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Ecker S, Lord A, Gurin L, Olivera A, Ishida K, Melmed KR, Torres J, Zhang C, Frontera J, Lewis A. An Exploratory Analysis of Preclinical and Clinical Factors Associated With Sleep Disturbance Assessed via the Neuro-QoL After Hemorrhagic Stroke. Neurohospitalist 2024; 14:242-252. [PMID: 38895018 PMCID: PMC11181970 DOI: 10.1177/19418744241231618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Background and Purpose Sleep disturbance after hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) can impact rehabilitation, recovery, and quality of life. We sought to explore preclinical and clinical factors associated with sleep disturbance after hemorrhagic stroke assessed via the Quality of Life in Neurological Disorders (Neuro-QoL) short form sleep disturbance inventory. Methods We telephonically completed the Neuro-QoL short form sleep disturbance inventory 3-months and 12-months after hemorrhagic stroke for patients >18-years-old hospitalized between January 2015 and February 2021. We examined the relationship between sleep disturbance (T-score >50) and social and neuropsychiatric history, systemic and neurological illness severity, medical complications, and temporality. Results The inventory was completed for 70 patients at 3-months and 39 patients at 12-months; 18 (26%) had sleep disturbance at 3-months and 11 (28%) had sleep disturbance at 12-months. There was moderate agreement (κ = .414) between sleep disturbance at 3-months and 12-months. Sleep disturbance at 3-months was related to unemployment/retirement prior to admission (P = .043), lower Glasgow Coma Scale score on admission (P = .021), higher NIHSS score on admission (P = .041) and infection while hospitalized (P = .036). On multivariate analysis, sleep disturbance at 3-months was related to unemployment/retirement prior to admission (OR 3.58 (95% CI 1.03-12.37), P = .044). Sleep disturbance at 12-months was related to premorbid mRS score (P = .046). Conclusion This exploratory analysis did not demonstrate a sustained relationship between any preclinical or clinical factors and sleep disturbance after hemorrhagic stroke. Larger studies that include comparison to patients with ischemic stroke and healthy individuals and utilize additional techniques to evaluate sleep disturbance are needed.
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Affiliation(s)
- Sarah Ecker
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Aaron Lord
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | - Lindsey Gurin
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
- Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
- Department of Rehabilitation Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Anlys Olivera
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
- Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Koto Ishida
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Kara R. Melmed
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | - Jose Torres
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Cen Zhang
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Jennifer Frontera
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | - Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
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Zawada SJ, Ganjizadeh A, Conte GM, Demaerschalk BM, Erickson BJ. Accelerometer-Measured Behavior Patterns in Incident Cerebrovascular Disease: Insights for Preventative Monitoring From the UK Biobank. J Am Heart Assoc 2024; 13:e032965. [PMID: 38818948 DOI: 10.1161/jaha.123.032965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The goal was to compare patterns of physical activity (PA) behaviors (sedentary behavior [SB], light PA, moderate-to-vigorous PA [MVPA], and sleep) measured via accelerometers for 7 days between patients with incident cerebrovascular disease (CeVD) (n=2141) and controls (n=73 938). METHODS AND RESULTS In multivariate models, cases spent 3.7% less time in MVPA (incidence rate ratio [IRR], 0.963 [95% CI, 0.929-0.998]) and 1.0% more time in SB (IRR, 1.010 [95% CI, 1.001-1.018]). Between 12 and 24 months before diagnosis, cases spent more time in SB (IRR, 1.028 [95% CI, 1.001-1.057]). Within the year before diagnosis, cases spent less time in MVPA (IRR, 0.861 [95% CI, 0.771-0.964]). Although SB time was not associated with CeVD risk, MVPA time, both total min/d (hazard ratio [HR], 0.998 [95% CI, 0.997-0.999]) and guideline threshold adherence (≥150 min/wk) (HR, 0.909 [95% CI, 0.827-0.998]), was associated with decreased CeVD risk. Comorbid burden had a significant partial mediation effect on the relationship between MVPA and CeVD. Cases slept more during 12:00 to 17:59 hours (IRR, 1.091 [95% CI, 1.002-1.191]) but less during 0:00 to 5:59 hours (IRR, 0.984 [95% CI, 0.977-0.992]). No between-group differences were significant at subgroup analysis. CONCLUSIONS Daily behavior patterns were significantly different in patients before CeVD. Although SB was not associated with CeVD risk, the association between MVPA and CeVD risk is partially mediated by comorbid burden. This study has implications for understanding observable behavior patterns in cerebrovascular dysfunction and may help in developing remote monitoring strategies to prevent or reduce cerebrovascular decline.
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Affiliation(s)
| | - Ali Ganjizadeh
- Mayo Clinic Artificial Intelligence Laboratory Rochester MN
| | | | - Bart M Demaerschalk
- Mayo Clinic College of Medicine and Science Phoenix AZ
- Mayo Clinic Division of Stroke and Cerebrovascular Diseases Department of Neurology Phoenix AZ
- Mayo Clinic Center for Digital Health Phoenix AZ
| | - Bradley J Erickson
- Mayo Clinic College of Medicine and Science Phoenix AZ
- Mayo Clinic Artificial Intelligence Laboratory Rochester MN
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3
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Su Q, Wang L, Yu H, Li H, Zou D, Ni X. Chinese herbal medicine and acupuncture for insomnia in stroke patients: A systematic review and meta-analysis of randomised controlled trials. Sleep Med 2024; 120:65-84. [PMID: 38905930 DOI: 10.1016/j.sleep.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Insomnia is highly prevalent in stroke patients; however, there is no ideal intervention. This systematic review examined the effect and safety of Chinese herbal medicine (CHM) and acupuncture on sleep in adults with stroke. METHODS Six databases were searched from inception to June 2023 to identify randomised controlled trials (RCTs). The primary outcome was Pittsburgh Sleep Quality Index (PSQI) scores. Risk of bias and evidence quality was assessed. A pairwise random-effect meta-analysis was performed. RESULTS A total of 54 RCTs published in 55 articles were finally included in the systematic review, including 35 of CHM and 19 of acupuncture therapies. Compared with placebo/sham procedure, CHM and acupuncture were more effective in improving PSQI scores. The evidence of moderate quality suggested that CHM outperformed benzodiazepine drugs (BZDs) while it presented an effect similar to that of non-BZDs in improving sleep quality. CHM and acupuncture also provided additional benefits to the patients treated with pharmacological agents alone. However, the evidence specific to individual CHM prescriptions lay in various factors and methodological quality, and the evidence on the comparative effectiveness between acupuncture and other therapies was conflicting or limited. CONCLUSIONS Overall, CHM and acupuncture used alone or in combination with pharmacotherapy can safely improve sleep in stroke patients with insomnia. In the future, RCTs on outstanding CHM prescriptions and the comparative effectiveness research between acupuncture and other therapies are needed. REGISTRATION PROSPERO No. CRD42020194029 and No. CRD42020194030.
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Affiliation(s)
- Qing Su
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China; The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Liyan Wang
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Hongshen Yu
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Huishan Li
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China; The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Danmei Zou
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China; The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Xiaojia Ni
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China; The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China; Guangdong Provincial Key Laboratory of Research on Emergency in Traditional Chinese Medicine, Guangzhou, 510120, China.
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4
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Gu P, Ding Y, Ruchi M, Feng J, Fan H, Fayyaz A, Geng X. Post-stroke dizziness, depression and anxiety. Neurol Res 2024; 46:466-478. [PMID: 38488118 DOI: 10.1080/01616412.2024.2328490] [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: 03/25/2023] [Accepted: 03/03/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE Vestibular and psychiatric disorders are very closely related. Previous research shows that the discomfort and dysfunction caused by dizziness in patients can affect psychological processes, leading to anxiety and depression, and the irritation of anxiety and depression can aggravate the discomfort of dizziness. But the causal relationship between dizziness in the recovery period of stroke and Post-stroke depression (PSD) / Post-stroke anxiety (PSA) is not clear. Identifying the causal relationship between them can enable us to conduct more targeted treatments. METHODS We review the epidemiology and relationship of dizziness, anxiety, and depression, along with the related neuroanatomical basis. We also review the pathophysiology of dizziness after stroke, vestibular function of patients experiencing dizziness, and the causes and mechanisms of PSD and PSA. We attempt to explore the possible relationship between post-stroke dizziness and PSD and PSA. CONCLUSION The treatment approach for post-stroke dizziness depends on its underlying cause. If the dizziness is a result of PSD and PSA, addressing these psychological factors may alleviate the dizziness. This can be achieved through targeted treatments for PSD and PSA, such as psychotherapy, antidepressants, or anxiolytics, which could indirectly improve dizziness symptoms. Conversely, if PSA and PSD are secondary to vestibular dysfunction caused by stroke, a thorough vestibular function assessment is crucial. Identifying the extent of vestibular impairment allows for tailored interventions. These could include vestibular rehabilitation therapy and medication aimed at vestibular restoration. By improving vestibular function, secondary symptoms like anxiety and depression may also be mitigated.
