Symptom Burden Research Articles

Diverticulitis in Older Adults: A Review of Etiology, Diagnosis, and Management.

Diverticulitis accounts for over 300,000 hospitalizations annually in the United States and its incidence increases with age. Among older adults, diverticulitis is the fourth leading cause for emergency surgery. Older adults with multimorbidity and geriatric syndromes are often excluded from clinical studies, leaving a gap in the evidence needed to guide management. Here, we provide a clinically oriented review of the diagnosis and management of older adults with diverticulitis through the lens of age-friendly care. We reviewed the literature describing the epidemiology, diagnosis, management, and prevention of diverticulitis in older adults. Due to age-related physiologic changes, the presence of geriatric syndromes, and multimorbidity, older adults with diverticulitis often present with atypical symptoms, variable laboratory findings, and are at higher risk for complications than younger patients. Guidelines support a more aggressive approach to diagnosis in this population, with lower threshold for obtaining diagnostic imaging. Antibiotics remain a mainstay of treatment for uncomplicated disease, and surgical management should be focused on severity of disease and the balance between the likelihood of improving quality of life and risks and burden of treatment. Diverticulitis is a common disease that has a unique presentation among older individuals with limited evidence to guide management. Diagnosis and treatment should focus on what matters most to the patient, providing the most meaningful outcome possible within the context of multimorbidity, patient goals, symptom burden, and anticipated treatment outcomes.

Chronic autonomic symptom burden in long-COVID: a follow-up cohort study.

Autonomic dysfunction is a common and often debilitating feature oflong-COVID (LC), however, studies evaluating frequency and severity of chronic autonomic dysfunction in LC are limited. We utilized an established online cohort of participants with LC to assess duration and severity of autonomic dysfunction, impact on quality of life, risk factors of autonomic diagnoses including postural tachycardia syndrome (POTS), and efficacy of common treatments. Our international cohort included 526 adults with LC aged 20-65 years who previously completed baseline evaluations of LC symptoms, autonomic symptom burden, and quality of life. Participants repeated survey instruments and completed new instruments assessing risk factors and symptom mitigation strategies. A subset of individuals completed a 10-min active stand test. Multivariable logistic regression identified predictors of autonomic symptom burden and incident autonomic diagnoses including POTS. A total of 71.9% of participants with LC had a Composite Autonomic Symptom Score-31 (COMPASS-31) score ≥ 20, suggestive of moderate-to-severe autonomic dysfunction. The median symptom duration was 36 [30-40] months, and 37.5% of participants could no longer work or had to drop out of school due to their illness. In addition, 40.5% of individuals with autonomic dysfunction were newly diagnosed with POTS, representing 33% of the total LC cohort. Female sex and joint hypermobility were associated with an increased risk of autonomic dysfunction. Evidence of chronic moderate-to-severe autonomic dysfunction was seen in most participants with LC in our cohort and was significantly associated with reduced quality of life and functional disability. POTS was the most common post-COVID autonomic diagnosis.

Influence of symptom burden on social alienation in lung cancer patients receiving chemotherapy: the chain mediating effect of perceived social support and positive psychological capital.

Social alienation is prevalent among lung cancer (LC) patients undergoing chemotherapy. Although previous research has established an association between social alienation and symptom burden, the mechanisms underlying this relationship remain not fully understood. This cross-sectional study used convenience sampling to select 378 LC patients undergoing chemotherapy from September 2022 to December 2023 at a tertiary care hospital in Guangzhou, China. Data collection was conducted using a proprietary Sociodemographic Information Questionnaire, MD Anderson Symptom Inventory (MDASI), Social Alienation Questionnaire, Perceptions of Social Support (PSS) Questionnaire, and Positive Psychological Capital (PPC) Questionnaire. To analyze chain-mediated effects, the PROCESS v3.3 Model 6 SPSS macro software was employed. The analysis revealed that the burden of symptoms significantly exacerbates social alienation, as evidenced in the mediation effects model (Bootstrap 95% CI: 0.031, 0.092). Furthermore, the burden of symptoms indirectly diminishes PSS (Bootstrap 95% CI: 0.019, 0.057) and PPC (Bootstrap 95% CI: 0.002, 0.020). It is crucial to note that both PSS and PPC significantly mediate the relationship between symptom burden and social alienation, as evidenced (Bootstrap 95% CI: 0.001, 0.011). The impact of symptom burden on social alienation is moderated through PSS and PPC, manifesting both directly and indirectly. Moreover, the influence of PPC tends to mitigate the mediating role of PSS. Clinical interventions aimed at bolstering PSS and augmenting PPC may potentially alleviate social alienation and enhance the quality of life for patients undergoing chemotherapy for LC.

