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Background: Chronic insomnia disorder is a common sleep disorder. Previous studies have reported increased demand for anesthetics in patients with chronic insomnia disorder. However, few studies have investigated the effective dose of dexmedetomidine for sedation in patients with chronic insomnia disorder. We aimed to determine the 95% effective dose of dexmedetomidine to induce adequate sedation in patients with chronic insomnia disorder. Methods: This is a biased coin design up-and-down sequential allocation trial in patients aged 18–65 years with chronic insomnia disorder (n = 60). The dose of dexmedetomidine for the subsequent patient was determined based on the response of the previous patient, with an interval of 0.1 µg/kg. Sedation was assessed using the bispectral index. The 95% effective dose was calculated using isotonic regression. Results: The 95% effective dose of dexmedetomidine to induce adequate sedation in patients with chronic insomnia disorder was 1.75 (95% confidence interval, 1.70–1.94) µg/kg. Four patients (6.7%) experienced bradycardia and no other adverse events were observed during the study. Conclusions: The 95% effective dose of dexmedetomidine to induce adequate sedation in patients with chronic insomnia disorder was 1.75 µg/kg. Trials registration: Chinese Clinical Trial Registry (ChiCTR2200063212); first registered 01/09 /2022. [ABSTRACT FROM AUTHOR]

Melanin concentrating hormone (MCH) controls many brain functions, such as sleep/wake cycle and memory, and modulates the inflammation response. Previous studies have shown that influenza A virus (IAV) infection-induced neuroinflammation leads to central nervous damage. This study investigated the potential effects of MCH against neuroinflammation induced by IAV infection and its mechanism. MCH (1 and 2 mg/ml) was administrated for 5 consecutive days before IAV infection. Pentobarbital-induced sleep tests, an open-field test, and a Morris water maze were performed to measure sleep quality, spatial learning and memory ability. Neuronal loss and microglial activation were observed with Nissl staining and immunofluorescence assay. The levels of inflammatory cytokines and the expression of the JNK/ERK signaling pathway were examined by ELISA and western blot. IAV infection led to poor sleep quality, impaired the ability of spatial learning and memory, caused neuronal loss and microglial activation in mice's hippocampus and cortex. Meanwhile the level of inflammatory cytokines increased, and the JNK/ERK signaling pathway was activated after IAV infection. MCH administration significantly alleviated IAV-induced neuroinflammation, cognitive impairment, and sleep disorder, decreased the levels of inflammatory cytokines, and inhibited neuronal loss and microglial activation in the hippocampus and cortex by regulating the JNK/ERK signaling pathway. Therefore, MCH alleviated the neuroinflammation, spatial learning and memory impairment, and sleep disorder in IAV-infected mice by regulating the JNK/ERK signaling pathway. Highlights: IAV infection could cause the sleep disorder, impairment of the spatial learning and memory. IAV infection could cause the neuronal loss and activation of microglia, increase the inflammatory cytokines to result in neuroinflammation. MCH alleviated the cognitive impairment and sleep disorder in IAV-infected mice. MCH inhibited the neuron damage, microglia activation, and inflammatory cytokines expression, to alleviate the neuroinflammation in IAV-infected mice. MCH alleviated the neruoinflammation in IAV-infected mice by regulating the JNK/ERK signaling pathway. [ABSTRACT FROM AUTHOR]

Background: The Egyptian health system faces numerous challenges, including overpopulation, limited resources, and high patient load. Long working hours, inadequate sleep, and exposure to traumatic events further strain health care workers. This study aims to investigate the association between physical activity and psychosocial status of healthcare professionals in Egypt. Methods: This cross-sectional study was conducted in Egypt from 20th March to 20th April 2023. An online self-administered survey was used to recruit 647 healthcare professionals. The International Physical Activity Questionnaire (IPAQ) and Psychosocial Index (PSI) were used to measure physical activity and psychosocial status, respectively. Results: Among the 647 participants, 82% were aged 24–30 years, with 49.9% females and 66.5% doctors. Only 41% engaged in physical activity, and among them, only 5.7% exercised more than three times per week. The median work hours per week were 36, and based on the Total Work MET, participants were classified into high (32%), moderate (40%), and low (28%) physical activity levels. Half of the participants experienced highly stressful lives, while only 40% reported good-to-excellent well-being. Physical activity correlated with psychological distress (r = 0.116, p = 0.003) and abnormal illness behaviors (r = 0.081, p = 0.038), while average working hours per week correlated with psychological distress (r = 0.084, p = 0.033) and sleep disturbance (r = 0.14, p < 0.001). Conclusion: In this study, physical activity levels varied among participants, and the majority of participants had a poor psychological status. Additionally, physical activity significantly correlated with psychological distress and abnormal illness behaviors, while average working hours per week correlated with psychological distress and sleep disturbance. [ABSTRACT FROM AUTHOR]

Internet gaming disorder (IGD) refers to sustained, uncontrolled online gaming behavior associated with negative consequences. Previous research has revealed that IGD was a risk factor for daily impaired cognitive outcomes. However, the potential underlying mechanisms are not clear. The present study aimed to examine the mediating role of sleep quality and the moderating role of mindfulness in the link between IGD and daily cognitive failures. Data are from 851 university students using self-reported questionnaires. The results indicated that IGD positively predicted daily cognitive failures and sleep quality partially mediated this association. Furthermore, mindfulness did not regulate the direct pathway between IGD and daily cognitive failures. It moderated the mediating effect of sleep quality, specifically, low mindfulness amplified the positive effect of IGD on daily cognitive failures through sleep quality. This study contributes to a better understanding of the negative influence of IGD on cognitive ability and facilitates the development of targeted prevention strategies aimed at reducing sleep problems and cognitive deficits in daily life for university students with IGD. [ABSTRACT FROM AUTHOR]

ABSTRACT Propranolol has been the primary treatment for infantile hemangioma (IH) since 2008. Prior studies have investigated the effects in late childhood of propranolol therapy given in infancy for IH, including neurocognitive dysfunction, sleep disorders, and hypoglycemia. However, few studies have determined the risk of these adverse effects later in life. Using the TrinetX database, we studied the risk of growth impairment, sleep disorders, learning disabilities, and diabetes mellitus in children aged 10–17 years who had received propranolol for IH in infancy. The maximum age of 17 years was chosen for the study, as propranolol was established as a treatment for IH in 2008. The results showed no statistically significant risk of growth impairment, sleep disorders, learning disabilities, or diabetes mellitus in IH patients treated with propranolol. These findings support existing evidence that propranolol therapy given in infancy for IH is not associated with long‐term adverse effects up to age 17 years in the studied patient population. [ABSTRACT FROM AUTHOR]

Investigating the characteristics of the gut flora in children who go to bed early versus late. The study sample consisted of 88 healthy children aged 2–14 years, with an equal number of boys and girls. The researchers collected faecal samples from all participants and sequenced the genome of their gut flora. Findings indicate that beta diversity was statistically significant at the genus level for both the early and late sleeper groups (P = 0.045). Furthermore, alpha diversity indicators, including Simpson's index (P = 0.0011) and Shannon's index (P = 0.0013), exhibited higher values at the genus level. The differences observed in terms of species diversity, abundance, and metabolic pathways offer potential avenues for implementing pharmacological interventions aimed at addressing sleep disorders in children. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsConclusionsSleep disorder is a growing public health concern that requires attentive assessment and treatment. However, the length of assessment tools for sleep disorders, including insomnia, hinders their use in both research and clinical settings. Brief assessment measures expedite assessment time, reducing respondent burden, and save resources, especially in resource-limited settings.This study investigated the validity and reliability of a short three-item insomnia scale, the Insomnia Severity Index-3 (ISI-3) and established two cutoff scores in a sample of 238 healthcare providers in Oman (45.8% physicians and 54.2% nurses).The ISI-3 demonstrated good convergent and divergent validity. The receiver operator characteristic recommended two cutoff scores of > 4 (a sensitivity of 0.87.3 and a specificity of 0.96.4) and > 6 (a sensitivity of 0.96.9 and a specificity of 0.97.1).The ISI-3 is a good assessment index of insomnia, especially when the utilization of the full insomnia index is unfeasible. [ABSTRACT FROM AUTHOR]

Objective Methods Results Interpretation To delineate the characteristics of stroke‐like episodes (SLEs) in patients with adult‐onset neuronal intranuclear inclusion disease (NIID) and to compare these characteristics with those of patients with MELAS.Twenty‐three adult‐onset NIID patients who presented with acute or subacute brain disorders and 13 late‐onset MELAS patients were enrolled in the study. Patients with NIID were categorized into the SLEs group and the encephalopathy‐like episodes (ELEs) group according to the associated stroke‐like lesions (SLLs) findings. Clinical characteristics were compared between the SLEs group and the ELEs group among NIID patients and between NIID patients with SLEs and MELAS patients.Eleven (47.8%) NIID patients who manifested acute or subacute brain disorders had detectable associated SLLs and were categorized into SLEs group. SLEs patients were more likely to report fever, headache, and seizures instead of sleep disorders than ELEs patients. Four (36.4%) NIID patients with SLEs absence of diagnostic or suggestive NIID imaging features. The clinical manifestations, laboratory test results, and neuroimaging and muscle biopsy histological features of NIID patients with SLEs majorly overlapped with those of late‐onset MELAS patients. Older age at the first SLE (OR [95% CI], 1.203 [1.045–1.384]), symptoms of movement disorders on admission (OR [95% CI], 9.625 [1.378–67.246]), and white matter hyperintensity in corpus callosum (OR [95% CI], 16.00 [1.542–166.46]) associated with the NIID diagnosis in patients with SLEs.NIID patients with SLEs exhibit evident features of mitochondrial disorders. Interventions aimed at mitochondrial dysfunction might be a promising therapeutic approach for treating this disease. [ABSTRACT FROM AUTHOR]