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Affiliation(s)
- Pan Gu
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mangal Ruchi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jing Feng
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Huimin Fan
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Aminan Fayyaz
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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Barone DA. Secondary RBD: Not just neurodegeneration. Sleep Med Rev 2024; 76:101938. [PMID: 38657360 DOI: 10.1016/j.smrv.2024.101938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/20/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
Rapid eye movement sleep behavior disorder is a parasomnia characterized by excessive muscle activity during rapid eye movement sleep (rapid eye movement sleep without atonia), along with dream enactment behavior. Isolated rapid eye movement sleep behavior disorder tends to occur in older males and is of concern due to the known link to Parkinson's disease and other synucleinopathies. When rapid eye movement sleep behavior disorder occurs in association with other neurological or general medical conditions, or resulting from the use of various substances, it is called secondary rapid eye movement sleep behavior disorder; the most common cause is neurodegenerative illness, specifically the synucleinopathies. Here, the focus will be on the subset of secondary rapid eye movement sleep behavior disorder in which there is no neurodegenerative disease.
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Affiliation(s)
- Daniel A Barone
- Weill Cornell Center for Sleep Medicine, 425 East 61st Street, New York, NY, 10065, USA.
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6
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Ozkan H, Ambler G, Banerjee G, Browning S, Leff AP, Ward NS, Simister RJ, Werring DJ. Prevalence, patterns, and predictors of patient-reported non-motor outcomes at 30 days after acute stroke: Prospective observational hospital cohort study. Int J Stroke 2024; 19:442-451. [PMID: 37950351 DOI: 10.1177/17474930231215660] [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: 11/12/2023]
Abstract
BACKGROUND Adverse non-motor outcomes are common after acute stroke and likely to substantially affect quality of life, yet few studies have comprehensively assessed their prevalence, patterns, and predictors across multiple health domains. AIMS We aimed to identify the prevalence, patterns, and the factors associated with non-motor outcomes 30 days after stroke. METHODS This prospective observational hospital cohort study-Stroke Investigation in North and Central London (SIGNAL)-identified patients with acute ischemic stroke or intracerebral hemorrhage (ICH) admitted to the Hyperacute Stroke Unit (HASU) at University College Hospital (UCH), London, between August 1, 2018 and August 31, 2019. We assessed non-motor outcomes (anxiety, depression, fatigue, sleep, participation in social roles and activities, pain, bowel function, and bladder function) at 30-day follow-up using the Patient-Reported Outcome Measurement Information System-Version 29 (PROMIS-29) scale and Barthel Index scale. RESULTS We obtained follow-up data for 605/719 (84.1%) eligible patients (mean age 72.0 years; 48.3% female; 521 with ischemic stroke, 84 with ICH). Anxiety (57.0%), fatigue (52.7%), bladder dysfunction (50.2%), reduced social participation (49.2%), and pain (47.9%) were the commonest adverse non-motor outcomes. The rates of adverse non-motor outcomes in ⩾ 1, ⩾ 2 and ⩾ 3 domains were 89%, 66.3%, and 45.8%, respectively; in adjusted analyses, stroke due to ICH (compared to ischemic stroke) and admission stroke severity were the strongest and most consistent predictors. There were significant correlations between bowel dysfunction and bladder dysfunction (κ = 0.908); reduced social participation and bladder dysfunction (κ = 0.844); and anxiety and fatigue (κ = 0.613). We did not identify correlations for other pairs of non-motor domains. CONCLUSION Adverse non-motor outcomes were very common at 30 days after stroke, affecting nearly 90% of evaluated patients in at least one health domain, about two-thirds in two or more domains, and almost 50% in three or more domains. Stroke due to ICH and admission stroke severity were the strongest and most consistent predictors. Adverse outcomes occurred in pairs of domains, such as with anxiety and fatigue. Our findings emphasize the importance of a multi-domain approach to effectively identify adverse non-motor outcomes after stroke to inform the development of more holistic patient care pathways after stroke.
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Affiliation(s)
- Hatice Ozkan
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Gargi Banerjee
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK
| | - Simone Browning
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex P Leff
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nick S Ward
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Robert J Simister
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - David J Werring
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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7
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Guo C, Harshfield EL, Markus HS. Sleep Characteristics and Risk of Stroke and Dementia: An Observational and Mendelian Randomization Study. Neurology 2024; 102:e209141. [PMID: 38350061 PMCID: PMC11067695 DOI: 10.1212/wnl.0000000000209141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/16/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep disturbances are implicated as risk factors of both stroke and dementia. However, whether these associations are causal and whether treatment of sleep disorders could reduce stroke and dementia risk remain uncertain. We aimed to evaluate associations and ascertain causal relationships between sleep characteristics and stroke/dementia risk and MRI markers of small vessel disease (SVD). METHODS We used data sets from a multicenter population-based study and summary statistics from genome-wide association studies (GWASs) of sleep characteristics and outcomes. We analyzed 502,383 UK Biobank participants with self-reported sleep measurements, including sleep duration, insomnia, chronotype, napping, daytime dozing, and snoring. In observational analyses, the primary outcomes were incident stroke, dementia, and their subtypes, alongside SVD markers. Hazard ratios (HRs) and odds ratios (ORs) were adjusted for age, sex, and ethnicity, and additional vascular risk factors. In Mendelian randomization (MR) analyses, ORs or risk ratios are reported for the association of each genetic score with clinical or MRI end points. RESULTS Among 502,383 participants (mean [SD] age, 56.5 [8.1] years; 54.4% female), there were 7,668 cases of all-cause dementia and 10,334 strokes. In longitudinal analyses, after controlling for cardiovascular risk factors, participants with insomnia, daytime napping, and dozing were associated with increased risk of any stroke (HR 1.05, 95% CI 1.01-1.11, p = 8.53 × 10-3; HR 1.09, 95% CI 1.05-1.14, p = 3.20 × 10-5; HR 1.19, 95% CI 1.08-1.32, p = 4.89 × 10-4, respectively). Almost all sleep measures were associated with dementia risk (all p < 0.001, except insomnia). Cross-sectional analyses identified associations between napping, snoring, and MRI markers of SVD (all p < 0.001). MR analyses supported a causal link between genetically predicted insomnia and increased stroke risk (OR 1.31, 95% CI 1.13-1.51, p = 0.00072), but not with dementia or SVD markers. DISCUSSION We found that multiple sleep measures predicted future risk of stroke and dementia, but these associations were attenuated after controlling for cardiovascular risk factors and were absent in MR analyses for Alzheimer disease. This suggests possible confounding or reverse causation, implying caution before proposing sleep disorder modifications for dementia treatment.
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Affiliation(s)
- Chutian Guo
- From the Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Eric L Harshfield
- From the Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Hugh S Markus
- From the Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
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Mohandas P, Alomari Z, Arti F, Alhneif M, Alejandra Ruiz P, Ahmed AK, Wei CR, Amin A. A Systematic Review and Meta-Analysis on the Identification of Predictors Associated With Insomnia or Sleep Disturbance in Post-stroke Patients. Cureus 2024; 16:e56578. [PMID: 38646398 PMCID: PMC11027028 DOI: 10.7759/cureus.56578] [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] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
The aim of this study was to identify the factors associated with sleep disturbances in individuals after a stroke. To systematically identify relevant studies, an extensive search strategy was devised. We conducted comprehensive searches in major electronic databases including PubMed, Embase, PsycINFO, and Cochrane Library. The search was limited to articles published in English between January 1, 2011, and February 10, 2024. Pooled effect estimates, such as odds ratio (OR) or mean difference (MD) along with their confidence interval (CIs), were calculated using random-effects models for categorical variables and continuous variables, respectively. A total of nine studies were included in this meta-analysis. The pooled prevalence of insomnia across the included studies was determined to be 40% (95% CI = 30%-49%), with individual study prevalence ranging from 22% to 72%. A pooled analysis showed that gender demonstrated a statistically significant association with sleep disturbance, with females exhibiting a higher likelihood (OR = 1.49, 95% CI = 1.16-1.91, p = 0.002) compared to males. The National Institutes of Health Stroke Scale (NIHSS) score, a measure of stroke severity, was associated with sleep disturbance (MD = 0.86, 95% CI = 0.56-1.17, p = 0.001), indicating that patients with severe strokes may be more prone to sleep disturbances. These findings underscore the importance of comprehensive evaluation and targeted interventions to address sleep-related issues in stroke patients, particularly those with severe neurological impairment.
