Mental Fatigue Research Articles

Athletes with meditation experience counteract the detrimental effect of mental fatigue on endurance performance and neurocognitive functions

ABSTRACT The current study examined whether meditation experience is associated with changes in endurance performance and inhibitory control-relevant neurocognitive functions caused by mental fatigue. Twenty-four athletes with meditation experience (AME) and twenty-five athletes without meditation experience (AWME) underwent a 30-min incongruent Stroop test in mental fatigue condition (MF) and a 30-min congruent Stroop test in control condition (CON) in a randomised-counterbalanced order. Inhibitory control-relevant neurocognitive functions were assessed using Flanker task and event-related potentials, followed by an endurance task using the Bruce treadmill protocol. Visual analogue scale was used to evaluate perceived mental fatigue (VAS-MF) before (T1), after Stroop test (T2) and after Flanker task (T3), and VAS for motivation (VAS-M) was used to evaluate motivation in Flanker task and endurance task. Results indicated that, compared to the CON, AWME in the MF exhibited overall lower accuracy, smaller incongruent N2 amplitude of the Flanker task (ps < .05), and shorter time to exhaustion (TTE) of the endurance task (p < .001), whereas AME did not exhibited difference in these outcomes between the conditions. Along with athletes in the MF reported lower VAS-M in endurance task. These findings suggest the benefits of meditation experience in mitigating the negative effects of mental fatigue.

The Effects of Mental Fatigue on Anaerobic Power and Power Endurance Performance.

Mental fatigue has been studied extensively in relation to its impact on aerobic-, strength-, and motor-based tasks, but anaerobic power-based tasks have received limited attention. Interdisciplinary research investigating the underlying mechanisms by which mental fatigue influences physical performance has been called for. In two studies, the effects of mental fatigue on maximal power jump and endurance jump performance as well as kinetics and kinematics during jump performance were examined. Samples of collegiate volleyball players (Study 1; N = 14) and recreationally active students (Study 2; N = 27) completed two 30 min experimental manipulations (high vs. low cognitive control exertion) before performing three maximal power squat jumps followed by 15 repeated countermovement jumps, with measurements of kinetics and kinematics. For Study 1, the maximal power performance was significantly lower under a mentally fatigued condition, but no differences were observed for repeated jump performance, which may have been attributable to alterations in jump mechanics. For Study 2, no between-condition differences were observed for the maximal power performance, although repeated jump performance was significantly lower under a mentally fatigued condition. Collectively, these findings suggest that the impacts of mental fatigue on power-based performance tasks may depend on the task demands as well as the training status of the individual.

Strategies to build a robotic liver surgery program

Over the past few decades, an increasing proportion of abdominal surgeries are performed through minimally invasive platforms. In contrast, adaptation of minimally invasive techniques for liver surgery has garnered slower attraction due to the complexity and associated morbidity and mortality with these operations. Compared to laparoscopy, the robotic-assisted surgical system provides a three-dimensional operative view and instruments with articulation that mimic and extend wrist movement. These elements improve operative dexterity making dissection and suturing easier. Additionally, robotic surgery improves operative ergonomics and decreases physical and mental fatigue. Studies show that the robotic platform is safe and versatile with many technical advantages for complex operations, improved short-term outcomes compared to open surgery, and comparable oncologic outcomes. As such, hepatobiliary surgeons are increasingly adapting robotic techniques in their practice. It is crucial that as more hospitals adopt this technology, patient safety monitoring and quality initiatives are maintained. Establishing a robotic liver surgery program revolves around three pillars: designing a curriculum to overcome the learning curve, building a strong clinical and administrative team, and appropriate patient selection.

