Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details assessment and management of the child with overweight or obesity. The term "child" is defined as the child between 2 and 12 years of age. Because children are in a continual state of development during this age range, we will specify when our discussion applies to subsets within this age range. For the purposes of this CPS, we will use the following definitions: overweight in the child is a body mass index (BMI) ≥ 85th and <95th percentile, obesity in the child is a BMI ≥95th percentile, and severe obesity is a BMI ≥120% of the 95th percentile.

Methods

The information and clinical guidance in this OMA Clinical Practice Statement are based on scientific evidence, supported by medical literature, and derived from the clinical perspectives of the authors.

Results

This OMA Clinical Practice Statement provides an overview of prevalence of disease in this population, reviews precocious puberty in the child with obesity, discusses the current and evolving landscape of the use of anti-obesity medications in children in this age range, discusses the child with obesity and special health care needs, and reviews hypothalamic obesity in the child.

Conclusions

This OMA Clinical Practice Statement on the child with obesity is an evidence based review of the literature and an overview of current recommendations. This CPS is intended to provide a roadmap to the improvement of the health of children with obesity, especially those with metabolic, physiological, psychological complications and/or special healthcare needs. This CPS addresses treatment recommendations and is designed to help the clinician with clinical decision making.

Validity, reliability, and responsiveness of the Brazilian version of the instrument World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with obstructive sleep apnoea

BACKGROUND

Obstructive sleep apnoea (OSA) is a disabling health condition, and there is no disease-specific patient-reported outcome instrument to assess individuals with OSA.

OBJECTIVES

To evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with OSA.

METHODS

One hundred individuals with OSA responded to the WHODAS 2.0 version of 36 items, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the 12-item health survey (SF-12). Internal consistency, convergent and discriminative validity, and responsiveness to continuous positive airway pressure (CPAP) were the psychometric properties tested.

RESULTS

Cronbach's α values indicate good internal consistency (0.91 - 0.73), except for the self-care domain (α = 0.52). Convergent validity indicated an excellent correlation (r = -0.80) between the domains of functioning and quality of life. Discriminative validity showed no association between OSA severity and functioning (p = 0.90). The responsiveness to CPAP treatment showed a large effect size (r = 0.82; p < 0.05) CONCLUSIONS: The WHODAS 2.0 instrument is valid, reliable, and responsive for assessing individuals with OSA.

"Wheels stuck in the mud": A qualitative study of experiences of academic burnout in graduate nursing students

BACKGROUND

Academic burnout is widespread in higher education, affecting academic achievements, professional development, and physical and mental health. Previous related research lacks qualitative studies on graduate nursing students.

AIM

This study aims to provide valuable information to relevant authorities and stakeholders by identifying the key experiences associated with academic burnout in graduate nursing students.

DESIGN

An exploratory qualitative research design.

SETTINGS

This research was carried out at two medical universities located in the southern region of China.

PARTICIPANTS

Nineteen enrolled graduate nursing students.

METHODS

Data collection spanned from December 2023 to January 2024. After obtaining informed consent from the participants, the researchers conducted in-depth, semi-structured interviews. Data processing and analysis were based on Giorgi's phenomenological method. The reporting of this study strictly adhered to the Standards for Reporting Qualitative Research (SRQR).

RESULTS

Nineteen participants completed the interviews, ranging in age from 22 to 42 years and including sixteen females and three males. "Wheels stuck in mud" was the core construct that explained graduate nursing students' academic burnout. Analyses revealed four themes: invisible hand, a battle with myself, two choices, find my way.

CONCLUSION

The academic burnout of nursing graduate students is perceived as a psychological dilemma akin to being "wheels stuck in mud." It is driven by an invisible force composed of multiple components, leading to intense internal struggles for individuals. Individuals exhibit two distinct trends in their academic performance: either "remaining detached and indifferent to academics" or "overcommitting and self-exploiting." It is encouraged to conduct intervention using an integrative strategy based on acceptance and commitment therapy, self-disclosure, and mindfulness.

High bioavailable testosterone levels increase the incidence of isolated REM sleep behavior disorder: Results from multivariable and network Mendelian randomization analysis

OBJECTIVES

To explore the causal relationships between sex hormone levels and incidence of isolated REM sleep behavior disorder (iRBD).

METHODS

In our study, we utilized Genome-Wide Association Studies (GWAS) data for iRBD, including 9447 samples with 1061 cases of iRBD provided by the International RBD Study Group. Initially, we conducted a two-sample univariate MR analysis to explore the impact of sex hormone-related indicators on iRBD. This was followed by the application of multivariable MR methods to adjust for other hormone levels and potential confounders. Finally, we undertook a network MR analysis, employing brain structure Magnetic Resonance Imaging (MRI) characteristics as potential mediators, to examine whether sex hormones could indirectly influence the incidence of iRBD by affecting brain structure.

RESULTS

Bioavailable testosterone (BioT) is an independent risk factor for iRBD (Odds Ratio [95 % Confidence Interval] = 2.437 [1.308, 4.539], P = 0.005, corrected-P = 0.020), a finding that remained consistent even after adjusting for other sex hormone levels and potential confounders. Additionally, BioT appears to indirectly increase the risk of iRBD by reducing axial diffusivity and increasing the orientation dispersion index in the left cingulum and cingulate gyrus.

CONCLUSIONS

Our research reveals that elevated levels of BioT contribute to the development of iRBD. However, the specific impact of BioT on different sexes remains unclear. Furthermore, high BioT may indirectly lead to iRBD by impairing normal pathways in the left cingulum and cingulate gyrus and fostering abnormal pathway formation.

Circuit-dependent carbon dioxide rebreathing during continuous positive airway pressure

BACKGROUND

The current standard treatment for obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP), is characterized by a low adherence rate due to various factors including circuit-dependent carbon dioxide (CO2) rebreathing, which can exacerbated by disparate factors, such as low PAP, use of auto-titrating PAP or ramps. However, risk factors for rebreathing are often overlooked or poorly understood in clinical practice. Therefore, our objective was to evaluate the extent of rebreathing occurring with commonly used CPAP masks across varying PAPs, tidal volumes, and respiratory rates.

METHODS

In a bench study, we assessed the rebreathing rate of nine masks interfacing a CPAP with a lung simulator providing different breathing respiratory rates (15 or 20 breaths/min) and tidal volumes (400, 500, 600, 700 and 750 mL). Additionally, a theoretical model was developed to describe the likelihood of CO2 rebreathing from four different masks at various breathing settings.

RESULTS

Overall, all masks performed worse in situations characterized by low PAPs, high tidal volumes, and high respiratory rates. However, Dreamwear, Nuance, Siesta, Vitera, and particularly V2 masks exhibited greater susceptibility to rebreathing compared to F20, P10, Brevida, and Rio masks for the same variations of PAPs or ventilatory parameters. The mathematical model suggested that the risk of rebreathing for Rio, P10 and Nuance mask is negligible for respiratory rates of 10 breaths/min or below.

CONCLUSIONS

Circuit-dependent CO2 rebreathing can be a common occurrence and warrants careful mask selection upon CPAP therapy initiation for optimal clinical outcomes.

Predicting response to stepped-care cognitive behavioral therapy for insomnia using pre-treatment heart rate variability in cancer patients

OBJECTIVE

This study examined whether high frequency heart-rate variability (HF-HRV) and HF-HRV reactivity to worry moderate response to cognitive behavioural therapy for insomnia (CBT-I) within both a standard and stepped-care framework among cancer patients with comorbid insomnia. Biomarkers such as HF-HRV may predict response to CBT-I, a finding which could potentially inform patient allocation to different treatment intensities within a stepped-care framework.

METHODS

177 participants (86.3 % female; Mage = 55.3, SD = 10.4) were randomized to receive either stepped-care or standard CBT-I. 145 participants had their HRV assessed at pre-treatment during a rest and worry period. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI) and daily sleep diary across five timepoints from pre-treatment to a 12-month post-treatment follow-up.

RESULTS

Resting HF-HRV was significantly associated with pre-treatment sleep efficiency and sleep onset latency but not ISI score. However, resting HF-HRV did not predict overall changes in insomnia across treatment and follow-up. Similarly, resting HF-HRV did not differentially predict changes in sleep diary parameters across standard or stepped-care groups. HRV reactivity was not related to any of the assessed outcome measures in both cross-sectional and longitudinal analyses.

CONCLUSION

Although resting HF-HRV was related to initial daily sleep parameters, HF-HRV measures did not significantly predict longitudinal responses to CBT-I. These findings suggest that HF-HRV does not predict treatment responsiveness to CBT-I interventions of different intensity in cancer patients.

Digital cognitive behavioral therapy for insomnia for people with comorbid psychological distress: A large scale randomized controlled trial

STUDY OBJECTIVES

To examine if comorbid anxiety and depression symptoms (psychological distress) moderate intervention effect in participants receiving digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) in a large-scale randomized controlled trial (RCT), compared to a patient education (PE) control condition. Further, we investigate if dCBT-I reduced levels of psychological distress for those with insomnia and comorbid psychological distress.

METHODS

1721 participants with insomnia completed online assessments of sleep, fatigue and psychological distress, at baseline and at nine-week follow-up. Primary outcome was Insomnia Severity Index (ISI), and secondary outcomes included self-reported sleep (diary), cognition, fatigue, and psychological distress. Participants with psychological distress (HADS>16) were separated from participants without psychological distress. Linear mixed models in SPSS were conducted to test the effects of the intervention.

