Total Pittsburgh Sleep Quality Index Research Articles

Association of sleep quality and diffusion MRI derived interstitial fluid content – insights in cerebral waste clearance

AbstractBackgroundDisruptions in sleep are associated with Alzheimer’s disease (AD) progression. As cerebral waste clearance is most active during sleep, these reductions in sleep quality could induce impaired clearance function. Waste products are washed through the parenchyma in the interstitial fluid (ISF), its volume being regulated by the sleep‐wake cycle. A smaller ISF‐volume is found in awake states and after sleep deprivation. IntraVoxel Incoherent Motion (IVIM) MRI can detect the diffusion of cerebral ISF (Dint) and its volume fraction (fint).Using IVIM, the current exploratory study investigates whether alterations in a proxy of ISF‐volume (fint) are related to hours of sleep or self‐reported sleep quality.MethodTwenty neurotypical elderly subjects (Table 1) underwent ultra‐high field MRI (7T research system, Siemens Healthcare GmbH, Erlangen, Germany) (Table 2).The intermediate diffusion components (Dint) in the range 1.5*10‐3<Diffusivity<4.0*10‐3 mm2/s were calculated using spectral analysis (Figure 1). The relative signal contribution of Dint was quantified by the ISF‐fraction (fint). Median fint values were extracted from the white matter (WM) and gray matter (GM).Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). In addition to the clinically used total PSQI (sum of all 7 components), the PSQI1 (Subjective sleep quality) and PSQI3 (Sleep duration) components were considered.Pearson correlations were computed between the PSQI scores and fint for WM and GM. To check for potential confounding influences, partial correlations were performed adjusting for age and time of MRI‐acquisition.ResultThe sample characteristics and descriptive statistics are summarized in Table 1. Worse reported sleep quality (PSQI1) significantly relates to lower WM fint (Table 3 and Figure 2). After adjusting for potential confounding influences, a trend towards significance remained (R=‐0.437, p=0.061).ConclusionThe current explorative study identified a lower diffusion MRI‐derived proxy of ISF‐volume in the WM of subjects who reported a subjective feeling of long‐term sleep deprivation. A reduction in ISF‐volume may leave less space for waste products, such as soluble Amyloid‐beta, to be cleared from in‐between the cells. Thereby, this study puts forward a potential method for future studies to investigate impaired clearance function in relation to sleep in patients with AD pathology.

Associations between plasma Neurofilament Light Chain (NfL), Sleep Quality and Cognition in individuals with autosomal‐dominant Alzheimer's Disease (ADAD): Findings from the Colombia‐Boston (COLBOS) biomarker study

AbstractBackgroundMethods available for in‐vivo diagnosis of Alzheimer's disease (AD) are expensive and invasive. Neurofilament light chain (NfL), a plasma‐based biomarker for neurodegeneration, is a promising marker for early detection in individuals at increased risk. We previously reported that Presenilin1 (PSEN1) E280A carriers have increased levels of plasma NfL relative to non‐carrier family members twenty years before the onset of clinical symptoms. Here, we examined whether baseline levels of plasma NfL predict self‐reported sleep quality and cognition 10 years later in non‐demented PSEN1‐E280A carriers and non‐carriers. MethodsA total of 51 PSEN1‐E280A carriers (mean age = 30.06, SD = 4.63), including 2 mildly impaired carriers and 49 age‐matched non‐carriers (mean age = 35.55, SD = 6.16) from the Colombia‐Boston (COLBOS) longitudinal biomarker study were included. Participants underwent blood sampling at baseline and completed the Pittsburgh Sleep Quality Index (PSQI), Mini Mental State Exam (MMSE), and memory testing (CERAD Word List) at follow‐up approximately 10 years later. Self‐reported sleep quality was assessed by calculating the PSQI score. Plasma NfL concentrations were measured with a single molecule array (Simoa) method. Linear regressions were used to examine associations among NfL levels, sleep quality, and memory.ResultsThere were no group differences, between carriers and non‐carriers, in baseline NfL levels, memory performance, or total PSQI scores (p>0.05). However, carriers had lower MMSE scores than non‐carriers (carriers M=27.90; non‐carriers M=28.47; p = 0.05). Among the entire sample, baseline NfL levels predicted recall scores on the CERAD word list (p = 0.03) and MMSE performance (p = 0.02). Additionally, associations between NfL levels and age trended toward significance (p = 0.06). Sleep quality (PSQI) was not associated with age, memory performance, or NfL levels.ConclusionsPreliminary findings support the hypothesis that plasma NfL levels may predict memory function and overall cognitive status in ADAD. However, our findings suggest that NfL levels may not be associated with self‐reported sleep quality in individuals in prodromal stages of ADAD. Future work using objective sleep metrics and larger samples across the preclinical/prodromal spectrum will allow a more comprehensive examination of these associations.