Long-term cognitive and affective consequences of mild traumatic brain injury: comparison with older adults

ABSTRACT Objective Memory and affective processing were compared in young adults with a remote mild traumatic brain injury (mTBI), to healthy younger and older adults. We evaluated memory performance when encoding was done under multi-tasking (divided attention) conditions, likely to exacerbate cognitive and psychological symptoms in mTBI. Methods Participants studied pairs of unrelated words under either full or divided attention conditions. Memory for single words (item memory) and for pairs of words (associative memory) was then assessed in sequential independent recognition tests, under full attention. Results Associative memory was poorer than item memory, and worse when encoding was done under divided than full attention. The decline in recognition accuracy from full to divided attention conditions on the associative memory test was significantly greater in mTBI compared to young adults and was similar in magnitude to that observed in older adults under full attention. Self-reported mental and total fatigue increased significantly as performance on the memory tests, following the divided attention condition, decreased, but only in the mTBI group. Conclusions Results show lingering memory deficits, and suggest that cognitive tasks may be experienced as psychologically more demanding in those with a mTBI, even months or years after injury.

Brain Endurance Training Improves Dynamic Calisthenic Exercise and Benefits Novel Exercise and Cognitive Performance: Evidence of Performance Enhancement and Near Transfer of Training.

Dallaway, N, Mortimer, H, Gore, A, and Ring, C. Brain endurance training improves dynamic calisthenic exercise and benefits novel exercise and cognitive performance: Evidence of performance enhancement and near transfer of training. J Strength Cond Res XX(X): 000-000, 2024-The purpose of this dual study was to evaluate whether brain endurance training (BET)-a mental fatigue countermeasure involving physical and cognitive training-enhanced exercise compared with physical training alone. Two studies (N = 29) used a pretest/training/posttest design, with participants randomized to BET or control groups. During testing, participants performed calisthenic exercises (study 1: press-ups, wall sit, and plank; study 2: burpees, jump squats, leg raises, press-ups, and plank) to failure before and after completing 20-minute cognitive tasks (study 1: memory updating; study 2: memory updating, response inhibition, and nonexecutive functions). Training comprised 3 sessions per week for 4 weeks. In study 1 training sessions, participants completed 2 submaximal exercise sets; each exercise was followed by a 3-minute cognitive task with high (BET) or low (control) cognitive loads. In study 2 training sessions, participants completed 1 submaximal exercise set; after 12-minute cognitive tasks (BET) or rest (control), each exercise was preceded by a 3-minute cognitive task (BET) or rest (control). These cognitive tasks involved response inhibition and memory updating. Performance (exercise repetitions/duration), perceived exertion, and mental fatigue were assessed. In pretesting, exercise performance was matched between groups. In posttesting, BET groups performed more dynamic exercises than control groups but the same number of static exercises. Cognitive task performance was either greater for BET or not different between groups. Neither perceived exertion nor mental fatigue differed between groups and tests. Brain endurance training enhanced dynamic but not static calisthenic exercise performance compared with physical training alongside near transfer of training benefits for novel physical and cognitive task performance.

Nature-Based Therapeutic Intervention for Individuals with Post-Concussion Symptoms.

This study investigated the efficacy of a 10-session nature-based therapeutic intervention for people with post-concussion symptoms. The intervention involved physical and vestibular exercises, sensory training, relaxation, and psychoeducation, all of which were integrated with the natural environment in a forest therapy garden. This study was designed with a passive control period followed by the intervention (n = 30). The Mental Fatigue Scale (MFS) was the primary outcome measure. The secondary outcome measures were the Warwick-Edinburg Mental Wellbeing Scale and the short version of the Quality of Life after Brain Injury. A Likert scale was used to examine the mental strain of the sessions themselves. The MFS (primary outcome) exhibited a significant decrease with a medium-sized effect from before to after the intervention. The secondary outcomes exhibited significant increases from the beginning to the end of the intervention. All outcomes were sustained at follow-up ten weeks later. No significant difference was found from the control period. This study indicates that the described nature-based intervention is a feasible treatment for reducing prolonged post-concussion symptoms. However, it should be studied more in-depth to understand the impact of the natural environment and to validate the results on a larger representative population.

Immediate mental health status of refugees during the Ukrainian armed conflict of 2022.

