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Gogoll C, Peters E, Köllner V, Koczulla R. [S1 guideline long/post-COVID syndrome]. UROLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00120-024-02373-9. [PMID: 38886205 DOI: 10.1007/s00120-024-02373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Christian Gogoll
- Ambulante Dienste, Ev. Lungenklinik Berlin, Berlin, Deutschland.
| | - Eva Peters
- Universitätsklinik Gießen und Marburg, Gießen und Marburg, Deutschland
- Schwerpunkt Psychoneuroimmunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Volker Köllner
- Forschungsgruppe Psychosomatische Rehabilitation & Rehazentrum Seehof der Deutschen Rentenversicherung mit aktuell Entwicklung eines kardiopsychosomatischen ambulanten Rehakonzeptes für Post-COVID Patienten, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Rembert Koczulla
- Schön Klinik Berchtesgadener Land, Forschungsinstitut für Pneumologische Rehabilitation, Philipps-Universität Marburg, Marburg, Deutschland
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2
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Di Laudo F, Mainieri G, Provini F. Parasomnias During the COVID-19 Pandemic. Sleep Med Clin 2024; 19:177-187. [PMID: 38368064 DOI: 10.1016/j.jsmc.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
COVID-19 had a massive impact on sleep, resulting in overall increase of sleep disturbances. During lockdown many factors contributed to sleep disturbances, in particular changes in sleep-wake habits and stress. This article will describe the frequency and features of the principal parasomnias and the impact of the pandemic and the government restriction measures on sleep. Among different pathophysiological hypotheses, we will discuss the role of stress, considered as an expression of the allostatic load. Finally, during the pandemic, parasomnias were mainly investigated by questionnaires, with controversial results; video-polysomnographic studies are crucial to obtain a definitive diagnosis, even in critical conditions.
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Affiliation(s)
- Felice Di Laudo
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Via Massarenti, 9, Pad. 11, Bologna 40138, Italy
| | - Greta Mainieri
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Via Massarenti, 9, Pad. 11, Bologna 40138, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna 40139, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Via Massarenti, 9, Pad. 11, Bologna 40138, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna 40139, Italy.
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Jarosch I, Schneeberger T, Stegemann A, Gloeckl R, Leitl D, Dennis C, Hitzl W, Schoen C, Koczulla AR. Impaired Sleep in Patients with Post-COVID-19 Syndrome Compared to Healthy Controls: A Cross-Sectional Trial. Respiration 2024; 103:177-181. [PMID: 38432219 PMCID: PMC10997262 DOI: 10.1159/000536272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/22/2023] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION To objectify self-reported sleep disorders in individuals with post-COVID-syndrome (PCS), we aimed to investigate the prevalence and nature of sleep disturbances by polysomnography (PSG) in PCS compared to healthy individuals. METHODS People with PCS (n = 21) and healthy controls (CON, n = 10) were included in this prospective trial. At baseline, clinical and social anamnesis, lung function, 1 min sit-to-stand test (STST) and Pittsburgh Sleep Quality Index (PSQI) were assessed. For a single-night, sleep health was evaluated by video-PSG. The apnoea/hypopnea index (AHI) was used as the primary outcome. RESULTS Twenty patients with PCS (50 ± 11 y, BMI 27.1 m2/kg, SARS-CoV-2 infection 8.5 ± 4.5 months ago) and 10 CON participants (46 ± 10 y, BMI 23.0 m2/kg, no SARS-CoV-2 infection in the history) completed the study. Forced vital capacity (p = 0.018), STST repetitions (p < 0.001), and symptoms of dyspnoea (at rest: p = 0.002, exertion: p < 0.001) were worse in PCS compared to CON. PSQI score (PCS: 7.5 ± 4.7 points) was higher in PCS compared to CON (Δ = 3.7 points, 95% CI [0.4-7.1] p = 0.015), indicating poor sleep in 80% of patients with PCS. Although PSG showed comparable sleep stage distributions in both groups, AHI (Δ = 9.0 n/h, 95% CI [3.3-14.8], p = 0.002), PLM index (Δ = 5.1 n/h, 95% CI [0.4-9.8], p = 0.017), and the prevalence of sleep apnoea (60% vs. 10%, p = 0.028) was significantly higher in PCS compared to CON. CONCLUSION Quantifiable subjective limitations of sleep have been revealed by PSG data in this PCS cohort. More than half of PCS patients had signs of sleep apnoea, highlighting the importance of sleep screening in PCS.
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Affiliation(s)
- Inga Jarosch
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research (DZL), Marburg, Germany
| | - Tessa Schneeberger
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research (DZL), Marburg, Germany
| | - Antje Stegemann
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research (DZL), Marburg, Germany
| | - Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research (DZL), Marburg, Germany
| | - Daniela Leitl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research (DZL), Marburg, Germany
| | - Clancy Dennis
- The University of Sydney, Faculty of Medicine and Health Science, Sydney, NSW, Australia
- Zamanian Lab, Department of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
| | - Wolfgang Hitzl
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management (RIM), Team Biostatistics and publication of clinical trial studies/machine learning, Paracelsus Medical University (PMU), Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria
| | | | - Andreas Rembert Koczulla
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research (DZL), Marburg, Germany
- Teaching Department of the Paracelsus University Salzburg (PMU), Salzburg, Austria
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4
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Tackey C, Slepian PM, Clarke H, Mittal N. Post-Viral Pain, Fatigue, and Sleep Disturbance Syndromes: Current Knowledge and Future Directions. Can J Pain 2024; 7:2272999. [PMID: 38239826 PMCID: PMC10795785 DOI: 10.1080/24740527.2023.2272999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/16/2023] [Indexed: 01/22/2024]
Abstract
Background Post-viral pain syndrome, also known as post-viral syndrome, is a complex condition characterized by persistent pain, fatigue, musculoskeletal pain, neuropathic pain, neurocognitive difficulties, and sleep disturbances that can occur after an individual has recovered from a viral infection. Aims This narrative review provides a summary of the sequelae of post-viral syndromes, viral agents that cause it, and the pathophysiology, treatment, and future considerations for research and targeted therapies. Methods Medline, PubMed, and Embase databases were used to search for studies on viruses associated with post-viral syndrome. Conclusion Much remains unknown regarding the pathophysiology of post-viral syndromes, and few studies have provided a comprehensive summary of the condition, agents that cause it, and successful treatment modalities. With the COVID-19 pandemic continuing to affect millions of people worldwide, the need for an understanding of the etiology of post-viral illness and how to help individuals cope with the sequalae is paramount.
