Application of the Chinese Version of the Pittsburgh Sleep Quality Index in People Living With HIV: Preliminary Reliability and Validity

Analysing the effect of social jetlag on burnout among shift nurse using a chained mediation model

The purpose of the present research is to explore the relationship between social jetlag and burnout among Chinese shift nurses. Furthermore, we seek to demonstrate how perceived stress and sleep quality play as chain mediators in this relationship. A cross-sectional study. There are 429 Chinese shift nurses data records included through one-on-one format using the subjects' sociodemographic information, the Munich Chronotype Questionnaire for shift workers (MCTQshift), the Chinese version of the 14-item Perceived Stress Scale (CPSS-14), the Pittsburgh Sleep Quality Index (PSQI), and the Chinese version of Maslach Burnout Inventory-General Survey. The positive correlations are found between social jetlag and burnout among Chinese shift nurses; perceived stress and sleep quality, respectively, play a partial mediating role in this relationship. Furthermore, perceived stress and sleep quality play a chain mediating role between social jetlag and burnout. These findings contribute to understanding the impact mechanism of social jetlag on shift nurses' burnout and provide a theoretical foundation for nurses managers to develop programs designed for reducing the burnout that affects shift nurses.

Exploring the effects of aromatherapy and acupoint herbal patching on fatigue and sleep disorders in people living with HIV: a pilot randomized trial

The purpose of this study was to investigate the effects of aromatherapy and acupoint herbal patching on fatigue and sleep disorders in people living with HIV (PLWH). Aromatherapy and acupoint herbal patching are ancient alternative therapies in traditional Chinese medicine. We randomly selected 90 patients from the Nanjing Public Health Medical Center in China and divided them into three groups: aromatherapy group, acupoint herbal patching group and control group. They were supposed to fill in the Pittsburgh Sleepiness Index Scale (PSQI), the Piper Fatigue Scale (PFS), and the Liver Depression and Spleen Deficiency Insomnia Symptoms Scale (LDSSIPS) before and after the intervention. The results showed that the difference between the PSQI score and fatigue score of the aromatherapy group and acupressure group before and after the intervention was statistically significant (P < 0.05), and the difference between the scores of the three groups after the intervention was statistically significant (P < 0.05). This study found that aromatherapy and acupoint herbal patching could effectively alleviate fatigue of PLWH and improve the quality of sleep, and that the therapeutic effect of the aromatherapy group was comparable with that of the acupoint herbal patching group.

Evaluation of the impact of continuous nursing and cluster nursing on carpal tunnel syndrome release surgery

BACKGROUND

This study aimed to estimate the influence of continuous and cluster nursing on carpal tunnel syndrome (CTS) release surgery.

METHODS

Ninety-six patients with CTS were treated in our hospital from November 2019 to December 2021. These patients were randomly divided into two groups of 48 patients. Both groups underwent open carpal tunnel release surgery. The control group received routine nursing care, while the study group received a combination of continuous and cluster nursing interventions. The Boston carpal tunnel question, the Visual Analogue Scale (VAS), the Numerical Rating Scale (NRS), the Pittsburgh Sleep Quality Index (PSQI), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and the Barthel index were used to compare hand function recovery, hand pain, sleep quality, and quality of life between the two groups before and 3 months after surgery.

RESULTS

Both groups experienced improvements in hand function and pain 3 months after surgery. However, the study group demonstrated lower scores in symptom and dysfunction, as well as lower VAS and NRS scores compared to the control group (P < 0.05). Additionally, both groups showed an increase in the Barthel and PSQI scores 3 months after surgery. Notably, the study group exhibited higher Barthel scores and lower PSQI scores than the control group (P < 0.05).

CONCLUSION

The use of continuous and cluster nursing in patients undergoing CTS release surgery proves to be advantageous in alleviating hand pain, facilitating hand function recovery, and effectively enhancing sleep quality and overall quality of life for patients.

Acceptance and commitment therapy for nurses' sleep, rumination, psychological flexibility, and it's neural mechanism: A randomized controlled fNIRS study

BACKGROUND

Given nurses often face sleep problems, this study compares two internet-delivered Acceptance and Commitment Therapy (ACT) interventions to improve sleep quality (SQ), psychological flexibility (PF), reduce rumination, and explore neural mechanisms. Methods: 477 nurses were randomly assigned to ACT linear psychotherapy model (LINEAR), ACT loop psychotherapy model (LOOP) and wait-list group. SQ, rumination, and PF were assessed with questionnaires. Prefrontal cortical activation changes were measured using functional near-infrared spectroscopy. Results: The linear mixed-effects model demonstrated significant improvements in SQ, PF, and reduced rumination compared to pre-intervention for both models through enhanced psychological flexibility. LOOP showed a significantly superior effect compared to LINEAR. DLPFC activation increased following both interventions, with LOOP additionally stimulating the frontopolar area. Changes in the DLPFC mediated the relationship between intervention and outcome improvements. Frontopolar changes mediated SQ improvements but not rumination or PF. No significant changes in functional connectivity were observed during the verbal fluency task. Conclusions: Both interventions improved outcome variables, with LOOP being notably more effective, offering a novel approach. Mediation analyses highlight the role of DLPFC activation in understanding ACT's mechanisms and targeting insomnia treatment, while the mechanisms of LOOP's superior effect warrant further research. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2200063533). https://www.chictr.org.cn/.

The effect of emotional freedom techniques on anxiety depression and sleep in older people living with HIV: a randomized controlled trial

OBJECTIVE

To investigate the effect of Emotional Freedom Techniques on anxiety, depression and sleep in older people living with HIV (PLWH).

METHODS

70 older PLWH experiencing anxiety, depression, and sleep disorders were randomly divided into control and experimental groups using a random number table system (RNT), with 35 participants in each group. The experimental group received Emotional Freedom Techniques once a day for 15-20 min as part of their routine care and health counselling, and the intervention lasted for 2 weeks. The control group received standard nursing care and health guidance. The two groups were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) to measure changes in anxiety, depression, and sleep quality before and after the intervention.

RESULTS

There are totally 67 participants in the trial. In the EFT group (n = 33), PSQI scores decreased from 12.36 ± 2.409 to 9.15 ± 2.476(mean ± SD P < 0.001), HA scores decreased from 12.39 ± 2.344 to 9.12 ± 2.176(mean ± SD P < 0.001), HD scores decreased from 11.58 ± 1.969 to 8.94 ± 2.015 (mean ± SD P < 0.001), compared with no change in the usual care group (n = 34). The EFT group showed significantly lower post-intervention scores than the control group on all scales (P < 0.001), indicating the effectiveness of the intervention.

CONCLUSION

Emotional Freedom Techniques can effectively alleviate anxiety and depression in older PLWH and improve their sleep quality.

