Subjective Sleep Research Articles

Exploring the Relationship between Sleep Pattern and Quality of Life in the Middle-aged Population Based on Fuzzy-set Qualitative Comparative Analysis.

This study aims to investigate the effects of 7 factors (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction), as measured by the Pittsburgh Sleep Quality Index, on the quality of life (QOL) in middle-aged individuals. A total of 194 middle-aged individuals aged 45 to 59 years participated in this study. The Chinese version of the medical outcomes study 36-item short-form health survey and the Pittsburgh Sleep Quality Index were used to assess the QOL and sleep quality, respectively. The relationship between sleep patterns and QOL was analyzed using fuzzy-set qualitative comparative analysis. Improvement in sleep disturbances and reduction in the use of sleeping medications are necessary conditions for enhancing QOL. Two configurations of sleep patterns positively influence QOL: the "sufficiency type" with high level of sleep duration, non-sleep disturbances, and non-daytime dysfunction as core conditions; and the "efficiency type" with high habitual sleep efficiency and non-daytime dysfunction as core conditions. Three configurations of sleep patterns negatively influence QOL: the "low-quality type" with non-high-level subjective sleep quality, sleep duration, and habitual sleep efficiency as core conditions; the "barrier type" with high level of sleep disturbances, non-high-level sleep latency, and non-high-level subjective sleep quality/sleep duration as core conditions; and the "drug-based type" with high level of use of sleeping medications and subjective sleep quality as core conditions. Using the fuzzy-set qualitative comparative analysis method, this study initially reveals that the influence of sleep patterns on QOL in middle-aged individuals is a holistic effect combining multiple elements. This deepens and enriches the understanding of the relationship between sleep patterns and QOL and expands new perspectives for more in-depth research on how to improve the QOL of middle-aged individuals through sleep interventions.

Cognitive Behavioral Therapy for Paroxysmal Atrial Fibrillation: Heart Rate Variability, Physical Activity, and Sleep

BackgroundCognitive behavioral therapy for symptom preoccupation in paroxysmal atrial fibrillation (AF-CBT) significantly improved AF-specific quality of life in a recent trial. To what extent this may this may be associated with changes in physiological parameters is yet to be determined. ObjectivesThe purpose of this study was to assess the effects of AF-CBT on heart rate variability (HRV), physical activity, and sleep. MethodsPatients with symptomatic paroxysmal AF on optimal medical therapy (mean ± standard deviation 65.4 ± 8.3 years, 58% females, 61% on beta-blockers) were randomized to a 10-week online AF-CBT (n = 65) or AF education (n = 62). AF-CBT was therapist-led and focused on social and physical avoidance. A 5-day Patch-Holter with an integrated accelerometer was applied at baseline, post-treatment, and at 3-month follow-up to assess AF burden, HRV, physical activity, and sleep duration. Subjective assessments were made by the International Physical Activity (IPAQ) and Insomnia Severity Index questionnaires. ResultsAt baseline, participants walked on average 8040 ± 2600 steps/day and slept 8.0 ± 1.1 hours. Objective and subjective physical activity and sleep duration remained unchanged after treatment, with no significant difference between the groups. The Insomnia Severity Index score went from subclinical insomnia (12.2 ± 6.7) to near normal values (8.1 ± 5.6), a significant change compared to controls (P = 0.032). No changes were found in AF burden or HRV indices at rest during the day or at night. ConclusionsIn this select cohort, AF-CBT decreased insomnia severity but had no impact on HRV or physical activity. Thus, AF-CBT may operate through psychological and behavioral factors that are not targeted by current medical and lifestyle interventions.

Analysis of vitamin D metabolism, thyroid and autoimmune markers in the vitiligo pathways and their possible interaction with sleep.

