Pittsburgh Sleep Quality Index Score Research Articles

Determining the Relationship Between Sleep Problems, Shock Pain, and Shock Anxiety in Patients With ICD.

This study aimed to determine the relationship between sleep problems, shock pain, and shock anxiety in patients with implantable cardioverter defibrillator (ICD) and the affecting factors. The population of this descriptive cross-sectional study consisted of all patients who underwent ICD implantation in university hospital (N = 200), and the sample consisted of patients who met the inclusion criteria of the study (n = 132). Data were obtained using a "General Information Form", the "Florida Shock Anxiety Scale (FSAS)", the "Epworth Sleepiness Scale (ESS)", the "Pittsburgh Sleep Quality Index (PSQI)", and the "Visual Pain Scale (VPS)". The mean age of the patients was 66.13 years. The VPS was 6.40±3.36; the mean FSAS score was 29.98±8.46; the mean PSQI score was 8.02±3.81; the mean ESS score was 7.59±4.10. PSQI had a statistically significant correlation with the total FSAS score (p<0.001) and a statistically insignificant correlation with ESS (p>0.001). Age, sex, marital status, smoking status, cohabitants, previous ICD shocks, the status of lying on ICD, and fear of dislocation of ICD affected the total FSAS score; sex, employment status, history of heart attack, defined sleep disorder, awakening from sleep due to nightmares, and cessation of breathing during sleep affected the total PSQI score; history of previously defined sleep disorder, history of heart attack, use of medication for a sleep disorder, the pain felt when lying on ICD, and pain experienced during ICD shocks affected the total ESS score. The mean shock VPS scores differed between patients who received an ICD shock during sleep and those who were awakened by nightmares. It was found that the shock anxiety and shock pain scores of ICD patients were above average, that they had poor sleep quality, and that their sleepiness was at the level of "normal but increased daytime sleepiness".

Effects of chamomile oil inhalation on sleep quality in young adults with insomnia: A randomized controlled trial.

Insomnia is characterized by difficulty falling asleep, staying sleep, or both. Aromatherapy is a commonly used complementary and alternative medicine practice by persons with insomnia. Previous studies have shown that use of chamomile oil during massage therapy improves the quality of sleep (QoS). However, to our knowledge, no randomized controlled trials have examined the effects of chamomile oil inhalation on the treatment of insomnia. The present study evaluated the effect of chamomile oil inhalation on QoS and insomnia severity in persons with insomnia. A total of 80-participants ages 18-35 with insomnia were randomly allocated to aromatherapy group (AG; n = 40) or a control group (CG; n = 40). Those in the AG group received chamomile oil inhalation, while those in the CG engaged in their normal routine for 10minutes a day, daily for 15 days. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were administered before and after the intervention. Within-group analysis showed a significant reduction both in PSQI and ISI scores among those in the AG (P < 0.001 for both scores), whereas the CG reported a significant reduction in PSQI score (P = 0.033) and no significant changes in ISI score (P = 0.068). The between groups analysis after the intervention demonstrated a significant reduction in PSQI and ISI scores in the AG group (P < 0.001 for both) compared to the CG. No participant in either group reported adverse events during or after the study. Fifteen days of chamomile oil inhalation before bedtime reduced insomnia severity and enhanced the quality of sleep for young adults suffering from insomnia. Further studies are needed to replicate the results of this study using an active control group.

The altered hypothalamic network functional connectivity in chronic insomnia disorder and regulation effect of acupuncture: a randomized controlled neuroimaging study.

The hypothalamus has been recognized as a core structure in the sleep-wake cycle. However, whether the neuroplasticity of the hypothalamus is involved in the acupuncture treatment of insomnia remains elusive. We recruited 42 patients with chronic insomnia disorder (CID) and 23 matched healthy controls (HCs), with CID patients randomly assigned to receive real acupuncture (RA) or sham acupuncture (SA) for four weeks. Insomnia severity was evaluated using the Pittsburgh Sleep Quality Index (PSQI) score, and the resting-state functional connectivity (rsFC) of the hypothalamus was assessed via functional magnetic resonance imaging (fMRI). In the cross-sectional investigation, CID patients showed increased rsFC between the medial hypothalamus (MH) and left lateral orbital frontal cortex (LOFC), and bilateral medial orbital frontal cortex (MOFC) compared to HCs. In the longitudinal experiment, PSQI scores significantly decreased in the RA group (p = 0.03) but not in the SA group. Interestingly, the increased MH-LOFC connectivity was found to be reduced following RA treatment. In addition, the altered rsFC of MH-LOFC significantly correlated with clinical improvement in the RA group (r = -0.692, p = 0.006). This randomized neuroimaging study provides preliminary evidence that acupuncture may improve insomnia symptoms by restoring circuits associated with hypothalamic subregions. This trial has been registered on the Chinese Clinical Trial Registry ( www.chictr.org.cn ) with the identifier (ChiCTR1800017092). Registered date: 11/07/2018.

