Significant Improvement In Sleep Quality Research Articles

Effect of melatonin on sleep quality and EEG features in childhood epilepsy: a possible non-conventional treatment.

Sleep and epilepsy are characterized by a bidirectional relationship. Indeed, epilepsy predisposes to the development of sleep disorders, while sleep deprivation may exacerbate epilepsy. In addition, antiseizure medication can disrupt normal sleep architecture. Therefore, adequate sleep hygiene could lead to improvement in seizure control. The present study aimed to evaluate the effect of melatonin on seizure frequency, EEG tracing, and sleep in children with focal idiopathic epilepsy. This observation study evaluated the effect of 4 mg oral melatonin in ameliorating sleep-wake cycle, seizure frequency, and EEG features in children with focal idiopathic epilepsy of infancy. Twenty children were enrolled from September 2020 to August 2021. The study consisted of serial controls at enrollment (t0), at 3 months (t1), and at 6 months (t2) including neurological examination, questionnaire about sleep disturbances (CSHQ), and EEG. A significant improvement in sleep quality and daytime sleepiness was observed after melatonin supplementation. Furthermore, we observed a noteworthy improvement in EEG tracing at t2 that exhibited a significant correlation with improvements in CSHQ scores. The studies conducted so far to evaluate the effect of melatonin in persons with epilepsy do not lead to definitive conclusions. Despite the small population sample and the study design, we report sleep and EEG improvement after melatonin administration in our cohort. Larger studies are needed to further study the neuroprotective and anticonvulsant properties of melatonin.

Effects of rational emotive behavior therapy on alexithymia, anxiety, depression and sleep quality of older people in nursing homes: a quasi-experimental study

BackgroundAlexithymia, a subclinical cognitive-affective impairment, is prevalent in older people and increases the risk of mental disorders. There is a vast alexithymia treatment gap, with majority of older people in nursing homes lacking access to adequate mental health care. The study aimed to evaluate the effects of rational emotive behavior therapy (REBT) on alexithymia, anxiety, depression and sleep quality of older people in nursing homes.MethodsThis quasi-experimental study was conducted with two groups (the control group and intervention) from March to November 2021. This study enrolled 86 participants, two of whom were lost to follow-up; 42 received usual care (control group) and 42 received REBT based on usual care (intervention group) in nursing homes. The older people in both groups were evaluated at baseline (T0), within one-week post-intervention (T1), and at 3-month follow-up (T3). Generalized estimating equations were used by SPSS version 26 to assess the differential change in the outcomes between the two groups.ResultsThe intervention group shows significantly greater improvement in alexithymia than the control group at both T1 (β = -8.167, 95%CI= -10.965, -5.368, P < 0.001) and T2 (β=-4.119, 95%CI= -7.171, -1.067, P = 0.008). The two groups showed significant differences at both T1 and T2 in both difficulty identifying feelings and difficulty describing feelings. Compared to the control group, the intervention group shows a significant improvement in sleep quality at T2 (β = -2.048, 95%CI=-4.004, -0.091, P = 0.040). The two groups showed significant differences at both T1 and T2 in both sleep disturbance and daytime dysfunction. For depression and anxiety, no significant differences were found between the intervention and control groups.ConclusionsREBT showed to be an effective method for improving alexithymia and sleep quality of older people in nursing homes. However, it failed to significantly alleviate anxiety and depression at least in a short-term trial. Refining this intervention may have a broader, more substantial impact on future research.

The Effect of Box Breathing on Sleep Disorders in Elderly at Tresna Werdha Social Institution

