Sleep Scores Research Articles

Coffee Consumption and Sleep Quality: A Cross-Sectional Study among Saudi Adults

Background: Caffeine is one of the most commonly consumed stimulants in Saudi Arabia. We aim to examine the relationship between caffeine consumption and sleep quality among individuals residing in Saudi Arabia. Methods: This is a cross-sectional study using the Pittsburgh Sleep Quality Index (PSQI). Data was collected through social media platforms such as WhatsApp, Twitter, LinkedIn, and Facebook. The study included adults 18 years and older who reside in Saudi Arabia. Descriptive statistics were performed to examine the population characteristics, and the logistic regression model was used to examine the association between caffeine consumption and sleep quality. Results: A total of 636 respondents participated in the study. Nine out of ten respondents reported consuming caffeine (90%). The respondents were predominately aged 30 to 44 (52.04%), females (63.11%), married (62.89%), and overweight/obese (60.47%). Around two-thirds were Saudi nationals (69.68%). More than half of the respondents reported a good quality sleep score (56.88%). In multivariate analysis adjusted for potential confounders, body mass index was the only statistically significant demographic predictor for sleep quality. Overweight/obese respondents had a statistically significantly lower sleep quality score mean than non-overweight/obese respondents (coefficient -0.48; P-value 0.05). Conclusion: Caffeine consumption was highly prevalent among Saudis; however, it was not associated with poor sleep quality. On the contrary, those with high body mass index, particularly in obese individuals, were significantly associated with poor sleep quality. Caffeine consumers have to monitor their caffeine consumption carefully and set a daily consumption limit for themselves.

Effect of preoperative oral carbohydrate on the postoperative recovery quality of patients undergoing daytime oral surgery: a randomized controlled trial

BackgroundPreoperative oral carbohydrate intake can improve the postoperative recovery of fasting patients in many kinds of surgeries; however, the effect of carbohydrates on patients undergoing daytime oral surgery is still unclear. This study was designed to evaluate the effect of preoperative oral carbohydrate intake on the quality of recovery of patients undergoing daytime oral surgery using the quality of recovery-15 (QoR-15) questionnaire.MethodsNinety-two patients scheduled for daytime oral surgery were randomly allocated to the midnight fasting group (F group, n = 45) or the carbohydrate-Outfast loading group (O group, n = 47). Participants in the F group fasted from midnight the day before surgery. Patients in the O group also fasted but received the Outfast drink (4 ml/kg) 2–3 h before the induction of anesthesia. QoR-15 questionnaire, patient well-being, and satisfaction were assessed before anesthesia induction and 24 h after surgery. Perioperative blood glucose, postoperative exhaust time, and adverse events were also recorded.ResultsThe QoR-15 scores were significantly higher in the O group than in the F group preoperatively and postoperatively. Seven parameters representing patient well-being evaluated on a numeric rating scale (NRS, 0–10) were lower in the O group than in the F group postoperatively, except for the hunger and sleep quality scores. Patient satisfaction scores on a 5-point scale were higher in the O group than in the F group preoperatively and postoperatively. Meanwhile, the postoperative exhaust time was significantly shorter in the O group compared to the F group, while there were no significant differences in blood glucose concentrations between two groups.ConclusionsPreoperative oral carbohydrate intake could improve postoperative recovery quality, well-being, and satisfaction of patients undergoing daytime oral surgery 24 h after surgery, and may serve as a treatment option for patients undergoing daytime oral surgery.Trial registrationThis trial was registered in the Chinese Clinical Trial Registry (ChiCTR2100053753) on 28/11/2021.

Sleep Quality in School-Aged Children: The Role of Environmental Factors and Screen Time

