Middle-of-the-night Research Articles

Comparison of Climatology of Precipitation Diurnal Cycle in Kalimantan Deduced from Rain Gauge and IMERG Data

Abstract The diurnal cycle is repetitive pattern of changes in weather factors on land and oceans due to the Earth rotation. Kalimantan Island as the largest island in the Maritime Islands region has a complex rainfall pattern that is influenced by local factors and global circulation. The research was conducted to find out the climatological comparison of the diurnal cycle of rain in Kalimantan based on rain gauge data and Integrated Multi-SatellitE Retrievals for GPM Version 07 (IMERG V07) data for the period 2016 - 2022. Data validation using rain gauge data to validate and calibrate IMERG satellite data, improving the accuracy and reliability of satellite rainfall estimates. The diurnal cycle is evaluated through a Precipitation Amount (PA), Precipitation Frequency (PF), and Precipitation Intensity (PI) every hour. The results show that the maximum rainfall occurs in the afternoon and evening along the coast, and in the middle of the night and morning on the Kalimantan plains. Kalimantan has high rainfall intensity values at short rainfall durations, i.e. rain lasting less than 3 hours. This is expected to improve the quality of hydrometeorological disaster mitigation in Kalimantan.

Perception, use of social media, and its impact on the mental health of Indian adolescents: A qualitative study.

Mental illness is a health challenge faced by adolescents that has grown worse after the Coronavirus disease 2019 pandemic. Research on social media and young people's mental health has recently increased, and numerous studies have examined whether frequent use of social media is linked to issues such as anxiety, stress, depression, eating disorders, insomnia, frustration, feeling alone, and externalizing problems among adolescents. This influence of social media on adolescents' lives is clear, with many platforms like Facebook, Instagram, and YouTube playing an important role in daily interactions and self-expression. Even though social media offers numerous benefits, such as connectivity and information sharing, excessive usage can have detrimental effects on mental health, particularly among adolescents. To study the impact of social media on the mental wellbeing of adolescents, and the associated potential dangers in India. A total of 204 adolescents aged 14 years to 23 years were included in the study. This study explored the intricate relationship between social media usage and adolescent mental health in India. The study employs a cross-sectional survey design to capture a snapshot of adolescent mental health and social media usage patterns. Data collection involved administering structured questionnaires and the analysis utilized quantitative methods, including descriptive statistics. Excessive use of social media is correlated with increased stress, anxiety, and depression. Adolescents engage in compulsive behaviors such as scrolling in the middle of the night, which negatively impacts their mental and physical health, and leads to significant sleep disruption. Findings from the study aim to provide insights into the current state of adolescent mental health and inform strategies to promote positive wellbeing in the Indian population. The study underscores the need for further research to better understand the complex interplay between social media and adolescent mental health, and need for effective strategies to combat online harassment.

Quality of sleep in doctors posted in rural areas

Abstract Introduction: Among medical students, sleep is subjected to various obstacles such as curriculum and postings. Sleep is also influenced by sociodemographic factors but the intersectionality theory shows that multiple social factors within a person can influence health and behavior. Rural postings are another factor. We aim to explore the above in the study. Materials and Methods: It is a cross-sectional study done among 199 medical students across the country. We used a standardized Pittsburgh Sleep Quality Index questionnaire and analyzed the data using SPSS software. The Chi-square test for associations between various demographic factors and sleep indicators. Results: About 71.9% of the participants were interns. Only 37.2% of the participants reported good sleep in rural areas. There was a statistical significance between sleep quality and the duration it takes to fall asleep, waking up in the middle of the night, and duration of stay in rural areas. Conclusion: Good sleep is a crucial factor in keeping the human body working efficiently and functioning well. The main issues such as hectic academic schedules, lack of infrastructure, and flexibility in their allowances, especially during their residency, training will help to improve their sleep and in turn their quality of work. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement.