The short-term and long-term prognosis of discharged COVID-19 patients in Guangdong during the first wave of pandemic

COVID-19 survivors concerning about the rehabilitation and sustained sequelae of Coronavirus Disease 2019 (COVID-19) infection. We aimed to investigate the sequelae of patients' psychological and physical condition and its related factors in the early and late stages. This longitudinal study tracked 281 COVID-19 patients discharged from hospitals in Guangdong, China, for one year. Assessments occurred at 2,4,12,24 and 48 weeks post-discharge. We define 2 weeks, 4 weeks, and 12 weeks as early stage, and 24 weeks and 48 weeks as late stage. Psychological health was measured using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and Pittsburgh Sleep Quality Index (PSQI) scales. Physical health was assessed through laboratory tests, chest computed tomography (CT) scans, and pulmonary function tests. Data were analyzed using multivariate regression models to evaluate the influence of demographic and clinical variables on health outcomes. COVID-19 survivors exhibited psychological and physical sequelae in both the early and late stages. Compared to the early stage, the proportions of patients with depression (early stage 14.6%, late stage 4.6%), anxiety (early stage 8.9%, late stage 5.3%), PTSD(early stage 3.6%, late stage 0.7%), abnormal liver function (early stage 24.6%, late stage 11.0%), abnormal cardiac function (early stage 10.0%, late stage 7.8%), abnormal renal function (early stage 20.6%, late stage 11.0%) and abnormal pulmonary function (early stage 40.9%, late stage 13.5%) were significantly reduced in the late stage. Factors such as gender, age, severity of COVID-19, hospitalization duration, and various comorbidities were significantly associated with these sequelae. We noticed that psychological and physical sequelae occurred to COVID-19 survivors in short and long stages, and these would gradually decrease as time went on. Male gender, age > 50 years old, severe clinical condition, longer hospitalization time and comorbidity history were related factors that significantly affected the rehabilitation of COVID-19 patients.

Prevalence and influencing factors of sleep disorders in medical students after the COVID-19 pandemic

BACKGROUND

The prevalence of sleep disorders among medical students was high during the COVID-19 pandemic. However, fewer studies have been conducted on sleep disorders among medical students after the COVID-19 pandemic. This study investigated the prevalence and factors influencing sleep disorders among Chinese medical students after COVID-19.

METHODS

A total of 1,194 Chinese medical students were included in this study from 9th to 12th July 2023. We used the Self-administered Chinese scale to collect the demographic characteristics. In addition, we used the Chinese versions of the Self-rating Depression Scale (SDS), the Self-rating Anxiety Scale (SAS), and the Pittsburgh Sleep Quality Index (PSQI) to assess subjects' depression, anxiety, and sleep disorders, respectively. The chi-square test and binary logistic regression were used to identify factors influencing sleep disorders. The receiver operating characteristic (ROC) curve was utilized to assess the predictive value of relevant variables for sleep disorders.

RESULTS

We found the prevalence of sleep disorders among medical students after COVID-19 was 82.3%. According to logistic regression results, medical students with depression were 1.151 times more likely to have sleep disorders than those without depression (OR = 1.151, 95% CI 1.114 to 1.188). Doctoral students were 1.908 times more likely to have sleep disorders than graduate and undergraduate students (OR = 1.908, 95% CI 1.264 to 2.880).

CONCLUSION

The prevalence of sleep disorders among medical students is high after COVID-19. In addition, high academic levels and depression are risk factors for sleep disorders. Therefore, medical colleges and administrators should pay more attention to sleep disorders in medical students after the COVID-19 pandemic. Regular assessment of sleep disorders and depression is essential.

The effect of aromatherapy on post-stroke depression: study protocol for a pilot randomized controlled trial

Background

Post-stroke depression (PSD) is a prevalent psychiatric disorder affecting about one-third of stroke survivors, significantly hindering recovery and quality of life. PSD also imposes a substantial burden on caregivers and healthcare systems. Aromatherapy has shown promise in alleviating depression, anxiety, and sleep disorders. This pilot randomized controlled trial aims to assess the feasibility and preliminary efficacy of mixed herb aromatherapy in treating PSD. Feasibility outcomes encompass recruitment, intervention adherence, assessment completion and safety assessment. Secondary outcomes include evaluations of depression, anxiety, cognitive function, sleep quality, quality of life, and brain function using EEG and fNIRS.

Methods

This single-blind pilot randomized controlled trial will be conducted at the Second Rehabilitation Hospital of Shanghai, enrolling ninety-nine post-stroke patients with PSD. Participants will be randomized into three groups: a Non-Active Control Group receiving standardized rehabilitation therapy, a CBT Group receiving conventional rehabilitation with bi-weekly CBT sessions, and an Aromatherapy Group receiving conventional rehabilitation with daily aromatic inhalation sessions. Interventions will last for four weeks, with efficacy assessed at baseline, post-intervention, and one month post-intervention. Rating scales will be used to measure changes in depression, sleep quality, cognitive function, and quality of life. EEG and fNIRS will specifically be used to measure changes in cerebral cortex activity and their correlations with depression. Feasibility will be evaluated through recruitment, intervention adherence, assessment completion and safety assessment.

Discussion

This pilot study highlights the potential of mixed herb aromatherapy inhalation for treating PSD, addressing limitations of CBT by promoting self-management. While demonstrating feasibility through recruitment, adherence, assessment completion and safety assessment, the study also acknowledges limitations such as unequal intervention times, the lack of physical function data. And the use of culturally relevant plant powders may enhance compliance but limits generalizability. Despite these constraints, the study provides valuable preliminary data and insights into the mechanisms of aromatherapy, encouraging further research and development of effective PSD treatments.

Effect of music therapy combined with aerobic exercise on sleep quality among breast cancer patients undergoing chemotherapy after a radical mastectomy: a randomized controlled trial

PURPOSE

We aimed to study the effect of music therapy combined with aerobic exercise on the sleep quality of patients undergoing chemotherapy after a radical mastectomy.

METHODS

A randomized controlled trial was conducted at the Breast Disease Diagnosis and Treatment Center, Shaanxi Province Tumor Hospital, from July 2017 to June 2019. 110 female breast cancer patients who underwent a radical mastectomy were recruited and randomly allocated into an intervention group or a control group. The intervention group completed music therapy combined with aerobic exercise from the first to the sixth admission to the hospital for chemotherapy, while the control group received only routine nursing care. The sleep quality of these patients was measured using the Pittsburgh Sleep Quality Index (PSQI). A linear mixed model was used to adjust the PSQI of patients after controlling for other confounding factors.

RESULTS

The mean sleep quality score of the breast cancer patients who received chemotherapy after a radical mastectomy (baseline) was 8.86 ± 2.34. The intervention group had a significantly lower mean global PSQI score than the control group from the first test to the third test, with an adjusted mean difference of -1.05 (95%CI: -1.86, -0.24; P = 0.01), -2.89 (95%CI: -3.70, -2.08; P < 0.001) and - 4.84 (95%CI: -5.65, -4.03; P < 0.001), respectively. A change in the global PSQI score from baseline for the intervention group was from 0.55 (95%CI: -0.24, 1.34; P = 0.171) at the first test to 2.75 (95%CI: 1.96, 3.53; P < 0.001) at the last test, and for the control group was from - 0.51 (95%CI: -1.31, 0.29; P = 0.213 at the first test to -2.10 (95%CI: -2.91, -1.30; P < 0.001) at the last test.