The study assessed stressors and the immediate mental health status of the Ukrainian refugees during the ongoing Ukrainian armed conflict of 2022 and analyzed strategies for reducing anxiety levels. The questionnaire-based prospective study was undertaken in Lviv, Ukraine (five study groups) and Israel (two groups) among 27,901 refugees and 1,259 controls. We assessed the levels of anxiety with General Anxiety Disorder-7 (GAD-7; score range = 0-21, mild to severe) and Refugees' Anxiety Reasons-6 (RAR-6) with a score ranging from 30 (no anxiety) to 6 (extreme anxiety) questionnaires. RAR-6 assessed worries about personal safety, money matters, relatives under fire, the future of the country, limited medications, and general mental fatigue. The study involved refugees in the migration phase and internally displaced persons. The GAD-7 score of 16.1 ± 2.6 (severe anxiety) showed that all participants experienced anxiety during current hostilities. The RAR-6 score of 21.8 ± 1.7 demonstrated that participants worried about numerous acute problems, but the results varied from group to group. The refugees who moved abroad independently and without a clear goal had the worst GAD-7 score of 19.4 ± 1.7. The refugees who traveled abroad in a group-organized manner had the best RAR-6 score of 24.8 ± 1.5, while passing through Lviv refugees had the worst RAR-6 score of 19.0 ± 1.6 (p = .03). During hostilities, refugees, internally displaced persons, and regular inhabitants are mentally affected to varying degrees. For refugees, group-organized travel abroad is the best option to maintain adequate mental health, followed by an internal refugee status and traveling abroad independently (the worst strategy). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Analysis of traditional Chinese medicine syndrome elements and clinical symptoms in prediabetes: A systematic review.

Prediabetes mellitus (PDM) and impaired glucose regulation precedes diabetes and serve as early warning signals. A 2018 Chinese epidemiological survey reported prediabetes at 25.5% prevalence and type 2 diabetes at 10.8%, respectively. Untreated carries one-third of the risk of diabetes progression. This study aimed to understand traditional Chinese medicine syndromes in PDM to guide clinical practice and diabetes prevention. We systematically searched the Chinese and English literature in PubMed, EMBASE, Sinomed, CNKI, VIP, Wanfang until March 31, 2023. We manually explored the Chinese prediabetes literature, trial registrations, and references, adhering to predefined criteria. The results were independently summarized by 2 researchers. Statistical analysis was performed using EXCEL, IBM SPSS 27.0, and IBM SPSS Modeler 18.0, with data mining techniques including association and cluster analysis. Analysis of 23 clinical trials (8943 patients) identified phlegm dampness syndrome as predominant, with qi deficiency, dampness, and phlegm as the principal pathogenic elements. Spleen syndrome elements dominated, with a priori correlation analysis favoring spleen dampness. The prevalent PDM clinical symptoms include amnesia, mental fatigue, limb fatigue, dizziness, and lumbar discomfort. Prediabetes is strongly associated with spleen dampness, highlighting its role. Common traditional Chinese medicine syndrome elements include qi deficiency, phlegm, and dampness. Clinical diagnosis and treatment should prioritize syndrome differentiation and emphasize spleen-focused approaches. Although limited research exists on prediabetes syndromes, further exploration of PDM and spleen dampness is crucial.

Sleep, Mental Health, and the Need for Physical and Real-Life Social Contact with (Non-)Family Members during the COVID-19 Pandemic: A Bayesian Network Analysis.

Background/Objectives: The forced social isolation implemented to prevent the spread of the COVID-19 virus was accompanied by a worsening of mental health, an increase in insomnia symptoms, and the emergence of 'skin hunger'-an increased longing for personal touch. This study aimed to enhance our understanding of the interconnection between sleep, mental health, and the need for physical (NPC) and real-life social contact (NRL-SC). Methods: A total of 2827 adults participated in an online survey during the second COVID-19 lockdown. A Bayesian Gaussian copula graphical model (BGCGM) and a Bayesian-directed acyclic graph (DAG) were estimated, and mixed ANOVAs were carried out. Results: NPC with non-family members (t(2091) = 12.55, p < 0.001, d = 0.27) and relational lifestyle satisfaction (t(2089) = 13.62, p < 0.001, d = 0.30) were lower during the second lockdown than before the pandemic. In our BGCGM, there were weak positive edges between the need for PC and RL-SC on one hand and sleep and mental health on the other. Conclusions: During the second lockdown, people craved less physical contact with non-family members and were less satisfied with their relational lifestyle than before the pandemic. Individuals with a greater need for PC and RL-SC reported poorer mental health (i.e., worry, depression, and mental fatigue).

