Insomnia Patients Research Articles

Incidence of adverse cardiovascular events in patients with insomnia: A systematic review and meta-analysis of real-world data.

Insomnia is a prevalent sleeping disorder associated with increasing cardiovascular (CV) mortality and morbidity. However, data incorporating recent clinical studies evaluating these outcomes is scarce. Hence, we aimed to investigate the association of insomnia with CV mortality, myocardial infarction (MI), all-cause mortality, and incidence of CV disease by conducting the first-ever meta-analysis of real-world data evaluating these CV outcomes. MEDLINE and Scopus databases were queried till August 2022 to identify studies comparing prespecified outcomes in patients with and without insomnia. The primary outcomes were CV mortality and myocardial infarction, while secondary outcomes included all-cause mortality, and CV-disease incidence. All data were pooled using an inverse-variance weighted random-effects model, and results were reported as relative risks (RRs) and p-values. 21 studies were analyzed. Risks for CV mortality and MI were significantly higher in patients with insomnia (RR 1.53, p<0.01, and RR 1.48, p = 0.03, respectively). The risk for all-cause mortality and CV disease incidence was also significantly higher in insomnia patients (RR 1.14, p = 0.03, and RR 1.31, p<0.01, respectively). Individuals with insomnia experience a higher risk of long-term mortality, MI, and incidence of CV disease.

Intervention effect of electroacupuncture therapy on drug reducing and discontinuation of insomnia patients with long-term excessive use of zolpidem

ObjectiveTo explore therapeutic interventions after drug withdrawal reduction for insomnia patients who used zolpidem excessively for a long time. MethodsA total of 86 patients with simple insomnia were randomly rolled into treatment (Tre) group (electroacupuncture therapy under low-dose zolpidem+relaxation treatment intervention, n=40) and control (Ctrl) group (low-dose zolpidem+relaxation treatment intervention, n=40), all of which received treatment and intervention for four weeks. ResultsAs a result, after the dosage of zolpidem was gradually reduced, the deep sleep time of patients in the two groups was reduced in the first stage. However, with the prolongation of treatment time, the reduction trend of the two groups was gradually alleviated, but no great difference was found between groups (P>0.05). In the second stage of treatment, the deep sleep time of patients in the two groups gradually recovered and increased, and that in Tre group was greater than that in Ctrl group, and the upward trend was significant but differed slightly between groups (P>0.05). After treatment, the insomnia severity index (ISI) scores of the two groups gradually decreased, and that in Tre group was drastically inferior to those of Ctrl group on days 14 and 28 after treatment (both Ps<0.05). ConclusionsIn summary, electroacupuncture therapy can effectively alleviate the effect of zolpidem on sleep quality in patients with insomnia after drug discontinuation and promote the recovery of deep sleep time in patients, thereby alleviating the side effects and drug dependence of patients.

Effectiveness of Kasa Kasa Kudineer in Treating Insomnia Patients – A Pilot Study

