repair on sleep, but none have characterized the observed benefits. The purpose of this study is to evaluate sleep improvement after rotator cuff repair including the speed of sleep recovery, the time at which improvement plateaus, and the longer-term maintenance of improved sleep. A retrospective review of our institution's shoulder and elbow repository identified patients who underwent primary arthroscopic rotator cuff repair from 2012 - 2021 and reported sleep disturbance preoperatively. Patients were evaluated using sleep-related questions from the Simple Shoulder Test and American Shoulder and Elbow Surgeons score. Sleep outcomes were compared from a preoperative visit to 3-month, 6-month, 12-month, and most recent follow-ups to evaluate efficacy of treatment, speed of recovery and improvement plateaus. Among 677 RCR patients, 95.7% (648/677) reported sleep disturbance preoperatively. A total of 474 met inclusion criteria with median follow-up of 4.1 years (IQR, 2.1-6.1). At most recent follow-up, 81.8% were able to sleep comfortably and 65.7% were able to sleep on the affected side. A plateau in the ability to sleep comfortably was seen at 6 months while no plateau was observed in the ability to sleep on the affected side. More rapid improvement in the ability to sleep comfortably occurred during the first 3 months and from 3 - 6 months for the ability to sleep on the affected side. The majority of patients with sleep disturbance who undergo RCR, report significant, rapid, and lasting improvement in the ability to sleep comfortably and the ability to sleep on the affected side.

Does Spinal Cord Stimulation Improve Sleep Disturbances Independently of Pain Relief in Patients With Chronic Pain? An Explorative, Observational Study

ObjectivesChronic pain poses a significant health challenge worldwide and is associated with both disability and reduced quality of life. Sleep disturbances are reported in 67% to 88% of patients with chronic pain.Pain and sleep affect each other reciprocally; we aimed to study this bidirectional relationship in patients treated with spinal cord stimulation (SCS) for chronic pain. Specifically, we investigated whether sleep improves after treatment with SCS and whether this improvement may be mediated by pain reduction. Materials and MethodsAn observational cohort study was conducted in patients with chronic neuropathic pain treated with SCS at a single neurosurgical department in Denmark. Outcomes were assessed preoperatively and at three, six, and 12 months postoperatively, and thereafter annually. Primary outcomes were pain intensity (numeric rating scale) and insomnia at first follow-up (Insomnia Severity Index). The association between sleep and pain was investigated using linear regression and mediation analysis. ResultsForty-three patients were included in the study. The mean insomnia score was reduced by 25% from 18.1 (SD 6.0) to 13.5 (SD 6.6) (p = 0.0001). Pain intensity was reduced 38% from 7.4 (SD 1.6) to 4.6 (SD 2.1) at the first follow-up (p ≤ 0.0001). Changes in pain and changes in insomnia scores were significantly but weakly associated (regression coefficient = 1.3, 95% CI [0.3; 2.2], p = 0.008, r2 = 15.7%); and changes in pain score were not found to mediate changes in sleep score (β = −0.02, 95% CI [−0.15; 0.11], p = 0.76). ConclusionsWe found that patients treated with SCS showed significant improvements in both insomnia and pain intensity at first follow-up. Improvements in insomnia and pain intensity were significantly but weakly associated, and improvements in pain intensity score did not mediate improvements in insomnia score. Thus, improvements in self-reported insomnia in patients treated with SCS for chronic pain may predominantly be caused by other factors than reduced pain intensity.

Novel electrical therapy to improve sleep disturbance in patients with autoimmune rheumatic diseases.