Psychological detachment from work during nonwork time as a moderator and mediator of the relationship of workload with fatigue and sleep in hospital nurses

ObjectivesTo examine differences in psychological detachment from work during nonwork time by nurses’ personal and work-related characteristics, and to examine the moderating and mediating effects of psychological detachment on the relationships between nursing workload and fatigue and sleep. MethodsThis study employed a cross-sectional design with a self-administered online survey. Survey data from 827 hospital nurses providing direct patient care in the United States were used. Moderating and mediating effects of psychological detachment between workload and fatigue/sleep relationships were assessed using Hayes’ PROCESS macro in SPSS. ResultsThere were significant differences in psychological detachment from work based on age, highest nursing degree, work experience, shift length, weekly work hours, and frequency of providing care to patients with COVID-19. The associations of workload with physical fatigue, mental fatigue, and sleep quality were weakened when psychological detachment was high. Psychological detachment statistically mediated the associations between workload and fatigue and sleep problems. ConclusionHealthcare organizations are encouraged to facilitate nurses’ psychological detachment during time-off to protect them from fatigue and sleep problems.

Perspectives on reasons why football and handball players sustain acute and severe knee injuries: a mixed-methods concept mapping study

BackgroundThe high incidence of knee injuries in football/handball challenges effective prevention. Identifying tangible and modifiable factors associated with a knee injury may innovate preventive actions. Engaging key stakeholders can reveal...

Labor fatigue and work organization in a food factory, Aragua-Venezuela, 2023

The objective was to evaluate work fatigue and work organization in a food factory, in the state of Aragua, 2023. Research with a quantitative, field, descriptive, cross-sectional and correlational scope approach. The population was 135 workers and the sample was 101 workers, obtained by snowball sampling. The Yoshitake questionnaire (1978) modified by INSAT 1987 was applied. The statistical programs IBM SPSS ® Statistics Version 25 and EPIDAT were used. The sample was characterized using descriptive statistics and correlated by applying the chi-square and p-value tests. Results: The average age was 42.59 years, predominantly female; 44.6% single; 52.5% live with their partner.; 51.5% have secondary education; the family burden is less than or equal to three members in 61.4%; working workforce 80.2% all under rotating shift schemes; 63.4% have a length of service greater than 16 years; the travel time to the workplace is less than 30 minutes in 56.4%; 62.38% presented fatigue, in this group, 84.13% with general symptoms of fatigue, followed by 9.52% with mental fatigue, and 6.35% physical fatigue. It is concluded that 62.4% present mixed type work fatigue. Women, workers, those who live far away and those who worked shifts are more affected. There are no statistically significant differences between socio-occupational characteristics, shift work and the presence of fatigue.

A Cross-Sectional Study to Analyze the Physical and Cognitive Fatigue Due to Sleep Disruption Among Shift Workers in Tamilnadu