Introduction: The elderly population has become a global phenomenon. Almost every country in the world is experiencing an increase in the elderly population There are 703 million people in the world who are 65 or older. An elderly person will require more time to fall asleep and will experience less or shorter deep sleep. Factors that affect sleep disorders include age, history of illness, drinking coffee, and smoking cigarettes. To improve sleep quality in the elderly, a deep breathing relaxation technique, specifically the box breathing relaxation technique, is required. Aim: Research to identify the effect of box breathing on sleep disorders in the elderly at Tresna Werdha Social Institution, Bekasi City. Methods: In this, the quasi-experiment design was employed, which included a non-equivalent control group pretest-posttest design with an intervention group and a control group. The sample size in this study was 62 respondents and was divided into two groups, including 31 elderly people in the intervention group and 31 respondents in the control group. Results: It can be seen that the average difference in posttest minus pretest scores (posttest-pretest) or expressed as ∆ mean in the intervention group of 5.29 and in the control group of 0.32. With a p value of 0.000 (p&gt;0.05), there are statistically significant differences in social sleep disorder in the elderly in Tresna Werdha Bekasi City in 2022 between the intervention and control groups. Conclusion: The box breathing technique can be an effective intervention to improve sleep quality in elderly individuals. The results showed a statistically significant improvement in sleep quality.

Using gamma-band transcranial alternating current stimulation (tACS) to improve sleep quality and cognition in patients with mild neurocognitive disorders due to Alzheimer's disease: A study protocol for a randomized controlled trial.

Sleep disturbances are highly prevalent in patients with age-related neurodegenerative diseases, which severely affect cognition and even lead to accumulated β-amyloid. Encouraging results from recent studies on transcranial direct current stimulation (tDCS) showed moderate positive effects on sleep quality in preclinical Alzheimer's disease (AD). Compared to tDCS, transcranial alternating current stimulation (tACS) enables the entrainment of neuronal activity with optimized focality through injecting electric current with a specific frequency and has significant enhancement effects on slow wave activities. This is a randomized, double-blind, sham-controlled clinical trial comparing 40 Hz tACS with tDCS in mild neurocognitive disorders due to AD with sleep disturbances. Magnetic resonance imaging (MRI) data is used to construct personalized realistic head model. Treatment outcomes, including sleep quality, cognitive performance and saliva Aβ levels will be conducted at baseline, 4th week, 8th week, 12th week and 24th week. It is expected that the repeated gamma-band tACS will show significant improvements in sleep quality and cognitive functions compared to tDCS and sham tDCS. The findings will provide high-level evidence and guide further advanced studies in the field of neurodegenerative diseases and sleep medicine. ClinicalTrials.gov Identifier: NCT05544201.

Daily consumption of Lactobacillus gasseri CP2305 improves quality of sleep in adults – A systematic literature review and meta-analysis

The gut-brain axis is one of the proposed interactions between the brain and peripheral intestinal functions; of particular interest is the influence of food components on the gut-brain axis mediated via the gut microbiome. Probiotics and paraprobiotics have been proposed to interact with the intestinal environment and provide health benefits such as improving sleep quality. The aim of this research was to undertake a systematic literature review and meta-analysis to evaluate the current evidence regarding the effects of Lactobacillus gasseri CP2305 on sleep quality for the general population. A systematic literature search was conducted of peer-reviewed articles published up to 04 November 2022. Randomised controlled trials were identified that investigated the effects of Lactobacillus gasseri CP2305 on sleep parameters in adults. Meta-analysis of the change in the Pittsburgh Sleep Quality Index (PSQI) global score was conducted. Quality assessments of individual studies were conducted using the Cochrane Risk of Bias and Health Canada tools. Seven studies were included in the systematic literature review; six studies included data for meta-analysis to quantify the effect of L.gasseri CP2305 on sleep quality. The ingestion of L.gasseri CP2305 resulted in significant improvement in the PSQI global score compared to control (-0.77, 95% CI:-1.37 to-0.16, P=0.01). In the two studies that included electroencephalogram (EEG) data, output was significantly improved for at least half of the measured EEG outcomes after consumption of L.gasseri CP2305. No serious concerns were found in the potential biases of included studies, indirectness of the included evidence, and other methodological issues. The present systematic review and meta-analysis indicates significant improvement in sleep quality of adults with mild to moderate stress as an effect of daily consumption of L.gasseri CP2305. Based on existing evidence, the relationship between L.gasseri CP2305 and enhanced sleep quality is plausible, however further investigations are required to confirm the mechanisms of actions for this effect.

