Improvement In Sleep Quality Research Articles

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

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

The intensity of neuropathic pain and the severity of insomnia in diabetic polyneuropathy

To determine the prevalence of insomnia and the effectiveness of its treatment in patients with a painful form of diabetic polyneuropathy (DPN). Fifty patients with the painful form of DPN were randomly divided into 2 groups: the standard therapy group (ST) and the extended therapy group (ET). In the ST group, a single lesson on sleep hygiene was conducted, in the ET group there were 3-4 face-to-face individual sessions for the treatment of insomnia for two weeks. Both groups were interviewed at the time of hospitalization, after 3 and 6 months. The severity of polyneuropathy and the nature of neuropathic pain were assessed using the Neuropathic Neuropathy Impairment Score in the Lower Limbs (NIS-LL) and the Neuropathy Total Symptom Score - 9 (NTSS-9); the intensity of pain was assessed using a Visual Analog Scale (VAS). Sleep disorders were analyzed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Sleep disorders of varying severity were observed in 82% of patients in the initial survey. In both groups, improvement in sleep quality was noted during treatment, but significantly better results were in the ET group, the ISI score after 6 months was 7.15±2.08 for the ST group and 3.07±2.49 for the ET group (p<0.0001). In the ST group, there was no significant decrease in the intensity of pain and the severity of polyneuropathy in dynamics. In the ET group, a significant decrease in NTSS-9 and VAS scores was found during the initial survey and after 6 months (p<0.0001). The intensity of pain also significantly decreased in the ET group compared with the ST group (p<0.0001) at the end of follow-up, which indicates the importance of sleep normalization in the treatment of neuropathic pain. Most patients with the painful form of DPN have insomnia. Treatment of insomnia has shown its effectiveness as part of a multimodal approach to the managing of neuropathic pain in DPN and improving the quality of life of patients.

Integrative assessment of the effectiveness and safety of outpatient use of Picamilon

To study the efficacy and safety of the use of the drug Picamilon with various therapy regimens in patients with stage I of chronic cerebral ischemia (CCI). Material and methods. An open randomized comparative clinical trial included 44 patients with stage CCI aged 46 to 67 years (average age 55.6±6.76 years). Patients were randomized into two groups, patients of group 1 (n=23) received Picamilon orally in tablets of 50 mg 3 times/day for 60 days; group 2 (n=21) received Picamilon first parenterally at 100 mg i/m for 10 days, then in tablets of 50 mg 3 times/day for 50 days. The total duration of therapy was 60 days. The study included 4 visits (before treatment, 10 days later, 60 days later, 1.5 months after completion of treatment). The dynamics of cognitive status were assessed according to the Montreal Cognitive Function Assessment Scale (MoCA), vegetative disorders on the A.M. Wayne scale, neurological disorders on the A.I. Fedin scale, and sleep quality on the Ya.I. Levin scale. The study of the state of cerebral blood flow (dopplerography of intracranial vessels) and endothelial function (assessment of the level of methylation. During treatment, in the total sample of patients, there was a positive trend in the results of the MoCA scale, increasing in the delayed period (24.9/26.5/28.3 points, p=0.022 and p<0.001); improvement in sleep quality in 50% of patients by visit 3 and in 84% by visit 4, in the 2nd group the effect occurred in 28% of patients, in the 1st - in 11%, by the end of the study the effect was comparable (p=0.508). Improvement according to Fedin A.I. scale noted in 77% of patients, values decreased from 11.9±8.3 to 6±6.1 points (p<0.0001) and to 2.77±4.43 points by visit 4 (p<0.0001). Normalization of autonomic functions was observed in 29% of patients (p=0.024) without intergroup differences. Picamilon therapy showed high efficacy in terms of clinical outcomes (up to 89%), good tolerability (98% of patients) and a favorable safety profile (less than 8.6% of AEs). The use of Picamilon was accompanied by an increase in the linear velocity of blood flow, a decrease in the thickness of the intima-media complex and the resistance index; a decrease in elevated ADMA concentrations and ADMA/MMA and (ADMA+SDMA)/MMA ratios. The use of Picamilon is effective in patients with stage I CCI, contributes to a significant regression of neurological deficits, cognitive impairment, improved sleep quality and autonomic function; improves vascular endothelial function, reduces the risk of atherosclerosis and cardiovascular complications in patients. The optimal duration of therapy with Picamilon in stage I of chronic cerebral ischemia is 2 months.

