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Tyler G, Machaalani R, Waters KA. Three-dimensional orthodontic imaging in children across the age spectrum and correlations with obstructive sleep apnea. J Clin Sleep Med 2023; 19:275-282. [PMID: 36123956 PMCID: PMC9892738 DOI: 10.5664/jcsm.10312] [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: 03/17/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES To determine baseline facial convexity measurements in children with obstructive sleep apnea (OSA) across the age spectrum. METHODS Polysomnogram, stereophotogrammetry, and biometric data were collected from children aged 0-18 years who were being investigated for OSA. Analyses evaluated differences in facial convexity according to OSA severity and other sleep parameters, while adjusting for age, ethnicity, and sex. RESULTS Ninety-one children, aged 0.05-16.02 years, met the inclusion criteria for this study. Initial analysis showed that the logarithm of age had a significant effect on facial convexity (P = 8.3·10-7) with significant effects of sex (P = 1.3·10-2), while excluding OSA. Ordinal logistic regression taking into consideration age, sex, weight, height, and ethnicity with OSA severity categorized as obstructive apnea-hypopnea index negative, mild, moderate, or severe showed that facial convexity was associated with OSA severity (P = 2.2·10-3); an increasing obtuse angle of convexity increased the tendency to be classified as having severe OSA. CONCLUSIONS Using three-dimensional imaging, we found an added impact of infancy on changes of facial convexity with age. While modeling could describe facial convexity without any OSA-associated sleep parameters, differences in facial convexity were present among groups with different levels of OSA severity adjusted for growth (age, weight, and height), sex, and ethnicity. The method provides a safer and cheaper alternative to other medical imaging techniques in children and holds potential for future use in studies of craniofacial structure. CITATION Tyler G, Machaalani R, Waters KA. Three-dimensional orthodontic imaging in children across the age spectrum and correlations with obstructive sleep apnea. J Clin Sleep Med. 2023;19(2):275-282.
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Affiliation(s)
- Gemma Tyler
- Faculty of Science, University of Sydney, Camperdown, New South Wales 2006, Australia
- Sleep Unit, The Children’s Hospital at Westmead, Westmead, New South Wales 2145, Australia
| | - Rita Machaalani
- Sleep Unit, The Children’s Hospital at Westmead, Westmead, New South Wales 2145, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales 2050, Australia
| | - Karen A. Waters
- Sleep Unit, The Children’s Hospital at Westmead, Westmead, New South Wales 2145, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales 2050, Australia
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2
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Eastwood P, Gilani SZ, McArdle N, Hillman D, Walsh J, Maddison K, Goonewardene M, Mian A. Predicting sleep apnea from three-dimensional face photography. J Clin Sleep Med 2021; 16:493-502. [PMID: 32003736 DOI: 10.5664/jcsm.8246] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES Craniofacial anatomy is recognized as an important predisposing factor in the pathogenesis of obstructive sleep apnea (OSA). This study used three-dimensional (3D) facial surface analysis of linear and geodesic (shortest line between points over a curved surface) distances to determine the combination of measurements that best predicts presence and severity of OSA. METHODS 3D face photographs were obtained in 100 adults without OSA (apnea-hypopnea index [AHI] < 5 events/h), 100 with mild OSA (AHI 5 to < 15 events/h), 100 with moderate OSA (AHI 15 to < 30 events/h), and 100 with severe OSA (AHI ≥ 30 events/h). Measurements of linear distances and angles, and geodesic distances were obtained between 24 anatomical landmarks from the 3D photographs. The accuracy with which different combinations of measurements could classify an individual as having OSA or not was assessed using linear discriminant analyses and receiver operating characteristic analyses. These analyses were repeated using different AHI thresholds to define presence of OSA. RESULTS Relative to linear measurements, geodesic measurements of craniofacial anatomy improved the ability to identify individuals with and without OSA (classification accuracy 86% and 89% respectively, P < .01). A maximum classification accuracy of 91% was achieved when linear and geodesic measurements were combined into a single predictive algorithm. Accuracy decreased when using AHI thresholds ≥ 10 events/h and ≥ 15 events/h to define OSA although greatest accuracy was always achieved using a combination of linear and geodesic distances. CONCLUSIONS This study suggests that 3D photographs of the face have predictive value for OSA and that geodesic measurements enhance this capacity.