Regional brain dysfunction in insomnia after ischemic stroke: A resting-state fMRI study.

This study aimed to explore the abnormality of local brain function in patients with post-stroke insomnia (PSI) based on fMRI and explore the possible neuropathological mechanisms of insomnia in patients with PSI in combination with the Pittsburgh sleep quality index (PSQI) score and provide an objective evaluation index for the follow-up study of acupuncture treatment of PSI. A total of 27 patients with insomnia after stroke were enrolled, and the PSQI was used to evaluate their sleep status. Twenty-seven healthy participants who underwent physical examinations during the same period were selected as controls. Resting-state brain function images and structural images of the two groups of participants were collected, and the abnormal changes in the regional brain function in patients with PSI were analyzed using three methods: regional homogeneity (ReHo), the amplitude of low-frequency fluctuations (ALFF) and fractional ALFF (fALFF), and a correlation analysis with the PSQI scale score. Compared with the HCs, the ReHo values of the PSI group in the bilateral lingual gyrus, right cuneus, right precentral and postcentral gyri were significantly lower, and the ReHo values of the left supramarginal gyrus were significantly higher. In the PSI group, the ALFF values in the bilateral lingual gyrus were significantly decreased, whereas those in the bilateral middle temporal gyrus, right inferior temporal gyrus, right inferior frontal gyrus, right limbic lobe, right precuneus, left posterior cingulate gyrus, and left middle occipital gyrus were significantly increased. Compared with HCs, the fALFF values of the bilateral lingual gyrus, bilateral inferior occipital gyrus, and bilateral cuneus in the PSI group were significantly higher. The ReHo value of the left supramarginal gyrus in the PSI group was significantly negatively correlated with the total PSQI score. Patients with PSI have abnormal local activities in multiple brain regions, including the visual processing-related cortex, sensorimotor cortex, and some default-mode network (DMN) regions. Over-arousal of the DMN and over-sensitivity of the audiovisual stimuli in patients with PSI may be the main mechanisms of insomnia and can lead to a decline in cognitive function and abnormalities in emotion regulation simultaneously.

Adaptive Auricular Point Acupressure for Sleep Disturbance in Women with Breast Cancer: A Randomized Controlled Trial

The study aimed to evaluate the preliminary effect and efficacy of auricular point acupressure (APA) on the quality of sleep in women with breast cancer who were undergoing chemotherapy. Sample & Setting. We conducted a randomized controlled trial on 68 patients with breast cancer who reported poor sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) scores (>7). Methods & Variables. Participants were randomly assigned to an APA treatment group or a control group. Patients in the APA group had magnetic pellets attached to selected auricular points and were instructed to apply pressure to these points 4×/day for three consecutive weeks. We objectively measured sleep quality using the Actiwatch Spectrum and the PSQI at the baseline and postintervention. Statistical analyses of changes in sleep data were performed using the t-test, a rank-sum test, and analyses of covariance. In patients treated with APA, the PSQI total score and sleep onset latency had significantly decreased, while the total sleep time and sleep efficiency had significantly increased. Although the total PSQI score differed between groups at the baseline, ANCOVA results showed that the APA group had a significantly lower total PSQI score. APA could be an inexpensive and effective approach to improving sleep quality and reducing sleep disturbance in patients with breast cancer. Further research needs a larger sample size to verify our findings.

Correlation between PTSD and sleep quality in community-dwelling elderly adults in Hunan province of China.