Effect of Ergonomic and Corrective Movement Interventions on Improving Sleep Quality and Reducing Musculoskeletal Disorders in Police Officers

Effect of Ergonomic and Corrective Movement Interventions on Improving Sleep Quality and Reducing Musculoskeletal Disorders in Police Officers

Improved Sleep Quality with Anti-itch Fibers

Improved Sleep Quality with Anti-itch Fibers

Reverse Remodeling of Methamphetamine-Associated Cardiomyopathy: An Update on Mechanisms for Recovery

Methamphetamine (MA) use continues to rise worldwide. The adverse effects of MA on the cardiovascular system include cardiomyopathy, dysrhythmias, coronary arterial vasospasm, and atherosclerosis. Methamphetamine-associated cardiomyopathy (MACM) affects predominantly younger male patients and is responsible for an increasing proportion of heart failure emergency department visits, hospital admissions/readmissions, morbidity, and mortality. Reverse remodeling of MACM and full cardiac recovery is achievable in patients who cease using MA and remain abstinent with self-direction, cognitive behavioral therapy, brief interventions, contingency management, motivational interviewing, and residential rehabilitation. Recovery is further enhanced by the addition of an exercise program and guideline-based pharmacotherapy for heart failure, which includes β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors. Alternative heart failure treatment with isosorbide dinitrate plus hydralazine, ivabradine, vericiguat, and omecamtiv mecarbil represent further adjuncts which may promote reverse remodeling. Antioxidant compounds such as coenzyme-Q10, omega-3 polyunsaturated fatty acids, resveratrol, and cannabidiol may aid in cardiac restoration. Diet changes, metformin and glucose control, stem cell therapy, melatonin, and sleep quality improvement are further steps on the road to recovery. In this article we review the cardiotoxicity of MA, pathogenesis of MACM, and evidence behind pharmacologic and lifestyle interventions to reverse its progression.

Cannabis for medical use versus opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised clinical trials

ObjectiveThe objective of this study is to evaluate the comparative benefits and harms of opioids and cannabis for medical use for chronic non-cancer pain.DesignSystematic review and network meta-analysis.Data sourcesEMBASE, MEDLINE,...

Nonlinear Heart Rate Variability Analysis for Sleep Stage Classification Using Integration of Ballistocardiogram and Apple Watch.

Wearable or non-contact, non-intrusive devices present a practical alternative to traditional polysomnography (PSG) for daily assessment of sleep quality. Physiological signals have been known to be nonlinear and nonstationary as the body adapts to states of rest or activity. By integrating more sophisticated nonlinear methodologies, the accuracy of sleep stage identification using such devices can be improved. This advancement enables individuals to monitor and adjust their sleep patterns more effectively without visiting sleep clinics. Six participants slept for three cycles of at least three hours each, wearing PSG as a reference, along with an Apple Watch, an actigraphy device, and a ballistocardiography (BCG) bed sensor. The physiological signals were processed with nonlinear methods and trained with a long short-term memory (LSTM) model to classify sleep stages. Nonlinear methods, such as return maps with advanced techniques to analyze the shape and asymmetry in physiological signals, were used to relate these signals to the autonomic nervous system (ANS). The changing dynamics of cardiac signals in restful or active states, regulated by the ANS, were associated with sleep stages and quality, which were measurable. Approximately 73% agreement was obtained by comparing the combination of the BCG and Apple Watch signals against a PSG reference system to classify rapid eye movement (REM) and non-REM sleep stages. Utilizing nonlinear methods to evaluate cardiac dynamics showed an improved sleep quality detection with the non-intrusive devices in this study. A system of non-intrusive devices can provide a comprehensive outlook on health by regularly measuring sleeping patterns and quality over time, offering a relatively accessible method for participants. Additionally, a non-intrusive system can be integrated into a user's or clinic's bedroom environment to measure and evaluate sleep quality without negatively impacting sleep. Devices placed around the bedroom could measure user vitals over longer periods with minimal interaction from the user, representing their natural sleeping trends for more accurate health and sleep disorder diagnosis.