The objective of this research is to analyse the extent and manner of the kind of fatigue among shift workers in Tamil Nadu, India. As for shift workers, they often have disturbed night’s sleep. Shift work is distinguished by its irregular and unique work hours, unlike the regular day-time Schedule. It is combined with circadian alteration, which affects most of the bodily activities. They have diverse sorts of health problems, such as physical and mental fatigue. A Cross-sectional Analysis was done among airport workers. 200 participants were randomly selected for the study aged 35-45 years and conducted for a duration of 6 months in the Airport, Tamilnadu. Sleep quality and cognition were assessed using a validated questionnaire. The muscle fatigue was evaluated using Mosso’s ergograph. R-statistical Software (version 4.0.2) was used for Data Analysis. The Primary analyses of data set’s normality were done by Kolmogorov - Smirnov Z test. Significant negative correlation exists between global PSQI score and both cognition score (r= -0.315, P&lt;0.001) and Work done by Mosso (r= -0.405, P&lt;0.001) There is also negative correlation exists between work done and the cognition score (r= - 0.565, P&lt;0.001) which is statistically significant. Decreased Sleep Quality, more fatigue and lowering of cognition levels not only affects physical health but also the quality of life. It has been noted that sleep disturbance leads to physical and mental exhaustion among Tamil Nadu shift workers. The outcomes underscore the need for targeted interventions to improve sleep-related behaviours as well as the treatment of fatigue in this population. Reducing the disturbances of shift work effects on produce, growth as well as health may be authorized by way of implementing organized work shifts and also promoting sleep promotion.

Examining the effect of maintenance work on employees’ physical and mental health, as well as their overall well-being, in industrial settings

This study examines the impact of maintenance work on the physical, mental health, and overall well-being (PMHOW) of employees in some industry types in South Eastern Nigeria. The research aims to enhance occupational health standards and support interventions for industrial maintenance workers. It identifies the stressors that maintenance workers face (physical work demands, high-pressure work environment, shift work and irregular work hours, lack of recognition and support, exposure to hazardous conditions, job complexity and technical challenges, and; monotony and repetitive tasks), these stressors affect employees’ health and well-being through musculoskeletal disorders, mental fatigue, increased risk of accidents, stress, anxiety, and burnout to mention but a few, it proposes strategies for mitigating them which include ergonomic practices, realistic workloads, supportive work culture, adequate staffing etc. Employee Satisfaction Survey was conducted across targeted industries. Based on survey results, employees' perceptions of variances in work characteristics reveal a mix of stable and fluctuating trends. This information helped identify which work characteristics were consistently experienced and which ones vary significantly among employees. Euclidean Distance assessment carried out also aided in identifying areas of intervention by focusing on specific groups of related work characteristics to enhance the work environment and promote better health outcomes. To enhance the mental and physical well-being of maintenance workers, organizations should implement comprehensive strategies that are tailored to the unique stressors and challenges of their work. This approach will not only boost job satisfaction but also contribute to a more efficient and healthier workforce.

Does the Effect of Mental Fatigue Created by Motor Imagery on Upper Extremity Functions Change with Diaphragmatic Breathing Exercises? A Randomized, Controlled, Single-Blinded Trial.

Background and Objectives: This study focused on the impact of mental fatigue induced by motor imagery on upper limb function, an area with limited research compared to lower limb performance. It aimed to explore how diaphragmatic breathing exercises influence these effects. Materials and Methods: This study included 30 participants, and Group 1 participated in 12 sessions of diaphragmatic breathing exercises under the supervision of a physiotherapist; Group 2 did not receive any intervention. For all the participants, mental fatigue was induced with motor imagery before and after the intervention, and evaluations were performed before and after mental fatigue. Upper extremity functions were evaluated using isometric elbow flexion strength, hand grip strength, upper extremity reaction time and endurance, finger reaction time, the nine-hole peg test, shoulder position sense, light touch-pressure threshold, and two-point discrimination. Results: The study results showed that after mental fatigue, there was a decrease in isometric elbow flexion strength, nondominant hand grip strength, and nondominant upper extremity endurance, and an increase in nondominant tactile sensation (p < 0.05). No changes were found in two-point discrimination, nine-hole peg test time, and position sense on either side (p > 0.05). The effect of mental fatigue on isometric elbow flexion strength and nondominant grip strength showed significant improvement following diaphragmatic breathing exercises (p < 0.05). Conclusions: This study found that mental fatigue from motor imagery can impact elbow flexion, hand grip strength, upper extremity endurance, and tactile sensitivity. Breathing exercises may help improve strength parameters affected by mental fatigue. It is crucial to consider these effects on upper extremity functions in rehabilitation programs.

Boosting arousal and cognitive performance through alternating posture: Insights from a multi-method laboratory study.