To understand the occurrence of post-traumatic stress disorder (PTSD) and the current status of sleep quality among community-dwelling elderly adults in Hunan Province of China, to explore the correlation between the two, and to analyze the trend of sleep disorders in PTSD elderly adults. A simple random sample containing 1,173 community-dwelling elderly adults in Hunan Province was established between March and May 2022, and an on-site face-to-face survey was administered using the PTSD Checklist-Civilian Version (PCL-C) with good reliability and validity, the Pittsburgh Sleep Quality Index (PSQI) scale, and a self-designed general condition questionnaire. The incidence of PTSD in the 1,173 participants was 14.3% (168/1,173). The total incidence of sleep disorders was 40.9% (480/1,173); more specifically, the incidence of sleep disorders in participants with no PTSD symptom, in participants with mild-to-moderate PTSD symptoms, and in participants with severe PTSD symptoms was 36.3, 69.8, and 66.7%, respectively. The Spearman's rank correlation analysis showed that the total PTSD score and the scores of each dimension (i.e., re-experiencing symptom cluster, avoidance symptom cluster and hypervigilance symptom cluster) were positively correlated with the total PSQI score and its dimension scores (i.e., sleep quality, time to fall asleep, sleep duration, sleep efficiency, sleep disturbance, hypnotic medication, and daytime function) (P < 0.05). The correlation coefficients ranged from 0.013 to 0.495. For all PSQI dimensions, the differences across participants with different degrees of PTSD were statistically significant (P < 0.05). The overall status of PTSD and sleep quality in community-dwelling elderly adults in Hunan Province was not optimistic. The elderly with PTSD were more prone to sleep disorders, and the more severe the symptoms of PTSD, the poorer the sleep quality was. However, differences were observed in the scores of each dimension of sleep across participants with different degrees of PTSD. Regardless of the degree of PTSD symptoms, the sleep quality of the elderly is severely affected, and the occurrence rate is not unlimited.

Effectiveness of Clonidine in Child and Adolescent Sleep Disorders.

Objective We aimed to investigate the improvement in sleep quantity and quality when clonidine was used in children and adolescents with insomnia. We also examined how sociodemographic characteristics such as age, sex, underlying psychological problems, and levels of depression and anxiety affected the effect of clonidine. Methods We retrospectively reviewed outpatients aged 6 to 24 who took clonidine due to insomnia from September 2019 to September 2021 at the Department of Psychiatry at Eunpyeong St. Mary’s Hospital of Catholic University. We used the Pittsburgh Sleep Quality Index (PSQI), Children’s Depression Inventory (CDI), and State-Trait Anxiety Inventory (STAI) for our study. Results A total of 62 participants were included in our study (34 females, mean age 13.94±4.94 years). After using clonidine, there was a significant decrease in PSQI components 1, 2, and 5, especially PSQI component 2. There was a greater decrease in sleep latency when clonidine was used in females, those aged between 13 and 24, those with mood/anxiety disorder or attention-deficit/hyperactivity disorder, those whose sleep latency exceeded 60 minutes at baseline, and those who used clonidine for more than 14 days. Those with higher STAI-Trait scores and CDI scores at baseline showed less improvement in total PSQI scores. Conclusion Considering that there are currently no Food and Drug Administration-approved sleep drugs for children and adolescents and no apparent difference in efficacy and safety among sleep drugs, we demonstrated that treatment with clonidine might be a good approach to improve sleep quality and quantity for children and adolescents.

Relationship between Neuroticism and Gastrointestinal Symptoms in Irritable Bowel Syndrome: The Mediating Role of Sleep.

We aimed to explore the relationship between the sleep and gastrointestinal symptoms in patients with irritable bowel syndrome (IBS) from the perspective of personality factors. Overall, 167 patients with IBS- from First Affiliated Hospital of Nanjing Medical University in Jiangsu Province of China in 2019 were included. Gastrointestinal Symptom Score (GIS), Chinese version of Pittsburgh Sleep Quality Index (PSQI) and Eysenck Personality Questionnaire (EPQ) were used to assess gastrointestinal symptoms, sleep and personality. We use mediator variables analyze to explore the relationship between sleep, neurotic personality and gastrointestinal symptoms in IBS patients. 48.5% of IBS patients had sleep disorders. IBS patients with high neuroticism had higher total PSQI scores, longer sleep latency, worse sleep persistence, more nocturnal sleep disturbances and daytime dysfunctions, and more use of sleep medication (P<0.05). Stomach distention, cramping epigastric pain, loss of appetite, and epigastric pain were more prominent in IBS patients with high neuroticism (P<0.05). In addition, neurotic personality was significantly predictive of sleep and some gastrointestinal symptoms, and sleep was a complete mediator of neurotic personality and gastrointestinal symptoms in IBS patients. High neurotic personality in IBS patients leads to more prominent gastrointestinal symptoms by causing sleep disturbance.

