Medical Outcomes Study Sleep Scale Research Articles

Sleep and discrimination among undergraduate students: A descriptive study

ABSTRACT Although racial and ethnic health disparities are recognized social and health issues, few studies have explored associations between sleep problems and everyday discrimination. Additionally, to date, there is little, if any, social work literature on associations of sleep and discrimination. Thus, this study explored sleep and discrimination among behavioral and health sciences students at a southeastern, public university. Students (N = 519) completed the Medical Outcomes Study (MOS) Sleep Scale and Everyday Discrimination Scale. A bivariate correlation analysis revealed a moderate relationship between experiences of discrimination and sleep as reported in the MOS-Sleep Problems Index II (r = .27, p < .001). Further, social work majors (n = 126) had a statistically significant difference in mean scores for sleep outcomes (M = 50.06, SD = 1.62) compared to other College of Behavioral and Health Sciences (CBHS) majors. More than 25% of Social Work majors reported MOS Sleep Problems Index II scores >60 and in general had more sleep issues than other CBHS majors. This result indicated that social worker majors had more reported sleep problems. The present study highlighted a need to address sleep as an integral part of professional self-care. Adequate sleep can contribute to health, academic performance, and effective social work practice.

Omalizumab improves sleep and health status for patients with chronic rhinosinusitis with nasal polyps: An analysis of randomized clinical trials.

Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have high incidence of sleep impairment. We evaluated the impact of omalizumab treatment on sleep characteristics and associated health status in patients with CRSwNP. Prespecified exploratory analysis assessed outcomes from patients included in the POLYP 1 and POLYP 2 phase 3 clinical trials and the open-label extension. Sleep was assessed by the sleep domain of the Sino-Nasal Outcome Test-22 (SNOT-22; MCID>4 in patients with CRS) and the Medical Outcomes Study Sleep Scale (MOS-Sleep). Health status was assessed by Healthy Days Core Module (HDCM) and sinonasal-specific Patient Global Impression of Change (PGIC). Omalizumab improved sleep as assessed by the SNOT-22 sleep domain. At week 24, adjusted mean (95%CI) SNOT-22 sleep scores had reduced from baseline by -8.5 (-9.9 to -7.1) with omalizumab versus -2.7 (-4.1 to -1.3) with placebo. At week 52 (all patents on OMA), adjusted mean (95%CI) SNOT-22 sleep scores had reduced from baseline by -10.1 (-11.4 to -8.7) with omalizumab. Improvements were observed in all eight items of the SNOT-22 sleep domain: difficulty falling asleep, fatigue, frustration/restlessness/irritability, lack good night's sleep, reduced concentration, reduced productivity, wake up tired, and wake up at night. In addition, omalizumab improved six of eight sleep outcomes on the MOS-Sleep scale. There were concurrent improvements in HDCM and PGIC. Omalizumab improved sleep and self-reported health status in patients with CRSwNP. This contributes to evidence that omalizumab provides value for patients beyond the reduction of sinonasal symptoms.

Confirmatory study of the usefulness of quantum molecular resonance and microdissectomy for the treatment of lumbar radiculopathy in a prospective cohort at 6 months follow-up.

Low back pain is a common musculoskeletal complaint and while prognosis is usually favorable, some patients experience persistent pain despite conservative treatment and invasive treatment to target the root cause of the pain may be necessary. The aim of this study is to evaluate patient outcomes after treatment of lumbar radiculopathy (LR) with quantum molecular resonance radiofrequency coblation disc decompression and percutaneous microdiscectomy with grasper forceps (QMRG). This prospective cohort study was carried out in two Spanish hospitals on 58 patients with LR secondary to a contained hydrated lumbar disc hernia or lumbar disc protrusion of more than 6 months of evolution, which persisted despite conservative treatment with analgesia, rehabilitation, and physiotherapy, and/or epidural block, in the previous 2 years. Patients were treated with QMRG and the outcomes were measured mainly using the Douleur Neuropathique en 4 Questions, Numeric Rating Scale, Oswestry Disability Index, SF12: Short Form 12 Health Survey, Patient Global Impression of Improvement, Clinical Global Impression of Improvement, and Medical Outcomes Study Sleep Scale. Patients who received QMRG showed significant improvement in their baseline scores at 6 months post-treatment. The minimal clinically important difference (MCID) threshold was met by 26-98% of patients, depending on the outcome measure, for non-sleep-related outcomes, and between 17 and 62% for sleep-related outcome measures. Of the 14 outcome measures studied, at least 50% of the patients met the MCID threshold in 8 of them. Treatment of LR with QMRG appears to be effective at 6 months post-intervention.

Sleep quality, sleep duration, and sleep disturbances among hospital night workers: a prospective cohort study.