Moderated serial mediation effects of adaptation problems, academic stress, and interpersonal relationships on the sleep quality of early-year university students

PurposeDue to heightened anxiety levels, sleep disorders become more prevalent among university students. This study, centered on adaptive capacity in early-year university students, aimed to explore the underlying mechanisms through which anxiety affects sleep quality.MethodsBetween February 2023 and June 2023, a cohort of first- and second-year university students (mean age 18.8 years) from Hunan Province, China, took part in an online survey. Anxiety was assessed using the Self-rating Anxiety Scale; adaptation problems, academic stress, and interpersonal relationships were assessed using the Adolescent Self-Rating Life Events Checklist; and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). A moderated serial mediation model, based on Hayes’ Model 92, was used to assess the hypothesized model.ResultsThe survey resulted in 3,490 valid responses. Among respondents, 24% exhibited anxiety symptoms and 30.4% showed abnormal sleep patterns (i.e., PSQI score ≥ 8). The most significant path identified based on indirect effects was anxiety (β = 0.109), adaptation problems (β = 0.183), academic stress (β = 0.081), and sleep quality (all p-values &amp;lt; 0.001). Furthermore, interpersonal relationships moderated the effects of adaptation problems (β = −0.015, p &amp;lt; 0.001), academic stress (β = −0.012, p &amp;lt; 0.001), and anxiety (β = 0.003, p = 0.002) on sleep quality.ConclusionElevated anxiety and sleep disorders are common among university students. Adaptive capacity may play a crucial role in sleep disorders among early-year university students. Interventions such as fostering strong interpersonal relationships in campus environments, may prove beneficial in improving academic performance and sleep quality.

Effects of Jin's three-needles therapy combined with low-frequency repetitive transcranial magnetic stimulation on sleep disorders and EEG in children with spastic cerebral palsy

To investigate the effects of Jin's three-needles therapy combined with low-frequency repetitive transcranial magnetic stimulation (rTMS) on sleep disorders and EEG activity in children with spastic cerebral palsy (CP). By using stratified randomization method, 100 children of spastic CP with sleep disorders were randomly assigned to a control group and an observation group, with 50 cases in each group. The patients in the control group were treated with medication, comprehensive rehabilitation training, and low-frequency rTMS, while the patients in the observation group were treated with Jin's three-needles therapy in addition to the interventions given to the control group. Acupoints selected included temporal three needles, brain three needles, intelligence three needles, four spirits needles, and bilateral Ganshu (BL 18), Shenshu (BL 23), Shenmai (BL 62), and Zhaohai (KI 6). Treatment was given once daily, five times a week, for 12 weeks. The Pittsburgh sleep quality index (PSQI) and children's sleep habits questionnaire (CSHQ) scores, modified Ashworth grade, Peabody developmental motor scales-2 (PDMS-2) score, and relative power values of δ, θ, β1, and β2 frequency bands in EEG were observed before and after treatment in both groups. Treatment safety was also evaluated. Compared before treatment, PSQI and CSHQ scores were decreased in both groups after treatment (P<0.05), with lower scores in the observation group than the control group (P<0.05). The modified Ashworth grade showed improvement (P<0.05), with better results in the observation group (P<0.05). PDMS-2 scores were increased in all dimensions (P<0.05), with higher scores in the observation group (P<0.05). Relative power values of δ and θ frequency bands in EEG were decreased (P<0.05), with lower values in the observation group (P<0.05), while relative power values of β1 and β2 frequency bands were increased (P<0.05), with higher values in the observation group (P<0.05). Children in both groups did not occurred obvious adverse reactions. Jin's three-needles therapy combined with low-frequency rTMS can effectively improve sleep disorders, spasticity and motor function, regulate EEG activity in children with spastic CP and sleep disorder, and have good safety.

Clinical study of different frequency transcranial magnetic stimulation combined with paroxetine in the treatment of poststroke depression with insomnia.