The Impact of Kiwifruit Consumption on the Sleep and Recovery of Elite Athletes.

Poor sleep and resultant under-recovery can negatively impact training adaptations, increase the risk of injury and reduce subsequent performance. Due to the 'food first' approach adopted by many athletes, there is scope for investigation of 'functional food' based interventions (i.e., kiwifruit contains melatonin which plays a role in circadian rhythm regulation) designed to promote athlete recovery and/or enhance sleep quality and quantity. Following the baseline assessment (Week 1) all subjects began the intervention (Weeks 2-5). During the 4-week intervention, participants were asked to consume 2 medium-sized green kiwifruit (Actinidia Deliciosa) an hour before bed. Participants completed a questionnaire battery at baseline and post-intervention, and a daily sleep dairy for the duration of the study. The results demonstrated a positive impact of kiwifruit consumption on key aspects of sleep and recovery in elite athletes. From baseline to post-intervention, there were clinically significant improvements in sleep quality (i.e., improved PSQI global scores and sleep quality component scores) and improvements in recovery stress balance (reduced general stress and sports stress scales). Moreover, the intervention improved sleep as evidenced by significant increases in total sleep time and sleep efficiency % and significant reductions in number of awakenings and wake after sleep onset. The findings broadly suggested that kiwifruit does impact positively on sleep and recovery in elite athletes.

The impact of laparoscopic Roux-en-Y gastric bypass on sleep quality and duration after one year of follow-up

Several studies have shown the association between obesity and sleep. Roux-en-Y gastric bypass (RYGB) surgery may improve sleep disturbances in patients with obesity by influencing a variety of factors. This study aims to evaluate the impact of bariatric surgery on sleep quality. Patients with severe obesity referred to the obesity clinic of a center from September 2019 to October 2021 were collected. The patients were divided into two groups, depending on whether they underwent RYGB surgery. Medical comorbidities and self-report questionnaires regarding sleep quality, anxiety, and depression were collected at baseline and 1-year follow-up. 54 patients were included, including 25 in the bariatric surgery group and 29 in the control group. However, five patients in the RYGB surgery group and four patients in the control group were lost in the follow-up. Pittsburgh Sleep Quality Index (PSQI) was decreased from a mean of 7.7 to 3.8 in the bariatric surgery group (p-value<0.001). In contrast to the control group, the number of patients with obstructive sleep apnea was significantly reduced in the bariatric surgery group. We showed a significant improvement in sleep quality following RYGB surgery. Obstructive sleep apnea, obesity/overweight, and depressive symptoms significantly improved in our study. There is a lack of a better understanding of the association between these factors and sleep quality following surgery. Therefore, further studies are recommended regarding this issue.

Effect of gut microbiota modulation on sleep: a systematic review and meta-analysis of clinical trials.

A bidirectional relationship between gut microbiota (GM) and circadian rhythms has been proposed. The aim of this study was to analyze the efficacy of probiotic or prebiotic intervention on sleep quality and quantity. A systematic review and meta-analysis were conducted using the databases PubMed (MEDLINE), Embase, CINAHL, and Web of Science. Only randomized clinical trials written in English or Spanish were considered. The initial search resulted in 219 articles. Following the removal of duplicates and consideration of the selection criteria, 25 articles were selected for the systematic review and 18 articles for the meta-analysis. Microbiota modulation was not demonstrated to be associated with significant improvement in sleep quality in the present meta-analysis (P = 0.31). In terms of sleep duration, the meta-analysis found no improvement due to GM modulation (P = 0.43). The results of this meta-analysis indicate that there is still insufficient evidence to support the relationship between GM modulation and improved sleep quality. While several studies assume that including probiotics in the diet will undoubtedly improve sleep quality, more research is needed to fully understand this phenomenon. PROSPERO registration no. CRD42021245118.

