Restless Sleep Research Articles

Koroner Arter Baypas Operasyonu Sonrası Uyku Bozukluğu

Introduction: In general, after coronary artery bypass operation, 39% to 69% of patients experience insomnia, poor sleep quality, and lack of sleep continuity (frequent awakening, difficult sleep, restless sleep, and early morning awakening). The aim of this study was to investigate the sleep quality of patients on the preoperative 1st day, postoperative 3rd day, postoperative 7th day, and postoperative 30th day of a coronary artery bypass operation. Patients and Methods: Ninety-nine patients who underwent elective coronary bypass operation in our clinic between January 2017 and January 2018 were included in this study. The patients were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire on the preoperative 1st day, postoperative 3rd day, postoperative 7th day, and postoperative 30th day. Results: The mean age of total patients was 61.5 ± 11.4 years (range: 35-80); 67 were male and 22 were female. According to the results of the PSQI survey conducted on patients, there is a statistically significant increase in sleep quality on the postoperative 3rd day in comparison with the results of the preoperative 1st day evaluation. According to the postoperative 3rd day evaluation, there is a statistically significant decrease in sleep quality compared with the postoperative 7th and 30th days. Also, the PSQI scores of the postoperative period have a statistically significant correlation with age (p= 0.002, p= 0.004, p= 0.009). Conclusion: Although sleep disturbance has a significant impact on the physical and emotional adaptation and recovery after coronary artery bypass operation, the number of studies conducted on this subject is quite low.

Fruit and Vegetable Consumption is Protective from Short Sleep and Poor Sleep Quality Among University Students from 28 Countries.

IntroductionThe aim of the study was to investigate the association between fruit and vegetable (FV) consumption and sleep duration and sleep quality in university students.MethodsUsing a cross-sectional study design, 21,027 university students with a median age of 20 years from 28 countries replied to self-reported measures of FV consumption and sleep duration and quality.ResultsThe prevalence of short and long sleep was 38.9% and 12.8%, respectively, and the prevalence of poor sleep quality was 9.6% and restless sleep 19.7%. There was a linear decrease in the prevalence of short sleep with increasing FV consumption beyond ≥2 FV servings/day (vs 0–1 FV servings/day). Consuming 2 FV servings/day (vs 0–1 FV servings/day) was associated with a 21% decreased (ARRR: 0.79, 95% CI: 0.70–0.80) and 7 or more FV servings/day with a 33% decreased odds (ARRR: 0.67, 95% CI: 0.55–0.81) for short sleep. Consuming 5 FV servings/day (vs 0–1 FV servings/day) was associated with a 34% decreased (ARRR: 0.79, 95% CI: 0.51–0.84) and 7 or more FV servings/day with a 34% decreased odds (ARRR: 0.66, 95% CI: 0.50–0.88) for long sleep. In the final adjusted logistic regression model, consuming 3 FV servings/day (vs 0–1 FV servings/day) was associated with a 49% decreased (AOR: 0.51, 95% CI: 0.42–0.0.62) and 7 or more FV servings/day with a 30% decreased odds (AOR: 0.70, 95% CI: 0.53–0.93) for poor sleep quality. Consuming 5 FV servings/day (vs 0–1 FV servings/day) was associated with a 34% decreased odds (AOR: 0.66, 95% CI: 0.54–0.81) for restless sleep.ConclusionThe study extended previous findings of an association between inadequate FV consumption and short sleep and an inverse association between FV consumption and poor sleep quality and restless sleep.

Sleep-Wake Disorders in Childhood.

The presentation of sleep issues in childhood differs from the presentation in adulthood and may be more subtle. Sleep issues may affect children differently than adults, and distinct treatment approaches are often used in children. Sodium oxybate was approved by the US Food and Drug Administration (FDA) in October 2018 for an expanded indication of treatment of sleepiness or cataplexy in patients with narcolepsy type 1 or narcolepsy type 2 aged 7 years or older, with side effect and safety profiles similar to those seen in adults. Restless sleep disorder is a recently proposed entity in which restless sleep, daytime sleepiness, and often iron deficiency are observed, but children do not meet the criteria for restless legs syndrome or periodic limb movement disorder. Children's sleep is discussed in this article, including normal sleep patterns and effects of insufficient sleep. Sleep disorders of childhood are reviewed, including insomnia, obstructive sleep apnea, restless legs syndrome, parasomnias, narcolepsy, and Kleine-Levin syndrome. Children with neurologic issues or neurodevelopmental disorders frequently have sleep disorders arising from an interaction of heterogeneous factors. Further attention to sleep may often be warranted through a polysomnogram or referral to a pediatric sleep specialist. Sleep disorders may cause indelible effects on children's cognitive functioning, general health, and well-being, and awareness of sleep disorders is imperative for neurologists who treat children.

