Sleep Disturbance Symptoms Research Articles

Effect of the maternal sleep disturbances and obstructive sleep apnea on feto-placental Doppler: A systematic review.

Literature evidenced an association of maternal sleep disturbances and maternal obstructive sleep apnea with significant obstetric complications. Moreover, the maternal sleep disturbances effect on feto-placental circulation had not been extensively examined. Our objective is to explore the possible maternal sleep disturbances impact on the feto-placental indices evaluated through the Doppler study. A systematic review of the following databases was performed: PubMed, EMBASE, Cochrane Library and Google Scholar from the beginning to June 2024. Only studies that enrolled pregnant women with signs and symptoms of maternal sleep disturbances or obstructive sleep apnea diagnosis, which analysed the feto-placental Doppler parameters, were considered eligible (PROSPERO ID: CRD42024553926). We included a total of four studies with 1715 cases of pregnant women. Various instrumental and non-instrumental diagnostic methods were adopted for detection of maternal sleep disturbances. The ultrasound exam was performed mainly in the third trimester of pregnancies, and all the studies explored the uterine Doppler parameters. Only two studies explore the foetal Doppler parameters. Only one study disclosed that maternal sleep disturbances are related to altered uterine Doppler indices with probable placental dysfunction. This review did not evidence a significant influence of maternal sleep disturbances and obstructive sleep apnea on foetal Doppler indices. Moreover, one large prospective study showed a possible impact of maternal sleep disturbances on uterine Doppler with a potential impairment of the placentation function. Additional studies with detailed data and larger samples are needed to throw light on this relationship and its impact on the foetal outcomes.

The study protocol of a double-blind randomized controlled trial of EMDR and multifocal transcranial current stimulation (MtCS) as augmentation strategy in patients with fibromyalgia

BackgroundFibromyalgia (FM) is a generalized, widespread chronic pain disorder affecting 2.7% of the general population. In recent years, different studies have observed a strong association between FM and psychological trauma. Therefore, a trauma-focused psychotherapy, such as Eye Movement Desensitization and Reprocessing (EMDR), combined with a non-invasive brain stimulation technique, such as multifocal transcranial current stimulation (MtCS), could be an innovative adjunctive treatment option. This double-blind randomized controlled trial (RCT) analyzes if EMDR therapy is effective in the reduction of pain symptoms in FM patients, and if its potential is boosted with the addition of MtCS.MethodsNinety-six patients with FM and a history of traumatic events will be randomly allocated to the treatment as usual (TAU) condition, EMDR + active-MtCS condition, or EMDR + sham-MtCS condition. Therapists and patients will be kept blind to MtCS conditions, and raters will be kept blind to both EMDR and MtCS. All patients will be evaluated at baseline, post-treatment, and follow-up at 6 months after post-treatment. Evaluations will assess the following variables: sociodemographic data, pain, psychological trauma, sleep disturbance, anxiety and affective symptoms, wellbeing, self-care, emotional regulation, self-esteem, and cognitive functioning.DiscussionThis study will provide evidence of whether EMDR therapy is effective in reducing pain symptoms in FM patients, and whether the effect of EMDR can be enhanced by MtCS.Trial registration numberThis trial was registered at ClinicalTrials.gov on 2 August 2019, identifier: NCT04084795.

Oral administration of ethinyl estradiol and the brain-selective estrogen prodrug DHED in a female common marmoset model of menopause: Effects on cognition, thermoregulation, and sleep.