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Affiliation(s)
- Caleb Tackey
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - P. Maxwell Slepian
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Nimish Mittal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
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5
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Eschbach E, Wang J. Sleep and critical illness: a review. Front Med (Lausanne) 2023; 10:1199685. [PMID: 37828946 PMCID: PMC10566646 DOI: 10.3389/fmed.2023.1199685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Critical illness and stays in the Intensive Care Unit (ICU) have significant impact on sleep. Poor sleep is common in this setting, can persist beyond acute critical illness, and is associated with increased morbidity and mortality. In the past 5 years, intensive care clinical practice guidelines have directed more focus on sleep and circadian disruption, spurring new initiatives to study and improve sleep complications in the critically ill. The global SARS-COV-2 (COVID-19) pandemic and dramatic spikes in patients requiring ICU level care also brought augmented levels of sleep disruption, the understanding of which continues to evolve. This review aims to summarize existing literature on sleep and critical illness and briefly discuss future directions in the field.
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Affiliation(s)
- Erin Eschbach
- Division of Pulmonary, Critical Care, and Sleep, Mount Sinai Hospital, New York, NY, United States
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Rabady S, Hoffmann K, Aigner M, Altenberger J, Brose M, Costa U, Denk-Linnert DM, Gruber S, Götzinger F, Helbok R, Hüfner K, Koczulla R, Kurz K, Lamprecht B, Leis S, Löffler J, Müller CA, Rittmannsberger H, Rommer PS, Sator P, Strenger V, Struhal W, Untersmayr E, Vonbank K, Wancata J, Weber T, Wendler M, Zwick RH. [S1 guidelines for the management of postviral conditions using the example of post-COVID-19]. Wien Klin Wochenschr 2023; 135:525-598. [PMID: 37555900 PMCID: PMC10504206 DOI: 10.1007/s00508-023-02242-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 08/10/2023]
Abstract
These S1 guidelines are an updated and expanded version of the S1 guidelines on long COVID differential diagnostic and management strategies. They summarize the state of knowledge on postviral conditions like long/post COVID at the time of writing. Due to the dynamic nature of knowledge development, they are intended to be "living guidelines". The focus is on practical applicability at the level of primary care, which is understood to be the appropriate place for initial access and for primary care and treatment. The guidelines provide recommendations on the course of treatment, differential diagnostics of the most common symptoms that can result from infections like with SARS-CoV-2, treatment options, patient management and care, reintegration and rehabilitation. The guidelines have been developed through an interdisciplinary and interprofessional process and provide recommendations on interfaces and possibilities for collaboration.
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Affiliation(s)
- Susanne Rabady
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich.
| | - Kathryn Hoffmann
- Leiterin der Abteilung Primary Care Medicine, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Martin Aigner
- Abteilung für Psychiatrie und psychotherapeutische Medizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich
| | - Johann Altenberger
- Pensionsversicherungsanstalt, Rehabilitationszentrum Großgmain, Salzburger Str. 520, 5084, Großgmain, Österreich
| | - Markus Brose
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich
| | - Ursula Costa
- Ergotherapie und Handlungswissenschaft, fhg - Zentrum für Gesundheitsberufe Tirol GmbH/fh, Innrain 98, 6020, Innsbruck, Österreich
| | - Doris-Maria Denk-Linnert
- Klinische Abteilung für Allgemeine Hals‑, Nasen- und Ohrenkrankheiten, Klin. Abteilung Phoniatrie-Logopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Samuel Gruber
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich
| | - Florian Götzinger
- Abteilung für Kinderheilkunde, Klinik Ottakring, Montleartstr. 37, 1160, Wien, Österreich
| | - Raimund Helbok
- Universitätsklinik für Neurologie, Johannes Kepler Universität Linz, Standort Neuromed Campus & Med Campus Kepler Universitätsklinikum GmbH, 4020, Linz, Österreich
| | - Katharina Hüfner
- Dep. für Psychiatrie, Psychotherapie, Psychosomatik und Medizinische Psychologie, Universitätsklinik für Psychiatrie II, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Rembert Koczulla
- Fachbereich Medizin, Klinik für Pneumologie Marburg, Baldingerstr., 35035, Marburg, Deutschland
| | - Katharina Kurz
- Innere Medizin II, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Bernd Lamprecht
- Universitätsklinik für Innere Medizin mit Schwerpunkt Pneumologie, Kepler Universitätsklinikum, 4020, Linz, Österreich
| | - Stefan Leis
- Universitätsklinik für Neurologie der PMU, MME Universitätsklinikum Salzburg Christian-Doppler-Klinik, Ignaz-Harrer-Str. 79, 5020, Salzburg, Österreich
| | - Judith Löffler
- Innere Medizin II, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Christian A Müller
- Klinische Abteilung für Allgemeine Hals‑, Nasen- und Ohrenkrankheiten, Klin. Abteilung für Allgemeine HNO, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | | | - Paulus S Rommer
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Paul Sator
- Dermatologische Abteilung, Klinik Hietzing, Wolkersbergenstr. 1, 1130, Wien, Österreich
| | - Volker Strenger
- Klinische Abteilung für Allgemeinpädiatrie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, 8036, Graz, Österreich
| | - Walter Struhal
- Klinische Abteilung für Neurologie, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Eva Untersmayr
- Institut für Pathophysiologie und Allergieforschung Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Karin Vonbank
- Klinische Abteilung für Pulmologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Johannes Wancata
- Klinische Abteilung für Sozialpsychiatrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Thomas Weber
- Kardiologische Abteilung Klinikum Wels-Grieskirchen, Grieskirchnerstr. 42, 4600, Wels, Österreich
| | | | - Ralf-Harun Zwick
- Ludwig Boltzmann Institute for Rehabilitation Research, Kurbadstr. 14, 1100, Wien, Österreich
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Eyfferth T, Koczulla AR, Freytag HW, Krahl G, Ackermann C, Bultmann S, Reimertz R, Dresing K. [The problem of long/post-COVID in expert assessments]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:373-386. [PMID: 37079057 PMCID: PMC10117274 DOI: 10.1007/s00113-023-01297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 04/21/2023]
Abstract
Assessing long/post-COVID syndrome (PCS) following an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a multidisciplinary challenge due to the diverse and complex symptoms. Besides discipline-specific evaluation of infection-related organ damage, the main issue is expert objectivity and causality assessment regarding subjective symptoms. The consequences of long/PCS raise questions of insurance rights in all fields of law. In cases of persistent impairment of performance, determining reduction in earning capacity is crucial for those affected. Recognition as an occupational disease (BK no. 3101) is vital for employees in healthcare and welfare sectors, along with occupational accident recognition and assessing the illness's consequences, including the reduction in earning capacity (MdE) in other sectors or work areas. Therefore, expert assessments of illness consequences and differentiation from previous illnesses or damage disposition are necessary in all areas of law, individually based on corresponding organ manifestations in medical fields and interdisciplinarily for complex late sequelae, for instance, by internists with appropriate qualifications for pulmonary or cardiac manifestations and neurologists, psychiatrists, and neuropsychologists for neurological and psychiatric manifestations, etc.
