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Purpose: To characterize risk factors associated with obstructive sleep apnea (OSA) and its relationship with nurses' absenteeism., Methods: A cross-sectional study was conducted from 2018 to 2020 at a 1,000-bed academic hospital complex and biomedical research facility in Tehran, Iran. Participants were selected through consecutive sampling after obtaining ethical approval and informed consent. Data on demographics, medical conditions, occupational characteristics, and absenteeism were collected through face-to-face interviews. The STOP-Bang questionnaire was utilized to assess the probability of OSA. Statistical tests included the Mann-Whitney U, t-test, Chi-square, and multivariable regression., Results: In this study involving 304 nurses, the majority were female (81.3%), with an average age of 35. About 27 participants (8.9%) had a high probability of OSA, with male sex, older age, higher body mass index, neck circumference, and diastolic BP identified as the main determinants of OSA. Additionally, shift work and night shifts were associated with increased absenteeism, while sex showed no significant association with absenteeism rates among nurses., Conclusion: Male sex, neck circumference (obesity), night shifts, and diastolic BP can predict OSA risk. However, unauthorized absence from work is not associated with a high risk for OSA (STOP-BANG ≥3) or the individual risk factors of OSA., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Several studies have suggested that sleep disorders have adverse effects on blood pressure. However, the findings remain controversial and only a few studies have investigated the association between sleep duration and hypertension among all age and sex subgroups., Aim: To evaluate the dose-response association between sleep duration and blood pressure in the Iranian population using the Ravansar non-communicable disease cohort study., Methods: This was a cross-sectional study of 9865 participants aged 35-65 years from the 2014-2017 Ravansar non-communicable disease cohort study. Night sleep duration was classified as ≤5 hours, 6 hours, 7 hours, 8 hours, 9 hours, and ≥10 hours. The association between self-reported sleep duration and hypertension was examined using multivariable logistic regression in STATA version 14. Restricted cubic spline analysis showed the dose-response association between sleep duration and hypertension., Results: The age-adjusted prevalence of hypertension was 16.50% among men, 24.20% among women and 20.50% in the total population. Compared with reference sleep duration (7 hours) in the total population, the multivariable odds ratio [OR (95% CI)] for hypertension was 0.70 (0.55-0.88) for the group with 9 hours sleep duration and 0.90 (0.74-1.09) for the group with ≤5 hours sleep duration. Among pre-menopausal women, we observed an inverse association between 9 hours sleep duration and hypertension [0.62 (0.42-0.90)]. The age-adjusted cubic spline suggested a linear inverse association between sleep duration and prevalence of hypertension among men and the total population and a non-linear association among women., Conclusion: Longer sleep duration (from 9 hours) had a negative association with hypertension. Further studies are needed to identify the risk factors associated with sleep duration and hypertension among the general population in the Islamic Republic of Iran., (Copyright: © Authors 2023; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Reliable obstructive sleep apnea (OSA) prevalence information in Iran is lacking due to inconsistent local study results. To estimate OSA prevalence and identify clinical phenotypes, we conducted a nationally representative study using multi-stage random cluster sampling. We recruited 3198 individuals and extrapolated the results to the entire Iranian population using complex sample survey analyses. We identified 3 clinical phenotypes as "sleepy," "insomnia," and "restless legs syndrome (RLS)." The prevalence of OSA was 28.7% (95%CI: 26.8-30.6). The prevalence of "sleepy," "insomnia," and "RLS" phenotypes were 82.3%, 77.8%, and 36.5% in women, and 64.8%, 67.5%, and 17.9% in men, respectively. "Sleepy" and "insomnia" phenotypes overlapped the most. Age (OR: 1.9), male sex (OR: 3.8), BMI (OR: 1.13), neck circumference (OR: 1.3), RLS (OR: 2.0), and insomnia (OR: 2.3) were significant OSA predictors (p-values: 0.001). In men, "sleepy" phenotype was associated with youth and unmarried status but not in women. The "insomnia" phenotype was associated with shorter sleep duration in women; cardiovascular diseases (CVD), urban residency, and shorter sleep duration in men. "RLS" phenotype was associated with shorter sleep duration and CVD in women and older age, lower educational level, CVD, and hypertension in men. The findings point to the need for funding of OSA screening in Iran, for a different assessment of men and women, and for future sleep research to consider overlapping phenotypes., (© 2023. Springer Nature Limited.)

Background: Sleep apnea is one of the most common sleep disorders that facilitating and accelerating its diagnosis will have positive results on its future trend., Objective: This study aimed to diagnosis the sleep apnea types using the optimized neural network., Material and Methods: This descriptive-analytical study was done on 50 cases of patients referred to the sleep clinic of Imam Khomeini Hospital in Tehran, including 11 normal, 13 mild, 17 moderate and 9 severe cases. At the first, the data were pre-processed in three stages, then The Electrocardiogram (ECG) signal was decomposed to 8 levels using wavelet transform convert and 6 nonlinear features for the coefficients of this level and 10 features were calculated for RR Intervals. For apnea categorizing classes, the multilayer perceptron neural network was used with the backpropagation algorithm. For optimizing Multi-layered Perceptron (MLP) weights, the Particle Swarm Optimization (PSO) evolutionary optimization algorithm was used., Results: The simulation results show that the accuracy criterion in the MLP network is allied with the Backpropagation (BP) training algorithm for different types of apnea. By optimizing the weights in the MLP network structure, the accuracy criterion for modes normal, obstructive, central, mixed was obtained %96.86, %97.48, %96.23, and %96.44, respectively. These values indicate the strength of the evolutionary algorithm in improving the evaluation criteria and network accuracy., Conclusion: Due to the growth of knowledge and the complexity of medical decisions in the diagnosis of the disease, the use of artificial neural network algorithms can be useful to support this decision., Competing Interests: None, (Copyright: © Journal of Biomedical Physics and Engineering.)

Background: Health care workers (HCWs) are at the frontline of the fight against the coronavirus disease 2019 (COVID-19). Long COVID is defined as "the persistence of some symptoms of COVID-19, more than 4 weeks after the initial infection." The aim of the present study was to investigate the prevalence of long COVID status among HCWs in the largest hospital complex of Iran., Methods: In this cross-sectional study, all patients with COVID-19 who had taken sick leave were included in the study (n = 445). Data regarding sick leave characteristics were collected from the records of the nursing management department of the hospital. Study variables included demographic and occupational information, variables related to mental health assessment, organ systems involved in COVID-19, and duration of symptoms. Frequencies, percentage distributions, means, standard deviation, and range (minimum, maximum) were used as descriptive analysis methods. Associations between symptoms' persistency and clinical characteristics were assessed by logistic and linear regressions., Results: Age, N95 mask use, and respiratory protection significantly contributed to the persistence of COVID-19 symptoms ( P < 0.05). The prevalence of long COVID among HCWs was 9.44% among 445 participants. The loss of taste persisted longer than the other symptoms before returning to normal. Among the postrecovery complications asked, anxiety was the most common persistent mental symptom (58.5%), followed by gloomy mood (46.3%) and low interest (46.2%), respectively., Conclusion: HCWs with COVID-19 symptoms had prolonged symptoms of COVID-19 that can affect their work performance, thus, we recommend evaluating COVID-19 symptoms in HCWs with infection history., Competing Interests: The authors declare that they have no competing interests., (© 2023 Iran University of Medical Sciences.)

According to the importance of management of obstructive sleep apnea syndrome by otolaryngologists, this study was designed to investigate knowledge, attitudes and practice of junior and senior residents of otolaryngology and evaluate the effect of current residency training program on choosing the first lines of treatment. A total of 110 residents of otolaryngology were selected. Our study tools were obstructive sleep apnea knowledge and attitudes (OSAKA and OSAKA-KIDS) questionnaires. The participants were classified as junior and senior. Senior residents had significantly higher total knowledge score for OSAKA based on independent t test (12.73 Vs. 10.52). No significant difference was observed for OSAKA-KIDS (11.31 Vs. 10.69). The most frequent choice for the first line was CPAP (63.8%) and weight loss (41.5%) among junior and senior residents, respectively. Although the knowledge of otolaryngology residents increased during their program, the choice of first line treatment in obstructive sleep apnea was different between junior and senior residents. We found a need for further multidisciplinary education for residents especially in the management of sleep apnea particularly toward CPAP usage and this syndrome in pediatrics., Competing Interests: Conflict of interestThe authors report no conflicts of interest., (© Association of Otolaryngologists of India 2021.)

