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Objectives Narcolepsy symptoms, such as excessive daytime sleepiness or cataplexy, can pose a risk to safety. Stimulants or antidepressants have been used to treat these symptoms. The study investigated the risk of bone fractures in narcolepsy patients. Also, the exposure pattern of stimulants and antidepressants to the risk of bone fractures was examined. Methods In all, 493 narcolepsy patients and 490 controls matched by gender, age, index year, and comorbidity severity were enrolled between 1998 and 2012, then followed until the end of 2013 using Taiwan's National Health Insurance Research Database. During the follow-up period, participants who developed bone fractures were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) for the incidence rates of bone fractures between narcolepsy patients and unaffected controls. Results Narcolepsy patients had a significantly increased risk of bone fractures compared with unaffected controls (19.6 versus 12.3 per 1000 person-years, HR: 1.74, 95% CI: 1.29–2.35). In addition, the use of stimulants in narcolepsy patients showed lower incidence rates of bone fractures compared to non-users (incidence rates were 14.2, 11.9, and 20.0 per 1000 person-years, respectively, among frequent users, infrequent users, and non-users), but the risk estimate was not statistically significant. The evidence for associations between antidepressant use in narcolepsy patients and bone fractures was contradictory. Conclusion This study highlights the need to pay attention to the risk of bone fractures in narcolepsy patients, and the importance of adequate stimulants use might reduce the risk of bone fractures.

Patients with schizophrenia (SCZ) have a higher prevalence of known risk factors for obstructive sleep apnea (OSA). This study aims to determine if SCZ patients are at increased risk of incident OSA. A total of 5092 newly diagnosed SCZ patients and 5092 non-SCZ controls matched by gender, age, and index year were included between 2000 and 2012 and followed to 2013. Participants newly diagnosed with OSA were defined as incidents. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence intervals (CI) of the OSA incidence rate between the two groups studied. SCZ patients were at increased risk of OSA compared to non-SCZ controls after adjusting for gender, age, comorbidities, and duration of antipsychotic use (2.12 versus 1.01 per 1000 person-years, HR: 1.97, 95% CI: 1.36–2.85). Also, this study confirmed the existence of some known risk factors for OSA, including male gender (HR 1.65, 95% CI 1.14–2.37), obesity (HR 2.62, 95% CI 1.19–5.80), hypertension (HR 1.61, 95% CI 1.06–2.47), hyperlipidemia (HR 1.55, 95% CI 1.04–2.38), diabetes (HR 1.53, 95% CI 1.01–2.38), and antipsychotic use (duration

Narcolepsy is a rare brain disorder characterized by excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, and sleep paralysis. Stimulants have been used to relieve the symptoms of EDS. Narcolepsy symptoms may pose a risk to burn injury. The study aimed to investigate the risk of burn injury in narcolepsy patients and to examine the relationship between the use of stimulants and the risk of burn injury. In all, 507 narcolepsy patients and 504 controls matched by gender, age, index year, and Charlson Comorbidity Index (CCI) score were enrolled between 1998 and 2012, then followed until the end of 2013 using Taiwan’s National Health Insurance Research Database. During the follow-up period, participants who developed burn injury were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) of the burn incidence rate between narcolepsy patients and unaffected controls. Narcolepsy patients had a significantly increased risk of burn injury compared to unaffected controls (5.37 versus 2.69 per 1,000 person-years, HR: 2.04, 95% CI: 1.13–3.67) after adjusting for gender, age, CCI score, urbanization degree, and duration of stimulants use. Also, the use of stimulants in narcolepsy patients was associated with a lower incidence rate of developing burn injury, but the risk estimate was not statistically significant after adjusting for the above-mentioned variables. This study shows narcolepsy patients have an increased risk of burn injury and the use of stimulants may reduce the burn incidence rate, providing a reference for developing prevention interventions.

Objective: Obstructive sleep apnea (OSA) is a sleep disorder which results in daytime sleepiness and impaired memory function. The aim of this study was to investigate the effect of continuous positive airway pressure (CPAP) on sleepiness and memory function in OSA patients. We also investigated whether CPAP compliance impacted the effect of this treatment.Methods: The case-control study enrolled sixty-six patients with moderate to severe OSA subjects. All subjects completed a polysomnographic study, sleepiness questionnaires (the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index), and four memory function tests (WM: working memory; PS: processing speed; LM: logical memory; FM: face memory).Results: Prior to CPAP treatment, no significant differences (p< 0.05) were noted in the demographic data, daytime sleepiness, or memory function between the two groups (with/without CPAP). However, OSA patients treated with CPAP for two months showed significant improvements in daytime sleepiness, PS, LM, and FM compared to those who did not receive CPAP treatment. A significant improvement in LM was observed in subjects who exhibited good compliance with CPAP treatment compared to those with poor compliance. Conclusions: In conclusion, CPAP treatment for two months improved daytime sleepiness and memory function in OSA patients. Patients exhibiting good CPAP compliance demonstrated greater improvements in daytime sleepiness and LM function.