Study the treatment of poststroke depression and insomnia using varied repetitive transcranial magnetic stimulation (rTMS) frequencies alongside paroxetine. Aim to enhance rTMS effectiveness for depression, insomnia, neurological impairment, and daily living skills. Ninety poststroke depression (PSD) patients were randomly divided into a low-frequency group (low-frequency rTMS + enteric-coated paroxetine), a high-frequency group (high-frequency rTMS + enteric-coated paroxetine), and a control group (sham stimulation + enteric-coated paroxetine). The treatment was administered 5 times a week for a total of 2 weeks. Before treatment, at the end of the 2-week treatment, and at the end of the 6-week follow-up, the 3 groups of patients were assessed using the Hamilton Depression Rating Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), National Institutes of Health Stroke Scale (NIHSS), and Modified Barthel Index (MBI). The mean differences of scores measured at different frequencies and at different times were analyzed by repeated measure one-way analysis of variance. The interaction between different frequency and score before and after treatment was significant. HAMD, PSQI, and NIHSS scores of the 3 groups after 2 weeks of treatment and 6 weeks of follow-up were significantly lower than before treatment, while MBI scores were opposite. The main effect of treatment scores in different frequency groups showed that HAMD, NIHSS, and MBI scores were not significantly different among the 3 groups before treatment. The HAMD, PSQI, and NIHSS scores of the low frequency group and the high frequency group were significantly lower than those of the control group after treatment, and the MBI scores were the opposite, except that there was no significant difference in HAMD-17 scores among the 3 groups at the 6-week follow-up. Among them, HAMD score in high-frequency group was significantly lower than that in low-frequency group, and PSQI score was significantly higher than that in low-frequency group. Low-frequency rTMS combined with medication has a better therapeutic effect on the insomnia symptoms of PSD, while high-frequency rTMS combined with medication has a more pronounced therapeutic effect on the depressive symptoms of PSD. Both high-frequency and low-frequency rTMS have an improving effect on neurofunctional deficits and activities of daily living.

Smartphone-Based Cognitive Behavioral Therapy and Customized Sound Therapy for Tinnitus: A Randomized Controlled Trial.

To evaluate the efficacy of a smartphone-based application providing tinnitus-specific cognitive behavioral therapy and customized sound therapy for tinnitus. In a prospective randomized controlled trial, the treatment group participated in daily sound therapy and weekly interactive CBT modules, and the control group did not receive the program (waitlisted). Outcome measures after 8 weeks included the Tinnitus Functional Index (TFI), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Perceived Stress Scale (PSS), and Pittsburgh Sleep Quality Index (PSQI). Ninety-two patients (mean age = 57.2 ± 11.9 years) were included. The treatment (n = 47) and control (n = 45) cohorts had similar TFI, PHQ-9, GAD-7, PSS, and PSQI scores at presentation (all P > .05). Treatment-group patients had significantly higher improvements than controlled patients in their TFI (16.7 ± 14.9 vs 1.9 ± 10.8, P < .001), PHQ-9 (1.9 ± 4.2 vs -0.7 ± 3.4, P = .002), GAD-7 (1.1 ± 3.6 vs -0.9 ± 3.3, P = .009), and PSQI scores (2.5 ± 3.2 vs -1.1 ± 2.1, P < .001). Treatment-group subjects also significantly improved in 7 of the 8 TFI domains (all P < .05). TFI improvements of ≥20 occurred in 18 (38.3%) treatment subjects. Of the 9 treatment-group patients presenting with moderate-severe depression, 4 (44.4%) improved to minimal depression. Of the 4 treatment-group patients with moderate-severe anxiety, 2 (50.0%) improved to minimal anxiety. Of the 17 treatment-group patients with moderate-severe sleep difficulties, 10 (55.6%) had considerable sleep improvement. This novel smartphone application providing cognitive behavioral therapy and customized sound therapy was effective in reducing symptom severity and improving anxiety, sleep, and mood for tinnitus patients.

Effect of weighted blankets on sleep quality among adults with insomnia: a pilot randomized controlled trial.

Weighted blanket is an emerging non-pharmacotherapy for sleep disorders, but its effect on sleep among relatively healthy adults with insomnia remains uncertain. This study aimed to evaluate whether weighted blankets could better improve sleep quality and sleep-related symptoms among adults with insomnia. In a prospective, pilot randomized controlled trial conducted in three tertiary hospitals in China, participants with clinical insomnia were randomized (1:1) to receive weighted blanket intervention or normal blanket intervention for 1 month by random-number tables. The primary outcomes were sleep quality assessed with Pittsburgh Sleep Quality Index (PSQI) and insomnia severity assessed with Insomnia Severity Index. Subjective outcomes were measured at baseline, 1 week, and 1-month post-intervention. Sleep was also objectively monitored by actigraphy. We did analysis by intention to treat. A total of 102 participants were randomly assigned to receive weighted blanket intervention (n = 52) or normal blanket intervention (n = 50). 95 (93.1%) participants completed the follow-up, and 7 (6.9%) participants dropped out of the study. The weighted blanket group had significant improvements in sleep quality compared to the normal blanket group after 1 month of intervention (changes in the mean [SD] of PSQI score: -4.1 [4.1] vs. -2.0 [3.2], P = 0.006). Similar results were observed for daytime sleepiness, stress, anxiety, fatigue, and bodily pain (all P < 0.05). Recordings from actigraphy showed a decrease in the mean (SD) of the number of awakenings in weighted blanket group (-1.4 [9.5]) and an increase in normal blanket group (+ 1.0 [7.9]) (P = 0.280). No severe adverse events occurred. Weighted blanket might be an effective, safe and promising non-pharmacotherapy tool for improving sleep-related symptoms among adults with insomnia, although validation with a larger sample size is needed. Chinese Clinical Trial Registry: ChiCTR2300078011, date of registration: 11/27/2023, retrospectively registered.