CONCLUSIONS

An intervention of music therapy combined with aerobic exercise can significantly improve the sleep quality of female breast cancer patients undergoing chemotherapy after a radical mastectomy, and this intervention continuously improves many aspects of sleep reactivity.

CLINICAL TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100042975, 02/02/2021).

Sleep Quality and Subjective Cognitive Decline among Older Adults: The Mediating Role of Anxiety/Depression and Worries

Background

Subjective cognitive decline (SCD) in older individuals has been implicated as a possible precursor to Alzheimer's disease. Poor sleep quality and anxiety/depressive symptoms have been linked to the progression of SCD, but these associations and older adults' worries have yet to be fully established in the Chinese older adult population, which is one of the largest in the world. The aim of this study was to explore the relationship between sleep quality, anxiety/depression symptoms, and worries, and SCD prevalence among Chinese community-dwelling older individuals.

Methods

A total of 707 adults aged between 60 and 99 from Shanghai, China, completed self-report questionnaires that covered their cognitive and mental well-being, as well as demographic information. Subjective cognitive decline (SCD) was evaluated using the memory/cognition syndromes of the old adult self-report (OASR). Sleep quality, anxiety/depression, and worries were measured from their respective sections of the OASR.

Results

The general linear regression models showed that poorer sleep quality was associated with an increased prevalence of anxiety/depression symptoms, worries, and SCD among older adults. As suggested by the mediation analysis, anxiety/depression and worries were significant mediators in the relationship between sleep quality and SCD prevalence, and these two factors also have a serial mediation effect between sleep quality and SCD prevalence.

Conclusions

Poorer sleep quality is associated with a higher rate of SCD among older adults, and a higher prevalence of anxiety/depression and worries mediate this relationship, suggesting possible mechanism pathways that lead to SCD. These factors may provide the basis for early, targeted interventions for older adults' mental health preservation and improved quality of life.

Liver fat as a dietary target by Chinese Medical Nutrition Therapy (CMNT) diet for treating type 2 diabetes with non-alcoholic fatty liver disease: study protocol for a randomised controlled trial

INTRODUCTION

Type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) often coexist and increase risk for developing liver fibrosis and diabetes complications if no effective measures are taken. Dietary intervention is known to be able to achieve diabetes remission, while evidence regarding the long-term effect on liver fat is limited for comorbidity management of type 2 diabetes and NAFLD. This study aims to investigate the long-term effect of a Chinese Medical Nutrition Therapy (CMNT) diet accompanied by intermittent energy restriction on reducing liver fat and glycated haemoglobin (HbA1c) in patients with type 2 diabetes and NAFLD.

METHODS AND ANALYSIS

This is a multicentre two-armed parallel randomised controlled trial study. 120 participants with type 2 diabetes and NAFLD will be recruited from the physical examination centres of multiple hospitals in China. Participants will be randomly allocated 1:1 to either the CMNT group or the usual care group. The CMNT group will be instructed to consume the provided specific meal replacement Chinese medicinal foods consisting of 6 cycles of 5 consecutive days followed by 10 days of regular food intake. The usual care group will be given standard dietary advice. Primary outcomes are changes in the controlled attenuation parameter value by transient elastography and HbA1c level. Secondary outcomes include differences in anthropometrics, clinical blood markers, questionnaires, gut microbiota and metabolomics. Further follow-up will be performed at 6 months, 1 year and 2 years.

ETHICS AND DISSEMINATION

The study protocol was approved by the Biomedical Research Ethics Committee of Hunan Agricultural University (BRECHAU20200235).The results will be disseminated via relevant peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT05439226.

Association between movement behavior patterns and cardiovascular risk among Chinese adults aged 40-75: a sex-specific latent class analysis

BACKGROUND

Cardiovascular disease (CVD) is a major global health threat, particularly in China, contributing to over 40% of deaths. While sleep behaviors, sedentary behaviors, and physical activities are recognized as independent lifestyle risk factors for CVD, there remains limited understanding of specific movement behavior patterns and their CVD risks, especially considering sex-specific differences. This study examines movement behavior patterns among Chinese adults (40-75) and their associations with cardiovascular risk, with a focus on sleep, physical activity (PA), and sedentary behavior (SB).

METHODS

Data pertaining to 13,465 male participants and 15,613 female participants, collected from the Chronic Disease and Risk Factor Surveillance Survey in Nanjing from February 2020 to December 2022. The latent class analysis method was employed to identify underlying movement patterns across sexes. Multinomial logistic regression models assessed CVD risk, and the China-PAR model calculated 10-year risk.

RESULTS

Three male and four female movement patterns emerged. Active Movers (17.10% males, 5.93% females) adhered to PA recommendations but had poorer sleep quality. Moderate Achievers (61.42% males, 45.32% females) demonstrated moderate behavior. Sedentary Sleepers (21.48% males, 10.20% females) exhibited minimal PA but good sleep. Female Moderate Physical Activity (MPA) Dominant Movers demonstrated a prevalent adherence to recommended MPA levels. Active movers had the lowest CVD risk. After adjusting for potential confounders, moderate achievers (OR = 1.462, 95% CI 1.212, 1.764) and sedentary sleepers (OR = 1.504, 95% CI 1.211, 1.868) were both identified as being associated with a high-risk of cardiovascular diseases (CVDs) compared to active movers in males, demonstrating a similar trend for intermediate risk. Such associations were not statistically significant among females.

CONCLUSIONS

Our study revealed sex-specific movement patterns associated with CVD risks among middle-aged Chinese adults. We suggest that adopting an active movement behavior pattern, characterized by meeting or exceeding recommended levels of vigorous physical activity (VPA) and reducing sedentary behavior, is beneficial for all middle-aged adults, particularly males. An active lifestyle could help counteract the adverse effects of relatively poor sleep quality on the risk of developing CVD in this population. Integrating sleep, PA, and SB information provides a holistic framework for understanding and mitigating CVD risks.

Prevalence of Risk Factors Associated With Poor Quality of Sleep in People Living with HIV and the Correlation between Quality of Sleep and Cd4+ T Lymphocyte Reconstitution: A Cross-Sectional Study from Turkey

INTRODUCTION

The prevalence of sleep disorders in people living with HIV (PLWH) is higher than in the general population. Even if viral suppression is achieved with Antiretroviral Therapy (ART), the chronic immune activation and increased inflammation due to immune reconstitution persist. The aim of our study was to determine the prevalence of poor quality of sleep (QoS) and associated risk factors in PLWH and to investigate the relationship between poor QoS and CD4 T lymphocyte count and CD4 reconstitution.

METHODS

PLWH ≥18 years old, attending for routine HIV monitoring were recruited. PLWH with conditions that may affect their QoS (pregnant, hospitalized, malignancy, substance-alcohol abuse, psychiatric disease or treatment, sleeping pill) were excluded. Pittsburgh Sleep Quality Index (PSQI, score ≥5 indicates poor QoS), Epworth Sleepiness Scale (ESS, score ≥11 indicates daytime sleepiness), and Beck Depression Scale (BDS, score ≥10 indicates clinical depression) were applied. CD4+ T lymphocyte reconstitution (current-baseline CD4+ count) and CD4+ T lymphocyte reconstitution rate [(current-baseline CD4+ count)/duration of HIV infection in years] were calculated for PLWH on ART. Student t-test and Pearson's chi-squared test were used for analysing the data, and p<0.05 was considered significant.