Obstructive sleep apnea (OSA) has various complications for individuals' health. This study aimed to evaluate the factors for referring obstructive sleep apnea patients to otolaryngologists in Iranian residency entrance examination volunteers. This cross-sectional study recruited volunteer participants from the Iranian Residency Entrance Examination on March 2, 2018. The Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA)/the Obstructive Sleep Apnea Knowledge and Attitudes in Children (OSAKA-KIDS) Questionnaires were distributed among residents attending exam preparation. Number of years working as a physician, number of adult and pediatric patients visited during the academic rank in residency examination, and the main specialty during general physician education in which they get familiar with obstructive sleep apnea were documented. The effect of the mentioned variables evaluated on patient referral preference specialty. Of the 95 volunteers, 57.9% were female; mean age was 29.6 ± 3.3 years. The overall knowledge score of the OSAKA questionnaire was 9.85 ± 3.9 and for the OSAKA-KIDS questionnaire was 9.2 ± 4.9. In patients under 18 years of age, the most frequent referrals were from otolaryngology specialists (51.2%). The only factor which had positive significant effect on adult patient referral preference was source of obstructive sleep apnea knowledge during general physician taring ( p  < 0.001). Given the low awareness about OSA in candidates for the residency entrance exam and the high importance of this treatable disease, the need for comprehensive training courses during residency is warranted and the adequacy of sleep apnea education through all involved specialty during general physician education should be improved., Competing Interests: Conflict of interestThe authors have no conflicts of interest to declare that are relevant to the content of this article., (© Association of Otolaryngologists of India 2021.)

Background: Prevalence of short and long sleep duration varies in different countries and changes over time. There are limited studies on Iranians' sleep duration, and we aimed to evaluate the prevalence of short and long sleep duration and associated factors among people living in Kermanshah, Iran., Methods: This population-based cross-sectional study was conducted between November 2014 and February 2017. Data was collected from 10,025 adults aged 35 to 65 years using census sampling, and we evaluated the short and long sleep duration (≤ 6 and ≥ 9 h, respectively) and its relation with the socio-demographic factors and health-related status of the participants., Results: Mean age of participants was 48.1 years (standard deviation = 8.2), and 47.4% of participants were male. Of our participants, 11.6% had short, and 21.9% had long sleep duration. Age ≥ 50 years, female gender, being single, mobile use for longer than 8 h per day, working in night shifts, moderate and good levels of physical activity, BMI ≥ 30, past smoking, and alcohol use were associated with short sleep duration (P < 0.05). Female gender and living in rural areas were associated with long sleep duration (P < 0.05)., Conclusion: In the Ravansar population, short and long sleep duration are prevalent, with long sleep duration having higher prevalence. People at risk, such as night shift workers, as well as modifiable factors, such as mobile phone use, can be targeted with interventions to improve sleep hygiene., (© 2022. The Author(s).)

Blind source separation (BSS) methods have received a great deal of attention in electroencephalogram (EEG) artifact elimination as they are routine and standard signal processing tools to remove artifacts and reserve desired neural information. On the other hand, a classifier should follow BSS methods to automatically identify artifactual sources and remove them in the following steps. In addition, removing all detected artifactual components leads to loss of information since some desired information related to neural activity leaks to these sources. So, an approach should be employed to detect and suppress the artifacts and reserve neural activity. This study introduces a novel method based on EEG and Poincare planes in the phase space to detect artifactual components estimated by second-order blind identification (SOBI). Artifacts are detected using a mixture of well-known conventional classifiers and were removed employing stationary wavelet transform (SWT) to reserve neural information. The proposed method is a combination of signal processing techniques and machine learning algorithms, including multi-layer perceptron (MLP), K-nearest neighbor (KNN), naïve Bayes, and support vector machine (SVM) which have significant results while applying our proposed method to different scenarios. Simulated, semi-simulated, and real EEG signals are employed to evaluate the proposed method, and several evaluation criteria are calculated. We achieved acceptable results, for example, 98% average accuracy and 97% average sensitivity in artifactual EEG component detection or about 2% as mean square error in EEG reconstruction after artifact removal. Results showed that the proposed method is effective and can be used in future studies as we have considered different real-world scenarios to evaluate it., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zangeneh Soroush, Tahvilian, Nasirpour, Maghooli, Sadeghniiat-Haghighi, Vahid Harandi, Abdollahi, Ghazizadeh and Jafarnia Dabanloo.)

Introduction: Narcolepsy is a chronic neurological and a genetic disorder of autoimmune origin, which is characterized by five main symptoms, including excessive day time sleepiness, sudden loss of muscle tone or cataplexy, sleep paralysis, hypnagogic hallucinations, and disturbed nocturnal sleep. While there are several diagnostic tests for Narcolepsy such as MSLT (mean sleep latency test), polysomnography and low range of hypocretin in cerebrospinal fluid (CSF), sensitivity and specificity in these methodologies are not sufficient enough. Therefore, methods with higher sensitivity for the accurate diagnosis and confirmation of the disease are necessary., Methods: According to the infrequent prevalence of narcolepsy disease, we scheduled a case-control association study with 20 narcoleptic patients and 150 healthy individuals in a high-resolution HLA typing procedure employing SSP-PCR., Results: Our study demonstrates that the DQB1*06:02 allele provides the highest susceptibility with absolute risk of 0.13%, for Narcolepsy (P = 1x10 -14 , RR = 60.5, PcPPV = 0.13%), while, HLA-DQB1* 03:05 allele presents protection to Narcolepsy (P = 1x10 -4 , PcPPV = 3.19x10 -4 %). Furthermore, for the first time, the AA analysis displayed that AA serine 182 and threonine 185 located on epitope of DQβ1 chain receptor (DQB1 Ser182, Thr185 ) present significant susceptibility for Narcolepsy (Pc= 87.03 × 10 -13 , PcPPV = 0.024%) while, asparagine 182 located on epitope of DQβ1 protein receptor (DQB1 Asn182 ) confers the highest protection against development of Narcolepsy (Pc= 2.16 × 10 -5 , PcPPV = 0.0012%)., Conclusion: Thus, this can be proposed that the polymorphic differences in the epitope of the HLA receptor could contribute to their differential association with the Narcolepsy in Iranian population.

Objective: Several studies confirmed a positive association between obstructive sleep apnea (OSA) and metabolic syndrome. Continuous positive airway pressure (CPAP) is the main treatment for patients with moderate and severe OSA. CPAP therapy in adults with OSA results in reduction in sleepiness, blood pressure and improvement of metabolic profile. In this study, we aimed to evaluate the effects of CPAP therapy on various components of metabolic syndrome and subjective sleep parameters in patients with OSA., Material and Methods: In this prospective trial study, 28 patients with moderate and severe OSA enrolled. Patients were asked to fill out the validated Persian version of questionnaires including Epworth sleepiness scale, insomnia severity index, STOP-BANG and Beck depression inventory - II, before and after treatment with CPAP. Weight and blood pressure were recorded before and after treatment. Only 14 patients agreed to blood sampling before and after CPAP therapy (at least 3 months of treatment). Fasting blood samples were analyzed for measuring the levels of FBS (fasting blood sugar), TG (triglyceride), total cholesterol, HDL, LDL, AST, and ALT., Results: Diastolic blood pressure, ISI and STOP-BANG score significantly decreased after treatment ( p -value: 0.008, 0.022 and 0.004, respectively). FBS and TG levels decreased after treatment, but only TG levels had significant difference ( p -value: 0.46 and 0.016, respectively)., Discussion: CPAP therapy had positive effects on diastolic blood pressure, TG levels and ISI score. More studies with larger sample size and longer follow-up periods are warranted to investigate the effects of CPAP therapy on blood pressure, and metabolic parameters.

Estimating the prevalence of SARS-CoV-2 antibody seropositivity among health care workers (HCWs) is crucial. In this study, the seroprevalence of anti-SARS-CoV-2 antibodies among HCWs of five hospitals of Tehran, Iran with high COVID-19 patient's referrals from April to June, 2020, was assessed. In this cross-sectional study, HCWs from three public and two private hospitals, selected randomly as a pilot, were included. Participants were asked questions on their demographic characteristics, medical history, hospital role, and usage of personal protective equipment (PPE). Iran FDA-approved SARS-CoV-2 ELISA kits were used to detect IgG and IgM antibodies in blood samples. The seroprevalence was estimated on the basis of ELISA test results and adjusted for test performance. Among the 2,065 participants, 1,825 (88.4%) and 240 (11.6%) HCWs were recruited from public and private hospitals, respectively. A total of 340 HCWs were tested positive for SARS-CoV-2-specific IgG or IgM antibodies, and 17.9% of seropositive individuals were asymptomatic. The overall test performance-adjusted seroprevalence estimate among HCWs was 22.6 (95% CI: 20.2-25.1), and PPE usage was significantly higher among HCWs of public vs. private hospitals (66.5 vs. 20.0%). This study found that seroprevalence of SARS-CoV-2 among HCWs was higher in private hospitals (37.0%; 95% CI: 28.6-46.2) than public hospitals (20.7%; 95% CI: 18.2-23.3), and also highest among assistant nurses and nurses, and lowest among janitor or superintendent categories. The PPE usage was especially suboptimal among HCWs in private hospitals. Continued effort in access to adequate PPE and regular screening of hospital staff for detecting asymptomatic personnel, especially during the upcoming wave of infection, are warranted., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Darvishian, Sharafkhah, Mohammadi, Sadeghniiat-haghighi, Abdollahi, Jafary, Talaschian, Tabarsi, Baghai, Mardani, Shayanrad, Shafighian, Markarian, Roozafzai, Zamani, Alvand, Hariri, Sadeghi, Poustchi and Malekzadeh.)