Menopausal symptoms of sleep disturbances, cognitive deficits, and hot flashes are understudied, in part due to the lack of animal models in which they co-occur. Common marmosets (Callithrix jacchus) are valuable nonhuman primates for studying these symptoms, and we examined changes in cognition (reversal learning), sleep (48h/wk of sleep recorded by telemetry), and thermoregulation (nose temperature in response to mild external warming) in middle-aged, surgically-induced menopausal marmosets studied at baseline, during 3-week phases of ethinyl estradiol (EE2, 4μg/kg/day, p.o.) treatment and after EE2 withdrawal. We also assessed a brain-selective hormonal therapy devoid of estrogenic effects in peripheral tissues on the same measures (cognition, sleep, thermoregulation) after treatment with the estrogen prodrug 10β,17β-dihydroxyestra-1,4-dien-3-one (DHED, 100μg/kg/day, p.o) and DHED withdrawal. Reversal learning performance was improved with EE2 or DHED treatment relative to phases without hormone administration, as indicated by a faster reversal of the stimulus/reward contingencies. Both EE2 and DHED increased non-REM sleep and reduced nighttime awakenings relative to baseline, but to the detriment of REM sleep which was highest at baseline. Nasal temperature in response to mild external warming was highest, and overnight core body temperature lowest, in the DHED treatment phase compared to both the EE2 and baseline phases. These results suggest that low dose estradiol, delivered either peripherally or centrally via DHED, benefits selective aspects of cognition and sleep in a marmoset menopause model. DHED appears a promising therapeutic candidate for alleviating the cognitive and sleep disruptions associated with estrogen deficiency in primates.

Feasibility of Hypnotherapy in Fatigue and Sleep Disturbance Management in Patients with Multiple Sclerosis Disease

ABSTRACT The aim of this study was to test the clinical feasibility of hypnotherapy in the management of fatigue and sleep disturbances among multiple sclerosis (MS) patients in the south of Iran. Forty patients aged 25–47 were enrolled, and 22 (19 females, 3 males) completed eight 50-minute sessions of hypnotherapy for 10 weeks. Patients were required to practice the hypnotherapy sessions at home throughout the week. Participants completed the Multidimensional Fatigue Inventory (MFI) and Pittsburgh Sleep Quality Index (PSQI) at baseline and after the final hypnotherapy session. The mean MFI score was significantly reduced by 8.19 points following hypnotherapy (p < .05). The mean PSQI global score following hypnosis treatment significantly decreased from 7.4 ± 3.3 to 5.52 ± 3.12 (p < .05). Our results suggest that MS patients might benefit from hypnotherapy for controlling fatigue and sleep disturbance symptoms. Confirmative assessment is required in a randomized controlled trial after feasibility has been established.

Effect of Ethylene Oxide Exposure on Sleep Health: Using NHANES Data from 2015 to 2020.

Background/Objectives: This study aims to investigate the effects of ethylene oxide (EO) exposure on sleep health, focusing on sleep duration and quality. Methods: The study analyzed data from the NHANES (National Health and Nutrition Examination Survey) 2015-2020 cycles, including 4268 participants aged 20 and older. EO exposure was measured using hemoglobin adducts of EO (HbEO), which serve as a reliable biomarker. Sleep health was assessed through self-reported questionnaires on sleep duration and quality. Participants were categorized based on sleep duration (<6 h, 6-9 h, >9 h) and symptoms of sleep disturbances. Statistical analyses employed survey-weighted logistic regression models to evaluate the associations between HbEO levels and sleep outcomes, adjusting for sociodemographic, health-related, and behavioral factors. Moreover, to examine whether the impact of ethylene oxide exposure on sleep quality and sleep duration varies by sociodemographic characteristics, stratified analyses were conducted based on gender, age, marital status, and employment type. Results: According to the results, higher EO exposure was associated with shorter sleep durations and increased likelihood of sleep disturbances. Moreover, according to sub-group analysis by sex, men with higher exposure to EO, were likely to have short sleep duration, and women with higher exposure to EO had higher risk of daytime sleepiness and sleep problems. Conclusions: The findings suggest that EO exposure may negatively impact sleep health, emphasizing the need for stricter EO exposure regulations and public health interventions to reduce associated risks.

Promoting Psychological Health and Overall Wellness in Female Veterans With Military Sexual Trauma Through Complementary Health Interventions: A Quality Improvement Project.