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Affiliation(s)
| | - Zaid Alomari
- Internal Medicine, Tbilisi State Medical University, Tbilisi, GEO
| | - Fnu Arti
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Mohammad Alhneif
- Neuropathology, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | | | | | - Calvin R Wei
- Research and Development, Shing Huei Group, Taipei, TWN
| | - Adil Amin
- Cardiology, Pakistan Navy Ship Shifa, Karachi, PAK
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Li RY, Zhu DL, Chen KY. Efficacy and safety of eszopiclone combined with drug therapy in the treatment of insomnia after stroke: A network meta-analysis and systematic review. PLoS One 2024; 19:e0297064. [PMID: 38315683 PMCID: PMC10843102 DOI: 10.1371/journal.pone.0297064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of multi-drug therapy based on eszopiclone in the treatment of insomnia after stroke using a network meta-analysis method and to provide evidence for clinical practice. METHOD Computer searches of PubMed, Excerpt Medica Database (Embase), Cochrane Library Central Register of Controlled Trials, APA PsycInfo, CNKI, WanFang, Sinomed and other databases were performed to search for clinical randomized controlled studies (RCTs) on multi-drug therapy based on eszopiclone in the treatment of insomnia patients after stroke. The search time was from the establishment of each database until July 2023. The bias risk assessment tool recommended by Cochrane was used to evaluate the quality of the included RCTs. Stata 14.0 was applied to perform network meta-analysis using Review Manager 5.3 software for traditional meta-analysis. RESULT Eighteen RCTs and 1646 patients were ultimately included, involving 11 treatment options. The results of the network meta-analysis showed that the ranking of Pittsburgh Sleep Quality Index (PSQI) decline was eszopiclone combined with sweet dream oral liquid (ESZ+SDOL)>eszopiclone combined with a shugan jieyu capsule (ESZ+SGJYC)>eszopiclone combined with agomelatine (ESZ+AGO)>eszopiclone combined with flupentixol and melitracen tablets (ESZ+FMT)>eszopiclone combined with yangxue qingnao granules (ESZ+YXQNG)>eszopiclone combined with mirtazapine (ESZ+MIR)>ESZ>FMT; the modified Edinburgh Scandinavia Stroke Scale (MESSS) decline ranking was ESZ+SDOL>ESZ+AGO>ESZ; and the clinical total effective rate ranking was eszopiclone combined with a xuefu zhuyu capsule (ESZ+XFZYC)>ESZ+MIR>ESZ+SGJYC>ESZ+SDOL> ESZ+FMT>ESZ+YXQNG>ESZ>FMT. In terms of clinical adverse reactions, in addition to ESZ therapy, ESZ+ESC had the highest number of adverse reactions, with abdominal pain being the most common. ESZ+YXQNG had the most types of adverse reactions, with 8 types. CONCLUSION Multi-drug therapy based on eszopiclone can effectively improve the sleep quality of patients with insomnia after stroke, and ESZ+SDOL has significant efficacy and safety. However, due to the limitations of this study, efficacy ranking cannot fully explain the superiority or inferiority of clinical efficacy. In the future, more multicentre, large sample, double-blind randomized controlled trials are needed to supplement and demonstrate the results of this study.
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Affiliation(s)
- Ruo-Yang Li
- Geriatric Diseases Institute of Chengdu, Department of Rehabilitation, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - De-Liang Zhu
- Geriatric Diseases Institute of Chengdu, Department of Rehabilitation, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Ke-Yu Chen
- Department of traditional Chinese medicine, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
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10
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Keil SA, Schindler AG, Wang MX, Piantino J, Silbert LC, Elliott JE, Werhane ML, Thomas RG, Willis S, Lim MM, Iliff JJ. Longitudinal Sleep Patterns and Cognitive Impairment in Older Adults. JAMA Netw Open 2023; 6:e2346006. [PMID: 38048131 PMCID: PMC10696486 DOI: 10.1001/jamanetworkopen.2023.46006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/22/2023] [Indexed: 12/05/2023] Open
Abstract
Importance Sleep disturbances and clinical sleep disorders are associated with all-cause dementia and neurodegenerative conditions, but it remains unclear how longitudinal changes in sleep impact the incidence of cognitive impairment. Objective To evaluate the association of longitudinal sleep patterns with age-related changes in cognitive function in healthy older adults. Design, Setting, and Participants This cross-sectional study is a retrospective longitudinal analyses of the Seattle Longitudinal Study (SLS), which evaluated self-reported sleep duration (1993-2012) and cognitive performance (1997-2020) in older adults. Participants within the SLS were enrolled as part of a community-based cohort from the Group Health Cooperative of Puget Sound and Health Maintenance Organization of Washington between 1956 and 2020. Data analysis was performed from September 2020 to May 2023. Main Outcomes and Measures The main outcome for this study was cognitive impairment, as defined by subthreshold performance on both the Mini-Mental State Examination and the Mattis Dementia Rating Scale. Sleep duration was defined by self-report of median nightly sleep duration over the last week and was assessed longitudinally over multiple time points. Median sleep duration, sleep phenotype (short sleep, median ≤7 hours; medium sleep, median = 7 hour; long sleep, median ≥7 hours), change in sleep duration (slope), and variability in sleep duration (SD of median sleep duration, or sleep variability) were evaluated. Results Of the participants enrolled in SLS, only 1104 participants who were administered both the Health Behavior Questionnaire and the neuropsychologic battery were included for analysis in this study. A total of 826 individuals (mean [SD] age, 76.3 [11.8] years; 468 women [56.7%]; 217 apolipoprotein E ε4 allele carriers [26.3%]) had complete demographic information and were included in the study. Analysis using a Cox proportional hazard regression model (concordance, 0.76) showed that status as a short sleeper (hazard ratio, 3.67; 95% CI, 1.59-8.50) and higher sleep variability (hazard ratio, 3.06; 95% CI, 1.14-5.49) were significantly associated with the incidence of cognitive impairment. Conclusions and Relevance In this community-based longitudinal study of the association between sleep patterns and cognitive performance, the short sleep phenotype was significantly associated with impaired cognitive performance. Furthermore, high sleep variability in longitudinal sleep duration was significantly associated with the incidence of cognitive impairment, highlighting the possibility that instability in sleep duration over long periods of time may impact cognitive decline in older adults.
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Affiliation(s)
- Samantha A Keil
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, New York, New York
| | - Abigail G Schindler
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Geriatric Research Education and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, Washington
- Gerontology Division, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Marie X Wang
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Now with Seagen, Inc, Bothell, Washington
| | - Juan Piantino
- Department of Pediatrics, Oregon Health & Science University, Portland
- Department of Neurology, Oregon Health & Science University, Portland
| | - Lisa C Silbert
- Department of Neurology, Oregon Health & Science University, Portland
- Neurology Service, VA Portland Health Care System, Portland, Oregon
- Oregon Alzheimer's Disease Research Center, Oregon Health & Science University, Portland
| | - Jonathan E Elliott
- Department of Neurology, Oregon Health & Science University, Portland
- Research Service, VA Portland Health Care System, Portland, Oregon
| | - Madeleine L Werhane
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington
| | - Ronald G Thomas
- School of Public Health, University of California, San Diego
| | - Sherry Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Miranda M Lim
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington
- Department of Neurology, Oregon Health & Science University, Portland
- Neurology Service, VA Portland Health Care System, Portland, Oregon
- Oregon Alzheimer's Disease Research Center, Oregon Health & Science University, Portland
- Oregon Institute of Occupational Health Sciences, Portland
| | - Jeffrey J Iliff
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Department of Neurology, University of Washington School of Medicine, Seattle
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11
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Amalia L, Garyani MD, Lailiyya N. Increasing of Cortisol Level and Neutrophil-Lymphocyte-Ratio are Associated with Severity Level and Sleep Disturbances in Acute Ischemic Stroke. Int J Gen Med 2023; 16:5439-5448. [PMID: 38021057 PMCID: PMC10676643 DOI: 10.2147/ijgm.s439149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background Acute ischemic stroke can cause sleep disturbances. These complaints involve various factors, such as disturbances of the hormone cortisol and Neutrophil-Lymphocyte-Ratio (NLR) that can cause increasing severity levels in acute ischemic stroke patients. This study aimed to determine the relationship between cortisol levels and NLR with severity levels and sleep disturbances in acute ischemic stroke patients. Methods A cross-sectional analytic observational study was conducted on acute ischemic stroke patients during Agustus - December 2022. Examine cortisol levels using the ELISA method, NLR from blood test, asses severity levels using the National Institute of Health Stroke Scale (NIHSS), and The Pittsburgh Sleep Questionnaire Index (PSQI) is used as a measure for the initial screening of sleep disturbances-statistical analysis using Spearman correlation. Results Total study subjects were 48 patients, with the majority 62.5% women; the mean age of study subjects was above 60 years (56.3%), and the most common type of stroke was large artery atherosclerotic stroke (77.1%), the highest NIHSS score was in the moderate category (85.4%), the most common risk factor is hypertension (64.4%), and basal ganglia area is the most common ischemic stroke location (52.1%). There was a positive correlation between cortisol levels with NIHSS (r=0.874; p-value <0.001), NLR with sleep disturbances (r=0.829; p-value<0.001), NLR with NIHSS (r=0.893; p-value<0.001), and NIHSS with PSQI (r=0.836; p-value<0.001). Conclusion There were a positive correlation between cortisol level, NLR level, and NIHSS score with sleep quality disturbances based on PSQI in acute ischemic stroke patients.