RESULTS

A total of 131 (15 newly diagnosed, 116 on ART for at least six months) PLWH were enrolled. Poor QoS was detected in 60.3% of PLWH. When compared, the ratio was higher in newly diagnosed PLWH (vs PLWH on ART, p>0,05). Daytime sleepiness in PLWH with poor Qos (p=0.04) was significantly increased (vs good QoS). Clinical depression (p=0.001) was significantly more common in PLWH with poor QoS (vs good QoS). Although statistically nonsignificant (p>0,05), younger age, female sex, being single, homosexüel sexual preference, high income and living with the family were associated with poor QoS. No association was found between the ART regime and QoS. PLWH with poor QoS had a higher CD4+ T lymphocyte count (p>0,05), a higher number of CD4+ T lymphocyte reconstitution (p<0.05), and a higher reconstitution rate than PLWH with good QoS (p<0.05).

CONCLUSION

Prevalence of poor QoS was high in our cohort. Poor QoS was associated with CD4+ T lymphocyte reconstitution and reconstitution rate.

Clinical characteristics of patients with interstitial cystitis/bladder pain syndrome combined with migraine

OBJECTIVES

Interstitial cystitis/bladder pain syndrome (IC/BPS) and migraine are both chronic pain syndromes with similarities in pathophysiology and clinical presentation. This study aims to investigate the clinical characteristics of IC/BPS patients with comorbid migraine.

METHODS

A retrospective analysis was conducted on the clinical data of 303 IC/BPS patients treated at the Second and Third Affiliated Hospitals of Qiqihar Medical University from January 2019 to December 2023. Disease severity, bladder pain and/or headache intensity, anxiety, depression, sleep quality, somatic symptoms, and quality of life were assessed using the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI), Numerical Rating Scale (NRS), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), Self-Rating Somatic Symptom Scale (SSS), and Visual Analogue Scales (VAS) for quality of life. Serum inflammatory cytokines [interleukin-1β (IL-1β), interleukin-6 (IL-6)] and pain mediators [prostaglandin E2 (PGE2), substance P (SP)] were measured using enzyme-linked immunosorbent assay (ELISA).

RESULTS

Among the 303 IC/BPS patients, 87 (28.71%) had comorbid migraine. Compared to IC/BPS patients without migraine, those with migraine had a longer IC/BPS duration, higher ICSI scores, elevated bladder pain NRS, GAD-7, PHQ-9, PSQI, SSS, VAS scores for quality of life, and higher serum levels of IL-1β, IL-6, PGE2, and SP, along with fewer weekly exercise sessions (all P<0.05). Among the 87 IC/BPS patients with migraine, the 39 patients with severe IC/BPS had higher headache frequency, longer headache duration, and significantly higher headache NRS, bladder pain NRS, GAD-7, PSQI, SSS, VAS scores for quality of life, and serum levels of IL-1β, IL-6, PGE2, and SP compared to the 48 patients with mild-to-moderate IC/BPS (all P<0.05). In IC/BPS patients with migraine, ICSI scores were positively correlated with headache NRS (r=2.072, P=0.032), headache frequency (r=2.184, P=0.028), headache duration (r=1.843, P=0.041), bladder pain NRS (r=2.295, P=0.023), GAD-7 scores (r=2.210, P=0.025), SSS scores (r=3.159, P=0.009), and VAS scores for quality of life (r=2.891, P=0.013) but not with PSQI scores (r=1.515, P=0.070).

CONCLUSIONS

Patients with IC/BPS and comorbid migraine exhibit more severe clinical and psychological symptoms. The severity of IC/BPS symptoms is associated with migraine severity.

Reduced left hippocampal perfusion is associated with insomnia in patients with cerebral small vessel disease

OBJECTIVES

Insomnia was associated with cerebral structural changes and Alzheimer's disease. However, associations among cerebral perfusion, insomnia with cerebral small vessel disease (CSVD), and cognitive performance were little investigated.

METHODS

This cross-sectional study included 89 patients with CSVDs and white matter hyperintensities (WMHs). They were dichotomized into the normal sleep and poor sleep group, according to Pittsburgh sleep quality index (PSQI). Baseline characteristics, cognitive performance, and cerebral blood flow (CBF) were measured and compared between the two groups. The association or correlation between cerebral perfusion, cognition, and insomnia was analyzed using binary logistic regression.

RESULTS

Our study found that declined MoCA score (P = .0317) was more prevalent in those with poor sleep. There was a statistical difference in the recall (P = .0342) of MMSE, the delayed recall (P = .0289) of MoCA between the two groups. Logistic regression analysis showed educational background (P < .001) and insomnia severity index (ISI) score (P = .039) were independently correlated with MoCA scores. Arterial spin labeling demonstrated that left hippocampal gray matter perfusion was significantly reduced (P = .0384) in the group with poor sleep. And, negative correlation was found between left hippocampal perfusion and PSQI scores.

CONCLUSIONS

In the patients with CSVDs, insomnia severity was associated with cognitive decline. Left hippocampal gray matter perfusion was correlated with PSQI scores in CSVDs.

Non-pharmacological interventions for improving sleep in people living with HIV: a systematic narrative review

Background

Sleep disturbances are common in people living with Human Immunodeficiency Virus (HIV) and may lead to poor adherence to antiretroviral therapy and worsen HIV symptom severity. Due to the side effects of pharmacotherapy for sleep disturbances, there is more room for non-pharmacological interventions, but knowledge of how these non-pharmacological interventions have been used to improve sleep in people living with HIV (PLWH) is still missing.

Objective

To investigate the content of non-pharmacological interventions, sleep measurements, and the impact of these interventions on improving sleep in PLWH.

Methods

Following PRISMA guidelines, we conducted a systematic search on PubMed, EMBASE, Cochrane Central Registry of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, China National Knowledge Infrastructure, Wanfang Data, and China Biology Medicine disc. Non-pharmacological interventions for improving sleep in PLWH were included, and study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. We performed a narrative approach to synthesize the data to better understand the details and complexity of the interventions.

Results

Fifteen experimental studies in three categories for improving sleep in PLWH were included finally, including psychological interventions (components of cognitive-behavioral therapy for insomnia or mindfulness-based cognitive therapy, n = 6), physical interventions (auricular plaster therapy, acupuncture, and exercise, n = 8), and elemental interventions (speed of processing training with transcranial direct current stimulation, n = 1). Wrist actigraphy, sleep diary, and self-reported scales were used to measure sleep. Psychological interventions and physical interventions were found to have short-term effects on HIV-related sleep disturbances.

Conclusions

Psychological and physical interventions of non-pharmacological interventions can potentially improve sleep in PLWH, and the combination of patient-reported outcomes and actigraphy devices can help measure sleep comprehensively. Future non-pharmacological interventions need to follow protocols with evidence-based dosing, contents, and measures to ensure their sustainable and significant effects.