Sleep plays a vital role in the optimal functioning of our body and is crucial for overall well-being. However, many parents are unaware of the negative consequences of sleep deprivation in children. This study examines factors affecting sleep in children and their correlation with screen time. The aim is to evaluate the relationship between screen time and environmental factors impacting sleep quality among school-aged children.A cross-sectional observational study was conducted on children aged 6 to 12 years. Sleep quality was assessed using a 22-item, pre-validated, parent-administered Children’s Sleep Habits Questionnaire (CSHQ). Contributing factors, including a screen time questionnaire, were gathered from parents. Children with pre-existing sleep disorders, neurobehavioral disorders, and chronic illnesses were excluded. A CSHQ score above 41 was considered abnormal, indicating a sleep problem. Data were analyzed using the Chi-square test with SPSS version 20.0.In this study, 40.3% of children experienced sleep disturbances. The total mean sleep score was 39.56 ± 14.84, with private school children showing greater disruptions (41.78 ± 12.96) compared to public school children (37.14 ± 16.33; p = 0.001). Significant correlations were found between sleep quality, screen time exposure, and environmental factors such as lower socio-economic status, bed sharing, and room sharing.This study highlights that both excessive screen time and adverse environmental conditions negatively impact children's sleep quality. Efforts to increase awareness among parents, educators, and healthcare providers are needed to reduce sleep disturbances.

THE EFFECT OF SELF-ACUPRESSURE ON REDUCING BLOOD PRESSURE, HEADACHE AND SLEEP QUALITY DISORDERS IN HYPERTENSIVE PATIENTS

Hypertension is still a major health problem in Indonesia. Various efforts to overcome the problem of hypertension have been made, both pharmacological and non-pharmacological treatments. A therapy based on the patient's habits or culture will certainly be easier to implement and obey by. Therefore, this study aims to analyze the effect of self-acupressure on blood pressure, headache, and sleep quality of hypertensive patients. The research method used is a quasi-experiment, single-group pre-post-test design. The sample in this study were hypertensive patients who fit the inclusion and exclusion criteria at Wonokerto Health Centre, Pekalongan Regency. The data analysis used was univariate and bivariate analysis. Bivariate analysis used paired group t-test technique. The results showed that there was an effect of self-acupressure in reducing systolic blood pressure (p-value: 0.004), headache pain scale (p-value: 0.001), and decreased sleep quality disorder score (p value: 0.000). Massaging at acupressure points has the effect of improving blood flow, stimulating endorphin hormones and providing a relaxing effect so that it can reduce blood pressure, headache pain scale and sleep quality disturbance scores. Recommendations for future research are to add a control group and/or compare it with other independent complementary therapy techniques.

Sleep Health Composite and Diabetes Symptom Burden in Young Adults With Type 1 Diabetes.

Multiple individual sleep health dimensions (satisfaction, regularity, and duration) are associated with diabetes symptoms, precursors to micro-and macrovascular complications, among young adults with type 1 diabetes mellitus (T1DM). Nearly half of young adults with T1DM develop vascular complications; however, modifiable contributors of diabetes symptoms, including sleep health, have been understudied. This cross-sectional quantitative descriptive study involved the completion of multiple validated self-report questionnaires and the collection of raw continuous glucose monitor and diary data over a 14-day period. The sleep health composite score was calculated by summing the number of dimensions with "good" sleep health. Chronotype was estimated with the 19-item Morningness-Eveningness Questionnaire. Multiple linear regression analyses were conducted to evaluate the associations between the independent variables (sleep health composite and chronotype) and diabetes symptom burden. Covariates, including age, race, sex at birth, T1D duration, continuous subcutaneous insulin infusion use, and hemoglobin A1C (HbA1C), were considered to determine their contribution to these relationships. One hundred nineteen young adults with T1DM who were aged 18 to 26 years were included in this study from 2 cohorts. Higher sleep health composite scores were associated with a lower overall diabetes symptom burden, even after adjusting for covariates in the linear regression models. Initially, a later chronotype was linked to a higher diabetes symptom burden, but this association became insignificant after accounting for HbA1C levels. Improving multiple dimensions of sleep health may alleviate the diabetes symptom burden among young adults with T1DM.

The influence of sleep education supported and unsupported with social media reminders on the sleep quality in adolescents aged 14-18: a three-center, parallel-arm, randomized controlled study.