Military sexual trauma (MST) has been associated with long-term negative outcomes such as increased rates of cardiovascular disease, post-traumatic stress disorder (PTSD), and suicidal thoughts and behaviors. While evidence supports the effectiveness of psychotherapeutic approaches as treatments for MST and related PTSD symptoms, these interventions have limited impact, attributed to perceived stigma with high dropout rates in female Veterans. Complementary and integrative health (CIH) interventions provide an alternative that may be more acceptable and can help transition Veterans into mental health treatments. Although evidence supports the utility of individual CIH interventions to be both effective and acceptable treatments for MST-related PTSD amongst female Veterans, there are limited evaluations of interventions that combine multiple CIH modalities, specifically in populations of at-risk female Veterans with histories of suicidal ideation or behavior. Thus, this quality improvement (QI) project aimed to assess the impact of a multimodal CIH intervention on mental and physical health symptoms specifically in female at-risk Veterans with MST. A total of 19 female Veterans with histories of MST and suicidal ideation and/or behavior who participated in an interventional programming in an urban VA in New York City were included in a secondary analysis for QI evaluation. These female Veterans comprised a subset of participants who previously engaged in a larger QI multimodal CIH intervention delivered over 4-week long in a cohort setting during which Veterans (both males and females) engaged in meditation and mindfulness, physical exercise, nutrition, and motivational curricula. Integrated as part of this programming, mental health symptoms (i.e., depression, PTSD, and stress/anxiety) and other factors related to suicide risk were assessed before and after program participation for all participants. Improvements across these symptoms pre- vs. post-program participation were examined. For this secondary analysis, a total of 73% of females with MST who participated in the multimodal CIH interventional programming had a prior history of suicidal ideation or behavior. These participants showed elevated levels of depression and sleep disturbance symptoms at baseline prior to engagement in the multimodal CIH interventions, with medium-to-large reductions in these symptoms following completion of the multimodal CIH programming (Cohen's d > 0.61 magnitude differences in symptom reduction pre vs. post). The results of this QI evaluation add to the growing body of evidence demonstrating that CIH interventions can be effective in attenuating mental health symptom-related MST and particularly within female Veteran populations at-risk for suicide, underscoring the potential importance of investigating integration of multiple CIH interventions for treatment of at-risk populations in future clinical research studies.

Key Components of Trauma-Informed Yoga Nidra.

Trauma exposure is universal to the human condition, with many affected individuals experiencing either posttraumatic stress disorder (PTSD) or subthreshold manifestations. Both scenarios can become functionally debilitating and collectively lay a heavy burden on individuals and society. Yoga nidra is one adjunctive treatment of growing interest, holding potential for its ability to alleviate symptoms of trauma, including hypervigilance, sleep disturbances, and disembodiment. However, yoga nidra practices can have re-traumatizing side-effects if not delivered conscientiously. For instance, adverse reactions such as overwhelming flashbacks, emotional distress, and extended dissociation have been reported as a result of yoga nidra practice. To prevent harm and maximize yoga nidra's therapeutic potential, 10 key components of trauma-informed yoga nidra practice are presented: (1) safe(r) and comfortable environment; (2) personal autonomy, healthy boundaries, and consent; (3) skillful mindful awareness; (4) appropriate length and preparation; (5) adequate settling and externalization; (6) sleep permission; (7) self-chosen intention; (8) flexible rotation of consciousness and breath awareness; (9) embodied pairs of opposites; and (10) conscientious visualizations. These measures protect those living with trauma and have extended benefits for nonclinical populations as well. That said, some of these components may be adapted based on context, especially in settings where direct feedback is readily available and can be prioritized. Ultimately, thoughtful decisions must be made with the intention of optimizing the safety of and benefit to the practitioners under the facilitator's care.

Urinalysis and perceived effects following 2-week use of a commercial broad-spectrum cannabidiol product.