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Affiliation(s)
- Lisda Amalia
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Mitha Dewi Garyani
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Nushrotul Lailiyya
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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12
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Song Z, Ying chen, Li J, Chen Z, Lu X, Wang Z. Comparative effectiveness of different treatments for post-stroke insomnia: A network meta-analysis. Heliyon 2023; 9:e21801. [PMID: 38027586 PMCID: PMC10658229 DOI: 10.1016/j.heliyon.2023.e21801] [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: 04/15/2023] [Revised: 08/25/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Background :Post-stroke insomnia(PSI)is one of the common complications after stroke and it is a chronic problem and hampers the patient's recovery. Some treatments have been shown to be effective in treating post-stroke insomnia. However, it is not clear which treatment is more effective. Methods In this study, we searched CNKI, PubMed, and Cochrane Library for appropriate keywords with a deadline of October 2022 to select 23 randomized controlled trials(RCTs). The mean difference between different treatments was assessed and summarized as mean and 95 % confidence interval (CI), resulting in a Bayesian network meta-analysis. Results By meta-analysis of Bayesian networks, we found acupuncture(MD, -2.49; 95 % CI, [-3.63, -1.31]) and herbal (MD, -2.79; 95 % CI, [-4.9, -0.69]) were significantly better than estazolam in terms of PSQI score change, and the difference was statistically significant. Dexzopiclone, electrics stimulation, rTMS and zopiclone were not statistically significant with other treatments. Conclusion Herbal, zopiclone, and acupuncture were more effective in improving PSQI scores in patients with post-stroke insomnia, followed by rTMS and dexzopiclone. However, the effectiveness between herbal, zopiclone and acupuncture was not statistically significant. Acupuncture and herbal are promising for the treatment of PSI, and more research remains to be invested.
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Affiliation(s)
- Zhaoming Song
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China
| | - Ying chen
- Department of Neurosurgery, The First People's Hospital of Taicang, Taicang Affiliated Hospital of Soochow University, Soochow Medical College of Soochow University, Suzhou, Jiangsu Province, 215400, China
| | - Jian Li
- Department of Neurosurgery, The First People's Hospital of Zhangjiagang, Jiangsu Province, 215600, China
| | - Zhouqin Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China
| | - Xiaojun Lu
- Department of Neurosurgery, The First People's Hospital of Taicang, Taicang Affiliated Hospital of Soochow University, Soochow Medical College of Soochow University, Suzhou, Jiangsu Province, 215400, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China
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13
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Yang T, Sun Y, Li Q, Alraqmany N, Zhang F. Effects of Ischemic Stroke on Interstitial Fluid Clearance in Mouse Brain: a Bead Study. Cell Mol Neurobiol 2023; 43:4141-4156. [PMID: 37634198 DOI: 10.1007/s10571-023-01400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023]
Abstract
The clearance of brain interstitial fluid (ISF) is important in maintaining brain homeostasis. ISF clearance impairment leads to toxic material accumulation in the brain, and ischemic stroke could impair ISF clearance. The present study investigates ISF clearance under normal and ischemic conditions. The carboxylate-modified FluoSpheres beads (0.04 μm in diameter) were injected into the striatum. Sham or transient middle cerebral artery occlusion surgeries were performed on the mice. The brain sections were immunostained with cell markers, and bead distribution at various time points was examined with a confocal microscope. Primary mouse neuronal cultures were incubated with the beads to explore in vitro endocytosis. Two physiological routes for ISF clearance were identified. The main one was to the lateral ventricle (LV) through the cleft between the striatum and the corpus callosum (CC)/external capsule (EC), where some beads were captured by the ependymal macrophages and choroid plexus. An alternative and minor route was to the subarachnoid space through the CC/EC and the cortex, where some of the beads were endocytosed by neurons. After ischemic stroke, a significant decrease in the main route and an increase in the minor route were observed. Additionally, microglia/macrophages engulfed the beads in the infarction. In conclusion, we report that the physiological clearance of ISF and beads mainly passes through the cleft between the CC/EC and striatum into the LV, or alternatively through the cortex into the subarachnoid space. Stroke delays the main route but enhances the minor route, and microglia/macrophages engulf the beads in the infarction. Ischemic stroke impairs the clearance of brain interstitial fluid/beads. Under physiological conditions, the main route ( ① ) of interstitial fluid clearance is to the lateral ventricle, and the minor one ( ② ) is to the subarachnoid space. Ischemic stroke weakens the main route ( ① ), enhances the minor one ( ② ), and leads to microglial/macrophage phagocytosis within the infarction ( ③ ).
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Affiliation(s)
- Tuo Yang
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA
| | - Yang Sun
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Qianqian Li
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Nour Alraqmany
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Feng Zhang
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Kalita J, Bharadwaz MP, Aditi A. Prevalence, contributing factors, and economic implications of strokes among older adults: a study of North-East India. Sci Rep 2023; 13:16880. [PMID: 37803041 PMCID: PMC10558533 DOI: 10.1038/s41598-023-43977-z] [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: 07/16/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023] Open
Abstract
Stroke is a significant cause of mortality and disability in India, with its economic impact on the rise. This study aims to investigate the prevalence and factors associated with stroke among the elderly population in seven north-eastern states of India and its economic consequences. Data from the initial phase of the Longitudinal Ageing Study in India (2017-2018) were utilized, and bivariate and multivariate analyses were done. Stroke prevalence (1.53%) was notable among both genders, with approximately 1% in females and 2.3% in males. Individuals with low physical activity, higher socio-economic status, and unemployment faced a higher risk of stroke. Females exhibited a 60% lower likelihood [AOR 0.40; (CI 0.250-0.627)] of stroke compared to males and hypertension was a significant risk factor. Stroke patients incur up to INR 50,000 of financial burden, with a considerable proportion facing disability in comprehension and speech. The economic burden of stroke-related hospitalization was significantly high, emphasizing the need for government-funded health insurance to cover stroke-related medications and reducing out-of-pocket expenses for patients seeking treatment in healthcare facilities. The study highlights the urgency for better schemes to address the growing threat of strokes in the north-eastern parts of India for comprehensively tackling this public health challenge.
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Affiliation(s)
- Jumi Kalita
- Lalit Chandra Bharali College, Guwahati, Assam, India
| | | | - Aditi Aditi
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, 400088, India.
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15
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Zhu M, Pan G, Luo F, Sui S, Zhang Y. Modified Suanzaoren decoction in treating post-stroke cognitive impairment with comorbid insomnia symptoms: A clinical trial. Medicine (Baltimore) 2023; 102:e35239. [PMID: 37800827 PMCID: PMC10553162 DOI: 10.1097/md.0000000000035239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/24/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Cognitive impairment and insomnia are common complications for stroke patients, and often coexist without effective therapy. Modified Suanzaoren decoction (M-SZRD), derived from a famous classic prescription, has been used as an alternative treatment for these patients. The objective of this study is to investigate the effectiveness of M-SZRD in treating post-stroke cognitive impairment with comorbid insomnia symptoms. METHODS A total of 80 participants were randomly assigned into 2 groups to 40 cases in the treatment group (treated with modified Suanzaoren decoction) and 40 cases in the control group (treated with zolpidem). The intervention period was 4 weeks. Cognitive function, sleep quality, depression, and anxiety disorders were evaluated in both groups before and after treatment. Clinical assessment of patients with stroke included National Institutes of Health Stroke Scale and Barthel Index evaluations. Hormone levels of the hypothalamic-pituitary-adrenal and hypothalamus-pituitary-thyroid axis were also measured. RESULTS Out of the total 80 participants, 5 withdrew during the experiment and did not complete the study, leaving 75 patients for analysis to 38 in the treatment group and 37 in the control group. The findings showed that M-SZRD was more effective than the control group in improving cognitive function (P = .006). However, both groups were found to have a similar effect in improving insomnia (P = .323). There was no significant difference between the 2 groups in terms of activities of daily living and National Institutes of Health Stroke Scale improvement. M-SZRD was superior to the control group in improving depression state (P = .034), but when including dropouts in the intention-to-treat analysis, the difference was not statistically significant (P = .150). Furthermore, the M-SZRD group was better than the control group in reducing cortisol levels (P = .036), and the improvement in serum-free triiodothyronine (FT3) levels was also more significant in the M-SZRD group than in the control group (P = .0007). CONCLUSION M-SZRD is a more effective treatment for improving cognitive function in patients with post-stroke cognitive impairment and comorbid insomnia symptoms, possibly by regulating the cortisol levels of the hypothalamic-pituitary-adrenal axis and FT3 levels of the hypothalamus-pituitary-thyroid axis.