RESULTS

At nine-week follow-up we found no difference in effect of the intervention between those who had comorbid psychological distress vs. those without psychological distress in terms of insomnia severity (p = 0.552) and fatigue (p = 0.744). Both groups had large effect size improvements on insomnia severity (p < 0.001=), small to medium (Cohen d < 0.08) improvements on fatigue (p < 0.01=) and sleep efficiency (p < 0.001), and small improvement on other sleep diary measures, compared to their respective control group. The psychological distress group showed a small, but statistically significant decrease in psychological distress (d = 0.2, p < 0.05) with dCBT-I compared to PE.

CONCLUSION

dCBT-I is a viable treatment for Insomnia also for those who have comorbid psychological distress.

A Preliminary Analysis of Stress Burden and Cognitive Function and Clinically Adjudicated Cognitive Outcomes in Black American Adults

BACKGROUND

The combination of exposure to multiple stressors and psychological distress may contribute to the disproportionate burden of dementia risk among Black Americans. This study estimates the effect of an index of stress and psychological distress (ie, "stress burden") on cognitive function and clinically adjudicated cognitive outcomes among older Black American adults, and examines sleep as a mediator.

METHODS

The sample included 204 Black adults (79% female; mean age = 64 years) from Pittsburgh, PA, USA. Stress burden comprised 3 self-reported stress and distress measures assessed in 2016: discrimination, psychological distress, and posttraumatic stress. Potential mediators included actigraphy-assessed sleep duration and efficiency from 2018. Cognitive battery and clinical adjudication in 2019 assessed cognitive function and clinically adjudicated outcomes. Causal mediation analysis estimated the direct effect between stress burden and cognitive outcomes, and indirect effects through sleep, after adjusting for sociodemographics and hypertension.

RESULTS

Higher stress burden had a significant direct effect on lower executive functioning and visuospatial performance. However, there were no significant indirect effects (ie, mediation) by sleep disturbances on any domain of cognitive function assessed. Also, there were no significant direct or indirect effects on clinically adjudicated outcomes.

CONCLUSIONS

Multiple stressors often co-occur and may contribute to racial disparities in cognitive health. Findings suggest that higher stress burden had negative effects on functioning in executive and visuospatial domains in this community-based sample of older Black American adults. However, there was no evidence of mediation by sleep. Findings highlight the importance of continued work to identify modifiable pathways between stress burden and cognitive health disparities.

Validation and performance of the sleep inertia questionnaire in central disorders of hypersomnolence

BACKGROUND

Optimal measurement tools for problematic sleep inertia, common in some central disorders of hypersomnolence (CDH), have not yet been determined. We evaluated the performance of the Sleep Inertia Questionnaire (SIQ) in CDH, and how well it distinguished hypersomnolent groups from controls, and IH (idiopathic hypersomnia) from narcolepsy type 1 (NT1).

METHODS

This prospective, bi-centric study included 63 control, 84 IH, 16 NT1, 18 narcolepsy type 2 (NT2), and 88 subjective excessive daytime sleepiness (sEDS) participants, using ICSD-3 criteria. 126 (47.2 %) participants were on any medication at the time of SIQ completion. We assessed construct validity of SIQ scores, and sleep inertia duration (SID), and compared them across diagnoses, controlling for age and center. We derived cutpoints to distinguish hypersomnolent patients from controls and IH from NT1. Sensitivity analyses for depression, chronotype, and medication were performed.

RESULTS

The SIQ sum and composite score were significantly lower in controls than in other groups (p < 0.0001), demonstrating outstanding ability to distinguish patients from controls (AUCs 0.92), without differences among hypersomnolent groups. SID (AUC 0.76) was significantly shorter in controls than in all hypersomnolent groups except NT1, and was shorter in NT1 than in IH or sEDS. Optimal SIQ sum cutpoint was 42 (J = 0.71) for patients versus controls. Optimal SID cutpoint in distinguishing IH from NT1 was 25 min (J = 0.39).

CONCLUSION

The SIQ has excellent ability to distinguish hypersomnolent patients from healthy controls, after controlling for depression, eveningness, and medication. SID is best at distinguishing IH from NT1.

The Effect of Combined Transcranial Direct Current Stimulation and Pneumatic Compression as Part of a Comprehensive Recovery Strategy in Professional Male Top-Level Soccer Players

ABSTRACT

Gonçalves, DS, Moscaleski, LA, da Silva, GM, Morgans, R, Okano, AH, and Moreira, A. The effect of combined transcranial direct current stimulation and pneumatic compression as part of a comprehensive recovery strategy in professional male top-level soccer players. J Strength Cond Res 38(9): 1658-1666, 2024-This retrospective study aimed to examine the effect of transcranial direct current stimulation (tDCS) combined with lower limb pneumatic compression during the postmatch recovery period in top-level professional male soccer players' physiological and perceptual markers of recovery status. During the 2022 season (baseline), pneumatic compression was performed as part of the recovery strategy, applied the day after official match play and psychophysiological measurements (pain, sleep, perceived recovery, and creatine kinase [CK] sampling) were performed on the second day postmatch. During the 2023 season, the tDCS protocol was introduced, with its application being performed simultaneously (in conjunction) with pneumatic compression. Recovery sessions following 10 matches in the 2022 season and following 10 matches in the 2023 season were included in the analyses. Compared with 2022 (baseline; pneumatic compression isolated), the players perceived an increased recovery on the second day postmatch when tDCS was used in conjunction with the pneumatic compression (mean = 12%; p = 0.008) and rated improved sleep quality for the nights after applying tDCS combined with pneumatic compression (mean = 7.5%; p = 0.029). On the second day postmatch, a significant reduction was observed in muscle pain/soreness (mean = 64%; p < 0.0001) and the CK concentration decreased when baseline (pneumatic compression isolated) was compared with tDCS + pneumatic compression (mean = 76%; p = 0.001). In summary, combining pneumatic compression with tDCS may enhance the effects of both interventions, leading to greater overall improvements in recovery. Further research is warranted to confirm these findings and explore the underlying mechanisms in more detail.

Insomnia in patients with MRI-negative epilepsy: The associated factors and 3D-pCASL cerebral blood flow perfusion changes

OBJECTIVE

This study aimed to identify the factors associated with insomnia in MRI-negative epilepsy and uncover the underlying pathological mechanism driving insomnia within the context of epilepsy.

METHODS

We conducted a retrospective study of patients with MRI-negative epilepsy recruited consecutively from December 2021 to December 2022. All subjects completed the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS). Additionally, some subjects underwent the three-dimensional pseudo continuous arterial spin labeling(3D-pCASL) imaging examination. Bilateral frontal lobe, temporal lobe, hippocampus, thalamus, amygdala, caudate nucleus and lenticular nucleus were selected as regions of interest(ROI) and cerebral blood flow(CBF) values were measured in these regions. Subjects were classified into insomnia (ISI ≥ 10) or non-insomnia (ISI < 10) groups, and univariate and stepwise logistic regression analyses were employed to identify the factors associated with insomnia. Furthermore, CBF values in each ROI were compared between the two groups to identify the brain regions potentially related to the underlying pathological mechanism of insomnia in epilepsy.

RESULTS

A total of 73 patients with MRI-negative epilepsy were recruited in this study(men, 49.3 %). Among them, 14 patients(19.2 %) had insomnia. Univariate regression revealed that nocturnal seizures, number of anti-seizure medication(ASM), anxiety, use of valproic acid(VPA), depression, and excessive daytime sleepiness(EDS) may be associated with insomnia in MRI-negative epilepsy (all p＜0.05). Stepwise regression demonstrated that nocturnal seizures, anxiety, and EDS were independently associated with insomnia in MRI-negative epilepsy (OR[95 %CI]P: 14.64[2.02-106.27]0.008,49.35[3.06-796.61]0.006, 13.28[1.25-140.66]0.032, respectively). Furthermore, CBF values in the left amygdala were significantly lower in patients with MRI- negative epilepsy who had insomnia.

CONCLUSION

The prevalence of insomnia in MRI-negative epilepsy is 19.2%. Nocturnal seizures, anxiety, and EDS were independently associated with insomnia in MRI-negative epilepsy. The noteworthy decrease in CBF values in the left amygdala might be connected to the underlying pathological mechanism of insomnia in epilepsy.

Multi-omics revealed anti-fatigue property of polyphenol from areca nut

BACKGROUND

Areca nut polyphenols (AP) that extracted from areca nut, have been demonstrated for their potential of anti-fatigue effects. However, the underlying mechanisms for the anti-fatigue properties of AP has not been fully elucidated to date. Previous studies have predominantly concentrated on single aspects, such as antioxidation and anti-inflammation, yet have lacked comprehensive multi-dimensional analyses.

PURPOSE

To explore the underlying mechanism of AP in exerting anti-fatigue effects.

METHODS

In this study, we developed a chronic sleep deprivation-induced fatigue model and used physiological, hematological, and biochemical indicators to evaluate the anti- fatigue efficacy of AP. Additionally, a multi-omics approach was employed to reveal the anti-fatigue mechanisms of AP from the perspective of microbiome, metabolome, and proteome.