Efforts to Overcome the Moral Crisis among Children of Fishermen Families in Nibung Hangus District, Batu Bara Regency

This research examines various moral problems among teenagers in Ujung Kubu Village, Nibung Hangus Sub-district, Batu Bara Regency. This research aims to identify and analyze the factors that influence adolescents' moral behavior and the efforts made by fishermen's families to overcome these problems. A qualitative approach with a case study was used as the primary method. Data collection techniques included passive participatory observation, in-depth interviews with key informants, and document study. Data analysis was conducted using descriptive analysis techniques, narrative compilation, and verification through triangulation and member checks to ensure the accuracy and consistency of the findings. The research findings show that behavior against parents, abusive speech, fighting among friends, and often leaving the house in the middle of the night are serious moral problems among adolescents in this village. Factors influencing these problems include the role of parents, the influence of the peer environment, and the lack of consistent religious education. Parents face challenges in implementing moral education amid negative environmental influences. Family efforts include open communication, setting clear rules, and limiting the peer environment, although there are limitations in fully controlling children's behavior. This study reinforces previous theories about the importance of family and environment in adolescent moral formation and provides new insights into the complexity of moral issues in fishing communities. A more adaptive and responsive approach is needed to create an environment conducive to healthy and responsible adolescent development.

Efficacy and Optimal Timing of Warm-white or Red + Far-red LED Lamps in Regulation of Flowering in Long-day Ornamentals

When natural days are short, photoperiodic lighting at the end or beginning of the day (day extension) or in the middle of the night (night break) promotes flowering of long-day plants. The objective of this study was to compare broad-spectrum warm-white light-emitting diodes (LEDs) and red (R) + far-red (FR) LEDs at flowering regulation when delivered at different timings in the night period. We performed a greenhouse experiment on four long-day ornamentals [coreopsis (Coreopsis grandiflora) ‘Early Sunrise’, snapdragon (Antirrhinum majus) ‘Liberty Classic Yellow’, petunia (Petunia ×hybrida) ‘Easy Wave Burgundy Star’, and petunia ‘Wave Purple Improved’]. We grew plants under a truncated 8-hour photoperiod with or without low-intensity (∼2 μmol·m−2·s−1) nighttime lighting from warm-white or R+FR LEDs. For each light quality, we delivered four timings: 1) 8 hours after dusk; 2) 8 hours before dawn; 3) 4 hours after dusk + 4 hours before dawn; and 4) 4-hour night break. The effectiveness of floral promotion was determined by time from the treatment onset to the first open flower. Coreopsis flowered similarly under all lighting treatments, irrespective of light quality and timing, but did not flower under the short-day treatment by the end of the experiment. At flowering, coreopsis was 18% to 19% shorter under white than R+FR LEDs. In contrast, snapdragon flowered 9 to 20 days later under white than R+FR LEDs, when delivered for 8 hours at night, but flowered similarly under these two lamp types as a 4-hour night break. Compared with the short-day treatment, white and R+FR LEDs promoted flowering of both petunia cultivars, although flowering generally occurred later under white than R+FR LEDs. Snapdragon and petunia ‘Easy Wave Burgundy Star’ developed 30% to 122% more lateral branches under white than R+FR LEDs, when delivered for 8 hours at night. The effectiveness of warm-white LEDs was generally unaffected by timing, although it was most promotive of flowering in snapdragon when delivered for 8 hours before dawn. For R+FR LEDs, 8-hour day-extension lighting was generally more effective than 4-hour night-break lighting, irrespective of timing. We conclude when delivered for 8 hours at night, warm-white LEDs are generally less effective than R+FR LEDs at promoting flowering of long-day ornamentals but similarly effective as 4-hour night-break lighting. The effectiveness of day-extension lighting is generally independent of timing, although for R+FR LEDs, 8 hours after-dusk and/or before-dawn lighting was generally more effective than 4-hour night-break lighting.

