Reduced Daytime Sleepiness Research Articles

Adaptation of a sleep hygiene intervention for individuals with poor sleep and their companions: Results of a randomized controlled pilot trial.

Sleep is a major health issue for young adults. While sleep hygiene interventions have small-to-moderate effects, better outcomes might be achieved by delivering interventions individually to those reporting sleep difficulties, or in the presence of a supportive other or companion. To examine the feasibility, acceptability, and initial effects of an adapted sleep hygiene intervention for young adults with poor sleep, we conducted an ORBIT Phase IIb pilot randomized controlled trial (n=51). Young adults with poor sleep were randomized to receive a sleep hygiene intervention individually or with a companion. Sleep patterns were measured at baseline and 4 weeks. Participants completed daily dairies and wore wearable devices for the month following the intervention. Attrition at follow-up was minimal (3.9%), and missing rates were low for diary data (8%), and in line with prior studies for wearable devices (14%). Participants expressed high levels of satisfaction with the study, with no differences between study arms. Significant effects were found postintervention for all participants, indicating improved sleep quality (t=6.14, P < .001), greater sleep duration (t=3.8, P < .001), and reduced daytime sleepiness (t=2.13, P = .039). There were no significant differences in sleep efficiency pre and postintervention, or between study arms for any sleep outcome based on self-reported and objective data. Results from this pilot provide evidence for the feasibility and acceptability of a sleep hygiene intervention for young adults and lay the groundwork for a larger, fully powered study.

The CORE syndrome: an overlap of severe asthma, obstructive sleep apnea, rhinosinusitis, and esophageal reflux.

Asthma, obstructive sleep apnea (OSA), rhinosinusitis, and esophageal reflux are conditions that may overlap, forming a syndrome known as CORE. Whenever clinical remission of severe asthma (SA) is not achieved, it is essential to investigate the presence of comorbidities, in particular the presence of OSA that may lead to the diagnosis of CORE syndrome. The study was conducted on naive patients with SA and concomitant rhinosinusitis and esophageal reflux, referred to our institute since 2018. Patients who did not experience clinical remission were investigated for OSA through a home sleep apnea test. Subsequently, for those diagnosed with OSA, continuous positive airway pressure (CPAP) was proposed and was re-evaluated after 12months. Six patients with CORE syndrome were enrolled. The mean apnea-hypopnea index (AHI) was 33.25 ± 20.13 events/h, oxygen desaturation index (ODI) was 28.95 ± 19.95 events/h, and time in bed with SaO2 < 90% (T90) was 26.40 ± 27.22% for which continuous positive airway pressure (CPAP) treatment was proposed but only 3 out of 6 patients accepted. After 12months, all CPAP-treated patients manifested a significant reduction in daytime sleepiness (ESS score was 6.33 ± 3.8), an improvement in ACT score (+ 8 (+ 32%), + 9 (+ 36%), and + 14 (+ 56%) points), a discontinuation of oral corticosteroids (OCS), an absence of exacerbations, and an improvement of lung function leading to clinical remission of asthma. Whenever facing SA patients, non-responders to therapy, it is important to suspect the presence of CORE syndrome; in particular, the detection and subsequent treatment of OSA would seem to improve the outcome of such patients.

Evaluation of a daily facial massage on perceived sleep quality and well-being: A pilot study.

Sleep disorders are widespread and constitute a major public health risk. The present study thus aims to investigate the effect of a facial cosmetic self-massage daily routine on women's sleep and well-being. The present pilot study was conducted on 62 middle-aged women declaring daily tiredness and sleep troubles. We examined the effect of a regular facial cosmetic self-massage routine on sleep patterns, daytime sleepiness, and well-being over the course of 2 months. After 1 and 2 months, our results show improved sleep quality (Pittsburgh Sleep Quality Index, PSQI - -20.2% after 2 months), reduced daytime sleepiness (Epworth Sleepiness Scale, ESS, -31.2% after 2 months), and increased well-being measures. The number of participants with abnormal sleep (PSQI >5) decreased over the course of the experiment as well, from 71.9% to 49.2% at the end of the 2 months [odds ratio 95% CI for decrease: 0.38 (0.18-0.81)]. Similarly, the number of participants with excessive daytime sleepiness (>10 on the ESS) decreased over the course of the study from 44.3% to 21% after 1 month [95% CI: 0.33 (0.15-0.73)] and to 16.1% after 2 months [95% CI: 0.24 (0.10-0.56)]. These results suggest that a facial cosmetic self-massage routine may improve sleep patterns and is likely to be a useful addition to a standard sleep hygiene routine.