Distress and Symptom Burden in Patients with Monoclonal Gammopathy of Undetermined Significance and Smoldering Myeloma.

Distress and Symptom Burden in Patients with Monoclonal Gammopathy of Undetermined Significance and Smoldering Myeloma.

Early detection of rheumatoid arthritis through patient empowerment by tailored digital monitoring and education: a feasibility study

Patients at risk for rheumatoid arthritis (RA) describe fluctuating and nonspecific symptoms, making it difficult to quantify symptom burden and recognize RA progression. This study aimed to assess feasibility and diagnostic value of a multimodal digital self-monitoring program in preclinical RA. This prospective cohort study included individuals at-risk for RA, who first watched self-produced educational videos about (preclinical) RA and joint self-examination techniques and then started the REMOTRA symptom monitoring. Key outcomes measured included patient acceptance (Net Promoter Score: NPS), monitoring program usability (System usability scale: SUS), monitoring adherence, diagnostic accuracy, and reported symptom burden. A total of 43 participants (65.9% female, mean age 50.1 years) were enrolled. The educational and self-examination videos received NPS ratings of 54.4 and 31.6, respectively. The monitoring software received usability scores of 88.1/100 (SD: 5.5) at three months and 85.4/100 (SD: 16.0) at 6 months. 24/41 (58.5%) completed all questionnaires, and the average app usage was 4.8 months (SD: 1.8). None of the patients with a REMOTRA score below 10 developed RA, yielding a negative predictive value and sensitivity of 100%. However, the positive predictive value was 12%, and the specificity was 42.1%. Analgesic and cortisone usage was reported by 58.5% and 29.3% of participants, respectively. The strong patient acceptance, ease of use, and high adherence rates, combined with encouraging diagnostic outcomes, underscore the potential of this personalized digital monitoring and education approach. These findings suggest that further validation through multicenter studies is warranted.

Spontaneous Pain and Pain Sensitivity in Response to Prolonged Experimental Sleep Disturbances-Potential Sex Differences.

Insomnia is a highly prevalent condition that predisposes individuals to many chronic pain disorders, with most of them showing pronounced sexual dimorphism. We investigated whether experimental insomnia-like sleep disturbances (ESD) affect spontaneous pain and pain sensitivity, and whether sex modulates pain responses. Twenty-four healthy participants (50% females, age 28.3 ± 5.9 years) participated in a study consisting of two 19-day in-laboratory protocols-an ESD protocol consisting of repeated nights of short and disrupted sleep with intermittent nights of undisturbed sleep and a control sleep (CS) protocol consisting of 18 nights with an undisturbed 8-h sleep opportunity. Spontaneous pain was assessed using electronic rating scales during daytime and night-time wake periods. Pain sensitivity was assessed through pressure and heat pain threshold measures every other day of the protocol. Females responded with higher daytime pain ratings in the ESD compared to the CS condition, while males responded with lower pain ratings (p < 0.05 for condition*sex). Spontaneous pain ratings were higher at night-time than during daytime and worsened across successive nights of sleep disturbances, independent of sex (p < 0.05 for condition*study day*daytime-night-time). Females developed greater pressure pain sensitivity, while males developed greater pain sensitivity to heat in the ESD compared to the CS condition (p < 0.05 for condition*sex). Pain responses to sleep disturbances strongly vary by sex and may contribute to sex differences in the prevalence and symptom burden of many chronic pain conditions. Because the study was not a priori powered on sex, findings are preliminary and require follow-up in larger samples. Findings further suggest to specifically target night-time pain in sleep disturbed individuals, for example, through optimised timing of analgesic-acting medications. Exploration of sex as a modulator suggest that sleep disturbances amplify spontaneous pain and pressure pain sensitivity to a greater extent in females than in males, and this may contribute to females' overrepresentation and disproportionate symptom burden observed for many pain-related disorders for which insomnia is comorbid or a risk factor.