Diazepam nasal spray administration is effective to control seizure clusters irrespective of time of day

IntroductionNeurologic circadian influences, including sleep/wake transitions, processes (e.g., hormonal variation), and behavioral patterns (e.g., consumption of food and oral medications), may affect seizure patterns. Specific circadian patterns of seizures have been reported depending on type, onset location, and severity; however, data on patterns for patients with seizure clusters and effectiveness of rescue therapy by time of day are limited.MethodsWe conducted post hoc analyses using patient diary data from the phase 3 safety study of diazepam nasal spray, which is indicated for acute treatment of seizure clusters in patients with epilepsy aged ≥6 years. Patients were administered age- and weight-based doses; second doses could be administered if needed to control a seizure cluster. We assessed clock timing of seizure-cluster onset along with second-dose use as a proxy for effectiveness. Treatment-emergent adverse events were recorded.ResultsSeizure-cluster onset was observed to be generally highest during mornings and late evenings and lowest in the early evening and middle of the night. Second-dose use was not consistently associated with a specific time of day. The safety profile was consistent with that expected from previous studies of diazepam nasal spray.ConclusionThese results suggest that diazepam nasal spray can be effectively administered at any time of day.

Circadian coupling of mitochondria in a deep-diving mammal.

Regulation of mitochondrial oxidative phosphorylation is essential to match energy supply to changing cellular energy demands, and to cope with periods of hypoxia. Recent work implicates the circadian molecular clock in control of mitochondrial function and hypoxia sensing. Because diving mammals experience intermittent episodes of severe hypoxia, with diel patterning in dive depth and duration, it is interesting to consider circadian-mitochondrial interaction in this group. Here, we demonstrate that the hooded seal (Cystophora cristata), a deep-diving Arctic pinniped, shows strong daily patterning of diving behaviour in the wild. Cultures of hooded seal skin fibroblasts exhibit robust circadian oscillation of the core clock genes per2 and arntl. In liver tissue collected from captive hooded seals, expression of arntl was some 4-fold higher in the middle of the night than in the middle of the day. To explore the clock-mitochondria relationship, we measured the mitochondrial oxygen consumption in synchronized hooded seal skin fibroblasts and found a circadian variation in mitochondrial activity, with higher coupling efficiency of complex I coinciding with the trough of arntl expression. These results open the way for further studies of circadian-hypoxia interactions in pinnipeds during diving.

IJCM_106A: Motivating factor, Health and Quality of life: A mixed methods study of elderly residents in a senior living facility in Bangalore, South India

Background: Senior living communities, offering autonomous living in India are nascent but are experiencing increased demand due to a growing proportion of financially independent seniors and the prevalent phenomenon of nuclear families. Objective: To determine factors influencing elderly citizens choosing to live in a senior living community, to assess their quality of life, mental health and sleep hygiene; and to qualitatively explore contributing factors. Methodology: This mixed methods study was done exploratively among residents of a private paid-for senior living facility in Bangalore. Quantitative data was collected using standard questionnaires. Linear and logistic regression was performed to look for associations. Subsequently, key informant interviews were conducted. The data were manually coded, and inductive thematic analysis was performed. Results: The median age of the 100 participants was 76 years and 73% were financially independent. Comorbidities were present in 89% of them. Reasons for living in the facility were lack of family support (69%) and preferring to live with peers (13%). The Old People Quality of Life Brief Questionnaire revealed a median score of 44 with 88% strongly agreeing that they enjoyed their life overall. Quality of life was significantly lesser in those lacking family support. Screening for psychological distress using PHQ4 was positive in 22%. Sleep disturbance was perceived by 71%, with waking up in the middle of the night being the commonest complaint. Qualitative findings revealed that the management allocates funds effectively for the residents needs and well-being. Residents stated that staff worked with patience and compassion. Regular recreational activities enhance mental health. Shared religious and social ties foster support. Conclusion: Most residents of this senior living facility said they have a good quality of life and that they were satisfied with the community support and facilities provided.