Sleep characteristics vary between populations. Detrimental sleep habits have cognitive consequences leading to daytime functioning debilitation. Until now no study has been done to investigate sleep characteristics in Iran thoroughly. In this study, we aimed to evaluate Iranians' sleep characteristics and their association with daytime functioning. We conducted a population-based study from January 2017 to May 2019 on people more than 18 years old who lived in 11 urban destricts and 3 rural areas of Tehran, Iran. We randomly selected the participants using a multistage random stratified clustered sampling method. We obtained the participants' demographic and anthropometric characteristics and details of bedtime, sleep duration, sleep onset latency, wake-up time and sleep impact on daytime functioning. Logistic regression model was used to assess the relationship between sleep characteristics) and daytime functioning. In total, 1830 people with a mean age of 40.83 years participated in the study. The gender distribution of the participants was even, and 70.98% of them were married. After adjusting for age and sex, the following three factors had a significant impact on daytime functioning: bedtime, sleep onset latency, and sleep duration. (OR = 1.12, P < 0.038, OR = 1.01, P < 0.011, and OR = 0.99, P = 0.01, respectively). We also found that longer sleep onset latency (P = 0.004) and shorter sleep durations (P = 0.029) significantly interfere with daytime functioning. Iranians' sleep characteristics, especially their sleep duration and sleep onset latency, are associated with their daytime function. Interventions on people's sleep hygiene are warranted to promote healthier sleep behaviors among Iranians, considering the high impact of current sleep characteristics on their daily lives., (© 2022. The Author(s).)

Background: Shift work may be associated with insulin resistance., Objective: This study aimed to investigate the potential association between shift work and the homeostatic model assessment of insulin resistance (HOMA-IR) index in professional drivers., Method: A total of four hundred fifty-three professional drivers were invited to participate in the study within a periodic medical examination in the occupational setting. One hundred seventy-seven daytime workers were compared with 175 night shifts and 101 early morning shift drivers. Demographic, occupational, and medical examination including blood pressure, anthropometric data was assessed. Measurement of serum insulin, fasting blood glucose and lipid profile were done for all drivers., Results: Compared with day workers, night shift and early morning shift drivers displayed higher levels of HOMA-IR. Metabolic syndrome was found to be significantly increased in night workers. In linear regression analysis, insulin resistance was correlated with shift work independently of demographic and occupational characteristics., Conclusion: The study revealed that shift work could be a risk factor in developing the risk of metabolic syndrome and insulin resistance. Suggestively, health strategies such as structured lifestyle counseling in occupational health settings are warranted to improve and modify cardiometabolic risk factors.

Introduction: Sleep quality in nurses along with workplace bullying, are concerned with nursing care quality. There exist a few investigations on workplace bullying and its relationship with sleep quality. This study aims at determining the impact of work schedules, workplace bullying, and some demographic characteristics on nurses' sleep quality., Material and Methods: This study was conducted on 333 nurses who worked in a hospital in Tehran, Iran. Sampling conducted from February 12 to April 23, 2020. Instruments of this study were Pittsburg sleep quality index and Quine's workplace bullying scale., Results: 63% of nurses had low sleep quality. Male nurses had lower sleep quality in comparison with females; 90% of nurses had encountered workplace bullying. Bullying and work schedules did not have a statistically significant effect on nurses' sleep quality., Conclusion: According to this study, work schedules and workplace bullying had no significant effect on nurses' sleep quality; but regarding that low sleep quality and encountering bullying is a cause of mental and physical problems for nurses and reduces the quality of care, it is recommended that nurses' sleep quality and facing the bullying behavior should be taken into account by hospital authorities.

Objective: COVID-19 pandemic has influenced almost every country worldwide. Being in a pandemic situation can cause psychological distress to people, which can lead to sleep disorders. The present study aimed to assess prevalence of depression, anxiety, and insomnia among Iranian people and their relations with COVID-19 fear in the early stages of COVID-19 pandemic. Method: A cross-sectional and population-based online study was designed. We created an online form and used Fear of COVID-19 scale (FCV-19), Generalized Anxiety Disorder 2 scale (GAD-2), Patient Health Questionnaire-2 (PHQ-2), and Insomnia Severity Index (ISI), to assess fear of COVID-19, anxiety, depression, and insomnia, respectively. We sent the link to the online survey to Iranians interested in participating in the study via social media, and 1223 Iranian completed the form. Results: A total of 1223 individuals with a mean age of 39.82 ± 10.75 years participated in the study. Prevalence of insomnia, depression and anxiety among our participants were 55.2%, 61.5%, and 50.9%, respectively. The mean FCV-19 score among the participants was 19.70 ± 5.08. Insomnia was more common among those who were 50 years or older. Fear of COVID-19 was related to a more risk of progression toward depression, anxiety, and insomnia. Conclusion: Fear of COVID-19 has a considerable association with depression, anxiety, and insomnia in the pandemic, and strategies to reasonably decrease people's fears can help to reduce incidence of psychological issues during the pandemic., (Copyright © 2022 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

The factors affecting the dynamics of lengthening of symptoms and serologic responses are not well known. In order to see how the serologic responses change in relation to the clinical features, we selected a group of 472 adults with a positive IgM/IgG antibody test result from a baseline study of the anti-SARS-CoV-2 seropositivity, assessed their COVID-19 and past medical histories, and followed them up in about 3 months. Nearly one-fourth of the subjects were asymptomatic at the baseline; 12.8% subjects became symptomatic at the follow-up (FU) when 39.8% of the subjects had some persisting symptoms. At the baseline, 6.1% showed anti-SARS-CoV-2 IgM positive, 59.3% only for IgG, and 34.5% for both. At the FU, these figures declined to 0.6, 54.0, and 4.4%, respectively, with the mean IgM and IgG levels declining about 6.3 and 2.5 folds. Blood group A was consistently linked to both sustaining and flipping of the gastrointestinal (GI) and respiratory symptoms. The baseline IgM level was associated with GI symptoms and pre-existing cirrhosis in multivariate models. Both of the baseline and FU IgG levels were strongly associated with age, male, and lung involvement seen in chest computed tomography (CT)-scan. Finally, as compared with antibody decayers, IgM sustainers were found to be more anosmic [mean difference (MD): 11.5%; P = 0.047] with lower body mass index (BMI) (MD: 1.30 kg/m 2 ; P = 0.002), while IgG sustainers were more commonly females (MD: 19.2%; P = 0.042) with shorter diarrhea duration in the FU (MD: 2.8 days; P = 0.027). Our findings indicate how the anti-SARS-CoV-2 serologic response and COVID-19 clinical presentations change in relation to each other and basic characteristics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Niavarani, Poustchi, Shayanrad, Sharafkhah, Mohammadi, Mansour-Ghanaei, Joukar, Roshandel, Hormati, Ghadimi, Sadeghniiat-haghighi, Abdollahi, Mardani, Bahadorimonfared, Ghanbari, Delavari, Vosoogh-Moghaddam, Zamani, Roozafzai, Alvand, Darvishian and Malekzadeh.)

The menopausal period is associated with several complications in women. One of these complications is sleep disorders including insomnia disorder that can affect all aspects of personal life. The present study aimed to evaluate the effectiveness of cognitive behavioural therapy for insomnia (CBT-I) on insomnia severity and sleep quality among postmenopausal women. This was a randomised clinical trial in which 46 women were recruited and randomly allocated into two groups, one receiving CBT-I and a control group. The CBT-I group received six sessions of training, while the control group received only usual care. A demographic questionnaire, Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI), were used to collect the data. The ISI and PSQI were measured at baseline, 3 and 6 weeks after intervention, and in a 4-week follow-up. The Independent t test, the chi-square test, generalised estimating equation models, and Bonferroni correction were applied to analyse the data. According to our results, in the CBT-I group compared to the control group, the mean ISI, PSQI, sleep onset latency, sleep time, and sleep quality score reduced continuously from baseline to week 3 and from week 3 to week 6, and remained constant from week 6 to week 10. The mean sleep efficiency score improved significantly from baseline to week 3 in the CBT-I group and remained unchanged until the end of the study. CBT-I could significantly improve insomnia severity and sleep quality in postmenopausal women. Therefore, using this method is recommended for menopausal women with insomnia., (© 2021 European Sleep Research Society.)