This study investigated the role of arousal and effort costs in the cognitive benefits of alternating between sitting and standing postures using a sit-stand desk, while measuring executive functions, self-reports, physiology, and neural activity in a 2-h laboratory session aimed to induce mental fatigue. Two sessions were conducted with a one-week gap, during which participants alternated between sitting and standing postures each 20-min block in one session and remained seated in the other. In each block, inhibition, switching, and updating were assessed. We examined effects of time-on-task, acute (local) effects of standing versus sitting posture, and cumulative (global) effects of a standing posture that generalize to the subsequent block in which participants sit. Results (N = 43) confirmed that time-on-task increased mental fatigue and decreased arousal. Standing (versus sitting) led to acute increases in arousal levels, including self-reports, alpha oscillations, and cardiac responses. Standing also decreased physiological and perceived effort costs. Standing enhanced processing speed in the flanker task, attributable to shortened nondecision time and speeded evidence accumulation processes. No significant effects were observed on higher-level executive functions. Alternating postures also increased heart rate variability cumulatively over time. Exploratory mediation analyses indicated that the positive impact of acute posture on enhanced drift rate was mediated by self-reported arousal, whereas decreased nondecision time was mediated by reductions in alpha power. In conclusion, alternating between sitting and standing postures can enhance arousal, decrease effort costs, and improve specific cognitive and physiological outcomes.

Portrait of mental health identified by people with the post-covid syndrome.

This study aimed to produce a patient-centered understanding of mental health symptoms of people with the post-COVID-19 syndrome (PCS). A cross-sectional analysis of 414 participants in a longitudinal study was carried out involving people who self-identified as having symptoms of PCS. People were asked to name their most frequent and most bothersome mental health symptoms affected by PCS using the structure of the Patient Generated Index (PGI). The text threads from the PGI were grouped into topics using BERTopic analysis. 20 topics were identified from 818 text threads referring to PCS mental health symptoms. 35% of threads were identified as relating to anxiety, discussed in terms of five topics: generalized/social anxiety, fear/worry, post-traumatic stress, panic, and nervous. 29% of threads were identified as relating to low mood, represented by five topics: depression, discouragement, emotional distress, sadness, and loneliness. A cognitive domain (22% of threads) was covered by four topics referring to concentration, memory, brain fog, and mental fatigue. Topics related to frustration, anger, irritability. and mood swings (7%) were considered as one domain and there were separate topics related to motivation, insomnia, and isolation. This novel method of digital transformation of unstructured text data uncovered different ways in which people think about classical mental health domains. This information could be used to evaluate whether existing measures cover the content identified by people with PCS, to initiate a clinical conversation, or to justify the development of a new measure of the mental health impact of PCS.

Factors influencing fatigue, mental workload and burnout among Chinese health care workers during public emergencies: an online cross-sectional study

ObjectivesThe purpose of this study was to investigate fatigue, mental workload, and burnout among health care workers (HCWs) and explore the possible underlying factors.Materials and methodsAn online cross-sectional survey design was used to collect data from HCWs in Chongqing, China. The online survey included the Fatigue Severity Scale, NASA Task Load Index, and Chinese version of the Maslach Burnout Inventory-General Survey to assess fatigue, mental workload, and burnout, respectively, and was conducted from February 1 to March 1, 2023.ResultsIn this study, the incidence of fatigue and burnout among HCWs was 76.40% and 89.14%, respectively, and the incidence of moderate to intolerable mental workloads was 90.26%. Work–family conflict, current symptoms, number of days of COVID-19 positivity, mental workload, burnout and reduced personal accomplishment were significantly associated with fatigue. Mental workload was affected by fatigue and reduced personal accomplishment. Furthermore, burnout was influenced by marital status and fatigue. Moreover, there was a correlation among mental workload, fatigue, and burnout.ConclusionsFatigue, mental workload and burnout had a high incidence and were influenced by multiple factors during COVID-19 public emergencies in China.

