Severity Of Sleep Disorders Research Articles

Mental Health in Emergency Medical Clinicians: Burnout, STS, Sleep Disorders. A Cross-Sectional Descriptive Multicentric Study

Emergency medicine specialists’ mental and physical health may be threatened if they experience burnout, sleep disorders, and secondary traumatic stress (STS). We aimed to investigate whether Emergency Medical Services (EMs) professionals’ mental and physical health status, depression, and anxiety are associated with burnout, STS, and sleep disorders. We hypothesized that burnout, STS, and the severity of sleep disorders would raise the risk of impaired mental, and physical health, depression, and anxiety in emergency medical clinicians. A cross-sectional multicentric study was conducted. In total,178 EMs specialists completed validated surveys to assess mental health complaints (Mental Health Inventory, MHI-5 screening test), physical health complaints (Ware scale), depression, and anxiety (Depression, Anxiety and Stress Scale-DASS), burnout (Maslach Burnout Inventory-general survey, MBI-GS), sleep disorders (Insomnia Severity Index, ISI), and STS (STS scale). This study aimed to analyze the influence that work-related factors can have on EMs specialists’ mental and physical health, depression, and anxiety. Specifically, mental health was predicted by exhaustion (β = 0.16), cynicism (β = 0.21), insomnia severity (β = 0.13), and STS (β = 0.35); physical health was predicted by exhaustion (β = 0.33) and insomnia severity (β = 0.18); depression was predicted by cynicism (β = 0.21) and STS (β = 0.46); and anxiety was predicted by STS (β = 0.63) and inefficacy (β = 0.20). Work-related stress symptoms such as burnout, STS, and sleep disorders were found to predict emergency medicine clinicians’ mental and physical health, as well to increase the risk of depression and anxiety. It is of most importance to develop practices to prevent such symptoms and to promote mental health and well-being among the emergency medicine personnel.

QUALITY OF SLEEP IN PATIENTS WITH MYASTHENIA GRAVIS

Myasthenia gravis (MG) is a chronic neuromuscular disease that leads to progressive weakness, fatigue of the skeletal muscles, and is often associated with psychological changes, especially with poorer quality of sleep. To evaluate the quality of sleep in patients suffering from MG in relation to sociodemographic and clinical characteristics of the disease. A total of 70 adult patients have been classified according to Myasthenia Gravis Foundation of America classification and divided into groups with regard to the age of onset, gender, employment status and type of work, presence or absence of pathological changes on thymus and presence or absence of anti-nAchr antibodies. Severity of clinical manifestations was evaluated by using quantitative MG scores and MG composite scores. Pittsburgh questionnaire was used to assess the subjective quality of sleep. In addition, Hamilton's anxiety and depression scales and questionnaires for quality of life assessment were also implemented. The results of our research show a correlation between poor quality of sleep and prolonged duration of the disease, pathological changes on thymus, positive anti-nAchr antibodies. The correlation between poor quality of sleep with more severe clinical presentation, poor quality of life, anxiety and depression was confirmed. Quality of sleep is impaired in patients with MG, especially in the case of severe clinical manifestations and prolonged duration of the disease. Considering the lack of literature on the subject, a better understanding of the prevalence and severity of sleep disorders in MG requires further research.

Therapeutic efficacy of zolpidem combined with cognitive-behavioral therapy on primary insomnia.

Background:In this study, we intend to assess the efficacy of zolpidem combined with cognitive-behavioral therapy (CBT) for patients with primary insomnia (PI).Methods:A predefined search strategy will be used to search for associated literature from inception to the July 1, 2019: PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, Google Scholar, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure with no language limitation. In addition, we will also retrieve reference lists of included studies and relevant reviews, as well as the conference proceedings. All randomized controlled trials related to the zolpidem and CBT for PI will be included. Two authors will perform study selection, data collection, and study quality, respectively. We will also apply RevMan 5.3 software for statistical analysis.Results:This study will provide a comprehensive overview of the available evidence of the benefits and safety of zolpidem and CBT for PI. Primary outcomes are sleep quality and severity of sleep disorders. Secondary outcomes consist of sleep-onset latency, total sleep duration, sleep efficiency, and frequency and adverse events.Conclusion:The results of this study will inform clinical and policy decisions regarding the benefits and harm of zolpidem and CBT for patients with PI.PROSPERO registration number:PROSPERO CRD42019142796.

Association of sensitive skin with sensitive corneas and sensitive eyelids.

