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Nature and Science of Sleep 2024Sleep quality and disturbances have gained heightened scholarly attention due to their well-established association with both mental and physical health. This study aims...
BACKGROUND
Sleep quality and disturbances have gained heightened scholarly attention due to their well-established association with both mental and physical health. This study aims to assess sleep-wake habits and disturbances in Tunisian adults.
METHODOLOGY
This cross-sectional study employed an online questionnaire to assess 3074 adults ≥ 18 years. Primary outcomes, including sleep quality, daytime vigilance, mood, and subjective well-being, were measured using validated questionnaires [the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), the Patient Health Questionnaire (PHQ)-9, and the World Health Organisation-Five Well-Being Index (WHO-5)].
RESULTS
Less than two-thirds (n= 1941; 63.1%) of participants were females and the mean age was 36.25±13.56. The prevalence of poor sleep quality was 53.8% when defined as a PSQI > 5. The prevalence of insomnia, short sleep duration, long sleep duration, EDS, severe depression, and poor well-being were 14.5%, 34.7%, 12.3%, 32.4%, 7.4%, and 40.2%, respectively. Some factors were associated with an increased likelihood of poor sleep quality, including female gender, chronic hypnotics use, internet use close to bedtime, daily time spent on the internet >3 hours, smoking, university- level education, nocturnal work, severe depression, impaired well-being status, insomnia, and EDS.
CONCLUSION
The high prevalence of sleep-wake disturbances among Tunisian adults emphasizes the need for an appropriate screening strategy for high-risk groups. Individuals with unhealthy habits and routines were significantly more likely to experience these kinds of disturbances. Consequently, there is a pressing need for educational programs on sleep to foster healthier sleep patterns.
PubMed: 38854484
DOI: 10.2147/NSS.S456879 -
Blood Cell Therapy May 2024Melphalan-induced encephalopathy is a rare complication observed in patients undergoing autologous stem cell transplantation (ASCT) and is characterized by symptoms...
Melphalan-induced encephalopathy is a rare complication observed in patients undergoing autologous stem cell transplantation (ASCT) and is characterized by symptoms ranging from drowsiness to seizures. Previous reports have described similar cases, including a review of a large cohort of patients in whom melphalan-associated encephalopathy was identified in 2% of the patients undergoing ASCT. We describe the case of a 63-year-old male with Multiple Myeloma and underlying chronic kidney disease (CKD) who underwent ASCT with a reduced dose of melphalan due to renal dysfunction in complete remission following induction therapy and subsequent neurological deterioration, which necessitated an extensive evaluation of several neurological and infective etiologies. In this report, we highlight that melphalan-associated encephalopathy is a distinct entity complicating ASCT in patients with myeloma, especially in those with preexisting renal insufficiency, and consider its management.
PubMed: 38854402
DOI: 10.31547/bct-2023-025 -
Cureus May 2024An innovative healthcare delivery model in Greater Detroit is proposed to integrate religious and cultural identities with health strategies to address specific...
An innovative healthcare delivery model in Greater Detroit is proposed to integrate religious and cultural identities with health strategies to address specific disparities, such as higher rates of diabetes and cardiovascular diseases linked to poor sleep, among minority communities, particularly among its diverse Muslim population. This model advocates for culturally conscious care, deeply appreciating the sociocultural determinants of health. It proposes utilizing mosques as community hubs to deploy sleep health ambassadors trained in sleep science and cultural sensitivity. These ambassadors would engage the community through trusted platforms, offering tailored health interventions aligned with religious practices and cultural norms. This approach not only promises improved health outcomes, such as enhancements in sleep quality, reductions in sleep-related health issues, and increased community health awareness, but also empowers the community by incorporating local religious leaders and stakeholders in program planning and implementation, for example, through the introduction of tailored sleep hygiene workshops that align with the timing of religious practices, such as Ramadan, and culturally sensitive screening for sleep apnea. Success will be measured by improvements in self-reported sleep quality, a reduction in daytime sleepiness, and community surveys assessing awareness and engagement. By demonstrating efficacy in managing sleep health, this model could scale to address broader health issues, ensuring interventions are culturally appropriate and effectively managed within community-specific contexts. This model holds the promise of significantly reducing health disparities by adapting health interventions to the cultural and religious contexts of communities, potentially transforming the landscape of community health management.
