Nocturnal Awakenings Research Articles

Insights into the Overlap of Chronic Obstructive Pulmonary Disease and Sleep Apnea: Experience from the Clinic of Pneumology, Târgu Mureș

Introduction: Chronic obstructive pulmonary disease (COPD) has a severe impact on patients’ health and can lead to multiple complications. Material and methods: We analyzed the co-occurrence of obstructive sleep apnea (OSA) in COPD patients hospitalized in the Pneumology Clinic of Târgu Mureș, Romania. Results: A total of 150 COPD patients were investigated by clinical examination, STOP-BANG and Epworth questionnaires, ventilatory polygraphy (PG), EKG, cardiac ultrasound, blood lipids, and sugar. Sixty-eight patients (45.3%) had OSA associated with COPD. A total of 61.7% were COPD gr. E, and 30.8% were gr. B. Frequently shown symptoms were snoring and nonrestorative sleep (100%), somnolence (73.5%), nocturnal awakenings (41.17%), morning headache (32.3%), and aggravated dyspnea. Types of OSA included obstructive (97.05%), central (2.5%), and associated obesity–hypoventilation (39.7%). A total of 76.4% were recently diagnosed with OSA. Men predominated at 70.5%, 76.4% were smokers, and 61.7% had experienced alcohol abuse. A total of 25% were overweight, and 71% had obesity. A total of 13.2% belonged to the category of 38–50-year-olds, 55.8% were in the 51–65-year-old category, 17.6% were in the 66–70-year-old category, and roughly 13.2% were in the 71-year-old category. Overlap syndrome (OS) comorbidities and complications were frequently present: 41% experienced respiratory failure, 66.1% experienced blood hypertension, 58.8% experienced ischemic cardiac disease, 32.35% experienced diabetes mellitus, 50% experienced dyslipidemia, and 29.4% experienced cor pulmonale. Conclusions: OS conferred gravity or directly contributed to cardiovascular, respiratory, and metabolic complications. OS was associated with more severe COPD and obesity. The prevalence of smoking in OS patients was higher than the national/European average.

Nutritional management, skipping breakfast, glycemic control, and cardiovascular risk on type 2 diabetes mellitus

Abstract Background Meal timing is an emerging field that investigates the influence of eating patterns on circadian rhythm and general health. There is still disagreement in the literature as to whether eating windows could impact weight gain and biochemical markers. Purpose 1- Evaluate the impact of nutritional interventions on weight, body mass index (BMI), waist circumference (WC), fasting blood glucose (FG), glycated hemoglobin (HbA1c), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), triglycerides, systolic blood pressure (SBP), and diastolic blood pressure (DBP), between 0th and 12th month in Type 2 Diabetes Mellitus (T2D); 2-Observe breakfast skipping and sleep disorders, and also analyze the influence of these data with possible changes in anthropometric and biochemical markers. Methods This experimental and observational study recruited 44 participants with T2D. The assessments were carried out in October 2022 and 2023. The nutritional assessment consisted of prescribing a personalized eating plan (Mediterranean diet and DASH). Statistical analysis: For the variables "breakfast habits", "nocturnal awakenings", and "sleep duration", the numbers of participants were converted into percentages of the total number of individuals. Parametric variables were compared using the paired t-test and non-parametric variables were compared by the Wilcoxon test. To evaluate the influence of the habit of eating breakfast and sleep disorders on quantitative variables, variations were calculated between the 0th and 12th month between participants who had or did not have the habit of eating breakfast and had or did not have sleep disorders. Parametric variables were compared using the unpaired t test and non-parametric variables using the Mann-Whitney test. Parametric data were presented as mean ± standard deviation and non-parametric data as median ± interquartile range, both accompanied by the dispersion of all repetitions. α<0.05 and P<0.05 were adopted. Results Significant reductions were found between the 0th and 12th month of FG, HbA1c, LDL-C, triglycerides, SBP, DBP, BMI, WC, and weight (p<0.0001). Regarding breakfast habits, in the 1st month, 77.3% of participants skipped this meal, reducing to 13.6% in the 12th month. For sleep duration, in the 1st month, 90.9% of participants slept less than 6 hours, reducing to 40.9% in the 12th month. For nocturnal awakenings, 70.5% of participants had at least 1 awakening in the 1st month, reducing to 54.5% in the 12th month. For influence analysis, no significant differences were found between changes in FG, HbA1c, LDL-C, triglycerides, SBP, DBP, BMI, WC, and weight on breakfast habit or sleep disorders, except for HDL-C and sleep disorders (p<0.005). Conclusion Nutritional management improved biochemical markers, reduced anthropometric data, regulated the eating window, reduced nocturnal awakenings, and optimized sleep duration in patients with T2D.

