Including Pittsburgh Sleep Quality Index Research Articles

Effect of Ketogenic Diet on Sleep Quality of Children with Drug Resistant Epilepsy and Their Mothers

Abstract Background Children with drug-resistant epilepsy (DRE) often suffer from sleep disorders and psychosocial dysfunction. Their mothers also complain of sleep difficulties in relation to poorly controlled of seizure activity of their children. Recently, several studies confirmed the positive effects of the ketogenic diet (KD) on DRE both in adult and in pediatric populations. Objectives The objective of the study was to assess the effect of using KD as an adjuvant treatment on the sleep quality of children with DRE and their mothers. Patients and Methods The current prospective observational study was conducted on forty epileptic children on KD who followed up at Pediatric Neurology and Clinical Nutrition Outpatient clinics or were admitted due to drug resistant seizures at the Pediatric Neurology Department. Patients and their mothers were assessed at baseline and after 3 months of starting KD. Measures for children included children’s sleep habits questionnaire (CSHQ) and measures for mothers included Pittsburgh Sleep Quality Index (PSQI). Results The mean age of the studied children was 5.19 years (±3.22). About 52.5% of the children’s parents were relatives and 20% of the children had a perinatal history of neonatal asphyxia, 87.5% gave a history of delayed development and 5% had a family history of similar cases. For children the mean score of CSHQ showed a statistically significant difference between baseline and after 3 months of starting KD with p value (<0.001). Regarding the mothers, the results showed that there was a statistically significant difference in PSQI between baseline and after 3 months of their children starting KD with p value (<0.001). Conclusion The results of this study showed an improvement of sleep quality for children with drug resistant epilepsy and their mothers over the course of 3 months of KD therapy.

Outcomes of Twice Repeated High-Voltage Long-Duration Pulsed Radiofrequency Treatment in Subacute Postherpetic Neuralgia: a Retrospective Single-Center Analysis.

The treatment of herpes zoster-related pain is challenging, and requires a variety of methods including pulse radio frequency modulation. Among them, single-time high-voltage long-term pulsed radiofrequency (HL-PRF) has been proved to be an effective treatment for subacute postherpetic neuralgia. However, it has the possibility of poor long-term curative effect and recurrence of neuralgia. In this study, we aim to identify the clinical efficacy and safety of twice repeated HL-PRF treatment in patients with subacute postherpetic neuralgia. We conducted a retrospective analysis of subacute postherpetic neuralgia patients who underwent HL-PRF treatment. Pain Management Department of First Affiliated Hospital of Wannan Medical College. We enrolled all patients with subacute postherpetic neuralgia, who underwent HL-PRF treatment from January 2023 to October 2023. The primary outcome variable was the visual Analog Scale (VAS) scores at 1, 4, 8, and 12 weeks after treatment. Secondary outcomes included Pittsburgh sleep quality index (PSQI), 36-item short-form health survey (SF-36) score, and total effective rate after treatment. A total of 63 patients were included in the analysis. Among them, 33 patients received single-time HL-PRF treatment (Group S) and 30 patients received twice repeated HL-PRF treatment (Group T). Pain scores, PSQI scores, and SF-36 score were reduced in both groups after treatment (P < 0.001). Compared to group S, the VAS scores, PSQI scores, anxiety scores, and depression scores were significantly lower at 1, 4, 8, and 12 weeks in group T. (P < 0.001). The total efficiency rate at 12 weeks after treatment of group T was statistically higher than that of group S (60.6% vs 86.7%, P < 0.05). Twice repeated high-voltage long-duration PRF therapy demonstrates satisfactory efficacy in patients with subacute postherpetic neuralgia and is associated with no significant adverse reactions.