Sensitive scalp or irritable bowel syndrome has been previously shown to be associated with sensitive skin. We wondered whether sensitive eyelids and sensitive eyes could also be associated with sensitive skin. A cross-sectional epidemiological study was carried out on a representative sample of French people, according to the quota method, using a questionnaire. A total of 2048 subjects were included in the present study. Notably, 52.2% declared sensitive eyes, which was more frequent in women than in men. The subjects who reported sensitive eyes were more numerous according to the severity of skin sensitivity, the severity of sleep disorders and the presence of bright eyes. More than half of the subjects with sensitive eyes thought that they were sensitive to sun exposure, dust, computer or touch pads or dry air. The presence of sensitive eyelids was reported by 18.65% (more frequent in women) and was associated with sensitive skin and sensitive eyes, sun exposure and exposure to dust. This study is the first to investigate sensitive eyelids or sensitive eyes. Sensitive eyelids can be considered a localization of sensitive skin. The concept of sensitive eyes is not commonly used by ophthalmologists and remains to be more precisely defined.

Effects of melatonin in children with attention-deficit/hyperactivity disorder with sleep disorders after methylphenidate treatment.

PurposeMethylphenidate (MPH), the first-line medication in children with attention-deficit/hyperactivity disorder (ADHD), is associated with increased risk of sleep disorders. Melatonin has both hypnotic and chronobiotic properties that influence circadian rhythm sleep disorders. This study explores the effectiveness of melatonin in children with ADHD who developed sleep problems after starting MPH.Patients and methodsThis study, based on a clinical database, included 74 children (69 males, mean age 11.6±2.2 years) naturalistically treated with MPH (mean dosage 33.5±13.5 mg/d). The severity of sleep disorder (sleep onset delay) was recorded at baseline and after a follow-up of at least 4 weeks using a seven-point Likert scale according to the Clinical Global Impression Severity score. Effectiveness of melatonin on sleep (mean dosage 1.85±0.84 mg/d) after 4 weeks was assessed using a seven-point Likert scale according to the Clinical Global Impression Improvement (CGI-I) score, and patients who scored 1 (very much improved) or 2 (much improved) were considered responders.ResultsClinical severity of sleep disorders was 3.41±0.70 at the baseline and 2.13±1.05 after the follow-up (P<0.001). According to the CGI-I score, 45 patients (60.8%) responded to the treatment with melatonin. Gender and age (children younger and older than 12 years) did not affect the response to melatonin on sleep. Patients with or without comorbidities did not differ according to sleep response. Specific comorbidities with disruptive behavior disorders (oppositional defiant disorder or conduct disorder), affective (mood and anxiety) disorders and learning disabilities did not affect the efficacy of melatonin on sleep. Treatment was well tolerated, and no side effects related to melatonin were reported.ConclusionIn children with ADHD with sleep problems after receiving MPH treatment, melatonin may be an effective and safe treatment, irrespective of gender, age and comorbidities.

A machine learning approach using EEG signals to measure sleep quality

Sleep quality has a vital effect on good health and well-being throughout a life. Getting enough sleep at the right times can help protect mental health, physical health, quality of life, and safety. In this study, an electroencephalography (EEG)-based machine-learning approach is proposed to measure sleep quality. The advantages of this approach over standard Polysomnography (PSG) method are: 1) it measures sleep quality by recognizing three sleep categories rather than five sleep stages, thus higher accuracy can be expected; 2) three sleep categories are recognized by analyzing EEG signals only, so the user experience is improved because fewer sensors are attached to the body during sleep. Using quantitative features obtained from EEG signals, we developed a new automatic sleep-staging framework that consists of a multi-class support vector machine (SVM) classification based on a decision tree approach. We used polysomnographic data from PhysioBank database to train and evaluate and test the performance of the framework, where the sleep stages have been visually annotated. The results demonstrated that the proposed approach achieves high classification performance, which helps to measure sleep quality accurately. This framework can provide a robust and accurate sleep quality assessment that helps clinicians to determine the presence and severity of sleep disorders, and also evaluate the efficacy of treatments.