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Affiliation(s)
- T Eyfferth
- BG Service- und Rehabilitationszentrum, BG Unfallklinik Frankfurt am Main gGmbH, Akademisches Lehrkrankenhaus, Johann-Wolfgang-Goethe Universität Frankfurt Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland.
- Sektion Begutachtung der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Berlin, Deutschland.
| | - A R Koczulla
- Schön Klinik Berchtesgadener Land, Schönau am Königssee, Deutschland
- Professur für Pneumologische Rehabilitation Philipps Universität Marburg, Deutsches Zentrum für Lungenforschung, Marburg, Deutschland
| | - H W Freytag
- Psychotraumatologie (PZDT), BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - G Krahl
- Psychotraumatologie (PZDT), BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Ch Ackermann
- Psychotraumatologie (PZDT), BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - S Bultmann
- Sozialgericht Hamburg, Hamburg, Deutschland
| | - R Reimertz
- BG Service- und Rehabilitationszentrum, BG Unfallklinik Frankfurt am Main gGmbH, Akademisches Lehrkrankenhaus, Johann-Wolfgang-Goethe Universität Frankfurt Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
| | - K Dresing
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
- Sektion Begutachtung der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Berlin, Deutschland
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8
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Cesari M, Heidbreder A, Gaig C, Bergmann M, Brandauer E, Iranzo A, Holzknecht E, Santamaria J, Högl B, Stefani A. Automatic analysis of muscular activity in the flexor digitorum superficialis muscles: a fast screening method for rapid eye movement sleep without atonia. Sleep 2023; 46:zsab299. [PMID: 34984464 PMCID: PMC9995778 DOI: 10.1093/sleep/zsab299] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To identify a fast and reliable method for rapid eye movement (REM) sleep without atonia (RWA) quantification. METHODS We analyzed 36 video-polysomnographies (v-PSGs) of isolated REM sleep behavior disorder (iRBD) patients and 35 controls' v-PSGs. Patients diagnosed with RBD had: i) RWA, quantified with a reference method, i.e. automatic and artifact-corrected 3-s Sleep Innsbruck Barcelona (SINBAR) index in REM sleep periods (RSPs, i.e. manually selected portions of REM sleep); and ii) v-PSG-documented RBD behaviors. We quantified RWA with other (semi)-automated methods requiring less human intervention than the reference one: the indices proposed by the SINBAR group (the 3-s and 30-s phasic flexor digitorum superficialis (FDS), phasic/"any"/tonic mentalis), and the REM atonia, short and long muscle activity indices (in mentalis/submentalis/FDS muscles). They were calculated in whole REM sleep (i.e. REM sleep scored following international guidelines), in RSPs, with and without manual artifact correction. Area under curves (AUC) discriminating iRBD from controls were computed. Using published cut-offs, the indices' sensitivity and specificity for iRBD identification were calculated. Apnea-hypopnea index in REM sleep (AHIREM) was considered in the analyses. RESULTS RWA indices from FDS muscles alone had the highest AUCs and all of them had 100% sensitivity. Without manual RSP selection and artifact correction, the "30-s phasic FDS" and the "FDS long muscle activity" had the highest specificity (85%) with AHIREM < 15/h. RWA indices were less reliable when AHIREM≥15/h. CONCLUSIONS If AHIREM<15/h, FDS muscular activity in whole REM sleep and without artifact correction is fast and reliable to rule out RWA.
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Affiliation(s)
- Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carles Gaig
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Iranzo
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Evi Holzknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joan Santamaria
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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9
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Quantification of REM sleep without atonia: A review of study methods and meta-analysis of their performance for the diagnosis of RBD. Sleep Med Rev 2023; 68:101745. [PMID: 36640617 DOI: 10.1016/j.smrv.2023.101745] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
The present review focuses on REM sleep without atonia (RSWA) scoring methods. In consideration of the numerous papers published in the last decade, that used different methods for the quantification of RSWA, their systematic revision is an emerging need. We made a search using the PubMed, Embase, Scopus and Web of Science Databases, from 2010 until December 2021, combining the search term "RSWA" with "scoring methods", "IRBD", "alfasyn disease", and "neurodegenerative disease", and with each of the specific sleep disorders, diagnosed according to current criteria, with the identification of the references of interest for the topic. Furthermore, a Meta-analysis of the diagnostic performance of RSWA scoring methods, in terms of sensitivity and specificity, was carried out. The comparison of the hierarchical summary receiver-operating characteristic curves obtained for visual methods and that obtained for the automated REM sleep atonia index (RAI), shows substantially similar prediction areas indicating a comparable performance. This systematic review and meta-analysis support the validity of a series of visual methods and of the automated RAI in the quantification of RSWA with the purpose to guide clinicians in the interpretation of their results and their correct and efficient use within the diagnostic work-up for REM sleep behavior disorder.