The association between nicotine dependence and sleep quality in patients referred to a smoking cessation outpatient clinic: A cross-sectional study.

Nicotine addiction is one of the most common forms of dependence. It is shown to be associated with many chronic diseases that develop mostly through smoking. The association between sleep quality and smoking or nicotine addiction has not been clarified yet. This study aimed to investigate the association between nicotine addiction and sleep quality. In this cross-sectional study, the Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), Fagerström test for nicotine dependence (FTND), and Hospital anxiety-depression scale (HADS) were administered to patients who applied to the smoking cessation outpatient clinic of a reference hospital between April and June 2023. FTND measured nicotine dependence, and its association with sleep quality estimated by PSQI was assessed by binary logistic regression with the potential confounders. In the study group of 280 participants, 67.1% were male, and 57.8% had poor sleep quality. The median (IQR) FNTD score was 7.0 (3.0), and the median global PSQI score was 6.0 (5.0). Poor sleep quality increased by 1.12 times (AOR=1.12; 95% CI: 1.02-1.22, p=0.016) for each unit increase in hospital anxiety score and by 1.22 times (AOR=1.22; 95% CI: 1.05-1.42, p=0.011) for each unit increase in FTND score. Increased nicotine dependence and anxiety are independently associated with poor sleep quality. The findings support smoking cessation efforts. It is recommended to study the effect of combating anxiety and tobacco addiction to improve sleep quality.

Improvement of sleep quality and sub-health conditions through pasteurized fermented milk consumption: A human intervention study

The sub-health state refers to a transitional condition between optimal health and disease, impacting physical, psychological, and social well-being. In this 42-day human intervention trial, we investigated the effects of two pasteurized fermented milks on sub-health symptoms. These pasteurized fermented milks shared the same starter culture and probiotic strains (Lacticaseibacillus paracasei PC-01, Lactiplantibacillus plantarun Lp-6, Lactobacillus helveticus H9, and Bifidobacterium animalis subsp. lactis Probio-M8), differing only in the presence of inulin. Qualified subjects were randomly assigned to the probiotic group (received milk without inulin; n = 49 or synbiotic group (received milk with inulin; n = 51). Outcome measures included Sub-Health Measurement Scale (SHMS) and Pittsburgh Sleep Quality Index (PSQI) scores, fecal metagenomes, metabolomes, and short-chain fatty acids, and serum neurotransmitter levels at baseline, after a 4-week intervention (day 28), and a 2-week-follow-up period (day 42). Our results showed that both pasteurized fermented milks improved sleep quality and alleviated sub-health symptoms, with no significant added benefit from inulin. Fecal metagenome analysis revealed post-interventional changes in gut microbial composition, including increased Bifidobacterium longum and decreased potentially pro-inflammatory bacteria (Blautia sp. and Dorea sp.). Changes in Blautia sp. and B. longum correlated significantly with SHMS and PSQI scores, respectively. Fecal and serum metabolite analysis showed post-interventional modulation of fecal short-chain fatty acids, anti-inflammatory bioactive metabolites, and serum neurotransmitters such as gamma-aminobutyric and serotonin hydrochloride. In conclusion, pasteurized fermented milk intake alleviated sub-health symptoms, affected the gut microbiome, metabolome, and serum metabolites. These findings highlight the potential of pasteurized fermented milk for mitigating sub-health conditions.

Interactions between pregnant women's nutrition habits, psychological well-beings, sleep quality and biochemical parameters.

