Improvement In Sleep Patterns Research Articles

Effectiveness of exercise and pramipexole in the treatment of restless leg syndrome: Implications on the dopaminergic system and PTPRD

ObjectiveDopaminergic dysfunction, iron reduction and variations in the PTPRD gene (protein tyrosine phosphatase receptor type delta) may be associated with restless leg syndrome (RLS). Here, we evaluate the effect of pramipexole (PPX) and exercise on genes and proteins associated with RLS and on sleep patterns in spontaneously hypertensive rats (SHR). MethodsAnimals were distributed into 4 groups: 1) Control (CTRL); 2) Exercise (EX); 3) Exercise and pramipexole (EX + PPX); and 4) Pramipexole (PPX). PPX treatment was performed daily (0.125 mg/kg), while exercise was conducted over 5 sessions per week, both for 4 weeks. ResultsEX + PPX increased the protein levels of PTPRD, reduced the protein levels of the enzyme tyrosine hydroxylase (TH) and improved sleep parameters in both cycles; on the other hand, the use of PPX reduced mRNA and protein levels of PTPRD and TH but improved the sleep pattern in the light cycle. However, in the dark cycle, pramipexole caused the worsening of symptoms. ConclusionsWe suggest that the improvement in sleep pattern by EX + PPX may be associated with the increased protein levels of PTPRD and that EX + PPX can reverse the negative effects of PPX.

Sleep Apnea and Serum Serotonin Level Pre- and Post-PAP Therapy: A Preliminary Study.

IntroductionThe high prevalence of obstructive sleep apnea (OSA), which impairs quality of life for numerous patients and leads to various OSA complications, has contributed to the continued interest in this disorder. The role of serotonin (5-HT) in many physiological processes, studies on its connection with the circadian system, and relationship to changes in sleep architecture are insufficient to assess the interaction of this neurotransmitter with nocturnal hypoxia. The aim of this study was to determine changes in sleep patterns and serum serotonin levels before and after positive airway pressure (PAP) therapy in patients with OSA.MethodsThe study involved 30 OSA patients (27 men and 3 women) who were treated with PAP for 3 months. Polysomnography using the GRASS TELEFACTOR (USA) and blood collection were conducted before and after PAP courses. Determination of serum serotonin was performed by high-performance liquid chromatography (HPLC). PAP therapy was performed using an automatic Prisma 20A (Germany) continuous positive airway pressure (CPAP) device.ResultsThe use of PAP for 3 months revealed a significant improvement as measured by sleep data and serotonin levels (before: apnea index [AI] 17.2 eV/h, after: 2.4 eV/h p = 0.001; SpO2 < 90% − 45.7 min vs. 6.2 min p = 0.001; serotonin 20.3 ng/mL vs. 26.03 ng/mL p = 0.036].ConclusionOur results demonstrate an improvement in sleep patterns. There was an increase in serum serotonin levels in OSA patients following PAP therapy, which could be an effect of intermittent hypoxia decline, and could be used as criteria for the effectiveness of PAP and an improvement in sleep quality.

Mindful Digital Program–based Interventions and their Role in Pregnancy and Fetal Outcomes