Poor sleep quality is a global health problem for adolescent. The aim of this study was to examine how sleep education, with or without social media reminders, affects sleep quality in adolescents aged 14 to 18. The study was a three-center, parallel-arm, randomized controlled study, recruiting participants from September 9, 2019, to January 6, 2020. Adolescents with poor sleep quality and sleepiness, using smartphones apps and internet browser, without chronic diseases, and obesity, and without mental problems were included in the study. Primary outcomes were sleep quality, sleepiness, sleep hygiene, and sleep parameters at week 5 as measured by subjective report scales and actigraphy. Sleep quality was measured by the Pittsburgh Sleep Quality Index (Poor sleep quality = PSQI > 5), sleepiness by the Cleveland Adolescent Sleepiness Questionnaire (CASQ > 16), and sleep hygiene developed by the researchers in the literature of Adolescent Sleep Habits Form. A total of 55 participants (mean [SD] age, 15.64 [1.22] years) participated. PSQI and CASQ scores of adolescents in sleep education that were not supported by social media reminders decreased compared to the baseline (p = 0.01, p = 0.02). Adolescent PSQI score in sleep education supported by social media reminders decreased from baseline, their sleep hygiene score increased (p = 0.02). There were no significant differences between the groups in terms of sleep parameters (total sleep duration, deep and light sleep levels, nighttime sleeping, and morning wake-up times) (p > 0.05). This study suggests that sleep education, supported by reminders via social media, can be used to improve the quality of sleep of adolescents. ClinicalTrials.gov Identifier: NCT05071989.

Effect of sleep quality on repetitive transcranial magnetic stimulation outcomes in depression.

While repetitive transcranial magnetic stimulation (rTMS) is effective for 50-60% of those treatment-resistant depression, it is critical to identify predictors of response for optimal patient selection to improve therapy. Insomnia is a known symptom of depression that is both correlated with depression severity and associated with poor antidepressant response. Therefore, understanding this relationship may open new opportunities for the optimization of rTMS treatment. We aimed to explore whether baseline sleep quality, specifically insomnia, is associated with rTMS outcomes in a naturalistic sample of 975 patients (age 18-90; 63.9% F) receiving a standard course of rTMS treatment from two outpatient TMS clinics located within psychiatric hospitals in the United States. One site additionally collected information on concurrent medication use on 350 patients; among these, we examined whether pharmacological treatment of insomnia affected TMS treatment response. Depression was measured using the 30-item Inventory of Depressive Symptomology Self Report (IDS-SR) in site one and an abbreviated 16-item Quick Inventory of Depressive Symptomology (QIDS) derived from the IDS-SR in site two. Sleep disturbances were measured using three insomnia-related questions. Multilevel logistic regression was used to determine whether baseline insomnia scores were associated with TMS treatment outcome. Upon dichotomous categorization of the sample by insomnia and sleep-medication use, depression and sleep scores were analyzed across time using mixed repeated measures ANOVA. We found that sleep quality improves after TMS (p<.001) and correlates with improvement in non-insomnia related depression symptoms (r= .318, p<.001). We found that among those who had significant insomnia at baseline, those not using sleep medications had significantly worse post-treatment IDS-SR scores compared to those using sleep medications (p=. 021) despite no difference in final insomnia score. Together, our results suggest that while baseline insomnia is not associated with TMS effectiveness, treating insomnia may affect the trajectory of TMS therapy. Future prospective studies are needed to examine the effect of insomnia treatment alongside TMS for depression.

Bidirectional associations between sleep and anxiety among Chinese schoolchildren before and after the COVID-19 lockdown

The COVID-19 pandemic has critical implications for mental health in children. This study examined how the COVID-19 lockdown affected sleep duration and anxiety symptoms in Chinese school-aged children and the bidirectional association between sleep and anxiety before and during the COVID-19 lockdown. A school-based longitudinal cohort study was conducted to examine the relationship between sleep duration and anxiety scores before and after the COVID-19 lockdown from January to May 2020. Generalized estimating equations model was used to identify variables that contributed to the changes in sleep duration. The bidirectional relationship between sleep duration and anxiety symptoms was explored by cross-lagged analysis. 7681 children completed two waves of surveys were included in the analysis. The daily exercise duration, anxiety symptoms, and sleep duration decreased significantly during the lockdown compared with that before the lockdown. Based on generalized estimating equations model, older age, secondary school, and higher anxiety scores of participants were positively associated with sleep duration, while female and no COVID-19 infection history were negatively associated with it. Cross-lagged analysis showed higher anxiety score of children before the lockdown was significantly associated with shorter sleep duration during the lockdown; and shorter sleep duration of children before the lockdown was also significantly associated with a higher anxiety score during the lockdown. Under the context of the COVID-19 pandemic, there were longitudinal, bidirectional associations between children’s anxiety symptoms and sleep duration. For school students, mental health services and sleep education should be considered in the daily health education curriculum.