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Affiliation(s)
- Mingjin Zhu
- Department of Rehabilitation Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Guoyua Pan
- Department of Rehabilitation Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Fang Luo
- Department of Rehabilitation Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Shuyan Sui
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yonghua Zhang
- Department of Clinical Psychology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
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Yousofvand V, Torabi M, Oshvandi K, Kazemi S, Khazaei S, Khazaei M, Azizi A. Impact of a spiritual care program on the sleep quality and spiritual health of Muslim stroke patients: A randomized controlled trial. Complement Ther Med 2023; 77:102981. [PMID: 37640165 DOI: 10.1016/j.ctim.2023.102981] [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: 06/24/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Stroke patients often experience poor sleep quality and spiritual health due to complications and limitations. In this situation, implementing spiritual care may reduce these problems. Therefore, this study aimed to examine the effect of a spiritual care program on sleep quality and spiritual health of Muslim stroke patients. METHODS This was a two-group randomized clinical trial conducted in Hamadan, Iran, in 2021, with 117 stroke patients. The samples were selected by convenience sampling and assigned to experimental (N = 59) and control (N = 58) groups based on random permutation blocks. The data were collected using the demographic information form, the Pittsburgh Sleep Quality Index, the Paloutzian and Ellison Spiritual Well-Being Scale, and the Modified Rankin Scale before and one month after the intervention. The experimental group received five daily sessions of spiritual care for 45-60 min based on standard and local methods, including patient orientation and identification of spiritual needs, religious care, supportive spiritual care, and beneficial evaluations. Data were analyzed by chi-square test, Fisher's exact test, independent t-test, and paired t-test at 0.05 significance level in SPSS 21. RESULTS The socio-demographic characteristics were similar between the groups (p > 0.05). At baseline, there was no significant difference in sleep quality and spiritual health between the experimental and control groups (p > 0.05). However, after the intervention, the sleep quality and spiritual health of patients in the experimental group improved significantly compared with the control group (p < 0.05). CONCLUSION The spiritual care program improved sleep quality and spiritual health of stroke patients; therefore, nurses should consider these aspects to provide holistic care.
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Affiliation(s)
- Vahid Yousofvand
- Department of Medical-Surgical Nursing, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Torabi
- Chronic Diseases (Home Care) Research Centre, Malayer School of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeid Kazemi
- Department of Islamic Education, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Department of Epdemiology, Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mojtaba Khazaei
- Department of Neurology, Besat Educational and Medical Center, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Azim Azizi
- Department of Medical -Surgical Nursing, Chronic Diseases (Home Care) Research Centre, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran.
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Sorici A, Băjenaru L, Mocanu IG, Florea AM, Tsakanikas P, Ribigan AC, Pedullà L, Bougea A. Monitoring and Predicting Health Status in Neurological Patients: The ALAMEDA Data Collection Protocol. Healthcare (Basel) 2023; 11:2656. [PMID: 37830693 PMCID: PMC10572511 DOI: 10.3390/healthcare11192656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
(1) Objective: We explore the predictive power of a novel stream of patient data, combining wearable devices and patient reported outcomes (PROs), using an AI-first approach to classify the health status of Parkinson's disease (PD), multiple sclerosis (MS) and stroke patients (collectively named PMSS). (2) Background: Recent studies acknowledge the burden of neurological disorders on patients and on the healthcare systems managing them. To address this, effort is invested in the digital transformation of health provisioning for PMSS patients. (3) Methods: We introduce the data collection journey within the ALAMEDA project, which continuously collects PRO data for a year through mobile applications and supplements them with data from minimally intrusive wearable devices (accelerometer bracelet, IMU sensor belt, ground force measuring insoles, and sleep mattress) worn for 1-2 weeks at each milestone. We present the data collection schedule and its feasibility, the mapping of medical predictor variables to wearable device capabilities and mobile application functionality. (4) Results: A novel combination of wearable devices and smartphone applications required for the desired analysis of motor, sleep, emotional and quality-of-life outcomes is introduced. AI-first analysis methods are presented that aim to uncover the prediction capability of diverse longitudinal and cross-sectional setups (in terms of standard medical test targets). Mobile application development and usage schedule facilitates the retention of patient engagement and compliance with the study protocol.
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Affiliation(s)
- Alexandru Sorici
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Lidia Băjenaru
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Irina Georgiana Mocanu
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Adina Magda Florea
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Panagiotis Tsakanikas
- Institute of Communication and Computer Systems, National Technical University of Athens, 10682 Athens, Greece;
| | - Athena Cristina Ribigan
- Department of Neurology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
- Department of Neurology, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, 16149 Genoa, Italy;
| | - Anastasia Bougea
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
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Xie H, Chen J, Chen Q, Zhao Y, Liu J, Sun J, Hu X. The Diagnostic Value of Gut Microbiota Analysis for Post-Stroke Sleep Disorders. Diagnostics (Basel) 2023; 13:2970. [PMID: 37761337 PMCID: PMC10530055 DOI: 10.3390/diagnostics13182970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Gut microbiota have been associated with many psychiatric disorders. However, the changes in the composition of gut microbiota in patients with post-stroke sleep disorders (PSSDs) remain unclear. Here, we determined the gut microbial signature of PSSD patients. METHODS Fecal samples of 205 patients with ischemic stroke were collected within 24 h of admission and were further analyzed using 16 s RNA gene sequencing followed by bioinformatic analysis. The diversity, community composition, and differential microbes of gut microbiota were assessed. The outcome of sleep disorders was determined by the Pittsburgh Sleep Quality Index (PSQI) at 3 months after admission. The diagnostic performance of microbial characteristics in predicting PSSDs was assessed by receiver operating characteristic (ROC) curves. RESULTS Our results showed that the composition and structure of microbiota in patients with PSSDs were different from those without sleep disorders (PSNSDs). Moreover, the linear discriminant analysis effect size (LEfSe) showed significant differences in gut-associated bacteria, such as species of Streptococcus, Granulicatella, Dielma, Blautia, Paeniclostridium, and Sutterella. We further managed to identify the optimal microbiota signature and revealed that the predictive model with eight operational-taxonomic-unit-based biomarkers achieved a high accuracy in PSSD prediction (AUC = 0.768). Blautia and Streptococcus were considered to be the key microbiome signatures for patients with PSSD. CONCLUSIONS These findings indicated that a specific gut microbial signature was an important predictor of PSSDs, which highlighted the potential of microbiota as a promising biomarker for detecting PSSD patients.
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Affiliation(s)
- Huijia Xie
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (H.X.); (J.C.); (Q.C.); (Y.Z.)
| | - Jiaxin Chen
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (H.X.); (J.C.); (Q.C.); (Y.Z.)
| | - Qionglei Chen
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (H.X.); (J.C.); (Q.C.); (Y.Z.)
| | - Yiting Zhao
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (H.X.); (J.C.); (Q.C.); (Y.Z.)
| | - Jiaming Liu
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China;
| | - Jing Sun
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (H.X.); (J.C.); (Q.C.); (Y.Z.)
| | - Xuezhen Hu
- Department of Emergency Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China
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Wang TC, Tsai YH, Yang JT, Lin MS, Lin YC, Huang TJ, Chen MY. The prevalence of chronic dehydration and associated with cardiometabolic risks among agriculture and aquaculture workers. Front Public Health 2023; 11:1183557. [PMID: 37744492 PMCID: PMC10516687 DOI: 10.3389/fpubh.2023.1183557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Background Chronic dehydration is associated with complications and mortality in acute ischemic stroke patients. Prior literature indicates that farmers and fishery workers are commonly affected by cardiometabolic diseases and there is a need for early prevention of stroke. This study explores the prevalence of dehydration and the association of cardiometabolic risk profiles in agricultural and aquaculture workers. Methods We conducted a community-based, cross-sectional study of agriculture and aquaculture workers in Yunlin County of Taiwan between August 1 and December 31, 2021. Data on demographic characteristics and health-related lifestyles were collected through one-on-one interviews using a questionnaire. The threshold for dehydration is defined as serum osmolality ≥295 mOsm/kg, and physiological biomarkers were collected from a collaborating hospital. Multivariable logistic regression analyses adjusted for demographic characteristics were performed to investigate the association between dehydration levels, cardiometabolic risks, and health-related behaviors. Results A total of 962 Taiwanese agriculture and aquaculture workers who were predominantly women (65%) with a mean age of 64 years (SD = 13.8) were enrolled. The findings showed a high prevalence of dehydration (36%), metabolic syndrome (44.5%), abnormal waist circumference (64.4%), and abnormal blood pressure (68.5%). Multivariate logistic regression demonstrated that dehydration was significantly associated with metabolic syndrome (p < 0.001), 10-year stroke risk prediction (p < 0.001), and an unhealthy lifestyle (p < 0.001). Conclusion The prevalence of chronic dehydration was higher in Taiwanese agriculture and aquaculture workers, which was significantly associated with cardiometabolic risks and unhealthy lifestyles.