Vitiligo is an autoimmune skin disease that can be influenced by stress, including that resulting from sleep deprivation and sleep disturbances. Sleep is essential in the regulation of several hormonal, metabolic and autoimmune pathways that may have important roles in vitiligo. This study aimed to investigate the potential interplay between hormonal, metabolic, and autoimmune markers in vitiligo patients, and the possible influence of sleep quality in these vitiligo pathways. A cohort of 30 vitiligo patients and 26 healthy controls were assessed for various laboratory markers, including thyroid-stimulating hormone (TSH), parathyroid hormone (PTH), serum calcium, 1.25(OH)2D, 25(OH)D, anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG), and antinuclear antibodies (ANA). The study evaluated sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Positive anti-TPO were found in the vitiligo group, but did not in the control group. Vitamin D 25(OH)D mean levels were clinically insufficient in both groups (< 30mg/dL). Reactive ANA was analyzed with 2 variables related to vitiligo: phototherapy and skin activity. No statistical correlation was found in the chi-square test on this relationship. Descriptive findings have shown that the positivity to anti-TPO and anti-TG, associated or not with reactive ANA, was higher in vitiligo group. Great part (85.7%) of vitiligo group were "poor sleepers" (PSQI > 5), which has increased (88.2%) when considering only individuals with signs of vitiligo activity. Autoimmune hypothyroidism and positive anti-TPO are expected in vitiligo, although this marker is not usually measured in the first laboratory screening to this disease. Adequate vitamin D levels may be a key adjuvant in skin pigmentation, and be related to sleep quality and immune regulation, as this vitamin can be related to better sleep and immunomodulation in autoimmune diseases. Evaluating ANA before phototherapy can be controversial, but it should be considered in cases with a poor response to this treatment, or when there is a higher risk of other autoimmune diseases. Poor sleep predominated in the vitiligo group, based on PSQI scores that reported worse subjective sleep in these patients. Worse sleep predominated in individuals with signs of skin activity and reactive autoimmune markers. Screening these components could be important in the management of vitiligo, as maintaining body homeostasis can help to improve the disease course. Sleep should be considered as a potential modulator of several multidirectional vitiligo pathways.

Study protocol for an observational cohort study of heat stress impacts in pregnancy in The Gambia, West Africa

Climate change has resulted in an increase in heat exposure globally. There is strong evidence that this increased heat stress is associated with poor maternal and fetal outcomes, especially in vulnerable populations. However, there remains poor understanding of the biological pathways and mechanisms involved in the impact of heat in pregnancy. This observational cohort study of 764 pregnant participants based in sub-Saharan Africa, a geographical region at risk of extreme heat events, aims to evaluate the physiological and biochemical changes that occur in pregnancy due to heat stress. The key objectives of the study are to 1) map exposure to heat stress in the cohort and understand what environmental, social and community factors increase the risk of extreme heat exposure; 2) assess the impact of heat stress on maternal health, e.g. heat strain, subjective psychological well-being, sleep and activity level; 3) evaluate how heat stress impacts placenta structure and function; 4) determine how chronic heat exposure impacts birth outcomes; and 5) explore the epigenetic changes in the placenta and infant by heat stress exposure per trimester. Pregnant women will be recruited from two distinct regions in The Gambia to exploit the naturally occurring heat gradient across the country. Microclimate mapping of the area of recruitment will give detailed exposure measurements. Participants will be asked to wear a watch-style device at 28- and 35-weeks gestational age to evaluate maternal heart rate, activity and sleep. At the end of the week, an ultrasound scan will be performed to evaluate fetal size and placental blood flow. At delivery, birth outcomes will be recorded and maternal, placental and cord samples taken for epigenetic, biochemical and histological evaluation. Evaluation of neuro-behaviour and final infant samples will be taken at 1 month following birth.

Short Sleep Duration and Hypertension: A Double Hit for the Brain.