Evaluation of lifestyle behaviors, anxiety and depression in patients with hematologic disorders

Patients with hematologic disorders may experience anxiety and depression due to their immunocompromised status and potential side effects of therapies. Healthy lifestyle behaviors might enhance the mental health. To evaluate the association of both separate and clustering pattern lifestyle behaviors with anxiety and depression in hematological patients, healthcare providers can develop future initiatives that respond to the specific needs of this population. A total of 185 patients with hematologic disorders were enrolled in this cross-sectional study. Linear regression analysis was performed to measure the association of separate lifestyles with anxiety and depression. Latent class analysis was further conducted to identify homogeneous and mutually exclusive lifestyle classes, and the logistic regression was then used to assess the relationship between class memberships and symptoms of anxiety and depression. The study found sleep quality was correlated with anxiety and depression. Nevertheless, no association of anxious and depressive symptoms with sitting and exercise, dietary habits, toxicant exposure, drinking, and smoking, in either the overall patient population or patients classified by hematologic neoplasms. Two latent classes of lifestyle behaviors were further identified, but the class memberships were independent of anxiety and depression. The study suggested that promoting sleep quality was a viable intervention for patients with hematologic disorders. However, the clustering pattern of lifestyles may not be a reliable indicator of psychological issues.

Association between psychological discomforts and sleep quality among people living with HIV/AIDS

BACKGROUND

Psychological discomfort and sleep problems are considered separate disorders. Due to the high prevalence of both disorders among people living with HIV (PLWH), this study was designed to evaluate how those challenges are present among PLWH.

METHOD

A cross-sectional study was conducted using data from a national survey of 1185 confirmed PLWH from 15 provinces in Iran from April to August 2019. Psychological discomfort and sleep quality were assessed using standardized versions of related Persian questionnaires. Logistic regression was used to assess the association between psychological discomfort and sleep quality in PLWH.

RESULTS

The overall prevalence of poor sleep quality, depression, anxiety, and stress was 47.71%, 50.95%, 44.26%, and 41.77%, respectively. The results of multivariate-adjusted logistic regression showed that each psychological discomfort covariate increased the odds of poor sleep quality. Depression by adjusting for anxiety and stress, anxiety by adjusting for depression and stress, and stress by adjusting for depression and anxiety all increased the odds of poor sleep quality.

CONCLUSION

A high prevalence of psychological discomfort was observed in PLWH. Depression, anxiety, and stress were strongly associated with sleep quality. PLWH needed more attention and social support in order to reduce sleep and psychological issues.

The prevalence and associated factors of sleep deprivation among healthy college students in China: a cross-sectional survey

Background

The prevalence of sleep deprivation among college students is increasing and has a few associated factors.

Methods

The present study analyzed 2,142 college students from 28 provinces in China. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep duration. Binary logistic regression was conducted to explore the sleep deprivation related factors. Age and gender were controlled as covariates.

Results

Among the 2,142 college students (27.7% male, 72.3% female), 1,620 (75.6%) reported the average sleep duration was below 7 h per day for one month, 49.3% (1,055/2,142) slept 6∼7 h (contains 6 h), 21.0% (449/2,142) slept 5∼6 h (contains 5 h), and 5.4% (116/2,142) slept <5 h. Age increased the risk of sleep deprivation, the adjusted odds ratio = 1.05 (95% CI [1.01∼1.10]). The adjusted odds ratio (A-OR) for sleep deprivation was higher for students of more than 60 min nap duration per day (A-OR = 2.35, 95% CI [1.45∼3.80]), and age growth (A-OR = 1.05, 95% CI [1.01∼1.10]). In contrast, A-ORs were lower among sleeping inconsistency between work and rest days (A-OR = 0.61, 95% CI [0.49∼0.75]), accustomed to staying up late (A-OR = 0.45, 95% CI [0.36∼0.57]), staying up late to work or study (A-OR = 0.62, 95% CI [0.49∼0.78]), stress (A-OR = 0.75, 95% CI [0.58∼0.98]), and repeated thoughts in bed had (A-OR = 0.79, 95% CI [0.62∼0.99]).

Conclusions

Sleep deprivation is extremely common among healthy college students in China. It is necessary to perform methods maintaining enough sleep due to the current high incidence of sleep deprivation. Controlling the nap duration and getting enough sleep on rest days to replace missing hours of sleep on workdays might improve college students' sleep.

Loneliness, depression and sleep quality among the type 2 diabetic patients during COVID-19 local epidemic: A mediation analysis

AIMS

To investigate loneliness, depression and sleep quality in patients with Type 2 Diabetes (T2DM) and to examine the mediating role of depression between loneliness and sleep quality among this group of patients with T2DM.

DESIGN

A cross-sectional study.

METHODS

A group of T2DM patients was recruited from a tertiary hospital affiliated with a university in Wuhu City, Anhui Province from May to October 2021 by convenient sampling. Pearson correlation analysis and structural equation modelling were used for data analysis in this study.

RESULTS

The direct effect of loneliness on sleep quality was not statistically significant, but the indirect effect of depression on sleep quality was statistically significant. Depression mediated the relationship between loneliness and sleep quality. Depression can affect emotional health and reduce sleep quality. We should reduce the loneliness of patients, prevent the occurrence of depression and improve the quality of sleep.

Sleep quality, social rhythms, and depression among people living with HIV: a path analysis based on social zeitgeber theory

Background

People living with HIV frequently report sleep disturbances. The social zeitgeber theory, which proposes that stressful life events can interfere with sleep and even depression by destabilizing daily routines, provides new insights into identifying predictors of sleep disturbances and improving sleep in people living with HIV.

Objective

To explain the pathways affecting sleep quality in people living with HIV based on social zeitgeber theory.

Methods

A cross-sectional study was conducted to assess sleep quality, social rhythms, depression, social support, and coping styles from December 2020 to February 2021. The hypothetical model was tested and respecified by performing path analysis and a bias-corrected bootstrapping method using IBM AMOS 24 software. The report of this study followed the STROBE checklist.

Results

A total of 737 people living with HIV participated in the study. The final model presented a good fit (goodness of fit = 0.999, adjusted goodness of fit index = 0.984, normed fit index = 0.996, comparative fit index = 0.998, Tucker-Lewis index = 0.988, root mean square error of approximation = 0.030, chi-squared/degree of freedom = 1.646), explaining 32.3% of the variance in sleep quality among people living with HIV. Lower social rhythm stability was directly associated with poorer sleep quality, and depression mediated the relationship between social rhythms and sleep quality. Social support and coping styles affected sleep quality through social rhythms and depression.

Limitation

The cross-sectional study design precludes making assumptions about causality among factors.

Conclusion

This study validates and extends the applicability of the social zeitgeber theory in the HIV context. Social rhythms have direct and indirect effects on sleep. Social rhythms, sleep, and depression is not simply linked in a cascading sequence but is theoretically linked in a complex way. More studies are needed to explore the predictors of social rhythms, and interventions for stabilizing social rhythms have the potential to alleviate sleep disturbances and depression in people living with HIV.