This study aimed to assess among hospital night workers (i) to what extent sleep quality, sleep duration and sleep disturbances overlap, and (ii) associations between sociodemographic factors, lifestyle factors and work characteristics and sleep components. Data were used from 467 hospital night workers participating in the Klokwerk + study, a prospective cohort study with two measurements. Sleep quality was measured by the Pittsburgh Sleep Quality Index, sleep duration and sleep disturbances were measured by the Medical Outcomes Study Sleep Scale. The overlap between the three sleep measures was visualized with a Venn diagram and the proportions of overlap was calculated. Associations between independent variables (sociodemographic factors, lifestyle factors and work characteristics) and the three sleep outcomes were estimated using between-within Poisson regression models. About 50% of the hospital night workers had at least one poor sleep outcome. Overlap in poor sleep outcomes was apparent for 36.8% of these workers, while the majority had a poor outcome in one of the sleep components only (63.1%). Former smoking had a significant association with poor sleep quality. For most independent variables no associations with poor sleep outcomes were observed. Our findings suggest that sleep quality, sleep duration and sleep disturbances are separate entities and should be studied separately. Lifestyle factors and work characteristics were generally not associated with poor sleep. Since these factors can have an acute effect on sleep, future research should consider ecological momentary assessment to examine how exposure and outcomes (co)vary within-persons, over time, and across contexts. Trial registration Netherlands Trial Register trial number NL56022.041.16.

Sleep quality, sleep quantity, and sleep disturbances among hospital night workers

Abstract Background Night work impacts sleep and is unavoidable in healthcare. Different sleep components have been studied, such as quality, duration and disturbances, which need to be considered different fundamental components of sleep. In the general population sociodemographic, lifestyle and work factors are associated with these sleep components, but less is known among night workers. Therefore, this study assessed among hospital night workers i) to what extent sleep quality, sleep duration and sleep disturbances overlap, and ii) associations between sociodemographic, lifestyle and work factors and these sleep components. Methods Data were used from 467 hospital night workers from the Klokwerk+ study, a prospective cohort study with two measurements. Sleep quality was measured by the Pittsburgh Sleep Quality Index, sleep duration and disturbances were measured by the Medical Outcomes Study Sleep Scale. The proportions of overlap between the three sleep measures were calculated and visualized with a Venn diagram. Associations of sociodemographic, lifestyle, and work factors with the three sleep outcomes were estimated using between-within Poisson regression models. Results About 50% of the hospital night workers had at least one poor sleep outcome. Overlap in poor sleep outcomes was apparent for 36.8% of these workers, while the majority had a poor outcome in only one sleep component (63.1%). Former smoking had a significant association with poor sleep quality. For most independent variables no associations with poor sleep outcomes were observed. Conclusions Our findings suggest that sleep quality, duration and disturbances are separate entities and should be studied separately. Lifestyle and work factors were generally not associated with poor sleep. Since these factors can have acute effects on sleep, future research should consider ecological momentary assessment to examine how exposure and outcomes (co)vary within-persons, over time, and across contexts. Key messages • Sleep quality, sleep duration and sleep disturbances are separate entities of sleep and should be studied as such. • Lifestyle factors and work characteristics were generally not associated with poor sleep among hospital night workers.

Self-reported and urinary biomarker-based measures of exposure to glyphosate and mancozeb and sleep problems among smallholder farmers in Uganda

ObjectiveWe aim to showcase the impact of applying eight different self-reported and urinary biomarker-based exposure measures for glyphosate and mancozeb on the association with sleep problems in a study among 253 smallholder farmers in Uganda. MethodsThe questionnaire-based exposure measures included: (1) the number of application days of any pesticide in the last 7 days (never, 1–2; >2 days) and six glyphosate and mancozeb-specific measures: (2) application status over the last 12 months (yes/no), (3) recent application status (never, last 7 days and last 12 months), (4) the number of application days last 12 months, (5) average exposure-intensity scores (EIS) and (6) EIS-weighted number of application days in last 12 months. Based on 384 repeated urinary biomarker concentrations of ethylene thiourea (ETU) and glyphosate from 84 farmers, we also estimated (7) average biomarker concentrations for all 253 farmers. Also in the 84 farmers the measured pre-work and post-work biomarker concentrations were used (8). Multivariable logistic regression models were used to assess the association between the exposure measures and selected Medical Outcomes Study Sleep Scale (MOS-SS) indices (6-item, sleep inadequacy and snoring). ResultsWe observed positive associations between (1) any pesticide application in the last 7 days with all three MOS-SS indices. Glyphosate application in the last 7 days (3) and mancozeb application in the last 12 months (3) were associated with the 6-item sleep problem index. The estimated average urinary glyphosate concentrations showed an exposure–response association with the 6-item sleep problem index and sleep inadequacy in the same direction as based on self-reported glyphosate application in the last 7 days. In the analysis with the subset of 84 farmers, both measured and modelled post-work urinary glyphosate concentration showed an association with snoring. ConclusionsSelf-reported, estimated average biomarker concentrations and measured urinary biomarker exposure measures of glyphosate and mancozeb showed similar exposure–response associations with sleep outcomes.

