Can mindfulness-based interventions improve outcomes in cognitive-behavioural therapy for chronic insomnia disorder in the general population? Systematic review and meta-analysis

Cognitive-behavioural therapy for insomnia (CBT-I) is the recommended first-line therapy for adults with chronic insomnia disorder (ID), which is characterized by hyperarousal. Mindfulness-based interventions (MBIs) are protocols aimed at stress reduction based on non-judgmental attention control in the present moment. However, MBIs have been increasingly used without a clear scientific basis. The objective of this analysis was to examine if MBIs could be useful as a component of the CBT-I therapeutic system through a systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized studies (NRS) searched in PubMed, PsycINFO, Cochrane and WoS. The Insomnia Severity Index (ISI) was the primary outcome, while the Pittsburgh Sleep Quality Index (PSQI) and a composite sleep variable (CSV) were secondary outcomes. Thirteen articles corresponding to nine studies (three pragmatic RCTs, three explanatory RCTs and three NRS) were included. The omnibus test found that MBIs had a small to medium effect size on ISI nearing signification when comparing active control groups in the pretest-posttest period [Δ = 0.44, p = 0.07], a medium, non-significant, effect size on PSQI [Δ = 0.52, p = 0.18], and a significant though small effect size on CSV [Δ = 0.05, p < 0.01]. No heterogeneity was found. The analysis could not demonstrate that MBIs, combined with CBT-I components in some studies, positively affected ID in the general adult population. This was probably due to the lack of pragmatic designs and suitable measuring instruments. Recommendations are made for designing further studies to address these issues.

Variables associated with the success of group cognitive behavioral therapy for insomnia: preliminary results

Insomnia Disorder (ID) is defined as the predominant dissatisfaction with the quantity or quality of sleep associated with difficulty in initiating or maintaining sleep or early-morning awakenings with the inability to go back to sleep.

Labial dystonia after facial and trigeminal neuropathy controlled with a maxillary splint

A 27-year-old woman with bruxism suffered a spider bite (Loxosceles rufescens) on the left cheek that caused severe local cellulitis, facial palsy, and painful hyperesthesia over the two lower trigeminal nerve divisions. Facial but not trigeminal neuropathy improved, and she developed a labial dystonia that only corrected while pressing the right medial incisor. A specially designed maxillary splint that continuously pressed it suppressed both dystonia and related spontaneous firing of motor unit potentials in electromyography. Overstimulation of the contralateral trigeminal territory possibly compensated for the altered left trigeminal nerve input, balanced proprioceptive influences at the central inhibitory-excitatory circuitry, and controlled dystonia.

Bronchial involvement in the cramp-fasciculation syndrome

BACKGROUND/AIMS

Cramp-fasciculation syndrome (CFS) is an acquired, chronic, usually benign and rather heterogeneous condition with isolated fasciculations and muscle cramps generally induced by physical exercise. They commonly involve calf and quadriceps muscles. The pathophysiology of CFS is related to peripheral nerve hyperexcitability, most often located at the motor nerve terminal or intramuscular arborization.

METHODS

A 21-year-old man presented with a progressive syndrome of bronchospasm, cramps and muscle twitches related to physical exercise. Spirography showed bronchial hyperresponsiveness, so he received inhaled corticosteroids and beta2-agonists that improved respiratory symptoms. Electrodiagnostic studies were consistent with CFS. Gabapentin was then introduced.

RESULTS

Both respiratory and muscle symptoms improved. A new spirogram after all inhaled medication had been discontinued was normal.

CONCLUSION

This picture suggests a concomitant involvement of the peripheral motor nerves of both skeletal and airway autonomic smooth muscle, a presentation not previously reported in CFS.