Sleep disturbance is common in autoimmune rheumatism diseases (ARD) and it plays an important role in activating disease and affects the quality of life. This study aims to evaluate the efficacy and acceptability of the novel electrical therapy on sleep disturbance in ARD patients and its effect on immunologic factors. A total of 51 ARD patients (26 treatment group and 25 control group) with sleep disturbance were enrolled in this study. Sleep parameters and immunological indicators (serum level of 12 cytokines and immune function) were collected. The novel electrical therapy was prescribed for 15-30 min 3-6 times a day. The Pittsburg Sleep Index (PSQI) was assessed before and after 3 months' treatment by Mi Energy equipment. Immune function and serum levels of cytokines of all participants at baseline and after treatment were tested with flow cytometry and flow immunofluorescence, respectively. Correlation analysis was used to analyze the relationship between sleep disturbance and immunologic factors. Multiple linear regression analysis was employed to investigate the risk of sleep disturbance in ARD. The global score of PSQI (Baseline: 12.81 ± 4.07, After novel electrical therapy: 4.88 ± 2.76) was effectively improved after 3 months of adjuvant therapy by electrical therapy. We also found that serum levels of IL-8 and IL-1β statistically significantly decreased after novel electrical therapy. This adjuvant therapy can also significantly decrease the percentage of CD4 + CD8 + T cell, effector memory CD8 + T cell, Memory CD8 + T cell, Th17 cell, and plasma cell and significantly can increase the percentage of naïve CD8 + T cell, Th2 cell, and Tfh2 cell. Nevertheless, all serum level of 12 cytokines and the percentage of immune cells did not correlate with the PSQI global score except the Tc17 cell. Furthermore, age is an independent risk factor influencing PSQI scores (OR = 1.15, p < 0.05) in patients with autoimmune diseases through multiple linear regression analysis. Novel electrical therapy can effectively improve sleep disturbance in patients with ARD. It can also change the serum level of some cytokines (IL-8 and IL-1β) and percentage of immune cells (CD4 + CD8 + T cell, effector memory CD8 + T cell, Memory CD8 + T cell, Th17 cell, naïve CD8 + T cell, Th2 cell, Tfh2 cell, and plasma cell).

Effects of yoga on sleep quality among the geriatric population: Systematic review and meta-analysis

BackgroundSleep disorders are prevalent in the elderly and tend to have a substantial influence on their daytime functioning as well as their quality of life. Pursuant to the latest studies, yoga may have benefits for enhancing a variety of aspects of sleep in this demographic. This meta-analysis and systematic review aim to give an up-to-date and complete assessment of the effects of yoga on sleep quality in the elderly. MethodsWe conducted a thorough search of electronic databases (MEDLINE/PubMed, Cochrane Library, Scopus, and Science Direct) for English-language articles. We focused on randomized control trials and experimental studies; for evaluating yoga interventions aimed at improving sleep quality in the elderly. After assessing the risk of bias, we meta-analyzed the extracted data using a random-effects model to assess various sleep outcome parameters. ResultsFive studies with a total of 467 participants that met our inclusion criteria were included in this study. The meta-analysis demonstrated that yoga has a significant positive effect on sleep quality. Specifically, yoga interventions were associated with improvements in sleep disturbance (standardized mean difference [SMD]: −0.63; 95% CI −1.01 to −0.25), sleep duration (SMD: −0.96; 95% CI −1.89 to −0.02), sleep efficiency (SMD: −0.63; 95% CI −1.01 to −0.25), and the PSQI-Global score of sleep quality (SMD: −0.96; 95% CI −1.63 to −0.28). These results were statistically significant. ConclusionsOur meta-analysis indicates that yoga practices can lead to improvements in sleep quality among the elderly, demonstrating meaningful progress based on the results of conducted studies. To enhance the significance and generalizability of these findings, future studies should consider larger sample sizes and a higher number of RCTs, which can contribute to minimizing bias.

Effect of L-Methylfolate Supplementation on Sleep for Patients with Reduced Methylenetetrahydrofolate Reductase Activity

Introduction Clinicians have limited options outside controlled substances to address sleep disturbance, which left untreated can negatively affect patient outcomes in cardiovascular health, mental health, immunologic function, and more. For some, genetic factors may influence sleep disturbances. L-methylfolate, the active form of folate, plays a critical role in regulation of monoamine neurotransmitters known to have significant impact on sleep regulation: dopamine, serotonin, norepinephrine. Single nucleotide polymorphisms of the enzyme methylene-tetrahydrofolate-reductase are common and can impact monoamine production. The goal of this study was to evaluate effects of L-methylfolate supplementation on sleep in a cohort with reduced methylene tetrahydrofolate reductase (MTHFR) activity. Methods A retrospective cohort of patients being treated with L-methylfolate in a concierge medical clinic setting was studied. Patients presenting with sleep complaints were evaluated using the Patient-Reported Outcomes Measurement Information System at baseline. Patients with known MTHFR polymorphisms at either C667T and/or A1298C were recommended 5 mg of L-methylfolate daily and were reevaluated at 2 wks, at 4 wks, and at 8 wks of supplementation. Statistical comparisons were made utilizing ANOVA and T-test comparisons. Results Ten were included in the final cohort: six male and four female, average age 43 ± 16 years. Beginning at wk 2, average sleep disturbance improved significantly by −6.94 points (p = 0.005) and by 8 wks, all patients had improvement with a −14.34 change in disturbance from baseline (p = 0.001). Conclusion Improvement in sleep disturbance was seen in both low and intermediate function phenotypes. L-methylfolate may be useful for improving sleep in patients with MTHFR polymorphism.