The joint family system provides a support system especially for children, young parents, and parents-to-be and is a major factor in their survival, health, education, development, and protection. It has the major potential to provide stability and support when there are problems. The joint family system even in India is on the decline, and nuclear families are on the rise both in urban and rural areas. This has left the pregnant woman with little or no family support to fall back on, which can be a cause of stress and thus affect the outcome of pregnancy. Moreover, during the COVID, the medical support was also limited, which has added to the distress. Stress in the mother can result in hypertensive disorders of pregnancy with resultant low-birth-weight babies, preterm delivery, adverse neurodevelopmental outcomes for the child, and developmental delays in babies, and all these need to be avoided. iMumz pregnancy, the baby care and parenting digital program, has sought to address these issues by partnering closely with pregnant women, offering a wide range of assistance and activities for maternal well-being in the comfort of their own homes. This study captures the responses and pregnancy outcomes of the women who have used the iMumz pregnancy digital program during pregnancy. Materials and methods: This longitudinal study (panel study) was conducted on 512 primigravidas. The study group included 255 pregnant women who opted for a digital holistic health program: “Baby Care Program” (BCP), while the control group consisted of 257 pregnant women who received no such interventions. The BCP included mindfulness meditation, 3 hours of yoga and breathing practices every week, 2 hours of harmonizing music every week, 1 hour of baby bonding activities every week, and 1 hour of personalized diet and pregnancy education each week. The data were collected at 15 and 35 weeks of pregnancy and then from 1 month until 6 months of postdelivery. Results: The study showed a statistically significant improvement in sleep patterns and stress levels. It also showed a statistically significant decrease in the incidence of preterm delivery and low birth weight and a better maternal–fetal bonding or attachment (MFA) in the BCP study group compared to the control group. After initiation of BCP activities in the App, 88% of the patients reported a significant reduction in stress. The BCP study group also reported a higher sense of mastery in coping with postpartum blues. Eighty percent of the control group reported postpartum blues as compared to 19% of the BCP users. Moreover, 81.4% of the BCP study group reported more sense of control in managing their pregnancies, despite the stressful COVID environment. Conclusion: The BCP activities, such as meditation, yoga and breathing exercise, harmonizing music, baby bonding activities and personalized diet, and pregnancy education, have helped pregnant women to reduce their stress levels with improvement in sleep quality, increased a sense of control over diet and nutrition, and educated about MFA. The use of BCP has also positively correlated with better early childhood development and milestones. © Jaypee Brothers Medical Publishers.

216 Resilience, sleep difficulties, and subjective sleep quality during COVID-19

IntroductionWe have shown in a previous study that despite significant improvements in sleep patterns and sleep duration during COVID-19 in teens and young adults, only teens reported better sleep quality and satisfaction. Moreover, sleep difficulties seem to be more prominent in the older group during the pandemic, suggesting that there could be additional risk factors involved. The current study aimed to investigate the role of resilience in the association between changes in sleep and the subjective sleep quality (SSQ) in teens and young adults during COVID-19.Methods289 teens (12-17 years old) and 294 young adults (18-25 years old) completed the Connor-Davidson Resilience Scale-10 and an adapted version of the Pittsburgh Sleep Quality Index online. Teens and young adults were each divided into a resilient and less resilient group. Hierarchical regression models were conducted to examine the unique contribution of weekdays sleep duration, sleep difficulties, and resilience to SSQ. Sleep duration, sleep difficulties and SSQ before COVID-19, and gender were entered as controls.ResultsResults show that in less resilient teens, changes in sleep onset difficulties (β=-.285, p=.003), nocturnal and early awakenings (β=-.218, p=.019), and weekdays sleep duration (β=.282, p=.001) significantly predicted SSQ and explained 36.5% of the variance. In less resilient young adults, changes in nightmares (β=-.309, p=.027) and sleep onset difficulties (β=-.263, p=.012) significantly predicted SSQ and explained 24.1% of the variance. In resilient teens, changes in weekdays sleep duration (β=.296, p=.007) significantly predicted SSQ and explained 20.1% of the variance. In resilient adults, changes in sleep onset difficulties (β=-.325, p=.001), nocturnal and early awakenings (β=-.374, p=.000), and weekdays sleep duration (β=.192, p=.009) significantly predicted SSQ and explained 46.0% of the variance.ConclusionOur results suggest that resilience appears to be a protecting factor in the impacts of sleep difficulties on sleep quality, but only in adolescents. Indeed, in young adults, sleep difficulties seem to be a more important factor modulating sleep quality than changes in sleep duration. These results underline the importance of focusing on the intrinsic characteristics of each population to better target interventions.Support (if any):

Improvement in Sleep Patterns After Hip and Knee Arthroplasty: A Prospective Study in 780 Patients