Infant and Toddler Sleep: The Existing Knowledge Gaps!

Abstract Background: Sleep architecture of infants is vastly different from adults and a significant knowledge gap exists in understanding infant sleep. We aimed to study infant sleep behavior by using validated revised Brief Infant Sleep questionnaire at a tertiary care center in Western Maharashtra. Methodology: We enrolled 65 infants from 1 month to 3 years of age visiting Pediatric OPD between October 2023 to March 2024. We aimed to study infant sleep behavior in a cross section of population at a tertiary care center with a view to find out prevalence of behavioral insomnia of childhood in study population. Results: Around 38.5% children were sleeping less than 5 hours at night and 12.3 % were sleeping only for 6-7 hours. 58.5% children had prolonged sleep onset latency between 30-60 minutes. Around 27.7% children had sleep latency even more than 60 minutes after being put to bed. 70.8% children reported nocturnal awakenings of whom 18.3% reported frequent awakenings. Total sleep duration in our study was 8.592 ± 1.79 hours (Mean ± 2SD). Longest stretch of nocturnal sleep was 5.869 ± 3.72 hours (Mean ± 2SD). Based on the total duration of sleep, prevalence of behavioural insomnia of childhood in our study was 41.5%. The most common associations with behavioural insomnia of childhood were breastfeeding, bottle feeding and rocking but the results were not statistically significant. Conclusion: Prevalence of behavioral insomnia of childhood in India is higher than western population. Indian children have shorter average sleep duration compared to their western counterparts. Bedtime routine needs to be observed regularly to avoid development of behavioral insomnia of childhood which requires strict bedtime rules and consistency.

Nocturnal Awakening Associated with Greater Social Disconnectedness in Older Adults: The Compensatory Role of Cognition

ABSTRACT Objectives This study aimed to explore the association between sleep and social disconnectedness by examining the role of global cognitive function in diverse samples of older adults. Methods Study 1 compared differences in social disconnectedness between older adults with clinical sleep disorders and healthy sleepers. Studies 2 and 3 examined the relationship between objective sleep and social disconnectedness in community-dwelling older adults from two independent datasets. In the three studies, we analyzed the moderating effect of global cognitive function in the association between objective sleep and social disconnectedness. Results Study 1 showed that older adults with clinical sleep disorders had greater social disconnectedness, among whom those with better cognition showed less influence of sleep disorder on social disconnectedness. Studies 2 and 3 showed that nocturnal awakening was robustly associated with social disconnectedness in community-dwelling older adults. Global cognitive function moderated this association, counteracting the negative effect of nocturnal awakening on social function. Conclusions These findings suggest a relationship between objective sleep, particularly nocturnal awakening, and social disconnectedness, and the compensatory role of global cognitive function. Clinical Implications Geriatric caregivers are encouraged to consider cognitive interventions to mitigate sleep-related, specifically excessive nocturnal awakening-related, social disconnectedness in older adults.

Characterizing disrupted nighttime sleep and associated functional outcomes in youth with narcolepsy type 1.