English

Introduction: Due to demographic changes in fertility and mortality, it is predicted that in 2050 the proportion of the world population aged 60 and over will increase from 11% to 22%. Objective: To analyze the effects of high-intensity interval training in healthy older adults. Material and method: A bibliographic search was carried out in the following Pubmed, Scielo and ScienceDirect databases, using the Boolean terms High-intensity interval excercise OR High-intensity interval training OR high intensity interval activity AND aged OR older adult OR elderly. The PICoR strategy was used to define eligibility criteria (P) Healthy Older Adults, (I) Use High Intensity Interval Training (HIIT), (C) be subjected to evaluation using the PEDRO scale and obtain a score equal to or greater than 6 points, (O) effect of high-intensity interval training in Adults Healthy elderly (S) studies with control groups or other interventions, published between the years 2016 to 2021. Results: 1.516 articles were identified, but only those that met the inclusion criteria (7 studies) were included. Significant improvements in sleep quality, fatigue, and body composition were obtained by combining HIIT training with nutritional support. Other improvements were obtained in strength, anabolic hormones, blood lipids, VO2max, exercise tolerance, and systolic BP using only HIIT training. Conclusion: The adapted HIIT training is applicable to healthy older adults and causes significant improvements in this age group.

Long-Term Follow-Up Result of Connective Tissue Manipulation in Young Women with Primary Dysmenorrhea: Different Intervention Durations.

The purpose of this study was to reveal the effect of connective tissue manipulation (CTM) on long-term pain severity, fatigue, sleep quality, premenstrual symptom severity, general health status, anxiety, and depression in women with primary dysmenorrhea (PD). Thirty-five women with PD were divided into two groups. CTM was applied to the participants in each group on the days when they were not on menstruation between two menstrual cycles for the group 1 (n=18) and between three menstrual cycles for the group 2 (n=17). Intensity of menstrual pain, the sleep quality, and fatigue status of the participants during dysmenorrhea were evaluated by the Visual Analog Scale (VAS). Depressive symptoms and anxiety were evaluated using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI), respectively. Also, the Premenstrual Syndrome Scale (PMSS) and the General Health Questionnaire (GHQ) were used to investigate the severity of premenstrual symptoms and mental health status during menstrual period. A significant decrease in the pain severity and fatigue of the participants was observed in both group 1 and group 2 after treatment, after 3rd, and 6th month follow-up (p=0.001). Also, this decrease lasted for 12th month follow-up after treatment in group 2 (p=0.0001). There was no statistically significant improvement in sleep quality within each group (p>0.05). Moreover, none of the parameters were significantly different between two groups (p>0.05). We can suggest that 2-cycle CTM treatment should be preferred in clinical settings to obtain long-lasting effects for decreasing pain, fatigue, and premenstrual symptoms in women with PD. CLINICAL TRIAL NUMBER: NCT04509934. Registration date: 8 November 2020.

The Influence of Scent on Sleep Quality

The use of scents in sleep medicine is gaining increasing attention since they have been shown to improve sleep quality. This randomized double-blinded crossover trial measured the extent to which a continuous nightly presentation of a synthetic jasmine scent combined with lavender oil and passionflower herb improves subjective and objective sleep quality. Thirty sensitive sleepers (ISI 7-14) who suffer from delayed sleep-onset and frequent sleep disturbances (2-3 per week) were monitored under four conditions in the sleep laboratory over four nights. The first night was for acclimation (baseline), and the other nights were randomized in a counterbalanced order (placebo rose scent, a high-dose of jasmine scent, or a low-dose relative to the essential oils). Alongside this, subjects were given standardized questionnaires to complete in the morning and evening. There was a significant improvement in sleep quality and total sleep time when using scents compared to baseline. Furthermore, both variants of jasmine decreased wake after sleep onset. The results also indicated that the application of scent on the T-shirt was well tolerated by all subjects. Overall, it was shown that the jasmine scent may positively affect sleep parameters, and moderators such as dosage, application method, and duration of the scent should be further investigated.

Effectiveness of Digital Cognitive Behavior Therapy for the Treatment of Insomnia: Spillover Effects of dCBT.