Prevalence and predicors of COVID-centred obsessive compulsive disorder among Iranian COVID-19 recovered individuals: a Bayesian analysis

BACKGROUND

The evidence on the psychological consequences of coronavirus 2019 mainly relates to general psychiatric problems, and a few studies have reported the incidence and predictors of obsessive-compulsive disorder.

OBJECTIVE

To determine the prevalence of obsessive-compulsive disorder (OCD) and its predictors in Iranian COVID - 19 recovered individuals at 3-6 months, 6-12 months, and 12-18 months after recovery.

METHOD

In this cross-sectional analytical study, 300 participants were randomly selected based on the inclusion criteria from three hospitals in three different regions of Tehran, Iran, and were assessed by the Clinical Demographic Information Questionnaire, the Obsessive Compulsive Inventory-Revised (OCI-R), the Depression, Anxiety and Stress Scale 21 (DASS21), The Pittsburgh Sleep Quality Index (PSQI) and Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). The obtained data were analyzed with SPSS version 26.

RESULTS

The results showed that the mean score of OCD is 30.58 ± 15.22, with a prevalence of 71% (n = 213). Female gender (BF = 0.50, p = 0.01), sleep disturbance (BF = 0.02, p = 0.001), PTSD (BF = 0.009, p = 0.0001), depression (BF = 0.0001, p = 0.0001), and stress (BF = 0.0001, p = 0.001) are the strongest predictors of the presence of OCD in recovered COVID - 19 individuals.

CONCLUSION

OCD-like symptoms was observed in the majority of COVID - 19 recovered individuals with mild to moderate severity. In addition, the stated prevalence, severity, and significance varied according to sociodemographic and health inequalities.

The risk factors of progestational anxiety, depression, and sleep disturbance in women with recurrent pregnancy loss: A cross-sectional study in China

Background

The risk factors of progestational anxiety, depression, and sleep disturbance in women with a history of recurrent pregnancy loss (RPL) remain controversial, additional study is needed to investigate the incidence and risk factors of progestational anxiety, depression, and sleep quality in RPL women.

Methods

A cross-sectional study was conducted among 663 non-pregnant RPL women in Northeast China from October 2019 to July 2022. We assessed the state of anxiety, depression, and sleep quality before pregnancy using structured questionnaires, including sociodemographic characteristics, state-trait anxiety scale (STAI), center for epidemiological survey, depression scale (CES-D), Pittsburgh sleep quality index (PSQI), and symptom self-rating scale (SCL-90). Logistic regression was used to evaluate the association between sleep quality and anxiety, depression. Pearson’s correlation was used to evaluate the correlation between anxiety and depression. Multivariate logistic regression analysis was used to find the risk factors of depression symptoms. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of the model.

Results

The incidence of state anxiety, trait anxiety, depression, and sleep disturbance in RPL women were 60.3, 51.7, 33.9, and 31.2%, respectively. The level of anxiety and depression in RPL women varied at different stages of treatment. In a longitudinal study (25 pairs), we found the level of state anxiety and trait anxiety were significantly lower after the cause was identified. Sleep disturbance is positively correlated with anxiety and depression. Logistic regression showed that the number of miscarriages ≥4 (Odds ratio (OR) = 2.268, 95%CI 1.300–3.956), Low household family income (OR = 1.613, 95%CI 1.036–2.513/OR = 2.361, 95%CI 1.095–5.092), interval since last miscarriage &lt;6 months (OR = 2.154, 95%CI 1.246–3.726) and sleep disturbance (OR = 5.523, 95%CI 3.542–8.614) were associated with the occurrence of depressive symptoms. At the same time, anxiety can be used as a predictor of depression.

Conclusion

Recurrent pregnancy loss women have a certain degree of anxiety, depression, and sleep disturbance. Education level, interval since the last miscarriage &lt;6 months, and sleep disturbance are risk factors for anxiety and depression. A history of pregnancy loss after 14 weeks and no living birth are also closely related to anxiety. Therefore, it is necessary to pay close attention to the psychological state of RPL women and provide appropriate psychosocial support to reduce the occurrence of negative emotions.

Cardiometabolic Diseases and Quality-of-Life Outcomes in Adults With HIV in the Deep South: A Cross-sectional Study

ABSTRACT

The role of cardiometabolic diseases (CMDs) on physical health-related quality of life (P-HRQoL) and quality of sleep was examined among 261 PLWH ≥40 years, recruited from a university-affiliated HIV clinic in the Deep U.S. South. Using a cross-sectional study design, participants completed the Medical Outcomes Study HIV Health Survey (MOS-HIV; P-HRQoL) and Pittsburgh Sleep Quality Index. The overall prevalence of self-reporting ≥1 CMD was 64.4%. P-HRQoL scores were lower in PLWH with ≥1 CMD compared with those with no CMDs (45.53 ± 11.54 vs. 49.67 ± 10.77, p <.01). Poor sleep quality was higher among participants with ≥1 CMD compared with those with no CMDs (9.28 ± 4.42 vs. 7.26 ± 4.17, p <.01). Each additional CMD resulted in a 1.83-point decrease in P-HRQoL and 0.74-point increase in poor sleep quality scores. Interventions that focus on targeting these quality-of-life domains in PLWH with CMDs are needed.

Efficacy of repetitive transcranial magnetic stimulation and agomelatine on sleep quality and biomarkers of adult patients with mild to moderate depressive disorder

BACKGROUND

Mild to moderate depressive disorder (DD), which accounts for much larger patient population, has been largely neglected in previous studies exploring the sleep quality of DD patients; in addition, most of these patients had comorbid insomnia. Thus, this study aimed to explore the effect of repetitive transcranial magnetic stimulation (rTMS) and agomelatine on sleep quality of adult patients with mild to moderate DD.

METHODS

100 participants were randomly divided into high-frequency rTMS group and sham rTMS group (n = 50 each). All patients were administered agomelatine simultaneously. Hamilton Depression Scale-17 Items (HAMD-17), Pittsburgh Sleep Index (PSQI), and polysomnography were used to evaluate the efficacy. Serum norepinephrine (NE), 5-hydroxytryptamine, brain-derived neurotrophic factor (BDNF), and melatonin were also determined.

RESULTS

The HAMD-17 and PSQI scores in high-frequency rTMS group were lower than those in sham rTMS group at the 4th and 8th weekend after treatment (P < 0.05). Post-treatment total sleep time, sleep efficiency, and N3 percentage in high-frequency rTMS group were better than those in sham rTMS group (P < 0.05); while post-treatment sleep latency, awakening time, micro-awakening times, and N1 percentage were significantly less than those in sham rTMS group (P < 0.01). Post-treatment serum levels of NE and BDNF in high-frequency rTMS group were higher than those in sham rTMS group (P < 0.05).

LIMITATIONS

Small sample size and short follow-up duration.

CONCLUSION

The combination of high-frequency rTMS and agomelatine is effective in the treatment of mild to moderate DD, which can improve the sleep quality and increase the levels of some neurotransmitters and neurotrophic factors.