Link between psychiatric symptoms and cognition

Researchers have found both positive and negative associations between mental symptom severity and general cognition. Prior studies showed mixed findings. But this study, by noting that the associations were nonlinear, reconciled those prior studies, which assumed that symptom severity tracked with cognitive ability. In fact, the association between cognition and symptoms may be the opposite in low vs. high symptom severity samples. The study shows that it's necessary to use clinical information in studies of cognitive impairment. Because mental illnesses are a leading cause of disability, and cognitive impairments often play a role across psychiatric disorders. The researchers wanted to determine if the association between general cognition and mental health symptoms diverges at different symptom severities in children. For the study, researchers used the ongoing Adolescent Brain and Cognitive Development (ABCD) study to assess 5175 children at ages 9 to 11 years. They evaluated aggregate cognitive test scores (general cognition) in relation to total and subscale‐specific symptoms reported from the Child Behavioral Checklist. Linear models showed differing associations between general cognition and mental health symptoms, depending on the range of symptom severities queried. Nonlinear models confirm that internalizing symptoms were significantly positively associated with cognition at low symptom burdens and significantly negatively associated with cognition at more severe symptoms. [Pines, A., Tozzi, L., Bertrand, C., et al. (2024, Dec). Psychiatric symptoms, cognition, and symptom severity in children. JAMA Psychiatry, 81(12), 1236–1245. https://doi.org/10.1001/jamapsychiatry.2024.2399.]

Patients with Adult-Onset Still’s Disease in Germany: A Retrospective Analysis of Clinical Characteristics and Treatment Practices Ahead of the Release of the German Recommendations

Background/Objectives: Adult-onset Still’s disease (AOSD) is an autoinflammatory disorder that can be challenging to diagnose and manage. The aim of this study was to analyze retrospective data to provide insights into the clinical presentation, disease activity, and treatment patterns and outcomes of AOSD during routine clinical care prior to the release of new AOSD guidelines. Methods: This retrospective database analysis evaluated adult patients (≥18 years) with a diagnosis of AOSD who engaged in a clinical visit between 1 January 2010 and 31 December 2020. The evaluated outcomes included demographic characteristics, symptoms, disease activity, and treatment. Results: Our study included 120 patients (67 [55.8%] of whom were female) diagnosed with AOSD according to the Yamaguchi criteria at ten German rheumatology centers. The median (quartile [Q] 1, Q3) age was 51 (36, 62) years, and the median (Q1, Q3) time from diagnosis was 9 (4, 11) years. Approximately half (66 [55.0%]) had a polycyclic disease course. The most frequent symptoms at initial diagnosis were arthralgia (105 [87.5%]) and fever (86 [71.7%]), and these symptoms continued for a substantial proportion of patients at the current visit (35 [29.2%] and 22 [18.3%], respectively). High neutrophil and ferritin levels were also common. The mean Still Activity Score, a measure of disease activity, improved from 4.66 at initial diagnosis to 1.97 at the most recent visit. The treatments most frequently used at some point in the disease course were glucocorticoids (118 [98.3%]), interleukin (IL)-1 inhibitors (89 [74.2%]), and methotrexate (85 [70.8%]). The most common current treatments were IL-1 inhibitors (55 [45.8%]), followed by methotrexate (29 [24.2%}) and glucocorticoids (28 [23.3%]). Conclusions: Our cohort of patients with AOSD seen at German rheumatology clinics showed strong improvements in symptoms and disease activity from initial diagnosis, but a high symptom burden remained for some patients. Future studies may be able to build on our data to document the impact of new guidelines on treatment patterns.