PubMed: 38854297
DOI: 10.7759/cureus.59890 -
Pharmacology, Biochemistry, and Behavior Jun 2024The history of narcolepsy research began with the pioneering work of Jean-Baptiste-Édouard Gélineau in the late 19th century. In the 1880s, Gélineau introduced the... (Review)
Review
The history of narcolepsy research began with the pioneering work of Jean-Baptiste-Édouard Gélineau in the late 19th century. In the 1880s, Gélineau introduced the term "narcolepsy" to describe a condition characterized by sudden and uncontrollable episodes of sleep. His clinical descriptions laid the foundation for our understanding of this complex disorder. Over the last half-century, the pharmacological landscape for narcolepsy treatment has evolved remarkably, shifting from merely managing symptoms to increasingly targeting its underlying pathophysiology. By the 1930s, treatments such as ephedrine and amphetamine were introduced to alleviate excessive daytime sleepiness, marking significant advancements in narcolepsy management. These stimulants provided temporary relief, helping patients maintain wakefulness during the day. As research progressed, the focus shifted towards understanding the disorder's underlying mechanisms. The discovery of orexin (also known as hypocretin) in the late 1990s revolutionized the field. This breakthrough underscored the importance of orexin in regulating sleep-wake cycles and provided new targets for pharmacological intervention. Looking ahead, the future of narcolepsy pharmacotherapy is poised for further innovation. The ongoing exploration of orexin receptor agonists and the potential development of neuroprotective therapeutic targets underscore a promising horizon. Emerging research into the genetic and immunological underpinnings of narcolepsy opens new avenues for personalized medicine approaches and the identification of biomarkers for more precise treatment strategies. Additionally, the refinement of existing treatments through improved delivery systems and the investigation of combination therapies offer opportunities for enhanced efficacy and improved quality of life for patients with narcolepsy.
PubMed: 38852786
DOI: 10.1016/j.pbb.2024.173804 -
BMC Oral Health Jun 2024To assess the efficacy of positional therapy and oral appliance therapy for the management of positional obstructive sleep apnea. (Meta-Analysis)
Meta-Analysis
AIM
To assess the efficacy of positional therapy and oral appliance therapy for the management of positional obstructive sleep apnea.
METHODS
We searched PubMed, Web of Science, Cochrane, and SCOPUS for relevant clinical trials. Quality assessment of the included trials was evaluated according to Cochrane's risk of bias tool. We included the following outcomes: The apnea-hypopnea index (AHI), AHI non-supine, AHI supine, sleep efficiency, percentage of supine sleep, Adherence (≥ 4 h/night, ≥ 5 days/week), Oxygen desaturation Index, Arousal Index, Epworth Sleepiness Scale score (ESS), Mean SpO2, and Functional Outcomes of Sleep Questionnaire.
RESULTS
The AHI non-supine and the ESS scores were significantly lower in the OAT cohort than in the PT cohort. The PT cohort was associated with a significantly decreased percentage of supine sleep than the OAT cohort (MD= -26.07 [-33.15, -19.00], P = 0.0001). There was no significant variation between PT cohort and OAT cohort regarding total AHI, AHI supine, ODI, sleep efficiency, arousal index, FOSQ, adherence, and mean SpO2.
CONCLUSION
Both Positional Therapy and Oral Appliance Therapy effectively addressed Obstructive Sleep Apnea. However, Oral Appliance Therapy exhibited higher efficiency, leading to increased supine sleep percentage and more significant reductions in the Apnea Hypopnea Index during non-supine positions, as well as lower scores on the Epworth Sleepiness Scale.