BackgroundThis study assessed change in sleep patterns before and after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and its relationship to patient-reported outcome measures (PROMs). MethodsBetween July 2016 and June 2018, surgical data and PROMs were collected on 780 subjects before and 12 months after THA or TKA. PROMs included Knee Injury and Osteoarthritis Outcome Score, Hip Disability and Osteoarthritis Outcome Score, patient satisfaction, and 2 questions from the Pittsburgh Sleep Quality Index. ResultsBefore surgery, 35% (270 of 780) reported poor quality sleep. Sleep quality and duration were worse in females over males, and in THA patients (39%) over TKA patients (30%; P = .011). Of those reporting bad sleep, 74% (201 of 270) were improved after arthroplasty. Satisfaction was higher in subjects reporting good sleep quality (626 of 676; 93%) compared with those reporting bad sleep quality (67 of 86; 78%) (P = .001). Sleep was positively correlated with better Hip Disability and Osteoarthritis Outcome Score/Knee Injury and Osteoarthritis Outcome Score (r = 0.2-0.3). ConclusionImprovement in sleep quality and duration can be expected after THA and TKA and is associated with better outcome scores and satisfaction.

Resistance training improves sleep quality, redox balance and inflammatory profile in maintenance hemodialysis patients: a randomized controlled trial

Patients in maintenance hemodialisys (HD) present sleep disorders, increased inflammation, unbalanced redox profiles, and elevated biomarkers representing endothelial dysfunction. Resistance training (RT) has shown to mitigate the loss of muscle mass, strength, improve inflammatory profiles, and endothelial function while decreasing oxidative stress for those in HD. However, the relation between those factors and sleep quality are inadequately described. The aim of this study was to verify the effects of 3 months of RT on sleep quality, redox balance, nitric oxide (NO) bioavailability, inflammation profile, and asymmetric dimethylarginine (ADMA) in patients undergoing HD. Our primary goal was to describe the role of RT on sleep quality. Our secondary goal was to evaluate the effect of RT on NO, metabolism markers, and inflammatory and redox profiles as potential mechanisms to explain RT—induced sleep quality changes. Fifty-five men undergoing maintenance hemodialysis were randomized into either a control (CTL, n = 25) and RT group (RTG; n = 30). Participants in the RT group demonstrated an improvement in sleep pattern, redox, inflammatory profiles, and biomarkers of endothelial function (NO2− and ADMA). This group also increased muscle strength (total workload in RT exercises of upper and lower limbs). These findings support that RT may improve the clinical status of HD patients by improving their sleep quality, oxidative and inflammatory parameters.

Pharmacological Management of Acute Sleep Disorders During the First 48 hours of the Postoperative Period. A Narrative Review

Abstract Introduction: The positive effects of restorative sleep must be carefully considered during the early postoperative period. The literature on the treatment of acute sleep disorders taking place during the postoperative period is scarce. Most pharmacological therapies are based on the administration of benzodiazepines; however, a personalized approach is strongly recommended, due to their side effects. The objective of this narrative review was to evaluate rational pharmacological therapies for the management of acute sleep disorders during the first 48 hours of the postoperative period in patients undergoing scheduled surgery procedures. Methods: A narrative review was conducted in the Embase, PubMed, and Cochrane databases. Only controlled randomized trials and systematic reviews were considered for inclusion. Outcome: The primary outcome was the improvement of sleep patterns after pharmacological treatments for acute sleep disorders, its administration routes, and its impact on postoperative descents. Results: The initial search yielded 271 studies, however only 7 met the eligibility criteria. Pharmacological therapies based on the administration of Zolpidem at a dose of 5 milligrams at night, Gabapentin at doses> 900 mg/day, and Dexmedetomidine intravenous infusion at a 0.05 mcg/kg/h dose were reported as being effective for the treatment of these disorders during the early postoperative period. Conclusions: The oral administration of Zolpidem and Gabapentin and the intravenous administration of Dexmedetomidine are effective for the management of acute sleep disorders in carefully selected postoperative patients. Somehow, due to drug side effects, non-pharmacological management alone or combined with pharmacological therapy should be always considered.