Short sleep duration has been associated with an increased risk of cognitive impairment and dementia. Short sleep is associated with elevated blood pressure, yet the combined insult of short sleep and hypertension on brain health remains unclear. We assessed whether the association of sleep duration with cognition and vascular brain injury was moderated by hypertensive status. A total of 682 dementia-free participants (mean age, 62±9 years; 53% women) from the Framingham Heart Study completed assessments of cognition, office blood pressure, and self-reported habitual and polysomnography-derived sleep duration; 637 underwent brain magnetic resonance imaging. Linear regressions were performed to assess effect modification by hypertensive status on total sleep time (coded in hours) and cognitive and magnetic resonance imaging outcomes. There was a significant interaction between sleep duration and hypertensive status when predicting executive function/processing speed (Trail Making B-A) and white matter hyperintensities. When results were stratified by hypertensive status, longer sleep duration was associated with better executive functioning/processing speed scores in the hypertensive group (meaning that shorter sleep duration was associated with poorer executive function/processing speed scores) (self-report sleep: β=0.041 [95% CI, 0.012-0.069], P=0.005; polysomnography sleep: β=0.045 [95% CI, 0.002-0.087], P=0.038), but no association was observed for the normotensive group. Similarly, shorter subjective sleep duration was associated with higher white matter hyperintensity burden in the hypertensive group (β=-0.115 [95% CI, -0.227 to -0.004], P=0.042), but not in the normotensive group. In individuals with hypertension, shorter sleep duration was associated with worse cognitive performance and greater brain injury.

Sleeping on the edge: Adolescents living at moderate altitude report greater sleep need

PurposeResearch in adults suggests that altitude impacts the restorative properties of sleep and increases risk for mental health concerns. The aim of this study was to extend this research to an adolescent sample to examine how living at altitude may be associated with greater sleep need and mental health symptoms during a period of the life-span when risk for insufficient sleep and mental health difficulties is high. MethodsData were collected from 105 adolescents aged 10–17 years residing at moderate-high altitudes. Parents reported on sociodemographics and adolescent depressive and anxiety symptoms, and adolescents reported on their subjective sleep need and sleep duration. Altitude was calculated using U.S. Geological Survey data. ResultsAdjusting for age, sex, socioeconomic status, rurality, and sleep duration, living at higher altitude was associated with reports of greater sleep need. Altitude was unrelated to mental health symptoms. DiscussionThe majority of adolescents do not obtain the recommended amount of sleep. These findings suggest that adolescents living at moderate-high altitudes may be at further risk due increased sleep need at higher elevations.

Restless sleep is associated with increased anxiety in physical therapy students: a cross sectional survey study

BackgroundSleep and mental health are intimately related and shown to impact graduate students enrolled in health sciences programs, including physical therapy education. Doctorate of Physical Therapy (DPT) students’ attitudes and behaviors surrounding sleep and whether these factors are associated with mental health are unknown. This study aimed to describe sleep behaviors and attitudes of entry-level DPT students and to explore the relationship between subjectively reported sleep quality and self-reported symptoms of anxiety in these students.MethodsA cross-sectional online survey consisting of the Sleep Practices and Attitudes Questionnaire (SPAQ), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and demographic questions were used. Analyses investigated sleep behaviors and attitudes, along with the relationship (unadjusted odds ratio) between restless sleep and anxiety in DPT students in hybrid and traditional DPT programs across the United States (US).ResultsA total of 271 DPT students completed the survey. A majority of students reported feeling tired during most days (80.8%, n = 219), a quarter of participants (24.7%) reported having a history of trouble sleeping and four (1.5%) reported being diagnosed with a sleep disorder. Of those who reported their sleep duration, participants slept an average of 6.86 h. The mean GAD-7 score was 7.68 (SD = 4.90), suggestive of mild anxiety. Sixty-seven (24.7%) reported having a diagnosed anxiety disorder, with generalized anxiety being the most common diagnosis. Those who reported having restless sleep were 4.09 times more likely to have moderate to severe anxiety [unadjusted odds ratio = 4.09 (95% CI 2.27,7.35; p < 0.001)] compared to those who reported restful sleep.ConclusionsDPT students who rated sleep as restless exhibit signs of poor subjective sleep quality associated with an increased risk of experiencing moderate to severe anxiety compared to students who had restful sleep. Students reported behaviors surrounding sleep that may contribute to anxiety. These findings have implications for including sleep and mental health education and practices within DPT programs.

Effect of probiotics and paraprobiotics on patients with sleep disorders and sub-healthy sleep conditions: a meta-analysis of randomized controlled trials.