Obstructive sleep apnea syndrome and autonomic dysfunction in Duchenne muscular dystrophy.

Cardiac and respiratory involvement constitutes serious complications of Duchenne muscular dystrophy (DMD). We hypothesized that obstructive sleep apnea syndrome (OSAS) may play a role in cardiac autonomic dysfunction in DMD. We sought to assess the presence of cardiac autonomic function in patients with DMD by analyzing heart rate variability (HRV) during polysomnography (PSG). In a prospective study, all participants had whole-night PSG recorded and scored according to American Academy of Sleep Medicine guidelines. HRV analysis was performed on electrocardiography recordings from PSG recordings. Twelve consecutive males with DMD (mean age 9.0 ± 3.1 years, mean BMI 20.6 ± 4.8 kg/m2) and eight age-matched healthy males were enrolled. On clinical evaluation, 58% of patients with DMD had at least one symptom related to OSAS, such as snoring, witnessed apnea, or restless sleep. None of the controls had OSAS-related complaints. By PSG none of the controls had OSAS, while 42% of patients with DMD had OSAS (p = 0.004). Average R-R duration and mean percentage of successive R-R intervals > 50 ms values were significantly lower in patients with DMD than those in controls (p < 0.006). In patients with DMD and OSAS, LF/HF (low/high-frequency) ratio was significantly increased in NREM sleep compared with those in controls (p = 0.005). Higher apnea-hypopnea index and lower oxygen saturation showed significant correlations with higher LF power and LF/HF ratio (p < 0.001). Cardiac autonomic dysfunction is present in DMD, being more pronounced in the presence of OSAS.

Skipping Breakfast and Its Association with Health Risk Behaviour and Mental Health Among University Students in 28 Countries.

IntroductionThe study aimed to investigate the associations between skipping breakfast and various health risk behaviours and mental health in university students in 28 countries.MethodsUsing a cross-sectional study design, 21,972 university students with a median age of 20 years from 28 countries in Africa, the Americas and Asia, replied to self-reported measures of breakfast consumption, health compromising behaviours, mental health measures and protective factors.ResultsIn adjusted logistic regression analysis, infrequent and/or frequent breakfast skipping was associated with inadequate fruit and vegetable intake, frequent soft drink intake, not avoiding fat and cholesterol, current binge drinking, current tobacco use, gambling, not always wearing a seatbelt, inadequate physical activity, inadequate tooth brushing, not seeing a dentist in the past year and having been in a physical fight. In addition, infrequent and/or frequent breakfast skipping was associated with depression, lower happiness, posttraumatic stress disorder, loneliness, short sleep, long sleep, sleep problem, restless sleep, sleep problem due to traumatic event, and poor academic performance.DiscussionWe found evidence that skipping breakfast was associated with 10 of 15 health risk behaviours, all of nine poor mental health indicators and poor academic performance.

Tobacco use and associated health risk behaviours among university students in 27 countries.

Evidence of the relationship between tobacco use and multiple health risk behaviours is limited. The study aimed to investigate the relationship between tobacco use and health risk behaviours in university students across different cultures. In a cross-sectional study the sample included 23,396 university students from 27 countries in Africa, Asia and the Americas. Indicate that 5.8 and 5.5% were daily and not daily tobacco users, respectively. In adjusted logistic regression analysis, less than daily and/or daily tobacco use was associated with nutrition and dietary risk behaviour (overweight or obesity, high sodium consumption, rarely or never having breakfast and not avoiding fat and cholesterol), addictive behaviour (binge drinking, drug use, and gambling), sleep risk behaviours (long sleep, poor sleep quality and restless sleep) and other health risk behaviour (having been in a physical fight, inadequate tooth brushing, and multiple sexual partners in the past year). Compared to non-tobacco users, less than daily and/or daily tobacco users had significantly higher overweight or obesity, dietary risk behaviour, addictive behaviour, sleep risk behaviours and other health risk behaviour. These associations may be taken into account in health promotion strategies targeting multiple health compromising behaviours.