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Affiliation(s)
- Ta-Chin Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shyang Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Family Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Yu-Chih Lin
- Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Tung-Jung Huang
- Department of Family Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Mei-Yen Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Family Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan
- School of Nursing, Chang Gung University, Taoyuan, Taiwan
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20
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Dzirkale Z, Pilipenko V, Pijet B, Klimaviciusa L, Upite J, Protokowicz K, Kaczmarek L, Jansone B. Long-term behavioural alterations in mice following transient cerebral ischemia. Behav Brain Res 2023; 452:114589. [PMID: 37481076 DOI: 10.1016/j.bbr.2023.114589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
Ischemic stroke is one of the leading causes of disability and mortality worldwide. Acute and chronic post-stroke changes have variable effects on the functional outcomes of the disease. Therefore, it is imperative to identify what daily activities are altered after stroke and to what extent, keeping in mind that ischemic stroke patients often have long-term post-stroke complications. Translational studies in stroke have also been challenging due to inconsistent study design of animal experiments. The objective of this study was to clarify whether and to what extent mouse behaviour was altered during a 6 months period after cerebral stroke. Experimental stroke was induced in mice by intraluminal filament insertion into the middle cerebral artery (fMCAo). Neurological deficits, recovery rate, motor performance, and circadian activity were evaluated following ischemia. We observed severe neurological deficits, motor impairments, and delay in the recovery rate of mice during the first 14 days after fMCAo. Aberrant circadian activity and distorted space map were seen in fMCAo mice starting one month after ischemia, similarly to altered new and familiar cage activity and sucrose preference using the IntelliCage, and was still evident 60- and 180- days following stroke in the voluntary running wheel using the PhenoMaster system. A preference towards ipsilateral side turns was observed in fMCAo mice both acutely and chronically after the stroke induction. Overall, our study shows the importance of determining time-dependent differences in the long-term post-stroke recovery (over 180 days after fMCAo) using multiple behavioural assessments.
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Affiliation(s)
- Zane Dzirkale
- Department of Pharmacology, Faculty of Medicine, University of Latvia, 3 Jelgavas Street, LV-1004 Riga, Latvia.
| | - Vladimirs Pilipenko
- Department of Pharmacology, Faculty of Medicine, University of Latvia, 3 Jelgavas Street, LV-1004 Riga, Latvia
| | - Barbara Pijet
- Laboratory of Neurobiology, BRAINCITY - Centre of Excellence for Neural Plasticity and Brain Disorders, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland
| | - Linda Klimaviciusa
- Department of Pharmacology, Faculty of Medicine, University of Latvia, 3 Jelgavas Street, LV-1004 Riga, Latvia
| | - Jolanta Upite
- Department of Pharmacology, Faculty of Medicine, University of Latvia, 3 Jelgavas Street, LV-1004 Riga, Latvia
| | - Karolina Protokowicz
- Laboratory of Neurobiology, BRAINCITY - Centre of Excellence for Neural Plasticity and Brain Disorders, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland
| | - Leszek Kaczmarek
- Laboratory of Neurobiology, BRAINCITY - Centre of Excellence for Neural Plasticity and Brain Disorders, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland
| | - Baiba Jansone
- Department of Pharmacology, Faculty of Medicine, University of Latvia, 3 Jelgavas Street, LV-1004 Riga, Latvia.
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21
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Keil SA, Schindler AG, Wang MX, Piantino J, Silbert LC, Elliott JE, Thomas RG, Willis S, Lim MM, Iliff JJ. Instability in longitudinal sleep duration predicts cognitive impairment in aged participants of the Seattle Longitudinal Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.07.23291098. [PMID: 37398317 PMCID: PMC10312848 DOI: 10.1101/2023.06.07.23291098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Importance Sleep disturbances and clinical sleep disorders are associated with all-cause dementia and neurodegenerative conditions. It remains unclear how longitudinal changes in sleep impact the incidence of cognitive impairment. Objective To evaluate how longitudinal sleep patterns contribute to age-related changes in cognitive function in healthy adults. Design Setting Participants This study utilizes retrospective longitudinal analyses of a community-based study within Seattle, evaluating self-reported sleep (1993-2012) and cognitive performance (1997-2020) in aged adults. Main Outcomes and Measures The main outcome is cognitive impairment as defined by sub-threshold performance on 2 of 4 neuropsychological batteries: Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale, Trail Making Test, and Wechsler Adult Intelligent Scale (Revised). Sleep duration was defined through self-report of 'average nightly sleep duration over the last week' and assessed longitudinally. Median sleep duration, change in sleep duration (slope), variability in sleep duration (standard deviation, Sleep Variability), and sleep phenotype ("Short Sleep" median ≤7hrs.; "Medium Sleep" median = 7hrs; "Long Sleep" median ≥7hrs.). Results A total of 822 individuals (mean age of 76.2 years [11.8]; 466 women [56.7%]; 216 APOE allele positive [26.3%]) were included in the study. Analysis using a Cox Proportional Hazard Regression model (concordance 0.70) showed that increased Sleep Variability (95% CI [1.27,3.86]) was significantly associated with the incidence of cognitive impairment. Further analysis using linear regression prediction analysis (R2=0.201, F (10, 168)=6.010, p=2.67E-07) showed that high Sleep Variability (β=0.3491; p=0.048) was a significant predictor of cognitive impairment over a 10-year period. Conclusions and Relevance High variability in longitudinal sleep duration was significantly associated with the incidence of cognitive impairment and predictive of decline in cognitive performance ten years later. These data highlight that instability in longitudinal sleep duration may contribute to age-related cognitive decline.
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Affiliation(s)
- Samantha A Keil
- VISN 20 Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Abigail G Schindler
- VISN 20 Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA
- Geriatric Research Education and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Gerontology Division Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Marie X Wang
- VISN 20 Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Juan Piantino
- Department of Pediatrics, Oregon Health & Science University, Portland, OR
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Lisa C Silbert
- Neurology Service VA Portland Health Care System, Portland, OR
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Jonathan E Elliott
- Research Service VA Portland Health Care System, Portland, OR
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Ronald G Thomas
- School of Public Health, University of California, San Diego, San Diego, CA
| | - Sherry Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Miranda M Lim
- VISN 20 Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA
- Neurology Service VA Portland Health Care System, Portland, OR
- Department of Neurology, Oregon Health & Science University, Portland, OR
- Department of Medicine, Oregon Health & Science University, Portland, OR
- Oregon Institute of Occupational Health Sciences, Portland, OR
| | - Jeffrey J Iliff
- VISN 20 Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Department of Neurology, University of Washington School of Medicine, Seattle, WA
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22
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Iwuozo EU, Enyikwola JO, Asor PM, Onyia UI, Nwazor EO, Obiako RO. Sleep disturbances and associated factors amongst stroke survivors in North Central, Nigeria. Niger Postgrad Med J 2023; 30:193-199. [PMID: 37675695 DOI: 10.4103/npmj.npmj_56_23] [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: 09/08/2023]
Abstract
Introduction Sleep disturbance is common in persons with stroke and when unrecognised and untreated may hinder rehabilitation efforts and lead to poor functional outcome. It may also result in increased risk for stroke recurrence. Aim We investigated the frequency and associated factors of sleep disturbances amongst stroke survivors. Methodology One hundred and ten stroke survivors attending the neurology outpatient clinics of two tertiary hospitals, from February 2021 to January 2022, were interviewed after obtaining ethical approval and informed consent. We used a structured questionnaire to obtain their socio-demographic, clinical characteristics and sleep disturbances. Excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Data were analysed with statistical significance set at P < 0.05. Results Eighty (72.7%) patients were males with a mean age of 61.4 ± 11.8, slightly older than the females (30, 27.3%) with a mean age of 60.9 ± 2.9. Their median follow-up duration was 7.5 months. Majority (84, 76.4%) had ischaemic stroke, and the frequency of sleep disturbances was 37 (33.6%) consisting of insomnia (19, 17.3%), hypersomnia (10, 9.0%), sleep-disordered breathing (5, 4.5%) and sleep-related movement disorder (3, 2.7%), respectively. Using the ESS score, 22 (20.0%) had mild, 10 (9.0%) had moderate and 7 (6.4%) had severe ESS scores, respectively. Univariate analysis showed depression to be significantly associated with ESS (P = 0.006) whereas multivariate analysis revealed age and sex as significant associated factors (P = 0.008 and P = 0.009) of ESS. Conclusion More than one-third of participants reported sleep disturbances with depression, age and gender as associated factors.
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Affiliation(s)
- Emmanuel Uzodinma Iwuozo
- Department of Medicine, College of Health Sciences, Benue State University; Department of Medicine, Neurology Unit, Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria
| | | | - Paul Msugh Asor
- Department of Medicine, Neurology Unit, Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria
| | - Uzoma Ikenna Onyia
- Department of Medicine, Neurology Unit, Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria
| | - Ernest Okwundu Nwazor
- Department of Medicine, Neurology Unit, Federal Medicine Centre, Owerri, Imo State, Nigeria
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23
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Allgood JE, Roe A, Sparks BB, Castillo M, Cruz A, Brooks AE, Brooks BD. The Correlation of Sleep Disturbance and Location of Glioma Tumors: A Narrative Review. J Clin Med 2023; 12:4058. [PMID: 37373751 DOI: 10.3390/jcm12124058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Sleep disturbance can occur when sleep centers of the brain, regions that are responsible for coordinating and generating healthy amounts of sleep, are disrupted by glioma growth or surgical resection. Several disorders cause disruptions to the average duration, quality, or patterns of sleep, resulting in sleep disturbance. It is unknown whether specific sleep disorders can be reliably correlated with glioma growth, but there are sufficient numbers of case reports to suggest that a connection is possible. In this manuscript, these case reports and retrospective chart reviews are considered in the context of the current primary literature on sleep disturbance and glioma diagnosis to identify a new and useful connection which warrants further systematic and scientific examination in preclinical animal models. Confirmation of the relationship between disruption of the sleep centers in the brain and glioma location could have significant implications for diagnostics, treatment, monitoring of metastasis/recurrence, and end-of-life considerations.
