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Applied Nursing Research : ANR Apr 2020We systematically reviewed the quality of sleep measurement instruments applied to shift-work nurses and analyzed the effects of intervention research. (Meta-Analysis)
Meta-Analysis
AIM
We systematically reviewed the quality of sleep measurement instruments applied to shift-work nurses and analyzed the effects of intervention research.
BACKGROUND
There is a need to test the effects of experimental studies worldwide that conducted interventions to improve the sleep quality of nurses who work shiftwork.
METHODS
In this systematic literature review and meta-analysis, we used PICO (Participant, Intervention, Comparison, and Outcome) and searched for papers in Korean and English published up until August 2018. We utilized Cochrane Review Manager Software 5.3.
RESULTS
Thirteen articles from 1991 to 2018 were included in the systematic literature review, and 6 of those were used in a meta-analysis. The instrument used most often to asses subjective sleep quality was the Pittsburgh Sleep Quality Index. Additionally, an actigraph and sleep logs were used to collect physiological data about participants' sleep quality. Intervention types were categorized into aroma-inhalation therapy, shift-rotation interventions, physical-activity interventions, and cognitive-behavioral therapy. Ultimately, the effects of the aroma-inhalation therapy intervention significantly improved shift-work nurses' sleep quality.
CONCLUSIONS
We established a basic understanding of a strategy to measure and improve participants' sleep quality. Consequently, sleep interventions that can positively promote nurses' health and foster effective job performance should be developed.
Topics: Adult; Female; Humans; Job Satisfaction; Male; Middle Aged; Nursing Staff, Hospital; Sleep Disorders, Circadian Rhythm; Work Schedule Tolerance
PubMed: 31902652
DOI: 10.1016/j.apnr.2019.151227 -
European Respiratory Review : An... Dec 2021Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have... (Review)
Review
Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) therapies for OSA, we present recommendations determined by a systematic review of the literature. It is an update of the 2011 ERS statement on non-CPAP therapies, advanced into a clinical guideline. A multidisciplinary group of experts, including pulmonary, surgical, dentistry and ear-nose-throat specialists, methodologists and patient representatives considered the most relevant clinical questions (for both clinicians and patients) relating to the management of OSA. Eight key clinical questions were generated and a systematic review was conducted to identify published randomised clinical trials that answered these questions. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of the evidence and the strength of recommendations. The resulting guideline addresses gastric bypass surgery, custom-made dual-block mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors and positional therapy. These recommendations can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes.
Topics: Adult; Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Occlusal Splints; Respiratory System; Sleep Apnea, Obstructive
PubMed: 34853097
DOI: 10.1183/16000617.0200-2021 -
PloS One 2020This systematic review and meta-analysis examines the associations of allergic rhinitis with sleep duration and sleep impairment. Observational studies published before... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis examines the associations of allergic rhinitis with sleep duration and sleep impairment. Observational studies published before August 2019 were obtained through English language literature searches in the PubMed, Embase, and CINAHL databases. Mean differences and odds ratios with 95% confidence intervals were extracted and used for meta-analysis. Heterogeneity was confirmed by the I2-heterogeneity test. Subgroup analysis was conducted to evaluate the influence of study design. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine the level of evidence. In total, 2544 records were identified through database searches; 914 duplicate records were excluded, 1452 records were removed after screening of titles and abstracts, 151 records were excluded after full-text screening, and 27 articles were included in the final meta-analyses. A total of 240,706,026 patients (19,444,043 with allergic rhinitis) were considered. No significant difference in sleep duration between the allergic rhinitis and the control groups was found. Patients with allergic rhinitis presented with significantly higher sleep quality scores, sleep disturbances scores, and sleep latency scores; more frequent use of sleep medications; and lower sleep efficiency as measured by the Pittsburgh Sleep Quality Index and polysomnography. Meta-analyses for adjusted odds ratios showed that allergic rhinitis was also associated with higher risks of nocturnal dysfunctions, including insomnia, nocturnal enuresis, restless sleep, sleep-disordered breathing, obstructive sleep apnea, and snoring. Meta-analysis for adjusted odds ratio also showed that allergic rhinitis was associated with daytime dysfunction, including difficulty waking up, daytime sleepiness, morning headache, and the use of sleep medications. The overall quality of evidence ranged from low to very low, indicating that caution is required when interpreting these results. This study demonstrates that there is a significant association of AR with sleep characteristics.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Humans; Middle Aged; Observational Studies as Topic; Polysomnography; Quality of Life; Rhinitis, Allergic; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep Wake Disorders; Snoring; Young Adult
PubMed: 32053609
DOI: 10.1371/journal.pone.0228533 -
BMC Psychiatry May 2020To examine the effectiveness and safety of yoga of women with sleep problems by performing a systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
BACKGROUND
To examine the effectiveness and safety of yoga of women with sleep problems by performing a systematic review and meta-analysis.