Melatonin treatment has consistent but transient beneficial effects on sleep measures and pain in patients with severe chronic pain: the DREAM–CP randomised controlled trial

BackgroundSleep disturbance is a major issue for patients with chronic pain. Melatonin has been shown to improve symptoms of fibromyalgia, but its efficacy in other chronic non-malignant pain conditions is not fully known. Hence, we determined the effect of melatonin in patients with severe noncancer chronic pain. MethodsThis was a randomised double-blinded crossover trial of modified-release melatonin as Circadin™ compared with placebo. Sixty male and female subjects with chronic severe pain were randomised to receive either 2 mg of Circadin™ or placebo before sleep for 6 weeks, followed by a >4 week washout, then crossing over to the other treatment. Sleep disturbance, quality, and latency were measured using three different validated sleep assessment tools. The primary outcome measure was self-reported sleep disturbance after 6 weeks of treatment. Adverse events were also recorded. ResultsSleep disturbance after 6 weeks was not significantly altered by melatonin treatment, but differences between melatonin and placebo treatment periods after 3 weeks were seen: sleep disturbance (P=0.014), latency (P=0.04), overall sleep quality (P=0.004), and effect of pain on sleep (P=0.032). Pain intensity scores improved during both treatment periods (both P<0.001). There were no differences in adverse events between treatment periods. ConclusionsCircadin™ treatment did not improve sleep disturbance in patients with severe chronic pain compared with placebo at 6 weeks, but there were consistent improvements in aspects of sleep in the shorter term. Given its favourable safety profile, it could be beneficial for some patients with chronic pain. Clinical trial registrationISRCTN12861060.

A single-armed proof-of-concept study of Lymfit: A personalized, virtual exercise intervention to improve health outcomes in lymphoma survivors in the pandemic.

Treatments of lymphoma can lead to reduced physical functioning, cancer-related fatigue, depression, anxiety, and insomnia. These side effects can negatively impact the cancer survivor's quality of life. Mounting evidence indicates that physical activities are highly therapeutic in mitigating the short- and long-term side effects of cancer treatments. Yet, lymphoma survivors' participation in physical activities remains suboptimal, which has been further exacerbated by the deleterious effects of isolation during the COVID-19 pandemic. The Lymfit intervention aims to offer motivational support, expert guidance, and a personalized exercise prescription to optimize physical activities among lymphoma survivors. This proof-of-concept study explores implementation feasibility (retention, technical and safety), and the preliminary effects of Lymfit on various health outcomes. This was a single-armed trial with a pre-and post-test design. Twenty lymphoma survivors were recruited to participate in the 12-week Lymfit intervention. Wearable activity trackers (Fitbit) were given to participants as a motivational tool and for data collection purposes. Participants received a personalized exercise prescription designed by a kinesiologist. Physiologic metrics were collected by the Fitbit monitors and were stored in the Lymfit database. Self-reported questionnaires measuring health outcomes were collected at baseline and post-intervention. The retention rate of this trial was 70%. Minimal technical issues and no adverse effects were reported. Lymfit led to significant improvements in sleep disturbances and the ability to participate in social activities and decreased fear of cancer recurrence. It also increased daily steps and decreased sedentary time in participants who did not meet the recommended physical activity guidelines. With access to resources and fitness centers being limited during the pandemic, the Lymfit intervention filled an immediate need to provide physical activity guidance to lymphoma survivors. Findings provide preliminary support that implementing the Lymfit intervention is feasible and demonstrated promising results.

Moderation by better sleep of the association among childhood maltreatment, neuroticism, and depressive symptoms in the adult volunteers: A moderated mediation model.