The effects of digital Cognitive Behavior Therapy for insomnia (dCBT-i) on sleep quality have been previously demonstrated but the spillover effects on fatigue, flow (a state of immersion in activities of interest), and cognitive flexibility remain unclear. The current study examined the effectiveness of dCBT-i. A total of 97 college students (20.96 ± 1.87 years, 73.1% female students) were randomly selected from a shortlist and divided into sleep intervention (n = 39), conventional education (n = 37), and healthy control (n = 21) groups. Task switching paradigm, Fatigue Severity Scale (FSS), Flow Experience Scale (FES), and the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) were measured pre- and post-intervention. Results show that the sleep quality of the intervention group improved, and fatigue was relieved. Participants in the sleep intervention group had increased flow experience scores post-intervention and improved cognitive flexibility. The control group’s sleep quality deteriorated and fatigue level increased. dCBT-i can not only achieve a significant improvement in sleep quality and reduce fatigue, but also improve learning abilities, quality of life, flow, and cognitive flexibility. Future research should pay attention to indicators such as work efficiency, sedative use, and the durability and stability of such effects.

SAS CARE 1: Sleep architecture changes in a cohort of patients with Ischemic Stroke/TIA

ObjectiveChanges in sleep architecture following ischemic stroke have been poorly investigated. Our objective was to explore changes of sleep structure in patients with ischemic stroke or transient ischemic attack in order to verify a possible predictive value of sleep with respect to clinical outcome. MethodsPatients recruited in the prospective SAS-CARE study received two polysomnographies (PSG) in the acute and chronic phases after stroke/TIA. Sleep parameters were compared between the two time-points and matched with a non-stroke population randomly selected from the HypnoLaus cohort. ResultsOf the 169 patients investigated with PSG in the acute phase, 104 were again studied 3 months after stroke symptom onset and compared with 162 controls. The acute phase of stroke/TIA was associated with sleep disruption, which significantly improved in the chronic phase, but remained worse than controls (total sleep time improve from 318.8 ± 90.8 to 348.4 ± 81.5 min, compared to 388.2 ± 71.3 in controls, sleep latency from 49.9 ± 58.4 to 27.9 min, compared to 20.2 ± 22 in controls, sleep efficiency from 58.2 ± 18.1% to 27.9 ± 36.4 min, compared to 83.4 ± 10.3% in controls, wakefulness after sleep onset percentage from 36.5 ± 17.3 to 29.3 ± 15.6, compared to 13.2 ± 9.2 in controls). The percentage of REM sleep was negatively associated with stroke severity, whereas stroke topography did not correlate with sleep parameters. ConclusionsThis study confirmed a severe sleep disruption in the acute phase of stroke. Although a significant improvement of sleep quality was observed during the three months after stroke, sleep architecture did not normalize. In particular, sleep efficiency and REM sleep seem to be particularly affected by stroke in the acute phase, with a relative preservation of NREM sleep. We suggest that these sleep architecture changes represent a persistent marker of brain damage due to stroke. Further studies are needed to assess the relationship with stroke topographic and outcome.

Music to improve sleep quality in adults with depression-related insomnia (MUSTAFI): randomized controlled trial

Background Insomnia in depression is common and difficult to resolve. Unresolved depression-related sleep disturbances increase risk of relapse at high costs for individuals and society. Trials have suggested music for insomnia in various populations, but there is little research on the effectiveness of music for depression-related insomnia. Methods We examined the efficacy of a music intervention on insomnia, depression symptoms and quality of life in adults with depression-related insomnia. A two-armed randomized controlled trial was conducted, including depression outpatients with insomnia (n = 112) in a 1:1 ratio to music intervention and waitlist control group. The intervention group listened to music at bedtime for 4 weeks. Participants received treatment as usual during 8 weeks with assessments at baseline, at 4 and 8 weeks. The primary outcome measure was Pittsburgh Sleep Quality Index (PSQI), secondary outcomes comprised Actigraphy, the Hamilton Depression Rating Scale (HAMD-17) and World Health Organisation well-being questionnaires (WHO-5, WHOQOL-BREF). Results The music intervention group experienced significant improvements in sleep quality and well-being at 4 weeks according to global PSQI scores (effect size = −2.1, 95%CI −3.3; −0.9) and WHO-5 scores (effect size 8.4, 95%CI 2.7;14.0). At 8 weeks, i.e. 4 weeks after termination of the music intervention, the improvement in global PSQI scores had decreased (effect size = −0.1, 95%CI −1.3; 1.1). Actigraphy sleep assessments showed no changes and there was no detection of change in depression symptoms. Conclusions Music intervention is suggested as a safe and moderately effective sleep aid in depression-related insomnia. Trial registration: Clinicaltrials.gov. ID NCT03676491