1069 Posttraumatic Stress Disorder is Associated With Poorer Sleep Specific Quality of Life, but Not With Sleep Apnea

Abstract Introduction The degree that posttraumatic stress disorder (PTSD) contributes to obstructive sleep apnea (OSA) or sleep specific quality of life (QOL) remains uncertain. Methods We evaluated consecutive military veterans (n=3,155) with suspected OSA using multivariable regressions to test associations between sleep and QOL measures including the apnea-hypopnea index (AHI), Pittsburgh Sleep Quality Index (PSQI) and Short-Form-12 mental component score (MCS). A mental health expert determined PTSD presence with severity measured utilizing the PTSD Checklist (PCL). Subjects were evaluated with prospectively collected questionnaires, sleep studies, and detailed electronic medical record reviews. Results Current-PTSD (n=1,172, 37%) were younger, more likely single, unemployed on disability, report non-white ethnicity or have current alcohol or drug dependence, report past suicide attempt, have current insomnia, restless sleep or nightmares, report lower MCS or higher Epworth Sleepiness, Fatigue Severity, Beck Depression Inventory-II (BDI) and PSQI scores than non-PTSD (n=1,880) or past-PTSD (n=103) veterans. Among current-PTSD, instigating trauma was 75% combat and 13% sexually related. In multivariable regressions, male gender (OR 4.5, p&amp;lt;0.001), age &amp;gt;65 years (OR 2.3, p&amp;lt;0.001), BMI ≥35 kg/m2 (OR 3.5, p&amp;lt;0.001), prior stroke (OR 1.8, p&amp;lt;0.006), current hypertension (OR 1.4, p&amp;lt;0.001), neck circumference &amp;gt;40 cm (OR 1.3, p=0.032), and non-white ethnicity (OR 1.2, p=0.034) were associated with moderate-severe OSA (AHI ≥15/h), however current (OR 0.9, p=0.06) or past-PTSD (OR 1.2, p=0.41) were not. PCL (p=0.937) was not associated with AHI. Factors most associated with lower MCS included current-PTSD (scaled standardized beta[SSB]=0.09, p=0.001), depression (SSB=0.09, p=0.001), age &amp;lt;50 years (SSB=0.09, p&amp;lt;0.001), non-white ethnicity (SSB=0.07, p=0.004), female gender (SSB=0.06, p=0.007) or single/no-partner (SSB=0.05, p=0.03). Likewise, factors most associated with a higher PSQI included depression (SSB=0.19, p&amp;lt;0.001), current-PTSD (SSB=0.15, p&amp;lt;0.001), unemployed on disability (SSB=0.14, p&amp;lt;0.001), non-white ethnicity (SSB=0.13, p&amp;lt;0.001) or age &amp;lt;50 years (SSB=0.10, p=0.001). Among current-PTSD, higher PSQI was associated with BDI ≥20 (SSB=0.31, p&amp;lt;0.001), PCL ≥50 (SSB=0.24, p&amp;lt;0.001) and non-white ethnicity (SSB=0.11, p=0.034), but not with moderate-severe OSA (SSB= -0.09, p=0.095). Conclusion In the largest PTSD sleep cohort to date, PTSD is associated with insomnia, restless sleep, poorer sleep specific QOL, and greater daytime sleepiness and fatigue, but is not associated with OSA. Support None