Do differences in chronotypes affect sleep and health-related quality of life of nursing students? A cross-sectional study

ABSTRACT Nursing students experience higher levels of stress and more sleep-related problems than other students; however, the relationship of chronotype to nursing students’ sleep status and health-related quality of life (HRQOL) is unclear. This cross-sectional, observational study investigated whether chronotype affected Japanese nursing college students’ sleep and HRQOL. Nursing students completed the Attribute Questionnaire about Subject Background, Japanese Version Morningness‒Eveningness Questionnaire (MEQ), Munich Chrono-Type Questionnaire‒Japanese Version (MCTQ), Japanese Version of the Pittsburgh Sleep Quality Index (PSQI), SF-12v2 Standard, Japanese Version 2.0 (SF-12), Japanese Translation of Profile of Mood States 2nd Edition‒Adult Short (POMS2). Of the 241 students (mean age 20.16 ± 1.80 years; 80.9% female), 80 (33.2%) had evening, 142 (58.9%) had intermediate, and 19 (7.9%) had morning chronotype. The overall total PSQI score was 6.86 ± 2.97. Additionally, 141 students (64.1%) scored ≥ 6, suggesting disturbed sleep. Approximately 80% of the evening chronotype students had a total PSQI score of 8.34 ± 3.11, clearly indicating disturbed sleep. Sleep-related parameters (total PSQI score, bedtime, sleep latency, wake-up time, sleep duration, social jetlag) were worse in evening than in other chronotypes. SF-12 and POMS2 did not differ among chronotypes. Thus, evening chronotype nursing students require sleep-related support from early on.

Results of a pilot study of a cooling mattress pad to reduce vasomotor symptoms and improve sleep.

This single-arm pilot study was designed to generate pilot data on the use of a cooling mattress pad system on vasomotor symptoms (VMS; hot flashes and/or night sweats), self-assessed sleep, and daily hot flash interference among perimenopausal and postmenopausal women. A total of 15 perimenopausal and postmenopausal women aged 45 to 59 years experiencing four or more VMS per day were recruited from the community. After completion of baseline questionnaires and a 2-week daily diary to confirm VMS eligibility, all women received a cooling mattress pad system to use at night for 8 weeks, during which time they continued to complete their daily diaries to record VMS frequency and severity. The primary study outcome was change from baseline in VMS frequency. Secondary outcomes were sleep quality, measured by the Pittsburgh Sleep Quality Index, and hot flash interference with daily life, assessed by the Hot Flash Related Daily Interference Scale, where higher sores indicate worse sleep quality and higher interference, respectively. We used repeated-measures methods (analysis of covariance, paired t tests, and McNemar test) to evaluate outcomes. VMS frequency significantly declined by 52% at 8 weeks ( P < 0.0001). Mean total Pittsburgh Sleep Quality Index score significantly declined 3.27 points from 11.14 at baseline to 7.87 at follow-up ( P = 0.011). The total Hot Flash Related Daily Interference Scale score significantly declined from 4.16 at baseline to 1.92 at follow-up ( P = 0.011). Women who used a cooling mattress pad system experienced significant and clinically meaningful reductions in VMS frequency, sleep disturbance, and hot flash interference with daily activities over an 8-week period. These results provide preliminary evidence suggesting that a cooling mattress pad used while sleeping can provide a nonpharmacological option to reduce VMS and sleep disturbance for women experiencing menopausal hot flashes.

Treatment of insomnia in suboptimal health status with Zhuang medicine herbal-thread moxibustion: A randomized clinical trial 壮医药线点灸疗法治疗亚健康失眠的疗效观察-随机临床研究

ObjectiveThe objective of this study is to explore the clinical effect and safety of Zhuang medicine herbal-thread moxibustion therapy for the treatment of suboptimal health status-related insomnia through a randomized clinical trial. MethodsA total number of 60 patients with insomnia of suboptimal health status (SHS) were enrolled from the Clinic of Zhuang Medicine, Renai Branch of the First Affiliated Hospital of Guangxi University of Chinese Medicine and the Clinic of Zhuang Medicine, the First Affiliated Hospital of Guangxi University of Chinese Medicine, as well as Guangxi University of Chinese Medicine. According to the random number table method, they were randomized into a Zhuang medicine herbal-thread moxibustion therapy group (30 patients) and a western medication group (30 partients).The outcome assessors were blinded for patients allocation. In the herbal-thread moxibustion group, Zhuang medicine herbal-thread moxibustion therapy was provided once daily. In the western medication group, alprazolam tablets were prescribed for oral administration once daily. One course consisted of 10 treatments. After three consecutive courses of treatment, the score of the Pittsburgh sleep quality index (PSQI) was compared between groups, and both clinical effect and safety were assessed. ResultsSixty eligible patients were enrolled, and thirty were assigned to each group and included in the data analysis. After treatment, the score of each PSQI indicator (sleep latency, sleep duration, sleep efficiency, sleep disturbance, and daytime dysfunction) and total PSQI score were compared with those before treatment in both groups (all changes were statistically significant when P < 0.05). Scores in the herbal-thread moxibustion group were superior to those in the western medication group (all values were statistically significant at P < 0.05). The total effective rate was 93.3% in the herbal-thread moxibustion group and 80.0% in the western medication group (P < 0.05). During treatment, no adverse reactions were reported in the herbal-thread moxibustion group. In the western medication group, three patients reported dizziness and headache, and one patient reported dry mouth, the incidence of adverse reactions was 13.3%. ConclusionThe Zhuang medicine herbal-thread moxibustion therapy is a safe and effective management strategy for the clinical symptoms of suboptimal health status-related insomnia.