METHODS
Medline/PubMed, ClinicalKey, ScienceDirect, Embase, PsycINFO, and the Cochrane Library were searched throughout the month of June, 2019. Randomized controlled trials comparing yoga groups with control groups in women with sleep problems were included. Two reviewers independently evaluated risk of bias by using the risk of bias tool suggested by the Cochrane Collaboration for programming and conducting systematic reviews and meta-analyses. The main outcome measure was sleep quality or the severity of insomnia, which was measured using subjective instruments, such as the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), or objective instruments such as polysomnography, actigraphy, and safety of the intervention. For each outcome, a standardized mean difference (SMD) and confidence intervals (CIs) of 95% were determined.
RESULTS
Nineteen studies in this systematic review included 1832 participants. The meta-analysis of the combined data conducted according to Comprehensive Meta-Analysis showed a significant improvement in sleep (SMD = - 0.327, 95% CI = - 0.506 to - 0.148, P < 0.001). Meta-analyses revealed positive effects of yoga using PSQI scores in 16 randomized control trials (RCTs), compared with the control group in improving sleep quality among women using PSQI (SMD = - 0.54; 95% CI = - 0.89 to - 0.19; P = 0.003). However, three RCTs revealed no effects of yoga compared to the control group in reducing insomnia among women using ISI (SMD = - 0.13; 95% CI = - 0.74 to 0.48; P = 0.69). Seven RCTs revealed no evidence for effects of yoga compared with the control group in improving sleep quality for women with breast cancer using PSQI (SMD = - 0.15; 95% CI = - 0.31 to 0.01; P = 0.5). Four RCTs revealed no evidence for the effects of yoga compared with the control group in improving the sleep quality for peri/postmenopausal women using PSQI (SMD = - 0.31; 95% CI = - 0.95 to 0.33; P = 0.34). Yoga was not associated with any serious adverse events.
DISCUSSION
This systematic review and meta-analysis demonstrated that yoga intervention in women can be beneficial when compared to non-active control conditions in term of managing sleep problems. The moderator analyses suggest that participants in the non-breast cancer subgroup and participants in the non-peri/postmenopausal subgroup were associated with greater benefits, with a direct correlation of total class time with quality of sleep among other related benefits.
Topics: Female; Humans; Quality of Life; Recreation; Sleep; Sleep Initiation and Maintenance Disorders; Yoga
PubMed: 32357858
DOI: 10.1186/s12888-020-02566-4 -
Chest Dec 2020Therapy options for OSA and central sleep apnea (CSA) are limited, thus many patients remain untreated. Clinically, acetazolamide is sometimes used for CSA; however,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Therapy options for OSA and central sleep apnea (CSA) are limited, thus many patients remain untreated. Clinically, acetazolamide is sometimes used for CSA; however, given overlapping pathophysiologic properties of OSA and CSA, we hypothesized that acetazolamide is equally effective for both types. Prior reviews focused on specific subtypes of sleep apnea, study designs, and languages, thus including few studies (typically ≤3) limiting insights.
RESEARCH QUESTION
How efficacious is acetazolamide for sleep apnea, and is its effect modified by sleep apnea type or acetazolamide dose?