0872 Correlates Of Restless Sleep Among Female Sex Workers In Baltimore, MD

Abstract Introduction Sleep quality is understudied among street-based female sex workers (FSW), a population characterized by high rates of structural vulnerability. FSW may be at higher risk for poor sleep due to food and housing insecurity, violence, substance use and irregular work hours. We studied correlates of restless sleep in an urban, street-based risk environment. Methods Data are from a year-long observational prospective cohort study of street-based FSW (n=250) in Baltimore, MD. Baseline survey data, collected April 2016 to February 2017, included topics such as structural vulnerability, mental and physical health, substance use and lifetime violence. Sleep was measured with item 7 on the CES-D-10 Scale; respondents indicated how many days in the past week their sleep was restless (&amp;lt; 1 day, 1-2 days, 3-4 days, 5-7 days). We conducted bivariate and multivariable logistic analysis to identify correlates of experiencing 5-7 days of restless sleep vs. fewer. Results Median age was 35 years. Most (66%) were Non-Hispanic White, 62% were homeless, 61% reported food insecurity, and 65% injected heroin. We documented a high prevalence of trauma; 81% reported lifetime sexual or physical violence by family members, intimate partners, paying clients, or police officers, and 62% screened positive for PTSD on the PCL-5 Checklist. 54% reported 5-7 days of restless sleep in the past week. Independent associations with frequent restless sleep included older age (age 35+ aOR: 2.67 [1.64-4.36]), food insecurity (aOR: 2.02 [1.42-2.88]), self-reported poor health (aOR: 3.98 [1.99-7.96]), and lifetime violence: a greater number of violent experiences corresponded with higher odds of restless sleep (1-2 vs. 0 experiences aOR: 2.38 [1.43-3.99], 3-4 vs. 0 experiences aOR: 3.67 [2.22-6.05]). Conclusion These data demonstrate high prevalence of restless sleep among street-based FSW with higher risk among those who experience intersecting vulnerabilities and multiple exposures to violence. Trauma-informed structural interventions may improve sleep quality among this population. Support This work was supported by the National Institute of Drug Research (R01DA038499-01).

0343 Associations of Endogenous Hormones and Phthalate Exposure with Subjective and Objective Sleep Measures in Midlife Women

Abstract Introduction Impaired sleep during the menopausal transition reduces quality of life and increases risk of multiple diseases. The changing hormonal milieu during midlife is associated with impaired sleep. Endocrine disrupting chemicals, such as phthalates, may also contribute to the increased prevalence of sleep disturbances in midlife women. Phthalates are known to impact the endogenous hormones associated with sleep. However, the link between phthalate exposure and sleep quality remains unexplored. Methods We recruited 26 midlife women (median age 50 years) through the Carle Regional Sleep Disorders Center in Urbana, Illinois. Subjective sleep was assessed through the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and self-reported frequency of sleep disturbances, insomnia, and restless sleep. Objective sleep was measured using actigraphy and manual sleep logs (7-day average). Serum levels of follicle-stimulating hormone, estradiol, progesterone, testosterone, free estradiol, and free testosterone were quantified using ELISAs from a single sample from each participant. Phthalate metabolites were quantified from urine using high performance liquid chromatography-mass spectrometry (HPLC-MS). Covariates, including depression, hot flashes, quality of life, demographics, and lifestyle factors, were measured via surveys. Results Preliminary unadjusted logistic regression was used to determine the association between hormone values and subjective sleep quality binomial variables, including daytime sleepiness, sleep efficiency, sleep onset latency, sleep duration, number of sleep disturbances, and frequency of sleep disturbances. Each of these subjective sleep measures is significantly associated with one or more hormones. Conclusion Our results are consistent with literature identifying associations between hormones and subjective sleep in midlife women. Additional analyses will determine associations between hormones and objective sleep, and phthalates with both subjective and objective sleep measures. Excitingly, our study will be among the first to investigate the association between endocrine disruption and sleep quality in this population. Support Carle Illinois Seed Grant Program

0928 Heart Rate Variability During Sleep in Children and Adolescents with Restless Sleep Disorder or Restless Legs Syndrome and Normal Controls