Per-and polyfluoroalkyl substances and disrupted sleep: mediating roles of proteins

BackgroundPer-and polyfluoroalkyl substances (PFAS) contamination may disrupt sleep through disrupted metabolic and immune functions. The study aims to investigate the association and potential mechanism between PFAS and sleep. MethodsWe included 136 young adults recruited between 2014-2018 and 76 were re-assessed between 2020-2022. Additional 8 participants only had complete data between 2020-2022. Plasma PFAS (PFOS, PFOA, PFHxS, PFHpS, PFPeS, PFNA, PFDA) were measured at both visits using liquid-chromatography high-resolution mass spectrometry. Plasma proteins were measured by Olink® Explore 384 Cardiometabolic and Inflammation Panel I. Sleep duration was self-reported at both visits along with follow-up sleep disturbance and sleep-related impairment using validated instruments. We utilized multiple linear regression to explore the association between individual PFAS (in tertile) and these sleep outcomes. PFAS associated with sleep outcomes were subjected to computational toxicology analysis using the Comparative Toxicogenomics Database and Toxicology in the 21st Century database to identify potential genetic links between them. Mediation analysis using proteomic data was then performed to confirm the findings from computational toxicology analysis. ResultsAt baseline, one tertile increase in PFDA was associated with 0.39 (95 % CI: 0.05, 0.73) hours of shorter nightly sleep duration, and, at follow-up, PFHxS and PFOA were associated with 0.39 (95 % CI: 0.05, 0.72) and 0.32 (95 % CI: 0.01, 0.63) hours shorter sleep duration, respectively. One tertile increase in PFOS exposure was associated with a 2.99-point increase in sleep disturbance scores (95 % CI: 0.67, 5.31) and a 3.35-point increase in sleep-related impairment scores (95 % CI: 0.51, 6.20). Computational toxicology and mediation analyses identified potential mediating roles for several proteins in the PFAS-sleep associations, including 11-beta-dehydrogenase isozyme 1 (HSD11B1), cathepsin B (CTSB) and several immune system-related proteins. ConclusionFuture large scale epidemiological and mechanistic studies should confirm our findings and test effect measure modification of the associations by age.

Effect of foot reflexology massage on sleep, anxiety and quality of life in hemodialysis patients: A single-blind, randomized, placebo-controlled trial

ObjectiveThe aim of this study is to investigate the effects of reflexology foot massage on sleep, anxiety, and quality of life as compared to foot massage only in patients undergoing hemodialysis treatment. MethodsThis study was conducted as a single blinded randomized placebo-controlled parallel-group trial. Data were collected using the “Demographic Characteristics Form”, “Richards-Campbell Sleep Scale”, “State-Trait Anxiety Inventory” and “Nottingham Health Profile”. Individuals in the reflexology and placebo groups received massages for three weeks; three times a week, for 15 minutes on each foot. Participants in the reflexology and placebo groups were followed-up before the massage and after the ninth massage session. ResultsIn the statistical evaluation of the sleep quality scale mean scores, after the ninth massage session, it was determined that the average sleep score of the reflexology massage group was higher than that of the placebo group. Additionally, the state anxiety level was found to be lower in the reflexology group compared to the placebo group. As for the quality of life after the ninth massage session, it was determined that there was an improvement in the reflexology massage group compared to the placebo group. ConclusionsThis study has found that foot reflexology massage is effective in reducing anxiety levels, improving sleep, and enhancing the quality of life in patients undergoing hemodialysis treatment. The findings of this study may offer nurses greater awareness of the potential benefits of reflexology. In this way, more healthcare professionals can be encouraged to use reflexology in addition to other cares.