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10
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Chiffi G, Grandgirard D, Stöckli S, Valente LG, Adamantidis A, Leib SL. Tick-borne encephalitis affects sleep–wake behavior and locomotion in infant rats. Cell Biosci 2022; 12:121. [PMID: 35918749 PMCID: PMC9344439 DOI: 10.1186/s13578-022-00859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/21/2022] [Indexed: 08/30/2023] Open
Abstract
Background/Aims Tick-borne encephalitis (TBE) is a disease affecting the central nervous system. Over the last decade, the incidence of TBE has steadily increased in Europe and Asia despite the availably of effective vaccines. Up to 50% of patients after TBE suffer from post-encephalitic syndrome that may develop into long-lasting morbidity. Altered sleep–wake functions have been reported by patients after TBE. The mechanisms causing these disorders in TBE are largely unknown to date. As a first step toward a better understanding of the pathology of TBEV-inducing sleep dysfunctions, we assessed parameters of sleep structure in an established infant rat model of TBE. Methods 13-day old Wistar rats were infected with 1 × 106 FFU Langat virus (LGTV). On day 4, 9, and 21 post infection, Rotarod (balance and motor coordination) and open field tests (general locomotor activity) were performed and brains from representative animals were collected in each subgroup. On day 28 the animals were implanted with a telemetric EEG/EMG system. Sleep recording was continuously performed for 24 consecutive hours starting at day 38 post infection and visually scored for Wake, NREM, and REM in 4 s epochs. Results As a novelty of this study, infected animals showed a significant larger percentage of time spend awake during the dark phase and less NREM and REM compared to the control animals (p < 0.01 for all comparisons). Furthermore, it was seen, that during the dark phase the wake bout length in infected animals was prolonged (p = 0.043) and the fragmentation index decreased (p = 0.0085) in comparison to the control animals. LGTV-infected animals additionally showed a reduced rotarod performance ability at day 4 (p = 0.0011) and day 9 (p = 0.0055) and day 21 (p = 0.0037). A lower locomotor activity was also seen at day 4 (p = 0.0196) and day 9 (p = 0.0473). Conclusion Our data show that experimental TBE in infant rats affects sleep–wake behavior, leads to decreased spontaneous locomotor activity, and impaired moto-coordinative function. Supplementary Information The online version contains supplementary material available at 10.1186/s13578-022-00859-7.
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Abstract
The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.
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12
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Heidbreder A, Kotterba S. Aktuelle Entwicklungen in der Schlafforschung und Schlafmedizin – eine Einschätzung der AG „Motorik“. SOMNOLOGIE 2022; 26:165-166. [PMID: 36061475 PMCID: PMC9425805 DOI: 10.1007/s11818-022-00371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 10/25/2022]
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13
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The Impact of Iron Dyshomeostasis and Anaemia on Long-Term Pulmonary Recovery and Persisting Symptom Burden after COVID-19: A Prospective Observational Cohort Study. Metabolites 2022; 12:metabo12060546. [PMID: 35736479 PMCID: PMC9228477 DOI: 10.3390/metabo12060546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is frequently associated with iron dyshomeostasis. The latter is related to acute disease severity and COVID-19 convalescence. We herein describe iron dyshomeostasis at COVID-19 follow-up and its association with long-term pulmonary and symptomatic recovery. The prospective, multicentre, observational cohort study “Development of Interstitial Lung Disease (ILD) in Patients With Severe SARS-CoV-2 Infection (CovILD)” encompasses serial extensive clinical, laboratory, functional and imaging evaluations at 60, 100, 180 and 360 days after COVID-19 onset. We included 108 individuals with mild-to-critical acute COVID-19, whereas 75% presented with severe acute disease. At 60 days post-COVID-19 follow-up, hyperferritinaemia (35% of patients), iron deficiency (24% of the cohort) and anaemia (9% of the patients) were frequently found. Anaemia of inflammation (AI) was the predominant feature at early post-acute follow-up, whereas the anaemia phenotype shifted towards iron deficiency anaemia (IDA) and combinations of IDA and AI until the 360 days follow-up. The prevalence of anaemia significantly decreased over time, but iron dyshomeostasis remained a frequent finding throughout the study. Neither iron dyshomeostasis nor anaemia were related to persisting structural lung impairment, but both were associated with impaired stress resilience at long-term COVID-19 follow-up. To conclude, iron dyshomeostasis and anaemia are frequent findings after COVID-19 and may contribute to its long-term symptomatic outcome.
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14
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Schilling C, Meyer-Lindenberg A, Schweiger JI. [Cognitive disorders and sleep disturbances in long COVID]. DER NERVENARZT 2022; 93:779-787. [PMID: 35576015 PMCID: PMC9109661 DOI: 10.1007/s00115-022-01297-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 02/07/2023]
Abstract
Hintergrund In den letzten 2 Jahren der COVID-19(„coronavirus disease 2019“)-Pandemie ist das Wissen um Langzeitfolgen der Erkrankung, das sog. „Long-COVID“, rapide gewachsen. Es bleiben jedoch noch viele Fragen offen, v. a. was die Ursachen überdauernder Beschwerden und ihre Prognose betrifft. Kognitive Störungen und Schlafstörungen gehören zu den häufig beklagten Beschwerden. Beide gehen mit starkem Leidensdruck und deutlicher Alltagsbeeinträchtigung einher. Ziel der Arbeit Wie ist die Datenlage zum Auftreten kognitiver Störungen und Schlafstörungen bei Long-COVID? Welches sind Einflussfaktoren und was ist bekannt zum Verlauf und zu möglichen zugrunde liegenden Mechanismen? Welche Therapieoptionen gibt es? Material und Methode In einem narrativen Review werden die wichtigsten Befunde zu kognitiven Störungen und Schlafstörungen bei Long-COVID dargestellt. Es wird ein Überblick gegeben über die Kohortenstudien mit Daten zu Prävalenz und Einflussfaktoren beider Symptomkomplexe. Es werden derzeitige Kenntnisse und Hypothesen zu pathophysiologischen Mechanismen dargestellt und ein Ausblick auf Behandlungsansätze gegeben. Ergebnisse Etwa ein Fünftel der Betroffenen berichtet mehr als 3 Monate nach einer SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Infektion über kognitive Einschränkungen, etwa ein Drittel über Schlafstörungen, wobei es neben insomnischen auch zu hypersomnische Beschwerden kommt. Kognitive Störungen und Schlafstörungen treten bei Betroffenen aller Schweregrade auf. Es gibt Hinweise auf eine Besserung kognitiver Defizite im Verlauf, allerdings sind weitere Längsschnittstudien notwendig. Diskussion Neben der Prognose sind die zugrunde liegenden Krankheitsmechanismen noch unzureichend verstanden. Zudem besteht großer Forschungsbedarf zur Wirksamkeit und zu spezifischen Wirkfaktoren therapeutischer Interventionen.