Abstract Introduction Restless sleep disorder (RSD) has been recently characterized clinically and polysomnographically in children and differentiated from restless legs syndrome (RLS). Heart rate variability (HRV) is a reliable method to quantify autonomic changes during sleep. The aim of this study was to characterize HRV in children with RSD, RLS and normal controls, with the hypothesis that children with RSD have a shift toward sympathetic predominance during sleep. Methods Polysomnographic recordings from thirty-two children who fulfilled RSD diagnostic criteria (19 boys and 13 girls), 32 children with RLS (20 boys and 12 girls) and 33 controls (17 boys and 16 girls) were included. Four ECG epochs were chosen, one for each stage, and were analyzed for automatic detection of R waves. Time domain and frequency domain HRV parameters were obtained and analyzed. Results Age and gender were not statistically different between groups. In terms of time domain only the standard deviation of the average RR interval during stage N3 was slightly but significantly higher in RSD than in RLS patients. In terms of frequency domains, the LF band and the LF/HF ratio were increased in RSD and the HF percentage was lower in RSD during sleep stages N3 and R. The LF band and the LF/HF ratio increased in RLS and the HF percentage was lower in RLS during stage W. Conclusion Children with RSD have increased sympathetic activation during sleep, particularly N3 and REM, compared to controls but, as expected, not during wakefulness. Differently, children with RLS have sympathetic activation during relaxed wakefulness preceding sleep and during sleep. Support Partial support by a grant of the Italian Ministry of Health RC n. 2751598 (R.F.)

0943 Increased Non-REM Sleep Instability in Children with Restless Sleep Disorder

Abstract Introduction Restless sleep disorder (RSD) is a newly recognized condition characterized by motor movements involving large muscle groups with frequent repositioning or bed sheets disruption. We analyzed cyclic alternating pattern (CAP) in these children, a marker of sleep instability that might be associated with the motor episodes of RSD and may play a role in their daytime symptoms. Methods Polysomnographic recordings from thirty-eight children who fulfilled RSD diagnostic criteria (23 boys and 15 girls), 23 children with restless legs syndrome (RLS, 18 boys and 5 girls) and 19 controls (10 boys and 9 girls) were included. For CAP analysis, a previously developed, highly precise automated system, based on a deep learning recurrent neural network, was used. Results Age and gender were not statistically different between groups. RSD patients showed a lower percentage of A3 CAP subtypes than controls (median 9.8 vs. 18.2, p=0.0089), accompanied by shorter duration of the B phase of the CAP cycle (median 28.2 vs. 29.8 in controls, 30.2 in RLS, p=0.005) and shorter CAP cycle duration than both controls and RLS subjects (median 33.8 vs. 35.0 in controls, 35.8 in RLS, p=0.002). Finally, RSD children also showed a longer duration of CAP cycle sequences, when compared to controls (median 172.7 vs. 141.9, p=0.0063). Conclusion In conclusion, our study indicates that NREM sleep EEG shows an increased instability in RSD; these findings add to the current knowledge on the mechanisms of this newly recognized sleep disorder and suggest that sleep instability might be a favoring mechanism for the emergence of the motor episodes characterizing RSD. Support Partial support by a grant of the Italian Ministry of Health RC n. 2751598 (R.F.)

0975 Iron Infusion Protocol For Restless Leg Syndrome In Pediatric Patients

Abstract Introduction Iron dextran protocols have been studied for adults with restless leg syndrome; this study aims to determine the benefit of iron infusions (iron dextran or sucrose) in the improvement or resolution of restless sleep in pediatric patients. Methods IRB approval was granted by New Hanover Regional Medical Center. A retrospective chart review was performed using the hospital’s electronic medical record (EMR). A data report was requested for all pediatric patients who received the iron dextran protocol. Patients who received at least one dose of iron dextran or iron sucrose per the protocol were included. Manual data collection included patient demographics, CBCs, iron panels, the dose of iron they received, polysomnogram results, symptom resolution (as described by the physician), and adverse events. Results Between January 1, 2017 and January 3, 2018, 55 patients received iron dextran per the weight-based protocol. Patients’ ages ranged from 23 months to 17 years and 5 months old. Of the 55 patients, 27 patients (49%) had documented restless leg syndrome and/or symptoms of leg pain or movement during sleep. All patients experienced restlessness or difficulty sleeping prior to the infusion. Of the 27 patients who experienced leg pain, 10 patients (37%) experienced an improvement in their leg pain or restlessness. Fifty-five percent (55%) of patients in this group reported an improvement in sleep symptoms. Conclusion Iron dextran protocols have been studied for adults with restless leg syndrome, but this is the first published data for a weight-based protocol in pediatric patients. While only 27 patients included in this study had a diagnosis of restless leg syndrome or leg pain symptoms, all patients experienced restlessness or other negative sleep symptoms. Overall, most patients with restless leg syndrome experienced an improvement in their leg and sleep symptoms. No patients reported worsening of symptoms. Intravenous iron dextran infusion may greatly improve the quality of life for children with restless leg syndrome or poor sleep quality. With the overall safety of the iron infusions, this protocol’s benefits outweigh their risks and should be considered in this patient population. Support