Introduction. Insomnia is a common sleep disorder in cancer patients, characterized by a reduction in the quality or quantity of sleep. It can lead to fatigue, mood disturbances, and may contribute to immunosuppression, affecting both disease progression and quality of life. Materials and methods. In an attempt to answer the question: "Does non-pharmacological treatment of insomnia improve the quality of life in cancer patients?", we conducted a systematic search in the international databases PubMed and ScienceDirect, following the PRISMA guidelines. The search keywords were "insomnia," "sleep disorders," "cancer," and "quality of life." Results. The systematic review included eight randomized trials that evaluated the effect of non-pharmacological therapies on insomnia and quality of life in oncology patients. Cognitive-behavioral therapy (CBT) is the first-line treatment with proven efficacy. Variants of CBT delivered through online platforms were found to be non-inferior in studies involving small patient groups. Another alternative treatment is acupuncture, which, while not as effective as CBT, improves sleep quality and enhances quality of life. Physical exercise, dance, nutrition programs, and psychological counseling also improve sleep and enhance quality of life compared to the usual hospital approaches. Conclusions. Non-pharmacological treatment of insomnia improves the quality of life in cancer patients. [ABSTRACT FROM AUTHOR]

According to the Centers for Disease Control and Prevention (CDC), 100,306 drug overdose deaths occurred in the US during a 12-month period ending in April 2021. Opioids were involved in 75% of these related deaths. Opioid Use Disorder (OUD) is a constantly evolving public health crisis with potentially lethal consequences. In 2017, 900 adolescents began to misuse opioids every day. Nearly 10% of high school seniors reported using opioids nonmedically. Additionally, the incidence for hospitalizations for adolescents among children 1-19 years of age increased nearly 2-fold from 1997 to 2012. This data emphasizes the dangers associated with the increasing accessibility of pharmaceutical and non-pharmaceutical opioids, particularly for adolescents. All three of the currently FDA approved medications for OUD have shown clear efficacy in decreasing all-cause mortality in adults. It is proposed that the same effects should be seen in adolescents but limited data is present. A recent study analyzed buprenorphine and naltrexone treatment amongst OUD in adolescents between 2001-2014; only 1 in 4 youth received any medication therapy within six months of diagnosis. Adolescents under 16 were the most likely to receive medications. However, even adolescents aged 17, for whom buprenorphine is FDA approved for, were less likely to receive therapy than adults over 18 years of age. The following case report aims to demonstrate how subcutaneous extended release buprenorphine treatment can be initiated effectively as an outpatient in an adolescent with OUD. It is critical that clinicians work to expand access to pharmacotherapy for adolescents struggling with OUD to ensure proper management and reduction of opioid-related overdoses. [ABSTRACT FROM AUTHOR]

Although internationally adopted children experience elevated sleep problems and psychosocial difficulties, little research has evaluated predictors and correlates of sleep issues in this population. The current study aims to address gaps in current research by examining associations between pre-adoptive risk, sleep disturbance, emotion lability/negativity, and internalizing and externalizing behavior in a sample of internationally adopted children. Parents completed questionnaires about the children's (N = 109; M age = 7.9, SD = 1.5; 39.6% male, 60.4% female) history, behavior, and functioning. Results reveal that sleep difficulties and emotion lability/negativity later in childhood mediated the relation between pre-adoptive conditions and internalizing and externalizing behavior in a sample of internationally adopted children. Future studies of internationally adopted children are needed to continue exploring trajectories of sleep problems and other self-regulatory difficulties in this population. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a chronic disease that leads to non-traumatic disability and is influenced by both hereditary and environmental factors. Objectives: This study aims to investigate the state of obstructive sleep apnea (OSA) syndrome and the factors affecting it in patients with multiple sclerosis. Methods: This cross-sectional and descriptive study included 180 patients, selected based on previous studies on MS patients and the prevalence of sleep apnea syndrome. The STOP-BANG questionnaire, Epworth Sleepiness Scale (ESS), and Fatigue Severity Scale (FSS) were used for data collection. Additionally, a demographic profile form was utilized to gather information on age, sex, marital status, education level, and income status of the patients. Data were analyzed using SPSS 16 software, employing mean and standard deviation, chi-square test, ANOVA, correlation coefficient, and one-way analysis of variance. Results: The results showed that among patients with a low risk of OSA, 87.3% were female, whereas among those with a high risk of OSA, 71.4% were male. This indicates that the risk of OSA is higher in men than in women with MS. Additionally, the mean ± SD of the Epworth score in high-risk individuals was 16.41 (1.56), compared to 14.27 (1.78) in low-risk individuals, indicating poorer Epworth scores in those at high risk of OSA. Conclusions: The prevalence of OSA and other sleep disorders among patients with MS in Ilam was found to be high. Therefore, it is recommended that necessary therapeutic and rehabilitation interventions be implemented to reduce OSA and improve the sleep quality of these patients. [ABSTRACT FROM AUTHOR]

Background: Sleep apnea and nocturnal bruxism belong to sleep disorders that can affect the quality of life. The aim of this study was to investigate the effects on patients with moderate sleep apnea and nocturnal bruxism of Botox injection as monotherapy or associated with wearing thermoformed occlusal splints and to determine the patients' satisfaction degree after the applied treatments. Methods: The selected patients for study were divided into two groups: in the first group, the patients (n = 18) treatment consisted of injecting Botox (Allergan) into the masseter muscle as monotherapy; in the second group, the patients (n = 18) benefited from associated therapy, Botox injections in masseter muscle, and the wear of thermoformed occlusal splints. At baseline, at three weeks, at three months, and six months after the effectuation of therapies, the monitoring sessions were realized. Results: The associated therapy presented better results in decreasing the studied symptoms than the monotherapy. Both therapies improved patient satisfaction. Conclusions: The applied therapies for treating the specific symptomatology in moderate sleep apnea and sleep bruxism were efficacious. Patient satisfaction was very good in both groups after the applied treatments, but the associated therapy presented better results than monotherapy. [ABSTRACT FROM AUTHOR]

Simple Summary: This review explores how common sleep disorders, such as insomnia and sleep apnoea, can affect heart health, particularly by increasing the risk of a heart condition called atrial fibrillation (AF). Sleep is vital for overall health, and disruptions in sleep can lead to significant health issues. Insomnia and sleep apnoea are widespread problems that affect millions of people worldwide. This paper examines how these sleep issues might cause changes in the body that lead to heart problems, such as inflammation and stress. The review also discusses how treating sleep disorders, especially with therapies such as continuous positive airway pressure for sleep apnoea, can help reduce the risk of developing AF and improve overall heart health. These conclusions are important because they suggest that addressing sleep disorders could be a key part of preventing and managing heart conditions, ultimately helping to improve people's quality of life and reduce the burden of heart disease on society. Sleep is a complex biobehavioural process essential for overall health, with various dimensions including duration, continuity, timing, and satisfaction. This study investigated the intricate relationships between common sleep disorders such as insomnia and obstructive sleep apnoea (OSA) and their impact on atrial fibrillation (AF), a prevalent arrhythmia with significant health implications. Using a comprehensive review of the current literature, this study examined the pathophysiological mechanisms linking sleep disorders to cardiovascular risks, focusing on autonomic nervous system disturbances, inflammation, and oxidative stress associated with OSA. These findings indicate that sleep disorders significantly elevate the risk of AF through mechanisms such as increased sympathetic activity and structural cardiac remodelling. Additionally, this study highlights the potential benefits of treating sleep disorders, particularly with continuous positive airway pressure (CPAP) therapy, in reducing AF recurrence and improving cardiovascular outcomes. This conclusion emphasises the importance of integrated therapeutic approaches that address both sleep disorders and AF to enhance patient outcomes and quality of life. Future research should explore these connections to develop more effective and holistic treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Exogenous melatonin, a nutraceutical for maintaining a healthy sleep–wake cycle and managing sleep disorders, requires large, repeated doses due to its low bioavailability and short half-life. This necessitates the development of a sustained-release formulation with a longer half-life and sustained plasma concentration. Therefore, exogenous novel 5 mg sustained-release melatonin capsules (Melatonin-SR, test product) were formulated. Methods: This open-label cross-over study compared the pharmacokinetics (maximum concentration [Cmax], time to reach Cmax [Tmax], area under the curve [AUC], and elimination half-life [t1/2]) and the safety of Melatonin-SR with 5 mg immediate-release melatonin capsules (Melatonin-IR, reference product) after single-dose oral administration in healthy fasting adults. Results: Sixteen participants (aged 18–45 years) were randomized (1:1) to receive either Melatonin-SR or Melatonin-IR in two periods with a 7-day washout period. Melatonin-SR reported a lower Cmax (11,446.87 pg/mL) compared to Melatonin-IR (22,786.30 pg/mL). The mean Tmax of Melatonin-SR and Melatonin-IR was 1.26 h and 0.87 h, respectively. The mean t1/2 of Melatonin-SR (5.10 h) was prolonged by five-fold compared to Melatonin-IR (1.01 h). One adverse event (vomiting) was reported following the administration of the Melatonin-IR. Conclusions: Melatonin-SR resulted in higher and sustained plasma melatonin concentrations for an extended period and was well-tolerated. Hence, Melatonin-SR may be a promising nutraceutical for maintaining healthy sleep. [ABSTRACT FROM AUTHOR]