Introduction Continuous positive airway pressure (CPAP) is the main treatment for obstructive sleep apnea (OSA). To date, the link between CPAP usage and incident stroke has been inconsistent. Objective This nationwide population study is designed to examine the effect of CPAP on stroke incidence in OSA patients. Methods Using Taiwan's National Health Insurance Research Database (NHIRD), this study collected data from 4275 OSA patients diagnosed between 2000 and 2011 and divided them into two groups according to whether they received CPAP treatment. After matching baseline demographics and comorbidities, both cohorts contained 959 OSA patients and were followed to a newly diagnosed stroke or until the end of 2013. Cox regression analysis was performed to examine the incidence of stroke between patients with OSA receiving CPAP or no CPAP treatment. Results CPAP treatment for OSA patients predicted a lower incidence rate (3.41 vs 5.43 per 1000 person-years) and tended to protect against the development of stroke (hazard ratio (HR): 0.68, 95% confidence interval (95% CI): 0.38-1.23) compared to those without CPAP treatment, but the estimate was not statistically significant. Similar results were also observed by dividing stroke into ischemic (2.65 vs 4.30 per 1000 person-years; HR: 0.67, 95% CI: 0.35-1.31) or hemorrhagic origin (0.76 vs 1.12 per 1000 person-years; HR: 0.67, 95% CI: 0.19-2.40). Conclusions It is possible that treatment with CPAP might be beneficial for protection against stroke, but this conclusion should be interpreted with caution. Future studies with satisfactory CPAP quality and duration are needed to validate this observation.

Obstructive sleep apnea (OSA), a sleep disorder, results in decreased daytime alertness and neurocognitive dysfunction. Obesity is considered a major risk factor for the development and progression of OSA and the resulting cognitive dysfunction. However, the effect of obesity on neurocognitive dysfunction in OSA has been rarely investigated. Eighty-three patients with moderate to severe OSA syndrome were recruited in our study. After matching for education, age, and body mass index (BMI), 40 patients were enrolled into our study with matched obese (BMI ≧ 30) and non-obese (BMI

Teaching patients about sleep hygiene is a common practice in nursing. This study investigated the relationships of nursing students' sleep quality, sleep knowledge, and attitudes toward sleep hygiene with the teaching of sleep hygiene to patients with sleep disorders. A descriptive correlational design was adopted to investigate 258 nursing students from 2 nursing schools in different regions of Taiwan. A series of self-developed and standardized questionnaires was used to collect data. Binary logistic regression analysis was used to identify the predictors of nursing students' teaching patients about sleep hygiene. The overall response rate was 92.8%. A total of 63.6% of the participants taught their patients about sleep hygiene. The findings reveal that the participants were generally less knowledgeable about sleep, particularly in the aspect of sleep hygiene. Those with higher sleep quality, more knowledge about sleep, and more positive attitudes toward sleep hygiene were more likely to teach their patients about sleep hygiene. Sleep quality, sleep knowledge, and attitudes toward sleep hygiene were independent predictors of nursing students' teaching patients about sleep hygiene. The study findings suggest that educators and clinical preceptors may develop effective strategies, such as relaxation, to improve nursing students' sleep quality and integrate sleep education into nursing curricula to further advance the students' sleep knowledge in educational programs and practice.

Objectives The present study aimed to compare the effects of music and music video interventions on objective and subjective sleep quality in adults with sleep disturbances. Design A randomized controlled trial was performed on 71 adults who were recruited from the outpatient department of a hospital with 1100 beds and randomly assigned to the control, music, and music video groups. Interventions During the 4 test days (Days 2–5), for 30 min before nocturnal sleep, the music group listened to Buddhist music and the music video group watched Buddhist music videos. They were instructed to not listen/watch to the music/MV on the first night (pretest, Day 1) and the final night (Day 6). The control group received no intervention. Main outcome measures Sleep was assessed using a one-channel electroencephalography machine in their homes and self-reported questionnaires. Results The music and music video interventions had no effect on any objective sleep parameters, as measured using electroencephalography. However, the music group had significantly longer subjective total sleep time than the music video group did (Wald χ2 = 6.23, p = 0.04). Conclusion Our study results increase knowledge regarding music interventions for sleep quality in adults with sleep disturbances. This study suggested that more research is required to strengthen the scientific knowledge of the effects of music intervention on sleep quality in adults with sleep disturbances. (ISRCTN94971645)

Background: Actigraphy plus single-channel electroencephalography (EEG) has a high agreement with polysomnography and is considered a simple method for monitoring sleep at home. No studies, however, have evaluated its agreement with sleep logs. Purpose: A sleep log was compared to a single-channel EEG in adults with sleep disturbances. The determinants of the agreement between the two recording methods were explored. Method: This prospective comparison substudy included 71 participants aged 22–67 years sampled from a previous study of nonpharmacological therapy for sleep disturbances. The participants concurrently used a sleep log and a single-channel EEG machine for 6 days to measure their sleep at home. Total sleep time (TST) and sleep onset latency (SOL) were compared. Results: Correlations between measurements were .43 for TST ( p < .001) and .30 ( p < .01) for SOL. Bland–Altman analysis revealed that the mean bias between methods was 81.54 min (standard deviation [ SD] = 66.72 min) for TST and 5.58 min ( SD = 25.38 min) for SOL. SDs for both TST and SOL were higher for the sleep log than for EEG. A multivariate linear regression model demonstrated that age (standardized coefficient β = .42, p = .001) was a significant predictor of the mean difference in SOL measurements, accounting for 13.7% of the total variance in the mean difference. Conclusion: Sleep log and single-channel EEG sleep measures are distinct from one another, and age predicts the mean level of disagreement between the two measures in adults with sleep disturbances.