Is sleep quality a potential predictor of neurocognitive disorders? A 6-year follow-up study in Chinese older adults.

To investigate the longitudinal association of sleep quality with incidence of neurocognitive disorders in 6years. This was a 6-year follow-up study of community-living older adults who scored a Clinical Dementia Rating (CDR) of 0 at baseline. Sleep quality was assessed by the self-rated Pittsburgh Sleep Quality Index (PSQI) questionnaire, where higher scores indicated poorer sleep quality, and a cutoff score of 5 or above was suggestive of sleep disorder. The study outcome was incident neurocognitive disorders in 6years, as identified by a CDR of 0.5 or above. Poisson regression analysis was conducted to test if baseline sleep quality was independently associated with risk of incident neurocognitive disorders in 6years. Of the 290 participants in this study, 166 (57.2%) developed neurocognitive disorders in 6years. They had poorer sleep quality (mean [SD] total PSQI score: 6.2 [3.8] vs. 4.9 [3.2], p=0.001) and higher prevalence of sleep disorder (100 [60.2%] vs. 56 [45.2%], p=0.01) at baseline than those who remained free of neurocognitive disorder. After controlling for age, gender, education, and physical and psychiatric morbidities, the risk ratios (RRs) for incident neurocognitive disorders were 1.05 (95% confidence interval (CI)=1.00-1.11, p<0.05) for PSQI total score and 1.50 (95% CI=1.05-2.14, p=0.03) for sleep disorder at baseline. Sleep quality might predict the development of neurocognitive disorders. From a clinical perspective, enquiry of sleep quality and screening for sleep disorder should be promoted as part of the neurocognitive disorder risk assessment in older adults.

The Mediating Role of Coping Style in the Relationship Between Sleep Quality and Burnout: A Cross-Sectional Study Among Psychiatric Nurses.

BackgroundAlthough sleep quality is clearly associated with job burnout as shown in the existing research, the mechanism underpinning such relationship remains undefined. This work, thus, aimed to assess the current situation of sleep quality and burnout in Chinese psychiatric nurses, and to analyze the relationships between sleep quality, burnout and coping style, in order to provide possible targets to enhance mental health and wellbeing among psychiatric nurses.MethodThis cross-sectional study was carried out in seven rehabilitation centers located in four different regions of China. The Pittsburgh Sleep Quality Index, the Epworth Sleeping Scale, the Maslach Burnout Inventory General Survey, and the Coping Style Questionnaire were distributed to 853 nurses in various mental hospitals, with a total of 664 participants being recruited in the final research.ResultsThe results of this current study showed a high prevalence of sleep disorders and burnout in Chinese psychiatric nurses. Moreover, emotional exhaustion (r = 0.456), cynicism (r = 0.323) and negative coping style (r = 0.191) in nurses were all positively correlated with total Pittsburgh Sleep Quality Index (PSQI) score, while professional efficacy (r = −0.079) and positive coping style (r = −0.140) were negatively correlated with total PSQI score. More interestingly, of all negative coping strategies, we found that self-blame had the most significant effect (β = 0.156).ConclusionsThe above results showed that coping style mediates the association of poor sleep quality with job burnout in Chinese psychiatric nurses. This study claimed that there is an urgent need to development the coping skills to sustain a healthy work life for nurses.

Investigation of the Relationship between Vestibular Disorders and Sleep Disturbance.