A pilot randomised controlled trial exploring the feasibility and efficacy of a human-AI sleep coaching model for improving sleep among university students.

Sleep quality is a crucial concern, particularly among youth. The integration of health coaching with question-answering (QA) systems presents the potential to foster behavioural changes and enhance health outcomes. This study proposes a novel human-AI sleep coaching model, combining health coaching by peers and a QA system, and assesses its feasibility and efficacy in improving university students' sleep quality. In a four-week unblinded pilot randomised controlled trial, 59 university students (mean age: 21.9; 64% males) were randomly assigned to the intervention (health coaching and QA system; n = 30) or the control conditions (QA system; n = 29). Outcomes included efficacy of the intervention on sleep quality (Pittsburgh Sleep Quality Index; PSQI), objective and self-reported sleep measures (obtained from Fitbit and sleep diaries) and feasibility of the study procedures and the intervention. Analysis revealed no significant differences in sleep quality (PSQI) between intervention and control groups (adjusted mean difference = -0.51, 95% CI: [-1.55-0.77], p = 0.40). The intervention group demonstrated significant improvements in Fitbit measures of total sleep time (adjusted mean difference = 32.5, 95% CI: [5.9-59.1], p = 0.02) and time in bed (adjusted mean difference = 32.3, 95% CI: [2.7-61.9], p = 0.03) compared to the control group, although other sleep measures were insignificant. Adherence was high, with the majority of the intervention group attending all health coaching sessions. Most participants completed baseline and post-intervention self-report measures, all diary entries, and consistently wore Fitbits during sleep. The proposed model showed improvements in specific sleep measures for university students and the feasibility of the study procedures and intervention. Future research may extend the intervention period to see substantive sleep quality improvements.

A systematic review and meta-analysis of music interventions to improve sleep in adults with mental health problems.

Music listening has been used as a sleep intervention among different populations. This systematic review and meta-analysis aimed to explore whether music is an effective sleep aid in adults with mental health problems. We searched for studies investigating music interventions for sleep in adults with mental health problems. The primary outcome was subjective sleep quality; secondary outcomes were objective sleep outcomes, quality of life, and other mental health symptoms. Risk of bias assessment (RoB1) and random-effect model were used for the systematic review and meta-analyses. The initial screening (n=1492) resulted in 15 studies in the systematic review. Further qualified studies led to the meta-analysis of sleep quality (n=7), depression (n=5), and anxiety (n=5). We found that the music listening intervention showed a potential effect on subjective sleep quality improvement compared to treatment-as-usual or no-intervention groups. When excluding an outlier study with an extreme effect, the meta-analysis showed a moderate effect on sleep quality (Hedges' g=-0.66, 95% CI [-1.19, -0.13], t=-3.21, p=0.0236). The highest risk of bias was the blinding of participants and researchers due to the nature of the music intervention. Our results suggest that music interventions could have the potential to improve sleep quality among individuals with mental health problems, even though more high-quality studies are needed to establish the effect fully.