Efficacy of Prolonged-Release Melatonin Administration in Elderly Patients With Treatment Resistant Insomnia: A Post-Hoc Analysis

Objective: Melatonin, both immediate and prolonged-release formulations, has been explored as an adjunctive treatment for insomnia, with prolonged-release melatonin demonstrating enhanced efficacy compared to its immediate-release counterpart. However, there remains a gap in understanding its effectiveness specifically in individuals with treatment-resistant insomnia, who continue to experience sleep difficulties despite using traditional hypnotic medications.Methods: An 8-week prospective, open-label, observational study was conducted on 115 patients aged 55 years or older with insomnia several years ago. This is a post-hoc analysis, which was performed on 63 out of 115 patients who were already taking hypnotics and still reported symptoms of insomnia. Per protocol (n=40) and last observation carried forward (LOCF) approaches (n=63) were used, assessing changes in sleep indicators after administering 2 mg of prolonged-release melatonin. Psychometric scales including Pittsburgh Sleep Quality Index (PSQI) and WHO-5 Well-Being Index were used for evaluation at baseline, week 4, and week 8.Results: The per protocol and LOCF analysis revealed substantial improvements in sleep latency, total sleep time, sleep efficiency, and total PSQI scores after 8 weeks of prolonged-release melatonin treatment. The LOCF analysis also revealed WHO-5 Well-Being Index significantly increased. Compared to prolonged-release melatonin monotherapy group with combination therapy group (adding prolonged-release melatonin to previous hypnotics) at baseline, 4 weeks, and 8 weeks after treatment, most variables did not differ between two groups in the per protocol and LOCF analysis. However, only WHO-5 Well-Being Index was higher in monotherapy group than in combination group at 4 weeks and 8 weeks after prolonged-release melatonin treatment in the per protocol analysis.Conclusion: Prolonged-release melatonin demonstrated notable efficacy in ameliorating sleep latency, duration, efficiency, and overall quality in treatment-resistant insomnia patients. The study highlights its potential as a treatment avenue for this challenging cohort, prompting further exploration into its benefits, particularly in improving overall well-being, and advocating for expanded research in this domain.

Effects of preoperative quetiapine on postoperative delirium and sleep quality in elderly orthopaedic patients

Objective: To investigate the effects of preoperative quetiapine on postoperative delirium (POD) and sleep quality in elderly orthopedic patients. Methods: Prospectively, 111 elderly patients, American Society of Anesthesiologists (ASA) grade Ⅱ-Ⅲ, scheduled to undergo knee or hip surgery in the Affiliated Huangyan Hospital of Wenzhou Medical University under continuous spinal anesthesia from August 2021 to March 2023, were selected and randomly divided into two groups by random number table: control group (group C, 1 h preoperative placebo) and quetiapine group (group Q, 1 h preoperative quetiapine 12.5 mg). In group C, 54 cases were enrolled, including 25 males and 29 females, with an average age of (73.5±4.9) years. In group Q, 57 cases were enrolled, including 26 males and 31 females, with an average age of (74.8±5.0) years. The primary outcome measures were the incidence of POD evaluated by using confusion assessment method (CAM) at 24, 48, and 72 hours after surgery, and the secondary outcome measures included Pittsburgh sleep quality index (PSQI) scores at 24 and 48 hours after surgery and satisfaction of pain management within 24 hours after surgery. Results: The incidence of POD at 24, 48, and 72 h after surgery in group Q was 5.4% (3/57), 12.5% (7/57), 14.3% (8/57), respectively, while that in group C was 18.2% (10/54), 21.8% (12/54), 21.8% (12/54), respectively. The incidence of POD at 24 h after surgery in group Q was lower than that in group C (P=0.036). There was no significant difference in the incidence of POD at 48 and 72 h after surgery between two groups (all P>0.05). The PSQI score of patients in group Q at 24 and 48 h after surgery were (3.8±1.2) and (6.9±1.1) scores, respectively, which in group C were (10.5±2.8) and (7.3±1.3) scores, respectively. Compared with group C, the PSQI score of patients in group Q at 24 h after surgery was significantly higher (P<0.001), but there was no significant difference at 48 h after surgery (P=0.068). The satisfaction scores of pain management at 24 h after surgery in group Q was (91±7) scores, which was higher than that in group C of (81±6) scores (P<0.001). Conclusion: Oral intake of low-dose quetiapine 1 h preoperatively can reduce the incidence of POD, improve postoperative sleep quality and enhance postoperative satisfaction of pain management at 24 hours after surgery in elderly orthopedic patients undergoing knee or hip surgery.