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Affiliation(s)
- JuliAnne E Allgood
- Department of Neuroscience, University of Wyoming, Laramie, WY 82071, USA
| | - Avery Roe
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Bridger B Sparks
- Department of Neuroscience, University of Wyoming, Laramie, WY 82071, USA
| | - Mercedes Castillo
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Angel Cruz
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Amanda E Brooks
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Benjamin D Brooks
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
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24
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Guo H, Ge YR, Dong YB, Zhao XC, Su GL, Wang JC. Effect of hyperbaric oxygen on post-stroke depression. World J Psychiatry 2023; 13:226-233. [PMID: 37303936 PMCID: PMC10251359 DOI: 10.5498/wjp.v13.i5.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND In patients with post-stroke depression (PSD) in diabetes, the situation may be more complex, requiring simultaneous treatment of blood glucose, depressive symptoms, and neurological dysfunction. Hyperbaric oxygen (HBO) therapy can improve tissue oxygen content and improve the situation of ischemia and hypoxia, thus playing a role in protecting brain cells and restoring the function of brain cells. However, there are few studies on HBO therapy for patients with PSD. This study explores the clinical efficacy of such therapy for stroke complicated with depression and diabetes mellitus, and to provide reference and basis for clinical treatment and development through the application of relevant rating scales and laboratory test indicators.
AIM To evaluate the clinical effects of HBO therapy on patients with diabetes with PSD.
METHODS A total of 190 diabetic patients with PSD were randomly divided into observation and control groups (95 patients per group). The control group received escitalopram oxalate 10mg once a day for eight weeks. In addition, the ob-servation group was also given HBO therapy, once a day, five times a week, for eight weeks. The Montgomery Depression Rating Scale (MADRS), National Institutes of Health Stroke Scale (NIHSS), hypersensitive C-reactive protein, tumor necrosis factor (TNF)-α, and fasting glucose levels were compared.
RESULTS There were no significant differences in age, sex, or depression course between the groups (P > 0.05). After HBO treatment, MADRS scores in both groups decreased significantly (14.3 ± 5.2), and were significantly lower in the control group (18.1 ± 3.5). After HBO treatment, NIHSS scores in both groups decreased significantly, and scores in the observation group (12.2 ± 4.0) decreased more than in the control group (16.1 ± 3.4), the difference was statistically significant (P < 0.001). The levels of hypersensitive C-reactive protein and TNF-α in both groups were significantly decreased, and the observation group was significantly lower than the control group (P < 0.001). Fasting blood glucose levels in both groups decreased significantly, and those in the observation group decreased more (8.02 ± 1.10) than in the control group (9.26 ± 1.04), with statistical significance (t = -7.994, P < 0.001).
CONCLUSION HBO therapy can significantly improve depressive symptoms and neurological dysfunction in patients with PSD, and reduce the levels of hypersensitive C-reactive protein, TNF-α and fasting blood glucose.
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Affiliation(s)
- Hong Guo
- Department of Psychology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yi-Ran Ge
- Department of Clinical Psychology, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Yan-Bin Dong
- Department of Psychology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiao-Chuan Zhao
- Department of Psychiatry, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Guan-Li Su
- Department of Psychiatry, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jin-Cheng Wang
- Department of Psychiatry, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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25
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Huang X, Xiong Y, Jiang S, Tang L, Lin X, Fang X, Shi Y, Lan W, Xie Y, Peng T. Chaihu Longgu Muli Decoction for post-stroke insomnia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33376. [PMID: 37058036 PMCID: PMC10101286 DOI: 10.1097/md.0000000000033376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Poststroke insomnia (PSI) is a frequent complication of stroke usually as a comorbidity of poststroke depression and mainly occurs within the first 6 months after stroke.[1] Addressing PSI to improve stroke prognosis is of great value. Herbal medicine like Chaihu Longgu Muli Decoction (CLMD), which is commonly considered to be a good treatment for depression and epilepsy, has the therapeutic potential on PSI; however, insufficient systematic reviews were conducted to testify its efficacy. Therefore, the objective of this paper is to provide reliable evidence of the efficacy and safety of CLMD on PSI and a foundation for further investigation. METHODS The literature of clinical randomized controlled trials (RCTs) regarding CLMD for PSI published before June of 2021 will be retrieved in the databases, and 2 investigators will be asked to collect and crosscheck the data independently. For the including studies, the quality evaluation on methodology will be assessed in the light of the Cochrane Handbook for Systematic Review of Interventions V.5.1.0 as well as the quality of evidence will be evaluated by the Grading of Recommendations Assessment, Development, and Evaluation. Besides, the assessment of heterogeneity and reporting bias, the sensitivity analysis and the subgroup analysis will be conducted. Stata 15 will be applied to analyze the above data. RESULTS The review will conduct a high-quality synthesis on present evidence of CLMD for PSI. CONCLUSION The conclusion of the study will indicate whether CLMD is effective and safe for PSI.
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Affiliation(s)
- Xuedi Huang
- Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Jiangxi, China
| | - Yue Xiong
- Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Jiangxi, China
| | - Sichen Jiang
- Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Jiangxi, China
| | - Lihua Tang
- Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Jiangxi, China
| | - Xingzhen Lin
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Jiangxi, China
| | - Xinyue Fang
- Guangzhou University of Chinese Medicine, Jiangxi, China
| | - Yuzhen Shi
- Guangzhou University of Chinese Medicine, Jiangxi, China
| | - Wanning Lan
- Guangzhou University of Chinese Medicine, Jiangxi, China
| | - Yaying Xie
- Guangzhou University of Chinese Medicine, Jiangxi, China
| | - Tianzhong Peng
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Jiangxi, China
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26
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Korabelnikova EA, Akavov AN, Baranov ML. [Insomnia in neurological patients with disabilities]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:12-20. [PMID: 36843454 DOI: 10.17116/jnevro202312302112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Sleep is the most important factor reflecting the level of psychophysical well-being of a person and influencing him/her to the same extent. The greater susceptibility to sleep disturbances in patients with disabilities is associated with numerous factors. In the existing literature, there are few studies of insomnia in people with neurological disabilities. This article presents a current view on sleep disorders in disabled people and methods for their treatment.
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Affiliation(s)
- E A Korabelnikova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A N Akavov
- Dagestan State Medical University, Makhachkala, Russia
| | - M L Baranov
- Main Military Clinical Hospital of the National Guard Forces, Moscow, Russia
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27
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Hou X, Hu J, Wang E, Wang J, Song Z, Hu J, Shi J, Zhang C. Self-Reported Sleep Disturbance is an Independent Predictor of All-Cause Mortality and Respiratory Disease Mortality in US Adults: A Population-Based Prospective Cohort Study. Int J Public Health 2023; 68:1605538. [PMID: 36865999 PMCID: PMC9971003 DOI: 10.3389/ijph.2023.1605538] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
Objective: Self-reported sleep disturbance is common but its association with mortality has rarely been investigated. Methods: This prospective cohort analysis included 41,257 participants enrolled in the National Health and Nutrition Examination Survey from 2005 to 2018. Self-reported sleep disturbance in the present study refers to the patients who have ever consulted doctors or other professionals for trouble sleeping. Univariate and multivariate survey-weighted Cox proportional hazards models were used to evaluate the association of self-reported sleep disturbance with all-cause and disease-specific mortality. Results: Approximately 27.0% of US adults were estimated to have self-reported sleep disturbance. After adjusting for all sociodemographic variables, health behavioral factors, and common comorbidities, participants with self-reported sleep disturbance tend to have higher all-cause mortality risk with a hazard ratio (HR) of 1.17 (95% CI, 1.04-1.32) and chronic lower respiratory disease mortality risk (HR, 1.88; 95% CI, 1.26-2.80), but not cardiovascular disease mortality risk (HR, 1.19; 95% CI, 0.96-1.46) and cancer mortality risk (HR, 1.10; 95% CI, 0.90-1.35). Conclusion: Self-reported sleep disturbance could be associated with higher mortality in adults, and may need to be paid more attention in public health management.
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Affiliation(s)
- Xinran Hou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jiajia Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zongbin Song
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Shi
- Department of Anesthesiology, Changsha Yamei Plastic Surgery Hospital, Changsha, China
| | - Chengliang Zhang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Chengliang Zhang,
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28
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Jiang H, Deng S, Zhang J, Chen J, Li B, Zhu W, Zhang M, Zhang C, Meng Z. Acupuncture treatment for post-stroke depression: Intestinal microbiota and its role. Front Neurosci 2023; 17:1146946. [PMID: 37025378 PMCID: PMC10070763 DOI: 10.3389/fnins.2023.1146946] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Stroke-induced depression is a common complication and an important risk factor for disability. Besides psychiatric symptoms, depressed patients may also exhibit a variety of gastrointestinal symptoms, and even take gastrointestinal symptoms as the primary reason for medical treatment. It is well documented that stress may disrupt the balance of the gut microbiome in patients suffering from post-stroke depression (PSD), and that disruption of the gut microbiome is closely related to the severity of the condition in depressed patients. Therefore, maintaining the balance of intestinal microbiota can be the focus of research on the mechanism of acupuncture in the treatment of PSD. Furthermore, stroke can be effectively treated with acupuncture at all stages and it may act as a special microecological regulator by regulating intestinal microbiota as well. In this article, we reviewed the studies on changing intestinal microbiota after acupuncture treatment and examined the existing problems and development prospects of acupuncture, microbiome, and poststroke depression, in order to provide new ideas for future acupuncture research.