The microbial-gut-brain axis has received much attention in recent years, and regulating intestinal flora can effectively improve sleep disorders, which hints the potential effects of probiotics on sleep disorders, but lack of research evidence for meta-analysis. Therefore, this study aims to quantitatively evaluate the influence of probiotics on sleep disorders and sub-healthy sleep conditions. Up to 2023, online databases including Pubmed, Embase, Cochrane library, Web of science have been searched for studies involving adults who consume probiotics or paraprobiotics in controlled trials, during which, changes in subjective and/or objective sleep parameters and contributing factors in sleeping quality are examined. We conduct a meta-analysis of 11 clinical randomized controlled studies. Probiotic supplementation improves sleep states to some extent in adults with sleep disorders and healthy adults with condition-induced sleep disorders (-0.34 [-0.56 to -0.13]; I 2 = 42.6%; p = 0.001). Meanwhile, subgroup analysis shows that the effect of probiotics on improving sleep disorders is influenced by other factors such as the health states of the subjects, the duration of the intervention, the type of strain, and the test criteria. Probiotics and paraprobiotics have a significant positive effect on the sleep quality of adults with sleep disorders or sub-healthy sleep conditions. However, the therapeutic effects of probiotics on sleep problems need future additional trials. https://inplasy.com/inplasy-2022-12-0066/, identifier 2022120066.

Objective and Subjective Sleep Characteristics of Japanese University Students: Analysis Using Questionnaires and Wearable Trackers

AbstractThe transition from high school to university is characterized by changes in students' social and learning environments, potentially impacting sleep and learning behaviors. To examine the sleep characteristics of university students, this study aimed to (a) measure sleep in a living environment using a wearable tracker; (b) use a self‐administered questionnaire to examine the relationship between objective and subjective sleep; and (c) examine how psychological aspects are related to objective and subjective sleep. Fifty undergraduate and graduate students participated, with 310 sleep records obtained. The objective means total sleep time showed a moderately positive correlation with sleep quantity in the 3‐Dimensional Sleep Scale. Furthermore, we found that mental health, trait anxiety, and quality of life do not correlate with objective total sleep time but are significantly moderately correlated with subjective sleep quantity. The combination of wearable trackers and subjective reports may provide a more precise understanding of university students' actual sleep patterns and how different aspects of sleep behavior are associated with health outcomes.

Key Associations Found in the Struggle With Sleep in Lung Transplant Recipients.

Gaps exist in the understanding of the etiology of poor sleep quality after lung transplantation. Research Question: What factors are associated with poor sleep quality in lung transplant recipients? A quantitative, single-site, cross-sectional study used an anonymous survey based on 3 scales. The Pittsburgh Sleep Quality Index scale with scores dichotomized to poor versus good sleepers based on the cutoff score > 8. The Hospital Anxiety and Depression Scale evaluated symptoms of anxiety and depression, and the Short Form-12 measured health-related quality of life using the mental and physical component scores. Additional self-reported data included demographic and transplant-related variables. The response rate was 38.4% (61/158), and 52.5% of the sample (32/61) evidenced a Pittsburgh Sleep Quality Index score > 8, suggestive of poor sleep quality. Bivariate analyses demonstrated that poor sleep was significantly related to symptoms of depression (P < .01), anxiety (P < .01), stressors of hospitalization (P < .05), and treatment of acute rejection (P < .05). Multivariate analysis demonstrated that anxiety was significantly associated with poor sleep (odds ratio = 1.34, P < .05). Poor subjective sleep quality remains prevalent in lung transplant recipients. Individuals with anxiety symptoms were at a greater risk for poor sleep. Guidance for strategies to improve sleep quality requires further in-depth exploration before implementation of interventions.