“Completely Free”: How a Subsumption of Labour and Nature Framework Explains the Surprising Expressions of “Freedom” by Immigrant Worm pickers in Ontario

AbstractCanadian nightcrawler (Lumbricus terrestris) worms, the most popular live bait for recreational freshwater anglers, are hand‐picked from Ontario dairy farmers’ fields by an immigrant labour force working in the middle of the night with limited equipment. Though no picker enjoys the arduous activity of picking worms, they do express feelings of “freedom” and “autonomy” in the job. Such expressions are surprising coming from mostly non‐English‐speaking immigrants, labouring with bent backs under dreary conditions producing profit for their employers in an unregulated industry. To understand these counterintuitive conceptions of freedom, I connect debates around “un/free labour” and “constrained agency” with the Marxist concepts of formal and real subsumption of labour and nature to reveal how the ecological conditions of commodity production shape capitalist control over labour. I argue worm‐picker agency should be understood by seeing how the subsumption of labour is related to the subsumption of nature.

Lightning Stroke Strength and Its Correlation with Cloud Macro- and Microphysics over the Tibetan Plateau

Lightning stroke strength, characterized by energy and peak currents, over the Tibetan Plateau (TP), is investigated by utilizing datasets from the World Wide Lightning Location Network and the Chinese Cloud-to-Ground Lightning Location System during 2016–2019. Focused on the south-central (SC) and southeast (SE) of the TP, it reveals that SE-TP experiences strokes with larger average energy and peak currents. Strong strokes (energy ≥ 100 kJ or peak currents ≥ |100| kA), exhibiting bimodal distribution in winter and summer, are more frequent and have larger average values over the SE-TP than the SC-TP, with diurnal distribution indicating peaks in energy and positive strokes in the middle of the night and negative strokes peaking in the morning. Utilizing the ECMWF/ERA-5 and MERRA-2 reanalysis, we find that stronger strokes correlate with thinner charge zone depths and larger CIWCFs but stable warm cloud depths and zero-degree levels over the SC-TP. Over the SE-TP, stronger strokes are associated with smaller CIWCFs and show turning points for warm cloud depths and zero-degree levels. Thicker charge zone depths correlate with stronger negative strokes but weaker positive strokes. Generating strokes of similar strength over the SC-TP requires larger CIWCFs, thinner warm cloud depths, and lower zero-degree levels than over the SE-TP.

A Depiction of Hallucination in Patrick Ness’s A Monster Calls

A Monster Callsis anIntrusion Fantasy novel, written for young adults by Patrick Ness, elucidated by Jim Kay and published by Walker in 2011. The story basically about hallucination and denying the reality, Set-in modern-day England, featuring a boy who strives to cope up with the significances of his mother’s illness. He is frequently visited by a monster in the middle of the night who tells stories. In his hallucination it helps him to oppress his distress and face the reality and, in the end, the lone parent brought up boy,recognizes his mom’s impending death. The monster assures to stay with him until the end, and he cries, knowing that the end is very near. His family is shattered, which adds to the strain of watching his mother death. He wants to live with his father, but his father is not ready to take him in. He is influenced that he will not be able to sufficiently care for Conor.

Cold‐air pool development in a small Alpine valley

A field campaign in a valley near Seefeld, Austria, well known for the frequent occurrence of cold‐air pools, was conducted to identify the processes leading to the formation and erosion of the cold‐air pool. Here, we focus on a case study in January 2020 that featured cold‐air pool formation interrupted by a wind disturbance. Simulations with the Weather Research and Forecasting model were performed at a horizontal grid spacing of 40 m and compared with measurement results. The model was able to reproduce the intense cooling in the beginning of the night and the cold‐air pool erosion in the middle of the night caused by the wind disturbance, but stronger winds than observed prevented the cold‐air pool from fully re‐establishing in the model after the disturbance. The dominant cooling processes were long‐wave radiative heat loss and turbulent exchange, both of which are parametrized and cool the air locally. Advection was the most important warming contribution during the cold‐air pool disturbances, especially its cross‐valley and vertical components. Owing to numerical constraints and the shallow nature of the cold‐air pool, its extent was limited to the lowest model level. Further improvements to the cold‐air pool's representation in the model would require a finer grid resolution.