Aim This study was conducted to evaluate the effect of clinical factors on the treatment outcomes of lung cancer patients with active epidermal growth factor receptor (EGFR) mutations treated by first-line tyrosine kinase inhibitors (TKIs). Methods Patients of stage IIIb or IV lung adenocarcinoma harboring mutated EGFR were enrolled between March 2010 and June 2014 and followed up until December 2015. The effects of various clinical features, such as age, sex, smoking history, EGFR mutation types, TKIs used, presence of pleural effusion, metastatic sites on progression-free survival (PFS) and overall survival (OS), were analyzed retrospectively. Results A total of 104 patients were included in this study. Patients with pleural effusion at initial diagnosis had significantly shorter PFS and OS than those without pleural effusion (median PFS: 8.2 months vs 15.3 months, P = 0.0004; median OS: 16.3 months vs 28.2 months, P = 0.0003). Univariate analysis revealed that being male or a smoker was associated with short PFS, whereas smoking history, bony metastasis and malignant pleural effusion were associated with poor OS. Stepwise multivariate Cox regression analysis showed that the presence of pleural effusion and different TKI use were independent prognostic factors for PFS [hazard ratio [HR] = 2.50 (95% confidence interval [CI], 1.53-4.10), P = 0.0003 and HR = 0.55 (95% CI, 0.31-0.97), P = 0.0396, respectively], whereas the presence of pleural effusion and liver metastasis were associated with poor OS [HR = 2.79 (95% CI: 1.46-5.30), P = 0.0018 and HR = 2.12 (95% CI, 1.02-4.40), P = 0.0440, respectively]. Conclusion The presence of pleural effusion predicts poor PFS and OS in lung adenocarcinoma patients receiving TKIs as the first-line treatment. Additional studies are warranted to elucidate the underlying mechanisms and determine novel strategies for improving the outcome of these patients.

Aim To examine the effects of a soothing music intervention before bedtime and a treadmill brisk walking exercise combined with music in the evening on sleep quality of sedentary older adults with chronic insomnia. Background There is evidence to support the use of complementary interventions to improve sleep. They are rarely applied in Taiwanese elderly population. Methods Using a crossover controlled trial, 38 participants aged 50 to 75 years were randomly assigned to a music intervention/brisk walking sequence or a brisk walking/music intervention sequence. Each participant completed two intervention sessions (separated by 1 week). Each intervention lasted 30 min. An actigraph extended with electroencephalography (EEG) and questionnaires were used to assess the sleep quality. Results Both interventions exhibited beneficial effects on subjective sleep quality in adults with insomnia. Also listening to soothing music before bedtime significantly shortened the wake time after sleep onset measured by EEG, compared with brisk walking in the evening. Conclusions The interventions applied in this study could be applied as the evidence-based nursing interventions for insomnia older adults.

Obstructive sleep apnoea (OSA) is a sleep disorder involving repeated nocturnal desaturation and sleep fragmentation. OSA can result in decreased daytime alertness and neurocognitive dysfunction. Hypercapnia status is also related to neurocognitive dysfunction in patients with pulmonary diseases. We evaluated the effects of hypercapnia on cognitive performance and memory function in a prospective case-controlled study. We enrolled thirty-nine obese patients with OSA and collected their arterial blood samples. All the participants provided arterial blood samples, and completed two questionnaires (the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale) and six cognitive tasks (the psychomotor vigilance task [PVT], the Stroop task, the Eriksen flanker task, processing speed [DSST], and verbal and visual memory [LM&FM]), which were used to evaluate daytime sleepiness, cognitive function, and memory function within one week of a polysomnographic study. When compared to the OSA without diurnal hypoventilation, the patients with stable hypercapnia (OHS) had increased reaction times in the PVT, Stroop task, and flanker task. Hypercapnic obese patients with OSA also had comparatively significantly lower scores in the processing speed and logical memory tests. OHS had increased reaction times in the attention and cognitive function assessments, and deficits in the logical memory, when compared to those with OSA without diurnal hypoventilation.

Aim This study determined the prevalence, perceived efficacy, and influencing factors and evaluated the sources of information as well as the barriers and facilitators for the use of integrative medicine approaches (IMA) within the previous 12 months to treat adults with sleep disturbances. Background No studies have assessed the use of integrative medicine approaches in adults with sleep disturbances. Methods A cross-sectional postal survey was conducted. Adults with sleep disturbances were purposively selected from the sleep center of a hospital in Taiwan. Binary logistic regression was used to analyze and compare the differences between groups of use and non-use IMA. Results The response rate was 94.5% (n = 515). The prevalence for the use of integrative medicine approaches was 53.4% (n = 275). The most prevalent IMA was music. However, the most perceivably efficacious integrative medicine approaches was acupressure, followed by music and meditation. Independent explanatory variables were educational attainment, the number of chronic diseases/symptoms, and healthy lifestyles for the use of IMA. The most common source of information was television/radio. The top facilitator and barrier for the use of integrative medicine approaches were side effects of sleeping pills and limited accessibility. Conclusions IMA are used by a considerable proportion of adults for treating sleep disturbances in Taiwan. The findings of this study identified the significant explanatory variables of IMA use and provided a fundamental understanding the aspects of IMA use in the adults with sleep disturbances is particularly important for health care providers in practice associated with their patients.

