Quality In Adult Patients Research Articles

Nutritional Status and Sleep Quality in Adult Patients with CKD

Nutritional Status and Sleep Quality in Adult Patients with CKD

Variations in vertebral muscle mass and muscle quality in adult patients with different types of cancer

ObjectivesAssessment of malnutrition-related muscle depletion with computed tomography (CT) using skeletal muscle index (SMI) and muscle radiation attenuation (MRA) at the third lumbar vertebra is well validated. However, SMI and MRA values at other vertebral locations and interchangeability as parameters in different types of cancer are less known. We aimed to investigate whether adult patients with different types of cancer show differences in SMI and MRA at all vertebral levels. MethodsWe retrospectively analyzed CT images from 203 patients:120 with head and neck cancer, esophageal cancer, or lung cancer (HNC/EC/LC) and 83 with melanoma (ME). Univariate and multivariate linear regression analyses determined the association between SMI (cm²/m2) and MRA (Hounsfield units) and cancer type at each vertebral level (significance corrected for multiple tests, P ≤ 0.002). The multivariate analyses included age, sex, cancer stage, comorbidity, CT protocol, and body mass index (BMI) (MRA analyses). ResultsSMI was lower in the HNC/EC/LC group versus the ME group at all vertebral levels, except C4 through C6 in the multivariate analyses. Female sex was associated with lower SMI at almost all levels. MRA was similar at most vertebral levels in both cancer groups but was lower at C1 through C4, T7, and L5 in the multivariate analyses. Use of contrast fluid and BMI were associated with higher MRA at all vertebral levels except T8 to T9 and C1 to C2, respectively. ConclusionsSMI, but not MRA, was lower in HNC/EC/LC patients than in ME patients at most vertebral levels. This indicates that low muscle mass presents itself across the various vertebral muscle areas. MRA may less consistently mark muscle depletion in malnourished patients.

Sperm Quality in 1252 Adolescents and Young Adults (AYAs) Undergoing Fertility Preservation Due to Cancer or Nonmalignant Diseases.

Purpose: To investigate the quality of emergency-collected semen samples aimed at sperm cryopreservation provided by adolescents and young adults (AYAs) presenting with cancer or nonmalignant diseases. Methods: This is a prospective cohort study of postpubertal males referred for sperm cryopreservation who provided at least one semen sample for fertility preservation at the Reproductive Medicine Clinic of Karolinska University Hospital, Stockholm, Sweden, between January 2009 and January 2020. Sperm quality was assessed by total sperm count, concentration, and motility. Sperm quality by disease groups was compared with the reference population data of fertile men defined by the World Health Organization (WHO). Results: Among the 1252 patients who provided samples for cryopreservation, 1063 had cancer and 189 had nonmalignant diseases. The most common malignant indications included testicular cancers (n = 501) and Hodgkin lymphoma (n = 102). Among those with nonmalignant disease, 35% (n = 66) had testicular disease. Sperm quality was significantly lower in all groups of patients with cancer compared with the reference population. In total, azoospermia was found in 8% of the patients with cancer, in 9% of those with nonmalignant testicular disease, and in 3% of the remaining men with nonmalignant disease. Conclusion: Sperm quality in adult patients with cancer was significantly impaired compared with the WHO reference population standards for fertile men. For adolescent patients, standard reference values are lacking. AYAs wishing to preserve fertility should receive individualized counseling regarding sperm quality at the time of cryopreservation, and in selected cases, banking of additional samples should be recommended depending on the sperm quality parameters.

Enhancing sleep quality for adult patients: Interventions and insights.