Disrupted nighttime sleep (DNS) and sleep instability are common in children and adolescents with Narcolepsy Type 1 (NT1), but optimal objective sleep measures have not been determined. We compared self-reported and objective sleep measures between young people with NT1 and healthy controls (HC) and test the hypotheses that the Wake/N1 Index is the best objective measure of perceived nocturnal wakings vs. other DNS measures reported in the literature and is associated with daytime functional problems. N=26 HC and N=27 NT1 participants ages 8-21 years completed a 15-item habitual sleep quality survey and an in-lab polysomnogram. We compared group survey responses and performed stepwise regression of sleep quality and instability measures with a survey question ("During the night, I wake more than once"). Last, we used logistic regression to identify associations between the Wake/N1 Index with daytime functional concerns across groups. Compared to HC, NT1 participants reported more frequent restless sleep, nighttime moaning/groaning/talking, tossing and turning, and nocturnal wakings (all p's < 0.01), but no greater difficulties in falling asleep or returning back to sleep. Across groups, self-reported waking from sleep was associated with increased Wake/N1 Index and SSRI/SNRI use. The Wake/N1 Index was associated with daytime fatigue but no other behavioral or cognitive concerns. DNS is a multi-factorial complaint that differs from insomnia. We believe the Wake/N1 Index is a useful sleep instability measure that should be helpful in research and as a treatment target in clinical practice, especially for fatigue concerns.

A case study on the exposure-response relationship of sleep disturbance due to road traffic noise - As a case in Japan in the 2020s

A socio-acoustic survey was conducted among residents living along major arterial roads in Kanagawa Prefecture, Japan, to examine the occurrence of sleep disturbances due to road traffic noise. Lnight noise maps was introduced for estimating ranges from 30 dB to 80 dB. We asked the frequency of "difficulty falling asleep," "nocturnal awakenings," "early morning awakenings", "feeling unrefreshed in the morning",and "daytime sleepiness" due to road traffic noise. Cases experiencing any of these items more than three times a week were defined as "highly sleep disturbed (HSD)", and that one or twice a week were defined as "sleep disturbed (SD)", respectively. The exposure response relationships between those and Lnight were examined with the independent variables of noise sensitivity, gender, and age. The results of multiple logistic regression analysis revealed that Lnight, and noise sensitivity had a significant effect on SD, while noise sensitivity significantly affected HSD. We show the results of this study in comparison with previous surveys on sleep disturbances conducted in Japan and other regions.

70 - From nocturnal awakenings to nocturnal voiding: the relationship between insomnia and nocturia. A systematic review.

70 - From nocturnal awakenings to nocturnal voiding: the relationship between insomnia and nocturia. A systematic review.

Dream habits in a large cohort of preteens and their relation to sleep and nocturnal awakenings.

The present study examined dream habits, and their relation to sleep patterns, in 1151 preteens (597 boys; 554 girls; 11.31 ± 0.62 years old). Dream questionnaires assessed the frequency of dream recall, nightmare, and lucid dream, as well as the intensity of emotions experienced in dreams. Sleep variables included sleep duration and efficiency, but also different measurements of nocturnal awakenings. Among the preteens, 49.21% of them reported that they recalled dreams several times a week or almost every morning over the past few months. In addition, 52.00% of the preteens reported that they experienced nightmares, and 45.48% lucid dreams, less than once a month or never over the past few months. No gender differences were observed in dream variables. Nocturnal awakenings were linked to all dream variables, while sleep duration and sleep efficiency were related to nightmare frequency and emotions in dreams. Importantly, sleep duration and sleep efficiency were not associated with dream recall nor lucid dream frequency, with Bayesian analyses supporting the null hypothesis. These findings offer a comprehensive understanding of preteens' dreams and their connection to key sleep aspects.

Changes in Sleep of Families After the Arrival of an Autism Service Dog.

This study aimed to investigate the changes in sleep quality and quantity among families following the arrival of an autism service dog. We hypothesized that the sleep of the child or adolescent with autism spectrum disorder (assessed objectively with actigraphy and subjectively with a parent-reported sleep diary), and of both parents (assessed by self-reported diaries) would improve after the dog's arrival. The sleep of 18 youths (15 boys) aged from 5 to 16 years (M = 8.86), and of their parents (14 mothers, 11 fathers) was assessed for a 5- to 7-day period before (pretest) and eight to ten weeks after the dog's arrival (posttest). A designated parent (the same at the pretest and posttest) completed the sleep diary of the child, who wore an actiwatch in the meantime. Significant improvement in most sleep parameters was observed from pretest to posttest for the child and the mother, as reported in the sleep diaries. However, there was no improvement in the child's sleep when assessed objectively. Fathers' sleep duration increased after the dog's arrival, when adjusting for the child's age. All significant effects had medium to large sizes. This study provides the first quantitative evidence of the positive effect of autism service dogs on the sleep of families. These findings suggest that the dog's presence may increase the sense of safety for the child, who would resume sleeping faster or stay in the bedroom after nocturnal awakenings, leading to improved parents' sleep.