Developing Topics.

How people with dementia perceive the world has been recently described in better detail, making it easier to understand their unique situations and needs. In caregiving situations, it is desirable to understand the subjective world of people with dementia and to consider the impact of the caregiver's approach. This study aimed to explore how care providers identify cues to understand the needs and subjective world of people with dementia. Overall, 4,000 sites (24.3% sampling rate) were selected from all small facilities (with less than 30 residents) providing dementia care in Japan. A questionnaire was mailed to caregiver leaders, and data was collected online. A two-case vignette depicted a situation in which care staff experienced significant difficulty caring for residents with dementia; one described a resident who refused to bathe and the other a resident who walked around the facility in the middle of the night. In each situation, respondents were asked to speculate on how they would act to understand the thoughts of the person with dementia. The analysis consisted of 1) segmenting and coding the behavioural and verbal descriptions of each scene, and 2) interpreting and categorising the caregivers' intentions. There were 599 respondents (response rate 15.0%); of these, 566 and 558 were for the bathing and night-time situations, respectively. The descripted responses were categorised into the following five groups. 1) Before providing specific care, it is necessary to 'build a secure relationship' by spending time together doing activities and talking about unrelated topics, regardless of the care. 2) To understand the resident's thoughts and feelings, care workers 'explore the subjective world' by asking residents directly about their reasons. 3) Care workers also 'infer from objective information' such as care records and other sources. 4) Caregivers should 'keep trying acceptable methods until the resident agrees to receive care'. 5) Caregivers should 'allow things to not work out as intended'. The study showed that care providers use a variety of strategies to build rapport and respect the autonomy of the residents, such as exploring, speculating, suggesting, and waiting for the residents to express their intentions.

Once-nightly sodium oxybate (FT218) improved symptoms of disrupted nighttime sleep in people with narcolepsy: a plain language summary.

This is a plain language summary of a published article in the journal CNS Drugs. Narcolepsy is a rare sleep condition. Most people with narcolepsy experience disrupted nighttime sleep and have poor quality of sleep. Sometimes these symptoms are not easily diagnosed as a symptom of narcolepsy. Sodium oxybate is an approved treatment for narcolepsy. The only version of sodium oxybate that was available until 2023 required people to take their sodium oxybate at bedtime and then again in the middle of the night. The US Food and Drug Administration (FDA for short) has approved a once-nightly bedtime dose of sodium oxybate (ON-SXB for short, also known as FT218 or LUMRYZ™) to treat symptoms of narcolepsy in adults. These symptoms are daytime sleepiness and cataplexy, which is an episode of sudden muscle weakness. The once-nightly bedtime dose of ON-SXB removes the need for a middle-of-the-night dose of sodium oxybate. The REST-ON clinical study compared ON-SXB to a placebo (a substance that contains no medicine) to determine if it was better at treating symptoms of disrupted nighttime sleep associated with narcolepsy. This summary looks at whether; ON-SXB was better than placebo at treating symptoms of disrupted nighttime sleep. Compared to people who took placebo, people who took ON-SXB had fewer number of changes from deeper to lighter sleep stages and woke up less during the night. They also reported that they slept better at night and felt more refreshed when waking up in the morning. People with narcolepsy sometimes take alerting agents to help with sleepiness during the day, but alerting agents can cause difficulty sleeping at night. This study showed that people who took ON-SXB had better nighttime sleep even if they were taking alerting agents during the day. The most common side effects of ON-SXB included dizziness, nausea (feeling sick to your stomach), vomiting, headache, and bedwetting. A once-nightly bedtime dose of ON-SXB is a narcolepsy treatment option for people without the need for a middle-of-the-night dose of sodium oxybate.