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Affiliation(s)
- Peter Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia.,West Australian Sleep Disorders Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Syed Zulqarnain Gilani
- School of Computer Science and Software Engineering, University of Western Australia, Perth, Western Australia, Australia.,School of Science, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nigel McArdle
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia.,West Australian Sleep Disorders Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - David Hillman
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia.,West Australian Sleep Disorders Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jennifer Walsh
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia.,West Australian Sleep Disorders Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Kathleen Maddison
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia.,West Australian Sleep Disorders Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Mithran Goonewardene
- Oral Development and Behavioural Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Ajmal Mian
- School of Computer Science and Software Engineering, University of Western Australia, Perth, Western Australia, Australia
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3
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Abstract
Purpose of the Review Skin disease is associated with obstructive sleep apnea (OSA) both epidemiologically and mechanistically. In this review we highlight conditions which have a well-established link to obstructive sleep apnea, such as psoriasis and atopic dermatitis. Recent findings We describe putative mechanistic links between OSA and skin disease involving inflammatory pathways, obesity, mechanical upper airways obstruction, and hypoxia. In the context of these mechanisms we describe specific skin conditions, and other conditions which are associated with both skin manifestations (including hair/nail findings) and OSA. The risks/ benefits of CPAP in the context of skin disease are also reviewed. Summary We conclude that further research is needed to understand the mechanisms behind the associations between OSA and skin disease. Given the frequent co-occurrence of OSA and skin conditions, there would be great benefit for OSA clinical trials to consider improvement in skin disease as an outcome measure.
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Affiliation(s)
- Vinaya Soundararajan
- University of Illinois at Chicago, Department of Internal Medicine, Chicago, IL USA
| | - Jennifer Lor
- University of Illinois at Chicago, Department of Internal Medicine, Chicago, IL USA
- Ann & Robert H. Lurie Children's Hospital Department of Allergy, Division of Pediatric Allergy & Immunology, Chicago IL, USA
| | - Anna B Fishbein
- Ann & Robert H. Lurie Children's Hospital Department of Allergy, Division of Pediatric Allergy & Immunology, Chicago IL, USA
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4
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Patients With OSA Are Perceived as Younger Following Treatment With CPAP. Chest 2019; 156:553-561. [DOI: 10.1016/j.chest.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/06/2019] [Accepted: 03/01/2019] [Indexed: 11/19/2022] Open
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5
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Holding BC, Sundelin T, Cairns P, Perrett DI, Axelsson J. The effect of sleep deprivation on objective and subjective measures of facial appearance. J Sleep Res 2019; 28:e12860. [PMID: 31006920 DOI: 10.1111/jsr.12860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/28/2022]
Abstract
The faces of people who are sleep deprived are perceived by others as looking paler, less healthy and less attractive compared to when well rested. However, there is little research using objective measures to investigate sleep-loss-related changes in facial appearance. We aimed to assess the effects of sleep deprivation on skin colour, eye openness, mouth curvature and periorbital darkness using objective measures, as well as to replicate previous findings for subjective ratings. We also investigated the extent to which these facial features predicted ratings of fatigue by others and could be used to classify the sleep condition of the person. Subjects (n = 181) were randomised to one night of total sleep deprivation or a night of normal sleep (8-9 hr in bed). The following day facial photographs were taken and, in a subset (n = 141), skin colour was measured using spectrophotometry. A separate set of participants (n = 63) later rated the photographs in terms of health, paleness and fatigue. The photographs were also digitally analysed with respect to eye openness, mouth curvature and periorbital darkness. The results showed that neither sleep deprivation nor the subjects' sleepiness was related to differences in any facial variable. Similarly, there was no difference in subjective ratings between the groups. Decreased skin yellowness, less eye openness, downward mouth curvature and periorbital darkness all predicted increased fatigue ratings by others. However, the combination of appearance variables could not be accurately used to classify sleep condition. These findings have implications for both face-to-face and computerised visual assessment of sleep loss and fatigue.