Nursing intervention in older adults with insomnia

Introduction. Aging is loosely related to the chronological age of the person and in turn to the loss of physical, functional, psychological and social capacities. Sleep is a physiological process of fascination and of vital importance for the comprehensive health of the human being, the aging process alters the stages of sleep, which in the long term has side effects and represents economic costs for those older adults who are prescribed with pharmacological treatments. The amount of sleep remains constant throughout adult life, which is why doctors recommend that older adults sleep 7 to 8 hours a day to meet their sleep needs. There are sleep problems in older adults and one of them is insomnia, which is reflected in their daily lives, which is why music therapy appears as a non-pharmacological treatment to help reduce insomnia. Objetive. To evaluate the effect of nursing intervention in older adults with insomnia. Methodology. This research is quantitative, quasi-experimental in design, longitudinal and descriptive in scope. It was carried out in a period between April 2024-June 2024, in the province of Tungurahua, Canton Ambato, Parroquia La Matriz, Neighborhood Ciudadela España. The sample was 21 older adults from the Hogar de Ancianos Sagrado Corazón de Jesús, who met the inclusion and exclusion criteria. Results. The results obtained in this research demonstrate that music therapy as a nursing intervention has positive effects on older adults with insomnia. Conclusion. With the application of the Athens Test before and after the music therapy sessions, a significant improvement was shown in various aspects of sleep, such as difficulty falling asleep, nocturnal awakenings and total sleep duration.

Multivariate time series approaches to extract predictive asthma biomarkers from prospectively patient-collected diary data: a systematic review

ObjectivesLongitudinal data are common in asthma studies, to assess asthma progression in patients and identify predictors of future outcomes, including asthma exacerbations and asthma control. Different methods can quantify temporal...

Biologics in T2 Severe Asthma: Unveiling Different Effectiveness by Real-World Indirect Comparison.

Background: Indirect comparison among biologics in severe asthma (SA) is a challenging but desirable goal for clinicians in real life. The aim of the study is to define characteristics of a biologic-treated T2-driven-SA population and to evaluate the effectiveness of biologic treatments in a real-world setting by variation in intra/inter-biologic parameters in an up to 4-year follow-up. Methods: Demographic, clinical, functional, and biological characteristics were evaluated retrospectively in 104 patients recruited until July 2022 at baseline (T0) and over a maximum of 4 years (T4) of biologic therapy (omalizumab/OmaG = 41, from T0 to T4, mepolizumab/MepoG = 26, from T0 to T4, benralizumab/BenraG = 18, from T0 to T2, and dupilumab/DupiG = 19, from T0 to T1). Variations of parameters using means of paired Delta were assessed. Results: At baseline, patients had high prevalence of T2-driven comorbidities, low asthma control test (ACT mean 17.65 ± 4.41), impaired pulmonary function (FEV1 65 ± 18 %pred), frequent exacerbations/year (AEs 3.5 ± 3), and OCS dependence (60%). DupiG had lower T2 biomarkers/comorbidities and AEs, and worse FEV1 (57 ± 19 %pred) compared to other biologics (p < 0.05). All biologics improved ACT, FEV1%, FVC%, AEs rate, and OCS use. FEV1% improved in MepoG and BenraG over the minimal clinically important difference and was sustained over 4 years in OmaG and MepoG. A significant RV reduction in OmaG (T4) and DupiG (T1), and BenraG normalization (T2) of airflow limitation were found. We observed through inter-biologic parameters pair delta variation comparison a significant nocturnal awakenings reduction in BenraG vs. OmaG/MepoG, and neutrophils reduction in BenraG/DupiG vs. OmaG. Conclusions: Indirect comparison among biologics unveils clinical and functional improvements that may mark a different effectiveness. These results may highlight the preference of a single biologic compared to another with regard to specific treatable traits.