Sleep is critical to a person's physiological and psychological functioning. Approximately 30% to 40% of the general population experiences insomnia, and among patients with mental health conditions, the prevalence of insomnia and other sleep disturbances rises to about 70%. Insomnia is associated with many adverse health issues, including lower immunity, weight gain, elevated BP, and increased mortality, and it is often undiagnosed and either untreated or self-treated. Providers can work together with patients to enact measures-such as implementation of enhanced sleep hygiene, engagement in cognitive behavioral therapy, and treatment of any underlying causes-that can markedly improve patient sleep quality. This article provides an overview of evidence-based best practices and whole-person strategies that NPs can adopt to address poor sleep quality in adult patients, and it serves as a primer for primary care NPs on common presentations of several sleep disorders.

Enhancing sleep quality for adult patients: Interventions and insights.

Sleep is critical to a person's physiological and psychological functioning. Approximately 30% to 40% of the general population experiences insomnia, and among patients with mental health conditions, the prevalence of insomnia and other sleep disturbances rises to about 70%. Insomnia is associated with many adverse health issues, including lower immunity, weight gain, elevated BP, and increased mortality, and it is often undiagnosed and either untreated or self-treated. Providers can work together with patients to enact measures-such as implementation of enhanced sleep hygiene, engagement in cognitive behavioral therapy, and treatment of any underlying causes-that can markedly improve patient sleep quality. This article provides an overview of evidence-based best practices and whole-person strategies that NPs can adopt to address poor sleep quality in adult patients, and it serves as a primer for primary care NPs on common presentations of several sleep disorders.

P189 The effect of infective exacerbations on sleep quality in adult patients with cystic fibrosis

P189 The effect of infective exacerbations on sleep quality in adult patients with cystic fibrosis

Efficacy of the voice therapy protocol (VTP) for adult patients with unilateral vocal fold mobility impairment; a feasibility study

Background: Unilateral vocal fold mobility impairment (UVFMI) causes dysphonia and/or dysphagia, which can significantly affect a patient’s ability to communicate and perform regular daily life activities as well as the quality of life. Voice therapy offers a less invasive and more preferential method for patients. However, there are limitations concerning the integration of multiple therapy approaches. Voice therapy exercises with clear methodologies are required to plan and conduct therapy systematically, and frequency would be required for each exercise. Therefore, this study was conducted by applying the protocols of voice therapy in adult patients with unilateral vocal fold mobility impairment. Objective: This feasibility study is a prospective cohort, pre-post single arm, designed to determine whether the voice therapy protocol (VTP) can enhance voice quality in adult patients with unilateral vocal fold mobility impairment (UVFMI) in a pilot study. Materials and methods: All subjects received 12 sessions of voice therapy protocol, with each session conducted weekly for 45 minutes. The voice therapy protocol applied in this study consisted of vocal hygiene education, abdominal breathing exercises, vocal function exercises, pushing exercises, muscle relaxation exercises, and applied resonance voice therapy. The outcomes of protocols for voice therapy were measured before and after treatment using subjective voice assessments (GIRBAS scale) and objective voice assessments (Dr. Speech program and electroglottography-EGG). Results: Cases 2, 7, 10, 11, and 13 improved after receiving VTP. As for other participants, there are still some voice parameters that need to be monitored. Overall, it was found that the participants’ voice parameters were changing within the acceptable range, with MPT, jitter, shimmer, and HNR values significantly different (p<0.05). Conclusion: The findings of this study indicated that the voice therapy protocol was a worthwhile alternative and could be used to develop further treatment guidelines for adult patients with UVFMI at a speech clinic.

Impact of ultrasound on the perception of health quality in adult patients with rheumatoid arthritis