Long-Term Epidural Patching Outcomes and Predictors of Benefit in Patients With Suspected CSF Leak Nonconforming to ICHD-3 Criteria.

Spinal CSF leaks lead to spontaneous intracranial hypotension (SIH). While International Classification of Headache Disorders, Third Edition (ICHD-3) criteria necessitate imaging confirmation or low opening pressure (OP) for SIH diagnosis, their sensitivity may be limited. We offered epidural blood patches (EBPs) to patients with symptoms suggestive of SIH, with and without a documented low OP or confirmed leak on imaging. This study evaluates the efficacy of this strategy. We conducted a prospective cohort study with a nested case-control design including all patients who presented to a tertiary headache clinic with clinical symptoms of SIH who completed study measures both before and after receiving an EBP between August 2016 and November 2018. The mean duration of symptoms was 8.7 ± 8.1 years. Of 85 patients assessed, 69 did not meet ICHD-3 criteria for SIH. At an average of 521 days after the initial EBP, this ICHD-3-negative subgroup experienced significant improvements in Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical Health score of +3.3 (95% CI 1.5-5.1), PROMIS Global Mental Health score of +1.8 (95% CI 0.0-3.5), Headache Impact Test (HIT)-6 head pain score of -3.8 (95% CI -5.7 to -1.8), Neck Disability Index of -4.8 (95% CI -9.0 to -0.6) and PROMIS Fatigue of -2.3 (95% CI -4.1 to -0.6). Fifty-four percent of ICHD-3-negative patients achieved clinically meaningful improvements in PROMIS Global Physical Health and 45% in HIT-6 scores. Pain relief following lying flat prior to treatment was strongly associated with sustained clinically meaningful improvement in global physical health at an average of 521 days (odds ratio 1.39, 95% CI 1.1-1.79; p < 0.003). ICHD-3-positive patients showed high rates of response and previously unreported, treatable levels of fatigue and cognitive deficits. Patients who did not conform to the ICHD-3 criteria for SIH showed moderate rates of sustained, clinically meaningful improvements in global physical health, global mental health, neck pain, fatigue, and head pain after EBP therapy. Pre-treatment improvement in head pain when flat was associated with later, sustained improvement after EBP therapy among patients who did not meet the ICHD-3 criteria. This study provides Class IV evidence that epidural blood patch is an effective treatment of suspected CSF leak not conforming to ICHD-3 criteria for SIH.

Machine learning based severity classification of obstructive sleep apnea patients using awake EEG

Obstructive sleep apnea (OSA) is one of the most widespread breathing-based sleep disorders. Previous studies reported daytime sleepiness, mental fatigue, and cognitive decline in patients with OSA. The diagnosis of OSA is done with laborious overnight polysomnography (PSG) recording. This study aims to classify the severity of OSA patients according to the Apnea-Hypopnea Index (AHI) into mild and moderate to-serve groups (AHI ≥ 15) without using recorded signals during sleep, non-PSG signals and investigate the relevant features. For this purpose, 25 OSA patients participated in 3-minute eyes closed resting state EEG session on the following morning of overnight PSG recording. Time, spectral domain, and nonlinear features were extracted from the delta, theta, and alpha subbands’ of EEG signals. Several machine learning algorithms were used to classify patients’ severity. To investigate optimal feature combinations features were grouped according to their types (Time domain/spectral domain and nonlinear), their electrodes (frontal/central/parietal/occipital), and their subbands (delta/theta/alpha). Also, the Relief method was applied to select the most relevant features. A 5-fold cross validation method was used to generalize the model behaviour. Optimal feature combinations were selected according to classifiers' performances that were evaluated by accuracy, sensitivity, specificity, and area under curve (AUC) parameters when feature sets were used as input. The 15 selected features by the Relief method showed the best performances in the K-Nearest Neighbours (K = 5) classifier [accuracy: 93.33 % ± 5.27 %; sensitivity: 92.30 % ± 4.97 %; specificity: 94.14 % ± 4.24 %; AUC:0.98]. The findings establish that awake resting state EEG records might be used as a faster tool to use OSA severity level.