A growing number of hemp-derived cannabidiol (CBD) products are available with negligible amounts (< 100 ppm) of delta-9-tetrahydrocannabinol (THC) due in part to consumer concerns regarding the risk of positive drug screens. There are, however, no published studies that report whether repeated use of these products may lead to positive urine drug tests for THC. There is also scant research on the effects of these products on physical and mental well-being. Twenty healthy adults consumed a hemp-derived broad-spectrum CBD product every day for 2 weeks. Participants attended study visits at the beginning and end of the 2-week period. At each visit, participants underwent urinalysis testing for CBD, THC, and metabolites (analyzed via liquid chromatography with tandem mass spectrometry) and completed a validated assessment of physical and mental well-being. Participants reported using an average of 1.09 ± 0.51 ml (34.20 ± 16.00 mg CBD) of study product per day. Neither tetrahydrocannabinol nor its metabolites were detectable in urine following the 2-week period of use. Ingestion of the broad-spectrum product was associated with a significant reduction in sleep disturbance and pain intensity symptoms (p < .05), which remained significant after correcting for possible confounds (i.e., age, sex, dosage). No adverse events were reported. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The trajectories and associations of sleep disturbance symptoms with suicidal ideation in adolescents: A three-wave longitudinal study

BackgroundThis study aimed to investigate the developmental trajectories of sleep disturbance symptoms and examine whether specific trajectory memberships of sleep disturbance symptoms could prospectively predict suicidal ideation (SI) among a large sample of Chinese adolescents over one year. MethodsA three-wave longitudinal study was conducted from April 2021 to June 2022, with a sample of 19,095 adolescents from Shenzhen in Guangdong Province, China (51.2 % males; mean age = 12.4 ± 1.6 years at baseline). Socio-demographics (at baseline), SI, sleep disturbance symptoms (at each assessment), depressive symptoms (at the last follow-up), and negative life events (at two follow-ups) were assessed. Data were analyzed employing Growth Mixture Modeling and binary logistic regressions. ResultsThe Growth Mixture Modeling identified four trajectories of sleep disturbance symptoms over one year: resistant group (76.2 %), delayed-dysfunction group (8.8 %), recovery group (7.4 %), and chronic-dysfunction group (7.6 %). Binary logistic regression analysis revealed that adolescents in the group of delayed-dysfunction (OR = 2.86, 95 % CI = 2.51–3.27) and chronic-dysfunction (OR = 2.14, 95 % CI = 1.84–2.47) exhibited higher risks of developing SI compared to those in the resistant group, even after controlling for socio-demographics, negative life events, depressive symptoms, and baseline SI. ConclusionsThese findings underscore the importance of identifying individuals at higher risks of sleep disturbance and providing personalized and effective mental health services to reduce the incidence of SI.

Abnormal beta bursts of depression in the orbitofrontal cortex and its relationship with clinical symptoms

BackgroundRecent researches have reported that frequency-specific patterns of neural activity contain not only rhythmically sustained oscillations but also transient-bursts of isolated events. The aim of this study was to investigated the correlation between beta burst and depression in order to explore depressive disease and the neurological underpinnings of disease-related symptoms. MethodsWe collected resting-state MEG recordings from 30 depressive patients and a matched 40 healthy controls. A Hidden Markov Model (HMM) was applied on source-space time courses for 78 cortical regions of the AAL atlas and the temporal characteristics of beta burst from the matched HMM states were captured. Group differences were evaluated on these beta burst characteristics after permutation tests and, for the depressive group, associations between burst characteristics and clinical symptom severity were determined using Spearman correlation coefficients. ResultsAt a threshold of p=0.05corrected, burst characteristics revealed significant differences between depression patients and controls at the group level, including increased burst amplitude in frontal lobe, decreased burst duration in occipital regions, increased burst rate and decreased burst interval time in some brain regions. Furthermore, burst amplitude in the orbitofrontal cortex (OFC) was positively related to the severity of sleep disturbance and burst rate in the OFC was negatively related to the severity of anxiety in depression patients. ConclusionsThe findings highlight OFC may be a targeted area responsible for the anxiety and sleep disturbance symptom by abnormal beta burst in depressive patients and beta burst characteristics of OFC might serve as a neuro-marker for the depression.