Introduction Vestibular pathologies cause physical and psychological symptoms, as well as cognitive problems. Objective To evaluate the deterioration in sleep quality associated with vestibular pathologies. Methods The Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Index (PSQI), and the Limits of Stability test (LOS) were applied to the participants. Results We included 25 patients with Meniere's disease (MD), 22 patients with benign paroxysmal positional vertigo (BPPV), 21 patients with unilateral peripheral vestibular loss (UPVL), 23 patients with vestibular migraine (VM), and 43 controls. The total PSQI scores of the controls were better than those of the MD ( p = 0.014), VM ( p < 0.001), BPPV ( p = 0.003), and UPVL ( p = 0.001) groups. The proportion of poor sleepers in the MD ( p = 0.005), BPPV ( p = 0.018), and UPVL ( p < 0.001) groups was significantly higher than that of the controls. The highest total DHI score (45.68 ± 25.76) was found among the MD group, and it was significantly higher than the scores of the BPPV ( p = 0.007) and control ( p < 0.001) groups. The highest BDI score was obtained in the VM group, and it was significantly higher than the scores of the BPPV ( p = 0.046) and control ( p < 0.001) groups. Moreover, the BDI scores of the MD ( p = 0.001) and UPVL groups were also significantly worse than the score of the controls ( p = 0.001). Conclusion The present study showed thatpatients with vestibular symptoms have physical and functional complaints, as well as increased psychosocial stress and decreased sleep quality. Evaluating multiple parameters of quality of life may contribute to a better understanding of vestibular physiology and symptoms, and may help establish a more effective therapeutic approach.

Relationship between menopausal symptoms and sleep quality in women during the climacteric period: a cross-sectional study

The aim of this study was to evaluate the relationship between the menopausal symptoms and sleep quality in women in the climacteric period. This cross-sectional study was conducted on 383 women aged 40–64 years at the Cancer Early Diagnosis Screening and Training Centre. The data were collected with the questionnaire form, Menopause Rating Scale (MRS) and the Pittsburgh Sleep Quality Index (PSQI). The sleep quality was poor in 77.8% of the women in the study. A significant relationship was found between PSQI scores and the somatic and psychological subscale scores of the MRS in the presence of other variables that could affect sleep according to multiple linear regression analysis (p < .05). We recommend training and consulting services provided by health care professionals and further experimental studies on the subject to decrease the negative effects of the somatic and psychological symptoms found to worsen sleep quality in women in the climacteric period. IMPACT STATEMENT What is already known on this subject? Sleep problems are a common health problem in women in the climacteric period. What do the results of this study add? The most common menopausal symptoms were joint and muscle problems, physical and emotional fatigue, nervousness, hot flushes, unhappiness, anxiety, and sleep problems in order of frequency. There was a weak positive significant relationship between the total PSQI score and the psychological and urogenital subscale scores of the MRS, in addition to a moderate positive significant relationship between the total PSQI scores and the total and somatic subscale scores of the MRS. What are the implications of these findings for clinical practice and/or further research? We believe effective management of the somatic and psychological symptoms during the climacteric period with health care staff providing training and consultancy services to the women aimed at decreasing the symptoms according to evidence-based procedures could help improve the sleep quality. Conducting multicenter studies with a larger subject group where the effect of menopausal symptoms on sleep quality in addition to that of multifactorial causes are evaluated in depth is recommended.

Stress, Sleep Quality, and Academic Performance among Dental Students in Shiraz, Iran.

Background Quality of sleep and stress level can affect the health, capacity of learning, and academic performance of the students. This study aimed to investigate the association between stress and sleep quality with academic performance among undergraduate clinical dental students in Shiraz, Iran. Methods This cross-sectional study was conducted during the second semester of the academic year 2020–2021 among clinical dental students at Shiraz Dental School, Iran. A total of 138 students completed Pittsburgh Sleep Quality Index (PSQI) and dental environment stress (DES) questionnaire. The grade point averages (GPAs) of the previous terms of the participants were also collected. Data analysis was performed using Kolmogorov–Smirnov test, the one-way ANOVA, post hoc Duncan's test, nonparametric Kruskal–Wallis H test, Wilcoxon–Mann–Whitney test, and the chi-squared test. The p values of less than 0.05 were considered statistically significant. Results Clinical dental students participated in this study experienced moderate levels of stress and poor sleep quality. Mean total DES and PSGI scores did not differ by sex, year of study, marital status, and place of residence (p values >0.05). Most of the students (52.9%) had moderate GPAs. A significant relationship was observed between sex and GPA as well as between place of residence and GPA (p values <0.05). No significant differences were found between DES total score or PSQI score and GPA categories (p values >0.05). A significant direct relationship between DES total score and PSQI score was observed (p < 0.05). Conclusion Dental undergraduates in Shiraz, Iran, experienced moderate levels of stress and poor sleep quality. The results showed no significant difference between sleep quality or DES and academic achievement. However, a significant direct correlation was observed between sleep quality and dental environment stress.