Anxiety as a mediator between symptom distress and quality of life in peritoneal dialysis patients: insights from mediation analysis and nonlinear models.

This study investigates anxiety's role as a mediator between symptom burden and quality of life in patients undergoing peritoneal dialysis, emphasizing the potential for targeted interventions to enhance patient outcomes. In a cross-sectional design, 320 peritoneal dialysis patients were recruited, with 305 providing valid responses (response rate: 95.31%). Symptom burden (occurrence and distress), anxiety levels, and quality of life were measured using validated tools. Multiple linear regression and restricted cubic spline models assessed associations, using β with a 95% confidence interval (95% CI), while mediation analysis with 1000 bootstrap samples quantified anxiety's mediating effects. Participants reported an average of 8.2 ± 2.3 concurrent symptoms, with 'worry,', 'tiredness', and 'dry skin' being the most severe. Both symptom number (β = -0.90; 95%CI: -1.26 to -0.55) and distress (β = -1.20; 95%CI: -1.41 to -0.98) negatively correlated with quality of life. Anxiety mediated these relationships significantly, explaining 38.9% (95%CI: 18%-62%) and 33.3% (95%CI: 19%-49%) of the total effects for symptom number and distress, respectively. Restricted cubic spline models revealed an 'L-shaped' relationship between symptom burden and quality of life. Anxiety significantly mediates the relationship between symptom burden and quality of life in peritoneal dialysis patients. These findings underline the importance of integrating psychological interventions and routine symptom screening into patient care to enhance quality of life. Future research should explore longitudinal designs and standardized intervention strategies.

Cognitive Frailty for Young Breast Cancer Survivors After Chemotherapy: Implication for the Design of Health Education Materials

Background: As the most common cancer among women globally, breast cancer often leads to accelerated frailty in younger survivors, particularly during chemotherapy, causing cognitive impairments. This highlights the urgent need for tailored health education materials to address these challenges. Objective: To analyze cognitive load in young breast cancer survivors (YBCSs) after chemotherapy and contribute to the development of more tailored and effective health education materials for this population. Methods: Cognitive load theory informed a semistructured interview guide to investigate the challenges YBCSs face when engaging with health education materials. Results: Eleven participants aged 18–45 years were interviewed. Based on cognitive load theory, 4 themes were identified as follows: symptom burden, impairment of working memory, decrease the intrinsic cognitive load, and decrease the extraneous cognitive load. Conclusions: YBCSs frequently experience cognitive burden due to chemotherapy and perimenopause, which can trigger adverse personal states that lead to working memory overload and depletion. They prefer health education materials that offer credible, relevant information presented in modern formats, particularly short videos lasting around 10 seconds. However, excessive transient information and interactive elements may create unnecessary cognitive load. Implications for Practice: Developing health education materials should focus on conciseness, visual appeal, and small, digestible segments to ease cognitive load. Incorporating storytelling and relatable scenarios can significantly boost engagement and comprehension. What is Foundational: This model, informed by cognitive load theory, could be used as the basis of educational materials of greater care usefulness for these younger survivors of breast cancer.

Pilot Testing a Peer-Led Self-Management Program for Women After Breast Cancer.