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Affiliation(s)
- Benjamin C Holding
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tina Sundelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, New York University, New York, NY.,Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Patrick Cairns
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, UK
| | - David I Perrett
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, UK
| | - John Axelsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
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6
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Sundelin T, Lekander M, Sorjonen K, Axelsson J. Negative effects of restricted sleep on facial appearance and social appeal. ROYAL SOCIETY OPEN SCIENCE 2017; 4:160918. [PMID: 28572989 PMCID: PMC5451790 DOI: 10.1098/rsos.160918] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
The importance of assessing evolutionarily relevant social cues suggests that humans should be sensitive to others' sleep history, as this may indicate something about their health as well as their capacity for social interaction. Recent findings show that acute sleep deprivation and looking tired are related to decreased attractiveness and health, as perceived by others. This suggests that one might also avoid contact with sleep-deprived, or sleepy-looking, individuals, as a strategy to reduce health risk and poor interactions. In this study, 25 participants (14 females, age range 18-47 years) were photographed after 2 days of sleep restriction and after normal sleep, in a balanced design. The photographs were rated by 122 raters (65 females, age range 18-65 years) on how much they would like to socialize with the participants. They also rated participants' attractiveness, health, sleepiness and trustworthiness. The results show that raters were less inclined to socialize with individuals who had gotten insufficient sleep. Furthermore, when sleep-restricted, participants were perceived as less attractive, less healthy and more sleepy. There was no difference in perceived trustworthiness. These findings suggest that naturalistic sleep loss can be detected in a face and that people are less inclined to interact with a sleep-deprived individual.
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Affiliation(s)
- Tina Sundelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 17177, Sweden
- Department of Psychology, Stockholm University, Stockholm 10691, Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 17177, Sweden
- Stress Research Institute, Stockholm University, Stockholm 10691, Sweden
| | - Kimmo Sorjonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 17177, Sweden
| | - John Axelsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 17177, Sweden
- Stress Research Institute, Stockholm University, Stockholm 10691, Sweden
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7
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Walia HK, Mehra R. Overview of Common Sleep Disorders and Intersection with Dermatologic Conditions. Int J Mol Sci 2016; 17:E654. [PMID: 27144559 PMCID: PMC4881480 DOI: 10.3390/ijms17050654] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 01/12/2023] Open
Abstract
Sleep disorders are very common, often under-recognized and therefore undertreated, are associated with a myriad of medical conditions and could lead to significant impairment of quality of life. This review provides an up-to-date synopsis of common sleep disorders encompassing insufficient sleep syndrome, insomnia, circadian rhythm disorders and obstructive sleep apnea with a brief overview of epidemiology, screening, diagnostic testing and treatment. We also emphasize the emerging area of the intersection of sleep disorders and dermatologic conditions and present compelling data regarding underlying mechanisms including sleep dysfunction in relation to disorders of skin inflammation, aging and skin cancer.
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Affiliation(s)
- Harneet K Walia
- Center for Sleep Disorders Cleveland Clinic 11203, Stokes Blvd Cleveland, Cleveland, OH 44195, USA.
| | - Reena Mehra
- Center for Sleep Disorders Cleveland Clinic 11203, Stokes Blvd Cleveland, Cleveland, OH 44195, USA.
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8
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Espinoza-Cuadros F, Fernández-Pozo R, Toledano DT, Alcázar-Ramírez JD, López-Gonzalo E, Hernández-Gómez LA. Speech Signal and Facial Image Processing for Obstructive Sleep Apnea Assessment. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:489761. [PMID: 26664493 PMCID: PMC4664800 DOI: 10.1155/2015/489761] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurring breathing pauses during sleep caused by a blockage of the upper airway (UA). OSA is generally diagnosed through a costly procedure requiring an overnight stay of the patient at the hospital. This has led to proposing less costly procedures based on the analysis of patients' facial images and voice recordings to help in OSA detection and severity assessment. In this paper we investigate the use of both image and speech processing to estimate the apnea-hypopnea index, AHI (which describes the severity of the condition), over a population of 285 male Spanish subjects suspected to suffer from OSA and referred to a Sleep Disorders Unit. Photographs and voice recordings were collected in a supervised but not highly controlled way trying to test a scenario close to an OSA assessment application running on a mobile device (i.e., smartphones or tablets). Spectral information in speech utterances is modeled by a state-of-the-art low-dimensional acoustic representation, called i-vector. A set of local craniofacial features related to OSA are extracted from images after detecting facial landmarks using Active Appearance Models (AAMs). Support vector regression (SVR) is applied on facial features and i-vectors to estimate the AHI.