Sleep, constituting approximately one‐third of the human lifespan, is a crucial physiological process essential for physical and mental well‐being. Normal sleep consists of an orderly progression through wakefulness, non‐rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep, all of which are tightly regulated. Melatonin, often referred to as the "hormone of sleep," plays a pivotal role as a regulator of the sleep/wake cycle and exerts its effects through high‐affinity G‐protein coupled receptors known as MT1 and MT2. Selective modulation of these receptors presents a promising therapeutic avenue for sleep disorders. This review examines research on the multifaceted role of melatonin in sleep regulation, focusing on selective ligands targeting MT1 and MT2 receptors, as well as studies involving MT1 and MT2 knockout mice. Contrary to common beliefs, growing evidence suggests that melatonin, through MT1 and MT2 receptors, might not only influence circadian aspects of sleep but likely, also modulate the homeostatic process of sleep and sleep architecture, or could be the molecule linking the homeostatic and circadian regulation of sleep. Furthermore, the distinct brain localization of MT1 and MT2 receptors, with MT1 receptors primarily regulating REM sleep and MT2 receptors regulating NREM sleep, is discussed. Collectively, sleep regulation extends beyond the circulating levels and circadian peak of melatonin; it also critically involves the expression, molecular activation, and regulatory functions of MT1 and MT2 receptors across various brain regions and nuclei involved in the regulation of sleep. This research underscores the importance of ongoing investigation into the selective roles of MT1 and MT2 receptors in sleep. Such research efforts are expected to pave the way for the development of targeted MT1 or MT2 receptors ligands, thereby optimizing therapeutic interventions for sleep disorders. [ABSTRACT FROM AUTHOR]

Background: A mismatch between biological and social time, often referred to as social jetlag (SJL), can lead to inadequate sleep and activities or taking meals at times that do not align with our biological rhythms, increasing the risk of metabolic abnormalities. Although the association between sleep and metabolic syndrome (MetS) is well established, the effects of SJL on MetS and the components of MetS in adults remain unclear. Purpose: This study was designed to explore the relationship between SJL and MetS components in adults. Methods: A systematic review and meta-analysis was conducted on studies registered in PubMed, Cochrane, Web of Science, and Embase between the inception of each database until November 15, 2023.We focused on studies designed to evaluate the relationship between SJL and either MetS or its components. Only studies using cross-sectional, prospective, or retrospective designs were considered for inclusion. The relationship between SJL and MetS was depicted as an odds ratio with a corresponding 95% confidence interval (CI). We determined the mean differences and 95% CIs to estimate the associations between SJL and MetS components. The Joanna Briggs Institute Critical Appraisal Checklist was used to evaluate the methodological rigor of the selected studies. Data were analyzed using RevMan software Version 5.4. Results: The systematic review included 16 studies, with five analyzed via a meta-analysis covering four outcomes, each based on two to three studies. When comparing SJL of less than 1 hour with SJL of 2 hours or more, the latter showed a higher likelihood of MetS (pooled odds ratio: 1.52). Although a significant decrease in systolic blood pressure (pooled mean differences = −3.52 mmHg, 95% CI [−6.41, −0.64]) and a significant increase in waist circumference (pooled mean differences = 2.17 cm, 95% CI [0.61, 3.73]) were observed, the correlation between SJL and diastolic blood pressure failed to reach statistical significance. Conclusions/Implications for Practice: The meta-analysis conducted in this study found an association between SJL and MetS. Healthcare practitioners should prioritize the management of sleep quality and duration, especially for individuals exhibiting substantial SJL. Improving sleep can aid in controlling blood pressure and managing weight and should form part of MetS management strategies. [ABSTRACT FROM AUTHOR]