Different approaches exist to support self-management in breast cancer (BC) survivors. The aim of this project was to cocreate a new version of an existing peer-led program to meet the needs of BC survivors in Switzerland. In a pilot study, the preliminary efficacy in terms of self-management skills and symptom burden and the feasibility of implementing it in two Swiss university hospitals was assessed. A prospective nonequivalent pretest-posttest control group design with two consecutive cohorts of women with early-stage BC who had completed primary treatment was applied. BC survivors (peers) led the 7-week course of weekly small-group sessions of 2.5 to 3 hours. The primary outcome was change in self-management skills; secondary outcomes included change in self-efficacy, symptom burden, and health literacy. Between-group changes were assessed using the Mann-Whitney U or X² test, individual changes using the Reliable Change Index. Feasibility was assessed using qualitative methods. Of the 95 BC survivors screened for inclusion criteria, 68 were eligible, 18 agreed to participate in the control group and 20 in the intervention group. No significant differences were found between the groups for any of the outcomes. Individual changes in self-management skills were noted in both groups. Several issues related to course delivery and feasibility were identified. The current form of the program did not fully meet the needs of BC survivors, and implementation into the clinical care pathway appeared to be challenging. The program may benefit from providing the possibility of spontaneous interaction and discussion and considering elements of e-health interventions.

Concussion characteristics in children and adolescents with ADHD: Exploring symptom burden and recovery trajectories

Concussions are a significant health concern for pediatric populations as children and adolescents engage in sports and recreational activities that increase their likelihood of sustaining brain injuries. Physical, cognitive, and emotional symptoms resulting from concussion overlap with other diagnoses, particularly mimicking many symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). This study aimed to investigate and compare concussion characteristics, including symptom burden and recovery timeline, among pediatric patients with and without ADHD who have been diagnosed with a concussion. A retrospective chart review of 316 patients aged 6-18 years seen in a specialty concussion clinic in the Northwest United States was conducted. Patients with ADHD were selected, and patients without a positive developmental history were selected as an age-matched control group. Data from initial phone interviews and the Rivermead Post-Concussion Symptoms Questionnaire were recorded into Epic EHR. Variables included demographics, concussion details, and symptom severity. Younger patients with ADHD had a longer time to their first visit, but ADHD did not significantly impact overall recovery time. Adolescents with ADHD and concussion were more likely to have diagnoses of depression and anxiety than adolescents without ADHD who had a concussion. The findings highlight the complexity of outcomes following concussion in children and adolescents. Although ADHD was associated with delayed care-seeking and higher rates of depression and anxiety diagnoses, an ADHD diagnosis did not significantly affect concussion symptom burden, as measured by the Rivermead Post-Concussion Symptoms Questionnaire, or recovery timeline.

Impact of Multimorbidity on Symptom Burden and Symptom Clusters in Patients Receiving Chemotherapy.

Detailed information on patient characteristics and symptom burden associated with multimorbidity in oncology patients is extremely limited. Purposes were to determine the prevalence of low (≤ 2) and high (≥ 3) multimorbidity in a sample of oncology outpatients (n = 1343) undergoing chemotherapy and evaluate for differences between the two multimorbidity groups in demographic and clinical characteristics; the occurrence, severity, and distress of 38 symptoms; and the stability and consistency of symptom clusters. Using the Self-Administered Comorbidity Questionnaire, patients were classified into low and high multimorbidity groups. Memorial Symptom Assessment Scale was used to assess the occurrence, severity, and distress of 38 symptoms prior to the patients' second or third cycle of chemotherapy. For each multimorbidity group, symptom clusters based on occurrence rates were identified using exploratory factor analysis. Compared to the low group (61.4%), patients in the high group (38.6%) were older, had fewer years of education, were less likely to be married or partnered, less likely to be employed, and had a lower annual income. In addition, they had a higher body mass index, poorer functional status, were a longer time since their cancer diagnosis, and were more likely to have received previous cancer treatments and have metastatic disease. Patients in the low and high groups reported 12.7 (±6.7) and 15.9 (±7.5) concurrent symptoms, respectively. Eight and seven symptom clusters were identified for the low and high groups, respectively. Psychological, gastrointestinal, weight gain, hormonal, and respiratory clusters were stable across multimorbidity groups. Weight gain and respiratory clusters were consistent. Three unstable clusters were identified in the low group and two in the high group. Findings suggest that higher multimorbidity is associated with various social determinants of health and a higher symptom burden. Differences between multimorbidity groups may be related to aging, treatments, and/or comorbid conditions.

HomeRNA self-blood collection enables high-frequency temporal profiling of presymptomatic host immune kinetics to respiratory viral infection: a prospective cohort study.