A cross-sectional survey on sleep disturbances with special reference to sleep quality among COVID-19-recovered patients attending outpatient department of a medical college hospital in Eastern India

Background: The prevalence of sleep problems is approximately 40% among the general and health-care populations. Post-covid-19 sleep disturbances may persist for a long time and are often precursors of psychiatric disorders and expeditors of many systemic diseases. Studies on sleep quality in COVID-19 patients are considerable but in post-COVID-recovered subjects are scanty. There is no study on sleep quality of such patients in Eastern India. Aims and Objectives: We hypothesize that both sleep disturbances and sleep quality may be affected in subjects in their post-COVID state. Therefore, we planned to study the prevalence of sleep disturbances, sleep quality, severity of insomnia, and the relationship of different parameters with respect to sleep quality. Materials and Methods: Two hundred and fifty COVID-19-recovered patients were administered a pre-structured questionnaire including Pittsburgh sleep quality index and insomnia severity index containing various sleep parameters. Results: Majority of the study participants had sleep disturbances in the form of change in sleep pattern (59.6%), poor sleep quality (77.6%), reduced sleep duration (29.6%), daytime sleepiness (20%), difficulty in sleep initiation (29.6%), and subthreshold insomnia (53.6%). Poor sleep quality was strongly associated with reinfection, change in sleep pattern after infection, sleep pattern alteration during pandemic, and those who felt tired during daytime. Conclusion: This study concludes that a significant number of COVID-19-recovered subjects experienced sleep disturbances including poor sleep quality.

Is There a Link Between Sleep Quality and a Tendency for Eating Disorders?

Aim: Poor sleep quality has been associated with an increased risk of developing eating disorders, and unhealthy eating behaviours. The aim of the study was to explore the potential link between sleep quality and eating disorders. Subjects and Method: This descriptive, observational, and cross-sectional study was conducted with 357 (84 male; 273 female) university students between the ages of 18-25 years. Exclusion criteria included being diagnosed with chronic disease and psychiatric disorders, being pregnant and lactating, using drugs that affect sleep patterns, being shift workers, and participants who did not complete the questionnaire. The questionnaire consisted of six parts including Pittsburgh Sleep Quality Index (PSQI), Three-Factor Eating Questionnaire (TFEQ-21), SCOFF (REZZY) Eating Disorders Scale, anthropometric measurements, demographic properties, and nutritional habits. Results: The prevalence of poor sleep quality was found to be 63% and there was no significant difference between gender in terms of sleep quality (p=0.769). There was significant relationship between total TFEQ 21 (p=0.02), SCORF (REZZY) (p&lt;0.001) scores and sleep quality. Uncontrolled eating behaviours was found higher in students with poor sleep quality (p&lt;0.05). Age, body mass index (kg/m2), and smoking were not significant predictors of sleep quality. However, participants with a tendency towards eating disorders behaviour were found to have a significantly higher risk of poor sleep quality (odds ratio [OR]: 2.338, 95% confidence interval [CI]: 1.444-3.785, p=0.001), as were those with a tendency towards emotional eating behaviour (OR: 1.575, 95% CI: 1.022-2.427, p=0.040). Conclusion: Students with poor sleep quality had higher levels of uncontrolled eating behaviour and a tendency towards unhealthy eating attitudes than those with good sleep quality.

A longitudinal examination of psychosocial mechanisms linking discrimination with objective and subjective sleep

ObjectiveAlthough chronic discrimination negatively impacts sleep, the cross-sectional nature of most research limits the understanding of how changes in discrimination over time are associated with sleep health. Therefore, the aims of this study were to explore the: (1) longitudinal association between daily discrimination and subjective and objective sleep; (2) mediating roles of anxiety and social well-being; and (3) moderating role of change in discrimination over time. MethodsAn archival analysis was completed using data from the Midlife in the United States study across 3 timepoints. Participants were primarily female-identifying, white, and college-educated. Measures included Pittsburgh Sleep Quality Index (N = 958), sleep diaries (N = 307), and actigraphy (N = 304). Daily discrimination, the Social Well-Being Scale, and the Mood and Anxiety Symptom Questionnaire were also administered. Moderated parallel mediations were performed using the PROCESS macro controlling for depressive symptoms. ResultsMore discrimination at time 1 was associated with worse global sleep quality (b = 0.10 and p = .001) and daily sleep quality (b = 0.03 and p = .02) and worse objective sleep-onset latency (b = 0.93 and p = .02), wake after sleep onset (b = 1.09 and p = .002), and sleep efficiency (b = −0.52 and p < .001) at time 3. Social well-being mediated the associations between discrimination and subjective global sleep quality 95% CI [0.00, 0.03] and daily sleep quality 95% CI [0.00, 0.01] and objective TST 95% CI [0.00, 0.96] when discrimination was increasing or chronic. Anxiety mediated the discrimination—global sleep quality association regardless of changes in discrimination. ConclusionsDiscrimination showed durable associations with a broad array of sleep outcomes across a 10-year period. Anxiety and social well-being linked discrimination to subjective sleep outcomes, illustrating the importance of psychosocial well-being for sleep health in those experiencing discrimination.