Don’t forget to mind the mind: a prospective cohort study over 12 months on mental health symptoms in active professional male footballers

AimsWe examined the prevalence and incidence of mental health symptoms (MHS) in active professional male footballers over a 12-month period and investigated if MHS was associated with severe injuries or surgeries.Participants and methodsFootball Players Worldwide (FIFPRO) affiliated national unions invited active professional male football players to participate in the study. MHS was operationalised in symptoms of anxiety, disordered eating, depression, distress, sleep disturbance, alcohol misuse and drug misuse, all being assessed with validated questionnaires.ResultsOf the 101 participants enrolled, the prevalence of distress was 53% and MHS was between 6% for drug misuse and 48% for alcohol misuse. The incidence of distress was 29% and MHS ranged from 1% for anxiety to 11% for sleep disturbance. At baseline, players suffering from injury/surgery were more likely to report depression (OR 1.35; 95%CI 1.10–1.70) and disordered eating (OR 1.22; 95%CI 1.02–1.47). At follow-up, players who suffered injury or surgery were inclined to report distress (OR 2.15; 95%CI 1.26–4.31) and drug misuse (OR 2.05; 95%CI 1.01–4.04).ConclusionThere seems to be a greater prevalence of MHS in active professional male footballers than in the global population and other sports. After severe injury/surgery, the risk of developing MHS is increased, confirming that healthcare professionals should be aware of the mental health of injured players.

Psychosocial Determinants for Self-Reported Health Status in Hemodialysis Patients: A Cohort Analysis of the CONVINCE Randomized Trial.

We investigated whether psychosocial determinants self-efficacy and social support are associated with Health-Related Quality of Life in hemodialysis patients enrolled in the CONVINCE trial. We used baseline data from the cohort of patients involved in the CONVINCE randomized trial of hemodiafiltration versus hemodialysis. Measures included age, gender, relationship status, children, housing, education, employment, comorbidities, dialysis schedules, time of first dialysis, residual kidney function, general self-efficacy and social support scores, and PROMIS measurements for health-related quality of life. Associations were analyzed using hierarchical regression. One thousand three hundred and sixty patients from CONVINCE were the cohort of interest. Mean age was 62±13.5 years (range 20-92), and 66.9% were men. Self-efficacy was a significant predictor for all health-related quality of life domains: depression (β = -0.36, p < 0.001), anxiety (β = -0.35, p < 0.001), social participation (β = 0.32, p < 0.001), cognition (β = 0.29, p < 0.001), fatigue (β = -0.29, p < 0.001), physical function (β = 0.27, p < 0.001), sleep disturbance (β = -0.23, p < 0.001), pain interference (β = 0.21, p < 0.001), pain intensity (β = -0.17, p < 0.001), interdialytic symptoms (β = -0.14, p = 0.002) and intradialytic symptoms (β = -0.14, p = 0.002). Social support was a significant predictor for cognition (β = 0.21, p < 0.001), sleep disturbance (β = -0.11, p = 0.017) and intradialytic symptoms (β =- 0.11, p = 0.02). Higher general self-efficacy scale scores are associated with improvements in cognition, depression, anxiety, social participation, fatigue, physical function, sleep disturbance, pain interference, interdialytic symptoms, pain intensity and intradialytic symptoms. Associations for self-efficacy are larger than those for social support and stronger than previously reported. It is plausible that targeted psychosocial interventions may improve health outcomes in people on hemodialysis.

The Impact of Adenotonsillectomy on the Quality of Life of Children with Obstructive Sleep Apnea.

Introduction In children, obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is caused by adenotonsillar hypertrophy and is characterized by upper airway obstruction disturbing sleep. Objective We conducted this study to evaluate health-related quality of life (QoL) in children with OSA before and after adenotonsillectomy. Methods A descriptive, observational study was conducted among 43 children in the 4-to-12 years old age group who had symptoms of OSA due to adenotonsillar hypertrophy and who underwent adenotonsillectomy at a tertiary care center during the period from February 2020 to February 2021. The QoL was assessed using the OSA-18 questionnaire preoperatively and at 2 and 6 months postoperatively. Results Among the study population, males (72)%) were more affected with OSA, with a male-to-female ratio of 2.6:1. Based on the OSA-18 questionnaire assessment, the most severe and frequently observed symptoms were in the domains of sleep disturbance and physical symptoms, in which the mean score was 77 preoperatively. After adenotonsillectomy, the mean OSA-18 score decreased to 28.605 and 22.465 at 2 and 6 months, respectively. At 2 months postsurgery, more significant improvement was noticed in sleep disturbances, physical symptoms, and parent's concern while at 6 months postsurgery, all domains showed equal improvement. Therefore, following adenotonsillectomy, the QoL improved significantly. Conclusion Obstructive sleep apnea can adversely affect sleep quality as well as neurocognitive and cardiovascular functions. Adenotonsillectomy resulted in significant improvement in the QoL.