Early host immunity to acute respiratory infections (ARIs) is heterogenous, dynamic, and critical to an individual's infection outcome. Due to limitations in sampling frequency/timepoints, kinetics of early immune dynamics in natural human infections remain poorly understood. In this nationwide prospective cohort study, we leveraged a Tasso-SST based self-blood collection and stabilization tool (homeRNA) to profile detailed kinetics of the presymptomatic to convalescence host immunity to contemporaneous respiratory pathogens. We enrolled non-symptomatic adults with recent exposure to ARIs who subsequently tested negative (exposed-uninfected) or positive for respiratory pathogens. Participants self-collected blood and nasal swabs daily for seven consecutive days followed by weekly blood collection for up to seven additional weeks. Symptom burden was assessed during each collection. Nasal swabs were tested for SARS-CoV-2 and common respiratory pathogens. 92 longitudinal blood samples spanning the presymptomatic to convalescence phase of eight participants with SARS-CoV-2 infection and 40 interval-matched samples from four exposed-uninfected participants were subjected to high-frequency longitudinal profiling of 785 immune genes. Generalized additive mixed models (GAMM) were used to identify temporally dynamic genes from the longitudinal samples and linear mixed models (LMM) were used to identify baseline differences between exposed-infected (n=8), exposed-uninfected (n=4), and uninfected (n=13) participant groups. Between June 2021 and April 2022, 68 participants across 26 U.S. states completed the study and self-collected a total of 691 and 466 longitudinal blood and nasal swab samples along with 688 symptom surveys. SARS-CoV-2 was detected in 17 out of 22 individuals with study-confirmed respiratory infection, of which five were still presymptomatic or pre-shedding, enabling us to profile detailed expression kinetics of the earliest blood transcriptional response to contemporaneous variants of concern. 51% of the genes assessed were found to be temporally dynamic during COVID-19 infection. During the pre-shedding phase, a robust but transient response consisting of genes involved in cell migration, stress response, and T cell activation were observed. This is followed by a rapid induction of many interferon-stimulated genes (ISGs), concurrent to onset of viral shedding and increase in nasal viral load and symptom burden. Finally, elevated baseline expression of antimicrobial peptides was observed in exposed-uninfected individuals. We demonstrated that unsupervised self-collection and stabilization of capillary blood can be applied to natural infection studies to characterize detailed early host immune kinetics at a temporal resolution comparable to that of human challenge studies. The remote (decentralized) study framework enables conduct of large-scale population-wide longitudinal mechanistic studies. This study was funded by R35GM128648 to ABT for in-lab developments of homeRNA and data analysis, a Packard Fellowship for Science and Engineering from the David and Lucile Packard Foundation to ABT for the study execution, sample collection, and analysis, and R01AI153087 to AW for data analysis.

Association of Longitudinal Oral Microbiome Activity and Pediatric Concussion Recovery

Mild traumatic brain injury (mTBI) results in a constellation of symptoms commonly referred to as a concussion. It is unclear why certain individuals experience persistent symptoms. Given the growing evidence linking the microbiome with cognition and inflammation, we examined whether longitudinal microbiome patterns were associated with concussion symptoms. A cohort study of 118 children (aged 7–21 years) was conducted. Symptoms were assessed at three timepoints post-injury (4, 11, and 30 days) using the Post-Concussion Symptom Inventory. Saliva microbial activity was measured at each timepoint using RNA sequencing. A linear mixed model assessed the relationship between microbial activity and symptom burden while controlling for age, sex, and days post-mTBI. The participants’ mean age was 16 (±3) years. The symptom burden decreased across all three timepoints (25 ± 22, 13 ± 17, and 5 ± 12). The longitudinal symptom burden was associated with elevated activity of Lactobacillus (F = 5.47; adj. p = 0.020) and Saccharomyces (F = 6.79; adj. p = 0.020) and reduced activity of Micrococcus (F = 7.94, adj. p = 0.015). These results do not establish a causative relationship, or support the use of microbial measures as a concussion test. Further studies are needed to explore the role of the gut–brain axis in mTBI.