RESULTS

The detection of physiology, hematology and biochemistry index indicated that AP markedly alleviate mice fatigue state induced by sleep deprivation. The 16S rRNA sequencing showed the AP promoted the abundance of probiotics (Odoribacter, Dubosiella, Marvinbryantia, and Eubacterium) and suppressed harmful bacteria (Ruminococcus). On the other hand, AP was found to regulate the expression of colonic proteins, such as increases of adenosine triphosphate (ATP) synthesis and mitochondrial function related proteins, including ATP5A1, ATP5O, ATP5L, ATP5H, NDUFA, NDUFB, NDUFS, and NDUFV. Serum metabolomic analysis revealed AP upregulated the levels of anti-fatigue amino acids, such as taurine, leucine, arginine, glutamine, lysine, and l-proline. Hepatic proteins express levels, especially tricarboxylic acid (TCA) cycle (CS, SDHB, MDH2, and DLST) and redox-related proteins (SOD1, SOD2, GPX4, and PRDX3), were significantly recovered by AP administration. Spearman correlation analysis uncovered the strong correlation between microbiome, metabolome and proteome, suggesting the anti-fatigue effects of AP is attribute to the energy homeostasis and redox balance through gut-liver axis.

CONCLUSION

AP increased colonic ATP production and improve mitochondrial function by regulating gut microbiota, and further upregulated anti-fatigue amino acid levels in the blood. Based on the gut-liver axis, AP upregulated the hepatic tricarboxylic acid cycle and oxidoreductase-related protein expression, regulating energy homeostasis and redox balance, and ultimately exerting anti-fatigue effects. This study provides insights into the anti-fatigue mechanisms of AP, highlighting its potential as a therapeutic agent.

Probable sleep and awake bruxism in adolescents: A path analysis

BACKGROUND

Bruxism has a multifactorial etiology, including the influence of sleep characteristics and chronotypes.

AIM

To identify the pathways that influence the occurrence of probable sleep bruxism (PSB) and probable awake bruxism (PAB) in adolescents.

DESIGN

A total of 403 adolescents, aged 12-19 years, participated in the study. Parents/caregivers filled out a questionnaire about sociodemographic issues and the adolescent's health conditions, and the adolescents about sleep characteristics, occurrence of bruxism (based on previous study and the International Consensus of Bruxism), and chronotype (Circadian Energy Scale). Clinical examinations were performed. Statistical analysis included descriptive analysis and path analysis.

RESULTS

PSB and PAB are related to each other, with moderate and positive correlation (β = .390). Poor sleep quality and higher household income had a direct effect on both PSB (β = -.138; β = .123, respectively) and PAB (β = -.155; β = .116, respectively). Chronotype had a direct effect on PSB, in such a way that adolescents with a morningness chronotype tend to have PSB (β = -.102). Adolescents that drool on the pillow (β = .184) and/or have agitated sleep (β = .104) tend to have PSB.

CONCLUSION

Poor sleep quality, household income, morningness chronotype profile, drooling on the pillow, and agitated sleep influence the paths taken by PSB. PAB was influenced by the quality of sleep and family income.

A meta-analysis of the prevalence and risk of mental health problems in allergic rhinitis patients

OBJECTIVE

Allergic rhinitis (AR), a prevalent global health concern, is increasingly recognized for its impact beyond physical symptoms, affecting mental health. This research examined the extent of AR's psychological burden and sleep disturbances.

METHODS

A systematic search of four databases yielded 49 studies reporting mental health problems in 18,269,265 individuals (15,151,322 AR patients and 3,117,943 controls). The primary outcomes included all mental health problems in AR patients. Subgroup analyses based on outcome and AR severity, country, AR diagnosis, recruitment setting, and age were performed. Secondary outcomes included the risk of these problems compared to controls (healthy or without AR).

RESULTS

In AR, depression (25%), anxiety (25%), stress (65%), distress (57%), suicidal thoughts (14%) and attempts (4%), poor sleep quality (48%), insomnia (36%), sleep impairment (33%), and insufficient sleep duration <7 h (59%) were prevalent. The severity of these outcomes differed significantly. Patients' country, AR diagnostic method, recruitment method/setting, and age group were significant effect modifiers. Compared to controls, AR resulted in significantly higher risk of depression, anxiety, stress, suicidal attempts and thoughts, insomnia, and sleep impairment.

CONCLUSION

AR patients had significantly lower sleep duration. Mental health problems are very common among AR patients, further exacerbating their sleep quality and duration and intention to suicide.

Cyclic Alternating EEG Patterns: From Sleep to Encephalopathy

SUMMARY

In the 2021 version of the Standardized Critical Care EEG Terminology, the American Clinical Neurophysiology Society introduced new definitions, including for the cyclic alternating pattern of encephalopathy (CAPE). CAPE refers to changes in background EEG activity, with two patterns alternating spontaneously in a regular manner. CAPE shares remarkable similarities with the cyclic alternating pattern, a natural EEG phenomenon occurring in normal non-rapid eye movement sleep, considered the main electrophysiological biomarker of sleep instability. This review explores similarities and differences between cyclic alternating pattern and CAPE and, leveraging the existing expertise on cyclic alternating pattern, aims to extend knowledge on CAPE. A standardized assessment of CAPE features is key to ascertain its prevalence and clinical significance among critically ill patients and to encompass the impact of confounding factors such as anesthetic and sedative agents. Although the preservation of non-rapid eye movement sleep-related elements has a well-known prognostic value in the critical care setting, the clinical importance of cyclic oscillating patterns and the prognostic significance of CAPE remain to be elucidated.

Association between adenotonsillar hypertrophy and dentofacial characteristics of children seeking for orthodontic treatment: A cross-sectional study

OBJECTIVE

To compare the dentofacial characteristics of children with and without adenoid and/or tonsillar hypertrophy.

METHODS

A consecutive sample of orthodontic patients aged 6-12 that took pre-treatment lateral cephalograms were included in this study. Those with history of previous orthodontic treatment, adenoidectomy or tonsillectomy, or craniofacial anomalies were excluded. The diagnosis of adenoid and tonsillar hypertrophy was based on Fujioka's and Baroni's methods, according to which the subjects were divided into four groups: the adenoid hypertrophy only (AHO) group; tonsillar hypertrophy only (THO) group; combined adenoid and tonsillar hypertrophy (AH+TH) group; and no adenoid or tonsillar hypertrophy (NH) group. Cephalograms were used for skeletal and dental measurement. Data were analyzed using one-way ANOVA, LSD post-hoc tests and Chi-square test.

RESULTS

A total of 598 patients were included. Compared with the NH group, the THO group had significantly larger SNB angle (P < 0.001), as well as significantly smaller ANB angle (P<0.001) and Wits value (P = 0.001). The U1-L1 angle of AHO group was significantly smaller than that in the NH group (P = 0.035). The proportion of adenoid hypertrophy in Class II patients was significantly higher than that in Class III patients (P = 0.001). The proportion of tonsillar hypertrophy in Class III patients was significantly higher than that in Class I patients (P < 0.001) and Class II patients (P < 0.001).

CONCLUSION

Over 80 % of children seeking orthodontic treatment had either adenoid or tonsillar hypertrophy. Children with adenoid hypertrophy tend to have skeletal Class II malocclusion, while those with tonsillar hypertrophy tend to have skeletal Class III malocclusion.

Clinical Characteristics and Treatment Efficacy for Co-Morbid Insomnia and Sleep Apnea (COMISA): Evidence from Qualitative and Quantitative Analysis

OBJECTIVES

A multitude of physical and mental challenges are being faced in the population with Co-morbid Insomnia and Sleep Apnea (COMISA). Unfortunately, research about clinical characteristics and management of COMISA based on quantitative evidence is lacking.

METHOD

Standard procedures for literature retrieval, selection and quality assessment, data extraction, analysis, and interpretation were conducted step by step. For studying the sleep characteristics, common complications and widely recognized treatment options for COMISA, Weighted Mean Difference (WMD) and Odds Ratio (OR) were applied to assess the mean and risk differences between compared groups. Outcomes included sleep health parameters and secondary impairments in physical and mental well-being.

RESULTS

COMISA showed worse sleep quality than OSA only by PSQI (WMD = 3.38 point) and heavier sleep fragmentation (WMD = 11.46 min) than insomnia only. Besides, COMISA patients showed a higher risk for depression (OR [95%CI] = 5.03[2.31, 10.93]) and PTSD (OR [95%CI] = 3.96[1.85, 8.46]) in comparison with OSA alone. Compared to insomnia alone, COMISA patients suffered from more than two times higher risk of cardiovascular diseases, hypertension, and diabetes. In treating COMISA patients, combining CBTI with PAP treatment can enhance the improvement of insomnia severity (ISI, WMD [95%CI] =-3.26[-4.51, -2.00] point) and sleep efficiency (WMD [95%CI] = 6.39[1.97, 10.81] %) compared to PAP alone.

CONCLUSIONS

Impaired sleep domains in COMISA cover sleep quality and sleep structure. Also, COMISA has a higher risk for cardiometabolic diseases and mental disorders. Combining CBTI with PAP can be a recommended treatment to relieve sleep impairments for COMISA.

Orexin and Sleep Disturbances in Alpha-Synucleinopathies: a Systematic Review

PURPOSE OF REVIEW

Sleep disturbances are amongst most frequent non-motor symptoms of Parkinson's Disease (PD), and they are similarly frequently reported in other alpha-syncleinopathies, such as Dementia with Lewy Bodies (DLB) and Multiple System Atrophy (MSA). More recently, the orexin system has been implicated in control of arousal based on salient environmental set points, and its dysregulation in sleep issues in alpha-synucleinopathies suggested by the findings from the translational animal models. However, its role in the patients with alpha-synucleinopathies remains unclear. We thus set to systematically review, and to critically assess, contemporary evidence on the association of the orexinergic system and sleep disturbances in alpha-synucleinopathies. In this systematic review, studies investigating orexin and sleep in alpha-synucleinopathies (Rapid Eye Movement (REM) Behaviour Disorder (RBD), Parkinson's Disease (PD), Dementia with Lewy Bodies (DLB), Multiple System Atrophy (MSA)) were identified using electronic database searches of PubMed, Web of Science and PsychINFO using MeSH terms, keywords, and title words such as "Alpha-synucleinopathies" AND "Orexin" AND "Sleep Disturbances".