Physical Activity, Fatigue, and Sleep in People with Parkinson's Disease: A Secondary per Protocol Analysis from an Intervention Trial.

Symptoms of Parkinson's can result in low physical activity and poor sleep patterns which can have a detrimental effect on a person's quality of life. To date, studies looking into exercise interventions for people with Parkinson's (PwP) for symptom management are promising but inconclusive. The aim of this study is to estimate the effect of a clearly defined exercise prescription on general physical activity levels, fatigue, sleep, and quality of life in PwP. Method. PwP randomised into either an exercise group (29; 16 males, 13 females; mean age 67 years (7.12)) or a control handwriting group (36; 19 males; 17 females; mean age 67 years (5.88)) as part of a larger trial were included in this substudy if they had completed a 6-month weekly exercise programme (intervention group) and had complete objective physical activity data (intervention and control group). Sleep and fatigue were recorded from self-reported measures, and physical activity levels measured through the use of accelerometers worn 24 hours/day over a seven-day testing period at baseline and following the 24-week intervention. A Wilcoxon's test followed by a Mann–Whitney post hoc analysis was used, and effect sizes were calculated. Results. Participants showed a significant increase in time spent in sedentary and light activities during the overnight period postintervention in both exercise and handwriting groups (p < 0.05) with a moderate effect found for the change in sedentary and light activities in the overnight hours for both groups, over time (0.32 and 0.37-0.38, resp.). There was no impact on self-reported fatigue or sleep. Conclusion. The observed moderate effect on sedentary and light activities overnight could suggest an objective improvement in sleep patterns for individuals participating in both exercise and handwriting interventions. This supports the need for further studies to investigate the role of behavioural interventions for nonmotor symptoms.

Effect of low-frequency repetitive transcranial magnetic stimulation on sleep pattern and quality of life in patients with focal epilepsy

ObjectiveIn this study we analyzed the effects of transcranial magnetic stimulation (TMS) on sleep and on the self-perceived quality of life in epileptic patients. MethodsA total of 24 male patients diagnosed with focal epilepsy were included in the study. Pharmacological treatment with levetiracetam was standardized at 2 g daily. Before TMS onset, all-night polysomnographic recording (PSG) was performed, and the Quality of Life in Epilepsy Inventory (QOLIE-31) was administered. Thereafter, patients underwent low-frequency repetitive TMS (1000 pulses/1 Hz) daily for 10 days. After the end of the treatment, a second polysomnographic study was performed, and the QOLIE-31 questionnaire was administered again. ResultsTMS induced a significant increase in sleep efficiency and in total sleep time, along with a decrease in sleep latency and the number of awakenings. In addition, the number of interictal discharges during sleep decreased significantly. Concerning the QOLIE-31 scale values, the patients showed great improvement in the self-perceived quality of life. ConclusionThe present results indicate that TMS may mediate therapeutic effects in the treatment of patients with focal epilepsy, and that TMS treatment is accompanied by improvement of sleep patterns as well as improvement in self-perceived quality of life. However, a study that includes a control group undergoing sham stimulation is needed to confirm these findings.

Sleep Quality – Impact of Relaxation Techniques and Autogenic Training in Patients Diagnosed with Insomnia