Background: The commonest form of Sleep Disordered Breathing is obstructive sleep apnea (OSA). OSA is a common disease with relative unawareness in society and is associated with significant morbidity, prompting the need for research and studies on this topic. Objective: 1. To study the sensitivity, specificity of the STOP-BANG Score, Epworth Sleepiness Score, and Berlin Questionnaire. 2. To evaluate the ease of use of the STOP-BANG Score, Epworth Sleepiness Score, and Berlin Questionnaire. Methods: A survey was conducted on apparently healthy adult individuals in the department of respiratory medicine at Rohilkhand Medical College & Hospital, Bareilly, Uttar Pradesh, India from 1 NOV 2022-31 OCT 2023. Subjects were screened based on the Berlin Questionnaire, STOP-BANG score, and Epworth Sleepiness Scale. They were categorized as High-risk and low-risk groups based on questionnaires. All the high-risk patients and 30% of the low-risk group were advised for polysomnography. Subjects who consented to overnight PSG were then diagnosed as OSA on the basis of apnea and hypopnea index (AHI) =5. The sensitivity and specificity of the screening tool were calculated taking PSG as the gold standard diagnostic tool. Results: Out of 2118 subjects approached, 1832 (response rate 86.49%) participated in the survey. 221 (12.06%) were found to be at high risk of OSA and rest 1611 (87.93%) subjects were at low risk of OSA as per questionnaires. 165 (74.66%) subjects from the high-risk group and 313 (19.4%) subjects from the low-risk group consented to polysomnography. The sensitivity and specificity of the screening tool were calculated among these 478 subjects, taking PSG as the gold standard diagnostic tool. Sensitivity for prediction of AHI =5 of ESS was found to be 81.87% (95% CI 75.49 to 87.18), BQ was 82.42% (95% CI 76.1 to 87.65) and STOP-BANG score was 90.66% (95%CI 85.47%-94.46%). And specificity of ESS was found to be 94.93% (95%CI 91.78 to 97.14), BQ was 94.59% (95% CI 91.37 to 96.88) and STOP-BANG score was and 77.70% (95% CI 72.53% - 82.32%). The positive likelihood ratio of ESS was 16.16 (95% CI 9.82 to 26.58), BQ was 15.25(95% CI 9.42 to 24.67) and STOP-BANG score was 4.07 (95% CI 3.27-5.05). Negative Likelihood Ratio OF ESS was 0.19 (95% CI 0.14 to 0.26), BQ was 0.19 (95%CI 0.14 to 0.25) and STOP-BANG score was 0.12 (95%CI 0.08 to 0.19). Conclusion: We found the STOP-BANG score, the Epworth sleepiness scale, and Berlin Questionnaire to be reliable for screening of OSA. For evaluating the risk of OSA, the STOPBANG score was found to be more sensitive while the Berlin questionnaire and the Epworth sleepiness scale were more specific. Given that the STOP-BANG score has fewer variables than other scores and is both subjective and objective, estimating a person's risk for OSA takes less time. Taking into account the relatively poorer specificity of the STOP-BANG score, we advise a two-step screening method. First, to segregate the high and intermediate-risk groups using the STOP-BANG score and then, lengthier scores, the Berlin Questionnaire and the Epworth sleepiness scale, can be applied to these groups only, making the screening more efficient. On the other hand, only individuals at high risk of OSA, excluding those at intermediate risk, could be recommended for polysomnography to maximize the specificity of the STOP-BANG score. Hence, it is concluded that the STOP-BANG score is the best screening tool in a busy day-to-day OPD. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is being recognized as an important public health problem worldwide. The timely diagnosis and treatment of OSA with underlying etiology leads to decreased symptoms and increases quality of life among OSA patients. Present study was aimed to study clinical profile of patients with obstructive sleep apnea attending tertiary care hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients more than 18 years of age, had symptoms suggestive of Sleep Disordered Breathing such as, excessive daytime somnolence, disruptive snoring, fragmented sleep, choking and gasping, un-refreshing sleep, morning headache, personality changes and Impaired concentration, insomnia, daytime headache. Sleep study parameters collected from polysomnography were Apnea-Hypopnea Index (AHI). Results: During study period, total 66 patients underwent evaluation. Mean age was 47.9 ± 14.2 years. Majority were male (62.12 %) as compared to female (37.88 %). Mean body measurements such as mean height was 1.59 ± 0.14 meters, mean weight 91.2 ± 23.3 kgs, mean Body Mass Index was 30.4 ± 6.1 kg/m2, mean neck circumference was 35.2 ± 4.2 cms & lowest saturation % in sleep study was 82.2 ± 9.6 %. Common co-morbidities noted were hypertension (57.58 %), overweight (48.48 %), smoking (31.82 %), obesity (30.3 %), diabetes mellites (25.76 %), asthma (13.64 %) & COPD (10.61 %) In present study, majority patients had Severe OSA (56.06 %) followed by moderate OSA (28.79 %), mild OSA (9.09 %) while 4 patients had no OSA (6.06 %). Conclusion: Obesity, Hypertension and diabetes were common associations in patients with significant obstructive sleep apnea. Polysomnography is a useful investigation which helps in diagnosis of OSA. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance is a significant symptom associated with both rotator cuff tears and arthroscopic rotator cuff repair. Melatonin has been shown to be safe and effective in managing multiple sleep disorders, including secondary sleep disorders, with relatively minor adverse effects and lack of addictive potential. Purpose: To investigate the effects of oral melatonin on postoperative sleep quality after arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This was a prospective randomized clinical trial evaluating patients undergoing arthroscopic rotator cuff repair. Exclusion criteria included history of alcohol abuse, current antidepressant or sedative use, revision rotator cuff repair, severe glenohumeral arthritis, and concurrent adhesive capsulitis. Patients were randomly assigned in a 1:1 ratio to 1 of 2 groups: 5-mg dose of melatonin 1 hour before bedtime or standard sleep hygiene (≥6 hours per night, avoiding caffeine and naps in the evening). Patients in the melatonin group took their assigned melatonin dose for 6 weeks beginning the day of surgery. Patient-reported outcome assessments, including the Pittsburgh Sleep Quality Index (PSQI), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the Single Assessment Numeric Evaluation (SANE), and pain medication charts were collected preoperatively as well as at 2 weeks, 6 weeks, 3 months, 4 months, and 6 months postoperatively. Numeric variables were analyzed using paired and unpaired t tests, with significance set at P <.05. Results: Eighty patients were included for final analysis (40 in the control group, 40 in the melatonin group). Patient characteristics such as age, sex, race, body mass index, and laterality did not differ significantly (P ≥.05). Preoperative ASES, SANE, and PSQI scores did not differ between groups (P ≥.055). PSQI scores were significantly lower (better quality sleep) in the melatonin group at the 6-week postoperative period (P =.036). There was a positive correlation between how patients rated the intensity of their pain and the PSQI at the 6-week postoperative period (0.566). The PSQI question regarding sleep quality was found to be significantly lower in the melatonin group at the 3-month, 4-month, and 6-month postoperative periods (P =.015, P =.041, and P ≤.05, respectively). SANE scores were significantly lower in the melatonin group (P =.011) at 6 weeks and then higher in the melatonin group (P =.017) at 6 months. ASES scores were significantly higher in the melatonin group at 4 and 6 months (P =.022 and P =.020, respectively). Lastly, patients who were randomized into the melatonin group were found to use significantly less narcotic medication at the 4-month postoperative period (P =.046). Conclusion: Melatonin use after arthroscopic rotator cuff repair led to improved sleep quality (PSQI) in the early postoperative period as well as improved functional outcomes (ASES and SANE scores) and decreased narcotic use in the later postoperative period. Patients with significant sleep disturbances associated with rotator cuff repairs may benefit from the use of melatonin. Registration: NCT04278677 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Objective To investigate the causal association of liver function and lipid metabolism levels with sleep disorders based on the Mendelian randomization analysis. Methods The analysis was conducted using the data from genome-wide association studies, with the exposure factors of liver function and lipid metabolism levels (alanine aminotransferase [ALT], aspartate aminotransferase [AST], gamma-glutamyl transpeptidase [GGT], albumin [Alb], serum total protein [TP], total bilirubin [TBil], alkaline phosphatase [ALP], triglyceride [TG], triglyceride-to-glycerol-3-phosphate [TG/G3P] ratio, total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], poly-unsaturated fatty acids [PUFA], total fatty acids [TFA], PUFA/TFA ratio) and the outcome factor of sleep disorders (nonorganic) . The regression models including inverse variance weighted, MR-Egger, Simple mode, weighted median, and Weighted mode were used to perform the Mendelian randomization analysis. Results Serum Alb (odds ratio [OR] =0.728, 95% confidence interval [CI] : 0.535 — 0.989, P<0.05), HDL-C (OR=0.879, 95%CI: 0.784 — 0.986, P< 0.05), and PUFA/TFA ratio (OR=0.800, 95%CI: 0.642—0.998, P<0.05) were negatively associated with sleep disorders, while TG/G3P ratio (OR=1.222, 95%CI: 1.044—1.431, P<0.05) was positively associated with sleep disorders. The results of Mendelian randomization did not show a causal association of ALT, AST, GGT, TP, TBil, ALP, TG, TC, LDL-C, PUFA, and TFA with sleep disorders (all P>0.05) . The results of the MR-Egger intercept test showed no pleiotropy (P>0.05), and Mendelian randomization was a valid method for causal inference in this study. Conclusion According to the results of the Mendelian randomization analysis, liver function and lipid metabolism show significant association with sleep disorders. Liver function and lipid metabolism can be used as indicators for predicting the risk of sleep disorders and performing intervention. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is a very common condition in patients with temporomandibular disorders (TMD). However, there is little evidence of a connection between them. Objective: The aim of this systematic review and meta‐analysis is to assess the association between OSA and TMD in adult population. Methods: Case–control, cross‐sectional and cohort studies on the association between TMD and OSA were searched in the EMBASE, LILACS, LIVIVO, PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, Open Grey and Pro Quest databases. TMD should be assessed using Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD) and OSA using polysomnography (PSG) and/or a validated questionnaire. The risk of bias was evaluated using the Joanna Briggs Institute Critical Assessment Checklists; and an association meta‐analysis was performed. The effect measure included the odds ratio (OR) in dichotomous variables and a 95% confidence interval (CI). Certainty of evidence was determined by analysing groups using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Out of the 1024 articles screened, 7 met the inclusion criteria for the qualitative synthesis, and 6 for quantitative analysis. All articles were classified at low risk of bias. A positive association with OSA was found in patients with TMD (OR = 2.61; 95% CI = 2.31, 2.95). A significant association was also found irrespective to the OSA diagnostic methods applied (for studies using PSG + validated questionnaires: OR = 2.74; 95% CI = 2.11, 3.57; for studies using validated questionnaires only: OR = 2.55; 95% CI = 2.22, 2.92). GRADE was moderate. Conclusion: Patients with TMD presented a significant association with OSA regardless of the OSA diagnostic method (PSG and/or validated questionnaires). OSA screening should be part of the TMD examination routine. Furthermore, due to the different OSA assessment methods used and the small number of studies included, there is a need to include a larger number of studies using PSG to better elucidate this association. [ABSTRACT FROM AUTHOR]

Background: Somatosensory tinnitus (ST) is associated with activation of the auditory pathway by trigeminal or cervical afferents. Objective: This is a cross‐sectional observational study that aims to verify the association of ST with TMD, bruxism, migraine and psychosocial aspects. Methods: This study was conducted at the Tinnitus Outpatient Clinic of the Clinical Hospital Complex of the Federal University of Paraná. Specific ST characteristics, were evaluated according to the last consensus for the diagnosis of ST. Two groups with 39 individuals each one were formed, the ST group (STG) and the comparison group (CG). TMD was classified according to the Diagnostic Criteria for Temporomandibular Disorders and migraine by the International Classification of Headaches. The presence of probable sleep and awake bruxism was associated with individual's reports and clinical inspections. The applied questionnaires investigated oral behaviours (OB), sleep quality (SQ), psychosocial aspects (PA), central sensitization (CS), tinnitus impact on quality of life (TIQF), and graded chronic pain scale (GCPS). Results: The STG showed a significant association with modulation manoeuvres and trigger points; myalgias and arthralgia; disc displacement with and without reduction; subluxation; bruxism; and presence of migraine. For the same group, we found a significant association with OB, PA, CS, TIQF and GCPS. There was no significant difference between groups regarding SQ. Conclusion: There is a significant association between the presence of ST and the occurrence of TMD, probable sleep and awake bruxism, and migraine. There is also a greater impairment of OB, PA, CS and TIQF. [ABSTRACT FROM AUTHOR]

Objective: The role of lifestyle habits in patients with laryngopharyngeal reflux disease (LPRD) is comparatively underexplored. We aim to examine the specific lifestyle habits in patients with LPRD. METHODS: Systematic sampling was applied to select respondents aged 18 through 80 years in otorhinolaryngology-head and neck surgery (OHNS) clinics in Nan Fang Hospital during August 2017–July 2018, 1658 eligible participants were included by a systematic sampling method. Subjects with RSI score>13 were considered as LPRD patients. The risk of reflux symptoms was estimated and multivariate calculated as odds ratios in relation to exposure to tobacco smoking, alcohol, coffee, tea, carbonated drinks, chocolate, spicy food, night sleep time, dinner-to-bed time, subjective sleep quality, and physical exercise. Results: There was a significant dose-response association between carbonated beverage and LPRD. Among people who had drinking carbonated drinks the odds ratio was 1.76 (OR 1.77, 95% CI 1.24–2.50, P =.002) compared with non-carbonated drinker. A similar positive association was found for poor subjective sleep quality and shorter night sleeping time, the odds ratio for reflux was 1.58 (95% CI 1.14 to 2.18) among those who always have poor subjective sleep quality compared with those whose have good subjective sleep quality. The odds ratio for reflux was 2.29 (95% CI 1.23–4.28, P =.015) among those who always sleep 3–5 hours every night compared with those who sleep more than 8 hours every night. Beyond that, we found high BMI may have a negative correlation with LPRD, the odds ratio for reflux was.61 (95% CI 0.39 to.95, P =.054) among those whose BMI >25 kg/m2 compared with those BMI ≤ 20 kg/m2. Conclusions: Patients with LPRD may have certain lifestyle habits, avoid carbonated beverage, poor subjective sleep quality, and lack of sleep should be advised in treatment of LPRD. [ABSTRACT FROM AUTHOR]