Background: Inflammation and sleep disturbances increase the risk of multiple diseases, including cardiovascular disease, type 2 diabetes and dementia. Since diet plays a significant role in inflammatory responses and sleep quality, this study aimed to investigate the association of a plant-based diet index (PDI) with sleep quality and inflammatory markers in overweight and obese women., Methods: 390 overweight and obese women aged 18-48 years participated in this cross-sectional study. A validated food frequency questionnaire (FFQ) was used to create an overall PDI, healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI). Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI). Higher scores on the PSQI were indicative of poor sleep. Anthropometric measurements and serum concentrations of high-sensitivity C-reactive protein (hs-CRP), interleukin 1 beta (IL-1β) and transforming growth factor-beta (TGF-β) were evaluated. Linear regression models were used to determine the association between exposure and outcomes., Results: After taking potential confounders into account, we found a significant inverse association between adherence to hPDI and hs-CRP (β = -0.14, 95% confidence interval [CI]: -0.22,0.06, P = .001) and a significant positive association between uPDI and hs-CRP (β = 0.13, 95% CI: 0.05,0.21, P = .001). Overall, PDI was significantly associated with TGF-β (β = 2.04, 95% CI: 0.54,3.55, P = .008). No association was detected between PDI indices and IL-1β. Higher adherence to uPDI was significantly associated with higher PSQI score (lower sleep quality) (β= 0.20, 95% CI:0.007,0.40, P = .04). A significant positive association was found between TGF-β (β = 0.05, 95% CI:0.005,0.10, P = .03) and hs-CRP (β = 0.32, 95% CI:0.02,0.62, P = .03) with PSQI., Conclusion: Our findings indicated a significant association between adherence to a plant-based diet with inflammation and sleep quality in obese and overweight females. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Sleep is an essential part of life, and sleep quality has a significant impact on individual well-being and performance. There is a bidirectional relationship between disturbed sleep and elevated levels of inflammatory markers. Diet plays a major part in sleep quality and its related health consequences. Plant-based diets are associated with lower risk of chronic diseases such as coronary artery disease (CAD), type 2 diabetes, obesity and reduced level of inflammation. WHAT DOES THIS ARTICLE ADD?: Adherence to a healthful plant-based diet is associated with lower level of hs-CRP, while adherence to an unhealthful plant-based diet is associated with higher concentrations of hs-CRP. Adherence to an unhealthful plant-based diet is associated with lower sleep quality., (© 2021 John Wiley & Sons Ltd.)

Objectives: There are limited studies on the psychological issues and sleep problems among the Iranian people living with HIV (HIV). In this study, we aimed to assess sleep disorders, psychiatric characteristics, and employment status among Iranian PLWH., Results: In total, 304 PLWH with a mean age of 40.01 (SD = 9.60) years participated in the study. About 72% of the participants had a global PSQI score of more than 5, with a mean score of 7.71 (SD = 3.31). About 55.6%, 50%, and 67.4% of subjects had abnormal scores for depression, anxiety, and stress. Unemployed participants had 2.13 times more chance (95% CI 1.01-4.53) of having poor sleep quality compared to employed patients, and stress increased its likelihood by 3.18 times (95% CI 1.47-5.88)., (© 2021. The Author(s).)

Objective: Numerous offshore jobs require 24-hour tasks, such as in industrial workplaces (eg, oil rigs). The purpose of this study was to assess shift work disorder (SWD), insomnia, daytime sleepiness, and depression among Iranian offshore oil rig workers in different shift schedules. Method : This cross-sectional study was conducted on Iranian offshore oil workers at the Persian Gulf. A questionnaire package consisted of Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI- II), and SWD filled. The scores were calculated among different groups of shift schedules (fixed-day, fixed-night, swing and standby shift workers). ISI, BDI-II, and ESS scores were also compared between individuals with or without SWD. Results: A total of 188 participants were recruited in the study, and all were male. The mean age was 37.06 ± 9.2 years. Among different shift schedules, the highest and lowest ISI and ESS scores were related to fixed-night shifts workers and fixed-day shift workers, respectively. ISI, ESS, and BDI mean scores in different shift schedules were not significantly different (p values = 0.14, 0.57, and 0.93, respectively). SWD was diagnosed in 57 (30.3%) of studied shift workers. The difference between SWD prevalence was not significant between different shift schedules (P value =0.13). Workers with SWD had higher ISI, ESS, and BDI-II score (P values <0.0001, <0.0001, and <0.0001, respectively) and workers without SWD had higher job satisfaction (p value = 0.04). Conclusion: SWD is considered as a serious health-related issue in Persian Gulf oil rig shift workers. Insomnia, daytime sleepiness, and depression are associated with SWD., (Copyright © 2021 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Background: Insomnia disorder is characterized by nighttime and daytime symptoms. The aim of this study was to assess the validity and reliability of a Persian version of the Insomnia Diurnal Impact Scale (IDIS) as a screening tool to evaluate diurnal effects of sleep fragmentation in Iranians., Methods: Of 300 individuals recruited, 150 had insomnia disorder based on DSM-5 criteria and 150 were good sleepers based on research diagnostic criteria. All subjects completed the IDIS, Pittsburg Sleep Quality Index, Insomnia Severity Index, Depression-Anxiety-Stress Scale-21, and sleep diaries., Results: The Persian version of the IDIS showed adequate psychometric properties for internal consistency and test-retest reliability. The result of principal component analysis confirmed a single component with six items as the final structure of the scale in the insomniac group. The total IDIS score significantly correlated with the Pittsburg Sleep Quality Index, Insomnia Severity Index, and subscales of Depression-Anxiety-Stress Scale-21 verifying the convergent validity of the scale. The Persian version of the IDIS significantly discriminated the insomniac group from the non-insomniac group. The result of the fit estimates for the one-factor unidimensional model met the previously specified fit criteria and adequately fit the data in the non-insomniac group., Conclusion: The Persian version of the IDIS was shown to be a valid and reliable clinical tool in evaluating the daytime consequences of insomnia in Iranians.

Objective: To assess the frequency of coronavirus disease-2019 (COVID-19) and the effect of obstructive sleep apnea (OSA) management on COVID-19 among patients with confirmed OSA., Design: Cross-sectional telephone interview survey., Setting: Academic sleep labs., Participants: Iranian adults ≥ 18 years old with confirmed OSA., Results: Among 275 participants with OSA, 20% (n = 55) were suspected to have history of COVID-19 but had no positive test, and 18% (n = 51) were in the definite COVID-19 group according to their reported symptoms or confirmed positive test. Having severe OSA (apnea hypopnea index ≥ 30) was associated with an increased risk of definite COVID-19, with an odds ratio (OR) with 95% confidence interval (95% CI) of 2.31 (0.87-5.55) compared to having mild OSA in definite COVID-19 group. Those not undergoing treatment for OSA had an OR (95% CI) of 2.43 (1.26-4.67) for definite COVID-19 compared to those accepting treatment in definite COVID-19 group. Total sleep times (TSTs) were 354, 340, and 320 minutes in healthy, suspected, and COVID-19 groups, respectively; TST was associated with COVID-19 (P-value = .04). Similarly, sleep efficiency (SE) scores were 75.7, 74.2, and 67.9% for the healthy, suspected, and COVID-19 groups, respectively (P-value = .005); Beck Depression scores were 13.8, 13.0, and 17.7, respectively (P-value = .056)., Conclusions: OSA as a proinflammatory condition with multiple comorbidities may be a contributing factor to developing COVID-19. Greater OSA severity, no treatment for OSA, and lower TST and SE were associated with increased COVID-19 prevalence among patients with OSA., (Copyright © 2020 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Given the potential impact of insomnia on nurses' performance, it is assumed that insomnia is associated with their absence from work. The present study aimed to determine the insomnia status and its association with absenteeism among a selective group of Iranian healthcare providers., Material and Methods: This cross-sectional study was conducted on 304 healthcare providers working at Imam-Khomeini hospital complex in Tehran. The study population were assessed by insomnia severity index for characterization of insomnia symptoms. The data of absenteeism was collected from the employees' attendance system of hospital's nursing and staff department. The multivariable linear regression model used for predicting determinants of insomnia and absenteeism in nursing team., Results: Different degrees of insomnia was found in 79.9% of the study population, which 57.2% suffered from mild insomnia, 21.4% from moderate insomnia, and 1.3% from severe insomnia. The prevalence of insomnia was significantly higher in persons who were absent from their workplace frequently, or left because of illness. The mean days for total absenteeism in healthcare workers with moderate to severe insomnia was significantly higher than others with mild and no insomnia. In multivariate analysis, having night shifts and the severity of insomnia could predict absenteeism in studied population., Discussion: A majority of healthcare workers suffer from insomnia that may lead to their work absenteeism and decreased performance. Proper administrative and individuals for management of sleep problems is required to avoid long hours of absenteeism among nursing team.