The Effect of Progressive Muscle Relaxation Exercises on the Sleep Quality of Menapause Women in the Kolaka Health Center Work Area

Menopause is the final phase of a woman's reproduction or it is said that the last menstruation experienced by a woman has a psychological impact, especially sleep disorders.. Four of five women who were surveyed stated that their sleep was often disturbed, especially when it was difficult to fall asleep and woke up feeling it was the middle of the night so they complained of blisters in the morning because the duration of sleep at night was around 4 o'clock. The purpose of this study was to analyze the quality of sleep of mothers before and after carrying out progressive muscle relaxation exercises. Quasy Experiment Method in one group pre test-post test design is the method used with a sample of 30 respondents. The quality of sleep before exercise and after exercise progressive muscle relaxation was measured using a questionnaire. Provision of progressive muscle relaxation exercises in accordance with Standard Operating Procedures (SOP). There were significant differences in the quality of sleep of mothers before and after progressive muscle relaxation exercises on sleep quality of postmenopausal women, namely sleep quality (p value 0.000), sleep latency (p value 0.000), efficiency (p value 0.000), sleep disturbance (p value 0.000), sleep disturbance (p value 0.000), value 0.001), and disturbed activity (0.005). Postmenopausal women's sleep quality improves after doing progressive muscle relaxation exercises is effective. It can be said that the application of progressive muscle relaxation exercises in menopausal women is very good so that the quality of sleep for menopausal women is of high quality.

THU249 Use Of The Pittsburgh Sleep Quality Index In People WithT2DM: Initial Results Of The Diabetes Sleep Assessment (DSA) Study

Abstract Disclosure: S. Shaikh: None. S. Shaikh: None. S. Shaikh: None. A. Shaikh: None. M. Shaikh: None. Z. Memon: None. R. Sayed: None. Background: The Pittsburgh Sleep Quality Index (PSQI) is a well-known, validated, and reliable instrument used to measure the clinical construct of sleep quality. PSQI > 5 indicates poor sleep quality. Aim: To evaluate PSQI for psychometric properties through glycemic and anthropometric parameters, in T2DM who are on regular follow-up for glycemic care Method: We examined 236 known T2DM in the Diabetes Sleep Assessment (DSA) study, an ongoing observational study examining the effect of control of diabetes and metabolic parameters on the quality of sleep Results: The glycemic and anthropometric parameters were age 55 years (±11, 95% CI 53 to 56), BMI 28 kg/m2 (±5.8, 95% CI 28 to 29), FPG 140 mg/dl (±50, 95% CI 134 to 147), PPG 197 mg/dl (±76, 95% CI 188 to 207), HbA1c 7.4% (±1.2, 95% CI 7.1 to 7.6), duration of diabetes 9.2 years (±, 7.5 95% CI 8.3 to 10), neck circumference 36 cm (±6.2, 95% CI 36 to 37), waist circumference 117 cm (±17, 95% CI 114 to 119). 76.2% (n=180) had PSQI >5. The mean PSQI was 8.3 (±3.7, minimum 0, maximum 19, 95% CI 7.8. to 8.8). No significant correlation was found between PSQI and glycemic and anthropometric parameters. The greatest dysfunction (>3 component score) was reported to get up to go to the bathroom by 66.9% (n=158), followed by waking up in the middle of the night or early morning by 49.1% (n=116). The median time to go to bed and wake in the morning was 11 pm and 7 am, respectively. The median no. of hours to fall asleep, for actual sleep and in bed were 1, 6.5, and 8, respectively. Mean PSQI in the group with inadequate glycemic control (HbA1c >7, n=130), was 8.4 (±3.9) as compared to the group with adequate glycemic control (HbA1c ≤7, n=106), which had a mean PSQI 8.1 (±3.5), was comparable, p=0.56 (ns). Conclusion: Our results reveal that the anthropometric parameters have no significant impact on the quality of sleep and are independent of the glycemic control in T2DM. The need to go to the bathroom at night and wake up in the night or early morning were the largest contributors to the poor quality of sleep. The result of our study needs large-scale, multi-centric collaboration to further address the gaps and challenges to improve the quality of sleep in T2DM Presentation: Thursday, June 15, 2023