The effectiveness of acceptance and commitment therapy (ACT) on sleep quality and quality of life of patients with cardiovascular problems

Introduction: People with cardiovascular problems have poor sleep quality and quality of life. These problems exacerbate the process of their disease. Aim: The purpose of this study was to investigate the effectiveness of acceptance and commitment-based therapy on improving quality of life and sleep quality of cardiovascular patients. Method: This research has been executed in context of a clinical trial plan with pre-test, post-test and two-month and six-month follow up period. Among the patients with cardiovascular disease of Kermanshah city who had referred in hospitals of this city in year 2020-2021, 40 people were purposefully selected and were randomly assigned to experimental (n=20) and control (n=20) groups. Tools of this research included: Pittsburgh sleep quality index (PSQI) and The Short form health survey (SF-36). The experimental group received eight sessions of 90-minute acceptance and commitment therapy. SPSS-24 software and repeated measures analysis of variance were used to analyze the data. Results: The results of this research indicated that acceptance and commitment therapy leads to a significant improvement in sleep quality and quality of life in the experimental group (P&lt;0.01). The effect size for quality of life and quality of sleep were 0.63 and 0.62, respectively (P&lt;0.01). Conclusion: The findings of this study showed that acceptance and commitment therapy leads to improved quality of life and quality of sleep in patients with cardiovascular problems. Based on these findings, this treatment can be used to improve sleep quality and quality of life problems that play an exacerbating role in the process of disease in patients with cardiovascular problems.

Can improving quality of sleep reduce the symptoms of cancer-related fatigue in adults?: A systematic review.

PurposeCancer‐related fatigue (CRF) results in reduced quality of life for cancer patients. The relationship between tiredness and fatigue has been established in cancer patients and has been shown to be reciprocal, meaning the relationship is somewhat ‘chicken or the egg’ with tiredness influencing fatigue and vice versa. The aim of this study is to determine whether an improvement in sleep quality can ease the symptoms of CRF and whether this can support the theory that CRF symptoms stem from the effect of tiredness.MethodThree databases were searched producing 259 papers. The papers were filtered using several inclusion criteria, resulting in a final list of 20 papers for analysis. The remaining papers (20) were critically appraised using the Critical Appraisals Skills Programme (CASP) randomised control trial checklist and assessed for bias using the Cochrane Collaboration's tool for assessing risk of bias in randomised trials.ResultsFourteen papers showed an increase in sleep quality that also resulted in an improvement in fatigue symptoms. Cognitive behavioural therapy was shown to be the most effective intervention with a statistically significant decrease in fatigue alongside significant improvement in sleep quality shown in six of the papers (p < 0.05). Sleep education also had a positive impact on both sleep and fatigue scores with three papers showing significant improvements. Three papers focusing on exercise interventions produced a significant improvement in fatigue symptoms and quality of sleep.ConclusionImproving quality of sleep does ease the symptoms of CRF; however, the ‘chicken or the egg’ question regarding CRF and tiredness cannot be answered at this stage.

Development and Study of Ezzence: A Modular Scent Wearable to Improve Wellbeing in Home Sleep Environments.