Public health crises can significantly impact the emotional well‐being of healthcare workers. Network analysis is a novel approach to exploring interactions between mental disorders at the symptom level. This study aimed to elucidate the characteristics of post‐traumatic stress disorder (PTSD), anxiety, depression, and insomnia symptoms network among frontline nurses under sudden public health crisis. A cross‐sectional survey was conducted online among 556 frontline nurses through convenience sampling in Hubei Province, China, from 21 February 2020, to 10 March 2020. Symptoms of PTSD, anxiety, depression, and insomnia were assessed by the Post‐Traumatic Stress Disorder Checklist (PCL‐5), Generalized Anxiety Disorder scale (GAD‐7), Patient Health Questionnaire (PHQ‐9) and Insomnia Severity Index, respectively. Central symptoms (the most important symptoms, activation has the strongest influence the other nodes) and bridge symptoms (nodes where deactivation can prevent activation from spreading from one disorder to another) were identified via centrality and bridge centrality indices, respectively. Network stability was examined using the case‐dropping procedure. We found that the correlation between PHQ‐9 item 9 'suicidal thoughts' and PCL‐5 item 16 'reckless or self‐destructive behaviour' was the strongest. Moreover, 'reckless or self‐destructive behaviour' was the strongest central symptom, and PHQ‐9 item 3 'sleep problems' was the most important bridge symptom. Other major symptoms included GAD‐7 item 6 'uncontrollable anxiety' and PHQ‐9 item 2 'depressed or sad mood'. Timely, systemic targeting interventions on central symptoms and bridge symptoms may effectively alleviate co‐occurring experiences of psychopathological symptoms among frontline nurses. [ABSTRACT FROM AUTHOR]

The current study tested a longitudinal mediation model throughout the COVID‐19 pandemic focused on whether students' housing instability stress and food/financial instability stress at the beginning of the pandemic in spring 2020 (T1) informed sleep dissatisfaction and duration in fall 2020 (T2) and, in turn, physical and mental health in spring 2021 (T3). Further, we tested whether relations varied based on students' ethnic‐racial backgrounds. Participants included 879 Asian, Black, Latine, Multiracial, and White emerging adult college students (Mage = 19.95, SD = 0.33) from a large public university in the mid‐Atlantic region of the United States who attended college during the COVID‐19 pandemic and completed surveys about their experiences. Findings indicated a significant mediation process, such that T1 housing instability stress predicted greater T2 sleep dissatisfaction and, in turn, less physical health, greater depressive symptoms, and greater anxiety symptoms at T3. Additionally, T1 food/financial instability stress was significantly associated with less T2 sleep duration but was not, in turn, associated with any T3 outcomes. Findings did not vary by students' ethnicity/race. Results highlight that sleep dissatisfaction is an important factor that accounts for relations between COVID‐19 stressors predicting mental and physical health outcomes throughout the pandemic. [ABSTRACT FROM AUTHOR]

Purpose: Insomnia is an important sleep disorder in older persons. Conceptual analysis studies on this nursing diagnosis have been developed, but the diagnostic accuracy has not been verified. This study aimed to verify the diagnostic accuracy of the nursing diagnosis of Insomnia (00095) in older adults in a community center in Brazil. Methods: A validation study for diagnostic accuracy of the defining characteristics of the nursing diagnosis Insomnia. Data were collected through telephone interviews with 90 participants. Latent class analysis was used to verify the sensitivity and specificity of the defining characteristics. Poisson regression was used to assess the prevalence of the association of factors related to the nursing diagnosis of insomnia. Findings: A 47.42% prevalence of insomnia in the sample was identified. Defining characteristics such as expresses dissatisfaction with sleep and nonrestorative sleep–wake cycle showed the best accuracy values for insomnia, with a specificity of 0.92 (0.78–1.00) and 0.89 (0.74–1.00), respectively. Related factors such as stressors and frequent naps during the day were more likely to develop insomnia in individuals. Conclusions: This study indicates diagnostic accuracy of nursing diagnosis of insomnia in community‐dwelling older people from a community center. The findings highlighted the importance of the defining characteristics of nursing diagnosis insomnia and its main related factors contributing to accurate diagnostic identification. Implications for nursing practice: This study can contribute to providing objective clinical indicators of insomnia in the older population to guide nurses in early diagnostic confirmation for the selection of health interventions. In addition, it can be a consistent contribution to theoretical and conceptual reviews of this diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the psychological impact of COVID‐19 on burning mouth syndrome (BMS) patients. It focuses on comparing post‐traumatic stress symptoms (PTSS), post‐traumatic growth (PTG), and resilience between BMS patients and Controls. Methods: A total of 100 BMS patients and 100 Controls from five Italian centers participated in this observational cross‐sectional study. They completed several assessments, including the General Health Questionnaire, Depression Anxiety and Stress Scale, Insomnia Severity Index, National Stressful Events Survey Short Scale, Impact of Event Scale‐Revised, Post Traumatic Growth Inventory Short Form, and Connor‐Davidson Resilience Scale. Results: BMS patients had significantly higher stress, anxiety, and depression (DASS‐21 score) and post‐traumatic stress symptoms (IES‐R‐6 score), particularly in terms of intrusive thoughts. They showed lower post‐traumatic growth (PTGI‐SF score) compared to Controls. The resilience scale (CDRS‐10) was a key predictor of PTG in both groups, explaining a significant variance in PTGI‐SF scores. Conclusions: BMS patients experienced heightened post‐traumatic stress, stress, anxiety, and depression during the COVID‐19 pandemic, with reduced post‐traumatic growth. This highlights the need to prioritize their psychological well‐being, focusing on stress management and fostering post‐traumatic growth in challenging times. [ABSTRACT FROM AUTHOR]

Objectives: To investigate knowledge and awareness of dental complications with oral piercings among adults with oral piercings, a control population with no piercings and body‐piercing professionals in South‐East Queensland, Australia. Methods: Participants recruited from public and private dental clinics and body‐piercing professionals from piercing centres in the same region completed questionnaires to assess knowledge and attitudes. Results: Respondents comprised 54 pierced individuals, 54 controls and 35 body‐piercing professionals. Only 13% of the pierced group were informed about oral piercing‐related complications, and 14% of body‐piercing professionals did not warn their clients about long‐term complications. The latter included chipped teeth (26%) and gingival recession (15%). About 76% play with their piercing, developing teeth grinding (15%), jaw clenching (15%) and sleep disturbances (4%). Interestingly, 41% of those with oral piercings advised others against getting piercings. Conclusions: There is a lack of awareness about dental‐related complications among pierced individuals and body‐piercing professionals. A significant proportion of pierced individuals advise others against getting piercings. Body piercers do not consistently advise clients about risks associated with oral piercings. Thus, it is recommended that programmes be developed to improve awareness of oral and dental complications associated with oral piercings. [ABSTRACT FROM AUTHOR]

Purpose: To investigate serum levels of VEGF, IGF-1 and FGF-2, and relationships with several clinical characteristics in children and adolescents with autism spectrum disorder (ASD) with and without bipolar disorder (BD). Method: 40 subjects with ASD + BD as study group, and 40 subjects with ASD as control group were included. Serum levels of VEGF, IGF-1, and FGF-2 were measured using commercial enzyme-linked immunosorbent assay kits. Results: The study group was significantly higher than the control group in terms of ASD severity, self-harming behavior and sleep disturbance. Serum VEGF and FGF-2 levels were significantly higher in the ASD + BD group than in the control group. There was no significant difference in serum IGF-1 levels between the two groups. There was no correlation between VEGF, IGF-1 and FGF-2 serum levels and ASD severity in the study group. However there was a negative correlation between VEGF levels and age at first diagnosis of BD, and a positive correlation between IGF-1 levels and the number of bipolar episodes in the study group. Conclusion: Growth factors like VEGF and FGF-2 may be potential biomarkers of bipolar disorder in young subjects with ASD. Given the difficulty of clinical management of BD in young subjects with ASD, potential biomarkers would help clinicians in the diagnosis and follow up of BD in this special population. Further research is needed whether VEGF and FGF-2 can be potential biomarkers in the clinical management of young subjects with ASD and BD. [ABSTRACT FROM AUTHOR]

There is a lack of awareness of how sleep health and sleep disorders are experienced. Previous research has found that living with narcolepsy has a debilitating impact on several areas of an individual's life alongside significant diagnostic delays. This study uses a phenomenological, qualitative methodology to explore experiences of being diagnosed with and living with narcolepsy. Six women with type 1 narcolepsy participated in semi-structured interviews. Transcripts were analysed using Interpretative Phenomenological Analysis. Capturing the whole illness experience of narcolepsy, our analysis illuminated three superordinate themes; 'minimising, dismissing and downplaying symptoms', 'navigating the winding journey to diagnosis' and 'a different way of living'. Through our analysis, we are able to demonstrate the affective impact lack of awareness of sleep and sleep disorders has; resulting in significant diagnostic delays and a lack of support post-diagnosis. Findings demonstrate a need for greater awareness and increased support. [ABSTRACT FROM AUTHOR]