Objective: To investigate the prevalence of insomnia and its different phenotypes as well as their association with fear of COVID-19 in the general population., Material and Methods: This was a cross-sectional study conducted using an online survey (e-poll). All available participants who completed the online survey form were included in the current study. All individuals with a history of sleep problems were excluded. A questionnaire package consisted of insomnia severity index (ISI), and FCV-19 for corona fear was administered for all participants. Insomnia was defined as ISI≥8. Insomnia phenotypes were considered as: (a) DIS: difficulty initiating sleep; (b) DMS: difficulty maintaining sleep; (c) EMA: early morning awakening; and (d) combined insomnia., Results: A total of 1,223 participants [827 (67.6%) female, mean age=39.82±10.75 years old], enrolled in the current survey. Based on ISI, 675 (55.2% [95%CI=52.40-57.98]) were categorized into the insomnia group. Insomnia was more prevalent in females (p=0.006), participants with 50 years old or higher (p=0.04), or high fear of COVID-19 (p<0.0001). Totally, 67.4%, 66.4%, and 55% of all participants had DIS, DMS, and EMA, respectively, in the current outbreak. Besides, 79% had impaired daily functioning, 51.6% had impaired quality of life, and 62% were worried about their sleep problem. Notably that a considerable percentage of individuals with normal ISI scores had at least one insomnia phenotype or impaired daily functioning and quality of life. Further analyses revealed a significant increasing trend in all four insomnia phenotypes prevalence with an increase in fear of COVID-19 (all p-values<0.0001)., Conclusion: Individuals with higher age, female gender, or higher fear of COVID-19 are at higher risk of all types of insomnia as well as impaired daytime performance or quality of life.

Objectives: Modulation of sympathetic activity during acute sleep deprivation can produce various effects on body functions. We studied the effects of acute sleep deprivation before ischemia/reperfusion on myocardial injury in isolated rat hearts, and the role of sympathetic nervous system that may mediate these sleep deprivation induced effects., Methods: The animals were randomized into four groups (n = 11 per group): Ischemia- Reperfusion group (IR), Acute sleep deprivation group (SD), Control group for sleep deprivation (CON-SD) and Sympathectomy + ASD group (SYM-SD). In SD group, sleep deprivation paradigm was used 24 h prior to induction of ischemia/reperfusion. In SYM-SD group, the animals were chemically sympathectomized using 6-hydroxydopamine, 24 h before sleep deprivation. Then, the hearts of animals were perfused using Langendorff setup and were subjected to 30 min regional ischemia followed by 60 min of reperfusion. Throughout the experiment, the hearts were allowed to beat spontaneously and left ventricular developed pressure (LVDP) and rate pressure product (RPP) were recorded. At the end of study, infarct size and percentage of the area at risk were determined., Results: We found that SD increased LVDP and RPP, while reducing the myocardial infarct size. Moreover, sympathectomy reversed SD induced reduction in infarct size and showed no differences as compared to IR., Conclusion: This study shows cardioprotective effects of acute sleep deprivation, which can be abolished by chemical sympathectomy in isolated hearts of rats., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: We studied the clinical characteristics and outcomes of 905 hospitalized coronavirus disease 2019 (COVID-19) patients admitted to Imam Khomeini Hospital Complex (IKHC), Tehran, Iran., Methods: COVID-19 patients were recruited based on clinical symptoms and patterns of computed tomography (CT) imaging between February 20 and March 19. All patients were tested for the presence of COVID-19 RNA. The Poisson regression model estimated the incidence rate ratio (IRR) for different parameters., Results: The average age (± standard deviation) was 56.9 (±15.7) years and 61.77% were male. The most common symptoms were fever (93.59%), dry cough (79.78%), and dyspnea (75.69%). Only 43.76% of patients were positive for the RT-PCR COVID-19 test. Prevalence of lymphopenia was 42.9% and more than 90% had elevated lactate dehydrogenase (LDH) or C-reactive protein (CRP). About 11% were severe cases, and 13.7% died in the hospital. The median length of stay (LOS) was 3 days. We found higher risks of mortality in patients who were older than 70 years (IRR = 11.77, 95% CI 3.63-38.18), underwent mechanical ventilation (IRR = 7.36, 95% CI 5.06-10.7), were admitted to the intensive care unit (ICU) (IRR = 5.47, 95% CI 4.00-8.38), tested positive on the COVID-19 test (IRR = 2.80, 95% CI 1.64-3.55), and reported a history of comorbidity (IRR = 1.76, 95% CI 1.07-2.89) compared to their corresponding reference groups. Hydroxychloroquine therapy was not associated with mortality in our study., Conclusion: Older age, experiencing a severe form of the disease, and having a comorbidity were the most important prognostic factors for COVID-19 infection. Larger studies are needed to perform further subgroup analyses and verify high-risk groups., (© 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Coronavirus disease of 2019 (COVID-19) pandemic originated from Wuhan in December 2019 and has been spread in whole China and the world. Worldwide outbreaks of COVID-19 triggered a large number of morbidities and mortalities beside its economic and social burdens, which are discussed a lot, in scientific literature and different types of media. As a sleep medicine specialist, we may wonder how we can be involved in this field. In this short theoretical essay, we will discuss about the known facts as well as the hypotheses, which associate the sleep medicine to COVID-19. The discussed points may provide a source of research ideas throughout the world for better understanding of novel coronavirus-19 that has devastating effects on humanity.

Introduction: Increased use of shift work has led to more and more people working outside a traditional daytime schedule. Currently, approximately 20% of the labor force in developed countries is shift workers. Shift work can have devastating effects on employees' quality of life and sleep, leading to negative consequences for individuals and their families. This study evaluates the effect of different shift schedules (seven days/seven nights, fixed-day or fixed-night, and stand-by shift) on the sleep of oil rig shift workers., Participants and Methods: In this cross-sectional study, 43 offshore workers from the National Iranian Drilling Company were enrolled. Subjects were asked to complete a questionnaire package consisting of the Epworth Sleepiness scale and Pittsburgh Sleep Quality Index (PSQI). Changes in sleep patterns were measured using actigraphy for different shift schedules., Results: The mean age of the participants was 35.9 ± 7.9 years and the mean tenure with the drilling company was 10 ± 6.8 years. The mean total sleep time was 353 ± 58 min. The seven day/seven night shift workers had less total sleep time than the other three groups of shift workers. The mean PSQI and Epworth Sleepiness scale scores were 6.77 ± 3.1 and 7.49 ± 4.3, respectively. Twelve shift workers (27%) were diagnosed with shift work disorder in the current study and 31 participants had poor sleep quality according to PSQI score (≥5)., Conclusion: Poor sleep quality is common in oil rig shift workers. Further research is needed to evaluate sleep problems in oil rig shift workers., (Copyright © 2020 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Coronavirus pandemic has been announced by World Health Organization Director General on March 11th, 2020. Imam Khomeini Hospital Complex, affiliated to Tehran University of Medical Sciences, was one the first referral hospitals in the capital city of Tehran, I.R.Iran that entered the crisis and started a serious battle with the disease. The hospital had to change many routine operations to cope with the situation and during this journey, we used published leadership principles and reached to some new experiences. As this is probably the most severe health-related crisis in Iran in the past 100 years, we gathered our lessons learned in the first fifty days of epidemic from the leadership point of view to share those with all colleagues worldwide. We know that leadership is of pivotal role in such a massive crisis and focused leadership experiences can help health care providers to manage the crisis while we are in the middle of it.