Analyze quantitatively and qualitatively, the impact of relaxation techniques and autogenic training program on sleep quality in patients with insomnia related to anxiety disorder or depression. The study went on for six months. Each subject completed twelve group sessions, which took place always on the same weekday and at the same time. During the sessions, subjects were taught respiratory training techniques, Schultz's Autogenic Training (inferior and superior cycles), Jacobson's progressive relaxation, creative visualization and meditation, as well as group exercise dynamics and the hug technique. To evaluate results, in sleep quality, the Insomnia Severity Index (ISI) was applied, in the beginning and in the last session of the program. The data was statistically analyzed using SPSS version 19.0. A total of 28 patients were enrolled: 22 were female and 6 male, with a mean age of 42.2 years. There was a statistical significant (p=0.007) decreased in the insomnia severity level (from 16.36 to 11.89; i.e. moderate to mild). Subjectively, the patients demonstrated satisfaction with the improvement in sleep pattern, with lower interference in performance of daily tasks, as well a decrease in the inconvenience caused by a sleep disorder. There was also improvement in mood, vigor, self-esteem and self-control. The most common causes of insomnia are cognitive and emotional dysfunctions. Our results shows that psychopharmacological therapy, combined with relaxation techniques and autogenous training programs, that can be learned and implemented independently, can help improve sleep quality. Further studies are needed to validate these results in other populations.

The impact of changing work schedules on American firefighters’ sleep patterns and well-being

Across the nation, fire departments are adopting the 48/96 work schedule, in which firefighters work 48 consecutive hours with the following 96 hours off. Our study objective was to explain and quantify the impact of switching from the Kelly schedule to the 48/96 schedule by measuring changes in sleep, feelings of daytime function, as well as perceptions of professional and personal well-being for American firefighters. Sleep diaries and self-reported surveys were administered to firefighters at an urban fire department. Sleep diaries measuring the number of hours slept and feelings of refreshment were compared one month before and four months after implementation of the 48/96 schedule. The self-reported surveys measured sleepiness levels via the Epworth Sleepiness Scale. Secondary study objectives included changes in professional and personal well-being time for personal schedules, satisfaction, and health habits before and after the 48/96 schedule was implemented. The 59 firefighters included in the study reported an increase in sleep on-shift after the new schedule implementation (5.8 to 6.6 hours/night, p &lt; 0.001). Participants also reported increased feelings of refreshment on days off (p &lt; 0.001) and decreased daytime sleepiness (p &lt; 0.001). We also found a general trend of improved perceptions of satisfaction, less shift interference with personal schedules and decreased feelings of burnout. American firefighters appeared to benefit from a 48/96 schedule, with short-term improvements in sleep patterns, feelings of burnout, and time for personal schedules.

Efficacy of paravertebral block versus local lidocaine/capsaicin in the treatment of postherpetic neuralgia

Background Postherpetic neuralgia (PHN) is an extreme form of neuropathic pain. Although a number of treatment options are available, drug interactions and side effects frequently limit their use. This study aimed to compare the efficacy of repeated paravertebral block with that of topical sequential lidocaine/capsaicin therapy, considering the degree of patient comfort, in the management of pain of PHN after resolution of the acute phase. Patients and methods We compared the efficacy of repeated paravertebral block with that of topical sequential lidocaine/capsaicin therapy, considering the degree of patient comfort, in the management of pain of PHN after resolution of the acute phase in 80 patients divided into two equal groups. The patients in group I received topical lidocaine 2% cream, followed after 20 min by capsaicin 7% ointment. The patients in group II received twice-weekly paravertebral injections of the affected dermatomes with a mixture of bupivacaine 0.25%+dexamethasone. Patients were followed up for pain (using visual analogue score), allodynia (using numeric rating scale), Q+-uality of life [using The European quality-of-life questionnaire (EQ-5D) and sleep questionnaire (sleep Q)], and finally their satisfaction (on a three-category score). Results It was found that after 1 week of therapy, reduction in the severity of pain and allodynia was significantly more remarkable in group 1 compared with group 2. After 2 weeks of therapy, there was a significantly greater improvement in pain and allodynia, associated with a greater improvement in quality of life in group I compared with group II. By the end of the study period, the topical regimen was shown to be significantly more pleasant for most of the patients. Conclusion The use of topical lidocaine/capsaicin sequentially leads to better improvement of pain and allodynia, with more improvement in sleep pattern and hence of quality of life than repetitive paravertebral block with bupivacaine/dexamethasone when either of them is combined with gabapentin/amitriptyline oral therapy.