Previously, we demonstrated that childhood maltreatment could worsen depressive symptoms through neuroticism. On the one hand, some studies report that sleep disturbances are related to childhood maltreatment and neuroticism and worsens depressive symptoms. But, to our knowledge, no reports to date have shown the interrelatedness between childhood maltreatment, neuroticism, and depressive symptoms, and sleep disturbance in the one model. We hypothesized that sleep disturbance enhances the influence of maltreatment victimization in childhood or neuroticism on adulthood depressive symptoms and the mediation influence of neuroticism between maltreatment victimization in childhood and adulthood depressive symptoms. Total 584 Japanese volunteer adults recruited through convenience sampling from 4/2017 to 4/2018 were assessed regarding their characteristics of demographics, history of childhood maltreatment, sleep disturbance, neuroticism, and depressive symptoms with questionnaires self-administered. Survey data were analyzed using simple moderation models and a moderating mediation model. The interaction of sleep disturbance with childhood maltreatment or neuroticism on depressive symptoms was significantly positive. Furthermore, the moderating effect of sleep disturbance on the indirect effect of childhood maltreatment to depressive symptoms through neuroticism was significantly positive. Because this was a cross-sectional study, a causal relationship could not be confirmed. Our findings indicate that individuals with milder sleep disturbance experience fewer depressive symptoms attributable to neuroticism and childhood maltreatment. Additionally, people with less sleep disturbance have fewer depressive symptoms arising from neuroticism owing to childhood maltreatment. Therefore, improvement of sleep disturbance will buffer the aggravating effect of childhood maltreatment, neuroticism caused by various factors, and neuroticism resulting from childhood maltreatment on depressive symptoms.

Menstrual disturbances and its association with sleep disturbances: a systematic review

BackgroundMenstrual disturbances harm women’s health, and general well-being. As growing evidence highlights the relationship between sleep and menstrual disturbances, it is imperative to comprehensively examine the association between sleep and menstrual disturbance considering the multiple dimensions of sleep. This systematic review aims to identify the association between sleep and menstrual disturbances by evaluating using Buysse’s sleep health framework.MethodsA comprehensive search of the literature was conducted in PubMed, EMBASE, psychINFO, and CINAHL to identify publications describing any types of menstrual disturbances, and their associations with sleep published between January 1, 1988 to June 2, 2022. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The findings were iteratively evaluated menstrual disturbances and their association with sleep using Buysse’s sleep health framework. This framework understands sleep as multidimensional concept and provides a holistic framing of sleep including Satisfaction, Alertness during waking hours, Timing of sleep, Efficiency, and Sleep duration. Menstrual disturbances were grouped into three categories: premenstrual syndrome, dysmenorrhea, and abnormal menstrual cycle/heavy bleeding during periods.ResultsThirty-five studies were reviewed to examine the association between sleep and menstrual disturbances. Premenstrual syndrome and dysmenorrhea were associated with sleep disturbances in sleep health domains of Satisfaction (e.g., poor sleep quality), Alertness during waking hours (e.g., daytime sleepiness), Efficiency (e.g., difficulty initiating/maintaining sleep), and Duration (e.g., short sleep duration). Abnormal menstrual cycle and heavy bleeding during the period were related to Satisfaction, Efficiency, and Duration. There were no studies which investigated the timing of sleep.Conclusions/ImplicationsSleep disturbances within most dimensions of the sleep health framework negatively impact on menstrual disturbances. Future research should longitudinally examine the effects of sleep disturbances in all dimensions of sleep health with the additional objective sleep measure on menstrual disturbances. This review gives insight in that it can be recommended to provide interventions for improving sleep disturbances in women with menstrual disturbance.

Percutaneous Electrical Nerve Field Stimulation in Children and Adolescents With Functional Dyspepsia—Integrating a Behavioral Intervention