Hormonal changes during pregnancy may cause various changes in biological, physiologic and psychosocial areas. The main objective of this study was to analyze the relationship between dietary habits, psychological well-being, sleep quality and biochemical parameters of pregnant women. The study was conducted on a total of 93 patients who applied to Ankara Koru Sincan Hospital Gynecology and Obstetrics Outpatient Clinic for routine pregnancy control between November-December 2023, were between the ages of 18-45, had a live singleton fetus, had no diagnosed psychiatric disease or chronic disease, and agreed to participate in the study. Anthropometric measurements and biochemical findings of the individuals were recorded with a questionnaire including the psychological well-being scale (PWBS) and Pittsburgh sleep quality index (PSQI). According to the study, PSQI scores during the second and third trimesters are significantly higher than the first trimester. It was observed that while individuals have bad sleep quality during the second and third trimesters, they have good sleep quality during the first trimester (χ2 = 14.736; P < 0.001). In the biochemical results, the thyroid-stimulating hormone (TSH) value in the second trimester was higher (P > 0.05). Weight gain during pregnancy, age and trimester have a negative effect on sleep quality. When the effects of lifestyles and eating habits of pregnant women on the process are considered, there is a relationship between smoking/alcohol consumption, less physical activity, poor eating habits, sleep quality and depressive symptoms. Factors such as age, educational background, trimester period and other basic sociodemographic variables are also involved.

Association of sleep disturbances with diminished ovarian reserve in women undergoing infertility treatment

With an aging population seeking infertility treatment, diminished ovarian reserve (DOR) is a prevalent indication for assisted reproductive technology (ART). This study aims to investigate the relationship between sleep parameters and DOR among women attending an infertility clinic. Methods We consecutively enrolled women attending an infertility clinic from July 2020 to June 2021. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale(ESS), and STOP-Bang Questionnaire to assess self-reported sleep quality. DOR-related indices including antral follicle count, anti-Müllerian hormone(AMH), follicle-stimulating hormone (FSH) were evaluated. A total of 979 women were enrolled, with 148 classified into the DOR group and 831 in the non-DOR group. The DOR group was notably older compared to the non-DOR group. Analysis showed that the DOR group exhibited significantly shorter sleep onset latency (p = 0.001) and shorter total sleep duration (p = 0.014) compared to the non-DOR group. Logistic regression analysis identified age, PSQI-sleep latency, and PSQI score as independent factors associated with an increased risk of DOR(all p < 0.05). Furthermore, stratified analysis by age group revealed that snoring and PSQI-sleep latency were particularly notable risk factors for DOR among women aged 35 years and older (OR = 2.489, p = 0.040; OR = 2.007, p = 0.008, respectively). Our study highlights that shorter sleep onset latency and shorter total sleep duration may be associated with DOR among women undergoing ART treatments. Particularly noteworthy, snoring and sleep latency were identified as additional risk factors for DOR among women aged 35 years and older.

Sleep quality and associated factors in adults living in the southern Brazil: A population-based study

ObjectiveTo analyze sleep quality and associated socio-demographic and lifestyle factors in participants from a city originally colonised by Germans in southern Brazil. MethodsA cross-sectional population-based study of 2333 individuals aged 20 to 79 years. Data was collected by interview using a structured questionnaire. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The prevalence of poor sleep quality (PSQI score five or more) was estimated and the associations with study variables were measured by crude and adjusted prevalence ratios using Poisson regression. Resultsparticipants were mostly women (50.9 %), with an average age of 43.3 years. The median total PSQI score was 4 (IQ = 3-7). The frequency of poor sleep quality was 32.7 % (95 % CI 30.7-34.4), higher in older adults (44.0 % vs 30.7 %; p<0.001) and women (40.0 % vs 25.2 %; p<0.001). Multivariate analysis showed that women (PR = 1.3; 95%CI 1.1- 1.5; p<0.001), former smokers (PR = 1.2; 95%CI 1.0-1.4; p = 0.014), current smokers (PR = 1.3; 95%CI 1.1-1.5; p = 0.006), depression (PR = 1.5; 95%CI 1.3-1.7; p<0.001), taking 5 or more medications (PR = 1.2; 95%CI 1.1-1.4; p = 0.001), self-perceived fair health (PR = 2.1; 95%CI 1.8-2.4; p<0.001) or poor/very poor health (PR = 2.6; 95%CI 2.1-3.1; p<0.001) were risk factors for poor sleep quality. Germanic culture (PR = 0.8; 95%CI 0.7-0.9; p<0.001), high school (PR = 0.8; 95%CI 0.6–1.0; p = 0.046) or elementary school (PR = 0.7; 95%CI 0.6-1.0; p = 0.025) or being at work (RP = 0.8; 95%CI 0.7-0.9; p = 0.002) were inversely associated with poor sleep quality. ConclusionsWomen, older adults and some clinical, social, cultural and behavioural conditions are associated with poor sleep quality.

Disruptions in Sleep Health and Independent Associations with Psychological Distress in Close Family Members of Cardiac Arrest Survivors: A Prospective Study.

