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Objective: We aimed to determine if selected genetic polymorphisms in the aryl hydrocarbon receptor (AHR)-signaling pathway and circadian locomotor output cycles kaput (CLOCK) are associated with insomnia and early awakening in middle-aged women. Methods: Women aged 45 to 54years (n =639) were recruited into a middle-aged health study and agreed to complete questionnaires and donate blood samples. Questionnaires were used to assess sleep outcomes. Blood samples were processed for genotyping for the selected polymorphisms: AHR (rs2066853), AHR repressor (AHRR) (rs2292596), aryl hydrocarbon nuclear translocator (ARNT) (rs2228099), and CLOCK (rs1801260). Data were analyzed using multivariable logistic regression. Results: Women heterozygous for the AHRR alleles (GC) had decreased odds of insomnia compared to women homozygous for the AHRR_C allele (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.49–0.96). Women with at least one of the AHRR_G or CLOCK_C alleles had significantly decreased odds of insomnia compared to women homozygous for the AHRR_C and CLOCK_T alleles (aOR, 0.64; 95% CI, 0.43–0.96). Additionally, women homozygous for the AHRR_G and CLOCK_C alleles had significantly decreased odds of insomnia compared to women homozygous for the AHRR_C and CLOCK_T alleles (aOR, 0.56; 95% CI, 0.35–0.89). None of the selected single nucleotide polymorphisms (SNPs) or combinations of SNPs were significantly associated with early awakening. Conclusions: Selected genetic polymorphisms in the AHR-signaling pathway (i.e., AHRR) and CLOCK may play a role in decreasing the risk for experiencing insomnia during the menopausal transition. [ABSTRACT FROM AUTHOR]

Sleepiness is linked to accidents and reduced performance, and is usually attributed to short/poor prior sleep and sleepiness. However, while the link between reduced sleep and subsequent sleepiness is well established in laboratory experiments of sleep reduction, very little is known about the day-to-day variation of sleepiness in everyday life and its relation to the immediately preceding sleep episode. The purpose of the present study was to investigate the characteristics of this relation across 42 consecutive days. Fifty volunteers participated. Self-reports of sleep were given in the morning and recorded with actigraphy; health was rated in the evening; and sleepiness was rated at eight points during the day (on a scale of 1-9). Results from mixed-model regression analyses showed that, on average, total sleep time predicted sleepiness during the rest of the day across the 42 days, with sleepiness increasing with shorter preceding sleep (β = −0.15 units h−1, P < 0.001). Sleepiness also increased with earlier time of rising and lower-rated sleep quality. Days off reduced sleepiness, but was accounted for by sleep. Self-rated health improved when sleepiness was low during the same day (β = −0.36 unit unit−1 of rated health, P < 0.001), but the two were measured simultaneously. Napping was related to high sleepiness during the same day. Actigraphy measures of sleep duration showed similar, but somewhat weaker, effects than diary measures. It was concluded that the main determinants of daytime sleepiness in a real-life day-to-day context were short sleep, poor sleep and early rising, and that days with high sleepiness ended with ratings of poorer health. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate an enhanced recovery after surgery (ERAS)-based free flap management protocol implemented at our center., Study Design: Prospective cohort study of patients after implementation of an ERAS-based perioperative care protocol for patients undergoing free flap reconstruction of the head and neck as compared with a historical control group., Setting: Tertiary care academic medical center., Participants and Methods: All patients undergoing free flap reconstruction were prospectively enrolled in the ERAS protocol group. A retrospective control group was identified by randomly selecting an equivalent number of patients from a records search of those undergoing free flap surgery between 2009 and 2015. Blood transfusion, complications, 30-day readmission rates, intensive care unit (ICU) and hospital length of stay, and costs of hospitalization were compared., Results: Sixty-one patients were included in each group. Patients in the ERAS group underwent less frequent flap monitoring by physicians and had lower rates of intraoperative (70.5% vs 86.8%, P = .04) and postoperative (49.2% vs 27.2%, P = .026) blood transfusion, were more likely to be off vasopressors (98.3% vs 50.8%, P < .01) and ventilator support (63.9% vs 9.8%, P < .01) at the conclusion of surgery, and had shorter ICU stays (2.11 vs 3.39 days, P = .017). Length of stay, readmissions, and complication rates did not significantly differ between groups., Conclusion: ERAS-based perioperative practices for head and neck free flap reconstruction can reduce time on the ventilator and in the ICU and the need for vasopressors, blood transfusions, and labor-intensive flap monitoring, without adverse effects on outcomes., (© The Authors 2020.)