Poor sleep hygiene practices are associated with a higher increase in sleep problems during the COVID-19 pandemic: A latent change score model.

The Coronavirus 2019 (COVID-19) pandemic significantly influenced physical and mental health worldwide. The present study aimed to investigate changes in sleep problems across three waves of the COVID-19 pandemic, and to identify potential predictors of the inter-individual variability around these changes, with a particular focus on the role of detrimental sleep hygiene practices. A total of 352 participants completed an online survey of self-report questionnaires at three different waves of the COVID-19 pandemic: T1 (Spring 2020); T2 (Autumn-Winter 2020); and T3 (Spring 2021). The questionnaires collected information on socio-demographic and COVID-19-related variables, psychological distress (i.e. the Depression Anxiety Stress Scale-21), sleep hygiene (i.e. the Sleep Hygiene Index) and sleep problems (i.e. the Medical Outcomes Study-Sleep Scale). Latent change score modelling revealed an average increase in sleep problems between T1 and T2 with significant inter-individual variability. No substantial changes were observed on average between T2 and T3. Notably, poorer sleep hygiene practices were associated with a more pronounced increase in sleep problems between T1 and T2 (β = 0.191, p = 0.013), even after controlling for relevant confounders such as demographic factors, COVID-19-related information and psychological distress. These findings expand on previous research regarding the detrimental effects of the pandemic on mental health, suggesting that interventions targeting sleep hygiene practices may be beneficial for mitigating its negative impact on sleep disruptions.

Associating night-shift work with lifetime use of sleep medication and sleep quality in a cohort of female nurses.

Night-shift workers often sleep at moments, not in sync with their circadian rhythm. Though the acute effects of night-shift work on sleep quality directly after a night shift are well described, less is known about the chronic effects of night-shift work on sleep. We associated ever-working night shifts and recently working night shifts (<4 wk) with lifetime use of sleep medication and melatonin, self-reported average sleep duration and sleep quality over the 4 wk preceding inclusion (measured using the Medical Outcomes Study Sleep scale). We explored trends in sleep outcomes with average frequency of night shifts per week, tenure of night-shift works in years, and time since last performed night work. This research was conducted within the Nightingale study which is a Dutch cohort study of 59,947 female registered nurses aged 18 to 65. Working night shifts was not associated with self-reported nonoptimal sleep length and sleep quality. However, we observed higher odds of lifetime use of sleep medication for nurses who ever-worked night shifts (OR 1.24; 95% CI 1.13, 1.35) and who recently worked night shifts (OR 1.13; 95% CI 1.05, 1.22); with night-shift work frequency and tenure being associated with lifetime use of sleep medication (P-value for trend < 0.001 for both). Odds for melatonin use were elevated for nurses who ever worked night shifts (OR 1.55; 95% CI 1.40, 1.71) and recently worked night shifts (OR 1.72; 95% CI 1.59, 1,86). The findings of this study have practical implications for healthcare organizations that employ nurses working night shifts. The observed associations between night-shift work and increased lifetime use of prescribed sleep medication and melatonin highlight the need for targeted support and interventions to address the potential long-term sleep problems faced by these nurses.

Poster (Knowledge Generation) ID 1969163

Background This ongoing study aims to examine the potential cognitive and psycho-social benefits of continuous positive airway pressure (CPAP) therapy in people with chronic spinal cord injury (SCI) and moderate-to-severe sleep apnea (SA). Methods This study included adults with chronic SCI who underwent a 4-month trial of CPAP therapy for management of recently diagnosed moderate-to-severe SA. Outcome measures included the Epworth Sleepiness Scale (ESS), Medical Outcomes Study Sleep Scale (MOS-SS), Fatigue Severity Scale (FSS), Depression, Anxiety &amp; Stress Scale-21 (DASS-21), Montreal Cognitive Assessment (MoCA), SF-36, and Craig Handicap Assessment &amp; Reporting Technique (CHART). The participants were also asked about their lived experience before and after CPAP trial (qualitative analysis). Results By February 2023, we screened 33 individuals (10 females, 23 males; age range: 37-79 years; mean age: 58.3 years) with motor complete (n=15) or incomplete SCI at cervical (n=22) or thoracic levels. Time since SCI varied from 4 to 793 months. The apnea-hypopnea index (AHI) varied from 2.6 to 83.7 events/hour. Of the 33 individuals, 25 participants with moderate-to-severe SA initiated CPAP therapy; 19 individuals have completed the CPAP trial. Daytime sleepiness and sleep quality, fatigue and quality of life significantly improved with CPAP therapy. There was a trend for improvement of cognitive, mental health and participation scores, but they have not reached significance yet (p=0.079, p=0.207, p=0.221, respectively). Conclusions Our preliminary results suggest that 4 months of CPAP therapy significantly improves sleep quality, and quality of life, and mitigates daytime sleepiness, fatigue, and anxiety in people with chronic SCI.