Topics: Sleep Apnea, Obstructive; Humans; Randomized Controlled Trials as Topic; Supine Position; Patient Positioning
PubMed: 38849827
DOI: 10.1186/s12903-024-04277-8 -
Clinical Neurophysiology : Official... May 2024Drowsiness has been implicated in the modulation of centro-temporal spikes (CTS) in Self-limited epilepsy with Centro-Temporal Spikes (SeLECTS). Here, we explore this...
OBJECTIVE
Drowsiness has been implicated in the modulation of centro-temporal spikes (CTS) in Self-limited epilepsy with Centro-Temporal Spikes (SeLECTS). Here, we explore this relationship and whether fluctuations in wakefulness influence the brain networks involved in CTS generation.
METHODS
Functional MRI (fMRI) and electroencephalography (EEG) was simultaneously acquired in 25 SeLECTS. A multispectral EEG index quantified drowsiness ('EWI': EEG Wakefulness Index). EEG (Pearson Correlation, Cross Correlation, Trend Estimation, Granger Causality) and fMRI (PPI: psychophysiological interactions) analytic approaches were adopted to explore respectively: (a) the relationship between EWI and changes in CTS frequency and (b) the functional connectivity of the networks involved in CTS generation and wakefulness oscillations. EEG analyses were repeated on a sample of routine EEG from the same patient's cohort.
RESULTS
No correlation was found between EWI fluctuations and CTS density during the EEG-fMRI recordings, while they showed an anticorrelated trend when drowsiness was followed by proper sleep in routine EEG traces. According to PPI findings, EWI fluctuations modulate the connectivity between the brain networks engaged by CTS and the left frontal operculum.
CONCLUSIONS
While CTS frequency per se seems unrelated to drowsiness, wakefulness oscillations modulate the connectivity between CTS generators and key regions of the language circuitry, a cognitive function often impaired in SeLECTS.
SIGNIFICANCE
This work advances our understanding of (a) interaction between CTS occurrence and vigilance fluctuations and (b) possible mechanisms responsible for language disruption in SeLECTS.
PubMed: 38848666
DOI: 10.1016/j.clinph.2024.05.005 -
Sleep Medicine: X Dec 2024Melatonin, the primary hormone secreted by the pineal gland, regulates central and peripheral oscillators and adapts the internal environment to the external one through...
Melatonin, the primary hormone secreted by the pineal gland, regulates central and peripheral oscillators and adapts the internal environment to the external one through MT1 and MT2 receptors. The authors present a case of 16-year-old male intentionally overdosed on 900mg of melatonin (180 tablets) and 10 tablets of 0.5mg alprazolam. Admitted to the emergency department, he was extremely drowsy and minimally responsive with a Glasgow coma scale score of 8/15. Vital signs were stable, and no renal or liver dysfunction was noted. Elevated total leucocyte count and positive benzodiazepine urine test were observed. Gastric lavage was performed, and toxicology reports showed blood alprazolam levels at 0.15 mg/litre eight hours post-overdose. The patient regained consciousness 32 hours post-ingestion and was transferred to the psychiatry unit. This case underscores the increasing abuse of melatonin due to its easy availability and lack of regulation. Although melatonin has a low toxicity potential, side effects and interactions with other drugs can be severe. Supportive measures and vital sign control are crucial in overdose treatment.
PubMed: 38846909
DOI: 10.1016/j.sleepx.2024.100116 -
Sleep Science (Sao Paulo, Brazil) Jun 2024In adults, nightmare disorder is related to sleep deprivation, drug consumption or abuse, or other comorbid sleep disorders such as insomnia or insufficient sleep...