Internet Addiction and Its Effect on Sleep Quality Among Medical Students

Aim: This study was carried out to determine the prevalence of internet addiction in medical school students, and to examine the relationship between internet addiction and sleep quality, sleepiness and psychological resilience. Method: The study was conducted with 213 participants studying at Bolu Abant Izzet Baysal University Faculty of Medicine. A sociodemographic questionnaire, Young Internet Addiction Test-Short Form, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Brief Psychological Resilience Scale were applied to all participants, and the results were statistically evaluated. Results: The average age of the participants was found as 21.25±2.00. 65.3% (n=139) of the participants were women and 27.2% (n=58) were first-year students. The average score of Young's internet addiction was 27.15±7.35; the average Pittsburgh Sleep Quality Index score was 5.49±2.47. 60% of them were evaluated as having poor sleep quality. Average Epworth Sleepiness Scale scores were 6.62±4.22; average scores of the Psychological Resilience Scale were 19.35±5.04. There was a positive and significant relationship between Young Internet Addiction and Pittsburgh Sleep Quality. As internet addiction increased, sleep quality decreased. A negative significant relationship was found between Young's Internet Addiction and the Brief Psychological Resilience Scale. As internet addiction increased, psychological resilience decreased. Conclusion: In our study, it was determined that as internet addiction increased, sleep quality and psychological resilience decreased, and daytime sleepiness increased. We can improve sleep quality by preventing internet addiction, and increase participation in daily activities and psychological resilience by reducing daytime sleepiness. Keywords: internet addiction disorder, sleeplessness, resiliency, psychological

Effectiveness of Mediterranean Diet on Daytime Sleepiness among Individuals with Type 2 Diabetes Mellitus in Oman.

Background Sleep disturbance is a major complaint among individuals with diabetes mellitus and may be augmented by dietary interventions. The objective of this randomized controlled trial was to determine the effectiveness of a Mediterranean diet intervention on daytime sleepiness among individuals with type 2 diabetes mellitus (T2DM) in Oman. Methods In total, 134 eligible individuals with T2DM (61 and 73 participants in the intervention and control groups, respectively) were recruited. The intervention participants underwent a 6-month Mediterranean diet intervention consisting of individual dietary counseling, cooking classes, phone calls, and social media messages, while the control group continued with standard diabetes care. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. All data was analyzed using IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA). Results Daytime sleepiness was evident, with ∼ 30% of the participants experiencing it, with no significant difference between control and intervention participants at baseline. There was a significant reduction in daytime sleepiness in both the intervention and control groups after 6 months, with daytime sleepiness significantly lower in the intervention group, with a modest difference of 42.56% ( p < 0.001). Conclusion Adherence to the Mediterranean diet is effective in reducing daytime sleepiness among individuals with T2DM. Clinical Trial UMIN000041152.

CPAP Treatment Improves Quality of Life and Self-perception of Voice Impairment in Patients with OSA

The purpose of this study is to examine vocal fatigue and impairment, gastroesophageal symptoms, dysphagia risk, and sleep-related quality of life in individuals with obstructive sleep apnea (OSA) who have been treated with continuous positive airway pressure (CPAP) compared to those who have not received treatment. Fifty-four participants diagnosed with OSA completed an online research form. Of these, 29 were receiving CPAP treatment, while 25 were not undergoing treatment. The following instruments were used: Vocal Fatigue Index, Voice Handicap Index, Gastroesophageal symptoms, Eating Assessment Tool, and Quebec Sleep Questionnaire. The group that received CPAP treatment had significantly lower scores in the functional domain and total Voice Handicap Index. They also experienced fewer symptoms of regurgitation, reduced daytime sleepiness, fewer nocturnal symptoms, and better emotional and social interactions in their quality of life compared to the untreated group. There were no significant differences in voice fatigue and dysphagia risk between the groups. Individuals treated with CPAP experience reduced vocal impairment, fewer regurgitation symptoms, and improvement in the emotional and social interactions domains of their quality of life compared to individuals without treatment.