A moderated serial mediation analysis of the association between HIV stigma and sleep quality in people living with HIV: a cross-sectional study

With the wide use of antiretroviral therapy in people living with HIV (PLWH), the mortality and morbidity rates among this community are dramatically decreasing. However, sleep disorder is still one of the prominent health issues among PLWH, and it lowers their quality of life. Although we already know the potential biological pathway that links poor sleep quality among PLWH, the potential contribution of the psychosocial pathway (e.g., stigma) is far from understood. In this study, we aimed to explore the potential serial mediating effects (HIV stigma-loneliness-depression-sleep quality) and potential moderating effects of perceived social support. We recruited a consecutive sample of 139 participants from voluntary counseling testing (VCT) clinics of Beijing Youan Hospital and participant referrals. Then, we used serial mediation models and moderated serial mediation models to fit our data. We found significant serial mediation effects between three types of HIV stigma (enacted, anticipated, and internalized) and sleep quality via depression and loneliness. Perceived social support also significantly moderated this serial mediation between enacted stigma, internalized stigma, and sleep quality. Our results highlight the potential role of perceived social support in moderating the negative effects of enacted and internalized stigma on sleep quality and identify potential psychosocial pathways.

Association of lifestyle behaviors with health-related quality of life among patients with hematologic diseases

PURPOSE

Health-related quality of life (HRQoL) is a multi-dimensional construct used to assess the impact of health status on quality of life, and it is known to be affected by lifestyle behaviors. This study focused on multiple lifestyle behaviors among patients with hematologic diseases, including physical activity, dietary intake, sleep quality, occupational exposure, alcohol consumption and smoking. The main objective was to investigate the association of both individual and clustering of health behaviors with HRQoL among the population with hematologic diseases based on a comprehensive lifestyle survey.

METHODS

A total of 539 patients with hematologic diseases aged over 18 years were enrolled in this cross-sectional study. Latent class analysis was used to identify homogeneous, mutually exclusive lifestyle classes, and multinomial logistic regression was then performed to explore the association of lifestyle classes membership with HRQoL. Meanwhile, multiple linear regression and quantile regression were used to identify the relationship between individual lifestyle behaviors and HRQoL.

RESULTS

A three-class model was selected based on conceptual interpretation and model fit. We found no association between multiple lifestyle behaviors and HRQoL in the 3-class model, either in the whole patients or in subgroups stratified by hematological malignancies. Further research on each lifestyle found that physical activity, dietary intake, occupational exposure, alcohol consumption or smoking were independent of HRQoL. Sleep quality was positively associated with HRQoL.

CONCLUSION

Our findings suggested that clustering of lifestyle behaviors may not be an indicator to reflect the health quality of patients with hematologic diseases. Sleep represents a viable intervention target that can confer health benefits on the hematologic patients.

Psychological and sleep disturbances among first-line, second-line, and at home medical staff during the COVID-19 pandemic in Shanghai, China

Objectives

Medical workers are prone to psychological and sleep disturbances during the coronavirus disease 2019 (COVID-19) pandemic. Little is known about the varying degrees of influence among vaccinated medical staff working in different positions. The current study is aimed to evaluate and compare depression, anxiety and sleep disturbances among first-line, second-line and at home vaccinated medical staff during the COVID-19 pandemic in Shanghai, China.

Methods

A cross-sectional online survey was conducted in May 2022. In addition to demographic data, levels of depression, anxiety, sleep quality, and insomnia were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index (PSQI), and Athens Insomnia Scale (AIS).

Results

A total of 236 vaccinated medical workers completed the questionnaires, including 85 first-line medical staff (FMS), 82 second-line medical staff (SMS) and 69 at home medical staff (HMS). The proportions of depressive symptoms, anxiety symptoms, poor sleep quality, and insomnia were 52.1, 44.1, 55.9, and 49.2%, respectively. Compared with HMS, medical staff at work (FMS and SMS) got significantly higher frequency of poor sleep quality (both p < 0.001), insomnia (both p < 0.001), depressive (p < 0.001 and p = 0.003, respectively) and anxiety symptoms (p < 0.001 and p = 0.002, respectively). Compared with SMS, FMS were more likely to have poor sleep quality (p = 0.020). Besides, nurses got significantly higher percentage of poor sleep quality (OR = 1.352, p = 0.016) and insomnia (OR = 1.243, p = 0.041) than doctors. Whereas, the proportion of anxiety symptoms was increased in females than in males (OR = 2.772, p = 0.008).

Conclusions

Psychological and sleep disturbances are common among medical staff at work during the COVID-19 pandemic. More psychological intervention should be administrated for FMS, especially for nurses.

Efficacy of music therapy and predictors of sleep disturbance among patients with chronic schizophrenia: A prospective study

STUDY OBJECTIVES

Patients with schizophrenia often suffer from sleep disturbance. Music therapy, as a non-invasive intervention, may have benefit on sleep problem in such population. Our study aimed to investigate the efficacy of music therapy on sleep disturbance among patients with schizophrenia.

METHOD

This prospective study recruited participants with schizophrenia along with sleep disturbances in the chronic wards. Patients in the control group received standard care, and those in the intervention group received additional music therapy before sleeping at night for four weeks. The Pittsburgh Sleep Quality Index (PSQI) was used to measure the severity of sleep disturbance. The generalized estimating equation (GEE) was used to analyze measure the difference of change in PSQI scores between both groups at the baseline and four weeks later. It was also applied to find the predictors of treatment efficacy within intervention group.

FINDINGS

A total of 66 (31 in control group and 35 in intervention group) participants were recruited. After adjusting with the demographic variables, the change of PSQI among intervention group was significantly more than the change among control group (Group × time; Estimate = -7.05, p < 0.001), indicating the efficacy of music therapy. In addition, irreligious patients and those with chronic medical disease predicted better efficacy. Whereas, elderly patients had compromising efficacy of music therapy.

CONCLUSION

Music therapy demonstrated its merit on sleep disturbance among patients with schizophrenia. Whereas, healthcare workers should consider the variability of severity in schizophrenia during clinical practice.

Risk factors and prediction model of sleep disturbance in patients with maintenance hemodialysis: A single center study

Objectives

This study aimed to explore the risk factors and develop a prediction model of sleep disturbance in maintenance hemodialysis (MHD) patients.

Methods

In this study, 193 MHD patients were enrolled and sleep quality was assessed by Pittsburgh Sleep Quality Index. Binary logistic regression analysis was used to explore the risk factors for sleep disturbance in MHD patients, including demographic, clinical and laboratory parameters, and that a prediction model was developed on the basis of risk factors by two-way stepwise regression. The final prediction model is displayed by nomogram and verified internally by bootstrap resampling procedure.

Results

The prevalence of sleep disturbance and severe sleep disturbance in MHD patients was 63.73 and 26.42%, respectively. Independent risk factors for sleep disturbance in MHD patients included higher 0.1^*age (OR = 1.476, 95% CI: 1.103–1.975, P = 0.009), lower albumin (OR = 0.863, 95% CI: 0.771–0.965, P = 0.010), and lower 10^*calcium levels (OR = 0.747, 95% CI: 0.615–0.907, P = 0.003). In addition, higher 0.1^*age, lower albumin levels, and anxiety were independently associated with severe sleep disturbance in MHD patients. A risk prediction model of sleep disturbance in MHD patients showed that the concordance index after calibration is 0.736, and the calibration curve is approximately distributed along the reference line.