Фенотипы невропатической боли

Невропатическая боль (НБ) возникает вследствие прямого повреждения или болезни соматосенсорной нервной системы. Целью настоящего исследования было проведение анализа базы данных пациентов с НБ для поиска групп пациентов имеющих сходные профили сенсорных симптомов, а также определение взаимосвязи между наличием и выраженностью этих симптомов с интенсивностью боли, тяжестью нарушений сна, степенью ограничений повседневной активности и тяжестью нарушений общего соматического здоровья. Материал и методы. Проведен кластерный и сравнительный анализ базы данных больных с НБ (n = 6506), полученной в скрининговом когортном двухэтапном исследовании пациентов, обратившихся за амбулаторной помощью к врачу неврологу. Результаты и обсуждение. Анализ методом К-средних выявил 3 кластера сенсорных симптомов, не связанных с этиологическими причинами НБ. Фенотипы (кластеры) НБ отличались по интенсивности боли, степени тяжести нарушений сна, степени снижения повседневной активности и тяжести нарушений общего соматического здоровья. Выводы. В реальной клинической практике фенотипическая стратификация НБ важна не только с позиций механизм-обоснованого подхода к её терапии, но и для прогнозирования интенсивности боли и степени ухудшения качества жизни у конкретного больного. Neuropathic pain (NeP) is caused by a direct damage or disease of the somatosensory nervous system. The aim of this study was to conduct an additional analysis of the database of patients with NeP to identify groups of patients with similar profiles of the sensory symptom and to determine the relationship between the presence and severity of these symptoms and the intensity of pain, severity of sleep disorders, degree of limitations in daily activity, and severity of disorders in general physical health. Material and methods. Cluster and comparative analyses were performed of the database of patients with NeP (n = 6506). The database was obtained in a two-stage screening cohort study of patients who had sought outpatient care of a neurologist. Results and discussion. The analysis using the K-means method provided 3 clusters of sensory symptoms not related with etiological causes of NeP. The phenotypes (clusters) differed in pain intensity, severity of sleep disorders, degree of decline in daily activity, and severity of disorders in general somatic health. Conclusions. In real clinical practice, the phenotypic stratification of NeP is important not only from the standpoint of the mechanism-based approach to its treatment but also for predicting the intensity of pain and the degree of deterioration of the quality of life in a particular patient.

Epidemiology of sleep disorders in the Republic of Tatarstan

To evaluate the variability and severity of sleep disorders in people of the Republic of Tatarstan. A continuous survey using a questionnaire based on the Epworth Sleepiness Scale, the Hospital Anxiety and Depression Scale (HADS), sleep apnea risk scale, restless leg syndrome scale was performed. The survey was conducted in a random sample of people (n=1156). A high level of sleep disorders associated with anxiety disorders and comorbid pathologies was shown. Low awareness of patients about methods of tretament sleep disorders and a trend to self-medication (mostly using benzodiazepine drugs) were revealed.

In Patients with Chronic Kidney Disease Short Term Blood Pressure Variability is Associated with the Presence and Severity of Sleep Disorders

Background/Aims: In chronic kidney disease (CKD) patients blood pressure variability (BPV) is associated with poor outcome. Sleep disturbances alter BP profiles in hypertensives but their influence on BPV in CKD patients is unknown. We screened a cohort of CKD/ESRD patients to investigate whether sleep quality impacts on BPV. Methods: Consecutive CKD patients’ sleep quality was assessed using validated questionnaires (Epworth Sleepiness Scale-ESS); International Restless legs scale-IRLS; Functional Outcomes of Sleep Questionnaire-FOSQ: Insomnia Severity Index-ISI; STOP-Bang). All patients underwent ambulatory blood pressure measurement. Results: 104 out of 143 enrolled patients (78.32% stage-3 CKD; 10.49% Stage-4; 11.19% Stage-5; 6.99% ESRD-under dialysis) completed all the questionnaires. 95.8% were hypertensives, 70% were non-dippers and 27.8% had resistant hypertension. STOP-Bang>4 proved sleep disorders in 84.84% of patients. Patients with IRLS>10 had greater diastolic nocturnal standard deviation (DNSD) and a trend (p=0.05) for systolic nocturnal SD (SNSD). Patients with ISI>14 had greater SNSD and in 28.8% FOSQ showed severely impaired sleep quality. Their systolic nocturnal BPV was significantly greater. ISI was independently associated with SNSD. FOSQ and diastolic nocturnal BPV were negatively correlated at the bivariate analysis and FOSQ independently predicts systolic nocturnal BPV at multivariate regression analysis. Conclusions: In CKD patients impaired sleep quality increases BPV, might contribute to their disease progression and worsen prognosis. Searching for sleep problems in CKD patients could help planning their treatment of sleep problems contributing to CV risk reduction. Our data provide the rationale working hypothesis for the need of studies with larger number of patients aimed to demonstrate improved outcome of CKD progression and CV risk with the treatment also of sleep disorders.