Poster (Health Services, Economics and Policy Change) ID 1969166

Background We studied the feasibility of a home-based screening sleep test (HBSST), the validity of four questionnaires used to screen for sleep-related breathing disorders (SRBDs), and the potential association between SRBD and clinical features in individuals with spinal cord injury (SCI). Methods Adults with subacute/chronic (&amp;gt;1 month post-injury) SCI were recruited for the cross-sectional study and qualitative analysis. Feasibility of the HBSST was objectively evaluated and participants shared their experience. We also examined the validity of the Berlin, STOP, Medical Outcomes Study Sleep Scale [MOS-SS], and STOP-Bang screening questionnaires. We investigated the association between the degree of SRBD and three features (i.e., neck circumference, body mass index [BMI] and oropharynx opening as assessed using the Modified Mallampati classification [MMC]). Results There were 13 females and 18 males with ages varying from 20 to 86 years (mean age: 54.7 years) with motor complete (n=8) or incomplete SCI at cervical (n=21) or thoraco-lumbar levels. Time since SCI varied from 1.5 to 474 months. Overall, 28 individuals completed the HBSST and endorsed its feasibility. Mean apnea-hypopnea index (AHI) was 17.3 events/hour (range: 0.5-83.7). AHI was significantly correlated with Berlin (p=0.036) and STOP-Bang scores (p=0.009). There was no significant correlation between AHI and MOS-SS (p=0.348) or STOP (p=0.165). AHI was not associated with neck circumference (p=0.614), BMI (p=0.958), or MMC (p=0.335). Conclusions Our results suggest that HBSST is a feasible screening method, and Berlin and STOP-Bang are valid screening questionnaires for the SCI population. AHI was not correlated with BMI, neck circumference, or MMC.

The association of self-reported symptoms of central sensitization and sleep disturbances in neuropathic pain.

Patients with neuropathic pain (NP) report a higher impairment of quality of life and sleep than patients with chronic pain without neuropathic characteristics. These include somatosensory peculiarities like allodynia, a surrogate marker for central sensitization. This study aimed to investigate the relation between symptoms of central sensitization and sleep disturbances in patients with NP. Within this cross-sectional study, data sets of 3339 patients with chronic NP syndromes (painful diabetic polyneuropathy, n = 543; postherpetic neuralgia, n = 1480) or complex regional pain syndromes (CRPS, n = 1316) were analyzed. Neuropathic pain symptoms were assessed with the painDETECT questionnaire (PD-Q), depression with the Patient Health Questionnaire-9, and sleep impairment with items of the Medical Outcomes Study Sleep Scale in 4 subscales. The association of demographic/clinical data, somatosensory phenotype, depression, and pain intensity with sleep impairment was assessed by unadjusted Spearman correlation analyses and multivariable regression analyses. Sleep impairment was observed in all pain aetiologies although with some significant differences in the single sleep items. The intensity of the individual PD-Q items differed to some extent between the 3 pain entities, whereas the PD-Q sum score was similar. Thermal hyperalgesia and burning assessed by the PD-Q were significantly associated with sleep disturbance, adequacy, and quantity but not with sleep somnolence. Only depression and self-reported allodynia had a significant relation to all 4 sleep elements. Beside depression, allodynia as a surrogate marker hints to a possible impact of central sensitization on the sleep disruption of patients with NP.