ObjectivesFunctional dyspepsia (FD) includes postprandial distress and epigastric pain syndrome. Percutaneous electrical nerve field stimulation (PENFS) in addition to behavioral interventions (BI) has shown benefits in children with functional abdominal pain but not specifically in FD. We aimed to assess the efficacy of PENFS for treating FD and compare the outcomes with those who received the combination of PENFS + BI. Materials and MethodsCharts of patients with FD who completed four weeks of PENFS were evaluated. A subset of patients received concurrent BI. Demographic data, medical history, and symptoms were documented. Outcomes at different time points included subjective symptom responses and validated questionnaires collected clinically (Abdominal Pain Index [API], Nausea Severity Scale [NSS], Functional Disability Inventory [FDI], Pittsburgh Sleep Quality Index [PSQI], Children’s Somatic Symptoms Inventory [CSSI], Patient-Reported Outcomes Measurement Information Systems [PROMIS] Pediatric Anxiety and Depression scales). ResultOf 84 patients, 61% received PENFS + BI, and 39% received PENFS alone. In the entire cohort, API (p < 0.0001), NSS (p = 0.001), FDI (p = 0.001), CSSI (p < 0.0001), PSQI (p = 0.01), PROMIS anxiety (p = 0.02), and depression (p = 0.01) scores improved from baseline to three weeks and at three months. Subjective responses showed nausea improvement (p = 0.01) and a trend for improvement in abdominal pain (p = 0.07) at week three. Abdominal pain subjectively improved at week three and three months (p = 0.003 and 0.02, respectively), nausea at week three and three months (p = 0.01 and 0.04, respectively), and a trend for improvement in sleep disturbances at week three and three months (p = 0.08 and p = 0.07, respectively) in the PENFS + BI group vs PENFS alone. ConclusionAbdominal pain, nausea, functioning, somatization, sleep disturbances, anxiety, and depression improved at three weeks and three months after PENFS in pediatric FD. Subjective pain and nausea improvement were greater in the PENFS + BI group than in the group with PENFS alone, suggesting an additive effect of psychologic therapy.

Tenuigenin promotes non-rapid eye movement sleep via the GABAA receptor and exerts somnogenic effect in a MPTP mouse model of Parkinson's disease

Sleep disturbances are commonly non-motor symptoms in Parkinson's diseases (PD). However, standard dopamine replacement therapies for the treatment of motor symptoms often prove inadequate in combating sleep disturbances. Previous studies conducted by our research group have reported the neuroprotective effects of tenuigenin, a natural extract from Polygala tenuifolia root, which has been traditionally employed in treating insomnia. The objective of this study was to investigate the potential of tenuigenin in modulating sleep-wake behaviors and elucidate the underlying mechanisms. We employed EEG/EMG recordings to evaluate the impact of tenuigenin on sleep-wake profiles. Furthermore, we utilized c-Fos immunostaining, whole-cell patch clamping and local field potentials (LFP) recording to explore the mechanisms involved in sleep-promoting effects of tenuigenin. Additionally, we examined the effects of tenuigenin on sleep-promoting in MPTP PD mice. Here, we found tenuigenin demonstrated a significant increase in NREM sleep and a reduction in sleep latency in mice, without altering the EEG power density. Moreover, tenuigenin increased c-Fos expression in the ventrolateral preoptic area (VLPO) and stimulated sleep-promoting neurons in VLPO. The sleep-promoting effects of tenuigenin were abolished when mice were pretreated with flumazenil, an antagonist at the benzodiazepine site of the GABAA receptor. Furthermore, tenuigenin was found to ameliorate sleep disturbances in MPTP-induced mice. The results suggesting that tenuigenin facilitated a type of NREM sleep comparable to physiological NREM sleep through interaction with the GABAA receptor. Additionally, tenuigenin demonstrated improvements in sleep disturbances in MPTP-induced PD mice, suggesting its potential as a sleep-promoting substance, particularly for PD patients experiencing sleep disturbances.

Improvement in Sleep Disturbance Following Anatomic and Reverse Shoulder Arthroplasty.

Sleep disturbance is commonly reported by patients with arthritis and rotator cuff disease. Small cohort studies have demonstrated sleep improvements following anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). However, to our knowledge, no large cohort study has evaluated sleep improvement after shoulder arthroplasty. The purpose of the present study was to determine the effects of shoulder arthroplasty on sleep improvement, including the speed of sleep recovery, improvement plateaus, and any differences observed between TSA and RSA. A retrospective analysis of our institution's shoulder and elbow repository evaluated patients who had been managed with TSA and RSA between 2012 and 2021. Our analysis focused on visual analog scale (VAS) pain scores as well as specific sleep-related questions included in the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) questionnaires. Preoperative characteristics were compared, and comparisons at the 3-month, 6-month, 1-year, and most recent follow-ups were performed to evaluate the efficacy of improvement, speed of recovery, improvement plateaus, and differences among implant types. Our search identified 1,405 patients who were treated with shoulder arthroplasty, including 698 who underwent TSA and 707 who underwent RSA. Six hundred and seventy-six (97%) of those who underwent TSA and 670 (95%) of those who underwent RSA reported sleep disturbance prior to surgery and were eligible for inclusion. With the exclusion of 357 patients without complete follow-up, 989 patients (517 who underwent TSA and 472 who underwent RSA) met the inclusion criteria, with a median follow-up of 36 months for the TSA group and 25 months for the RSA group. Postoperatively, significant improvements in the ability to sleep comfortably and sleep on the affected side were observed in both the TSA group and the RSA group (p < 0.001). The ability to sleep comfortably returned faster than the ability to sleep on the affected side, with the ability to sleep comfortably reaching a plateau at 3 months and the ability to sleep on the affected side reaching a plateau at 6 months. Despite improvements in terms of sleep disturbance, at the time of most recent follow-up, 13.2% of patients in the TSA group and 16.0% of those in the RSA group could not sleep comfortably and 31.4% of those in the TSA group and 36.8% of those in the RSA group could not sleep on the operative side. The results of the study demonstrated that both TSA and RSA provide significant and rapid improvement in patients' ability to sleep comfortably and, to a lesser extent, improves their ability to sleep on their affected side. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Trazodone for sleep disturbance in opioid dependent patients maintained on buprenorphine: A double blind, placebo-controlled trial