Considering the interconnected nature of social identities in neuroimaging research.

Considerable heterogeneity exists in the expression of complex human behaviors across the cognitive, personality and mental health domains. It is increasingly evident that individual variability in behavioral expression is substantially affected by sociodemographic factors that often interact with life experiences. Here, we formally address the urgent need to incorporate intersectional identities in neuroimaging studies of behavior, with a focus on research in mental health. We highlight how diverse sociodemographic factors influence the study of psychiatric conditions, focusing on how interactions between those factors might contribute to brain biology and illness expression, including prevalence, symptom burden, help seeking, treatment response and tolerance, and relapse and remission. We conclude with a discussion of the considerations and actionable items related to participant recruitment, data acquisition and data analysis to facilitate the inclusion and incorporation of diverse intersectional identities in neuroimaging.

Sex differences in clinical and polysomnographic features of obstructive sleep apnea: The Turkish sleep apnea database (TURKAPNE) cohort.

Previous reports from relatively small clinical cohorts have suggested that the clinical presentation of obstructive sleep apnea (OSA) differs between men and women. We aimed to explore sex differences in clinical and polysomnographic features of OSA in a large nationwide registry. Participants from the ongoing Turkish Sleep Apnea Database (TURKAPNE) Study from 34 centers were included in the current analysis. OSA was defined as an apnea-hypopnea index (AHI) ≥5 events/hour and was classified as mild, moderate, and severe according to AHI cut-offs 5, 15, and 30 events/hour, respectively. In all, 7130 patients (2259 women) were included. OSA was observed in 6323 (88.7%), of whom 70.2% were male and 29.8% were female. In the OSA group, women were older (56.7±11.9 vs. 49.5±11.3 years; p<0.001) and more obese (body mass index 34.3±7.2 vs. 31.4±5.6kg/m2; p<0.001) and had lower AHI (29.8±24.1 vs. 36.8±26.2 events/h; p<0.001) than men. Loud snoring and witnessed apnea were more common in men than in women whereas women were more frequently presented with insomnia, headache, and mood changes. Women had significantly less total sleep time, less sleep efficiency, and longer sleep latency compared with men (p<0.001 for each). Additionally, comorbid diseases such as diabetes mellitus, hypertension, asthma, psychiatric disorders, hypothyroidism as well as drug use were more common in women than in men independent of age and obesity (p<0.05 for each). Our results suggest significant sex differences in clinical and polysomnographic features in this nationwide Turkish adult population. Women with OSA have more symptom burden and comorbidities despite having a less severe AHI.

A Prognostic Symptom Model Incorporating Patient-Reported Symptoms for Transplant-Ineligible Patients with Multiple Myeloma

Introduction: Patients with transplant-ineligible (TIE) multiple myeloma (MM) have high rates of symptom burden. The aim of this study was to develop and validate a prognostic model to predict symptoms in patients with TIE MM. Methods: In this population-based, retrospective cohort study, using multiple administrative health care databases linked using a unique encrypted patient identifier in Ontario, Canada, symptoms were identified using the patient self-reported Edmonton Symptom Assessment System (ESAS) at each clinic visit. The primary outcome was the presence of moderate-to-severe (ESAS score 4–10) symptoms (specifically symptoms of pain, tiredness, depression, and impaired well-being) within one year from the index date. Using the entire cohort, a multivariable logistic regression model with baseline covariates was developed to predict the risk of experiencing each of the above symptoms, categorized as moderate to severe within 1 year post-index date. Internal validation of the model was assessed via bootstrap validation methods. Results: A total of 1535 TIE adults with MM met the inclusion criteria. The median age was 75, with 25.2% of patients aged 80 years or older. In the multivariate analysis, baseline symptoms continued to be most associated with future symptom burden. Baseline severe pain (OR 9.84, 95% CI 6.29–15.7) was most associated with patients experiencing moderate–severe pain one year post-index date. Similarly, baseline severe tiredness (OR 17.34, 95% CI 9.00–33.42), baseline severe depression (OR 28.07, 95% CI 15.96–49.38), and baseline severely impaired well-being (OR 4.12, 95% CI 2.30–7.37) were the biggest predictors of patients experiencing moderate–severe tiredness, depression, and impaired well-being, respectively, at one year after the index date. Conclusions: Patients with MM experience persisting symptoms of pain, tiredness, depression, and impaired well-being, with baseline symptoms being the biggest predictor of future symptom burden.