Self‐report sleep duration associates with plasma Aβ42/40 rate of change in late middle‐aged, African American Adults

AbstractBackgroundSleep abnormalities may play a prominent role in the pathogenesis or exacerbation of Alzheimer’s disease (AD). Sleep is considered a modifiable target for prevention and treatment. Racial sleep health disparities exist, and may contribute to the disproportionately increased risk for developing AD associated with being African American. Yet, the relationships between sleep health and AD pathophysiology in African American individuals are under‐studied. This investigation was designed to address research gaps by evaluating the associations of self‐report sleep duration, sleep disturbances, and daytime sleepiness with change in plasma‐derived amyloid β 42/40 ratio (Aβ42/40) in an African American sample.MethodArchival data from African American participants enrolled in the Wisconsin Registry for Alzheimer’s Prevention study and the Wisconsin Alzheimer’s Disease Research Center were utilized. Data included the Medical Outcomes Study Sleep Scale (MOS‐Sleep), Epworth Sleepiness Scale (ESS), and demographic information. Sleep duration was determined by MOS‐Sleep #2, sleep disturbances were captured by a related MOS‐Sleep subscale (SLPD4), and ESS assessed daytime sleepiness. Participants provided plasma samples across multiple timepoints. PrecivityADTM assays quantified Aβ42/40. Aβ42/40 rate of change (Aβ42/40_ROC) was computed for follow‐up collections to serve as the primary outcome measure. Aβ42/40_ROC was computed as the difference in Aβ42/40 between follow‐up and first collection divided by years between collections. Linear mixed‐effects models determined associations with Aβ42/40_ROC. Observations were nested within participant. Fully adjusted models included age at collection, gender, BMI, education, parental history of dementia, and APOEe4 carrier status.ResultData included 339 follow‐up collections from 143 participants. Women provided 70.8% of collections, with average age at collection = 66.6 ± 8.84 years, Aβ42/40_ROC = ‐0.0005 ± 0.003, and sleep duration = 6.35 ± 1.00 hours. Sleep duration significantly associated with Aβ42/40_ROC in the fully adjusted model (β = ‐0.0005; SE = 0.0002; p = 0.02) (Figure 1). Associations between SLPD4 and ESS with Aβ42/40_ROC were nonsignificant.ConclusionLonger self‐report sleep duration associated with a steeper reduction rate for plasma Aβ42/40, a biomarker for amyloid pathology. Further research is necessary to clarify the relationships between sleep health components and changes in AD‐related biomarkers within African American adults to identify focal risk factors and interventional strategies.

0710 Effects of tonic motor activation (TOMAC) therapy on sleep quality for refractory restless legs syndrome

Abstract Introduction Tonic motor activation (TOMAC) is a noninvasive medical device therapy that has been shown to reduce symptoms of refractory restless legs syndrome (RLS). Here, we evaluated the effects of TOMAC on subjective sleep quality. Methods One hundred and thirty-three adults with primary moderate-severe refractory RLS were 1:1 randomized to TOMAC or sham control for 4 weeks. Participants were instructed to self-administer a 30-minute TOMAC session bilaterally over the head of the fibula to electrically stimulate the peroneal nerve whenever RLS symptoms presented. Sleep quality was assessed through prespecified analysis of changes to Medical Outcomes Study Sleep Scale (MOS-Sleep) Sleep Problems Index I (MOS-I) and II (MOS-II) scores from baseline to Week 4. Post hoc t-tests were conducted on each MOS-Sleep item included in the MOS-I or MOS-II. Results MOS-I score changed by -11.8 points (48.5 to 36.7) for TOMAC and -2.8 points for sham (44.5 to 41.7), a difference of -9.0 points (p&amp;lt; 0.001). MOS-II score changed by -13.7 points (52.5 to 38.9) for TOMAC and -4.0 points for sham (48.3 to 44.3), a difference of -9.7 points (p&amp;lt; 0.001), which exceeds the proposed minimal clinically important difference (MCID) of 6 points. Post hoc analysis demonstrated statistically significant reductions in trouble falling asleep (item #7; -34.0% for TOMAC vs. -5.8% for sham; p&amp;lt; 0.01) and trouble staying awake during the day (item #9; -33.6% for TOMAC vs. -2.1% for sham; p&amp;lt; 0.05), which exceeded the standard MCID threshold of 30% relative to baseline. Conclusion For adults with refractory RLS, TOMAC improved subjective sleep quality, sleep latency, and daytime somnolence relative to sham control. Each of these improvements represented clinically important improvements. These data demonstrate that TOMAC can provide meaningful improvements to sleep quality and daytime functioning for patients with refractory RLS. Support (if any) Funding was provided by Noctrix Health, Inc.