While recent guidelines have noted the deleterious effects of poor sleep on cardiovascular health, the upstream impact of cardiac arrest-induced psychological distress on sleep health metrics among families of cardiac arrest survivors remains unknown. Sleep health of close family members of consecutive cardiac arrest patients admitted to an academic center (8/16/2021 - 6/28/2023) was self-reported using the Pittsburgh Sleep Quality Index (PSQI). The baseline PSQI, focused on sleep in the month before cardiac arrest, was administered during hospitalization and repeated one month after cardiac arrest, alongside the Patient Health Questionnaire-8 (PHQ-8) to assess depression severity. Multivariable linear regressions analyzed associations between total PHQ-8 scores and changes in global PSQI scores between baseline and one month with higher scores indicating deterioration. A prioritization exercise explored potential interventions categorized into the family's information and well-being needs to reduce psychological distress. In our sample of 102 close family members (mean age 52±15 years, 70% female, 21% Black, 33% Hispanic), mean global PSQI scores showed a significant decline between baseline and one month after cardiac arrest (6.2±3.8 vs. 7.4±4.1; p<0.01). This deterioration was notable for sleep quality, duration, and daytime dysfunction. Higher PHQ-8 scores were significantly associated with higher change in PSQI scores, after adjusting for family members' age, sex, race/ethnicity, prior psychiatric history, and patient's discharge disposition [B=0.4 (95% C.I 0.24, 0.48); p<0.01, β=0.5]. Most families expressed a higher priority for information-based interventions over well-being needs to help alleviate psychological distress during the first month following cardiac arrest (76% vs. 34%, p<0.01). A significant sleep health decline was observed among close family members of cardiac arrest survivors during the acute period, with psychological distress associated with this disruption. Understanding these temporal associations will help guide the development of targeted interventions to support families during this uncertain time.

Analysis of vitamin D metabolism, thyroid and autoimmune markers in the vitiligo pathways and their possible interaction with sleep.

Vitiligo is an autoimmune skin disease that can be influenced by stress, including that resulting from sleep deprivation and sleep disturbances. Sleep is essential in the regulation of several hormonal, metabolic and autoimmune pathways that may have important roles in vitiligo. This study aimed to investigate the potential interplay between hormonal, metabolic, and autoimmune markers in vitiligo patients, and the possible influence of sleep quality in these vitiligo pathways. A cohort of 30 vitiligo patients and 26 healthy controls were assessed for various laboratory markers, including thyroid-stimulating hormone (TSH), parathyroid hormone (PTH), serum calcium, 1.25(OH)2D, 25(OH)D, anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG), and antinuclear antibodies (ANA). The study evaluated sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Positive anti-TPO were found in the vitiligo group, but did not in the control group. Vitamin D 25(OH)D mean levels were clinically insufficient in both groups (< 30mg/dL). Reactive ANA was analyzed with 2 variables related to vitiligo: phototherapy and skin activity. No statistical correlation was found in the chi-square test on this relationship. Descriptive findings have shown that the positivity to anti-TPO and anti-TG, associated or not with reactive ANA, was higher in vitiligo group. Great part (85.7%) of vitiligo group were "poor sleepers" (PSQI > 5), which has increased (88.2%) when considering only individuals with signs of vitiligo activity. Autoimmune hypothyroidism and positive anti-TPO are expected in vitiligo, although this marker is not usually measured in the first laboratory screening to this disease. Adequate vitamin D levels may be a key adjuvant in skin pigmentation, and be related to sleep quality and immune regulation, as this vitamin can be related to better sleep and immunomodulation in autoimmune diseases. Evaluating ANA before phototherapy can be controversial, but it should be considered in cases with a poor response to this treatment, or when there is a higher risk of other autoimmune diseases. Poor sleep predominated in the vitiligo group, based on PSQI scores that reported worse subjective sleep in these patients. Worse sleep predominated in individuals with signs of skin activity and reactive autoimmune markers. Screening these components could be important in the management of vitiligo, as maintaining body homeostasis can help to improve the disease course. Sleep should be considered as a potential modulator of several multidirectional vitiligo pathways.