Background: The study was designed to compare the efficacy and tolerability of a fixed combination of extra-fine beclomethasone and formoterol, with the fixed combination fluticasone and salmeterol in Taiwanese asthmatic patients. Methods: This was a phase III, multicentre, randomized, two-arm parallel groups, controlled study. Patients with moderate to severe asthma were randomized to a 12-week treatment with either beclomethasone 100 mcg plus formoterol 6 mcg (BDP/F) or fluticasone 125 mcg plus salmeterol 25 mcg (FP/S), both delivered 2 inhalations twice daily. The efficacy and tolerability of these two combinations were compared. Results: Among the 253 randomized subjects, 244 patients were evaluable (119 in the BDP/F group and 125 in the FP/S group). A significant improvement from baseline to the end of treatment period was observed in both BDP/F and FP/S groups in forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), morning and evening peak expiratory flow (PEF), Asthma Control Test (ACT) score and the use of rescue medication. FVC increase from pre-dose was significant after 5 min post inhalation in the BDP/F group only, while statistically significant within group improvement was not achieved until 30 min post inhalation in the FP/S group. Conclusion: The BDP/F combination is comparable in efficacy and tolerability to FP/S combination in Taiwanese asthmatic patients, with the advantage of rapid onset of improvement of FVC, consistent with the faster improvement of pulmonary hyperinflation with BDP/F. Keywords: Asthma, Combination therapy, Inhaled corticosteroid, Long acting beta2-agonist, Pulmonary hyperinflation

Background Obstructive sleep apnea involves repeated nocturnal desaturation and sleep fragmentation that leads to poor sleep quality, anxiety, and depression. This study aimed to investigate short- and long-term improvements in the anxiety and depression of patients with different obstructive sleep apnea treatments. Methods This is a prospective, non-randomized hospital-based study evaluated 55 patients (46 male, 9 female) with obstructive sleep apnea. The patients were divided into three groups based on different treatment: uvulopalatopharyngoplasty group, continuous positive airway pressure group, and no treatment group (by their own decision). They completed the Beck Depression Inventory II, Beck Anxiety Inventory, and Pittsburgh Sleep Quality Index before treatment and at one and six months after treatment. Results Compared to the no treatment group, the surgery and continuous positive airway pressure groups had higher body mass index, AHI, and Epworth sleepiness scale, but no difference in Pittsburgh Sleep Quality Index, Chinese Health Questionnaire-12, Beck Depression Inventory II, and Beck Anxiety Inventory. The continuous positive airway pressure and surgery groups still had no improvements in Pittsburgh Sleep Quality Index, Chinese Health Questionnaire-12, Beck Depression Inventory II, and Beck Anxiety Inventory scores one month after treatment. At six months after treatment, the continuous positive airway pressure group had significantly decreased Pittsburgh Sleep Quality Index, Chinese Health Questionnaire-12, Beck Depression Inventory II, and Beck Anxiety Inventory, whereas the surgery group had significant difference in Beck Anxiety Inventory only and the no treatment group still had no significant difference in any of the parameters. Conclusions Continuous positive airway pressure can improve the sleep quality, quality of life, depression, and anxiety of obstructive sleep apnea patients after six months of treatment. However, surgery can significantly improve anxiety only in the same period.

Listening to soothing music has been used as a complementary therapy to improve sleep quality. However, there is no empirical evidence for the effects of music videos (MVs) on sleep quality in adults with insomnia as assessed by polysomnography (PSG). In this randomized crossover controlled trial, we compared the effects of a peaceful Buddhist MV intervention to a usual-care control condition before bedtime on subjective and objective sleep quality in middle-aged and older adults with chronic insomnia. The study was conducted in a hospital’s sleep laboratory. We randomly assigned 38 subjects, aged 50–75 years, to an MV/usual-care sequence or a usual-care/MV sequence. After pretest data collection, testing was held on two consecutive nights, with subjects participating in one condition each night according to their assigned sequence. Each intervention lasted 30 min. Sleep was assessed using PSG and self-report questionnaires. After controlling for baseline data, sleep-onset latency was significantly shorter by approximately 2 min in the MV condition than in the usual-care condition ( p = .002). The MV intervention had no significant effects relative to the usual care on any other sleep parameters assessed by PSG or self-reported sleep quality. These results suggest that an MV intervention may be effective in promoting sleep. However, the effectiveness of a Buddhist MV on sleep needs further study to develop a culturally specific insomnia intervention. Our findings also suggest that an MV intervention can serve as another option for health care providers to improve sleep onset in people with insomnia.