CPAP Therapy for 4 Months Improves Sleep Quality, Daytime Alertness, Fatigue, and Mental Health in People with Chronic Spinal Cord Injury and Moderate-to-Severe Sleep-Related Breathing Disorder: The Preliminary Results of an Ongoing Prospective Study. (S38.002)

<h3>Objective:</h3> To examine the cognitive and psychological effects of continuous positive airway pressure (CPAP) therapy in people with chronic spinal cord injury (SCI) and moderate-to-severe sleep-related breathing disorder (SRBD). <h3>Background:</h3> SRBDs are common but under-recognized after SCI. <h3>Design/Methods:</h3> An ongoing single-arm clinical trial (NCT04007380) aims to evaluate the effects of 4 months of CPAP therapy on cognition and mental health in people with SCI who were diagnosed with moderate-to-severe SRBD. Outcomes included the Epworth Sleepiness Scale, Medical Outcomes Study Sleep Scale, Fatigue Severity Scale, Depression, Anxiety &amp; Stress Scale-21, and Montreal Cognitive Assessment (MoCA). The participants shared their experience in a 1-hour semi-structured interview (qualitative analysis). <h3>Results:</h3> By September 2022, we screened 31 individuals (10 females, 21 males; ages range: 37–79 years; mean age: 58.4 years) with complete motor (n=14) or incomplete SCI at cervical (n=20) or thoracic level. Time from SCI onset varied from 4 to 793 months (mean time: 190.5 months). Of the 31 screened participants, the apnea-hypopnea index (AHI) varied from 2.6 to 83.7 events per hour (mean AHI: 23.0). Of the 24 individuals who initiated CPAP therapy, 11 individuals have completed it, whereas three individuals withdrew from the study. The overall mean adherence rate to CPAP was 78.6%; mean nighttime CPAP usage was approximately 5 hours. Daytime sleepiness (p=0.003) and sleep quality (p&lt;0.001) significantly improved with CPAP therapy. Fatigue significantly decreased with CPAP therapy (p=0.048). Mental health indicators improved with CPAP therapy (p=0.049). There was a numeric increase in MoCA scores, but this did not reach significance yet (p=0.160). All 11 participants confirmed that CPAP therapy had a positive impact in their lives. <h3>Conclusions:</h3> Our preliminary results suggest that 4 months of CPAP therapy significantly improves sleep quality, and reduces daytime sleepiness, fatigue, stress, anxiety and mood in people with chronic SCI. The participants’ adherence to CPAP therapy was high (78.6%). <b>Disclosure:</b> The institution of Dr. Furlan has received research support from Wings for Life Spinal Cord Research Foundation. The institution of Dr. Furlan has received research support from Craig H Neilsen Foundation. The institution of Dr. Furlan has received research support from Ontario Neurotrauma Foundation. The institution of Dr. Furlan has received research support from Cervical Spine Research Society. The institution of Dr. Furlan has received research support from J P Bickell Foundation. The institution of Dr. Furlan has received research support from Praxis Spinal Cord Institute. The institution of Dr. Furlan has received research support from Cervical Spine Research Society. Dr. Hitzig has nothing to disclose. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jazz Pharmaceuticals. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Paladin Labs. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Boulos has received research support from Interaxon. The institution of Dr. Boulos has received research support from The Mahaffy Family Research Fund. The institution of Dr. Boulos has received research support from Canadian Institutes of Health Research. The institution of Dr. Boulos has received research support from Slamen-Fast New Initiatives in Neurology Award. The institution of Dr. Boulos has received research support from Green Mountain . Dr. Boulos has received personal compensation in the range of $5,000-$9,999 for serving as a speaker with Jazz Pharmaceuticals.

Clinical features of epilepsy course during COVID-19

Background. Currently, a great body of data regarding the link between epilepsy and novel coronavirus infection (NCI) has been accumulated. Numerous studies have paid a great attention to rise in frequency and severity of epileptic seizures as well as failure of remission in individuals suffering from epilepsy.Objective: to study clinical and mental changes during NCI in patients with epilepsy.Material and methods. Fifty patients with epilepsy were examined, who were divided into two groups depending on the NCI history: Group 1 (main) – 25 patients undergone COVID-19 in the period from 2020 to 2022; Group 2 (control) – 25 patients not undergone COVID-19 during the same period. Clinical-anamnestic and psychometric methods were used as well as the following scales and questionnaires: National Hospital Seizure Severity Scale (NHS-3), Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Medical Outcomes Study Sleep Scale (MOS-SS), Multidimensional Fatigue Inventory (MFI-20).Results. In patients with epilepsy who had undergone COVID-19, there was a tendency for more frequent epileptic seizures and increased severity of seizure course. Among such patients, mild depression and more severe asthenia, cognitive impairment, moderate sleep disturbances were more common than in the control group.Conclusion. The NCI pandemic has had a pronounced negative impact on the severity of epilepsy (the underlying disease).

Combination analgesic development for enhanced clinical efficacy (the CADENCE trial): a double-blind, controlled trial of an alpha-lipoic acid-pregabalin combination for fibromyalgia pain.