STUDY DESIGN AND METHODS
We queried MEDLINE, EMBASE, and ClinicalTrials.gov from inception until March 11, 2019. Any study in which adults with OSA/CSA received oral acetazolamide vs no acetazolamide (control) that reported sleep apnea-related outcomes was eligible, independent of study design or language. Two reviewers independently assessed eligibility and abstracted data. Primary outcomes were apnea-hypopnea index (AHI) and oxygen saturation nadir. Quality of evidence (QoE) was rated with the use of Grades of Recommendation Assessment, Development and Evaluation methods.
RESULTS
We included 28 studies (13 OSA/15 CSA; N = 542; N = 553) that enabled meta-analyses for 24 outcomes. Acetazolamide doses ranged from 36 to 1000 mg/d and treatment duration from 1 to 90 d (median, 6 d). Overall, acetazolamide vs control lowered the AHI by -0.7 effect sizes (95% CI, -0.83 to -0.58; I = 0%; moderate QoE) that corresponded to a reduction of 37.7% (95% CI, -44.7 to -31.3) or 13.8/h (95% CI, -16.3 to -11.4; AHI = 36.5/h). The AHI reduction was similar in OSA vs CSA, but significantly greater with higher doses (at least up to 500 mg/d). Furthermore, acetazolamide improved oxygen saturation nadir by +4.4% (95% CI, 2.3 to 6.5; I = 63%; no evidence of effect modification; very low QoE) and several secondary outcomes that included sleep quality measures and BP (mostly low QoE).
INTERPRETATION
Short-term acetazolamide improved both OSA and CSA. Rigorous studies with long-term follow up are warranted to assess Acetazolamide's value for the chronic treatment of patients with sleep apnea.
CLINICAL TRIAL REGISTRATION
PROSPERO (CRD42019147504).
Topics: Acetazolamide; Carbonic Anhydrase Inhibitors; Humans; Sleep Apnea, Central; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 32768459
DOI: 10.1016/j.chest.2020.06.078 -
Sleep Medicine Reviews Oct 2016Although bright light therapy seems a promising treatment for sleep problems, research shows inconclusive results. This meta-analysis is the first to systematically... (Meta-Analysis)
Meta-Analysis Review
Although bright light therapy seems a promising treatment for sleep problems, research shows inconclusive results. This meta-analysis is the first to systematically review the effect of light therapy on sleep problems in general and on specific types of sleep problems in particular (circadian rhythm sleep disorders, insomnia, sleep problems related to Alzheimer's disease and dementia). Fifty-three studies with a total of 1154 participants were included. Overall effects and effects on separate circadian and sleep outcomes were examined. We calculated Hedges' g effect sizes and we investigated the effects of twelve moderators (design-related, treatment-related, participant-related). Light therapy was found effective in the treatment of sleep problems in general (g = 0.39), and for circadian rhythm sleep disorders (g = 0.41), insomnia (g = 0.47), and sleep problems related to Alzheimer's disease/dementia (g = 0.30) specifically. For circadian rhythm sleep disorders, effects were smaller for randomised controlled trials. For insomnia, we found larger effects for studies using a higher light intensity, and for sleep problems related to Alzheimer's disease/dementia larger effects were found for studies with more female participants. There was indication of publication bias. To conclude, light therapy is effective for sleep problems in general, particularly for circadian outcomes and insomnia symptoms. However, most effect sizes are small to medium.