IntroductionUltrasound has shown its usefulness in multiple aspects in the management of inflammatory joint disease and in particular of rheumatoid arthritis (RA). The evidence using patient outcomes and its aspects related to quality of health care is scarce. The aim of this study is to determine the level of satisfaction in the perception of the quality of health care in a group of patients with RA who underwent ultrasound during the consultation, and whether it is higher than those who did not have the ultrasound. MethodsAn observational, cross-sectional descriptive study was performed. Patients older than 18 years with a diagnosis of RA using the ACR/EULAR classification criteria were included. One group underwent skeletal muscle ultrasound to study RA during the outpatient medical consultation, as decided by the attending physician. After the completion of the medical action according to prior verbal acceptance by the patient, the Servqhos questionnaire and an ultrasound questionnaire were completed. A satisfied patient was defined as one who had 70% or more in the responses in the Servqhos questionnaire greater than or equal to 4, and a score of 5 in this questionnaire was defined as maximum satisfaction. There were no significant differences between the number of satisfied patients in the two groups. Univariate analysis was performed according to the distribution in the ultrasound or non-performing groups. Subsequently, a bivariate analysis of the different questions was carried out according to the distribution in the satisfaction and very high satisfaction groups. It was established if there was any degree of association using the Chi squared test for categorical variables, and the parametric tests (Mann Whitney U) or non-parametric tests (Kruskal-Wallis test) for the numerical variables were performed according to the distribution. ResultsA total of 126 patients were obtained, of whom 62 corresponded to the group of patients who underwent ultrasound during the consultation and 62 to the control group in whom no ultrasound was performed. The majority were women (91%). Ultrasound was mostly performed to study joint disease (93%), with a third of the time to assess more than one aspect. In those on whom the ultrasound was performed, the number of satisfied patients was 56 (90%) and for the control group it was 48 (77%). The difference in the proportion of satisfied patients (13%) was statistically significant (P = .05). A difference was found between the groups in the number of patients with the highest level of satisfaction in the questions regarding presentation of staff and technology (P < .05). The vast majority of patients considered that ultrasound was useful during the consultation (93%), and that it generates greater confidence in the treatments and the doctor (93%). ConclusionsPerforming skeletal muscle ultrasound during consultation in patients with RA improves satisfaction rates of health care, perception of the doctor, and treatments.

Cohort study of sleep quality in adult patients with acute pulmonary exacerbations of cystic fibrosis.

The impact of an acute pulmonary exacerbation of cystic fibrosis (CF) on sleep quality has not been established. Patients have greater burden of symptoms, higher intensity of therapy and are often admitted to hospital outside of their usual sleeping environment. To evaluate the prevalence of, and factors associated with, poor sleep quality in adult patients admitted to hospital with an acute exacerbation of CF lung disease. This prospective, observational study determined the prevalence of impaired sleep quality and associated factors in adult patients admitted to a single CF unit with an acute pulmonary exacerbation of CF. Sleep quality was defined by the Pittsburgh Sleep Quality Index (PSQI), with >5 indicating poor sleep quality. Data were obtained through patient questionnaires, chart review and examination. Sixty-six percent of patients had impaired sleep quality. Patients with poor sleep had more sleep disruption due to pain (median response 'mild sleep disruption' vs 'no sleep disruption'; P = 0.003) and insomnia (mean Insomnia Severity Index (ISI) 13 vs 5; P < 0.001). In patients with symptoms of restless legs, poor sleepers had worse symptoms (mean International Restless Legs Severity Score (IRLSS) 15 vs 5; P = 0.029). Univariate modelling showed relationships between PSQI and symptoms of depression and anxiety as well as with sleep disruption due to pain, general noise and nursing observations. In a multivariable model, ISI was the only variable that remained significantly associated with PSQI. Mean PSQI score increased 0.58 units for each 1 unit increase in ISI (95% CI 0.42-0.73; P < 0.001). Poor sleep quality is common among patients admitted with an acute exacerbation of CF and is strongly associated with insomnia symptoms in this cohort.

Comparison of emotional disturbance, sleep, and life quality in adult patients with painful temporomandibular disorders of different origins.