Sleep patterns, physical activity, genetic susceptibility, and incident rheumatoid arthritis: a prospective cohort study

BackgroundSleep and physical activity (PA) are thought to be interconnected with the development of rheumatoid arthritis (RA). However, the precise nature and extent of these relationships have yet to be fully quantified. This study aimed to quantify the longitudinal effects of sleep behaviors, PA, and genetic susceptibility on the incidence of RA and to estimate the combined effects and interactions among these exposures.MethodsA total of 363,211 adults were derived from a large European cohort. We incorporated five sleep behaviors (sleep duration, insomnia, snoring, chronotype, and daytime sleepiness) to generate sleep patterns, which were defined based on healthy sleep scores. Multivariate-adjusted Cox proportional hazard models were conducted to assess the individual and combined associations of sleep patterns, PA, and genetic susceptibility with the risk of RA occurrence. Multiplicative and additive interactions were estimated by Pinteraction and relative excess risk due to interaction (RERI) between each of the two exposures.ResultsDuring a follow-up of 12.5 years, 4262 RA cases were ascertained. A healthy sleep pattern was associated with a decreased risk of RA in a dose-response manner, with an adjusted hazard ratio (HR) of 0.79 (95% confidence interval [CI] = 0.75–0.84), independent of traditional risk factors and genetic predisposition. Under the restricted cubic splines model, a non-linear association was detected for PA and RA risk. Participants in the intermediate quintile 3 showed the lowest risk for developing RA, with a HR 95% CI of 0.84 (0.76–0.92). Moreover, there was an additive interaction effect of intermediate sleep pattern and PA, with a 0.45 (95% CI = 0.02–0.87) RERI of developing RA. Additionally, individuals at high genetic risk had the greatest 10-year absolute risk reduction (10.58 per 1000 person-years) when adopting both favorable behaviors.ConclusionsA healthy sleep pattern and moderate PA were associated with a reduced risk of developing RA, which can offset the deleterious effects of predisposing genetic components. Implementing these modifiable lifestyle factors into public health practices is beneficial for RA prevention.

Mental health, substance use, and a composite of sleep health in adults, 2018 Ohio behavioral risk factor surveillance system

ObjectivesVarious factors impact sleep health including mental health and substance use. Mental health issues and substance use continue to rise in the United States. Yet, the association between mental health, substance use and sleep health in adults remains unclear. MethodsWe used multivariable linear regression models to examine the associations between mental health (poor mental health days in the past 30 days) and substance use (marijuana, tobacco, alcohol) with sleep health (individual dimensions of sleep: alertness, sleep efficiency, duration, and sleep health composite score) in 4333 participants from the 2018 Ohio Behavioral Risk Factor Surveillance System Survey. ResultsBetter mental health was associated with higher alertness, higher sleep efficiency, longer sleep duration and a higher sleep health composite score even after controlling for covariates (individual: sex at birth, age, body mass index, race, education, sleep disordered breathing, and area-level: socioeconomic deprivation) (all p < .001). Higher marijuana and tobacco use were associated with lower individual sleep health dimensions (marijuana with sleep efficiency and duration and tobacco use with lower efficiency) and a lower sleep health composite score even after controlling for covariates for tobacco use (p < .001). Contrary to the hypothesis, higher alcohol use was associated with higher alertness and a higher sleep health composite score (p < .001), however after adjusting for covariates these associations were no longer significant. ConclusionsThe implications of these trends on sleep health are important to address as mental health and substance use are modifiable targets to consider when addressing sleep health.

Factors associated with poor sleep in children with drug-resistant epilepsy.

We aimed to investigate sleep in children with drug-resistant epilepsy (DRE), including developmental and epileptic encephalopathies (DEEs). Next, we examined differences in sleep macrostructure and microstructure and questionnaire outcomes between children with well-controlled epilepsy (WCE) and children with DRE. Furthermore, we wanted to identify factors associated with poor sleep outcome in these children, as some factors might be targets to improve epilepsy and neurodevelopmental outcomes. A cross-sectional study was conducted in children 4 to 18-years-old. Children without epilepsy, with WCE, and with DRE were included. Overnight electroencephalography (EEG), including chin electromyography and electrooculography, to allow sleep staging, was performed. Parents were asked to fill out a sleep questionnaire. Classical five-stage sleep scoring was performed manually, spindles were automatically counted, and slow wave activity (SWA) in the first and last hour of slow wave sleep was calculated. One hundred eighty-two patients were included: 48 without epilepsy, 75 with WCE, and 59 with DRE. We found that children with DRE have significantly lower sleep efficiency (SE%), less time spent in rapid eye movement (REM) sleep, fewer sleep spindles, and a lower SWA decline over the night compared to children with WCE. Subjectively more severe sleep problems were reported by the caregivers and more daytime sleepiness was present in children with DRE. Least absolute shrinkage and selection operator (LASSO) regression showed that multifocal interictal epileptiform discharges (IEDs), benzodiazepine treatment, and longer duration of epilepsy were associated with lower SE% and lower REM sleep time. The presence of multifocal discharges and cerebral palsy was associated with fewer spindles. Benzodiazepine treatment, drug resistance, seizures during sleep, intellectual disability, and older age were associated with lower SWA decline. Both sleep macrostructure and microstructure are severely impacted in children with DRE, including those with DEEs. Epilepsy parameters play a distinct role in the disruption REM sleep, spindle count, and SWA decline.