THU315 Sleep And Circadian Regulation, And Intrinsically Photosensitive Retinal Ganglion Cells Function In Diabetic Retinopathy

Abstract Disclosure: S. Reutrakul: None. J.J. McAnany: None. J.C. Park: None. F.Y. Chau: None. K.K. Danielson: None. P. Bharati: None. S. Pannain: None. E. Van Cauter: None. E.C. Hanlon: None. Background: Diabetic retinopathy (DR) is associated with a dysfunction of intrinsically photosensitive retinal ganglion cells (ipRGCs), a crucial component of the entrainment of the circadian system and of the photic entrainment of melatonin secretion. We explored ipRGC function, sleep, 24-h melatonin and cortisol profiles in patients with and without DR. Methods: Type 2 diabetes patients with DR (n=10) and without DR (n=7,) participated. ipRGC function was inferred from the post illumination pupil response (PIPR). Sleep was assessed by 14-day actigraphy. Serum was sampled at hourly intervals for 24hrs for melatonin and cortisol measurement. Results: Mean (SD) age (53.8 (8.1) vs (54.0 (8.6) yr) and mean A1C (7.5 (1.7) vs. 7.1 (0.9)%) did not differ between DR and no-DR patients. PIPR was significantly smaller in DR than no-DR patients (0.14 (0.16) vs. 0.33 (0.10), p=0.001). Nightly sleep duration and efficiency were similar, but sleep variability (standard deviation of daily sleep duration over 7 nights) tended to be larger in DR than no-DR patients (84.1 (29.8) vs. 59.5 (21.8) minutes), p=0.08. Twenty four-hour serum melatonin output was significantly lower in DR than no-DR patients (103.1 (95.4) pg/ml vs. 231.1 (131.3) pg/ml, p=0.034). All no-DR patients exhibited the classical 24-h profile of melatonin with consistently low levels during the day time and a clear nocturnal rise peaking around the middle of the night. In contrast, a normal melatonin rhythm was observed only in 3 of the 10 patients with DR. Six DR patients had 24-h mean melatonin level under 3 pg/ml, five without any evident day-night pattern. One DR patient had a shift in melatonin timing. There was a significant correlation between PIPR and 24-h melatonin output, r= 0.726, p<0.001, but not with sleep variability. In contrast, mean 24-h cortisol profiles and levels, however, were not significantly different between the two groups (mean levels DR 6.18 (1.23) vs no-DR 6.18 (0.73) μg/dL), Conclusion: DR is associated with ipRCGs dysfunction, irregular sleep, and with major disruptions of the 24-hour melatonin rhythm while cortisol rhythm was maintained, suggesting circadian dysfunction in those with type 2 diabetes and retinopathy. Whether melatonin supplementation is beneficial in type 2 diabetes with DR should be explored. Presentation: Thursday, June 15, 2023

Redefining Comorbid Insomnia and Sleep Apnea: The Association of Sleep Breathing Impairment and Insomnia with Incident Diabetes.