Four-year follow-up on fatigue and sleep quality of a three-armed partly randomized controlled study in breast cancer survivors with cancer-related fatigue

Cancer-related fatigue (CRF) is a frequent long-term symptom in non-metastasized breast cancer patients (BC). This 4-year follow-up intended to compare the long-term effects of a 10-week multimodal therapy (MT: sleep education, psychoeducation, eurythmy- and painting therapy) and combination therapy [CT: MT plus aerobic training (AT)] to AT-control. BC-patients were randomized or allocated by preference to three arms in a comprehensive cohort study. Primary outcome was a composite score including Pittsburgh Sleep Quality Index (PSQI) and Cancer Fatigue Scale (CFS-D), captured at baseline, after 10 weeks of intervention (T1), 6 months later (T2), and after 4 years (T3). We exploratively tested for superiority of MT and CT versus AT after 4 years (T3) based on the statistical model of the main analysis. Of 126 (65 randomized) BC-patients included, 105 started treatments and 79 were re-assessed for long-term effects (T3). MT and CT were superior over AT after 4 years regarding PSQI/CFS-D and PSQI sum-score, respectively (all p < 0.05), but not for CFS-D. The multimodal and combination treatment for breast cancer patients with CRF indicates sustainable long-term superiority over aerobic training for the outcomes sleep quality and combined sleep quality/fatigue. A confirmative randomized controlled trial is warranted.

Predicting the Quality of Sleep Based on Job Burnout and the Anxiety of Being Infected by the Coronavirus among the Treatment Staff Taking Care of Patients with COVID-19

Background and Objective: Psychological problems including sleeping problems, anxiety, and job burnout are more prevalent among the treatment staff of the patients who suffer from coronavirus disease 2019 (COVID-19) rather than other treatment staff. Therefore, the current study aimed to predict the quality of sleep based on job burnout and the anxiety of being infected by the disease among this staff.&#x0D; Materials and Methods: The current study was a cross-sectional research in which 215 participants from the treatment staff filled out the relevant questionnaires online. The sampling was performed by available method and the instruments included Pittsburgh Sleep Quality Index (PSQI), Corona Disease Anxiety Scale (CDAS), and Maslach Burnout Inventory (MBI). Finally, the data were analyzed in two sections of descriptive and inferential statistics using SPSS software.&#x0D; Results: A correlation among all variables was observed. Moreover, the total model was significant (adjusted r² = 0.37, P = 0.01) and COVID-19 anxiety (standardized beta = 0.33, P = 0.01) and emotional exhaustion (standardized beta = 0.40, P = 0.01) predicted the sleep quality more than variables of depersonalization (standardized beta = -0.22, P = 0.01) and feeling of success (standardized beta = -0.12, P = 0.06).&#x0D; Conclusion: COVID-19 anxiety and job burnout are good predictors for sleep problems in the treatment staff of the patients who suffer from COVID-19.&#x0D;

Perceived sleep quality mediates the relationship between posttraumatic stress and somatic symptoms.