Patients with Chiari type I malformation may also present with sleep disordered breathing mainly central sleep apnea. Here, we report a patient with Chiari I malformation referred to our clinic because of snoring and sleep disordered breathing. He was a 28-year-old man referred to us for evaluation of snoring. An overnight polysomnography revealed central sleep apnea. On further evaluation of central sleep apnea, the patient found to have Chiari malformation type I on brain MRI. The patient developed obstructive sleep apnea after surgery for Chiari malformation. Accordingly, pap titration was performed for the patient's obstructive sleep apnea. In patients with central sleep apnea comprehensive evaluation of predisposing causes is required. Lesions of central nervous system including Chiari malformation should not be overlooked. Furthermore, after treatment of central sleep apnea follow up PSG is warranted to confirm newly emerged sleep breathing disorder such as obstructive sleep apnea.

Background: Metabolic syndrome involves a set of metabolic risk factors that directly increases the risk of atherosclerotic cardiovascular disease. Physical inactivity due to driving can increase the risk of metabolic syndrome. It is also known that sleep disorders (sleep apnea) can result in MetS. Driving in Iran is considered a very popular but risky occupation, so paying attention to this profession is of special importance. Therefore, the researchers aimed to investigate the association between sleep disorders and metabolic syndrome in drivers in Shahroud city in 2018., Methods: This cross-sectional study was carried out on 948 drivers from Shahroud city in 2018. After obtaining consent from participants, 3 questionnaires including demographic, Epworth Sleepiness Scale and STOP-BANG were completed. Clinical and anthropometric measurements were assessed, including blood pressure, waist circumference, hip circumference, weight, height, and body mass index. In addition, blood was drawn to measure High Density Lipoprotein, Low Density Lipoprotein, Triglyceride, cholesterol, and Fasting Blood Sugar levels. The relationship between metabolic syndrome and sleep disorders was then studied. In this study, statistical analyses were performed using SPSS software version 23 at a significance level of 0.05., Results: Mean age of drivers was 44.15 ± 11.66 (years). The mean waist circumference and mean hip circumference in subjects with a Class 1 Driver's License (a certificate for trucks and buses) were higher than those with a Class 2 Driver's License (a certificate for motorcars, minibuses, vans, etc. (seating< 20)) (P = 0.01 and P = 0.003, respectively). Moreover, the BMI in subjects with a Class 1 Driver's License was higher compared to subjects with a Class 2 Driver's License. The correlation between metabolic syndrome with sleep apnea based on STOP-BANG questionnaire was significant (p < 0.001) irrespective of definition (ATP and IDF)., Conclusions: According to the results of this study, there was a bi-directional association between sleep disorders and Mets, so this group should pass periodic medical examinations and training courses. Moreover, their families should be informed of prevention and treatment of this syndrome.

Background: Insomnia is an important problem in medical sciences students and has implications for their educational progress. The current study aimed to estimate the prevalence of sleep disorders and investigating the impact of sweet almond on quality of sleep in students of the Tehran University of Medical Sciences (TUMS), Tehran, Iran who live in dormitories., Methods: This is a before-after study conducted in 2017. At first, using the ISI questionnaire prevalence of sleep disorders was determined. Sweet almond was the study intervention. Each day, 10 almonds were given to 446 students for 14 d. At the end of the second week, again ISI questionnaire was filled. SPSS was used to analyze data. The McNemar, Wilcoxson Signed Ranks, and Repeated Measures tests were used., Results: Out of 442 participants, 217 (49.1%) were female. Before intervention, 343 (77.6%) had insomnia and 99 (22.4%) had normal sleep. After intervention, 306 (69.2%) had insomnia and 136 (30.8%) had normal sleep. Having sweet almond for two weeks is associated with reducing insomnia ( P <0.05). Investigating the almond impact in different categories also showed that it has a reducing impact on severe, mild, weak and normal sleep categories ( P <0.05)., Conclusion: Sweet almond has impacts on quality of sleep of those students of the TUMS that are living in dormitories. Intervention programs to improve quality of sleep are necessary and with regard to the high prevalence of insomnia, students must be protected, guided and consulted., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Background: Insomnia is a prevalent disorder leading to psychological problems such as anxiety and depression., Methods: This study investigates the effect of a combination of herbs ( Melissa officinalis L. and Nepeta menthoides Boiss. & Buhse) on anxiety and depression for insomniacs and on insomnia severity. This study is a double-blind randomized placebo-controlled clinical trial. A total number of 67 participants met the inclusion criteria who were diagnosed as cases of insomnia. The patients were randomized into the herbal treatment or placebo groups. The herbal treatment group received a combination of Melissa officinalis and Nepeta menthoides Boiss. & Buhse. The primary outcomes were insomnia, depression and anxiety. We used per-protocol analysis., Results: The all outcomes of herbal treatment were significantly improved compared with placebo in the ISI, BAI and BDI scores after four weeks' treatment ( p value: 0.008, 0.005 and <0.001 respectively)., Conclusion: A combination of Melissa officinalis L. and Nepeta menthoides Boiss. & Buhse may improve insomnia and its comorbid depression and anxiety.

Background: It has been implicated that obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular disease including stroke, myocardial infarction, coronary artery disease (CAD) and hypertension. The aim of this study was to investigate the correlation between OSA and severity of atherosclerosis assessed by angiography., Methods: This study included 337 patients undergoing diagnostic coronary angiography at Tehran Heart Center, Iran. The Gensini score was obtained from each patient for coronary angiogram, and OSA were assessed by using Multivariable apnea prediction (MAP) risk index on the day of cardiac catheterization. The Gensini scores increased in accordance with increases in the MAP value., Results: The prevalence rates of three-vessel disease were 68.0% in OSA group and 32.0% in non-OSA group. The MAP index was the most significant independent determinant for the Gensini score., Conclusions: The independent association between OSA and CAD, even after adjustment for traditional confounders, suggests that, OSA should be taken into account when considering risk factors for CAD., Competing Interests: none

Background: Insomnia is a prevalent sleep disorder that has not been well managed thus far. There are numerous medicaments for treatment of insomnia, but they have undesirable side effects that make herbal medicine a more viable option., Objectives: The effectiveness of a combination of Melissa officinalis L. (dry powder) and Nepeta menthoides Boiss. & Buhse (freeze-dried aqueous extract) on insomnia was evaluated., Design and Setting: Insomniacs who met the entry criteria participated in a triple-blind randomized placebo-controlled clinical trial at the Persian Medicine (PM) clinic in Tehran., Interventions: The subjects received either 1000 mg of M. officinalis plus 400 mg N. menthoides or a placebo nightly for four weeks in accordance with prescriptions from the pharmaceutical manuscripts on PM and the results of previous studies., Outcome Measures: The Pittsburgh Sleep Quality Index (PSQI), sleep diary, and Insomnia Severity Index (ISI) were used for assessment of insomnia., Results: Comparison of the treatment and placebo groups showed a significant decrease in the mean difference of ISI (4.97 ± 4.69 vs. 1.60 ± 3.70; p =; 0.002) and total PSQI (4.14 ± 3.69 vs. 1.42 ± 2.81; p = 0.001) scores in the treatment group. A significant increase was also observed in total sleep time of treatment group (p < 0.001) based on the sleep diary., Conclusions: A combination of M. officinalis and N. menthoides Boiss. & Buhse could be an alternative sleep improvement therapy.

One of the important reasons for accidents is sleepiness.With this description, the sleep disorders are associated with health and mortality, and not only affect the person but also the family and the whole society. Aim of this study was assessing of relationship between Sleep Quality, Obstructive sleep Apnea and Sleepiness during day with related factors in professional drivers. This was a cross-sectional study measuring correlation between sleep quality questionnaire (Pittsburgh Sleep Quality Index or PSQI), Epworth Sleepiness Scale (ESS) and Stop Bang questionnaire (STOP BANG).the appropriate sample size to achieve a 95% confidence level was 943 people. The study population was chosen among qualified drivers using a convenience sampling method that took place over 12 months duration. Exclusion criterion consisted of the presence of a physical or mental disability. Data analyzed by software SPSS, version 15. In this study, all drivers were men with mean of age 36±9/5 year (minimum 22 year and maximum 72 year), 799 (84.7%) were married, 535 (56.7%) had high school education. Also, 96.4 % of drivers had undesirable sleep quality, 25.8% obstructive sleep apnea and 6.8% abnormal sleepiness during day. Multiple linear regression test showed, Score of STOP-Bang was correlated with smoking (OR (β)=0/2, P=0.006) and history of hurt disease (OR (β)=0.95, P=0.003), shift work (OR (β)=0.19, P=0.006) more probability. Moreover, PSQI was statistically significant with shift work (OR (β)=0.44, P=0.02), smoking (OR (β)=0.98, P=0.001), history of pulmonary disease (OR (β)=3.58, P=0.009) more probability , and ESS was statistically significant with smoking (OR (β)=0.64, P=0.007) and history of pulmonary disease(OR (β)=2.82, P=0.006), shift work (OR (β)=0.59, P=0.008) more probability. In our study, according to the results, it should be planning to reduce the driving time in day and night and also it are recommended short breaks during driving. It is suggested the more widespread and prospective studies, as well as informing the drivers about the benefits of proper sleep and annual checkup drivers of health.