Developing a Performance Brain Training™ Approach for Baseball: A Process Analysis with Descriptive Data

Neurofeedback may be useful for improving sports performance but few studies have examined this potential. Here we present data of five development players from a major league baseball team. The aims were to evaluate the feasibility of conducting sessions within a professional organization, assess changes in quantitative electroencephalograph (QEEG), NeuroPerformance Profile™, and report qualitative self-report data before and after brain training. The EEG was recorded with 19 electrodes for 20 min of baseline conditions and approximately 21 min of a continuous performance test. The fast Fourier transform analysis provided average cross-spectral matrices for bands delta (1-3.5 Hz), theta (4-7.5 Hz), alpha (8-12 Hz), low beta (13-16 Hz), beta 1 (13-21 Hz), beta 2 (22-32 Hz), and gamma (32-45 Hz) from the pre and post intervention evaluations in the baseline condition of eyes open. The continuous performance test metrics included the errors of omission, errors of commission, response time and response time variability. The 9 scales of the NeuroPerformance Profile™ were examined. The QEEG data, CPT data and NeuroPerformance Profile™ data were all compared between the pre and post 15 sessions of brain training using a within subject paired t test design corrected for multiple comparisons using false discovery rate method. Following brain training, comparative QEEG, CPT and NeuroPerformance Profile™ analyses illustrated significant differences. The QEEG findings of all participants illustrated significant changes within the training parameters but also across other frequency bands and electrode sites. Overall, the positive findings in both objective and subjective measures suggest further inquiry into the utility of brain training for performance enhancement with the specific application of sport is warranted. Particularly QEEG and CPT gains were noted in the areas that correspond to client self-report data demonstrating improvement in attention, decreased intrusive thought patterns and improvements in sleep patterns.

Autogenic Training as a behavioural approach to insomnia: a prospective cohort study

Insomnia is commonly associated with chronic health problems. Behavioural and cognitive factors often perpetuate a vicious cycle of anxiety and sleep disturbance, leading to long-term insomnia. National Institute for Health and Clinical Excellence currently recommends behavioural approaches before prescribing hypnotics. Behavioural approaches aim to treat underlying causes, but are not widely available. Research usually includes patients diagnosed with insomnia rather than secondary, co-morbid sleep- related problems. To examine the effectiveness of autogenic training (AT) as a non-drug approach to sleep-related problems associated with chronic ill health. Prospective pre- and post-treatment cohort study. AT centre, Royal London Hospital for Integrated Medicine, University College London Hospitals NHS Foundation Trust. All patients referred for AT from April 2007 to April 2008 were invited to participate. Participants received standard 8-week training, with no specific focus on sleep. Sleep questionnaires were administered at four time points, 'Measure Your Medical Outcome Profile' (MYMOP) and Hospital Anxiety and Depression Scale, before and after treatment. Results before and after treatment were compared. Camden and Islington Community Local Research and Ethics Committee approved the study. The AT course was completed by 153 participants, of whom 73% were identified as having a sleep-related problem. Improvements in sleep patterns included: sleep onset latency (P = 0.049), falling asleep quicker after night waking (P < 0.001), feeling more refreshed (P < 0.001) and more energised on waking (P = 0.019). MYMOP symptom, well-being, anxiety and depression scores significantly improved (all P < 0.001). This study suggests that AT may improve sleep patterns for patients with various health conditions and reduce anxiety and depression, both of which may result from and cause insomnia. Improvements in sleep patterns occurred despite, or possibly due to, not focusing on sleep during training. AT may provide an approach to insomnia that could be incorporated into primary care.