Introduction: For stepping towards a healthy living, parameters like good food, sound sleep and right mind, all plays major role to attain health and eternity, which were spelled by Siddhars since ancient times. Additionally, Sleep is the best, fruitful meditation for a quality of life. But, getting quality sleep with sufficient period is a matter of concern in the modern civilized world, irrespective of ages, which leads to serious consequences. When you're constantly losing sleep because of insomnia, your brain doesn't cooperate your body, thereby disturbing to perform important tasks. Hence, Insomnia is a significant health problem because of its high prevalence and management challenges. The aim of the study was to evaluate the effectiveness of Siddha medicine Kasa Kasa Kudineer (KKK), in treating insomnia patients, attending OPD at AAGHIM, Chennai.&#x0D; Study Design: This was a Pilot study with a sample size of 20, with the intervention of Siddha Medicine Kasa Kasa Kudineer, and the outcome was assessed by the Insomnia Severity Index Score.&#x0D; Place of Study: The study was conducted at Arignar Anna Government Hospital of Indian Medicine and Homeopathy, attached with Government Siddha Medical College (AAGHIM attached with GSMC), Chennai- 106.&#x0D; Materials and Methods: The study was conducted at the Arignar Anna Govt. Hospital of Indian Medicine (AAGHIM), attached with Govt. Siddha Medical College, Chennai 106, with a sample size of 20. The study protocol and informed consent were reviewed and approved by IEC (with a waiver from IEC). Patients attending the OPD of AAGHIM with complaints of sleep disturbances were chosen for enrollment based on their insomnia severity index score of more than 15. Siddha Medicine Kasa Kasa Kudineer were adminstrated and the observations were made before and after the treatment using the score.&#x0D; Results: Results were analyzed. Descriptive statistics, Paired t- test were analyzed using SPSS trial version 25, and out of 20 patients, 17 patients shown significant improvement in their sleep pattern and the total score were also moved to no clinically significant category of Insomnia severity index score. All parameters whose p value is less than 0.05 reject the null hypothesis. Results were encouraging, as it shown considerable improvement by the end of the study.&#x0D; Conclusion: This study reveals the significant effectiveness of treating Clinically significant insomnia patients, attending OPD at AAGHIM, Chennai with Kasa Kasa Kudineer (KKK), which may ignite a new Siddha medicine for a better quality of life.

Chronic insomnia: are patients also suffering from PTSD symptoms?

IntroductionInsomnia is highly prevalent in the general population, and is commonly associated with somatic and psychiatric comorbidities. However, its origins remain poorly-understood. Recently, adverse childhood events (ACE), including traumatic experiences, have been found to be significantly associated with both insomnia and Post-Traumatic Stress Disorders (PTSD). Many patients with PTSD suffer from sleep disorders. However, we know much less about traumatic childhood experiences in patients with insomnia and PTSD.MethodsOur exploratory study investigated a cohort of 43 patients (14 males, 29 females) clinically diagnosed with chronic insomnia at a sleep center, and systematically evaluated their condition using the trauma history questionnaire (THQ), and the PTSD checklist (PCL-5).ResultsOur results show that 83.72% of insomnia patients reported at least one traumatic event, while the prevalence of PTSD symptoms was 53.49%. For 11.6% of patients, insomnia began in childhood, while for 27.07% it began in adolescence. PCL-5 scores were associated with higher Insomnia Severity Index (ISI) scores, but not trauma. ISI scores were also higher for women, and positive relationships were observed between ISI scores, PCL-5 scores and the number of self-reported traumatic events among women.ConclusionsThese exploratory results highlight that the relationship between PTSD symptoms and insomnia could be sex-specific. They also highlight the importance of PTSD symptoms screening for patients diagnosed with chronic insomnia.

The psychometric properties of the Turkish version of the Pre-sleep Arousal Scale.

The aim of the present study was to examine the psychometric properties of the Turkish version of the Pre-sleep Arousal Scale (PSAS), which measures pre-sleep arousal, a significant predictor of insomnia symptoms. 651 participants were recruited via social media and the Internet. Confirmatory factor analysis was conducted in the total sample (65.28% females; Mage1 = 28.09 ± 14.00). Convergent, divergent, incremental, and known-groups validity and internal consistency coefficients were assessed in a subsample of 556 participants (62.77% females; Mage2 = 29.25 ± 14.81). A second separate sample of 88 participants (80.68% females; Mage3 = 22.19 ± 4.98) was used to evaluate three-week test-retest reliability. The results of factor analysis confirmed the two-factor structure of the Turkish PSAS with cognitive (PSAS-C) and somatic (PSAS-S), similar to the original scale. The correlations of the PSAS with convergent and divergent measures showed that the Turkish form had good convergent and acceptable divergent validity. PSAS-C and PSAS-S were able to explain an 18% additional variance in insomnia severity beyond depression and anxiety, an 18% additional variance in depression beyond insomnia severity, and a 35% additional variance in anxiety beyond insomnia severity. Moreover, insomnia patients had significantly higher PSAS-C and PSAS-S scores than good sleepers. Finally, the PSAS, PSAS-C, and PSAS-S had satisfactory internal consistency coefficients (α = 0.92, 0.91, and 0.86, respectively) and three-week test-retest correlations (ICC = 0.82, 0.82, and 0.71, respectively). The Turkish form of thePSAS was a valid and reliable measure of pre-sleep arousal and can be utilized in sleep studies. The online version contains supplementary material available at 10.1007/s41105-023-00483-z.