Posttraumatic stress symptoms (PTSS) have been associated with increased somatic symptom expression. Sleep concerns have been associated with PTSS and somatic symptoms. Previous research suggests that sleep affects multiple domains of functioning including comorbid psychological and physical health concerns. The current study examines whether perceived sleep quality or sleep efficiency/duration may be mediating the relationship between PTSS and somatic symptoms in a trauma-exposed sample. The sample consisted of 864 students, recruited from a large Midwestern university and compensated with research participation credit. Data were collected online over approximately 39 months (October 2015 through January 2019), and the pertinent scales examined in this study included Pittsburgh Sleep Quality Index, Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and Screening for Somatoform Symptoms-7. Of the 864 students, 668 participants identified as female (77.3%) and 540 identified as non-Hispanic White (62.5%), with an overall average age of 23.14 years (SD = 6.64). Mediation analyses indicated that the overall model examining global sleep quality complaints as a mechanism of the relationship between PTSS and somatic symptoms was significant, F(3, 860) = 193.97, R² = .40, p < .001, and that perceived sleep quality was found to be the only significant specific mediator (indirect effect = .21). Although females reported greater somatic severity, PTSS, and sleep concerns, models were significant, even after examining the influence of gender. Global sleep complaints are associated with both PTSS and somatic symptoms. Perceived sleep quality specifically mediated the relationship between PTSS and somatic symptoms, highlighting a potential intervention for improving physical health consequences in trauma-exposed individuals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cognitive behavioural group therapy for insomnia (CBGT-I) in patients undergoing haemodialysis: a randomized clinical trial.

Given the many complications of drug therapy, it seems reasonable to use non-pharmacological therapies that can improve mental and physical disorders in haemodialysis patients. This study aims to determine the effectiveness of cognitive behavioural group therapy for insomnia (CBGT-I) in sleep quality, depression, anxiety and general psychological health of haemodialysis patients. This randomized clinical trial was conducted on 116 haemodialysis patients who were randomly assigned to experimental (n=58) and control (n=58) groups. In the experimental group, CBGT-I was provided during nine weekly sessions. Data collection tools included Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II (BDIII), Beck Anxiety Inventory (BAI), General Health Questionnaire (GHQ-28), Clinical Global Improvement Scale (CGI), Client Satisfaction Questionnaire (CSQ) and Working Alliance Inventory-Short Form (WAI-S). Data were analysed by SPSS-25 and p<.05 was considered significant. The findings demonstrated that CBGT-I compared with control group was effective in improving sleep quality (p<.001, η2=.790), depression (p<.001, η2=.616), anxiety (p<.001, η2=.682) and general psychological health (p<.001, η2=.871). Participants of CBGT-I showed notable improvements as a result of the treatment, were satisfied with treatment, and had a good therapeutic relationship. CBGT-I is effective in reducing depression and anxiety in addition to improving sleep quality and general psychological health in haemodialysis patients. Therefore, it is recommended to be used as a complementary treatment for these patients.

Improved Regional Homogeneity in Chronic Insomnia Disorder After Amygdala-Based Real-Time fMRI Neurofeedback Training.

BackgroundChronic insomnia disorder (CID) is a highly prevalent sleep disorder, which influences people's daily life and is even life threatening. However, whether the resting-state regional homogeneity (ReHo) of disrupted brain regions in CID can be reshaped to normal after treatment remains unclear.MethodsA novel intervention real-time functional magnetic resonance imaging neurofeedback (rtfMRI-NF) was used to train 28 CID patients to regulate the activity of the left amygdala for three sessions in 6 weeks. The ReHo methodology was adopted to explore its role on resting-state fMRI data, which were collected before and after training. Moreover, the relationships between changes of clinical variables and ReHo value of altered regions were determined.ResultsResults showed that the bilateral dorsal medial pre-frontal cortex, supplementary motor area (SMA), and left dorsal lateral pre-frontal cortex had decreased ReHo values, whereas the bilateral cerebellum anterior lobe (CAL) had increased ReHo values after training. Some clinical scores markedly decreased, including Pittsburgh Sleep Quality Index, Insomnia Severity Index, Beck Depression Inventory, and Hamilton Anxiety Scale (HAMA). Additionally, the ReHo values of the left CAL were positively correlated with the change in the Hamilton depression scale score, and a remarkable positive correlation was found between the ReHo values of the right SMA and the HAMA score.ConclusionOur study provided an objective evidence that amygdala-based rtfMRI-NF training could reshape abnormal ReHo and improve sleep in patients with CID. The improved ReHo in CID provides insights into the neurobiological mechanism for the effectiveness of this intervention. However, larger double-blinded sham-controlled trials are needed to confirm our results from this initial study.