Obstructive sleep apnea and periodic limb movement disorder in a population of children with hypertension and/or nocturnal nondipping blood pressures

There is a reported association between hypertension (HTN) and sleep disorders. The American Academy of Pediatrics recommends screening children with HTN for sleep disorders because sleep disorders increase the risk for cardiovascular disease. We quantified the frequency and severity of sleep disorders within our institution's hypertensive pediatric population and evaluated the effectiveness of performing nocturnal polysomnography (NPSG). In the hypertensive pediatric population referred for NPSG at our institution, 64% were diagnosed with obstructive sleep apnea (OSA) and/or periodic limb movement disorder. Thirty-three percent of those children with HTN had moderate to severe OSA, whereas only 20% of all children evaluated by NPSG had moderate to severe OSA. Those children with HTN were also two times more likely to be diagnosed with periodic limb movement disorder. Screening for sleep disorders and obtaining NPSG in children with HTN increase the identification of comorbid sleep disorders and reduce the risk for cardiovascular disease.

Cross-sectional analysis and prospective observational study of sleep quality, lung function, ventilatory muscle strength, ventilatory patterns, autonomic nervous activity, disease severity, clinical status and quality of life in Myasthenia Gravis: a rese

Introduction: The presence of sleep disorders in Myasthenia gravis (MG) patients, can negatively affect the ventilation and the mechanics of breathing in patients with neuromuscular diseases. Some studies have shown a poor quality of sleep, excessive daytime sleepiness and the presence of sleep disordered breathing, while others did not observe a positive correlation. The aim of the study is to investigate sleep quality, lung function, ventilatory patterns, autonomic nervous activity, disease severity, clinical status and quality of life in clinically stable MG patients. Method: We propose a cross sectional analysis and prospective observational study of sleep quality, lung function, ventilatory patterns, autonomic nervous activity, disease severity, clinical status and quality of life in MG patients which will be conducted at the Sleep Laboratory of Nove de Julho University and the Neuromuscular Research Department of the Federal University of São Paulo. The design, conduct, and reporting of this study will follow the rules of The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. The protocol will includes body weight; height; body mass index; circumferences of the neck, waist, and hip; heart and respiratory rates; Mallampati index; maximum ventilatory pressures; spirometry; and standard overnight polysomnography, as well as the administration of specific questionnaires addressing the risk of obstructive sleep apnoea, excessive daytime sleepiness and HRQoL. Moreover, specific questionnaires addressing sleep apnoea; excessive daytime sleepiness; symptoms of stress, depression, anxiety, disease severity, clinical status and quality of life will be administered. The 8 outcome variables which will be measured include subjective sleepiness Epworth Sleepiness Scale (ESS), risk of OSA through The Berlin Questionnaire, stress and its manifestations by The Inventory of Symptoms of Stress for Adults (LIPP), anxiety and depression by The Hospital Anxiety and Depression Scale (HAD), general quality of life questionnaire using The Short Form 36 (SF36) and specific outcome measure MGQOL 15, MG Composite Scale and The Quantitative Myasthenia Gravis Score. Discussion: This protocol expects to identify the presence and severity of sleep disorders, changes of autonomic nervous activity, HRQoL and consequently contribute to an earlier diagnosis, thus reducing the impact on quality of life of MG patients. Trial registration: The protocol for this study is registered with the Brazilian Registry of Clinical Trials (ReBEC RBR-7ckpdd) and World Health Organization under Universal Trial Number UTN: (U1111-1147-7853).

Sleep Disorders in Patients with Dementia in Parkinson’s Disease

Dementia and psychotic diseases represent a common complication of Parkinson’s disease (PD), occurring in 40–70% of cases. These complications are commonly accompanied by sleep disorders, which constitute non-motor manifestations of PD. The aims of the present work were to assess the relationship between the severity of daytime drowsiness and REM sleep behavior disorder on the one hand and the severity of cognitive deficits and hallucinations on the other; to compare methods for assessing sleep impairments in Parkinson’s disease using questionnaires and polysomnograms; and to evaluate the effects of treatment with galantamine in sleep disorders. A number of scales (MMSE, FAB, ESS, PDSS), as well as polysomnographic investigations, were used to assess sleep and cognitive functions in 26 patients with PD with dementia before and after treatment with galantamine. The results revealed a significant negative correlation between the severity of sleep disorders (increased daytime drowsiness and REM sleep behavior disorder) with hallucinations and cognitive deficits. Treatment with galantamine produced significant improvements in the quality of nocturnal sleep (restoration of its structure, decreased fragmentation), with reductions in the severity of REM sleep behavior disorder and decreases in daytime drowsiness, along with reductions in cognitive deficits and hallucinations.