The Impact of Melatonin on Inflammatory Status and Quality of Life

Objective: This study aimed to assess whether the use of melatonin as an initial insomnia treatment can enhance inflammatory status and quality of life (QoL). We also explored a potential correlation between these improvements and sleep pattern ameliorations and whether baseline status correlated to differences in sleep quality, inflammatory status, and QoL. Methods: We enrolled 67 subjects from 6 different hospitals who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) insomnia criteria. The patients took 2 mg per day of prolonged-release melatonin (PRM) for 8 weeks. We administered the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality and the WHO-5 Well-Being Index to assess QoL at baseline, week 4, and week 8. We measured tumor necrosis factor-alpha (TNF-α) levels to determine inflammatory status at baseline and week 8.Results: The mean global PSQI score declined significantly from 13.97 to 10.39 (p&lt;0.001) after 8 weeks of PRM treatment. The mean WHO-5 Well-Being Index score improved significantly from 7.30 to 11.0 (p&lt;0.001) over the study period. The mean TNF-α nonsignificantly declined from 0.62 to 0.60 (p=0.28). The PSQI improvement over 8 weeks was correlated to the baseline PSQI score (r=0.40, p=0.001). The decrease in TNF-α over 8 weeks was correlated to the baseline TNF-α level (r=0.43, p&lt;0.001).Conclusion: This study reported measurable improvement in sleep quality and QoL after 8 weeks of PRM. Although the decrease in TNF-α level over 8 weeks was not significant, it showed correlation to the baseline TNF-α level. PRM can prevent excessive inflammation and may be beneficial in chronic inflammation involving TNF-α.

Electromagnetic Field Exposure and Sleep: An Investigation into the Effects and Potential Interventions to Improve Sleep Quality

Electromagnetic Field Exposure and Sleep: An Investigation into the Effects and Potential Interventions to Improve Sleep Quality

The interplay between stigma and sleep quality in breast cancer: A cross-sectional network analysis

PurposeStigma, a subjective internal shame, arises from the association of cancer with death. Sleep quality can be considered a product of stigma. However, the extent of overlap or difference between the two remains unclear. MethodsIn total, 512 survivors with breast cancer were recruited from the “Be Resilient to Breast Cancer” project between May and August 2023. This study estimated the stigma, sleep quality, and their relationship by conducting a cross-sectional network analysis. The social impact scale and Pittsburgh Sleep Quality Index scale were employed in this study. ResultsThe core symptom for stigma from the network analysis was alienation by people (Strength = 1.213, Betweenness = 13, Closeness = 0.00211). The core symptom for sleep quality were the sleep quality (Str = 1.114, Bet = 17, Clo = 0.01586). Regarding the combination network, results showed that self-isolation and daytime dysfunction were the bridge nodes and that daytime dysfunction was positively associated with feeling less capable than before (according to self) (r = 0.15). ConclusionOur study demonstrates the core symptoms in different symptomatic networks, which can be targeted for treatment personalization and aid in the improvement of sleep quality and stigma in breast cancer patients.

Effectiveness of the 30-Degree Lateral Sleeping Position on Sleep Quality in Elderly Individuals Post-Stroke

Background: Post-stroke conditions can have an impact on the sleep quality of the elderly. Sleep disorders are a common health problem for the elderly, requiring serious attention. Poor sleep quality in the elderly is caused by increased sleep potential, reduced sleep efficiency, and early awakenings due to the ageing process.&#x0D; Objective: This research aims to determine the effectiveness of a 30-degree lateral sleeping position compared to a supine sleeping position on the sleep quality of elderly individuals post-stroke.&#x0D; Method: The design of this research uses a quasi-experiment design with a non-equivalent control group design approach. The study will be conducted in 2023 in Ekasari Village, Jembrana Regency, Bali. The total research population is 126 elderly individuals, and the sample size meeting the criteria is 64 respondents, divided into 32 respondents in the intervention group and 32 respondents in the control group. Data analysis in this study uses the Mann-Whitney U Test.&#x0D; Results: The Mann-Whitney U Test shows a difference between the intervention and control groups (p = 0.000, Z score = -4.830), which means that the 30-degree lateral sleep position is better at helping older people who have had a stroke sleep better than the supine sleep position.&#x0D; Conclusion: Post-stroke elderly individuals tend to experience an improvement in sleep quality when they sleep in the lateral position of 30 degrees. Therefore, elderly people who are having sleep quality issues can adopt this sleeping position to improve their sleep.