Sleep quality in men with androgenetic alopecia.

Sleep disturbances affect human health and contribute to several comorbidities. In men, androgenetic alopecia (AGA) is a common, non-scarring form of hair loss that affects a patient's self-esteem. There are limited data regarding the association between poor sleep quality and male AGA. We aimed to compare the prevalence of sleep abnormalities between male patientswith AGA and controls to identify an association between the two conditions. A case-control study on patients with AGA and age-matched controls was conducted. Participants completed a standardized questionnaire that contained self-evaluated sleep measures, including Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and STOP-BANG questionnaire. Patientswith AGA were classified into mild, moderate, and severe subgroups according to the Hamilton-Norwood classification for stratified analyses. Data between groups and among subgroups were compared. Of 446 male participants, 223 (50%) were in the AGA group, and the remainder (50%) were in the control group. Multivariable logistic regression analysis revealed that hypertension (odds ratio [OR] = 1.90, 95% confidence interval [CI] = 1.16-3.11, p = 0.011) and STOP-BANG score ≥ 5 (OR = 2.05, 95%CI = 1.15-3.66, p = 0.015) were associated with AGA. For subgroup analyses, ordinal logistic regression model showed a significant association between severe AGA and three sleep profiles, namely total sleep time ≤ 6h (OR = 2.16, 95%CI = 1.02-4.57, p = 0.044), PSQI > 5 (OR = 3.72, 95%CI = 1.42-9.72, p = 0.008), and STOP-BANG score ≥ 5 (OR = 3.01, 95%CI = 1.11-8.13, p = 0.030). Our findings revealed an association between sleep disturbances and AGA, which may help guide appropriate management in these patients.

Efficacy and safety of Shumian capsules in treating insomnia: A systematic review and meta-analysis.

Background:It is known to all that the incidence of insomnia is becoming higher and higher with the increase of people's life stress. To some extent, it has brought about bad effects on people's life, work, study, and health, such as mental exhaustion, low work efficiency, and mood irritability. Now there are medications and non-medications methods for insomnia. As one of the treatments for insomnia, western medicine is to prolong the sleeping time and improve the anxious mood. However, taking western medicine to treat insomnia can also be accompanied by some adverse reactions at the same time, such as drug dependence, an allergic reaction, and so on. Traditional Chinese medicine therapy is based on syndrome differentiation and holistic concept. Shumian capsules (SM) are a kind of proprietary Chinese medicine for insomnia, which have the effect of relieving depression and calming the mind. But there are no studies on the efficacy and safety of SM in the treatment of insomnia. Therefore, I will provide a systematic review and meta-analysis to evaluate the efficacy and safety of SM for insomnia.Methods:All the studies searched were from PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, and WanFang databases, and the studies types included in the analysis were all randomized controlled trials. All the retrieval contents were completed independently by 2 researchers, and a third reviewer would be involved when there existed any disagreement. The eligible studies were screened out according to the inclusion criteria and exclusion criteria, and some useful information was extracted and made into a feature table, including the year of the included studies, the age, and disease course of the participants in the studies and intervention methods, etc. Cochrane risk-of-bias tool was used to evaluate the quality of literature and meta-analysis was conducted by RevMan 5.4 software.Results:A total of 9 articles including 709 participants were included in the study after screening out. The primary outcomes of statistical analysis were cure rate and total effective rate, while the secondary outcomes included Pittsburgh sleep quality index score and incidence of adverse reactions. The results showed that Pittsburgh sleep quality index score of the SM group and Western medicine group were statistically significant (MD = –0.50, 95% confidence interval [CI] = [–0.78, –0.22], P = .0005). The total effective rate of the SM group was slightly higher than that of the Western medicine group, but there was no statistical significance (relative risk [RR] = 1.03, 95% CI = [0.95,1.13], P = .43).Conclusion:This meta-analysis provides evidence for the efficacy and safety of SM in the treatment of insomnia, and provides a new idea for the clinical treatment of insomnia. But more research is needed to support further evidence.