Rationale: Obstructive sleep apnea (OSA) is a prevalent sleep disorder that is frequently comorbid with insomnia and often accompanied by metabolic diseases such as type 2 diabetes. Although the apnea-hypopnea index (AHI) is currently the diagnostic criterion for gauging the severity of OSA, the AHI has not consistently predicted incident diabetes. Objectives: To test whether a combined insomnia-OSA (COMISA) phenotype based on comorbid insomnia and sleep breathing impairment index (COMISA-SBII) predicts incident diabetes and to compare the association with an AHI definition of COMISA (COMISA-AHI) in the MrOS (Osteoporotic Fractures in Men) study. Methods: The study samples came from participants in the MrOS sleep study without diabetes at their baseline examination. The SBII was derived as the product of the duration of each respiratory event (apnea and hypopnea) and the accompanying desaturation area from baseline unattended polysomnography. A subgroup of individuals classified as having comorbid insomnia (difficulties falling asleep, waking up in the middle of the night and/or early morning awakenings >15 times per month, and daytime impairments) and sleep breathing impairment (greater than 50th percentile of SBII) were identified at baseline. The primary outcome was incident diabetes during the follow-up visits. Cox proportional models were built to assess the adjusted hazard ratios of COMISA-AHI and COMISA-SBII. Prediction model performances of incident diabetes were compared across different models. Results: A total of 2,365 men (mean age, 76 yr) without diabetes at baseline were included. During a median follow-up of 10.0 years, diabetes developed in 181. After adjusting for demographic characteristics, comorbidities, and behavioral risk factors, participants with COMISA-SBII had a higher risk of incident diabetes (hazard ratio, 1.82; 95% confidence interval, 1.15-2.89) than those without sleep disorders (those with an SBII ⩽13.17 and no insomnia). The result remained significant in the risk competing model. Compared with COMISA-AHI, the addition of COMISA-SBII to a crude model with established risk factors significantly improved the predictive value of incident diabetes. Conclusions: COMISA-SBII, but not COMISA-AHI, predicted incident diabetes after accounting for multiple covariates in a cohort of older men. A comorbid insomnia phenotype based on SBII plus insomnia symptoms may be an important clinical subtype.

PENGALAMAN KUALITAS TIDUR PADA PASIEN HIPERTENSI : STUDI FENOMENOLOGI

Hypertension is one of the leading causes of death and one of the diseases with the highest incidence in the world. Hypertension can be caused by several factors such as age, gender, personality type, genetic factors, obesity, exercise, diet, lifestyle, stress, and sleep patterns. Poor sleep quality is a factor in the occurrence of physical, psychological, environmental and lifestyle problems. The physical problems caused include a decrease in daily activities, weakness, fatigue, decreased endurance, and instability of vital signs, while psychological factors impact depression, anxiety, and difficulty concentrating. Study was to determine the experience of sleep quality in hypertensive patients at the Karanganyar 1 Health Center. The design of this study was qualitative using a phenomenological approach by involving 3 hypertension participants who had poor sleep quality. Three themes that emerged were then used to reflect the objectives of the study, including: 1) perceptions of hypertensive patients about sleep quality 2) problems perceived by hypertensive patients with sleep quality 3) how hypertensive patients deal with sleep quality. All participants experienced poor sleep quality, such as difficulty sleeping, short sleep hours, frequent daytime sleepiness, waking up in the middle of the night, difficulty sleeping again. Participants felt complaints such as dizziness, neck pain, and participants experienced drug dependence.

Relationship between Sleep Quality and Anxiety-Depressive Disorders in Moroccan Women with Breast Cancer: A Cross-Sectional Study.

Breast cancer is the most common female cancer in the world. Sleep disruption is one of the major problems of breast cancer patients. This study aimed to evaluate the quality of sleep in a group of Moroccan women with breast cancer and analyze the association between sleep quality, depression, and anxiety. This cross-sectional study was carried out among 337 Moroccan women treated for breast cancer at the Mohammed VI Cancer Treatment Center in Casablanca in 2019. A questionnaire was designed for this purpose based on two scales: Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety Depression Scale (HADS). 71.5% of the participants had significant sleep disturbances; the subjective quality of patients' sleep was considered to be quite poor (20.8%) and 43.9% of participants need more than 60 minutes to fall asleep. The average sleep duration was 6.16 h/night and 84.3% of patients had not taken sleep medicines in the last month. The most common reasons for sleep disturbances were getting up to use the bathroom (67.4%) and waking up in the middle of the night or early morning (54%). Anxiety and depression were positively correlated with PSQI scores. The present study highlights how much breast cancer patients are vulnerable to psychological disorders and then incites the decision makers in oncology departments to implement rigorous psychological health care strategies in order to ameliorate mental health and sleep quality of breast cancer patients.