Intervention Programmes among Obstructive Sleep Apnea Patients: A Systematic Review

Aims: To assess the effectiveness of intervention programs to improve functional outcomes, continuous positive airway pressure (CPAP) adherence, daytime sleepiness, and knowledge among obstructive sleep apnea (OSA) patients. Background: Oxygen desaturations, awakenings, and snoring are symptoms of OSA. Design: Through five databases such as Google Scholar, Science Direct, Web of Science, Medline, and Research Gate. Conclusions: Patients improved their knowledge; CPAP compliance was higher in the intervention group compared to the control group. Regular CPAP utilization can improve functional outcomes and reduce daytime sleepiness. Implication for practice: researchers need to develop educational initiatives appropriate for OSA patients in Malaysia.

Evaluation of the therapeutic efficacy of the drug Cytochrome C in the treatment of asthenia in outpatients (CITRIN study)

Asthenic syndrome occurs in most chronic diseases, and doctors encounter it in outpatient appointments for both somatic and neurological pathologies. Drugs that normalize energy metabolism, have an antioxidant effect and antihypoxic properties are used to treat asthenia.Objective: to investigate the therapeutic efficacy of the drug Cytochrome C in patients with asthenia of various origin in an outpatient setting.Material and methods. The study included 147 outpatients with asthenia who received Cytochrome C 10 mg intramuscularly daily for 10 days. The assessment of the initial level of asthenia manifestations and their changes in dynamics was carried out using the MFI-20 scales, the assessment of daytime sleepiness, the assessment of fatigue (FAS), the severity of symptoms of the disease and the dynamics of the condition according to the doctor and the patient.Results. By the 10th day of therapy, there was a decrease in the severity of asthenia on the MFI-20 scale from 72.2±12.7 to 41.1±12.3 points (p&lt;0.01), including general (by 45%), physical (by 42%) and mental (by 45%) asthenia according to the MFI-20 subscales (p&lt;0.001), improvement in night sleep and reduction in daytime sleepiness on the Epworth scale by 65% – from 9.1±5.6 to 4.6±4.3 points (p&lt;0.001), reduction in severity of fatigue by 29% (p&lt;0.01). The clinically significant improvement lasted until the 30th day of observation, 3 weeks after the end of the therapy. Overall, a significant reduction in asthenia symptoms was observed in 99% of patients on day 10 of therapy and in 96% of cases on day 30.Conclusion. Cytochrome C has been shown to be very effective in patients with asthenia as it reduces all manifestations of asthenia, improves night sleep and reduces daytime sleepiness.