322 Comparisons of clinical and polysomnographic characteristics between negative and positive sleep state misperception in insomnia

Abstract Introduction Most of insomnia patients tend to underestimate their sleep duration and quality. In current study, we classified insomnia patients into negative sleep state misperception (NSSM) group and positive sleep state misperception (PSSM) group according to difference between subjective and objective sleep duration. We compared clinical and polysomnographic characteristics between two groups. Methods Objective sleep measures using nocturnal polysomnography (nPSG) and subjective measures including Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI) and subjective questionnaire at the morning after overnight nPSG of 150 insomnia patients were reviewed. The questionnaire included subjective total sleep time (subjective TST), subjective sleep latency (subjective SL). Additionally, TST/SL discrepancy was calculated by subtracting objective variables of nPSG from the morning subjective questionnaire. We calculated misperception index (MI) using the following method; MI=(objective TST-subjective TST)/objective TST. According to MI value, insomnia patients were classified into NSSM (MI&amp;gt;0, n=115), and PSSM (MI&amp;lt;0, n=35) groups. Results There were no significant differences in nPSG parameters, except N3 sleep (%); the PSSM group had significantly higher N3 sleep than NSSM group (p=0.002). On the subjective measures, the NSSM group had significantly higher PSQI score (p&amp;lt;0.001), longer subjective SL (p=0.001) and higher SL discrepancy (p=0.001). In the NSSM group, MI showed positive correlations with N1 sleep proportion (r=0.250, p=0.011), PSQI (r=0.250, p=0.011), BDI (r=0.211, p=0.032), subjective SL (r=0.441, p&amp;lt;0.001) and SL discrepancy (r=0.453, p&amp;lt;0.001). Meanwhile, there were no significant correlations of MI with subjective measures in PSSM group. In the multiple regression analysis, MI was related with SL discrepancy and BDI (R2=0.216, p=0.004) in NSSM group. For belonging the PSSM group, associated factors were N3 sleep (OR=1.075, p=0.001), PSQI (OR=0.813, p=0.002) and SL discrepancy (OR=0.956, p&amp;lt;0.001) on binary logistic regression analysis. Conclusion In the NSSM group, MI was related with high SL discrepancy and depressive mood. High N3 sleep, low PSQI score, and low SL discrepancy were associated factors in the PSSM group. Perception of sleep should be properly evaluated and managed, since they vary with different characteristics of sleep state misperception. Support (if any) This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF-2018R1D1A1B07049704).

155 Evening blue light exposure, maternal glucose and infant birth weight

Abstract Introduction During pregnancy, the use of light-emitting electronic devices before bedtime may contribute to or exacerbate sleep problems. Exposure to blue-wavelength light in particular from these devices may affect sleep by inhibiting melatonin release and causing neurophysiologic arousal which may affect the uterus environment. However, the health consequences of blue-wavelength light on maternal glucose level and fetus development is poorly understood. The purpose of this study was to test the hypothesis that nocturnal blue-light exposure is associated with maternal glucose level and infant’s birth weight. Methods A group of pregnant women aged 24-39 years old who wore 7-day actigraphy, and completed questionnaires including Pittsburgh Sleep Quality Index participated in the study. Infant’s birth weight (n=41) and fasting glucose level (n=30) was abstracted from mothers’ medical charts. Blue-wavelength light exposure was obtained from actigraphy recordings. Unadjusted linear regression analyses were performed to determine sleep characteristics that were associated with fasting glucose and infant’s weight (p&amp;lt;0.2). Using infant’s birth weight and fasting glucose as outcome variables, confounding variables were evaluated in full linear regression models as independent variables. Results The mean gestational age was 30.66 (Standard Deviation (SD) 3.46) weeks. The mean fasting glucose, infant’s birth weight and gestational age at delivery were 95.73 mg/dL (SD 24.68), 3261 gr (SD 470) and 38.78 (SD 1.69), respectively. In unadjusted analysis, infant birth weight was significantly associated with only blue light value (μW/cm2) (β=76.98, p=0.002) and remained significant (β=78.26, p=0.003) after adjusting for BMI, maternal age and gestational diabetes. Fasting glucose was associated with blue light value (β=2.81, p=0.055) and became significantly associated (β=78.26, p=0.003) after adjusting for sleep duration, parity and gestational diabetes. The coefficient demonstrates that for each unit increase in the evening blue light exposure, there is a 78 gr increase in infant weight after controlling the effect of maternal age, BMI and gestational diabetes. Conclusion Evening blue light exposure during mid and late pregnancy may alter maternal glucose regulation and placental nutrient transport to fetus, but these remain to be studied. This study may shed light on future research on the effect of evening light exposure on pregnancy outcomes. Support (if any) National Institutes of Health (R00-NR013187)

Sleep quality and its predictors among hospital-based nurses: a cross-sectional study.