Respiratory Status in Children and Exposure to Animal Allergens-The Problem of Reverse Causality in Cross-Sectional Studies.

Some epidemiological studies suggest that early exposure to animal allergens during infancy reduces the risk of bronchial asthma in school-age children. However, the observed associations in some cases may be an effect of the study used (epidemiological observational studies, especially a cross-sectional study) and indicate reverse causality. This study aimed to determine the association between exposure to animal allergens and the prevalence of respiratory diseases, including bronchial asthma, considering the potential impact of reverse causality on the observed relationships. An analysis of data from a cross-sectional epidemiological study conducted in 2020 involving 3237 primary school students aged 7-15 years in the Silesian Province (Southern Poland) was carried out. The parents of students completed a questionnaire based on The International Study on Asthma and Allergies in Childhood (ISAAC). The relationship between the occurrence of chronic cough, wheezing, and dyspnea in the last 12 months, night waking due to dyspnea, and asthma in the presence of pets was assessed. Exposure to animal allergens was determined by answering the question, "Are there any furry or feathered animals in the home?" with three response options: "yes; they have been in the past; no" (Scenario 1). For the analyses and to reveal a potential reverse causality effect, the last two response categories regarding pet ownership were combined to form a "no" category in Scenario 2, and the first two answers were combined into a "yes" category in Scenario 3. A chi-square test was used to assess the relationship between variables, and a statistical significance level of p < 0.05 was adopted. Chronic cough affected 9.5% of children, wheezing in the last 12 months-9.2%, night waking due to dyspnea-5.8%, dyspnea in the last 12 months-4.8%, bronchial asthma-9.2%. Analysis considering the category of having or not having pets (yes vs. no) showed that bronchial asthma was statistically significantly more common in children who did not have pets at home (10.9% vs. 7.9%, p = 0.002). A similar situation was observed for wheezing in the past 12 months (10.7% vs. 8.1%; p = 0.01) and nocturnal awakening due to dyspnea (6.8% vs. 5.1%, p = 0.03). No statistically significant differences were observed for the other symptoms. Analysis by time of pet ownership (a. present; b. present but in the past; c. not present) highlighted similar relationships. Asthma (a. 7.7% vs. b. 13.4% vs. c. 7.7%; p = 0.004), wheezing in the past 12 months (a. 8.1% vs. b. 8.9% vs. c. 10.9%, p = 0.03) and night waking (a. 5.0% vs. b. 4.5% vs. c. 7.1%; p = 0.04) were more common in children without pets and those who had owned pets in the past. The highest proportion of children with asthma was in homes where pets were present in the past. Analyses indicating a relationship between a higher prevalence of asthma and some respiratory symptoms, and the absence of pets cannot be considered as a casual association. The analysis conducted did not reveal a reverse causality effect. The results of observational epidemiological studies, especially a cross-sectional study, should always be interpreted with caution, considering possible distortions and conclusions drawn.

Correlates of multidimensional sleep in premenopausal women: The BioCycle study

PurposeTo identify sleep dimensions (characteristics) that co-occur in premenopausal women. The second aim was to examine associations between multiple dimensions of sleep and a set of demographic, lifestyle, and health correlates. The overarching goal was to uncover patterns of poor-sleep correlates that might inform interventions to improve sleep health of women in this age group. MethodsThe BioCycle Study included 259 healthy women aged 18–44y recruited between 2005 and 2007 from Western New York. Participants reported sleep data through daily diaries and questionnaires that were used to create five sleep health dimensions (duration, variability, timing, latency, and continuity). We used multivariate analysis – canonical correlation methods – to identify links among dimensions of sleep health and patterns of demographic, psychological, and occupational correlates. ResultsTwo distinct combinations of sleep dimensions were identified. The first - primarily determined by low variability in nightly sleep duration, low variability in bedtime (timing), greater nocturnal awakening, and less sleep onset latency – was distinguished from the second – primarily determined by sleep duration.The first combination of sleep dimensions was associated with older age and higher parity, fewer depressive symptoms, and higher stress level. The second combination of sleep dimensions was associated with perception of longer sleep duration as optimal, lower parity, not engaging in shift work, older age, lower stress level, higher prevalence of depressive symptoms, and White race. ConclusionAmong premenopausal women, we demonstrated distinct patterns of sleep dimensions that co-occur and vary by demographic, health, and lifestyle correlates. These findings shed light on the correlates of sleep health vulnerabilities among young women.