First results from a multimodal psychosomatic post-COVID treatment approach - a prospective longitudinal study.

Clinical experiences using a psychosomatic-oriented multimodal treatment approach in patients with post-COVID are promising. We established a half-day multimodal treatment program for post-COVID patients at the Department of Psychosomatic Medicine at General Hospital Nuremberg, Paracelsus Medical University, Germany. This observational study between January 2022 and March 2023 comprised baseline documentation of Patient Health Questionnaire (PHQD), ICD-10 Symptom Rating (ISR), Fatigue Scale (FS) and Health Status Questionnaire (SF-12) at admission and discharge of 65 patients suffering from post-COVID. Multimodal psychosomatic treatment was scheduled for 3-4weeks. At admission, PHQ and FS showed a high level of somatic symptom burden (PHQ-15: M=16.0, SD=5.6) and fatigue symptoms (FS: M=27.1, SD=4.4). Depressive (PHQ-9: M=14.0, SD=5.3) and anxiety symptoms (GAD-7: M=9.6, SD=5.6) were moderately and mildly pronounced, respectively. Compared to patients from our standard clinical settings post-COVID patients had a comparably high or even higher mental symptom burden (e.g. PHQ-15: p<.001, d=0.79; PHQ-9: p=.009, d=0.39). Compared to admission, symptomatology of post-COVID patients at discharge was improved (e.g. PHQ-15: p=.004, d=0.26; FS: p=.009, d=0.32). Despite the short duration of treatment, the patients showed a significant reduction in symptoms between admission and discharge. Further data including a control group and extending the duration of treatment will show whether the changes in symptoms are of the multimodal psychosomatic treatment.

Sleep difficulties related to psychopathology and neurocognition in people with 22q11.2 deletion syndrome.

The 22q11.2 Deletion Syndrome (22q11.2DS) is a multisystem genetic disorder with prominent sleep disturbances, neuropsychiatric conditions and neurocognitive challenges. Poor sleep can impact cognitive development, psychopathology and daily functioning. An integrative approach in clinical settings can help link these manifestations and suggest interventions. A comprehensive sleep interview was conducted with 100 affected individuals and their parents, complemented with electronic health record review. Independent psychiatric and neurocognitive assessments were conducted in 92 participants, divided into Good Sleeper (score 1-4) and Poor Sleeper (score ≥ 5) groups based on the Pittsburgh Sleep Quality Index (PSQI). Sleep disorders were common, 78% of participants met International Classification of Sleep Disorders criteria. Most prevalent were Insomnia, Sleep Disorder Breathing, Delayed Sleep Phase Disorder and Restless Leg Syndrome. 74% of participants met criteria for at least one current psychiatric disorder. Poor Sleepers had lower Global Assessment of Function (GAF), higher severity of psychosis positive, negative, and general symptoms, and lower performance efficiency on executive, spatial memory, complex cognition and social cognition tests. Mediation models showed that association of psychosis scores and GAF were mediated by PSQI and the association between PSQI and GAF was mediated by psychosis scores. Sleep disorders are prevalent in individuals with 22q11.2DS and impact psychiatric manifestation and neurocognitive performance. Results suggest a possible "vicious cycle " whereby disordered sleep is associated with increased psychosis which, in turn, results in worsening sleep, all affecting GAF. Identification of sleep disorders can facilitate appropriate interventions reducing burden of psychiatric symptoms and improving cognition and functioning.