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Affiliation(s)
- Claudia Schilling
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland.
| | - Andreas Meyer-Lindenberg
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
| | - Janina Isabel Schweiger
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
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15
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Rass V, Ianosi BA, Zamarian L, Beer R, Sahanic S, Lindner A, Kofler M, Schiefecker AJ, Mahlknecht P, Heim B, Limmert V, Sonnweber T, Pizzini A, Tymoszuk P, Scherfler C, Djamshidian A, Kiechl S, Tancevski I, Seppi K, Pfausler B, Loeffler-Ragg J, Helbok R. Factors associated with impaired quality of life three months after being diagnosed with COVID-19. Qual Life Res 2022; 31:1401-1414. [PMID: 34580823 PMCID: PMC8476326 DOI: 10.1007/s11136-021-02998-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess patient characteristics associated with health-related quality of life (HR-QoL) and its mental and physical subcategories 3 months after diagnosis with COVID-19. METHODS In this prospective multicentre cohort study, HR-QoL was assessed in 90 patients using the SF-36 questionnaire (36-item Short Form Health Survey), which consists of 8 health domains that can be divided into a mental and physical health component. Mental health symptoms including anxiety, depression, and post-traumatic stress disorders were evaluated using the Hospital Anxiety and Depression Scale (HADS) and Post-traumatic Stress Disorder Checklist-5 (PCL-5) 3 months after COVID-19. Using descriptive statistics and multivariable regression analysis, we identified factors associated with impaired HR-QoL 3 months after COVID-19 diagnosis. RESULTS Patients were 55 years of age (IQR, 49-63; 39% women) and were classified as severe (23%), moderate (57%), or mild (20%) according to acute disease severity. HR-QoL was impaired in 28/90 patients (31%). Younger age [per year, adjOR (95%CI) 0.94 (0.88-1.00), p = 0.049], longer hospitalization [per day, adjOR (95%CI) 1.07 (1.01-1.13), p = 0.015], impaired sleep [adjOR (95%CI) 5.54 (1.2-25.61), p = 0.028], and anxiety [adjOR (95%CI) 15.67 (3.03-80.99), p = 0.001) were independently associated with impaired HR-QoL. Twenty-nine percent (n = 26) scored below the normal range on the mental health component of the SF-36 and independent associations emerged for anxiety, depression, and self-reported numbness. Impairments in the physical health component of the SF-36 were reported by 12 (13%) patients and linked to hypogeusia and fatigue. CONCLUSION Every third patient reported a reduction in HR-QoL 3 months after COVID-19 diagnosis and impairments were more prominent in mental than physical well-being.
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Affiliation(s)
- Verena Rass
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Bogdan-Andrei Ianosi
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Ronny Beer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Sabina Sahanic
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Anna Lindner
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Mario Kofler
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Alois Josef Schiefecker
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Philipp Mahlknecht
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Victoria Limmert
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Thomas Sonnweber
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Alex Pizzini
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Piotr Tymoszuk
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Ivan Tancevski
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Bettina Pfausler
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Judith Loeffler-Ragg
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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16
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Liu Y, Partinen E, Chan NY, Dauvilliers Y, Inoue Y, De Gennaro L, Plazzi G, Bolstad CJ, Nadorff MR, Merikanto I, Bjorvatn B, Han F, Zhang B, Cunha AS, Mota‐Rolim S, Léger D, Matsui K, Espie CA, Chung F, Morin CM, Sieminski M, Thomas P, Holzinger B, Partinen M, Wing YK. Dream-enactment behaviours during the COVID-19 pandemic: an international COVID-19 sleep study. J Sleep Res 2022; 32:e13613. [PMID: 35474255 PMCID: PMC9115143 DOI: 10.1111/jsr.13613] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 02/05/2023]
Abstract
There has been increasing concern about the long-term impact of coronavirus disease 2019 (COVID-19) as evidenced by anecdotal case reports of acute-onset parkinsonism and the polysomnographic feature of increased rapid eye movement sleep electromyographic activity. This study aimed to determine the prevalence and correlates of dream-enactment behaviours, a hallmark of rapid eye movement sleep behaviour disorder, which is a prodrome of α-synucleinopathy. This online survey was conducted between May and August 2020 in 15 countries/regions targeting adult participants (aged ≥18 years) from the general population with a harmonised structured questionnaire on sleep patterns and disorders, COVID-19 diagnosis and symptoms. We assessed dream-enactment behaviours using the Rapid Eye Movement Sleep Behaviour Disorder Single-Question Screen with an additional question on their frequency. Among 26,539 respondents, 21,870 (82.2%) answered all items that were analysed in this study (mean [SD] age 41.6 [15.8] years; female sex 65.5%). The weighted prevalence of lifetime and weekly dream-enactment behaviours was 19.4% and 3.1% and were found to be 1.8- and 2.9-times higher in COVID-19-positive cases, respectively. Both lifetime and weekly dream-enactment behaviours were associated with young age, male sex, smoking, alcohol consumption, higher physical activity level, nightmares, COVID-19 diagnosis, olfactory impairment, obstructive sleep apnea symptoms, mood, and post-traumatic stress disorder features. Among COVID-19-positive cases, weekly dream-enactment behaviours were positively associated with the severity of COVID-19. Dream-enactment behaviours are common among the general population during the COVID-19 pandemic and further increase among patients with COVID-19. Further studies are needed to investigate the potential neurodegenerative effect of COVID-19.