Snoring is a common symptom among the adult population, and it is the most common complaint in patients with obstructive sleep apnea (OSA) syndrome. Patients who snore in a sitting position while taking a nap or sleeping may have a narrower upper airway. The aim of this study was to evaluate if snoring in a sitting position is a predictor of OSA in patients. We prospectively enrolled 166 SS+ (with a history of snoring in a sitting position) subjects and 139 SS− (who denied having a history of snoring in a sitting position) patients. All of the participants received questionnaires as well as a standard polysomnography thereafter. Patients with self-reported snoring in a sitting position (with a tilt position greater than 70°, SS+ group) had a higher body mass index as well as greater neck, waist, and buttock circumference and scored higher on the Epworth Sleepiness Scale. During the polysomnographic study, the SS+ group had a higher percentage of N1 sleep and lower percentage of N2 sleep. In addition, the SS+ group had a higher apnea–hypopnea index (AHI) as well as higher arousal index and oxygen desaturation index. The sensitivity and specificity of the SS+ group for OSA (defined as AHI ≥ 5) were 0.59 and 0.73, respectively, with a positive predictive value of 0.93. The likelihood ratio was 2.2. On the other hand, the sensitivity and specificity of the SS+ group for moderate to severe OSA (defined as AHI ≥ 15) were 0.82 and 0.48, respectively. Both SS+ and greater neck circumference have a high likelihood ratio for diagnosing OSA. In the present study, the symptoms of self-reported snoring in a sitting position and greater neck circumference can be useful clinical predictors of OSA in Chinese patients.

Obstructive sleep apnea (OSA) is a sleep disorder with sleep fragmentation, which decreased daytime alertness and induced neurocognitive dysfucntion. The standard treatment of continuous positive airway pressure (CPAP) treatment on OSA patients has been demonstrated to improve daytime sleepiness but the effects on cognitive functions were poorly understood. Our study took psychomotor vigilance task, flanker task, stroop task and two questionnaires (Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS)) to measure cognitive function and daytime sleepiness in OSA patients before, after 3-week, and after 3-month standard CPAP treatment. Forty-five OSA patients show significant improvement in executive function with flanker task and Stroop task after 3-weeks and 3-months CPAP treatment as well as improvement of PSQI and ESS. OSA patients improved accuracy rate (AR) as well as decreased omission rate (OR), error rate (ER) and post-error error rate in flanker task after 3 weeks CPAP treatment. Further, three-month CPAP treatment improved incongruent reaction time (RT) in flanker task. The same group improved AR and decreased mean RT, OR, ER, as well as improved congruent and incongruent AR and shorten RT after 3 weeks treatment. Congruent accuracy rate can significant improved after 3 months CPAP used. However, the OSA patients show no significant improvement in vigilance task after 3-week and 3-mpnth CPAP treatment. In conclusion, our study demonstrates that short term and long term CPAP treatment could improve both executive function (improved accuracy rate and shortened reaction time) and sleep quality in OSA patients.

This study was conducted to evaluate the effect of clinical factors on the treatment outcomes of lung cancer patients with active epidermal growth factor receptor (EGFR) mutations treated by first-line tyrosine kinase inhibitors (TKIs).Patients of stage IIIb or IV lung adenocarcinoma harboring mutated EGFR were enrolled between March 2010 and June 2014 and followed up until December 2015. The effects of various clinical features, such as age, sex, smoking history, EGFR mutation types, TKIs used, presence of pleural effusion, metastatic sites on progression-free survival (PFS) and overall survival (OS), were analyzed retrospectively.A total of 104 patients were included in this study. Patients with pleural effusion at initial diagnosis had significantly shorter PFS and OS than those without pleural effusion (median PFS: 8.2 months vs 15.3 months, P = 0.0004; median OS: 16.3 months vs 28.2 months, P = 0.0003). Univariate analysis revealed that being male or a smoker was associated with short PFS, whereas smoking history, bony metastasis and malignant pleural effusion were associated with poor OS. Stepwise multivariate Cox regression analysis showed that the presence of pleural effusion and different TKI use were independent prognostic factors for PFS [hazard ratio [HR] = 2.50 (95% confidence interval [CI], 1.53-4.10), P = 0.0003 and HR = 0.55 (95% CI, 0.31-0.97), P = 0.0396, respectively], whereas the presence of pleural effusion and liver metastasis were associated with poor OS [HR = 2.79 (95% CI: 1.46-5.30), P = 0.0018 and HR = 2.12 (95% CI, 1.02-4.40), P = 0.0440, respectively].The presence of pleural effusion predicts poor PFS and OS in lung adenocarcinoma patients receiving TKIs as the first-line treatment. Additional studies are warranted to elucidate the underlying mechanisms and determine novel strategies for improving the outcome of these patients.