Drug therapy for fibromyalgia is limited by incomplete efficacy and dose-limiting adverse effects (AEs). Combining agents with complementary analgesic mechanisms-and differing AE profiles-could provide added benefits. We assessed an alpha-lipoic acid (ALA)-pregabalin combination with a randomized, double-blind, 3-period crossover design. Participants received maximally tolerated doses of ALA, pregabalin, and ALA-pregabalin combination for 6 weeks. The primary outcome was daily pain (0-10); secondary outcomes included Fibromyalgia Impact Questionnaire, SF-36 survey, Medical Outcomes Study Sleep Scale, Beck Depression Inventory (BDI-II), adverse events, and other measures. The primary outcome of daily pain (0-10) during ALA (4.9), pregabalin (4.6), and combination (4.5) was not significantly different (P = 0.54). There were no significant differences between combination and each monotherapy for any secondary outcomes, although combination and pregabalin were both superior to ALA for measures of mood and sleep. Alpha-lipoic acid and pregabalin maximal tolerated doses were similar during combination and monotherapy, and AEs were not frequent with combination therapy. These results do not support any additive benefit of combining ALA with pregabalin for fibromyalgia. The observation of similarly reached maximal tolerated drug doses of these 2 agents (which have differing side-effect profiles) during combination and monotherapy-without increased side effects-provides support for future development of potentially more beneficial combinations with complementary mechanisms and nonoverlapping side effects.

Associations between self-reported sleep patterns and health, cognition and amyloid measures: results from the Wisconsin Registry for Alzheimer's Prevention.

Previous studies suggest associations between self-reported sleep problems and poorer health, cognition, Alzheimer's disease pathology and dementia-related outcomes. It is important to develop a deeper understanding of the relationship between these complications and sleep disturbance, a modifiable risk factor, in late midlife, a time when Alzheimer's disease pathology may be accruing. The objectives of this study included application of unsupervised machine learning procedures to identify distinct subgroups of persons with problematic sleep and the association of these subgroups with concurrent measures of mental and physical health, cognition and PET-identified amyloid. Dementia-free participants from the Wisconsin Registry for Alzheimer's Prevention (n = 619) completed sleep questionnaires including the Insomnia Severity Index, Epworth Sleepiness Scale and Medical Outcomes Study Sleep Scale. K-means clustering analysis identified discrete sleep problem groups who were then compared across concurrent health outcomes (e.g. depression, self-rated health and insulin resistance), cognitive composite indices including episodic memory and executive function and, in a subset, Pittsburgh Compound B PET imaging to assess amyloid burden. Significant omnibus tests (P < 0.05) were followed with pairwise comparisons. Mean (SD) sample baseline sleep assessment age was 62.6 (6.7). Cluster analysis identified three groups: healthy sleepers [n = 262 (42.3%)], intermediate sleepers [n = 229 (37.0%)] and poor sleepers [n = 128 (20.7%)]. All omnibus tests comparing demographics and health measures across sleep groups were significant except for age, sex and apolipoprotein E e4 carriers; the poor sleepers group was worse than one or both of the other groups on all other measures, including measures of depression, self-reported health and memory complaints. The poor sleepers group had higher average body mass index, waist-hip ratio and homeostatic model assessment of insulin resistance. After adjusting for covariates, the poor sleepers group also performed worse on all concurrent cognitive composites except working memory. There were no differences between sleep groups on PET-based measures of amyloid. Sensitivity analyses indicated that while different clustering approaches resulted in different group assignments for some (predominantly the intermediate group), between-group patterns in outcomes were consistent. In conclusion, distinct sleep characteristics groups were identified with a sizable minority (20.7%) exhibiting poor sleep characteristics, and this group also exhibited the poorest concurrent mental and physical health and cognition, indicating substantial multi-morbidity; sleep group was not associated with amyloid PET estimates. Precision-based management of sleep and related factors may provide an opportunity for early intervention that could serve to delay or prevent clinical impairment.

Sleep quality and predictors of optimal sleep in patients with rheumatoid arthritis: data from a recent-onset cohort.

Sleep disorders are part of the symptomatology of rheumatoid arthritis (RA) patients and are related to disease characteristics and comorbidities. The study describes sleep quality among RA patients and identifies predictors of optimal sleep. Patients whose data were analysed were identified from the recent-onset RA cohort initiated in 2004. In 2010, the Medical Outcome Study Sleep Scale (MOS-SS) was incorporated into the patients' assessments. Up to December 2019, the cohort comprised 187 patients with at least one MOS-SS application (in 78 patients at cohort entry) and six months of outcomes behaviour (cumulative) previous to the MOS-SS application: DAS28-ESR, pain-VAS, fatigue, HAQ-DI, SF-36, treatment (corticosteroids, DMARDs/patient and adherence), Charlson score, and major depressive episodes. A trained data abstractor retrospectively reviewed their charts. Multiple logistic regression analysis estimated odds ratios (95% confidence interval) to define baseline and cumulative variables predictive of optimal sleep (dichotomised variable derived from the quantity of sleep dimension of the MOS-SS). At the first MOS-SS application, patients were primarily middle-aged women with short disease duration and low disease activity. They scored higher on the "snoring" and "sleep non-adequacy" MOS-SS dimensions. There were 96 patients (51.3%) with optimal sleep. Lower baseline BMI, better baseline fatigue score, longer follow-up at the clinic, and better SF-36 physical summary score were predictors of optimal sleep (mental summary score also remained in the model when switched to the physical summary score). Optimal sleep is achieved by half of the RA patients and predicted by BMI, patient-reported outcomes, and follow-up.