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Affiliation(s)
- Yaping Liu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of MedicineThe Chinese University of Hong KongHong KongSpecial Administrative Region (SAR)China
| | - Eemil Partinen
- Helsinki Sleep Clinic, Terveystalo Healthcare and Department of Clinical Neurosciences, ClinicumUniversity of HelsinkiHelsinkiFinland
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of MedicineThe Chinese University of Hong KongHong KongSpecial Administrative Region (SAR)China
| | - Yves Dauvilliers
- Sleep‐Wake Disorders Unit, Department of Neurology, Gui‐de‐Chauliac Hospital, CHU Montpellier, INM, INSERMUniversity of MontpellierMontpellierFrance
| | | | - Luigi De Gennaro
- Department of Psychology, SapienzaUniversity of RomeRomeItaly,IRCCS Fondazione Santa LuciaRomeItaly
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly,Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio‐EmiliaModenaItaly
| | - Courtney J. Bolstad
- Department of PsychologyMississippi State UniversityMississippi StateMississippiUSA
| | - Michael R. Nadorff
- Department of PsychologyMississippi State UniversityMississippi StateMississippiUSA,Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | - Ilona Merikanto
- SleepWell Research Program, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland,Department of Public Health SolutionsFinnish Institute for Health and WelfareHelsinkiFinland
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, Norway and Norwegian Competence Center for Sleep DisordersHaukeland University Hospital, University of BergenBergenNorway
| | - Fang Han
- The Sleep CenterPeking University People's HospitalBeijingChina
| | - Bin Zhang
- Department of Psychiatry, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Ana Suely Cunha
- Department of Production EngineeringFederal University of Rio Grande do NorteNatalBrazil
| | - Sérgio Mota‐Rolim
- Brain Institute, Physiology and Behavior Department, and Onofre Lopes University HospitalFederal University of Rio Grande do NorteNatalBrazil
| | - Damien Léger
- APHP, VIFASOM, Hôtel Dieu, Centre du Sommeil et de la VigilanceUniversité de ParisParisFrance
| | - Kentaro Matsui
- Department of Laboratory Medicine, National Center HospitalNational Center of Neurology and PsychiatryKodairaJapan
| | - Colin A. Espie
- Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, University Health NetworkUniversity of TorontoTorontoOntarioCanada
| | - Charles M. Morin
- Centre de recherche CERVO/Brain Research Center, École de psychologieUniversité LavalQuebec CityQuebecCanada
| | - Mariusz Sieminski
- Department of Emergency MedicineMedical University of GdanskGdanskPoland
| | - Penzel Thomas
- Sleep Medicine CenterCharite Universitätsmedizin BerlinBerlinGermany
| | - Brigitte Holzinger
- Institute for Dream and Consciousness ResearchMedical University of ViennaViennaAustria
| | - Markku Partinen
- Helsinki Sleep Clinic, Terveystalo Healthcare and Department of Clinical Neurosciences, ClinicumUniversity of HelsinkiHelsinkiFinland
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of MedicineThe Chinese University of Hong KongHong KongSpecial Administrative Region (SAR)China
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17
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Neculicioiu VS, Colosi IA, Costache C, Sevastre-Berghian A, Clichici S. Time to Sleep?-A Review of the Impact of the COVID-19 Pandemic on Sleep and Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063497. [PMID: 35329184 PMCID: PMC8954484 DOI: 10.3390/ijerph19063497] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 02/06/2023]
Abstract
Sleep is intrinsically tied to mental and overall health. Short sleep duration accompanies the modern lifestyle, possibly reaching epidemic proportions. The pandemic and subsequent lockdowns determined a fundamental shift in the modern lifestyle and had profound effects on sleep and mental health. This paper aims to provide an overview of the relationship between sleep, mental health and COVID-19. Contrasting outcomes on sleep health have been highlighted by most reports during the pandemic in the general population. Consequently, while longer sleep durations have been reported, this change was accompanied by decreases in sleep quality and altered sleep timing. Furthermore, an increased impact of sleep deficiencies and mental health burden was generally reported in health care workers as compared with the adult general population. Although not among the most frequent symptoms during the acute or persistent phase, an increased prevalence of sleep deficiencies has been reported in patients with acute and long COVID. The importance of sleep in immune regulation is well known. Consequently, sleep deficiencies may influence multiple aspects of COVID-19, such as the risk, severity, and prognosis of the infection and even vaccine response.
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Affiliation(s)
- Vlad Sever Neculicioiu
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.A.C.); (C.C.)
- Correspondence:
| | - Ioana Alina Colosi
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.A.C.); (C.C.)
| | - Carmen Costache
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.A.C.); (C.C.)
| | - Alexandra Sevastre-Berghian
- Department of Physiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.S.-B.); (S.C.)
| | - Simona Clichici
- Department of Physiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.S.-B.); (S.C.)
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18
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Cardoso E, Herrmann MJ, Grize L, Hostettler KE, Bassetti S, Siegemund M, Khanna N, Sava M, Sommer G, Tamm M, Stolz D. Is sleep-disordered breathing a risk factor for COVID-19 or vice versa? ERJ Open Res 2022; 8:00034-2022. [PMID: 35475113 PMCID: PMC8883039 DOI: 10.1183/23120541.00034-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Sleep is a physiologically invigorating, mostly nocturnal state, that plays an important role in the empowerment of the immune system [1]. Obstructive sleep apnoea (OSA) is the most frequent form of sleep disordered breathing (SDB) [2], which may represent a relevant risk factor for the clinical course and prognosis of coronavirus disease 2019 (COVID-19) [3, 4]. Common characteristics and comorbidities of OSA and COVID-19 (male gender, age >60 years, metabolic syndrome, cardiovascular and chronic pulmonary disease) were recently described as prognostic factors in COVID-19 [5]. However, the prevalence of SDB after COVID-19 remains insufficiently explored. Sleep disordered breathing may be a risk factor or a sequela of COVID-19.https://bit.ly/37v5Gyz
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19
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Merikanto I, Dauvilliers Y, Chung F, Holzinger B, De Gennaro L, Wing YK, Korman M, Partinen M. Disturbances in sleep, circadian rhythms and daytime functioning in relation to coronavirus infection and Long-COVID - A multinational ICOSS study. J Sleep Res 2021; 31:e13542. [PMID: 34964184 DOI: 10.1111/jsr.13542] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 02/05/2023]
Abstract
This protocol paper describes the second survey produced by the International Covid Sleep Study (ICOSS) group with the aim to examine the associations between SARS-CoV-2 infection and sleep, sleepiness, and circadian problems as potential predisposing factors for more severe COVID-19 disease profile and for development of Long-COVID in the general population. The survey consists of 47 questions on sleep, daytime sleepiness, circadian rhythm, health, mental wellbeing, life habits, and socioeconomic situation before and during the pandemic, and conditional questions to those reporting having had coronavirus infection, being vaccinated, or suffering from particular sleep symptoms or sleep disorders. Surveys will be administered online between May and November 2021 in Austria, Brazil, Bulgaria, Canada, China, Croatia, Finland, France, Germany, Israel, Italy, Japan, Norway, Portugal, Sweden and USA. Data collected by the survey will give valuable information on the open questions regarding COVID-19 disease risk factors, symptomatology and evolution of Long-COVID, and on other long-term consequences related to the pandemic.