Aim The purpose was to examine the effects of non-commercial music on quality of sleep and relaxation indices, including heart rate, mean arterial pressure, and respiratory rate in patients in intensive care units. Background There is currently insufficient scientific knowledge for the effects of music on quality of sleep in critically ill patients. Design A randomized controlled trial. Methods Between January–December 2010, 28 patients aged 39–78 years were randomly assigned to music and control groups. Participants in the music groups listened to non-commercial music for 45 minutes at nocturnal sleep time. In the control group, participants slept with no music. Participants were assessed using vital signs monitors, standardized questionnaire, and polysomnography. Polysomnography sleep was recorded for the first 2 hours of the nocturnal sleep. General estimating equation was applied to analyse data. Findings Participants in the music group had shorter stage N2 sleep and longer stage N3 sleep in the first 2 hours of the nocturnal sleep and improved self-reported sleep quality, compared with those in the control group. The music group patients also had significantly lower heart rates than those in the control group. The intensive care units patients experienced fragmented sleep with a high frequency of awakenings and severe reduction in random eye movement sleep during the first 2 hours of the nocturnal sleep. Conclusion The findings provided evidence for nurses to use soothing music as a research-based nursing intervention for intensive care unit patients' sleep improvement.

Background Research-based evidence supports the therapeutic use of music to improve the sleep quality measured by self-reported questionnaires. However, scientific knowledge of the effects of music measured using standard polysomnography in chronic insomnia adults is currently insufficient. Objectives The objective of this study was to evaluate the effect of soothing music on objective and subjective sleep quality in adults with chronic insomnia. Methods Fifty participants were enrolled in a randomized controlled trial conducted in the sleep laboratory of a hospital, with 25 participants allocated to the music group and 25 to the control group. For four days, the experimental group was exposed to soothing music selected by the participants or researchers for 45min at nocturnal sleep time, whereas the control group was not exposed to music. Sleep was measured using polysomnography (PSG) and self-reported questionnaires. A general estimating equation was applied to analyze the data. Results After controlling for baseline data, the music group had significantly better scores for rested rating ( p =0.01), shortened stage 2 sleep ( p =0.03), and prolonged REM sleep ( p =0.04) compared to the control group, shown by the generalized estimating equations. However, there was no evidence of the effectiveness of music on other sleep parameters as measured by PSG. Additional findings indicate no difference in sleep quality between those who listened to their own preferred music ( n =10) and those who listened to music selected by the researchers ( n =15). Conclusion The results contribute to knowledge of the effectiveness of music as a therapy to improve sleep quality in adults experiencing insomnia. Listening to soothing music at nocturnal sleep time improved the rested rating scores, shortened stage 2 sleep, and prolonged REM sleep, but has little effect on sleep quality as measured by polysomnography and self-reported questionnaires.

This study determined the prevalence of and factors associated with insomnia in rotating-shift nurses. A two-stage, cross-sectional, hospital-based study was conducted in eastern Taiwan. Participants were randomly-sampled, rotating-shift nurses (n = 661), ranging in age from 21 to 62 years, with a mean age of 31.86 (standard deviation = 8.09). Insomnia disorder was identified using the Pittsburgh Sleep Quality Index. Nurses completed the self-reported Index, together with other questionnaires designed by the researchers for the purpose of the study. The prevalence of insomnia disorder was 59% (n = 390). Multivariate logistic regression analyses revealed that poor sleepers are more likely to have higher anxiety, feelings of depression, and a poor working atmosphere. Anxiety, depression, and working atmosphere are independent predictors of insomnia. These results suggest that it is crucial to implement a more appropriate shift system and to develop prevention programs for nurses with insomnia to improve their occupational health.

ObjectiveHeart rate variability is useful in evaluating cardiac autonomic balance. We investigated cardiac autonomic modulation in patients with severe chronic obstructive pulmonary disease (COPD) during heavy and very heavy exercise at and above the critical power (CP).Materials and MethodsNine nonhypoxemic patients with COPD (mean forced expiratory volume in 1 second: 1.2±0.5L; forced expiratory volume in 1 second/forced vital capacity: 37.6±12%) completed an initial incremental exercise test on a cycle ergometer followed by four constant work rate tests to define their CP. In addition, patients underwent a test at their calculated CP for a target of 20 minutes. The CP test plus a test above CP of sufficient duration to allow heart rate variability analysis were studied further. In these tests, R-R interval data were analyzed for variability in the frequency domain before and during exercise.ResultsCompared with rest, the power of the normalized low-frequency component (nuLF) decreased (73.0±20.9 vs. 54.2±20.1; p=0.01) and the power of normalized high-frequency component (nuHF) increased (27.0±20.9 vs. 45.8±20.1; p=0.01) during exercise, resulting in a decrease in LF/HF (4.1±2.3 vs. 1.6±1.2; p=0.01) suggesting a relative increase in parasympathetic tone during exercise. When compared with exercise at CP, exercise above CP featured significantly higher values for the square root of the mean squared differences of the successive R-R intervals, the baseline width of the minimum square difference triangular interpolation of the highest peak of the histogram of all N-N intervals and the nuHF, as well as significantly lower values for the nuLF and LF/HF. During exercise above and at the CP, both LF and HF negatively correlated with the respiratory rate (r=−0.76 and r=−0.70, p

Gender differences was an important issue in obstructive sleep apnea syndrome (OSA). Our goal is to investigate clinical characteristics and polysomnographic differences between male and female OSA subjects. We retrospectively collected 396 OSA adults in recent 5 years. All subjects completed polysomnographic and CPAP titration study. Besides, sixty-four male matched age and apnea-hypopnea index with 64 females was compared in the same database. Compared to male, female who has OSA were older and less neck circumference. Male has more N1 sleep and less N2 sleep and N3 sleep compared to female. Higher AHI severity, NREM AHI and arousal index (AI) in male OSA patients was noted. In the age and AHI matched study, male had higher neck circumference, increasing N1 sleep, decreasing N2 sleep compared to female subjects. Compared to female, male OSA subjects shift sleep stage from N1 to N2 significantly during CPAP used, as well as significant decreased AI during CPAP used in male. Our study shows even adjusting the variables of age and AHI, male has more N1 sleep and less N2 sleep comparing to female OSA patients. With using CPAP therapy, male OSA patients shift sleep from N1 to N2 and less arousal during CPAP used compared to female groups.