In adults, nightmare disorder is related to sleep deprivation, drug consumption or abuse, or other comorbid sleep disorders such as insomnia or insufficient sleep syndrome. Behavioral treatment has solid scientific evidence in disorders such as insomnia and, more recently, parasomnias. The aim of the present study was to investigate the clinical effectiveness of a Brief Behavioral Telemedicine Therapy in Nightmare Disorder in a 23-year-old female patient. The procedure consisted of the case study, with pre and posttreatment measures as well as follow-up after 1 month; and the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Paris Arousal Disorders Severity Scale, and a sleep diary were applied. In parallel with changes recorded in the sleep diary, a decrease in nightmares, sleepiness, and insomnia symptoms was observed when the intervention was finished. The behavioral intervention was clinically effective; therefore, the present case report provides information on behavioral treatments for nightmare disorder.
PubMed: 38846595
DOI: 10.1055/s-0043-1777707 -
Sleep Science (Sao Paulo, Brazil) Jun 2024Leptin is an appetite-suppressing hormone released by adipose tissue that plays an important role in severe obstructive sleep apnea syndrome (OSAS). However, it is...
Leptin is an appetite-suppressing hormone released by adipose tissue that plays an important role in severe obstructive sleep apnea syndrome (OSAS). However, it is unclear whether leptin levels are a useful biomarker for this syndrome. The present study aimed to assess the effect of continuous positive airway pressure (CPAP) treatment on the syndrome according to leptin levels, using a cluster classification based on clinical features of the syndrome. We performed a hierarchical cluster analysis of data from 97 OSAS patients diagnosed via polysomnography. We also evaluated the effect after 6 months of CPAP administration. Clusters 1 (49 patients; 50.5%) and 2 (6 patients; 6.2%) presented normal leptin levels, and clusters 3 (11 patients; 11.3%) and 4 (31 patients; 32%) presented high leptin levels. Clusters 3 and 4 presented different leptin levels, but the same degree of obesity. After treatment, the levels of excessive daytime sleepiness improved in all clusters. In Cluster 3, leptin levels were significantly reduced after treatment. Using the conventional diagnostic method of the apnea-hypopnea index, it was not clear whether leptin is a useful biomarker for the CPAP treatment. However, it may be helpful for particular clusters, including obese women, and where particular populations require CPAP treatment.
PubMed: 38846593
DOI: 10.1055/s-0043-1777779 -
Sleep Science (Sao Paulo, Brazil) Jun 2024The onset of narcolepsy type 1 (NT1) occurs after 50 years of age in less than 2% of the cases. In older adults, the diagnosis is often delayed due to the presence of...
The onset of narcolepsy type 1 (NT1) occurs after 50 years of age in less than 2% of the cases. In older adults, the diagnosis is often delayed due to the presence of neurological degenerative and inflammatory comorbidities and overlapping sleep disorders. We report the case of a 63-year-old man with a 5-year history of excessive daytime sleepiness (EDS) and a 2-year diagnosis of obstructive sleep apnea syndrome (OSAS), which. OSAS was confirmed by respiratory polygraphy that showed an apnea-hypopnea index (AHI) of 71 events/hour of sleep associated with significant nocturnal hypoxemia (lowest oxygen saturation: 53%), which lead to the initiation of continuous positive airway pressure (CPAP) treatment. Cognitive complaints, unexplained spells of dizziness, and lack of improvement in EDS with CPAP led to further diagnostic investigation of infectious, inflammatory, and neurodegenerative disorders. Low hypocretin levels in the cerebrospinal fluid (CSF) confirmed the diagnosis of NT1, and the patient's symptoms improved with the treatment with pitolisant. Though exceptional in older adults, NT1 should be suspected in the presence of atypical EDS with neurological complaints, unexplained dizzy spells, or OSAS that resists the CPAP treatment. Low levels of hypocretin in the CSF are highly specific and rule out other neurological and sleep disorders.
PubMed: 38846592
DOI: 10.1055/s-0043-1777832