This study compared the differences in emotional disturbance, sleep, and life quality among adult patients with temporomandibular (TMD) muscle and/or joint pain. The study involved an analytical cross-sectional design. A total of 420 consecutive patients diagnosed with pain-related TMDs based on the Diagnostic Criteria for TMDs (DC/TMD) were recruited from a TMD referral centre and stratified into three groups, namely muscle pain (MP; n = 50), joint pain (JP; n = 329), and combined muscle-joint pain (CP; n = 41). Emotional disturbance, sleep quality, and oral health-related quality of life (OHRQoL) were assessed with the Depression, Anxiety, and Stress Scale-21 (DASS-21), Pittsburgh Sleep Quality Index (PSQI), and Oral Health Impact Profile-TMDs (OHIP-TMDs) respectively. Statistical analyses were performed using the chi-square test, one-way ANOVA, and Pearson's correlation (p < 0.05). Mean age for the three pain groups (females = 349; males = 71) ranged from 37.15 ± 14.91 to 38.60 ± 14.37 years (p = 0.973). Ranking of depression, anxiety, and stress scores was as follows: CP > MP > JP. Significant differences in emotional disturbances were observed (p < 0.001). CP patients had significantly poorer sleep quality than those with JP (p = 0.004). Moreover, OHRQoL was also significantly more impaired as compared to both MP (p = 0.006) and JP (p < 0.001) patients. Correlations between global PSQI and OHIP-TMDs scores were weak to moderate (rs = 0.30-0.47). Patients with combined muscle-joint pain presented higher levels of emotional disturbance than those with only MP or JP. They also had significantly poorer sleep quality and lower OHRQoL. Emotional and sleep health must be considered in the management of painful TMDs.

Correlation Between the Severity of Chronic Rhinosinusitis and Sleep Quality in Adult Patients

Introduction: Chronic rhinosinusitis (CRS) usually accompanied by one of the symptoms (nasal obstruction, rhinorrhea) and one of associated symptoms (facial pain and/or hyposmia/anosmia). In addition, most of CRS sufferers have poor sleep quality. Thus, we aim to determine the relationship between the severity of CRS and sleep quality in adult patients.Methods: This study was cross-sectional method study. Consecutive sampling technique with estimate a proportion in finite population formula was used. The variables studied were the CRS severity based on visual analogue scale (VAS), and subjects’ sleep quality based on the Pittsburgh sleep quality index (PSQI). The data collection was carried out using a questionnaire and analyzed using chi-square test and continued with fisher’s exact test.Results: Of the 24 study subjects, 45.8% were male and 54.2% female. 83.3% had a nasal obstruction, 66.7% had rhinorrhea, 54.2% had hyposmia/anosmia, and 66.7% had facial pain. The severity of subject was mild, moderate and severe by 41,67%, 29,17%, and 41,67% respectively. 87.5% had poor sleep quality. There was no significant correlation between the severity of CRS and sleep quality (p=1,00).Conclusion: Although there was no correlation between CRS severity and sleep quality in adult patients, but CRS patients in general had poor sleep.Further study using more subjects, apply objective assessments, and include other more specific will help describe the correlation in population.

Subjective sleep quality in adult patients affected by Duchenne muscular dystrophy. Beyond nocturnal hypoventilation

ObjectiveIn stable neuromuscular patients under long-term non-invasive ventilation (NIV), subjective sleep quality may be predicted by chronic hypoventilation, as assessed by base excess (BE), and %N3 sleep stage duration. In this study, we explored how other variables, closely associated with self-reported health complaints, contributed to subjective sleep quality in adult patients with Duchenne muscular dystrophy (DMD). MethodsThis is a secondary analysis of a quality of life study in 48 adult DMD patients under NIV therapy, with little evidence of residual hypoventilation. Subjective sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI). A PSQI score >5 was considered indicative of poor sleep quality. Several other symptoms were evaluated: sleepiness, by the Epworth Sleepiness Scale (ESS); depression and anxiety, by the anxiety and depression subscales of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D); autonomic symptoms, by the Composite Autonomic Symptom Score 31; pain, by the Numeric Pain Rating Scale (NPRS); and fatigue, by the Fatigue Severity Scale (FSS). ResultsMean PSQI was 6.1 ± 2.9. Abnormal scores were found for NPRS in 40, for HADS-A in 10 and for FSS in 24 subjects. The NPRS, HADS-A and FSS scores and the N3 sleep stage, independently predicted PSQI (R2 = 0.47, p < 0.0001). ConclusionsIn adult DMD patients, pain, fatigue and anxiety may have a prominent influence on subjective sleep quality. Improvement of sleep quality may be of utmost importance in DMD, as it may ameliorate quality of life and extend its benefits to cardiovascular morbidity and life expectancy.