An Observational Study on the Treatment Outcomes of Adenotonsillar Hypertrophy in Children

Background: Adenotonsillar hypertrophy, marked by abnormal enlargement of the adenoids and tonsils, is common in children and can cause various health issues. For severe cases, surgical intervention, mainly adenotonsillectomy, is often recommended and has proven effective in improving airway obstruction, sleep quality, and overall health outcomes. This study aimed to assess the treatment Outcomes of adenotonsillar hypertrophy in children. Methods: This prospective observational study was conducted in the Department of Head &amp; Neck Surgery (ENT), Dhaka National Medical Institute Hospital, Dhaka, Bangladesh from January 2023 to June 2023. A total of 57 children with primary symptoms of mouth breathing, snoring, and sleep disturbances were purposively enrolled as study subjects. For data analysis, MS Office tools were applied. Results: Most participants (61.4%) were aged 2-5 years and female (60%). All participants (100%) reported symptoms of nasal blockage, snoring, and mouth breathing. A majority (61.4%) had grade 2 tonsillar hypertrophy. After 3 months of medical treatment, 57.9% experienced complete relief of nasal symptoms, including sleep apnea, 24.6% showed moderate improvement, and 17.5% saw no improvement. Conclusion: Intranasal steroids, combined with oral amoxicillin e-clavulanic acid and montelukast, reduce adenotonsillar hypertrophy symptoms and lower surgical intervention rates. This approach targets inflammation and infection, potentially improving patients' quality of life. More studies are needed to establish guidelines and optimize treatment.

Do acute mountain sickness and psychiatric disorders show overlapping symptoms?

The Lake Louise Score (LLS) is a common tool for diagnosing acute mountain sickness (AMS) after a recent gain in altitude. Required symptoms (headache, dizziness, fatigue or gastrointestinal symptoms) are unspecific, subjective and not detectable by physiological parameters. (Talks et al., 2022; Boos et al., 2018) This study aimed to enhance present knowledge concerning the impact of mental health on LLS. In a cross-sectional questionnaire study, we assessed 3 groups: 100 inpatients (Ward for psychosomatic medicine – Innsbruck, PSY), 73 mentally healthy individuals (Innsbruck, Austria at an altitude of 570 m, CO) and 223 mountaineers in Nepal (Pheriche 4,371 m and Dingboche 4,410 m, NEPAL). Beside social demographics and LLS 2018 (cutoff for LLS-positivity: LLS ≥ 3 including at least 1 point for headache), we examined symptoms of anxiety (Zung Self-Rating Anxiety Scale [SAS], General Anxiety Disorder Questionnaire 7 [GAD-7]), affective states (International Positive and Negative Affect Schedule Short form [I-PANAS-SF]) and sleep (Insomnia Severity Index [ISI]). In this preliminary analysis, the average age was 39 ± 16 years in PSY, 34 ± 16 years in CO and 40 ± 14 years in NEPAL. Gender distribution showed greater portion of women in PSY and CO (PSY: 72% female 24% male 3% non-binary, CO: 64% female 36% male) contrary to NEPAL (36% female 64% male). At sea level, 67% scored LLS-positive in PSY and 12% in CO (Fishers exact test, p &lt; 0.001). In NEPAL 25% met AMS-criteria by LLS. CO and NEPAL score significantly lower in LLS than PSY (ANOVA: diff = -3.70, p &lt; 0.0001; diff = -3.68, p &lt; 0.0001, respectively). PSY and CO showed significant weak to moderate correlations (Spearman-Rho, p &lt; 0.001) of anxiety (SAS, GAD), affective states (I-PANAS-SF) and sleep impairment (ISI) with LLS-sum. NEPAL showed significant very-weak to weak correlations of insomnia, anxiety and negative affect with LLS-sum. Using logistic regression analysis (Figure 1), higher odds of LLS-positivity are significantly associated with insomnia and anxiety (ISI, SAS) in PSY, with anxiety in CO (SAS) and insomnia and negative affect in NEPAL. While of course a recent gain in altitude is a prerequisite for the diagnosis of AMS this study shows that patients with pre-existing mental illness at low altitude score more frequently false-positive on the LLS than a mentally healthy cohort. Symptoms of anxiety, negative affect and sleep disturbance can affect the AMS-defining questionnaire of LLS both at sea level and at high altitude. There is still uncertainty on a possible common pathophysiological pathway of psychiatric diseases and AMS since there is no Gold Standard in diagnosing AMS. Concerning (well-)established risk-factors for AMS like speed of ascent (Berger et al., 2023) and female sex (Hou et al., 2019), we see no evident data. The data presented here suggest that strength of expression of negative affect can cause positive LLS scoring. Acute mountain sickness and psychiatric disorders show overlapping symptoms at sea level. At high altitudes, negative affect seems to be a possible cause for the development of AMS. Further research focus should be placed on mountaineers in high altitude with psychiatric disorders and their mental state.