The Impact of Alpha-s1 Casein Hydrolysate On Chronic Insomnia: A Randomized, Double-Blind Controlled Trial

BackgroundAlpha-s1 casein hydrolysate (ACH; Lactium®) is recognized as a supplementary treatment to enhance sleep quality. However, limited studies utilizing objective sleep assessment tools have resulted in a lack of substantial validation. This study aimed to assess the effects of ACH on both subjective sleep assessments and objective polysomnography (PSG) recordings in a hospital-based cohort of Taiwanese individuals with chronic insomnia. MethodsIn this 4-week randomized, double-blind, placebo-controlled trial, 36 participants diagnosed with chronic insomnia were enrolled and randomly assigned to either the ACH or placebo groups. Initially, participants in the ACH group received 600 mg of ACH daily, which was reduced to 300 mg for the latter two weeks; the placebo group received maltodextrin capsules throughout the study. The study utilized polysomnography (PSG), along with detailed sleep questionnaires including the Insomnia Severity Index (ISI), Global Sleep Disorders Score (GSDS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Hospital Anxiety and Depression Scale (HADS), to assess improvements in sleep quality and related health markers. The efficacy of the intervention was assessed through measures of sleep efficiency, stage distribution, and psychological well-being, comparing results from before to after the treatment phase. ResultsThe study demonstrated that ACH treatment notably enhanced sleep quality, evidenced by significant improvements in ISI, GSDS, PSQI, ESS, and HADS scores at both week 2 and 4 (all p-values < 0.05) compared with baseline scores. When compared to the placebo group, the ACH group experienced a marked reduction in GSDS scores over time (p = 0.045). Furthermore, PSG data revealed a significant decrease in sleep onset latency from baseline in the ACH group compared to the placebo group (p = 0.012; -7.7 ± 16.0 minutes vs. 6.1 ± 17.7 minutes for ACH and placebo groups, respectively). These results indicate that ACH treatment effectively improved sleep initiation and overall sleep quality. ConclusionACH Supplementation significantly improved sleep quality, particularly by reducing GSDS scores and sleep onset latency, demonstrating its potential as an effective intervention for chronic insomnia. Future studies with larger samples and exploration of long-term effects are needed to confirm these results.

Efficacy and mechanism of Tiaoshu Anshen Decoction in treating insomnia with spleen and stomach Qi dysfunction: A retrospective study.

This study investigates the clinical efficacy of Tiaoshu Anshen Decoction in treating insomnia characterized by spleen and stomach Qi dysfunction. According to the differences of previous treatment, 94 patients were divided into treatment group and control group. The treatment group was treated with Tiaoshu Anshen Decoction, and the control group was treated with oral esazolam for 2 weeks. We compared serum levels of 5-hydroxyindoleacetic acid (5-HIAA), 5-hydroxytryptamine (5-HT), norepinephrine (NE), dopamine (DA), DASS-21, and HAMD scores before and after treatment. We also evaluated gastrointestinal function, traditional Chinese medicine syndrome scores, quality of life, and adverse reactions, with statistical analysis conducted using SPSS 25.0. The overall efficacy and clinical outcomes were comparable between the 2 groups. Both groups showed increased serum factor levels and decreased Pittsburgh Sleep Quality Index (PSQI), HAMD, and DASS-21 scores post-treatment. Notably, the treatment group exhibited significant improvement in stool consistency, digestive symptoms, DOB < 4 and DOB ≥ 4 distribution, and TCM syndrome scores, outperforming the control group. No adverse reactions were reported in either group. This study suggests that spleen and stomach Qi dysfunction significantly contribute to insomnia, affecting its occurrence, type, and severity. Tiaoshu Anshen Decoction effectively enhances 5-HIAA, 5-HT, NE, and DA levels, reduces inflammatory factors, and improves sleep quality, gastrointestinal function, and overall quality of life. The decoction may exert its effects by regulating Qi dynamics and gastrointestinal function, indicating the gastrointestinal system as a potential key target in treating sleep disorders.

Resting-State Functional Connectome Predicts Sleep Quality Two Months After the First Negative COVID-19 Antigen Test

BackgroundThe COVID-19 pandemic has led to long-term neurological and psychological effects, including sleep disturbances. While prior studies have identified altered brain function post-COVID-19, specific functional connectivity (FC) patterns predicting sleep quality after recovery remain unclear. This study aims to identify FC patterns associated with sleep quality two months after the first negative COVID-19 antigen test. MethodsUsing a connectome-based predictive modeling (CPM) approach, we identified the functional connectome regulating sleep quality based on a 164-region parcellation. Significant connections were analyzed using mediation models to examine their role in the relationship between anxiety, depression, and sleep. ResultsFC between the right cerebellar peduncle and the left VIII of the cerebellum, and between the left middle temporal pole (MTP) and left ventral tegmental area (VTA), significantly predicted Pittsburgh Sleep Quality Index (PSQI) scores for sleep disturbance two months post-recovery (q2 = 0.059, MSE = 0.154, p = 0.017, r = 0.350). Mediation analysis showed a significant indirect effect of FC between the left MTP and VTA on the relationship between generalized anxiety and sleep disturbances (indirect effect = 0.013, 95% CI = [0.002, 0.03], pfdr < 0.05). FC between the right dorsal raphe nucleus and ipsilateral regions—including occipital, parietal, and temporal areas—predicted PSQI scores for daytime dysfunction (q2 = 0.092, MSE = 0.678, p = 0.025, r = 0.342). ConclusionPost-COVID-19 brain connectivity and anxiety predict sleep quality. These findings highlight the potential for targeted therapeutic strategies to improve sleep and identify patients at risk for prolonged disturbances through FC biomarkers.