Sleep deprivation worsens inflammation and delays recovery in a mouse model of colitis

Background and aim We recently showed that patients with inflammatory bowel disease (IBD) report significantly more sleep disturbances. To determine whether disrupted sleep can affect the severity of inflammation and the course of IBD, we used an animal model of colonic inflammation to determine the effects of acute and chronic intermittent sleep deprivation on the severity of colonic inflammation and tissue damage in colitis and recovery from this damage. Methods Acute sleep deprivation (ASD) consisted of 24 h of forced locomotor activity in a mechanical wheel rotating at a constant speed. Chronic intermittent sleep deprivation (CISD) consisted of an acute sleep deprivation episode, followed by additional sleep deprivation periods in the wheel for 6 h every other day throughout the 10 day study period. To induce colitis, mice were given 2% dextran sodium sulfate (DSS) in their daily drinking water for 7 days. The development and severity of colitis were monitored by measuring weight loss and tissue myeloperoxidase (MPO) activity daily and colon histology scores 10 days after initiation of colitis. Results ASD or CISD did not cause colonic inflammation in vehicle-treated mice. Changes in daily body weight, tissue MPO levels and colon histopathology score were similar between mice that were sleep deprived and controls. Daily DSS ingestion caused colitis in mice. ASD worsened colonic inflammation: tissue MPO levels in ASD/DSS-treated mice were significantly higher than in DSS-treated mice that were not sleep deprived. However, the worsening of colonic inflammation by ASD was not enough to exacerbate clinical manifestations of colitis such as weight loss. In contrast, the deleterious effects of CISD were severe enough to cause worsening of histological and clinical manifestations of colitis. The deleterious effects of sleep deprivation on severity of colitis appeared to be due to both increased colonic inflammation and a decrease in the ability of mice to recover from DSS-induced colonic injury. Conclusion Both acute and chronic intermittent sleep deprivation exacerbate colonic inflammation. Thus, sleep deprivation could be an environmental trigger that predisposes IBD patients to develop flare ups and a more severe disease course. These results provide a scientific rationale to conduct an interventional trial to determine whether improvement in sleep patterns will prevent IBD flare ups, modify the disease course, and improve quality of life.

Polysomnography and Heart Failure: Central Sleep Apnoea and Biventricular Pacing

There are 2 types of nocturnal respiratory disorders: the obstructive sleep apnoea (OSA) and the central sleep apnoea (CSA). Correlation of CSA with severity of cardiac disfunction and arrhythmias has been hypothesized. Evaluate the prevalence of OSA/CSA in heart failure patients, the effect of cardiac resynchronyzation therapy (CRT) on OSA/CSA and the predictive value of positive response to CRT. We submitted 10 pts, mean age 70y±4.8 affected by dilated cardiomyopathy, III NYHA class, EF<40%, VO2 < 15 and QRS duration >130ms to polysomnography before CRT. After CRT we repeated the exam in 5. We documented a prevalence of light sleep and a moderate or severe fragmentation of sleep. 6 showed an abnormal index of apnoea-hypopnoea (AHI) and number of AHI per sleep/hour: 4 had light AHI, 1 moderate AHI and 1 severe AHI. Most frequent event recorded was CSA; 2 of the 4 pts with normal AHI had OSA/CSA. In the 5 pts controlled after CTR we found improvement in sleep pattern. Polysomnography found high prevalence of sleep disorders in our patients with heart failure. Our data suggest that CRT can improve sleep quality.

Effect of Music Therapy on the Anxiety Levels and Sleep Patterns of Abused Women in Shelters