Clinical efficacy and mechanism study of mid-frequency anti-snoring device in treating moderate obstructive sleep apnea-hypopnea syndrome.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is primarily caused by airway obstruction due to narrowing and blockage in the nasal and nasopharyngeal, oropharyngeal, soft palate, and tongue base areas. The mid-frequency anti-snoring device is a new technology based on sublingual nerve stimulation. Its principle is to improve the degree of oropharyngeal airway stenosis in OSAHS patients under mid-frequency wave stimulation. Nevertheless, there is a lack of clinical application and imaging evidence. To investigate the clinical efficacy and mechanisms of a mid-frequency anti-snoring device in treating moderate OSAHS. We selected 50 patients diagnosed with moderate OSAHS in our hospital between July 2022 and August 2023. They underwent a 4-wk treatment regimen involving the mid-frequency anti-snoring device during nighttime sleep. Following the treatment, we monitored and assessed the sleep apnea quality of life index and Epworth Sleepiness Scale scores. Additionally, we performed computed tomography scans of the oropharynx in the awake state, during snoring, and while using the mid-frequency anti-snoring device. Cross-sectional area measurements in different states were taken at the narrowest airway point in the soft palate posterior and retrolingual areas. Compared to pretreatment measurements, patients exhibited a significant reduction in the apnea-hypopnea index, the percentage of time with oxygen saturation below 90%, snoring frequency, and the duration of the most prolonged apnea event. The lowest oxygen saturation showed a notable increase, and both sleep apnea quality of life index and Epworth Sleepiness Scale scores improved. Oropharyngeal computed tomography scans revealed that in OSAHS patients cross-sectional areas of the oropharyngeal airway in the soft palate posterior area and retrolingual area decreased during snoring compared to the awake state. Conversely, during mid-frequency anti-snoring device treatment, these areas increased compared to snoring. The mid-frequency anti-snoring device demonstrates the potential to enhance various sleep parameters in patients with moderate OSAHS, thereby improving their quality of life and reducing daytime sleepiness. These therapeutic effects are attributed to the device's ability to ameliorate the narrowing of the oropharynx in OSAHS patients.

The effect of chrono-nutritional manipulation of carbohydrate intake on sleep macrostructure: A randomized controlled trial

Over the years, there is a rapid increase in the prevalence of inadequate sleep and its detrimental consequences. Yet, the impact of prolonged nutritional interventions on sleep optimization remains unexplored. To examine the effect of carbohydrate manipulation combined with exercise training on sleep macro-structure. Forty-two healthy, trained male volunteers were recruited for this study. The 4-week intervention consisted of three groups: i) Sleep Low-No Carbohydrates (SL-NCHO): participants consumed all their carbohydrate intake at regular intervals prior to evening training, ii) Sleep High-Low Glycemic Index (SH-LGI) and iii) Sleep High-High Glycemic Index (SH-HGI): Carbohydrate intake was spread throughout the day, both prior (60% of total CHO intake) and after evening training (40% of total CHO intake). The SH-LGI and SH-HGI groups differentiated by consuming either LGI or HGI foods in the evening, respectively. Alongside, participants performed a standardized exercise program combining resistance exercise and high-intensity interval training. Participants' sleep macro-structure was assessed with polysomnography, actigraphy, sleep diary, and sleep-wake questionnaires. Objective assessments revealed a substantial time-effect on sleep initiation, duration, and continuity. After the intervention, sleep onset latency decreased (p<0.001), sleep duration was prolonged (p=0.006), sleep efficiency increased (p<0.001), and wake after sleep onset decreased (p=0.035). Sleep macroarchitecture did not significantly change, while the percentage of REM sleep stage to the total sleep time increased over time (p<0.01). Consistent with the objective findings, subjects reported improved subjective sleep quality (p=0.043) and reduced daytime sleepiness (p=0.047). The combination of a personalized dietary plan with exercise training enhances sleep initiation, sleep continuity, sleep duration, REM and N1 sleep stages, independently of carbohydrate type or timing. Lifestyle interventions should be investigated further to promote sleep quality and recovery. The trial was registered at clinicaltrials.gov as NCT05464342.

Sleep quality, coping, and related depression: A cross-sectional study of Turkish nurses.

The sleep quality of nurses affects both their health and standard of nursing care. Working conditions, depression, and coping potential can also lead to sleep problems. Sleep plays a crucial role in overall health at every stage of life. The purpose of this study is to determine the effect of sleep quality, depression, and coping mechanisms on the performance of nurses, whose sleep quality is strongly affected due to shift-based work. The sample of this descriptive correlational study consisted of 133 healthcare workers. Data were collected using the Personal Information Form, Beck Depression Inventory (BDI), Coping Response Inventory (CRI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) and evaluated using the t test, Mann-Whitney U test, one-way ANOVA, Enter method, and linear regression. One in three nurses reported having poor-quality sleep, and one in two nurses said they felt sleepy during the day. With declining sleep quality, the nurses' ability to cope with stress diminished, and their degree of depression increased. The nurses' financial situation and level of depression were key factors that influenced their quality of sleep and capacity to handle stress. To improve nurses' sleep, the shift pattern needs to change. To increase the quantity of sleep and enhance mental health, changes should be made to the shift schedules of nurses to allow for appropriate rest and reduce daytime sleepiness. Improved working conditions for nurses and updated nursing standards are required to improve nurses health and wellbeng.