Neuroscience should be at the core of a sound sleep health curriculum, especially in early classroom-based medical education. This article canvasses ways in which sleep medicine has been rapidly transformed by tele-sleep tools and by research on neurobiological mechanisms underlying sleep disorders and on comorbidities associated with sleep disorders, including stroke, traumatic brain injury, and movement or neurocognitive disorders. [ABSTRACT FROM AUTHOR]

Autistic children are at higher risk of experiencing adverse childhood experiences, which lead to negative health outcomes such as sleep difficulties. In the general population, family resilience can help reduce the negative impact of adverse childhood experiences on child functioning. The aim of this study was to examine the impact of adverse childhood experiences on sleep duration, and whether family resilience moderates this impact in autistic children. With data from 2882 caregivers of children with autism from the National Survey of Children's Health, we examined the role of family resilience on the relationship between adverse childhood experiences and sleep duration. As shown in previous findings, there was a main effect of adverse childhood experiences on sleep duration. There was no significant main effect of family resilience on sleep duration. Results also show that family resilience moderates the relationship between adverse childhood experiences and sleep duration, possibly serving as a protective factor. Autistic children are more likely to have sleep difficulties and to experience adverse childhood experiences. Adverse childhood experiences can include parental divorce, bullying, or witnessing violence. We also know that children in families who are resilient (e.g. families who are connected, work together, and help each other) are less impacted by adverse childhood experiences. Our study examined whether there was a relationship between adverse childhood experiences and sleep duration in autistic children. We also wanted to find out whether family resilience protects from the negative impact of adverse childhood experiences on sleep duration. We used data from 3247 parent surveys about their children that we got from the National Survey of Children's Health. We found that children with adverse childhood experiences are more likely to get less sleep. We also found that children with resilient families were more likely to get more sleep. Our results show that family resilience helps weaken the relationship between adverse childhood experiences and sleep, so it is important to help families build resilience. [ABSTRACT FROM AUTHOR]

Objective: Despite recognition that people with HIV (PWH) are more vulnerable to sleep issues, there is limited understanding of clinically recognized sleep disorders in this population. Our objective was to evaluate the full spectrum of sleep disorder types diagnosed among PWH in care. Methods: We conducted a retrospective cohort study of PWH, and a comparator group of people without HIV (PWoH), in a large healthcare system. The incidence of clinically diagnosed sleep disorders was calculated using Poisson regression for three outcomes: any type of sleep disorder, insomnia, and sleep apnea. Incidence was compared between PWH and PWoH by computing the adjusted incidence rate ratio (aIRR), accounting for sleep disorder risk factors. Comparisons to PWoH were made for all PWH combined, then with PWH stratified by HIV management status (well‐managed HIV defined as being on antiretroviral therapy, HIV RNA <200 copies/mL, and CD4 count ≥500 cells/μL). Results: The study included 9076 PWH and 205 178 PWoH (mean age 46 years, 90% men). Compared with PWoH, sleep disorder incidence was greater among PWH overall [aIRR = 1.19, 95% confidence interval (CI): 1.12–1.26], particularly for insomnia (aIRR = 1.56, 95% CI: 1.45–1.67). Sleep apnea incidence was lower among PWH (aIRR = 0.90, 95% CI: 0.84–0.97). In HIV management subgroups, PWH without well‐managed HIV had lower sleep apnea incidence (vs. PWoH: aIRR = 0.79, 95% CI: 0.70–0.89) but PWH with well‐managed HIV did not (vs. PWoH: aIRR = 0.97, 95% CI: 0.89–1.06). Conclusions: PWH have high sleep disorder incidence, and insomnia is the most common clinical diagnosis. Lower sleep apnea incidence among PWH may reflect underdiagnosis in those with sub‐optimally treated HIV and will be important to investigate further. [ABSTRACT FROM AUTHOR]

Background: Patients with migraine are vulnerable to insufficient sleep, but the impact of sleep restriction is largely unknown. In addition, the importance of sleep may be different in patients with migraine who mostly have attack onsets during sleep, so called sleep-related migraine, compared to patients with non-sleep-related migraine. In this study we investigate the effect of sleep restriction on endogenous pain modulation in patients with migraine and healthy controls. We also compared the effect of sleep restriction in sleep-related and in non-sleep-related migraine. Methods: Measurements were conducted in 39 patients with migraine between attacks and 31 controls, once after habitual sleep and once after two consecutive nights of partial sleep restriction. There were 29 and 10 patients with non-sleep-related and sleep-related migraine respectively. Test stimulus was 2-min tonic noxious heat to the left volar forearm. Temporal summation was calculated as the regression coefficient for rated pain in the late part of this 2-min stimulation. Conditioning stimulus was right hand-immersion in 7 °C water. Conditioned pain modulation was defined as the difference in rated pain with and without the conditioning stimulus and was calculated for temporal summation and mean rated pain for the test stimulus. The effect of sleep restriction on temporal summation and conditioned pain modulation was compared in migraine subjects and controls using two-level models with recordings nested in subjects. Results: Conditioned pain modulation for temporal summation of heat pain tended to be reduced after sleep restriction in patients with migraine compared to controls (p = 0.060) and, in an exploratory analysis, was reduced more after sleep restriction in sleep-related than in non-sleep-related migraine (p = 0.017). No other differences between groups after sleep restriction were found for temporal summation or conditioned pain modulation. Conclusion: Patients with migraine may have a subtly altered endogenous pain modulation system. Sleep restriction may have an increased pronociceptive effect on this system, suggesting a mechanism for vulnerability to insufficient sleep in migraine. This effect seems to be larger in sleep-related migraine than in non-sleep-related migraine. [ABSTRACT FROM AUTHOR]

Background: Limited research has examined the association between moderate to vigorous physical activity (MVPA), sedentary behavior (SB), and sleep-related outcomes in cancer survivors. Therefore, this study aimed to examine these associations using a nationally representative sample of US adults. Methods: Data from the 2005–2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. A total of 3229 adults with cancer histories were included. Physical activity was measured through accelerometry, and questions on daily activities, sedentary time, and sleep were collected during the household interview. Weighted multivariable analyses were conducted after accounting for the complex sampling design of the NHANES dataset. Results: After adjustments, physical activity and SB outcomes were associated with several self-reported sleep-related parameters. Increases in minutes of self-reported MVPA and SB were associated with a decreased likelihood of reporting ≥ 8 h of sleep (OR = 0.92, 95% CI = 0.86, 0.99 and OR = 0.88, 95% CI = 0.82, 0.95). Converse associations were found between device-measured MVPA and SB with the likelihood of reporting often/always feeling overly sleepy during the day (OR = 0.86, 95% CI = 0.75 and OR = 1.13, 95% CI = 1.05, respectively). However, an increased likelihood of waking up too early in the morning (OR = 1.22, 95% CI = 1.04) was observed with increases in minutes of device-measured MVPA. Conclusions: A sensible strategy to decrease the frequency of sedentary breaks and increase minutes of physical activity throughout the day may reduce sleep complaints reported in cancer survivors. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is identified by instances of either full or partial collapse of the airway during sleep, leading to reduced oxygen levels or awakening from sleep. This disruption causes interrupted and insufficient sleep, impacting cardiovascular well-being, mental health, and overall quality of life. Pediatric OSA is more challenging to diagnose and a single apnoea is considered to be significant in this age group. A hospital based prospective study with 100 children between the ages of 4 and 12 years with sleep disordered breathing. Evaluated for the severity of obstructive sleep apnea and also assessed if surgery was beneficial to treat OSA in mild cases. General physical examination, evaluation of facial/oral features were conducted to rule out adenoid facies. Additionally, ENT examination was conducted. Medical history and lateral neck radiographs were reviewed, and the paediatric sleep questionnaire was administered to evaluate neurobehavioral morbidities associated with OSA. These children were evaluated for sleep disorders by conducting the polysomnography. Pediatric sleep questionnaire was also administered. The scoring and results analysis were conducted according to standardised guidelines provided by the American association for sleep medicine. Furthermore, medical management protocols were outlined, including a 6-week course of intranasal steroids and leukotriene receptor antagonist therapy, with consideration of adenotonsillectomy for patients failing medical therapy. In our study on paediatric obstructive sleep apnea (OSA), medical treatment significantly reduced clinical symptom scores in cases of mild OSA, as evidenced by pre- and post-parental sleep questionnaire scores of 23.62 ± 8.24 and 13.55 ± 6.05, respectively (paired samples test, P = 0.00). Similarly, both the pre- and post-Apnoea/Hypopnoea Index (AHI) scores (2.278 ± 1.5658 and 1.19 ± 1.420) and central sleep apnea index scores (1.252 ± 0.8972 and 0.61 ± 0.815) significantly improved post-treatment (paired samples test, P = 0.03, respectively). Additionally, significant changes were observed in tonsillar grade after the 12-week medication course, and sleep architecture showed notable improvement during the repeat follow-up study. These findings highlight the efficacy of treatment interventions in alleviating symptoms and enhancing sleep efficiency in paediatric OSA. The findings of this study underscore the efficacy of a medical management using intranasal corticosteroids and oral montelukast in mitigating the severity of mild obstructive sleep apnea (OSA) in children. This research substantiates the therapeutic value of corticosteroids and oral montelukast in paediatric patients with mild OSA, offering compelling evidence for their use as beneficial interventions in this population. [ABSTRACT FROM AUTHOR]