Enhancing Sleep Quality: Assessing the Efficacy of a Fixed Combination of Linden, Hawthorn, Vitamin B1, and Melatonin.

Sleep is essential for overall health, yet various sleep disorders disrupt normal sleep patterns, affecting duration, quality, and timing. This pilot study investigate the impact of a food supplement (SPINOFF®) on both sleep quality and mental well-being in 41 participants (mean age: 45.3 years). Initial assessments revealed sleep disturbances (Pittsburgh Sleep Quality Index-PSQ-mean score: 8.2) and insomnia symptoms (Insomnia Severity Index-ISI- mean score: 12.7). Mental health assessments showed psychological distress (Dass-21 Depression mean score: 4.2, Anxiety mean score: 6.9, Stress mean score: 11.6, Total mean score: 22.7). This study assessed sleep continuity using Awakenings per Night (ApN) via a smartwatch (HELO HEALTH®) and conducted the study in two phases: baseline (T0) and after 30 days of treatment (T1) (Phase A). No placebo-control was used in this study. After 30 days (Phase B), 21 patients were selected for reassessment. Eleven continued treatment for another 30 days (T2), while ten discontinued. Following the intervention, we observed remarkable improvements in sleep quality and mental distress. The SPINOFF® supplement significantly reduced the PSQI scores (22.4%), indicating enhanced sleep quality. Additionally, there was a 19.6% decrease in ISI scores, demonstrating a reduction in insomnia symptoms. Moreover, overall psychological distress decreased by 19.5% signifying improved psychological well-being. In the second phase, participants who continued treatment experienced more substantial improvements, with a mean decrease of 0.8 points in PSQI scores (±0.9) and a mean decrease of 0.9 points in ISI scores. Our findings suggest that the SPINOFF® supplement has the potential to effectively address both sleep disturbances and psychological distress in our study population.

Progressive Muscle Relaxation for Sleep Quality in Menopausal Women's

Background: Problems that often occur in women who experience menopause psychologically are emotional disturbances, feelings of fear, anxiety, irritability, difficulty concentrating, depression, and impaired libido. Physiologically there are problems, including pain during intercourse, menstrual cycles and increasingly varied bleeding patterns, hot flashes (repeated periods of sweating), respiratory problems, vaginal dryness, dry skin, disturbed sleep patterns, and sleep quality. During the transition process of menopausal women, sleep quality is one of the most common and disturbing problems. This research aims to analyze the influence of Progressive Muscle Relaxation (PMR) on Sleep Quality in Menopausal Women. Methods: this research, using the purposive sampling technique, the researcher selected the respondents according to the inclusion criteria so that respondents have the same opportunity to be selected. In the intervention group, respondents were given progressive Muscle Relaxation (PMR). The sampling method is non-probability sampling with a purposive sampling technique. The number of samples is 17 respondents, carried out at menopause in Badang Village, Ngoro District, Jombang Regency on 04 - 19 July 2023. The analysis used the Wilcoxon Signed Ranks Test. Results: Statistical test results using the Wilcoxon Signed Ranks test obtained p value = .000, which means that there is an influence of progressive Muscle Relaxation (PMR) in improving Sleep Quality in Menopausal WomenDusun Wates Elderly PosyanduBadang Village, Ngoro District, Jombang Regency. Conclusion: Progressive Muscle Relaxation (PMR) is Effectively used to help improve sleep quality in postmenopausal women. Because the therapy trains the muscles of the head, neck, arms, and back in a controlled manner, it works against the sympathetic nervous system to achieve a relaxed and calm state and is easy to do.