Sleep Disturbances in Autoimmune Neurological Diseases: Mechanisms, Clinical Characteristics, Assessment, and Treatment Strategies.

Sleep disturbances are a hallmark feature of various autoimmune neurological diseases (AINDs). However, limited awareness of these sleep manifestations exists among clinicians. We provide a comprehensive overview of assessment methods, characteristic sleep disturbances, the impact of specific antibodies on sleep patterns, and treatment strategies for sleep disturbances in AINDs. Research advancements in sleep disturbances in autoimmune neurological disease focus primarily on four areas: mechanisms, clinical characteristics, assessment, and treatment. Regarding mechanisms, animal models for AINDs, particularly those involving specific antibodies like anti-NMDAR, anti-LGI1, and anti-IgLON5, have become more comprehensive. Recent advancements in animal models have led to the establishment of numerous models for AINDs; these models include a wide range of antibodies, including anti-NMDAR, anti-LGI1, and anti-IgLON5. Several studies using these models have revealed common mechanisms underlying sleep disturbances in these diseases. In terms of clinical characteristics, the identification of antibodies associated with recently discovered AINDs has expanded the spectrum of sleep disturbance symptoms observed compared to prior findings. A comprehensive evaluation system for the assessment of sleep disturbances has been established, including questionnaires, polysomnography, functional magnetic resonance imaging, and 18F-FDG PET/CT. Additionally, cardiopulmonary coupling shows promise as a novel assessment tool. Currently, no universally effective treatment exists for sleep disturbances in autoimmune neurological diseases, either through symptomatic treatment or immunosuppressive therapy. Further studies are needed to confirm the efficacy of new therapies and validate the benefits of existing treatments. Sleep disturbances are a hallmark feature of AINDs. Recent advancements have significantly expanded our understanding of their assessment and treatment. However, further studies are needed to address the remaining uncertainties in sleep disturbance management.

A systematic review of yoga for the treatment of gastrointestinal disorders.

Several studies have reviewed yoga for the treatment of disorders of gut-brain interaction (DGBI) with most demonstrating a benefit for symptom reduction; however, yoga has been studied beyond DGBI. The aim of this systematic review is to provide a comprehensive summary of yoga as treatment for gastrointestinal conditions. We conducted literature searches in PubMed and Embase and included yoga trials of adults with a diagnosis of a gastrointestinal disorders and diseases. We identified 1275 articles; 12 studies were eligible. Most studies compared yoga to controls, for patients with different GI conditions (irritable bowel syndrome, ulcerative colitis, chronic pancreatitis, and gastrointestinal cancer). The type, method, and duration of yoga used varied. Across IBS studies, most demonstrated that yoga improved IBS symptom severity, mood-related symptoms, and quality of life compared with controls. In one study of inflammatory bowel disease, yoga improved quality of life compared to controls. Two studies of gastrointestinal cancer demonstrated that yoga led to a reduction in sleep disturbance and mood symptoms. One study of chronic pancreatitis found that yoga led to improvements in quality of life, stress, mood changes, alcohol dependence, and appetite. Yoga was generally safe, and no serious adverse events were attributed to the intervention. In conclusion, yoga appears to be safe and has potential to improve functioning across a spectrum of gastrointestinal diseases; however, current studies are limited by heterogeneity and methodological weaknesses. Further research is needed to evaluate the impact of yoga on health outcomes for a broader range of gastrointestinal conditions.