BackgroundSleep disturbances are seen even in individuals on opioid agonist treatment (OAT). Established pharmacotherapy for sleep disturbances such as benzodiazepines have misuse potential and increased mortality risk in patients with OAT. No study has explored the role of trazodone on sleep disturbance in individuals maintained on buprenorphine. We aimed to assess the efficacy of trazodone in improving sleep disturbance among individuals maintained on buprenorphine. MethodsThe study was a double-blind, placebo-controlled, parallel, randomised trial. Adult males (18–60 years) stabilised on buprenorphine with Pittsburgh Sleep Quality Index (PSQI) score of above five, without other psychiatric comorbidity were randomised to receive either trazodone (50–150mg per day) or placebo. Sleep-50 questionnaire, Epworth Sleepiness Scale (ESS), Brief Pain Inventory (BPI), Clinical Opiate Withdrawal Scale (COWS), Depression, Anxiety and Stress Scale (DASS)−21, Visual Analogue Scale (VAS) for opioid craving, and PSQI were assessed at baseline and at the end of six weeks. ResultsFifty-one patients were allocated to trazodone arm and 49 to placebo arm. Side-effects of trazodone were minimal and well-tolerated with comparable discontiuation rates between both groups. Significantly greater proportion of patients on trazodone (82%, mean dose 101.9 mg) had PSQI scores five or less than those on placebo (16%) at the end of six weeks. Sleep improvement was in various components like sleep quality, latency, efficiency, and duration of sleep. ConclusionTrazodone is well-tolerated and effective in improving sleep disturbances in individuals with opioid dependence maintained on buprenorphine over a six-week period.

0833 Acceptability of the Transdiagnostic Behavioral Sleep and Circadian Intervention to Individuals in Cardiac Rehabilitation

Abstract Introduction Sleep health is often compromised among individuals undergoing cardiac rehabilitation and does not consistently improve over the course of treatment. Behavioral sleep and circadian interventions may improve the sleep health of cardiac rehabilitation patients but have not been widely tested in this context. We conducted a preliminary test of an adapted version of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) with Veterans in cardiac rehabilitation to evaluate its acceptability with these unique patients. Methods Eight Veterans with sleep disturbance and/or sleep-related impairment who were participating in outpatient cardiac rehabilitation completed the adapted TranS-C intervention and post-intervention acceptability measures. Intervention acceptability was assessed quantitatively with subscales from the Multidimensional Treatment Satisfaction Measure (subscale scores range from 0-4; higher scores indicate greater satisfaction) and qualitatively via semi-structured interviews. We calculated descriptive statistics for quantitative measures and analyzed semi-structured interviews using a rapid qualitative analysis approach. Results Participants felt the intervention was suitable to their needs (M=3.00, SD=.94) and useful for increasing their knowledge and understanding of sleep problems and how to manage them (M=3.50, SD=.69). Participants endorsed positive attitudes toward the intervention (M=3.63, SD=.58) and high likelihood of recommending the intervention to others similarly experiencing sleep problems (M=3.63, SD =.58). Following the intervention, 62.5% of participants indicated that their sleep disturbance and sleep-impairment were ‘much better’ than at the first study visit and 37.5% indicated their sleep disturbance and sleep-related impairment were ‘somewhat better’. Qualitative findings converged with the noted quantitative findings. Conclusion Veteran cardiac rehabilitation patients expressed satisfaction and positive attitudes toward the adapted TranS-C intervention. All participants reported subjective post-intervention improvements in sleep disturbance and sleep-related impairment. These findings provide preliminary support for further large-scale testing of adapted TranS-C in cardiac rehabilitation. Support (if any) Dr. Tighe is supported by a Career Development/Capacity Building Award (IK2 RX003393) from the United States Department of Veterans Affairs Rehabilitation R&amp;D (Rehab RD) Service. This material is the result of work supported with resources and use of facilities at the VISN 4 Mental Illness Research, Education, and Clinical Center at VA Pittsburgh Healthcare System.