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Affiliation(s)
- Ilona Merikanto
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Orton Orthopaedics Hospital, Helsinki, Finland
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, INM, Univ Montpellier, INSERM, Montpellier, France
| | - Frances Chung
- Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Brigitte Holzinger
- Institute for Consciousness and Dream Research, Vienna, Austria.,ZK-Schlafcoaching, Medical University Vienna, Wien, Austria
| | | | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Maria Korman
- Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Markku Partinen
- Helsinki Sleep Clinic, Terveystalo Healthcare, Helsinki, Finland.,Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
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20
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Krey L, Huber MK, Höglinger GU, Wegner F. Can SARS-CoV-2 Infection Lead to Neurodegeneration and Parkinson's Disease? Brain Sci 2021; 11:1654. [PMID: 34942956 PMCID: PMC8699589 DOI: 10.3390/brainsci11121654] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022] Open
Abstract
The SARS-CoV-2 pandemic has affected the daily life of the worldwide population since 2020. Links between the newly discovered viral infection and the pathogenesis of neurodegenerative diseases have been investigated in different studies. This review aims to summarize the literature concerning COVID-19 and Parkinson's disease (PD) to give an overview on the interface between viral infection and neurodegeneration with regard to this current topic. We will highlight SARS-CoV-2 neurotropism, neuropathology and the suspected pathophysiological links between the infection and neurodegeneration as well as the psychosocial impact of the pandemic on patients with PD. Some evidence discussed in this review suggests that the SARS-CoV-2 pandemic might be followed by a higher incidence of neurodegenerative diseases in the future. However, the data generated so far are not sufficient to confirm that COVID-19 can trigger or accelerate neurodegenerative diseases.
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Affiliation(s)
- Lea Krey
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (M.K.H.); (G.U.H.); (F.W.)
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21
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Rabady S, Altenberger J, Brose M, Denk-Linnert DM, Fertl E, Götzinger F, de la Cruz Gomez Pellin M, Hofbaur B, Hoffmann K, Hoffmann-Dorninger R, Koczulla R, Lammel O, Lamprecht B, Löffler-Ragg J, Müller CA, Poggenburg S, Rittmannsberger H, Sator P, Strenger V, Vonbank K, Wancata J, Weber T, Weber J, Weiss G, Wendler M, Zwick RH. [Guideline S1: Long COVID: Diagnostics and treatment strategies]. Wien Klin Wochenschr 2021; 133:237-278. [PMID: 34851455 PMCID: PMC8633909 DOI: 10.1007/s00508-021-01974-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 02/07/2023]
Abstract
This guideline comprises the state of science at the time of the editorial deadline. In view of the high turnover of knowledge the guideline is designed as a living guideline. The main objective was to provide a tool for the use in primary care, being considered well suited as a first point of entry and for the provision of care. The guideline gives recommendations on the differential diagnosis of symptoms following SARS-CoV‑2 infection, on their therapeutic options, as well as for guidance and care of the patients concerned. It also offers advice concerning return to daily life and rehabilitation. Long COVID being a very variable condition, we chose an interdisciplinary approach.
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Affiliation(s)
- Susanne Rabady
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Österreich.
| | - Johann Altenberger
- Pensionsversicherungsanstalt, Rehabilitationszentrum Großgmain, Großgmain, Österreich
| | - Markus Brose
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Österreich
| | - Doris-Maria Denk-Linnert
- Klinische Abteilung Phoniatrie-Logopädie, Universitätsklinik für Hals‑, Nasen- und Ohrenkrankheiten, Medizinische Universität Wien, Wien, Österreich
| | - Elisabeth Fertl
- Neurologische Abteilung, Klinik Landstraße, Wiener Gesundheitsverbund, Wien, Österreich
| | - Florian Götzinger
- Abteilung für Kinder- und Jugendheilkunde, Klinik Ottakring, Wiener Gesundheitsverbund, Wien, Österreich
| | - Maria de la Cruz Gomez Pellin
- Unit Versorgungsforschung in der Primärversorgung, Zentrum für Public Health, Medizinische Universität Wien, Wien, Österreich
| | | | - Kathryn Hoffmann
- Unit Health Services Research and Telemedicine in Primary Care, Department of Preventive- and Social Medicine, Center for Public Health, Medical University of Vienna, Wien, Österreich
| | | | - Rembert Koczulla
- Abteilung für Pneumologische Rehabilitation, Philipps Universität Marburg, Marburg, Deutschland
| | - Oliver Lammel
- Praxis Dr Oliver Lammel, Ramsau am Dachstein, Österreich
| | - Bernd Lamprecht
- Klinik für Lungenheilkunde, Kepler Universitätsklinikum, Linz, Österreich
| | | | - Christian A Müller
- Universitätsklinik für Hals‑, Nasen- und Ohrenkrankheiten, Medizinische Universität Wien, Wien, Österreich
| | | | - Hans Rittmannsberger
- Abteilung Psychiatrie und Psychotherapie, Pyhrn-Eisenwurzen-Klinikum, Steyr, Österreich
| | - Paul Sator
- Dermatologische Abteilung, Klinik Hietzing, Wiener Gesundheitsverbund, Wien, Österreich
| | - Volker Strenger
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Karin Vonbank
- Klinische Abteilung für Pulmologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Wien, Österreich
| | - Johannes Wancata
- Klinische Abteilung für Sozialpsychiatrie, Medizinische Universität Wien, Wien, Österreich
| | - Thomas Weber
- Abteilung für Innere Medizin 2 (Kardiologie, Intensivmedizin), Klinikum Wels-Grieskirchen, Wels, Österreich
| | - Jörg Weber
- Klinikum Klagenfurt, Feschnigstraße 11, 9020, Klagenfurt, Österreich
| | - Günter Weiss
- Univ.-Klinik für Innere Medizin II, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Maria Wendler
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Österreich
| | - Ralf-Harun Zwick
- Ambulante internistische Rehabilitation, Therme Wien Med, Wien, Österreich
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22
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[The pulmonary view on post-/Long-COVID]. Dtsch Med Wochenschr 2021; 146:1559-1563. [PMID: 34826844 DOI: 10.1055/a-1578-0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A majority of COVID patients suffers from hetereogenous symptoms after acute infection which are limiting patients participation in social life, activities of daily living and the return to work. In March 2021, the German Society of Pneumology initiated the AWMF S1 guideline Post-COVID/Long-COVID in order to show an individual practice-oriented, diagnostic and therapeutic clinical algorithm according to the individual symptoms. This article is based on the S1 guideline and highlights some trials of interest with a focus on pulmonary symptoms. The guideline and, accordingly, this article have an explicitly practical and clinical purpose. The guideline will be further developed by the author team based on the current increase in knowledge this is reflected in the clinical summary article.