Unhappiness and age

I examine the relationship between unhappiness and age using data from eight well-being data files on nearly 14 million respondents across forty European countries and the United States and 168 countries from the Gallup World Poll. I use twenty different individual characterizations of unhappiness including many not good mental health days; anxiety; worry; loneliness; sadness; stress; pain; strain, depression and bad nerves; phobias and panic; being downhearted; having restless sleep; losing confidence in oneself; not being able to overcome difficulties; being under strain; being unhappy; feeling a failure; feeling left out; feeling tense; and thinking of yourself as a worthless person. I also analyze responses to a further general attitudinal measure regarding whether the situation in the respondent's country is getting worse. Responses to all these unhappiness questions show a, ceteris paribus, hill shape in age, with controls and many also do so with limited controls for time and country. Unhappiness is hill-shaped in age and the average age where the maximum occurs is 49 with or without controls. There is an unhappiness curve.

Associations between symptoms of sleep-disordered breathing and maternal sleep patterns with late stillbirth: Findings from an individual participant data meta-analysis.

Sleep-disordered breathing (SDB) affects up to one third of women during late pregnancy and is associated with adverse pregnancy outcomes, including hypertension, diabetes, impaired fetal growth, and preterm birth. However, it is unclear if SDB is associated with late stillbirth (≥28 weeks' gestation). The aim of this study was to investigate the relationship between self-reported symptoms of SDB and late stillbirth. Data were obtained from five case-control studies (cases 851, controls 2257) from New Zealand (2 studies), Australia, the United Kingdom, and an international study. This was a secondary analysis of an individual participant data meta-analysis that investigated maternal going-to-sleep position and late stillbirth, with a one-stage approach stratified by study and site. Inclusion criteria: singleton, non-anomalous pregnancy, ≥28 weeks' gestation. Sleep data ('any' snoring, habitual snoring ≥3 nights per week, the Berlin Questionnaire [BQ], sleep quality, sleep duration, restless sleep, daytime sleepiness, and daytime naps) were collected by self-report for the month before stillbirth. Multivariable analysis adjusted for known major risk factors for stillbirth, including maternal age, body mass index (BMI kg/m2), ethnicity, parity, education, marital status, pre-existing hypertension and diabetes, smoking, recreational drug use, baby birthweight centile, fetal movement, supine going-to-sleep position, getting up to use the toilet, measures of SDB and maternal sleep patterns significant in univariable analysis (habitual snoring, the BQ, sleep duration, restless sleep, and daytime naps). Registration number: PROSPERO, CRD42017047703. In the last month, a positive BQ (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 1.02-2.04), sleep duration >9 hours (aOR 1.82, 95% CI 1.14-2.90), daily daytime naps (aOR 1.52, 95% CI 1.02-2.28) and restless sleep greater than average (aOR 0.62, 95% CI 0.44-0.88) were independently related to the odds of late stillbirth. 'Any' snoring, habitual snoring, sleep quality, daytime sleepiness, and a positive BQ excluding the BMI criterion, were not associated. A positive BQ, long sleep duration >9 hours, and daily daytime naps last month were associated with increased odds of late stillbirth, while sleep that is more restless than average was associated with reduced odds. Pregnant women may be reassured that the commonly reported restless sleep of late pregnancy may be physiological and associated with a reduced risk of late stillbirth.