0386 Brief cognitive-behavioral therapy for insomnia among Japanese university students with sleep disturbances

Abstract Introduction Sleep disturbances among Japanese university students negatively affect their academic performance and mental health. Student habits, such as naps and using smartphones in bed, may lead to sleep problems. We hypothesized the Sleep Health through University Student Habits (SHUSH) program, a four-week cognitive-behavioral therapy for insomnia intervention, would improve sleep disturbances in university students. Methods We used a pretest-posttest, single arm pilot study design and evaluated the feasibility and preliminary efficacy of SHUSH. Occupational therapy and physical therapy students (N = 18) in a university with self-reported sleep disturbances (Insomnia Severity Index; ISI score ≥ 9) were offered 90-minutes of sleep education (e.g., two-process model of sleep regulation, stimulus control, and sleep hygiene) then prescribed personalized sleep restriction therapy (SRT) and stimulus control therapy (SCT) goals based upon 10-days of sleep diary data. This was followed by weekly 15-minute individualized meetings for three consecutive weeks; SRT and SCT goals were titrated based upon sleep diaries, and occupational therapists supported treatment adherence. Assessments included validated Japanese versions of sleep-related (e.g., sleep disturbance), mental health-related (e.g., depression) and sleep diary (e.g., sleep efficiency) variables. Dependent t-tests (d) and Wilcoxon rank sum tests (r) were used to test differences between baseline and posttest assessments. Results There were 15 students who completed SHUSH with a mean age of 19.7 years; 9 were women. Improvements were found in sleep disturbance (r = 0.843), sleep quality (r = 0.851), daytime sleepiness (d = 0.762), sleep hygiene practice (d = 1.216) and change from an eveningness towards a morningness circadian preference (d = 0.990). Anxiety (d = 0.604) and depression (d = 0.729) improved. Sleep onset latency (r = 0.851), nighttime awakening (r = 0.514), and sleep efficiency (r = 0.880) also improved. Participants were satisfied with the SHUSH group-based education, one-on-one therapist meetings, and program brevity; there were no adverse events. Conclusion SHUSH is a feasible and preliminarily effective sleep improvement program for reducing sleep disturbances among Japanese university students. Improved sleep was associated with improved mental health and sleep-promoting behaviors. A randomized controlled trial of SHUSH is recommended. Support (if any) Fulbright U.S. Scholar Award to Japan

0528 Effects of continuous positive airway pressure on white matter microstructure in patients with obstructive sleep apnea

Abstract Introduction Obstructive sleep apnea (OSA) has significant effects on quality of life and may lead to cognitive impairments. Continuous positive airway pressure (CPAP) is the standard treatment for OSA, and has been shown to improve sleep disturbances and daytime dysfunction. In this study, we aimed to assess the effects of CPAP on white matter (WM) integrity using longitudinal diffusion tensor imaging (DTI) tests. Methods Twenty-two male patients with moderate to severe OSA were recruited and underwent DTI scanning before and 6-44 months after CPAP treatment. Sixteen male patients with untreated OSA who were not compliant with CPAP were included as a reference group. We compared the functional anisotropy (FA) values between baseline and follow-up MRI in both the CPAP and untreated groups using tract-specific statistical analysis (TSSA) method. Results The TSSA analysis showed that FA values in the middle part of the right CST were increased after treatment in the CPAP group. No significant change in FA value was observed between baseline and post-scan in the untreated group. In the CPAP group, the post-treatment FA value in the anterior part of the right ATR was significantly correlated with durations of CPAP therapy after controlling for age, body mass index, and baseline FA value. Conclusion Our study suggests that long-term CPAP treatment could gradually reverse OSA-induced injury to the WM microstructure, particularly WM associated with the motor and limbic systems. The study findings provide new insights into the mechanisms of cognitive improvement after CPAP treatment in patients with OSA. Support (if any)