How Do We Improve Sleep Quality After Total Joint Arthroplasty? A Systematic Review of Randomized Controlled Trials.

Despite the importance of sleep for physiological function, rehabilitation, and recovery, sleep quality after total joint arthroplasty (TJA) remains poor. The objective of this systematic review was to identify, summarize, and evaluate postoperative interventions aimed at improving sleep quality after TJA. A systematic review of PubMed (MEDLINE) and Scopus (Embase, MEDLINE, COMPENDEX) from inception to April 2024 was conducted (PROSPERO ID: CRD42023447317). Randomized controlled trials on interventions to improve sleep quality were included. Sleep outcomes, including the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Patient-Reported Outcome Measurement Information System-Sleep Disturbance, Numeric Rating Scale sleep scores,l9 were extracted. Descriptive statistics were used to analyze the available data. Of the 1,549 articles identified, seven randomized trials with a total of 840 patients were included (394 total hip arthroplasties [THA], 446 total knee arthroplasties [TKA]). Pittsburgh Sleep Quality Index was the most commonly used outcome for assessing sleep quality. Among THA studies, zolpidem, combined fascia iliaca compartment block (FICB) and dexmedetomidine (DEX), and perioperative methylprednisolone were shown to markedly improve postoperative sleep quality. Neither topical cannabidiol nor topical essential oil was found to improve postoperative sleep quality after TKA. Melatonin had no effect on sleep outcomes after TJA. Zolpidem, FICB + DEX, and perioperative methylprednisolone are effective interventions to improve sleep quality after THA. Topical cannabis, topical essential oil, and melatonin did not improve sleep quality. No effective sleep interventions for TKA patients were identified. Improving sleep quality remains a potential therapeutic goal to improve patient satisfaction after TJA. Continued investigation on this topic is therefore necessary.

Sleep disruption in patients with active and treated endogenous Cushing’s syndrome

ContextThe hypothalamic-pituitary-adrenal axis is a critical regulator of circadian rhythm in humans. Impaired sleep adversely affects metabolic, emotional, and cognitive health.ObjectiveTo characterize sleep disturbances in patients with active and treated Cushing’s syndrome (CS), and identify factors associated with impaired sleep in treated patients.DesignSingle-center cross-sectional study.MethodsPatients with pituitary or adrenal CS enrolled in an observational study completed Nottingham Health Profile (NHP), CushingQoL, and Hospital Anxiety and Depression assessments. Cross-sectional analysis was conducted including patients with active and treated disease.Results113 (94 female) patients with CS were included, 104 pituitary and 9 adrenal, with mean age at diagnosis of 43.9 ± 13.4 years. Mean and maximum duration of follow up was 5.1 and 23 years. Mean NHP sleep score was lower (i.e., improved) in patients with treated vs. active disease (29.6 ± 30.2 vs. 51.9 ± 30.9, p = 0.0005), as was CushingQoL sleep score (p = 0.015), but 41.5% of patients with treated disease stated they often or always had trouble sleeping. The proportion of treated vs. active patients taking medication for sleep, mood, or pain was not different. Neither NHP nor CushingQoL pain scores were lower in treated vs. active patients (p = 0.39 and 0.53). In patients with treated CS, anxiety and depression correlated with worse sleep scores.ConclusionsPatients with treated CS report improved sleep quality compared to those with active disease, but almost half of treated patients still report sleep challenges. The need for sleep medications, reported by one third of patients, was not different after CS treatment. Ongoing mood disturbances may play a role in persistent sleep disruption. Further work should focus on determinants of sleep impairments in treated CS patients.