Impact of an Intervention Aimed at Improving Sleep Quality in Hospitalized Children.

Hospitalized children need adequate sleep to favor early recovery. To study the sleep pattern of children admitted to a pediatric inpatient unit, a cross-sectional study was carried out at a reference hospital in northern Spain. The main study variables were medical specialty of admission, sleep-inducing treatment, hours of sleep at home and during admission, number of nocturnal awakenings, and reasons for awakening. Differences in the hours of sleep and nighttime awakenings between the initial period and at six months were calculated using the Student's t-test. We included 100 baseline patients and 100 post-intervention patients. Up to 4% of the baseline sample and 3% of the six-month sample had been prescribed a sleep-promoting drug. Regarding awakenings, 79% of the children in the baseline sample suffered awakenings, with a mean of 1.98 awakenings (range 1-13). At six months, the percentage of children who experienced awakenings decreased by 17%, with a mean of 1.34 (range 1-5). In the baseline sample, 48% were caused by nursing care, decreasing to 34% after the intervention. An educational intervention with the implementation of targeted evidence-based practices is a useful measure for improving the sleep pattern by decreasing the number of awakenings.

Hot flashes and sleep disruption in a randomized trial in menopausal women

BackgroundHot flashes, common during menopause, affect up to 80% of Western menopausal women and are reported to contribute to sleep disturbances in midlife. Few prospective data are available to confirm the specific role of hot flashes in disrupting sleep in midlife women, however, or confirm whether changes in hot flashes in response to clinical therapies result in improvement in sleep. ObjectiveTo examine the effects of continuous nitroglycerin therapy on sleep quality in peri- and postmenopausal women with frequent hot flashes (pre-specified secondary trial endpoint), and to examine prospective associations between hot flashes and sleep disruption in this population. Study DesignSleep data were analyzed from a randomized, double-blinded, placebo-controlled trial of continuous transdermal nitroglycerin (NTG) therapy to suppress nitric oxide-mediated vasodilation in peri- or postmenopausal women with hot flashes. Participants were randomized to uninterrupted use of transdermal NTG (0.2-0.6 mg/hour) or placebo for 12 weeks. Nocturnal hot flashes awakening participants from sleep were evaluated using 7-day symptom diaries at baseline, 5 weeks, and 12 weeks. Sleep disruption (wake time after sleep onset, WASO) was assessed using validated sleep diaries, and global sleep quality was assessed by the validated Pittsburgh Sleep Quality Index (PSQI: range 0 [best] 21 [worst]) questionnaire. Mixed linear models examined changes in sleep quality and disruption, as well as the strength of associations between nocturnal hot flash frequency and sleep outcomes, over 5 and 12 weeks, adjusting for baseline values, age, race, and ethnicity. ResultsAmong the 141 participants (70 to NTG and 71 to placebo, mean age 54.6 [±3.9] years), the mean baseline hot flash frequency was 10.8 (±3.5) per day, including 2.6 (±1.7) nocturnal hot flashes awakening participants. At baseline, hot flashes were the most commonly reported reason for nocturnal awakening, with 62.6% of participants reporting waking due to hot flashes at least twice nightly. Over 5 and 12 weeks, mean frequency of nocturnal hot flashes causing awakenings decreased in both groups (NTG: -0.9 episodes/night, placebo: -1.0 episodes/night). Sleep disruption as measured by average nightly WASO also decreased (NTG: -10.1 minutes, placebo: -7.3 minutes), and mean PSQI score improved (NTG: -1.3 points, placebo: -1.2 points). No significant between-group differences in change in sleep outcomes were detected from baseline to 5 and 12 weeks, including PSQI sleep quality score as a pre-specified secondary trial endpoint (P ≥ .05 for all). Greater improvement in nocturnal hot flash frequency over 5 and 12 weeks was associated with greater improvement in PSQI sleep quality score (β= -0.30, P=.01) and sleep disruption reflected by WASO (β= -1.88, P=.02) in the combined sample. ConclusionAmong menopausal women in a randomized trial of continuous NTG therapy for hot flashes, hot flashes were the most frequently reported cause of nocturnal awakenings. Compared to placebo, continuous NTG therapy did not result in greater improvements in sleep quality from baseline to 5 and 12 weeks. Based on night-by-night symptom diaries and questionnaires, however, greater improvement in nocturnal hot flash frequency in both groups was associated with greater improvement in sleep quality and disruption.