Opposing inflammatory biomarker responses to sleep disruption in cancer patients before and during oncological therapy.

BackgroundSleep disruption is known to be highly prevalent in cancer patients, aggravated during oncological treatment and closely associated with reduced quality of life, therapeutic outcome and survival. Inflammatory factors are associated with sleep disruption in healthy individuals and cancer patients, but heterogeneity and robustness of inflammatory factors associated with sleep disruption and how these are affected by oncological therapy remain poorly understood. Furthermore, due to the complex crosstalk between sleep-, and therapy-associated factors, including inflammatory factors, there are currently no established biomarkers for predicting sleep disruption in patients undergoing oncological therapy.MethodsWe performed a broad screen of circulating biomarkers with immune-modulating or endocrine functions and coupled these to self-reported sleep quality using the Medical Outcomes Study (MOS) sleep scale. Ninety cancer patients with gastrointestinal, urothelial, breast, brain and tonsillar cancers, aged between 32 and 86 years, and scheduled for adjuvant or palliative oncological therapy were included. Of these, 71 patients were evaluable. Data was collected immediately before and again 3 months after onset of oncological therapy.ResultsSeventeen among a total of 45 investigated plasma proteins were found to be suppressed in cancer patients exhibiting sleep disruption prior to treatment onset, but this association was lost following the first treatment cycle. Patients whose sleep quality was reduced during the treatment period exhibited significantly increased plasma levels of six pro-inflammatory biomarkers (IL-2, IL-6, IL-12, TNF-a, IFN-g, and GM-CSF) 3 months after the start of treatment, whereas biomarkers with anti-inflammatory, growth factor, immune-modulatory, or chemokine functions were unchanged.ConclusionOur work suggests that biomarkers of sleep quality are not valid for cancer patients undergoing oncological therapy if analyzed only at a single timepoint. On the other hand, therapy-associated increases in circulating inflammatory biomarkers are closely coupled to reduced sleep quality in cancer patients. These findings indicate a need for testing of inflammatory and other biomarkers as well as sleep quality at multiple times during the patient treatment and care process.

Sensory Profiles in Patients with Low Back Pain with and Without Radiculopathy.

During routine clinical evaluation, it can be challenging to differentiate between lumbar radiculopathy (RAD) and lower back pain with non-radicular somatic referred pain (SRP) or even axial non-radiating low back pain (LBP). The aim of this study was to characterize patients with RAD, axial LBP (aLBP), and SRP on the basis of somatosensory profiles. Patients with LBP (n = 54) were assessed with quantitative sensory testing in the area of LBP and, in cases of RAD, additionally in the area of projecting pain. Questionnaires (PainDETECT®, EuroQol-5D, Medical Outcomes Study Sleep Scale, Hannover Functional Ability Questionnaire for Back Pain, Roland Morris Disability Questionnaire, Short Form-12 Health Survey, and Hospital Anxiety and Depression Scale) were answered by all patients. Patients with RAD (n = 12) had higher pain intensity scores (numeric rating scale: 5.7 ± 1.5 vs 4.1 ± 2.2; P < 0.05) and higher PainDETECT scores (14.6 ± 6.13 vs 9.7 ± 6.2; P < 0.05) than did patients with aLBP and SRP (n = 42). Patients with RAD had a more pronounced loss of small-fiber function, increased mechanical hyperalgesia, and a trend toward increased sensitivity to thermal pain in the area of LBP compared with patients with aLBP and SRP. Within patients with RAD, sensory profiles of the area of projecting pain and the area of LBP did not differ. Pressure pain hyperalgesia (measured by pressure pain threshold) and loss of mechanical detection (measured by mechanical detection threshold) in combination with the PainDETECT items numbness and prickling reached the best predictive value in detecting a radiculopathy. Patients with RAD demonstrated more somatosensory abnormalities than did patients with aLBP and SRP, including increased mechanical hyperalgesia and a loss of mechanical detection. The combination of pressure pain threshold, mechanical detection threshold, numbness, and prickling in the area of LBP can be a time-efficient tool to identify patients with RAD.