EFFECTS OF COMPANION ROBOTS ON DEPRESSION AND SOCIAL ISOLATION AMONG KOREAN AMERICAN OLDER ADULTS

Abstract Objectives During the COVID-19, older immigrants in low resource areas who are already excluded from much of social life, had to distance themselves even further, deepening their social isolation. Lack of stimulation can be particularly detrimental, as it influences mood and increases loneliness. Selected for cost-effectiveness and interactive features, we introduced the Companion Robot (CR) system. Preliminary studies conducted in South Korea found statistically significant improvement in quality of sleep and cognition among low-income older patients living alone with multiple chronic conditions and cognitive impairment. Method. Thirty CRs were deployed to solo-living Korean American older adults. We followed up with them after 3 months. In this Stage 1A clinical trial, we tested feasibility, usability and acceptability of CRs, investigating which features of CRs will help improve health behaviors such as medication adherence and daily exercises. Robotic Social Attitude (RoSAS) are assessed with a generic 18-items questionnaire (Krägeloh et al., 2019). Results The primary clinical outcomes measured at pre-and post-intervention were medication adherence and reduction of depression, social isolation and disabilities. The user-friendly doll-shaped design of CRs helped participants feel comfortable interacting with the CR on their own. Exposure to individualized CR-delivered content, including quizzes for brain training and inspirational messages, combined with consistent interaction with CR appeared to be beneficial for cognitive function. Discussion Since very few participants had reported diagnosis of dementia, we need to screen for undetected dementia using the Modified Mini-Mental Status Exam. The next stage is to implement further cultural adaptation for the U.S. participants.

THE EFFECTIVENESS OF NON-PHARMACOLOGICAL INTERVENTIONS ON SLEEP QUALITY IN RA AND FMS: A SYSTEMATIC REVIEW

Abstract Objective Sleep disturbances can significantly impact the well-being of individuals with Rheumatoid Arthritis (RA) and Fibromyalgia (FMS), leading to daytime sleepiness, fatigue, and increased pain. This systematic review aims to assess the available evidence on the effectiveness of non-pharmacological interventions in improving sleep quality for individuals with RA and FMS. Method A comprehensive search was conducted in English electronic databases (CINAHL plus, SPORTDiscus, EMBASE, Medline, PubMed, Web of Science, and Google Scholar) to identify relevant articles. The review includes 15 studies, consisting of 13 randomized controlled trials (RCTs) and 2 non-randomized controlled trials (non-RCTs), published between 2012 and 2022. Primary and secondary outcome measures related to sleep quality were assessed using subjective and objective measures. Results Interventions in the studies were diverse, involving physical and mind-body approaches, lasting 6 to 16 weeks with session durations of at least 30 minutes. The total intervention hours ranged from 6 to 32 hours across all studies. Follow-up evaluations were conducted in four studies up to 6 months after the last treatment. While the Arthritis Foundation Exercise Program and Yoga did not report statistically significant improvements in sleep quality for RA, non-pharmacological interventions showed a positive impact on sleep outcomes for RA and FMS populations. Conclusion Non-pharmacological interventions show promise as a potential alternative method to improve sleep quality for individuals with RA and FMS. However, there is no evidence to support the superiority of one intervention over another. Keywords: Rheumatoid Arthritis. Fibromyalgia Syndrome. Sleep quality. Sleep disturbance. Exercise. Non-pharmacological intervention.

Adaptive servo-ventilation for sleep-disordered breathing in patients with heart failure with reduced ejection fraction (ADVENT-HF): a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial

In patients with heart failure and reduced ejection fraction, sleep-disordered breathing, comprising obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is associated with increased morbidity, mortality, and sleep disruption. We hypothesised that treating sleep-disordered breathing with a peak-flow triggered adaptive servo-ventilation (ASV) device would improve cardiovascular outcomes in patients with heart failure and reduced ejection fraction. We conducted a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial of peak-flow triggered ASV in patients aged 18 years or older with heart failure and reduced ejection fraction (left ventricular ejection fraction ≤45%) who were stabilised on optimal medical therapy with co-existing sleep-disordered breathing (apnoea-hypopnoea index [AHI] ≥15 events/h of sleep), with concealed allocation and blinded outcome assessments. The trial was carried out at 49 hospitals in nine countries. Sleep-disordered breathing was stratified into predominantly OSA with an Epworth Sleepiness Scale score of 10 or lower or predominantly CSA. Participants were randomly assigned to standard optimal treatment alone or standard optimal treatment with the addition of ASV (1:1), stratified by study site and sleep apnoea type (ie, CSA or OSA), with permuted blocks of sizes 4 and 6 in random order. Clinical evaluations were performed and Minnesota Living with Heart Failure Questionnaire, Epworth Sleepiness Scale, and New York Heart Association class were assessed at months 1, 3, and 6 following randomisation and every 6 months thereafter to a maximum of 5 years. The primary endpoint was the cumulative incidence of the composite of all-cause mortality, first admission to hospital for a cardiovascular reason, new onset atrial fibrillation or flutter, and delivery of an appropriate cardioverter-defibrillator shock. All-cause mortality was a secondary endpoint. Analysis for the primary outcome was done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT01128816) and the International Standard Randomised Controlled Trial Number Register (ISRCTN67500535), and the trial is complete. The first and last enrolments were Sept 22, 2010, and March 20, 2021. Enrolments terminated prematurely due to COVID-19-related restrictions. 1127 patients were screened, of whom 731 (65%) patients were randomly assigned to receive standard care (n=375; mean AHI 42·8 events per h of sleep [SD 20·9]) or standard care plus ASV (n=356; 43·3 events per h of sleep [20·5]). Follow-up of all patients ended at the latest on June 15, 2021, when the trial was terminated prematurely due to a recall of the ASV device due to potential disintegration of the motor sound-abatement material. Over the course of the trial, 41 (6%) of participants withdrew consent and 34 (5%) were lost to follow-up. In the ASV group, the mean AHI decreased to 2·8-3·7 events per h over the course of the trial, with associated improvements in sleep quality assessed 1 month following randomisation. Over a mean follow-up period of 3·6 years (SD 1·6), ASV had no effect on the primary composite outcome (180 events in the control group vs 166 in the ASV group; hazard ratio [HR] 0·95, 95% CI 0·77-1·18; p=0·67) or the secondary endpoint of all-cause mortality (88 deaths in the control group vs. 76 in the ASV group; 0·89, 0·66-1·21; p=0·47). For patients with OSA, the HR for all-cause mortality was 1·00 (0·68-1·46; p=0·98) and for CSA was 0·74 (0·44-1·23; p=0·25). No safety issue related to ASV use was identified. In patients with heart failure and reduced ejection fraction and sleep-disordered breathing, ASV had no effect on the primary composite outcome or mortality but eliminated sleep-disordered breathing safely. Canadian Institutes of Health Research and Philips RS North America.

Hubungan Gelombang Cahaya Lampu dan Cahaya Biru dengan Kualitas Tidur Remaja Dewasa

Sleep is a crucial part of the human circadian cycle. The quality and quantity of sleep significantly influence various aspects of health, both physical and psychological. The hormone melatonin, which plays a vital role in sleep regulation, is produced as the intensity of light received by the eyes decreases. Currently, the use of lights and electronic devices emitting blue light is widespread, especially among teenagers to adults. This blue light can interfere with the production of melatonin, potentially disrupting sleep quality and patterns. In this age group, most are active students with busy schedules. This study uses a sequential explanatory design approach, combining quantitative and qualitative questionnaires to collect data and measure the impact of light on sleep duration and patterns. The respondents of this study were 71 people, coming from various universities and different study programs in Bandung City, ranging in age from 18 to 25 years. The research data results show that 38.6% of respondents experience sleep disturbances when the light is on, impacting sleep quality. Conversely, sleep quality improvement occurs in 81.4% of respondents when sleeping with the light off. The use of night mode on electronic devices, designed to reduce blue light emissions, positively impacts sleep quality, as felt by 38% of the 67.1% of respondents who use the night mode feature.