Sleep quality in adult patients with pulmonary exacerbations of Cystic Fibrosis

Sleep quality in adult patients with pulmonary exacerbations of Cystic Fibrosis

Selective anti-scatter grid removal during coronary angiography and PCI: a simple and safe technique for radiation reduction.

Objectives The aim of this study was to quantify the radiation dose reduction during coronary angiography and percutaneous coronary intervention (PCI) through removal of the anti-scatter grid (ASG), and to assess its impact on image quality in adult patients with a low body mass index (BMI). Methods A phantom with different thicknesses of acrylic was used with a Westmead Test Object to simulate patient sizes and assess image quality. 129 low BMI patients underwent coronary angiography or PCI with or without the ASG in situ. Radiation dose was compared between both patient groups. Results With the same imaging system and a comparable patient population, ASG removal was associated with a 47% reduction in total dose-area product (DAP) (p < 0.001). Peak skin dose was reduced by 54% (p < 0.001). Operator scatter was reduced to a similar degree and was significantly reduced through removal of the ASG. Using an image quality phantom it was demonstrated that image quality remained satisfactory. Conclusions Removal of the ASG is a simple and effective method to significantly reduce radiation dose in coronary angiography and PCI. This was achieved while maintaining adequate diagnostic image quality. Selective removal of the ASG is likely to improve the radiation safety of cardiac angiography and interventions.

Sleep quality change after upper airway surgery in obstructive sleep apnea: Electrocardiogram-based cardiopulmonary coupling analysis.

To test the effect of upper airway surgery on sleep quality in adults with obstructive sleep apnea (OSA) and the potential usefulness of electrocardiogram (ECG)-based cardiopulmonary coupling (CPC) analysis as metrics of sleep quality. Retrospective outcome research. A total of 62 consecutive adult patients with OSA, consisting of 36 with successful and 26 with unsuccessful outcomes, were included in the study. Mean age was 37.7 ± 8.9 years, and body mass index (BMI, kg/m(2) ) was 26.9 ± 2.3. We compared clinical characteristics (age, BMI, and Epworth Sleepiness Scale [ESS]), sleep (sleep efficiency, stage non-rapid eye movement [N]1, N2, N3, rapid eye movement, and arousal index [ArI]), respiratory (apnea index [AI], apnea-hypopnea index [AHI], and minimum arterial oxygen saturation [SaO2 ]), and CPC (high-frequency coupling [HFC], low frequency coupling [LFC], very-low-frequency coupling, and elevated low-frequency coupling [e-LFC]) parameters between the success and nonsuccess groups before and after surgery. Surgical success was defined when the postoperative AHI was both <20 per hour and 50% of the preoperative value. Sleep quality measured by CPC analysis improved significantly (HFC, P = .001; LFC, P = .002; e-LFC, P = .003), along with parallel reduction in ESS, respiratory parameters (AHI, AI, minimum SaO2 ), and sleep fragmentation (ArI) in the group with surgical success after upper airway surgery. Successful upper airway surgery can improve objective sleep quality in adult patients with OSA. CPC metrics of sleep quality are potentially useful to monitor therapeutic responses during long-term postoperative follow-up, as the ECG-based analysis is available as a standalone option outside laboratory polysomnography.