Association Between Gastrointestinal and Sleep Problems in the General Population of Japan: A Cross-Sectional Community-Based Observational Study.

Background and aim Poor sleep is known to be associated with functional gastrointestinal (GI) problems in the general population, but the exact mechanisms underlying the relationship remainunclear. Deeper insights into the exact mechanisms underlying the connection may benefit individuals suffering from these conditions without efficient treatments. Therefore, this study investigated the association between functional GI symptom levels and sleep-related characteristics in the general population of Japan. Methods In this cross-sectional questionnaire-based observational study, data including the self-reported levelof poor sleep and functional GI symptoms in the last one month were collected fromconsecutive individuals who visited a hospital in Miyagi Prefecture, Japan, for regular medical checkups between April 2020 and March 2023. The levels of other physical and mental conditions, such as stress at home, fatigability, irritability, thermoregulatory problems, and edema in the limbs, were measured with an 11-point Numerical Rating Scale (NRS) between 0 and 10. Additional sleep-related specific information, such as sleep length, wake-up time, bedtime, trouble falling asleep, and nocturnal awakening, were further collected. Correlations with functional GI symptoms in these characteristics were evaluated by bivariate correlation analyses and generalized regression analyses. Results A total of 151 consecutive adults aged ≥18 years (77 males and 74 females) participated in this study. In bivariate correlation analyses, chronic GI symptom levels were significantly correlated with stress at home (p=0.0005), fatigability (p=0.0008), irritability (p=0.0022), edema in the limbs (p<0.0001), and sleep problem (p<0.0001). In the following generalized regression analysis, significant correlations with GI symptom levels were observed in sleep problems (p=0.0042) and edema in the limbs (p=0.0256). Further bivariate correlation analyses using sleep-related subscales revealed that trouble falling asleep in bed (p=0.0001), midnight awakening (p=0.0143), and wakeup time (p=0.0465) were correlated with GI symptom levels. In the following generalized regression analysis, a significant correlation withGI symptom levels was observed in trouble falling asleep (p=0.0239). Conclusion Functional GI symptoms in the general population of Japan were associated with poor sleep, even after adjusting for daily stress and irritability levels. Among the sleep-related characteristics, trouble falling asleep was associated with GI dysfunctions. Assessing sleep-related information and achieving good sleep quality with smooth sleep induction may be a clue to relieving GI dysfunctions with uncertain causes.

Children's nocturnal awakenings and sleep duration during the first two years of life in the NASCITA cohort study