Exploring the Factors Associated with Sleep Concerns and Perceived Need for Treatment among Patients with Sleep Disorders

ABSTRACT Objectives This study aimed to investigate the factors affecting patient perceptions of sleep concerns and the need for treatment to understand and enable effective management. Methods This cross-sectional study analyzed data collected between November 2018 and October 2022 at the sleep clinic of a tertiary hospital. Adults aged > 19 years who completed sleep questionnaires and polysomnography (PSG) were included. Logistic regression models were used to assess the associations between demographic, clinical, and social factors, sleep questionnaire responses, and PSG data with self-reported sleep concerns (n = 3,457) and perceived need for treatment(n = 3,135). Results Insomnia-related symptoms affect both sleep concerns and need for treatment, and sleep maintenance is the most influential factor in both sleep concerns (odds ratio[OR] = 19.74, 95% confidence interval[CI] 6.17–63.20) and need for treatment (OR = 3.84, 95% CI 2.19–6.73). Young age (OR = 2.66, 95% CI 1.38–5.12), employment status, and daily life dysfunction were determinants of treatment readiness. None of the PSG parameters showed an independent association with sleep concerns or need for treatment. Conclusions Sleep maintenance problems had the most profound effect on sleep concerns and the need for treatment. Social needs are key factors in seeking treatment. A discrepancy has been noted between the effects of subjective and objective factors on sleep concerns and the need for treatment; therefore, patient management should pay attention to subjective sleep complaints.

Does gaming keep subjects awake?: Subjective and objective sleep parameters following gaming in comparison to a passive control

ObjectivesGaming is a global phenomenon often associated with impaired health and sleep patterns. Although the research activities are growing, the evidence to date is rare due to the various gaming titles and inconsistent study designs. Thus, this study aimed to examine the impact of excessive gaming in the evening on subjective as well as objective sleep parameters by focusing on specific game titles and assessing several evenings/nights using a mixed-methods approach. MethodsA total of 33 experienced young male adults (23.00 ± 3.53 years old, ranked players in League of Legends or Counter-Strike: Global Offensive) took part. The individuals’ sleep parameters were assessed via diary and actigraphy. In randomized order, one week apart and for a duration of 120 min each, two study evenings were spent gaming, while the other two evenings were spent without digital media and gaming, but instead watching a nature documentary. ResultsNo significant difference between the conditions were found (p > 0.05) in either the sleep duration nor the sleep quality. Daytime sleepiness was significantly increased after watching the documentary movie, when compared to gaming (p < 0.001). ConclusionsThese results indicate that, one the one hand, the gaming activity leads to higher arousal and alertness as it requires concentration and dedication. On the other hand, this impact seems only short-term and does not necessarily affect sleep patterns. Future studies are needed to gain deeper insights, especially regarding the long-term health effects of gaming.

Dose and timing effects of caffeine on subsequent sleep: A randomised clinical crossover trial.

To investigate the effect of a typical dose of caffeine and a high dose of caffeine consumed in the morning, afternoon, and evening on subsequent sleep. Using a placebo-controlled, double-blind, randomised crossover design, 23 males (25.3±5.0 years) with a moderate habitual caffeine intake (<300mg∙day-1) completed seven conditions: placebo, and 100 and 400mg of caffeine consumed 12, eight, and four hours prior to bedtime, with a 48-hour washout. In-home partial polysomnography and sleep diaries were used to assess sleep. Linear mixed models estimated the effect of each condition. No significant effect on objective or subjective sleep occurred with the 100mg dose of caffeine compared to the placebo (p>0.05) but significant effects occurred with the 400mg dose (p<0.05). Significant delays in sleep initiation and alterations to sleep architecture were observed when 400mg was consumed within 12 hours of bedtime (p<0.05), and significantly greater sleep fragmentation occurred when 400mg was consumed within eight hours of bedtime (p<0.05). Additionally, perceived sleep quality was significantly reduced when 400mg was consumed four hours prior to bedtime (-34.02%, p=.006) but not at eight or 12 hours. A 100mg dose of caffeine can be consumed up to four hours prior to bedtime, but 400mg may negatively impact sleep when consumed as one dose within 12 hours of bedtime, with the adverse influence on sleep increasing the closer consumption occurs to bedtime. The discrepancy between objective and subjective sleep quality suggests individuals may have difficulty accurately perceiving the influence of caffeine on sleep quality.