Troubles du sommeil et de l’éveil : mise au point

Insomnia is the most prevalent sleep disorders and affects severely 10% of adults worldwide. From poor sleep to insomnia, the severity of sleep disorders should be assessed clinically and by the use of validated questionnaires based on international consensual definitions. One main sign of insomnia is impaired daytime functioning. Insomnia may be treated with hypnotics only for a limited duration. Behavioural and cognitive therapies have been found efficient on chronic insomnia. Sleepiness is also a common sleep disorders due to altered sleep schedules, sleep deprivation, sleep disorders or as an adverse effect of some treatments. The risk of car accidents and the impaired quality of daytime functioning are the main consequences of sleepiness. The aim of this paper is to give some recommendations for the diagnosis and treatment of insomnia and sleepiness.

Assessment of Sleep Impairment in Persistent Allergic Rhinitis Patients Using Polysomnography

Background: Although questionnaires have demonstrated an association between impairment of quality of sleep and symptoms in allergic rhinitis (AR) patients, to date there is no report of an objective assessment of sleep in patients with persistent allergic rhinitis (PER) as defined by ARIA guidelines. The aim of the present study was therefore to assess sleep disturbance in PER patients by polysomnography (PSG). Methods: Ninety-eight PER patients with moderate-to-severe nasal obstruction and 30 healthy volunteers were included in the study. All patients underwent PSG during nocturnal sleep to assess the presence and severity of sleep disorders. Peak nasal inspiratory flow (PNIF) was also measured to assess nasal resistance. Results: There were statistically significant, though clinically modest, differences between PER patients and healthy controls in most PSG parameters including sleep efficiency, arousal index, average SaO₂, lowest SaO₂, time spent with a saturation below 90%, and snoring time. Although the apnea-hypopnea index (AHI) was not significantly different between the 2 groups, 17 subjects (17.3%) in the PER group but none of the control subjects had an AHI >5. Patients with higher T5SS scores (12 ≤ T5SS ≤ 15) had a greater tendency to snore than did patients with lower scores (8 ≤ T5SS ≤ 11). Finally, PNIF in the PER group was significantly lower than in the control group. Weak correlations between the arousal index and PNIF, average SaO₂, and PNIF were found. Conclusion: PSG showed modest changes in PER patients versus control subjects.

Relationships between Some Individual Characteristics and Occupational Accidents in the Construction Industry

Relationships between Some Individual Characteristics and Occupational Accidents in the Construction Industry: A Case‐Control Study on 880 Victims of Accidents Occurred during a Two‐ Year Period: Nearkasen Chau, et al. National Institute for Health and Medical Research (INSERM), Unit 420, Faculte de Medecine—This case‐control study assessed the relationships between certain individual characteristics (age, body mass index, training, length of time in present job, sleep disorders, certain disabilities, smoking habits, sporting activities) and occupational accidents in construction male labourers: 880 cases with at least one occupational accident in 1995‐1996, 880 controls with no occupational accident during the previous five years, matched to cases on the job. A standardised questionnaire, filled in by the occupational physician, was used. The statistical analyses were made by the conditional logistic regression method for paired data. The main causes of accidents were handling or carrying objects, falls to a lower level, construction machinery and devices, falls on the same level, moving objects, hand tools. For all accidents combined, the factors with significant adjusted odds‐ratios (OR) were: age&lt;30 yr (OR 1.30, 95%C11.01‐1.68), sleep disorders (1.97, 1.42‐2.73), and current smoker (1.27, 1.04‐1.54). Sleep disorders were a significant factor in falls to a lower level (OR 2.25, 95%CI 1.14‐4.44), age&lt;30 yr and sleep disorders for accidents caused by moving objects (4.64, 1.48‐14.5 and 13.11, 2.64‐65.2 respectively), and no sporting activity for injuries by handling or carrying objects (1.70, 1.11‐2.60). Sleep disorders were significant for accidents with sick leave lengths of &gt;15 d, whereas age&lt;30 yr and current smoker were significant for the others (&lt;14 d). A relationship was observed between the severity of sleep disorders and accidents. Occupational accidents are mainly due to work conditions, but certain individual characteristics may also play a role; this should be confirmed by further studies.