Narcolepsy is a rare, disabling disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations and sleep paralysis. Several studies demonstrated its association with HLA-DQB1*0602 in various ethnic groups. Our study aimed to determine the prevalence of HLA-DQB1*0602 allele in Iranian patients with narcolepsy and assess its predictive parameters for diagnosing narcolepsy. In addition, car accidents and job problems were assessed among narcoleptic patients. We studied 44 narcoleptic patients, 30 patients with other types of excessive daytime sleepiness (EDS)  and 50 healthy age and sex matched individuals in this case-control study. Patients and controls filled out a questionnaire including items about car accidents due to sleepiness and job problems. International classification of sleep disorders-2 criteria was used as the gold standard for diagnosis of narcolepsy. The DNAs isolated from whole blood samples were collected from the patients and controls to assess the presence of HLA-DQB1*0602. The results showed that HLA DQB1*0602 was present in 4 (8%) individual of controls and 20 (45.5%) patients with higher prevalence in patients with cataplexy (78.9%) than patients without cataplexy (p<0.001). The sensitivities of the DQB1*0602 for diagnosing narcolepsy with cataplexy and narcolepsy without cataplexy were 78.9 and 20; specificities were 88 and 72.4, respectively. 18.2% of patients had car accidents due to sleepiness and 68.2% suffered from job problems. Our study shows that evaluation of DQB1*0602 in patients suspected to narcolepsy could be helpful especially in complex cases with atypical cataplexy and indistinguishable multiple sleep latency test MSLT results. Moreover, high rates of car accidents and job problems are found among narcoleptic patients.

Background: Disturbed sleep is common in shift work. It is hypothesized that administration of exogenous melatonin could reduce the sleep latency and improve the sleep quality., Objective: To evaluate the efficacy of 3 mg melatonin taken 30 min before night time sleep on shift workers with difficulty falling asleep., Methods: Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were applied to find out shift workers with difficulty falling asleep. A randomized, double-blind, placebo-controlled crossover study with periods of 3 night and washouts of 2 weeks comparing melatonin with placebo was performed. Night time sleep parameters obtained from somnowatch including total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE) and wakening after sleep onset (WASO) were analyzed., Results: Among 295 workers, 103 had difficulty falling asleep. Finally, from 50 randomly selected workers with difficulty falling asleep, 39 workers completed the study. Melatonin treatment significantly increased SE and decreased SOL in comparison with baseline and taking placebo. SE was increased from 82.1% at baseline to 85.5% after melatonin therapy. Also SOL was decreased from 0.27 h at baseline to 0.20 h after melatonin therapy. Effects of Melatonin administration on TST and WASO were not significant., Conclusions: This study showed that melatonin therapy in shift workers with difficulty falling asleep significantly improved the sleep onset latency and sleep efficiency.

Purpose: Iran has a high rate of road traffic accidents. Poor quality of sleep brings about loss of attention, which is an important cause of road traffic accidents particularly in monotonous roads. The causes of poor quality of sleep in occupational drivers are multifactorial. The objective of the present study was to assess the prevalence of poor sleep quality among occupational drivers with rotating work schedules and analyze its different risk factors., Methods: 2200 professional long-haul truck drivers who had been referred to the Occupational Health Clinic for routine education course were invited. We obtained data from eight provinces from various parts of Iran during 2012-2013. Data were collected using a questionnaire including questions about demographic and job characteristics. Pittsburg Sleep Quality Index (PSQI) was used to assess drivers' sleep quality., Results: Mean working (driving) time was (9.3±2.5) hours daily and (55.5 ± 18.29) hours weekly. About 23.5% of the drivers reported history of smoking, 14.5% had low job satisfaction and 60% had irregular work schedule. 16.4% of drivers had an accidents leading to injury during the past five years. The mean PSQI score was 4.2 ± 2.7; 54% had a PSQI>5 (poor quality of sleep). Multivariate logistic regression showed that smoking, job satisfaction, history of accidents, shift work and work hours per day were the most important risk factors for poor sleep quality., Conclusion: Results obtained from the current study showed a high prevalence of poor quality of sleep among professional drivers. It warrants more attention to this significant problem using some measures to improve working conditions in professional drivers, as well as health promotion interventions.

Purpose: The aim of this study was the translation, cross-cultural adaptation, and validation of the Sleep Apnea Quality of Life Index (SAQLI) in Persian-speaking patients with obstructive sleep apnea (OSA)., Methods: Ninety-six patients with OSA completed a series of questionnaires including SAQLI, Epworth Sleepiness Scale (ESS),10-item Functional Outcomes of Sleep Questionnaire (FOSQ-10), and Medical Outcome Survey Short form 12 (SF-12) for assessment of reliability, validity, and responsiveness of Persian version of SAQLI., Results: The Persian version of SAQLI had a very good internal consistency and also demonstrated good test-retest reliability. Concurrent validity was confirmed by significant correlations with ESS, FOSQ-10 and SF-12 subscale scores. Comparison of SAQLI scores in groups of patients categorized by ESS showed the high discriminative power of this instrument. However, there was no significant difference in the SAQLI scores of patients with mild, moderate, and severe sleep apnea. The results of sensitivity to change verified that the SAQLI was able to detect changes after continuous positive airway pressure (CPAP) treatment., Conclusion: The findings of this study indicate that the Persian version of SAQLI is a reliable, valid, and responsive measure for evaluation of quality of life in patients with OSA.

Purpose: The purpose of this study was to evaluate the psychometric properties of the Farsi version of 10-item Functional Outcomes of Sleep Questionnaire (FOSQ-10) in Iranian patients with obstructive sleep apnea (OSA)., Methods: The FOSQ-10 was translated into Farsi using the standard forward-backward method. One hundred patients who fulfilled the inclusion criteria completed a series of questionnaires including IR-FOSQ-10, Medical Outcome Survey Short Form 12 (SF-12) and Epworth Sleepiness Scale (ESS). Internal consistency, test-retest reliability, concurrent validity, discriminant validity and responsiveness of IR-FOSQ-10 were investigated., Results: The Cronbach's alpha coefficient was 0.85 in IR-FOSQ-10 total score and ranged from 0.78 to 0.83 in each subscale. The test-retest reliability demonstrated by intraclass coefficient was 0.92. There were significant moderate-to-good negative correlations between IR-FOSQ-10 subscales and ESS except for sexual relationship subscale. FOSQ-10 subscales generally correlated higher with related subscales of SF-12. The IR-FOSQ-10 was able to distinguish patients with abnormal sleepiness score from those with normal sleepiness score. The results of sensitivity to change proved that the IR-FOSQ-10 was able to detect changes after continuous positive airway pressure therapy., Conclusion: The psychometric properties of the IR-FOSQ-10 suggest that it is a reliable and valid measure among Iranian patients with OSA.

The most common chronic occupational lung disease is occupational asthma. This study aimed to assess the prevalence of work-related respiratory symptoms (WRS) in asthmatic adults at pulmonary clinics. A cross-sectional study was performed. Current employed subjects were subdivided into 2 groups by WRS status according to questionnaire mainly based on one developed by the National Institute for Occupational Safety and Health (NIOSH). Subjects' occupation and workplace exposures were evaluated by asthma-specific job exposure matrix (JEM). Thirty-nine of 179 current employed asthmatics had WRS. Subjects with WRS were more likely to have self-reported allergy and exposure to low-molecular-weight antigens (prevalence ratio [PR]: 2.7). The 2 most frequent occupational classes for asthmatics with WRS were trades, transport and equipment operators, and processing and manufacturing. Self-reported allergy, high-risk exposures, and occupations unique to processing, manufacturing, and utilities were estimated to be risk factors of WRS.