0758 Behavioral Determinants of PAP Use in Veterans with COMISA: Results of a Randomized Trial

Abstract Introduction Nonadherence to positive airway pressure (PAP) therapy is common in comorbid insomnia and obstructive sleep apnea (COMISA). We previously reported a novel behavioral treatment for COMISA which improves both PAP adherence and sleep. Our current goal was to assess whether improvements in PAP self-efficacy, knowledge, and decisional balance (targets of treatment) are associated with improvements in PAP use and sleep quality. We also collected participants’ perceptions of benefits and challenges of PAP during intervention. Methods 125 veterans (96% men, 39% non-Hispanic white, 24% Black, 17% Hispanic/Latino) with COMISA were randomized to a 5-week intervention integrating behavioral insomnia therapy with a PAP adherence program versus general sleep education (control). Objective PAP use data and Pittsburgh Sleep Quality Index (PSQI) were collected over 6 months. Three behavior change subscales (PAP Self-Efficacy [PAP-SE], Decisional Balance Index [DBI], Knowledge [KNOW]) were administered at 6-months. Weekly self-report of participant-perceived benefits and challenges of PAP use were collected among intervention participants. Subscale scores, PAP use and PSQI were compared between intervention and control, and associations were tested. Change in mean number of benefits and challenges of PAP use were also tested (all analyses intent-to-treat). Results At 6-months, compared to controls, intervention participants had higher scores on all three subscales: PAP-SE (4.1 intervention versus 3.5 control, respectively), DBI (8.3, 0.9) and KNOW (10.5, 9.6, all p&amp;lt;.05). Intervention participants had more PAP use and lower (better) PSQI scores at 6-months (all p&amp;lt;.05). In the total sample, PAP use and PSQI correlated with PAP-SE (r=.52 PAP use, r=-.27 PSQI, respectively), DBI (r=.49, -.35) and KNOW (r=.43, -.21; all p&amp;lt;.05). Among intervention participants, perceived benefits of PAP increased over time (4.3 at week 2, 5.8 at week 4, respectively), and challenges decreased (3.7, 2.3; all p&amp;lt;.05). Conclusion Behavioral treatment for COMISA improves behavioral determinants of PAP use, which is associated with improvements in PAP use and sleep quality. In addition, with treatment, perceived benefits of PAP increase and challenges decrease. These findings suggest improvements in self-efficacy, knowledge and perceived benefits of PAP are important mechanisms through which behavioral interventions improve PAP use in older adults with COMISA. Support (If Any) VAHSRD (IIR12–353-Alessi, RCSA20-191-Martin) and NIH (NHLBI K24HL143055-Martin, NIA K23AG049955-Dzierzewski)

Sleep disturbance and health-related quality of life in Parkinson's disease: A clear correlation between health-related quality of life and subjective sleep quality

IntroductionComorbid insomnia and poor sleep quality in Parkinson's disease (PD) are associated with a poor health-related quality of life (HRQoL). However, the relationship between HRQoL and sleep measures obtained using polysomnography (PSG) remains unclear. We aimed to examine the association between various sleep measures and HRQoL in PD patients. MethodsWe retrospectively included patients with PD who underwent PSG and responded to self-administered questionnaires including the Pittsburgh Sleep Quality Index (PSQI) and Medical Outcomes Study 36-Item Short-Form Health Survey. ResultsThe patients' (n = 120) mean age was 67.06 (SD = 8.77) years, and their mean Hoehn and Yahr stage was 2.25 (SD = 0.78). A higher PSQI score (worse subjective sleep quality) was correlated in PSG with shorter sleep latency, less N1 sleep, and more N2 sleep. Multiple regression analysis showed that the total PSQI score correlated with both physical and mental HRQoL (p < 0.001 in both cases). However, neither type of HRQoL studied correlated with objective sleep measures, including indicators of sleep architecture, sleep-disordered breathing, and sleep related movement disorders. ConclusionDespite the association between subjective sleep quality and HRQoL, the associations between objective measures and HRQoL were negligible. Objective sleep fragmentation may not be perceived as a sleep disturbance in patients with PD, and therefore may not adversely affect their subjective health, given the paradoxical correlation between PSQI score and sleep architecture.