RECENT FINDINGS

17 studies were included in this systemic review, of which 2 studies on RBD, 10 on PD, 4 on DLB, and 1 on MSA patients. Taken together, RBD and PD studies suggest a potential adaptive increase in orexin levels in early stages of the neurodegenerative process, with reduced levels more often reported for later, more advanced stages of illness. To date, no differences in orexin levels were demonstrated between MSA patients and healthy controls. There is a dearth of studies on the role of orexin levels in alpha-synucleinopathies. Moreover, significant methodologic limitations in the current body of work, including use of non-standardised research protocols and lack of prospective, multi-centre studies, disallow for any finite conclusion in regards to underlying pathomechanisms. Nonetheless, a picture of a complex, multifaceted relationship between the dysregulation of the orexinergic pathway and sleep disturbances in alpha-synucleinopathies is emerging. Hence, future studies disentangling orexinergic pathomechanisms of alpha-syncleinopathies are urgently needed to obtain a more comprehensive account of the role of orexinergic pathway in alpha-synucleinopathies. Pharmacological manipulations of orexins may have multiple therapeutic applications in treatment strategies, disease diagnosis, and might be effective for treating both motor and non-motor symptoms.

Duration of cochlear implant use in children with prelingual single-sided deafness is a predictor of word perception in the CI ear

As part of a longitudinal study regarding the benefit of early cochlear implantation for children with single-sided deafness, the current work explored the children's daily device use, potential barriers to full-time device use, and the children's ability to understand speech with the cochlear implant (CI). Data were collected from 20 children with prelingual SSD who received a CI before the age of 2.5 years, from the initial activation of the sound processor until the children were 4.8 to 11.0 years old. Daily device use was extracted from the CI's data logging, while word perception in quiet was assessed using direct audio input to the children's sound processor. The children's caregivers completed a questionnaire about habits, motivations, and barriers to device use. The children with SSD and a CI used their device on average 8.3 h per day, corresponding to 63 % of their time spent awake. All children except one could understand speech through the CI, with an average score of 59 % on a closed-set test and 73 % on an open-set test. More device use was associated with higher speech perception scores. Parents were happy with their decision to pursue a CI for their child. Certain habits, like taking off the sound processor during illness, were associated with lower device use. Providing timely counselling to the children's parents, focused on SSD-specific challenges, may be helpful to improve daily device use in these children.

Sleep Quality Moderates the Associations between Cardiorespiratory Fitness and Hippocampal and Entorhinal Volume in Middle-Aged and Older Adults

INTRODUCTION/PURPOSE

As individuals age, the entorhinal cortex (ERC) and hippocampus-crucial structures for memory-tend to atrophy, with related cognitive decline. Simultaneously, lifestyle factors that can be modified, such as exercise and sleep, have been separately linked to slowing of brain atrophy and functional decline. However, the synergistic impact of fitness and sleep on susceptible brain structures in aging adults remains uncertain.

METHODS

We examined both independent and interactive associations of fitness and subjective sleep quality with regard to ERC thickness and hippocampal volume in 598 middle-aged and older adults from the Human Connectome Lifespan Aging Project. Cardiorespiratory fitness was assessed using the 2-min walk test, whereas subjective sleep quality was measured with the continuous Pittsburgh Sleep Quality Index global score. High-resolution structural magnetic resonance imaging was used to examine mean ERC thickness and bilateral hippocampal volume. Through multiple linear regression analyses, we investigated the moderating effects of subjective sleep quality on the association between fitness and brain structure, accounting for age, sex, education, body mass index, gait speed, and subjective physical activity.

RESULTS

We found that greater cardiorespiratory fitness, but not subjective sleep quality, was positively associated with bilateral hippocampal volume and ERC thickness. Notably, significant interaction effects suggest that poor subjective sleep quality was associated with a weaker association between fitness and both hippocampal volume and ERC thickness.

CONCLUSIONS

Findings suggest the potential importance of both cardiorespiratory fitness and subjective sleep quality in preserving critical, age-vulnerable brain structures. Interventions targeting brain health should consider potential combined effects of sleep and fitness on brain health.

Children's nocturnal awakenings and sleep duration during the first two years of life in the NASCITA cohort study

PURPOSE

Previous studies have analyzed the characteristics and prevalence of sleep disturbances among Italian children. Less attention has been paid, however, to the factors involved in sleep disturbances in the first two years of life. The goals of the present study were, therefore: 1) to provide a developmental trajectory of Italian infants' night awakenings and duration during the first two years of life and 2) to analyze which factors affect night awakenings the most over time.

METHODS

Data for this study were collected in the NASCITA cohort. During the well-child visits conducted at 6, 12, and 24 months, pediatricians asked parents to report if the child had any sleep disturbances, especially frequent night awakenings. Univariate and multivariable analyses were performed to test the association between child and family variables and the likelihood of frequent awakenings.

RESULTS

2973 toddlers, out of 5054 initially enrolled newborns, were included in this study; 875 (29.4 %) of whom presented frequent awakenings in at least one visit (peak of prevalence of 19.8 % at 12 months). Bed-sharing (adjusted OR 2.53; 95%CI:2.05-3.12) and living in the northern Italy (aOR 2.25; 95%CI:1.80-2.81) were the variables more strongly associated with an increased likelihood of frequent awakenings in the binomial logistic regression, while sleeping alone was associated with a decreased chance (aOR 0.62; 95%CI 0.45-0.89). A short sleep duration (<11 h/day) was reported for 801 (26.9 %) at 12 months, for 743 (25.0 %) at 24 months of age; in 383 cases, the short sleep duration was reported at both time points. An association was observed between frequent awakenings at 12 or 24 months and short sleep duration (OR 1.23; 95%CI 1.05-1.44 -ꭓ2 6.25, p = 0.012).

CONCLUSIONS

The current study identified some early predictors of frequent awakenings during the first two years of life. Since optimal sleep practices in children are essential for their development, effective, early interventions must be defined and integrated into pediatric care practices.

Compliance with the 24-hour movement behavior guidelines and the impact of sleep methods among toddler, preschool, and school-aged children enrolled in the Guelph Family Health Study

Canadian movement guidelines focused on physical activity (PA), sleep, and screen time support childhood development and reduce the risk of chronic disease. Accelerometers are often used to capture these behaviors; however, they are limited in their ability to record daytime sleep due to potential misclassification.

OBJECTIVES

The objectives of this study were to 1) determine the prevalence of children enrolled in the Guelph Family Health Study who met the guidelines and to 2) compare the impact of different sleep measurement methods.

DESIGN/METHODS

Toddlers (1.5-<3 years; n = 128; valid data for all movement behaviors, n = 70), preschoolers (3-<5 years; n = 143; valid data for all movement behaviors, n = 104), and school-aged (5-<6 years; n = 49; valid data for all movement behaviors, n = 31) children were included. Screen time and sleep habits were obtained through parental report and published normative data. PA and sleep were recorded using accelerometers (wGT3X-BT ActiGraph; right hip).

RESULTS

It was found that 66 % of toddler, 44 % of preschool, and 63 % of school-aged children met the screen time guidelines. Further, 63 % of toddler, 98 % of preschooler, and 80 % of school-aged children met PA guidelines. Sleep guideline compliance ranged from 3 % to 83 % in toddler, 27 % to 92 % in preschooler, and 32 % to 90 % in school-aged children. These proportions were found to be significantly different (Cochran's Q and McNemar's tests).

CONCLUSIONS

Nearly all children met PA guidelines. In contrast, less than half to two-thirds met screen time guidelines. Compliance with sleep guidelines varied substantially with measurement method, highlighting the need for standardization.

Evidence-based interventions to improve sleep quality after thoracic surgery:A retrospective analysis of clinical studies

OBJECTIVE

To investigate and rank the evidence for the efficacy of interventions in improving sleep quality after cardiac surgery using comprehensive comparisons.

BACKGROUND

Clinical evidence suggests that over 80 % of adult cardiac surgery patients experience sleep disturbances during the first week postoperatively. While certain interventions have been shown to improve post-thoracic surgery sleep quality, a systematic description of the effects of these varied interventions is lacking.

METHODS

This systematic search was conducted across PubMed, Web of Science, Cochrane, Embase, and CINAHL databases to collate all published randomized clinical trials as evidence. Two researchers independently extracted pertinent information from eligible trials and assessed the quality of included studies. Based on statistical heterogeneity, traditional meta-analysis using fixed or random-effects models was employed to assess the efficacy of interventions, and a Frequentist network meta-analysis using a consistency model was conducted to rank the effectiveness of intervention protocols.

RESULTS

Our review incorporated 37 articles (n = 3569), encompassing 46 interventions, including 9 reports on pharmacological interventions (24.3 %), 28 on non-pharmacological interventions (75.7 %), and 5 on anesthetic management interventions (13.5 %). The analysis indicated the efficacy of Benson's relaxation technique, Progressive muscle relaxation, Education, Aromatherapy, Acupressure, Massage, and Eye masks in enhancing postoperative sleep quality. Specifically, Benson's relaxation technique (cumulative ranking curve area: 0.80; probability: 98.3 %) and Acupressure (cumulative ranking curve area: 0.96; probability: 58.3 %) were associated with the highest probability of successfully improving postoperative sleep quality, while Progressive muscle relaxation (cumulative ranking curve area: 0.70; probability: 35.2 %) and Eye masks (cumulative ranking curve area: 0.81; probability: 78.8 %) were considered secondary options. Eye masks and Massage significantly reduced postoperative sleep latency, with Eye masks (cumulative ranking curve area: 0.82; probability: 51.0 %) being most likely to enhance sleep quality postoperatively, followed by Massage (cumulative ranking curve area: 0.60; probability: 27.2 %). Education, Music, Massage, Eye masks, and Handholding were effective in alleviating pain intensity, with Education being most likely to successfully reduce postoperative pain (cumulative ranking curve area: 0.92; probability: 54.3 %), followed by Music (cumulative ranking curve area: 0.91; probability: 54 %).