Long-Term Efficacy and Safety of Pitolisant for Residual Sleepiness Due to OSA

In people with OSA, excessive daytime sleepiness is a prominent symptom and can persist despite adherence to CPAP, the first-line therapy for OSA. Pitolisant was effective in reducing daytime sleepiness in two 12-week randomized controlled trials (RCTs), one in patients adherent to CPAP (BF2.649 in Patients With OSA and Treated by CPAP But Still Complaining of EDS [HAROSA 1]) and the other in patients refusing or not tolerating CPAP (BF2.649 in Patients With OSA, Still Complaining of EDS and Refusing to be Treated by CPAP [HAROSA 2]). Does the efficacy and safety of pitolisant persist when these patients take it long-term? All adults included in the HAROSA 1 and HAROSA 2 RCTs (both pitolisant and placebo arms) were offered pitolisant (up to 20mg/d) after completion of the short-term double-anonymized phase (ie, from week 13) in an open-label cohort study. The primary efficacy outcome was the change in Epworth Sleepiness Scale score between baseline and week 52. Safety outcomes were treatment-emergent adverse event(s) (TEAE[s]), serious TEAEs, and special interest TEAEs. Out of 512 adults included in the two RCTs, 376 completed the 1-year follow-up. The pooled mean difference in Epworth Sleepiness Scale score from baseline to 1 year for the intention-to-treat sample was-8.0 (95%CI,-8.3 to-7.5). The overall proportions of TEAEs, serious TEAEs, and TEAEs of special interest were 35.1%, 2.0%, and 11.1%, respectively, without any significant difference between patients in the initial pitolisant and placebo arms. No cardiovascular safety issues were reported. Pitolisant is effective in reducing daytime sleepiness over 1 year in adults with OSA, with or without CPAP treatment. Taken for 1 year, it has a good safety profile (including cardiovascular). ClinicalTrials.gov; Nos.: NCT01071876 and NCT01072968; URL: www. gov.

Effectiveness evaluation of the complex medical and psychological method of treating patients with insomnia

This article presents an assessment of the effectiveness of the program for providing medical and psychological care to patients with insomnia, based on psychotherapeutic and psychophysiological approaches, including using a light lamp, biofeedback devices, taking into account clinical and psychological and socio-psychological characteristics, and also evaluates the effectiveness this program. The scientific literature does not describe analogues of the totality of the use of these methods for the contingent of patients with outpatient insomnia. The uniqueness of the developed program lies in its clear algorithmization, the absence of complex techniques of psychological (psychotherapeutic) intervention, which ensures the reproducibility of the program in practical health care institutions if there is a psychotherapist or clinical psychologist on staff who knows the skills of cognitive behavioral therapy and diaphragmatic breathing. The technique has passed clinical testing approved by the Ministry of Health of the Russian Federation (protocol 2020-37-3). The quantitative evaluation of the effectiveness of the method was carried out on seven indicators: (1) Improvement in the subjective characteristics of sleep, (2) Improvement in the quality of sleep, (3) Reduction of the insomnia severity index, (4) Reduction of daytime sleepiness, (5) Reduction of the consequences of sleep disorders, (6) Decreased anxiety, (7) Improved overall clinical impression. As part of the assessment of the achievement of the target result, in accordance with Order 46n of the Ministry of Health of the Russian Federation dated February 2, 2022 (Regulations on Clinical Approbation), a threshold of 85% was set. In terms of (1) Improvement in the subjective characteristics of sleep, (2) Improvement in the quality of sleep, (3) Decrease in the severity index of insomnia, (4) Decrease in daytime sleepiness, the target result was more than 85%, which is significantly higher compared to the control group. An assessment was made of the correspondence of the distribution of indicators to the normal law using the Kholmogorov-Smirnov criterion. Comparison of groups using methods of analytical statistics was carried out using Student's t-test for dependent samples and Mann Whitney's U-test for independent samples. The assessment of the correlation of quantitative results was carried out using the Pearson coefficient (r) for interval variables with a normal distribution. The results are considered to be significant at p&lt;0.01. All obtained empirical values were in the zone of statistical significance. Evaluation of the data obtained in the course of clinical testing shows the effectiveness of the proposed clinical and psychological method for the treatment of insomnia.

Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial.

This study aimed to determine the feasibility of a randomised controlled trial (RCT) evaluating oropharyngeal exercise (OPE) intervention as an alternative therapy for obstructive sleep apnea (OSA) in patients with stroke or transient ischaemic attack (TIA). Despite the high prevalence of OSA in this population, the standard therapy, continuous positive airway pressure (CPAP), is often poorly tolerated. Thirty stroke/TIA patients with OSA unable to tolerate CPAP were randomly assigned to an oropharyngeal exercise or sham exercise protocol. They performed exercises for 6 weeks, 5 days per week, 30 minutes twice per day. Feasibility was ascertained by the proportion of enrolled patients who completed more than 80% of the OPE regimen. Isometric tongue pressures, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), daytime sleepiness, and quality of life (QOL) outcomes were collected at baseline, post-training (6-week follow-up), and retention (10-week follow-up) to document preliminary efficacy. Adherence to study exercises was excellent, with 83% of participants completing more than 80% of the exercises. The isometric tongue pressures were observed to improve in the oropharyngeal exercise group (compared with the sham group), along with a decrease in OSA severity (measured by the AHI and ODI), reduced daytime sleepiness, and enhanced quality of life outcomes following the exercise programme. Only the effects on posterior isometric tongue pressure and daytime sleepiness remained significantly different between groups at the retention session. In conclusion, an RCT evaluating the efficacy of oropharyngeal exercises on post-stroke/TIA OSA is feasible and our preliminary results suggest a clinically meaningful effect.

Feasibility, Acceptability, and Preliminary Effectiveness of a Sleep Intervention in Adults at Risk for Metabolic Syndrome With Short Sleep Duration.

The prevalence of short sleep duration is rising and is linked to chronic comorbidities, such as metabolic syndrome (MetS). Sleep extension interventions in adults with MetS comorbidities and short sleep duration are limited and vary widely in terms of approach and duration. This pilot study aimed to test the feasibility and acceptability of a personalized 12-week systematic sleep time extension intervention on post-intervention sleep outcomes in middle-aged adults at risk for MetS with actigraphy-estimated short sleep duration. A single-arm, 12-week, 12-session systematic sleep time extension intervention was delivered weekly via videoconferencing. Feasibility and acceptability were assessed using retention rates and mean sleep diary completions. Sleep was estimated for 14 consecutive days prior to and immediately following the 12-week intervention using wrist actigraphy. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Paired sample t -tests modeled changes in study outcomes. Study participants ( N = 41) had a mean age of 52 years and were mostly female and White; 86% attended >80% of sessions, and mean sleep diary completion was 6.7 diaries/week. Significant improvements in sleep from pre- to post-intervention included increased total sleep time, earlier sleep onsets, more regular sleep onsets, a higher sleep regularity index, and reduced daytime sleepiness. Extending sleep, as well as improving sleep timing and regularity in middle-aged adults with actigraphy-estimated short sleep duration and at risk for MetS, is feasible and acceptable. Behavioral sleep characteristics may be modifiable and present a novel behavioral paradigm for mitigating MetS risk. This pilot study provides a proof of concept for the feasibility, acceptability, and preliminary effectiveness of a systematic sleep time extension for middle-aged adults at risk for MetS with actigraphy-estimated short sleep duration.