Costs and Resource Utilization of People with Stable Heart Failure and Insomnia: Evidence from a Randomized Trial of Cognitive Behavioral Therapy for Insomnia

ABSTRACT Objectives Nearly half of patients with chronic heart failure (HF) report insomnia symptoms. The purpose of this study was to examine the impact of CBT-I versus HF self-management on healthcare costs and resource utilization among patients with stable chronic HF who participated in a clinical trial of the effects of CBT-I compared to HF self-management education (attention control) over 1 year. Methods We measured resource utilization as self-reported (medical record review) physician office visits, emergency department visits, and inpatient admissions at 3-month intervals for 1 year after enrollment. Costs were estimated by applying price weights to visits and adding self-reported out-of-pocket and indirect costs. Univariate comparisons were made of resource utilization and costs between CBT-I and the HF self-management group. A generalized linear model (GLM) was used to model costs, controlling for covariates. Results The sample included 150 patients [79 CBT-I; 71 self-management (M age = 62 + 13 years)]. The CBT-I group had 4.2 inpatient hospitalizations vs 4.6 for the self-management group (p = .40). There were 13.1 outpatient visits, in the CBT-I compared with 15.4 outpatient visits (p-value range 0.39–0.81) for the self-management group. Total costs were not significantly different in univariate or ($7,813 CBT-I vs. $7,538 self-management), p = .96) or multivariable analyses. Conclusions Among patients with both HF and insomnia, CBT-I and HF self-management were associated with similar resource utilization and total costs. Additional research is needed to estimate the value of CBT-I relative to usual care and other treatments for insomnia in patients with HF.

Efficacy and safety of Tongdutiaoshen acupuncture on insomnia in maintenance hemodialysis patients: A randomized clinical trial protocol

BackgroundPatients undergoing maintenance hemodialysis (MHD) experience insomnia frequently. Poor sleep quality impairs the quality of life and adversely affects long-term outcomes. Currently, the treatment of insomnia in patients undergoing MHD is mainly based on medication, although it has severe side effects and poor compliance in patients. Therefore, developing complementary and alternative therapies with higher efficacies is important. This study explores the clinical efficacy and safety of Tongdutiaoshen acupuncture in treating insomnia in patients with MHD. MethodsThis randomized controlled trial (RCT) will be performed at Beijing Luhe Hospital, affiliated with Capital Medical University in China. We will strictly adhere to the Standards for Reporting Interventions in Clinical Trials of Acupuncture (2010). A total of 110 MHD patients with insomnia will be randomly allocated in a 1:1 ratio to the drug control (DC) or Tongdutiaoshen acupuncture (TA) group. Patients in the control group will be administered estazolam tablets (1 mg/day) for four weeks, followed by a 4-week follow-up period. Based on the background therapy provided for the DC group, the TA group will be administered the interventional cohort three times a week for four weeks in a row, followed by a 4-week follow-up period. The primary endpoints will include the Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAM-A), TCM Insomnia Syndrome Score, and clinical response rate, which will be evaluated on days 0, 14, 28, and 56. Secondary endpoints will include sleep data monitoring and related laboratory indices, which will be evaluated on days 0, 28, and 56, respectively. DiscussionThis study is designed based on a rigorous methodology to evaluate the efficacy and safety of Tongdutiaoshen acupuncture for insomnia in patients undergoing hemodialysis. The findings of this trial will be published in peer-reviewed journals as reliable evidence. Trial registrationChinese Clinical Trial Registry ChiCTR2200061967. Registered on July 07, 2022.