CONCLUSIONS

Our findings can be utilized to optimize strategies for managing post-thoracic surgery sleep disturbances and to develop evidence-based approaches for this purpose. Benson's relaxation technique, Progressive muscle relaxation, Education, Aromatherapy, Acupressure, Massage, and Eye masks significantly improve sleep quality in postoperative patients. KEY: disorders of initiating and maintaining sleep, sleep wake disorders, thoracic surgical procedures, cardiac surgical procedures, sleep quality, pain, network meta-analysis.

Amyloid profile is associated with sleep quality in preclinical but not in prodromal Alzheimer's disease older adults

BACKGROUND

Few studies have assessed whether neuropathological markers of AD in the preclinical and prodromal stages are associated with polysomnographic changes and obstructive sleep apnea (OSA).

METHODS

This was a cross-sectional, case-control study of older adults (≥60 years) without relevant clinical and psychiatric comorbidities selected randomly from a cohort of individuals without dementia in a tertiary university hospital in São Paulo, Brazil. They underwent neuropsychological evaluation for clinical diagnosis and were allocated into two samples: cognitively unimpaired (CU) and mild cognitive impairment (MCI). Also, they underwent PET-PiB to determine the amyloid profile and all-night in-lab polysomnography. For each sample, we compared polysomnographic parameters according to the amyloid profile (A+ vs A-).

RESULTS

We allocated 67 participants (mean age 73 years, SD 10,1), 70 % females, 14 ± 5 years of education, into two samples: CU (n = 28, 42.4 %) and MCI (n = 39, 57.6 %). In the CU sample, the group A+ (n = 9) showed worse sleep parameters than A- (n = 19) (lower total sleep time (p = 0.007), and sleep efficiency (p = 0.005); higher sleep onset latency (p = 0.025), wake time after sleep onset (p = 0.011), and arousal index (AI) (p = 0.007)), and changes in sleep structure: higher %N1 (p = 0.005), and lower %REM (p = 0.006). In the MCI sample, MCI A-had higher AI (p = 0.013), respiratory disturbance index (p = 0.025, controlled for age), and higher rates of severe OSA than A+.

DISCUSSION

The amyloid profile was associated with polysomnographic markers of worse sleep quality in individuals with preclinical AD but not with prodromal AD, probably due to the higher frequencies of severe OSA.

Relations of body dissatisfaction with self-injurious thoughts and behaviours in clinical and non-clinical samples: a meta-analysis of studies published between 1995 and 2022

Body dissatisfaction is a global public health concern. Self-injurious thoughts and behaviours (SITB), including suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI), have been documented as potentially significant correlates of body dissatisfaction. However, prior findings regarding associations between body dissatisfaction and SITB have been somewhat inconsistent. Therefore, this meta-analysis was conducted to determine the nature and strength of such associations in both clinical and non-clinical samples. A literature search identified 83 relevant articles and extracted 234 effect sizes. Using a three-level random-effects model, mean effect sizes (r values) for relationships between body dissatisfaction and suicidal ideation, suicide attempts, and NSSI in clinical samples were 0.29 (95% CI, 0.22-0.37), 0.16 (95% CI, 0.13-0.20) and 0.26 (95% CI, 0.19-0.34), respectively. In non-clinical samples, these values were 0.22 (95% CI, 0.16-0.28), 0.24 (95% CI, 0.17-0.30) and 0.22 (95% CI, 0.15-0.29), respectively. Several study features (e.g., participant age, geographic region and instrument validity) emerged as significant moderators. This meta-analysis provides robust support for body dissatisfaction as a significant correlate of SITB across clinical and non-clinical samples in addition to identifying study characteristics that contribute to effect size variability. Implications are discussed for SITB research, prevention and intervention.

Effects of chamomile (Matricaria chamomilla L.) on sleep: A systematic review and meta-analysis of clinical trials

OBJECTIVE

We aimed to investigate the effects of chamomile (Matricaria chamomilla L.) on sleep in this systematic review and meta-analysis of clinical trials.

METHODS

PubMed, Scopus, Web of Science, and Cochrane Library were searched until August 2023. All clinical trials that investigated the effects of chamomile on sleep, either in healthy or diseased adults, were eligible to enter the study. The quality of studies was assessed using the Cochrane tool. Random-effects meta-analysis was used to pool weighted mean differences (WMD) and 95 % CI for the outcomes assessed by at least three studies with relatively consistent participants.

RESULTS

The systematic review included ten studies (772 participants). Meta-analysis was conducted for the Pittsburgh Sleep Quality Index (PSQI) score and sleep length. A significant reduction in PSQI score (WMD: -1.88, 95 %CI: -3.46, -0.31, I2: 88.4 %, n = 5) was found. For other outcomes, meta-analysis was not conducted. Sleep onset latency or ease of getting to sleep were improved in three of the four studies. Daytime functioning measures, including fatigue severity index or postpartum fatigue scale, did not change in all three studies. Sleep efficiency did not change in two studies and deteriorated in one. The number of awakenings after sleep or staying asleep was improved in two of the three studies. No adverse events were reported in any of the studies although passive surveillance was used to assess adverse effects except in one study. Only one study surveyed the blinding success and tested the purity and/or potency of the used products.

CONCLUSION

Chamomile improved sleep, especially the number of awakenings after sleep or staying asleep; however, it did not lead to an improvement in the duration of sleep, percentage of sleep efficiency, and daytime functioning measures. Future studies are suggested to assess objective measures.

Sleep disturbance in rodent models and its sex-specific implications

Sleep disturbances, encompassing altered sleep physiology or disorders like insomnia and sleep apnea, profoundly impact physiological functions and elevate disease risk. Despite extensive research, the underlying mechanisms and sex-specific differences in sleep disorders remain elusive. While polysomnography serves as a cornerstone for human sleep studies, animal models provide invaluable insights into sleep mechanisms. However, the availability of animal models of sleep disorders is limited, with each model often representing a specific sleep issue or mechanism. Therefore, selecting appropriate animal models for sleep research is critical. Given the significant sex differences in sleep patterns and disorders, incorporating both male and female subjects in studies is essential for uncovering sex-specific mechanisms with clinical relevance. This review provides a comprehensive overview of various rodent models of sleep disturbance, including sleep deprivation, sleep fragmentation, and circadian rhythm dysfunction. We evaluate the advantages and disadvantages of each model and discuss sex differences in sleep and sleep disorders, along with potential mechanisms. We aim to advance our understanding of sleep disorders and facilitate sex-specific interventions.

Sexual and Gender Minority Sleep Health Disparities and Minority Stress in Early Adolescence

PURPOSE

Sleep is essential to adolescent development. Sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) adults are at high risk for poor sleep, partially due to minority stress (e.g., discrimination). However, sleep has rarely been studied among SGM adolescents. In a national sample of early adolescents, we analyzed sexual minority (SM) and gender minority (GM) identity, gender incongruence, and gender nonconformity in association with sleep and tested minority and general stressors as mediators.

METHODS

We cross-sectionally analyzed data from 10,070 adolescents aged 10-14 in the Adolescent Brain Cognitive Development℠ Study. Using logistic regression models, we analyzed associations between identity (SM and GM), sexual identity discrimination, minority and general stressors (sexual identity discrimination, teasing, and conflict with parents) and sleep health (duration, latency, and disturbance). We used Baron and Kenny's method to test for mediation.

RESULTS

Participants reported sexual identity (4% SM, 4% questioning) and gender identity (0.4% GM, 0.6% questioning); 65% were White, 20% were Hispanic, and 52% were assigned male at birth. Compared to heterosexual, SM participants had higher odds of short sleep duration, long sleep latency, and sleep disturbance. GM participants and those reporting gender incongruence and nonconformity had higher odds of long sleep latency and sleep disturbance. Sexual identity discrimination and general social stressors partially mediated some associations.

DISCUSSION

SGM participants reported poorer sleep. Minority and general social stressors partially accounted for some disparities. Policies need to address SGM identity-based discrimination and challenge social norms that produce minority stress for SGM early adolescents.

Assessing the importance and safety of hypoxia conditioning for patients with occupational pulmonary diseases: A recent clinical perspective

Occupational pulmonary diseases (OPDs) pose a significant global health challenge, contributing to high mortality rates. This review delves into the pathophysiology of hypoxia and the safety of intermittent hypoxic conditioning (IHC) in OPD patients. By examining sources such as PubMed, Relemed, NLM, Scopus, and Google Scholar, the review evaluates the efficacy of IHC in clinical outcomes for OPD patients. It highlights the complexities of cardiovascular and respiratory regulation dysfunctions in OPDs, focusing on respiratory control abnormalities and the impact of intermittent hypoxic exposures. Key areas include the physiological effects of hypoxia, the role of hypoxia-inducible factor-1 alpha (HIF-1α) in occupational lung diseases, and the links between brain ischemia, stroke, and OPDs. The review also explores the interaction between intermittent hypoxic exposures, mitochondrial energetics, and lung physiology. The potential of IHE to improve clinical manifestations and underlying pathophysiology in OPD patients is thoroughly examined. This comprehensive analysis aims to benefit molecular pathologists, pulmonologists, clinicians, and physicians by enhancing understanding of IHE's clinical benefits, from research to patient care, and improving clinical outcomes for OPD patients.