PurposePrevious studies have analyzed the characteristics and prevalence of sleep disturbances among Italian children. Less attention has been paid, however, to the factors involved in sleep disturbances in the first two years of life. The goals of the present study were, therefore: 1) to provide a developmental trajectory of Italian infants' night awakenings and duration during the first two years of life and 2) to analyze which factors affect night awakenings the most over time. MethodsData for this study were collected in the NASCITA cohort. During the well-child visits conducted at 6, 12, and 24 months, pediatricians asked parents to report if the child had any sleep disturbances, especially frequent night awakenings. Univariate and multivariable analyses were performed to test the association between child and family variables and the likelihood of frequent awakenings. Results2973 toddlers, out of 5054 initially enrolled newborns, were included in this study; 875 (29.4 %) of whom presented frequent awakenings in at least one visit (peak of prevalence of 19.8 % at 12 months). Bed-sharing (adjusted OR 2.53; 95%CI:2.05–3.12) and living in the northern Italy (aOR 2.25; 95%CI:1.80–2.81) were the variables more strongly associated with an increased likelihood of frequent awakenings in the binomial logistic regression, while sleeping alone was associated with a decreased chance (aOR 0.62; 95%CI 0.45–0.89). A short sleep duration (<11 h/day) was reported for 801 (26.9 %) at 12 months, for 743 (25.0 %) at 24 months of age; in 383 cases, the short sleep duration was reported at both time points. An association was observed between frequent awakenings at 12 or 24 months and short sleep duration (OR 1.23; 95%CI 1.05–1.44 -ꭓ2 6.25, p = 0.012). ConclusionsThe current study identified some early predictors of frequent awakenings during the first two years of life. Since optimal sleep practices in children are essential for their development, effective, early interventions must be defined and integrated into pediatric care practices.

QOL-25. DETERMINING THE BURDEN OF SLEEP PATHOLOGY AMONG PEDIATRIC NEURO-ONCOLOGY PATIENTS

Abstract BACKGROUND Children with brain and spinal cord tumors are at higher risk for sleep disruption. The incidence and characteristics of sleep difficulties in this population is not well understood. Our aim is to use survey and chart review to retrospectively and prospectively evaluate the frequency, severity, and types of sleep difficulties experienced by pediatric patients who have brain and spine tumors. METHODS Pediatric patients with a diagnosis of a brain or spinal cord tumor and their parents were surveyed at three time points during routine visits with their neuro-oncology team. Parents and children completed the following self-reported standardized surveys: The San Diego Pediatric Sleep Survey (Child) and The San Diego Pediatric Sleep Survey (Parent). RESULTS Identified sleep disturbances include difficulty initiating sleep, excessive movement while asleep, increased incidence of nocturnal awakening, and snoring. We identified high rates of behavioral and environmental modifiers of sleep quality including sleeping in a shared bed with another family member and poor sleep hygiene. CONCLUSIONS Identification of sleep disruption and factors contributing to sleep difficulties in this high risk population will encourage proactive screening and recognition of these issues in future patients. Next steps include implementation of interventions such as referral to appropriate specialists, sleep hygiene modification, and parent/patient education. Early intervention may lead to overall improvement in quality of life and health, including increased academic success and job productivity in children and their caregivers.

Insomnia in patients undergoing Autologous Hematopoietic Stem Cell Transplantation

Background: Insomnia has an elevated incidence in patients who receive autologous Hematopoietic Stem Cell Transplantation (HSCT), which can lead to psychic and physical dysfunctions and impair immunological and neuroendocrine processes, hence compromising the response to treatment. The aim of this study is to evaluate the incidence, severity, and changes in time of insomnia in patients following autologous HSCT. Identify the factors affecting the quality of sleep and, in the end, identify the number of nocturnal awakenings and night interruptions by healthcare personnel.Methods: insomnia was detected through the Insomnia Severity Index (ISI) questionnaire. The questionnaire was handed out in three different periods: on the first day of hospitalization (T0), the day after the transplantation (T1), and at the discharge (T2). The questionnaire was given out at the hematology ward in two hospitals in Italy.Results: The convenience sample consisted of 31 patients. 42% of patients (N=13) in the pre-hospitalization, 58% (N=18) the day of transplantation, and 65% (N=20) at discharge showed insomnia symptoms: a significant difference between the ISI score at T0 and the ISI score at T1 and T2. There was a relationship between the ISI score and the presence of adverse effects of chemotherapy.Conclusion: Insomnia is already present in patients following autologous HSCT from pre-admission and worsens during hospitalization. In detecting the symptoms of insomnia, the nurse plays an important role. Multidisciplinary management, both medical and nursing, is essential.