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Affiliation(s)
| | - Rubén Fernández-Pozo
- GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Doroteo T. Toledano
- ATVS Biometric Recognition Group, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Eduardo López-Gonzalo
- GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Luis A. Hernández-Gómez
- GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, 28040 Madrid, Spain
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9
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Gunn D, Dick J, van Heemst D, Griffiths C, Tomlin C, Murray P, Griffiths T, Ogden S, Mayes A, Westendorp R, Slagboom P, de Craen A. Lifestyle and youthful looks. Br J Dermatol 2015; 172:1338-45. [DOI: 10.1111/bjd.13646] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2014] [Indexed: 12/20/2022]
Affiliation(s)
- D.A. Gunn
- Unilever R&D; Colworth House; Sharnbrook Bedfordshire MK44 1LQ U.K
| | - J.L. Dick
- Unilever R&D; Colworth House; Sharnbrook Bedfordshire MK44 1LQ U.K
| | - D. van Heemst
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden the Netherlands
| | - C.E.M. Griffiths
- Dermatology Research Centre; Salford Royal Hospital; University of Manchester; Manchester Academic Health Science Centre; Manchester U.K
| | - C.C. Tomlin
- Unilever R&D; Colworth House; Sharnbrook Bedfordshire MK44 1LQ U.K
| | - P.G. Murray
- Unilever R&D; Colworth House; Sharnbrook Bedfordshire MK44 1LQ U.K
| | - T.W. Griffiths
- Dermatology Research Centre; Salford Royal Hospital; University of Manchester; Manchester Academic Health Science Centre; Manchester U.K
| | - S. Ogden
- Dermatology Research Centre; Salford Royal Hospital; University of Manchester; Manchester Academic Health Science Centre; Manchester U.K
| | - A.E. Mayes
- Unilever R&D; Colworth House; Sharnbrook Bedfordshire MK44 1LQ U.K
| | - R.G.J. Westendorp
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden the Netherlands
- Netherlands Consortium for Healthy Aging (NCHA); the Netherlands
| | - P.E. Slagboom
- Netherlands Consortium for Healthy Aging (NCHA); the Netherlands
- Section of Molecular Epidemiology; Department of Medical Statistics and Bioinformatics; Leiden University Medical Center; Leiden the Netherlands
| | - A.J.M. de Craen
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden the Netherlands
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10
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Oyetakin-White P, Suggs A, Koo B, Matsui MS, Yarosh D, Cooper KD, Baron ED. Does poor sleep quality affect skin ageing? Clin Exp Dermatol 2014; 40:17-22. [DOI: 10.1111/ced.12455] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2014] [Indexed: 01/12/2023]
Affiliation(s)
- P. Oyetakin-White
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland OH USA
| | - A. Suggs
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland OH USA
| | - B. Koo
- Department of Pulmonary and Sleep Medicine; University Hospitals Case Medical Center; Cleveland OH USA
| | | | - D. Yarosh
- Estee Lauder Companies Inc; Melville NY USA
| | - K. D. Cooper
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland OH USA
| | - E. D. Baron
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland OH USA
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11
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Abstract
Several diagnoses in the new DSM-5 chapter on 'Obsessive-Compulsive and Related Disorders' directly relate to psychodermatology. The new excoriation (skin-picking) disorder (SPD) and trichotillomania (TTM) both manifest as recurrent body-focused repetitive behaviors that have compulsive and dissociative features, the latter being more prevalent in TTM than SPD. The DSM-5 refers to SPD and TTM occurring without full awareness or preceding tension, however does not specifically mention the possible role of dissociation. This has important treatment implications, as patients with high dissociative symptoms are not likely to respond to the standard treatments for obsessive-compulsive disorder. Body dysmorphic disorder (BDD), which is frequently associated with cutaneous body image (CBI) dissatisfaction, is present in 9%-15% of dermatology patients. Treatment guidelines in dermatology are increasingly considering the psychosocial morbidity related to CBI in their treatment outcome measures. The presence of BDD, if unrecognized, may therefore directly affect the dermatologic treatment regimens offered to the patient.
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Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, 585 Springbank Drive, Suite 101, London, Ontario, N6J 1H3, Canada,
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12
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Gupta MA, Gupta AK, Knapp K. Dissatisfaction with cutaneous body image is directly correlated with insomnia severity: A prospective study in a non-clinical sample. J DERMATOL TREAT 2014; 26:193-7. [DOI: 10.3109/09546634.2014.883060] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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