Sleep quality in adult patients with sleep related bruxism

Sleep related bruxism (SB) is the grinding of teeth during sleep and may also be associated with various sleep disorders. However, little is known about sleep structures and disturbances of SB. This study aims to further understand sleep architectures using overnight polysomnography (PSG) in patients with SB. We analyze sleep parameters and architectures in 33 healthy subjects and 25 patients with SB. PSG and sleep questionnaires measured sleep variables including proportions of rapid eye movement (REM) sleep, non-REM sleep (N1, N2 and N3), latency to sleep onset, sleep efficiency, wake after sleep onset (WASO), apnea hypopnea index (AHI), respiratory disturbance index (RDI), and periodic limb movement index (PLMI) during sleep for both groups. Sleep efficiency and the proportion of N3 in the SB group were significantly lower than in the control group (P < 0.05). In addition latency to onset of sleep and WASO were markedly increased in the SB group (P < 0.05). AHI, RDI, and PLMI showed no differences between the groups. Epworth Sleepiness Scale was significantly higher in the SB group than in the control group (P < 0.05). In contrast to previous studies, we conclude that patients with SB are not good sleepers based on PSG study. Further studies are required to assess the relationship between sleep quality and the severity of SB.

Impact of parenteral nutrition standardization on costs and quality in adult patients.

Parenteral nutrition (PN) is a costly therapy that can also be associated with serious complications. Therefore, efforts are focusing on reducing rate of complications, and costs related to PN. The aim was to analyze the effect of the implementation of PN standardization on costs and quality criteria. Secondary aim was to assess the use of individualized PN based on patient's clinical condition. We compare the use of PN before and after the implementation of PN standardization. Demographic, clinical and PN characteristics were collected. Costs analysis was performed to study the costs associated to the two different periods. Quality criteria included were: 1) PN administration; 2) nutrition assessment (energy intake between 20-35 kcal/kg/day; protein contribution according to nitrogen balance); 3) safety and complications (hyperglycemia, hypertriglyceridemia, hepatic complications, catheter-related infection); 4) global efficacy (as serum albumin increase). Chi-square test was used to compare percentages; logistic regression analysis was performed to evaluate the use of customized PN. 296 patients were included with a total of 3,167 PN compounded. During the first period standardized PN use was 47.5% vs 85.7% within the second period (p < 0.05). No differences were found in the quality criteria tested. Use of individualized PN was related to critical care patients, hypertriglyceridemia, renal damage, and long-term PN. Mean costs of the PN decreased a 19.5%. Annual costs savings would be € 86,700. The use of customized or standard PN has shown to be efficient and flexible to specific demands; however customized PN was significantly more expensive.