Role of raw onion juice therapy in improving sleep, quality of life and alleviating fatigue among older adults: A triple blinded randomized placebo controlled trial

BackgroundInsomnia is associated with long-term morbidity for the patient’s health and well-being. This study was intended to determine if raw onion juice therapy, an anecdotal home-remedy, is effective in improving sleep, reducing fatigue, and improving quality of life (QoL) when used along with yoga and naturopathy-based lifestyle interventions (YNBL). Materials and methodsFifty-eight patients were randomized into two groups: the onion juice group (10 ml onion juice) or the placebo group (10 ml rice water) for 10 days along with the YNBL intervention. The Epworth sleepiness scale, insomnia severity index, total sleep time, sleep latency onset, fatigue severity scale, and SF-12 QoL were assessed at baseline and at the end of the 10th day. All the participants, investigators, and statisticians were blinded to the participants’ group assignments. ResultsThe raw onion juice group reported a significant reduction in daytime sleepiness (z = −2.839, p = 0.005), insomnia severity (z = −2.493, p = 0.013) and a significant improvement in total sleep time (z = −3.388, p = 0.001), when compared to the placebo group receiving rice water. Similarly, we observed a significant improvement in the quality of life domains (i) physical component summary (PCS) t(54) = 5.345, p = 0.000, and (ii) mental component summary (MCS) t(54) = 3.579, p = 0.001 in the experimental group compared to placebo. ConclusionRaw onion juice therapy is safe and effective in the management of insomnia as it improves sleep-related parameters, reduces fatigue, and enhances QoL. Future studies with longer follow-up periods and a larger sample size are warranted to substantiate the present findings.

Improvement of morning headache in adults with obstructive sleep apnea after positive airway pressure therapy

The aim of this study was to evaluate the association between obstructive sleep apnea and morning headache and to assess the improvement of morning headache following positive airway pressure therapy. One hundred and sixteen participants were enrolled in this study; all of them received positive airway pressure therapy for at least 3 months. We checked the differences in various sleep apnea-related parameters according to the presence of morning headache and evaluated the improvement of morning headache following positive airway pressure therapy. Among the 116 study participants, 103 were men, with a mean age and body mass index of 50.34 ± 10.23 years and 28.00 ± 4.21 kg/m2, respectively. The severity of morning headache was higher in the severe obstructive sleep apnea group than in the mild to moderate group (2.16 ± 1.70 vs. 1.50 ± 1.57, P = 0.027). However, the various polysomnographic parameters did not significantly differ according to the presence of headache. The Epworth sleepiness scale score was significantly higher in the morning headache presence group than in the absence group (10.90 ± 5.45 vs. 8.13 ± 4.27, P = 0.003). Furthermore, a notable correlation was observed between the reduction in daytime sleepiness and the improvement in morning headache following PAP treatment (r = 0.503, P < 0.001). Morning headache significantly improved following positive airway pressure therapy (prevalence: 53.4–16.4%; severity: 1.92 ± 1.67 vs. 0.86 ± 0.80, all P < 0.001), especially in the patients with morning headache before positive airway pressure therapy. Morning headache is significantly associated with daytime sleepiness and positive airway pressure therapy improves morning headache.

The Treatment of Parkinson's Disease with Sodium Oxybate.

Sodiun Oxybate (SO) has a number of attributes that may mitigate the metabolic stress on the substantia nigra pars compacta (SNpc) dopaminergic (DA) neurons in Parkinson's disease (PD). These neurons function at the borderline of energy sufficiency. SO is metabolized to succinate and supplies energy to the cell by generating ATP. SO is a GABAB agonist and, as such, also arrests the high energy requiring calcium pace-making activity of these neurons. In addition, blocking calcium entry impedes the synaptic release and subsequent neurotransmission of aggregated synuclein species. As DA neurons degenerate, a homeostatic failure exposes these neurons to glutamate excitotoxicity, which in turn accelerates the damage. SO inhibits the neuronal release of glutamate and blocks its agonistic actions. Most important, SO generates NADPH, the cell's major antioxidant cofactor. Excessive free radical production within DA neurons and even more so within activated microglia are early and key features of the degenerative process that are present long before the onset of motor symptoms. NADPH maintains cell glutathione levels and alleviates oxidative stress and its toxic consequences. SO, a histone deacetylase inhibitor also suppresses the expression of microglial NADPH oxidase, the major source of free radicals in Parkinson brain. The acute clinical use of SO at night has been shown to reduce daytime sleepiness and fatigue in patients with PD. With long-term use, its capacity to supply energy to DA neurons, impede synuclein transmission, block excitotoxicity and maintain an anti-oxidative redox environment throughout the night may delay the onset of PD and slow its progress.