Sleep Disturbance and Postconcussive Symptoms in Pediatric Mild Traumatic Brain Injury and Orthopedic Injury.

Sleep disturbance (SD) is common after pediatric mild traumatic brain injury (mTBI) and may predict increased postconcussive symptoms (PCS) and prolonged recovery. Our objective was to investigate the relation of SD with PCS in children with mTBI and those with orthopedic injury (OI). Emergency departments (EDs) at 2 children's hospitals in the Midwestern United States. Children and adolescents aged 8 to 16years old diagnosed with either a mTBI (n =143) or OI (n =74) and recruited within 24hours postinjury. Observational, prospective, concurrent cohort study with longitudinal follow-up. Parents rated children's preinjury sleep retrospectively shortly after injury, and postinjury sleep at 3 and 6months postinjury, using the Sleep Disorders Inventory for Students. Parents rated children's preinjury symptoms retrospectively in the emergency department, and parents and children rated PCS at 3 and 6months, using the Health and Behavior Inventory and the Postconcussive Symptom Interview. Weekly ratings on the Health and Behavior Inventory were also obtained remotely. Postinjury SD was modestly but not significantly higher in the mTBI group compared to the OI group (P =.060, d =0.32). Children with mTBI who were symptomatic postacutely based on parent ratings had worse parent-rated sleep outcomes at 3 and 6months postinjury compared to children who were not symptomatic. Greater preinjury SD also predicted more postinjury SD and more severe PCS regardless of injury type. The results suggest potential bidirectional associations between SD and PCS after mTBI. Studies of treatments for SD following pediatric mTBI are needed.

Hair cortisol and psychiatric symptomatology in children; outcomes of group CBT

The associations between hair cortisol concentration (HCC), a biomarker of chronic stress, and behavior and sleep disturbance symptoms have not been studied in children with psychiatric disorders. While cognitive behavioral therapy (CBT) has proven effective in treating psychiatric symptoms in children, its potential biological implications as determined by HCC have not been investigated. We explored associations between HCC, behavior and sleep disturbance symptoms, and different diagnostic groupings (depression/anxiety, ADHD, or other types of psychiatric disorders) in clinician-diagnosed 6-12-year-old children (n = 100) with mixed psychiatric disorders and comorbidities. In addition, we examined whether group CBT led to changes in HCC, behavior symptoms, and sleep disturbance symptoms and whether any fluctuations in HCC levels were associated with potential symptom change. We collected data on HCC, internalizing and externalizing symptoms (The Spence Children's Anxiety Self-Report, Child Behavior Checklist, and Teacher Report Form), and sleep disturbance symptoms (The Sleep Disturbance Scale for Children) at three time points (baseline, post-treatment, and seven-month follow-up). Baseline HCC was not associated with behavior or sleep disturbance symptoms, whereas behavior and sleep disturbance symptoms were mutually correlated. No changes in HCC levels were observed with group CBT. Moreover, potential variations in HCC levels over the course of the study did not appear to be associated with behavior symptom relief after group CBT. Our findings suggest that HCC may not be a methodologically relevant biomarker of behavior or sleep disturbance symptoms in children with diverse psychiatric disorders.

52100 Improvement of itch and sleep disturbance symptoms in patients with moderate-to-severe atopic dermatitis treated with lebrikizumab is maintained over 52 weeks as measured weekly with POEM

52100 Improvement of itch and sleep disturbance symptoms in patients with moderate-to-severe atopic dermatitis treated with lebrikizumab is maintained over 52 weeks as measured weekly with POEM