Effect of Anti-Allergic Therapy on Sleep Quality of Children with Allergic Conjunctivitis and Their Parents

PURPOSE

To assess the effect of anti-allergic therapy on sleep quality of children with allergic conjunctivitis (AC) and their parents.

METHODS

This prospective single-arm intervention study included 54 AC child-parent dyads. Chinese versions of the Children's Sleep Habits Questionnaire (CSHQ) and Pittsburgh Sleep Quality Index (PSQI) were used to assess the sleep quality of children and their parents, respectively.

RESULTS

CSHQ and PSQI total scores were significantly decreased after treatment, with fewer children and parents reporting poor sleep quality. Part impaired sleep behaviors of children and parents can recover to the normal levels. Sleep quality improved greater in children with a severe type of AC, those with worse baseline signs, and without other allergic diseases. For both children and parents, greater improvements in sleep quality were associated with longer treatment duration and with worse baseline sleep quality.

CONCLUSION

Successful management of AC improves sleep quality for both children and their parents.

Perfect Enough to Sleep? Perfectionism and Actigraphy-Determined Markers of Insomnia

OBJECTIVES

Perfectionism is an important factor in insomnia development and maintenance. Previous studies exploring the relationship between perfectionism and insomnia have predominantly relied on self-reported sleep measures. Therefore, this study sought to assess whether actigraphy-measured sleep parameters were associated with perfectionism.

METHODS

Sixty adults (85% females, mean age 30.18 ± 11.01 years) were sampled from the Australian general population. Actigraphy-derived objective sleep measures, subjective sleep diary measures, the Frost Multidimensional Perfectionism Scale (FMPS), Hewitt-Flett Multidimensional Perfectionism Scale (HFMPS) and Depression, Anxiety and Stress Scale 21 (DASS-21) were collected.

RESULTS

High perfectionism levels were associated with poor sleep, but these relationships differed between objective and subjective measures. Perfectionism via FMPS total score and subscales of Concern over Mistakes, Doubts about Actions, Personal Standards and Self-oriented Perfectionism correlated with subjective sleep onset latency and sleep efficiency with moderate effects (r = .26 to .88). In contrast, perfectionism via HFMPS total score and subscales of Socially Prescribed Perfectionism and Parental Expectations predicted objective sleep onset latency and sleep efficiency. Additionally, stress mediated the relationships between objective sleep efficiency and Concern over Mistakes and Doubts about Actions.

CONCLUSIONS

Perfectionism demonstrated stronger associations with subjective than objective sleep measures. Higher Parental Expectations and Socially Prescribed Perfectionism may increase one's vulnerability to objectively measured poor sleep. Therefore, perfectionism may be important in preventing and treating insomnia.

Life onboard a submarine: Sleep, fatigue, and lifestyle behaviors of sailors on a circadian-aligned watchstanding schedule

This study characterizes, for the first time, the lives of U.S. Navy submariners engaged in normal, sea-based operations while following a circadian-aligned 24-h watchstanding schedule. Fifty-eight submarine crewmembers provided objective (actigraphy) and subjective (questionnaires) sleep data, and information about mood and lifestyle behaviors during 30 days underway. Projected performance scores and estimated circadian phase times were also calculated from actigraphy-based sleep/wake data. Submariners' objective (6.62 ± 0.94 h; mean ± SD) and subjective (5.90 ± 1.38 h) daily sleep quantities while underway were largely comparable to the sleep reportedly received by Sailors across other Navy platforms and watchstanding schedules. Additionally, submariners' actigraphy-predicted circadian phases shifted progressively toward better alignment with watchstanding schedules across time. Nevertheless, subjective sleep quality was low, submariners engaged in unfavorable lifestyle behaviors (lack of regular meals and exercise), and participants reported decreased mood at the completion of their underway time. Recommendations for countermeasure development are provided.

Sleep stages classification by fusing the time-related synchronization analysis and brain activations

Sleep staging plays an important role in the diagnosis and treatment of clinical sleep disorders. The sleep staging standard defines every 30 seconds as a sleep period, which may mean that there exist similar brain activity patterns during the same sleep period. Thus, in this work, we propose a novel time-related synchronization analysis framework named time-related multimodal sleep scoring model (TRMSC) to explore the potential time-related patterns of sleeping. In the proposed TRMSC, the time-related synchronization analysis is first conducted on the single channel electrophysiological signal, i.e., Electroencephalogram (EEG) and Electrooculogram (EOG), to explore the time-related patterns, and the spectral activation features are also extracted by spectrum analysis to obtain the multimodal features. With the extracted multimodal features, the feature fusion and selection strategy is utilized to obtain the optimal feature set and achieve robust sleep staging. To verify the effectiveness of the proposed TRMSC, sleep staging experiments were conducted on the Sleep-EDF dataset, and the experimental results indicate that the proposed TRMSC has achieved better performance than other existing strategies, which proves that the time-related synchronization features can make up for the shortcomings of traditional spectrum-based strategies and achieve a higher classification accuracy. The proposed TRMSC model may be helpful for portable sleep analyzers and provide a new analytical method for clinical sleeping research.

Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Overlap Syndrome: An Update on the Epidemiology, Pathophysiology, and Management

This review provides an up-to-date summary of the prevalence, pathophysiology, diagnosis, and treatment of the chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) overlap syndrome (OVS). The presence of OVS is high in patients with COPD and in patients with OSA and is associated with profound nocturnal oxygen desaturation and systemic inflammation. There is a high prevalence of cardiovascular disease among patients with OVS and this likely contributes to increased mortality. Observational studies suggest that positive airway pressure therapy improves survival and reduces COPD exacerbations; however, randomized controlled trials will be required to confirm these findings.

Sexual health in adult survivors of childhood cancer: A Project REACH study

BACKGROUND

Sexual dysfunction is a significant complication of treatment for many adult-onset cancers. However, comparatively less is known about sexual dysfunction in adult childhood cancer survivors (CCSs). Research has been limited by the exclusion of specific cancers (e.g., central nervous system [CNS] tumors) and the lack of validated measures, which makes it difficult to understand the nature and prevalence of sexual dysfunction in CCSs.

METHODS

A total of 249 adult CCSs (aged 18-65 years) enrolled in Project REACH, a prospective cohort study, and completed measures of physical and mental health, including sexual dysfunction. Participants scoring ≤19 on the Female Sexual Function Index 6 or ≤21 on the International Index of Erectile Function 5 were classified as experiencing sexual dysfunction. Analyses examined the relationships between sexual dysfunction and demographic, disease, treatment, and health variables.

RESULTS

A total of 78 participants (32%) experienced clinically significant sexual dysfunction. In univariate analysis, sexual dysfunction was significantly associated with CNS tumor diagnosis (odds ratio [OR], 2.56) and surgery (OR, 1.96) as well as with health variables such as fatigue (OR, 3.00), poor sleep (OR, 2.84), pain (OR, 2.04), depression (OR, 2.64), poor physical health (OR, 2.45), and poor mental health (OR, 2.21). Adjusted analyses found that CNS tumor diagnosis (p = .001) and health variables (p = .025) contribute significantly to sexual dysfunction in CCSs.

CONCLUSIONS

Approximately one third of adult CCSs report clinically significant sexual dysfunction, which underscores a significant screening and treatment need. However, because available measures were developed for survivors of adult cancers, research to create a sexual health measure specifically for adult CCSs is necessary to better identify the sexual health concerns of this vulnerable population.

Meeting the WHO Physical Activity Guidelines is Associated With Lower Odds of Depression in Older Adults: Potential Psychosomatic Mechanisms

OBJECTIVES

Limited data exist on the association between physical activity (PA) and depression in older adults from low- and middle-income countries (LMICs). In this study, we examine the association between meeting the World Health Organization (WHO) PA guidelines and depression in adults aged ≥50 years in Ghana and investigate the psychosomatic factors explaining this association.

METHODS

Cross-sectional data from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (2016-18) were analyzed. Depression was assessed with the Center for Epidemiological Studies Depression Scale (CES-D-10). PA was assessed using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Multivariable logistic regression and Hayes PROCESS macro with bootstrapping mediation analyses were performed to evaluate the hypothesized associations.

RESULTS

The study included 1201 individuals (mean [SD] age 66.1 [11.9] years; 63.3% women). The prevalence of meeting PA guidelines and depression was 36.7% and 29.5%, respectively. Meeting the WHO-recommended PA guidelines was associated with a 16% lower rate of developing depression even after adjusting for potential confounders (OR = 0.84, p <0.001). This association was much stronger among men and those aged 50-64 years. Loneliness, social isolation, sleep problems, functional limitations, and pain characteristics largely mediated the association of PA with depression.

CONCLUSIONS

PA was negatively associated with depression among older adults in Ghana, and psychosocial and physical factors partially explained the association. The promotion of PA in old age may aid in the prevention of depression, especially in men and those aged 50-64 years. Longitudinal data may confirm our findings.

Person-centered exploration of work-related stress patterns, predictors, and their association with subhealth in midwives: A cross-sectional study

BACKGROUND

Midwives experience elevated levels of work-related stress. However, there is limited understanding of the patterns of this stress, its sociodemographic and work-related determinants, and its association with sub-health.