Topics: Alzheimer Disease; Circadian Rhythm; Humans; Phototherapy; Sleep; Sleep Disorders, Circadian Rhythm; Sleep Initiation and Maintenance Disorders
PubMed: 26606319
DOI: 10.1016/j.smrv.2015.08.009 -
Nutrients Apr 2021This study aimed to assess the effects of quantity, quality and periodization of carbohydrates consumption on sleep. PubMed, SCOPUS and Cochrane Library were searched... (Meta-Analysis)
Meta-Analysis
This study aimed to assess the effects of quantity, quality and periodization of carbohydrates consumption on sleep. PubMed, SCOPUS and Cochrane Library were searched through October 2020. Data were pooled using random-effects meta-analysis. Eleven articles were included in the meta-analysis which consisted of 27 separate nutrition trials, resulting in 16 comparison data sets (sleep quantity = 11; sleep quality = 5). Compared to high carbohydrate (HCI), low carbohydrate intake (LCI) moderately increased duration and proportion of N3 sleep stage (ES = 0.37; 95% CI = 0.18, 0.56; < 0.001 and ES = 0.51; 95% CI = 0.33, 0.69; < 0.001, respectively). HCI prolonged rapid eye movement (REM) stage duration (ES = -0.38; 95% CI = 0.05, -8.05; < 0.001) and proportion (ES = -0.46; 95% CI = -0.83, -0.01; < 0.001), compared to LCI. The quality of carbohydrate intake did not affect sleep stages. Meta-regression showed that the effectiveness of carbohydrate quantity and quality in sleep onset latency was significantly explained by alterations of carbohydrate intake as a percentage of daily energy intake (R = 25.87, = 0.018) and alterations in the glycemic load (R = 50.8, = 0.048), respectively. Alterations in glycemic load partially explained the variance of the effectiveness of carbohydrate quality in sleep efficiency (R = 89.2, < 0.001) and wake after sleep onset (R = 64.9, = 0.018). Carbohydrate quantity was shown to affect sleep architecture, and especially N3 and REM sleep stages. Alterations in both quantity and quality of carbohydrate intake showed a significant effect on sleep initiation. Variations in carbohydrate quality significantly affected measures of sleep continuation. Further studies are needed to assess the effect of long-term carbohydrate interventions on sleep.
Topics: Clinical Trials as Topic; Datasets as Topic; Dietary Carbohydrates; Feeding Behavior; Humans; Polysomnography; Sleep; Sleep Initiation and Maintenance Disorders; Treatment Outcome
PubMed: 33919698
DOI: 10.3390/nu13041283 -
International Journal of Environmental... Nov 2021Sleep disorders, especially insomnia, are very common in different kinds of cancers, but their prevalence and incidence are not well-known. Disturbed sleep in cancer is... (Review)
Review
INTRODUCTION
Sleep disorders, especially insomnia, are very common in different kinds of cancers, but their prevalence and incidence are not well-known. Disturbed sleep in cancer is caused by different reasons and usually appears as a comorbid disorder to different somatic and psychiatric diagnoses, psychological disturbances and treatment methods. There can be many different predictors for sleep disturbances in these vulnerable groups, such as pre-existing sleep disorders, caused by the mental status in cancer or as side effect of the cancer treatment.
METHODS
A systematic literature review of 8073 studies was conducted on the topic of sleep and sleep disorders in cancer patients. The articles were identified though PubMed, PsycInfo and Web of Knowledge, and a total number of 89 publications were qualified for analysis.
RESULTS
The identified eighty-nine studies were analyzed on the topic of sleep and sleep disorders in cancer, twenty-six studies on sleep and fatigue in cancer and sixty-one studies on the topic of sleep disorders in cancer. The prevalence of sleep disturbences and/or sleep disorders in cancer was up to 95%.
DISCUSSION
Sleep disturbances and sleep disorders (such as insomnia, OSAS, narcolepsy and RLS; REM-SBD) in cancer patients can be associated with different conditions. Side effects of cancer treatment and cancer-related psychological dysfunctions can be instigated by sleep disturbances and sleep disorders in these patients, especially insomnia and OSAS are common. An evidence-based treatment is necessary for concomitant mental and/or physical states.