Evaluation and Management of Children with Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea syndrome (OSAS) is a common pediatric disorder characterized by recurrent events of partial or complete upper airway obstruction during sleep which result in abnormal ventilation and sleep pattern. OSAS in children is associated with neurobehavioral deficits and cardiovascular morbidity which highlights the need for prompt recognition, diagnosis, and treatment. The purpose of this state-of-the-art review is to provide an update on the evaluation and management of children with OSAS with emphasis on children with complex medical comorbidities and those with residual OSAS following first-line treatment. Proposed treatment strategies reflecting recommendations from a variety of professional societies are presented. All children should be screened for OSAS and those with typical symptoms (e.g., snoring, restless sleep, and daytime hyperactivity) or risk factors (e.g., neurologic, genetic, and craniofacial disorders) should undergo further evaluation including referral to a sleep specialist or pediatric otolaryngologist and overnight polysomnography, which provides a definitive diagnosis. A cardiology and/or endocrinology evaluation should be considered in high-risk children. For the majority of children, first-line treatment is tonsillectomy with or without adenoidectomy; however, some children exhibit multiple levels of airway obstruction and may require additional evaluation and management. Anti-inflammatory medications, weight loss, and oral appliances may be appropriate in select cases, particularly for mild OSAS. Following initial treatment, all children should be monitored for residual symptoms and polysomnography may be repeated to identify persistent disease, which can be managed with positive airway pressure ventilation and additional surgical approaches if required.

Influence of respiratory allergy and restless sleep on definite sleep bruxism: a cross-sectional clinical study

ObjectiveThis cross-sectional clinical study evaluated the associations between sociodemographic, occupational, clinical conditions, psychological and sleep quality variables on definite sleep bruxism (SB). MethodsAll records obtained from adults (aged 20–60 years) and the elderly (aged >60 years) who had undergone polysomnography (PSG) at a private medical outpatients’ clinic from July 2017 to February 2018 were reviewed. Data from a questionnaire, based on the criteria of the American Academy of Sleep Medicine (AASM), were also gathered. Definite SB data pattern distribution was analyzed, and multivariate Poisson regression with robust variance was used to assess the associations between definite SB diagnosis, determined via PSG recordings, and the independent variables. A significance level of 5% was adopted. ResultsA total of 240 individuals were included in the study and the SB prevalence was 7.08% (n = 17). The adjusted Poisson regression analysis revealed association between definitive SB and individuals with respiratory allergy (PR = 3.63; 95% CI:1.01–13; P = 0.047) and restless sleep (PR = 2.97; 95% CI:1.04–8.50; P = 0.042). ConclusionThis study found associations between definite SB and clinical conditions (respiratory allergy) and sleep behavior (restless sleep). Knowledge regarding factors associated with definite SB can contribute to decision making in the clinical setting and management strategies involving a multidisciplinary approach.

Referral indications and prevalence of sleep abnormalities in children with early onset scoliosis.

This study describes the utility of overnight sleep studies in children with early onset scoliosis (EOS). Children with EOS have diminished respiratory reserve which is associated with abnormal breathing and sleep quality in children. Currently, there are no criteria for referral of these children to evaluate breathing during sleep or data on the use of sleep treatments as part of their supportive care. A review of the 159 patients with EOS who were followed at a single institution from 2003 to 2016 identified 68 who underwent overnight polysomnograms (PSGs). Sixty-five of 68 (96%) had elevated apnea-hypopnea index (AHI) and a majority (56%) were prescribed nighttime respiratory support. A majority of young children (< 5years) with PSG were referred for a history of snoring, apnea, or restless sleep; all 30 had abnormal PSGs. Twenty-seven (90%) had nighttime hypoxemia (nadir oxygen saturation values < 92%). Eighteen (60%) were referred to otolaryngology, of whom 11 (37%) subsequently underwent tonsil and/or adenoid removal. In older children (≥ 5years), those referred for PSGs had more severe restrictive chest wall disease [lower forced vital capacity (FVC) values] than those who were not sent for PSG. Correlation between FVC and apnea-hypopnea index, however, was not significant. Pre-operative coronal curve magnitude did not strongly correlate with nadir SaO2 or AHI in either age group. These results suggest that sleep studies are underutilized in the management of children with EOS. Inadequate and poor-quality sleep adversely affects growth, behavior, and cognitive function in children. This study suggests that screening for sleep abnormalities should be incorporated into assessment and treatment of more patients with EOS.

The association between allergic rhinitis and sleep: A systematic review and meta-analysis of observational studies.