Characteristics of Patients With Severe Obstructive Sleep Apnea Who Maintain Slow-Wave Sleep

Background and Objectives Obstructive sleep apnea (OSA) is a complex sleep-related respiratory disorder with various pathophysiology and clinical manifestations. Diagnosis and treatment considering only the number of respiratory events, such as sleep duration, may have limitations. The purpose of this study is to analyze the clinical and polysomnography (PSG) characteristics of patients with severe OSA in whom slow wave sleep (SWS) was well-maintained.Subjects and Method This study retrospectively analyzed 203 patients who underwent PSG due to suspected OSA. Severe OSA patients were classified into a SWS maintained group (SWS≥15%) and a SWS reduced group (SWS&lt;15%), and their clinical records, PSG results, and heart rate variability (HRV) were compared.Results The SWS maintained group (n=27), compared to the SWS reduced group (n=58), had a significantly longer total sleep time (&lt;i&gt;p&lt;/i&gt;=0.027) and lower wake after sleep onset (&lt;i&gt;p&lt;/i&gt;=0.001), rapid eye movoement (REM) latency (&lt;i&gt;p&lt;/i&gt;=0.007), non-supine apnea-hypopnea index (AHI, &lt;i&gt;p&lt;/i&gt;=0.006), non-REM AHI (&lt;i&gt;p&lt;/i&gt;&lt;0.001), arousal index (&lt;i&gt;p&lt;/i&gt;&lt;0.001) and Epworth Sleepiness Scale (&lt;i&gt;p&lt;/i&gt;=0.048). In addition, the SWS maintained group had a significantly low value in very low frequency in HRV than that of the SWS reduced group (&lt;i&gt;p&lt;/i&gt;=0.046).Conclusion The SWS maintained group in the severe OSA showed better PSG and HRV results and reduced daytime sleepiness than those of the SWS reduced group.

0590 Effect of a whole-food plant-based diet on daytime sleepiness in patients with obstructive sleep apnea

Abstract Introduction Consumption of diet rich in high saturated fats has been associated with a higher degree of daytime sleepiness. A whole-food, plant-based (WFPB) dietary pattern, which is low in saturated fat, has been shown to be beneficial in weight loss and other health conditions. Patients with obstructive sleep apnea (OSA) frequently experience excessive daytime sleepiness despite treatment. This study aims to assess the effect of a short term (21 days) WFPB diet on daytime sleepiness in patients with obstructive sleep apnea. Methods Patients were recruited from the Mayo Clinic Jacksonville sleep clinic who have a diagnosis of OSA who are on PAP therapy but have daytime sleepiness with Epworth Sleepiness Scale (ESS) score of 5 or above. Participants were asked to follow a strict WFPB diet for 21 days using the Fork Over Knives handbook as a guide. They were also asked to complete ESS before switching to and after completing a WFPB diet for 21 days. Results A total of 10 participants completed the 21-day WFPB diet. Eight out of ten participants had reported a reduction in daytime sleepiness. Overall, we found a mean decrease in ESS score of 3.8 in all participants, with 3 patients had a significant decrease in ESS score of ≥ 7. All participants completed the study with ≥ 90% adherence to a WFPB diet. In addition, participants also reported a mean weight loss of 4.2 kg. Two participants noted headaches during this 21-day period. Conclusion Significant improvement with daytime sleepiness was found in patients who switched to a WFPB diet for 21 days. No significant correlation between improvement in ESS and weight loss was found. Support (if any)