Sleep pattern, genetic risk, and the risk of incident rheumatoid arthritis: A cohort study

ObjectiveTo investigate the associations of sleep behaviors with the risk of rheumatoid arthritis, and whether the associations differ among individuals with low, intermediate, or high genetic risk. MethodsWe included participants who were free of rheumatoid arthritis at baseline based the UK Biobank. We evaluated the associations of five sleep behaviors with the risk of rheumatoid arthritis using Cox proportional hazard regression models. We then generated a sleep risk score which combined five sleep behaviors and assessed its association with the risk of rheumatoid arthritis. We finally generated a genetic risk score and examined the joint effects of sleep patterns and genetic susceptibility on the risk of rheumatoid arthritis. ResultsOf the 375,133 participants at baseline, 4913 incident rheumatoid arthritis cases were identified over a median follow-up of 11.73years. We found that insomnia and daytime sleepiness were associated with a 33% and a 38% increased risk of rheumatoid arthritis. A U-shaped association was observed between sleep duration and the risk of rheumatoid arthritis, with a 29% higher risk for those with short sleep and a 30% higher risk for those with long sleep. Participants with unfavorable sleep patterns had a 63% increased risk of rheumatoid arthritis compared with those with favorable sleep patterns. Participants with unfavorable sleep patterns and high genetic risk showed the highest risk of rheumatoid arthritis although no statistically significant multiplicative or additive interaction was found. ConclusionsOur study suggested that insomnia, daytime sleepiness, and short or long sleep duration, as well as sleep risk score were associated with an increased risk of rheumatoid arthritis.

Sleep patterns, genetic susceptibility, and digestive diseases: a large-scale longitudinal cohort study.

Sleep problems are prevalent. However, the impact of sleep patterns on digestive diseases remains uncertain. Moreover, the interaction between sleep patterns and genetic predisposition with digestive diseases has not been comprehensively explored. Four hundred ten thousand five hundred eighty-six participants from UK Biobank with complete sleep information were included in the analysis. Sleep patterns were measured by sleep scores as the primary exposure, based on five healthy sleep behaviors. Individual sleep behaviors were secondary exposures. Genetic risk of the digestive diseases was characterized by polygenic risk score. Primary outcome was incidence of 16 digestive diseases. Healthy sleep scores showed dose-response associations with reduced risks of digestive diseases. Compared to participants scoring 0-1, those scoring 5 showed a 28% reduced risk of any digestive disease, including a 50% decrease in irritable bowel syndrome, 37% in non-alcoholic fatty liver disease, 35% in peptic ulcer, 34% in dyspepsia, 32% in gastroesophageal reflux disease, 28% in constipation, 25% in diverticulosis, 24% in severe liver disease, and 18% in gallbladder disease, whereas no correlation was observed with inflammatory bowel disease and pancreatic disease. Participants with poor sleep and high genetic risk exhibited approximately a 60% increase in the risk of digestive diseases. A healthy sleep pattern is linked to lower digestive disease risk in participants of all genetic risk levels. In this large population-based cohort, a healthy sleep pattern was associated with a reduced risk of digestive diseases, regardless of genetic susceptibility. The authors' findings underscore the potential impact of healthy sleep traits in mitigating the risk of digestive diseases.

Efficacy of a Multi-lamellar Emulsion Containing a Synthetic Sphingosine Kinase 1 Activator and Pseudoceramide in Patients with Atopic Dermatitis: A Randomized Controlled Trial.