Effect of acupuncture on the sleep quality of hemodialysis patients in a capital city in the Northeast of Brazil

Objective: Analyze the effect of auricular acupuncture on the sleep quality of hemodialytic patients with chronic pain in a capital city in the Northeast of Brazil. Methods: This study includes double-blind, randomized in blocks and allocated at a rate of 1:1, controlled trial that was conducted in two hemodialysis clinics, with 94 chronic renal patients with chronic pain (auricular acupuncture [AA]: 47, sham acupuncture [SA]: 47). Both received 12 sessions for three months. We collected data using the Pittsburg Sleep Quality Index (PSQI). Data were analyzed using t-tests, Wilcoxon test and ANOVA. Results: Comparing the SA and AA groups, there was a statistically significant difference at baseline (p &lt; 0.001), a significant intergroup difference, and the AA group had better sleep quality than the SA group during and at the end of the 12 sessions (&lt; 0.001). A high magnitude of the effect of auricular acupuncture on sleep quality was found at the end of the sessions (D= -1.94). Conclusion: The auricular acupuncture intervention proved to be effective in improving the subjective sleep classification of renal patients.

Chronotype, sleep quality, depression and pre-sleep rumination: A diary and actigraphy study.

Eveningness has been associated with both disturbed sleep and depression. It is unclear, however, if deprived sleep explains evening types' vulnerability to depression. The role of pre-sleep rumination in these associations also remains understudied. The present study assessed the relationship between eveningness and sleep quality, as well as the possible mediating effect of pre-sleep rumination and the moderating effect of a history of depression, under naturalistic conditions. Eighty-eight Dutch-speaking participants (87.5% females, 21.4 ± 3.7years) were selected on the basis of their non-intermediate chronotype using the Morningness Eveningness Questionnaire (evening types (n = 53); morning types (n = 35)). Depression status was assessed through a diagnostic interview (healthy (n = 61); remitted depressed (n = 27)). Participants' sleep characteristics were monitored via actigraphy and sleep diaries for seven consecutive days and nights. Pre-sleep rumination was measured via a self-report questionnaire. Evening types had longer subjective and actigraphic sleep onset latency than morning types. Pre-sleep rumination did not mediate the former associations but predicted longer subjective sleep onset latency. Furthermore, the relationship between chronotype and subjective sleep onset latency was moderated by depression history. Remitted depressed evening types reported longer sleep onset latency than healthy evening and morning types, possibly posing the former at a higher risk for depressive relapse. Overall, the current findings address the need to further investigate the physiological signature of circadian rhythms and sleep latency. This could serve as a foundation for the development of prevention and early intervention programs, tailored for mood and sleep disorders.

Sleep Characteristics Among Children with a Parental History of Alcohol Use Disorder

Abstract Purpose of Review The purpose of the review was to examine findings on sleep characteristics among children with a parental history of alcohol use disorder (CPHAUDs) in different age groups. We identified unanswered questions and discussed directions for future research. We also discussed the implications of these current findings on alcohol prevention and intervention programs. Recent Findings Parental ratings and youth report of sleep difficulties have been longitudinally associated with the emergence of alcohol use and alcohol-related problems among both CPHAUDsand non-CPHAUDs. There were inconsistent findings comparing sleep characteristics in these two groups. Studies that used self-report and parental ratings reported no or minimal differences while studies that used actigraphy and polysomnography found significant, albeit moderate but meaningful differences. Summary Current research shows that CPHAUDs and non-CPHAUDs are similar on most objective and subjective sleep measures. There are a few significant differences between the two groups that may have implications for the development of behavioral problems, substance use and other risk behaviors.

The effect of diets with different inflammatory scores on inflammation and sleep in obese subjects: a randomized controlled trial.

The aim of this study was to investigate the effect of different dietary inflammatory index diets on inflammatory markers, anthropometric measurements, and sleep quality in obese subjects. This study was conducted in a public hospital in Turkey between November 2021 and May 2022. Participants with pro-inflammatory dietary habits were included in the study. Randomly divided into two groups of 33 participants, they were subjected to an anti-inflammatory diet or a control diet for 8 weeks. The study evaluated the anthropometric parameters, inflammatory biomarkers, and sleep quality indices of the diet groups. Significant reductions in body mass index were observed in both groups, more marked in the anti-inflammatory diet cohort. C-reactive protein levels, indicative of inflammation, also decreased substantially in both groups, with a more marked reduction in the anti-inflammatory diet cohort. Despite the improvement in sleep quality in both groups, the variation was not statistically significant. This study demonstrates the importance of anti-inflammatory diets in nutritional strategies for obesity by reducing body mass index and inflammation.