Subjective sleep quality in epilepsy patients with sleep-related seizures

Sleep quality is expected to be poor in epilepsy patients with sleep-related seizures as a consequence of the disruptive effect of seizures themselves on sleep patterns, a potentially heightened pre sleep emotional arousal due to patient’s worries about having seizures during sleep and associated sleep comorbidities. This study is aimed at investigating subjective sleep quality and features in adult patients with seizures occurring exclusively or predominantly during sleep. Patients affected with Nocturnal Frontal Lobe Epilepsy were not included. Fifty-seven subjects ( 18–72 years of age; 27 males), 27 (47.3%) diagnosed with sleep related undetermined epilepsy and 30 (52.7%) with focal epilepsy based on clinical, awake/sleep EEG and brain MRI findings, were investigated. Most of the patients (94%) had <1 seizure per month, with the seizures being in most cases generalized convulsive seizures during sleep. All the patients were given Pittsburgh questionnaire (PQ), Morningness – Eveningness Questionnaire (MEC), STAI 1 and 2, Beck Depression inventory (BDI). Patients reporting snoring and/or witnessed apneas during sleep underwent a nocturnal polysomnographic screening for obstructive sleep apnea (OSA). At the time of the questionnaire compiling the patients had had at least 1 seizure during the previous month (seizures recency) in 19% of the cases and they all were on antiepileptic drugs at bed time, with valproate, levetiracetam and carbamazepine, alone (89.5%) or in combination (10.5%) being the most frequently used drugs. Fifty-seven healthy subjects matched for age and sex served as controls. Univariate analyses were preliminary performed in comparing categorical (chi square test) and continuous variables ( T -test) between patients and controls and patients with PSQI >5 and those with PSQI <5. Neither PSQI total score (5.2 ± 3.6 in patients and 5.3 ± 3.4 in controls) nor its components differ significantly between patients and controls. PSQI >5 patients (39%) and PSQI <5 patients (61%) do not differ significantly for age (47.1 ± 15.0 vs. 43.9 ± 15.0 years), sex (41% vs. 50% males), STAI 1 ( 46.2 ± 13.2 vs. 37.9 ± 9.6) and STAI2 scores (44.2 ± 10.5 vs. 39 ± 10.7), BDI (12.8 ± 8.0 vs. 9.1 ± 9.0), MEQ chronotype, OSA prevalence (15.8% vs. 7.1%). As for illness-related parameters, PSQI >5 patients proved to have a significantly longer illness duration than PSQI <5 patients (17.5 ± 18.2 years vs 8.2 ± 0.3 years; p = 0.035) and a higher rate of seizures recency (54.5% vs. 15.4%; p = 0.04). Our data indicate that subjective sleep quality in adult patients with seizures occurring exclusively or predominantly during sleep is not poorer than in healthy controls. Patients’ sleep quality is influenced by some illness related parameters, with poor sleep quality being associated with longer disease duration and seizure recency. The relatively low frequency of seizures along with a blunting effect of antiepileptic treatment on arousal instability during sleep may explain the finding of a substantially good sleep quality in our patients series. However also epilepsy patients’ life style and their good compliance to sleep hygiene rules may account for a preserved sleep quality. The Authors wish to thank the technogists Valter Rustioni, Daniele Marchese, Laura Spelta, Federica Camasso for their technical support.

Patient-reported pain and impaired sleep quality in adult patients with cystic fibrosis

Background Sleep impairment has been described in patients with cystic fibrosis (CF). Pain is a known cause of sleep disturbance and as pain is commonly reported in patients with CF, we sought to find an association between impaired sleep quality and pain. Methods Fifty adult CF patients completed surveys of pain and sleep quality. The results were analyzed with additional clinical data including age, sex, nutritional status, and lung function. Results Thirty-two patients (64%) reported recent pain and 33 patients (66%) reported abnormal sleep quality. The patients with pain report worse sleep quality than those without pain ( p = 0.006). There was a strong correlation between impaired sleep quality and pain ( p < 0.0001). Conclusions We found that pain and poor sleep quality are reported in a majority of adult CF patients and there is a strong correlation between the two. This will have important clinical implications in the evaluation and treatment of adult patients.

Sleep quality in adult patients with attention deficit hyperactivity disorder (ADHD)

Sleep disorders are common in adults with attention deficit/hyperactivity disorder (ADHD). Two sleep questionnaires; the Brown ADD Scale, the Symptom-Checklist-90-R, and a self-developed symptom questionnaire were administered in this study. In a sample of 61 patients without comorbidity, current substance abuse and medication intake, sleep problems were reported more often than in healthy controls. A lack of being refreshed in the morning was very closely associated with ADHD symptomatology whereas insomnia was related to the presence of comorbidity and depressive symptoms. In the total sample (N = 120), medication intake (mainly stimulants) was not related to any of the sleep parameters. It seems important to screen adult patients with ADHD for the presence of sleep disorders, especially insomnia, restless legs syndrome, and sleep-related breathing disorders (the last in conjunction with the body mass index). Since primary sleep disorders are associated with cognitive impairment, one might expect that ADHD symptomatology may improve if comorbid sleep disorders are adequately treated in addition to the specific ADHD treatment.