Factors affecting preoperative sleep quality in patients undergoing myomectomy and hysterectomy

Objective: In this study, preoperative subjective sleep quality (SP) and the factors which affect the SP were investigated in patients who underwent myomectomy and hysterectomy. Material and Methods: A total of 172 patients were included in the present study; 67 patients undergoing myomectomy and 105 undergoing hysterectomies were evaluated. Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) were used preoperatively to evaluate subjective sleep quality, anxiety, and depression, respectively. The patients were classified into two groups according to sleep quality score: good quality (PSQI ≤ 5) and poor quality (PSQI &gt; 5). Results: Overall, 56.4% of patients reported poor sleep quality with a PSQI score &gt; 5. The total PSQI score, BAI score, subjective sleep quality, sleep latency, sleep duration, sleep disturbances, and the use of sleeping medication of the patients undergoing hysterectomy were significantly higher than those undergoing myomectomy (p &lt; 0.05). Age (odds ratio [OR] = 1.082; 95% confidence interval [CI], 1.012–1.157; p = 0.021), operation type (OR = 1.071; 95% CI, 1.015–1.149; p = 0.035), and BAI score (OR = 1.097; 95% CI, 1.073–1.294; p = 0.001) were significantly associated with poor sleep quality. Logistic regression analysis showed that age, the BAI score, and the type of surgery were significantly associated with poor sleep quality. Conclusion: The preoperative sleep quality of patients was significantly associated with the surgical procedure, patient age, and patient anxiety. Preoperative sleep quality of patients who underwent hysterectomy was worse than those who underwent myomectomy.

Resting-state functional connectivity of the sensory/somatomotor network associated with sleep quality: evidence from 202 young male samples.

Previous neuroimaging studies have demonstrated that sleep is associated with brain functional changes in some specific brain regions. However, few studies have examined the relationship between all possible functional connectivities (FCs) within the sensory/somatomotor network (SSN) and the sleep quality of young male samples. The SSN consists of two motor cortices and is known to play a critical role in sleep. Poor sleep quality may be associated with increased sensory/somatomotor functional connectivity during rest. Hence, 202 young male participants underwent a resting-state functional magnetic resonance imaging (fMRI) scan and completed the Pittsburgh Sleep Quality Index (PSQI). Results indicated that increased functional connectivity within the SSN was associated with poor sleep quality. Specifically, the total PSQI score was positively correlated with the increased functional connectivity of the left paracentral lobule (PCL), bilateral precentral gyrus (PreCG), supplementary motor area (SMA) and bilateral postcentral gyrus (PoCG). Additionally, our findings also exhibited that (a) the subjective sleep quality factor of PSQI was positively correlated with FC between the bilateral PoCG and the bilateral PCL as well as between the left PreCG and the right SMA; (b) the sleep latency factor of PSQI was positively correlated with FC between the left PoCG and the right precuneus (PCUN); (c) the sleep disturbances factor of PSQI was positively correlated with FC between the left PCL and the right PoCG, and (d) the daytime dysfunction factor of PSQI was positively correlated with FC between the bilateral PoCG and the left PCL as well as between the bilateral PreCG and the SMA. In short, our findings can be comprehensively understood as neural mechanisms of intrinsic SSN connectivity are associated with sleep quality of man. Meanwhile, it may expand our knowledge and provide new insight into a deeper understanding of the neurobiological mechanisms of sleep or sleep problems.

Respiratory Muscle Endurance in Obesity Hypoventilation Syndrome.

An increase in respiratory work load and resistance to respiration cause a decrease in respiratory muscle endurance (RME) in patients with obesity hypoventilation syndrome (OHS). We aimed to evaluate and compare RME in subjects with OHS and a control group using an incremental load test and compare the RME of subjects with OHS in whom noninvasive ventilation (NIV) was and was not used. Forty subjects with OHS (divided according to body mass index [BMI] as group I: 30-40 kg/m2; and group II: ≥ 40 kg/m2) and 20 subjects with obesity (control group: 30-40 kg/m2) were included in the study. RME was evaluated using the incremental load test, and respiratory muscle strength (RMS) was evaluated using mouth pressure measurements. The 6-min walk test, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), EQ-5D Health-Related Quality of Life Questionnaire (EQ-5D), and the Obesity and Weight-Loss Quality of Life Instrument (OWLQOL) were performed. RME and RMS (%) in group I were lower than the control group (P = .001, P = .005, and P = .001, respectively). No significant difference was found between the 3 groups in terms of 6-min walk distance (6MWD) percentage predicted values (P = .98). RME in the NIV user group was higher than the non-user group (P = .006). ESS, total PSQI, and FSS scores in the control group were less than group I (P = .01, P = .009, and P = .005, respectively) and group II (P = .01, P < .001, and P < .001, respectively). The EQ-5D scores of the control group were higher than group II only (P = .005 and P = .005, respectively). There were no differences in OWLQOL between the groups (P = .053). RME was low in subjects with OHS but higher in those who used NIV. The incremental load test could be performed easily and safely in a clinic setting.