Improvement of neurological recovery in the insomnia rats by Warming Yang Strategy through targeting SIRT4 by inhibiting inflammation and apoptosis.

The incidence rate of insomnia is increasing, but the mechanism of it remains unclear. Warming Yang Strategy (WY) is a kind of Traditional Chinese Medicine, and it is proved to be effective in treating insomnia patients. The insomnia animal was established with chlorophenylalanine (PCPA). Morris water maze and open field test were performed to evaluate the influence of WY on the neurological recovery of insomnia rats. TUNEL staining and flow cytometry were used to measure apoptosis level. WY promoted the neurological recovery in the insomnia rats through Morris water maze and open field test evaluation. The increase of γ-aminobutyric acid, dopamine, 5-hydroxytryptamine, and norepinephrine caused by WY was suppressed by siSIRT4. The decrease of apoptosis and inflammation factors expression induced by WY was promoted by siRNA-SIRT4 (siSIRT4). WY improve neurological recovery in the insomnia rats through SIRT4 by inhibiting inflammation and apoptosis. This research might provide a novel insight for the prevention and treatment of insomnia through targeting SIRT4.

RTMS in mental health disorders.

Transcranial magnetic stimulation (TMS) is an innovative and non-invasive technique used in the diagnosis and treatment of psychiatric and neurological disorders. Repetitive TMS (rTMS) can modulate neuronal activity, neuroplasticity and arousal of the waking and sleeping brain, and, more generally, overall mental health. Numerous studies have examined the predictors of the efficacy of rTMS on clinical outcome variables in various psychiatric disorders. These predictors often encompass the stimulated brain region's location, electroencephalogram (EEG) activity patterns, potential morphological and neurophysiological anomalies, and individual patient's response to treatment. Most commonly, rTMS is used in awake patients with depression, catatonia, and tinnitus. Interestingly, rTMS has also shown promise in inducing slow-wave oscillations in insomnia patients, opening avenues for future research into the potential beneficial effects of these oscillations on reports of non-restorative sleep. Furthermore, neurophysiological measures emerge as potential, disease-specific biomarkers, aiding in predicting treatment response and monitoring post-treatment changes. The study posits the convergence of neurophysiological biomarkers and individually tailored rTMS treatments as a gateway to a new era in psychiatric care. The potential of rTMS to induce slow-wave activity also surfaces as a significant contribution to personalized treatment approaches. Further investigations are called for to validate the imaging and electrophysiological biomarkers associated with rTMS. In conclusion, the potential for rTMS to significantly redefine treatment strategies through personalized approaches could enhance the outcomes in neuropsychiatric disorders.

Automatic Detection of Chronic Insomnia from Polysomnographic and Clinical Variables Using Machine Learning.

Insomnia is defined subjectively by the presence and frequency of specific clinical symptoms and an association with distress. Although sleep study data has shown some weak associations, no objective test can currently be used to predict insomnia. The purpose of this study was to use previously reported and relatively crafted insomnia-related polysomnographic variables in machine learning models to classify groups with and without insomnia. Demographics, diagnosed depression, Epworth Sleepiness Scale (ESS), and features derived from electroencephalography (EEG), arousals, and sleep stages from 3,407 sleep clinic patients (2,617 without insomnia and 790 insomnia patients based on responses to a set of questions) were included in this analysis. The number of features were reduced using pair-wise correlation and recursive feature elimination. Predictive value of three machine learning models (logistic regression, neural network, and support vector machine) was investigated, and the best performance was achieved with logistic regression, yielding a balanced accuracy of 71%. The most important features in predicting insomnia were depression, age, sex, duration of longest arousal, ESS score, and EEG power in theta and sigma bands across all sleep stages. Results indicate potential of machine learning-based screening for insomnia using clinical variables and EEG.