Topics: Humans; Narcolepsy; Neoplasms; Restless Legs Syndrome; Sleep; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders
PubMed: 34770209
DOI: 10.3390/ijerph182111696 -
Sleep Medicine Reviews Feb 2017Obstructive sleep apnea (OSA) is one of the common sleep breathing disorders in adults, characterised by frequent episodes of upper airway collapse during sleep.... (Meta-Analysis)
Meta-Analysis Review
Obstructive sleep apnea (OSA) is one of the common sleep breathing disorders in adults, characterised by frequent episodes of upper airway collapse during sleep. Craniofacial disharmony is an important risk factor for OSA. Overnight polysomnography (PSG) study is considered to be the most reliable confirmatory investigation for OSA diagnosis, whereas the precise localization of site of obstruction to the airflow cannot be detected. Identifying the cause of OSA in a particular ethnic population/individual subject helps to understand the etiological factors and effective management of OSA. The objective of the meta-analysis is to elucidate altered craniofacial anatomy on lateral cephalograms in adult subjects with established OSA. Significant weighted mean difference with insignificant heterogeneity was found for the following parameters: anterior lower facial height (ALFH: 2.48 mm), position of hyoid bone (Go-H: 5.45 mm, S-H: 6.89 mm, GoGn-H: 11.84°, GoGn-H: 7.22 mm, N-S-H: 2.14°), and pharyngeal airway space (PNS-Phw: -1.55 mm, pharyngeal space: -495.74 mm and oro-pharyngeal area: -151.15 mm). Significant weighted mean difference with significant heterogeneity was found for the following parameters: cranial base (SN: -2.25 mm, S-N-Ba: -1.45°), position and length of mandible (SNB: -1.49° and Go-Me: -5.66 mm) respectively, maxillary length (ANS-PNS: -1.76 mm), tongue area (T: 366.51 mm), soft palate area (UV: 125.02 mm), and upper airway length (UAL: 5.39 mm). This meta-analysis supports the relationship between craniofacial disharmony and obstructive sleep apnea. There is a strong evidence for reduced pharyngeal airway space, inferiorly placed hyoid bone and increased anterior facial heights in adult OSA patients compared to control subjects. The cephalometric analysis provides insight into anatomical basis of the etiology of OSA that can influence making a choice of appropriate therapy.
Topics: Cephalometry; Craniofacial Abnormalities; Humans; Pharynx; Polysomnography; Sleep Apnea, Obstructive
PubMed: 27039222
DOI: 10.1016/j.smrv.2016.01.007 -
Journal of Sleep Research Dec 2021Narcolepsy is an uncommon hypothalamic disorder of presumed autoimmune origin that usually requires lifelong treatment. This paper aims to provide evidence-based... (Review)
Review
BACKGROUND AND PURPOSE
Narcolepsy is an uncommon hypothalamic disorder of presumed autoimmune origin that usually requires lifelong treatment. This paper aims to provide evidence-based guidelines for the management of narcolepsy in both adults and children.
METHODS
The European Academy of Neurology (EAN), European Sleep Research Society (ESRS), and European Narcolepsy Network (EU-NN) nominated a task force of 18 narcolepsy specialists. According to the EAN recommendations, 10 relevant clinical questions were formulated in PICO format. Following a systematic review of the literature (performed in Fall 2018 and updated in July 2020) recommendations were developed according to the GRADE approach.
RESULTS
A total of 10,247 references were evaluated, 308 studies were assessed and 155 finally included. The main recommendations can be summarized as follows: (i) excessive daytime sleepiness (EDS) in adults-scheduled naps, modafinil, pitolisant, sodium oxybate (SXB), solriamfetol (all strong); methylphenidate, amphetamine derivatives (both weak); (ii) cataplexy in adults-SXB, venlafaxine, clomipramine (all strong) and pitolisant (weak); (iii) EDS in children-scheduled naps, SXB (both strong), modafinil, methylphenidate, pitolisant, amphetamine derivatives (all weak); (iv) cataplexy in children-SXB (strong), antidepressants (weak). Treatment choices should be tailored to each patient's symptoms, comorbidities, tolerance and risk of potential drug interactions.
CONCLUSION
The management of narcolepsy involves non-pharmacological and pharmacological approaches with an increasing number of symptomatic treatment options for adults and children that have been studied in some detail.
Topics: Adult; Cataplexy; Child; Humans; Modafinil; Narcolepsy; Sleep; Sodium Oxybate
PubMed: 34173288
DOI: 10.1111/jsr.13387