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Affiliation(s)
- Hailun Jiang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shizhe Deng
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jieying Zhang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junjie Chen
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Boxuan Li
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Weiming Zhu
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Menglong Zhang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chao Zhang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Chao Zhang,
| | - Zhihong Meng
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- *Correspondence: Zhihong Meng,
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Tsai HJ, Wong YS, Ong CT. Clinical course and risk factors for sleep disturbance in patients with ischemic stroke. PLoS One 2022; 17:e0277309. [PMID: 36346797 PMCID: PMC9642877 DOI: 10.1371/journal.pone.0277309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Studies on insomnia in patients with ischemic stroke, particularly in the acute phase, are limited. The proportion of patients with sleep disturbance during the acute stroke period who are likely to develop insomnia in subacute and chronic stages of stroke is unknown. This study aimed to investigate the risk factors for sleep disturbance and the clinical course of the disease in patients with acute ischemic stroke. Methods This prospective observational study included patients diagnosed with ischemic stroke between July 1, 2020, and October 31, 2021. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) for insomnia and the eight-item Athens Insomnia Scale (CAIS-8) were used to diagnose insomnia. Beck Depression Inventory (BDI) was applied to evaluate the mood of patients. Patient reported their sleeping conditions, before stroke onset and during the acute (within 7 days) and chronic (3 months after presentation) stroke periods. Results In total, 195 patients with ischemic stroke were included in this study. Of these, 34.3% (67), 37.4% (73), and 29.7% (58) presented with sleep disturbance before stroke onset and during the acute and chronic stroke periods, respectively. Of the 128 patients without insomnia before stroke onset, 15.6% (20/128) presented with insomnia symptoms 3 months after stroke onset. Moreover, 13 (12.7%) of the 102 patients without sleep disturbance during the acute stroke period developed insomnia 3 months after stroke onset. Of the 67 patients with insomnia before stroke onset 29 (43.3%) did not develop the condition 3 months after stroke onset. A higher risk of sleep disturbance was associated with atrial fibrillation, hypertension, and mood disturbance in the acute stroke period, and a higher risk of insomnia was associated with low education and mood disturbance in the chronic stroke period. Conclusion The prevalence rates of sleep disturbance before and during the acute and chronic stroke periods were 34.3%, 37.4%, and 29.7%, respectively. The incidence of stroke-related insomnia was 15.6%. Patients with insomnia before stroke may recover after the stroke. Atrial fibrillation, hypertension, and mood disturbance were associated with a higher risk of sleep disturbance in the acute stroke period, whereas low education and mood disturbance were associated with insomnia in the chronic stroke period.
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Affiliation(s)
- Hui-Ju Tsai
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yi-Sin Wong
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Cheung-Ter Ong
- Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- * E-mail:
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30
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Khambadkone SG, Benjamin SE. Sleep Disturbances in Neurological Disease: A Target for Intervention. Semin Neurol 2022; 42:639-657. [PMID: 36216356 DOI: 10.1055/a-1958-0710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sleep is a biological function required for neurological and general health, but a significant and under-recognized proportion of the population has disturbed sleep. Here, we briefly overview the biology of sleep, sleep requirements over the lifespan, and common sleep disorders. We then turn our attention to five neurological diseases that significantly contribute to global disease burden and neurology practice makeup: epilepsy, headache, ischemic stroke, Parkinson's disease, and Alzheimer's disease. For each disease, we review evidence that sleep disturbances contribute to disease risk and severity and discuss existing data that addressing sleep disturbances may have disease-modifying effects. We provide recommendations derived from the literature and existing clinical guidelines to facilitate the evaluation and management of sleep disturbances within the context of each neurological disease. Finally, we synthesize identified needs and commonalities into future directions for the field and practical sleep-related recommendations for physicians caring for patients at risk for or currently suffering from neurological disease.
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Affiliation(s)
- Seva G Khambadkone
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Sara E Benjamin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Johns Hopkins Center for Sleep, Columbia, Maryland
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31
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Sharma R, Chischolm A, Parikh M, Qureshi AI, Sahota P, Thakkar MM. Ischemic Stroke Disrupts Sleep Homeostasis in Middle-Aged Mice. Cells 2022; 11:cells11182818. [PMID: 36139392 PMCID: PMC9497108 DOI: 10.3390/cells11182818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Sleep disturbances, including insomnia and excessive daytime sleepiness, are highly prevalent in patients with ischemic stroke (IS), which severely impacts recovery and rehabilitation efforts. However, how IS induces sleep disturbances is unclear. Three experiments were performed on middle-aged C57BL/6J mice, instrumented with sleep recording electrodes and/or subjected to 1 h of middle cerebral artery (MCAO; Stroke group) or sham (Sham group) occlusion to induce IS. After 48 h of reperfusion (a) experiment 1 verified sensorimotor deficit (using Garcia scale) and infarction (using TTC staining) in this mouse model; (b) experiment 2 examined the effects of IS on the quality (sleep latency and NREM delta power) and quantity (duration) of sleep; and (c) experiment 3 determined the effects of IS on sleep homeostasis using sleep deprivation (SD) and recovery sleep (RS) paradigm. Stroke mice display (a) a significant correlation between sensorimotor deficit and cerebral infarction; (b) insomnia-like symptoms (increased sleep latency, reduced NREM duration and delta power) during the light (inactive) period and daytime sleepiness-like symptoms during the dark (active) period mimicking sleep in IS patients; and (c) impairments in the markers of sleep pressure (during SD) and sleep dissipation (during RS). Our results suggest that IS disrupts sleep homeostasis to cause sleep disturbances.
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Wang XX, Feng Y, Tan EK, Ondo WG, Wu YC. Stroke-related restless legs syndrome: epidemiology, clinical characteristics and pathophysiology. Sleep Med 2022; 90:238-248. [DOI: 10.1016/j.sleep.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/23/2022] [Accepted: 02/01/2022] [Indexed: 12/24/2022]
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Fatigue in Stroke, Do Not Underestimate the Role of Sleep Disorders: Comment on Poststroke Fatigue Association With Independence Levels. Arch Phys Med Rehabil 2021; 102:2049. [PMID: 34252396 DOI: 10.1016/j.apmr.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
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34
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Wang DZ, Guo FQ, Guo L, Yang S, Yu NW, Wang J, Wang JH. Serum Neurofilament Light Predicts 6-Month Mental Health Outcomes in a Cohort of Patients With Acute Ischemic Stroke. Front Psychiatry 2021; 12:764656. [PMID: 35197872 PMCID: PMC8859250 DOI: 10.3389/fpsyt.2021.764656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/10/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mental health problems after acute ischemic stroke (AIS) have caused wide public concerns, and the study on early identification of these disorders is still an open issue. This study aims to investigate the predictive effect of circulating neurofilament light (NfL) on long-term mental health status of AIS patients. METHODS This study collected demographic information and mental health measurements from 304 AIS patients from May 1, 2016 to Dec 31, 2019. Baseline serum neurofilament light (NfL) was determined within 2 h since patient admission. Six months after AIS onset, the degree of symptoms of depression, anxiety, and insomnia was assessed by the Chinese versions of the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), the 7-item Insomnia Severity Index (ISI), respectively. Subjects were divided into the high NfL group and the low NfL group. Multivariate logistic regression analysis was performed to identify factors associated with these mental health problems. RESULTS The high NfL group had significantly higher PHQ-9, GAD-7, and ISI scores than the low NfL group. The prediction of serum NfL for major depression generated a sensitivity of 70.27%, a specificity of 67.79% and an AUC of 0.694. The prediction of serum NfL for anxiety generated a sensitivity of 69.23%, a specificity of 64.02%, and an AUC of 0.683. The prediction of serum NfL for insomnia generated a sensitivity of 75.00%, a specificity of 66.43% and an AUC of 0.723. Higher serum NfL was a risk factor of post-AIS depression [ORs (95% CI): 4.427 (1.918, 10.217)], anxiety [ORs (95% CI): 3.063 (1.939, 6.692)], and insomnia [ORs (95% CI): 4.200 (1.526, 11.562)]. CONCLUSIONS These findings imply that circulating NfL might be a potential biomarker of long-term mental health problems after AIS.
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Affiliation(s)
- Duo-Zi Wang
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Fu-Qiang Guo
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Lei Guo
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shu Yang
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Neng-Wei Yu
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jian Wang
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Jian-Hong Wang
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, China
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