The purpose of this study was to explore the effect of a music therapy procedure (music listening paired with progressive muscle relaxation) on the reduction of anxiety and improvement of sleep patterns in abused women in shelters. Twenty-eight women residing in 2 domestic violence shelters in a Midwestern city met with the researcher on 5 consecutive days for half-hour sessions. A pretest-posttest design with control and experimental groups was used. The dependent variables included: stait anxiety measured by the STAI (Spielberger et al., 1983) before and after each music stimulus, sleep quality as measured by the PSQI (Buysse et al., 1989) on the first and last sessions, and levels of fatigue as measured by the Fatigue Scale (Lee, 1992) at waking time. The independent variable was a 20-minute recording of participant-selected music with a Progressive Muscle Relaxation script. Results indicated that music therapy constituted an effective method for reducing anxiety levels. Results also indicated a significant effect on sleep quality for the experimental group, but not for the control group. No significant relationships were found between anxiety levels and sleep quality, nor fatigue levels and sleep quality. These results seem promising in the light of domestic violence research, which has found that a greater amount of personal resources is a crucial aspect of abused women's recovery process. Reduction of anxiety and improvement of sleep quality can be considered as increased personal resources, and seem feasible through the use of music therapy.

An open study of the effects of sertraline on adolescent major depression.

This open study investigated the effects of sertraline in treating 13 adolescents, ages 12 to 18, who were hospitalized for treatment of a major depressive episode. The sample included 7 adolescents with nonendogenous depression and 6 with endogenous depression, as diagnosed by both Research Diagnostic Criteria (RDC) and Kiddie-SADS-P DSM-III-R endogenous subtype criteria. These patients were followed for an inpatient length of stay ranging from 9 to 38 days (mean 19 days), with later outpatient follow-up for a total of 12 weeks. Measures of depression were found to improve significantly, including suicidal ideation and most of the DSM-III-R symptoms of major depression. Sertraline (mean 110 mg or 1.96 mg/kg daily) significantly decreased scores on the 24-item Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale from premedication baseline to treatment week 12, and also between weeks 1 (after a large week 1 improvement, presumably due to nondrug effects) and 12. There was a small but significant improvement on the Children's Global Assessment Scale between baseline and week 12, but the Family Global Assessment Scale showed no significant change; neither global assessment scale showed significant effects between weeks 1 and 12. Sleep disturbance was common (69%) after 12 weeks of treatment, but clinically significant improvements in sleep patterns were also observed. This open-label prospective study suggests that sertraline might be useful in treating adolescents with major depression. Adverse effects, mainly insomnia and drowsiness, were relatively common but usually manageable. One patient developed mania after 8 days of sertraline treatment at a dose of 100 mg daily.

Effect of Spiritual Healing on Chronic Idiopathic Pain

To study over a period of one and a half years the effect of spiritual healing on patients with idiopathic pain syndrome using several psychological and medical parameters. Randomized clinical trial. Outpatient pain clinic. Twenty-four patients with idiopathic chronic pain who had passed a pretreatment psychological interview were allocated randomly to receive spiritual healing or no active treatment. Medical interview (Visual Analog Scale and Pain Clinic Investigation Formula); International Association for the Study of Pain (IASP) Data Base Outline; psychological interview (Hopkin's Symptom Checklist, Middlesex Hospital Questionnaire, Beck's Depression Inventory, Coping Strategy Questionnaire, Health Locus of Control scale). Patients were evaluated at baseline and at 2 weeks posttreatment. Final assessment at 1 year posttreatment was done with a modified form of IASP Data Base Outline. There was a minor decrease in analgesic drug intake and an improvement in sleep patterns in patients treated by the healer. Generally, clinical variables remained unchanged. Attitudes toward spiritual healing improved. There was a decrease in the feeling of hopelessness (p < 0.05) and an increased acceptance of psychological factors as reasons for pain (p < 0.05). Other scores of the psychological tests were unaffected by the healing. However, half (n = 6) of the treated patients felt that spiritual healing gave them some relief. Spiritual healing appears harmless and was subjectively helpful to some patients suffering from idiopathic chronic pain syndrome.

The effect of dietary caffeine manipulation on blood caffeine, sleep and disturbed behaviour

The effect of withdrawal of caffeine from the diet of a group of highly disturbed severely retarded adult patients was studied. Two weeks withdrawal produced no improvement in sleep pattern or behaviour, but re-introduction of normal diet was accompanied by a highly significant increase (P < 0.001) in ward disturbance ratings.