Effectiveness of Cognitive Behavioral Therapy for Insomnia on Sleep Quality in Patients with Insomnia: A Meta-Analysis

Background: The relationship between sleep quality and sleep quantity is very close and has a significant impact on a person's sleep needs. If someone does not get enough sleep, then this will have an impact on the quality of their sleep, and vice versa. Therefore, maintaining a good quality of sleep is very important to maintain a healthy body and improve quality of life. The aim of the study was to analyze the effect of cognitive behavior therapy for insomnia (CBT-I) on sleep quality in insomnia patients. Subjects and Method: This study is a meta-analysis with PICO. Population: insomnia patients. Intervention: given cognitive behavior therapy for insomnia (CBT-I). Comparison: not given cognitive behavior therapy for insomnia (CBT-I). Outcome: sleep quality. The articles used in this study were obtained from five databases, namely PubMed, Embase, Web of Science, ScienceDirect, and Google Scholar. The keywords used to search for articles use the medical subject heading (MeSH) term and the emtree of the keywords "Insomnia" AND "Cognitive Behavior Therapy for Insomnia" AND "Sleep Quality". The articles used were full text in English from 2013 to 2023. Articles were selected using the 2021 PRISMA flowchart and analyzed using the RevMan 5.3 application. Results: A total of 10 randomized controlled trial study articles came from Iran, Canada, Spain, Texas, Korea, Kansas and the United States. The total sample size is 473 research subjects. Based on the analysis, insomnia patients who were given CBT-I therapy showed an average PSQI score of 1.88 units lower than those not given CBT-I (placebo), and the difference was statistically significant (SMD = -1.88; 95% CI = -2.55 to -1.22; p&lt;0.001). Then insomnia patients who were given CBT-I showed an average PSQI score of 0.52 units lower than those given other insomnia therapies, and the difference was statistically significant (SMD= -0.52; 95% CI= -0.77 to -0.28; p &lt;0.001) . Then when viewed as a whole, it shows that insomnia patients who are given CBT-I therapy on average have or show a PSQI score of 0.78 units lower than other therapies and without CBT-I therapy (placebo), and this difference is statistically significant (SMD= -0.78; 95% CI= -1.13 to -0.42; p &lt; 0.001). Conclusion: Cognitive behavior therapy for insomnia (CBT-I) can improve sleep quality in insomnia patients (decrease the PSQI score). Keywords: insomnia, cognitive behavior therapy for insomnia, sleep quality. Correspondence: Cynthia Octaviani. Master's Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Jawa Tengah, Indonesia. Email: Cynthia.octaviani14@gmail.com. Mobile: +6287812315855.

Effect of insomnia and excessive daytime sleepiness on cardiac functions in older adults.

We investigated the potential harmful effect in older adults of insomnia and excessive daytime sleepiness (EDS) on myocardial functions and electrophysiologic changes of the heart in terms of heart rate and QT intervals corrected for heart rate (QTc). The study included 32 insomnia patients and 30 control subjects. An Insomnia Severity Index score of ≥15 indicated insomnia, while a score of <8 was accepted as the control group. The Epworth Sleepiness Scale was used to assess EDS, with a score of ≥11/24 points indicating EDS. Diastolic and systolic functions were evaluated in each patient by transthoracic two-dimensional, conventional and tissue Doppler echocardiography. Heart rate and QTc were calculated for electrophysiologic changes. The mean age was 73.2 ± 7.9 years, with 59.7% being female. Biventricular systolic and diastolic functions were impaired in the insomnia patients. The E' value for diastolic function was lower in the patients with insomnia than the controls (5.99 ± 1.59 vs. 6.88 ± 0.97, P = 0.053). Furthermore, values for the systolic function parameters Lateral-S (7.41 ± 1.92 vs. 9.37 ± 1.83, P < 0.001), Septal-S (6.69 ± 1.40 vs. 8.10 ± 1.30, P = 0.001), and Tricuspid-S (12.25 ± 2.00 vs. 14.37 ± 3.13, P = 0.004) were lower for insomnia patients than for controls. In the case of EDS coexistence, the heart rate and QTc values were higher than the controls (76.47 ± 7.18 vs. 71.03 ± 10.95, P = 0.001, and 413.72 ± 28.24 vs. 394.67 ± 24.47, P = 0.015, respectively). Insomnia is associated with impaired systolic-diastolic functions, independent of EDS. The co-existence of insomnia and EDS may lead to electrophysiological changes in older adults, including increased heart rate and longer QTc.