Sleep quality and the integrity of ascending reticular activating system – A multimodal MRI study

Sleep is crucial for maintaining brain homeostasis and individuals with insufficient sleep are prone to more pronounced brain atrophy as compared to sufficiently sleeping peers. Moreover, sleep quality deteriorates with ageing and ageing is also associated with cerebral structural and functional changes, pointing to their mutual bidirectional interrelationship. This study aimed at determining whether sleep quality and age, separately, affect brain integrity and subsequently, whether sleep significantly modulates the effect of age on brain structural and functional integrity. 113 healthy volunteers underwent a multi-modal MRI imaging to extract information about the microstructure and function of major nodes of the ascending reticular activating system. Sleep quality was assessed by self-administered Pittsburgh's sleep quality index (PSQI) questionnaire. Subject were divided into good (global PSQI score <5) and poor (global PSQI score ≥5) sleep quality group. Whereas only borderline correlations were found between sleep quality and MRI metrics, age exhibited widespread correlations with both functional and microstructural MRI metrics. The latter effect was significantly modulated by sleep quality in ascending reticular activating system, hypothalamus, thalamus and also hippocampus in MRI metrics associated with iron load, cellularity and connectivity, mainly in the subgroup with poor sleep quality. Ergo, our results indicate sleep quality as a substantial contributor to both microstructural and functional brain changes in ageing and call for further research in this emerging topic.

Efficacy of non-invasive brain stimulation for post-stroke sleep disorders: a systematic review and meta-analysis.

This study aimed to systematically assess the clinical efficacy of non-invasive brain stimulation (NIBS) for treating post-stroke sleep disorders (PSSD). We conducted thorough literature search across multiple databases, including PubMed, Web of Science, EmBase, Cochrane Library, Scopus, China Biology Medicine (CBM); China National Knowledge Infrastructure (CNKI); Technology Periodical Database (VIP), and Wanfang Database, focusing on RCTs examining NIBS for PSSD. Meta-analyses were performed using RevMan 5.4 and Stata 14. Eighteen articles were reviewed, including 16 on repetitive Transcranial Magnetic Stimulation (rTMS), one on Theta Burst Stimulation (TBS), and two on transcranial Direct Current Stimulation (tDCS). Meta-analysis results indicated that rTMS within NIBS significantly improved the Pittsburgh Sleep Quality Index (PSQI) score (MD = -1.85, 95% CI [-2.99, -0.71], p < 0.05), the 17-item Hamilton Depression Rating Scale (HAMD-17) score [MD = -2.85, 95% CI (-3.40, -2.30), p < 0.05], and serum brain-derived neurotrophic factor (BDNF) levels [MD = 4.19, 95% CI (2.70, 5.69), p < 0.05], while reducing the incidence of adverse reactions [RR = 0.36, 95% CI (0.23, 0.55), p < 0.05]. TBS significantly improved the PSQI score in patients with PSSD (p < 0.05). Conversely, tDCS significantly improved the HAMD-17 score in PSSD patients [MD = -1.52, 95% CI (-3.41, -0.64), p < 0.05]. Additionally, rTMS improved sleep parameters, including Stage 2 sleep (S2%) and combined Stage 3 and 4 sleep (S3 + S4%) (p < 0.05), while tDCS improved total sleep time (TST) and sleep efficiency (SE) (p < 0.05).Subgroup analysis results indicated: (1) Both LF-rTMS and HF-rTMS improved PSQI scores (p < 0.05). (2) Both rTMS combined with medication and rTMS alone improved PSQI scores (p < 0.05). Compared to the sham/blank group, the rTMS group showed improvements in SE, sleep latency (SL), S1%, S3 + S4%, and REM sleep (REM%). The rTMS combined with medication group showed improved SL compared to the medication-only group (p < 0.05). NIBS effectively improves sleep quality, structure, depression levels, and BDNF levels in PSSD patients, while also being safe. Further investigations into the potential of NIBS in PSSD treatment may provide valuable insights for clinical applications. https://www.crd.york.ac.uk/prospero/, CRD42023485317.