Ezzence is the first smartphone-controlled olfactometer designed for both day and night conditions. We discuss the design and technical implementation of Ezzence and report on a study to evaluate the feasibility of using the device in home-based sleep environments. The study results (N = 40) show that participants were satisfied with the device and found it easy to use. Furthermore, participants reported a significant improvement in sleep quality when using the device with scent in comparison to the control condition (p = 0.003), as well as better mood the following morning (p = 0.038) and shorter time to sleep onset (p = 0.008). The device is integrated with a wearable EEG and real-time sleep staging algorithm to release scent during specific sleep stages (N1, N2, N3, and REM), which is important for certain use cases (e.g., to study the effect of scent on REM dreams, or to improve memory consolidation with a re-exposure of scent during N2 and N3). Ezzence can be used for several applications, including those that require scent triggered day and night. They include targeted memory reactivation, longitudinal health treatments, therapy, and mental or physical exercises. Finally, this article proposes an interaction framework to understand relationships between scents and environments based on proxemic dimensions and passive or active interactions during sleep.

Vitamin D Supplementation and Sleep: A Systematic Review and Meta-Analysis of Intervention Studies.

Background: Vitamin D deficiency is associated with sleep disorders and poor sleep quality. Whether vitamin D supplementation (VDS) helps resolve these problems remains unclear. Objective: To systematically review the effect of VDS on sleep quantity, quality, and disorders, and perform a meta-analysis of available data. Methods: The reporting of this review followed the PRISMA statement. VDS human interventions studies that reported on sleep quality, quantity, or disorders were included. Medline, CINAHL, EMBASE, PsycInfo, the Cochrane Library, Clinicaltrials.gov, and the ICTRP were searched, in addition to the references of the included articles and previous relevant reviews, without language or time restrictions. Included studies were critically appraised, findings were narratively synthesized, and a meta-analysis was conducted. Furthermore, the overall certainty of the evidence was assessed. Results: A total of 19 studies were included (13 randomized controlled trials (RCTs), 1 opportunistic addition to an RCT, 4 pre–post studies, and 1 pre–post study analyzed as a case series); 3 RCTs were meta-analyses. The risk of bias was generally low. Pre–post studies showed a significant improvement in sleep quality with VDS. Similarly, the results of the meta-analysis revealed a statistically significant decrease in the Pittsburgh Sleep Quality Index with VDS compared with placebo (mean difference, −2.33 (95% CI, −3.09, −1.57); p < 0.001; I2 = 0%), with a moderate certainty of evidence. The results regarding the effect of VDS on sleep-related impairment, difficulty, and disorders, as well as sleepiness and restless legs syndrome, were not unanimous. Conclusions: VDS is promising in improving sleep quality; however, its effect on sleep quantity and disorders needs to be further investigated.

Longitudinal Analysis Evaluating Self-Reported CPAP Use for OSA during the COVID-19 Pandemic.

Continuous positive airway pressure therapy (CPAP) is a highly effective treatment for obstructive sleep apnea (OSA), but CPAP adherence remains suboptimal. The COVID-19 pandemic significantly altered sleep medicine services and aspects of daily living for sleep medicine patients, which may further compromise CPAP adherence. Sleep medicine patients were distributed an online survey at baseline and six months later (January–May 2021). Participants answered questions regarding CPAP use (any changes in CPAP use, sleep quality with CPAP use, CPAP use as advised, and changes in daily habits). Eighty-one adults completed the baseline survey, and 54 adults completed the follow-up survey. Twenty-seven participants reported a diagnosis of OSA and were prescribed CPAP (mean age 58 ± 18.2 years, 48% female, 67% Caucasian). Longitudinal analysis with chi-square association testing showed significant changes in CPAP use as advised and significant improvements in sleep quality with CPAP use when comparing the baseline to six-month follow-up survey. Additionally, logistic regression was performed to determine if pre-pandemic sleep study results (apnea-hypopnea index and respiratory disturbance index) predicted self-reported CPAP use during the pandemic, though no association was found. Throughout the pandemic, sleep medicine patients improved their CPAP use as advised and reported significant improvements in sleep quality with CPAP use.