Mood Disorders are Correlated with Autonomic Nervous Function in Chronic Insomnia Patients with OSA.

To evaluate the correlation between sleep microstructure, autonomic nervous system activity, and neuropsychological characteristics in chronic insomnia (CI) patients with obstructive sleep apnea (OSA). Forty-five CI-OSA patients, forty-six CI patients and twenty-two matched healthy control subjects (HCs) were enrolled. CI-OSA patients were then divided into two groups: mild OSA and moderate-to-severe OSA. All participants completed neuropsychological tests, which included the Hamilton Depression and Anxiety Scales (HAMD and HAMA), the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Mini-mental State Examination (MMSE). The autonomic nervous system activity and sleep microstructure were examined by the PSM-100A. The CI-OSA patients exhibited higher scores on the PSQI, ESS, ISI, HAMA, and HAMD than HCs and CI patients (all p < 0.01). The CI-OSA patients had a lower proportion of stable sleep, REM sleep and a higher proportion of unstable sleep ratio (all p < 0.01) than HCs and CI patients (all p < 0.01). The CI-OSA patients had higher ratios of LF and LF/HF, and lower ratios of HF and Pnn50% (all p < 0.01) than HCs and CI patients (all p < 0.01). Compared to CI-mild OSA patients, the CI-moderate-to-severe OSA patients presented with a higher ESS scores, higher ratios of LF and LF/HF, and lower ratios of HF (all p < 0.05). In CI-OSA patients, higher HAMD scores were correlated with decreased MMSE scores (r=-0.678, p < 0.01). A higher LF ratio was correlated with higher HAMD and HAMA scores (r=0.321, p=0.031, r =0.449, p =0.002), and a higher HF ratio was correlated with lower HAMD and HAMA scores (r=-0.321, P =0.031, r =-0.449, p =0.002). OSA exacerbates the abnormalities of sleep microstructure and the autonomic nervous dysfunction in CI patients. Dysfunction of the autonomic nervous system could contribute to mood deterioration in CI with OSA patients.

The REM microarousal and REM duration as the potential indicator in paradoxical insomnia

ObjectiveAlthough paradoxical insomnia is a prevalent subtype of chronic insomnia, the etiology of it is unclear. Contrary to complaints of little or no sleep, polysomnography (PSG) findings show that paradoxical insomnia patients have near normal sleep macrostructure. The purpose of this study is to determine the changes of microstructure and explore the etiology of paradoxical insomnia. MethodsThe PSG findings of 89 paradoxical insomnia patients were compared with those of 41 gender balanced healthy controls without sleep complaints. All subjects underwent nocturnal PSG recordings. Conventional PSG measures and microarousals were quantified and statistically analyzed. Receiver operating characteristic curve and correlation analysis were used to evaluate the potential of REM sleep microarousals and REM duration as indicators of paradoxical insomnia. ResultsCompared with the controls, paradoxical insomnia patients had no significant differences in sleep macrostructures. Statistical analysis showed that non-rapid eye movement (NREM) microarousals revealed no significant differences between paradoxical insomnia patients and controls. Noticeably, more spontaneous microarousals appeared in rapid eye movement (REM) stage for paradoxical insomnia patients. Based on receiver operating characteristic curve (ROC), the optimal cutoff value of REM sleep microarousals could predict paradoxical insomnia. Furthermore, a positive correlation between microarousals in REM sleep and the duration of REM sleep was presented in paradoxical insomnia patients. ConclusionsThe frequency of REM microarousals and the duration of REM sleep could reflect the real sleep state of paradoxical insomnia patients. That suggested PSG investigation extended to microarousal could be helpful to understand the etiology in paradoxical insomnia.