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23
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Pandey K, Thurman M, Johnson SD, Acharya A, Johnston M, Klug EA, Olwenyi OA, Rajaiah R, Byrareddy SN. Mental Health Issues During and After COVID-19 Vaccine Era. Brain Res Bull 2021; 176:161-173. [PMID: 34487856 PMCID: PMC8414813 DOI: 10.1016/j.brainresbull.2021.08.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/01/2021] [Accepted: 08/27/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has persisted for more than a year, and post-COVID-19 sequelae of neurological complications, including direct and indirect effects on the central nervous system (CNS), have been recognized. There is a plethora of evidence for neurological, cognitive, and emotional deficits in COVID-19 patients. Acute neurological symptoms like neuroinflammation, cognitive impairment, loss of smell, and brain stroke are common direct effects among SARS-CoV-2 infected individuals. Work-associated stress, lockdowns, social distancing, and quarantine in response to contain SARS-CoV-2 have also affected the mental health of large populations, regardless of age. Public health emergencies have affected individuals and communities, resulting in emotional reactions and unhealthy behaviors. Although vaccines have been widely distributed and administered among large populations, vaccine hesitancy still exists and may be due to apprehension about vaccine efficacy, preliminary trials, and associated side effects. This review highlights the impact of COVID-19 on the CNS by outlining direct and indirect effects and factors contributing to the decline in people's mental health throughout the COVID-19 pandemic both during and after vaccine administration. Furthermore, we also discuss reasons for vaccine hesitancy and why some groups of people are deprived of vaccines. Finally, we touched upon the social determinants of mental health and their impact on disadvantaged populations during times of crisis which may help policymakers set up some action plans to mitigate the COVID-19 mental health turmoil during this ongoing pandemic.
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Affiliation(s)
- Kabita Pandey
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michellie Thurman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Samuel D Johnson
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Arpan Acharya
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Morgan Johnston
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth A Klug
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Omalla A Olwenyi
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rajesh Rajaiah
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA; Department of Genetics, Cell Biology, and Anatomy, University of Nebraska Medical Center, Omaha, NE, USA; Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA.
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24
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Abstract
PURPOSE OF REVIEW To evaluate the impact of the COVID-19 pandemic on the care of people with sleep disorders, to explore relationships between OSA and COVID-19, and to describe current knowledge of the effect of the pandemic on sleep globally. RECENT FINDINGS COVID-19 has led to significant changes in the practice of sleep medicine, including the care of patients with OSA. An OSA diagnosis may portend a worse prognosis with COVID-19, whilst prior COVID-19 may have an impact on sleep breathing. SUMMARY The pandemic has caused marked difficulties with access to diagnostic sleep studies and reduced capacity for CPAP initiation. Conversely, adherence to CPAP therapy may have improved, and use of remote consultations and telemonitoring has increased. An OSA diagnosis may be associated with increased risk of severe COVID-19, although any apparent relationship may be attributable to confounding factors, such as obesity and metabolic disease. Small studies have reported some increase in CPAP requirements in OSA patients following COVID-19 infection. More generally, the pandemic has been associated with a deterioration in subjective sleep quality across the population; much of this appears because of increased anxiety and stress. Finally, studies assessing putative links between COVID-19 and REM sleep issues are ongoing.
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25
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Gogoll C, Leo F, Schueller PO, Grohé C. [Post-COVID sequela of the lung - follow up and treatment]. Dtsch Med Wochenschr 2021; 146:1399-1404. [PMID: 34670282 DOI: 10.1055/a-1492-8808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Most people recover completely after an acute infection with the novel corona virus SARS-CoV2. But some people continue to experience symptoms after their recovery. This phenomenon is called post-acute or long-COVID (from week 4 after the infection up to week 12) and persistent post-COVID (symptoms for effects that persist 12 or more weeks after onset). The exact processes that cause long COVID remain unknown.Most of those patients suffer from long-term symptoms of lung damage, including breathlessness, coughing, fatigue and limited ability to exercise. Today, 18 months after the first infections in Europe we have access to the first practical guidelines for the long-/post-COVID syndrome. Further on first prospective studies analysing the incidence of post-COVID are now available.In this review we will discuss some questions about treatment and follow up of patients suffering from pulmonary sequelae after their COVID-19 infection, based on the actual literature.
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26
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Koczulla AR, Ankermann T, Behrends U, Berlit P, Böing S, Brinkmann F, Franke C, Glöckl R, Gogoll C, Hummel T, Kronsbein J, Maibaum T, Peters EMJ, Pfeifer M, Platz T, Pletz M, Pongratz G, Powitz F, Rabe KF, Scheibenbogen C, Stallmach A, Stegbauer M, Wagner HO, Waller C, Wirtz H, Zeiher A, Zwick RH. [S1 Guideline Post-COVID/Long-COVID]. Pneumologie 2021; 75:869-900. [PMID: 34474488 DOI: 10.1055/a-1551-9734] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The German Society of Pneumology initiated the AWMFS1 guideline Post-COVID/Long-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendation describes current post-COVID/long-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an expilcit practical claim and will be continuously developed and adapted by the author team based on the current increase in knowledge.
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Affiliation(s)
| | | | - Uta Behrends
- Klinikum rechts der Isar der Technischen Universität München, Chronisches Fatigue Centrum
| | | | | | | | | | - Rainer Glöckl
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)
| | - Christian Gogoll
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)
| | - Thomas Hummel
- Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V
| | | | - Thomas Maibaum
- Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)
| | - Eva M J Peters
- Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM)
| | - Michael Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)
| | - Thomas Platz
- Deutsche Gesellschaft für Neurorehabilitation (DGNR) und Redaktionskomitee S2k-LL SARS-CoV-2, COVID-19 und (Früh-) Rehabilitation
| | - Matthias Pletz
- Paul Ehrlich Gesellschaft für Chemotherapie e. V. (PEG)/Sektion Infektiologie
| | - Georg Pongratz
- Deutsche Schmerzgesellschaft, Deutsche Migräne- und Kopfschmerzgesellschaft und Deutsche Gesellschaft für Rheumatologie
| | | | - Klaus F Rabe
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)
| | | | - Andreas Stallmach
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS), Deutsche Gesellschaft für Infektiologie (DGI)
| | | | - Hans Otto Wagner
- Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)
| | | | - Hubert Wirtz
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)
| | - Andreas Zeiher
- Deutsche Gesellschaft für Kardiologie- Herz- und Kreislaufforschung (DGK)
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