Sleep disorders are common among nurses and may have negative effects on their performance and well-being. This study aimed to investigate the level of sleep quality and its possible associated factors among hospital-based nurses in Jordan. A cross-sectional design targeting Jordanian hospital-based nurses. In addition to demographics and work habits, the outcome measures included Pittsburgh Sleep Quality Index (PSQI), Nordic Musculoskeletal Questionnaire (NMQ), and Depression Anxiety Stress Scale (DASS). Data were analyzed descriptively and by a multiple variable linear regression analysis to identify predictors of sleep quality. In total, 597 nurses with a mean age of 32.1 (± 5.7) years participated in this study and 47% were men. PSQI mean score was 7.8 (± 3.7) and 68% of the participants showed sleep quality deficits. Stress (β = 0.15 [95%CI 0.13 to 0.19, P < 0.001), depression (β = 0.05 [95%CI 0.009 to 0.08], P = 0.015), the number of joints with 12 months musculoskeletal pain (β = 0.25 [95%CI 0.15 to 0.36], P < 0.001) positively predicted decreased sleep quality. Manual handling training (β = - 0.48 [95%CI -0.96 to 0.003], P = 0.048) and years of experience (β = - 0.05 [95%CI -0.09 to 0.002], P = 0.039) negatively predicted decreased sleep quality. Nurses reported poor levels of sleep quality, high levels of mental health symptoms, and musculoskeletal pain complaints. Sleep quality among nurses and its predictors should be carefully considered by administrations of healthcare services.

Sleep Habits and Routines of Individuals Diagnosed with Mental and/or Substance-Use Disorders

The purpose of this study was to explore sleep habits and routines in individuals (N = 52) with mental and/or substance-use disorders attending community wellness centers. Outcome measures included Pittsburgh Sleep Quality Index (PSQI), a researcher developed survey to analyze habits and routines and its effect on sleep, and semi-structured interviews. Results showed 78.6% of participants had poor sleep as per PSQI. Facilitators of sleep included turning off lights, listening to music, and taking a bath/shower, while barriers included taking a nap, smoking, and using the phone. The findings can guide assessment and intervention for sleep preparation and participation.

Randomized controlled trial of an integrated approach to treating insomnia and improving the use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea.

Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use. 125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a "sleep coach" (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected. Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (-3.2 and -1.7), SOL-D (-16.2 and -15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p < 0.05). An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA. ClinicalTrials.govStudy name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older VeteransURL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist=Registration: NCT02027558.

Quality of Sleep and Quality of Life during Pregnancy

Background: The prevalence of sleep disorders increases as pregnancy progresses, which affects the health of pregnant women, fetal health, and the outcomes of pregnancy. The aim of this study is to evaluate the quality of sleep and life in pregnant women in Korea.Methods: This study is a prospective cross-sectional, case-control study of pregnant women and age-matched controls. From July to September 2019, all participants completed Korean-language versions of the sleep questionnaires including Pittsburgh sleep quality index (K-PSQI), Insomnia severity index, Epworth sleepiness scale, Back’s depression inventory-2(K-BDI), STOP (Snoring, Tiredness, Observed apneas, and high blood Pressure), and short-form 36 (K-SF-36).Results: A total of 422 participants consisted of 385 pregnant women and 137 controls. Second and third trimester were 200 and 185, respectively. K-PSQI scores were higher in pregnant women compared with the controls (7.87±3.49 and 8.50±3.55 vs. 5.79±2.76, &lt;i&gt;p&lt;/i&gt;&lt;0.001). Total score of K-SF-36 was lowest in third trimester (62.07±17.72) and highest in the control group(79.41±13.36). There was no statistical difference between groups in K-BDI.Conclusions: This study demonstrated worsening of sleep quality as well as life quality during pregnancy. More attention to sleep of pregnant women is needed.