METHOD

This multi-center cross-sectional study, conducted in 21 hospitals in Zhuhai City, Guangdong Province, China, involved 300 midwives. Work-related stress levels in midwives were evaluated using the Chinese version of the Nursing Stress Scale, while social, physical and mental sub-health status was measured with the Sub-Health Measurement Scale. Utilizing latent profile analysis, the study aimed to categorize midwives into homogeneous profiles based on patterns of work-related stress.

RESULTS

Among the 300 midwives examined, three distinct profiles were identified: profile 1 (n=57, 19 %), characterized by low work-related stress; profile 2 (n=149, 50 %), representing the moderate work-related stress class; and profile 3 (n=94, 31 %), indicative of high work-related stress. Midwives in the high work-related stress profile tended to be younger, with lower monthly income, lower professional titles, and a higher likelihood of night shift work (all P<0.01). Significant and noteworthy trends were observed in sociodemographic characteristics (age, monthly income, and professional title) and work-related characteristics (night shift status). After controlling for confounders, the work-related stress profile demonstrated a negative association with social, physical and mental sub-health status.

CONCLUSION

This study highlights integrating stress domains and adopting a person-centered approach to examine midwives' work-related stress. Identifying predictors of profile membership and their relationship with sub-health can inform tailored interventions to reduce stress and improve midwives' well-being.

The bidirectional relationship between sleep disturbance and anxiety: Sleep disturbance is a stronger predictor of anxiety

BACKGROUND

Both sleep disturbance and anxiety are common problems that significantly affect human health, but little is known about their causal relationship. The aim of this study was to explore the causal relationship between them with a large sample of community-dwelling adults included.

METHODS

Data for this study were extracted from the baseline survey of West China Natural Population Cohort Study (WCNPCS) and follow-up in the following year. The sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI), and anxiety was screened using the Generalized Anxiety Disorder Scale (GAD-7). Age, gender, educational level, marital status, smoking status, drinking status, depressive symptoms, loneliness and chronic diseases were taken as covariant factors. Logistic regression and cross-lagged models were used for data analyses.

RESULTS

A total of 16699 participants (67.5 % females) were enrolled, with the average age of participants being 57.3 ± 12.7 years. A total of 40.50 % of participants experienced poor sleep quality at baseline and 40.52 % at follow-up. The prevalence of anxiety was 7.58 % at baseline and 4.62 % at follow-up. The results showed that the risk of developing anxiety in individuals with sleep disturbance at baseline was 1.89 times higher than those without (95%CI = 1.43-2.48). Similarly, anxiety increased the risk of developing sleep disturbance by 1.20-fold (95%CI = 1.03-1.39). These results were further supported by the cross-lagged panel models.

CONCLUSION

Sleep disturbance and anxiety are mutually causal, and the effect of poor sleep on anxiety seems to be more significant. Timely interventions targeting sleep may help to break the vicious circle between sleep disturbance and anxiety symptoms, and improve the quality of life.

Association of long-term exposure to PM2.5 and its chemical components with the reduced quality of sleep

Poor sleep quality is a widespread concern. While the influence of particle exposure on sleep disturbances has received considerable attention, research exploring other dimensions of sleep quality and the chemical components of the particles remains limited. We employed a marginal structural model to explore the association of long-term exposure to PM2.5 and its chemical components with poor sleep quality. The odds ratio (95 % CI) for poor sleep quality was 1.335 (1.292-1.378), 1.097 (1.080-1.113), 1.137 (1.100-1.174), 1.197 (1.156-1.240), and 1.124 (1.107-1.140) per IQR increase in the concentration of PM2.5, SO42-, NO3-, NH4+, and BC, respectively. The score (and 95 % CI) of sleep latency, use of sleep medication, habitual sleep efficiency, subjective sleep quality, and daytime dysfunction were affected by PM2.5, with an increase of 0.059 (0.050-0.069), 0.054 (0.049-0.059), 0.011 (0.008-0.014), 0.011 (0.005-0.018), and 0.026 (0.018-0.034) per IQR increase in PM2.5 concentrations, respectively. This study supports the association of long-term exposure to PM2.5 and its chemical components with poor sleep quality.

Kleine-Levin syndrome. Clinical boarderlands based on a thorough analysis of 475 case reports

OBJECTIVE/BACKGROUND

Kleine-Levin syndrome (KLS) is a rare sleep disorder characterized by recurrent episodes of severe hypersomnolence in association with various degrees of cognitive impairment, perceptive abnormalities, apathy, behavioral disturbances. Some of these symptoms, hypersomnolence, compulsive eating and increased sexual drive may be replaced by their opposites or alternate with them. Remarkably enough, these « atypical symptoms » have never been enlighted nor compared in frequency with corresponding typical symptoms. Besides, KLS is more frequent in males than in females but no review has ever compared the frequency of precipitating factors and symptoms in males and females.

PATIENTS/METHODS

To uncover these as yet uninvestigated aspects of KLS, a predesigned template was used to extract precipitating factors and symptoms, in 475 case reports of KLS, comprising 364 males and 111 females.

RESULTS

Precipitating factors were more frequently recorded in males (67.31 %) than in females (49.55 %). Recurrent episodes of hypersomnolencee were present in 94.32 % of cases, recurrent insomnia in 1.05 % and alternation of hypersomnolence and insomnia in 4.63 %. Cognitive impairment was present in 67.37 % of cases and absent in 6.95 %. Derealization/altered perception was present in 38.32 % of cases and absent in 1.68 %. Severe apathy was present in 44.63 % of cases. Compulsive eating was present in 59.58 % of cases, absent in 13.26 %, replaced by anorexia in 9.05 %, alternation of compulsive eating and anorexia in 5.68 % and alternation of compulsive eating and no compulsive eating in 8.42 %. Increased sexual drive was present in 33.68 % of cases, absent in 22.74 %, replaced by decreased sexual drive in 1.47 %, alternation of increased sexual drive and no increased sexual drive in 2.95 %. Odd behaviors were present in 45.05 % of cases. Psychiatric features were present in 71.58 % of cases, absent in 2.95 %. Finally, the percentages of precipitating factors and of sleep disorder, apathy, sexual disorder, irritability/agressivity, were higher in males than in females.

CONCLUSIONS

The frequency of the opposites of hypersomnolence, compulsive eating and increased sexual drive appears to be quite significant. In addition, a systematic comparison of precipitating factors and symptoms in males and females has shown limited differences between sexes.

Fading Focus: Addressing the Association Between Challenge Stressors, Role Blurring, Insomnia, Fatigue, and Workplace Cognitive Failure

The primary goal of the present study is to inspect the plausible job-related (i.e., challenge stressors and role blurring) and individual factors (i.e., fatigue and insomnia) that potentially lead to work-related cognitive failures among healthcare staff. Through the judgmental sampling technique, data was collected from healthcare personnel in Iran. The results revealed that challenge stressors in the form of time pressure, job responsibility, and work overload are significantly related to role blurring. Moreover, role blurring increases fatigue and insomnia among medical staff, and both insomnia and fatigue cause workplace cognitive failure. The results also confirm the mediation effect of role blurring in the association between challenge stressors, insomnia, and fatigue. According to the results, insomnia and fatigue similarly mediate the role blurring on workplace cognitive failure association. Theoretical implications, useful suggestions for practitioners, and prospective research avenues are debated in the study.

School burnout and schoolwork engagement profiles among French high school students: Associations with perceived academic stress and social support

Adolescents' well-being at school is positively affected by social support from parents, teachers, and peers and negatively affected by academic stress. However, little is known about how specific academic stressors are related to study-related well-being profiles. This study used a person-centered approach to identify the profiles of high school students based on their school burnout (i.e., exhaustion and cynicism) and engagement levels to examine their associated levels of perceived academic stress, social support, and sociodemographic characteristics. Using cluster analysis on a sample of 540 high school students (67.8% girls), we identified five profiles labeled "Engaged" (22.4%), "Relaxed" (18.9%), "Overextended" (25.6%), "Disengaged" (17.6%), and "Burned out" (15.4%). The "Engaged" and "Relaxed" groups experienced similar levels of perceived social support, but the "Engaged" students showed higher academic stress levels. The "Overextended" group displayed high academic stress with lower social support, while the "Disengaged" group showed low stress with low social support. Finally, the "Burned out" group displayed the highest academic stress and the lowest perceived support. Results are discussed within the demands-resources model of school burnout and clinical implications are presented for each profile.

Advancing Patient-Centered Care: An International Survey of Adolescent Perspectives on Insomnia

OBJECTIVE

The study objective was to inform patient-centered care for adolescent insomnia by describing adolescents' perspectives on insomnia. Specific constructs of interest included: 1) factors that contributed to insomnia development or maintenance, 2) impact of insomnia on day-to-day life, 3) recommended research priorities, and 4) overall experience living with insomnia.

METHOD

A convenience sample of adolescents (ages 13-18 years) self-identifying with insomnia symptoms was recruited through social media. Respondents (n = 3,014) completed an online survey. Responses to an open-ended item assessing patient experience were coded using thematic analysis.

RESULTS

Participants identified as 70.8% White non-Hispanic, 77.0% female, and lived in one of five English-speaking countries (United States, United Kingdom, Canada, Australia, or New Zealand). Most (87.5%) met DSM-V diagnostic criteria for insomnia. The most common contributory factors to insomnia endorsed were stress (72.1%) and depressed mood (63.6%), while common impact areas were mood (72.2%), focus (61.0%), and pain (49.7%). Patient-centered research priorities were identifying insomnia causes (66.4%) and early detection (66.1%). Common adolescent experiences included high distress levels, feelings of invalidation, and helplessness about their insomnia.