Real-time biopsychosocial antecedents and correlates of functional neurological symptoms in daily life: A pilot remote monitoring technology study

Functional neurological symptom disorder (FNSD) is a neuropsychiatric diagnosis referring to symptoms resembling those of neurological disorders, occurring without causal neuropathology. FNSD has a complex biopsychosocial aetiology but its mechanisms are poorly understood. Remote monitoring technologies (RMT) could provide critical insights into functional neurological symptoms (FNS) in real-world contexts. We examined the feasibility and acceptability of a novel RMT protocol, to identify psychobiological correlates and antecedents of FNS in everyday life. Seventeen individuals with FNS (seizures/motor) and 17 healthy controls (HC) completed ecological momentary assessments (EMA) eight times daily for 1-week, reporting FNS severity, associated physical and psychological symptoms, and subjectively significant events. Sleep quality was reported daily. Physiological variables were measured using wearable Fitbit 5 devices. Multilevel modelling examined variables associated with FNS variability. Average EMA completion rates were good in both groups (≥80%). At week-level, the FNS group reported significantly greater subjective arousal, pain, fatigue, dissociation, negative affect, daily events, stressful events, and sleep duration, compared to HC. Objective sleep disturbance and duration, and resting heartrate, were also significantly greater in the FNS sample. FNS severity correlated significantly with daily events, affect, subjective arousal, pain, fatigue and sleep disturbance, at day- or within-day levels. Daily events and negative affect were the most prominent time-lagged predictors of within-day moment-to-moment FNS severity. RMTs are feasible and acceptable tools for investigation of FNS in real-world settings, revealing daily events and negative affect as possible triggers of FNS. Interventions targeting affective reactivity and regulation might be beneficial in this group. Larger-scale, longer-term RMT studies are needed in this population.

Neurologic Care for Transgender and Gender-Diverse People: A Review of Current Evidence and Clinical Implications.

To summarize the literature on neurologic care for transgender and gender-diverse (TGD) people and provide implications for clinical practice. There are limited data on the frequency and management of neurologic conditions among TGD people. TGD people have a higher prevalence of various neurologic conditions compared with cisgender or general population cohorts, including migraine, subjective cognitive decline, sleep disturbances, functional disorders, and cerebrovascular disease. Gender-affirming hormone therapy interacts with commonly prescribed neurologic medications and increases stroke risk among transfeminine people. Sex hormones and sex chromosomes may play a role in neurodegeneration and disability progression in neuroimmunologic diseases. Clitoral reduction surgeries on intersex children can cause neurologic disability and sexual dysfunction in adulthood. Socioeconomic disparities among TGD people contribute to health care barriers. Neurologists should consider the unique experiences and health care needs of TGD people in their clinical practice and research protocols.

Associations Between Perceived Social Status, Discrimination, With Subjective Sleep Quality Among Migrant Care Workers During COVID-19 Pandemic.

This study examines the relationship between perceived social status, COVID-19-related discrimination, and sleep quality among 158 migrant care workers in Taiwan. Data were collected via computer-assisted interviews, assessing perceived social status with the MacArthur scale and sleep quality using the Pittsburgh Sleep Quality Index. The results revealed that higher perceived social status in reference to the destination country (B = 0.31; 95% confidence interval [CI] = [0.08, 0.53]; P = .008) and experience of media stigmatization (B = 0.52; 95% CI = [0.04, 0.99]; P = .03) were associated with higher global Pittsburgh Sleep Quality Index (PSQI) scores, whereas perceived social status in reference to the home country and others forms of pandemic-related discrimination were not associated with PSQI scores. The study concludes that social comparison and stigmatization linked to sleep health of migrant care workers. Understanding these factors can inform the development of targeted interventions to address inequalities faced by migrants.