This systematic review and meta-analysis examines the associations of allergic rhinitis with sleep duration and sleep impairment. Observational studies published before August 2019 were obtained through English language literature searches in the PubMed, Embase, and CINAHL databases. Mean differences and odds ratios with 95% confidence intervals were extracted and used for meta-analysis. Heterogeneity was confirmed by the I2-heterogeneity test. Subgroup analysis was conducted to evaluate the influence of study design. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine the level of evidence. In total, 2544 records were identified through database searches; 914 duplicate records were excluded, 1452 records were removed after screening of titles and abstracts, 151 records were excluded after full-text screening, and 27 articles were included in the final meta-analyses. A total of 240,706,026 patients (19,444,043 with allergic rhinitis) were considered. No significant difference in sleep duration between the allergic rhinitis and the control groups was found. Patients with allergic rhinitis presented with significantly higher sleep quality scores, sleep disturbances scores, and sleep latency scores; more frequent use of sleep medications; and lower sleep efficiency as measured by the Pittsburgh Sleep Quality Index and polysomnography. Meta-analyses for adjusted odds ratios showed that allergic rhinitis was also associated with higher risks of nocturnal dysfunctions, including insomnia, nocturnal enuresis, restless sleep, sleep-disordered breathing, obstructive sleep apnea, and snoring. Meta-analysis for adjusted odds ratio also showed that allergic rhinitis was associated with daytime dysfunction, including difficulty waking up, daytime sleepiness, morning headache, and the use of sleep medications. The overall quality of evidence ranged from low to very low, indicating that caution is required when interpreting these results. This study demonstrates that there is a significant association of AR with sleep characteristics.

Gun ownership and sleep disturbance

Although there is no empirical evidence linking gun ownership with better sleep, speculation is widespread in gun culture. We assess the direct association between gun ownership and sleep disturbance and whether gun ownership moderates the association between neighborhood fear and sleep disturbance. We use four waves of cross-sectional data from the General Social Survey (2010–2018) and logistic regression to model sleep disturbance as a function of gun ownership and test the statistical interaction of gun ownership and neighborhood fear. Our analyses demonstrate that gun ownership is unrelated to sleep disturbance across sleep specifications. None of the statistical interactions between gun ownership and neighborhood fear reached statistical significance. Although being afraid to walk alone at night in one's neighborhood is associated with restless sleep, owning a gun is no consolation. In ancillary analyses, we observed that gun ownership is unrelated to sleep disturbance across survey years and a range of subpopulations. In the first empirical study of gun ownership and sleep, we find consistent evidence to suggest that people who own guns do not report better sleep in general or in the context of living in a dangerous neighborhood. Our analyses are important because they contribute to our understanding of the epidemiology of sleep. They also challenge theoretical perspectives and cultural narratives about how having a gun in the home helps individuals and their families to feel safe, secure, and protected. Additional research is needed to replicate our findings using longitudinal data and more reliable measures of sleep disturbance.

Sociodemographic and health correlates of sleep in U.S. Hispanic older adults

BackgroundThis project aims to understand the sociodemographic and health correlates of poor sleep in U.S. Hispanic older adults. MethodsData from the National Social Life, Health, and Aging Project (NSHAP): Wave 2 were analyzed to understand the prevalence of poor sleep among Hispanic older adults, sociodemographic predictors of sleep patterns, and the association between sleep quality and chronic disease. Only the data from Hispanic participants (n = 345) were used in the present study. Self-reported demographic, self-reported and actigraphy-measured sleep, and self-report health measures were used. ResultsResults of regression analyses indicated that self-reported restless sleep significantly predicted self-rated physical and mental health, hypertension, pain, and self-rated general happiness. Feeling rested was significantly associated with self-rated physical health and mental health, pain, and self-rated happiness. Neither restless sleep nor feeling rested were significant predictors of diabetes. Actigraphy-measured sleep duration was not significantly associated with health outcomes. ConclusionsWhile sleep deprivation has serious physical and mental health consequences for Hispanics, sleep disorders in Hispanic older adults have been overlooked in research. This study sheds some light on the associations between sleep and health in Hispanic older adults. Examination of potential mechanisms linking poor sleep with mental and physical health in Hispanic older adults is a critical next step.