The Effect of a Supportive Educational Intervention Through Virtual Social Networks on Sleep Quality and Insomnia of Patients with Cancer.

Sleep disturbances are very common among cancer patients, and they need more support in this regard. More access to technology has provided opportunities to use virtual teaching methods to educate and support cancer patients. This study aimed to investigate the effect of supportive educational intervention (SEI) through virtual social networks (VSNs) on the sleep quality and the severity of insomnia of cancer patients. The study was conducted on 66 patients with cancer: intervention (n = 33) and control (n = 33) groups (CONSORT). Intervention group received supportive educational intervention on sleep for 2months through virtual social networks (VSNs). All participants completed the Pittsburgh Sleep Quality Index and insomnia severity index (ISI) before and after the intervention. The mean scores of sleep quality (p = .001) and insomnia severity (p = .001) in the intervention group had a statistically significant decrease. Moreover, quality, latency, duration, efficiency, disturbances of sleep, and daytime dysfunction showed significant improvement in the intervention group, every two times after the intervention (p < .05). However, the participants' sleep quality deteriorated progressively in the control group (p = .001). Supportive educational intervention (SEI) through VSNs can be an effective method to improve sleep quality and decrease insomnia severity of patients with cancer.Trial registration number: RCT20220528055007N1Date of registration: 2022-08-31(retrospectively registered).

Relationship between lenght of undergoing hemodialysis therapy with insomnia in chronic renal failure patients

Complications that are often experienced by patients with chronic kidney failure undergoing hemodialysis are sleep disturbances. Sleep disturbances are experienced by at least 50-80% of patients undergoing hemodialysis &gt; 12 months. The purpose of this study was to determine the relationship between duration of hemodialysis therapy and insomnia in patients with chronic kidney failure at Arifin Achmad Hospital, Riau Province. The research method is a cross sectional approach. The population of this study were all 58 patients undergoing hemodialysis at Arifin Achmad Hospital. The sampling method was purposive sampling. The measuring instrument used in this research is the Insomia Severity Index (ISI) questionnaire. Statistical test using Chi Square test. Results Most of the levels of mild insomnia were 26 respondents (44.8%), moderate insomnia was 21 respondents (36.2%), not clinically significant as many as 8 respondents (13.8%), and severe insomnia was 3 respondents (5.2%). The results of statistical tests obtained p value of 0.487 &gt; (0.05). It can be concluded that there is no relationship between undergoing hemodialysis therapy with insomnia in patients with chronic kidney failure at Arifin Achmad Hospital, Riau Province. Suggestions for further research that can be expected to examine the factors associated with insomnia in patients with chronic kidney failure.

Facial Emotion Recognition in Insomnia: Mechanisms and Consequences

Insomnia is a sleep disorder that is closely related with various physiological and psychological problems. Facial emotion recognition (FER) is an important part of social function, and has been found impaired in individuals with insomnia. This paper aims to explore the mechanisms of the correlation between insomnia and FER impairment, and the possible consequences of impaired FER for people with insomnia. Impaired expression expressivity and amygdala dysfunction are proposed as potential mechanisms underlying the link between insomnia and impaired FER. FER impairment in insomnia patients might lead to overlooking danger and lower levels of vigilance and arousal, which could result in disastrous outcomes. Moreover, impaired FER could lead to social function disturbance, making insomnia patients vulnerable to bullying.

Transcutaneous Vagus Nerve Stimulation for Insomnia in People Living in Places or Cities with High Altitudes: A Randomized Controlled Trial.