Patients with atopic dermatitis(AD) have impaired barrier function, which decreases skin hydration, weakens their defense against microorganisms, and culminates in increased inflammatory responses. Here, we conducted a clinical trial to evaluate the efficacy of a multi-lamellar emulsion (MLE) containing the pseudoceramide PC-9S and a synthetic sphingosine kinase 1 (SPHK1) activator, Defensamide™, in improving mild-to-moderate atopic dermatitis. Forty patients aged ≥ 2years were randomized into a combined-therapy group treated with the MLE containing PC-9S and Defensamide™ plus a topical corticosteroid and a topical-corticosteroid-only group. Assessments based on therapeutic methods included the Eczema Area and Severity Index (EASI), the Investigator Global Assessment (IGA), transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin dryness, a visual analogue scale (VAS) of itchiness, a VAS of sleep disturbance, patientsatisfaction, and the Dermatology Life Quality Index (DLQI). Thirty-eight patients completed this study. In the combined-therapy group, significant improvements in clinical and instrumental measures such as EASI scores, skin hydration, and skin dryness were noted at 4weeks compared to baseline, but such improvements were not noted in the topical corticosteroid-only group. Subjective assessments of itching and sleep disturbance and DLQI scores also showed significant improvements in the combined-therapy group. Combined therapy with the MLE containing Defensamide™ and PC-9S and with topical corticosteroid demonstrated superior clinical outcomes compared with topical corticosteroid monotherapy. Our findings underscore the potential of MLE-containing formulations as effective adjunctive therapies for AD, offering both objective and subjective symptomatic relief and enhancing patients' quality of life.

Sleep Quality and its Associated Factors among Nurses in a Tertiary Care Public Hospital in Puducherry District: A Cross-sectional Study.

Adequate sleep is essential for human beings to maintain optimal health. Medical professionals, including nurses, work in stressful environments that could affect their sleep quality. The objective of this study was to determine the prevalence and the factors associated with poor sleep quality among nurses in a tertiary care public hospital. This cross-sectional analytical study was conducted on 1217 nurses aged between 21 and 60 years from May 2019 to April 2020 in a tertiary care public hospital in Puducherry. Sleep quality was assessed using the Pittsburgh sleep quality index scoring system, and the workplace stress scale was used to assess workplace stress. The Chi-squared test and adjusted Prevalence Ratio (aPR) were used to determine the factors associated with poor sleep quality. The response rate was 99% (1217/1229), and three-fourths of the participants were women (943, 77.50%). The mean (SD) PSQI score was 4.49 (2.98), and more than one-third of participants, 42.80% (95% CI: 40.10-45.70), had poor sleep quality. The prevalence of poor sleep quality was significantly higher among women (z = 2.33, p = 0.019) aPR (95% CI): 1.08 (1.01-1.16), those having severe to dangerous levels of workplace stress (z = 8.22, p > 0.001) aPR (95% CI): 1.54 (1.39-1.71) and chronic pain (z = 2.11, p = 0.016) aPR (95% CI): 1.09 (1.02-1.17). The prevalence of poor sleep quality among the study population was high. This highlights the urgent need for implementing health promotion programs among nurses.

A closer look at depression and sleep quality relation: A cross-sectional study of taxi drivers in Tabriz metropolis.

Taxi drivers play a significant role in urban mobility and safety as professional drivers. They typically have poor incomes, long work hours, lack of sleep, and high levels of stress, which increase the risk of physical and mental illnesses. The goal of this study was to explore the relationship between sleep disorders and depression among Tabriz metropolis taxi drivers. Using the street intercept technique, a cross-sectional study was conducted with the participation of 402 taxi drivers in Tabriz during January and March 2020. Data collection tools included the Pittsburgh Sleep Quality Index (PSQI) and Patient Health Questionnaire as well as demographic information. Twenty taxi stops were used as sampling sites, and the method used was random sampling based on the number of drivers at each stop. Statistical analysis was performed using Stata 13. The majority of drivers worked an average of 6 days each week, with a mean tenure of 13.3 years. The sleep quality mean score for drivers was 5 (SD = 2.3). Approximately, 21% of them had sleep disorder (PSQI >6). Moderate depression was recognized in 13% of drivers and moderately severe depression has been found in 5% of them. Drivers were more likely to experience sleep disorders if they had mild (odds ratio [OR] = 3.9), moderate (OR = 16.4), or fairly severe depression symptoms (OR = 35.3). A seven times higher risk of depression was identified among drivers with sleep disorders. It might be contended that a mutual relationship has been found between sleep disorders and depression, and disregarding this will deteriorate sleep turbulences. Considering the pivotal role of taxi drivers in urban mobility, accommodating initiatives that give a break time for drivers and improve their mental health is recommended.