Effect of Inquiry-Based Stress Reduction on Well-being and Views on Risk-Reducing Surgery Among Women With BRCA Variants in Israel

The high risk for breast and ovarian cancers conferred by being a carrier of BRCA1 or BRCA2 germline variant can negatively impact physical and psychological well-being. Novel nonpharmacological interventions on well-being in women with BRCA variants have rarely been reported. To determine the effect of a 12-week inquiry-based stress reduction (IBSR) program on psychological well-being, sleep quality, psychosocial variables, and attitudes toward risk-reducing surgical procedures among women in Israel who carried BRCA variants. This randomized clinical trial had a 12-week intervention period and a 12-week follow-up period. It was conducted between April 1, 2017, and July 31, 2020. Participants were recruited from the Meirav Breast Center at the Sheba Medical Center, Israel, and the intervention was conducted in Tel Aviv, Israel. The cohort included women with BRCA variants. Data were analyzed from August 1 to December 1, 2020. Women were randomly assigned to the 12-week IBSR program or standard care. The IBSR technique is based on the skills of mindfulness, inquiry, and cognitive reframing. The intervention included standardized, weekly group meetings conducted throughout 12 weeks. Standard care included semi-annual breast examinations and breast magnetic resonance imaging (alternating), a gynecological examination, a transvaginal ultrasonographic examination, and CA-125 serum determination. Differences between the groups were tested using mixed-effects models in an intent to treat analysis. The primary outcome was psychological well-being, including 6 parameters: autonomy, personal growth, positive relationships, control of the environment, goals in life, and self-acceptance. Secondary outcomes included sleep quality, attitudes toward risk-reducing surgical procedures, and psychosocial variables. Questionnaires were administered at baseline (T1), at completion of the 12-week intervention (T2), and 12 weeks after completion of the intervention (T3). Overall, 100 women (mean [SD] age, 41.37 [11.06] years) completed the study, with 50 randomized to the intervention group and 50 randomized to the control group. Mean (SD) time from variant discovery was 4.7 (3.3) years. There were no differences between the intervention and control groups in baseline mean (SD) scores of psychological well-being parameters (autonomy: 55.20 [11.12] vs 56.77 [9.90]; environmental control: 56.30 [11.98 vs 58.51 [11.41]; positive relationships: 63.10 [15.91] vs 68.10 [9.86]; goals in life: 60.00 [14.12] vs 64.82 [10.57]; self-acceptance: 55.02 [16.62] vs 60.32 [13.50]) except personal growth (63.70 [14.66] vs 68.85 [8.07]). The IBSR group, compared with the control group, experienced better mean (SD) scores on all psychological well-being parameters at T2 (autonomy: 63.64 [8.35] vs 54.73 [10.41]; environmental control: 63.95 [10.05] vs 57.45 [11.43]; personal growth: 73.00 [8.34] vs 65.76 [10.95]; positive relationships 71.17 [9.99] vs 65.06 [12.58]; goals in life: 67.57 [8.88] vs 61.18 [12.87]; self-acceptance: 66.93 [11.15] vs 58.09 [15.55]) and at T3 (autonomy: 62.68 [9.05] vs 56.12 [10.64]; environmental control: 64.55 [10.28] vs 59.35 [12.98]; personal growth: 72.00 [8.06] vs 67.15 [11.82]; positive relationships: 71.24 [9.78] vs 66.92 [12.37]; goals in life: 68.33 [8.54] vs 62.92 [13.24]; self-acceptance: 66.84 [11.35] vs 58.97 [17.03]). Individuals in the IBSR group also experienced statistically significant improvements in sleep quality (mean [SD]: T1, 7.35 [3.97]; T3, 4.63 [3.21], P < .001), whereas the control group experienced no statistically significant difference. Women in the intervention group had a more favorable consideration of risk-reducing oophorectomy, from 7 women (14%) who refused to consider oophorectomy at T1 to 1 woman (2%) who refused to consider it at T3 (P = .04), and similar change in consideration of mastectomy: from 23 women (46%) who refused to consider mastectomy at T1 to 13 women (29%) who refused to consider it at T3 (P < .001). This randomized clinical trial found that IBSR improved psychological well-being and led to a more favorable view on risk-reducing surgical procedures for at least 6 months among women in Israel who carried BRCA variants. These results suggest that IBSR may be implemented as a self-practice tool to enhance the well-being of individuals who carry BRCA variants and support them in their decision-making processes. ClinicalTrials.gov Identifier: NCT03162276.