Narcolepsy is a sleep disorder caused by an apparent degeneration of orexin/hypocretin neurons in the lateral hypothalamic area and a subsequent decrease in orexin/hypocretin levels in the cerebrospinal fluid. Narcolepsy is classified into type 1 (NT1) and type 2 (NT2). While genetic associations in the human leukocyte antigen (HLA) region and candidate autoantibodies have been investigated in NT1 to imply an autoimmune origin, less is known about the pathogenesis in NT2. Twenty‐six NT1 and 15 NT2 patients were included, together with control groups of 24 idiopathic hypersomnia (IH) patients and 778 general population participants. High‐resolution sequencing was used to determine the alleles, the extended haplotypes, and the genotypes of HLA‐DRB3, ‐DRB4, ‐DRB5, ‐DRB1, ‐DQA1, ‐DQB1, ‐DPA1, and ‐DPB1. Radiobinding assay was used to determine autoantibodies against hypocretin receptor 2 (anti‐HCRTR2 autoantibodies). NT1 was associated with HLA‐DRB5*01:01:01, ‐DRB1*15:01:01, ‐DQA1*01:02:01, ‐DQB1*06:02:01, ‐DRB5*01:01:01, ‐DRB1*15:01:01, ‐DQA1*01:02:01, ‐DQB1*06:02:01 (odds ratio [OR]: 9.15; p = 8.31 × 10−4) and HLA‐DRB5*01:01:01, ‐DRB1*15:01:01, ‐DQA1*01:02:01, ‐DQB1*06:02:01, ‐DRB4*01:03:01, ‐DRB1*04:01:01, ‐DQA1*03:02//03:03:01, ‐DQB1*03:01:01 (OR: 23.61; p = 1.58 × 10−4) genotypes. Lower orexin/hypocretin levels were reported in the NT2 subgroup (n = 5) that was associated with the extended HLA‐DQB1*06:02:01 haplotype (p =.001). Anti‐HCRTR2 autoantibody levels were not different between study groups (p =.8524). We confirmed the previous association of NT1 with HLA‐DQB1*06:02:01 extended genotypes. A subgroup of NT2 patients with intermediate orexin/hypocretin levels and association with HLA‐DQB1*06:02:01 was identified, indicating a possible overlap between the two distinct narcolepsy subtypes, NT1 and NT2. Low anti‐HCRTR2 autoantibody levels suggest that these receptors might not function as autoimmune targets in either NT1 or NT2. [ABSTRACT FROM AUTHOR]

Background: Children with neurodevelopmental disorders (NDD) experience high rates of sleep problems. The Better Nights, Better Days for Children with Neurodevelopmental DisordersTM (BNBD-NDDTM) program is an online intervention for parents of children with NDD who have insomnia/insomnia symptoms. The program has recently undergone a national implementation study (recruitment completed; data collection and analysis ongoing), where parental adherence and engagement are being evaluated. Preliminary results have shown that despite high levels of recruitment, there is less utilization of the program than the research team expected. Parental engagement may have been impacted by participants' motivation and readiness for change, as well as indirectly by the COVID-19 pandemic. The objective of the current study is to better understand engagement with the BNBD-NDDTM program concerning parental motivation and readiness for change, while considering the possible impacts of COVID-19. Methods: Parents of children with NDD (n = 18) who were enrolled in the BNBDNDDTM program for a minimum of 4 months completed exit interviews using a researcher-generated, semi-structured interview guide. During the interview, participants were asked about their engagement in the program, perspectives on their own readiness for changing their children's sleep, and the impact of COVID-19 on their engagement. Data were analyzed following an inductive content analysis approach. Results: Several categories of data were generated that explain levels of engagement, including: (1) severity of sleep problems; (2)motivation for change; (3) previous strategies for sleep; (4) confidence in the program; (5) sacrifices made to change sleep; (6) maintenance of change; (7) experience with levels of support provided; and (8) impact of the COVID-19 pandemic. Conclusion: Parents identified several factors related to their readiness for change as contributors to their engagement level in the BNBD-NDDTM program. The COVID-19 pandemic had varied impacts on engagement for participants in this sample. Understanding parents' engagement levels within the BNBDNDDTM eHealth program related to their motivation and readiness for change is crucial to optimize uptake and adherence to the program, improve the program's implementation and sustainability, and continue to help children with NDD to sleep better. [ABSTRACT FROM AUTHOR]

Background: Current research separately analyzed the connection between postpartum depression, fatigue, sleep and infant development. However, depression, fatigue and sleep quality often coexisted as adverse symptoms in postpartum women and influenced infant development together. This study explored the maternal postpartum symptoms on infant growth. Methods: Our study included 224 pairs of singleton full‐term mothers and their infants who underwent routine pediatric outpatient clinics. Latent profile analysis was applied to identify the latent classes based on mothers' postpartum depression, fatigue and sleep profile characteristics. We evaluated the maternal adverse symptoms and infant development using multivariable logistic regressions. Results: Totally, 224 pairs of eligible mothers (28.85 ± 4.43 years) and infants (30.93 ± 3.26 days) participated in this study. Latent profile analysis identified 3 latent groups: mild (58.04%), moderate (34.37%), and severe (7.59%) postpartum adverse symptoms. Postpartum adverse symptoms were associated with delayed development in the baby's motor level (χ2 = 6.572, p =.037) and weight‐for‐length (χ2 = 9.652, p =.008). After controlling for mother and infant related factors, postpartum adverse symptoms remained a risk factor for infant motor level (odds ratio [OR]: 4.35; 95% confidence interval [CI]: 1.25–15.08) and weight‐for‐length (OR: 5.53; 95% CI: 1.55–19.74). Conclusions: Maternal postpartum depression, fatigue and sleep quality are associated with infant development. Clinically, mothers with these symptoms should be intervened timely to avoid the aggravation of maternal symptoms, which affect baby's development. [ABSTRACT FROM AUTHOR]

In the last years, the hypothesis of a close relationship between sleep disorders (SDs) and Parkinson's disease (PD) has significantly strengthened. Whether this association is causal has been also highlighted by recent evidence demonstrating a neurobiological link between SDs and PD. Thus, the question is not whether these two chronic conditions are mutually connected, but rather how and when this relationship is expressed. Supporting this, not all SDs manifest with the same temporal sequence in PD patients. Indeed, SDs can precede or occur concomitantly with the onset of the clinical manifestation of PD. This review discusses the existing literature, putting under a magnifying glass the timing of occurrence of SDs in PD-neurodegeneration. Based on this, here, we propose two possible directions for studying the SDs–PD relationship: the first direction, from SDs to PD, considers SDs as potential biomarker/precursor of future PD-neurodegeneration; the second direction, from PD to SDs, considers SDs as concomitant symptoms in manifest PD, mainly related to primary PD-neuropathology and/or parkinsonian drugs. Furthermore, for each direction, we questioned SDs–PD relationship in terms of risk factors, neuronal circuits/mechanisms, and impact on the clinical phenotype and disease progression. Future research is needed to investigate whether targeting sleep may be the winning strategy to treat PD, in the context of a personalized precision medicine. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness, tolerability, and safety of topical amitriptyline as a potential route of administration for the management of burning mouth syndrome. Background: Burning mouth syndrome is a complex, idiopathic, and debilitating orofacial pain disorder that impairs quality of life, with a prevalence of up to 18% in menopausal women. Available drugs to alleviate its burning sensation have inconsistent and limited efficacy. Given its physicochemical properties, excellent tolerability, and ability to target peripheral pathways, topical amitriptyline seems a promising mechanistically specific analgesic drug for burning mouth syndrome. Methods: In this retrospective cross‐sectional real‐world evidence study, patients with burning mouth syndrome who were prescribed topical amitriptyline for 8 weeks were identified. Eligibility criteria stemmed from ICHD‐3, ICOP, and consensus definitions. The primary outcome measure was mean daily pain intensity (on a 0–10 scale); secondary outcomes included adverse events and patient global impression of improvement. Data are given as the mean ± SD. Results: A total of 15 patients fulfilling the eligibility criteria were included and analyzed. Mean daily pain was 6.7 ± 2.1 at baseline and 3.7 ± 2.3 after treatment, with a mean reduction of 3.1 ± 2.8 (p = 0.002). Half of the patients experienced a decrease in pain by at least 50% (p = 0.008). Several mild adverse events were reported, such as somnolence or dry mouth. Conclusions: Topical amitriptyline may be a safe and potent route of administration in the treatment of burning mouth syndrome, a hypothesis to be tested in further controlled trials. [ABSTRACT FROM AUTHOR]

The article focuses on the growing use of telemedicine in developmental pediatrics, driven by the rapid adoption of telehealth technologies, especially during the COVID-19 pandemic. Topics include the role of telemedicine in enhancing healthcare access, the challenges posed by the scarcity of pediatric subspecialists, and the difficulties that individuals with developmental disabilities face in obtaining adequate care.