CONCLUSIONS

Adolescents with insomnia offer a unique perspective that should inform patient-centered research and care. There is a need for heightened screening and awareness about insomnia as a condition that causes significant distress and impairment for adolescents. To provide validating care, providers should recognize the multifaceted causes of insomnia.

Maternal Sleep Health, Social Support, and Distress: A Mixed-Methods Analysis of Mothers of Infants and Young Children in Rural US

OBJECTIVES

The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population.

METHODS

39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design.

RESULTS

Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers.

CONCLUSIONS

Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.

The effects of diet quality, eating behavior, and sleep on the academic performance among elementary school students

The academic success of children contributes to their income, social status, and public health. This study was conducted with 217 elementary school students from western China. Scores on the Chinese Children Dietary Index (CCDI), Dietary Approaches to Stop Hypertension (DASH), adjusted DASH, and KIDMED index were calculated to evaluate diet quality. Eating behavior and sleep quality were assessed using the Children's Eating Behavior Questionnaire (CEBQ) and Children's Sleep Habits Questionnaire (CHSQ), respectively. Academic achievement was measured using school-provided average grades. Higher CCDI scores, longer sleep time, lower total CHSQ scores, and lower subscores on "satiety responsiveness," "slowness in eating," "emotional undereating," and "food fussiness" dimensions of the CEBQ were associated with high academic achievement. In conclusion, good diet quality, sleep quality, healthy eating behaviors, and adequate sleep duration were associated with better academic performance. Interventions are recommended to be developed in education system to improve healthy diets and lifestyles, enhancing academic achievement.

"Weeding out" violence? Translational perspectives on the neuropsychobiological links between cannabis and aggression

Recent shifts in societal attitudes towards cannabis have led to a dramatic increase in consumption rates in many Western countries, particularly among young people. This trend has shed light on a significant link between cannabis use disorder (CUD) and pathological reactive aggression, a condition involving disproportionate aggressive and violent reactions to minor provocations. The discourse on the connection between cannabis use and aggression is frequently enmeshed in political and legal discussions, leading to a polarized understanding of the causative relationship between cannabis use and aggression. However, integrative analyses from both human and animal research indicate a complex, bidirectional interplay between cannabis misuse and pathological aggression. On the one hand, emerging research reveals a shared genetic and environmental predisposition for both cannabis use and aggression, suggesting a common underlying biological mechanism. On the other hand, there is evidence that cannabis consumption can lead to violent behaviors while also being used as a self-medication strategy to mitigate the negative emotions associated with pathological reactive aggression. This suggests that the coexistence of pathological aggression and CUD may result from overlapping vulnerabilities, potentially creating a self-perpetuating cycle where each condition exacerbates the other, escalating into externalizing and violent behaviors. This article aims to synthesize existing research on the intricate connections between these issues and propose a theoretical model to explain the neurobiological mechanisms underpinning this complex relationship.

Coupling motor evoked potentials and brain [18F]FDG-PET in Amyotrophic Lateral Sclerosis: preliminary findings on disease severity

BACKGROUND

The diagnosis of amyotrophic lateral sclerosis (ALS) is primarily clinical, supported by the electromyographic examination to reveal signs of lower motor neuron damage. Identifying reliable markers of upper motor neuron (UMN) involvement is challenging. On this regard, the role of transcranial magnetic stimulation-induced motor-evoked potentials (TMS-MEPs), and its relationship with UMN burden, is still under investigation.

OBJECTIVE

To evaluate the ability of TMS-MEPs in delineating the neurophysiological UMN damage, and to determine the relationship between TMS-MEPs and [18F]FDG-PET measures of neural dysfunction.

METHODS

We retrospectively selected 13 ALS patients who underwent, during the diagnostic process, the TMS-MEPs and [18F]FDG-PET scans. Demographic and clinical data were collected. For the MEP evaluation, we considered normal MEP, absent MEP, or significantly increased central-motor-conduction-time. For [18F]FDG-PET, we conducted voxel-wise analyses, both at single-subject and group levels, exploring hypometabolism and hypermetabolism patterns in comparison with a large dataset of healthy controls (HC).

RESULTS

Based on TMS-MEPs, we identified 4/13 patients with normal MEP in all limbs (GROUP-NO), while 9/13 had an abnormal MEP in at least one limb (GROUP-AB). Despite the [18F]FDG-PET single-subject analysis revealed heterogenous expression of regional hypo- and hyper-metabolism patterns in the patients, the group-level analysis revealed a common hypometabolism, involving the precentral gyrus and the supplementary motor area, the paracentral lobule and the anterior cingulate cortex in the GROUP-AB. Moreover, exclusively for the GROUP-AB compared with HC, a relative hypermetabolism was observed in the right cerebellum, right inferior and middle temporal gyrus. The GROUP-NO showed no specific cluster of hypo- and hyper-metabolism compared to HC.

CONCLUSION

This study showed altered brain metabolism only in the ALS group with abnormal MEPs, suggesting an association between the two biomarkers in defining the UMN damage.

Sleepless nights, sour moods: daily sleep-irritability links in a pediatric clinical sample

BACKGROUND

Sleep, or a lack thereof, is strongly related to mood dysregulation. Although considerable research uses symptom scales to examine this relation, few studies use longitudinal, real-time methods focused on pediatric irritability. This study leveraged an ecological momentary assessment (EMA) protocol, assessing bidirectional associations between momentary irritability symptoms and daily sleep duration in a transdiagnostic pediatric sample enriched for irritability.

METHODS

A total of N = 125 youth (Mage = 12.58 years, SD = 2.56 years; 74% male; 68.8% White) completed digital, in vivo surveys three times a day for 7 days. For a subset of youth, their parents also completed the EMA protocol. Trait irritability was measured using youth-, parent-, and clinician-report to test its potential moderating effect on the association between sleep duration and momentary irritability.

RESULTS

Results from multilevel modeling dynamically linked sleep to irritability. Specifically, according to youth- and parent-report, decreased sleep duration was associated with increased morning irritability (bs ≤ -.09, ps < .049). A bidirectional association between parent-reported nightly sleep duration and anger was found-increased evening anger related to decreased nightly sleep duration, and decreased sleep duration related to increased morning anger (bs ≤ -.17, ps < .019). Trait irritability moderated this association, which was stronger for more irritable youth (b = -.03, p < .027).

CONCLUSIONS

This study adds to the literature and suggests sleep-irritability dynamics as a potential treatment target.

Caffeine Attenuates Exacerbated Central Fatigue during Moderate-Intensity Cycling Exercise in Women with Fibromyalgia

PURPOSE

To compare the development of fatigability during a moderate-intensity cycling exercise between women with fibromyalgia (FM) and control women (CON) after acute ingestion of caffeine and placebo.

METHODS

Ten FM and 10 CON women performed a 30-min moderate-intensity cycling exercise 1 h after the ingestion of a capsule containing either caffeine or a placebo. Fatigability and its central and peripheral determinants were determined via changes from pre- to post-15 and post-30 min of exercise in maximal voluntary isometric contractions, voluntary activation (VA), and quadriceps potentiated twitch torque ( Qtw-pot ), respectively. Heart rate, muscle oxygen saturation, perceptive responses, mood state, localized and widespread pain, and sleepiness were also monitored during and after exercise.

RESULTS

There was a time versus group interaction for maximal voluntary isometric contraction and VA ( P < 0.001) but not for Qtw-pot ( P = 0.363), indicating a greater rate of fatigability development, mainly caused by central mechanisms, in the FM than in the CON group. There was also a main effect of condition for VA ( P = 0.011), indicating that caffeine attenuates central mechanisms of fatigability in both groups. Caffeine ingestion also increased muscle oxygenation, perceived vigor, and energy, and decreased leg muscle pain, sleepiness, and perceived fatigue in both groups. However, caffeine improved perceived pleasure/displeasure and exercise adherence likelihood only in the FM group.

CONCLUSIONS

Compared with CON, women with FM present a greater rate of fatigability during exercise, mainly of central origin. Caffeine seems to be a promising bioactive to counteract the central mechanisms of fatigability and improve the exercise experience among FM women.

Sleep disorders and hyperarousal among patients with endometriosis: A case-control survey study

BACKGROUND

Endometriosis has been associated with sleep disorders, and hyperarousal appears to be involved in their pathogenesis; however, the presence of hyperarousal in the endometriosis population was never investigated.

METHODS

We conducted a case-control survey study by sending a questionnaire to all endometriosis patients followed up at our Centers. Controls were recruited among the general population. The questionnaire included demographic information, symptoms and history of endometriosis, the Hyperarousal Scale (H-Scale), the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI).

RESULTS

A total of 847 women completed the questionnaires: 430 (50.8 %) had endometriosis, and 417 (49.2 %) were controls. Endometriosis was associated with higher H-scale score (OR 2.9, 95 % CI 2.4-3.8, p = 0.000), higher PSQI score (OR 4.3, 95 % CI 3.2-5.7, p = 0.000), and higher ISI score (OR 4.6, 95 % CI 3.5-6.1, p = 0.000) in multivariable ordinal logistic regressions analysis. With path analysis, hyperarousal (H-Scale) reported a partial mediating role in the association between endometriosis and sleep disorders. The mediation effect represented 22.3-27.8 % of the entire association between endometriosis and sleep disturbances.

CONCLUSION

Endometriosis patients complaining sleep disorders may benefit by investigating the presence of hyperarousal given cognitive behavioral therapy was reported effective in improving hyperarousal and associated sleep disorders.