Recent evidence suggests that lack of slow-wave activity may play a fundamental role in the pathogenesis of insomnia. Pharmacological approaches and brain stimulation techniques have recently offered solutions for increasing slow-wave activity during sleep. We used slow (0.75 Hz) oscillatory transcranial direct current stimulation during stage 2 of non-rapid eye movement sleeping insomnia patients for resonating their brain waves to the frequency of sleep slow-wave. Six patients diagnosed with either sleep maintenance or non-restorative sleep insomnia entered the study. After 1 night of adaptation and 1 night of baseline polysomnography, patients randomly received sham or real stimulation on the third and fourth night of the experiment. Our preliminary results show that after termination of stimulations (sham or real), slow oscillatory transcranial direct current stimulation increased the duration of stage 3 of non-rapid eye movement sleep by 33 ± 26 min (P = 0.026), and decreased stage 1 of non-rapid eye movement sleep duration by 22 ± 17.7 min (P = 0.028), compared with sham. Slow oscillatory transcranial direct current stimulation decreased stage 1 of non-rapid eye movement sleep and wake time after sleep-onset durations, together, by 55.4 ± 51 min (P = 0.045). Slow oscillatory transcranial direct current stimulation also increased sleep efficiency by 9 ± 7% (P = 0.026), and probability of transition from stage 2 to stage 3 of non-rapid eye movement sleep by 20 ± 17.8% (P = 0.04). Meanwhile, slow oscillatory transcranial direct current stimulation decreased transitions from stage 2 of non-rapid eye movement sleep to wake by 12 ± 6.7% (P = 0.007). Our preliminary results suggest a sleep-stabilizing role for the intervention, which may mimic the effect of sleep slow-wave-enhancing drugs., (© 2015 European Sleep Research Society.)

Purpose: The snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck circumference, gender (STOP-BANG) is a concise and effective obstructive sleep apnea (OSA) screening tool, part questionnaire (STOP), and part demographic or anthropometric measurements (BANG). The main purpose of this study was to translate this well-liked questionnaire into Persian and assess its reliability and validity in sleep clinic population., Methods: Standard forward-backward method was used for translation. A sample of 603 patients, who admitted to the sleep clinic, completely answered to the STOP questionnaire and underwent in-laboratory polysomnography, included in this study. Height, weight, and neck circumference were measured by technicians for calculating BANG score. The apnea-hypopnea index (AHI) on the polysomnography was used as gold standard for OSA diagnosis: none (AHI < 5), mild (5 ≤ AHI < 15), moderate (15 ≤ AHI < 30), and severe (AHI ≥ 30). One hundred and forty one patients were answered to the STOP questionnaire twice at a time interval of 2-4 weeks for test-retest analysis., Results: In reliability analysis, 124 (87.9 %) patients had same STOP score and 130 (92.2 %) patients were classified in same risk of OSA. Based on the polysomnography, 438 patients (72.6 %) had mild (n = 124, 20.4 %), moderate (n = 114, 18.9 %), and severe (n = 201, 33.3 %) OSA, whereas according to the STOP-BANG, 502 patients (83.3 %) were at high risk of OSA. The sensitivity and specificity of the STOP-BANG were found to be 91.6 and 45.2 %, respectively, at AHI ≥ 5, 97.1 and 35.2 %, respectively, at AHI ≥ 15, and 98 and 29.4 %, respectively, at AHI ≥ 30. The area under the curve of the STOP-BANG for identifying mild, moderate, and severe OSA was 0.805, 0.779, and 0.755, respectively., Conclusions: Persian version of the STOP-BANG performs similar to its original version and is an easy-to-use questionnaire which could be considered as a reliable and valid tool for OSA screening.

Background: Galvanization is the process of coating steel or cast iron pieces with a thin layer of zinc allowing protection against corrosion. One of the important hazards in this industry is exposure to zinc compounds specially zinc oxide fumes and dusts. In this study, we evaluated chronic effects of zinc oxide on the respiratory tract of galvanizers., Methods: Overall, 188 workers were selected from Arak galvanization plant in 2012, 71 galvanizers as exposed group and 117 workers from other departments of plants as control group. Information was collected using American Thoracic Society (ATS) standard questionnaire, physical examination and demographic data sheet. Pulmonary function tests were measured for all subjects. Exposure assessment was done with NIOSH 7030 method., Results: The Personal Breathing Zone (PBZ) air sampling results for zinc ranged from 6.61 to 8.25 mg/m³ above the permissible levels (Time weighted average; TWA:2 mg/m³). The prevalence of the respiratory symptoms such as dyspnea, throat and nose irritation in the exposed group was significantly (P<0.01) more than the control group. Decreasing in average percent in all spirometric parameters were seen in the galvanizers who exposed to zinc oxide fumes and dusts. The prevalence of obstructive respiratory disease was significantly (P=0.034) higher in the exposed group., Conclusions: High workplace zinc levels are associated with an increase in respiratory morbidity in galvanizers. Therefore administrators should evaluate these workers with periodic medical examinations and implement respiratory protection program in the working areas.

Restless leg syndrome (RLS) is a distressing sleep disorder that is commonly experienced by patients undergoing maintenance hemodialysis. The aim of this study was to assess the prevalence of RLS and its related factors among hemodialysis patients. This was an analytical cross-sectional study that was performed on hemodialysis patients of the Bu"Ali Hospital of Qazvin during 2009 and 2010. One hundred and twelve patients were selected by the census sampling method as the study sample. Data collection was performed using the Insomnia Severity Index (ISI), Pittsburg Sleep Quality Index (PSQI), Berlin, Epworth Sleepiness Scale (ESS) and International Restless Leg Syndrome Study Group criteria (IRRLS) questionnaires. Student's ttest and chi-square test were applied to analyze the collected data. RLS complaints were very common among patients on long-term dialysis therapy and were reported in about 42.9% of the patients. Patients with RLS had higher daytime sleepiness, insomnia complaints and poorer sleep quality. Percentage of patients in the high-risk group was higher in the RLS group. RLS symptoms appear to be correlated with age (P = 0.012) and use of sedative drugs (P = 0.035). RLS is common in dialysis patients and is associated with a higher prevalence of other sleep disturbances. Therefore, the effective assessment and management of this sleep disturbance has the potential to significantly enhance patient outcomes.

Background: Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG., Methods: This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifestyle training plus designed intervention based on the PRECEDE-PROCEED model) or to the control group (recipient of exercise and lifestyle training). Eight training sessions over 8 weeks were conducted for the intervention group. Predisposing, enabling, and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points., Results: The mean age of the patients in the intervention (24% women) and control (24% women) groups was 59.3 ± 7.3 and 59.5 ± 9.3 years, respectively. The results showed that the mean scores of SQ (p value < 0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep self-efficacy (p value < 0.001), enabling factors (p value < 0.001), reinforcing factors (p value < 0.001), and social support (p value < 0.001) were significantly different between the intervention and control groups after the intervention., Conclusion: Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients.

Workers' fatigue is a significant problem in modern industry, largely because of high demand jobs, long duty periods, disruption of circadian rhythms, and accumulative sleep debt that are common in many industries. Fatigue is the end result of integration of multiple factors such as time awake, time of day, and workload. Then, the full understanding of circadian biologic clock, dynamics of transient and cumulative sleep loss, and recovery is required for effective management of workplace fatigue. It can be more investigated in a new field of sleep medicine called occupational sleep medicine. Occupational sleep medicine is concerned with maintaining best productivity and safety in the industrial settings. The fatigue risk management system (FRMS) is a comprehensive approach that is based on applying scientific evidence of sleep knowledge to manage workers fatigue. It is developing rapidly in the highly safety demand jobs; especially truck drivers, pilots, and power plant workers. The objective of this review is to explain about fatigue in the workplace with emphasis on its association work performance and errors/accidents. Also, we discussed about different methods of fatigue measurement and management.

Professional firefighting is among the most demanding jobs. Prior studies have showed the notable prevalence of poor sleep quality among professional firefighters that may result in catastrophes. The aim of this study was in field confirmation of zolpidem usage (10 mg/PO/bed time) for short term management of poor sleeps quality among professional firefighters. In a double-blind, randomized, placebo-controlled crossover clinical trial among professional firefighters, 27 poor sleepers were assigned randomly to one of the two groups. Two 14 days experimental periods were separated by a 14-day washout phase. Sleep quality was assessed using the Persian version of Pittsburgh Sleep Quality Index (PSQI). Six of the 27 enrolled voluntaries dropped out. Two rare side effects of zolpidem occurred in the study. A significant improvement of the PSQI score was detected in zolpidem period versus placebo in both groups (7.14 ± 3.02 vs 12.38 ± 2.51, P<0.001) although zolpidem had no significant effect on time of waking up (6.76 ± 1.21 vs.6.64 ± 1.27, P=0.89). Zolpidem significantly improved all components of PSQI (Subjective sleep quality, Sleep latency, Sleep duration, Habitual sleep efficiency, Sleep disturbances and Daytime dysfunction) in the current study except the use of sleep medication. Sleep onset latency was the component of PSQI with the greatest degree of abnormality among firefighters in a previous study. Interestingly, sleep latency was the component of PSQI with the most treatment effect of zolpidem in the current study. Zolpidem can be used asa part of treatment regimens in short time management of poor sleep quality among professional firefighters.