Conclusions

Older age, lower albumin and calcium levels are higher risk factors of sleep disturbance in MHD, and the prediction model for the assessment of sleep disturbance in MHD patients has excellent discrimination and calibration.

Evaluation of the correlation between frailty and sleep quality among elderly patients with osteoporosis: a cross-sectional study

Background

The incidence of osteoporosis increases with age. Frailty is a distinct characteristic seen in older osteoporosis patients. Poor sleep quality is common in elderly individuals. However, there are few studies on the correlation between frailty and sleep quality in elderly patients with osteoporosis in China.

Methods

This cross-sectional study was conducted from December 8, 2020, to April 30, 2021. A total of 247 patients who met the inclusion and exclusion criteria were recruited in outpatient departments at West China Hospital. A self-designed demographic data questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Frailty Phenotype scale were used to evaluate the sleep quality and frailty of the participants. Multivariate logistic regression was performed to evaluate the factors affecting frailty and sleep quality in osteoporosis patients.

Results

A total of 231 valid questionnaires were statistically analysed. The mean frailty score was 3.2 ± 1.6 and a total of 152 (65.8%) were frailty. The mean PSQI score was 11.9 ± 4.5 and a total of 183 (79.2%) patients had poor sleep quality (PSQI > 7). Multiple logistic regression showed that female, pain, polypharmacy, activities of daily living status (ADLs), and sleep quality were independent influencing factors for frailty, while comorbidity, ADLs and frailty status were independent influencing factors for sleep quality.

Conclusion

We found that frailty and sleep quality were prevalent and that frailty was positively correlated with the PSQI score in elderly patients with osteoporosis in China. The higher the frailty score is, the worse the sleep quality. It means the frailer old patients were, the worse their sleep quality, and poor sleep quality may increase the risk of frailty in elderly patients with osteoporosis. To manage elderly patients with osteoporosis effectively, medical staff should pay attention to frailty, sleep quality and its influencing factors.

Exploring Psychoneurological Symptom Clusters in Acute Stroke Patients: A Latent Class Analysis

Purpose

To identify latent classes of acute stroke patients with distinct experiences with the symptom clusters of depression, anxiety, fatigue, sleep disturbance, and pain symptoms and assess, if the selected variables determine a symptom-cluster experience in acute stroke patients.

Participants and Methods

A sample of 690 participants were collected from July 2020 to December 2020 in a cross-sectional descriptive study. Latent class analysis was conducted to distinguish different clusters of acute stroke participants who experienced five patient-reported symptoms. Furthermore, multinomial logistic regression was selected to verify the influencing indicators of each subgroup, with selected socio-demographic variables, clinical characteristics, self-efficacy, and perceived social support as independent variables and the different latent classes as the dependent variable.

Results

Three latent classes, named “all high symptom,” “high psychological disorder,” and “all low symptom,” were identified, accounting for 9.6%, 26.3%, and 64.1% of symptom clusters, respectively. Patients in the “all high symptom” and “high psychological disorder” classes reported significantly lower quality of life (F=40.21, p <0.05). Female gender, younger age, higher National Institutes of Health Stroke Scale scores, and lower self-efficacy and perceived social support were risk factors associated with the “high psychological disorder” class. Younger patients with lower self-efficacy and perceived social support were more likely to be in the “all high symptom” class.

Conclusion

This study identified latent classes of acute stroke patients that can be used in predicting symptom-cluster experiences following a stroke. Also, the ability to characterize subgroups of patients with distinct symptom experiences helps identify high-risk patients. Focusing on symptom clusters in clinical practice can inspire us to create effective targeted interventions for subgroups of stroke patients suffering from the same symptom cluster.

Sleep Disturbance in the Context of HIV: A Concept Analysis

Due to the differing definitions of the concept of sleep disturbance among people living with human immunodeficiency virus (HIV), reviewers in this area have not reached any firm conclusions. The study aimed to clarify and provide a stronger foundation for the definition of sleep disturbance in the context of HIV to enhance the concept's development. Following Beth Rodgers' concept analysis guidelines, two leading databases were searched, and 73 articles were used for this concept analysis. The attributes, surrogate terms, antecedents, and consequences of sleep disturbance have been identified using thematic analysis. In this analysis, two main attributes of sleep disturbance in the context of HIV were identified: a) subjective measures, including reduced total sleep time, difficulty falling asleep, nighttime and early morning awakenings, feeling sleepy and poorly rested after a night's sleep, frequent arousals, and irritability, and b) objective measures, including changes in sleep architecture and sleep continuity. Five antecedents of sleep disturbance in the context of HIV were identified. Meanwhile, the consequences of sleep disturbance in HIV are listed based on the frequency the points occur within the reviewed articles. The list is as follows: fatigue and pain; reduced neurocognitive functions; reduced health outcome and quality of life; poor anti-retroviral (ARV) therapy adherence; daytime sleepiness; depression, anxiety, and maladaptive coping; increased disease progression and cardiovascular mortality; and social phobia, living arrangement and sexual dysfunction. An improved understanding of sleep disturbance in the context of HIV will be beneficial in directing analysts to develop research plans. At the same time, the knowledge gaps identified in the analysis provided a solid basis for further study intending to fill in these gaps.

Sleep Quality and the Depression-Anxiety-Stress State of Frontline Nurses Who Perform Nucleic Acid Sample Collection During COVID-19: A Cross-Sectional Study

Objective

To explore the sleep quality and depression-anxiety-stress state of frontline nurses in high-risk areas who conduct nucleic acid sampling testing for COVID-19 to provide a basis for formulating intervention programs in crisis management.

Methods

From August 22 to 30, 2021, a convenient sampling method was used in Zhangjiajie City, Hunan Province, China. A total of 248 frontline nurses who performed nucleic acid sample collection were selected. The following tests were used: the general information questionnaire, Pittsburgh Sleep Quality Questionnaire (PSQI), and Depression–Anxiety Stress Scale (DASS-21).

Results

A total of 236 nurses completed the survey; 88.14% (n = 208) were women, the average age was 33.02±6.81, the PSQI score was 15 (13–17), and 231 (97.88%) nurses had sleep disorders during the period in Zhangjiajie, 219 nurses (81.36%) had anxiety, 135 nurses (45.76%) had depression, and 112 nurses (42.59%) felt stressed. Spearman correlation analysis was used to associate the PSQI with the DASS-21. The results showed that the use of hypnotic drugs was negatively correlated with DASS-21 (P<0.05), while the rest were positively correlated. The results of the multivariate analysis of sleep disorders showed that depression, anxiety, and stress were related to sleep quality (P<0.05), and there was no statistical difference in the other variables.

Conclusion

During the COVID-19 pandemic, the sleep quality and depression-anxiety-stress state of the frontline nurses performing nucleic acid testing were adversely affected. Sleep disturbance is a serious problem among nurses testing for the delta strain during the pandemic. Anxiety, stress, and depression are associated with sleep disorders. It is necessary to take corresponding measures and conduct crisis management interventions to improve sleep quality and mental health adjustment during public health emergencies.