Suicide among college students is a challenging problem globally. Yet, the association between sleep quality, depressive symptoms, and suicidal ideation remains unclear. This study aims to understand if depressive symptoms mediate the relationship between sleep quality and suicide ideation and whether the interaction between depressive symptoms and sleep quality on suicidal ideation is additive. A total of 1182 college students were recruited, and sleep quality, depressive symptoms, and suicidal ideation were assessed using questionnaires. Univariate analysis, logistic regression analysis, linear regression models, and the Sobel test were performed. The results showed that, among college students, poor sleep quality was positively associated with suicidal ideation, and the association was mediated through depressive symptoms. Moreover, there was a significant additive interaction between poor sleep quality and depressive symptoms on suicidal ideation. These findings suggest that, in the process of preventing and treating suicidal ideation in college students with sleep disorders, we should focus on the evaluation and intervention of depressive symptoms and adopt multidisciplinary team interventions for college students with sleep disorders and depression. [ABSTRACT FROM AUTHOR]

Adolescent loneliness is prevalent and has serious adverse impacts on mental and physical health outcomes. This study aimed at examining factors associated with loneliness among school-going adolescents. The country of interest is a low-income country, Timor-Leste, where empirical studies are lacking. Data from the Global School-Based Student Health Survey Timor-Leste 2015 (n = 3455) were used for secondary analyses. An ordered probit model was utilized to assess demographic, lifestyle, social, and parental factors correlated with different levels of loneliness (no loneliness, moderate loneliness, and severe loneliness). Approximately 46.3% of adolescents felt moderately lonely and about 13.5% felt severely lonely. Older adolescents were more likely to experience severe and moderate loneliness than younger adolescents. Going hungry and being bullied were associated with an increased likelihood of being severely and moderately lonely. Adolescents had a higher probability of experiencing moderate and severe loneliness if they had sleep difficulties and were physically active. Having understanding parents was positively associated with the likelihood of severe loneliness. In conclusion, a large proportion of adolescents in Timor-Leste have feelings of loneliness, which have been found to be associated with demographic, lifestyle, social, and parental factors. Policymakers should recognize the correlated factors of loneliness in order to formulate a more effective intervention strategy. [ABSTRACT FROM AUTHOR]

Purpose: Delirium is linked to brain abnormalities, yet the role of the glymphatic system is not well understood. This study aims to examine alterations in brain physiology in delirium by using diffusion-tensor imaging (DTI) to assess water diffusion along the perivascular space (ALPS) and to explore its correlation with clinical symptoms. Methods: We examined 15 patients with delirium and 15 healthy controls, measuring water diffusion metrics along the x-, y-, and z-axes in both projection and association fibers to determine the DTI-ALPS index. We used a general linear model, adjusted for age and sex, to compare the DTI-ALPS index between groups. We also investigated the relationship between the DTI-ALPS index and clinical symptoms using partial correlations. Results: Patients with delirium exhibited significantly lower DTI-ALPS indices compared to healthy controls (1.25 ± 0.15 vs. 1.38 ± 0.10, t = 2.903, p = 0.007; 1.27 ± 0.16 vs. 1.39 ± 0.08, 1.22 ± 0.16 vs. 1.37 ± 0.14, t = 2.617, p = 0.014; t = 2.719, p = 0.011; respectively). However, there was no significant correlation between the DTI-ALPS index and clinical symptoms. Conclusion: Our findings indicate a decreased DTI-ALPS index in patients with delirium, suggesting potential alterations in brain physiology that may contribute to the pathophysiology of delirium. This study provides new insights into the mechanisms underlying delirium. [ABSTRACT FROM AUTHOR]

Background: REM Sleep Behavior Disorder (RBD) is characterized by absence of physiological muscle atonia during REM sleep (REM sleep without atonia, RWA). Nigro-striatal dopaminergic impairment is a feature of Parkinson disease (PD) and can be identified in prodromal stages as well, such as idiopathic RBD (iRBD). Aims of this study are to explore the efficacy of an automatic RWA quantification in identifying RBD patients and the correlation between RWA and nigro-striatal dopaminergic function. Methods: Forty-five iRBD, 46 PD with RBD, 24 PD without RBD patients and 11 healthy controls were enrolled in the Genoa Center (group A) and 25 patients with iRBD (group B) were enrolled in the Danish Center. Group A underwent brain [123I]FP-CIT-SPECT and group B underwent brain [18F]PE2I-PET as measures of nigro-striatal dopaminergic function. Chin muscle activity was recorded in all subjects and analyzed by applying a published automatic algorithm. Correlations between RWA and nigro-striatal dopaminergic function were explored. Results: The automatic quantification of RWA significantly differentiated RBD from non-RBD subjects (AUC = 0.86), although with lower accuracy compared with conventional visual scoring (AUC = 0.99). No significant correlation was found between RWA and nigro-striatal dopaminergic function. Conclusion: The automatic quantification of RWA is a reliable tool to identify subjects with RBD and may be used as a first-line screening tool, but without correlations with nigro-striatal dopaminergic functioning. [ABSTRACT FROM AUTHOR]

Background: Poor sleep quality is often reported by individuals with asthma, particularly by those who have poor asthma control overall. However, there is little understanding of how underlying sleep disorders such as insomnia may impact asthma control. Furthermore, given the frequent overlap of depression and insomnia, the incremental impact of mood disorders and insomnia on asthma control remains unclear. Methods: We conducted a retrospective analysis of patients at a large asthma center to further elucidate connections between these disease processes. Asthma patients with and without a diagnosis of insomnia were matched by age, sex, Charlson comorbidity index, and biologic therapy. We evaluated the presence of concurrent obstructive sleep disorder, mood disorders, exacerbation frequency, and asthma control test (ACT) scores. Results: From a cohort of 659 patients with an asthma diagnosis, 89 subjects with insomnia (13.5%) were matched 1:1 to patients without insomnia. Compared to those without insomnia, patients with insomnia were more likely to have a concurrent diagnosis of obstructive sleep apnea (57.3% vs. 18%, p < 0.001) and to have a diagnosis of depression or anxiety (68.5% vs. 11.4%, p < 0.001). Among insomnia patients, there was an average of 0.93 asthma exacerbations per year, compared to 0.59 exacerbations per year for those without insomnia (p = 0.039). Conclusion: Our data reveal a considerable interaction between insomnia, depression, and obstructive sleep apnea in individuals with asthma. The increased exacerbation rate suggests that underlying sleep and mood disorders negatively affect asthma control. [ABSTRACT FROM AUTHOR]

• Abnormal functional connectivity was maintained throughout the whole sleep onset process in patients. • Depressed patients exhibited increased functional connectivity and inter-hemispheric long-range links. • Healthy controls showed more significant rates of change in EEG activity during sleep onset. Sleep disorders constitute a principal diagnostic criterion for depression, potentially reflecting the abnormal persistence of brain activity during the sleep onset (SO) transition. Here, we sought to explore the differences in the dynamic changes in the EEG activity and the EEG functional connectivity (FC) during the SO transition in depressed patients. Overnight polysomnography recordings were obtained from thirty-two depressed patients and thirty-three healthy controls. The multiscale permutation entropy (MSPE) and EEG relative power were extracted to characterize EEG activity, and weighted phase lag index (WPLI) was calculated to characterize EEG FC. The intergroup differences in EEG activity of relative power and MSPE were reversed near SO, which attributed to slower rates of change among depressed patients. Regarding the characteristics of the EEG FC network, depressed patients exhibited significantly higher inter-hemispheric and interregional WPLI values in both delta and alpha bands throughout the SO transition, concomitant with different dynamic properties in the delta band FC. During the process after SO, patients exhibited increased inter-hemispheric long-range links, whereas controls showed more intra-hemispheric ones. Finally, we found significant correlations in the dynamic changes between different EEG measures. Our research revealed that the abnormal changes during the SO transition in depressed patients were manifested in both homeostatic and dynamic aspects, which were reflected in EEG FC and EEG activity, respectively. These findings may elucidate the mechanism underlying sleep disorders in depression from the perspective of neural activity. [ABSTRACT FROM AUTHOR]

Background and purpose: Migraine and sleep disorders share a bidirectional relationship, but little is known about the specific association between migraine and rapid eye movement (REM) sleep behaviour disorder (RBD). The aim was to assess the prevalence of RBD and associated clinical characteristics in adults with migraine. Methods: This analysis is part of a cross‐sectional survey study conducted at the Headache Centre of the Charité—Universitätsmedizin Berlin between August 2020 and March 2023. At the end of their regular medical consultation, patients with migraine filled out (1) the validated RBD Screening Questionnaire (RBDSQ), (2) a questionnaire on REM sleep intrusions and (3) the Depression, Anxiety and Stress Scale 21. The primary endpoint was the percentage of patients with a positive RBD screening. A multivariate analysis was performed to identify characteristics independently associated with features of RBD. Results: A total of 751 patients (44.1 ± 13.2 years; 87.4% female) with complete RBDSQ were included in this analysis, of which 443 (58.9%) screened positive for RBD. In multivariate analysis, a positive screening for RBD was associated with younger age (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.8–0.9 per 10‐year increase; p = 0.005) and with features suggestive of REM sleep intrusions (OR 4.3, 95% CI 1.8–10.4; p = 0.001). Migraine aura remained in the model without reaching statistical significance (OR 1.3, 95% CI 0.9–1.8; p = 0.079). Discussion: Symptoms of RBD are frequent in adults with migraine. Further studies including polysomnography are required to confirm this association, and to explore potential common pathophysiological mechanisms. [ABSTRACT FROM AUTHOR]