This study examined the noneconomic factors affecting consumers' participation in purchase decisions, focusing in particular on the social aspect of the buyer-seller interaction. In addition, we attempted to clarify the association between consumer participation and price sensitivity. Of the four social dimensions of consumer participation--preparation, relationship building, information exchange, and intervention--our results indicated that the first three dimensions are negatively associated with price sensitivity but the intervention dimension is not. Additionally, we also found that, given the same level of preparation, industries typically characterized by higher participation, such as hair salons, are associated with lower consumer price sensitivity as compared to those typically characterized by lower participation, such as fast food restaurants. Similarly, given the same level of relationship building, information exchange, and intervention, industries typically characterized by higher participation have lower consumer price sensitivity than those typically characterized by lower participation. ********** Firms should be interested in maintaining low consumer price sensitivity since it enhances their ability to extract price premiums that stand to improve their long-term profitability (Shankar and Krishnamurthi 1996). The effect of several different factors on price sensitivity has already been studied, including: the effect of consumer satisfaction (Anderson 1996); the effect of brand loyalty (Krishnamurthi and Raj 1991); the effect of reference price, purchase frequency, and brand loyalty (Kalyanaram and Little 1994); and the effect of advertising (Kalra and Goodstein 1998; Krishnamurthi and Raj 1985; Papatla 1995; Wittink 1977). The first three studies cited above focused on the effect of consumers' post-purchase experience on price sensitivity, whereas the latter ones focused on the effect of consumers' pre-purchase experience on price sensitivity. As a result of these studies, we know that, whether before or after, purchase experiences will affect the price sensitivity of consumers. According to Kellogg, Youngdahl, and Bowen (1997) consumer participation is a form of consumer behavior which includes preparation, relationship building, information exchange, and intervention; in other words, consumer participation includes preparation for the purchase, communication with the firm during the purchase, and the interventions with or suggestions to the firm after the purchase. In contrast to the earlier research, Kellogg, Youngdahl, and Bowen view consumer participation as more accurately characterized as behaviors of purchase that are assumed to have a greater effect on price sensitivity. One of the distinctive characteristics of the service industry is the inseparability of production and consumption, which means the consumer should take some part in the creation of the service. Bitner et al. (1997) stated that the consumer's greater participation in service delivery would lead to greater knowledge about the product. Others have pointed out that the process of negotiation and information exchange inherent in the consumer's participation will lead the consumer to understand the production process and become more knowledgeable as to what quality the service provider can reliably provide (Mills and Morris 1986; Kellogg, Youngdahl, and Bowen 1997). When consumers have a better understanding of what quality of service to expect, they understand better what benefits they will obtain. This means the consumer will be more aware of what "value"-the ratio of benefits to sacrifices (Zeithaml 1988)--the service provider can provide. When rational consumers better understand the actual value of the service, they will be more sensitive to changes in value (e.g., if the firm changes the price), which may affect the intention to purchase (Chang and Wildt 1994). Thus, it could be inferred that when consumers increase participation, they become more aware of the value of the service, and this enhanced awareness results in increased price sensitivity. …

Summary Cases for lung cancer metastasizing to stomach are rare, especially for squamous cell carcinoma. A 52-year-old Chinese male had visited our hospital due to chronic coughing and hemaptysis. After examinations, chest radiography indicated the presence of right upper lobe collapse. In addition, bronchoscopic biopsy showed the presence of pulmonary squamous cell carcinoma. Before any treatments the male had admitted that he has tarry stool. The result of panendoscopy showed a submucosal tumor at greater stomach curvature with ulcerative bleeding. Biopsy from gastric tumor confirmed metastatic squamous cell carcinoma. Because of this reported case, we have decided to do further review on the clinical characteristics of reported patients who have metastatic gastric cancer from lung squamous cell carcinoma.

This study determined the prevalence of and factors associated with insomnia in rotating-shift nurses. A two-stage, cross-sectional, hospital-based study was conducted in eastern Taiwan. Participants were randomly-sampled, rotating-shift nurses (n=661), ranging in age from 21 to 62 years, with a mean age of 31.86 (standard deviation=8.09). Insomnia disorder was identified using the Pittsburgh Sleep Quality Index. Nurses completed the self-reported Index, together with other questionnaires designed by the researchers for the purpose of the study. The prevalence of insomnia disorder was 59% (n=390). Multivariate logistic regression analyses revealed that poor sleepers are more likely to have higher anxiety, feelings of depression, and a poor working atmosphere. Anxiety, depression, and working atmosphere are independent predictors of insomnia. These results suggest that it is crucial to implement a more appropriate shift system and to develop prevention programs for nurses with insomnia to improve their occupational health.

Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of a complete or partial collapse of the upper airway during sleep. Traditionally, the disease is diagnosed by overnight polysomnography. Studies have shown correlation between parameters of cephalometry and severity of sleep apnea. We wish to determine the variable of craniofacial dimensions in the upper airway that contribute to OSA, and to investigate the significance of craniofacial measurements in positional and non-positional sleep apnea patients.From July 2002 to June 2006, we studied 84 males and 15 females who came to the sleep center because of daytime sleepiness. All the participants underwent overnight polysomnography and lateral cephalograms, performed by an experienced technician.Craniofacial measurements of gnathion-gonion, anterior superior hyoid to mandibular plane (MP-H), posterior nasal spine (PNS) to the velum tip (SPL), widest point of the soft palate (SPW), and the product of PNS to the velum tip and widest point of the soft palate (product of soft palate (SPP)=SPL x SPW) were positively related to the apnea/hypopnea index (AHI). The velum tip to the pharyngeal wall parallel to the Frankfurt horizontal (PAS) was negatively related to the AHI. We further divided the study subjects into 4 groups according to AHI value (group 1, AHI5; group 2, 5or= AHI15; group 3, 15or= AHI30; group 4, AHIor=30). Age, body mass index (BMI), neck circumference (NC), distances of PAS, SPL, SPW, SPP and angle of sella-nasion-infradentale (SNB) were significantly different depending on the degree of severity of sleep-disordered breathing (SDB). Patients who were older, with a high BMI and longer MP-H distance, had more daytime sleepiness (Epworth sleepiness scale, ESS). Furthermore, lower AHI values and longer PAS measurements were found in the positional sleep apnea group when compared to the non-positional sleep apnea group. After adjusting for confounding factors of age, BMI and NC, we found that BMI, MP-H distance and PAS measurement were correlated with severity of OSA.Cephalometry could be a useful and inexpensive clinical tool to evaluate Chinese patients with OSA. MP-H and PAS should be measured in Chinese patients with OSA. MP-H was correlated with ESS. The PAS measurement was narrower in non-positional OSA patients compared to positional OSA patients.

Chromosomal anomalies of inv(3)(q21q26) and/or monosomy 7 in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) have been reported to be associated with central diabetes insipidus [1-4...

In this preclinical study, the authors hypothesised that deficiency of protein kinase G-1 (PKG-1), a serine/threonine kinase, would induce pulmonary hypertension (PH) in mice through Rho A/Rho kinase activation. Protein kinase G-1- knockout (Prkg1−/−) mice had decreased PKG-1 and increased pulmonary artery systolic pressure compared …

Background/Purpose Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of a complete or partial collapse of the upper airway during sleep. The disease is traditionally diagnosed by overnight polysomnography with detection flow limitation by nasal pressure cannulas. The aim of this study was to evaluate the accuracy of flow (X flow) from calibrated respiratory inductive plethysmography. Methods We studied 60 male and 26 female patients who came to our sleep center in 2007. All the participants received overnight polysomnography and data were graded blindly and randomly by two experienced technicians. Results Patients with OSA were predominantly male, with higher body mass index, higher percentage of snorers, and more events of oxygen desaturation and arousal than those without OSA. There was a good correlation of X flow and flow from nasal pressure cannulas, regardless of total apnea–hypopnea, apnea or hypopnea events. The correlation was especially strong in severe OSA patients. The sensitivity and specificity to find OSA (apnea–hypopnea index ≥5) from X flow versus standard polysomnography was 98% and 100%, respectively. Positive predictive value was 100% and negative predictive value was 97%. Conclusion X flow could be a good clinical tool to be used instead of flow from nasal pressure cannulas in OSA patients.

Objectives Obstructive sleep apnea (OSA) is a sleep disorder with repeated nocturnal desaturation and sleep fragmentation. It can lead to poor quality of life. Our goal was to compare improvement in the quality of life of patients with OSA between those treated with continuous positive airway pressure (CPAP) and autotitrating positive airway pressure (APAP) for 3 months. Materials and Methods This was a prospective, randomized, crossover study. Study participants were patients with OSA randomized into the APAP or CPAP group, with crossover to the other group 3 months later. All patients received CPAP or APAP treatment for > 4 h/d. Each patient completed the Short Form 36 Health Survey (SF-36) before and after the 3-month CPAP and APAP treatment. Results The 19 patients had severe OSA [mean apnea–hypopnea index (AHI) 59.7 ± 23.9/h] and the mean optimal pressure of CPAP titration was 8.7 ± 1.5 mmHg. The CPAP group had a higher mean pressure 8.7 ± 1.4 mmHg as well as a lower AHI 0.6 ± 1.4/h than the APAP group. There was no difference in compliance between groups. Both groups had significant improvement in general health and vitality after treatment compared with before treatment. However, there were no significant differences in improvement in any component of the SF-36 between groups. Conclusion In our study, the CPAP patients had a higher pressure and lower AHI than the APAP patients. OSA patients preferred APAP. Both CPAP and APAP can improve general health and vitality in OSA patients.