The purpose of this study was to investigate the effectiveness and safety of transcutaneous vagus nerve stimulation (tVNS) to improve insomnia in the special environment of a plateau. This study was a single-center, single-blind, randomized controlled trial. A total of 100 patients with insomnia at high altitude were randomized into three groups receiving either transcutaneous vagus nerve stimulation intervention in the left ear tragus (treatment group), pseudo-stimulation intervention (sham group), or cognitive behavioral therapy for insomnia (CBTI group). The primary measure was the Pittsburgh Sleep Quality Index (PSQI) score. In addition, we assessed the patients' objective sleep status with polysomnography and evaluated changes in the Insomnia Severity Index Scale (ISI) and Generalized Anxiety Disorder-7 (GAD-7) scores. We used one-way ANOVA and repeated-measures ANOVA for analysis. Patients' PSQI, ISI, and GAD-7 scale scores significantly decreased after 4 weeks of tVNS treatment and were greater than those of the control group. Polysomnographic data also demonstrated shortened sleep latency and longer deep sleep in the patients. tVNS is effective in improving sleep quality and reducing anxiety levels in high-altitude insomnia patients but should be confirmed in future adequate and prolonged trials to guide clinical promotion.

Night-Time Apomorphine Infusion: Who Are the Best Candidates?

We recently demonstrated in a randomized controlled trial (APOMORPHEE, NCT02940912) that night-time only subcutaneous apomorphine infusion improves sleep disturbances and insomnia in patients with advanced Parkinson's disease and moderate to severe insomnia. To identify the best candidates for receiving night-time only subcutaneous apomorphine infusion in routine care. In this post-hoc analysis of APOMORPHEE, we compared the characteristics of patients according to whether they chose to continue night-time only subcutaneous apomorphine infusion at the end of the study period or not. Half of the patients (22/42) chose to continue the treatment. Off duration (day or night), painful Off dystonia, and insomnia severity at baseline were associated with night-time only apomorphine continuation. Multivariate analysis retained only Off duration as an independent predictor of continuation. The best candidates for night-time only apomorphine are patients with severe and prolonged Off periods (day or night) and severe insomnia.

Perinatal Understanding of Mindful Awareness for Sleep (PUMAS): A single-arm proof-of-concept clinical trial of a mindfulness-based intervention for DSM-5 insomnia disorder during pregnancy

ObjectivesCognitive-behavioral therapy is effective for prenatal insomnia, but unresolved cognitive arousal limits patient outcomes. Therapies aimed at reducing cognitive arousal may benefit pregnant women with insomnia. This proof-of-concept trial evaluated Perinatal Understanding of Mindful Awareness for Sleep (PUMAS, which combines mindfulness with behavioral sleep strategies) on insomnia, depression, and cognitive arousal. MethodsA single-arm trial of 12 pregnant women with DSM-5 insomnia disorder (n = 5/12 with comorbid depression) who received six sessions of PUMAS delivered individually via telemedicine. Pretreatment and posttreatment outcomes included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), pre-sleep arousal scale's cognitive factor (PSASC; nocturnal cognitive arousal), perinatal-focused rumination (appended to PSASC), and Glasgow sleep effort scale. ResultsEleven of 12 patients completed all sessions. Intent-to-treat analyses revealed a 10.83-point reduction in ISI (Cohen's dz = 3.05), resulting in 83.3% insomnia remission. PUMAS produced large reductions in EPDS (Cohen's dz = 2.76 in depressed group), resulting in all five baseline depressed patients remitting from depression. PUMAS produced large reductions in nocturnal cognitive arousal, perinatal-focused rumination, and sleep effort (all Cohen's dzs>2.00). Patients were highly satisfied with PUMAS and identified the telemedicine format and meditation app as positive features of its delivery. Patients rated sleep restriction and guided meditations as the most helpful treatment components. ConclusionPrenatal insomnia patients were highly engaged in PUMAS, which produced large acute reductions in insomnia, depression, and cognitive arousal. These findings support the concept and feasibility of PUMAS for pregnant women with insomnia who present with or without comorbid depression. Clinicaltrials.gov idNCT04443959.